A periodontite produz uma descarga de quimiocinas inflamatórias que pode ser refletida na saliva. Com base nisso, o objetivo desse estudo foi mensurar as concentrações salivares de interleucina-8 (IL-8), RANTES (Regulated upon Activation, Normal T Cell Expressed and Secreted), MIG (monokine induced by gamma interferon), IP-10 (interferon &gamma;-inducible protein of 10 kD), e MCP-1 (macrophage chemotactic protein-1) em pacientes com periodontite crônica e saudáveis. 32 indivíduos foram divididos em dois grupos: saudáveis (Controle, n=11) e pacientes com periodontite crônica (DP, n=21). Dados clínicos foram registrados. Amostras de saliva não-estimulada foram analisadas e biomarcadores inflamatórios na saliva foram identificados utilizando a citometria de fluxo em ensaios multiplex. Dos biomarcadores analisados, IL-8, MCP-1, PI e MIG-10 foram encontrados em maior abundância nas amostras da saliva. Verificou-se diferenças estatisticamente significativas entre as proteínas salivares: IL-8 (p=0,0008), MCP-1 (p=0003), e RANTES (p=0,03). Nenhuma diferença estatística entre grupos foi observada para IP-10 (Controle 193,85 ± 64,21; PD 423,78 ± 85,67, p=0,08), e MIG (Controle 173,33 ± 79,28; DP 341,26 ± 77,23. p=0,05). Todos os biomarcadores avaliados estavam mais elevados nos pacientes com DP em comparação com o grupo controle. Os dados sugerem que o aumento dos níveis de quimiocinas MCP-1, IL-8 e RANTES na PD podem ser responsáveis pela manutenção de leucócitos específicos no local. Esse mecanismo pode servir para promover a migração de leucócitos para os sítios de inflamação e a manutenção da cronicidade da periodontite / Objective: Periodontitis produces an inflammatory proteins discharge that can be reflected in saliva. The aim of this study was to measure salivary concentrations of interleukin-8 (IL-8), RANTES (Regulated upon Activation, Normal T Cell Expressed and Secreted), MIG (monokine induced by gamma interferon), IP-10 (interferon &gamma;-inducible protein of 10 kD), e MCP-1 (macrophage chemotactic protein-1) in patients with chronic periodontitis and healthy. Material and Methods: A total of 32 subjects was divided in 2 groups: healthy (Control, n=11) and patients with periodontitis (PD, n=21. Clinical data were recorded. Non-stimulated saliva samples were analyzed and identified simultaneously using the human flow cytometry multiplex assays. Results: Of the target biomarkers examined, IL-8, MCP-1, MIG and IP-10 were found in greatest abundance in the saliva samples. It was found statistically significant differences among screened salivary proteins: IL-8 (p = 0.0008), MCP-1 (p = 0.003), and RANTES (p= 0.03). No statistical differences between the groups were observed for IP-10 (Ctrl 193.85 ± 64.21. PD 423.78 ± 85.67, p = 0.08), and MIG (Ctrl 173.33 ± 79.28; PD 341.26 ± 77.23. p = 0.05). All cytokines levels were higher on PD patients in comparison with controls samples. Only samples that stayed within the detection limit for the assay were considered for statistical analysis. For Control group, no correlation was found between clinical parameters and the chemokines levels. In PD group, positive Spearman correlation was observed between total amount of MCP-1 and Age (r 0.648; p<0.001) and negative correlation was observed between MCP-1 with PPD (r -0.462, p = 0.03) and CAL (r -0,461, p = 0.003). Significant negative correlation was found between total amount of RANTES and the percentage of SUP (r -0.457, p = 0.03). Conclusion: The above results suggest that the increased levels of chemokines MCP-1, RANTES and IL-8 in PD individuals may be responsible for maintaining the infiltration of specific leukocytes. This mechanism would serve to promote the migration of leukocytes into the sites of inflammation and the chronicity of inflammation in human periodontitis.

