Central nervous system demyelinating disorders differ substantially in pathobiology, reversibility, and capacity for tissue repair. Disease-modifying therapies can suppress inflammatory activity in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), but they do not replace lost oligodendrocytes or reliably reverse established neuroaxonal injury. Stem cell-based strategies therefore pursue distinct therapeutic goals, including immune reconstitution, paracrine immunomodulation and neuroprotection, direct cell replacement, remyelination, and correction of defined genetic defects. Autologous hematopoietic stem cell transplantation (AHSCT) currently has the most mature clinical evidence, particularly for carefully selected patients with highly active relapsing MS despite high-efficacy therapy, but its benefit is mediated primarily through immune ablation and reconstitution rather than direct remyelination. Mesenchymal stromal cell (MSC) approaches remain investigational because controlled trials have not established consistent efficacy and intrathecal delivery has raised route-specific safety concerns. MSC-derived extracellular vesicles and induced pluripotent stem cell (iPSC)-derived oligodendrocyte or neural progenitor products remain preclinical or early translational approaches for acquired demyelinating disease, whereas gene-modified hematopoietic stem cells have a distinct role in selected inherited leukodystrophies. Translation across these platforms is additionally constrained by product heterogeneity, potency assessment, manufacturing reproducibility, long-term safety, regulation, scalability, access, and the need for mechanism-matched clinical endpoints. This article aims to critically review the clinical evidence, therapeutic niches, safety considerations, and translational boundaries of stem cell-based therapies for central nervous system demyelinating diseases, with particular emphasis on MS and NMOSD.

BACKGROUND Twenty-four-hour fluid balance is routinely used as a surrogate marker of net fluid change in critically ill patients and frequently influences bedside clinical decision-making, including assessment of volume status and fluid management strategies. However, despite its widespread use in intensive care practice, the reliability and accuracy of this routinely recorded parameter as a measure of short-term fluid change remain uncertain. MATERIAL AND METHODS We conducted a prospective multicenter observational study comparing cumulative 24-hour fluid balance with 24-hour body weight change measured over identical time intervals in adult patients admitted to the intensive care unit (ICU). Paired measurements were collected and analyzed to evaluate the agreement between these 2 commonly used approaches for estimating short-term fluid changes. Agreement was assessed using Bland-Altman analysis, including regression-based evaluation of proportional bias. Clinically acceptable agreement was predefined as a difference within ± 1 kg between methods. RESULTS A total of 360 paired observations were analyzed. The mean bias between methods was small (0.082 kg), indicating minimal systematic difference at the population level. However, agreement at the individual level was poor, with wide 95% limits of agreement (-2.1 to +2.264 kg), exceeding the predefined threshold for clinical acceptability. Clinically significant disagreement (> 1 kg) occurred in 30.2% of observations. Proportional bias was present, with increasing discrepancy between methods across the range of measured values, suggesting that disagreement was not consistent across different levels of fluid change. CONCLUSIONS Routinely charted 24-hour fluid balance demonstrates clinically unacceptable agreement with body weight change and should not be considered an interchangeable measure of short-term fluid change in critically ill patients. An integrated approach combining fluid balance assessment, serial body weight measurements, and comprehensive clinical evaluation is recommended to improve assessment of fluid status and guide individualized patient management.

BACKGROUND Respiratory distress syndrome (RDS) is defined as acute respiratory distress caused by surfactant deficiency-induced gas exchange disturbance in premature infants. We aimed to assess the effects of T-piece resuscitator combined with intubation-surfactant-extubation (INSURE) on short-term respiratory outcomes and complications in premature infants with RDS. MATERIAL AND METHODS This retrospective observational study included 100 premature infants with RDS who were treated between January 2019 and December 2023. The primary outcomes were blood gas and oxygenation indicators, including oxygenation index, partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), and inhaled oxygen concentration. The infants were categorized into an INSURE group (n=50) and a combination group (n=50) based on treatment approaches. RESULTS Compared with the INSURE group, the combination group showed significantly lower oxygenation index, PaCO2, and inhaled oxygen concentration, as well as significantly higher PaO2 after intervention (P<0.05). In addition, the combination group had significantly increased blood oxygen saturation and shortened duration of nasal continuous positive airway pressure (nCPAP) ventilation compared with the INSURE group (P<0.05). Furthermore, the combination group exhibited significantly shorter length of hospital stay, duration of oxygen therapy, and duration of noninvasive ventilation, together with a lower incidence of complications (12% vs 30%, P<0.05). CONCLUSIONS T-piece resuscitator combined with INSURE technology may be associated with improved short-term blood gas and respiratory outcomes in premature infants with RDS, while potentially reducing the duration of respiratory support and incidence of complications. Nevertheless, further large-scale prospective studies are required to validate these findings.

