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People arriving to the emergency department with mental health problems experience varying and sometimes inferior outcomes compared with people without mental health problems, yet little is known about whether or how their arrival mode is associated with these outcomes. This study describes and compares demographics, clinical characteristics, and patient and health service outcomes of adult mental health emergency department patient presentations, based on arrival mode: brought in by ambulance, privately arranged transport, and brought in by police. Using a retrospective observational study design with state-wide administrative data from Queensland, Australia, mental health presentations from January 1, 2012, to December 31, 2017, were analyzed using descriptive and inferential analyses. Of the 446,815 presentations, 51.8% were brought in by ambulance, 37.2% arrived via privately arranged transport, and 11.0% were brought in by police. Compared with other arrival modes, presentations brought in by ambulance were more likely to be older and female and have more urgent triage categories and a longer length of stay. Presentations arriving by privately arranged transport were more likely than other arrival modes to present during the day, be assigned a less urgent triage category, be seen within their recommended triage time, have a shorter length of stay in the emergency department, have higher rates of discharge, and have waited longer to be seen by a clinician. Presentations brought in by police were more likely than other arrival modes to be younger and male and experience a shorter time to be seen by a clinician. Discrepancies between arrival modes indicates a need for further investigation to support inter- and intra-agency mental health care interventions. [ABSTRACT FROM AUTHOR]

The high mechanical loads in deep rolling lead to a beneficial surface topography, hardness alterations, and compressive residual stresses. The generation of defined residual stress values has been achieved in a mainly iterative way, as the relevant internal material loads occurring during the process could not be considered. They are difficult to determine experimentally and well-validated models are required to deduce them e.g. from finite element (FE) simulations. In this study, a 3D FE model has been developed to analyze the strains in the workpiece material as a measure for the internal material load during the process. The residual stress profiles were measured by X-ray-diffraction and are presented in a way that allows for deriving the internal material loads required to induce a desired residual stress state. [ABSTRACT FROM AUTHOR]

A series of flume- and laboratory-based experiments defined and quantified the thresholds of sunken oil transport using No.6 heavy fuel oil mixed with kaolinite clay. When the sunken oil became mobile, the current-induced bed shear stress exceeded a threshold value specific to the oil, known as critical shear stress (CSS). The oil's CSS was evaluated as a function of water velocity, water temperature, oil condition, and sediment size. Based on experimental results, the stages of oil transport were defined and empirical relationships using the oil's kinematic viscosity (v o) and sediment size were developed to predict oil CSS at each transport stage. For v o <2 × 104 cSt, multiple thresholds of movement were observed: (1) gravity dispersion, (2) rope formation, (3) ripple formation, and (4) break-apart/resuspension. When v o > 6 × 104 cSt, transport was more likely to occur as a single event with the oil remaining intact, saltating over the bed in the direction of flow. [Display omitted] • Heavy fuel oil critical shear stress determined through mesoscale flume experiments • Sunken oil critical shear stress correlated to oil kinematic viscosity and sediment grain size • The stages of sunken oil transport differ for high viscosity oils and lower viscosity oils. [ABSTRACT FROM AUTHOR]

The involvement of families, carers and significant others (i.e. social support networks) has a positive corollary for a person experiencing mental health problems. Accordingly, in Australia involvement of social support networks within mental health services is endorsed in national health policy and service guidelines. Despite the endorsement, this is yet to be fully realised in all areas that provide mental health services, including emergency departments. Social support networks are integral in the provision of mental health consumers' care. Supporting the involvement of social support networks in the emergency department can provide healthcare services with opportunities for enhanced and cost-effective care, contributing to improved outcomes for consumers. An overview of some of the barriers and facilitators of social support network involvement is provided. The intention of this paper is to encourage reflection and dialogue on this important area of mental health service provision and support the evolution of a new paradigm of research into social support network involvement in the emergency department. [ABSTRACT FROM AUTHOR]

