Brazilian Jiu‐Jitsu (BJJ) is a popular martial art that exposes participants to recurrent intermittent asphyxiation due to controlled application of neck chokes. To what extent the sport impacts the ...regulation of cerebral blood flow (CBF) and cognition has not been examined. This study compared eleven elite Brazilian Jiu‐Jitsu athletes (aged 30 ± 8 y) who trained 12 ± 6 hours/week for 8 ± 4 years against eleven cardiorespiratory fitness (CRF)‐ and age‐matched controls. Internal carotid (ICA) and vertebral artery (VA) blood flow were measured via duplex ultrasound to determine global cerebral blood flow (gCBF). Mild cognitive impairment and sub‐domains of memory, attention/concentration/visual motor coordination, and executive function were determined by psychometric testing. There was no evidence of mild cognitive impairment in the athletes, and cognitive function was comparable between groups (all p > 0.05). In contrast, resting gCBF was selectively elevated in the athletes (741 ± 186 mL∙min−1 vs. 573 ± 166 mL∙min−1, p = 0.037) due to combined differences in ICA (+65 mL∙min−1, p = 0.079) and VA (+19 mL∙min−1, p = 0.277) flow. In conclusion, the sustained elevation in resting cerebral perfusion provides preliminary evidence for adaptive neuroprotection that is independent of CRF and likely mediated by choke‐induced cerebral preconditioning and/or lifelong exposure to BJJ‐specific high‐intensity interval training.
ABSTRACT
Most research on non-GAAP financial measures focuses on earnings or earnings per share, although non-GAAP revenue disclosure has recently attracted SEC scrutiny. It is unclear ex ante what ...non-GAAP adjustments could improve revenue's usefulness because, unlike earnings, revenue is a top-line number related primarily to core (i.e., persistent) business activities. We present the first archival analysis of non-GAAP revenues using a large, hand-collected sample of disclosures from 2015 to 2018. Approximately one in five earnings announcements contains a non-GAAP revenue disclosure, focused on revenue growth. Our evidence suggests that firms disclose non-GAAP revenue when GAAP revenue is incomparable with prior periods, and not to compensate for poor GAAP performance. Furthermore, non-GAAP revenue growth predicts future revenue growth better than GAAP revenue growth, and the market responds to this information. Overall, non-GAAP revenue disclosures are motivated by economic fundamentals rather than opportunism, on average, and they provide investors with relevant information.
Neutrophil extracellular traps (NETs) clear pathogens but may contribute Q8 pathogenically to host inflammatory tissue damage during sepsis. Innovative therapeutic agents targeting NET formation and ...their potentially harmful collateral effects remain understudied.
We investigated a novel therapeutic agent, neonatal NET-Inhibitory Factor (nNIF), in a mouse model of experimental sepsis - cecal ligation and puncture (CLP). We administered 2 doses of nNIF (1 mg/ kg) or its scrambled peptide control intravenously 4 and 10 hours after CLP treatment and assessed survival, peritoneal fluid and plasma NET formation using the MPO-DNA ELISA, aerobic bacterial colony forming units (CFU) using serial dilution and culture, peritoneal fluid and stool microbiomes using 16S rRNA gene sequencing, and inflammatory cytokine levels using a multiplexed cytokine array. Meropenem (25 mg/kg) treatment served as a clinically relevant treatment for infection.
We observed increased 6-day survival rates in nNIF (73%) and meropenem (80%) treated mice compared to controls (0%). nNIF decreased NET formation compared to controls, while meropenem did not impact NET formation. nNIF treatment led to increased peritoneal fluid and plasma bacterial CFUs consistent with loss of NET-mediated extracellular microbial killing, while nNIF treatment alone did not alter the peritoneal fluid and stool microbiomes compared to vehicle-treated CLP mice. nNIF treatment also decreased peritoneal TNF-a inflammatory cytokine levels compared to scrambled peptide control. Furthermore, adjunctive nNIF increased survival in a model of sub-optimal meropenem treatment (90% v 40%) in CLP-treated mice.
Thus, our data demonstrate that nNIF inhibits NET formation in a translationally relevant mouse model of sepsis, improves survival when given as monotherapy or as an adjuvant with antibiotics, and may play an important protective role in sepsis.
Although race is a social construct, it is associated with variations in skin and retinal pigmentation. Image-based medical artificial intelligence (AI) algorithms that use images of these organs ...have the potential to learn features associated with self-reported race (SRR), which increases the risk of racially biased performance in diagnostic tasks; understanding whether this information can be removed, without affecting the performance of AI algorithms, is critical in reducing the risk of racial bias in medical AI.
To evaluate whether converting color fundus photographs to retinal vessel maps (RVMs) of infants screened for retinopathy of prematurity (ROP) removes the risk for racial bias.
