A haplotype in the dipeptidyl peptidase 4 gene impacts glycemic-related traits of Brazilian older adults.

Dipeptidyl peptidase 4 (DPP4) regulates various physiological pathways and has a pivotal role in glucose homeostasis. The objective of this study was to verify the association of a haplotype constituted by two single nucleotide polymorphisms (rs2268894 and rs6741949) in the DPP4 gene with type 2 diabetes mellitus (T2DM) and fasting glycemia-related variables in a sample of Brazilian older adults, taking serum levels and enzymatic activity of DPP4 into account. Clinical, biochemical, and anthropometric characteristics as well as DPP4 serum levels and enzymatic activity were determined in 800 elderly (≥60 years old) individuals. Assessment of polymorphic sites was performed by real-time PCR whereas haplotypes were inferred from genotypic frequencies. Statistical analyses compared measures and proportions according to T2DM diagnosis and DPP4 haplotypic groups. The most common haplotype consisted of the T-rs2268894/G-rs6741949 string, which was 20% more frequent among non-diabetics. Considering non-diabetic patients alone, carriers of the T/G haplotype had significantly lower levels of blood glucose, insulin, HOMA-IR index, and DPP4 activity. Among diabetic patients, the T/G haplotype was associated with lower DPP4 levels whereas glycemic scores were not affected by allelic variants. Our results suggested that the genetic architecture of DPP4 affects the glycemic profile and DPP4 serum levels and activity among elderly individuals according to the presence or absence of T2DM, with a possible implication of the T/G haplotype to the risk of T2DM onset.

A haplotype in the dipeptidyl peptidase 4 gene impacts glycemic-related traits of Brazilian older adults

Dipeptidyl peptidase 4 (DPP4) regulates various physiological pathways and has a pivotal role in glucose homeostasis. The objective of this study was to verify the association of a haplotype constituted by two single nucleotide polymorphisms (rs2268894 and rs6741949) in the DPP4 gene with type 2 diabetes mellitus (T2DM) and fasting glycemia-related variables in a sample of Brazilian older adults, taking serum levels and enzymatic activity of DPP4 into account. Clinical, biochemical, and anthropometric characteristics as well as DPP4 serum levels and enzymatic activity were determined in 800 elderly (≥60 years old) individuals. Assessment of polymorphic sites was performed by real-time PCR whereas haplotypes were inferred from genotypic frequencies. Statistical analyses compared measures and proportions according to T2DM diagnosis and DPP4 haplotypic groups. The most common haplotype consisted of the T-rs2268894/G-rs6741949 string, which was 20% more frequent among non-diabetics. Considering non-diabetic patients alone, carriers of the T/G haplotype had significantly lower levels of blood glucose, insulin, HOMA-IR index, and DPP4 activity. Among diabetic patients, the T/G haplotype was associated with lower DPP4 levels whereas glycemic scores were not affected by allelic variants. Our results suggested that the genetic architecture of DPP4 affects the glycemic profile and DPP4 serum levels and activity among elderly individuals according to the presence or absence of T2DM, with a possible implication of the T/G haplotype to the risk of T2DM onset.

Transplantation of Human Amniotic Membrane over the Liver Surface Reduces Hepatic Fibrosis in a Cholestatic Model in Young Rats.