Estimates of marine debris are often based on beach surveys. Few studies have documented the veracity of these observations and the factors that may affect accuracy. Our laboratory-scale experiment identified potential sources of error associated with visual identification of marine debris (1–2 cm long) during shoreline surveys of sand beaches. Characteristics of the survey site (beach characteristics), observer (personal characteristics), and debris (color and size) may be important factors to consider when analyzing data from shoreline surveys. The results of this study show that the ability of individuals to accurately identify plastic fragments depends on the plastic and sand color, and density of shell fragments. Most suggestively, the high accuracy of blue plastic counts (95%) and the under-counting of white (50%) and clear plastic counts (55%) confirmed the hypothesis that a significant amount of clear and white plastic fragments may be missed during shoreline surveys. These results highlight the need for further research and possible modifications of visual shoreline survey methodologies in order to optimize this cost-effective method of marine debris monitoring. • Accurate identification of plastic fragments during beach surveys depends on plastic and sand color, and density of shell fragments. • A significant amount of clear and white plastic fragments may be missed during beach surveys. • Further research and possible modifications of beach survey methodologies are needed. [ABSTRACT FROM AUTHOR]

Relapses represent a major limitation to the long-term remission of pathological fear and anxiety. Stress modulates the acquisition and expression of fear memories and appears to promote fear recovery in patients with anxiety disorders. However, the neural correlates underlying stress hormone effects on the return of fear in humans remain unexplored. Likewise, little is known about the interactions between sex and stress hormones on return of fear phenomena. In this functional magnetic resonance imaging study, 32 men and 32 women were exposed to a fear renewal paradigm with fear acquisition in context A and extinction in context B. On the following day, participants received either cortisol or placebo 40 min before return of fear was tested in both contexts in a renewal and reinstatement test. Cortisol increased differential conditioned skin conductance responses in the extinction context B following reinstatement in men but not in women. On the neural level, this effect was characterized by enhanced fear-related activation in the right amygdala in men, while an activation decrement in this region was observed after cortisol treatment in women. Our results revealed that cortisol promotes the return of fear in men by strengthening a key node of the fear network – the amygdala. We thereby provide novel insights into a sex-specific mechanism mediating stress-induced fear recovery which may translate into different relapse risks and treatment strategies for men and women. [ABSTRACT FROM AUTHOR]

Purpose The detection of small parenchymal hepatic lesions identified by preoperative imaging remains a challenge for traditional pathologic methods in large specimens. We developed a magnetic resonance imaging (MRI) compatible localization device for imaging of surgical specimens aimed to improve identification and localization of hepatic lesions ex vivo. Materials and methods The device consists of two stationary and one removable MR-visible grids lined with silicone gel, creating an orthogonal 3D matrix for lesion localization. To test the device, five specimens of swine liver with a random number of lesions created by microwave ablation were imaged on a 3 T MR scanner. Two readers independently evaluated lesion coordinates and size, which were then correlated with sectioning guided by MR imaging. Results All lesions ( n = 38) were detected at/very close to the expected localization. Inter-reader agreement of lesion localization was almost perfect (0.92). The lesion size estimated by MRI matched macroscopic lesion size in cut specimen (± 2 mm) in 34 and 35, respectively, out of 38 lesions. Conclusion Use of this MR compatible device for ex vivo imaging proved feasible for detection and three-dimensional localization of liver lesions, and has potential to play an important role in the ex vivo examination of surgical specimens in which pathologic correlation is clinically important. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to compare perceived self-management practices of adult type 2 diabetic patients after completing an American Diabetes Association (ADA) certified diabetes self-management education (DSME) program with unstructured individualized nurse practitioner led DSME. Methods: Demographic questions and the Self-Care Inventory-Revised (SCIR) were given to two convenience sample patient groups comprising a formal DSME program group and a group within a clinical setting who received informal and unstructured individual education during patient encounters. A t-test was executed between the formal ADA certified education sample and the informal sample's SCI-R individual scores. A second t-test was performed between the two samples' SCI-R mean scores. Results: A t-test determined no statistically significant difference between the formal ADA structured education and informal education samples' SCI-R individual scores. There was not a statistically significant difference between the samples' SCI-R mean scores. Discussion: The study results suggest that there are not superior DSME settings and instructional approaches. [ABSTRACT FROM AUTHOR]

