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15 pages, 1477 KiB  
Article
Objectification of the Functional Myodiagnosis Muscle Test
by Josef Franz Mahlknecht, Eugen Burtscher, Ivan Ramšak, Christine Zürcher and Johannes Bernard
J. Clin. Med. 2025, 14(15), 5555; https://doi.org/10.3390/jcm14155555 - 6 Aug 2025
Abstract
Objective: This study aimed to investigate whether the subjective assessments of strong and weak muscles in the Functional Myodiagnosis muscle test (FMD-MT) can be objectively and reproducibly verified using physically measurable parameters. Additionally, we sought to evaluate the reliability of the manual muscle [...] Read more.
Objective: This study aimed to investigate whether the subjective assessments of strong and weak muscles in the Functional Myodiagnosis muscle test (FMD-MT) can be objectively and reproducibly verified using physically measurable parameters. Additionally, we sought to evaluate the reliability of the manual muscle test in order to reinforce the scientific evidence supporting this accepted, yet not widely adopted, complementary medicine method. Methods: In a crossover observational study, three experienced medical practitioners conducted the FMD-MT of the rectus femoris muscle on 24 healthy participants using a specially designed therapy bench, with all measurements recorded via an oscillogram. The study investigated the force–time integral, joint angle change, additional force load, mean force turning point 1, as well as the interrater reliability and validity of both examiner assessments and instrumental analyses for the two muscle reaction variants: strong and weak. Results: A significant difference between the response pattern of strong and weak muscles was identified for the force–time integral (p = 0.005), the change in joint angle (p < 0.001), and the additional force load (p = 0.001). No difference between strong and weak muscles could be detected regarding the force turning point 1 (p = 0.972). The examiners demonstrated 100% accuracy in identifying weak muscle reactions as weak, and 99.2% accuracy in identifying strong muscle reactions as strong (p = 0.316). The overall intra-class correlation coefficient was 0.984. The oscillogram correctly visualized weak muscle reactions in weak muscles with an accuracy of 81.7%, and strong muscle reactions in strong muscles with an accuracy of 86.7% (p = 0.289). Conclusions: The Functional Myodiagnosis muscle test (FMD-MT) enables a clear and objective differentiation between strong and weak muscles, with statistically significant differences observed in the force–time integral, additional force load, and joint angle changes. Under rigorously standardized testing conditions, the FMD-MT of the rectus femoris muscle demonstrates a validity rate of 99.6% and an excellent reliability (ICC 0.984). Consequently, the FMD muscle test proves to be a reliable, reproducible, and objective diagnostic method. Trial registration: German Register of Clinical Studies U1111-1212-6622. Full article
(This article belongs to the Section Sports Medicine)
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13 pages, 783 KiB  
Article
The Immediate Hypoalgesic Effects of Mobilization and Manipulation in Patients with Non-Specific Chronic Low Back Pain: A Cross-Over Randomized Controlled Trial
by Thomas Sampsonis, Stefanos Karanasios and George Gioftsos
Healthcare 2025, 13(14), 1719; https://doi.org/10.3390/healthcare13141719 - 17 Jul 2025
Viewed by 1490
Abstract
Background/Objectives: Manual therapy techniques, including mobilization and manipulation, are commonly used for chronic low back pain (CLBP), with clinical guidelines recommending their use. This study aimed to compare the immediate hypoalgesic effects of mobilization and manipulation in patients with non-specific CLBP, evaluating their [...] Read more.
Background/Objectives: Manual therapy techniques, including mobilization and manipulation, are commonly used for chronic low back pain (CLBP), with clinical guidelines recommending their use. This study aimed to compare the immediate hypoalgesic effects of mobilization and manipulation in patients with non-specific CLBP, evaluating their impact on pain sensitivity and range of motion. Methods: A cross-over randomized controlled trial was conducted with 27 participants with non-specific CLBP. Participants received either mobilization or manipulation on two different intervention days. Outcome measures included pressure pain thresholds (PPTs) assessed with a digital algometer, pain intensity using a numeric rating scale, and lumbar range of motion (ROM) measured with a digital inclinometer. Results: The results indicated no statistically significant differences between mobilization and manipulation for any outcome measures (all p > 0.05). However, significant within-intervention improvements were observed, including pain reduction, increased PPTs, and enhanced ROM of the lower back. Conclusions: Our findings suggest that both mobilization and manipulation provide similar immediate benefits for patients with CLBP. The choice between these techniques should be based on therapists’ clinical reasoning and individualized risk stratification, considering the potential benefits and risks of each approach for a specific patient. Full article
(This article belongs to the Special Issue Pain Management in Healthcare Practice)
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15 pages, 1325 KiB  
Article
The OMNIVEG Study: Effects of Transitioning from a Traditional to a Vegan Mediterranean Diet on Fat Oxidation During Exercise
by Miguel López-Moreno, Ujué Fresán, Juan Del Coso, Alejandro Muñoz, Millán Aguilar-Navarro, María Teresa Iglesias-López, Francisco J. Amaro-Gahete and Jorge Gutiérrez-Hellín
Nutrients 2025, 17(14), 2274; https://doi.org/10.3390/nu17142274 - 9 Jul 2025
Viewed by 611
Abstract
Background: This study aimed to evaluate the changes in fat utilization associated with transitioning from a traditional to a vegan Mediterranean diet in healthy, physically active men during a ramp exercise test. Methods: In a controlled crossover design, fourteen healthy, physically active men [...] Read more.