A periodontite produz uma descarga de quimiocinas inflamatórias que pode ser refletida na saliva. Com base nisso, o objetivo desse estudo foi mensurar as concentrações salivares de interleucina-8 (IL-8), RANTES (Regulated upon Activation, Normal T Cell Expressed and Secreted), MIG (monokine induced by gamma interferon), IP-10 (interferon &gamma;-inducible protein of 10 kD), e MCP-1 (macrophage chemotactic protein-1) em pacientes com periodontite crônica e saudáveis. 32 indivíduos foram divididos em dois grupos: saudáveis (Controle, n=11) e pacientes com periodontite crônica (DP, n=21). Dados clínicos foram registrados. Amostras de saliva não-estimulada foram analisadas e biomarcadores inflamatórios na saliva foram identificados utilizando a citometria de fluxo em ensaios multiplex. Dos biomarcadores analisados, IL-8, MCP-1, PI e MIG-10 foram encontrados em maior abundância nas amostras da saliva. Verificou-se diferenças estatisticamente significativas entre as proteínas salivares: IL-8 (p=0,0008), MCP-1 (p=0003), e RANTES (p=0,03). Nenhuma diferença estatística entre grupos foi observada para IP-10 (Controle 193,85 ± 64,21; PD 423,78 ± 85,67, p=0,08), e MIG (Controle 173,33 ± 79,28; DP 341,26 ± 77,23. p=0,05). Todos os biomarcadores avaliados estavam mais elevados nos pacientes com DP em comparação com o grupo controle. Os dados sugerem que o aumento dos níveis de quimiocinas MCP-1, IL-8 e RANTES na PD podem ser responsáveis pela manutenção de leucócitos específicos no local. Esse mecanismo pode servir para promover a migração de leucócitos para os sítios de inflamação e a manutenção da cronicidade da periodontite / Objective: Periodontitis produces an inflammatory proteins discharge that can be reflected in saliva. The aim of this study was to measure salivary concentrations of interleukin-8 (IL-8), RANTES (Regulated upon Activation, Normal T Cell Expressed and Secreted), MIG (monokine induced by gamma interferon), IP-10 (interferon &gamma;-inducible protein of 10 kD), e MCP-1 (macrophage chemotactic protein-1) in patients with chronic periodontitis and healthy. Material and Methods: A total of 32 subjects was divided in 2 groups: healthy (Control, n=11) and patients with periodontitis (PD, n=21. Clinical data were recorded. Non-stimulated saliva samples were analyzed and identified simultaneously using the human flow cytometry multiplex assays. Results: Of the target biomarkers examined, IL-8, MCP-1, MIG and IP-10 were found in greatest abundance in the saliva samples. It was found statistically significant differences among screened salivary proteins: IL-8 (p = 0.0008), MCP-1 (p = 0.003), and RANTES (p= 0.03). No statistical differences between the groups were observed for IP-10 (Ctrl 193.85 ± 64.21. PD 423.78 ± 85.67, p = 0.08), and MIG (Ctrl 173.33 ± 79.28; PD 341.26 ± 77.23. p = 0.05). All cytokines levels were higher on PD patients in comparison with controls samples. Only samples that stayed within the detection limit for the assay were considered for statistical analysis. For Control group, no correlation was found between clinical parameters and the chemokines levels. In PD group, positive Spearman correlation was observed between total amount of MCP-1 and Age (r 0.648; p<0.001) and negative correlation was observed between MCP-1 with PPD (r -0.462, p = 0.03) and CAL (r -0,461, p = 0.003). Significant negative correlation was found between total amount of RANTES and the percentage of SUP (r -0.457, p = 0.03). Conclusion: The above results suggest that the increased levels of chemokines MCP-1, RANTES and IL-8 in PD individuals may be responsible for maintaining the infiltration of specific leukocytes. This mechanism would serve to promote the migration of leukocytes into the sites of inflammation and the chronicity of inflammation in human periodontitis.

