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Coronary angiography is the primary procedure for diagnosis and management decisions in coronary artery disease (CAD), but ad-hoc visual assessment of angiograms has high variability. Here we report a fully automated approach to interpret angiographic coronary artery stenosis from standard coronary angiograms. Using 13,843 angiographic studies from 11,972 adult patients at University of California, San Francisco (UCSF), between April 1, 2008 and December 31, 2019, we train neural networks to accomplish four sequential necessary tasks for automatic coronary artery stenosis localization and estimation. Algorithms are internally validated against criterion-standard labels for each task in hold-out test datasets. Algorithms are then externally validated in real-world angiograms from the University of Ottawa Heart Institute (UOHI) and also retrained using quantitative coronary angiography (QCA) data from the Montreal Heart Institute (MHI) core lab. The CathAI system achieves state-of-the-art performance across all tasks on unselected, real-world angiograms. Positive predictive value, sensitivity and F1 score are all ≥90% to identify projection angle and ≥93% for left/right coronary artery angiogram detection. To predict obstructive CAD stenosis (≥70%), CathAI exhibits an AUC of 0.862 (95% CI: 0.843-0.880). In UOHI external validation, CathAI achieves AUC 0.869 (95% CI: 0.830-0.907) to predict obstructive CAD. In the MHI QCA dataset, CathAI achieves an AUC of 0.775 (95%. CI: 0.594-0.955) after retraining. In conclusion, multiple purpose-built neural networks can function in sequence to accomplish automated analysis of real-world angiograms, which could increase standardization and reproducibility in angiographic coronary stenosis assessment.

This Article brings new perspectives on the well-known Viking and Laval cases, decided by the Court of Justice of the European Union (CJEU) in December 2007, by studying the processes and modalities of the construction of this case law as a major defeat for social Europe. It demonstrates that the political and legal implications of these two rulings were socially constructed by a variety of European actors (especially trade unionists and academics specialising in labour law) rather than legally inscribed in the rulings. In doing so, the author defends a constructivist approach in the analysis of European case law, both contextual and processual. The Article is divided into two parts. The first retraces the pre-ruling construction of the Viking and Laval cases, and shows that trade union and academic actors as well as parliamentarians worked to construct the judgements on these cases as decisive landmarks for social Europe. The second part considers the process of interpretation of the rulings after they were delivered by the CJEU. It evidences the central role played by trade union and academic actors in promoting a critical reading of the rulings, arguing that the Court subordinated social rights to economic liberties. The Article concludes by showing that this interpretation has tended to become subject to consensus, to the extent that it is now European common sense.

Abstract Over the two last decades, whole-body cryotherapy/cryostimulation (WBC) has emerged as an exciting non-pharmacological treatment influencing inflammatory events at a cellular and physiological level, which can result in improved sleep quality, faster neuromuscular recovery after high-intensity exercise, and chronic pain relief for patients suffering different types of diseases (fibromyalgia, rheumatism, arthritis). Some evidence even suggests that WBC has benefits on mental health (depression, anxiety disorders) and cognitive functions in both adults and older adults, due to increased circulating BDNF levels. Recently, some safety concerns have been expressed by influential public health authorities (e.g., FDA, INSERM) based on reports from patients who developed adverse events upon or following WBC treatment. However, part of the data used to support these claims involved individuals whose entire body (except head) was exposed to extreme cold vaporized liquid nitrogen while standing in a narrow bathtub. Such a procedure is known as partial-body cryotherapy (PBC), and is often erroneously mistaken to be whole-body cryotherapy. Although having similarities in terms of naming and pursued aims, these two approaches are fundamentally different. The present article reviews the available literature on the main safety concerns associated with the use of true whole-body cryotherapy. English- and French-language reports of empirical studies including case reports, case series, and randomized controlled trials (RCTs) were identified through searches of PubMed, Scopus, Cochrane, and Web of Science electronic databases. Five case reports and two RCTs were included for a total of 16 documented adverse events (AEs). A critical in-depth evaluation of these AEs (type, severity, context of onset, participant’s medical background, follow-up) is proposed and used to illustrate that WBC-related safety risks are within acceptable limits and can be proactively prevented by adhering to existing recommendations, contraindications, and commonsense guidelines.

