L'ingénierie écologique a permis l'émergence de nouvelles technologies telles que la phytoremédiation, une approche de dépollution des sols basée sur l'utilisation des plantes. Cependant, jusqu'à présent, les mécanismes physiologiques et moléculaires qui contrôlent la dégradation des polluants organiques, en particulier les HAPs, restent très mal documentés chez les plantes supérieures. Dans ce travail, une approche intégrative et un profilage trancriptomique à l'échelle du génome entier ont permis d'étudier les premiers événements moléculaires impliqués dans la réponse, chez les plantes, à un stress provoqué par le phénanthrène. Un réseau de gènes susceptibles d'intervenir dans la perception, la dégradation et/ou la transformation des HAPs en molécules moins dangereuses a ainsi été identifié. D'autre part, nous avons pu montrer que le saccharose induit une tolérance à ce polluant, qui se traduit (i) par une activité transcriptionnelle très rapide, ce qui suggère un effet signalétique, (ii) une reconfiguration importante à l'échelle transcriptionnelle du génome exprimé, qui conduit à une mise en place des voies métaboliques de production d'énergie, de détoxification et de réparation cellulaire. Parallèlement, un site pilote de dépollution a été conçu et mis en œuvre, en exploitant les données obtenues au laboratoire. Cette expérimentation, sur deux ans, nous a permis de comparer l'efficacité de plusieurs espèces végétales mais aussi de tester l'effet protecteur du saccharose in-situ. Malgré l'obtention de résultats contrastés, cette étude confirme l'incidence de la nature des espèces végétales et des pratiques culturales sur l'efficacité de cette méthode de dépollution. Elle souligne également le rôle important de l'interaction plante-microorganismes du sol. / Ecological engineering strategies allowed the emergence of new technologies such as phytoremediation to clean up environmental pollution. Polycyclic Aromatic Hydrocarbons (PAHs) are ubiquitous and hazardous molecules for natural ecosystems and human health. However, molecular mechanisms involved in PAHs detoxification in plant remain largely unknown. This work allowed to decipher the early plant response of phenanthrene induced stress through an integrative investigation using wide genome transcriptomic and targeted metabolomic approaches. Hence, a gene network was identified to be involved in the early perception and signalization of PAHs and putative degradation and/or transformation to harmless molecules. Additionally, we showed that sucrose mitigate phenanthrene induced stress, while Arabidopsis development was arrested and seedlings were unable to accumulate chlorophyll in the presence of high phenanthrene concentration, sucrose allowed growth and chlorophyll accumulation. These phenotypical changes were associated with (i) very early transcriptional regulation, suggesting a sucrose signaling effect (ii) reconfiguration of wide genome transcriptional changes, as metabolic, detoxification and cell repair pathways were induced. In parallel, based on previous results accumulated in controlled conditions. Field investigation allowed the evaluation of the ability of different plant species to clean up PAHs polluted soil. We also evaluate the impact of sucrose supply on natural phytoremediation efficiency. Despite contrasted results, this study confirms the incidence of the plant species and the cultural practices on the efficiency of this method. It also underlines the role of soil microorganisms and plant interactions.

91 Abstract - Means of substitution of custody The topic of this thesis are the means of substitution of custody. The institute of custody is a very actual topic that is developing dynamically and is still controversial. Thanks to both domestic and international courts, the standard of protection of basic human rights keeps increasing and custody is therefore considered an extreme securing measure that can only be used in case there are no usable milder means. The aim of this thesis is to introduce these means of substitution of custody, stating their issues in theory and in praxis, their critical evaluation and suggestions de lege ferenda. The first chapter of this thesis focuses on general characteristics of custody and conditions of its use. The first chapter is a crucial part of the thesis as the means of substitution of custody directly relate to the institute of custody itself. The second chapter of this thesis focuses on the development of individual means of substitution of custody. It is a rather brief overview of the most significant amendments to legislation. In the author's opinion though, to correctly understand the current legislation concerning means of substitution of custody, it is necessary to be aware of the historical context of the establishment and use of these means. The third and...

