Search Results (900)

Background: Hemodialysis (HD) patients frequently develop muscle wasting and chronic inflammation, conditions associated with functional decline and reduced quality of life (QoL). Nutritional strategies that provide targeted anabolic support without increasing nitrogen load may offer clinical benefits. The aim of this study was to evaluate the possible impact of a food for special medical purposes (FFSMP), composed of free-form branched-chain amino acids, β-hydroxy-β-methylbutyrate, and zinc, on muscle mass and strength, laboratory parameters, physical performance (PP), and QoL in HD patients. Methods: in this randomized double-blind crossover study, 24 adult HD patients received the FFSMP (10 g/day; two sachets) supplementation or placebo for 12 weeks, separated by an 8-week wash-out (protocol code RS 29.23). Measured outcomes included quadriceps rectus femoris thickness (QRFT) muscle, body composition analysis, inflammatory markers, oxidative stress indices, other routine biochemical parameters, PP, and QoL (SF-36 questionnaire). Results: FFSMP supplementation resulted in significant increases in QRFT and in fat-free mass percentage. Reductions in oxidative stress and inflammatory biomarkers were observed. Routine biochemical parameters remained stable, with the exception of a decrease in pre-dialysis urea. Functional performance measures did not differ between treatment periods. Improvements were noted in selected SF-36 domains, specifically energy/fatigue and general health. No major adverse events occurred during the study. Conclusions: In HD patients, this FFSMP produced favorable changes in markers of muscle mass and systemic inflammation without affecting short-term physical performance. These findings support the potential clinical utility of targeted amino acid supplementation in this patient population, highlighting the need for larger, longer-term trials. Full article

Background/Objectives: This study examined the effects of a computerized naming intervention combined with either cerebellar anodal transcranial direct-current stimulation (A-tDCS) or sham (S-tDCS) on noun and verb naming in Cantonese-speaking persons with chronic stroke-related aphasia (PWA). Methods: A double-blind, randomized, crossover, sham-controlled clinical trial was conducted with six Cantonese-speaking PWA following stroke. Participants received a 60 min computerized naming intervention incorporating audio–visual speech perception cues over five consecutive days, paired with concurrent 20 min of either 2 mA cerebellar A-tDCS or S-tDCS. Generalized linear mixed-effects models (GLMM) and linear mixed-effects models (LME) were used to evaluate naming accuracy and reaction time (RT). Individual variability was further explored through single-case analyses of naming accuracy changes across conditions and grammatical categories. Results: The GLMM showed a significant three-way interaction of condition, grammatical category, and time (p < 0.05). Specifically, the intervention paired with S-tDCS significantly improved verb naming, whereas A-tDCS did not induce significant improvements at the group level, effectively showing significantly smaller gains regarding verb naming compared to S-tDCS. Overall, RT decreased post-treatment across groups, but no significant differences emerged by the tDCS condition. The results support the promising efficacy of the Cantonese computerized audio–visual noun and verb naming therapy. Single-case analyses revealed high inter-individual variability in response to neuromodulation effects on naming and behavioral treatment outcomes. Conclusions: This study contributes to the emerging literature on cerebellar neuromodulation in post-stroke aphasia and underscores the need for larger trials examining grammar-specific (particularly verb-related) effects and polarity-dependent outcomes. It also highlights the value of developing personalized neuromodulation protocols to optimize the efficacy of behavioral language interventions in people with aphasia. Full article

