Estimulação ultra-sônica da integração de enxertos de pele total: estudo experimental em coelhos.

$&7$25723%5$6

7UDEDOKRUHFHELGRHPDSURYDGRHP

$57,*225,*,1$/

5(6802

)RLUHDOL]DGRXPHVWXGRKLVWROyJLFRH[SHULPHQWDOGDLQIOXrQFLDGR XOWUDVRPWHUDSrXWLFRQDLQWHJUDomRGHHQ[HUWRVGHSHOHGHHVSHV VXUDWRWDOHPFRHOKDVDGXOWDV'RLVHQ[HUWRVTXDGUDGRVGHFP GHODGRIRUDPREWLGRVQDVUHJL}HVHVFDSXODUHVHWURFDGRVGHODGR 2HQ[HUWRjGLUHLWDIRLLUUDGLDGRGLDULDPHQWH0+]:FPGX UDomRPLQXWRVGHVGHRWHUFHLURGLDHSRUVHWHGLDVFRQVHFXWLYRV jHVTXHUGDRWUDWDPHQWRHUDVLPXODGR2HVWXGRKLVWROyJLFRHP FRUWHVGH—PGHHVSHVVXUDREWLGRVGHFDGDHQ[HUWRHFRUDGRV DOWHUQDWLYDPHQWHFRPRWULFU{PLFRGH*RPRUL3&1$HSLFURVtULXV LQFOXLXDPHGLGDGDViUHDVGDHSLGHUPHHGDGHUPHDFRQWDJHP GDVFpOXODVHPSUROLIHUDomRQDFDPDGDJHUPLQDWLYDHRVYDVRV QHRIRUPDGRVHDRULHQWDomRGDVILEUDVFROiJHQDV)RLREVHUYDGR DXPHQWRVLJQLILFDQWHGRQ~PHURGHFpOXODVSUROLIHUDWLYDVS HGRVYDVRVQHRIRUPDGRVS QRVHQ[HUWRVLUUDGLDGRVPDV QmRQDiUHDGDHSLGHUPHHGDGHUPH2VDXWRUHVFRQFOXtUDPTXH R 867 LQGX] DOWHUDo}HV PRUIROyJLFDV QRV SURFHVVRV ELROyJLFRV HQYROYLGRVQDLQWHJUDomRGRHQ[HUWRGHSHOHGHHVSHVVXUDWRWDO FRPR D SUROLIHUDomR GDV FpOXODV JHUPLQDWLYDV H D IRUPDomR GH QRYRVYDVRVVDQJtQHRVHVXJHUHPTXHKiSRWHQFLDOSDUDRXVR FOtQLFRHPKXPDQRV

'HVFULWRUHV(Q[HUWRGHSHOH7HUDSLDSRU8OWUDVRP&RHOKRV

(67,08/$d®28/75$6Ñ1,&$'$,17(*5$d®2

'((1;(5726'(3(/(727$/

(678'2(;3(5,0(17$/(0&2(/+26

$'5,$1$'$&267$*21“$/9(6$0Ž1&,2&/8',2+(15,48(%$5%,(5,1,/7210$==(56(5*,2%5,72*$5&,$-26•$17Ÿ1,27+20$=,1,

7UDEDOKRUHDOL]DGRQR3URJUDPDGH3yVJUDGXDomR2UWRSHGLD7UDXPDWRORJLDH5HDELOLWDomR'HSDUWDPHQWRGH%LRPHFkQLFD0HGLFLQDH5HDELOLWDomRGR$SDUHOKR/RFRPRWRU)DFXOGDGH GH0HGLFLQDGH5LEHLUmR3UHWR8QLYHUVLGDGHGH6mR3DXOR

(QGHUHoRSDUDFRUUHVSRQGrQFLD'HSDUWDPHQWRGH%LRPHFkQLFD0HGLFLQDH5HDELOLWDomRGR$SDUHOKR/RFRPRWRU)DFXOGDGHGH0HGLFLQDGH5LEHLUmR3UHWR&DPSXV8QLYHUVLWiULR &(35LEHLUmR3UHWR63%UD]LO(PDLOFKEDUELH#IPUSXVSEU

)LVLRWHUDSHXWD$OXQDGR&XUVRGH0HVWUDGR 3URIHVVRU7LWXODU2ULHQWDGRU

3URIHVVRU$VVRFLDGR&RRULHQWDGRU

3DWRORJLVWD&RODERUDGRU'HSDUWDPHQWRGH3DWRORJLDH0HGLFLQD/HJDO 0RUIRORJLVWD&RODERUDGRU'HSDUWDPHQWRGH&LUXUJLDH$QDWRPLD

,1752'8d®2

(Q[HUWRVDXWyORJRVGHSHOHFHUWDPHQWHVmRRSURFHGLPHQWRPDLV ODUJDPHQWHHPSUHJDGRSDUDSURYHUFREHUWXUDSDUDGHIHLWRVFXWkQHRV UHVXOWDQWHVGHXPDDPSODYDULHGDGHGHFDXVDV(OHVSRGHPVHUXWLOL]D GRVSDUDOHV}HVGHTXHLPDGXUDVDEUDV}HVRXDYXOV}HVWUDXPiWLFDV QHFURVHFXWkQHDVHJXLQGRVHDXPDRSHUDomRRXWUDXPDWLVPRGHIHL WRVFRQJrQLWRVSDVVDQGRSRUFRUUHomRFLU~UJLFDHDVVLPSRUGLDQWH QXPDOLVWDTXDVHLQILQLWDGHVLWXDo}HVDVTXDLVSUDWLFDPHQWHWRGR FLUXUJLmRSOiVWLFRRXRUWRSpGLFRYLYHQFLDPURWLQHLUDPHQWH

