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 safe zone for avoiding suprascapular nerve injury in bone block procedures for shoulder instability. A cadaveric study

Abstract: The purpose of the study is to identify the safe zone in which the surgeon can place the screws for fixation of the coracoid graft during the Latarjet procedure to avoid injuries of the suprascapular nerve with the shoulder in internal and external rotation. The dissection on twelve fresh-frozen shoulders was performed according to a standard posterior approach to the gleno-humeral joint. The suprascapular nerve and its branches for the infraspinatus muscle were identified at the spinoglenoid notch region. Then, the distance between the glenoid and the suprascapular nerve at the spinoglenoid notch region was measured by using a ruler with the shoulder at 90° internal rotation and at 90° of external rotation. The median distance between the glenoid and the suprascapular nerve was 12 mm (range 6–15 mm) with the shoulder at 90° of internal rotation and 19 mm (range 11–23 mm) with the shoulder at 90° of external rotation. The distance between the glenoid and the suprascapular nerve was statistically significantly greater with the shoulder at 90° of external rotation than 90° of internal rotation (P = 0.002). The suprascapular nerve is furthest away from the glenoid with the shoulder at 90° of external rotation. Therefore, the placement of screws in external rotation of the humerus during glenoid bone block procedures likely reduces the risk of iatrogenic injuries of the suprascapular nerve.

Exercise in Pregnancy: How Safe Is It?

Abstract: SUMMARY The role of exercise in pregnancy (EIP) is widely debated. Pregnancy produces marked changes of several physiologic variables of the mother. Regular EIP limits the increase in O2 requirement and produces an increase in the absolute anaerobic threshold, which persists for up to 36 weeks. Exercise in pregnancy reduces the incidence of muscle cramps, lower limb edema, fatigue, and shortness of breath. Increased knee cruciate ligament laxity does not normally produce any instability. Exercise in pregnancy reduces the increase in baseline maternal heart rate that occurs in pregnancy. Heart rate and stroke volume increase more markedly with exercise in pregnant women than in nonpregnant controls. Noradrenalin response to EIP is lower than in nonpregnant controls. Blood glucose levels decrease more promptly and to lower values with exercise in pregnant women than in nonpregnant controls. Glucose tolerance normally decreases in pregnancy, but increases during EIP. Regular EIP improves glucose tolerance in diabetic mothers and reduces total maternal weight gain and subcutaneous fat deposition toward the lower end of the normal range. Regular EIP produces higher plasma endorphin levels during labor and better pain tolerance than in sedentary controls. Women who undertake regular EIP have a lower incidence of 3rd- and 4th-degree vaginal tears. Children of exercising mothers have similar birth-weights as children of sedentary mothers, and mental performance at age 5 is higher. If there are no specific obstetric or medical contraindications, fit pregnant women can safely maintain the same level of fitness during pregnancy, although exercise schedules may have to be reduced.

Effect of training and sudden detraining on the patellar tendon and its enthesis in rats

Abstract: Different conditions may alter tendon characteristics. Clinical evidence suggests that tendon injuries are more frequent in athletes that change type, intensity and duration of training. Aim of the study was the assessment of training and especially detraining on the patellar tendon (PT) and its enthesis. 27 male adult Sprague-Dawley rats were divided into 3 groups: 20 rats were trained on a treadmill for 10 weeks. Of these, 10 rats were euthanized immediately after training (trained group), and 10 were caged without exercise for 4 weeks before being euthanized (de-trained group). The remaining 7 rats were used as controls (untrained rats). PT insertion, structure (collagen fiber organization and proteoglycan, PG, content), PT thickness, enthesis area, and subchondral bone volume at the enthesis were measured by histomorphometry and microtomography. Both PG content and collagen fiber organization were significantly lower in untrained and detrained animals than in trained ones (p < 0.05 and p < 0.0001). In the detrained group, fiber organization and PG content were worse than that of the untrained groups and the untrained group showed a significantly higher score than the detrained group (p < 0.05). In the trained group, the PT was significantly thicker than in untrained group (p < 0.05). No significant differences in the enthesis area and subchondral bone volume among the three groups were seen. Moderate exercise exerts a protective effect on the PT structure while sudden discontinuation of physical activity has a negative effect on tendons. The present results suggest that after a period of sudden de-training (such as after an injury) physical activity should be restarted with caution and with appropriate rehabilitation programs.

Validation of a new portable metabolic system during an incremental running test.

Abstract: We tested a new portable metabolic system, the Jaeger Oxycon Mobile (OM) at a range of running speeds. Six subjects carried out, in random order, two incremental tests on a treadmill, one of them using the OM, and the other using the Jaeger Oxycon Pro (OP). There are systematic errors in the measurements of oxygen consumption (VO2) and respiratory exchange ratio (RER) with the OM. Production of CO2 (VCO2) tends to be overestimated by the OM, although the differences are not significant. Ventilation (VE) showed very similar values in both analyzers. Data of VO2 and RER were corrected with a regression equation which minimised the differences among the devices. The portable metabolic system OM makes systematic errors in measurements of VO2 and RER which can be adjusted with a regression analysis to obtain data comparable to those obtained by fixed systems.

Lack of seasonal variation in idiopathic talipes equinovarus.

Abstract: Background: One proposed etiology of idiopathic talipes equinovarus is an in utero enterovirus infection. Enterovirus infections demonstrate seasonal variation in temperate climates. Methods: We collected data on 1202 children with idiopathic talipes equinovarus born in the Northeastern United States, Midwestern United States, and the United Kingdom to investigate a seasonal variation in this congenital deformity. Birth date, gestational age at the time of delivery, gender, race, and laterality were tabulated and subjected to univariate and bivariate analyses. Results: There were 774 boys and 428 girls with idiopathic talipes equinovarus. The birth location was the United Kingdom (458 children), the Midwestern United States (426 children), and the Northeastern United States (318 children). No significant differences were detected among the geographic groups with respect to gender, race, or laterality, and no variation in month of birth or month of conception was noted. Conclusions: This study does not support an in utero enterovirus infection as an etiology of idiopathic talipes equinovarus in industrialized populations.

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