Nicola Maffulli

Bio: Nicola Maffulli is an academic researcher from University of Salerno. The author has contributed to research in topics: Achilles tendon & Tendinopathy. The author has an hindex of 115, co-authored 1570 publications receiving 59548 citations. Previous affiliations of Nicola Maffulli include University of Aberdeen & University of Sydney.

The anterior cruciate ligament remnant: to leave it or not?

Abstract: 1. Jumping ability is an essential quality for athletes and a lack in jumping ability is very frustrating for an athlete. With our investigation we found that the DB is the technique that allows one to get closer to this with regard to vertical jump, hence the term “superior,”which is related to the regaining of this capacity. 2. For reasons of clarity and brevity, in the abstract conclusions, only the main findings were reported. 3. Together with Lachman and anterior drawer test, the results of the pivot-shift test were compared between the two groups: a statistically greater number of patients in the SB group showed a positive pivot-shift test compared with the DB group. An improvement in rotational stability, together with reduced anteroposterior displacement as assessed with the KT-1000 arthometer, supports the statement that improved stability can be obtained with DB ACL reconstruction, although no differences could be found in Lachman and anterior drawer tests. 4. In the results section of the abstract, both significant and nonsignificant results were reported. For clarity, wemade the choice thatwas also shared by the Editors of the Journal, to report only those statistically significant results in the abstract conclusions that, in our opinion, were the most likely to interest the readers.

Anterior cruciate ligament reconstruction: A cynical view from the British Isles on the indications for surgery.

Abstract: Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp 203–209

Pharmacological interventions for the treatment of Achilles tendinopathy: a systematic review of randomized controlled trials

Abstract: Introduction: Several pharmacological interventions have been proposed for the management of Achilles tendinopathy, with no agreement on which is the overall best option available. This systematic review investigates the efficacy and safety of different local pharmacological treatments for Achilles tendinopathy. Sources of data: We included only randomized controlled studies (RCTs) focusing on clinical and functional outcomes of therapies consisting in injection of a substance or local application. Assessment of the methodological quality was performed using a modified version of the Coleman methodology score (CMS) to determine possible risks of bias. Areas of agreement: Thirteen RCTs were included with a total of 528 studied patients. Eleven studies reported the outcomes of injection therapies. Two studies examined the outcomes of patients who applied glyceryl trinitrate patch. The mean modified CMS was 70.6 out of 90. Areas of controversy: There was no significant evidence of remarkable benefits provided by any of the therapies studied.

COVID-19: not a contraindication for surgery in patients with proximal femur fragility fractures.

Abstract: During the SARS-CoV-2 outbreak, Italy was the leading country for the number of new positive cases from March 8 2020, to March 21, and the first for the total number of deaths from March 19, to April 12 2020 [1– 4]. The Italian National Healthcare System required the conversion of many wards into COVID-19 care units, and the suspension of deferrable treatments, surgical procedures and outpatient visits, to dedicate human and material resources to free Intensive Care Unit (ICU) beds. In the most struck regions, some hospitals were designated as hubs for non-delayable treatments [5, 6]. Our institution (IRCCS Orthopaedic Institute Galeazzi) was chosen amongst the Trauma Hubs. Orthopaedic trauma surgery focused mainly on femoral fragility fractures in the elderly, since the “lockdown” began on March 10, 2020. Proximal femur fractures carry a high mortality rate [7], and the standard of care involves surgery within 48 h from the trauma [8]. These elderly patients are also the most susceptible to the nefarious consequences of COVID-19 [9]. Thus, orthopaedic surgeons face the daily dilemma of performing life-saving surgery on patients who, given their severe respiratory compromise, have a higher risk of peri-operative death. Preliminary reports from Wuhan, Bergamo (the Italian province with the highest number of cases) and Spain drew different conclusions on the possible benefit effects of surgery on COVID-19 patients with proximal femur fractures [10– 12]. In the first case series, six patients reported proximal femur fractures, but only three were considered eligible for surgery because of no signs of pneumonia at CT scan or non-severe respiratory symptoms [10]. Three of them died, two after conservative management. Of the three surviving patients, two underwent surgery: the authors concluded that patients with proximal femoral fractures and COVID-19 have a higher risk of death. In a series of 16 such patients in Bergamo (Lombardy), Italy [11], three patients died before surgeries for respiratory failure. The other 13 patients (temperature < 38 °C, pO2 > 90% and no signs of multiorgan dysfunction) underwent surgery, with four dying in the first postoperative week. Oxygen saturation improved after surgery in the survivors. Finally, a multicentre observational study on 136 proximal femoral fractures reported an overall 30.4% mortality in COVID19 patients. The mortality rate was 67% in COVID-19 patients treated non-operatively, and only 4% in patients who underwent surgery [12]. The early outcomes (March 17–April 17, 2020) from our Trauma hub endorse the “to fix” faction. Ten swabconfirmed COVID-19 patients (8 women and 2 men) with a mean age of 83.9 ± 7.4 years (range 72-98) underwent surgical treatment for their proximal femoral fractures within 48 h from admission at our facility: 8 patients received intramedullary nailing for AO 31A fractures, and 2 received hemiarthroplasty for AO 31B fractures [13]. The

