Beta-Alanine

Background: Explosive lower limb power, a critical determinant of success in volleyball, is a prime candidate for focused research. Consequently, nutritional supplements are commonly employed to gain an ergogenic edge. Despite this widespread practice, a comprehensive and evidence-based ranking of supplements for improving this key attribute is lacking, leaving athletes and practitioners without targeted evidence to guide decisions. Methods: PubMed, Web of Science, CENTRAL, and Embase were searched from inception to 1 August 2025. We included RCTs in volleyball athletes (≥14 years) with ≥1-week interventions and relevant explosive lower limb performance outcomes. A Bayesian NMA estimated effects with 95% credible intervals (CrIs) and SUCRA; certainty was appraised with CINeMA. Results: A total of 35 RCTs (n = 838 volleyball athletes) examining 13 different supplements were included. The results indicated that β-alanine was associated with the greatest improvement in vertical jump (MD 4.6; 95% CrI 1.2-7.8), followed by creatine (MD 3.7; 0.57-6.9) and caffeine (MD 2.1; 0.06-4.1). It also appeared to be the most promising method for substantially increasing lower limb peak power (SMD 1.1; 0.21-2.0). No statistically significant improvement was found in lower limb mean power, and no serious adverse events were reported. Conclusions: Among volleyball athletes, β-alanine appeared most promising effective supplement for enhancing key components of explosive lower limb performance, specifically vertical jump height and peak power. Creatine and caffeine are also effective for improving vertical jump height. However, these findings are based on low-to-moderate certainty of evidence; they should be interpreted with caution and regarded as preliminary. Supplement strategies should be individualized by age and competitive level; further, high-quality, standardized randomized controlled trials are warranted to validate these initial observations.

BACKGROUND: Carnosine and beta-alanine (β-alanine) have shown potential in the management of chronic conditions, including metabolic disorders. However, their therapeutic efficacy in individuals with type 2 diabetes mellitus (T2DM) and prediabetes remains inconclusive due to heterogeneity in clinical trial results and limited synthesis of human evidence. OBJECTIVE: This systematic review and meta-analysis aim to evaluate the effects of carnosine and β-alanine supplementation on patients with prediabetes and T2DM. METHODS: We searched PubMed, Cochrane Library, Web of Science, and Embase from inception to 9 October 2024 for randomized controlled trials that compared carnosine or β-alanine supplementation to placebo in prediabetic and diabetic populations. The quality of evidence was appraised using the Jadad scale, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Data were analyzed using RevMan and Stata, employing fixed-effects models and I-V methods. RESULTS: Eight trials met the inclusion criteria, totaling 377 participants. Our analysis indicated that supplementation significantly reduced fasting blood glucose (FBG) (SMD: -0.53; 95% CI: -0.75 to -0.31; p < 0.00001) and hemoglobin A1c (HbA1c) levels (SMD:-0.36; 95% CI:-0.59 to -0.12; p = 0.003) compared to placebo. No significant effects were observed on body mass index (BMI), fasting insulin. low-density lipoprotein cholesterol (LDL-c) or high-density lipoprotein cholesterol (HDL-c), but a lowering effect was observed in total cholesterol (TC). Notably, Homeostasis Model Assessment of Beta-cell Function (HOMA-β) values were improved, suggesting enhanced β-cell function, while changes in homeostasis model assessment of insulin resistance (HOMA-IR) did not reach statistical significance. CONCLUSIONS: Carnosine and β-alanine supplementation show potential as adjunct therapies for improving FBG, HbA1c and HOMA-β in prediabetes and T2DM. Further rigorous studies are warranted to establish optimal dosage, treatment duration, and long-term efficacy in clinical practice. © 2025. The Author(s).

BACKGROUND: Competitive swimmers have a high prevalence of sports supplement (SS) consumption. However, only a few SS are scientifically proven to be safe, effective, and legal. Therefore, before incorporating supplements to enhance performance and health in competitive swimming, it is crucial to conduct an analysis and review to assess their effects. The objective of this study was to analyze the demonstrated effects of SS, as reported in published studies, on the swimming performance of competitive swimmers. METHODS: Following PRISMA guidelines, a systematic search was conducted across six databases for the selection of studies included in this review. Studies that analyzed the effects of sports supplementation compared to placebo were included and subjected to meta-analysis. RESULTS: This revision included 23 studies, 16 of them (69.6%) qualified as excellent and 7 (30.4%) as good at the methodological level based on the punctuation in the PEDro scale. The systematic review included 422 swimmers (61.8% male, 38.2% female), with distances assessed ranging from 50 m to 800 m, including studies employing interval procedures. Creatine showed a significant effect (ES = -0.46; 95% CIs = -0.75 to -0.17, p = 0.002; I2 = 11%) on swimming performance, while the rest of the analyzed supplements did not show significant effects (all p > 0.05). CONCLUSIONS: Creatine supplementation demonstrated ergogenic benefits for competitive swimmers, although the evidence supporting the use of this supplement is still limited. Sodium bicarbonate and β-alanine may enhance performance in distances with higher glycolytic demands, while caffeine is effective at dosages of 3-6 mg/kg administered 60 min before exercise. Further research is needed to confirm the potential ergogenic effects of other supplements, such as beetroot juice.

