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1.
Poult Sci ; 97(5): 1484-1502, 2018 May 01.
Article in English | MEDLINE | ID: mdl-29462494

ABSTRACT

This 2 × 2 factorial experiment aimed to investigate the effects of stimulating foraging behavior from wk 6 and imposed stress at wk 16 on the development of severe feather pecking (SFP) in chickens reared for free-range egg production. Non-beak-trimmed ISA Brown chicks were purchased at one day old and floor-reared on wood shavings. From wk 6, straw was provided daily in dispensers (Forage vs. No forage) to stimulate foraging. At wk 15, there were 16 pens of 50 pullets. "Stressors" were applied to half the pens in wk 16 via combined transport, relocation, and mixing (TRM) of pullets, simulating activities around transfer from the rearing to egg-laying farm (TRM vs. Not TRM). Range access was permitted from wk 21. Behavior, plumage damage (PD), growth, egg production, feed use, injuries, and mortalities were recorded, along with litter moisture and pH. In wk 26, an SFP outbreak commenced. By wk 34, PD was worse in south- than north-aspect pens (P < 0.001). Further, PD was more affected by side of the shed than the experimental treatments. In wk 30, an outbreak of injurious pecking (IP) commenced in the 4 TRM-treatment pens on the south side, with IP deaths almost 3 times more common in the Forage+TRM than No forage+TRM treatment. We suggest factors associated with a 13-day rainfall event that occurred in late winter predisposed the flock to SFP. While multiple factors such as winter cold, muddy ranges, damp floor litter with elevated pH, among others coincided, hens were clearly more impacted in south- than north-aspect pens. Once initiated, SFP possibly spread via social learning, and by wk 40, ∼98% of hens had PD. Interestingly, the IP outbreak was related to a combination of factors (stressors?), such as being housed in colder, damper south-aspect pens (note: southern hemisphere), having added Forage, and TRM. These unexpected relationships could help direct future research to identify the specific factors involved in the causation of SFP and IP/cannibalism outbreaks.


Subject(s)
Aggression , Cannibalism , Chickens/physiology , Feathers/physiology , Feeding Behavior , Stress, Physiological , Animals , Australia , Female , Housing, Animal
2.
J Vet Intern Med ; 31(4): 1067-1073, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28626960

ABSTRACT

BACKGROUND: Increased delivery of taurine-conjugated bile acids to the distal bowel can lead to dysbiosis resulting in colitis in mouse models of inflammatory bowel disease. A similar situation also could occur in cats with intestinal disease and might therefore result in decreased whole-body taurine concentration. HYPOTHESIS/OBJECTIVES: To determine whether whole-blood taurine concentrations are decreased at the time of diagnosis in cats with intestinal disease and to correlate concentrations with clinical and laboratory variables. ANIMALS: Twenty-one cats with chronic inflammatory enteropathy and 7 cats with intestinal neoplasia from the University of Bristol. METHODS: Cats that had undergone a thorough investigation consisting of a CBC, serum biochemistry, serum cobalamin and folate concentrations, transabdominal ultrasound examination and histopathology of intestinal biopsy specimens, as well as additional testing if indicated, were included. Whole-blood from these cats collected at the time of histologic diagnosis and stored in ethylenediaminetetraacetic acid was retrospectively analyzed for taurine with an automated high-performance liquid chromatography amino acid analyzer. RESULTS: Although whole-blood taurine concentrations remained within the reference range, those cats with predominantly large intestinal clinical signs had significantly lower concentrations than did cats with small intestinal and mixed bowel clinical signs (P = 0.033) and this difference also was significant when assessed only in cats with chronic inflammatory enteropathy (P = 0.019). CONCLUSIONS AND CLINICAL IMPORTANCE: Additional studies are needed to determine whether large intestinal signs in cats with chronic inflammatory enteropathy are caused by alterations in the microbiota arising as a consequence of increased delivery of taurine-conjugated bile acids.