Dans Surveiller et Punir, Michel Foucault met en avant le fait que les peines prononcées contre les condamnés, qui s’exerçaient autrefois directement sur leur corps, s’exercent à présent sur leur âme, et plus précisément sur leur volonté. Changer l’individu par la norme en exerçant une influence sur sa volonté propre, laquelle est pourtant communément associée à un caractère irréductible, tel est le défi paradoxal du pouvoir normatif, du moins des relations ou rapports de pouvoir définis par Foucault. À travers une approche sociologique, psychologique, l’individu est appréhendé par l’autorité judiciaire comme s’il était en grande partie le fruit d’un déterminisme. C’est en changeant son milieu que l’on pourrait changer son comportement, que l’on ferait de sa volonté hors norme une volonté normée. Cependant, ces tentatives présentées comme des remèdes ont une efficacité mitigée. La prison, par exemple, qui entretient des mécanismes de mise à l’écart et d’oubli des individus ne peut qu’échouer à normaliser les volontés individuelles car elle cultive en son sein les «volontés déviantes», comme pour faire perdurer les illégalismes nécessaires à la conservation des relations de pouvoir au sein de la société. Mais de quelle façon la norme peut -elle agir sur la volonté individuelle ? Il semble que la pensée de Michel Foucault mettant en lumière les échecs de l’action du pouvoir normatif sur la volonté individuelle ait trouvé en cela certaines réponses juridiques actuelles, par exemple dans les récentes mises en place de procédures du plaider-coupable, par des velléités, finalement abandonnées, de fixation d’un âge de consentement sexuel ou encore par la multiplication des alternatives à la prison. / In Discipline and Punish, Michel Foucault highlights the fact that the sentences handed down against convicts, that were formerly exercising directly on their bodies, are now exercised on their souls, and more precisely on their will. To change the individual by the norm by exerting an influence on his own will, which is nevertheless commonly associated with an irreducible character, is the paradoxical challenge of the normative power, at least of the relations or relations of power defined by Foucault. Through a sociological and psychological approach, the individual is apprehended by the judicial authority as if it were largely the result of determinism. It is by changing his environment that one could change his behavior, that one would make his out -of-the-ordinary will a normed will. However, these attempts presented as remedies have a mixed effectiveness. Prison, for example, which maintains mechanisms of exclusion and forgetfulness of individuals can only fail to normalize individual wishes because it cultivates within it the "deviant wills", as if to perpetuate illegalisms necessary to preserve power relations within society. But how can the norm affect individual will? It seems that the thought of Michel Foucault highlighting the failures of the action of the normative power on the individual will has found in this certain current legal answers, for example in the recent establishment of procedures of the plea-guilty, by the setting, eventually forgotten, of an age of sexual consent or by multiplying alternatives to prison.

The diploma thesis deals with the role of the police authority in preliminary criminal proceedings. The thesis is divided into twelve chapters which are further structured into subchapters, describing in more detail the given procedure or institute. According to the phases of preliminary proceedings, the diploma thesis is chronologically divided into the examination phase and investigation phase, describing further the police authority proceedings. The objective of the diploma thesis is particularly to describe the procedure and actions of the police authority in individual phases of preliminary proceedings and to explain its role. The content of the diploma thesis is focused on the relation of the person against whom the criminal proceedings are being conducted (i.e. the suspected or accused) and the police authority. More specifically, particularly on the procedures of the Police of the Czech Republic bodies; marginally, it mentions other bodies in the position of a police authority, as well. This is the reason the reader most often encounters in the text a comparison of the criminal proceedings adjustments and the Act on the Police of the Czech Republic, possibly with notice to their differences. In the elaborated topic, emphasis is put on the right of the accused to a fair trial, right of the...

Clinical trials of medicinal products is increasingly important area of pharmaceutical law. Number of clinical trials and amount of financial resources is constantly rising and therefore the rules and principles of the clinical trials itself are being clarified overtime. This diploma thesis aims to provide an overview of the basic aspects of clinical trials of medicinal products for human use from a legal point of view. The author focuses in particular on the national legislation of clinical trials, which is complemented by the legislation of the European Union and important sources of the international law. Author is more closely analysing the particular procedures performed within the clinical trials, especially from the point of view of the administrative law. Particular attention is paid to the ethical review of the clinical trials, their particular aspects and the overall concept. The thesis is divided into twelve chapters. In the introduction, the author focuses on the development of the clinical trials and mentions the crucial moments that contributed to the formulation of the basic rules of the clinical trials. The following chapter focuses on the sources of law. Firstly, sources of international law are described, where more general sources and specific sources of law of medicinal products...