BACKGROUND: As dietary supplements play a crucial role in meeting the unique nutritional needs of soccer players, a growing body of studies are exploring the effects of dietary supplements on athletic performance in soccer players. The effectiveness of certain supplements, such as caffeine and creatine, remains debated due to inconsistent results across studies. Therefore, this systematic review and Bayesian network meta-analysis was conducted to tentatively identify the most effective dietary supplements for soccer players. METHODS: We searched PubMed, Web of Science, Cochrane, Embase, and SPORTDiscus from database establishment to 5 February 2024 to identify randomized controlled trials (RCTs) evaluating the effects of different dietary supplements on athletic performance in soccer players. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. A Bayesian network meta-analysis was performed using the R software and Stata 18.0. A subgroup analysis was conducted based on the competitive level of the athletes. RESULTS: Eighty RCTs were included, with 1,425 soccer players randomly receiving 31 different dietary supplements or placebo. The network meta-analysis showed that compared with placebo, carbohydrate + protein (SMD: 2.2, very large), carbohydrate + electrolyte (SMD: 1.3, large), bovine colostrum (SMD: moderate) and caffeine (SMD: 0.29, small) were associated with a significant effect on increasing the distance covered. Kaempferia parviflora (SMD: 0.46, small) was associated with a significant effect on enhancing muscular strength. Beta-alanine (SMD: 0.83, moderate), melatonin (SMD: 0.75, moderate), caffeine (SMD: 0.37, small), and creatine (SMD: 0.33, small) were associated with a significant effect on enhancing jump height. Magnesium creatine chelate (SMD: -3.0, very large), melatonin (SMD: -1.9, large), creatine + sodium bicarbonate (SMD: -1.4, large), and arginine (SMD: -1.2, moderate) were associated with a significant effect on decreasing sprint time. Creatine + sodium bicarbonate (SMD: -2.3, very large) and caffeine (SMD: -0.38, small) were associated with a significant effect on improving agility. Sodium pyr

BACKGROUND: Nutritional supplements are widely used by swimmers, but the effectiveness of various supplements and the identification of the most effective intervention require further investigation. PURPOSE: This paper evaluated and compared the effectiveness of various nutrition-based interventions on swimming performance through both direct and indirect comparisons. METHODS: PubMed, Embase, Web of Science, Cochrane Library, and SPORTDiscus databases were thoroughly searched up to 4 April 2024. The risk of bias was judged using the Cochrane risk of bias tool. A random-effect model was adopted to compute standardized mean differences (SMD) and 95% confidence intervals (CI). RESULTS: L-arginine (Arg) demonstrated superior performance to the placebo (SMD = -1.66, 95% CI [-2.92, -0.44]), emerging as the most effective intervention for reducing 100 swimming time (SUCRA = 89.5%). Beta-alanine (BA) was the best intervention for improving blood lactate (SUCRA = 80%). Creatine combined with sodium bicarbonate (Creatine_NaHCO3) significantly increased blood pH compared to the placebo (SMD = 3.79, 95% CI [1.85, 5.80]), with a SUCRA score of 99.9%, suggesting it is the most effective intervention for this parameter. No prominent differences were noted among the interventions in 50 m time, 200 m time, heart rate, and body mass. CONCLUSIONS: Dietary supplements might provide benefits for improving swimming performance. Arg emerged as the most efficacious modality for reducing 100 m time. BA proved to be the preeminent strategy for decreasing blood lactate. Creatine_NaHCO3 was distinguished as the optimal approach for improving blood pH.

With an increasing number of studies delving into the impact of dietary supplements on combat sports performance, researchers are actively seeking a more efficient dietary supplement for use in these sports. Nonetheless, controversies persist. Hence, we undertook a systematic review and Bayesian network meta-analysis to discern the most effective dietary supplements in combat sports by synthesizing the available evidence. We conducted a comprehensive search across PubMed, Web of Science, Cochrane, Embase, and SPORTDiscus, covering the period from their establishment to November 2, 2023. Our aim was to identify randomized controlled trials that evaluated the benefits of various dietary supplements for elite combat sports athletes. The risk of bias in these trials was assessed using the revised Cochrane Risk of Bias Tool for Randomized Trials. Subsequently, we employed Bayesian network meta-analysis through R software and Stata 15.0. During the analysis, we performed subgroup analysis based on the type of combat, distinguishing between striking and grappling disciplines. The analysis is based on 67 randomized controlled trials that meet all the inclusion criteria, involving 1026 elite combat sports athletes randomly assigned to 26 different dietary supplements or placebos. Results from the 50 trials included in the network meta-analysis indicate that compared to a placebo, sodium bicarbonate combined with caffeine (SMD: 2.3, 95% CrI: 1.5, 3.2), caffeine (SMD: 0.72, 95% CrI: 0.53, 0.93), beta-alanine (SMD: 0.58, 95% CrI: 0.079, 1.1), and sodium bicarbonate (SMD: 0.54, 95% CrI: 0.30, 0.81) was associated with a statistically significant increase in blood lactate concentrations. Compared to placebo, caffeine (SMD: 0.27, 95% CrI: 0.12, 0.41) was associated with a statistically significant increase in the final heart rate. Compared to placebo, creatine combined with sodium bicarbonate (SMD: 2.2, 95% CrI: 1.5, 3.1), creatine (SMD: 1.0, 95% CrI: 0.38, 1.6), and sodium bicarbonate (SMD: 0.42, 95% CrI: 0.18, 0.66) was associated with a statistically significant increase in mean power. Compared to placebo, creatine combined with sodium bicarbonate (SMD: 1.6, 95% CrI: 0.85,

