Background: Sepsis is a life-threatening syndrome characterized by organ dysfunction resulting from a dysregulated host response to infection. It is associated with an imbalance between pro-inflammatory and anti-inflammatory pathways, leading to multiple organ injury, including acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS). Despite advances in critical care medicine, sepsis remains one of the leading causes of mortality in intensive care units (ICUs). Increasing interest has focused on extracorporeal blood purification techniques aimed at modulating cytokine levels and facilitating carbon dioxide removal. Aim: The aim of this study was to provide an overview and critical evaluation of two extracorporeal blood purification modalities—extracorporeal carbon dioxide removal (ECCO₂R) and CytoSorb therapy. Materials and Methods: A narrative literature review was conducted using the PubMed database. Publications available up to April 2026 were identified using keywords related to CytoSorb, hemoadsorption, ECCO₂R, sepsis, ARDS, and critical care. Priority was given to systematic reviews, meta-analyses, randomized controlled trials, and observational studies. The retrieved evidence was synthesized narratively. Results: Both ECCO₂R, which facilitates carbon dioxide clearance, and CytoSorb hemoadsorption therapy, which removes circulating cytokines and inflammatory mediators, demonstrate high efficacy. However, current clinical trials have not shown significant improvements in mortality. This discrepancy may be related to patient heterogeneity and the lack of phenotype-based selection. ECCO₂R may be beneficial in ARDS phenotypes characterized by predominant hypercapnia, whereas CytoSorb therapy may be most effective in patients with the hyperinflammatory delta sepsis phenotype.
Background. Video gaming is one of the most common leisure activities among children and adolescents worldwide. Growing concerns about problematic gaming and Gaming Disorder have increased research on the impact of gaming on mental health and psychosocial functioning. Aim. This narrative review aimed to summarize and critically evaluate current evidence on the relationship between video gaming, mental health, and psychosocial functioning in children and adolescents. Material and methods. A narrative review was conducted using publications identified through PubMed, Scopus, Web of Science, and Google Scholar. The primary search focused on studies published between January 2014 and February 2026 examining associations between video gaming, mental health, and psychosocial functioning in individuals younger than 18 years. Seminal publications published before 2014 were also included to provide conceptual and historical context. Original studies, systematic reviews, and meta-analyses were considered. Results. Problematic gaming and Gaming Disorder are associated with increased risks of depression, anxiety, sleep disturbances, psychosocial difficulties, and poorer academic functioning. In contrast, moderate gaming may provide cognitive, emotional, and social benefits, including improved problem-solving, cognitive flexibility, stress reduction, and opportunities for social interaction. The relationship between gaming and mental health is influenced by individual, familial, and environmental factors. Conclusions. Video gaming may exert both positive and negative effects on mental health and psychosocial functioning in children and adolescents. Gaming duration alone is a poor predictor of adverse outcomes; functional impairment, gaming motivations, and psychosocial context appear to be more important determinants. Promoting balanced gaming habits and early recognition of problematic gaming may maximize benefits while reducing potential harms.
Osteoporosis is a major skeletal disorder characterised by reduced bone mineral density and deteriorating microarchitecture, imposing a considerable burden of fragility fractures on postmenopausal women worldwide (Compston, McClung and Leslie, 2019). The estrogen withdrawal that accompanies menopause accelerates bone resorption, tipping the remodelling balance toward net bone loss and increasing fracture vulnerability within the first decade after the final menstrual period (Cummings and Melton, 2002). Vitamin D, calcium, and a growing number of accessory micronutrients—including vitamin K2 and magnesium—play interrelated and mechanistically distinct roles in maintaining skeletal integrity (Capozzi, Scambia and Lello, 2020). This narrative review synthesises current evidence on the biology of bone loss after menopause, the contributions of individual micronutrients, clinical data on supplementation efficacy, diagnostic standards, management strategies, and the integration of nutritional support with pharmacologic therapy. Evidence indicates that vitamin D and calcium together modestly reduce fracture incidence and preserve bone mineral density, though benefits depend heavily on baseline nutritional status, dosing regimen, and patient adherence (Liu et al., 2020). Vitamin K2 and magnesium represent emerging adjuncts whose mechanistic rationale is compelling, although large randomised controlled trial data remain incomplete (Ma et al., 2022; Rondanelli et al., 2021). The review concludes that micronutrient optimisation is a necessary but insufficient sole strategy; it must be embedded within broader preventive and pharmacologic frameworks to achieve meaningful reductions in postmenopausal fracture risk.