The retinal fundus images (RFIs) of neonates with parent-reported Black or White race were collected for this study. A u-net, a convolutional neural network (CNN) that provides precise segmentation for biomedical images, was used to segment the major arteries and veins in RFIs into grayscale RVMs, which were subsequently thresholded, binarized, and/or skeletonized. CNNs were trained with patients' SRR labels on color RFIs, raw RVMs, and thresholded, binarized, or skeletonized RVMs. Study data were analyzed from July 1 to September 28, 2021.
Area under the precision-recall curve (AUC-PR) and area under the receiver operating characteristic curve (AUROC) at both the image and eye level for classification of SRR.
A total of 4095 RFIs were collected from 245 neonates with parent-reported Black (94 38.4%; mean SD age, 27.2 2.3 weeks; 55 majority sex 58.5%) or White (151 61.6%; mean SD age, 27.6 2.3 weeks, 80 majority sex 53.0%) race. CNNs inferred SRR from RFIs nearly perfectly (image-level AUC-PR, 0.999; 95% CI, 0.999-1.000; infant-level AUC-PR, 1.000; 95% CI, 0.999-1.000). Raw RVMs were nearly as informative as color RFIs (image-level AUC-PR, 0.938; 95% CI, 0.926-0.950; infant-level AUC-PR, 0.995; 95% CI, 0.992-0.998). Ultimately, CNNs were able to learn whether RFIs or RVMs were from Black or White infants regardless of whether images contained color, vessel segmentation brightness differences were nullified, or vessel segmentation widths were uniform.
Results of this diagnostic study suggest that it can be very challenging to remove information relevant to SRR from fundus photographs. As a result, AI algorithms trained on fundus photographs have the potential for biased performance in practice, even if based on biomarkers rather than raw images. Regardless of the methodology used for training AI, evaluating performance in relevant subpopulations is critical.
Background. The purpose of this study was to investigate if the addition of liposome bupivacaine (LB) to an interscalene block (ISB) had an effect on the number of patients with surgical- or ...block-related complications. Methods. This was a single-center retrospective chart view performed by identifying patients who received an ISB from January 1, 2014, through April 26, 2018, at the University of Minnesota. 1,518 patients were identified who received an ISB (LB = 784, nonliposomal bupivacaine = 734). Patients were divided into two groups those who did receive liposome bupivacaine in their ISB and those who did not receive liposome bupivacaine in their ISB. Medical records were individually reviewed for surgical procedure, block medications, complications related to the block or surgical procedure, phone calls to the healthcare system for issues related to opioids or pain within 3 and within 30 days, readmissions within 30 days, and emergency room visits for complications within 3 and 30 days. Results. There was no significant difference in the number of patients with surgical or anesthetic complications. Only phone calls for pain within 3 days were significantly different. The LB group had 3.2% of patients call compared to 5.6% in the nonliposomal bupivacaine group (aOR = 1.71 (95% CI: 1.04–2.87), p=0.036). We found no significant difference in any of the other secondary outcomes. Conclusions. The use of LB in an ISB demonstrated no significant difference compared to nonliposomal bupivacaine in numbers of complications, emergency room visits, and readmissions.
To utilize a deep learning (DL) model trained via federated learning (FL), a method of collaborative training without sharing patient data, to delineate institutional differences in clinician ...diagnostic paradigms and disease epidemiology in retinopathy of prematurity (ROP).
Evaluation of a diagnostic test or technology.
We included 5245 patients with wide-angle retinal imaging from the neonatal intensive care units of 7 institutions as part of the Imaging and Informatics in ROP study. Images were labeled with the clinical diagnoses of plus disease (plus, preplus, no plus), which were documented in the chart, and a reference standard diagnosis was determined by 3 image-based ROP graders and the clinical diagnosis.
Demographics (birth weight, gestational age) and clinical diagnoses for all eye examinations were recorded from each institution. Using an FL approach, a DL model for plus disease classification was trained using only the clinical labels. The 3 class probabilities were then converted into a vascular severity score (VSS) for each eye examination, as well as an "institutional VSS," in which the average of the VSS values assigned to patients' higher severity ("worse") eyes at each examination was calculated for each institution.
We compared demographics, clinical diagnoses of plus disease, and institutional VSSs between institutions using the McNemar-Bowker test, 2-proportion Z test, and 1-way analysis of variance with post hoc analysis by the Tukey-Kramer test. Single regression analysis was performed to explore the relationship between demographics and VSSs.
We found that the proportion of patients diagnosed with preplus disease varied significantly between institutions (P < 0.001). Using the DL-derived VSS trained on the data from all institutions using FL, we observed differences in the institutional VSS and the level of vascular severity diagnosed as no plus (P < 0.001) across institutions. A significant, inverse relationship between the institutional VSS and mean gestational age was found (P = 0.049, adjusted R
= 0.49).
A DL-derived ROP VSS developed without sharing data between institutions using FL identified differences in the clinical diagnoses of plus disease and overall levels of ROP severity between institutions. Federated learning may represent a method to standardize clinical diagnoses and provide objective measurements of disease for image-based diseases.
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