Background: This study aimed to evaluate the changes in fat utilization associated with transitioning from a traditional to a vegan Mediterranean diet in healthy, physically active men during a ramp exercise test. Methods: In a controlled crossover design, fourteen healthy, physically active men followed a traditional Mediterranean diet for three weeks (baseline). Then, participants transitioned to a four-week isocaloric vegan version of the Mediterranean diet, matched for macronutrient distribution but excluding all animal foods. Immediately after each dietary intervention, participants completed an incremental exercise test (from 30% to 70% of VO2peak) on a cycle ergometer in a fasted state to determine peak fat oxidation (PFO) and its associated exercise intensity (Fatmax). Exercise heart rate and the rating of perceived exertion were also recorded at each exercise intensity. Results: The traditional and vegan Mediterranean diets provided comparable amounts of energy (2599.6 ± 180.8 and 2634.9 ± 148.3 kcal/day, p = 0.140) and total fat (97.0 ± 17.8 and 99.0 ± 13.2 g/day; p = 0.620). However, the vegan Mediterranean diet contained a lower proportion of saturated fat (25.2 ± 6.8 vs. 13.6 ± 4.4% of total fat, p < 0.010). Still, the dietary transition was not associated with modifications in PFO (0.323 ± 0.153 and 0.347 ± 0.147 g/min; p = 0.678) or Fatmax (40.51 ± 7.30 and 40.51 ± 10.71%VO2peak; p = 1.000) during exercise. Moreover, the dietary transition did not significantly change the response curves across exercise intensities for fat oxidation (p = 0.553), heart rate (p = 0.280), or the rating of perceived exertion (p = 0.433). Conclusions: Switching from a traditional to a vegan Mediterranean diet did not affect fat oxidation, exercise intensity at peak fat oxidation, or perceptual responses during exercise in healthy, active men. These findings suggest that physically active individuals can adopt a vegan version of the Mediterranean diet without compromising fat utilization during submaximal aerobic exercise. Clinical Trial Registry: NCT06008886. Date of registration: 28 July 2023. Full article
(This article belongs to the Special Issue Reducing the Burden of Chronic Diseases Through Plant-Based Diets)
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16 pages, 893 KiB  
Article
Efficacy of Myofascial Techniques and Proprioceptive Neuromuscular Facilitation in the Treatment of Patients with Systemic Lupus Erythematosus—Randomized Crossover Clinical Study
by José-María Torres-Quiles, Rubén Cuesta-Barriuso and Raúl Pérez-Llanes
Healthcare 2025, 13(13), 1625; https://doi.org/10.3390/healthcare13131625 - 7 Jul 2025
Viewed by 457
Abstract
Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular [...] Read more.
Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular facilitation in patients with systemic lupus erythematosus. Methods: A randomized, single-blind, crossover clinical trial. Seventeen patients with systemic lupus erythematosus were randomly assigned to two sequences: Sequence A–B (intervention phase first, then control phase) and Sequence B–A (control phase first, then intervention phase). The intervention lasted for four weeks, with two weekly sessions lasting 50 min each. The intervention consisted of myofascial and proprioceptive neuromuscular facilitation techniques. The variables were: pain intensity (Visual Analog Scale), functional capacity of lower limbs (2-Minute Walk Test), physical function (Timed Up and Go Test), and fatigue (Fatigue Assessment Scale). After a 2-week follow-up and a 2-week washout period, the patients switched groups, and the methodology was replicated. Results: None of the patients developed injury or adverse effects as a direct consequence of the intervention. There were statistically significant differences between groups (p < 0.001) in the intensity of ankle (η2p = 0.38) and knee (η2 = 0.37) pain, functional capacity (η2 = 0.33), and physical function (η2 = 0.56). There were also intergroup changes in fatigue (η2 = 0.52), and the relevant mental (η2 = 0.26) and physical (η2 = 0.45) components. Conclusions: Proprioceptive myofascial and neuromuscular facilitation techniques are safe in patients with systemic lupus erythematosus. This physical therapy protocol can improve the intensity of knee and ankle joint pain in these patients. This intervention can improve functional capacity, physical function, and fatigue in people with systemic lupus erythematosus. Full article
(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)
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20 pages, 4947 KiB  
Article
Novel Micellar Formulation of Silymarin (Milk Thistle) with Enhanced Bioavailability in a Double-Blind, Randomized, Crossover Human Trial
by Chuck Chang, Yiming Zhang, Yun Chai Kuo, Min Du, Kyle Roh, Roland Gahler, Afoke Ibi and Julia Solnier
Pharmaceutics 2025, 17(7), 880; https://doi.org/10.3390/pharmaceutics17070880 - 4 Jul 2025
Viewed by 778
Abstract
Background: Silymarin, a flavonoid complex, and the main bioactive component of milk thistle (Silybum marianum), is known for its hepatoprotective properties but suffers from poor bioavailability due to its low solubility and extensive first-pass metabolism. Method: This study aimed to evaluate [...] Read more.