I and i

Abstract: There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality. Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012)

Abstract: ABI : ankle–brachial index ACCORD : Action to Control Cardiovascular Risk in Diabetes ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation AGREE : Appraisal of Guidelines Research and Evaluation AHA : American Heart Association apoA1 : apolipoprotein A1 apoB : apolipoprotein B CABG : coronary artery bypass graft surgery CARDS : Collaborative AtoRvastatin Diabetes Study CCNAP : Council on Cardiovascular Nursing and Allied Professions CHARISMA : Clopidogrel for High Athero-thrombotic Risk and Ischemic Stabilisation, Management, and Avoidance CHD : coronary heart disease CKD : chronic kidney disease COMMIT : Clopidogrel and Metoprolol in Myocardial Infarction Trial CRP : C-reactive protein CURE : Clopidogrel in Unstable Angina to Prevent Recurrent Events CVD : cardiovascular disease DALYs : disability-adjusted life years DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Trial ED : erectile dysfunction eGFR : estimated glomerular filtration rate EHN : European Heart Network EPIC : European Prospective Investigation into Cancer and Nutrition EUROASPIRE : European Action on Secondary and Primary Prevention through Intervention to Reduce Events GFR : glomerular filtration rate GOSPEL : Global Secondary Prevention Strategies to Limit Event Recurrence After MI GRADE : Grading of Recommendations Assessment, Development and Evaluation HbA1c : glycated haemoglobin HDL : high-density lipoprotein HF-ACTION : Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing HOT : Hypertension Optimal Treatment Study HPS : Heart Protection Study HR : hazard ratio hsCRP : high-sensitivity C-reactive protein HYVET : Hypertension in the Very Elderly Trial ICD : International Classification of Diseases IMT : intima-media thickness INVEST : International Verapamil SR/Trandolapril JTF : Joint Task Force LDL : low-density lipoprotein Lp(a) : lipoprotein(a) LpPLA2 : lipoprotein-associated phospholipase 2 LVH : left ventricular hypertrophy MATCH : Management of Atherothrombosis with Clopidogrel in High-risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke MDRD : Modification of Diet in Renal Disease MET : metabolic equivalent MONICA : Multinational MONItoring of trends and determinants in CArdiovascular disease NICE : National Institute of Health and Clinical Excellence NRT : nicotine replacement therapy NSTEMI : non-ST elevation myocardial infarction ONTARGET : Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial OSA : obstructive sleep apnoea PAD : peripheral artery disease PCI : percutaneous coronary intervention PROactive : Prospective Pioglitazone Clinical Trial in Macrovascular Events PWV : pulse wave velocity QOF : Quality and Outcomes Framework RCT : randomized clinical trial RR : relative risk SBP : systolic blood pressure SCORE : Systematic Coronary Risk Evaluation Project SEARCH : Study of the Effectiveness of Additional Reductions in Cholesterol and SHEP : Systolic Hypertension in the Elderly Program STEMI : ST-elevation myocardial infarction SU.FOL.OM3 : SUpplementation with FOlate, vitamin B6 and B12 and/or OMega-3 fatty acids Syst-Eur : Systolic Hypertension in Europe TNT : Treating to New Targets UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use VITATOPS : VITAmins TO Prevent Stroke VLDL : very low-density lipoprotein WHO : World Health Organization ### 1.1 Introduction Atherosclerotic cardiovascular disease (CVD) is a chronic disorder developing insidiously throughout life and usually progressing to an advanced stage by the time symptoms occur. It remains the major cause of premature death in Europe, even though CVD mortality has …

Harrison's Principles of Internal Medicine

Abstract: The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many