Indiana University-Purdue University (IUPUI) / Most pancreatic cancer patients receiving gemcitabine chemotherapy eventually develop resistance to gemcitabine. To improve survival and prognosis of pancreatic cancer patients, better understanding the mechanisms of gemcitabine resistance and discovery of new therapeutic targets are required. In this study, I investigated the molecular mechanisms of acquired gemcitabine resistance using a stepwise gemcitabine-selected pancreatic cancer cell line in comparison to the parental cell line. I found that 14-3-3σ is up-regulated in the drug resistant cell line due to demethylation in its first exon, and the up-regulation of 14-3-3σ gene expression, in turn, contributes to gemcitabine resistance. Intriguingly, I found that demethylation of the 14-3-3σ gene in gemcitabine resistant cells is reversibly regulated by DNMT1 and UHRF1. Furthermore, I found that 14-3-3σ over-expression causes gemcitabine resistance by inhibiting gemcitabine-induced apoptosis and caspase-8 activation possibly via binding to YAP1. The finding of demethylation of the 14-3-3σ gene in gemcitabine resistant cells led to a hypothesis that other genes may also be changed epigenetically following gemcitabine selection. By RRBS (Reduced Representation Bisulfite Sequencing) analysis, 845 genes were found to have altered methylation. One of these genes, PDGFD, was further investigated and found to have reversible demethylation at its promoter region in the drug resistant cells and contribute to gemcitabine resistance possibly via autocrine activation of the STAT3 signaling pathway. Together, these findings not only provide evidence that 14-3-3σ and PDGFD over-expression contribute to acquired gemcitabine resistance and that reversible epigenetic changes may play an important role in acquired gemcitabine resistance, but also demonstrate that the molecular mechanisms of acquired gemcitabine resistance in pancreatic cancer cells are complex and multifaceted.

Radon gas may be a major air quality hazard issue inside the home. Radon (222Rn) comes from the natural breakdown of radioactive uranium (238U) via radium (226Ra) in soil, rocks, and water. Radon and its progeny contribute more than 50% of the total radiation dose to the human population due to inhalation; it can result in severe and fatal lung disease. This investigation has determined the radon concentrations in seventy-seven domestic houses in a mountainous area of Hamadan in Iran which were monitored using track-etch detectors of type CR-39 exposed for three month periods. The arithmetic mean radon concentration in Hamadan buildings was determined to be 80 Bqm-3 and also an average indoor annual effective dose equivalent for the Hamadan city population was calculated as 1.5 mSv. Maximum radon concentrations were noted during the winter and spring season. In addition to this, 28 water wells were monitored by utilizing a Sarad Doseman detector at hourly intervals over extended periods. Radon measurements were also carried out in the nearby Alisadr show cave, using Solid State Nuclear Track etch Detectors (SSNTDs) during the winter and the spring periods. In the cave, the average annual effective geometric and arithmetic mean dose for guides was 28.1 and 34.2 mSv respectively. The dose received by visitors was very low. Hamadan city is built on alluvial fan deposits which are the source of the local water supply. The data from the wells shows that the groundwater in these alluvial deposits influences the flux of radon. The atmospheric radon concentration measurement in wells above the water surface ranged from 1,000 Bqm-3 to 36,600 Bqm-3. There is evidence that radon-rich ground waters play a significant role in the transport of radon through the alluvial fan system. There is evidence that the radon concentrations in homes in Hamadan are greatly influenced by the porous nature of the underlying geology and the movement of groundwater within the alluvial fan. / The Ministry of Health and Education; the University of Hamadan in Iran: University of Bradford: University of Kingston