Retalho posicionado coronalmente associado ao enxerto de tecido conjuntivo subepitelial (ETCS) é o padrão ouro para o tratamento de retrações gengivais. A matriz de colágena suína bioabsorvível Mucoderm® (MD) tem sido amplamente utilizada como substituto do ETCS e tem alcançado resultados semelhantes. o MD tem a vantagem de disponibilidade que supera as limitações do sítio doador em enxertos autógenos. O objetivo deste estudo é investigar o uso do MD nos procedimentos de recobrimento radicular combinado com retalho extendido posicionado coronalmente (REPC), grupo teste (GT), em comparação ao ETCS associado ao REPC, grupo controle (GC). Dezoito pacientes adultos, apresentando recessão tipo 1 bilateral foram selecionados. Parâmetros clínicos, profundidade de sondagem, nível clínico de inserção, altura (RG) e largura (LRG) da retração, altura (GQ) e espessura (EGQ) da gengiva queratinizada e área da retração (ARG) foram registrados no início, 3 e 6 meses após os procedimentos cirúrgicos por um examinador cego. Aos 6 meses, um periodontista realizou uma Escala Estética de Recobrimento Radicular (ERR) (Cairo et al. 2009) analisando a posição da margem gengival (MG), contorno do tecido marginal (CTM), textura do tecido mole (TTM), alinhamento da junção mucogengival (AJG) e coloração da gengiva (CG). Aos 3 e 6 meses, um questionário estético funcional para o paciente foi utilizado para avaliar a satisfação com a taxa de recobrimento (STR), coloração da gengiva (CG) e sensibilidade dentinária (SEN), esta última aplicada também no baseline, e se necessário, voltaria a realizar a cirurgia (CIR) em outras áreas. O paciente respondeu ao questionário em uma escala VAS. O GT e o GC apresentaram redução significativa na média da RG (3,33 ± 0,89mm a 1,31 ± 1,03mm (p &lt0,05) e 3,21 ± 0,80mm a 0,83 ± 0,86mm ( p &lt0,05)), LRG (4,03 ± 0,57mm a 2,73 ± 1,62mm 12 e 4,10 ± 0,63mm a 2,07 ± 1,79mm (p &lt0,05)) e ARG (222638 ± 99731pix&sup2 para 72727 ± 82631pix&sup2 e 196461 ± 84815pix&sup2 para 48414 ± 63398pix&sup2 (p &lt0,05)) respectivamente e ganho de GQ (1,87 ± 1,17mm para 2,85 ± 1,43mm (p &lt0,05) e 1,91 ± 0 , 95mm a 2,83 ± 1,41mm (p &lt0,05)) e EGQ (0,76 ± 0,21mm a 1,10 ± 0,31mm (p &lt0,05) e 0,86 ± 0,39mm a 1, 36 ± 0,40mm (p &lt0,05)) respectivamente em um período de 6 meses. A quantidade média de cobertura radicular não foi diferente entre GT (61,33%) e GC (73,90%) (p&gt 0,05). Não houve diferença entre o GC e o GT nos parâmetros analisados no ERR aos 6 meses e para o questionário estético funcional ao paciente houve redução significativa no parâmetro SEN no GT (54,55 ± 32,60% para 19,11 ± 25,73% (p &lt0,05)) e GC (55,61 ± 30,88% a 11,17 ± 17,51% (p &lt0,05)). Ambos os grupos mostraram uma redução significativa na RG. Considerando-se que não foram observadas diferenças significativas entre o GC e o GT para RG, LRG, ARG e GQ e EGQ foram significativamente diferentes favorecendo GT, pode-se especular que o MD possa ser usado como alternativa ao CTG para o tratamento de recessões gengivais / Coronally advanced flap plus connective tissue graft (CTG) is the gold standard therapy for root coverage. The bioabsorbable porcine collagen matrix Mucoderm® (MD) has been widely used in periodontal and mucogingival surgery as a substitute for CTG and has achieved similar results. The MD has the advantage of availability overcoming the limitations of donor site in autograft. The aim of this study is to investigate the use of MD in root coverage procedures combined with extended coronally positioned flap (ECAF), test group (TG) in comparison to the CTG associated with the ECAF, control group (CG). Eighteen adult patients, non-smokers, presenting bilateral Cairo´s Recession Type 1 (RT1) were selected. Clinical parameters, probing depth, clinical attachment level, recession height (RH) and width (RW), keratinized tissue height (KTH) and thickness (KTT) and gingival recession área (GRA) were recorded at baseline,3 and 6 months after the surgical procedures by a blinded examiner. At 6 months a specialist in periodontics performed a Root Coverage Esthetic Score (RES) (Cairo et al. 2009) analyzing position of the gingival margin (GM), marginal tissue contour (MTC), soft tissue texture (STT), mucogingival junction alignment (MJA) and gingival color (GI). At 3 and 6 months a functional aesthetic questionnaire to the patient was used to evaluate the satisfaction with recovering rate (SRR), gingival color (GI) and dentin sensitivity (SEN) (the latter applied initially in the baseline) and, if necessary, would return to perform the surgery (SUR) in other areas. The patient answered the questionnaire on a VAS scale.The TG and CG showed a significant reduction in average for RH (3.33 ± 0.89mm to 1.31±1.03mm (p&lt0.05) and 3.21±0.80mm to 0.83±0.86mm (p&lt0.05)), RW (4.03±0.57mm to 2.73±1.62mm and4.10±0.63mm to 2.07±1.79mm (p&lt0.05)) and GRA (222638±99731pix&sup2 