Beta-alanine is a nonessential amino acid that is commonly used to improve exercise performance. It could influence the buffering of hydrogen ions produced during intense exercise and delay fatigue, providing a substrate for increased synthesis of intramuscular carnosine. This systematic review evaluates the effects of beta-alanine supplementation on maximal intensity exercise in trained, young, male individuals. Six databases were searched on August 10, 2023, to identify randomized, double-blinded, placebo-controlled trials investigating the effect of chronic beta-alanine supplementation in trained male individuals with an age range of 18-40 years. Studies evaluating exercise performance through maximal or supramaximal intensity efforts falling within the 0.5-10 min duration were included. A total of 18 individual studies were analyzed, employing 18 exercise test protocols and 15 outcome measures in 331 participants. A significant (p = .01) result was observed with an overall effect size of 0.39 (95% confidence interval [CI] [0.09, 0.69]), in favor of beta-alanine supplementation versus placebo. Results indicate significant effects at 4 weeks of supplementation, effect size 0.34 (95% CI [0.02, 0.67], p = .04); 4-10 min of maximal effort, effect size 0.55 (95% CI [0.07, 1.04], p = .03); and a high beta-alanine dosage of 5.6-6.4 g per day, effect size 0.35 (95% CI [0.09, 0.62], p = .009). The results provide insights into which exercise modality will benefit the most, and which dosage protocols and durations stand to provide the greatest ergogenic effects. This may be used to inform further research, and professional or recreational training design, and optimization of supplementation strategies.

CONTEXT: Mental ill-health is a common and growing issue, affecting 1 in 8 individuals or 970 million people worldwide in 2019. Histidine-containing dipeptides (HCDs) have been suggested to mitigate some aspects of mental ill-health, but a quantitative synthesis of the evidence is lacking. Therefore, a systematic review and meta-analysis of randomized controlled trials was conducted. OBJECTIVE: To summarize the evidence on the effects of HCDs on mental health outcomes. DATA SOURCE: A systematic literature search was performed using electronic databases (Medline via Ovid, Embase via Ovid, Scopus, Google Scholar, and Cochrane) from inception to October, 2022. DATA EXTRACTION: Two authors independently extracted data using a structured extraction format. DATA ANALYSIS: Data analysis was performed using STATA version 17. Random-effects models were used, and heterogeneity was assessed using the I2 test. Quality appraisal was performed using the Cochrane risk-of-bias 2.0 tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. CONCLUSION: 5507 studies were identified, with 20 studies fulfilling the inclusion criteria. Eighteen studies comprising 776 participants were included in the meta-analysis. HCD supplementation (anserine/carnosine, l-carnosine, β-alanine) caused a significant reduction in depression scores measured with the Becks Depression Inventory (-0.79; 95% CI: -1.24, -0.35; moderate certainty on GRADE) when compared with placebo. An increase in quality-of-life scores measured with the 36-item Short-Form survey (SF-36) (0.65; 95% CI: 0.00, 1.30) and low certainty on GRADE in HCDs (anserine/carnosine, l-carnosine, β-alanine) when compared with placebo were found. However, the rest of the outcomes did not show a significant change between HCD supplementation and placebo. Although the number of studies included in the meta-analysis was modest, a significant mean reduction was observed in depression score as well as an increase in quality-of-life score for the HCD group when compared with placebo. Most of the studies included had small sample sizes with short follow-up periods and moderate to high risk of bias, highligh

CONTEXT: Histidine-containing dipeptides (carnosine, anserine, beta-alanine and others) are found in human muscle tissue and other organs like the brain. Data in rodents and humans indicate that administration of exogenous carnosine improved cognitive performance. However, RCTs results vary. OBJECTIVES: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of histidine-containing dipeptide (HCD) supplementation on cognitive performance in humans to assess its utility as a cognitive stabiliser. DATA SOURCES: OVID Medline, Medline, EBM Reviews, Embase, and Cumulative Index to Nursing and Allied Health Literature databases from 1/1/1965 to 1/6/2022 for all RCT of HCDs were searched. DATA EXTRACTION: 2653 abstracts were screened, identifying 94 full-text articles which were assessed for eligibility. Ten articles reporting the use of HCD supplementation were meta-analysed. DATA ANALYSIS: The random effects model has been applied using the DerSimonian-Laird method. HCD treatment significantly increased performance on Wechsler Memory Scale (WMS) -2 Delayed recall (Weighted mean difference (WMD) (95% CI (CI)) = 1.5 (0.6, 2.5), P < .01). Treatment with HCDs had no effect on Alzheimer's Disease Assessment Scale-Cognitive (WMD (95% CI) = -0.2 (-1.1, 0.7), P = .65, I2 = 0%), Mini-Mental State Examination (WMD (95% CI) = 0.7 (-0.2, 1.5), P = .14, I2 = 42%), The Wechsler Adult Intelligence Scale (WAIS) Digit span Backward (WMD (95% CI) = 0.1 (-0.3, 0.5), P = .51, I2 = 0%), WAIS digit span Forward (WMD (95% CI) = 0.0 (-0.3, 0.4), P = .85, I2 = 33%) and the WMS-1 Immediate recall (WMD (95% CI) = .7 (-.2, 1.5), P = .11, I2 = 0%). The effect on delayed recall remained in subgroup meta-analysis performed on studies of patients without mild cognitive impairment (MCI), and in those without MCI where average age in the study was above 65. CONCLUSION: HCD, supplementation improved scores on the Delayed recall examination, a neuropsychological test affected early in Alzheimer's disease. Further studies are needed in people with early cognitive impairment with longer follow-up duration and standardization of carnosine doses to delineate the true effect.