$SHVDUGLVVRRVUHVXOWDGRVGRVSURFHGLPHQWRVGHHQ[HUWLDGHSHOH QHPVHPSUHVmRFRPSOHWDPHQWHVDWLVIDWyULRVPDVDWpRPRPHQWR QmRKiQHQKXPPHLREHPHVWDEHOHFLGRSDUDHVWLPXODUDLQWHJUDomR H PD[LPL]DU RV UHVXOWDGRV HVWpWLFRV H IXQFLRQDLV GRV HQ[HUWRV 3RURXWURODGRDJHQWHVItVLFRVFRPRDHOHWULFLGDGHRVFDPSRV PDJQpWLFRVRXHOpWULFRVHRXOWUDVRPSRGHPLQIOXHQFLDUSRVLWLYD PHQWHRUHVXOWDGRGRSURFHVVRGHFLFDWUL]DomRRXUHJHQHUDomRGH GLIHUHQWHVWHFLGRVFRPRDSHOHRVRVVRVRVP~VFXORVHWHQG}HV

HRVQHUYRVSHULIpULFRV$LUUDGLDomRXOWUDV{QLFDWHUDSrXWLFD867 HIHWLYDPHQWHUHGX]RHGHPDDXPHQWDRIOX[RVDQJtQHRORFDOUH OD[DRVP~VFXORVDOLYLDDGRUDFHOHUDRUHSDURWHFLGXDOHPRGLILFD DIRUPDomRGHFLFDWUL]HV_{1RTXHVHUHIHUHjSHOHKiHYLGrQFLDV}

GHTXHR867SURSLFLDDUHJHQHUDomR_{UD]mRSRUTXHHOHWHP}

VLGRLQGLFDGRSDUDWUDWDU~OFHUDVYDULFRVDV_RXGHSUHVVmRH

MiIRLDWpLQYHVWLJDGRTXDQGRjFDSDFLGDGHGHDFHOHUDUHPHOKRUDU DLQWHJUDomRHDTXDOLGDGHGHHQ[HUWRVGHSHOH

1HVVH~OWLPRSDUWLFXODUQDGDDLQGDHVWiHVWDEHOHFLGRGHPRGR TXH IRL R SURSyVLWR GD SUHVHQWH LQYHVWLJDomR HVWXGDU R SDSHO GHVHPSHQKDGRSHOR867QDLQWHJUDomRGHHQ[HUWRVOLYUHVGHSHOH GHHVSHVVXUDWRWDOHPFRHOKRV

0$7(5,$/(0e72'26

2HVWXGRIRLDSURYDGRSHOD&RPLVVmRGHeWLFDQR8VRGH$QLPDLV GH([SHULPHQWDomRGD)DFXOGDGHGH0HGLFLQDGH5LEHLUmR3UHWR )RUDPXWLOL]DGDVYLQWHFRHOKDVGDUDoD1RYD=HOkQGLDSHVDQGRHP 8/75$621,&67,08/$7,212)727$/6.,1*5$)7681,21$1(;3(5,0(17$/678'<,15$%%,76

6800$5<

$QH[SHULPHQWDOKLVWRORJLFDOVWXG\ZDVSHUIRUPHGDGGUHVVLQJWKH LQIOXHQFH RI WKHUDSHXWLF XOWUDVRXQG RQ WRWDOWKLFNQHVV VNLQ JUDIWV XQLRQLQDGXOWIHPDOHUDEELWV7ZRFPVTXDUHVKDSHGJUDIWV ZHUHREWDLQHGDWVFDSXODUUHJLRQVZLWKVLGHVVZLWFKHG7KHJUDIW DWULJKWZDVLUUDGLDWHGRQDGDLO\EDVLV0+]:FPIRU PLQXWHVIURPWKHWKLUGGD\RQGXULQJVHYHQFRQVHFXWLYHGD\VWKH JUDIWDWOHIWUHFHLYHGDVKDPWUHDWPHQW7KHKLVWRORJLFDOVWXG\LQ µ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

.H\ZRUGV6NLQWUDQVSODQWDWLRQ8OWUDVRQLF7KHUDS\5DEELWV

&LWDomR$PkQFLR$&*%DUEDHUL&+0D]]HU1*DUFLD6%7KRPD]LQL-$(VWLPX ODomRXOWUDV{QLFDGDLQWHJUDomRGHHQ[HUWRVGHSHOHWRWDOHVWXGRH[SHULPHQWDOHP FRHOKRV$FWD2UWRS%UDV>SHULyGLFRQD,QWHUQHW@'LVSRQtYHO HP85/KWWSZZZVFLHOREUDRE

$&7$25723%5$6

)LJXUD6HTijQFLDGRSURFHGLPHQWRRSHUDW»ULR$SHOHVHQGRPDUFDGD FRPRPROGHGHPHWDOGHFP[FPDRHQ[HUWRVHQGROLPSRGH

TXDOTXHUUHPDQHVFHQWHGRWHFLGRVXEFXW«QHREHMªVXWXUDGRGHYROWD QROHLWRLQYHUWLGRFRFXUDWLYRWLSRWLHRYHUGH%URZQG

%,26(7²,QG~VWULDGH7HFQRORJLD(OHWU{QLFD/WGD%UDVLO

PpGLDNJYDULDomR²NJ$QWHVHGHSRLVGDRSHUDomR RVDQLPDLVIRUDPPDQWLGRVHPJDLRODVLQGLYLGXDLVFRPOLYUHDFHVVR jUDomRDOLPHQWDUHjiJXD7RGDVUHFHEHUDPXPDLQMHomRVXE FXWkQHDGHXPDGRVHSHVRGHSHQGHQWHGHDQWLELyWLFR3HQLFLOLQD SURFDtQD8,LPHGLDWDPHQWHDQWHVGDRSHUDomRDWtWXOR GHSURILOD[LDGHLQIHFo}HV

3URFHGLPHQWR FLU~UJLFR RV DQLPDLV IRUDP DQHVWHVLDGRV FRP XPDGRVHHQGRYHQRVDLQLFLDOGHSHQWREDUELWDOVyGLFR1HPEXWDO $EERWWŠ_{PJNJGHSHVRFRUSRUDODSOLFDGDQDYHLDPDUJLQDOGD}