to 72727±82631pix&sup2 and 196461±84815pix&sup2 to 48414±63398pix&sup2 (p&lt0.05)) respectively and gain of KTH (1.87±1.17mm to 2.85±1.43mm (p&lt0.05) and 1.91±0.95mm to 2.83±1.41mm (p&lt0.05)) and KTT 14 (0.76±0.21mm to 1.10±0.31mm (p&lt0.05) and 0.86±0.39mm to 1.36±0.40mm (p&lt0.05)) respectively in a period of 6 month. The average amount of root coverage was not different between TG (61.33%) and CG (73.90%) (p&gt0.05). There was no differences between CG and TG on the parameters analyzed in the RES on 6 months and for the functional aesthetic questionnaire to the patient significant reduction was found on SEN parameter on TG (54.55±32,60% to 19.11±25.73% (p&lt0.05)) and CG (55.61±30.88% to 11.17±17.51% (p&lt 0.05)).In these 6 months follow up study, both groups showed a significant reduction in recession height. Considering no significant differences were observed between CG and TG for RH, RW, GRA and KTH and KTT were significant different favoring TG, it can be speculated that MD can be used as an alternative to CTG for the treatment of gingival recessions

Introdução: Freqüentemente a progressão da doença coronariana aterosclerótica é observada por angiogramas seqüenciais e atribuída ao aumento da incidência de eventos coronarianos.O significado prognóstico desta progressão em pacientes randomizados e submetidos a diferentes formas terapêuticas ainda é pouco conhecido. Este estudo compara a progressão da aterosclerose nas artérias coronárias nativas de pacientes submetidos a tratamento clinico, cirúrgico ou através da angioplastia. Métodos: 611 pacientes portadores de DAC multiarterial estável com função ventricular preservada, foram estudados e submetidos de maneira randomizada, a três formas terapêuticas habituais. Após cinco anos de evolução, 392 pacientes (64%) foram submetidos à cinecoronariografia. A progressão da doença foi definida como surgimento de estenose de, pelo menos, 20% de obstrução em um segmento arterial, admitido previamente como normal. A progressão foi avaliada nas artérias nativas que correspondem a DA, CX, CD dos três grupos terapêuticos. Resultados: 392 pacientes estudados, 136 eram do grupo Cirúrgico, 146 do grupo Angioplastia e 110 do grupo Clínico. Os grupos eram homogêneos em relação às características basais. A análise de progressão entre os grupos terapêuticos mostrou maior progressão da doença na artéria DA do grupo angioplastia. Entre os fatores relacionados à progressão da doença a presença de HAS influenciou significativamente (p= 0,048). Em relação à oclusão total, houve maior incidência no sexo masculino (p= 0,0078) e novo IAM (p= 0,0006). Não se observou relação estatística entre eventos coronarianos e progressão da doença na amostra estudada. Conclusão: Nessa amostra observou-se a progressão da aterosclerose independente da opção terapêutica. Todavia, encontrou-se menor progressão da doença nos pacientes do grupo cirúrgico. Exceto pela presença de hipertensão, nenhum outro fator de risco parece ter influenciado nesta condição. / Introduction: The progression of atherosclerotic in the coronary artery disease (CAD) is observed through consecutive angiograms. The prognosis of this progression randomized patients is not clear. This study compared the progression of native coronary arteries and bypass graft in patients undergoing to surgery (CABG), angioplasty (PCI), or medical strategy (MT). Methods: Six hundred eleven patients with stable multivessel CAD and preserved ventricular function were randomly assigned to the 3 therapeutic options: MT, PCI, or CABG. After a 5-year of follow-up, 392 patients (64%) underwent routine coronary angiogram. Progression was defined as stenosis of at least 20% in an artery segment previously considered normal. Progression was assessed in the native arteries irrigating the three territories, left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). Uni and multivariate analysis were performed in all therapeutic groups. Results: Of the 392 patients, 136 were to CABG, 146 PCI, and 110 MT. Baseline characteristics of three treatment were homogeneous. Analysis of progression within the three groups showed a more significant progression of atherosclerosis in the LAD territories of the PCI group. Among the factors related to the progression, there was a significant influence by hypertension (p = 0.048). Males presented a higher incidence of occlusion (p= 0.0078) and new Myocardial Infarction. (p= 0.0006). There was no statistical difference between coronary events and the development of progression in the sample studied. Conclusion: In this study, we have observed the occurrence of atherosclerosis progression, regardless the treatment option. However, we?ve found less progression of disease in patients from the surgery group. Except for hypertension, any other risk factor seems to have no influence on the increase of this condition.