Most intervention studies investigating the effects of ergogenic aids (EAs) on sports performance have been carried out in the male population. Thus, the aim of this systematic review and meta-analysis was to summarize the effects in the existing literature of EAs used by female athletes on performance. A literature research was conducted, and a descriptive analysis of the articles included in the systematic review was carried out. Meta-analyses could be performed on 32 of the included articles, evaluating performance in strength, sprint, and cardiovascular capacity. A random-effects model and the standardized mean differences (SMD) ± 95% confidence intervals (CI) were reported. The results showed that caffeine helped to improve jumping performance, isometric strength values, and the number of repetitions until failure. Caffeine and sodium phosphate helped to improve sprint performance. Aerobic tests could be improved with the use of taurine, caffeine, and beta-alanine. No conclusive effects of beetroot juice, polyphenols, or creatine in improving aerobic performance were shown. In terms of anaerobic variables, both caffeine and sodium phosphate could help to improve repeated sprint ability. More studies are needed in female athletes that measure the effects of different EAs on sports performance, such as beetroot juice, beta-alanine or sodium phosphate, as the studies to date are scarce and there are many types of EA that need to be further considered in this population, such as creatine and taurine.

PURPOSE: Extend Phase 2A study to evaluate additional concentrations of H-1337 and dosing frequencies, and to compare them with a positive control. DESIGN: Phase 2B, randomized, double-masked, active-controlled, dose-response study of 28 days of four treatments: H-1337 0.6% b.i.d., 1.0% b.i.d., or 1.0% q.d. (1.0% in the morning with H-1337 vehicle in the evening), and timolol maleate 0.5% b.i.d. PARTICIPANTS: Two hundred one subjects with open-angle glaucoma or ocular hypertension at eight private practice sites in the United States. METHODS: Diurnal intraocular pressure (IOP) over 28 days of dosing. MAIN OUTCOME MEASURES: Non-inferiority to timolol in change from baseline in IOP at Day 1 and Day 28. RESULTS: Mean reduction in IOP was 4-7 mmHg for the H-1337 groups and 5-8 mmHg for the timolol group. Non-inferiority to timolol for H-1337 1.0% b.i.d. [upper limit of 95% confidence interval (CI) strictly lower than 1.5 mmHg] was met at 6/9 time points (Day 1: h 8 and 12; Day 28: h 2, 4, 8, and 12). Similar comparative efficacy was seen for the other H-1337 treatment groups. The most common adverse event observed was hyperemia, reported in 54.0% (27/50) for H-1337 1.0% q.d., 33.3% (17/51) for H-1337 0.6% b.i.d., 41.2% (21/51) for H-1337 1.0% b.i.d., and 8.2% (4/49) for timolol. CONCLUSION: H-1337 in doses of 0.6% b.i.d., 1.0% q.d., and 1.0% b.i.d. had ocular hypotensive efficacy in the range of timolol, although not within the strict Phase 3 non-inferiority margins, which would have required a larger sample size.

BACKGROUND: This study aimed to investigate the effects of a high-dose beta-alanine (BA) supplementation on physical performance, blood lactate concentration, and ratings of perceived exertion (RPE) in trained futsal players. METHODS: Sixteen trained futsal players participated in a randomized, parallel, double-blind experiment, completing a two-week supplementation period with either 12 g/day of BA (n = 8; age: 19 ± 2 years; height: 1.78 ± 0.03 m; body mass: 68.5 ± 5.4 kg) or a placebo (PLA) (n = 8; age: 18 ± 1 years; height: 1.74 ± 0.08 m; body mass: 65.6 ± 6.4 kg). Athletes completed the futsal intermittent endurance test (FIET) and a 30-m speed test before and after supplementation. Plasma lactate levels were measured before, immediately after, and three minutes post-FIET, while RPE was assessed during each FIET stage. RESULTS: There was a significant main effect of time for distance covered in the FIET (Pre-BA: 1618.13 ± 268.14 m; Post-BA: 1857.50 ± 277.81 m; Pre-PLA: 1519.13 ± 243.19 m; Post-PLA: 1621.88 ± 323.65 m; p = 0.003; ηp2 = 0.73), while no significant interaction effect was revealed for FIET (p = 0.147; ηp2 = 0.27). Furthermore, no significant interaction effects were found in the 30-m sprint test (p = 0.149; ηp2 = 0.27, Pre-BA: 4.33 ± 0.25 s; Post-BA: 4.22 ± 0.124 s; Pre-PLA: 4.33 ± 0.26 s; Post-PLA: 4.37 ± 0.22 s). Neither plasma lactate levels nor RPE showed significant main effects of treatment or timepoint (all p > 0.5). Conclusion: Two weeks of high-dose BA supplementation did not have an ergogenic impact on the distance covered during the intermittent endurance test, sprint performance, blood lactate, or RPE in trained futsal players.