PURPOSE: Biliary atresia precedes liver cirrhosis and liver transplantation. Amniotic membrane (AM) promotes tissue regeneration, inhibits fibrosis, and reduces inflammation. Here, we test amniotic membrane potential as a therapeutic tool against cholestatic liver fibrosis. METHODS: Three groups of rats were used: sham surgery (SS), bile duct ligature (BDL), and bile duct ligature plus human amniotic membrane (BDL + AM). After surgery, animals were sacrificed at different weeks. Biochemical and histopathological analyses of liver tissue were performed. Collagen was expressed as a percentage of total liver tissue area. qPCR was performed to analyse gene expression levels of transforming growth factor-ß1 (Tgfb1) and apelin (Apln). Statistical analysis performed considered p < 0.05 was significant. RESULTS: Groups undergoing BDL developed cholestasis. Biochemical markers from BDL + AM group improved compared to BDL group. Ductular reaction, portal fibrosis, and bile plugs were markedly reduced in the BDL + AM group compared to BDL group. Collagen area in BDL + AM group was statistically decreased compared to BDL group. Finally, expression levels of both Apln and Tgfb1 mRNA were statistically downregulated in BDL + AM group versus BDL group. CONCLUSION: AM significantly reduces liver fibrosis in a surgical animal model of cholestasis. Our results suggest that AM may be useful as a therapeutic tool in liver cirrhosis.

Alteraciones del sueño en el enfermo grave. Un evento de gran repercusión y poco tomado en cuenta / Sleep disorders in the critically ill patient. An event of great impact and little taken into account

Resumen: El sueño favorece una mejor evolución y recuperación en los enfermos graves. Las alteraciones del sueño afectan con frecuencia a los enfermos internados en la unidad de terapia intensiva, su causa es multifactorial y se asocia con alteraciones del sistema inmunitario, disfunción en el anabolismo, retardo en los procesos regenerativos, desorganización neurofisiológica, disfunción cognitiva, delirio, incremento en los días de hospitalización y mortalidad. Las alteraciones del sueño en el paciente grave se caracterizan por anomalías del ritmo circadiano sueño-vigilia, índice elevado de despertares, fragmentación, reducción del sueño de ondas lentas y disfunción grave de la fase de movimientos oculares rápidos. Las intervenciones para su tratamiento son no farmacológicas y farmacológicas. De las farmacológicas la melatonina es un agente terapéutico promisorio para la profilaxis y para el tratamiento. El objetivo de este trabajo es revisar los conceptos actuales relacionados con la disfunción del sueño en el enfermo grave, su repercusión en la práctica clínica y las medidas a implementar para su profilaxis y tratamiento.

Abstract: Sleep is important for good outcome and recovery in critically ill patients. Sleep disturbances affect commonly critically ill patients and are associated with impair of immune system, anabolic and regenerative processes, neurophysiologic organization, cognitive dysfunction, delirium, prolonged Intensive Care Unit stay and mortality. The critically ill present pathologic sleep patterns characterized by abnormal circadian rhythm, high arousal and awakening index, reduced slow wave sleep and rapid eye movement sleep. Melatonin is a promissory prophylactic or therapeutic agent in the management of sleep disturbances. The aim of this paper is to review current concepts related to sleep disturbances in the critically ill, their clinical impact, prevention and the new therapeutic alternatives.

Netrin-1 and multiple sclerosis: a new biomarker for neuroinflammation?

BACKGROUND AND PURPOSE: Netrin-1, an axon guidance protein, reduces serum levels of pro-inflammatory mediators and stabilizes the blood-brain barrier limiting the entrance of immune cells into the central nervous system. The aim was to investigate its presence in the experimental autoimmune encephalomyelitis (EAE) model and in multiple sclerosis (MS) patients with and without clinical activity. METHODS: Netrin-1 levels were evaluated in EAE mouse tissues. Afterwards, serum netrin-1 was cross-sectionally quantified in 90 patients with different MS phenotypes and 30 control subjects. An additional group of 10 relapsing-remitting MS (RRMS) patients was longitudinally evaluated throughout a relapse (RRMSr) with an interval of 60 days. Tumour necrosis factor α (TNFα), a reference inflammatory cytokine, and netrin-1 were quantified by enzyme-linked immunosorbent assay. RESULTS: Experimental autoimmune encephalomyelitis mice showed significantly lower netrin-1 levels and higher TNFα amounts in sera, spinal cord and cerebella than healthy control mice. MS patients showed significantly lower serum netrin-1 levels than controls (511.62 ± 209.30 and 748.32 ± 103.24 pg/ml, respectively; P ≤ 0.005). The lowest protein levels were found in RRMSr, remaining significantly lower throughout the relapse. TNFα serum concentrations were higher in MS patients compared to controls, and negatively correlated with netrin-1 levels (r = -0.3734, P ≤ 0.0001). CONCLUSIONS: Netrin-1 decreased in EAE and in MS patients, mainly during relapse, suggesting an anti-inflammatory role of netrin-1. Further research should be performed in a larger cohort of patients to validate netrin-1 as a biomarker of MS inflammatory activity.