Subject(s)
Cat Diseases/blood , Intestinal Diseases/veterinary , Taurine/blood , Animals , Cat Diseases/diagnosis , Cats , Chromatography, High Pressure Liquid/methods , Chromatography, High Pressure Liquid/veterinary , Colitis/blood , Colitis/diagnosis , Colitis/veterinary , Female , Folic Acid/blood , Intestinal Diseases/blood , Intestinal Diseases/diagnosis , Intestinal Neoplasms/blood , Intestinal Neoplasms/diagnosis , Intestinal Neoplasms/veterinary , Male , Serum Albumin/analysis , Vitamin B 12/blood
3.
Meat Sci ; 123: 21-28, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27591815

ABSTRACT

Meat quality parameters for 50 huacaya alpacas, representing three age groups (18, 24 and 36months) and two genders (females and castrated males) were studied. Prior to chilling, samples of m. longissimus thoracis et lumborum (LL) were taken to determine isocitrate dehydrogenase activity and glycogen concentration, and further meat quality samples were taken after 24h. Alpaca meat has low levels (<1%) of intramuscular fat in the LL, m. semimembranosus and m. biceps femoris, but the level in the LL increases with animal age, with levels of desirable polyunsaturated fatty acids (PUFA) ranging from 96.3 to 136.4mg/100g. Lipid oxidisation post retail display ranged from 1.27 to 1.96MDA/kg meat. Colour stability testing indicated alpaca meat was relatively stable during retail display with day of display having no significant effect on lightness (L*), or the 630nm/580nm ratio. These results may relate to the high proportion (76%) of glycolytic and type IIX muscle fibres in LL.


Subject(s)
Adipose Tissue/chemistry , Age Factors , Camelids, New World , Meat/analysis , Sex Factors , Animals , Color , Dietary Fats/analysis , Fatty Acids/analysis , Female , Food Analysis , Food Quality , Glycogen/analysis , Hydrogen-Ion Concentration , Isocitrate Dehydrogenase/analysis , Male , Muscle, Skeletal/chemistry , Thiobarbituric Acid Reactive Substances/analysis
4.
J Vet Intern Med ; 30(4): 1014-21, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27396683

ABSTRACT

BACKGROUND: Limited evidence exists in the literature regarding whether a specific mount is preferable to use for processing endoscopically obtained gastrointestinal biopsy specimens. HYPOTHESIS/OBJECTIVES: To compare 3 methods of handling endoscopically obtained gastrointestinal biopsy specimens from collection to laboratory processing and to determine if any technique produced superior results. ANIMALS: Twenty-three dogs and cats presented for gastrointestinal signs. METHODS: Prospective study of dogs and cats presented with gastrointestinal signs to a veterinary teaching referral hospital which underwent upper gastrointestinal endoscopy. Biopsy specimens were taken from the stomach and duodenum and submitted to the laboratory using 3 techniques: mounted on a cucumber slice, mounted on a moisturized synthetic foam sponge, and floating free in formalin. The techniques were compared with regard to the specimens' width, orientation, presence of artifacts, and pathologist's confidence in diagnosis. RESULTS: Twenty-three patients were included, with a total of 528 biopsies collected. Specimens on cucumber slice and on sponge were significantly wider (P < .001 and P = .001, respectively) compared to those floating free in formalin (mean width of 3.81 versus 3.31 and 2.52 mm, respectively). However, specimens on synthetic sponge had significantly fewer artifacts compared to those on cucumber slice (P = .05) and those floating free in formalin (P = .02). Confidence in the diagnosis also was superior with the sponge technique over floating free specimens (P = .002). CONCLUSIONS AND CLINICAL IMPORTANCE: The use of mounted gastrointestinal biopsy specimens was superior over the use of specimens floating free in formalin. This technique improved the quality of the specimens and the pathologist's confidence in their histopathologic interpretation.


Subject(s)
Cat Diseases/pathology , Dog Diseases/pathology , Duodenum/pathology , Specimen Handling/veterinary , Stomach/pathology , Animals , Biopsy/veterinary , Cats , Dogs , Duodenal Diseases/pathology , Duodenal Diseases/veterinary , Prospective Studies , Specimen Handling/methods , Stomach Diseases/pathology , Stomach Diseases/veterinary
5.
J Vet Intern Med ; 30(4): 996-1001, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27362482