RUHOKDRFDVLRQDOPHQWHFRQIRUPHRDQLPDOPDQLIHVWDVVHGRUXPD GRVHDGLFLRQDOHUDDGPLQLVWUDGDGXUDQWHRSURFHGLPHQWR7RGDD UHJLmRHVFDSXODUIRLSUHSDUDGDSDUDDRSHUDomRGDPDQHLUDURWLQHLUD WULFRWRPLDDQWLVHSVLDFRPVROXomRDOFRyOLFDGHLRGRDHD UHJLmRRSHUDWyULDIRLFREHUWDFRPFDPSRVFLU~UJLFRV'XDViUHDV TXDGUDGDVGHFP[FPIRUDPGHVHQKDGDVFRPRDX[tOLRGH XPPROGHGHPHWDOXPDGHFDGDODGRGDUHJLmRHVFDSXODUHORJR PHGLDOjVHVFiSXODVUHFRUWDGDVFRPXPELVWXULOkPLQDHLQWHL UDPHQWHUHPRYLGDVFRPRXPHQ[HUWROLYUHGHSHOHGHSRLVOLPSRGH TXDOTXHUUHVTXtFLRGHWHFLGRVXEFXWkQHRHJRUGXUD2VGRLVOHLWRV GRDGRUHVIRUDPUHYLVDGRVSDUDULJRURVDKHPRVWDVLDHRVHQ[HUWRV IRUDPVXWXUDGRVGHYROWDWURFDQGRGHODGRRGLUHLWRQROHLWRGD HVTXHUGDHYLFHYHUVDFRPSRQWRVLVRODGRVGHILRPRQRILODPHQWR GHQ\ORQGHFDOLEUHVHQGRXPHPFDGDkQJXORHXPHPFDGD ODGR2VHQ[HUWRVVXWXUDGRVIRUDPFREHUWRVFRPJD]HYDVHOLQDGD HXPFXUDWLYRWLSRWLHRYHUGH%URZQIRLDSOLFDGR)LJXUD

,UUDGLDomRXOWUDV{QLFDRFXUDWLYRHUDUHPRYLGRQRWHUFHLURGLD SyVRSHUDWyULRHDiUHDHQ[HUWDGDHUDFXLGDGRVDPHQWHOLPSDFRP VROXomRILVLROyJLFDSDUDUHPRYHUTXDOTXHUVLQDOGHVDQJXHRXVHFUH omRDVSHUJLGDFRPVROXomRDOFRyOLFDGHLRGRDHGHL[DGDSDUD VHFDU3DUDHYLWDUPRELOL]DomRLQYROXQWiULDGRHQ[HUWRVREUHROHLWR DUHJLmRWRGDHUDDEXQGDQWHPHQWHEDQKDGDFRPYDVHOLQDOtTXLGD HVWpULOHFREHUWDFRPXPILOPHSOiVWLFRFORUHWRGHSROLYLQLOGHXVR GRPpVWLFRPPGHHVSHVVXUDRTXDOHUDFREHUWRFRPRJHO GHDFRSODPHQWRGRFDEHoRWHGHLUUDGLDomRXOWUDV{QLFD$LUUDGLDomR HUDDSOLFDGDGLUHWDPHQWHVREUHRHQ[HUWRXWLOL]DQGRXPHTXLSDPHQWR SRUWiWLOGHXVRFOtQLFR621$&(/Š_{3OXV,,,VHULH5GRWDGRGH}

XPFDEHoRWHGHSHTXHQRGLkPHWURHVSHFLDOPHQWHFRQIHFFLRQDGR

FPGHGLkPHWURFP_{GHiUHDHSUHSDUDGRSDUDLUUDGLD}

omRSXOVDGDRXD0+]GHIUHTrQFLDH:FP_GH

LQWHQVLGDGH6$7$2HTXLSDPHQWRIRLFDOLEUDGRFRPXPGRVtPHWUR GHSUHFLVmR8OWUDVRQLF3RZHU0HWHUPRGHOR830'7DQWHVGH LQLFLDUDLUUDGLDomRHSHULRGLFDPHQWHGHSRLVGLVVR

)RUDPUHDOL]DGDVVHVV}HVGLiULDVGHFLQFRPLQXWRVGHGXUDomR FDGD LQLFLDGDV LPHGLDWDPHQWH DSyV D UHPRomR GR FXUDWLYR H UHSHWLGDVSRUVHWHGLDVFRQVH

FXWLYRVVHPSUHQRPHVPRKR UiULRSDUDUHVSHLWDURLQWHUYDOR GHKRUDVHQWUHDVVHVV}HV 2 FDEHoRWH XOWUDV{QLFR HUD PRYLGR JHQWLOPHQWH VREUH R HQ[HUWR SDUD HYLWDU GHVFROiOR GROHLWR,GrQWLFRSURFHGLPHQWR IRLUHDOL]DGRQDiUHDHQ[HUWDGD jGLUHLWD*UXSRHjHVTXHUGD *UXSRPDVFRPRHTXLSD PHQWRGHVOLJDGRQHVWH~OWLPR SDUD TXH KRXYHVVH DSHQDV R HIHLWRGHPDVVDJHPHPFRPXP HQWUHDPERVRVODGRV8PFXUD WLYR OHYHPHQWH FRPSUHVVLYR HUDDSOLFDGRDSyVDVHVVmRGH LUUDGLDomRPDQWHQGRXPDJD]H YDVHOLQDGDVREUHDiUHDHQ[HU WDGDSDUDSUHYHQLUDGHUrQFLDV