Background: Gastrointestinal discomfort affects up to 70% of individuals with spinal cord injury (SCI), largely due to gut dysbiosis caused by altered transit time and reduced gastrointestinal motility from autonomic disruption. Emerging evidence links prebiotics and probiotics to improved microbiome balance and reduced inflammation, yet data in SCI remain limited. Methods: Individuals aged ≥ 18 years, with a chronic SCI (≥1 year) experiencing significant gastrointestinal symptoms, will be invited to participate in this single-center randomized controlled crossover trial. Persons currently taking antibiotics, who have relevant eating or digestive disorders, or who have undergone a recent diet change will be excluded from the study. Participants will be randomized (1:1) into two groups. The first group will take a probiotic (Biotics-G, Burgerstein AG, Rapperswil-Jona, Switzerland) supplement for eight weeks, then after a four-week washout period, they will take a prebiotic (Oat Bran, Naturaplan, manufactured by Swissmill, Zurich, Switzerland) supplement for another eight weeks. The second group will receive the supplements in reverse order. The primary outcome is the Gastrointestinal Quality of Life Index, a questionnaire to assess quality of life related to gastrointestinal disorders. Secondary outcomes consist of gastrointestinal transit time, inflammatory blood markers, and gut microbiome composition. Ethics: The study will be conducted in accordance with the Declaration of Helsinki. The study was approved by the Ethics Committee for Northwest/Central Switzerland (EKNZ, ID: 2025-00238, 24.02.2025, Version 2.0). The study is registered at ClinicalTrials.gov (ID: NCT06870331, 02.04.2025). Written informed consent will be obtained from all participants involved in the study. Full article

Background/Objectives: Caffeine is a well-established ergogenic aid in many strength- and endurance-based sports, but its efficacy in sport climbing remains underexplored despite the sport’s unique physical demands on grip strength, power, and muscular endurance. Therefore, this study examined the acute impact of a low caffeine dose (3 mg/kg) on climbing-specific performance, including pull-up and grip tests, in intermediate-advanced climbers. Methods: In a triple-blind, randomized, crossover design, thirteen male climbers (age: 28.2 ± 8.6 years) completed two experimental trials (caffeine vs. placebo). Performance was assessed via a pull-up one-repetition maximum (1RM) and power test at various loads, a pull-up muscular endurance test, and grip tests including maximum dead-hang time, maximum dead-hang strength, and rate of force development (RFD). Results: Caffeine did not significantly enhance performance in any measured variable. While a non-significant increase in peak power was observed at 80% 1RM (+8.0%, 95% CI: −0.232 to 0.304, p > 0.05, g = 0.348), effects at other loads and on pull-up endurance were trivial based on effect size (e.g., repetitions: +3.3%, 95% CI: −3.30 to 4.37, p = 0.292, g = 0.061). For grip metrics, caffeine was associated with a modest reduction in endurance time (+7.4%, p = 0.162, g = 0.171) and a slight increase in maximum strength (+2.4%, p = 0.060, g = 0.120). RFD was unaffected (p > 0.169, g < 0.13). Despite the lack of objective improvement, participants reported significantly greater subjective feelings of strength, energy, and alertness with caffeine (p < 0.05). Conclusions: A 3 mg/kg dose of caffeine, while altering psycho-physiological state, did not elicit statistically or practically meaningful ergogenic effects on pull-up or grip performance in climbers. Higher doses or sport-specific performance tests should be investigated in future research. Full article

Chronic, low-grade inflammation is a characteristic of metabolic diseases like type 2 diabetes. Despite recommendations to select low- or non-fat dairy foods over full-fat dairy foods for metabolic health, recent research suggests potential anti-inflammatory benefits of dairy fat consumption. We aimed to compare the systemic inflammatory tone (i.e., circulating inflammatory biomarker concentrations and ex vivo peripheral blood mononuclear cell inflammatory responses) of individuals with prediabetes after consuming diets with full-fat (3.25%) or non-fat yogurt. We hypothesized that short-term consumption of three daily full-fat yogurt servings beneficially affects inflammatory tone. Thirteen participants aged 45–75 years completed an eight-week randomized, double-masked, controlled crossover study. The two, three-week experimental diets comprised three daily servings of full-fat or non-fat yogurt and were each preceded by a one-week run-in diet. Following each diet, circulating inflammatory biomarkers and cytokine concentrations in the supernatants of peripheral blood mononuclear cells under control or lipopolysaccharide-stimulated conditions were measured. Compared with non-fat yogurt intake, circulating immature granulocyte concentrations were lower following full-fat yogurt intake, but there were no other differences in leukocyte concentrations. Circulating concentrations of cytokines or other inflammatory markers did not differ by diet. Cell supernatant interleukin-1β concentrations were lower following the full-fat yogurt diet under unstimulated conditions but were not different between diets under stimulated conditions. There were no differences by diet in supernatant concentrations of other cytokines under unstimulated or stimulated conditions. Together, minimal differences in inflammatory tone were observed following the short-term consumption of three daily servings of full-fat or non-fat yogurt in individuals with prediabetes. Full article