PurposeThe aim of this case report was to describe the sleep responses in a male combat sport athlete, who was engaging in both chronic (CWL) and acute (AWL) weight loss practices in order to reduce body mass for a national competition.MethodsDuring the first seven weeks of training (Phases 1 and 2), the athlete adhered to a daily energy intake (EI) equating to their resting metabolic rate (1700 kcal·day−1) followed by a reduction in EI (915–300 kcal·day−1) in the 5 days before weighing in (Phase 3). Nocturnal sleep was monitored throughout the 8-week training period using wristwatch actigraphy and frequent measurements of body mass/composition, daily exercise energy expenditure and training load (TL) were taken.ResultsThe athlete was in a state of low energy availability (LEA) during the entire training period. There was a very large decrease in LEA status during phase 3 compared with phases 1 and 2 (3 vs. 20 kcal·kgFFM·day−1) and there was a small decrease in TL during phase 3 compared with phase 2 (410 vs. 523 AU). The athlete's sleep efficiency increased throughout the training period, but total sleep time displayed a small to moderate decrease in phase 3 compared with phases 1 and 2 (386 vs. 429 and 430 min). However, correlational analysis demonstrated trivial to small, non-significant relationships between sleep characteristics and the athlete's LEA status and TL.ConclusionThese findings suggest that CWL and AWL practices that cause fluctuations in LEA and TL may be implemented without compromising the sleep of combat sport athletes.

Abstract We assessed the effects of a 3-min partial-body cryostimulation (PBC) exposure—where the whole body is exposed to extreme cold, except the head—on cognitive inhibition performance and the possible implications of parasympathetic cardiac control and cerebral oxygenation. In a randomized controlled counterbalanced cross-over design, eighteen healthy young adults (nine males and nine females) completed a cognitive Stroop task before and after one single session of PBC (3-min exposure at − 150 °C cold air) and a control condition (3 min at room temperature, 20 °C). During the cognitive task, heart rate variability (HRV) and cerebral oxygenation of the prefrontal cortex were measured using heart rate monitoring and near-infrared spectroscopy methods. We also recorded the cerebral oxygenation during the PBC session. Stroop performance after PBC exposure was enhanced (562.0 ± 40.2 ms) compared to pre-PBC (602.0 ± 56.4 ms; P

Background"Sleep Low-Train Low" is a training-nutrition strategy intended to purposefully reduce muscle glycogen availability around specific exercise sessions, potentially amplifying the training stimulus via augmented cell signalling. The aim of this study was to assess the feasibility of a 3-week home-based "sleep low-train low" programme and its effects on cycling performance in trained athletes.MethodsFifty-five trained athletes (Functional Threshold Power [FTP]: 258 ± 52W) completed a home-based cycling training program consisting of evening high-intensity training (6 × 5 min at 105% FTP), followed by low-intensity training (1 hr at 75% FTP) the next morning, three times weekly for three consecutive weeks. Participant's daily carbohydrate (CHO) intake (6 g·kg-1·d-1) was matched but timed differently to manipulate CHO availability around exercise: no CHO consumption post- HIT until post-LIT sessions [Sleep Low (SL), n = 28] or CHO consumption evenly distributed throughout the day [Control (CON), n = 27]. Sessions were monitored remotely via power data uploaded to an online training platform, with performance tests conducted pre-, post-intervention.ResultsLIT exercise intensity reduced by 3% across week 1, 3 and 2% in week 2 (P < 0.01) with elevated RPE in SL vs. CON (P < 0.01). SL enhanced FTP by +5.5% vs. +1.2% in CON (P < 0.01). Comparable increases in 5-min peak power output (PPO) were observed between groups (P < 0.01) with +2.3% and +2.7% in SL and CON, respectively (P = 0.77). SL 1-min PPO was unchanged (+0.8%) whilst CON improved by +3.9% (P = 0.0144).ConclusionDespite reduced relative training intensity, our data demonstrate short-term "sleep low-train low" intervention improves FTP compared with typically "normal" CHO availability during exercise. Importantly, training was completed unsupervised at home (during the COVID-19 pandemic), thus demonstrating the feasibility of completing a "sleep low-train low" protocol under non-laboratory conditions.

BackgroundThanks to the specific materials they embed, far infrared (FIR)-emitting garments can interact with the body's physiological functions. Such effects have been sought in medicine and physiotherapy for a long time for the treatment/relief of a variety of pathologies and disabling conditions. Recently, FIR-emitting garments have been introduced in the sporting domain under the influence of manufacturers seeing here a new opportunity to support physical performance in athletes, though this is not clearly established. To fill this gap, in this systematic review, we summarize the scientific evidence on the use of FIR-emitting garments in sport and provide directions for future research by shedding light on current scientific limitations.MethodFive scientific databases (PubMed, Cochrane, ScienceDirect, Scopus and SPORTDiscus) were searched by two independent reviewers. Studies investigating the effects of FIR-emitting garments on at least one physiological outcome related to exercise performance and/or recovery in humans were selected. The methodological quality of retained studies was assessed using the Physiotherapy Evidence Database (PEDro) scale.Results and discussionEleven studies met the inclusion criteria and were included in the systematic review. Studies investigating similar outcomes related to exercise performance or recovery were scarce and results inconclusive, which prevents from drawing firm conclusion about the utilisation of FIR-emitting garments in athletes. However, these early results show that FIR-emitting garments may be of interest for exercise performance and recovery, mainly through their effects on the body's thermoregulation and haemodynamic function. The summary provided in this review can be used to inform the design of future studies. (PROSPERO registration number: CRD42021238029).