Depuis la dernière décennie, un nombre croissant de parents consultent divers praticiens en médecine complémentaire et alternative pour des troubles reliés à la santé de leurs bébés ou enfants. Les thérapies manuelles, incluant les mobilisations et manipulations vertébrales, sont des modalités thérapeutiques couramment utilisées dans ce domaine alternatif et malgré la popularité de ces thérapies, peu de littérature existe quant à la sécurité de celles-ci. La majorité des effets secondaires rapportés dans la littérature suite aux thérapies manuelles sont légers et transitoires (ex. : pleurs et raideur), mais certains plus graves (ex. : décès) ont déjà été rapportés. L’objectif de l’article présenté dans ce mémoire était d’évaluer les effets secondaires immédiats et différés (48h) associés aux thérapies manuelles chez les enfants de 5 ans et moins et de présenter des données préliminaires. L’obtention des données chez 73 participants-enfants fut réalisée par l’entremise d’un questionnaire en ligne complété par le tuteur légal. Les résultats de cette étude clinique pragmatique démontrent des effets secondaires bénins et transitoires (ex : irritabilité/pleurs, fatigue/somnolence) chez 30% des enfants ayant reçu des thérapies manuelles. La réalisation de ce projet a permis de confirmer la portion faisabilité auprès de chiropraticiens-participants dans leurs pratiques privées respectives. La limite principale de cette étude est la taille de l’échantillon, qui fut trop petite pour obtenir une puissance statistique permettant de tirer des conclusions sur la fréquence et la nature des effets secondaires. Les retombées de ce projet de recherche incluent un apport quant aux connaissances concernant les effets secondaires suite aux thérapies manuelles pédiatriques et surtout permettent de démontrer qu’il est faisable de réaliser un tel projet au sein des diverses professions pratiquant les thérapies manuelles comme la physiothérapie ou la chiropratique. / Over the past decade, a growing number of parents have been consulting various complementary and alternative medicine practitioners for health-related problems concerning their babies or children. Manual therapies, including spinal mobilizations and spinal manipulation, are one of the therapeutic modalities commonly used in this alternative field and despite the popularity of these therapies, little literature exists on their safety. The majority of adverse events reported in the literature following manual therapies are mild and transient (e.g. crying and stiffness), but some more serious (e.g. death) have already been reported. The objective of the article presented in this thesis was to evaluate immediate and delayed side effects associated with manual therapies in children 5 years of age and under and to present preliminary data. Those data was obtained from 73 child participant through an online questionnaire completed by the legal guardian. The results of this pragmatic clinical study demonstrate mild and transient adverse events (e.g. irritability/crying, fatigue/drowsiness) in 30% of children who received manual therapies. The realization of this project made it possible to confirm the feasibility portion with participating chiropractors in their private practices and the main limitation of it was the sample size, too small to obtain a statistical power allowing to draw conclusions on the frequency and nature of side effects. The benefits of this research project include a contribution to knowledge concerning adverse events following pediatric manual therapies and above all make it possible to demonstrate that it is feasible to carry out such a project within the various professions practicing manual therapies such as physiotherapy or chiropractic.

Obsessive compulsive disorder (OCD) is one of the most disabling psychiatric disorder. About 10% of patients with OCD do not respond to pharmacological treatment. However, deep brain stimulation (DBS) has advanced as an alternative treatment. In 2002, two patients who suffered from co-morbidity of Parkinson’s disease (PD) and OCD were treated with DBS for their PD, with DBS-electrodes placed in the subthalamic nucleus (STN). Surprisingly, not only PD symptoms but also OCD symptoms were improved. This was the first time that patients with OCD were treated with DBS in STN and it was found to markedly improve their symptoms. When performing DBS in patients with OCD, as well as for treating PD, several side-effectshave been observed. The side-effects can be both physical and psychological. In this project,the aim is to investigate the efficiency and side-effects of DBS in OCD, correlated with the position of the electrode in, or near, the STN. To address the aim, 10 published reports were analysed. It was found that all electrode positions reported resulted in great improvement of OCD symptoms. In fact, 88% of patients had significant improvement. There was no clear correlation between position of the electrode and number or type of side-effect. However, there was a trend that patients with the electrode placed in associative/limbic STN suffered from more side-effects. In conclusion, this project demonstrates that there might be a correlation between target for electrode stimulation and side-effects. It would be interesting analyse this closer, including additional electrode target areas, but also consider other possible explanations for the variety of side-effects caused by DBS for OCD.