ABSTRACT

BACKGROUND: Inflammatory bowel disease (IBD) is a common cause of signs of gastrointestinal disease in cats. A subset of cats with IBD has neutrophilic inflammation of the intestinal mucosa. HYPOTHESIS: Neutrophilic enteritis in cats is associated with mucosal invasion by microorganisms, and specifically Campylobacter spp. ANIMALS: Seven cats with neutrophilic IBD and 8 cats with lymphoplasmacytic IBD. METHODS: Retrospective review of duodenal biopsy specimens that were collected endoscopically for histologic examination. Cases were identified and selected by searching the histopathology archive for cats with a diagnosis of neutrophilic and lymphoplasmacytic IBD. Fluorescence in situ hybridization (FISH) targeting either all eubacteria or individual Campylobacter spp. was performed on archived samples. Neutrophils were detected on the same samples using a FISH probe for neutrophil elastase. RESULTS: Campylobacter coli was present in (6/7) cats with neutrophilic IBD and in (1/8) cats with lymphoplasmacytic IBD (P = .009). Cats with neutrophilic IBD had significantly higher number of C. coli (median bacteria 0.7/hpf) in the mucosa than cats with lymphoplasmacytic IBD (median bacteria 0/hpf) (P = 0.002). Colocalization of neutrophils and C. coli was demonstrated, with C. coli closer to the neutrophils than any other bacteria (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Identification of C. coli associated with neutrophilic inflammation suggests that C. coli is able either to produce compounds which stimulate neutrophils or to induce feline intestinal cells to produce neutrophil chemoattractants. This association should allow a directed therapeutic approach in cats with neutrophilic IBD, potentially improving outcome and reducing any zoonotic risk.


Subject(s)
Campylobacter Infections/veterinary , Campylobacter coli/isolation & purification , Cat Diseases/microbiology , Inflammatory Bowel Diseases/veterinary , Animals , Campylobacter Infections/microbiology , Campylobacter Infections/pathology , Cat Diseases/pathology , Cats , Female , Inflammatory Bowel Diseases/microbiology , Inflammatory Bowel Diseases/pathology , Male
6.
J Vet Intern Med ; 30(4): 1046-55, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27203848

ABSTRACT

BACKGROUND: Bacterial cholangitis and cholecystitis are rarely reported, poorly characterized diseases in the dog. OBJECTIVES: To characterize the clinical features of these conditions. ANIMALS: Twenty-seven client-owned dogs with bacterial cholangitis, cholecystitis, or both. METHODS: Multicenter, retrospective cases series of dogs with bacterial cholangitis, cholecystitis, or both, presenting January 2000 to June 2011 to 4 Veterinary Schools in Ireland/United Kingdom. Interrogation of hospital databases identified all cases with the inclusion criteria; histopathologically confirmed cholangitis or cholecystitis and bile culture/cytology results supporting a bacterial etiology. RESULTS: Twenty-seven dogs met the inclusion criteria with approximately 460 hepatitis cases documented over the same study period. Typical clinical pathology findings were increases in liver enzyme activities (25/26), hyperbilirubinemia (20/26), and an inflammatory leukogram (21/24). Ultrasound findings, although nonspecific, aided decision-making in 25/26 cases. The most frequent hepatobiliary bacterial isolates were Escherichia coli (n = 17; 16 cases), Enterococcus spp. (n = 8; 6 cases), and Clostridium spp. (n = 5; 5 cases). Antimicrobial resistance was an important feature of aerobic isolates; 10/16 E. coli isolates resistant to 3 or more antimicrobial classes. Biliary tract rupture complicated nearly one third of cases, associated with significant mortality (4/8). Discharged dogs had a guarded to fair prognosis; 17/18 alive at 2 months, although 5/10 re-evaluated had persistent liver enzyme elevation 2-12 months later. CONCLUSION AND CLINICAL SIGNIFICANCE: Bacterial cholangitis and cholecystitis occur more frequently than suggested by current literature and should be considered in dogs presenting with jaundice and fever, abdominal pain, or an inflammatory leukogram or with ultrasonographic evidence of gallbladder abnormalities.