Background: Approximately half of U.S. adults have ≥1 cardiovascular disease (CVD) risk factors. Exercise is universally recommended as a first-line lifestyle therapy to prevent and treat CVD. Objective: We will conduct a feasibility and pilot efficacy randomized controlled trial to test the usability and user satisfaction of an evidence-based digital health tool we developed for physicians—the Prioritizes Personalizes Prescribes EXercise algorithm (P3-EX)—to treat patients with CVD risk factors (ClinicalTrials.gov: NCT07238556). Methods: We will recruit 24 physicians who do not prescribe written exercise prescriptions (ExRx) from two local CT hospitals. Physicians will recruit two patients each (N = 48); both patients must have CVD risk factors. Each physician will deliver a P3-EX ExRx to one patient (n = 24) and the Physical Activity Vital Sign ExRx to the other patient (n = 24) in a random sequence crossover design. Physicians and patients will rate the feasibility and acceptability of each ExRx method using validated questionnaires. Patients will perform their ExRx for 12 weeks and complete an exercise diary to monitor exercise adherence with weekly virtual oversight by Research Assistants. Before and after the exercise intervention, we will measure patient CVD risk factors and physical activity levels via accelerometry. Results: This trial has received Institutional Review Board approval (E-HHC-2025-0198) and will begin in January 2026, with findings published in 2027. Conclusions: This protocol provides the scientific rationale and methodology to test P3-EX within a real-world clinical setting, to inform the feasibility of using P3-EX as a digital health support tool by physicians, and preliminary efficacy of P3-EX to improve patient cardiovascular health and physical activity levels. Full article

Background: Chronic pain, which affects over 50 million adults in the United States, has stimulated growing interest in natural and nutrition-based remedies as adjuncts to pharmacologic therapies. Evidence suggests that turmeric and related extracts (i.e., curcuminoids) may provide pain relief, albeit often at levels above dietary ranges, while piperine from black pepper exhibits bioenhancer characteristics of relevance with dietary exposures. Objective: To test the effectiveness of dietarily relevant amounts of turmeric with and without black pepper on self-reported pain ratings among adults with chronic pain. Methods: A randomized, crossover clinical trial tested the effectiveness of turmeric only (one of three amounts within culinary ranges) or turmeric with black pepper to influence pain in adults ≥ 40 years of age. Participants (n = 30, with moderate pain: 4–7 on 0–10-point scale) were enrolled in a 21-day trial, and an experience sampling methodology approach was used. Participants were prompted to report current pain using the numeric pain rating scale (NPRS; 0–10) via text message three times per day for the full study period. Data were averaged and analyzed via linear mixed effects models for repeated measurements. Results: Pain ratings from baseline to week 3 were reduced and statistically significant (p < 0.001) but not statistically different between groups. The provided turmeric, both with and without black pepper, and varying amounts of turmeric (300 mg, 1 g, and 3 g, n = 10 participants/amount) did not show statistically significant differences in pain ratings (p = 0.157 and p = 0.338, respectively). Conclusions: Consuming dietarily relevant amounts of turmeric, either alone or with black pepper, appears to improve average pain ratings. This result suggests a feasible dietary option for further study of nutritional interventions for chronic pain management. Full article