BACKGROUND: The topical application of a carnosine gel may increase intramuscular carnosine concentrations and thereby improve exercise performance. This study investigated the effect of a topical carnosine gel on intermittent high-intensity exercise performance in rugby sevens players. METHODS: Seven world-class rugby sevens players (body mass: 97.5 ± 4.1 kg; 1,452 International caps) completed two performance tests in a counterbalanced, crossover, triple-blind design. Players applied either 10 mL of a topical carnosine gel (CAR) or an ultrasound placebo gel (PLA) 40 minutes before undertaking 12 intermittent sprints on a cycle ergometer, interrupted by a 2-minute break after Sprint 6. The activity profile was 24 s cycling at 3 W/kg, 6 s at maximal intensity sprint, followed by a 30s rest. Average power, peak power, and HR were recorded for every 6 s sprint. RPE was recorded at the end of Sprint 6 and Sprint 12. RESULTS: For peak power, two-way ANOVA revealed time (p = 5.49 × 10-9) and treatment effects (p = 1.44 × 10-7). Following CAR, peak power output was higher in Sprint 2 (1433 vs 1332 W; p = 0.048; d = 0.99; large), Sprint 4 (1347 vs 1244 W; p = 0.043; d = 0.74; moderate) and Sprint 7 (1426 vs 1270 W; p = 0.025; d = 0.98; large) compared to PLA. For mean power output, HR, and RPE there were time effects but no treatment effect (p = 0.211 to 0.847). CONCLUSIONS: Topical carnosine gel improved power production in world-class rugby sevens players. Future research should determine whether carno- sine gels increase intramuscular carnosine concentrations to support the observed improvements in anaerobic performance during high-intensity exercise. Plain Language Summary: We demonstrate initial findings regarding the efficacy of a transdermal carnosine gel to impact repeated, high-intensity exercise in world-class rugby sevens players (+5–10%).The acute positive performance effects occurred rapidly without the need for a loading phase typical with β-alanine supplementation.The positive performance effects were evident during the initial sprint and thus, appear to be independent of intracellular buffering capability.The transdermal application would be of benefit

PRECIS: Netarsudil shows promise as a second-line drug in early glaucoma patients with an increase in most OCTA parameters as compared with Dorzolamide, with comparable rates of side effects. OBJECTIVE: To compare the effect of Netarsudil and Dorzolamide on macular and optic nerve head (ONH) perfusion changes on Optical Coherence Tomography Angiography (OCTA), and macular ganglion cell layer (mGCL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on OCT in preperimetric/early glaucoma patients. PARTICIPANTS AND METHODS: In this prospective, randomized, parallel group, active-controlled trial 90 preperimetric/early glaucoma eyes were recruited. The primary outcome measure was change in macular and ONH perfusion, and intraocular pressure (IOP). A total of 95 patients were randomized and 45 were prescribed Netarsudil 0.02% (group 1) and 45 were prescribed Dorzolamide 2% (group 2). The IOP, ONH perfusion, ONH flux index (FI), and macular vessel density (mVD) on OCTA; pRNFL thickness and mGCL thickness on OCT of the 2 groups were recorded at baseline, 4 months, 8 months, and 12 months. RESULTS: The mean baseline IOP in group 1 was 19.52±3.2 mm Hg and in group 2 it was 19.5±2.97 mm Hg. Group 1 showed 2.77 mm Hg (13.23%±8.27%) decrease in IOP ( P <0.001), while group 2 showed 1.85 mm Hg (8.98%±7.32%) decrease in IOP ( P <0.001) at 12 months. Group 1 showed 1.58 mm/mm 2 increase in mVD ( P <0.001), and 0.03 (7.6%) increase in ONH FI ( P <0.001) at 12 months. However, no trend in mVD or ONH FI was seen in group 2. Group 1 showed 1.03% increase in ONH perfusion ( P <0.001), while group 2 showed 1.16% increase in ONH perfusion ( P <0.001). There was no significant difference in ONH perfusion between the 2 groups. The OCT (pRNFL and mGCL) showed normal variability in both the groups. Congestion (40%) was the most common side effect observed in the Netarsudil group, while metallic taste (42.5%) was the most common side effect in the Dorzolamide group. The side effect profile of the 2 drugs was comparable ( P =0.65). CONCLUSION: Netarsudil causes an increase in all the OCTA parameters-mVD, ONH perfusion, and ONH FI-whereas Dorzolamide causes an increase only in O

BACKGROUND: Beta-alanine (βA) is a non-essential amino acid purportedly used to enhance aerobic exercise performance. While previous research indicates the benefits of βA on time to exhaustion (TTE) and aerobic capacity (VO2peak) in adults, evidence is lacking in adolescent athletes. Thus, the purpose of this study was to determine the effects of 4 weeks of βA supplementation on aerobic performance in adolescent runners. METHODS: Twenty-seven middle- and long-distance runners (aged 17.36 ± 2.17 years) were randomly divided into a βA or placebo (PL) group (maltodextrin). Subjects performed maximal graded exercise tests (GXT) and submaximal trials (SMT; 80% of VO2peak for 1500 m) on a treadmill before and after 14 and 28 days of supplementation or PL. Respiratory (VE) metabolic (VO2, RER, lactate [La]), and cardiovascular (HR) variables were measured during the GXT and SMT, along with the first (VT1) and second ventilatory threshold (VT2) and TTE monitored during the GXT only. Within- and between-group differences were assessed using a repeated-measures mixed-model analysis of variance. RESULTS: Findings indicated that despite a trivial increase in VO2peak over 4 weeks, the βA group increased TTE by 6.5% compared to 1.4% in the PL group (d = 0.46). Additionally, small effects in HRmax, VE, [La], and TTE were observed between groups favoring βA. Regarding the SMT, both average HR and RER decreased by 4% in the βA group, with no changes for the PL. CONCLUSIONS: Despite no evidence to suggest increases in VO2peak, practitioners should note that improvements in TTE may be observed after 28 days of βA supplementation in adolescent runners.