Background: Silymarin, a flavonoid complex, and the main bioactive component of milk thistle (Silybum marianum), is known for its hepatoprotective properties but suffers from poor bioavailability due to its low solubility and extensive first-pass metabolism. Method: This study aimed to evaluate the pharmacokinetics and tolerability of a novel micellar milk thistle formulation designed to enhance silymarin absorption, compared to an unformulated/standard milk thistle product, in a small-scale human bioavailability trial. In a randomized, double-blinded, crossover study, 16 healthy participants received a single dose of either the micellar formulation (LipoMicel Milk Thistle; LMM) or the standard formulation (STD) at a total daily dose of 130 mg silymarin. Blood concentrations were measured over 24 h, and key pharmacokinetic parameters—maximum plasma concentration (Cmax), time to reach maximum concentration (Tmax), and area under the curve (AUC)—were calculated. Tolerability and safety were assessed through adverse event monitoring during the study period. Results: Results demonstrated a significant increase in bioavailability with the micellar formulation, with 18.9-fold higher Cmax (95% CI: 1.9–30.7 ng/mL vs. 74.4–288.3 ng/mL; p = 0.007) and 11.4-fold higher AUC0–24 (95% CI: 7.40–113.5 ng·h/mL vs. 178–612.5 ng·h/mL; p = 0.015). Tmax was 0.5 (95% CI: 0.5–4.0) hours for the micellar formulation versus 2.5 (95% CI: 0.5–8.0) hours for the standard product (p = 0.015) indicating faster absorption of LMM. The standard formulation exhibited a significantly longer mean residence time compared to the LMM formulation (95% CI: 4.4–7.5 h vs. 2.8–4.2 h; p = 0.015). Conclusions: No adverse events or significant safety concerns were observed in either group. Compared to the standard, the micellar formulation showed superior pharmacokinetic outcomes, suggesting it may enhance silymarin’s clinical efficacy in liver health. Full article
(This article belongs to the Collection Pharmaceutical Sciences in Canada)
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13 pages, 986 KiB  
Review
Chronic Total Occlusions: Current Approaches, Evidence and Outcomes
by Remi Arnold, Richard Gervasoni and Florence Leclercq
J. Clin. Med. 2025, 14(13), 4695; https://doi.org/10.3390/jcm14134695 - 2 Jul 2025
Viewed by 522
Abstract
Chronic total occlusions (CTOs), defined as complete coronary artery blockages persisting for over three months, are frequently encountered in up to 25% of coronary angiograms. Although percutaneous coronary intervention (PCI) for CTO remains technically challenging, advancements in guidewires, microcatheters, re-entry devices, and intravascular [...] Read more.
Chronic total occlusions (CTOs), defined as complete coronary artery blockages persisting for over three months, are frequently encountered in up to 25% of coronary angiograms. Although percutaneous coronary intervention (PCI) for CTO remains technically challenging, advancements in guidewires, microcatheters, re-entry devices, and intravascular imaging, along with the expertise of specialized operators, have significantly improved procedural success rates, now exceeding 90% in expert centers. While recent evidence, such as the SYNTAX II study, emphasizes the importance of complete revascularization, over half of CTO cases continue to be managed conservatively with optimal medical therapy (OMT), partly due to the limited high-quality randomized evidence supporting revascularization. Observational studies have demonstrated that successful CTO-PCI is associated with improved angina relief, quality of life, left ventricular function, and possibly long-term survival. Extended observational follow-up, such as the Korean and Canadian registries, suggests long-term reductions in cardiac and all-cause mortality with CTO revascularization. However, randomized controlled trials (RCTs) have primarily shown symptomatic benefit, with no consistent reduction in major adverse cardiac events (MACE) or mortality, likely due to limited sample sizes, short follow-up, and treatment crossovers. Various strategies, including the hybrid algorithm, guide CTO interventions by balancing antegrade and retrograde techniques based on lesion complexity. Imaging modalities such as coronary CT angiography and intravascular ultrasound play a pivotal role in planning and optimizing these procedures. Future innovations, such as real-time fusion imaging of CCTA with coronary angiography, may enhance lesion visualization and guidewire navigation. While current guidelines recommend CTO-PCI in selected symptomatic patients with demonstrable ischemia or viable myocardium, the decision should be individualized, incorporating anatomical feasibility, comorbidities, patient preferences, and input from a multidisciplinary Heart Team. Looking ahead, adequately powered RCTs with extended follow-up are essential to determine the long-term clinical impact of CTO-PCI on hard outcomes such as mortality and myocardial infarction. Full article
(This article belongs to the Special Issue Advances in Coronary Artery Disease)
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15 pages, 567 KiB  
Article
Patient Satisfaction and Perception with Digital Complete Dentures Compared to Conventional Complete Dentures—A Pilot Study
by Andrea Bors, Melinda Szekely, Liana Beresescu, Alexandra Maier and Felicia Beresescu
Dent. J. 2025, 13(7), 291; https://doi.org/10.3390/dj13070291 - 27 Jun 2025
Viewed by 563
Abstract
Background: Patient satisfaction is a critical outcome in the rehabilitation of edentulous patients. While conventional fabrication methods are widely used, digital workflows are emerging as viable alternatives. However, direct comparative evidence from the patient’s perspective remains limited. Objective: To compare patient satisfaction between [...] Read more.