Saliva substitutes are the standard treatment for dry mouth. This study aimed to evaluate the clinical effectiveness of a novel artificial saliva gel (RSU gel) compared with a commercial product (GC Dry Mouth Gel^®). A randomized, double-blind, two-phase crossover clinical trial was conducted with 37 participants with xerostomia. In the short-term phase, oral wetness, xerostomia scores, and clinical score of oral dryness (CSOD) were assessed up to 60 min after a single gel application. In the short-term repeated-use phase, each gel was applied 4 times daily for 14 days, separated by a 14-day washout period. The same parameters, including patient satisfaction and adverse events, were re-evaluated. Data were analyzed using generalized linear mixed models and generalized estimating equations. Both the RSU and GC Dry Mouth Gel^® significantly improved oral wetness immediately after a single application. No significant difference was observed for the RSU gel relative to the GC Dry Mouth Gel^® for oral wetness (OR = 1.01, 95% CI 0.98, 1.04, p = 0.248), xerostomia score (OR = 1.10, 95% CI 0.42, 2.88, p = 0.661), or CSOD (OR = 0.95, 95% CI 0.58, 1.55, p = 0.765) at 60 min. After 14 days of use, oral wetness increased significantly in both groups (2.94%, 95% CI 0.30%, 5.76%, p = 0.030) and did not differ significantly between the two products (p = 0.110). The xerostomia scores and CSOD also significantly improved, independent of product type (OR = 7.21, 95% CI 2.56, 20.34, p < 0.001, and OR = 2.82, 95% CI 1.50, 5.32, p = 0.001, respectively). The participants reported high satisfaction and acceptable taste, and no adverse effects were detected in those using the RSU gel throughout the study. Its lower cost and local availability make it a practical option for xerostomia management, particularly in populations with limited access to commercial saliva substitutes. Full article

Aerobic exercise with eicosapentaenoic acid (EPA) may enhance cognition via cerebrovascular pathways. We tested whether mild hyperbaric oxygen (HBO; 1.41 atmospheres absolute [ATA], approximately 30% O₂) adds to gains in cognitive processing capacity (throughput) versus normobaric normoxia (1.0 ATA, approximately 21% [20.9%] O₂). Healthy young adults (n = 16) performed cycling exercise at 60–70% VO_2peak for 60 min, twice weekly, for 4 weeks per environment with a 1-week washout; EPA (2170 mg·day⁻¹) was taken during each 4-week training phase (total 8 weeks) and was paused during the washout. An EPA-only control (n = 8) was included for supplementary analysis. The primary outcome was throughput (correct·min⁻¹; T1–T4); secondary outcomes were interference indices (I1: stroop interference, I2: reverse-stroop interference). Effects were estimated using linear mixed models [environment, time, environment × time; AR(1), REML] and Hedges’ g_av; accuracy used generalized estimating equations. Throughput improved mainly with time (T1–T2 p < 0.001; T4 p = 0.017; T3 p = 0.055), with no environment or interaction effects. I1/I2 showed no significant change, and one task exhibited an accuracy ceiling. Under safe, feasible conditions (≤1.41 ATA), aerobic exercise improved processing capacity (throughput) independently of environmental oxygenation level. The absence of detectable additive effects should be interpreted cautiously under conservative settings. Full article

Background: The myokine response to various types of exercise may differ and influence the adaptations to various physiological systems in response to training. This study aimed to compare systemic myokines’ (apelin, interleukin-6 [IL-6], interleu-kin-15 [IL-15], fibroblast-growth factor-21 [FGF-21], and irisin) responses to acute moderate-intensity cardiovascular exercise (MICE), high-intensity interval exercise (HIIE), or resistance exercise (RE). Methods: Six healthy, recreationally active adults (n = 4 males, n = 2 females) completed this crossover pilot study. After baseline testing, in a balanced randomized order, participants completed all three exercise sessions with one week between each of the exercise sessions. Blood samples were obtained at rest, immediately post-exercise, and 1 and 3 h post-exercise. Myokine response was analyzed using a 3 (exercise condition: MICE, HIIE, RE) × 4 (time: baseline, post-exercise, 1 and 3 h post-exercise) repeated-measures ANOVA. Results: Our results showed no significant interaction of time × exercise type in any of the analyzed myokines (all p > 0.05). A significant main effect of time was found for FGF-21, where concentrations at baseline (188.96 ± 127.34 pg/mL; p = 0.038) and immediately post-exercise (206.27 ± 135.95 pg/mL; p = 0.006) were higher than 3 h post-exercise (111.08 ± 127.65 pg/mL). No other main effects for time or exercise type were identified (all p > 0.05). Conclusions: The three exercise types, when analyzed together in this study, demonstrated a reduction in FGF-21 3 h post-exercise, suggesting this myokine was removed from the systemic circulation following exercise. The negative results of this study are inconclusive given the lower statistical power observed in this research. These preliminary results indicate the need for a larger trial to evaluate the effects of different types of exercise on the specificity of myokine responses and how acute exercise responses may translate into long-term exercise training adaptations. Full article

