Clinical phenotypes and short-term outcomes based on prehospital point-of-care testing and on-scene vital signs

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Effects of a 12-week multicomponent exercise programme on physical function in older adults with cancer: Study protocol for the ONKO-FRAIL randomised controlled trial

Introduction Cancer in older adults is often associated with functional limitations, geriatric syndromes, poor self-rated health, vulnerability, and frailty, and these conditions might worsen treatment-related side effects. Recent guidelines for patients with cancer during and after treatment have documented the beneficial effects of exercise to counteract certain side effects; however, little is known about the role of exercise during cancer treatment in older adults. Materials and Methods This is a multicentre randomised controlled trial in which 200 participants will be allocated to a control group or an intervention group (the sample size has been calculated to detect a clinical difference of 1 point in Short Physical Performance Battery (SPPB) score, assuming an α error of 0.05, a β error of 0.20, and a 10 % loss rate). Patients aged ≥70 years, diagnosed with any type of solid cancer and candidates for systemic treatment are eligible. Subjects in the intervention group are invited to participate in a 12-week supervised multicomponent exercise programme in addition to receiving usual care. Study assessments are conducted at baseline and three months. The primary outcome measure is physical function as assessed by the SPPB. Secondary outcome measures include comprehensive geriatric assessment scores (including social situation, basic and instrumental activities of daily living, cognitive function, depression, nutritional status, polypharmacy, geriatric syndromes, pain, and emotional distress), anthropometric characteristics, frailty status, physical fitness, physical activity, cognitive function, quality of life, fatigue, and nutritional status. Study assessments also include analysis of inflammatory, endocrine, and nutritional mediators in serum and plasma as potential frailty biomarkers at mRNA and protein levels and multiparametric flow cytometric analysis to measure immunosenescence markers on T and NK cells. Discussion This study seeks to extend our knowledge on exercise interventions during systemic anticancer treatment in patients over 70 years of age. Results from this research will guide the management of older adults during systemic treatment in hospitals seeking to enhance the standard of care.

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Julia García-García mail , Ana Rodriguez-Larrad mail , Maren Martinez de Rituerto Zeberio mail , Jenifer Gómez Mediavilla mail , Borja López-San Vicente mail , Nuria Torrego Artola mail , Izaskun Zeberio Etxetxipia mail , Irati Garmendia mail , Ainhoa Alberro mail , David Otaegui mail , Francisco Borrego Rabasco mail , María M. Caffarel mail , Kalliopi Vrotsou mail , Jon Irazusta mail , Haritz Arrieta mail , Mireia Peláez mail mireia.pelaez@uneatlantico.es, Jon Belloso mail , Laura Basterretxea mail ,

García-García

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Efficacy of liposomal amphotericin B for treating post-kala-azar dermal leishmaniasis (PKDL): A systematic review and single-arm meta-analysis

Background Post-kala-azar dermal leishmaniasis (PKDL) is a skin condition that can become a complication in about 15 % of patients who have had kala-azar. Despite its significance, treatment options for PKDL are still limited. This systematic review and meta-analysis aim to evaluate the efficacy of amphotericin B for this condition. Methods PubMed, Embase, Cochrane, and Web of Science databases were searched for randomized controlled trials (RCTs) that reported the efficacy of Liposomal Amphotericin B in the treatment of PKDL. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Events per 100 observations with 95 % confidence intervals were performed for outcomes. Results Nine studies with 639 patients were included, the treatment durations ranging from 7 to 60 days. The mean age ranged from 9.2 to 31.0 years, and 359 patients were male. The PKDL treatment with liposomal amphotericin B resulted in a cure rate of 91.36 % (95 % CI: 76.60-97.15). However, a relapse was observed in 11.42 % (95 % CI: 6.20-20.8) of patients. Adverse events were common, with hepatic enzyme elevation (ALT/AST) being the most frequent (61.75 %; 95 % CI: 21.81–90.33), followed by fever in 29.93 % of cases (95 % CI: 5.09–77.30). Among the more serious side effects, decreased serum potassium was observed in 19.27 % (95 % CI: 3.84–58.82), and increased serum creatinine, indicative of nephrotoxicity, occurred in 15.08 % (95 % CI: 3.97–43.27). Nausea or vomiting, although less severe, affected 12.36 % of patients (95 % CI: 4.81–28.25). Conclusions These findings highlight that while liposomal amphotericin B is a potent therapeutic option for PKDL, its administration requires careful management and clinical vigilance to optimize outcomes and minimize risks.