Punching in boxing requires a combination of force and velocity of the acting arm, originating from an optimal synchronization of the different body segments. However, it is not well-understood what kinematic parameters of the punching execution influence boxing performance the most. This study aimed to investigate the differences in punching execution between 15 potential Olympic medalist boxers (Elite group) and 8 younger well trained boxers (Junior group). Each athlete was equipped with an instrumented suit composed of 17 inertial measurement units (IMU) and were asked to perform several series of 3 standardized punch types (cross, hook, and uppercut) with maximal force. Linear velocity, stability, and punch forces were computed from the different sensors. Our findings show that Elite boxers systematically produced more force and at a higher velocity for the three punch types compared to Juniors. Further analysis revealed differences in joint contributions between Elite and Juniors, Juniors presenting a higher contribution of the shoulder for the three punch types. Finally ground reaction force imbalance between the front and rear foot was revealed in the cross only, in all boxers (60.6 ± 24.9 vs. 39.4 ± 24.9% and 54.1 ± 7.1 vs. 45.9 ± 7.1%, p ≤ 0.05, for the front vs. rear foot in Elite and Juniors, respectively) but not different between groups. These results have important implications for practitioners involved in the talent identification process, longitudinal follow-up, and training of boxers.

Clinical multicenter imaging studies are frequent and rely on a wide range of existing tools for sharing data and processing pipelines. This is not the case for preclinical (small animal) studies. Animal population imaging is still in infancy, especially because a complete standardization and control of initial conditions in animal models across labs is still difficult and few studies aim at standardization of acquisition and post-processing techniques. Clearly, there is a need of appropriate tools for the management and sharing of data, post-processing and analysis methods dedicated to small animal imaging. Solutions developed for Human imaging studies cannot be directly applied to this specific domain. In this paper, we present the Small Animal Shanoir (SAS) solution for supporting animal population imaging using tools compatible with open data. The integration of automated workflow tools ensures accessibility and reproducibility of research outputs. By sharing data and imaging processing tools, hosted by SAS, we promote data preparation and tools for reproducibility and reuse, and participation in multicenter or replication “open science” studies contributing to the improvement of quality science in preclinical domain. SAS is a first step for promoting open science for small animal imaging and a contribution to the valorization of data and pipelines of reference.

Retraining and resuming competition following surgery is challenging for athletes due to the prolonged period of reduced physical activity and subsequent alteration of body composition and physical performance. This is even more challenging for master athletes who endure the additional effect of aging. Within this context, the purpose of this study was to evaluate the feasibility and benefits that evidence-based nutritional and training recommendations could have on the time course of reconditioning and retraining following hip arthroplasty in an endurance master triathlete. During 38 weeks (from 6 weeks prior to surgery through to the return to competition in week 32), the athlete was provided with detailed training and nutritional recommendations. Dietary intake (via the remote food photographic method), body composition (via DXA), peak oxygen uptake (VO2peak), peak power output (PPO), cycling efficiency (GE), and energy availability (EA) were assessed 6 weeks pre- and 8, 12, 18, 21, and 25-weeks post-surgery. Training load was quantified (via TRIMP score and energy expenditure) daily during the retraining. Total body mass increased by 8.2 kg (attributable to a 3.5–4.6 kg increase in fat mass and lean mass, respectively) between week −6 and 8 despite a reduction in carbohydrate (CHO) intake post-surgery (

In boxing, an efficient punch requires a combination of force, velocity and stability of the athlete. Being able to monitor these parameters has the potential to better inform training practices required to reach high performance. Hence, the aim of this study was to investigate the differences in punching execution between two groups of elite boxers (senior vs. junior) using three biomechanical indicators of performance in boxing. Each athlete was equipped with an instrumented suit composed of 17 inertial measurement units (IMU) and were asked to perform several series of punches with 3 standardized punching techniques (cross, hook and uppercut) on a punching bag with maximal force. Linear velocity, stability and punch forces were computed from the different sensors. Our findings show that senior boxers systematically produced more force and at a higher velocity for the three punching techniques compared to juniors. The IMU analysis also reveals differences of joint contributions between seniors and juniors, juniors presenting a higher contribution of the shoulder for the three punching techniques.