Purpose: To implement a protocol for PET/MR enterography for a multimodal assessment of intestinal pathologies.Materials and Methods: 19 patients with bowel malignancies, Crohn's disease or fever of unknown origin (male: n=14, female: n=5, age: 57±13years) underwent PET/MR enterography with either [(18)F]FDG (n=10) or [(68)Ga]-DOTATOC (n=9) using an integrated scanner. For small bowel distension a contrast solution (1500 cm(3) of mannitol and locust bean gum) was ingested. The following sequences were acquired: (a) coronal TrueFISP; (b) coronal T2w HASTE; (c) coronal dynamic T1w VIBE; (d) axial and coronal T1w FLASH post gadolinium. All datasets were reviewed by two readers with regard to co-registration of anatomical structures based on a 3-point ordinal scale as well as overall image quality using a 4-point ordinal scale. Furthermore, visualization of intestinal and extra-intestinal pathologies was assessed.Results: PET/MR enterography was well tolerated by all patients. High overall MR image quality was achieved (mean score: 3.2±0.6) with good co-registration of PET and MRI (mean scores: 2.6 to 3.0). PET/MR enterography allowed for an excellent visualization of both intestinal as well as extra-intestinal pathologies.Conclusion: PET/MR enterography is technically feasible and offers good co-registration of bowel structures. This novel method enables a multimodal assessment of bowel lesions in malignant and inflammatory disease. [ABSTRACT FROM AUTHOR]

Purpose: To compare the utility of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA), a liver-specific magnetic resonance (MR) imaging contrast agent, versus gadobutrol for treatment response evaluation of hepatocellular carcinoma (HCC) after radioembolization.Materials and Methods: This prospective study included 50 patients with HCC undergoing radioembolization. All patients underwent contrast-enhanced computed tomography (CT) and MR imaging with gadobutrol and Gd-EOB-DTPA on 2 consecutive days before radioembolization and 30 days, 90 days, 180 days, and 270 days after radioembolization. The standard of reference indicating tumor progression was CT combined with either α-fetoprotein or γ-glutamyltransferase. Gadobutrol-enhanced MR imaging, Gd-EOB-DTPA-enhanced MR imaging without late phase imaging (Gd-EOB-DTPA-), and Gd-EOB-DTPA-enhanced MR imaging with late phase imaging (Gd-EOB-DTPA+) were evaluated by 2 radiologists in consensus using a 4-point scale: 1 = definitely no tumor progression; 2 = probably no tumor progression; 3 = probably tumor progression; 4 = definitely tumor progression. Diagnostic accuracy was assessed with receiver operating characteristic analysis.Results: Tumor progression was detected in 14 of 82 study visits according to the reference standard. Pairwise comparison of the area under the curve showed a tendency toward a larger area under the curve for Gd-EOB-DTPA+ compared with gadobutrol (P = .056). Sensitivity and specificity were higher in Gd-EOB-DTPA+ (0.929 and 0.971) than in Gd-EOB-DTPA- (0.786 and 0.941) or gadobutrol (0.643 and 0.956). In 2 cases, tumor progression was detected by Gd-EOB-DTPA+ and by an increase in α-fetoprotein, but not by CT, gadobutrol, or Gd-EOB-DTPA-.Conclusions: Gd-EOB-DTPA+ MR imaging was not inferior to gadobutrol-enhanced MR imaging in therapy response evaluation after radioembolization and may allow a more accurate detection of early HCC recurrence in single cases. [ABSTRACT FROM AUTHOR]

The occurrence of panic symptoms in various anxiety disorders has been associated with more severely impaired and difficult-to-treat cases, but this has not been investigated in dental phobia. We examined the clinical implications of panic symptoms related to sub-clinical and clinically significant dental phobia. The sample consisted of 61 patients at a university dental clinic who endorsed symptoms of dental phobia, 25 of whom met criteria for a formal diagnosis of dental phobia. Participants with dental phobia endorsed more panic symptoms than did those with sub-clinical dental phobia. In the total sample, greater endorsement of panic symptoms was associated with higher dental anxiety, more avoidance of dental procedures, and poorer oral health-related quality of life. Among those with dental phobia, certain panic symptoms exhibited associations with specific anxiety-eliciting dental procedures. Panic symptoms may serve as indicators of clinically significant dental phobia and the need for augmented treatment. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and methods: 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w±IR) were acquired 20–30min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results: All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions: Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR. [Copyright &y& Elsevier]

