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Palladini G.,University of Pavia | Milani P.,University of Pavia | Foli A.,University of Pavia | Obici L.,University of Pavia | And 5 more authors.
Haematologica | Year: 2014

The combination of oral melphalan and dexamethasone is considered standard therapy for patients with light-chain amyloidosis ineligible for autologous stem cell transplantation. However, previous trials reported different rates of response and survival, mainly because of the different proportions of high-risk patients. In the present study, including a total of 259 subjects, we treated 119 patients with full-dose melphalan and dexamethasone (dexamethasone 40 mg days 1-4), and 140 patients with advanced cardiac disease with an attenuated dexamethasone schedule (20 mg). Hematologic response rates were 76% in the full-dose group and 51% in the patients receiving the attenuated schedule The corresponding complete response rates were 31% and 12%, respectively. The median survival was 7.4 years in the full-dose group and 20 months in the attenuated-dose group. Use of high-dose dexamethasone, amino-terminal pro-natriuretic peptide type-B >1800 ng/L, a difference between involved and uninvolved free light chains of >180 mg/L, troponin I >0.07 ng/mL, and response to therapy were independent prognostic determinants. In relapsed/refractory subjects bortezomib combinations granted high hematologic response rates (79% and 63%, respectively), proving the most effective rescue treatment after melphalan and dexamethasone. In summary, melphalan plus dexamethasone was highly effective with minimal toxicity, confirming its central role in the treatment of AL amyloidosis. Future randomized trials will clarify whether bortezomib is best used in frontline combination with melphalan and dexamethasone or as rescue treatment. © Ferrata Storti Foundation.

Cereda E.,Nutrition and Dietetics Service
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2012

Purpose of review To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). Recent findings Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the costeffectiveness of interventions based on its scoring deserves investigation. © 2011 Wolters Kluwer Health.

Cereda E.,Nutrition and Dietetics Service | Malavazos A.E.,U.O. di Diabetologia e Malattie Metaboliche | Caccialanza R.,Nutrition and Dietetics Service | Rondanelli M.,University of Pavia | And 2 more authors.
Clinical Nutrition | Year: 2011

Background & aims: To investigate the association between history of multiple weight loss diets followed by weight regain, namely weight cycling (WCy), and both body weight excess and abdominal fat accumulation. Methods: A one-day cross-sectional survey (" Obesity-Day" ) including 914 participants (605F:309M). Anthropometric variables (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WtHR]), covariates and WCy (≥5 intentional weight loss episodes of ≥5 kg followed by rapid return to pre-diet or higher body weight) were assessed by a self-administered questionnaire, interview and physical examination. Results: Data on central fat accumulation (by WC and WtHR) were available in a representative sub-group (n = 600). WCy was reported by 119 participants (13.0%) of total population and by 79 (13.2%) of those with available data on central fat accumulation. At multivariable linear regressions WCy was independently associated with higher BMI (P = .004), WC (P = .011) and WtHR (P = .008). Sensitivity analyses, performed after excluding those being on a diet at the time of assessment, confirmed these findings. Conclusions: A history of WCy appears related to body weight excess and abdominal fat accumulation. These findings support the importance of designing adequate weight loss programs to achieve long-term weight maintenance and to prevent undesirable and unhealthy weight accumulation. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Dakanalis A.,University of Pavia | Carra G.,University College London | Calogero R.,University of Kent | Zanetti M.A.,University of Pavia | And 5 more authors.
European Archives of Psychiatry and Clinical Neuroscience | Year: 2015

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses. © 2014, Springer-Verlag Berlin Heidelberg.

Cereda E.,Nutrition and Dietetics Service | Pedrolli C.,Unita Operativa di Dietetica e Nutrizione Clinica | Zagami A.,Fondazione Bellaria Onlus | Vanotti A.,Servizio di Dietetica e Nutrizione Clinica | And 4 more authors.
British Journal of Nutrition | Year: 2013

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI <Â 92) and low (GNRI 92-98) nutritional risk were 36·1 and 30·6Â %, respectively. At multivariable linear regression, functional status was independently associated with age (P=Â 0·045), arm muscle area (P=Â 0·048), the number of co-morbidities (P=Â 0·027) and mainly with the GNRI (P<Â 0·001). During a median follow-up of 4·7 years (25th-75th percentile 3·7-6·2), 230 (66·5Â %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95Â % CI 1·32, 2·63; P<Â 0·001) and low nutritional risk (HR 1·52, 95Â % CI 1·08, 2·14; P=Â 0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI <Â 92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95Â % CI 1·28, 2·91; P<Â 0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly. Copyright © The Authors 2013.

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