Aim: This narrative review analyzes the role of teledentistry in improving access to dental care, identifies its main clinical and organizational applications, and discusses the clinical, equity-related and implementation conditions that determine whether remote dental care produces real improvement in access.
Respiratory physiotherapy is an important element in the prevention and treatment of postoperative respiratory complications, which frequently occur in patients after surgical procedures, particularly in the thoracic and abdominal areas. The aim of this study was to assess the impact of respiratory physiotherapy on reducing the risk of postoperative pulmonary complications and to determine the importance of early mobilization and patient education in the rehabilitation process. The study is based on a review of available scientific literature regarding the use of various respiratory physiotherapy methods in the postoperative period and their effectiveness in preventing pulmonary complications. The analysis of studies indicates that the use of respiratory techniques reduces the incidence of complications such as atelectasis and pneumonia, and the best therapeutic effects are achieved when breathing exercises are combined with early patient mobilization and appropriate preoperative education. The results of the review confirm that a comprehensive approach to respiratory physiotherapy increases its effectiveness in preventing postoperative complications. At the same time, the need for further research of high methodological quality is emphasized to standardize procedures and better determine the effectiveness of individual therapeutic methods.
The article examines the psychological characteristics of self-control and self-management among representatives of socionomic professions in the context of intolerance of uncertainty. Based on an analysis of contemporary scientific approaches, the concept of intolerance of uncertainty is defined. The content of self-control, self-regulation, self-monitoring, and self-management under conditions of uncertainty is clarified. An empirical research programme was developed. The sample comprised 63 representatives of socionomic professions -psychologists and educators aged 29 to 56 years. Groups with high and low levels of intolerance of uncertainty were identified within the overall sample. A qualitative descriptive-comparative analysis of self-control and self-management was conducted in the contrasting groups of socionomic professionals with high (High-IU) and low (Low-IU) levels of intolerance of uncertainty. The Low-IU group was characterised by the ability to monitor their internal states, behaviour, and ongoing activity; realistically evaluate their capabilities and performance outcomes; and adapt behavioural strategies to current circumstances. These professionals also demonstrated a more flexible attitude towards uncertain situations and a lower tendency to experience disorganisation in response to change. In the High-IU group, less developed self-monitoring may hinder the maintenance of professional organisation in ambiguous situations. These professionals may perceive conditions of uncertainty as more threatening, potentially complicating decision-making and reducing confidence in their ability to control the course of events.
Chronic sleep deprivation has emerged as a significant and modifiable risk factor for cognitive decline and mood disorders, with neurobiological consequences that extend far beyond transient impairment of alertness. Modern societies are characterised by widespread, voluntary curtailment of sleep, with surveys consistently indicating that large proportions of adults in industrialised nations sleep fewer than the recommended seven to nine hours per night (Watson et al., 2015). The consequences of this pervasive sleep deficit include measurable impairments in sustained attention, working memory, executive function, and decision-making, as well as substantially elevated risks of developing major depressive disorder, anxiety disorders, and bipolar spectrum conditions (Lim and Dinges, 2010; Baglioni et al., 2011). At the neurobiological level, sleep deprivation disrupts adenosine homeostasis, impairs prefrontal cortical function, dysregulates hypothalamic-pituitary-adrenal axis activity, elevates systemic inflammation, and suppresses hippocampal neurogenesis—mechanisms that collectively explain the breadth and severity of observed clinical effects (Xie et al., 2013; Irwin, 2015). This review synthesises current evidence on sleep physiology, the neurobiological basis of sleep deprivation effects, specific cognitive and mood consequences, vulnerable populations, diagnostic approaches, therapeutic strategies, and public health implications, with the goal of providing a comprehensive foundation for clinical recognition and intervention.
Meibomian gland dysfunction (MGD) is a chronic disorder of the eyelid margin and the leading cause of evaporative dry eye disease (EDE). Alterations in meibum secretion impair tear film stability, increase tear evaporation, and contribute to ocular surface inflammation and visual disturbances. This narrative review summarizes current knowledge regarding the anatomy and physiology of the meibomian glands, the pathophysiology of MGD, its relationship with dry eye disease (DED), contemporary diagnostic methods, and available treatment options. Recent advances in meibography, interferometry, lipid layer assessment, and artificial intelligence have improved diagnostic capabilities. In addition to conventional therapies, including eyelid hygiene, warm compresses, and anti-inflammatory treatment, device-based interventions such as thermal pulsation therapy, intense pulsed light, and low-level light therapy have expanded therapeutic possibilities. Emerging regenerative approaches may further improve future management strategies. Continued advances in diagnosis and treatment are expected to support more personalized and mechanism-based care for patients with MGD.