Abstract: Purpose: Estimate the prevalence and annual frequency of health risk indicators in young people serving community-based orders (CBOs) and custodial orders in the state of Victoria, Australia. Methods: Cross-sectional survey of 242 young people serving CBOs and 273 serving custodial orders in Victoria in 2002–2003. Validated measures included the Composite International Diagnostic Interview for substance dependence, Short Mood and Feelings Questionnaire for depression, and Psychosis Screening Questionnaire for psychosis symptoms. Prevalence estimates were adjusted for sampling bias and age- and sex-adjusted for between-group comparisons. Prevalence estimates were applied to 2010–2011 Victorian youth justice data to estimate annual frequencies at the state level. Results: The prevalence of substance dependence, poor mental health, and risky sexual behavior was high in both groups. Age- and sex-adjusted prevalence estimates were generally higher among those serving custodial orders; however, extrapolating prevalence estimates to statewide youth justice data generally resulted in higher estimated annual frequencies among CBOs. For example, the estimated prevalence of any substance dependence was 66% (95% confidence interval [CI], 60–72) in those serving custodial orders and 34% (95% CI, 26–42) in CBOs, but the estimated frequency of substance dependence in CBOs in 2010–2011 was 970 (95% CI, 750–1,180), compared with 490 (95% CI, 450–530) in those serving a custodial order. Conclusions: There is a compelling case for scaling up health services for young offenders in custody and in the community, and for routinely monitoring the health of young offenders serving custodial and community orders. [Copyright &y& Elsevier]

Aim: To evaluate whether the addition of diffusion-weighted imaging (DWI) in bowel abdominal magnetic resonance imaging (MRI) can improve diagnostic confidence. Materials and methods: One hundred and eleven consecutive patients with suspected or known inflammatory bowel disease (n = 59), tumour disease (n = 31), unspecific abdominal pain (n = 16), and suspected graft-versus-host disease (n = 5) underwent bowel MRI using a 1.5 T MRI machine. In addition to T2-weighted (T2W) and contrast-enhanced T1-weighted (CE-T1W) data, axial and coronal DWI sequences were collected (b = 50, 500, 1000). Diagnostic confidence for lesion detection with and without DWI was evaluated using a four-point Likert scale [1 = certainly no lesion(s), 2 = probably no lesion(s), 3 = probably lesion(s), 4 = certainly lesion(s)]. Results: In 11 of 111 patients (10%), the diagnostic confidence was improved by DWI. In seven patients, readers changed their diagnosis from “probable” to “certain presence of lesions”. In another four patients, lesions were diagnosed based on DWI, which were not delineated on CE-T1W and T2W imaging. Conclusion: DWI of the bowel can provide additional information to the reader and, therefore, improve diagnostic confidence. Hence, additional DWI should be integrated into a standard bowel MRI protocol. [Copyright &y& Elsevier]

Rationale and Objectives: To investigate the feasibility and performance of 7T magnetic resonance imaging compared to 1.5T imaging to discriminate benign (normal and inflammatory changed) from tumor-bearing lymph nodes in rabbits using ultrasmall particles of iron oxide (USPIO)-based contrast agents. Materials and Methods: Six New Zealand White rabbits were inoculated with either complete Freund's adjuvant cell suspension (n = 3) to induce reactively enlarged lymph nodes or with VX2 tumor cells to produce metastatic lymph nodes (n = 3). Image acquisition was performed before and 24 hours after bolus injection of an USPIO contrast agent at 1.5T and afterward at 7T using T1-weighted and T2*-weighted sequences. Sensitivities, specificities, and negative and positive predictive values for the detection of lymph node metastases were calculated for both field strengths with histopathology serving as reference standard. Sizes of lymph nodes with no, inflammatory, and malignant changes were compared using a Mann-Whitney U-test. Results: All 24 lymph nodes were detected at 1.5T as well as at 7T. At 1.5T, sensitivity amounted to 0.67, while specificity reached a value of 1. At the higher field strength (7T), imaging was able to reach sensitivity and specificity values of 1. No statistical differences were detected concerning lymph node sizes. Conclusions: Magnetic resonance lymphography with USPIO contrast agents allows for differentiation of normal and reactively enlarged lymph nodes compared to metastatic nodes. First experiments at 7T show promising results compared to 1.5T, which have to be evaluated in further trials. [Copyright &y& Elsevier]