BACKGROUND Patients undergoing long-term maintenance hemodialysis (HD) experience persistent low-grade inflammation and are at high risk of cardiovascular complications. Aortic stiffness, commonly assessed by carotid-femoral pulse wave velocity (cfPWV), is a well-established marker of cardiovascular risk. Glycoprotein acetylation (GlycA) reflects cumulative systemic inflammation; however, its association with aortic stiffness in patients undergoing HD remains unclear. MATERIAL AND METHODS In this cross-sectional study, 160 patients receiving maintenance HD were enrolled. Aortic stiffness was defined as cfPWV >10 m/s. Serum GlycA levels were measured using an enzyme-linked immunosorbent assay. Multivariable logistic and linear regression analyses were performed to evaluate the association between GlycA and aortic stiffness. RESULTS A total of 52 patients (32.5%) had aortic stiffness. These patients were older and had a higher prevalence of diabetes and hypertension, along with higher blood pressure, glucose, and GlycA levels (all P<0.05). In multivariable logistic regression analysis, GlycA remained independently associated with aortic stiffness, with each 1 μmol/L increase in GlycA associated with a higher likelihood of aortic stiffness (odds ratio 1.007, 95% CI 1.004-1.010; P<0.001). In linear regression analysis, cfPWV was positively associated with log-GlycA, systolic blood pressure, and glucose levels. CONCLUSIONS Circulating GlycA levels are independently associated with cfPWV and aortic stiffness in patients undergoing HD, suggesting that GlycA may serve as an integrative marker of inflammation-related vascular alterations in this population.

BACKGROUND Vaccine hesitancy remains an important public health challenge, particularly in settings where vaccine uptake may vary according to sociodemographic and contextual factors. This study aimed to assess sociodemographic and lifestyle factors associated with coronavirus disease 2019 (COVID-19) vaccination uptake among healthy individuals and patients with chronic comorbidities attending a primary health care clinic in Siedlce, Eastern Poland. MATERIAL AND METHODS A cross-sectional survey was conducted between November 2, 2022, and January 3, 2023, in a convenience sample of 458 adult primary care patients. Lifestyle was assessed using the Lifestyle Screening Questionnaire (LSQ)-Cavendish Diagnostic Questionnaire. RESULTS Full COVID-19 vaccination was mainly associated with older age, higher educational attainment, and retirement status. In the adjusted model, age remained a strong predictor of vaccination uptake; participants with higher education had greater odds of full vaccination relative to those with primary or lower secondary education. Rural residence was independently associated with higher odds of full vaccination, despite a borderline association in unadjusted analyses. Several lifestyle domains differed between vaccination groups in descriptive analyses; the overall pattern did not indicate a clear independent association between lifestyle and vaccination uptake. CONCLUSIONS In this primary care sample from Eastern Poland, COVID-19 vaccination uptake was mainly associated with age, education, retirement status, and place of residence rather than a consistent lifestyle profile. The finding of higher vaccination uptake among rural participants contrasts with international literature and may reflect the local health care context. Vaccination strategies should consider regional and primary care-based differences in access, trust, and patient engagement.