Crohn’s disease is an inflammatory bowel disease, which substantially impairs patients’ quality of life. Despite ongoing advances, effective long-term management remains challenging in many cases. Conventional therapies are often associated with significant adverse effects and limited suitability for sustained use. This review provides an overview of the current landscape of novel biological therapeutics and their molecular targets. Several biologic therapies are already well established in clinical practice. Among them, IL-23 inhibitors stand out due to their high efficacy in both inducing and maintaining remission. Agents targeting the TL1A pathway, as well as human amniotic epithelial cells have shown promising early results and are currently under further investigation in clinical trials. Nevertheless, discontinuation of some biologics trials proves that not all theoretically attractive targets translate into meaningful clinical outcomes. Importantly, variability in efficacy can be observed even within the same class of drugs. This is exemplified by the success of upadacitinib in contrast to tofacitinib, which did not meet primary endpoints and was not further developed for this indication. Overall, these findings highlight both the progress achieved and the ongoing challenges in optimizing targeted therapies for Crohn’s disease.
Introduction and purpose. Hybrid learning has become an established form of vocational education rather than a temporary response to a crisis. Yet most scholarly discussion concentrates on the teacher, while the student appears as a recipient of pedagogical influence. This contradicts the logic of hybridity, which requires continuous decisions about the mode of attendance, the pace and the depth of work, and therefore presupposes learner subjectivity. The purpose is to systematise current understanding of the student as an active participant of the hybrid learning environment in vocational education and to substantiate the pedagogical conditions that support such activity. A brief description of the state of knowledge. Frameworks that explain learner subjectivity are examined: self-determination theory, student agency and the Community of Inquiry model. Five interrelated dimensions of student activity are distinguished: behavioural, cognitive, emotional, social and agentic. The specificity of vocational education is analysed, where the practice-oriented component limits full virtualisation yet opens space for learner initiative. Attention is also given to digital competence, student participation in assessment, and barriers such as the digital divide, status asymmetry between online and on-site participants, and academic integrity. Summary. Active participation does not arise automatically from the provision of choice; it results from deliberate pedagogical design. A system of pedagogical conditions is proposed: transparency of instructional design, parity between modes of participation, priority of collaborative work over content delivery, distributed responsibility for communication, formative assessment, and systematic development of learners’ digital competence.
Introduction and purpose. The digital transformation of the labour market requires digital competence from future vocational education and training (VET) specialists, whereas the pedagogical practice of preparing such specialists mostly relies on separate technological solutions without an integral didactic instrumentarium that would combine them into a system. The purpose of the article is to substantiate an original structural-functional model of building the digital competence of future VET specialists, to define the principles of its construction, the pedagogical conditions of its implementation, and the criteria for diagnosing the outcome. Brief description of the main findings. On the basis of an analysis of 24 sources, a three-level structure of the digital competence of a VET specialist is clarified - transversal, professional-pedagogical, and occupation-specific levels – and six principles of model construction are formulated: didactic priority, functional correspondence, cyclical feedback, differentiation by occupational specificity, risk preventiveness, and contextual adaptability. A structural-functional model is proposed with five interrelated components – target, content, technological, organisational-methodological, and diagnostic; six pedagogical conditions for its implementation in Ukrainian VET institutions and four criteria of digital-competence formation with level-based indicators are defined. Summary. The proposed model shifts the emphasis from a list of separate technologies to the didactic mechanism of their integration, in which the digital-didactic competence of the teacher is the system-forming variable. The model is conceptual in status and requires further empirical validation against indicators of graduates’ professional performance.
Introduction and purpose. The digital transformation of vocational education and the human-centred priorities of Industry 5.0 require that the pedagogical and the digital-technological components of teacher training cease to be delivered in parallel and become genuinely interpenetrating. Theoretical substantiation of the integrative approach does not by itself guarantee an educational result: it becomes operational only when supported by a controllable set of pedagogical conditions. The purpose is to substantiate and structurally describe such a set for the training of future bachelors of vocational education specialising in digital technologies. Brief description of the state of knowledge. Pedagogical conditions are most often presented in the literature as unordered lists, without an explicit derivation procedure and without showing which component of competence each condition supports and which educational barrier it neutralises. Here five conditions were derived from three complementary sources: the seven-component structure of professional competence, the methodological triad of the systems, competence and activity approaches, and the educational barriers identified in the analysis of the state of the problem. A conditions-components matrix was constructed and two analytical indices were computed from it. Summary. The set comprises content integration; a human-centred integrative digital learning environment; practice-oriented and project technologies; readiness of the teaching staff; and the subject position of students. Readiness of the teaching staff possesses the highest integrative capacity and is system-forming, whereas the cognitive-content and reflective-evaluative components receive the weakest support and form the principal risk zone of the design.