Indiana University-Purdue University Indianapolis (IUPUI) / Aromatase inhibitors (AIs) are the current standard of care for the treatment of hormone receptor positive breast cancer in postmenopausal women. Nearly one-half of patients receiving AI therapy develop musculoskeletal toxicity that is characterized by joint and/or muscle pain and approximately one-fourth of patients discontinue their therapy as a result of musculoskeletal pain. Since there are no effective strategies for prevention or treatment, insight into the mechanisms of AI-induced pain is critical to improve treatment. However, there are few studies of AI effects in animal models of nociception. To determine whether AIs produce hypersensitivity in animal models of pain, I examined the effects of AI administration on mechanical, thermal, and chemical sensitivity in rats. The results demonstrate that (1) repeated injection of 5 mg/kg letrozole in male rats produces mechanical, but not thermal, hypersensitivity that extinguishes when drug dosing is stopped; (2) administering a single dose of 1 or 5 mg/kg letrozole in ovariectomized (OVX) rats also induces mechanical hypersensitivity, without altering thermal sensitivity and (3) a single dose of 5 mg/kg letrozole or daily dosing of letrozole or exemestane in male rats augments flinching behavior induced by intraplantar ATP injection. To determine whether the effects of AIs on nociceptive behaviors are mediated by activation or sensitization of peptidergic sensory neurons, I determined whether letrozole exposure alters release of calcitonin gene-related peptide (CGRP) from isolated rat sensory neurons and from sensory nerve endings in rat spinal cord slices. No changes in basal, capsaicin-evoked or high extracellular potassium-evoked CGRP release were observed in sensory neuronal cultures acutely or chronically exposed to letrozole. Furthermore, letrozole exposure did not alter the ability of ATP to augment CGRP release from sensory neurons in culture. Finally, chronic letrozole treatment did not augment neuropeptide release from spinal cord slices. Taken together, these results do not support altered release of this neuropeptide into the spinal cord as mediator of letrozole-induced mechanical hypersensitivity and suggest the involvement of other mechanisms. Results from this dissertation provide a new experimental model for AI-induced hypersensitivity that could be beneficial in delineating mechanisms mediating pain during AI therapy.

Diarrhoea, particularly infectious diarrhoea, in children below five years of age is recognised as one of the leading cause of morbidity and mortality throughout the world. This is especially true in residential areas of developing countries where there is substandard sanitation and overcrowding which are reservoirs for farther transmission. Shigellosis is endemic in developing countries and in Sub-Saharan Africa, including South Africa, a region where unique geographic, economic, political, sociocultural, and personal factors interact to create distinctive continuing challenges to prevention and control. Our study was undertaken to establish baseline information on incidences of Shigella, its serotype and resistant pattern of isolates from human faeces from residents of Johannesburg, South Africa. All stools received from January to April 2013 from the private health care system were cultured on standard media for isolation of Shigella and confirmed by standard biochemical reactions and serological method. Antibiotic sensitivity test was determined by the agar diffusion method. 11009 stool samples were assayed from patients aged between 22 days to 94 years with a 110 Shigella isolates yield, of which 47 (43%) were S. flexneri, 61 (55%) S. sonnei and 1 (1%) of S. dysentriae and S. boydii respectively. Majority of patients 76 (69%) were children between < 1 to 5 years old followed by those between 6 to 10 years 13(12%). Of the four species isolated from children of up to 10 years old, S. sonnie was confirmed in 52 cases (59%) and S. flexneri in 36 cases (41%). A total of 53 (48%) males and 57 (52%) females were infected. However, a hundred per cent susceptibility to ciprofloxacin and ceftriaxone but high levels of resistance to Co-trimoxazole (83%), tetracycline (72%), and ampicillin (26%) was noted. From the 110 isolates, 96 (87%) were resistant to one or more drugs while 14 (13%) were fully susceptible. These results show that S. sonnei followed by S. flexneri as predominating aetiology of shigellosis and Ceftriaxone and ciprofloxacin as effective drugs against all four Shigella species. / Health Studies / M. Sc. (Life Sciences)