Background: Patient satisfaction is a critical outcome in the rehabilitation of edentulous patients. While conventional fabrication methods are widely used, digital workflows are emerging as viable alternatives. However, direct comparative evidence from the patient’s perspective remains limited. Objective: To compare patient satisfaction between conventional complete dentures (C-CD) and digital complete dentures (D-CD) in maxillary edentulous patients, including changes in perceptions over time and final prosthesis preference. Methods: A prospective, randomized crossover clinical trial was conducted in 2023–2024 involving 40 completely maxillary edentulous patients meeting specific inclusion criteria. Participants were randomly allocated into two sequence groups: Group 1 (n = 20) received C-CD first, and Group 2 (n = 20) received D-CD first, each for 6 months (T1), followed by crossover to the alternate denture for another 6 months (T2). Patient satisfaction was measured using a 10-item questionnaire at 6 and 12 months. Statistical analysis: Wilcoxon signed-rank tests were used for within-subject comparisons of denture types, and Mann–Whitney U tests for between-group comparisons, with significance set at p ≤ 0.05. Results: Using the paired crossover analysis, D-CD showed significantly better comfort than C-CD (p < 0.05). D-CD scored significantly higher than C-CD in most satisfaction domains, including comfort, retention, speech, esthetics, and need for adjustments (p ≤ 0.05). Median scores for retention, speech, esthetics, and other domains were slightly higher with D-CD but did not reach statistical significance (p > 0.05). Additionally, the D-CD required fewer post-insertion adjustment visits than the C-CD (p < 0.05). By the end of the trial, 28 patients (70%) preferred the digital denture as their final prosthesis, whereas 12 patients (30%) preferred the conventional denture. Conclusions: Incorporating digital technology in the fabrication of complete dentures significantly enhances patient satisfaction compared to conventional methods. This study highlights the clinical relevance of modern dental prosthesis technology and supports the wider integration of digital workflows. Within the limitations of this pilot study, digitally fabricated complete dentures provided overall patient satisfaction comparable to conventional dentures, with the D-CD offering a notable improvement in comfort. The majority of patients ultimately favored the digital denture, supporting the clinical viability of CAD/CAM workflows. Full article
(This article belongs to the Special Issue Digital Dentures: 2nd Edition)
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18 pages, 669 KiB  
Article
Benefits of Short-Term (4-Week) Daily Walnut Consumption in Middle-Aged Adults at Risk for Metabolic Syndrome: Outcomes of a Randomized Controlled Trial
by Letiția Mateș, Doina Albert-Ani, Ionel Fizeșan, Andreea-Elena Petru, Roxana Banc, Marius Emil Rusu, Carmen Costache, Lorena Filip, Daniela-Saveta Popa and Daniel-Corneliu Leucuța
Nutrients 2025, 17(13), 2072; https://doi.org/10.3390/nu17132072 - 21 Jun 2025
Viewed by 1349
Abstract
Background: Epidemiological research has shown that regular walnut (from Juglans regia L.) consumption is associated with a reduced risk of cardiovascular disease (CVD), potentially attributable to their antioxidant and anti-inflammatory properties. The vascular cellular adhesion molecule-1 (VCAM-1), a protein upregulated in CVD, has [...] Read more.
