Abstract Introduction Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective To eval uate the ef ficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performeda prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction (p < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement (p < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short-and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD. (BET . (ETD) term 201 202 data Questionnaire7 Questionnaire 7 Questionnaire- ETDQ7, ETDQ7 ETDQ , (ETDQ-7) tympanometry followup. followup follow up. up 3 analyzed procedure shortterm average 75 5 7. weeks mediumterm months. months months) p 0.0001 00001 0 0001 ETDQ- periods 6 833 83 83.3 procedures mediumterm, respectively pressures 533 53 53.3 433 43 43.3 shortand 714 71 4 71.4 assessments This profile (ETD 20 (ETDQ-7 0.000 0000 000 83. 53. 43. 71. 2 (ETDQ- 0.00 00 (ETDQ 0.0 0.

Abstract Introduction: The use of prognostic markers to decide the most appropriate therapies to perform in each case is assumed as one of the pillars of the approach to the patient with squamous cell carcinoma (SCC) of the hypopharynx and larynx. In addition to the clinical and pathological stage determined by the classification system TNM, there is evidence that the tumor-related systemic inflammatory response (SIR) has implications for tumor aggressiveness and progression. However, its value as an independent prognostic factor remains ambiguous. Aims: To analyze the tumor SIR, its perioperative dynamic changes and after adjuvant treatment and its prognostic value in patients with SCC of the larynx and hypopharynx undergoing total pharyngolaryngectomy. Methods: Retrospective analysis of clinicopathological data of patients undergoing total pharyngolaryngectomy between January 2013 and December 2018 in a tertiary-level hospital. SIR was assessed using the following parameters: lymphocyte-monocyte ratio (LMR), platelets-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and systemic immuno-inflammatory index (SII). Kaplan-Meier analysis and Cox regression were used to analyze survival outcomes and associated risks. Results: 59 patients were included in the study, with a mean age of 59.2 years. The mean follow-up time was 49.2 months. Preoperative PLR was the best predictor of overall survival (OS) at 5 years (area under the curve (AUC) 0.796, p<0.005). The optimal cutoff value was determined for each inflammatory parameter analyzed preoperatively, postoperatively and after adjuvant treatment (LMR: 2.6, 2.8 and 2.2, respectively; PLR: 125.0, 162.6 and 57.2, respectively; NLR: 2.3, respectively; 2.3, 2.8 and 3.9, respectively; SSI: 931.4, 732.8 and 931.43, respectively). Multivariate survival analysis showed that OS and distant metastasis-free survival (MFS) were statistically lower in patients with preoperative PLR >125.0 (HR 4.39, p<0.005 and HR 17.65, p <0.005, respectively). There was a significant decrease in SIR after complete treatment with surgery with or without adjuvant chemoradiation. However, the pattern of parameters variation with treatments had no influence on OS or MFS. Patients with preoperative LPR >125.0 tend to have higher NLR and SII (p<0.005), although these did not prove to be independent predictors of survival. Conclusions: A high preoperative PLR was significantly associated with worse OS and MFS in patients undergoing total pharyngolaryngectomy. Still, the use of this marker in our current clinical practice to predict postoperative outcomes must be performed in a critical way.