Hipodermóclise (HDC) é uma importante técnica alternativa para a administração de medicamentos e fluidos pela via subcutânea. É usada com frequência para o controle dos sintomas em pacientes em cuidados paliativos com dificuldade de acesso venoso e que são incapazes de tolerar medicação oral. No entanto, raros estudos abordaram o uso da HDC de uma forma global, para reposição hidroeletrolítica e terapia medicamentosa, tanto na forma contínua quanto intermitente, observando detalhes e complicações do seu uso. Os objetivos deste estudo incluíram caracterizar o uso da HDC para administração de medicamentos, soluções e eletrólitos e avaliar as possíveis complicações locais, identificando também outros fatores que influenciam sua ocorrência. Estudo observacional prospectivo com coleta de dados em prontuário e acompanhamento diário de pacientes internados com câncer avançado, da equipe de Cuidados Paliativos do Instituto do Câncer do Estado de São Paulo (ICESP) em uso de HDC, verificando local de punção, medicamentos administrados e possíveis complicações, acompanhando os detalhes de seu uso. A análise estatística não-paramétrica e método de regressão logística foram realizados. Foram acompanhados 99 pacientes com 243 punções, das quais 166 (68,3%) em coxa e 46 (18,9%) em abdome. Os medicamentos mais utilizados foram morfina em 122 (50,2%) punções, seguido de dipirona em 118 (48,6%) e dexametasona em 86 (35,4%). A solução mais prescrita foi a glicofisiológica em 38 (15,6%) punções, pelo seu aporte calórico. 13,6% das punções (33 de 243) tiveram complicações, sendo apenas seis casos maiores (edema). Complicações ocorreram mais frequentemente até o segundo dia da punção e foram associadas com o número (p=0,007) e o volume (p=0,042) de medicamentos administrados e também com a solução glicofisiológica (p=0,003) e os eletrólitos cloreto de potássio (p=0,037) e cloreto de sódio (p=0,013). Este estudo permitiu o conhecimento de fatores associados a complicações e propõe algumas recomendações, como: individualização da terapia, especialmente relacionada com o volume de escolha, número de medicamentos administrados e evitar a adição de eletrólitos na solução glicofisiológica / Hypodermoclysis (HDC) is an important alternative technique for the administration of drugs and fluids into the subcutaneous tissue. It is frequently used for symptom control in palliative care patients, with difficult venous access and unable to tolerate oral medications. However, few studies address the use of HDC as a whole to fluid replacement and drug therapy, both continuous and intermittent mode, observing details and complications of its use. The objectives of this study included characterizing the use of HDC to administer drugs, solutions and electrolytes and to evaluate possible local complications also identifying other factors influencing their occurrence. Prospective observational study with data collection in medical records and daily monitoring of advanced cancer inpatients of the palliative care team of São Paulo State Cancer Institute (ICESP) in use of HDC, checking infusion site, administered drugs and possible complications, following the details of its use. Non-parametrical statistical analysis and logistic regression were performed. Were followed 99 patients with 243 infusion sites, which 166 (68.3%) in the thigh and 46 (18.9%) in the abdomen. The most commonly used drugs were morphine in 122 (50.2%) infusion sites, followed by dipyrone in 118 (48.6%) and dexamethasone in 86 (35.4%). The most prescribed solution was dextrose 5%/0,9% saline in 38 (15.6%) infusion sites because of its caloric intake. 13.6% of punctures (33 of 243) had complications, only six larger cases (edema). Complications occurred mainly up to the second day of the infusion sites and were associated with the number (p=0,007) and volume (p=0,042) of drugs used as also with 5% dextrose/0.9% saline solution (p=0,003) and NaCl (p=0,037) and KCl (p=0,013) electrolytes. This study has allowed the knowledge of factors associated with complications and proposes some recommendations as: individualization of therapy especially related to the volume of choice, number of drugs administered, and avoid adding electrolytes to the 5% dextrose/0.9% saline solution

Eine effektive Strategie zur Verhinderung der Ausbreitung von Infektionskrankheiten in der Aquakultur ist die Anwendung geeigneter Präventionsmaßnahmen, insbesondere die Impfung von Fischen. Das effektivste Impfverfahren stellt die individuelle Injektion des Impfstoffes dar. Bei Milliarden von Fischen jährlich ist dies jedoch sehr zeit- und kostenintensiv. Bei Säugetieren gilt Niederfrequenz-Sonophorese (LFS) als eine der fortschrittlichsten Technologien zur transdermalen Verabreichung von Wirkstoffen. So entstand die Idee, bei Fischen die Aufnahme von Wirkstoffen während einer Tauchbadbehandlung mit Hilfe von LFS zu verbessern. Die vorliegende Arbeit zeigt, dass mit einer Beschallungsintensität von etwa 60 mW/cm^2 die Aufnahme eines Bakterienimpfstoffs in das Kiemengewebe von Regenbogenforellen um den Faktor 240 erhöht werden konnte. Bei dieser Intensität traten geringe oder keine Nebenwirkungen auf. Bei höheren Beschallungsintensitäten wurde eine noch höhere Aufnahme des Bakterienimpfstoffes, aber auch schädliche Nebenwirkungen beobachtet. Darüber hinaus zeigte LFS eine durch eine lokale Entzündungsreaktion und Aktivierung von T-Helferzellen in den Kiemen charakterisierte, Adjuvans-ähnliche Wirkung. Ein Impfversuch mit Koi Karpfen und einem inaktivierten Impfstoff gegen das Koi-Herpesvirus zeigte, dass LFS das Potential hat, den mit einer Tauchbadimpfung erzielbaren Immunschutz zu verbessern. LFS konnte auch für die Verabreichung anderer Substanzen wie Antibiotika verwendet und die Aufnahme von Oxytetracyclin um den Faktor fünf erhöht werden. Zusammenfassend lässt sich sagen, dass die Effektivität einer Tauchbadimpfung von Fischen mit LFS durch die gesteigerte Impfstoffaufnahme und dessen Adjuvans-ähnlichen Wirkung verbessert werden kann. Darüber hinaus könnte mithilfe LFS die therapeutische Dosis von Antibiotika bei Badbehandlungen verringert werden. Es erfordert jedoch noch weitere Studien, um diese Technologie aus dem Labor in die Praxis zu übertragen. / In aquaculture, the use of prevention methods, such as vaccination of fish, is an effective strategy to avoid infectious diseases. However, the most effective route of vaccination for fish is the one-by-one intraperitoneal injection, which that is very laborious and expensive to apply for billions of fish every year. Low Frequency Sonophoresis (LFS) has been recognized as one of the most advanced technologies in transdermal delivery of substances in mammals. Thus, it has been suggested to use LFS to enhance the uptake of substances in fish during bath treatments. The present study shows that a low sonication intensity of ca. 60 mW/cm^2 at 37 kHz increased the uptake of a bacterin into the gill tissue of rainbow trout by up to a factor of 240. At this intensity, no or only minimal side effects occurred. At higher sonication intensities, an even higher bacterin uptake but also deleterious side effects were observed. In addition, LFS showed an adjuvant-like effect characterized by a local inflammatory response and T-helper cell activation in the gills. A vaccination trial with koi carp and an inactivated vaccine against the Koi Herpes Virus (KHV) showed that LFS has the potential to enhance the immune protection achieved by immersion vaccination. In addition LFS can also be used for the administration of other substances, such as antibiotics, here we showed that the uptake of Oxytetracycline could be increased by factor five. In summary, the efficacy of the immersion vaccination of fish could be improved by low-frequency ultrasound due, to the increased vaccine uptake along with its adjuvant-like effect. Furthermore, LFS could also reduce the required therapeutic dose of antibiotics in bath treatments, making them more effective, cheaper and environmentally friendly. However, further practical studies will be required to transfer this technology from the lab to the field.