Carbohydrates are known to play important roles in a large number of physiological and pathological processes. Conceivably, “binders” of carbohydrates of biological importance could be used as diagnostic and therapeutic agents. Currently, lectins are the major available tools in research for carbohydrate recognition. However, the available lectins often have cross-reactivity issues, along with the high costs and stability issues. Therefore, there is a critical need to develop alternatives (lectin mimics). In this regard, there have been very active efforts in developing different “binders”, such as small molecule lectinmimics and aptamers. Among all the small molecule lectinbmimics developments, boronic acid stands out as the most important building blocks of the sensors design for carbohydrates biomarkers due to its intrinsic binding affinities with diols. To address a fundamental question that whether boronic acid also binds to six-membered ring sugars, with very limited precedents, we provided a concrete experimental evidence of the binding. Specifically, a series of isoquinolinylboronic acids were found to have remarkably high binding affinities with fluorescence change upon binding to representative sugars. Most importantly, these isoquinolinylboronic aicds showed weak but very encouraging bindings with six-membered sugar model. All these promising results paves the way of using boronic acids, especially isoquinolinylboronic acid as building blocks for chemosensors design for biological carbohydrates biomarkers, which universally contain six-membered ring and liner diols. Aptamer provides another alternative way for sensors development for carbohydrates biomarkers as lectin mimics. Compared to lectins, they are normally cheaper and more stable. However, there is much less options. Another challenging area for aptamer-based lectin mimics development is the difficulty to differentiate changes in glycosylation patterns of a glycoprotein, which affect the function of a glycoprotein and thus recognized as biomarkers. To address this major challenge, our group first demonstrated that the incorporation of a boronic acid into DNA would allow for the aptamer selection process to gravitate towards the glycosylation site. To examine the generality of boronic acid incorporation, increase the structural diversity, and broaden the application of boronic acid-modified DNA, a series of B-TTP analogues with simplified structures were designed, synthesized, and successfully incorporated into DNA. A simple route was also developed using 1,7-octadiyne as a linker for both Sonogashira coupling with thymidine and CuAAC tethering of a boronic acid moiety. This paves the way for the preparation of a large number of B-TTPs with different structural features for aptamer selection or array analysis. Finally, bacterial quorum sensing has received much attention in recent years because of its relevance to pathological events such as biofilm formation. As one of the very first groups that developed a series of antagonists for AI-2 mediated quorum sensing, we herein designed and synthesized a series of analogues based on the structures of two lead inhibitors identified through virtual screening. Besides, we also examined their inhibitory activities, twelve of which showed equal or better inhibitory activities compared with the lead inhibitors. The best compound showed an IC50 of about 6 mM in a whole cell assay using Vibrio harveyi as the model organism. This encouraging results and SAR discuss also paves the way for the finding of more potent compound through further structure optimization.

PhD (Chemistry) / Department of Chemistry / Terminalia sericea Burch. ex. DC (Combretaceae) is one of the 50 most popular medicinal plants in Africa. The fruit, leaves, stems and roots are commonly used for the treatment of cough, skin infections, diabetes, diarrhoea, venereal diseases and tuberculosis. However, the roots are most commonly used in the preparation of traditional medicines. Pharmacological studies have revealed that the crude root extracts display antibacterial activity against several Gram-positive and Gram-negative bacteria. Anolignan b, termilignan b and arjunic acid are reported to be the major antibacterial constituents present in the roots. Other compounds isolated from the roots include resveratrol-3-rutinoside, sericic