Resumo Introdução: A utilização de marcadores de prognóstico para delinear as estratégias terapêuticas mais adequadas a cada caso (cirurgia, quimioradioterapia e/ou radioterapia) assume-se como um dos pilares da abordagem ao doente com carcinoma espinocelular (CEC) da hipofaringe e laringe. Para além dos estadio clínico e patológico determinado pelo TNM, já há evidência que a resposta inflamatória sistémica (RIS) relacionada com o tumor tem implicações na agressividade e progressão tumoral. No entanto, o seu valor como fator de prognóstico independente ainda continua ambíguo. Objetivos: Analisar a RIS tumoral, a sua variação dinâmica perioperatória e após tratamento adjuvante e o seu valor prognóstico em doentes com CEC da laringe e hipofaringe submetidos a faringolaringectomia total. Material e Métodos: Análise retrospetiva dos dados clinico-patológicos dos doentes submetidos a faringolaringectomia total entre janeiro de 2013 e dezembro de 2018 num hospital de nível terciário. A RIS foi avaliada utilizando os seguintes parâmetros: rácios linfócitos-monócitos (RLM), plaquetas-linfócitos (RPL), neutrófilos-linfócitos (RNL) e índice imuno-inflamatório sistémico (IIS). Foram utilizadas a análise de Kaplan-Meier e regressão de Cox para analisar os resultados de sobrevivência e riscos associados. Resultados: Foram incluídos 59 doentes no estudo, com uma média de idades de 59.2 anos. O tempo médio de seguimento dos doentes foi de 49.2 meses. O RPL pré-operatório foi o melhor preditor da sobrevivência global (SG) a 5 anos (area under the curve (AUC) 0.796, p<0.005). Determinou-se o valor de cutoff ótimo para cada parâmetro inflamatório analisado no período pré-operatório, pós-operatório e após tratamento adjuvante (RLM: 2.6, 2.8 e 2.2, respetivamente; RPL: 125.0, 162.6 e 57.2, respetivamente; RNL: 2.3, 2.8 e 3.9, respetivamente; IIS: 931.4, 732.8 e 931.43, respetivamente). A análise de sobrevivência multivariada ajustada para possíveis fatores de confundimento evidenciou que a SG e a sobrevivência livre de metastização à distância (SLM) foi estatisticamente inferior nos doentes com RPL pré-operatório >125.0 (HR 4.39, p<0.005 e HR 17.65, p<0.005, respetivamente). Verificou-se um decréscimo significativo da RIS após tratamento completo com cirurgia com ou sem quimioradioterapia adjuvante. No entanto, o padrão de variação dos parâmetros com o tratamento instituído não teve influência na SG ou SLM. Os doentes com RPL pré-operatória >125.0 tendem a apresentar RNL e IIS mais elevados (p<0.005), embora estes não evidenciaram ser fatores preditivos independentes de sobrevivência. Conclusões: Um elevado RPL pré-operatório foi significativamente associado a pior SG e SLM em doentes submetidos a faringolaringectomia total. Ainda assim, a utilização deste marcador na nossa prática clínica para prever os resultados pós-operatórios deve ser realizada de forma crítica.

Overview: The first trimester screening for fetal aneuploidy includes a combined evaluation of maternal age, obstetric history, ultrasound and biochemical markers. Variations in maternal serum levels of biochemical markers (free b-hCG and PAPP-A) have been associated with adverse obstetric outcomes, even in the absence of aneuploidy. This study aimed to evaluate the association of PAPP-A and free b-hCG with the occurrence of adverse obstetric outcomes, in an obstetric population with negative first trimester screening for chromosomal abnormalities. Study design: Observational, descriptive, analytic and retrospective study that included 1128 pregnancies with a negative first trimester screening, in 2013. Delivery occurred in our Hospital. Methods: The levels of both biochemical markers (free b-hCG and PAPP-A) were compared between groups with a given adverse obstetric outcome and women without any adverse event. Binary logistic regression and multiple linear regression analysis were performed to determine if free b-hCG and PAPP-A were important predictors for adverse outcomes. Results: Maternal serum levels of PAPP-A were significantly lower in women who developed pre-eclampsia compared to women without any adverse obstetric outcome (0.98±0.2 vs. 1.18±0.63 MoM; p=0.027). Maternal serum free b-hCG was significantly lower in pregnant women who had birth before 37 weeks of gestation, compared to pregnant women with a term birth (median; interquartile range: 0.78; 0.39 vs.0.94; 0.75 MoM; p=0.037). Linear regression analysis showed that PAPP-A is an independent predictor of fetal birth weight and that free b- hCG is a predictor of fetal gestational age at birth. Conclusion: Serum PAPP-A and free â-hCG in the first trimester are significantly reduced in pregnancies, with a negative first trimester combined screening for fetal aneuploidy, who developed pre-eclampsia and had a preterm delivery, respectively. In these populations, for a better risk assessment, we suggest to perform pre-eclampsia and preterm labour screening.