BACKGROUND Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and neonatal outcomes. Lifestyle factors, including physical activity, diet, and body composition, may influence GDM risk, but integrated clinical data remain limited. We compared lifestyle-related factors, physical activity, dietary behaviors, and body composition between pregnant women with GDM and those with normal glucose tolerance and assessed differences in supplementation use, environmental exposures, family history of metabolic diseases, and selected anthropometric parameters. MATERIAL AND METHODS This cross-sectional observational study included 80 pregnant women (30 with GDM and 50 controls). Participants completed structured questionnaires assessing diet, physical activity, supplementation, and lifestyle factors. Body composition was evaluated using bioelectrical impedance analysis and skinfold thickness measurements. Group differences were analyzed using nonparametric tests. RESULTS Women with GDM more frequently reported adherence to a prescribed diet (77% vs 0%, P<0.0001) and greater nutritional knowledge (93% vs 4%, P<0.001), likely reflecting behavioral changes following diagnosis. Compared with controls, women with GDM had greater skinfold thickness (21.5 vs 19.0 mm, P=0.011) and higher total body water (34.6% vs 31.9%, P=0.032), despite similar pre-pregnancy body mass index. Positive family histories of obesity (63% vs 38%, P=0.049) and diabetes (53% vs 28%, P=0.043) were more common in the GDM group. Supplementation use was widespread and comparable between groups. CONCLUSIONS GDM was associated with differences in body composition and family history of metabolic diseases. Reduced physical activity was observed in both groups, whereas dietary adherence and nutritional knowledge among women with GDM likely reflected post-diagnostic behavioral adaptations.

BACKGROUND Stone-associated acute pyelonephritis (APN) carries an increased risk of complicated hospitalization, but prognostic markers for prolonged length of stay (LOS) remain limited. We aimed to identify independent predictors of prolonged LOS and to compare the discriminative performance of C-reactive protein (CRP) and the immuno-nutritional HALP score (hemoglobin, albumin, lymphocytes, platelets). MATERIAL AND METHODS This retrospective, single-center study included 120 patients with stone-associated APN diagnosed on clinical, laboratory, and computed tomography findings. Firth-penalized multivariable logistic regression identified independent predictors of prolonged hospital stay (>5 days). Discriminative performance of CRP and the HALP score was assessed by receiver operating characteristic (ROC) analysis and compared using the DeLong test. RESULTS Mean length of stay was 7.0 ± 4.2 days, and 53.3% of patients had a prolonged stay. CRP was the only independent predictor in multivariable analysis. CRP discriminated better (AUC 0.815; cut-off ≥103.0 mg/L; sensitivity 68.8%, specificity 87.5%) than the HALP score (AUC 0.691; cut-off CONCLUSIONS In stone-associated APN, high admission CRP was an independent predictor of prolonged hospital stay. A low HALP score was associated with prolonged stay in univariate analysis and showed higher sensitivity at its optimal cut-off, but did not remain independently associated in the multivariable model. Admission CRP may help identify patients at risk of prolonged hospitalization; any additional prognostic value of the HALP score requires prospective validation.

