Research Note: Differences in the pecking behavior of turkey hens in proximity to the feeding pan depending on their beak condition

The present study aimed to provide further insight on different pecking behavior of beak-trimmed and untrimmed turkey hens in proximity to the feeding pan. Investigations were carried out in 4 housing compartments with female fattening turkeys where video were recorded and evaluated with regard to 4 different types of (pecking-) behavior (feeding, pecking on the ground, pecking at conspecifics, being pecked) observed in 1 focal animal in proximity to each feeding pan. Concerning the median duration, there were only small differences between the animals with different beak conditions. Pecking behavior varied in how many animals exhibited 'pecking on the ground' with more turkeys with intact beaks showing this activity in proximity to the feeding pan with a slightly increased median duration (0:06 vs. 0:04 min). Further discrepancies were observed in the maximum duration of recorded behaviors, as there were animals with intact beaks that showed "pecking on the ground" (4:09 vs. 2:54 min), "pecking at conspecifics" (3:46 vs. 1:25 min), and were "being pecked" (0:52 vs. 0:35 min) for a longer period of time. Based on this result, however, it can be assumed that especially individual animals with an intact beak forage more intensively and perform some pecking behaviors, which include injurious pecking, with longer duration in proximity to the feeding pan.

White Paper: Radiological Curriculum for Undergraduate Medical Education in Germany

Purpose: Radiology represents a highly relevant part of undergraduate medical education from preclinical studies to subinternship training. It is therefore important to establish a content base for teaching radiology in German Medical Faculties. Materials and Methods: The German Society of Radiology (DRG) developed a model curriculum for radiological teaching at German medical universities, which is presented in this article. There is also a European model curriculum for undergraduate teaching (U-level curriculum of the European Society of Radiology). In a modular concept, the students shall learn important radiological core principles in the realms of knowledge, skills and competences as well as core scientific competences in the imaging sciences. Results: The curriculum is divided into two modules. Module 1 includes principles of radiation biology, radiation protection and imaging technology, imaging anatomy as well as the risks and side effects of radiological methods, procedures and contrast media. This module is modality-oriented. Module 2 comprises radiological diagnostic decision-making and imaging-based interventional techniques for various disease entities. This module is organ system-oriented. Conclusion: The curriculum is meant as a living document to be amended and revised at regular intervals. The curriculum can be used as a basis for individual curricular development at German Medical Faculties. It can be integrated into traditional or reformed medical teaching curricula. Key Points: • Radiology is an integral and important part of medical education.• The German Society of Radiology (DRG) developed a model curriculum for teaching radiology at German Medical Faculties to help students develop the ability to make medical decisions based on scientific knowledge and act accordingly.• This curriculum can be used for individual curricular development at medical departments. It is divided into two modules with several chapters. Citation Format: • Ertl-Wagner B, Barkhausen J, Mahnken AH et al. White Paper: Radiological Curriculum for Undergraduate Medical Education in Germany. Fortschr Röntgenstr 2016; 188: 1017 - 1023.

Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center

BACKGROUND AND OBJECTIVES

Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort.

METHODS

A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed.

RESULTS

Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis.

CONCLUSIONS

Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.

Radiological anatomy - evaluation of integrative education in radiology

PURPOSE

Evaluation and analysis of the integrative course "Radiological Anatomy" established since 2007 at the Medical School Hannover (MHH) in comparison with conventional education.

MATERIALS AND METHODS

Anatomy and radiology are usually taught separately with a considerable time lag. Interdisciplinary teaching of these associated subjects seems logical for several reasons. Therefore, the integrative course "Radiological Anatomy" was established in the second year of medical education, combining these two closely related subjects. This interdisciplinary course was retrospectively evaluated by consideration of a student questionnaire and staff observations. The advantages and disadvantages of integrative teaching in medical education are discussed.

RESULTS

The course ratings were excellent (median 1; mean 1.3 on a scale of 1 to 6). This is significantly (p < 0.001) better than the average of all evaluated courses in the respective term (grade 2.8). The course improved the anatomical comprehension (90 %) and the students stated that the topics were relevant for their future medical education (90 %). Furthermore, interest in the subject's anatomy and radiology increased during the course (88 %). According to the students' suggestions the course was enhanced by a visitation in the Department of Radiology and the additional topic central nervous system.

