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Abstract Background The deployment of Artificial Intelligence (AI) in healthcare has the potential to transform patient care through improved diagnostics, personalized treatment plans, and more efficient resource management. However, the effectiveness and fairness of AI are critically dependent on the data it learns from. Biased datasets can lead to AI outputs that perpetuate disparities, particularly affecting social minorities and marginalized groups. Objective This paper introduces the “Data Artifacts Glossary”, a dynamic, open-source framework designed to systematically document and update potential biases in healthcare datasets. The aim is to provide a comprehensive tool that enhances the transparency and accuracy of AI applications in healthcare and contributes to understanding and addressing health inequities. Methods Utilizing a methodology inspired by the Delphi method, a diverse team of experts conducted iterative rounds of discussions and literature reviews. The team synthesized insights to develop a comprehensive list of bias categories and designed the glossary’s structure. The Data Artifacts Glossary was piloted using the MIMIC-IV dataset to validate its utility and structure. Results The Data Artifacts Glossary adopts a collaborative approach modeled on successful open-source projects like Linux and Python. Hosted on GitHub, it utilizes robust version control and collaborative features, allowing stakeholders from diverse backgrounds to contribute. Through a rigorous peer review process managed by community members, the glossary ensures the continual refinement and accuracy of its contents. The implementation of the Data Artifacts Glossary with the MIMIC-IV dataset illustrates its utility. It categorizes biases, and facilitates their identification and understanding. Conclusion The Data Artifacts Glossary serves as a vital resource for enhancing the integrity of AI applications in healthcare by providing a mechanism to recognize and mitigate dataset biases before they impact AI outputs. It not only aids in avoiding bias in model development but also contributes to understanding and addressing the root causes of health disparities. more...

ABSTRACT Emitter clogging is the main limitation of drip irrigation systems operating with wastewater. This paper aimed to employ discriminant analysis (DA) to generate classification functions that characterize aquaculture wastewater (AW) dilutions in well water (WA), delivered through non-self-compensating drippers. Five AW dilutions in WA were tested (D1: 100% AW; D2: 75% AW + 25% WA; D3: 50% AW + 50% WA; D4: 25% AW + 75% WA; and D5: 100% WA) to investigate the clogging susceptibility of three non-self-compensating dippers: TS (1.6 L h-1), SL (1.6 L h-1), and NJ (1.7 L h-1) after 160 h of operation. Three hydraulic performance evaluations of the drippers were performed in this period. During the same interval, the quality attributes of the AW dilutions in WA were also quantified. The statistical analyses included correlation matrix and DA. The correlation matrix identified 188 variables with significant correlations. Discriminant functions were constructed for each dripper using DA. These functions revealed Mg2+ as the most significant variable. The classification matrix of these functions achieved a 100% success rate. more...

Abstract Introduction: Multicenter research initiatives in Brazilian dialysis centers are scarce. We described the recruitment and implementation phases of the SARC-HD study, aimed at investigating sarcopenia and its impact on adverse clinical outcomes. Methods: The SARC-HD is a cohort study being conducted with patients on hemodialysis in Brazil. The recruitment phase was defined as the period from the invitation to the center until the start of patient enrollment, whereas the implementation phase lasted from then until the completion of enrollment and baseline data collection. Upon implementation, a structured questionnaire was distributed to collect feedback from principal investigators. Results: 21 centers from three Brazilian regions consented to participate, with two dropping out. Ten principal investigators oversaw the 19 sites. Nine centers (47%) were funded entirely by health insurance companies. A total of 1525 patients were screened for eligibility and 1008 were enrolled, with a 66.1% recruitment rate. Recruitment and baseline data collection took 12 [interquartile range: 5–15] weeks. Qualitative content analysis identified barriers such as a lack of infrastructure and logistics for research. Facilitators included the management and organization of the steering committee. Data collection challenges were mainly reported with the subjective 7-point global assessment and the international physical activity questionnaire. The main challenge for the ongoing maintenance phase will be the lack of standardized information in electronic health records. Conclusions: The recruitment and implementation phases of the multicenter SARC-HD study were feasible. Barriers and facilitators identified by principal investigators may help future multicenter initiatives to integrate research-related tasks into clinical routine, facilitating successful experiences. more...