Subject(s)
Cholangitis/veterinary , Cholecystitis/veterinary , Dog Diseases/microbiology , Animals , Bacterial Infections/complications , Bacterial Infections/epidemiology , Bacterial Infections/veterinary , Cholangitis/epidemiology , Cholangitis/microbiology , Cholecystitis/epidemiology , Cholecystitis/microbiology , Dog Diseases/epidemiology , Dog Diseases/pathology , Dogs , Female , Ireland/epidemiology , Male , Retrospective Studies , United Kingdom/epidemiology
8.
Epidemiol Infect ; 143(5): 1004-15, 2015 Apr.
Article in English | MEDLINE | ID: mdl-24977432

ABSTRACT

We undertook a longitudinal study within a cohort of 52 dairy heifers maintained under constant management systems and sampled weekly to investigate a comprehensive range of risk factors which may influence shedding or super-shedding of E. coli O157 (detected by direct faecal culture and immunomagnetic separation). E. coli O157 was detected from 416/933 (44.6%) samples (faeces and recto-anal mucosal swabs) and 32 (3.4%) samples enumerated at >10000 c.f.u./g. Weekly point prevalence ranged from 9.4% to 94.3%. Higher temperature (P < 0.001), rainfall (P = 0.02), relative humidity (P < 0.001), pasture growth (P = 0.013) and body score (P = 0.029) were positively associated with increased shedding. Higher rainfall (P < 0.001), hide contamination (P = 0.002) and increased faecal consistency (P = 0.023) were positively associated with super-shedding. Increased solar exposure had a negative effect on both shedding and super-shedding within bivariate analyses but in the final multivariate model for shedding demonstrated a positive effect (P = 0.017). Results suggest that environmental factors are important in E. coli O157 shedding in cattle.


Subject(s)
Bacterial Shedding , Cattle Diseases/microbiology , Escherichia coli Infections/veterinary , Escherichia coli O157 , Humidity , Rain , Temperature , Animals , Cattle , Cattle Diseases/epidemiology , Escherichia coli Infections/epidemiology , Feces/microbiology , Female , Longitudinal Studies , Multivariate Analysis , Prevalence , Risk Factors
9.
Vet Microbiol ; 173(1-2): 101-9, 2014 Sep 17.
Article in English | MEDLINE | ID: mdl-25064268

ABSTRACT

The fecal shedding and super-shedding of the human pathogen Escherichia coli O157 by cattle has been the focus of many previous studies with varied results observed. The heterogeneity of shedding is becoming more accepted, both in the numbers of animals shedding and the levels at which animals shed. To clarify patterns in shedding and super-shedding we undertook a longitudinal study to investigate shedding within a cohort of replacement dairy heifers. The cohort of 52 heifers was sampled 18 times at approximately weekly intervals with no significant changes in management during the sampling period. An overall prevalence of 44.3% (412/930 samples) was detected with prevalence ranging from 9.6 to 94.3% at individual sampling points. Each of the 52 heifers yielded at least one sample which was detected positive for E. coli O157. Super-shedding was detected at a sample level of 3.6% (32/893) and ranged between 0 and 9.6% at each sampling point. Of the 52 heifers, 24 (46.2%) were detected to be super-shedding at some point during the study, 19 of which were detected as super-shedding at only one point. From our findings we conclude that super-shedding is not associated with a small subset of animals that shed at high levels continually as had been proposed by earlier studies. We propose that the term 'super-shedding event' as opposed to 'super-shedding animal' better describes the nature of shedding.


Subject(s)
Cattle Diseases/epidemiology , Escherichia coli Infections/veterinary , Escherichia coli O157/isolation & purification , Animals , Australia/epidemiology , Cattle , Cattle Diseases/microbiology , Cattle Diseases/transmission , Dairying , Escherichia coli Infections/epidemiology , Escherichia coli Infections/microbiology , Escherichia coli Infections/transmission , Escherichia coli O157/genetics , Escherichia coli O157/pathogenicity , Feces/microbiology , Female , Humans , Longitudinal Studies , Prevalence , Specimen Handling
10.
Vet Pathol ; 51(5): 946-50, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24280943

