Naldi L.,Presidio |
Conti A.,Azienda Ospedaliero Universitaria Policlinico |
Cazzaniga S.,Presidio |
Patrizi A.,Dermatolologia |
And 16 more authors.
British Journal of Dermatology | Year: 2014
Background Increased body mass index and weight gain are risk factors for psoriasis, and the prevalence of obesity in patients with psoriasis is higher than in the general population. Limited data exist regarding the role of diet in psoriasis. Objectives To assess the impact of a dietary intervention combined with physical exercise for weight loss on improving psoriasis in overweight or obese patients. Methods This study included 303 overweight or obese patients with moderate-to-severe chronic plaque psoriasis who did not achieve clearance after 4 weeks of continuous systemic treatment. They were randomized to receive either a 20-week quantitative and qualitative dietary plan associated with physical exercise for weight loss or simple informative counselling at baseline about the utility of weight loss for clinical control of psoriatic disease. The main outcome was any reduction of the Psoriasis Area and Severity Index (PASI) from baseline to week 20. Results Intention-to-treat analysis showed a median PASI reduction of 48% (95% confidence interval 33·3-58·3%) in the dietary intervention arm and 25·5% (95% confidence interval 18·2-33·3%) in the information-only arm (P = 0·02). Among secondary outcomes, PASI score reduction of ≥ 50% significantly differed between study arms (49·7% with dietary intervention vs. 34·2% with information only, P = 0·006). The weight-loss target (a ≥ 5% reduction from baseline) was reached by 29·8% of patients in the dietary intervention arm compared with 14·5% in the information-only arm (P = 0·001). Conclusions A 20-week dietetic intervention associated with increased physical exercise reduced psoriasis severity in systemically treated overweight or obese patients with active psoriasis. What's already known about this topic? Obesity is a risk factor for psoriasis development in both adult and paediatric populations. Psoriasis is associated with metabolic derangements, such as type II diabetes. Obesity may reduce the response to systemic treatment. What does this study add? This randomized controlled trial shows that an intervention combining diet restriction and promotion of physical exercise in overweight or obese patients with active psoriasis helps to reduce psoriasis severity beyond the effects of systemic treatment over a 20-week period. The effect may be related to the weight loss alone, or to some indirect influence on patient compliance or other treatment components. © 2013 British Association of Dermatologists.
Suardi N.,Vita-Salute San Raffaele University |
Gandaglia G.,Vita-Salute San Raffaele University |
Nini A.,Vita-Salute San Raffaele University |
Montorsi F.,Vita-Salute San Raffaele University |
And 3 more authors.
Minerva Urologica e Nefrologica | Year: 2014
Aim. Although previous studies assessed the effects of Serenoa repens, quercetin and β-sitosterol on inflammatory parameters, no randomized studies have tested the combination of these agents neither on BPH symptoms nor on the inflammatory pattern. The aim of this trial was to evaluate the effects of Difaprost® on voiding dysfunction, histologi-cal inflammatory alterations and apoptotic molecular mechanisms in BPH patients. Methods. We included 36 patients affected by BPH with obstructive symptoms eligible for surgery. Patients were randomly assigned to two groups: 18 patients received Difaprost® for three months before surgery, and 18 patients did not receive any additional therapy and were scheduled for surgery. All patients receiving Difaprost® were evaluated with uroflowmetry with post-void residual volume (PVR) evaluation, serum PSA, and IPSS questionnaire before and after treatment. Moreover, we evaluated inflammatory patterns in prostatic specimens at final pathology. Results. Even without statistically significant differences on inflammatory pattern between patients receiving Difaprost® and controls, patients receiving Difaprost® had lower presence of edema and angiectasia at histological evaluation of prostate specimens. Moreover, patients included in the treatment group had a clinically significant reduction of PVR (46.1 vs. 25.2 mL; P=0.1) and a slight increase in Qmed (5.6 vs. 6.5 mL/s; P=0.9) after three months of chronic treatment with Difaprost®. No statistically significant differences were recorded in other clinical parameters between patients receiving Difaprost® and controls. Conclusion. Although not statistically significant, patients treated with Difaprost® showed an improvement in voiding function compared to controls (namely, an increase in Qmed and a reduction of PVR). Future trials with a larger number of patients and a longer treatment period could be necessary to evaluate the clinical efficacy of Difaprost®.