BACKGROUND This study aimed to compare the effects of the Federation Internationale de Football Association (FIFA) 11[+] program with and without transcranial direct current stimulation (tDCS) on proprioception, muscle strength, balance, power, and agility in male high school soccer players. MATERIAL AND METHODS Sixty players were randomly assigned to an experimental group (n=30) receiving FIFA 11[+] with tDCS or a comparison group (n=30) receiving FIFA 11[+] with sham stimulation. Both groups trained for 20 minutes and received stimulation for 20 minutes, 3 times weekly for 8 weeks. Proprioception was assessed through joint position sense, muscle strength through quadriceps and hamstring testing, balance through functional reach and Y balance tests, power through vertical and standing long jumps, and agility through the use of the T test and Side-Step Test. The study was registered with the Clinical Research Information Service (KCT0011079). RESULTS Within-group pre- and post-intervention changes showed significant improvements in proprioceptive sensation, muscle strength, static balance, dynamic balance, power, and agility in both the experimental and comparison groups (P<0.05). Between-group comparisons revealed that the experimental group showed significantly greater improvements than the comparison group in proprioception, muscle strength, static balance, dynamic balance, power, and agility (all P<0.05). CONCLUSIONS FIFA 11[+] combined with tDCS resulted in greater improvements in proprioception, muscle strength, balance, power, and agility than FIFA 11[+] alone in male high school soccer players. These findings suggest that combining tDCS with the FIFA 11[+] program may be beneficial for enhancing neuromuscular function and athletic performance.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder in which spirometry reflects airflow limitation but incompletely captures the underlying structural injury. Patients with similar spirometric impairment may have markedly different patterns of emphysema, small-airway disease, and pulmonary vascular involvement. Computed tomography (CT) can visualize these abnormalities in vivo and may detect structural changes before overt airflow limitation develops. This narrative review examined whether CT-derived imaging markers provide clinically meaningful information beyond spirometry, particularly for phenotyping, early structural detection, prognostic enrichment, and selective clinical decision support. A focused narrative review of diverse publications in PubMed, published between January 2000 and April 2025, was conducted using COPD-related MeSH terms and free-text keywords. Across the reviewed literature, emphysema, quantified by low-attenuation area and emphysema index, and air-trapping measures showed consistent associations with expiratory volume measures and identified structural abnormalities in symptomatic smokers with preserved spirometry. Airway wall metrics such as wall area percentage distinguished airway-predominant phenotypes and were associated with airflow limitation and chronic bronchitis. CT vascular markers, including small-vessel cross-sectional area and the pulmonary artery-to-aorta ratio, reflected microvascular disease; a pulmonary artery enlargement to aorta ratio greater than 1 independently predicted severe exacerbations. Xenon CT and dual-energy CT added regional ventilation and perfusion information but remain investigational. CT imaging markers add complementary structural, phenotypic, and prognostic information beyond spirometry for established COPD and pre-COPD. Their most supported current role is phenotypic characterization and prognostic enrichment in selected clinical settings, whereas advanced functional CT techniques remain research tools. Routine CT for all patients is not supported by current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidance.

BACKGROUND Readiness for hospital discharge is critical for rehabilitation outcomes, yet traditional discharge education often fails to meet individualized needs after laryngeal cancer surgery. The Cox Interaction Model of Client Health Behavior (IMCHB) provides a patient-centered framework emphasizing interaction and empowerment, but its application in this population is rarely reported. IMCHB-based discharge preparation intervention in patients undergoing laryngeal cancer surgery was evaluated. MATERIAL AND METHODS This quasi-experimental, non-randomized controlled study used convenience sampling to recruit patients undergoing laryngeal cancer surgery at a tertiary hospital. Sixty-five patients (33 intervention, 32 control) were assigned by admission order. The control group received routine nursing care; the intervention group received an IMCHB-based discharge preparation intervention plus routine care. Groups were compared for readiness for hospital discharge, self-management ability, and anxiety/depression before the intervention, at discharge, and 1 month after discharge. Effect sizes and 95% CIs were calculated for key between-group comparisons. RESULTS At discharge, the intervention group had higher readiness-for-discharge scores (99.97±6.31 vs 88.09±6.14; MD=11.88, 95% CI: 8.65-14.71; Cohen's d=1.91), higher self-management ability (174.73±9.35 vs 152.13±12.78; MD=22.60, 95% CI: 17.05-28.15; Cohen's d=2.02), and lower anxiety scores (41.48±2.89 vs 43.19±3.70; MD=-1.71, 95% CI: -3.36 to -0.06; Cohen's d=0.51). One month after discharge, self-management remained higher (189.00 [186.00, 191.50] vs 144.00 [133.00, 154.50]; Mann-Whitney r=0.86), and depression scores were lower (40.73±3.18 vs 46.75±3.09; MD=-6.02, 95% CI: -7.57 to -4.47; Cohen's d=1.92). CONCLUSIONS IMCHB-based discharge preparation was associated with higher readiness for discharge and self-management ability and lower anxiety/depression scores after laryngeal cancer surgery. These findings should be interpreted cautiously, and randomized controlled trials are needed to confirm its effectiveness and clinical utility.