Abstract: Background: Health outcomes after release from prison are typically poor with elevated rates of morbidity and mortality widely documented. Under-utilisation of health services contributes to these outcomes, but interventions to increase health service utilisation in ex-prisoners are in their infancy and few have been rigorously evaluated. Methods: Single-blinded randomised controlled trial of a service brokerage intervention (the ‘Passports study’) for N=1325 adult ex-prisoners in Queensland, Australia. Participants in the intervention group received a personalised booklet summarising their health status and identifying appropriate community health services; trained workers made weekly telephone contact in the first 4weeks post-release to identify health needs and facilitate health service utilisation. Participants in the control arm received usual care. Baseline data were collected within 6weeks of expected release from custody with follow-up telephone interviews 1, 3 and 6months post-release. Participant identities were linked with federal health service utilisation records, a national death register and corrective services records, two years post-release. The primary outcome was self-reported health service utilisation in the first 6months post-release. Results: Between 2008 and 2010 1976 prisoners were screened for eligibility, 1665 met eligibility criteria and 1325 were recruited; 665 were randomised to the intervention and 660 to the control condition. Participants were broadly representative of adults being released from prison in Queensland except that women were intentionally oversampled (21% vs. 11%). Conclusions: Outcomes from this large RCT will provide the first robust evidence of the effect of service brokerage on health service utilisation and health outcomes for ex-prisoners. [Copyright &y& Elsevier]

Abstract: Background: Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia. Methods: Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination. Results: We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR=3.07, 95%CI 1.83–5.12), being unemployed prior to incarceration (ARR=1.34, 95%CI 1.01–1.76), use of three or more drug types prior to incarceration (ARR=1.80, 95%CI 1.40–2.31), a history of needle/syringe sharing (ARR=5.00, 95%CI 3.06–8.16), receiving a tattoo during the current prison sentence (ARR=2.19, 95%CI 1.67–2.86) and HCV exposure (ARR=1.47, 95%CI 1.08–2.02). Older age was protective (ARR=0.90 per 5 years older, 95%CI 0.83–0.99). Conclusion: Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings. [Copyright &y& Elsevier]

Magnetic resonance imaging (MRI) has evolved as a powerful tool for the assessment of the small bowel. Strengths of MRI include the superb soft-tissue contrast, lack of radiation exposure, and the implementation of fast scanning techniques. Clinically relevant findings such as inflammation and tumor disease can be well-depicted. We describe in this article current techniques of small bowel MRI including its implementation and clinical outcome in comparison to other radiological and endoscopic procedures. [ABSTRACT FROM AUTHOR]

Abstract: This article will outline the clinical presentation and management of patellar instability and fracture. Patellar instability is a generic term that describes anything from symptomatic apprehension to patellar subluxation and through to patellar dislocation. It can result from osseous abnormalities such as patella alta or patellofemoral dysplasia or it can arise secondary to soft tissue abnormalities such as a torn medial patellofemoral ligament. Failing conservative management, surgical treatment is directed to the underlying cause(s) of the instability, and can include medial patellofemoral ligament reconstruction or a bony realignment procedure. Patellar fracture is a common injury caused by excessive tension through the extensor mechanism or a direct blow. Such injury can lead to stiffness, extension weakness and patellofemoral arthritis. Non-surgical management is indicated for non-displaced fractures with an intact extensor mechanism. Surgical fixation is recommended for fractures that either disrupt the extensor mechanism or that demonstrate over 2–3 mm of step-off and/or over 1–4 mm of displacement. Anatomic reduction and fixation with a tension-band technique is associated with the best outcomes; however, symptomatic hardware is a frequent complication. [Copyright &y& Elsevier]