Abstract. Introduction:. The effect of pain education (PE) on pain intensity and function diminishes after a few months in people with chronic low back pain (CLBP). One possible explanation is the return of underlying fears and worries related to the condition. Objective:. To explore topics related to participants' beliefs and feelings that might explain why fears and worries persist after a PE-grounded intervention for CLBP. Methods:. We conducted a qualitative study involving semistructured interviews with participants from the active arm of a randomised controlled trial who received an individualised PE-grounded intervention for adults with CLBP. We used reflexive thematic analysis with an inductive approach. Results:. Twenty participants were interviewed (9 women and 11 men, median age = 54 years, median pain duration = 4 years, 13 reporting at least 30% pain reduction on the trial primary outcome). Three themes were identified: 1) “Are you implying my pain is not real?”: a few participants believed the validity of their pain was being questioned. 2) “You don't understand, my pain is different”: most participants considered the influence of an altered nervous system but did not exclude the possibility of having structural and biomechanical influences for the persistence of their back pain. 3) “I am unsure how to fit it into my daily life”: fear and worries persisted when participants could not figure out how to apply an alternative way of making sense of pain in their daily lives. Conclusion:. Patients' perceptions about PE should be monitored and might be addressed with communication strategies, educational content that matches patients' characteristics, and reinforcements over time. more...

Abstract. Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, [95% confidence intervals]) for pain intensity (0–100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: −8.2 [−11.8, −1.9]; medical procedures/surgical pain: −6.9 [−10.4, −3.3]; burn wound care: −8.8 [−13.8, −3.9]). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (−11.5 [−19.7, 3.3]) but not postsurgery pain (−2.0 [−7.8, 3.7]). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (−2 [−3.7, −0.3]). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (−13.2, [−22.5, −3.8]). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted. more...

Flavor is essential to consumer preference of foods and is an increasing focus of plant breeding programs. In fruit crops, identifying genes underlying volatile organic compounds has great promise to accelerate flavor improvement, but polyploidy and heterozygosity in many species have slowed progress. Here we use octoploid cultivated strawberry to demonstrate how genomic heterozygosity, transcriptomic intricacy and fruit metabolomic diversity can be treated as strengths and leveraged to uncover fruit flavor genes and their regulatory elements. Multi-omics datasets were generated including an expression quantitative trait loci map with 196 diverse breeding lines, haplotype-phased genomes of a highly-flavored breeding selection, a genome-wide structural variant map using five haplotypes, and volatile genome-wide association study (GWAS) with > 300 individuals. Overlaying regulatory elements, structural variants and GWAS-linked allele-specific expression of numerous genes to variation in volatile compounds important to flavor. In one example, the functional role of anthranilate synthase alpha subunit 1 in methyl anthranilate biosynthesis was supported via fruit transient gene expression assays. These results demonstrate a framework for flavor gene discovery in fruit crops and a pathway to molecular breeding of cultivars with complex and desirable flavor. more...

PURPOSETo investigate the discordance in sarcoma diagnoses between nonspecialized institutions following revision by dedicated sarcoma pathologists at a reference center in Brazil and the relevance of molecular pathology in this context.METHODSWe conducted a retrospective analysis of sarcoma samples initially analyzed at outside laboratories and subsequently reviewed by two specialized pathologists between January 2014 and December 2020. After obtaining demographic and tumor characteristics, pathology results were matched and classified as complete discordance (CD; benign v malignant, sarcoma v other malignancies), partial concordance (similar diagnosis of connective tumor, but different grade/histological subtype/differentiation), and complete concordance (CC). The concordance for histology or grade, and the role of molecular assessments supporting the diagnosis were also independently determined. Statistical analyses were conducted through the kappa coefficient of agreement and adherence by χ2 test, χ2 test by Person, and Fisher exact test.RESULTSIn total, 197 cases were included, with samples obtained predominately from male patients (57.9%) and localized/primary tumors (86.8%). Following revision, the most frequent final diagnoses were undifferentiated pleomorphic sarcoma (17.8%), well-differentiated/dedifferentiated liposarcoma (8.6%), and leiomyosarcoma (7.6%). CD was found in 13.2%, partial discordance in 45.2%, and CC in 41.6% of reviews (P < .001). We found a concordance for histology or grade of 53.5% (P < .001) and 51.8% (P < .001), respectively. Molecular assessments, comprising next-generation sequencing panels (79.5%) and fluorescent in situ hybridization (20.5%), were performed in 44 (22.3%) cases, with findings classified as of diagnostic relevance in 31.8%.CONCLUSIONIn nearly 60% of the cases, the initial sarcoma diagnosis was modified when revised by a reference center and dedicated pathologists, assisted by molecular pathology techniques. These results justify the assembly of referral networks in countries with limited health care resources. more...