3UHSDUDo}HVKLVWROyJLFDVRV DQLPDLVHUDPPRUWRVQRR_GLD

SyVRSHUDWyULRFRPXPDLQMHomR

HQGRYHQRVDGHXPDGRVHH[FHVVLYDGHDQHVWpVLFRHFDGDiUHD HQ[HUWDGDHUDUHVVHFDGDFDGDXPDFRPSUHHQGHQGRXPTXDGUD GRGHSHOHGH[FPFRPRHQ[HUWRQRPHLR$SHOHUHVVHFDGD HUDIL[DGDHPXPDPROGXUDGHSDSHOFDUWmRLGHQWLILFDGDHLPHUVD HP XPD VROXomR DTXRVD GH IRUPDOGHLGR D SRU GRLV GLDV SDUDIL[DomRDSyVRTXHRHQ[HUWRHUDUHFRUWDGRGRUHVWDQWHGD SHOHUHFHSWRUDHSURFHVVDGRGDPDQHLUDURWLQHLUDSDUDHVWXGRV KLVWROyJLFRV)RUDPREWLGRVFRUWHVWUDQVYHUVDLVVHULDGRVGH—P GH HVSHVVXUD FRPHoDQGR GH XPD GDV ERUGDV HP GLUHomR DR FHQWURGRHQ[HUWRHFRUDGRVDOWHUQDWLYDPHQWHFRPRWULFU{PLFR GH*RPRULFRPRDQWtJHQRQXFOHDUSDUDFpOXODVHPSUROLIHUDomR 3&1$SUROLIHUDWLRQFHOOQXFOHDUDQWLJHQ_{RXFRPR3LFURV\ULXV}

&DGDHQ[HUWRUHQGHXFHUFDGHFRUWHVVHULDGRVGRVTXDLV IRUDPH[DPLQDGRVHIRUDPHIHWLYDPHQWHDQDOLVDGRV &DGDOkPLQDHUDPRQWDGDFRPFLQFRFRUWHVGRHQ[HUWRLUUDGLDGR ODGRDODGRFRPFLQFRGRHQ[HUWRGHFRQWUROHGRPHVPRDQLPDO SDUDIDFLOLWDUDVFRPSDUDo}HV2VFRUWHVIRUDPH[DPLQDGRVHP PLFURVFySLRGHOX]&DUO=HLVV$[LRSKRWRXFRPPLFURVFySLRGH OX]SRODUL]DGDFRUWHVFRUDGRVFRPR3LFURV\ULXVHTXLSDGRFRP XPDFkPHUDGHYtGHRFRQHFWDGDDXPPLFURFRPSXWDGRUGRWDGR GRSURJUDPD6QDSS\9LGHR6QDSVKRWSDUDFDSWXUDGHLPDJHP 2V FRUWHV FRUDGRV FRP R WULFU{PLFR GH *RPRUL TXH PRVWUD FODUDPHQWHROLPLWHHQWUHDVFDPDGDVFHOXODUHVFXWkQHDVIRUDP XWLOL]DGRVSDUDPHGLUDiUHDGDHSLGHUPHHGDGHUPHVREEDL[D PDJQLILFDomR[HXWLOL]DQGRRSURJUDPD6FLRQ,PDJHWUrV FDPSRVVHSDUDGRVGDHSLGHUPHHGDGHUPHHUDPVHOHFLRQDGRVHP FDGDFRUWHGHWDOPRGRTXHRFRPSULPHQWRGHFDGDFDPDGDHUD RPHVPRHPFDGDFDPSRD~QLFDYDULiYHOVHQGRVXDHVSHVVXUD &RPDVPHGLGDVGRFRPSULPHQWRHGDHVSHVVXUDFDOFXODYDVHD

iUHDHSLGHUPHHGDGHUPH—P_{HPFDGDFDPSRUHVSHFWLYRXP}

YDORUPpGLRGDVWUrVPHGLGDVHUDFDOFXODGRSDUDFDGDFRUWH$LQGD QHVVHVFRUWHVHFRPJUDQGHDXPHQWR[RVYDVRVQHRIRUPD GRVHUDPFRQWDGRVQDGHUPHUHWLFXODUYL]LQKDjWUDQVLomRHQWUH RHQ[HUWRHROHLWRUHFHSWRUHPFLQFRFDPSRVGLIHUHQWHVGHFDGD FRUWHVHQGRGHSRLVFDOFXODGRXPYDORUPpGLRSDUDFDGDFRUWH FDGDHQ[HUWRHILQDOPHQWHSDUDFDGDJUXSR

$VFpOXODVHPSUROLIHUDomRIRUDPFRQWDGDVQDFDPDGDJHUPLQDWLYD GDSHOHQRVFRUWHVFRUDGRVFRPR3&1$HH[DPLQDGRVDRPL FURVFySLRGHOX]GLUHWD-HQDPHG3ULPHLURHUDPVHOHFLRQDGRV WUrVFDPSRVVHSDUDGRVFRPRGHVFULWRDFLPDWRGDVDVFpOXODV VHQGRFRQWDGDVFRPJUDQGHDXPHQWR['HSRLVDSHQDVDV FpOXODVIRUWHPHQWHPDUFDGDVHUDPFRQWDGDVVXDIUHTrQFLDVHQGR H[SUHVVDHPSHUFHQWDJHPGRWRWDO

$ RULHQWDomR GDV ILEUDV FROiJHQDV HUD DQDOLVDGD VRE DXPHQWR PRGHUDGR [ QRV FRUWHV FRUDGRV FRP R 3LFURV\ULXV XVDQGRXPPLFURVFySLRGHOX] SRODUL]DGD RV DFKDGRV VHQGR PHUDPHQWHGHVFULWLYRV $QiOLVH HVWDWtVWLFD RV GDGRV QmR SDUHDGRV GD PHGLGD GD iUHD GD HSLGHUPH H GD GHUPH IRUDP VXEPHWLGRV D DQiOLVH HVWDWtVWLFD FRP R WHVWH QmR SDUDPpWULFR GH :LOFR[RQ QR QtYHO GH VLJQLILFkQFLD GH S”2WHVWH7GH6WXGHQW IRLXWLOL]DGRSDUDDDQiOLVHGRV GDGRV SDUHDGRV GD FRQWDJHP GDV FpOXODV HP SUROLIHUDomR H GRVYDVRVQHRIRUPDGRVLJXDO PHQWHQRQtYHOGHVLJQLILFkQFLD GH”