PURPOSE: To compare the intraocular pressure (IOP) lowering effect and safety of topical netarsudil 0.02% once daily with topical ripasudil 0.4% twice daily in primary open angle glaucoma (POAG) patients. METHODS: A prospective, comparative, randomized study conducted on 140 eyes of patients diagnosed to have POAG, in a tertiary care hospital of Northern India. Patients divided into groups, A and B in a 1:1 ratio and were treated with ripasudil 0.4% or netarsudil 0.02% respectively and followed up. The mean diurnal IOP noted at 3rd week and 3rd month comparing it from baseline values, with their side effects. RESULTS: At 3rd month, meandiurnal IOP for ripasudil 0.4% group ranged from 19.22 to 20.69 mmHg whereas for netarsudil group it was 17.11-18.47 mmHg, an intergroup statistically significant difference in IOP of 2.3 mmHg (p < 0.0001) noted. At 3rd month the difference from baseline was 2.77 mmHg (p = 0.048) for ripasudil and 4.64 mmHg (p = 0.001) for netarsudil. At the end of 3 months the adverse events were seen less in group B than group A (59.8% and 66.7% respectively. Eye irritation followed by conjunctival hyperemia was seen. Overall incidence of adverse events was 32.9% and 44.3% for topical netarsudil and ripasudil respectively. CONCLUSION: Topical netarsudil 0.02% once daily was well tolerated with fewer side effects and in reducing IOP than topical ripasudil 0.4% twice daily dosing in POAG patients. Netarsudil 0.02% once daily may be considered an important option for the IOP control in POAG. © 2025. The Author(s), under exclusive licence to Springer Nature B.V.

PURPOSE: Athletes often use sport supplements to improve their physical and physiological performance. This randomized, double-blind, placebo (PL) -controlled study aimed to investigate the effects of combined versus single supplementation of creatine (Cr), beta-alanine (BA), and L-citrulline (L-Cit) during short sprint interval training (SSIT) on basketball players' physical and physiological performance over a period of 28 days. METHODS: Forty-eight basketball players were equally assigned to 6 groups of Cr (0.1 g/kg of Cr monohydrate daily), BA (4.8 g daily), L-Cit (6 g daily), combined supplementation, PL, and an active control group, and each group consisted of 8 participants. The training groups participated in SSIT (3 sets of 10 repetitions of 5-s all-out runs) sessions 3 times a week for 4 weeks. Physical (vertical jump, 20-m sprint, Illinois change of direction) and physiological (Wingate anaerobic power and cardiorespiratory fitness test) performance were evaluated before and after the training period. RESULTS: All training groups (Cr, BA, L-Cit, combined, and PL) showed significant improvements in physical and physiological performance over the 4-week intervention (P < .05). Interestingly, the supplement groups displayed significantly (P = .001) greater changes than the PL group, indicating better outcomes in performance adaptations. However, significant differences in performance variables were observed among the supplement groups. CONCLUSION: Our findings indicate that short-term supplementation with Cr, BA, and L-Cit, as well as a combination of them during SSIT, can significantly improve the physical and physiological performance of basketball players compared to a PL.

Some prior studies suggested that supplementation with carnosine or β-alanine can improve cognitive abilities and neurodegenerative disorders in certain elderly or at-risk populations. However, the efficacy of carnosine in improving cognitive performance in a healthy, adult population has not been assessed. We examined this as a post-hoc secondary outcome in the placebo-controlled, randomized Nucleophilic Defense Against PM Toxicity (NEAT) clinical trial (NCT03314987). Participants in this trial were instructed to take either cornstarch (placebo) or carnosine capsules (2g daily) for up to 12wk. Cognitive ability was assessed using the Cognition test battery, which consists of ten individual tests known to engage specific brain systems and covering a range of cognitive domains. Speed, accuracy, and efficiency were obtained for the whole battery as well as for each of the ten individual tests. Participant testing occurred at baseline, prior to randomization, after approximately 6wk of supplementation (Follow-up-1), and after approximately 12wk of supplementation (Follow-up-2). Of the 299 participants who were randomized, we obtained useable measures for 242 participants at Follow-up-1 and 231 ​at Follow-up-2. Age-based stratification (23-35 years, 36-50 years, 51-65 years), showed statistically significant improvements in overall speed and efficiency in the youngest age group stratum at both follow-up visits. This same group also demonstrated significant improvements in seven speed or accuracy scores of the individual tests. The other age groups demonstrated few or no significant improvements. Thus, in a study population largely devoid of susceptibility factors or pre-existing conditions, carnosine supplementation selectively improved high-level cognitive performance in young individuals.