Background: Epidemiological research has shown that regular walnut (from Juglans regia L.) consumption is associated with a reduced risk of cardiovascular disease (CVD), potentially attributable to their antioxidant and anti-inflammatory properties. The vascular cellular adhesion molecule-1 (VCAM-1), a protein upregulated in CVD, has been previously examined in relation to walnut consumption. However, the clinical findings regarding the effects of walnuts on endothelial function among middle-aged individuals susceptible to metabolic syndrome (MetS) remain inconclusive. Objective: This study examined the effects of daily walnut consumption over a four-week period on cardiometabolic parameters (lipid and glycemic profiles, as well as soluble VCAM-1 levels) and anthropometric measurements in middle-aged individuals with at least one altered MetS parameter and no medication. Methods: In a randomized controlled cross-over trial, 22 eligible Caucasian participants (48.81 ± 4.3 years) were selected and randomly assigned to receive either 45 g of walnuts per day or no walnuts within a controlled diet. There were two 28-day intervention periods, with a one-month washout period in between. Clinical and biochemical evaluations were conducted at the beginning and end of each intervention period. Results: A total of 20 participants completed the intervention and were analyzed, with walnuts being well tolerated. A significant decrease in waist circumference (p = 0.049) and a slight change in fasting blood glucose (p = 0.089) were noted following walnut intake. Conclusions: Short-term (4 weeks) dietary supplementation with walnuts resulted in a statistically significant reduction in waist circumference while not impacting the overall health status of participants. Longer-term studies are necessary to investigate the benefits of daily walnut consumption and its impact on the onset and development of MetS in this age group. Full article
(This article belongs to the Special Issue The Relationship Between Nuts and Chronic Diseases)
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10 pages, 1547 KiB  
Article
A Comparative Evaluation of the Quality and Feasibility of ‘Over-the-Head’ Cardiopulmonary Resuscitation by a Single Rescuer: Pocket Mask vs. Bag-Valve Mask—A Pilot Study
by Silvia San Román-Mata, Marc Darné, Ernesto Herrera-Pedroviejo, Martín Otero-Agra, Rubén Navarro-Patón, Roberto Barcala-Furelos and Silvia Aranda-García
Healthcare 2025, 13(12), 1428; https://doi.org/10.3390/healthcare13121428 - 14 Jun 2025
Viewed by 394
Abstract
Aim: The present study evaluated the feasibility and quality of cardiopulmonary resuscitation (CPR) performed by a single rescuer, comparing the over-the-head (OTH) technique using mouth-to-pocket mask ventilation with bag-valve mask (BVM) ventilation. The study analyzed the chest compression (CC) quality, ventilation adequacy, [...] Read more.
Aim: The present study evaluated the feasibility and quality of cardiopulmonary resuscitation (CPR) performed by a single rescuer, comparing the over-the-head (OTH) technique using mouth-to-pocket mask ventilation with bag-valve mask (BVM) ventilation. The study analyzed the chest compression (CC) quality, ventilation adequacy, interruption minimization, and the rescuers’ perceived difficulty. Methods: A randomized simulation crossover study was conducted with 26 lifeguard students trained in basic life support and both ventilation techniques. All of the participants performed two solo CPR trials (2 min each) using OTH with a pocket mask or BVM on a manikin connected to a feedback system (Little Anne QCPR, Laerdal). The overall CPR quality, ventilation, and CC quality were assessed, along with the perceived difficulty (scale 0–5). A 5 min rest was provided between the trials. Results: The overall CPR quality was excellent for both techniques with a median of 98% (IQR: 97–99) for BVM-OTH and 99% (IQR: 94–99) for Pocket-OTH (p = 0.31). The ventilation quality was better when using BVM-OTH (100%, IQR: 99–100) compared to that with Pocket-OTH (99%, IQR: 77–100; p = 0.046). No differences were found in the CC quality (99%, IQR: 99–100; p = 0.24). However, Pocket-OTH had more CCs and shorter interruption times (p ≤ 0.001). The perceived difficulty was low for both techniques. Conclusions: Both techniques enable high-quality CPR when performed alone. Given that no clinically relevant differences emerged in the resuscitation quality, the OTH technique using a pocket mask offers a viable alternative, particularly in scenarios with a single rescuer and limited resources. Full article
(This article belongs to the Section Prehospital Care)
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23 pages, 5667 KiB  
Article
Effects of Pork Protein Ingestion Prior to and Following Performing the Army Combat Fitness Test on Markers of Catabolism, Inflammation, and Recovery
by Drew E. Gonzalez, Kelly E. Hines, Ryan J. Sowinski, Landry Estes, Sarah E. Johnson, Jisun Chun, Hudson Lee, Sheyla Leon, Adriana Gil, Joungbo Ko, Jacob Broeckel, Nicholas D. Barringer, Christopher J. Rasmussen and Richard B. Kreider
Nutrients 2025, 17(12), 1995; https://doi.org/10.3390/nu17121995 - 13 Jun 2025
Viewed by 2902
Abstract
Tactical athletes and military personnel engaged in intense exercise need to consume enough quality protein in their diet to maintain protein balance and promote recovery. Plant-based protein sources contain fewer essential amino acids (EAAs), while pork loin contains a higher concentration of EAAs [...] Read more.