5(68/7$'26

$FKDGRV PDFURVFySLFRV

$&7$25723%5$6

)LJXUD&RUWHVKLVWRO»JLFRVWUDQVYHUVDLV PRVWUDQGRDWHQG³QFLDDRDXPHQWR GDHVSHVVXUDGDHSLGHUPHGRHQ[HUWR

LUUDGLDGRDHPFRPSDUD°¬RFRPR FRQWUROHE7ULFU¼PLFRGH*RPRUL[

)LJXUD&RUWHVKLVWRO»JLFRV WUDQVYHUVDLVPRVWUDQGRRDXPHQWRGD FRQFHQWUD°¬RGHF²OXODVHPSUROLIHUD°¬R

QDFDPDGDEDVDOVHWDGRHQ[HUWR LUUDGLDGRDHPFRPSDUD°¬RFRPR

FRQWUROHE3&1$[

GLIHUHQoD PDFURVFySLFD HYLGHQWH HQWUH RV HQ[HUWRV LUUDGLDGRV *UXSR H GH FRQWUROH

*UXSRQRR_{GLDSyVRSHUDWyULR3HTXHQDV}

iUHDVGLVSHUVDVGHQHFURVHDSDUHFLDPSUy[LPR DRVFDQWRVHERUGDVGRHQ[HUWRHPDPERVRV JUXSRV(SLGHUPyOLVHSDUFLDOELODWHUDOHQ[HUWRV LUUDGLDGRV H GH FRQWUROH IRL REVHUYDGD HP TXDWUR DQLPDLV H XQLODWHUDO ODGR GH FRQWUROH HPXPFXMRDVSHFWRFRVPpWLFRSDUHFLDPHOKRU GRTXHRGRVHQ[HUWRVVHPQHFURVH1mRKRXYH QHQKXPFDVRGHLQIHFomR

ÉUHDGDHSLGHUPHHGDGHUPHDiUHDPpGLD GD HSLGHUPH PHGLX —P PHGLDQD —P QR *UXSR H —P QR *UXSR PHGLDQD —P PDV DV GLIHUHQoDV HQWUH RV JUXSRV QmR IRUDP VLJQLIL FDQWHVS $iUHDPpGLDGDGHUPHPHGLX —P PHGLDQD —P QR *UXSRH—PPHGLDQD —P QR *UXSR DV GLIHUHQoDV HQWUH DPERV QmR VHQGR LJXDOPHQWH VLJQLILFDQWHV S )LJXUD7DEHOD

&pOXODVHPSUROLIHUDomRHYDVRVQHRIRUPD

GRVKRXYHXPDXPHQWRVLJQLILFDQWHS

QRQ~PHURGHFpOXODVHPSUROLIHUDomRQR*UXSR SRLVHODVUHVSRQGHUDPHPPpGLDSRUGR WRWDOHPFRPSDUDomR

FRPQR*UXSR )LJXUD7DEHOD +RXYH LJXDOPHQWH XP DXPHQWR VLJQLIL FDQWH S QR Q~PHURGHYDVRVQHR IRUPDGRVQDFDPDGD UHWLFXODUGDGHUPHQR

*UXSRQRTXDOHOHVIRUDPFRQWDGRVQDIDL [DGHYDVRVSRUFDPSRHPPpGLDHP FRPSDUDomRFRPYDVRVSRUFDPSRQR *UXSR)LJXUD7DEHOD

2ULHQWDomR GDV ILEUDV FROiJHQDV WDQWR QR*UXSRFRPRQR*UXSRIRLPDQWLGR RSDGUmRXVXDOGHILEUDVFROiJHQDVORQJLWX GLQDLVSULQFLSDLVSDUDOHODVjVXSHUItFLHHGH ILEUDV REOtTXDV H WUDQVYHUVDLV VHFXQGiULDV GLUHFLRQDGDV SDUD D VXSHUItFLH GD SHOH DSHQDV FRP XP OHYH GHVDUUDQMR 1mR IRL REVHUYDGD GLIHUHQoD LPSRUWDQWH HQWUH RV JUXSRV)LJXUD

',6&866®2

6HMDPWHPSRUiULRVRXGHILQLWLYRVRVHQ[HUWRV DXWyORJRV GH SHOH VmR PXLWR LPSRUWDQWHV H DGHTXDGRV SDUD D FREHUWXUD FXWkQHD GH SUDWLFDPHQWH TXDOTXHU WLSR GH SHUGD DGTXLULGD RX WUDXPiWLFD 1D PDLRULD GRV FDVRV RV HQ[HUWRV GH SHOH VH LQWHJUDP VHP FRQWUDWHPSRV PDV jV YH]HV HOHV VH SHUGHPGHYLGRDXPDYDULHGDGHGHFDXVDV ORFDLVRXJHUDLV'HVGHTXHDVD~GHJHUDO GRSDFLHQWHVHMDERDHROHLWRUHFHSWRUVHMD DGHTXDGRRFLUXUJLmRSRGHHVFROKHUHQWUH HQ[HUWRVGHHVSHVVXUDSDUFLDORXWRWDOHHQWUH HQ[HUWRVIUDJPHQWDGRVHPPDOKDRX HPOkPLQD(PTXDOTXHUFDVRXPD YH] WHUPLQDGR R SURFHGLPHQWR H D UHJLmRHQ[HUWDGDSURWHJLGDFRPXP FXUDWLYR DGHTXDGR SRXFR UHVWD D ID]HUDOpPGHHVSHUDUSHORUHVXOWDGR HPPpGLDFLQFRDVHWHGLDVGHSRLV

TXDQGR R FXUDWLYR p UHPRYLGR (P FHUFD GH GRVFDVRVRHQ[HUWRGHSHOHWRWDOVRIUH DOJXPJUDXGHQHFURVHQDPDLRULDGDVYH]HV DIHWDQGRDVFDPDGDVJUDQXODUO~FLGDHFyUQHD HPFXMRFDVRRHQ[HUWRVHLQWHJUDHPERUDFRP UHVXOWDGRFRVPpWLFRFRPSURPHWLGR4XDQGRD FDPDGDEDVDORXJHUPLQDWLYDHDFDPDGDGH FpOXODVIXVLIRUPHVVmRDIHWDGDVRHQ[HUWRHVWi FRPSOHWDPHQWHSHUGLGRKDYHQGRQHFHVVLGDGH GHXPQRYRSURFHGLPHQWRUHSDUDWLYR