ABSTRACT

Significant interobserver variability in the diagnostic interpretation of endoscopic gastrointestinal (GI) specimens exists even with the use of World Small Animal Veterinary Association (WSAVA) standardization criteria. Chi-square analyses compared the extent of pathologists' agreement for microarchitectural features of inflammation in endoscopic specimens obtained from 253 animals of the original WSAVA study. Patterns of agreement between pathologists were classified as broad (3/4 pathologists agreed), dichotomous (2/4 pathologists agreed), or divergent (no agreement between pathologists). The simplified model for GI inflammation was based on those parameters for which the pathologists had either broad or minimally divergent opinions of histopathologic significance. In this model, the parameters chosen were as follows: gastric parameters (intraepithelial lymphocytes [IELs], lamina propria [LP] infiltrates, and mucosal fibrosis), duodenal parameters (villus atrophy, epithelial injury, IELs, crypt changes, and LP infiltrates), and colonic parameters (epithelial injury, crypt dilation, fibrosis, LP infiltrates, and goblet cell depletion). Preliminary data using this simplified model showed excellent correlation between pathologists in defining the presence and extent of GI inflammation in dogs.


Subject(s)
Cat Diseases/classification , Dog Diseases/classification , Gastroenteritis/veterinary , Animals , Biopsy/veterinary , Cat Diseases/pathology , Cats , Disease Models, Animal , Dog Diseases/pathology , Dogs , Gastroenteritis/classification , Gastroenteritis/pathology , Observer Variation , Retrospective Studies
14.
Vet J ; 185(2): 152-6, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19546016

ABSTRACT

The aim of this study was to evaluate the application of the 13C-galactose breath test (13C-GBT) in assessing canine liver function by applying it to a group of healthy dogs, and to a group with clinicopathological evidence of liver dysfunction. Breath samples were collected 30 min before ingestion of 13C-galactose, and then at regular intervals thereafter for 6 h. The proportion of 13CO2/12CO2 in the breath samples was measured by isotope-ratio mass spectrometry. There was no significant difference in recovery of 13CO2 in the diseased group, compared to the healthy controls, but there was considerable inter-subject variation in both groups, possibly due to differences in the rate of gastric emptying, which could preclude detection of alterations in hepatic metabolism of galactose. The results of this study do not support the application of the 13C-GBT for assessment of canine liver function.


Subject(s)
Breath Tests , Dog Diseases/diagnosis , Galactose/metabolism , Liver Diseases/veterinary , Liver Function Tests/veterinary , Animals , Carbon Dioxide/analysis , Carbon Isotopes , Case-Control Studies , Dog Diseases/metabolism , Dogs , Female , Liver Diseases/diagnosis , Liver Diseases/metabolism , Male
15.
Adv Space Res ; 46(6): 681-686, 2010 Sep 01.
Article in English | MEDLINE | ID: mdl-24431481

ABSTRACT

Loss of function of DNA repair genes has been implicated in the development of many types of cancer. In the last several years, heterozygosity leading to haploinsufficiency for proteins involved in DNA repair was shown to play a role in genomic instability and carcinogenesis after DNA damage is induced, for example by ionizing radiation. Since the effect of heterozygosity for one gene is relatively small, we hypothesize that predisposition to cancer could be a result of the additive effect of heterozygosity for two or more genes critical to pathways that control DNA damage signaling, repair or apoptosis. We investigated the role of heterozygosity for Atm, Rad9 and Brca1 on cell oncogenic transformation and cell survival induced by 1GeV/n 56Fe ions. Our results show that cells heterozygous for both Atm and Rad9 or Atm and Brca1 have high survival rates and are more sensitive to transformation by high energy Iron ions when compared with wild-type controls or cells haploinsufficient for only one of these proteins. Since mutations or polymorphisms for similar genes exist in a small percentage of the human population, we have identified a radiosensitive sub-population. This finding has several implications. First, the existence of a radiosensitive sub-population may distort the shape of the dose-response relationship. Second, it would not be ethical to put exceptionally radiosensitive individuals into a setting where they may potentially be exposed to substantial doses of radiation.