Polytrauma is frequently accompanied by the early development of trauma-induced coagulopathy (TIC), which may occur within minutes after injury and has a significant impact on the severity of shock and patient survival. The pathogenesis of this condition is primarily driven by the combination of tissue injury and hemorrhagic shock, which triggers endogenous coagulopathy, systemic anticoagulation, and hyperfibrinolysis. Subsequent blood loss, hypothermia, acidosis, and hemodilution further exacerbate coagulation disturbances, creating a self-perpetuating cycle that results in severe hemostatic dysfunction. Viscoelastic assays, particularly thromboelastography (TEG) and rotational thromboelastometry (ROTEM), enable rapid assessment of the functional status of coagulation in whole blood and are widely used for the early detection of hypocoagulability, hyperfibrinolysis, and fibrinogen deficiency.
The early period of acute polytrauma is characterized by the rapid development of systemic pathophysiological disturbances that largely determine patient survival during the first hours after injury and the quality of care provided at both prehospital and hospital stages. Trauma-induced coagulopathy, hemorrhagic shock, hypothermia, acidosis, and hypocalcemia form a complex interconnected pathological process that contributes to ongoing bleeding and progressive impairment of the body's coagulation system. The Lethal Diamond concept represents a modern extension of the classical Lethal Triad and provides a more comprehensive explanation of the mechanisms underlying early decompensation in severe trauma. The aim of this review is to analyze current research elucidating the pathophysiology of the Lethal Diamond, its clinical significance, and the role of early hemostatic resuscitation in acute polytrauma.
Introduction. According to the World Health Organization (WHO), injuries and violence cause approximately 4.4 million deaths worldwide each year and account for nearly 8% of all deaths; among people aged 5–29 years, injuries are among the leading causes of mortality. Hypofibrinogenemia is one of the key components of early trauma-induced coagulopathy and is associated with impaired hemostasis and an increased risk of massive bleeding. This review was based on an analysis of international guidelines, original clinical studies, and recent review publications addressing viscoelastic monitoring, FIBTEM, and fibrinogen-targeted therapy in trauma. Results. FIBTEM enables rapid assessment of fibrin-dependent clot strength, while its A5, A10, and MCF parameters demonstrate an acceptable correlation with fibrinogen levels measured by the Clauss method in trauma patients. Conclusions. FIBTEM is a clinically important tool for the early dete ction of hypofibrinogenemia and can be integrated into goal-directed algorithms for hemostatic resuscitation.
Background: Depression is a common and complex psychiatric disorder that poses a significant burden on individuals and healthcare systems. Despite extensive research, its pathogenesis remains incompletely understood, and many patients do not respond adequately to standard treatments. The gut and brain communicate through a bidirectional pathway known as the gut-brain axis. Increasing attention has been given to the role of gut microbiota in regulating this communication, leading to the concept of the microbiota-gut-brain axis (MGBA). Aim: This review aims to synthesize current evidence on the role of gut microbiota in major depressive disorder, with emphasis on MGBA-related pathways. Materials and Methods: A literature review was conducted using PubMed and Scopus. Relevant studies addressing the relationship between gut microbiota and depression were selected. Results and Discussion: The gut microbiota influences central nervous system through several interconnected pathways, including neuronal signaling, immune modulation, regulation of the hypothalamic-pituitary-adrenal (HPA) axis, and production of bioactive metabolites. Dysbiosis may lead to increased intestinal permeability, inflammation, HPA axis dysregulation, and disturbances in neurotransmission, all of which have been associated with depressive symptoms. Conclusions: Changes within the MGBA may play a role in the pathophysiology of depression. Gut microbiota represents a promising target for future therapeutic strategies. However, further research is needed to clarify causal relationships and develop effective interventions.