CONCLUSION

Integrative teaching of anatomy and radiology was well received by the students. Both, anatomical and radiological comprehension and the motivation to learn were improved. However, it should be considered, that the amount of work and time required by the teaching staff is considerably increased compared to traditional teaching.

Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: how we do it

PURPOSE

Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed.

MATERIALS AND METHODS

Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded.

RESULTS

The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner.

CONCLUSIONS

Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

Thoracic wall reconstruction for primary malignancies in children: short- and long-term results

AIM

Primary thoracic wall malignancy is a rare and diverse entity in children. Surgical treatment commonly involves major chest wall resection causing large defects requiring complex reconstruction. In adults, the use of alloplastic and/or xenogenic materials and muscle flap repair is well established. However, literature provides only little information on procedures in children. We report our experience in 8 consecutive children who underwent chest wall resection and reconstruction with regard to surgical treatment and outcome.

PATIENTS AND METHODS

Retrospective study of all children with primary malignant chest wall tumors requiring rib resection and reconstruction with prosthetic material performed in our institution between November 2002 and April 2010. Endpoints were postoperative complications and long-term results, focusing on scoliosis defined radiologically by the Cobb angle.

RESULTS

8 children (7 male, 1 female) with a median age of 10.6 (4.1-18.9) years underwent resection of thoracic wall tumors. A mean number of 3 (1-5) ribs were resected. Stability was obtained using rigid prosthetic material (STRATOS™ titanium bar) in 2 patients and/or non-rigid prosthetic material (Goretex® patch in 6 patients, Vicryl® patch in 3 patients, Tutopatch® in 1 patient). A muscular flap was added in 5 patients. Postoperative complications included superficial wound infection (n = 2) and dislocation of a titanium bar necessitating removal in 1 patient. No infections of the prosthetic material were observed. No perioperative mortality occurred. At a mean follow-up of 37.5 (4-97) months, 6 patients were alive. 2 patients died due to early tumor recurrence. Mild scoliosis (Cobb angle 10-20°) was detected in 2 of the surviving patients (33%).

CONCLUSION

Surgical reconstruction after resection of malignant thoracic wall tumors using non-rigid prosthetic material is safe and effective in pediatric patients, whereas rigid prosthetic material might dislocate. Scoliosis represents a long-term complication after chest wall reconstruction and should be monitored during routine follow-up.

Method for the Rapid Determination of Protein in Meats Using the CEM Sprint™ Protein Analyzer: Collaborative Study

A collaborative study was conducted to determine the protein content of raw and processed meat products by a protein-tagging and colorimetric technique. Meat products were prepared following AOAC Official MethodSM 983.18 and analyzed using CEM Corporation's Sprint Rapid Protein Analyzer. Sprint provides protein results by combining an accurately weighed test portion with a known amount of dye-binding agent. The dye-binding agent binds with the lysine, histidine, and arginine, as well as the n-terminus of the proteins commonly found in raw meat and processed meat products. Results are displayed and reported by the Sprint as a percentage (g/100 g) of protein. Ten blind duplicate study samples were sent to 10 collaborating laboratories in the United States. The within-laboratory (repeatability) relative standard deviation (RSDr) ranged from 0.91 to 3.04%, and between-laboratories (reproducibility) relative standard deviation (RSDR) ranged from 1.50 to 3.41% for protein. The method is recommended for Official First Action.

Human iliac vein replacement with a tissue-engineered graft

The modification of a previously described technique to generate venous conduits in a lamb model from a decellularised matrix and autologous cells and its application to human tissue is described. A 49-year-old woman underwent surgery for a large malignant pelvic tumour (carcinoma of unknown primary) involving the right iliac artery and vein. The right iliac artery was reconstructed with a cryopreserved human arterial allograft. For iliac vein reconstruction a tissue-engineered neo-vein was developed utilising a decellularised cryopreserved vein allograft that was reseeded in a bioreactor with autologous endothelial cells derived from the recipient's great saphenous vein. Both interposition grafts were patent initially, after 3, 6, 12, and 24 months, but the tissue-engineered neo-vein had become obstructed due to evolving disease four month postoperatively. Tissue engineered neo-veins may be a therapeutic option in selected cases with symptomatic vein stenosis or obstruction not curable with interventional methods or standard prosthetic replacement.