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Deivyd Vieira Silva Cavalcante mail , Lilia Maria Lima de Oliveira mail , Noor Husain mail , Beatriz Ximenes Mendes mail , Ana Clara Felix de Farias Santos mail , Luciana Borrigueiro mail , Lyria de Oliveira Rosa mail , Christian Ndikuryayo mail , Sarah Soares Amorim mail , Lalit Mohan mail , Fabiana Castro Porto Silva Lopes mail ,

Cavalcante

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The SAM-m6A axis as an unexplored therapeutic hub for plant-derived regulation of disease metabolism

S-adenosylmethionine (SAM) is the main cellular methyl donor and a core product of one-carbon metabolism. Its balance with S-adenosylhomocysteine (SAH) defines methylation potential and shapes epigenetic and epitranscriptomic outputs. RNA N6-methyladenosine (m6A) directly depends on SAM and is controlled by a writer-reader-eraser system. This review summarizes how altered SAM supply, SAH accumulation, and shifts in the SAM/SAH ratio can reprogram m6A landscapes. These changes can occur in cancer, metabolic disease, inflammation, and neurodegeneration. We integrate metabolic control of SAM generation and consumption with regulation of METTL3/METTL14, WTAP and related cofactors, and the erasers FTO and ALKBH5. We also assess plant-derived bioactive compounds proposed to act on this coupling. Most phytochemicals do not behave as potent, selective m6A enzyme inhibitors. They more often act upstream by reshaping one-carbon metabolism, redox state, and protein expression. This profile contrasts with canonical synthetic inhibitors that block a single node with higher affinity and more predictable pharmacodynamics. Together, the evidence supports the SAM-m6A axis as a practical framework to connect nutrient state with RNA fate decisions. It also highlights key gaps for translation, including target engagement, dose-exposure alignment, and causal validation of m6A-dependent phenotypes.

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Yuxuan Zhao mail , Jingyimei Liang mail , Wanning Ma mail , Jianbo Xiao mail , Hui Cao mail ,

Zhao

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Inflammatory potential of the diet and self-rated quality of life in Italian adults

Background: Dietary quality is widely acknowledged as a key factor in maintaining good health. Recommendations that promote plant-based eating patterns are largely grounded in evidence showing that dietary choices can modulate the immune function. In line with such a hypothesis, diet may be considered as a potential driver of persistent low-grade inflammation. Quality of life (QoL), on the other hand, serves as a broad indicator that encompasses both physical and psychological wellbeing.Aim: The purpose of this cross-sectional study was to examine the relationship between the inflammatory potential of the diet and QoL in a population sample of Italian adults.Design: A total of 1,936 participants completed a 110-item food frequency questionnaire to assess eating habits. The inflammatory potential of their diet was calculated using the dietary inflammatory score (DIS). Quality of life was measured with the Manchester Short Appraisal (MANSA).Results: Higher DIS values, reflecting a more pro-inflammatory diet, were linked to reduced likelihood of reporting high QoL (OR = 0.56; 95% CI: 0.40–0.78). Several specific domains of QoL, including general life satisfaction, social relationships, personal safety, satisfaction with cohabitation, physical health, and mental health, also showed significant associations with DIS.Conclusion: The findings suggest an association between the inflammatory potential of the diet and QoL.

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Francesca Giampieri mail francesca.giampieri@uneatlantico.es, Justyna Godos mail , Giuseppe Caruso mail , Marco Antonio Olvera-Moreira mail , Fabrizio Furnari mail , Andrea Di Mauro mail , Irma Dominguez Azpíroz mail irma.dominguez@unini.edu.mx, Raynier Zambrano-Villacres mail , Evelyn Frias-Toral mail , Fabio Galvano mail , Giuseppe Grosso mail ,

Giampieri

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A scalable and secure federated learning authentication scheme for IoT

Secure and scalable authentication remains a fundamental challenge in Internet of Things (IoT) networks due to constrained device resources, dynamic topology, and the absence of centralized trust infrastructures. Conventional password-based and certificate-driven authentication schemes incur high computation, storage, and communication overhead, limiting their suitability for large-scale deployments. To address these limitations, this paper proposes ScLBS, a federated learning (FL)–based self-certified authentication scheme for distributed and sustainable IoT environments. ScLBS integrates self-certified public key cryptography with FL-driven trust adaptation, enabling decentralized public key derivation without reliance on third-party certificate authorities or exposure of private credentials. A zero-knowledge mechanism combined with location-aware authentication strengthens resistance to impersonation, Sybil, and replay attacks. Hierarchical key management supported by a -tree enables efficient group rekeying and preserves forward and backward secrecy under dynamic membership. Formal security verification is conducted under the Dolev–Yao adversary model using ProVerif, confirming secrecy of private and session keys (SKs) and correctness of authentication. Extensive NS-3 simulations and ablation analysis demonstrate that ScLBS achieves lower authentication delay, reduced message overhead, improved network utilization, and decreased energy consumption compared to representative IoT authentication schemes, while maintaining bounded FL overhead. These results indicate that ScLBS provides a balanced trade-off between security strength, scalability, and resource efficiency for constrained IoT networks.

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Premkumar Chithaluru mail , B. Veera Jyothi mail , Fahd S. Alharithi mail , Wojciech Ksiazek mail , M. Ramchander mail , Aman Singh mail aman.singh@uneatlantico.es, Ravi Kumar Rachavaram mail ,

Chithaluru