2 867 p XVDGR SDUD WUDWDU XPD YDULHGDGH GH FRQGLo}HV SDWROyJLFDV GR VLVWHPD P~VFXOR HVTXHOpWLFR _{PDV PXLWR SRXFR p FRQKHFLGR}

VREUHVHXVHIHLWRVVREUHDSHOH(QWUHWDQWRKi HYLGrQFLDVGHTXHHOHHVWLPXODRSURFHVVRGH FLFDWUL]DomRGHOHV}HVFXWkQHDVSRLV'\VRQHW DO_{PRVWUDUDPHIHLWRVEHQpILFRVR867SXOVDGR}

:FP _{DSOLFDo}HV GH PLQXWRV SRU GLD}

HPGLDVDOWHUQDGRVSRUGLDVFRPHoDQGRQR R_{GLDSyVRSHUDWyULRVREUHDFLFDWUL]DomRGH}

OHV}HVDFRPHWHQGRDHVSHVVXUDWRWDOGDSHOH SURGX]LGDVQDRUHOKDGHFRHOKRVGHDFRUGRFRP HVVHVDXWRUHVR867DFHOHURXRSURFHVVRGHFL FDWUL]DomRQDVVXDVIDVHVLQLFLDLVPDVQHQKXPD GLIHUHQoDIRLREVHUYDGDDSyVRR_GLDHPFRP

SDUDomRFRPDVOHV}HVQmRWUDWDGDV$LQGD'\ VRQH6XFNOLQJ_XWL

OL]DUDP867SXOVDGR

0+]:FP

DSOLFDo}HVGLiULDVGH PLQXWRVSDUDWUDWDU ~OFHUDVYDULFRVDVGR PHPEUR LQIHULRU H UHIHULUDPGLPLQXLomR VLJQLILFDQWH GD iUHD GDVOHV}HVUHVXOWDGRUHODWDGRLJXDOPHQWHSRU 5RFKHH:HVW_{FRPGLIHUHQWHVSDUkPHWURV}

GH8670+]:FP_{SDUD~OFHUDVFRP}

iUHDVPHQRUHVTXHFP_{,YDQRYGHFODURX}

HPXPFRPXQLFDGRFXUWRTXHR867DFHOHUD D LQWHJUDomR H PHOKRUD R UHVXOWDGR GH HQ [HUWRVGHSHOHIL[DGRVQROHLWRUHFHSWRUFRP FLDQRDFULODWR(QWUHWDQWRDWpRPRPHQWRRV IHQ{PHQRVELROyJLFRVHQYROYLGRVQDUHDomR GHHQ[HUWRVGHSHOHjLUUDGLDomRXOWUDV{QLFD QmR HVWmR LQWHLUDPHQWH HVFODUHFLGRV R TXH PRWLYRXDSUHVHQWHLQYHVWLJDomRH[SHULPHQWDO FRPSDUWLFXODUDWHQomRDRHVWtPXORjSUROLIH UDomR GDV FpOXODV JHUPLQDWLYDV H GH YDVRV QHRIRUPDGRV

1RPRGHORH[SHULPHQWDOXWLOL]DGRRHQ[HUWR GHSHOHGHHVSHVVXUDWRWDOIRLSUHIHULGRDR GHHVSHVVXUDSDUFLDOSRUTXHQRSULPHLURD HVSHVVXUDILFDSDGURQL]DGDGHVGHRFRPHoR DOpPGRTXHRVGHHVSHVVXUDWRWDOVmRGH LQWHJUDomRPDLVGLItFLOIDFLOLWDQGRDGHWHFomR GRVHIHLWRVGR867HDFRPSDUDomRHQWUHRV HQ[HUWRVLUUDGLDGRVHRVGHFRQWUROH2SUR FHGLPHQWRIRLUHDOL]DGRQDUHJLmRHVFDSXODU SRUGXDVUD]}HVSULPHLURHVVDUHJLmRHVWi IRUDGRDOFDQFHGRSUySULRDQLPDOSRUWDQWR PDLVSURWHJLGDGHTXDOTXHUFRQWDPLQDomR VHJXQGR D SHOH GHVVD UHJLmR DSUHVHQWD FDUDFWHUtVWLFDV WHJXPHQWDUHV PDLV DSURSULDGDV DR HVWXGR LQFOXLQGR VXDHVSHVVXUD2VOHLWRVUHFHSWRUHV IRUDPFXLGDGRVDPHQWHSUHSDUDGRV FRPSDUWLFXODUDWHQomRjKHPRVWDVLD H SUHYHQomR GH KHPDWRPDV TXH 7DEHODUHDGHHSLGHUPHHGDGHUPHµPQRVHQ[HUWRVLUUDGLDGRVHGHFRQWUROH

$&7$25723%5$6 5()(5È1&,$6%,%/,2*5É),&$6

&RDNOH\:7%LRSK\VLFDOHIIHFWVRIXOWUDVRXQGDWWKHUDSHXWLFLQWHQVLWLHV3K\ VLRWKHUDS\

'\VRQ06XFNOLQJ-6WLPXODWLRQRIWLVVXHUHSDLUE\XOWUDVRXQGDVXUYH\RIWKH PHFKDQLVPVLQYROYHG3K\VLRWKHUDS\

'\VRQ07KHUDSHXWLFDSSOLFDWLRQVRIXOWUDVRXQG,Q1\ERUJ:/=LVNLQ0&%LR ORJLFDOHIIHFWVRIXOWUDVRXQG1HZ<RUN&KXUFKLOO/LYLQJVWRQHS '\VRQ05ROHRIXOWUDVRXQGLQZRXQGKHDOLQJ,Q.ORWK/&0LOOHU.+:RXQG