acid, sericoside and arjunglucoside I. Authorities worldwide, including the Medicines Control Council of South Africa, have begun to regulate herbal drugs sold in the form of commercial formulations. Quality control of herbal drugs is challenging, since the chemical profiles of the raw materials may vary, depending on the origin of the plant material and the way that it was handled and processed. The chemistry, in turn, impacts on the safety and efficacy of the plant material. To date, there are no available data on parameters that can be used to standardise the quality of T. sericea raw materials. The aim of this study was therefore to provide information on the variation of the chemical constituents that contribute to the biological effects of the roots of T. sericea and also establish its safety. Since the compounds previously isolated from the roots were not commercially available, isolation of the major constituents of the roots was undertaken to obtain analytical standards. A crude dichloromethane:methanol (1:1) extract was initially fractionated using silica gel column chromatography, where after, some of the fractions were further purified using silica gel and Sephadex LH-20 column chromatography. Final purification of the enriched fractions was achieved using preparative high performance liquid chromatography coupled with mass spectrometry (prep-HPLC-MS). The structures of these compounds were subsequently elucidated using one- and two- dimensional nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry and identified as sericic acid (340 g), sericoside (500 g), resveratrol-3-rutinoside (240 mg) and arjunglucoside I (74 mg). The chemical variation within the crude root extracts of samples (n = 42) from ten populations in the Limpopo Province of South Africa, was determined using ultra performance liquid chromatography-mass spectrometry (UPLC-MS). A method was developed for the simultaneous determination of sericic acid, resveratrol-3-rutinoside, sericoside and arjungluicoside I in the extracts using UPLC with photodiode array detection (PDA). The method was validated according to the guidelines of the International Council for Harmonisation (ICH). A regression coefficient (R2) of 0.998 was obtained for sericic acid, resveratrol-3- rutinoside and arjunglucoside I, while the R2 value for sericoside was 0.999, indicating a linear relationship between the concentration and the detector response. Satisfactory limits of detection for sericic acid (25.2 ng/mL), sericoside (11.6 ng/mL), resveratrol-3-rutinoside (23.3 ng/mL) and arjunglucoside I (8.81 ng/mL) were determined. Recoveries of 98 % and 80% were obtained for samples spiked with 12.5 μg/mL and 25 μg/mL of resveratrol-3-rutinoside, respectively, indicating that the method is accurate. The intra- and inter-day variation in resveratrol-3-rutinoside concentration, measured over three days, indicated excellent analytical precision, since all the relative standard deviations were below 0.70 %. The quantitative data revealed that sericic acid (1.59 to 8.45 mg/g), sericoside (2.07 to 20.17 mg/g), resveratrol-3-rutinoside (0.65 to 29.82 mg/g) and arjunglucoside I (0.86 to 8.44 mg/g dry weight) were the major constituents of the root samples, but their concentrations were highly variable. Chemometric analysis of the aligned UPLC-MS data was used to investigate similarities and differences in the chemical profiles of the samples using an untargeted approach. A principal component analysis (PCA) model was constructed and subsequently hierarchical cluster analysis (HCA) indicated the presence of two main groups, which were found to be independent of the populations to which the samples belong. Classes, based on the HCA class identifiers, were subsequently assigned to the samples, and an orthogonal projection to latent structures-discriminant analysis (OPLS-DA) model was then constructed, (R2 cum = 0.996 and Q2 cum = 0.967). The corresponding loadings plot allowed sericic acid, sericoside and resveratrol-3-rutinoside to be identified as biomarkers associated with the first group. Quantitative, rather than qualitative differences were responsible for the observed clustering pattern. Techniques that could be applied in quality control protocols for T. sericea root were investigated. High performance thin layer chromatography (HPTLC) analysis of the root extracts was optimised