This study aimed to investigate whether 14 weeks of β-alanine supplementation and high-intensity intermittent training improves brain-derived neurotrophic factor concentrations and cognitive aspects related to executive functions assessed by the Stroop test. Thirteen healthy and active men underwent a 4-week supplementation period (β-alanine: 6.4 g/d or a placebo) followed by 10-week supplementation combined with high-intensity intermittent training, totaling 14 weeks of intervention. Participants underwent a graded exercise test, while the blood samples for brain-derived neurotrophic factor analysis and the Stroop test (cognitive task) were assessed before and after a high-intensity intermittent exercise (10 runs of 1:1 min effort and a pause ratio at 130% of respiratory compensation point). These measurements were performed three times across the study being at baseline, after 4 weeks of supplementation (POST4weeks) and at the end of the 14 weeks of study (POST14weeks). Compared to baseline values, there were no improvements in brain-derived neurotrophic factor concentrations or Stroop test performance with either β-alanine or high-intensity intermittent training. Lactate peak concentrations in a high-intensity intermittent exercise session also did not differ between groups. However, high-intensity intermittent training did improve some cardiorespiratory parameters (i.e., intensity associated with V̇O2max p=0.01 and respiratory compensation point, p=0.01). In conclusion, β-alanine supplementation alone or associated with high-intensity intermittent training did not improve the brain-derived neurotrophic factor concentrations and Stroop test performance in healthy men. Thieme. All rights reserved.

OBJECTIVE: Overweight and obesity are characterized by excess adiposity and systemic, chronic, low-grade inflammation, which is associated with several metabolic disorders. The aim of this study was to assess the feasibility and tolerability of β-alanine supplementation and to explore the effects on cardiometabolic health and cardiovascular, hepatic, and renal function in adults with overweight and obesity. METHODS: A total of 27 adults (44% female; mean [SD], age: 58 [10] years, BMI: 31.1 [2.9] kg/m2, hemoglobin A1c: 39.8 [4.3] mmol/mol) received β-alanine (4.8 g/day) or a matched placebo for 3 months. Feasibility and tolerability outcomes included adherence, side effects, recruitment, attrition, and blinding, and exploratory outcomes included biochemical markers, blood pressures, and transthoracic echocardiography parameters. Data were analyzed using a Bayesian approach presented with 95% credible intervals (CrI). RESULTS: β-alanine was well tolerated and adhered to (adherence: placebo, 0.91 [95% CrI: 0.84-0.95]; β-alanine, 0.92 [95% CrI: 0.85-0.95]), and side effects remained at or below baseline throughout. The probability that β-alanine supplementation affected cardiometabolic, cardiovascular, or clinical biochemical outcomes was low. CONCLUSIONS: Sustained-release β-alanine supplementation is well tolerated and adhered to in adults with overweight and obesity. Future research should consider more advanced metabolic conditions, which may benefit from longer duration supplementation. © 2025 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.

Based on the synergistic therapeutic effect of nitric oxide (NO) and Rho-associated protein kinase (ROCK) inhibitors on glaucoma, a series of NO-donating Netarsudil derivatives were designed, synthesized, and their activities in vitro and in vivo were evaluated. Among them, (S)-10e released an appropriate amount of NO in aqueous humor in vitro and displayed potent ROCK inhibition. Topical administration of (S)-10e significantly lowered intraocular pressure in an acute ocular hypertension rabbit model and protected retinal ganglion cells in a magnetic microbead occlusion mouse model. A metabolism investigation revealed that (S)-10e released 7a, a metabolite after NO releasing, and 13, an active metabolite of (S)-Netarsudil, in rabbit eyes. Notably, introducing an NO donor moiety attenuated ROCK inhibition-induced ocular irritation in an sGC-independent manner, suggesting that the attenuated conjunctival hyperemia effect of (S)-10e is related to the NO-induced protein S-nitrosation of phosphodiesterase 3A (PDE3A). Overall, (S)-10e is a promising candidate for glaucoma treatment.

BACKGROUND: Acute mesenteric ischemia arises through sudden interruption of mesenteric blood flow, mostly due to an occlusion of the superior mesenteric artery and is associated with a high mortality of approximately 50% to 90%. In previous studies, the single application of β-alanine or aprotinin caused an ameliorated intestinal damage but without any systemic effects. METHODS: To analyze the combined effect of β-alanine and aprotinin on acute ischemia and reperfusion of the small intestine, a model with anesthetized rats was used. Ischemia and reperfusion were initiated by occluding and reopening the superior mesenteric artery. After 120 min of ischemia and 180 min of reperfusion, the intestine was analyzed for tissue damage, the activity of the saccharase, and accumulation of granulocytes. In addition, systemic and metabolic as well as inflammatory parameters were measured in blood at certain points in time. RESULTS: The combination of β-alanine and aprotinin resulted in a clearly stabilized mean arterial blood pressure and blood glucose level during the reperfusion period. Furthermore, the combined administration resulted in significantly reduced tissue damage parameters, cytokine and cell-free hemoglobin concentrations in blood plasma. In addition, the damage to the small intestine was significantly attenuated, so that the animals ultimately survived the entire test period because of the administration of both substances. CONCLUSIONS: Overall, the simultaneous application of both substances leads to a synergistic protection without the occurrence of undesirable side effects. The combined usage of β-alanine and aprotinin can be seen as a promising approach to inhibit the onset of acute mesenteric ischemia.