16.
J Vet Intern Med ; 24(1): 84-9, 2010.
Article in English | MEDLINE | ID: mdl-20002551

ABSTRACT

BACKGROUND: Prior studies failed to detect significant association between hypoalbuminemia and small intestinal lesions. HYPOTHESIS: Use of pictorial templates will enhance consistency of interpathologist interpretation and identification of intestinal lesions associated with hypoalbuminemia. ANIMALS: Tissues from 62 dogs and 25 cats examined as clinical cases at 7 referral veterinary practices in 4 countries. METHODS: Retrospective, observational study. Histopathology slides from sequential cases undergoing endoscopic biopsy were examined by 4 pathologists by pictorial templates. Changes for 9 microscopic features were recorded as normal, mild, moderate or severe, and 2- and 4-point scales were tested for consistency of interpretation. Logistic regression models determined odds ratios (OR) of histologic lesions being associated with hypoalbuminemia while kappa statistics determined agreement between pathologists on histologic lesions. RESULTS: There was poor agreement (kappa = -0.013 to 0.3) between pathologists, and institution of origin of slides had effect (kappa = 1.0 for 3 of 4 lesions on slides from Institution 5) on agreement between pathologists on selected histologic features. Using 2 point as opposed to 4-point grading scale increased agreement between pathologists (maximum kappa = 0.69 using 4-point scale versus maximum kappa = 1.0 using 2-point scale). Significant association (P = .019- .04; 95% OR = 3.14-10.84) between lacteal dilation and hypoalbuminemia was found by 3 pathologists. CONCLUSIONS AND CLINICAL IMPORTANCE: Substantial inconsistency between pathologists remains despite use of pictorial template because of differences in slide processing. Distinguishing between mild and moderate lesions might be important source of the disagreement among pathologists.


Subject(s)
Biopsy/veterinary , Cat Diseases/pathology , Dog Diseases/pathology , Endoscopy/veterinary , Gastrointestinal Diseases/veterinary , Specimen Handling/veterinary , Animals , Cat Diseases/diagnosis , Cats , Dog Diseases/diagnosis , Dogs , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/pathology
17.
J Vet Intern Med ; 24(1): 80-3, 2010.
Article in English | MEDLINE | ID: mdl-20002555

ABSTRACT

BACKGROUND: In the investigations of dogs with chronic small intestinal diarrhea collection of ileal biopsies lengthens procedural time and has been of uncertain value. OBJECTIVES: To evaluate whether there was agreement between histologic changes present in samples of duodenal and ileal mucosa, and hence to provide initial information in the process of determining whether collection of ileal biopsies is clinically justified. ANIMALS: 40 dogs with chronic small and large intestinal diarrhea from which endoscopic (in 30 cases) or surgical (in 10 cases) duodenal and ileal biopsies had been collected. METHODS: Samples were reviewed concurrently by two observers (MJD and MDW) using the scoring system developed by the World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group. Comparisons were made by kappa analysis. RESULTS: Microscopic pathology was observed in 30 cases. Only eight out of this 30 (27%) had the same histopathologic diagnosis in both the duodenum and the ileum. This dropped to 3 out of 30 (10%) if different disease severity was also considered as disagreement. Microscopic pathology would have been found in 60% and 80% of the 30 cases, if only duodenal or ileal biopsies respectively, had been available. CONCLUSIONS AND CLINICAL IMPORTANCE: There was poor agreement between histopathological findings from duodenal versus ileal biopsies with abnormalities sometimes being more readily detected in the ileum. Routine collection of ileal plus duodenal samples appears warranted when concurrent small and large intestinal diarrhea is present.


Subject(s)
Biopsy/veterinary , Dog Diseases/pathology , Duodenum/pathology , Enteritis/metabolism , Ileum/metabolism , Animals , Dogs , Retrospective Studies
18.
Emerg Med J ; 26(3): 160-3, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19234001

ABSTRACT

Abdominal x rays expose patients to significant doses of radiation and have limited use in emergency medicine. This review explores the evidence supporting the use of abdominal x rays in the emergency department, with particular reference to recent guidelines published by the Royal College of Radiologists. The authors' recommendations for the use of abdominal x rays in the emergency department are given.


Subject(s)
Abdomen, Acute/diagnostic imaging , Emergency Service, Hospital/standards , Appendicitis/diagnostic imaging , Colic/diagnostic imaging , Emergencies , Foreign Bodies/diagnostic imaging , Guideline Adherence , Humans , Kidney Diseases/diagnostic imaging , Pancreatitis/diagnostic imaging , Practice Guidelines as Topic , Radiography
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