by testing different developing solvents and visualization reagents. The presence of the sericic acid (Rf = 0.80), sericoside (Rf = 0.49) and resveratrol-3-rutinoside (Rf = 0.36) were clearly visible on the plates. There were visible variations in the concentrations of resveratrol-3-rutinoside in representative samples from the 10 populations, corresponding to the UPLC results. The powdered samples were then analysed by mid-(MIR) infrared spectroscopy. Chemometric analysis of the data revealed no definitive clustering pattern. Partial least squares-discriminant analysis (PLS-DA) calibration models were established from the MIR spectral data combined with the accurate UPLC-values, for the prediction of the sericoside (R2Y = 0.848, Q2 = 0.757, RMSEP = 2.70 mg/g) and resveratrol-3-rutinoside (R2Y = 0.794, Q2 = 0.695, RMSEP = 4.37 mg/g) concentrations in powdered root samples. The antibacterial activities of the root extracts, column fractions and isolated compounds were determined using three Gram-positive and five Gram-negative bacteria, all selected due to their ability to cause intestinal and skin disorders. Extracts and fractions containing high concentrations of sericic acid exhibited the highest activities against Klebsiella pneumoniae (ATCC 13883), Pseudomonas aeruginosa (ATCC 27858), Salmonella typhimurium (ATCC 14028), Staphylococcus aureus (ATCC 25923), Staphylococcus epidermidis (ATCC 12223) and Shigella sonnei (ATCC 9292). The pure compound (sericic acid) was highly active against S. sonnei (MIC 0.078 μg/mL), a Gram- negative bacterium. There were no variations in the activity of the crude extracts against B. cereus and P. aeruginosa, while the MIC values obtained against S. typhi were variable and ranged from 0.25 to 1.0 mg/mL. Sericoside and resveratrol-3-rutinoside did not display any activity. The anti-oxidant activities were evaluated using DPPH (2,2-diphenyl-1-picrylhydrazyl) and reducing power assays. The anti-oxidant assays revealed that resveratrol-3- rutinoside exhibited lower activity (DPPH = 186 μg/mL; RP = 184 μg/mL) compared to the crude extract (DPPH = 22.3 μg/mL; RP = 24.4 μg/mL) and ascorbic acid (DPPH = 11.3 μg/mL, RP = 145 μg/mL). Sericic acid and sericoside did not display any anti- oxidant activities. The variation in the anti-oxidant activities (4.58 to 26.0 μg/mL) of the samples from different populations was an indication of chemical variability. A toxicity study of the raw powdered plant material was conducted using vervet monkeys (Chlorocebus pygerythrus). Biochemical analysis (liver function tests, kidney function tests and hematology), physical and physiological examinations were conducted. The subjects were fed a normal diet supplemented with T. sericea root powder (2.14 g/kg per day) for 120 days, where after the diet was returned to normal (washout) for another 30 days. The treatment groups presented with elevated serum enzymes at Week 4, followed by the reduction of the elevated serum enzymes levels at Week 12. These results indicate short-term hepatotoxic effects, followed by hepatoprotective activity. Reduction of the serum glucose at Week 4 suggests hypoglycemic potential. However, elevated serum creatinine levels indicated possible nephrotoxicity. In conclusion, this study has indicated the variability in the chemical constituents of the roots of T. sericea, which affects the antibacterial and anti-oxidant activities. Sericic acid, resveratrol-3-rutinoside, and sericoside were, for the first time, identified as biomarkers that can be used for the quality control of raw root material to be used in herbal products. Sericic acid was also found to be the main antibacterial constituent of the roots. The hepatoprotective, nephrotoxic and hematotoxic effects observed in monkeys to which the root powder had been administered is cause for concern. / NRF