Abstract: Background: Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration. Methods: Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months. Results: One third of participants (n=829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently. Conclusions: Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group. [Copyright &y& Elsevier]

Abstract: Both total and unicompartmental knee arthroplasty are effective operations for the treatment of gonarthrosis. However, up to 20% of patients will return with pain and a suboptimal functional outcome. The investigation of such a patient is critical in determining an accurate diagnosis and establishing an effective management plan. Causes of pain can be broadly classified into extrinsic and intrinsic. The commonest intrinsic causes of pain are infection, component loosening, component mal-orientation and soft tissue impingement. Extrinsic causes, including hip and spinal pathology, may be responsible for the patient’s symptoms and must be considered. Accurate evaluation uses a four-step procedure involving a detailed history, thorough clinical examination and microbiological plus imaging analysis. This review article will focus on each of these key steps and highlight some of the latest modes of investigating the painful knee arthroplasty. [Copyright &y& Elsevier]

Rationale and Objectives: The purpose of this study was to perform high-resolution contrast-enhanced peripheral multistation magnetic resonance angiography using a new blood-pool contrast agent (gadofosveset trisodium; Vasovist) while suppressing venous signal by using an acquisition scheme with k-space segmentation. Materials and Methods: Multistation peripheral magnetic resonance angiography with Vasovist was performed in 20 patients with known peripheral arterial occlusive disease. The k-space of the three-dimensional data sets was segmented such that the central parts were acquired during the first pass of the blood-pool agent, while the peripheral parts were acquired in the steady state. A third magnetic resonance angiographic data set acquired using the conventional technique served as comparison for venous overlay. Two radiologists blindly compared vessel sharpness, conspicuity, and venous contamination. Furthermore, a semiautomatic program to compare edge sharpness was used. Results were compared by means of Wilcoxon’s signed rank sum test. Results: Comparison of vessel sharpness revealed statistically significant differences in favor of the fused data sets in all three stations. Arteries were depicted more sharply in the fused images and over longer parts, while veins were almost completely suppressed. Conclusions: Peripheral contrast-enhanced magnetic resonance angiography with first-pass and steady-state k-space segmentation using a blood-pool contrast agent proved feasible and provided high-resolution data with sharp delineation of the arteries while reducing venous contamination. [ABSTRACT FROM AUTHOR]

Summary: Background: The parascapular flap is a widely accepted and suitable option for covering defects in almost all anatomical areas. Here, we report our experience with the microvascular transfer of parascapular flaps for the coverage of large lower leg defects with reference to our retrospective study. Patients and methods: Twenty patients with free parascapular flaps (17 male, three female, age: 43±17 years, BMI 26.1±3.5) were examined 3 months to 3 years after free tissue transfer. All procedures and examinations were performed by the same experienced surgeon (2002–2005). Flap dimensions ranged from 8×4cm to 30×13cm, with an average of 20.4±6.6cm×8.9±2.6cm. The parameters studied included perioperative morbidity, donor site morbidity, flap vitality, complications, functional shoulder tests, patient satisfaction (visual analog scale, VAS), the duration of the hospital stay and the long-term outcome. Results: All of the 20 flaps remained vital. Adequate coverage and complete healing were obtained in all patients during the follow-up period and all patients were physically mobile. General patient satisfaction with the intervention was high (VAS: median 7.5; x25 =6.0; x75 =9.5); donor site morbidity was low, that is, only one patient presented with reduced range of motion and shoulder function compared to the preoperative status. The hospital stay after flap transfer was 20.8±9.8 days and the overall hospital stay was 32.1±15.0 days. Conclusions: Our study confirms that the parascapular flap is a very versatile and safe flap for lower limb reconstruction with low donor morbidity. [Copyright &y& Elsevier]