KHDOLQJ3KLODGHOSKLD)$'DYLVS

<RXQJ65'\VRQ0(IIHFWRIWKHUDSHXWLFXOWUDVRXQGRQWKHKHDOLQJRIIXOOWKL FNQHVVH[FLVHGVNLQOHVLRQV8OWUDVRQLFV

0D[ZHOO/7KHUDSHXWLFVXOWUDVRXQGLWVHIIHFWVRQWKHFHOOXODUDQGPROHFXODU PHFKDQLVPVRILQIODPPDWLRQDQGUHSDLU3K\VLRWKHUDS\ +DDU*%DVLF3K\VLFVRIWKHUDSHXWLFXOWUDVRXQG3K\VLRWKHUDS\ 5DVR99%DUELHUL&+0D]]HU1)DVDQ96&DQWKHUDSHXWLFXOWUDVRXQGLQIOXHQFH

WKHUHJHQHUDWLRQRISHULSKHUDOQHUYHV"-1HXURVFL0HWKRGV '\VRQ03RQG-3-RVHSK-:DUZLFN57KHVWLPXODWLRQRIWLVVXHUHJHQHUDWLRQ

E\PHDQVRIXOWUDVRXQG&OLQ6FL

5RFKH&:HVW-$$FRQWUROOHGWULDOLQYHVWLJDWLQJWKHHIIHFWRIXOWUDVRXQGRQYH

QRXVXOFHUVUHIHUUHGIURPJHQHUDOSUDFWLWLRQHUV3K\VLRWKHUDS\ 5LHW*.HVVHOV$*.QLSSVFKLOG3$UDQGRPL]HGFOLQLFDOWULDORIXOWUDVRXQGLQ

WKHWUHDWPHQWRISUHVVXUHXOFHUV3K\V7KHU

,YDQRY998VHRIXOWUDVRQLFVLQWKHIL[DWLRQRIDXWRORJRXVVNLQWUDQVSODQWV9HV WQ.KLU,P,,*UHN

+DOO3$/HYLVRQ'$:RRGV$/<X&&.HOORFN'%:DWNLQV-$HWDO3UROL IHUDWLQJFHOOQXFOHDUDQWLJHQ3&1$LPPXQRORFDOL]DWLRQLQSDUDIILQVHFWLRQV DQLQGH[RIFHOOSUROLIHUDWLRQZLWKHYLGHQFHRIGHUHJXODWHGH[SUHVVLRQLQVRPH QHRSODVPV-3DWKRO

'RFNHU0)3DWULFN0.)RXONHV'-8OWUDVRXQGFRXSODQWVIRUSK\VLRWKHUDS\ 3K\VLRWKHUDS\

:DUUHQ&*.REODVNL-16LJHOPDQQ5$8OWUDVRXQGFRXSOLQJPHGLDWKHLUUHOD WLYHWUDQVPLVVLYLW\$UFK3K\V0HG5HKDELO

*HEDXHU*3/LQ66%HDP+$9LHLUD33DUVRQV5/RZLQWHQVLW\SXOVHGXO WUDVRXQGLQFUHDVHVWKHIUDFWXUHVFDOOXVVWUHQJWKLQGLDEHWLF%%:LVWDUUDWVEXW GRHVQRWDIIHFWFHOOXODUSUROLIHUDWLRQ-2UWKRS5HV

<RXQJ 65 '\VRQ 0 7KH HIIHFW RI WKHUDSHXWLF XOWUDVRXQG RQ DQJLRJHQHVLV 8OWUDVRXQG0HG%LRO

)LJXUD&RUWHVKLVWRO»JLFRVFRUDGRVHSLGHUPH©GLUHLWD HGHUPH©HVTXHUGDH[DPLQDGRVFRPOX]GLUHWDDHEH SRODUL]DGDFHGPRVWUDQGRDDXV³QFLDGHGLIHUHQ°DQD RULHQWD°¬RGDVILEUDVFROªJHQDVQRHQ[HUWRLUUDGLDGRDHF

HQRFRQWUROHEHGJUDIWV3LFURV\ULXV[

)LJXUD$XPHQWRGDFRQFHQWUD°¬RGH YDVRVQHRIRUPDGRVVHWDVQDGHUPHGH HQ[HUWRLUUDGLDGRDHPFRPSDUD°¬RFRPR

FRQWUROHEWULFU¼PLFRGH*RPRUL[

7DEHOD1ÂPHURGHYDVRVVDQJĶQHRVSRUFDPSR

SRGHULDPGHVFRODURHQ[HUWRGROHLWRHFDXVDU VXDQHFURVH2VHQ[HUWRVIRUDPVXWXUDGRVjV ERUGDVGRVOHLWRVSDUDPDQWHUVXDVGLPHQV}HV RULJLQDLVHSDUDSHUPLWLUDDSOLFDomRGRFXUDWLYR FRPSUHVVLYR WLSR WLHRYHU GH %URZQ R TXDO HUDUHPRYLGRQRWHUFHLURGLDSDUDRLQtFLRGD LUUDGLDomRFRPR867QXPDVLWXDomRFOtQLFD HPKXPDQRVHVVHFXUDWLYRXVXDOPHQWHpUH PRYLGRDSyVXPDVHPDQDTXDQGRRHQ[HUWR MiHVWiFLFDWUL]DGRQROHLWR

$ LUUDGLDomR FRP R 867 IRL LQLFLDGD Mi QR WHUFHLURGLDSyVRSHUDWyULRSRLVpQHVVDIDVH SUHFRFHTXHDFLFDWUL]DomRWHFLGXDOSRGHVHU DFHOHUDGD _{$OpP GLVVR D LUUDGLDomR XVXDO}

PHQWHpDSOLFDGDDRUHGRUGRGHIHLWRFXWkQHR SDUDHVWLPXODUDFLFDWUL]DomRDSDUWLUGDSHUL IHULDGDIHULGDSDUDRFHQWURPDVQDSUHVHQWH LQYHVWLJDomRHODIRLDSOLFDGDGLUHWDPHQWHVREUH RHQ[HUWRFRPRREMHWLYRGHHVWLPXODUDQH RIRUPDomRYDVFXODUDSDUWLUGROHLWRUHFHSWRU HDSUROLIHUDomRFHOXODUWDQWRGHVWHFRPRGR SUySULRHQ[HUWR2HQ[HUWRIRLDGHTXDGDPHQWH SURWHJLGRGXUDQWHDLUUDGLDomRSDUDHYLWDUGHV FROiORGROHLWRRTXHFHUWDPHQWHUHVXOWDULDHP VXDQHFURVHSRURXWURODGRRPDWHULDOXWLOL]DGR SDUDSURWHJrORYDVHOLQDOtTXLGDILOPH GH39&QmRWrPTXDOTXHULQIOXrQFLD VREUH R VHX PHWDEROLVPR H QmR LQ WHUIHUHFRPVXDLQWHJUDomR₂₈₆₇

