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.

Matrix metalloproteases: a role in overuse tendinopathies.

Abstract: The balance between matrix metalloproteases and their inhibitors is important in maintaining healthy tendons Tendinopathy is a broad term used to describe disorders in and around tendons, with absence of inflammatory cells and a poor healing response, demonstrated by collagen fibrils separated from each other lengthwise and disrupted in cross section. Tendinitis, tendinosis, and paratenonitis are all examples of tendinopathy.1 MMPs, a family of zinc and calcium dependent endopeptidases active at a neutral pH, are involved in the remodelling of extracellular matrix (ECM) through their broad proteolytic capability.2 Degradation of collagen in tendon ECM is initiated by MMPs.3 Twenty three human MMPs have been identified,2 with a wide range of extracellular substrates (table 1).4,5 MMPs can be subdivided into four main groups: collagenases, which cleave native collagen types I, II, and III; gelatinases, which cleave denatured collagens and type IV collagen; stromelysins, which degrade proteoglycans, fibronectin, casein, collagen types III, IV, and V; membrane-type MMPs.5 View this table: Table 1 The main components of the matrix metalloprotease (MMP) family The activity of MMPs is inhibited reversibly by TIMPs in a non-covalent fashion in a 1:1 stoichiometry.5 There are four types of TIMP: TIMP1, TIMP2, TIMP3, and TIMP4.5 The balance between the activities of MMPs and TIMPs regulates tendon remodelling, and an imbalance produces collagen disturbances in tendons.6 MMP3 may play a major role in regulation of tendon ECM degradation and tissue remodelling. An increased expression of MMP3 may be necessary for appropriate tissue remodelling and prevention of tendinopathic changes.7 The timing of MMP3 production is probably also …

Eccentric calf muscle training in athletic patients with Achilles tendinopathy

Abstract: Purpose. To evaluate the effects of eccentric strengthening exercises (ESE) in athletic patients with Achilles tendinopathy.Methods. Forty-five athletic patients (29 men, average age 26 years ± 12.8, range 18 – 42; 16 women, average age 28 years ± 13.1, range 20 – 46; average height: 173 ± 16.8, range 158 – 191; average weight 70.8 kg ± 15.3, range 51.4 – 100.5) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks.Results. The mean pre-management VISA-A scores of 36 (SD 23.8; 95% CI: 29 – 46) improved to 52 (SD 27.5; 95% CI: 41.3 – 59.8) at the latest follow up (p = 0.001). Twenty seven of the 45 patients responded to the eccentric exercises. Of the 18 patients who did not improve with eccentric exercises, 5 (mean age: 33 years) improved with two peritendinous aprotinin and lo...

Minimally invasive stripping for chronic Achilles tendinopathy.

Abstract: Purpose. To present a minimally invasive technique for the management of chronic Achilles tendinopathy (AT).Methods. Four longitudinal skin incisions each 0.5 cm long are made. Two incisions are made just medial and lateral to the origin of the tendon; the other two incisions are made just medial and lateral to the distal end of the tendon close to its insertion. A mosquito is inserted in the incisions, and the proximal and distal portions of Achilles tendon are freed of all the peritendinous adhesions. A Number 1 unmounted Ethibond (Ethicon, Somerville, NJ) suture thread is inserted proximally, passing through the two proximal incisions over the anterior aspect of the Achilles tendon. The Ethibond is retrieved from the distal incisions, over the anterior aspect of the Achilles tendon. The Ethibond is slid on the tendon, which in this way is stripped and freed from adhesions. The procedure is repeated for the posterior aspect of the Achilles tendon. In addition, longitudinal percutaneous tenotomies parall...

Monitoring of serum enzymes in sport

Abstract: Monitoring of creatine kinase and lactate dehydrogenase can reveal the state of the muscle and its biochemical adaptation to physical load

Management of calcaneal fractures: systematic review of randomized trials

Abstract: Introduction: The optimal management of calcaneal fractures is controversial, as correlation between anatomical restoration and outcome has not been proven, and complications after surgery are frequent. Sources of data: MEDLINE, EMBASE, CINAHL, Google scholar, the Cochrane Controlled Trials Register, and the Cochrane Musculoskeletal Injuries Group Trials Register were searched using the keywords ‘calcaneal’ and ‘fractures’, without time limits or restriction to language. Randomized and quasi-randomized trials were included. Two separate comparisons were identified in the trials: operative versus non-operative management (five studies), and impulse compression versus no impulse compression (one study). Two reviewers independently assessed trial quality, with a 12-item scale used by the Cochrane Collaboration. Areas of agreement: Results showed no difference in residual pain, but favoured surgical management on ability to return to the same work and to wear the same shoes as before the fracture. Surgery reduced the need for subsequent subtalar fusion. workers’ compensation affected outcome. Areas of controversy: It is unclear whether general health outcome measures, injury specific scores and radiographic parameters improve after operative management, and whether the benefits of surgery outweigh the risks. Growing points: The existing trials are of relatively poor quality. Areas timely for developing research: There is still a need for a carefully designed large-scale trial comparing surgery and non-operative management. Other forms of fixation (external fixation or minimally invasive internal fixation) should be compared with ‘conventional’ surgery. Trials investigating joint reconstruction versus primary subtalar fusion for highly comminuted fractures, and impulse compression versus placebo could be of value.

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