ABSTRACT Objectives: To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. Materials and Methods: We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. Results: We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie’s Disease and one other clinical trial evaluated the applicability after radical prostatectomy. Conclusions: The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results. more...

Abstract Background Sarcopenia has been associated with adverse outcomes in patients with chronic kidney disease (CKD), particularly in those undergoing hemodialysis (HD). However, the trajectories across sarcopenia stages, their determinants, and associations with adverse clinical outcomes have yet to be comprehensively examined. Methods The SARC-HD is a multicenter, observational prospective cohort study designed to comprehensively investigate sarcopenia in patients on HD. Eligibility criteria include adult patients undergoing HD for ≥ 3 months. The primary objective is to investigate the trajectories of sarcopenia stages and their potential determinants. Secondary objectives include evaluating the association between sarcopenia and adverse clinical outcomes (i.e., falls, hospitalization, and mortality). Sarcopenia risk will be assessed by the SARC-F and SARC-CalF questionnaire. Sarcopenia traits (i.e., low muscle strength, low muscle mass, and low physical performance) will be defined according to the revised European Working Group on Sarcopenia in Older People and will be assessed at baseline and after 12 follow-up months. Patients will be followed-up at 3 monthly intervals for adverse clinical outcomes during 24 months. Discussion Collectively, we expect to provide relevant clinical findings for healthcare professionals from nephrology on the association between sarcopenia screening tools (i.e., SARC-F and SARC-CalF) with objective sarcopenia measurements, as well as to investigate predictors of trajectories across sarcopenia stages, and the impact of sarcopenia on adverse clinical outcomes. Hence, our ambition is that the data acquired from SARC-HD study will provide novel and valuable evidence to support an adequate screening and management of sarcopenia in patients on HD. more...

Doxorubicin (DOX) is a potent chemotherapeutic agent used to treat multiple types of cancer, but its clinical application is limited by cardiotoxicity, mainly due to oxidative stress. Curcumin (CUR) is a natural polyphenolic compound with strong antioxidant properties, but its potential protective effects against DOX-induced cardiotoxicity need further investigation. This study aimed to evaluate CUR’s efficacy in mitigating DOX-induced oxidative stress in the hearts of BALB/c mice. Mice received a DOX dose of 9 mg/kg or 16 mg/kg; half of the mice received daily doses of 100 mg/kg CUR for 15 days. Survival analysis, histopathological examination, and oxidative stress markers were assessed to determine the cardioprotective effects of CUR. Results showed that CUR significantly reduced oxidative damage and improved survival rates, particularly at the lower DOX dose (9 mg/kg). Mice treated with DOX-9 mg/kg plus CUR showed improved health conditions and reduced levels of reactive oxygen species (ROS), lipid peroxidation, sulfhydryl production, and protein carbonylation. Histopathological analysis confirmed reduced cardiac tissue damage. In conclusion, CUR combined with a lower dose of DOX effectively reduces oxidative stress and cardiac injury, enhancing survival in BALB/c mice. These findings suggest that CUR is a promising adjunct therapy to mitigate DOX-induced cardiotoxicity, potentially improving the DOX therapeutic index in cancer treatment. more...

Background: Kombucha, a fermented tea, has been suggested as an adjuvant in the treatment of obesity. Although animal and in vitro studies indicate its promising benefits, exploring kombucha’s impact on human health is necessary. Methods: This quasi-experimental pre–post-intervention assessed the effect of black tea kombucha consumption on cardiometabolic parameters for 8 weeks, considering the quality of the diet of individuals with and without obesity. Diet quality was assessed through the Dietary Inflammatory Index® and Dietary Total Antioxidant Capacity. Paired t-test/Wilcoxon was applied to compare differences between pre- and post-intervention (α = 0.05). Results: After the intervention, individuals with obesity showed a decrease in insulin, HOMA-IR, and GGT; those without obesity showed an increase in total cholesterol and alkaline phosphatase, but this was only observed in those with a worsened diet quality. Conclusion: kombucha intake demonstrated positive impacts on the metabolic health of individuals with obesity beyond the importance of combining it with healthy eating patterns. more...