Reduced Bone Stiffness in Women Is Associated with Clinical Attachment and Tooth Loss: The Study of Health in Pomerania.

The authors evaluated the association of reduced bone stiffness of the calcaneus with clinical attachment loss (CAL) and tooth loss. The authors analyzed data from 4,678 subjects (2,384 women), aged 20 to 88 y, from the second follow-up of the population-based Study of Health in Pomerania (SHIP-2) and the baseline examination of the SHIP-Trend cohort. Bone stiffness, characterized by the stiffness index (SI) and the osteoporotic fracture risk (OFR), was assessed by quantitative ultrasound of the heel. SI and OFR were significantly associated with the mean CAL in women. While 1) the SI showed a significant association with the mean CAL and 2) the OFR with the median number of teeth in just the postmenopausal women, the OFR showed a significant association with mean CAL for both pre- and postmenopausal women. In postmenopausal women, a 10-unit increase in the SI was associated with a decrease in the mean CAL of 0.05 mm (95% confidence interval [CI]: -0.10 to 0.00; P = 0.046). Moreover, the adjusted median number of teeth was 21.4 (95% CI: 20.9 to 21.9) among the postmenopausal women with a low OFR, while it was 19.1 (95% CI: 17.8 to 20.3; P = 0.001) among the postmenopausal women with a high OFR. For the premenopausal women with a low OFR, the mean CAL was 1.60 mm (95% CI: 1.53 to 1.66), while for the premenopausal women with a high OFR, it was 2.24 mm (95% CI: 1.78 to 2.69; P = 0.006). Reduced bone stiffness was associated with clinical attachment and tooth loss in women but not in men.

Dimensionamento de amostras e o mito dos números mágicos: ponto de vista / Tamaño muestral y el mito de los números mágicos: punto de vista (AU) / Sample size and the myth of magical numbers: point of view

O presente texto dissertará sobre aspectos que devem ser cuidadosamente ponderados por pesquisadores com o propósito de se estabelecer, a priori, o tamanho amostral em estudos na área da saúde, aptidão física e desempenho humano. Entretanto, é importante salientar que o cálculo de amostras é uma ciência que exige seguras suposições realistas, anterior à sua estimativa. Por fim, observamos que, apesar dos grandes avanços tecnológicos que têm contribuído para a maior velocidade de produção científica, é de vital importância que o pesquisador tenha o compromisso em respeitar premissas que habilitam a qualidade do trabalho científico. Nesse sentido, a apropriada especificação do tamanho amostral confere validade interna ao estudo e deve ser requisito obrigatório para a aprovação de projetos de pesquisa (AU)

El presente texto versará sobre aspectos que deberían ser cuidadosamente ponderados por parte de los investigadores con el objetivo de establecer, a priori, el tamaño muestral de estudios en áreas de la salud, actividad física y rendimiento humano. Hay que resaltar que el cálculo del tamaño de la muestra no es una ciencia exacta y, por tanto, requiere suposiciones realistas previas a su estimación. Por último, observamos que, a pesar de los enormes avances biotecnológicos que han contribuido a una más rápida producción científica, es de vital importancia que los investigadores se comprometan a respetar premisas que permitan la calidad del trabajo científico. En este sentido, una adecuada especificación del tamaño muestral confiere validez interna al estudio y deben ser un requisito obligatorio para la aprobación de proyectos de investigación (AU)