INTRODUÇÃO: Estenose e obstruções venosas são achados frequentes após o implante de cabos-eletrodos transvenosos. Manifestações clínicas dessas lesões venosas, entretanto, são raramente reportadas. Embora exista consenso de que fenômenos tromboembólicos sejam mais comuns após reoperações que envolvam o implante de novos cabos-eletrodos ou procedimentos de extração transvenosa, ainda não existem evidências que comprovem essa observação. OBJETIVOS: Em pacientes submetidos a reoperações para corrigir disfunção em cabos-eletrodos ou para mudar o modo de estimulação, o estudo visou identificar: a) a incidência de tromboembolia pulmonar (TEP) e de trombose venosa profunda (TVP) do membro superior ipsilateral ao procedimento; b) a prevalência de lesões venosas prévias ao procedimento cirúrgico, pelo estudo venográfico, e a ocorrência de modificações desse padrão seis meses após o procedimento; e c) fatores prognósticos para a ocorrência dos eventos clínicos e das alterações venográficas. MÉTODOS: No período de abril de 2013 a julho de 2016 foram estudados 84 pacientes. A avaliação pré-operatória incluiu: ultrassonografia com doppler dos membros superiores, angiotomografia de tórax com protocolo para TEP, venografia por subtração digital e coleta de biomarcadores laboratoriais específicos do sistema de coagulação e hemostasia. Os exames diagnósticos foram repetidos no momento pós-operatório para detectar os desfechos do estudo. Todos os pacientes foram acompanhados por 12 meses. Os desfechos primários foram a ocorrência de TEP ou TVP em até 30 dias após o procedimento. Os desfechos secundários foram as alterações venográficas no sexto mês após a intervenção cirúrgica. Na análise da associação das variáveis demográficas, clínicas, operatórias e laboratoriais com os desfechos do estudo, empregou-se os testes Qui-quadrado, Exato de Fisher ou \"t\" de Student. Modelos de regressão logística multivariados foram utilizados para identificar fatores prognósticos. RESULTADOS: Entre os 84 pacientes incluídos, houve equilíbrio entre os sexos e a idade média de 59,3 ± 15,2 anos. O principal motivo para realizar o procedimento cirúrgico foi a disfunção de cabos-eletrodos (75%). A remoção de cabos-eletrodos foi efetuada em 52,4% dos casos. A taxa de eventos clínicos e subclínicos pós-operatórios foi de 35,7%, representada por TVP em 24 (28,6%) casos e TEP em seis (7,1%). Alterações no padrão venográfico seis meses após a operação foram identificadas em 34,5% dos pacientes. Os fatores prognósticos independentes para TVP foram: a presença de circulação colateral significativa na venografia pré-operatória ([odds ratio (OR) = 4,7]), (intervalo de confiança de 95% (IC 95%); 1,1 - 19,8; P = 0,037), a extração transvenosa de cabos-eletrodos (OR = 27,4; IC 95%; 5,8 - 128,8; P < 0,0001) e o aumento do fibrinogênio no pós-operatório (OR = 1,02; IC 95%; 1,01 - 1,03; P = 0,018). O histórico de tabagismo foi o único fator prognóstico relacionado com a ocorrência de TEP (OR = 14,6; IC 95%; 2,3 - 91,8; P = 0,004). Somente a extração transvenosa de cabos-eletrodos foi fator prognóstico independente (OR = 5,0; IC 95%; 1,6 - 15,4; P = 0,004) para alterações venográficas pós-operatórias. CONCLUSÃO: Reoperações envolvendo o manuseio de território venoso com cabos-eletrodos previamente implantados apresentam elevados índices de complicações tromboembólicas e de alterações venográficas. Extração transvenosa de cabos-eletrodos apresentou impacto significativo no desenvolvimento de TVP e de alterações venográficas. Esses resultados mostram a necessidade de novos estudos específicos para avaliar o papel de estratégias preventivas para esse subgrupo de pacientes / INTRODUCTION: Venous stenosis or occlusion is a frequent finding in patients with previously-implanted transvenous leads. Clinical manifestations of these venous lesions, however, are rarely reported. Although there is a consensus that thromboembolic events are more frequent after reoperation involving the implantation of new leads or lead removal, there is still no evidence to support this observation. OBJECTIVES: In patients submitted to reoperations due to lead dysfunction or device upgrade, the study aimed to determine: a) the incidence of pulmonary embolism (PE) and upper extremity deep venous thrombosis (UEDVT) ipsilateral to the cardiac device; b) the prevalence of venous lesions determined by preoperative venography, and the occurrence of modifications or progression of these lesions six months after the procedure; and c) prognostic factors for clinical and venographic outcomes. METHODS: From April/2013 to July/2016, 84 patients were studied. The preoperative evaluation included: upper extremity venous ultrasound, computed tomography pulmonary angiography, digital subtraction venography and specific laboratory tests for coagulation and hemostasis. Diagnostic exams were repeated postoperatively to detect the study