Background: Branched-chain amino acids (BCAAs) are popular as sports supplements due to their ability to enhance performance and recovery. However, the full spectrum of metabolic alterations triggered by acute supplementation with BCAAs in conjunction with exercise remains incompletely understood. Methods: A randomized crossover trial was conducted in 8 healthy active young males, who received either BCAA or placebo supplementation for three consecutive days prior to a high-intensity cycling test. Plasma samples were collected pre- and post-exercise and analyzed by ultra-high-performance liquid chromatography–quadrupole time-of-flight mass spectrometry, followed by correlation and enrichment analyses. Results: Acute BCAA supplementation was significantly associated with enhanced fat oxidation and attenuated post-exercise increases in plasma ammonia, creatine kinase, and lactate dehydrogenase, suggesting the potential improvements in energy supply and membrane stability. Metabolomics analysis identified differential metabolites primarily involved in lipid, amino acid, and glucose metabolism. Pathway enrichment revealed coordinated regulation of fatty acid oxidation (FAO) and tryptophan-related pathways. Correlation analysis further showed that changes in metabolite profiles were strongly associated with biochemical outcomes, particularly linking enhanced fat oxidation and ammonia clearance with BCAA intake. Conclusions: Short-term BCAA supplementation could enhance FAO and membrane stability via coordinated regulation of lipid and amino acid metabolism post exercise, supporting its potential role as a precision nutrition strategy. Full article

Background: Various socket designs exist, linking the residual limb together with the prosthetic components to restore the ability to walk; however, lack of socket comfort is a frequent complaint. Objective: To evaluate the impact of socket design on end-user comfort and mobility. Methods: A randomized crossover trial was set to compare comfort and mobility of above-knee amputees (AKAs) wearing an ischial containment (IC) or subischial (I-SUB) socket. Patients actively wearing IC sockets were recruited from 10 rehabilitation centers across the country. They were then fitted for an I-SUB socket by Certified Prosthetists (CPs) as an alternate socket. Participants were randomly assigned to start with one or the other socket. After a minimum of 2 weeks, each participant evaluated the Socket Comfort Score (SCS) (primary outcome) in various situations, performed the 2-min walk test, and answered the PLUS-M questionnaire (secondary outcomes). Results: A total of 25 participants were included, of whom 23 completed the study with full (n = 21) or partial data (n = 2). SCS were improved with I-SUB compared with IC in all situations, with significant differences in general, when sitting on a rigid chair, sitting in a car, and standing. The differences in self-reported mobility and walking distance at the 2-min walk test were not significant. At the end of the study, more than 80% of the participants chose to keep the I-SUB socket for their daily use. Conclusions: For the first time, this study supports that the subischial suction socket improves comfort in daily life without negatively impacting user mobility in a group of individuals with AKA. Full article