The present text will deal with aspects that should be carefully taken into account by researchers with the purpose of establishing sample size in studies in the areas of health, physical capacities and human development. It is important to highlight that sample calculation is not an exact science, and, as such, it requires realistic suppositions before estimation. It is observed that, despite great biotechnological advances that have contributed to faster scientific production, it is of vital importance that researchers commit to respect premises that enable the quality of the scientific work. In this regard, appropriate specifications of sample size grant internal validity to the study and must be a mandatory requisite for research projects approva (AU)

Perspectives of TRPV1 Function on the Neurogenesis and Neural Plasticity.

The development of new strategies to renew and repair neuronal networks using neural plasticity induced by stem cell graft could enable new therapies to cure diseases that were considered lethal until now. In adequate microenvironment a neuronal progenitor must receive molecular signal of a specific cellular context to determine fate, differentiation, and location. TRPV1, a nonselective calcium channel, is expressed in neurogenic regions of the brain like the subgranular zone of the hippocampal dentate gyrus and the telencephalic subventricular zone, being valuable for neural differentiation and neural plasticity. Current data show that TRPV1 is involved in several neuronal functions as cytoskeleton dynamics, cell migration, survival, and regeneration of injured neurons, incorporating several stimuli in neurogenesis and network integration. The function of TRPV1 in the brain is under intensive investigation, due to multiple places where it has been detected and its sensitivity for different chemical and physical agonists, and a new role of TRPV1 in brain function is now emerging as a molecular tool for survival and control of neural stem cells.

Spinodal instabilities in polydisperse lyotropic nematics.

Many lyotropic liquid crystals are composed of mesogens that display a considerable spread in size or shape affecting their material properties and thermodynamics via various demixing and multi-phase coexistence scenarios. Starting from a generalized Onsager theory, we formulate a generic framework that enables locating spinodal polydispersities as well as identifying the nature of incipient size fractionation for arbitrary model potentials and size distributions. We apply our theory to nematic phases of both hard rods and disks whose main particle dimension is described by a unimodal log-normal distribution. We find that both rod-based and discotic nematics become unstable at a critical polydispersity of about 20%. We also investigate the effect of doping nematic assemblies with a small fraction of large species and highlight their effect on the stability of the uniform nematic fluid. Our main finding is that while rod-based are only weakly affected by the presence of large species, doping discotic nematics with very large platelets leads to a remarkable suppression of the spinodal instabilities. This could open up routes towards controlling the mechanical properties of nematic materials by manipulating the local stability of nematic fluid and its tendency to undergo fractionation-driven microphase separation.

A multisite community-based health literacy intervention for Spanish speakers.

The National Action Plan to Improve Health Literacy emphasizes the importance of community-based opportunities for education, such as English as a second language (ESL) programs. It recommends collaborations among the adult literacy and ESL communities. However, limited attention has been given to researching the effectiveness of community-based interventions that combine ESL and health literacy. The purpose of this study was to explore the feasibility of using different community settings for improving health literacy among adult Spanish speakers through an English language program. The study used a pre-experimental, single arm pretest-posttest design, and implemented the Health Literacy and ESL Curriculum. A collaborative was established between the community and university researchers. Participants were recruited at three distinctive sites. Health literacy was assessed using the Spanish version of the Test of Functional Health Literacy in Adults (TOFHLA). Analysis included descriptive and paired-group t test. Forty-nine participants completed the intervention and post-tests (92% retention rate). Overall--all sites--posttest scores significantly improved for total TOFHLA, raw numeracy, and reading comprehension (p < 0.0001). Similarly, all three sites yielded significantly better mean differences for the total TOFHLA score while numeracy and reading comprehension significantly improved in some sites. Results suggest that community sites are viable venues for delivering health literacy/language instruction to Spanish speaking adults. The study also points to community engagement and ESL programs as two essential components of effective health literacy interventions among Spanish speakers.