outcomes. All patients were followed for 12 months. Primary outcomes were occurrence of PE or UEDVT within 30 days after the procedure. Secondary outcomes were venographic changes six months after the surgical intervention. Student\'s t test, Chi-square or Fisher\'s Exact test were used in the univariate analysis of demographic, clinical, operative and laboratory variables. Multivariate logistic regression models were used to identify prognostic factors. RESULTS: Among the 84 patients included, there was a balance between gender and the mean age was 59.3 ± 15.2 years. Lead malfunctioning (75%) was the main surgical procedure indication. Lead removal was performed in 52.4% of the cases. The rate of postoperative clinical and subclinical events was 35.7%, represented by UEDVT in 24 (28.6%) cases and PE in 6 (7.1%). Alterations in the venography findings six months after the surgery were identified in 34.5% of the patients. Independent prognostic factors for UEDVT were: the presence of significant collateral circulation in the preoperative venography ([odds ratio (OR)= 4.7; [95% confidence interval (CI): 1.1 - 19.8; P=0.037), transvenous lead extraction (OR= 27.4; 95% CI 5.8-128.8; P < 0.0001) and fibrinogen variation (OR= 1.02; 95% CI 1.01 - 1.03; P=0.018). Smoking history was the only prognostic factor related to the occurrence of PE (OR= 14.6; 95% CI 2.3 - 91.8; P=0,004). Transvenous lead extraction was the only independent prognostic factor (OR= 5.0; 95% CI 1.6 - 15.4; P=0.004) for postoperative venographic endpoints. CONCLUSION: Reoperations involving previously transvenous implanted leads present high rates of thromboembolic complications and venographic alterations. Transvenous lead extraction had a significant impact on the development of UEDVT and venographic alterations. These results show the need for further studies to evaluate the role of preventive strategies for this subgroup of patients

INTRODUÇÃO: Estenose e obstruções venosas são achados frequentes após o implante de cabos-eletrodos transvenosos. Manifestações clínicas dessas lesões venosas, entretanto, são raramente reportadas. Embora exista consenso de que fenômenos tromboembólicos sejam mais comuns após reoperações que envolvam o implante de novos cabos-eletrodos ou procedimentos de extração transvenosa, ainda não existem evidências que comprovem essa observação. OBJETIVOS: Em pacientes submetidos a reoperações para corrigir disfunção em cabos-eletrodos ou para mudar o modo de estimulação, o estudo visou identificar: a) a incidência de tromboembolia pulmonar (TEP) e de trombose venosa profunda (TVP) do membro superior ipsilateral ao procedimento; b) a prevalência de lesões venosas prévias ao procedimento cirúrgico, pelo estudo venográfico, e a ocorrência de modificações desse padrão seis meses após o procedimento; e c) fatores prognósticos para a ocorrência dos eventos clínicos e das alterações venográficas. MÉTODOS: No período de abril de 2013 a julho de 2016 foram estudados 84 pacientes. A avaliação pré-operatória incluiu: ultrassonografia com doppler dos membros superiores, angiotomografia de tórax com protocolo para TEP, venografia por subtração digital e coleta de biomarcadores laboratoriais específicos do sistema de coagulação e hemostasia. Os exames diagnósticos foram repetidos no momento pós-operatório para detectar os desfechos do estudo. Todos os pacientes foram acompanhados por 12 meses. Os desfechos primários foram a ocorrência de TEP ou TVP em até 30 dias após o procedimento. Os desfechos secundários foram as alterações venográficas no sexto mês após a intervenção cirúrgica. Na análise da associação das variáveis demográficas, clínicas, operatórias e laboratoriais com os desfechos do estudo, empregou-se os testes Qui-quadrado, Exato de Fisher ou \"t\" de Student. Modelos de regressão logística multivariados foram utilizados para identificar fatores prognósticos. RESULTADOS: Entre os 84 pacientes incluídos, houve equilíbrio entre os sexos e a idade média de 59,3 ± 15,2 anos. O principal motivo para realizar o procedimento cirúrgico foi a disfunção de cabos-eletrodos (75%). A remoção de cabos-eletrodos foi efetuada em 52,4% dos casos. A taxa de eventos clínicos e subclínicos pós-operatórios foi de 35,7%, representada por TVP em 24 (28,6%) casos e TEP em seis (7,1%). Alterações no padrão venográfico seis meses após a operação foram