Vigo F.,Radiation Oncology Unit |
Ciammella P.,Radiation Oncology Unit |
Valli R.,Pathology Unit |
Cagni E.,Arcispedale Santa Maria Nuova IRCCS |
Iotti C.,Radiation Oncology Unit
Journal of Medical Case Reports | Year: 2012
Introduction: Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation: A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion: The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma. © 2012 Vigo et al.; licensee BioMed Central Ltd.
Masi G.,Azienda Ospedaliero Universitaria Pisana |
Salvatore L.,Azienda Ospedaliero Universitaria Pisana |
Boni L.,Clinical Trials Coordinating Center |
Loupakis F.,Azienda Ospedaliero Universitaria Pisana |
And 14 more authors.
Annals of Oncology | Year: 2015
Background: The combination of bevacizumab with fluorouracil-based chemotherapy is a standard first-line treatment option in metastatic colorectal cancer (mCRC). We studied the efficacy of continuing or reintroducing bevacizumab in combination with second-line chemotherapy after progression to bevacizumab-based first-line therapy. Patients and methods: In this phase III study, patients with mCRC treated with fluoropyrimidine-based first-line chemotherapy plus bevacizumab were randomized to receive in second-line mFOLFOX-6 or FOLFIRI (depending on firstline regimen) with or without bevacizumab. The primary end point was progression-free survival. To detect a hazard ratio (HR) for progression of 0.70 with an α and β error of 0.05 and 0.20, respectively, 262 patients were required. Results: In consideration of the results of the ML18147 trial, the study was prematurely stopped. Between April 2008 and May 2012, a total of 185 patients were randomized. Bevacizumab-free interval was longer than 3 months in 43% of patients in chemotherapy alone arm and in 50% of patients in the bevacizumab arm. At a median follow-up of 45.3 months, the median progression-free survival was 5.0 months in the chemotherapy group and 6.8 months in the bevacizumab group [adjusted HR = 0.70; 95% confidence interval (CI) 0.52-0.95; stratified log-rank P = 0.010]. Subgroup analyses showed a consistent benefit in all subgroups analyzed and in particular in patients who had continued or reintroduced bevacizumab. An improved overall survival was also observed in the bevacizumab arm (adjusted HR = 0.77; 95% CI 0.56-1.06; stratified log-rank P = 0.043). Responses (RECIST 1.0) were similar in the chemotherapy and bevacizumab groups (17% and 21%; P = 0.573). Toxicity profile was consistent with previously reported data. Conclusions: This study demonstrates that the continuation or the reintroduction of bevacizumab with second-line chemotherapy beyond first progression improves the outcome and supports the use of this strategy in the treatment of mCRC. Clinical Trials.gov number: NCT00720512. © The Author 2015.
Nahum Y.,Rabin Medical Center |
Nahum Y.,Tel Aviv University |
Iovieno A.,Arcispedale Santa Maria Nuova IRCCS |
Lipari E.,Phronema S.r.l. |
And 2 more authors.
Cornea | Year: 2016
Purpose: To evaluate whether a discrepancy between the orientation of graft and recipient collagen lamellae can significantly limit the visual acuity after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: A multicenter cohort study of eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy at Villa Serena-Villa Igea private Hospitals (Forlì, Italy) and at Santa Maria Nuova public hospital (Reggio Emilia, Italy), which were scheduled for a postoperative examination between July and September 2014. We have included eyes with a distance-corrected visual acuity of 8/10 or better, no ocular comorbidities, and a clear cornea. The main outcome measure was graft-recipient axis discrepancy of lamellar orientation around the visual axis as assessed by polarimetric interferometry. Results: Twelve eyes were included in this study. Eight eyes had a spectacle-corrected distance visual acuity of 8/10, 3 eyes had 9/10, and 1 eye had 10/10. In 8/12 (66.7%) eyes, 2 discernible axes of collagen lamellar orientation were identified and were all 30 degrees or more apart (range 30-90). In 2 eyes, only 1 axis was identified and in another 2 eyes, 2 axes 20 and 17 degrees apart were identified. The eye with 10/10 visual acuity presented a discrepancy of 17 degrees between lamellar axes. Conclusions: A discrepancy between the lamellar orientation of the graft and the recipient is compatible with excellent visual acuity after DSAEK. © 2016 Wolters Kluwer Health, Inc. All rights reserved.