Introdução: A episiotomia é uma ampliação cirúrgica do períneo amplamente utilizada na assistência ao parto, embora seu emprego rotineiro não seja justificado pelas evidências científicas. Está associada à dor e ao desconforto no período pós-parto. O Laser em Baixa Intensidade (LBI) vem se destacando na literatura como uma tecnologia promissora em relação ao tratamento de feridas. Apresenta efeitos de redução da dor, inflamação e estímulo à cicatrização. Objetivo: Avaliar os efeitos do laser em baixa intensidade na cicatrização da região perineal, na frequência e magnitude da dor perineal, após a episiotomia médio-lateral direita. Método: Ensaio clínico aleatorizado, paralelo e triplo cego, com uma amostra de 54 puérperas, divididas em grupo experimental (recebeu irradiação de laser) e controle (recebeu simulação de irradiação). As puérperas foram incluídas no estudo entre 6 e 10 horas após o parto no Alojamento Conjunto do Hospital Universitário da Universidade de São Paulo. Os critérios de inclusão foram: idade 18 anos, idade gestacional 37 e <42 semanas; sem parto vaginal anterior; parto espontâneo de feto único, vivo e em apresentação cefálica, com episiotomia médio-lateral direita; ausência de processo infeccioso, hemorroidas, hematomas ou varizes na região vulvoperineal; não ter realizado preparo da região perineal na gravidez; não ter feito uso de drogas fotossensibilizantes e sem intercorrências clínicas ou obstétricas. Foram excluídas do estudo mulheres que utilizaram qualquer produto diferente de água e sabão na região vulvoperineal. A intervenção com o laser consistiu em três irradiações (primeira: de 6 a 10 horas após o parto, segunda: 20 a 24 horas e terceira: 40 a 48 horas após a primeira aplicação), com laser diodo infravermelho, meio ativo semicondutor Gallium-Aluminum-Arsenide (GaAIAs), tamanho do spot de 0,04 cm2, densidade de energia de 5J/cm2, potência de 20 mW, duração da irradiação de 10 segundos por ponto. Em cada sessão, a episiotomia foi irradiada em nove pontos diferentes, com 0,2J por ponto e energia total de 1,8J por sessão. Na simulação da irradiação, a ponteira que emite o laser vermelho foi modificada pelo próprio fabricante, que substituiu o laser por uma luz guia. Em ambos os grupos, a cicatrização perineal foi avaliada em quatro momentos: antes das três irradiações e 7 a 10 dias após a alta hospitalar, por meio da escala Redness Edema Echymosis Discharge Aproximation (REEDA). A avaliação da dor perineal foi feita em sete ocasiões: antes e após as três irradiações e 7 a 10 dias, após a alta hospitalar pelo questionamento de presença ou ausência de dor e pela escala numérica de 0 a 10. A coleta de dados foi realizada entre junho e outubro de 2011. Resultados: Foram randomizadas 54 mulheres (29 no grupo experimental e 25 no grupo controle). Houve perda de seguimento de 11 mulheres na última avaliação (7 a 10 dias). Os grupos foram semelhantes quanto às variáveis: idade materna em anos completos; Índice de Massa Corporal; idade gestacional; peso do recém-nascido em gramas; Apgar de 1º, 5º e 10º minutos; perímetro cefálico em centímetros; extensão da episiotomia em centímetros; número de gestações, partos e abortos; cor; escolaridade; profissão; estado marital; presença de acompanhante; número de doses analgésicas e intervalo entre a ingestão do analgésico e a avaliação. A anestesia raquidiana foi usada com maior frequência no grupo controle (p=0,043). Quanto à cicatrização, os grupos não diferiram na escala REEDA em nenhuma das avaliações. Quanto às médias de dor perineal, os grupos diferiram nas seguintes ocasiões: o experimental apresentou maiores médias de dor na avaliação antes (grupo experimental 4,5; grupo controle 2,0; p=0,002), após a primeira irradiação (grupo experimental 4,1; grupo controle 2,0; p=0,008), e após a terceira irradiação (grupo experimental 1,5; grupo controle 0,6; p=0,019). Quanto à presença de dor, não houve diferença estatisticamente significante entre os grupos nos distintos momentos de avaliação. Não houve diferenças estatisticamente significantes entre os dois grupos entre a redução média de dor antes e após a irradiação laser, tanto em porcentagem quanto em relação a uma melhora <30% e 30%, nos três momentos em que a intervenção foi realizada. O procedimento foi considerado muito bom por 44,4% das mulheres, bom por 53,4% delas e ruim por 2,2% delas; 95,6% delas referiram o fariam novamente. Conclusão: O uso de LBI não teve efeito na cicatrização ou na frequência e na magnitude da dor perineal em mulheres com episiotomia, após o parto vaginal espontâneo. / Introduction: An episiotomy is a surgical widening of the perineum largely used in the childbirth, despite