La compréhension des pathologies humaines et du mode d'action des médicaments passe par la prise en compte des réseaux d'interactions entre biomolécules. Les recherches récentes sur les systèmes biologiques produisent de plus en plus de données sur ces réseaux qui gouvernent les processus cellulaires. L'hétérogénéité et la multiplicité de ces données rendent difficile leur intégration dans les raisonnements des utilisateurs. Je propose ici des approches intégratives mettant en oeuvre des techniques de gestion de données, de visualisation de graphes et de fouille de données, pour tenter de répondre au problème de l'exploitation insuffisante des données sur les réseaux dans la compréhension des phénotypes associés aux maladies génétiques ou des effets secondaires des médicaments. La gestion des données sur les protéines et leurs propriétés est assurée par un système d'entrepôt de données générique, NetworkDB, personnalisable et actualisable de façon semi-automatique. Des techniques de visualisation de graphes ont été couplées à NetworkDB pour utiliser les données sur les réseaux biologiques dans l'étude de l'étiologie des maladies génétiques entrainant une déficience intellectuelle. Des sous-réseaux de gènes impliqués ont ainsi pu être identifiés et caractérisés. Des profils combinant des effets secondaires partagés par les mêmes médicaments ont été extraits de NetworkDB puis caractérisés en appliquant une méthode de fouille de données relationnelles couplée à Network DB. Les résultats permettent de décrire quelles propriétés des médicaments et de leurs cibles (incluant l'appartenance à des réseaux biologiques) sont associées à tel ou tel profil d'effets secondaires / The understanding of human diseases and drug mechanisms requires today to take into account molecular interaction networks. Recent studies on biological systems are producing increasing amounts of data. However, complexity and heterogeneity of these datasets make it difficult to exploit them for understanding atypical phenotypes or drug side-effects. This thesis presents two knowledge-based integrative approaches that combine data management, graph visualization and data mining techniques in order to improve our understanding of phenotypes associated with genetic diseases or drug side-effects. Data management relies on a generic data warehouse, NetworkDB, that integrates data on proteins and their properties. Customization of the NetworkDB model and regular updates are semi-automatic. Graph visualization techniques have been coupled with NetworkDB. This approach has facilitated access to biological network data in order to study genetic disease etiology, including X-linked intellectual disability (XLID). Meaningful sub-networks of genes have thus been identified and characterized. Drug side-effect profiles have been extracted from NetworkDB and subsequently characterized by a relational learning procedure coupled with NetworkDB. The resulting rules indicate which properties of drugs and their targets (including networks) preferentially associate with a particular side-effect profile

Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíaca / This paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery