Search Results (454)

Background/Objectives: Although digital workflows for complete denture fabrication are increasingly implemented in clinical practice, randomized controlled pilot trials directly comparing their clinical performance and patient satisfaction with conventional complete dentures (CCDs) remain scarce. This study aimed to compare patient satisfaction and clinical effectiveness between conventionally and digitally fabricated complete dentures (DCDs). Methods: In the present exploratory randomized controlled clinical pilot study using a cross-over design, 15 edentulous patients received both a conventionally fabricated and a digitally fabricated complete denture in randomized order. Each denture was worn for a three-month adaptation period. Patients were blinded to the fabrication method. Oral health-related quality of life was assessed using the OHIP-G49 questionnaire, and clinical performance was evaluated using standardized criteria at baseline, after three months with the first denture, and after three months with the second denture. Results: Both fabrication methods yielded satisfactory clinical outcomes in all patients. All 15 patients rated the DCDs as highly satisfactory, while 14 patients rated the CCDs equally favorably; one patient was unable to tolerate the conventional denture. DCDs demonstrated a slight but consistent advantage in oral health-related quality of life (OHRQoL) scores. Conclusions: Both conventional and digital complete dentures are clinically effective and well accepted by edentulous patients. However, DCDs offer a modest improvement in patient satisfaction and OHRQoL. Digitally fabricated complete dentures provide comparable clinical results to conventional methods while offering potential advantages in patient comfort and perceived quality of life. Given the exploratory nature of the study and the limited sample size, the results should be interpreted with caution and primarily serve to inform future, adequately powered randomized clinical trials. Full article

Sleep quality is essential for maintaining physical health and psychological resilience. Because sleepwear remains in direct contact with the skin throughout the night, it may affect thermoregulation and comfort and, thereby, influence sleep. This randomized two-period, two-sequence crossover study investigated whether sleepwear infused with nanodiamond and nanoplatinum particles (DPV576) could improve sleep quality and promote fatigue recovery under free-living conditions. Fourteen healthy men (23.9 ± 1.7 years) wore DPV576 sleepwear and visually indistinguishable standard polyester sleepwear for one week each, separated by a one-week washout. Sleep was assessed using a wearable ECG-based actigraphy device; trained researchers additionally performed manual rescoring to verify automated outputs, including independent determination of sleep onset latency. Subjective sleep was assessed daily using the Sleep Quality Index of Daily Sleep and a visual analog scale; exploratory outcomes included voice-derived biomarkers and pre-/post-sleep grip strength. In manual rescoring, DPV576 was associated with higher sleep efficiency (93.0 ± 0.9% vs. 89.5 ± 1.5%, p < 0.05), fewer awakenings (8.4 ± 1.3 vs. 10.7 ± 1.4, p < 0.01), and shorter wake after sleep onset (30.4 ± 4.7 vs. 41.6 ± 6.0 min, p < 0.01), whereas total sleep time did not differ significantly (p = 0.096). These findings suggest that one-week use of DPV576 sleepwear may improve wearable ECG-derived sleep consolidation in young men, supporting a nonpharmacological wearable strategy to enhance sleep efficiency in everyday settings. Full article

Background: Carbohydrate quality and culinary processing can meaningfully alter postprandial glycemia in people with type 1 diabetes (T1D). Cooling gelatinized starch promotes retrogradation and increases resistant starch (RS), potentially attenuating postprandial glucose excursions. Objectives: We investigated whether pasta cooled after cooking (24 h at 4 °C) and reheated before consumption improves postprandial glycemia in adults with T1D without increasing hypoglycemia risk under routine insulin pump bolus-calculator dosing. Methods: In this randomized, single-blind, crossover study, 32 adults with T1D treated with continuous subcutaneous insulin infusion (CSII) consumed two standardized pasta-based meals (50 g of available carbohydrate): freshly cooked pasta and cooled/reheated pasta. Participants administered rapid-acting insulin boluses calculated by their pump bolus calculator 10 min before the meal. Interstitial glucose was recorded for 180 min using flash glucose monitoring. Results: Compared with freshly cooked pasta, cooled/reheated pasta produced lower maximum glycemia (10.7 vs. 12.6 mmol/L, p = 0.0001), lower maximum glycemic rise (2.8 vs. 4.7 mmol/L, p < 0.0001), lower incremental area under the curve (iAUC; 211.9 vs. 524.8 mmol/L × 180 min, p < 0.0001), and a shorter time-to-peak (65 vs. 125 min, p = 0.014). Resistant starch content increased after cooling (12.88 ± 0.06 vs. 8.03 ± 0.08 g/100 g). The number of hypoglycemic episodes did not differ between conditions. Conclusions: Cooling and reheating pasta therefore increased RS and attenuated postprandial glycemia in adults with T1D without increasing early postprandial hypoglycemia in the studied setting. Full article

This paper proposes a multi-strategy hybrid-enhanced Educational Competition Optimizer (MEECO) to improve the performance of swarm-based optimization algorithms in complex search environments. From the perspective of symmetry, population-based optimization algorithms inherently rely on the symmetric distribution and evolution of individuals in the search space, while the imbalance between exploration and exploitation often leads to symmetry breaking, resulting in premature convergence and loss of diversity. Unlike the standard ECO, which suffers from limited information exchange, premature convergence, and boundary stagnation, the proposed method integrates three complementary mechanisms: adaptive differential evolution, vertical crossover, and global-best-guided boundary handling. Specifically, the adaptive differential evolution strategy enhances global exploration and maintains population distribution symmetry through dynamic mutation, the vertical crossover mechanism improves inter-dimensional symmetry and information interaction, and the boundary-handling strategy restores symmetry by guiding infeasible solutions back to promising regions. These strategies jointly improve population diversity, exploration–exploitation balance, and convergence efficiency while preserving structural symmetry in the search process. Extensive experiments on CEC2017 and CEC2022 benchmark suites demonstrate that MEECO consistently achieves superior optimization accuracy, faster convergence speed, and stronger robustness compared with several state-of-the-art algorithms. Statistical analyses further confirm the significance and reliability of the improvements. In addition, the proposed method is applied to a wireless sensor network node deployment problem, where it significantly improves coverage rate and deployment uniformity. The results indicate that MEECO provides an effective, robust, and symmetry-preserving optimization framework for both benchmark problems and real-world engineering applications. Full article

Background/Objectives: Positive end-expiratory pressure (PEEP) is a standardized component of the invasive mechanical ventilation (IMV) settings to improve oxygenation; however, its physiological effects in patients with no documented prior lung disease remain poorly defined. This study evaluated the impact of moderate PEEP variations on macrohemodynamic parameters, gas exchange, and driving pressure (ΔP). Methods: This single-arm, non-randomized, crossover study included adult intensive care unit (ICU) patients with no documented prior lung disease during the early phase of IMV. Sequential PEEP levels of 6, 8, and 10 cmH₂O were applied for 30 min each within the first 24 h of ICU admission, while all other ventilatory parameters were kept constant. Arterial blood gases [partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), and arterial oxygen saturation (SaO₂)], oxygenation index [PaO₂/fraction of inspired oxygen (FiO₂)], systolic, diastolic, and mean arterial pressures, ΔP, and static compliance (Cstat) were measured. Friedman and Mann–Whitney U tests were used, with adjustment for multiple comparisons. Results: A total of 150 patients were enrolled (64.7% male). The observed mortality rate was 53.3%; however, mortality was not defined as a primary or secondary outcome, and was used only as a grouping variable for comparative analyses. Intraindividual comparison across PEEP levels of 6, 8, and 10 cmH₂O showed small but significant reductions in systolic and mean arterial pressure at higher PEEP (p-value < 0.05), with Bonferroni-adjusted significance for PEEP 6 vs. 10. No significant differences were observed in oxygenation (SaO₂, PaO₂, and PaO₂/FiO₂), PaCO₂, ΔP, or Cstat. These results suggest that moderate PEEP changes produced limited macrohemodynamic effects without relevant impact on gas exchange or respiratory mechanics. Overall, no clinically relevant or statistically significant differences were observed in gas exchange, macrohemodynamic parameters, ΔP, or Cstat across PEEP levels when mortality was used as the grouping variable. Among survivors, higher PEEP was associated with modest reductions in systolic and mean arterial pressures and higher PaCO₂ values; however, these findings did not translate into consistent physiological benefits. Conclusions: In mechanically ventilated patients with no documented prior lung disease, PEEP may exert divergent effects on macrohemodynamics, gas exchange, and ΔP, supporting a cautious and individualized approach to PEEP selection in this population. Full article