Tactical athletes and military personnel engaged in intense exercise need to consume enough quality protein in their diet to maintain protein balance and promote recovery. Plant-based protein sources contain fewer essential amino acids (EAAs), while pork loin contains a higher concentration of EAAs and creatine than most other animal protein sources. This study aimed to determine whether the ingestion of plant-based or pork-based military-style meals ready-to-eat (MREs) affects recovery from and subsequent Army Combat Fitness Test (ACFT) performance. Methods: Twenty-three (n = 23) University Corps of Cadets members participated in a randomized, double-blind, placebo-controlled, and crossover-designed study. Diets were prepared by a dietitian, food scientist, and chef to have similar taste, appearance, texture, and macronutrient content. The chef also labeled the meals for double-blind administration. Participants refrained from intense exercise for 48 h before reporting to the lab in a fasted condition with a 24 h urine sample. Participants donated a blood sample, completed questionnaires and cognitive function tests, and consumed a pre-exercise meal. After four hours, participants performed the ACFT according to military standards. Participants were fed three MREs daily while returning to the lab in a fasted condition at 0600 with 24 h urine samples after 24, 48, and 72 h of recovery. On day 3, participants repeated the ACFT four hours after consuming an MRE for breakfast. Participants resumed normal training and returned to the lab after 2–3 weeks to repeat the experiment while consuming the alternate diet. Data were analyzed using general linear model statistics with repeated measures and percent changes from baseline with 95% confidence intervals. Results: Results revealed that 3 days were sufficient for participants to replicate ACFT performance. However, those consuming the pork-based diet experienced less muscle soreness, urinary urea excretion, cortisol, inflammation, and depression scores while experiencing a higher testosterone/cortisol ratio and appetite satisfaction. There was also evidence of more favorable changes in red and white blood cells. Conversely, blood lipid profiles were more favorably changed when following a plant-based diet. Conclusions: These findings suggest that protein quality and the availability of creatine in the diet can affect recovery from intense military-style exercise. Minimally, plant-based MREs should include 6–10 g/d of EAA and 2–3 g/d of creatine monohydrate to offset dietary deficiencies, particularly in military personnel following a vegetarian diet. Registered clinical trial #ISRCTN47322504. Full article
(This article belongs to the Section Nutrition and Metabolism)
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14 pages, 1380 KiB  
Article
Impact of Isomaltulose on Glycemic Response in Diabetic and Healthy Populations: A Meta-Analysis
by Zhaojie Chen, Fangting Gu and Jianyong Wu
Nutrients 2025, 17(11), 1940; https://doi.org/10.3390/nu17111940 - 5 Jun 2025
Viewed by 1257
Abstract
Background: Effective management of postprandial glycemic control is critical for diabetic patients, as elevated postprandial glucose levels can lead to complications such as cardiovascular disease and neuropathy. This study evaluates isomaltulose, a low-glycemic-index carbohydrate, as an alternative to sucrose in mitigating postprandial glucose [...] Read more.
Background: Effective management of postprandial glycemic control is critical for diabetic patients, as elevated postprandial glucose levels can lead to complications such as cardiovascular disease and neuropathy. This study evaluates isomaltulose, a low-glycemic-index carbohydrate, as an alternative to sucrose in mitigating postprandial glucose spikes. Objectives: To synthesize evidence from existing studies and assess the efficacy of isomaltulose in reducing postprandial glycemic levels compared to sucrose in diabetic populations. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches were performed across PubMed, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials or crossover studies comparing isomaltulose and sucrose. Data were extracted, and the Cochrane Risk of Bias tool was used to assess study quality. Results: Ten studies were included, involving 367 participants. The meta-analysis showed that isomaltulose significantly reduced plasma glucose level at 60 min post-meal, though the actual effect could be modest in terms of clinical relevance compared to sucrose (MD: −7.99, 95% CI: −8.58, −7.39, p < 0.00001). Notable variability in the study results was observed, which may be attributed to multiple factors such as participant demographics and meal composition. Conclusions: The findings from the analysis are supportive for the use of isomaltulose as a beneficial dietary alternative to sucrose for managing postprandial glycemic levels in diabetic patients. Future research effort is suggested to focus on larger, diverse populations to enhance generalizability and explore the impact of dietary context on glycemic response. Full article
(This article belongs to the Special Issue Polysaccharides for Nutraceuticals and Future Foods)
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13 pages, 532 KiB  
Article
Do the Types of Dietary Carbohydrate and Protein Affect Postprandial Glycemia in Type 1 Diabetes?
by Xinyi Li, Alice Wainwright, Chantelle Z. Fio, Shannon Brodie, Kylie Alexander, Margaret McGill, Sally-Anne Duke, Gregory Fulcher, Stephen Twigg, Jencia Wong, Jennie Brand-Miller, Garry M. Steil and Kirstine J. Bell
Nutrients 2025, 17(11), 1868; https://doi.org/10.3390/nu17111868 - 29 May 2025
Viewed by 1085
Abstract
Background/Objectives: Dietary protein and carbohydrate affect postprandial glycemia in individuals with type 1 diabetes (T1D). This paper aimed to determine the relationship between the types of dietary protein (Study 1) and carbohydrate (glycemic index; GI, Study 2) and postprandial glycemia. Methods: [...] Read more.
