Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction.

OBJECTIVES: Fibula free flaps (FFF) are the standard approach to mandibular reconstruction after partial resection, with the goal of restoring aesthetics and masticatory function. The graft position affects both and must be carefully selected. Correlations between sagittal positioning and upper airway anatomy are known from orthognathic surgery. This study aims to evaluate changes in mandibular position and upper airway anatomy after reconstructive surgery with FFF and corresponding correlations. MATERIALS AND METHODS: Mandibular position after reconstruction was evaluated using three-dimensional datasets of pre- and postoperative computed tomography scans of patients treated between 2020 and 2022. Three-dimensional measurements were performed on both condyles and the symphyseal region. Changes in upper airway volume and minimum cross-sectional area (minCSA) were analysed. Intra-rater reliability was assessed. Correlations between changes in upper airway anatomy and sagittal mandibular position were tested. RESULTS: The analysis included 35 patients. Intra-rater reliability was good to excellent. Condylar deviations and rotations were mostly rated as small. Changes in symphyseal position were considerably greater. Median airway volume decreased in the oropharynx and hypopharynx. Posterior deviation of the symphysis was associated with a decreasing minCSA in the hypopharynx and vice versa. CONCLUSIONS: The overall accuracy of mandibular reconstructions with FFF is high, but there is room for optimization. The focus of research should be extended from masticatory to respiratory rehabilitation. CLINICAL RELEVANCE: Effects on respiratory function should be considered prior to graft positioning. The clinical relevance of upper airway changes within the complex rehabilitation of reconstructive surgery patients needs to be further investigated.

Identification of Risk Factors for African Swine Fever: A Systematic Review.

African swine fever (ASF) is an internationally-spreading viral pig disease that severely damages agricultural pork production and trade economy as well as social welfare in disease-affected regions. A comprehensive understanding of ASF risk factors is imperative for efficient disease control. As the absence of effective ASF vaccines limits disease management options, the identification and minimisation of ASF-associated risk factors is critical to preventing ASF outbreaks. Here, we compile currently known potential ASF risk factors identified through a systematic literature review. We found 154 observation-based and 1239 potential ASF risk factors, which we were able to group into the following defined risk categories: 'ASF-virus', 'Biosecurity', 'Disease control', 'Environment', 'Husbandry', 'Movement', 'Network', 'Pig', 'Society' and 'Surveillance'. Throughout the epidemiological history of ASF there have been similar risk categories, such as 'Environment'-related risk factors, predominantly reported in the literature irrespective of the ASF situation at the time. While ASF risk factor reporting has markedly increased since 2010, the majority of identified risk factors overall have referred to domestic pigs. The reporting of risk factors for ASF in wild boar mostly commenced from 2016 onwards. The compendium of ASF risk factors presented herein defines our current knowledge of ASF risk factors, and critically informs ASF-related problem solving.

Reproducibility of Non-Invasive Endothelial Cell Loss Assessment of the Pre-Stripped DMEK Roll After Preparation and Storage.

PURPOSE: To present a novel, reproducible, and noninvasive method to quantify endothelial cell loss (ECL) of pre-stripped endothelial Descemet membrane lamellae (EDML) caused by its preparation and storage for 5 days. DESIGN: Prospective laboratory investigation. METHODS: Thirty EDML were stripped from corneoscleral discs and placed in a well plate containing organ culture medium 1 without dextran. An additional 5 corneoscleral discs were also placed in the same medium and served as a control group. Endothelial cell density (ECD) was measured without any additional manipulation by using spectral microscopy following an extensive protocol by which 3 clear images from the center and periphery were used for each measurement, and each measurement was repeated 5 times. ECD was measured before and directly after preparation and on days 1, 2, and 5 of storage. RESULTS: The average ECD of the 30 corneoscleral discs, which later underwent stripping, was 2,292 ± 308 cells/mm2 vs 2,129 ± 222 cells/mm2 for the 5 corneoscleral discs of the control group. The ECL of the control group was significantly lower than that of the EDML group (P < .0001), reaching ±2% versus 11 ± 5%, respectively, on day 0; 3% ± 4% versus 19 ± 10%, respectively, on day 1; 2% ± 2% versus 22% ± 11%, respectively on day 2; and 4% ± 3% versus 23% ± 9%, respectively, on day 5. Reproducibility of the results on all measurement days was good, with Cronbach alpha values ranging from 0.85 to 0.98. CONCLUSIONS: A highly reproducible, noninvasive method was presented for measuring the ECD of the EDML. Prestripped EDML lose a significant amount of cells, up to 11%, due to the preparation process and up to 23% after 5 days of storage. Therefore, shipping them after several days of storage to be used in a DMEK surgery cannot be recommended.