Introduction: Postmenopausal osteoporosis is a common metabolic bone disease characterized by reduced bone mineral density (BMD) and an increased risk of fractures. Estrogen deficiency accelerates bone resorption, leading to progressive bone loss and impaired skeletal strength. Resistance training has gained attention as a non-pharmacological strategy for osteoporosis prevention due to its ability to stimulate bone remodeling through mechanical loading. Objective: To evaluate the effects of resistance training on bone mineral density, fracture risk, and musculoskeletal function in postmenopausal women based on current scientific evidence. Materials and methods: A narrative literature review was conducted using studies indexed in the PubMed database. Publications from 2015–2026 concerning resistance training and osteoporosis prevention in postmenopausal women were included. Earlier landmark studies were also considered when relevant. Results: The reviewed studies indicate that resistance training is an effective intervention for preventing postmenopausal osteoporosis. Most studies reported stabilization or modest increases in BMD, particularly in the lumbar spine and femoral neck. The effectiveness of training was influenced by exercise intensity, duration, and progressive overload. Moderate- to high-intensity, long-term programs produced the most favorable outcomes, whereas low-intensity or short-term interventions showed limited effects. Although evidence regarding fracture reduction remains inconclusive, improvements in muscle strength, balance, and fall prevention may indirectly decrease fracture risk. Conclusions: Resistance training appears to be a beneficial non-pharmacological approach for maintaining bone health in postmenopausal women. Regular participation may improve BMD and support fracture prevention. Further research is needed to establish standardized training protocols and optimize exercise recommendations.
Background: Weighted blankets are a non-pharmacological intervention based on deep pressure stimulation (DPS) that has gained increasing popularity as a supportive method for improving sleep, reducing anxiety, and enhancing daily functioning in individuals with mental and neurodevelopmental disorders. Despite their widespread use in both clinical and home settings, the evidence regarding their effectiveness remains inconsistent. Results: Available evidence suggests that weighted blankets are generally safe and well tolerated. Some studies indicate improvements in subjective sleep quality, insomnia severity, anxiety symptoms, and daytime functioning, particularly among individuals with insomnia co-occurring with anxiety or psychiatric disorders. However, findings regarding objective sleep parameters remain inconsistent. Evidence supporting the use of weighted blankets in ASD is limited, whereas preliminary findings in ADHD suggest potential benefits for sleep outcomes. Proposed mechanisms include modulation of autonomic nervous system activity, increased melatonin secretion, and effects on sensory processing, although these hypotheses require further confirmation. Conclusions: Current evidence does not support the routine use of weighted blankets as a standalone therapeutic intervention. Nevertheless, they may represent a safe and accessible adjunctive strategy for selected patients, particularly those experiencing insomnia and anxiety. Further high-quality studies employing objective outcome measures are needed to clarify their clinical effectiveness and mechanisms of action
Sports-related sudden cardiac arrest (SRSCA) is defined as a natural out-of-hospital collapse of presumed cardiac origin occurring during or within one hour of moderate-to-vigorous physical exercise. Despite the well-documented cardiovascular benefits of physical activity, vigorous exertion can transiently trigger life-threatening arrhythmias in vulnerable individuals, a phenomenon known as the "paradox of exercise". This scientific review aims to evaluate the combined influence of age and sex on the risk and clinical presentation of SRSCA by synthesizing high-quality evidence from contemporary literature, including 37 original research articles drawn from international registries such as the NCAA, FIFA, and ESCAPE-NET. The analysis reveals a striking and consistent male predominance, with men accounting for 90% to 98% of cases across various registries, while women exhibit a 10- to 13-fold lower incidence rate. Furthermore, the underlying pathological substrates shift significantly with age; inherited or congenital structural diseases like hypertrophic cardiomyopathy and coronary artery anomalies predominate in athletes under 35, whereas atherosclerotic coronary artery disease is the primary cause in those over 35. Survival rates following SRSCA are notably favorable compared to non-sports cardiac arrests, ranging from 45% to over 90% in organized settings, largely due to the witnessed nature of these events and the rapid utilization of automated external defibrillators (AEDs), which is associated with survival as high as 86%. Consequently, reducing the burden of sudden death requires a two-tier strategy: primary prevention through preparticipation screening initiated around age 12 to detect phenotypic manifestations of disease, and secondary prevention via robust emergency preparedness, including mandatory AED access and rehearsed emergency action plans at all sporting venues.
Microplastics (MPs) are plastic particles smaller than 5 mm in size. They have become one of the most ubiquitous environmental contaminants worldwide. Their presence has been documented in all major environmental reservoirs, including oceans, rivers, soils, and the atmosphere, and in recent years they have also been detected directly in human tissues and bodily fluids. This review paper presents the current state of knowledge regarding the sources, distribution, and environmental impacts of microplastics, pathways of human exposure, and the mechanisms underlying their potential effects on health. Particular attention is devoted to evidence concerning the presence of microplastics in the respiratory, gastrointestinal, cardiovascular, and urogenital systems, as well as their influence on the gut microbiome. Existing clinical evidence is also discussed, including the landmark study published in The New England Journal of Medicine in 2024, which demonstrated an association between the presence of microplastics in atherosclerotic plaques and an increased risk of cardiovascular events. Future research priorities and strategies for reducing exposure at both individual and systemic levels are also presented.