BACKGROUND Depression and anxiety-common among military recruits-are associated with gastrointestinal symptoms. The prophylactic effects of psychological interventions on depression, anxiety, and gastrointestinal symptoms in recruits remain unclear. MATERIAL AND METHODS Overall, 565 military recruits were prospectively screened. Eligible participants had no depression according to the Self-Rating Depression Scale (SDS); no anxiety according to the Self-Rating Anxiety Scale (SAS); no gastrointestinal symptoms according to the Gastrointestinal Symptom Rating Scale (GSRS); and normal stool form according to the Bristol Stool Form Scale (BSFS). Based on the company in which recruits were trained, participants were assigned to the intervention group, which received progressive muscle relaxation training combined with music intervention for 4 weeks (n=60), or the control group, which received no psychological intervention (n=99). SDS, SAS, GSRS, and BSFS questionnaires were completed at baseline, week 4 (ie, upon completion of psychological intervention), and week 6 (ie, 2 weeks after completion of psychological intervention). RESULTS The incidences of depression (1.7% vs 2.0%, P=1.000) and anxiety (3.3% vs 1.0%, P=0.557) at week 4 did not significantly differ between groups. Similarly, the incidences of depression (0% vs 1.0%, P=1.000) and anxiety (0% vs 2.0%, P=0.527) at week 6 did not significantly differ between groups. The incidences of various gastrointestinal symptoms, as well as constipation and diarrhea, also were not significantly different between groups. CONCLUSIONS Progressive muscle relaxation training combined with music intervention may not be effective for preventing depression, anxiety, or gastrointestinal symptoms in military recruits.

BACKGROUND We aimed to compare postoperative oxygenation and dorsal lung ventilation between supine and prone positions in patients undergoing craniotomy and to provide clinical evidence for lung-protective ventilation strategies. MATERIAL AND METHODS Eighty-four patients scheduled for elective craniotomy under general anesthesia were assigned to supine (S group) or prone (P group) according to different positions required for surgery (observational, non-randomized). All received volume-controlled ventilation with tidal volume set at 7 mL/kg predicted body weight, I: E=1: 2, and respiratory rate adjusted to maintain PetCO2 at 30-40 mm Hg. The decline in oxygenation index (ΔPaO2/FiO2) was calculated 24 hours after extubation. Dorsal lung ventilation proportion (ROI34) was measured before anesthesia (T1), after intubation (T2), before extubation (T3), 10 min after extubation (T4), and 24 hours after extubation (T5). Lung ultrasound score (LUS) was assessed at T1, T4, and T5. RESULTS ΔPaO2/FiO2 was significantly higher in the S group than P group (45.5 [34.7-58.0] vs 36.8 [30.5-40.8] mm Hg, P<0.05). Compared with P group, ROI34 was lower in the S group at T3 (26.2%±9.2% vs 30.7%±9.8%, P<0.05) and T4 (41.5%±12.4% vs 48.5%±11.4%, P<0.05). At T5, total LUS (4.0 [3.0-5.0] vs 2.0 [1.0-3.0], P<0.05) and posterior LUS (3.0 [3.0-4.0] vs 1.0 [0.0-1.0], P<0.05) were significantly higher in the S than P group. CONCLUSIONS General anesthesia with mechanical ventilation reduced postoperative oxygenation and dorsal lung ventilation in patients undergoing craniotomy, most notably in supine patients at 24 hours. Ventilation strategies should be individualized according to surgical position, with enhanced lung-protective strategies for supine patients.