Repeated sprint ability (RSA) is a critical component of football, yet high-intensity effort leads to H⁺ accumulation. Sodium bicarbonate (SB) is an effective buffering agent, though evidence supporting its use among female football players remains limited. We conducted a randomized, double-blind, placebo-controlled, crossover trial (NCT06098794) to examine the acute effects of SB on RSA in recreational female football players. Eleven athletes completed two RSA sessions on a cycle ergometer under SB and placebo (PL) conditions. Each session involved 3 sets of 6 maximal 6 s sprints performed every 30 s, with a 5 min recovery between sets. Participants ingested 0.2 g·kg⁻¹ of the supplement 2 h prior to testing and 0.1 g·kg⁻¹ 1 h before the session. The results showed that SB induced a greater blood lactate accumulation (SB: 14.0 ± 4.32 vs. PL: 10.9 ± 3.55 mmol·L⁻¹, p = 0.010) and a greater elimination of CO₂ through breathing (p = 0.038), while maintaining muscle oxygenation. These physiological responses were accompanied by improved performance, as SB prevented a decline in mean power output from the first to the second set (SB: +1.4% vs. PL: −3.7%) and reduced the post-test drop in jump height (SB: −2.0% vs. PL: −8.2%). These findings suggest that SB supplementation may be useful to reduce muscular acidosis and fatigue in recreational female football players. Full article

Background and Objectives: Physician burnout, commonly described as emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA), remains common. We assessed whether structured, individual-focused programs improve Maslach Burnout Inventory (MBI) subscale scores among physicians. Materials and Methods: Registration, Open Science Framework, doi: 10.17605/OSF.IO/UAZ6B (unfunded). PubMed (MEDLINE) was searched from 1 January 2009 to 9 December 2023 (last searched 9 December 2023) to conduct a meta-analysis. Eligible English language studies evaluated a physician-focused intervention intended to reduce burnout and reported MBI outcomes; eligible designs were randomized trials, crossover trials, prospective cohort studies, or single-group pre–post studies. Risk of bias was rated using the original Cochrane Risk of Bias by two reviewers with consensus resolution. For quantitative synthesis, we pooled mean differences (MD) using fixed-effect inverse-variance meta-analysis with 95% confidence intervals (CI); heterogeneity was summarized with I², and funnel plots were inspected qualitatively. Results: Of 2769 records, 17 studies met criteria for qualitative analysis, and 6 studies (n = 585 physicians; 273 intervention, 312 control) were pooled. Interventions included mindfulness curricula, professional coaching, or structured peer discussion groups. Compared with controls, interventions were associated with lower EE (MD −5.56; 95% CI, −6.68 to −4.44; I² = 42%), lower DP (MD −2.11; 95% CI, −2.64 to −1.58), and higher PA (MD 2.01; 95% CI, 1.41 to 2.60). Funnel plots suggested asymmetry for EE. Evidence was limited by few trials, frequent high or unclear risk of bias in at least one domain, and variable intervention formats, and one pooled study used a single-group pre–post design. Conclusions: Structured individual-focused programs were associated with small but statistically significant changes in MBI subscale scores in physicians, but confidence in magnitude and generalizability are limited by study quality and a small evidence base. These programs may be useful adjuncts to organizational approaches to burnout. Full article

Caffeine is widely used to enhance cognitive performance, but its efficacy may vary with the administration route and circadian timing. This study compared the acute effects of caffeine capsule ingestion and caffeine mouth rinsing on cognitive performance across morning, midday, and evening sessions in well-trained, adolescent male volleyball players. Twenty-four athletes completed three randomized, double-blind, crossover trials involving a caffeine capsule (3 mg·kg⁻¹), a caffeine mouth rinse of the same dose (expectorated), and a placebo. Cognitive performance was assessed using simple and choice reaction time tests and the Stroop task, alongside a side-effects questionnaire. Both caffeine forms improved performance versus the placebo, with the greatest enhancements occurring at midday and moderate benefits evident in the morning. Capsule ingestion produced the most consistent improvements across reaction speed and executive control, whereas mouth rinsing elicited smaller, task-dependent effects, particularly at midday. No consistent or practically relevant benefits were observed for either caffeine condition in the evening, when cognitive performance was naturally highest. Side effects were mild and infrequent, with occasional headaches after capsule ingestion. These findings indicate that caffeine capsules most effectively enhance cognitive performance when baseline alertness is suboptimal, while caffeine mouth rinsing represents a practical ingestion-free alternative with moderate efficacy. Full article