Oleanolic acid modulates the immune-inflammatory response in mice with experimental autoimmune myocarditis and protects from cardiac injury. Therapeutic implications for the human disease.

Myocarditis and dilated cardiomyopathy (DCM) are inflammatory diseases of the myocardium, for which appropriate treatment remains a major clinical challenge. Oleanolic acid (OA), a natural triterpene widely distributed in food and medicinal plants, possesses a large range of biological effects with beneficial properties for health and disease prevention. Several experimental approaches have shown its cardioprotective actions, and OA has recently been proven effective for treating Th1 cell-mediated inflammatory diseases; however, its effect on inflammatory heart disorders, including myocarditis, has not yet been addressed. Therefore, the present study was undertaken to determine the effectiveness of OA in prevention and treatment of experimental autoimmune myocarditis (EAM). The utility of OA was evaluated in vivo through their administration to cardiac α-myosin (MyHc-α614-629)-immunized BALB/c mice from day 0 or day 21 post-immunization to the end of the experiment, and in vitro through their addition to stimulated-cardiac cells. Prophylactic and therapeutic administration of OA dramatically decreased disease severity: the heart weight/body weight ratio as well as plasma levels of brain natriuretic peptide and myosin-specific autoantibodies production were significantly reduced in OA-treated EAM animals, compared with untreated ones. Histological heart analysis showed that OA-treatment diminished cell infiltration, fibrosis and dystrophic calcifications. OA also decreased proliferation of cardiac fibroblast in vitro and attenuated calcium and collagen deposition induced by relevant cytokines of active myocarditis. Furthermore, in OA-treated EAM mice the number of Treg cells and the production of IL-10 and IL-35 were markedly increased, while proinflammatory and profibrotic cytokines were significantly reduced. We demonstrate that OA ameliorates both developing and established EAM by promoting an antiinflammatory cytokine profile and by interfering with the generation of cardiac-specific autoantibodies, as well as through direct protective effects on cardiac cells. Therefore, we envision this natural product as novel helpful tool for intervention in inflammatory cardiomyopathies including myocarditis.

Natural triterpenes modulate immune-inflammatory markers of experimental autoimmune encephalomyelitis: therapeutic implications for multiple sclerosis.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE), are inflammatory demyelinating diseases that develop as a result of deregulated immune responses causing glial activation and destruction of CNS tissues. Oleanolic acid and erythrodiol are natural triterpenes that display strong anti-inflammatory and immunomodulatory activities. Oleanolic acid beneficially influences the course of established EAE. We now extend our previous observations to erythrodiol and address the efficacy of both compounds to protect against EAE, given under different regimens. EXPERIMENTAL APPROACH: The utility of both triterpenes in disease prevention was evaluated at a clinical and molecular level: in vivo through their prophylactic administration to myelin oligodendrocyte protein-immunized C57BL/6 mice, and in vitro through their addition to stimulated-BV2 microglial cells. KEY RESULTS: These triterpenes protected against EAE by restricting infiltration of inflammatory cells into the CNS and by preventing blood-brain barrier disruption. Triterpene-pretreated EAE-mice exhibited less leptin secretion, and switched cytokine production towards a Th2/regulatory profile, with lower levels of Th1 and Th17 cytokines and higher expression of Th2 cytokines in both serum and spinal cord. Triterpenes also affected the humoral response causing auto-antibody production inhibition. In vitro, triterpenes inhibited ERK and rS6 phosphorylation and reduced the proliferative response, phagocytic properties and synthesis of proinflammatory mediators induced by the addition of inflammatory stimuli to microglia. CONCLUSIONS AND IMPLICATIONS: Both triterpenes restricted the development of the characteristic features of EAE. We envision these natural products as novel helpful tools for intervention in autoimmune and neurodegenerative diseases including MS.

Patterns of fetal heart rate response at ∼30 weeks gestation predict size at birth.