identificadas em 34,5% dos pacientes. Os fatores prognósticos independentes para TVP foram: a presença de circulação colateral significativa na venografia pré-operatória ([odds ratio (OR) = 4,7]), (intervalo de confiança de 95% (IC 95%); 1,1 - 19,8; P = 0,037), a extração transvenosa de cabos-eletrodos (OR = 27,4; IC 95%; 5,8 - 128,8; P < 0,0001) e o aumento do fibrinogênio no pós-operatório (OR = 1,02; IC 95%; 1,01 - 1,03; P = 0,018). O histórico de tabagismo foi o único fator prognóstico relacionado com a ocorrência de TEP (OR = 14,6; IC 95%; 2,3 - 91,8; P = 0,004). Somente a extração transvenosa de cabos-eletrodos foi fator prognóstico independente (OR = 5,0; IC 95%; 1,6 - 15,4; P = 0,004) para alterações venográficas pós-operatórias. CONCLUSÃO: Reoperações envolvendo o manuseio de território venoso com cabos-eletrodos previamente implantados apresentam elevados índices de complicações tromboembólicas e de alterações venográficas. Extração transvenosa de cabos-eletrodos apresentou impacto significativo no desenvolvimento de TVP e de alterações venográficas. Esses resultados mostram a necessidade de novos estudos específicos para avaliar o papel de estratégias preventivas para esse subgrupo de pacientes / INTRODUCTION: Venous stenosis or occlusion is a frequent finding in patients with previously-implanted transvenous leads. Clinical manifestations of these venous lesions, however, are rarely reported. Although there is a consensus that thromboembolic events are more frequent after reoperation involving the implantation of new leads or lead removal, there is still no evidence to support this observation. OBJECTIVES: In patients submitted to reoperations due to lead dysfunction or device upgrade, the study aimed to determine: a) the incidence of pulmonary embolism (PE) and upper extremity deep venous thrombosis (UEDVT) ipsilateral to the cardiac device; b) the prevalence of venous lesions determined by preoperative venography, and the occurrence of modifications or progression of these lesions six months after the procedure; and c) prognostic factors for clinical and venographic outcomes. METHODS: From April/2013 to July/2016, 84 patients were studied. The preoperative evaluation included: upper extremity venous ultrasound, computed tomography pulmonary angiography, digital subtraction venography and specific laboratory tests for coagulation and hemostasis. Diagnostic exams were repeated postoperatively to detect the study outcomes. All patients were followed for 12 months. Primary outcomes were occurrence of PE or UEDVT within 30 days after the procedure. Secondary outcomes were venographic changes six months after the surgical intervention. Student\'s t test, Chi-square or Fisher\'s Exact test were used in the univariate analysis of demographic, clinical, operative and laboratory variables. Multivariate logistic regression models were used to identify prognostic factors. RESULTS: Among the 84 patients included, there was a balance between gender and the mean age was 59.3 ± 15.2 years. Lead malfunctioning (75%) was the main surgical procedure indication. Lead removal was performed in 52.4% of the cases. The rate of postoperative clinical and subclinical events was 35.7%, represented by UEDVT in 24 (28.6%) cases and PE in 6 (7.1%). Alterations in the venography findings six months after the surgery were identified in 34.5% of the patients. Independent prognostic factors for UEDVT were: the presence of significant collateral circulation in the preoperative venography ([odds ratio (OR)= 4.7; [95% confidence interval (CI): 1.1 - 19.8; P=0.037), transvenous lead extraction (OR= 27.4; 95% CI 5.8-128.8; P < 0.0001) and fibrinogen variation (OR= 1.02; 95% CI 1.01 - 1.03; P=0.018). Smoking history was the only prognostic factor related to the occurrence of PE (OR= 14.6; 95% CI 2.3 - 91.8; P=0,004). Transvenous lead extraction was the only independent prognostic factor (OR= 5.0; 95% CI 1.6 - 15.4; P=0.004) for postoperative venographic endpoints. CONCLUSION: Reoperations involving previously transvenous implanted leads present high rates of thromboembolic complications and venographic alterations. Transvenous lead extraction had a significant impact on the development of UEDVT and venographic alterations. These results show the need for further studies to evaluate the role of preventive strategies for this subgroup of patients