Comparison of the image quality of various fixed and dose modulated protocols for soft tissue neck CT on a GE Lightspeed scanner

PURPOSE

Up-to-date CT scanners provide high quality soft tissue imaging of the neck, but scanning protocols often are not optimized regarding radiation dose. Thus, we tried to find a dose-optimized protocol for soft tissue imaging of the neck.

MATERIAL AND METHODS

70 patients were scanned with a 16-row CT-scanner (Lightspeed, GE) with seven different protocols. We used four fixed tube current settings (225, 200, 175 and 150 mA; corresponding CTDI(vol)=10.6, 9.5, 8.3 and 7.1 mGy) and three z-axis dose modulations with a relatively high, moderate and low dose (calculated CTDI(vol)=10.5, 9.1, 7.7 mGy). Representative slices of seven anatomical regions (from the nasopharynx to the aortic arch) were subjectively judged by two radiologists with respect to image quality (five-point rating scale for noise and sharpness). For each protocol and for each judged anatomical region we determined and compared mean values regarding image quality and local tube current. For each protocol, mean values regarding the volume CT dose index (CTDI(vol)) and the dose-length product (DLP) were statistically compared. Moreover, using the software CT-Expo the respective effective doses and the cumulative organ doses of the thyroid gland were compared.

RESULTS

For a fixed tube current of at least 200 mA (CTDI(vol)=9.5 mGy) and for dose modulations with a moderate or high dose adjustment (calculated CTDI(vol)=9.1 and 10.5 mGy) the image quality was sufficient to excellent. As compared to a fixed tube current of 200 mA, dose modulation with a moderate dose adjustment improved the image quality in regions more vulnerable to noise-related artifacts such as at the level of the shoulder, without a noteworthy difference regarding the DLP. However, the cumulative organ dose of the thyroid gland was 17% lower using dose modulation with a moderate dose adjustment as compared to the fixed tube current of 200 mA. Thus, for a comparison with other scanners, we recommend dose modulation and an averaged CTDI(vol)<9 mGy (or a DLP<250 mGycm).

CONCLUSION

A combination of dose modulation and an averaged CTDI(vol)<9 mGy or a DLP<250 mGycm yields sufficient image quality for soft tissue CT-imaging of the neck.

Diffusion-weighted imaging-guided resection of intracerebral lesions involving the optic radiation

In this paper we report our experience with diffusion-weighted imaging (DWI) for optic radiation (OR) visualization during resection of tumors. We hypothesize that intraoperative OR visualization helps to maintain patients' visual fields. DWI studies were performed together with T1-weighted postcontrast magnetic resonance imaging (MRI) in four patients with lesions in or adjacent to the OR (glioblastoma, oligo-astrocytoma, cavernoma, and metastasis; n = 1 each). The OR was identified from one of six DWI data acquisitions, segmented and reconstructed three-dimensionally. The image data were neuronavigationally transferred into the operative field, and provided the neurosurgeon with information on lesion site and adjacent OR localization. Preoperative and postoperative neuroophthalmological testing included, among others, perimetry to define the value of diffusion-weighted image guidance during OR lesion resection. Three lesions were removed completely. In one case, low-grade tumor parts infiltrating the OR were intentionally left. No persistent visual field deficits were induced. In one patient, a transient homonymous hemianopia attributable to postoperative swelling completely resolved under steroid medication. The authors conclude that intraoperative OR visualization, realized by neuronavigationally displayed DWI data, might prove to be helpful to maintain patients' visual fields.