the fact that its routine use has not been justified by scientific evidence. It is associated with pain and discomfort in the postpartum period. The Low-Level Laser Therapy (LLLT) has been pointed out in the literature as a promising technology for the treatment of wounds. It has the effects of reducing pain and inflammation and healing stimulation. Objective: Evaluate the effects of low intensity laser therapy in the healing of the perineal region and in the frequency and magnitude of perineal pain, after right mediolateral episiotomy. Method: Parallel, triple blind randomized clinical trial, with a sample of 54 mothers who were divided into experimental (received laser irradiation) and control group (received simulated radiation). Postpartum women were included in the study from 6 to 10 hours after birth in the Rooming-in Unit of the Hospital of the University of São Paulo. Inclusion criteria were: age 18 years, gestational age 37 and <42 weeks, no previous vaginal delivery, to have a spontaneous delivery of a singleton fetus in cephalic presentation with right mediolateral episiotomy, absence of infection, hemorrhoids, bruises or varicose veins in the vulvoperineal region; no perineum preparation during pregnancy, no use of photosensitizing drugs and no clinical or obstetric complications. We excluded women who had used any product other than soap and water in the vulvoperineal region. The LLLT intervention consisted of three irradiations (first: from 6 to 10 hours after birth, second: from 20 to 24 hours after birth and third one from 40 to 48 hours after the first application), using infrared diode laser, with a semiconductor active medium Aluminum-Gallium-arsenide (GaAlAs), a size spot of 0.04 cm, 2 5J/cm2 energy density, power of 20 mW, and length of irradiation of 10 seconds per point. In each session, the episiotomy was irradiated in nine different points, with a total of 0.2 J per point and a total energy of 1.8 J per session. To simulate the irradiation, the tip that emits the red laser was modified by the manufacturer, who replaced the infrared laser by a guiding light in the same pen that emits the laser. In both groups, the perineal wound healing was assessed at four time moments: before the three irradiations and from 7 to 10 days after hospital discharge, through the scale Echymosis Discharge Aproximation Redness Edema (REEDA). The perineal pain was assessed in seven occasions: before and after the three sessions of irradiation and in one occasion from 7-10 days after birth, using numerical scale from 0 to 10 and questioning the woman on the presence or absence of pain. Data collection was carried out between June and October 2011. Results: We randomized 54 women (29 in the experimental group and 25 in the control group). Eleven women were lost in the follow-up, in the last evaluation (7-10 days). Both groups were similar with regard to the variables: maternal age in years, body mass index, gestational age, weight of the newborn in grams; Apgar score at 1, 5 and 10 minutes and head circumference in centimeters; episiotomy length in centimeters, number of pregnancies, births and miscarriages, skin color, education, profession, marital status, presence of caregiver, the number of analgesic doses and interval between the intake of analgesics and evaluation. The spinal anesthesia was more frequently used in the control group (p = 0.043). Regarding the healing, the groups did not differ in any assessments of the REEDA scale. Regarding the means of perineal pain, the groups differed on the following occasions: the experimental group had higher means of pain scores in the evaluation before (experimental group 4.5, control group 2.0, p = 0.002), and after the first irradiation (experimental group 4.1, control group 2.0, p = 0.008), and after the third irradiation (experimental group 1.5, control group 0.6, p = 0.019). Regarding the presence of pain, there was no statistically significant difference between groups in different stages of evaluation. There was no statistically significant differences between the two groups, both regarding the mean reduction of pain before and after laser irradiation in percentage and regarding an improvement <30% and 30% in the three moments when the intervention was performed. The procedure was evaluated as very good by 44.4% of women, as good by 53.4% and as bad by 2.2% of them; 95.6% of women who had the procedure reported that would have it again. Conclusion: The use of LLLT had no effect on wound healing or in the frequency and magnitude of perineal pain in women with episiotomies after spontaneous vaginal delivery, with the dosage and number of sessions used in this study.