Upper-limb involvement during walking increases metabolic demand compared with normal walking (WK); however, methods such as Nordic walking or hand-held weights require technical skills or may increase mechanical load. This study examined the effects of upper-limb-resisted walking using a novel portable elastic resistance device (band-pull walking; BPW) on cardiorespiratory and neuromuscular responses in healthy young adults. Fourteen healthy young adults performed BPW and WK on a treadmill at 60, 80, and 100 m·min⁻¹ in a randomized crossover design. Upper-limb resistance was individually standardized using triceps brachii activity (8% maximum voluntary contraction). Surface electromyography (EMG) of upper- and lower-limb muscles, oxygen uptake, heart rate, and perceived exertion were recorded. BPW significantly increased triceps brachii, biceps brachii, and deltoid muscle activity compared with WK at all or higher speeds (p < 0.05), whereas vastus lateralis and gastrocnemius lateralis activity remained unchanged. Metabolic equivalents and heart rate were higher during BPW across all speeds (p < 0.01), with increases of 8–12%. Upper-limb and whole-body perceived exertion were elevated, whereas lower-limb perceived exertion remained stable. These findings suggest that BPW was associated with increases in upper-limb muscle activation and metabolic demand, whereas no detectable increases were observed in vastus lateralis or gastrocnemius lateralis EMG activity or perceived lower-limb exertion under the present experimental conditions. Full article

Background/Objectives: Presbyopia is an age-related decline in near vision associated with lens stiffening and neuroretinal changes, while evidence for the effects of berry-derived phytochemicals remains limited. We investigated whether AKB, a double-standardised berry extract (anthocyanins ≥ 25%, iridoids ≥ 4.5%) from Aronia melanocarpa, Lonicera caerulea, and Vaccinium myrtillus, influences visual performance and circulating biomarkers potentially relevant to ocular homeostasis. Methods: In a randomised, double-blind, placebo-controlled, two-period crossover trial, 23 adults aged >50 years received AKB (400 mg twice daily) or placebo for 6 weeks, separated by a 5-week washout. Results: Compared with placebo, AKB was associated with improvements in selected visual-function outcomes, including near contrast sensitivity and visual-field parameters, together with directionally favourable changes in VEP and OCT readouts. AKB supplementation was also associated with lower circulating αA-/αB-crystallin and ALDH1A1 levels and higher circulating TRPV4 levels, whereas systemic antioxidant enzymes and advanced glycation end-products remained unchanged. Given the small sample size and the indirect nature of the biomarker assessment, these findings should be considered preliminary. Conclusions: Overall, short-term AKB supplementation was associated with modest, exploratory changes in selected functional and systemic biomarker outcomes, but larger and longer-term studies are needed to confirm clinical relevance and clarify underlying mechanisms. Full article