Background/Objectives: Dietary protein and carbohydrate affect postprandial glycemia in individuals with type 1 diabetes (T1D). This paper aimed to determine the relationship between the types of dietary protein (Study 1) and carbohydrate (glycemic index; GI, Study 2) and postprandial glycemia. Methods: Two acute randomized crossover trials were conducted in adults with T1D comparing postprandial glycemia for test meals varying by protein type (n = 16 adults; 5 meals: egg, beef, chicken, salmon or whey (all 30 g protein), each served with fried rice (45 g carbohydrate) or GI (n = 8 adults, high or low GI bread, GI 52% vs. 76%) with peanut butter (19 g protein, 30 g fat). Insulin was dosed based on usual individualized insulin: carbohydrate ratio and capillary blood glucose levels (BGL) measured from 30 min pre- to 5 h postprandially in 15–30 min intervals. Results: Study 1: Postprandial glycemia varied over an almost 2-fold range, however responses were highly variable and there were no significant differences between sources (iAUCglucose Chicken: 203 ± 66 mmol·min/L, Egg: 263 ± 100 mmol·min/L, Beef: 309 ± 89 mmol·min/L, Salmon: 338 ± 83 mmol·min/L and Whey: 397 ± 115 mmol·min/L respectively, p > 0.05). Hypoglycemia (≤3.5 mmol/L) occurred at least once per protein type (chicken: 6/16 participants, egg 2/16, beef 3/16, salmon 1/16, whey 2/16). However, there were no statistically significant differences in the risk of hypoglycemia between protein sources (p > 0.05). Study 2: Postprandial glucose response curves were virtually identical for high GI and low GI, and the incremental area under the curve (iAUC) for glucose was not statistically significant after 1 h (p = 0.185), 3 h (p = 0.538) or 5 h (p = 0.694) following the meal. Conclusions: Clinical practice guidelines and insulin dosing algorithms likely do not need to consider differences in protein sources or in GI in the context of a high fat, high protein meals, for individuals with T1D. Full article
(This article belongs to the Special Issue Nutritional and Dietary Approaches in Type 1 Diabetes)
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12 pages, 824 KiB  
Article
Evaluating Repetitive Transcranial Magnetic Stimulation for Refractory Chronic Cluster Headache Prevention: Insights from a Randomized Crossover Pilot Trial
by Leonardo Portocarrero-Sánchez, Cristian Rizea, Exuperio Díez-Tejedor, Moisés León-Ruiz and Javier Díaz-de-Terán
Brain Sci. 2025, 15(6), 554; https://doi.org/10.3390/brainsci15060554 - 23 May 2025
Viewed by 717
Abstract
Background/Objectives: Cluster headache (CH) is a debilitating primary headache disorder characterized by severe unilateral pain attacks. Chronic CH (CCH) poses significant treatment challenges, especially in refractory cases. Neuromodulation, including repetitive transcranial magnetic stimulation (rTMS), offers a potential alternative; however, evidence for its [...] Read more.
Background/Objectives: Cluster headache (CH) is a debilitating primary headache disorder characterized by severe unilateral pain attacks. Chronic CH (CCH) poses significant treatment challenges, especially in refractory cases. Neuromodulation, including repetitive transcranial magnetic stimulation (rTMS), offers a potential alternative; however, evidence for its efficacy in CCH is lacking. Methods: A randomized, double-blind, placebo-controlled, crossover pilot study was conducted. Eligibility criteria included patients with refractory CCH (rCCH), who were then randomized to receive two treatment sequences: A, rTMS followed by sham stimulation, or B, sham followed by rTMS, separated by a one-month washout, with a follow-up period of 3 months. The primary endpoint was to analyze efficacy by assessing the change in the number of attacks per week (APW). Secondary endpoints included treatment tolerability and changes in intensity, duration, and use of rescue medication. The trial was registered with ClinicalTrials.gov (NCT06917144). Results: Eight patients were enrolled and randomized with a 50% probability of assignment to either treatment arm. Despite this, five patients were allocated to sequence A and three to sequence B. Three patients completed the entire study; five received treatment with rTMS and six with sham. The APW change during rTMS showed a change of (mean ± SD) +2.2 (10.8) attacks per week (p = 0.672). Two patients achieved complete remission during the rTMS phase, though symptoms returned by the washout period. In comparison with sham, the difference was also not statistically significant. No significant changes were observed in secondary endpoints. Side effects (two cases) were mild and transient. Conclusions: This pilot study suggests that rTMS may provide clinical benefits for rCCH in selected cases, though its effects seem transient. Adherence to treatment remains a critical challenge. Full article
(This article belongs to the Special Issue Neuromodulation for Pain Management: Evidence of Safety and Efficacy)
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15 pages, 2346 KiB  
Article
Neurometabolite Changes After Transcranial Photobiomodulation in Major Depressive Disorder: A Randomized Controlled Trial Investigating Dose-Dependent Effects
by David R. A. Coelho, Ümit Tural, Aura Maria Hurtado Puerto, Katherine Anne Collins, Maia Beth Gersten, Zamfira Parincu, Kari Siu, Dan Vlad Iosifescu, Eva-Maria Ratai, Paolo Cassano and Akila Weerasekera
J. Clin. Med. 2025, 14(10), 3402; https://doi.org/10.3390/jcm14103402 - 13 May 2025
Viewed by 834
Abstract
Background: Transcranial photobiomodulation (t-PBM) is a promising non-invasive therapy for Major Depressive Disorder (MDD). MDD is associated with altered brain metabolism, including changes in N-acetylaspartate (NAA), choline (Cho), and creatine (Cr). This study assessed the effects of varying t-PBM doses on neurometabolite levels [...] Read more.