There is evidence that fetal exposure to maternal stress is associated with adverse birth outcomes. Less is known about the association between fetal responses to a stressor and indicators of fetal maturity and developmental outcomes. The purpose of the present study was to determine whether fetal heart rate (FHR) patterns in response to a startling stimulus at ∼30 weeks of gestation were associated with gestational age at birth and birth weight. FHR was measured in 156 maternal-fetal dyads following a vibroacoustic stimulus. All pregnancies were singleton intrauterine pregnancies in English-speaking women who were primarily married, middle class, White and at least 18 years of age. Group-based trajectory modeling identified five groups of fetuses displaying distinctive longitudinal trajectories of FHR response to the startling stimulus. The FHR group trajectories were significantly associated with birth weight percentile (P < 0.01) even after controlling for estimated fetal weight at the time of assessment and parity, which are the known factors influencing birth weight (P < 0.01). Post hoc analyses indicated that two groups accounted for the association between FHR patterns and birth weight. The group (n = 23) with the lowest birth weight exhibited an immediate FHR deceleration followed by an immediate acceleration that does not recover. An FHR pattern characterized by immediate and fast acceleration to the peak and a slow discovery to baseline was associated with the highest birth weight. This is the first direct evidence showing that low birth weight and the resulting neurological consequences may have their origins in early fetal development.

Dietary fat and apolipoprotein genotypes modulate plasma lipoprotein levels in Brazilian elderly women.

Studies show that genetic polymorphisms in apolipoproteins, which are in charge of lipid transport, predispose to atherogenic dyslipidemia. This study aimed to investigate the impact of apolipoprotein E, A5, and B genotypes and dietary intake on lipid profile in a sample of elderly women in Brazil. Two hundred and fifty-two women (60 years or older) living in the outskirts of the Brazilian Federal District underwent clinical and laboratory assessments to characterize glycemic and lipidemic variables, and also to exclude confounding factors (smoking, drinking, hormone replacement, cognitive impairment, physical activity). Three-day food records were used to determine usual dietary intake, whereas genotypic evaluations were in accordance to established methodologies. Genotype frequencies were consistent with the Hardy-Weinberg equilibrium. Prior to adjustment, individuals carrying the epsilon2 allele showed higher serum levels of triglycerides (P<0.05) and VLDL (P<0.005) compared to epsilon4 carriers, whereas LDL levels were considerably elevated in epsilon4 compared to epsilon2 carriers. In the presence of high intake of total fat or a low ratio of polyunsaturated to saturated fatty acid, epsilon4 carriers lost protection against hypertriglyceridemia. There was no association of the apolipoprotein A5 and B genotypes with lipidemic levels independently of the fat intake regimen. Results are suggestive of a dysbetalipoproteinemic-like phenotype in postmenopausal women, with remarkable gene-diet interaction.

Acute exercise performed close to the anaerobic threshold improves cognitive performance in elderly females

The objective of the present study was to compare the effect of acute exercise performed at different intensities in relation to the anaerobic threshold (AT) on abilities requiring control of executive functions or alertness in physically active elderly females. Forty-eight physically active elderly females (63.8 ± 4.6 years old) were assigned to one of four groups by drawing lots: control group without exercise or trial groups with exercise performed at 60, 90, or 110 percent of AT (watts) and submitted to 5 cognitive tests before and after exercise. Following cognitive pretesting, an incremental cycle ergometer test was conducted to determine AT using a fixed blood lactate concentration of 3.5 mmol/L as cutoff. Acute exercise executed at 90 percent of AT resulted in significant (P < 0.05, ANOVA) improvement in the performance of executive functions when compared to control in 3 of 5 tests (verbal fluency, Tower of Hanoi test (number of movements), and Trail Making test B). Exercising at 60 percent of AT did not improve results of any tests for executive functions, whereas exercise executed at 110 percent of AT only improved the performance in one of these tests (verbal fluency) compared to control. Women from all trial groups exhibited a remarkable reduction in the Simple Response Time (alertness) test (P = 0.001). Thus, physical exercise performed close to AT is more effective to improve cognitive processing of older women even if conducted acutely, and using a customized exercise prescription based on the anaerobic threshold should optimize the beneficial effects.