Introdução: a relação entre zumbido e pontos-gatilho miofasciais têm sido debatida, mas poucas são as condutas terapêuticas propostas. Este estudo teve os objetivos de verificar: (1) a eficácia da desativação dos pontos-gatilho miofasciais para o alívio do zumbido em pacientes com síndrome dolorosa miofascial, (2) a correlação de lateralidade entre zumbido e dor e a associação entre a melhora de ambos e (3) se o fenômeno da modulação do zumbido durante a palpação dos pontos-gatilho apresenta bom prognóstico para este tratamento. Métodos: um ensaio clínico randomizado duplo-cego e placebo controlado foi desenvolvido para verificar a eficácia de 10 sessões de desativação dos pontos-gatilho em uma população com zumbido e síndrome dolorosa miofascial. Os critérios de inclusão eram: presença de zumbido e pelo menos um ponto-gatilho ativo em oito possíveis músculos da região da cabeça, pescoço ou cintura escapular, excluindo-se aqueles com dor generalizada ou tratamento recente para ambos os sintomas. Depois de triados por um otorrinolaringologista e avaliados por uma \"pesquisadora cega\" no início e após a quinta e décima sessões de tratamento, os indivíduos foram encaminhados para uma fisioterapeuta, que realizou a randomização em dois grupos e o tratamento de ambos. O grupo experimental foi submetido à desativação dos pontos-gatilho por digito-pressão e a orientações de condutas domiciliares e o grupo controle, a uma leve pressão em pontos adjacentes aos pontos-gatilho existentes. Resultados: o tratamento do grupo experimental foi mais eficaz em relação à intensidade do zumbido, número de sons, valor total do questionário de gravidade do zumbido e intensidade da modulação (p< 0,001). Houve associação entre a melhora da dor e a melhora do zumbido (p= 0,013; correlação de Spearman= 0,426) e o tratamento foi eficaz em todas as variáveis relacionadas à dor (p< 0,001) como: a intensidade da dor, valor do algômetro e número de pontos-gatilho ativos e latentes totais. Houve correlação de lateralidade entre os lados de pior zumbido e de dor em 54,4% dos casos (Kappa= 0,32; p< 0,001). A modulação do zumbido foi bastante freqüente no grupo experimental e controle (75,7% e 83,3% respectivamente), porém este fenômeno não influencia o prognóstico deste tratamento. No entanto, diminuir a intensidade do zumbido na modulação foi uma condição importante para um bom resultado de alívio do zumbido (p= 0,002). Conclusões: o grupo experimental foi mais eficaz em todas as variáveis analisadas após o tratamento de desativação dos pontos-gatilho miofasciais. Também foi observada uma correlação de lateralidade de ambos os sintomas e a existência de uma relação direta entre a melhora da dor e a melhora do zumbido. Modular o zumbido na avaliação dos pontos-gatilho não influencia o prognóstico do tratamento, porém, diminuir a intensidade durante a modulação promove uma resposta maior de alívio do zumbido do que aqueles que aumentam a intensidade ou modificam o tipo de som. / Introduction: the relationship between tinnitus and myofascial trigger points has been subject to debate but few therapeutic guidelines have been proposed. This study aims at analyzing (1) efficacy of myofascial trigger point deactivation for the relief of tinnitus in patients with myofascial pain syndrome; (2) correlation of laterality between tinnitus and pain - and the relief of both of them - as well as (3) whether the presence of tinnitus modulation upon trigger point palpation represents good prognosis for the treatment. Methods: a double-blind randomized placebo controlled clinical trial was developed in order to ascertain efficacy of 10 sessions of myofascial trigger point deactivation in a population suffering from both tinnitus and myofascial pain syndrome. Inclusion criteria were: presence of tinnitus and at least one active trigger point in eight possible muscles of the head, neck or shoulder girdle, excluding patients with generalized pain or undergoing recent treatment for both symptoms. After having been selected by an otologist and evaluated by a \"blind researcher\" in the beginning and after the fifth and tenth session, subjects were directed to a physiotherapist, who randomized them in two groups and treated both. The experimental group was subject to myofascial trigger point deactivation by means of digital pressure and guidance related to procedures to be followed at home, whereas the control group was subject to light pressure in spots adjacent to the existing trigger points. Results: treatment of the experimental group was more effective in relation to tinnitus loudness, number of sounds, total value of the Tinnitus Handicap Inventory as well as modulation intensity (p< 0,001). There was an association between pain relief and tinnitus relief (p= 0,013; Spearman correlation = 0,426) and treatment was effective in all pain-related variables (p< 0,001) such as: pain intensity, algometer value and amount of active and latent trigger points. Laterality correlation was also observed between the side with the worst tinnitus and the side with pain in 54.4% of the cases (Kappa= 0,32; p< 0,001). Tinnitus modulation was frequent in both experimental and control groups (75.7% e 83.3% respectively), even though such phenomenon does not influence the prognosis of the treatment. Nevertheless, diminishing tinnitus intensity was an important condition for tinnitus relief (p= 0,002). Conclusions: the experimental group was more effective in all variables subject to evaluation after treatment with myofascial trigger point deactivation. Laterality correlation of both symptoms was also observed as well as the existence of a direct link between pain relief and tinnitus relief. Modulation of tinnitus during trigger point evaluation does not influence the treatment prognosis, even though diminishing intensity during modulation allows more tinnitus relief than raising intensity or modifying the type of sound.