[Diagnosis of an initial infratentorial central nervous system B-cell lymphoma during prolonged cortisone medication]

We present a patient with primary central nervous system B-cell lymphoma. He had suffered from slowly developing weight loss and presented to us with disorientation, seizures, and a supranuclear gaze disturbance. The patient was dismissed with the primary diagnosis of autoimmune encephalitis of the brainstem and put on oral corticosteroids. Four months later, his health status had deteriorated, and at that time diagnostic methods pointed to a cerebral lymphoma. Stereotactic biopsy with subsequent immunohistochemistry and polymerase chain reaction analysis revealed a highly malignant B-cell lymphoma of the CNS, despite prolonged corticosteroid treatment. The patient was treated with whole brain radiotherapy.

Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints

The cerebral activation pattern due to acupuncture is not completely understood. Although the effect of acupuncture on cerebral haemodynamics has been studied, no previous report has focused on different puncture and stimulation methods. We used functional MRI (fMRI) in 15 healthy subjects to investigate cortical activation during stimulation of two real acupoints (Liv3 and G40) and one sham point, needled in a random and, for the subjects, blinded order employing rotating and non-rotating methods, using a blocked paradigm on a 1.5 tesla imager. Compared to the non-rotating stimulation method, during rotating stimulation of the real acupoints, we observed an increase in activation in both secondary somatosensory cortical areas, frontal areas, the right side of the thalamus and the left side of the cerebellum; no such effects of the needling technique were seen while stimulating the sham point. The observation that rotating the needle strengthened the effects of acupuncture only at real acupoints suggests that, as claimed in Chinese traditional medicine, stimulation of these acupoints has a specific effect on cortical neuronal activity, absent with sham acupoints. These specific cerebral activation patterns might explain the therapeutic effects of acupuncture in certain subjects.

[Diffusion Weighted Imaging Combined with Intraoperative 3D-Ultrasound and fMRI for the Resection of an Optic Radiation Cavernoma]

A 17-year-old patient with a symptomatic cavernoma of the optic radiation underwent surgery supported by functional magnetic resonance imaging (fMRI), diffusion weighted magnetic resonance imaging (DWI) and navigated 3D-ultrasound. The primary visual cortex was visualized with fMRI. The optic radiation was delineated by means of DWI. The diffusion weigthed images were used for 3-dimensional reconstruction of the optic radiation. During surgery, the information of the localisation of functional brain regions were used together with the 3D-ultrasound, enabling the surgeon to remove the cavernoma without morbidity. This is the first report of the combined use of fMRI, fiber tract imaging and 3D-ultrasound for the safe resection of an optic radiation lesion.

A hypermedia tutorial for cross-sectional anatomy: HyperMed

Modern imaging techniques like computer tomography (CT) and nuclear magnetic resonance (MR) imaging have become essential in clinical diagnostics and also in teaching gross anatomy to medical students. As a consequence, special classes in (cross)-sectional anatomy are being added to the curriculum in many anatomical institutions. Since institutional budgets often do not allow extensive supervision beyond the very limited time frame of traditional courses in gross anatomy, a computer-based hypermedia tutorial (HyperMed) was created and integrated into the teaching program of the Institute of Anatomy at Essen University. HyperMed offers two components, one for authors (e.g. teachers who can customize the contents of the program) and a second for users (e.g. students). In the present version, digital cross-sectional human images have been edited. The relevant anatomical structures in these images have been marked, named, and linked to additional information and figures (in particular schematic figures and CT images). Users can obtain information at different levels: (1) index-based retrieval, (2) navigational retrieval (on inspecting cross-sectional images the user is asked to identify structures) and (3) a history list enabling users to go back to any previous point of navigation. HyperMed was first tested in the winter terms 1995/1996 and 1996/1997 during classes on cross-sectional anatomy which are a supplement to the traditional dissection course of the Institute of Anatomy, University Essen. It was well received by the students who found it a helpful adjunct to learning cross-sectional anatomy.

The evaluation of the abdominal aorta: a "how-to" for cardiac sonographers

A thorough evaluation of the abdominal aorta can be readily achieved by use of the standard views of the echocardiographic examination. The ultrasound evaluation of the abdominal aorta represents a logical extension of the standard echocardiographic examination of the adult patient. This article provides the information needed to carry out a complete ultrasound examination of the abdominal aorta including the anatomy, the vascular disease, and the steps involved in accomplishing the ultrasound examination of the abdominal aorta.