Acute exercise performed close to the anaerobic threshold improves cognitive performance in elderly females.

The objective of the present study was to compare the effect of acute exercise performed at different intensities in relation to the anaerobic threshold (AT) on abilities requiring control of executive functions or alertness in physically active elderly females. Forty-eight physically active elderly females (63.8 +/- 4.6 years old) were assigned to one of four groups by drawing lots: control group without exercise or trial groups with exercise performed at 60, 90, or 110% of AT (watts) and submitted to 5 cognitive tests before and after exercise. Following cognitive pretesting, an incremental cycle ergometer test was conducted to determine AT using a fixed blood lactate concentration of 3.5 mmol/L as cutoff. Acute exercise executed at 90% of AT resulted in significant (P < 0.05, ANOVA) improvement in the performance of executive functions when compared to control in 3 of 5 tests (verbal fluency, Tower of Hanoi test (number of movements), and Trail Making test B). Exercising at 60% of AT did not improve results of any tests for executive functions, whereas exercise executed at 110% of AT only improved the performance in one of these tests (verbal fluency) compared to control. Women from all trial groups exhibited a remarkable reduction in the Simple Response Time (alertness) test (P = 0.001). Thus, physical exercise performed close to AT is more effective to improve cognitive processing of older women even if conducted acutely, and using a customized exercise prescription based on the anaerobic threshold should optimize the beneficial effects.

Tratamiento quirúrgico de la inestabilidad rotuliana recurrente con reconstrucción del ligamento patelofemoral medial usando autoinjerto semitendinoso / Surgical treatment of recurrent patellar instability with medial patellofemoral ligament reconstruction using semitendinosus tendon autograft

The medial patellofemoral ligament (MPFL) reconstruction is an option for the recurrent patellar instability. We developed a prospective study whose objective was to show the functional results at 6 and 12 months of patients who underwent MPFL reconstruction with semitendinosus (St) autograft. Four patients (5 knees) were treated between May 2006 and May 2008. The Kujala´s test before surgery in all patients was poor (< 50 points); 6 months after the surgery 4 cases turned out to be "good and very good" (only 1 case "poor", but increased her score to 78 points) and after 12 months of follow-up, 5 cases scored "very good and excellent" (score > 90 points). The Tegner´s test showed an increased of activity that was normal for the patients, and with the Insall´s test all patients referred very satisfied 12 months after surgery. Up to this stage, there has been no recurrence. In our local environment, the MPFL reconstruction with St. is a valid treatment to recover the patellofemoral mecanic.

La reconstrucción del ligamento patelofemoral medial (LPFM) es una alternativa en la inestabilidad rotuliana recurrente. Desarrollamos un estudio prospectivo con el objetivo de exponer los resultados funcionales a los 6 y 12 meses de pacientes sometidos a una reconstrucción del LPFM con semitendinoso (St). Son 4 pacientes (5 rodillas) operados entre mayo 2006 y mayo 2008. El test de kujala preoperatorio era "malo" (< 50 pts) en todos, a los 6 meses post op. 4 casos de "bueno y muy bueno" resultado (sólo 1 caso "malo", pero con incremento de su score a 78) y a los 12 meses (5 casos) todos con función "muy bueno y excelente" (score > 90 pts). El test de Tegner mostró un aumento del nivel de actividad considerada de normal en todos los pacientes, y en el test de Insall todos refieren excelente mejoría a los 12 meses. Hasta la fecha no existen recidivas. En nuestro medio local, la reconstrucción del LPFM con St. es una alternativa válida para recuperar la mecánica patelofemoral.