SXOVDGRIRLUHJXODGRFRPDIUHTrQFLD

GH0+]HLQWHQVLGDGHGH:FP

SRLVpFRPHVVHVSDUkPHWURVTXHVmR REWLGRV RV HIHLWRV ILVLROyJLFRV PDLV PDUFDQWHV 'H IDWR p FRP DV DOWDV IUHTrQFLDVTXHVmRDWLQJLGRVDSHQDV RVWHFLGRVPDLVVXSHUILFLDLVHpFRP DVEDL[DVLQWHQVLGDGHVTXHRVHIHLWRV WpUPLFRVGR867VmRPLQLPL]DGRVDR PHVPRWHPSRHPTXHVXDVGHPDLV SURSULHGDGHVVmRHQIDWL]DGDV$LQGD PDLV R FDEHoRWH XOWUDV{QLFR HUD PDQWLGRFRQVWDQWHPHQWHQDSRVLomR YHUWLFDO HP UHODomR j VXSHUItFLH GR HQ[HUWR H HP FRQWDWR WRWDO FRP HOH VHQGR FRQWLQXDPHQWH PRYLPHQWDGR SDUD HYLWDU D IRUPDomR GH ]RQDV GH DTXHFLPHQWR ORFDOL]DGR TXH SXGHV VHPOHViOR

2V UHVXOWDGRV GD LUUDGLDomR IRUDP DQDOLVDGRV SURSRVLWDOPHQWH QXPD IDVHDLQGDSUHFRFHGDLQWHJUDomRQR

žGLDSyVRSHUDWyULRHDSyVVHWHVHVV}HVGH LUUDGLDomR'XUDQWHHVVHSHUtRGRDLQWHJUDomR GRHQ[HUWRTXHpPXLWRUiSLGDQRVUDWRVDLQGD p XP SURFHVVR HP DQGDPHQWR H QR TXDO DV GLIHUHQoDVHQWUHRVHQ[HUWRVLUUDGLDGRVHRVGH FRQWUROHVmRPDLVHYLGHQWHVQXPDIDVHPDLV DYDQoDGD FRP RV HQ[HUWRV FRPSOHWDPHQWH LQWHJUDGRVSUDWLFDPHQWHQmRKiPDLVGLIHUHQoDV HQWUHHOHVLQFOXVLYHDHVWLPXODomRGDSUROLIHUDomR FHOXODUHDQHRDQJLRJrQHVH(PERUDQmRHVSH WDFXODURVUHVXOWDGRVREWLGRVIRUDPFRQFOXVLYRV HPGHPRQVWUDUTXHR867GHIDWRHVWLPXORXD SUROLIHUDomRFHOXODUQDFDPDGDJHUPLQDWLYDGD HSLGHUPHFRPRYLVWRQRVFRUWHVKLVWROyJLFRV FRUDGRVFRPR3&1$_{HDQHRIRUPDomRGH}

YDVRVVDQJtQHRVQDFDPDGDUHWLFXODUGDGHUPH FRPRMiGHVFULWRDQWHULRUPHQWH_XPDUHDomR

TXHFHUWDPHQWHIDYRUHFHDLQWHJUDomRGRHQ[HUWR (QWUHWDQWRRDXPHQWRDOWDPHQWHVLJQLILFDQWHQD SUROLIHUDomRFHOXODUS QmRLPSOLFRXHP DXPHQWRFRUUHVSRQGHQWHQDiUHDGDHSLGHUPH DTXDODSUHVHQWRXDSHQDVXPDWHQGrQFLDDDX PHQWDUS RTXHSURYDYHOPHQWHVLJQLILFD TXHKiRXWURVIDWRUHVTXHDIHWDPDLQWHJUDomR GRVHQ[HUWRVGHSHOH2VGDGRVGDPRUIRPHWULD GDGHUPHQ~PHURGHFpOXODVHiUHD QmRIRUDPVLJQLILFDQWHPHQWHGLIHUHQWHV HQWUH RV HQ[HUWRV LUUDGLDGRV H RV GH FRQWUROHS $OpPGLVVRQHQKXPD GLIHUHQoDIRLREVHUYDGDHPUHODomRj RULHQWDomR GDV ILEUDV FROiJHQDV QRV GRLVJUXSRVH[SHULPHQWDLVFRORUDomR SHOR3LFURV\ULXVRTXHVLJQLILFDTXHHOD QmRVHDOWHUDGHPDQHLUDLPSRUWDQWHQRV HQ[HUWRVGHSHOHGHPRGRJHUDO 2VDXWRUHVFRQFOXHPTXHR867HV WLPXORX DOWHUDo}HV PRUIROyJLFDV HP QtYHOFHOXODUUHVXOWDQGRQRDXPHQWRGD SUROLIHUDomRGDFDPDGDJHUPLQDWLYD QDIRUPDomRGHQRYRVYDVRVVDQJt QHRVHQXPDLQWHJUDomRPDLVSUHFRFH GRHQ[HUWRFXWkQHRGHHVSHVVXUDWRWDO XPHIHLWRTXHSRGHVHU~WLOHPVLWXD o}HVFOtQLFDVHPKXPDQRV

$*5$'(&,0(1726

$JUDGHFHPRV DR 'U 0DUFHOR GH $OPHLGD 0DQWLOOD PpGLFR UHVLGHQWH GH &LUXUJLD 3OiVWLFD SHOR DX[tOLR QD GHILQLomR GR PRGHOR H[SHULPHQWDO H QDH[HFXomRGDVRSHUDo}HV

D