Evolutionary reinforcement learning (ERL) offers a compelling alternative for continuous control by combining the population-level exploration of evolutionary algorithms with the gradient-based exploitation of reinforcement learning. However, applying conventional genetic operators to deep networks can be highly destructive, often inducing abrupt behavioral shifts that erase previously learned skills. Proximal distilled evolutionary reinforcement learning (PDERL) addresses this issue with phenotype-aware operators, leveraging proximal mutation and distillation crossover to produce safer and more constructive variations. Despite these advances, PDERL and many ERL frameworks still exhibit a fundamental evaluation asymmetry: an evolving actor population is guided by a single, centralized critic for fitness evaluation and action filtering. This single-critic dependence creates a bottleneck and a potential single point of failure, where bias or instability in value estimation can misdirect the evolutionary search. To overcome this limitation, we propose co-evolutionary proximal distilled evolutionary reinforcement learning (Co-PDERL), a heterogeneous dual-population framework that co-evolves both actor and critic populations. Co-PDERL extends phenotype-aware evolution to the value-function landscape via a loss-filtered distillation crossover and a Jacobian-based proximal mutation tailored for critics, and employs a condition-gated synchronization mechanism to enable robust bidirectional knowledge transfer between the evolutionary populations and the reinforcement learning agent. Experiments on MuJoCo continuous control benchmarks show that Co-PDERL outperforms competitive baselines on most tasks, including standard ERL and PDERL, improving both sample efficiency and asymptotic performance by effectively alleviating the single-critic bottleneck. Full article

Background: Leading sports medicine and nutrition organizations recommend replacing sodium losses during prolonged exercise; however, practical guidance for implementing sodium replacement strategies remains limited. Estimating sodium needs during exercise requires assessment of both whole-body sweat sodium concentration (WBSSC) and sweat rate. Objectives: This study focused on WBSSC by examining its temporal stability, reproducibility, and predictability during prolonged cycling exercise while drinking according to two hydration strategies. Methods: Using a randomized, crossover, counterbalanced design, eight highly trained men completed two 5 h cycling sessions (183 ± 14 W, 30 °C) while consuming fluids either in a programmed (P) or ad libitum (A_L) fashion. Sweat was collected with patches applied on the forearm for ~20 min before sampling, which occurred at ~40, 130, 220, and 290 min. Local sweat sodium concentration was converted to WBSSC using a validated equation. Results: A main effect of time was observed for WBSSC (p < 0.05), with only the 40 min time point differing from later measurements; no condition or interaction effects were detected. The within-trial typical variation in WBSSC was 7.2 mmol·L⁻¹ for P and 6.1 mmol·L⁻¹ for A_L, while the between-trial typical variation was 5.6 mmol·L⁻¹. The WBSSC measured at 40 min predicted mean exercise WBSSC with good precision and moderate stability (y = 0.2738 + 1.3397x, R² = 0.87, standard error of the estimate = 5.4 mmol·L⁻¹, 95% confidence interval slope = 0.82–1.86 mmol·L⁻¹). Conclusions: These findings indicate that during prolonged cycling exercise, WBSSC (1) varies trivially within and between trials; (2) can reasonably be predicted using a single sweat sample and; (3) is not influenced by P or A_L drinking. Full article

Background/Objectives: This study aimed to evaluate the effects of short-term broccoli powder supplementation on metabolically demanding exercise performance, muscle power, and blood lactate recovery. It also investigated broccoli powder-derived sulforaphane bioavailability and its effects in attenuating exercise-induced oxidative stress. Methods: Seventeen healthy males (age 23.8 ± 4.9 years, height 182.3 ± 6.1 cm, weight 80.0 ± 12.8 kg), in a double-blind crossover design, three weeks apart, consumed ten standard doses of either broccoli powder or spinach powder as a placebo over a period of 2 weeks. They then performed a maximal progressive cycling task with concomitant analysis of expired gas composition. Plasma malondialdehyde (MDA) level was measured before and 60 min after the completion of the task, and blood lactate and muscle power (counter-movement vertical jump (CMJ) performance) were measured before and up to 60 min after exercise. Results: The main findings were that despite urine sulforaphane output being markedly higher following broccoli supplementation (p < 0.05), which confirms effective absorption and systemic availability of the compound, this did not influence exercise-induced changes in plasma MDA concentration, blood lactate dynamics, exercise test performance, or functional recovery measured as muscle power via CMJ performance (p > 0.05). Conclusions: In conclusion, broccoli powder supplementation, despite efficient delivery of sulforaphane, does not seem to either acutely affect performance or modify oxidative stress and recovery from metabolically demanding exercise. Full article

Glutathione (GSH), often referred to as the “master antioxidant,” plays a vital role in protecting cells against oxidative stress. This human pilot study aimed to evaluate the oral absorption and safety profile of a novel formulation of micellar glutathione (LipoMicel^®, LMG) compared with two commonly used dietary supplement forms: standard glutathione (STD) and liposomal glutathione (Setria^® Glutathione, LSG). In the first phase, a randomized, double-blind, crossover study was conducted in healthy adults (n = 14) to assess whole-blood GSH following single oral doses using baseline-adjusted pharmacokinetic parameters (incremental AUC_0–24 [iAUC_0–24], C_max, T_max) and a targeted panel of glutathione-related metabolites. In the second phase, a 30-day, single-arm follow-up assessed the safety and tolerability of the most bioavailable formulation (LMG) in the same participants. Compared with STD (500 mg), LMG (300 mg) produced significantly higher baseline-adjusted systemic GSH exposure and peak response (iAUC_0–24: 1287.5 ± 179.0 vs. 517.8 ± 180.0 µg·mL·h; p = 0.0064; ΔC_max: 103.9 ± 11.8 vs. 42.8 ± 11.5 µg/mL; p = 0.0003), corresponding to ~2.49-fold higher incremental exposure and ~2.43-fold higher peak response at the administered doses. When dose-normalized to a 300 mg equivalent, the incremental exposure (iAUC) and C_max were up to 4-fold higher for LMG than STD. In the targeted metabolite panel, most analytes showed no formulation-dependent differences; however, dose-normalized methionine exposure was significantly higher with LMG than STD (iAUC: 149.9 ± 30.8 vs. 32.7 ± 28.3 µg·mL·h; p = 0.0151; ~4.58-fold). No significant differences were observed in oxidized glutathione (GSSG) exposure, while the GSH/GSSG ratio was higher following LMG versus STD (p = 0.001). No significant changes in clinical safety markers (e.g., ALT, AST, ALP, creatinine) were observed following 30 days of daily LMG administration at 600 mg/d. The novel micellar glutathione formulation demonstrated enhanced oral bioavailability compared with a standard glutathione preparation and was well tolerated over 30 days in healthy adults. These findings present LipoMicel^® as a promising approach for oral glutathione delivery and warrant further investigation into its long-term physiological and clinical effects. This clinical trial was registered at ClinicalTrials.gov under trial ID NCT06345950 on 3 April 2024. Full article

With the deepening implementation of the dual-carbon strategy, the penetration rates of distributed power sources and flexible loads in new distribution grids continue to rise, posing significant challenges to system security and stability due to output fluctuations and randomness. To enhance voltage quality and achieve low-carbon economic operation in distribution grids, this paper proposes a multi-objective optimization model for Distributed Energy Storage System allocation. The model integrates power quality, economic benefits, and net carbon emissions. To efficiently solve this high-dimensional nonlinear problem, an improved Multi-Objective Gray Wolf Optimization algorithm is proposed. It employs a chaotic map to initialize the population, enhancing global distribution uniformity. A nonlinear convergence factor is introduced to dynamically balance global exploration and local exploitation. A dynamic grouping collaboration strategy is designed, combining Lévy flight and the elite crossover strategy to enhance search capability and convergence accuracy. Simulations on an IEEE 33-node system show that the improved MOGWO-optimized energy storage scheme reduces average voltage deviation by 37.0%, total operating costs by 7.0%, and net carbon emissions by 4.1%, compared to a no-storage scenario. Compared to the standard MOGWO algorithm, the proposed method achieves further optimization across all objectives, validating its effectiveness and superiority in realizing coordinated energy storage planning that balances safety, economy, and low-carbon goals. Full article

Background: Voluntary activation testing quantifies the ability of the motor nervous system to produce maximal force. Laboratory assessment of ankle plantar flexor voluntary activation is common, but field testing in practical settings is limited by equipment portability. We aimed to compare plantar flexor voluntary activation and maximal voluntary contraction (MVC) using a portable device with a standardised laboratory method and evaluate the test–retest reliability of the portable protocol. Methods: We performed a pseudo-randomised, crossover design. Participants completed two protocols: (1) portable force plate testing and (2) a laboratory-based isokinetic dynamometer. Voluntary activation was assessed using twitch interpolation via tibial nerve stimulation. Differences between protocols were analysed using generalised estimating equations. Reliability was assessed with the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and coefficient of variation (CV). Results: Twenty healthy participants (8 females, 12 males; median age 28.5 years) were included. No difference between protocols was detected for voluntary activation (β = 0.6, p = 0.68). The portable protocol demonstrated good reliability (ICC = 0.85) and low measurement error (SEM = 2.56%, CV = 2.79%). Conclusions: We demonstrated that the portable protocol is a valid and reliable method for assessing plantar flexor voluntary activation. It is suitable for assessing within-subject changes over time and can reduce participant attendance burden for neurophysiological muscle testing. Full article

Kefir is a traditional fermented milk beverage characterized by a complex community of lactic acid bacteria, acetic acid bacteria and yeasts that contributes to its unique sensory and nutritional properties. Regular consumption of kefir has been associated with a wide range of potential health benefits. This review aimed to evaluate the available clinical evidence on kefir consumption and its impact on human health. A literature search of the databases PubMed, Web of Science, and Scopus was conducted up to 30 August 2025. Eligible studies were human clinical trials investigating kefir as a fermented milk beverage without the addition of defined probiotic strains, prebiotics, or synbiotics. A total of 28 clinical studies were identified and included diverse study designs, such as crossover trials, parallel-group randomized controlled trials, multi-arm trials, early-phase exploratory studies, and pilot studies. Kefir intake showed potential benefits for gut microbiota modulation, metabolic parameters, inflammatory markers, immune function, and gastrointestinal health. However, interpretation of these findings is limited due to substantial heterogeneity in kefir preparation, microbial composition, dosage, intervention duration, study populations, and outcome measures. Consequently, although kefir may offer multiple health benefits, the overall strength of evidence remains limited. Larger, well-designed clinical trials with standardized kefir interventions are needed to better define kefir’s efficacy in specific populations and health conditions. Full article

Inorganic nitrate (NO₃⁻) has demonstrated therapeutic efficacy in several populations characterised by cardiovascular risk. However, it is unknown whether increasing nitric oxide (NO) bioavailability affects vascular and cardiovascular responses in men with androgenic–anabolic steroid (AAS) abuse. Objective: To investigate the effects of dietary NO₃⁻ on cardiovascular, autonomic, and strength performance in men with AAS abuse. Methods: In this double-blind, randomised, placebo-controlled crossover trial, participants consumed beetroot juice (12.8 mmol [800 mg] NO₃⁻) or a placebo (0.3 mmol NO₃⁻). After two hours, assessments included saliva collection, endothelial function, heart rate, and systolic (SBP) and diastolic (DBP) blood pressure at rest, during, and after an isometric handgrip test. Results: Thirteen resistance-trained males [mean (standard deviation) age: 31 (9) y; body mass index (BMI): 30 (4) kg/m²; SBP: 132 (3) mmHg; DBP: 70 (2) mmHg] completed the protocol. NO₃⁻-rich juice significantly increased salivary NO₃⁻ (40.6 μM, p < 0.001) and nitrite (NO₂⁻) (3.1 μM, p = 0.002) versus placebo. Flow-mediated dilation was greater with NO₃⁻ both at pre-exercise (2.37%, p = 0.02) and post-exercise (2.57%, p = 0.01). No between-group differences were observed in isometric strength (0.02 kgf, p = 0.99) or systolic/diastolic blood pressure across conditions. Conclusions: Dietary NO₃⁻ enhanced salivary NO₂⁻ and NO₃⁻ concentrations and modestly improved endothelial function but did not reduce the elevated blood pressure or alter cardiac autonomic responses associated with AAS abuse. Full article