Once-daily (p.m.) netarsudil ophthalmic solution 0.02% (Rhopressa) is approved in the United States for lowering elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Netarsudil, a Rho kinase (ROCK) inhibitor that lowers IOP primarily by increasing trabecular outflow, produces statistically and clinically significant reductions in mean IOP from baseline, with comparable effects on nocturnal and diurnal IOP. In three phase III trials of patients with elevated IOP, the ocular hypotensive efficacy of once-daily netarsudil 0.02% met the criteria for noninferiority to twice-daily timolol 0.5% at all time points over 3 months in patients with baseline IOP less than 25 mmHg. The most frequent adverse event (AE) was generally mild conjunctival hyperemia, the severity of which did not increase with continued dosing. Netarsudil was associated with minimal treatment-related serious or systemic AEs, likely due to the lack of systemic exposure. This report summarizes the available preclinical and clinical data on netarsudil. Copyright 2018 Clarivate Analytics.

β-Alanine is one of the more popular sport supplements used by strength/power athletes today. The popularity of β-alanine stems from its ability to enhance intracellular muscle-buffering capacity thereby delaying fatigue during high-intensity exercise by increasing muscle carnosine content. Recent evidence also suggests that elevated carnosine levels may enhance cognitive performance and increase resiliency to stress. These benefits are thought to result from carnosine's potential role as an antioxidant. This review will discuss these new findings including recent investigations examining β-alanine supplementation and increased resiliency to posttraumatic stress and mild traumatic brain injury. This review will focus on the physiology of carnosine, the effect of β-alanine ingestion on carnosine elevations, and the potential ergogenic benefits it has for competitive and tactical athletes. © 2018 Elsevier Inc. All rights reserved.

19. Praxis (Bern 1994). 2015 Jul 22;104(15):771-80. doi: 10.1024/1661-8157/a002077. [Direct acting oral anticoagulants in venous thromboembolism]. [Article in German] Walti C(1), Bächli E. Author information: (1)1 Medizinische Klinik, Spital Uster. DOI: 10.1024/1661-8157/a002077 PMID: 26204334 [Indexed for MEDLINE]

20. Circulation. 2015 Apr 21;131(16):e412-5. doi: 10.1161/CIRCULATIONAHA.114.012808. Cardiology patient page. Patient guide for taking the non-vitamin K antagonist oral anticoagulants for atrial fibrillation. Lane DA(1), Wood K(2). Author information: (1)From University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (D.A.L.); Duke University School of Nursing, Durham, NC (K.W.). [email protected] [email protected]. (2)From University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (D.A.L.); Duke University School of Nursing, Durham, NC (K.W.). DOI: 10.1161/CIRCULATIONAHA.114.012808 PMCID: PMC4408611 PMID: 25901074 [Indexed for MEDLINE]

Recently, new oral anticoagulants have been introduced as alternatives to warfarin. While national guidelines for treatment of dental patients taking warfarin as an anticoagulant are well-established, no such information is available for these novel therapeutic agents. At present, the local guidance available is contradictory between different health boards/health planning units, and liaison with the medical practitioner managing the individual patient's anticoagulation is imperative if any invasive procedure is proposed. This paper examines the available evidence regarding these drugs and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care.

INTRODUCTION: Direct oral anticoagulants are a recent alternative to vitamin K antagonists but there is a lack of data regarding patients receiving these new types of treatment. The aim of the study was to identify and describe patients receiving direct oral anticoagulants admitted to an emergency unit. METHODS: All the patients taking direct oral anticoagulants, admitted to the emergency room of the Clermont-Ferrand Hospital from January to August 2013, were included in this retrospective and descriptive study. RESULTS: Among the 73 patients included, 47.9% were treated with dabigatran and 52.1% with rivaroxaban. The indication was stroke prevention in 62 patients with atrial fibrillation whose average CHADS2 score was 2.6 [2.3-3](IC95%). The average age was 76.4 years [73.7-79.1](IC95%). Twenty-nine patients (39.7%) had at least one drug association known for increasing the risk of bleeding. Average scores for bleeding risk were: HAS-BLED 3.1 [2.9-3.3](IC95%) and Beyth 1.5 [1.3-1.6](IC95%). Bleeding patients included a higher percentage of men (68.8 vs. 38.2%, P=0.032). Creatinine clearance was lower in patients with major bleeding (45.2% vs. 68.8 mL/min, P=0.002). The Beyth score was highest in both sub-groups. CONCLUSION: In our study, we have found that the bleeding risk factors were: male gender, a high Beyth score, and a lowered creatinine clearance. Overall, patients treated with direct oral anticoagulants admitted to the emergency room were old with many co-morbidities, especially cardiovascular conditions; polymedication was frequent.

Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.

Venous thromboembolism and atrial fibrillation are among the most common cardiovascular disorders in the United States. For over 50 years, the standard of care has been anticoagulation with vitamin K antagonists. However, the numerous limitations of vitamin K antagonists led to the development of target-specific oral anticoagulants. Dabigatran, rivaroxaban, apixaban, and edoxaban have been shown to be as effective as warfarin in the treatment and prevention of venous thromboembolism and prevention of stroke in nonvalvular atrial fibrillation. This article compares the basic pharmacologic properties of these anticoagulants, reviews the data supporting their use, and discusses practical clinical issues including measurement of the anticoagulation effect, reversal strategies, and management of patients prior to surgery.