Background: Transcranial photobiomodulation (t-PBM) is a promising non-invasive therapy for Major Depressive Disorder (MDD). MDD is associated with altered brain metabolism, including changes in N-acetylaspartate (NAA), choline (Cho), and creatine (Cr). This study assessed the effects of varying t-PBM doses on neurometabolite levels in the dorsolateral prefrontal cortex (dlPFC) and their correlations with clinical outcomes. Methods: In this randomized, sham-controlled, cross-over study, 33 adults with MDD received one session of t-PBM at low, medium, and high doses and a sham treatment. Proton magnetic resonance spectroscopy (1H-MRS) measured NAA, Cho, and Cr pre- and post-treatment. Clinical outcomes were assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Symptoms of Depression Questionnaire (SDQ). Statistical analyses included paired t-tests or Wilcoxon signed-rank tests for neurometabolite changes, and linear mixed-effects regression models for t-PBM dose, neurometabolites, and time effects. Results: NAA levels increased significantly (7.52 ± 0.777 to 8.12 ± 1.05 mmol/L for one session; 7.36 ± 0.85 to 7.85 ± 0.68 mmol/L across all sessions); however, these changes were not associated with specific t-PBM doses or sham. No significant changes were observed for Cho and Cr levels. Positive correlations were found between Cho levels and MADRS scores (r = 0.59, p = 0.017), and negative correlations between Cr levels and SDQ scores at the medium dose (r = −0.91, p = 0.011). Conclusions: While NAA levels increased, and correlations between neurometabolites and clinical outcomes were observed, these findings do not suggest a specific effect of t-PBM. Larger randomized controlled trials with optimized dosing protocols, extended follow-up, and advanced spectroscopy are needed to clarify the neurometabolic therapeutic potential of t-PBM in MDD. Full article
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13 pages, 6089 KiB  
Article
Electromyographic Patterns of Muscle Activation During Running with Different Footwear at Different Speeds in Nulliparous Women: A Secondary Analysis
by María García-Arrabé, Fabien Guerineau, Beatriz Ruiz-Ruiz, Javier López-Ruiz, Mónica García-Mateos and María-José Giménez
Sensors 2025, 25(10), 3016; https://doi.org/10.3390/s25103016 - 10 May 2025
Viewed by 625
Abstract
With the global increase in women’s participation in running, understanding factors like footwear in performance and injury prevention has become essential. Minimalist shoes (MSs) and traditional shoes (TSs) influence muscle activation patterns, affecting running technique. Proper coordination of the core muscles is essential [...] Read more.
With the global increase in women’s participation in running, understanding factors like footwear in performance and injury prevention has become essential. Minimalist shoes (MSs) and traditional shoes (TSs) influence muscle activation patterns, affecting running technique. Proper coordination of the core muscles is essential for efficient stride and posture. This study analyzed muscle activation in nulliparous women running in MSs and TSs at different speeds and explored the correlations with age and BMI. A crossover clinical trial assessed the EMG activation of the lumbar erector (LE), gluteus maximus (GM), pelvic floor, and internal oblique (IO) muscles during treadmill running at 6, 9, and 11 km/h. Fifty-one healthy women (26.55 ± 5.11 years; body mass index (BMI): 21.29 ± 2.07 kg/m2) participated. The protocol included a warm-up, 30 s runs at each speed, and a 5-minute washout between trials. The statistical analyses included Wilcoxon, Friedman, and Spearman’s correlation tests. GM and IO showed the highest activation (p < 0.001) regardless of the footwear or speed. No significant differences were found between MSs and TSs. Weak-to-moderate correlations emerged between BMI and LE muscle activation with MSs, and between BMI and IO with both footwear. Significant correlations were also found with IO activations, but none with PF muscles. The correlations between personal variables, shoe types, and muscle activation suggest that individual and external factors may influence neuromuscular modulation, impacting injury prevention and personalized interventions. Full article
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