Objetivos: Avaliar o impacto das intervenções espirituais/religiosas sobre a saúde de indivíduos, descrever os protocolos utilizados e analisar a qualidade metodológica dos artigos. Métodos: Revisão sistemática e meta-análise realizada nos seguintes bancos de dados: PubMed, Scopus, Web of Science, PsycINFO, The Cochrane Collaboration, Embase e Scielo. Através de expressão booleana foram incluídos artigos que: (i) investigaram os desfechos na saúde; (ii) realizaram ensaios clínicos randomizados, e (iii) foram redigidos em inglês, espanhol ou português. Foram excluídos protocolos sobre prece intercessória ou cura à distância. O estudo foi realizado em duas fases: (1) a leitura de título e resumo, (2) leitura completa dos artigos e avaliação de sua qualidade metodológica. Resultados: Através da revisão sistemática, 4751 estudos foram obtidos, dos quais 4367 foram excluídos por não se encaixarem nos critérios de inclusão ou por serem repetidos (fase 1). Dos restantes 162 artigos, 123 foram excluídos por não serem intervenções espirituais/religiosas ou por apresentarem randomização inadequada, permanecendo assim 39 artigos (fase 2). Em geral, os estudos têm mostrado que as intervenções espirituais/religiosas diminuíram os sintomas de depressão, ansiedade, consumo de álcool, excesso de peso e estresse, e melhoraram qualidade de vida em diferentes doenças. A meta-análise mostrou efeitos significativos sobre a ansiedade (p < 0.0001), mas não sobre a depressão (p=0.41) ou qualidade de vida (p=0.56). Conclusão: Os estudos sobre intervenções espirituais/religiosas mostraram benefícios em sintomas clínicos (principalmente ansiedade e estresse), maior adesão a tratamento médico e satisfação com o procedimento. A diversidade de população e protocolos apontam para a necessidade de mais estudos envolvendo E/R como tratamento complementar na saúde / Objectives: To evaluate the impact of spiritual/religious interventions on the health of individuals, describe the protocols utilized and analyze the methodological quality of papers. Methods: A systematic review and meta-analysis conducted in the following databases: PubMed, Scopus, Web of Science, PsycINFO, The Cochrane Collaboration, Embase and Scielo. Through a Boolean expression, were included papers that: (i) investigated health outcomes; (ii) conducted randomized clinical trials, and (iii) were written in English, Spanish or Portuguese. Protocols of intercessory prayer or distance healing were excluded. The study was conducted in two phases: (1) reading the title and abstract, (2) reading full articles and assessing their methodological quality. Results: The systematic review obtained 4751 studies, of which 4367 were excluded because did not fit in eligibility criteria or were repeated (phase 1). Of the remaining 162 articles, 123 were excluded for not fit into spiritual/religious interventions definition or for inadequate randomization, remaining 39 articles (phase 2). In general, studies have shown that spiritual/religious interventions improved clinical symptoms in different diseases, as depression, anxiety, alcohol consumption, overweight and stress, and quality of life. The meta-analysis showed significant effects on anxiety (p < 0.0001), but not on depression (p=0.41) or quality of life (p=0.56). Conclusion: Studies on spiritual/religious interventions showed benefits such as reduction of clinical symptoms (especially anxiety and stress), greater adherence to medical treatment and satisfaction with the procedure. The diversity of population and protocols and indicate the need for further studies evaluating E/R as a complementary treatment in health