"Can we agree on that"? Plurality, power and language in participatory research.

Participatory epidemiology (PE) is a method that gathers data from groups through focus group interviews and participatory visual and scoring exercises. The method is often used in poor communities in low-income countries where it is hard to obtain conventional epidemiological data. This paper draws on research on the public sphere and democratic deliberation, along with research on language and interpretation, to suggest how PE research could be better equipped to account for diversity in local knowledge, include minority views and acknowledge power dynamics. These aspects are discussed under the three themes of 'plurality', 'power' and 'language'. A review of highly-cited PE literature suggests that PE research engages with plurality and power to a very limited extent, and only marginally more so with language and translation. Examples are taken from the authors' own PE research on African swine fever in -Uganda, classical swine fever in Germany, peste des petits ruminants (PPR) in Eastern Europe, and Ugandan pastoralists' understanding of cattle disease to provide more detail as to why conventional PE studies might fail to record issues of plurality, power and language, and also to suggest how this can be addressed. With reference to the literature on the public sphere and democratic deliberation, and on language and interpretation, this paper concludes with some suggestions as to how to take plurality, power and language into greater consideration in PE studies in future, thus improving the validity and reliability of PE data.

Surveillance strategies for Classical Swine Fever in wild boar - a comprehensive evaluation study to ensure powerful surveillance.

Surveillance of Classical Swine Fever (CSF) should not only focus on livestock, but must also include wild boar. To prevent disease transmission into commercial pig herds, it is therefore vital to have knowledge about the disease status in wild boar. In the present study, we performed a comprehensive evaluation of alternative surveillance strategies for Classical Swine Fever (CSF) in wild boar and compared them with the currently implemented conventional approach. The evaluation protocol was designed using the EVA tool, a decision support tool to help in the development of an economic and epidemiological evaluation protocol for surveillance. To evaluate the effectiveness of the surveillance strategies, we investigated their sensitivity and timeliness. Acceptability was analysed and finally, the cost-effectiveness of the surveillance strategies was determined. We developed 69 surveillance strategies for comparative evaluation between the existing approach and the novel proposed strategies. Sampling only within sub-adults resulted in a better acceptability and timeliness than the currently implemented strategy. Strategies that were completely based on passive surveillance performance did not achieve the desired detection probability of 95%. In conclusion, the results of the study suggest that risk-based approaches can be an option to design more effective CSF surveillance strategies in wild boar.

[Determining the support needs of patients who live at home following a stroke]. / Studie zur Ermittlung des Unterstützungsbedarfes von Patientinnen und Patienten, die nach einem Schlaganfall zu Hause leben.

The study "determining the support needs of patients who live at home following a stroke" was chosen because stroke is (one of) the most significant causes of permanent handicap in the elderly. (This project was developed as part of the studies for the degree of Nurse Manager/Teacher:) The results are based on qualitative and quantitative data collected from focus groups and a standardised questionnaire. Due to the small number of participants (57) the study cannot be regarded as representative. Typical key issues such as "going out of the house" were highlighted in the standard questionnaires. The interviews which were evaluated using the Mayring technique give an impression of themes, such as reduced tolerance levels and (greater) increased anxiety, which together with the physical burden dominate their daily life. It was apparent that the persons concerned have a general lack of understanding of their condition. The most significant results of the study are presented together with life enhancing recommendations.