BACKGROUND Common variable immunodeficiency (CVID) is an inborn error of immunity characterized by impaired antibody production, poor vaccine responses, and reduced serum immunoglobulin levels, resulting in respiratory manifestations that can progress to pulmonary complications. Although vitamin D has been associated with pulmonary outcomes in other populations, the association between serum 25-hydroxyvitamin D [25(OH)D] status and pulmonary manifestations, particularly atelectasis, in CVID remains unclear. MATERIAL AND METHODS We conducted a retrospective cross-sectional study of 48 adult patients with CVID stratified by serum 25(OH)D concentration (<30 ng/mL [insufficient] vs ≥30 ng/mL [sufficient]). Pulmonary outcomes (atelectasis, bronchiectasis, recurrent pneumonia, and chronic obstructive pulmonary disease [COPD]) were obtained from medical records. Associations were assessed via Fisher's exact test. Exploratory analyses included a longitudinal imaging review and descriptive Kaplan-Meier curves illustrating atelectasis-free disease duration by baseline 25(OH)D status. RESULTS Among 48 patients, 35 (73%) had 25(OH)D concentrations below 30 ng/mL. Atelectasis was more frequent in the insufficient group (15/35; 43%) (odds ratio=0.12; 95% confidence interval, 0.01-0.97; P=0.02). No significant associations were observed for bronchiectasis (63% vs 46%; P=0.53), recurrent pneumonia (91% vs 84%; P=0.49), or COPD (3% vs 8%; P=0.46). Kaplan-Meier curves did not show an apparent separation between groups. CONCLUSIONS Serum 25(OH)D sufficiency was associated with lower atelectasis prevalence in patients with CVID. This finding reflects a cross-sectional association and does not establish causality; it supports a potential link between 25(OH)D status and atelectasis. Prospective studies are needed to further evaluate this relationship.

Virtual reality (VR), defined as an immersive, interactive, computer-generated simulation delivered via head-mounted displays that create a sense of presence in a virtual environment, holds promise for otolaryngology nursing and is increasingly used in clinical practice worldwide. This narrative review covers both patient-facing VR applications (preoperative education, pain and anxiety relief, vestibular rehabilitation, swallowing assessment and therapy, hearing rehabilitation, and tinnitus management) and nurse-facing VR applications (professional training and skills development). By synthesizing recent clinical studies and technological advances, this review highlights the potential for VR to enhance the patient care experience, improve nursing quality and efficiency, and address common challenges such as severe surgical anxiety and poor adherence to rehabilitation; supporting evidence varies across applications. Vestibular rehabilitation is supported by strong evidence from randomized controlled trials, whereas swallowing therapy and tinnitus management are primarily supported by preliminary exploratory studies. We discuss technical, economic, and clinical limitations hindering implementation of VR, then present practical recommendations for future research and clinical practice. This review also highlights recent advances, including the integration of VR with artificial intelligence, wearable biosensors, and telerehabilitation platforms, to facilitate personalized remote otolaryngology nursing. Despite the potential for VR to improve rehabilitation outcomes and treatment adherence, current evidence remains heterogeneous due to variations in study designs and outcome measures. Rigorous, standardized, large-scale studies are urgently needed to strengthen the evidence base and support the reliable, standardized implementation of VR in otolaryngology nursing. This review summarizes the current evidence and future prospects of VR in otolaryngology patient care management.

BACKGROUND Hauck type II ulnar styloid fractures (USFs) occur at the base of the ulnar styloid process, where the triangular fibrocartilage complex attaches. Nonunion or disruption at this level may compromise distal radioulnar joint (DRUJ) stability, although the clinical significance of associated USFs in distal radius fractures (DRFs) remains debated. This retrospective cohort study compared outcomes after mini-anchor fixation vs no ulnar styloid fixation in patients with DRFs and concomitant Hauck type II USFs. MATERIAL AND METHODS Forty-five patients treated between 2021 and 2023 were included. Twenty-three patients underwent mini-anchor fixation of the ulnar styloid (group A), and 22 did not (group C). Primary outcomes were USF union and ulnar-sided or DRUJ stability-related complications. Secondary outcomes included wrist range of motion, grip strength, the Modified Mayo Wrist Score, and the Quick Disabilities of the Arm, Shoulder, and Hand score. RESULTS All DRFs healed in both groups. USF union occurred in all patients in group A, whereas 2 nonunions occurred in group C (P=0.233). Ulnar-sided pain was less frequent in group A than in group C (P=0.346), and DRUJ subluxation occurred only in group C (P=0.489). Range of motion, grip strength, and functional outcome scores were comparable between groups. CONCLUSIONS Mini-anchor fixation was associated with higher union rates and fewer ulnar-sided or DRUJ-related complications, although differences were not statistically significant, and overall wrist function was similar between groups. Given the modest sample size, these findings should be considered preliminary and require confirmation in larger prospective studies.