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Resistance to endocrine therapy remains a clinical challenge in the treatment of estrogen receptor-positive (ER+) breast cancer. We investigated if adding a traditional Asian herbal mixture consisting of 12 herbs, called Jaeumkanghwa-tang (JEKHT), to tamoxifen (TAM) therapy might prevent resistance and recurrence in the ER+ breast cancer model of 7,12-dimethylbenz[a]anthracene (DMBA)-exposed Sprague–Dawley rats. Rats were divided into four groups treated as follows: 15 mg/kg TAM administered via diet as TAM citrate (TAM only); 500 mg/kg JEKHT administered via drinking water (JEKHT only group); TAM + JEKHT and no treatment control group. The study was replicated using two different batches of JEKHT. In both studies, a significantly higher proportion of ER+ mammary tumors responded to TAM if animals also were treated with JEKHT (experiment 1: 47% vs 65%, P = 0.015; experiment 2: 43% vs 77%, P P = 0.002). JEKHT alone was mostly ineffective. In addition, JEKHT prevented the development of premalignant endometrial lesions in TAM-treated rats (20% in TAM only vs 0% in TAM + JEKHT). Co-treatment of antiestrogen-resistant LCC9 human breast cancer cells with 1.6 mg/mL JEKHT reversed their TAM resistance in dose–response studies in vitro. Several traditional herbal medicine preparations can exhibit anti-inflammatory properties and may increase anti-tumor immune activities in the tumor microenvironment. In the tumors of rats treated with both JEKHT and TAM, expression of Il-6 (P = 0.03), Foxp3/T regulatory cell (Treg) marker (P = 0.033) and Tgfβ1 that activates Tregs (P

The advent of CRISPR-Cas9 technology has increased attention, and contention, regarding the use and regulation of genome editing technologies. Public discussions continue to give evidence of this debate falling back into the previous polarized positions of technological enthusiasts versus those who are more cautious in their approach. One response to this contentious relapse could be to view this promising and problematic new technology from a radically different perspective that embraces both the excitement of this technological advance and the prudence necessary to use it well. The thought of Teilhard de Chardin provides this desired perspective, and some insights that may help carry forward public discussions to achieve widely accepted uses and regulations.

Philosophically, biologically, and colloquially, “creation” belongs properly to the act of conception. After the new human organism comes into existence, all subsequent changes in its life cycle ar...

Longline fishing utilizes monofilament lines that can be as much as 62 miles long. The line itself is buoyed by Styrofoam or plastic floats. Usually, at about every 100ft, a secondary line is attached and hangs down from the mainline. The lines are baited with mackerel, squid, or shark meat and have as many as 10,000 hooks. Every 12-24 hours, the line is hauled in, mechanically rebaited, and set back into the water behind the vessel. The baited hooks can be seen by albatross and other seabirds as they are placed in the water or being hauled out. When the birds dive for the bait, they are hooked, dragged behind the fishing boat, and drown. Spectacularly nonselective, longline fishing techniques also hook many other forms of marine life-"bycatch" (sea turtles, seals, dolphins, penguins, sharks, and many other nontarget finfish). It is estimated that 300,000 seabirds (including 100,000 albatross) die on longlines each year. Albatross are among the longest-lived birds. They can live up to 60 years and some species do not start breeding until they are 10 years old. They have a low reproductive rate and many species only breed every other year. In addition, a species like the Wandering Albatross (Diomedea exulans) rears its chicks for an average of more than 270 days. Albatross pair for life and may take years to find a new partner if their mate is killed. Owing to their incredibly low reproductive rate, albatross are particularly vulnerable to longline fishing. Currently, it is believed that 4 albatross drown per 100,000 hooks set. This is more than 400 birds a week. The current mortality rate for adult birds is not sustainable and for some species, the birds are dying faster that they can repopulate. Currently, 19 of the world's 22 albatross species are threatened with extinction. This year longline fishing ships will set 10 billion hooks worldwide. Various mitigation measures (bird-scaring lines, weighted, faster-sinking line, setting lines deeper out of the bird's sight, reduction in the amount of offal discarded from fishing boats, night fishing, and restriction of longline operations from areas where nesting and foraging birds are congregated during the breeding season, among others) have been proposed and attempted. There is no one panacea for the effects of longlining and mitigation efforts are most successful when used in combination. Some of these mitigation measures have shown very promising results. Some experts feel that government legislation, regulation, and enforcement in conjunction with incentives for the fishing industry to incorporate and implement mitigating techniques have the best chance in ameliorating the problem. The public is surprisingly unaware of this wanton and wasteful exploitation of the ocean's resources, and the worldwide demand for seafood continues to rise. Meanwhile, globally, fishermen voice the same complaints: fewer fish, smaller fish, shorter fishing seasons, bizarre developments in their seasonal appearance and dispersal, and fewer overall species seen. These are all the classic signs of overfishing. Each year it is estimated that some 90 million tons of wild fish are harvested from our planet's oceans. Nearly 30 million tons of this is discarded as the incidental bycatch of nontarget species. If international curbs are not placed upon wasteful fishing practices, we are doomed to learn a painful maxim. "The ocean is not infinite." Veterinarians must become involved in worldwide conservation efforts, acting locally, while thinking globally.

Polar bears are one of the most iconic animals on our planet. Worldwide, even people who would never see one are drawn to these charismatic arctic ice hunters. They are the world's largest terrestrial carnivore, and despite being born on land, they spend most of their lives out on the sea ice and are considered a marine mammal. Current global studies estimate there are around 20,000 animals in some 19 discrete circumpolar populations. Aside from pregnant females denning in the winter months to give birth, the white bears do not hibernate. They spend their winters on the sea ice hunting seals, an activity they are spectacularly adapted for. Research on these animals is incredibly difficult because of the inhospitable surroundings they inhabit and how inaccessible they make the bears. For many years, the sum of our understanding of the natural history of polar bears came from tracks, scats, the remains of their kills, abandoned dens, and anecdotal observations of native hunters, explorers, and early biologists. Nonetheless, the last 40 years have seen a much better picture of their biology emerge thanks to, first, dedicated Canadian researchers and, later, truly international efforts of workers from many countries. Veterinarians have contributed to our knowledge of the bears by delivering and monitoring anesthesia, obtaining blood samples, performing necropsies, investigating their reproduction, conducting radiotelemetry studies, and examining their behavior. Recently, new technologies have been developed that revolutionize the study of the lives and natural history of undisturbed polar bears. These advances include better satellite radiotelemetry equipment and the development of remote-controlled miniature devices equipped with high-definition cameras. Such new modalities provide dramatic new insights into the life of polar bears. The remarkable degree of specialized adaptation to life on the sea ice that allowed the bears to be successful is the very reason that the bears are so vulnerable to the effects of climate change. Polar bears have few alternatives if their habitat (the sea ice) and their access to their ringed seal prey rapidly disappear. Predictions that polar bears may be able to adjust and sustain themselves on alternative food sources are not based on reality. Spring breakup of the sea ice is happening much earlier as well as fall freezeup is getting later, thereby prolonging the open water period that the bears are shore bound. If trends continue and the ice continues to disappear, the effect on polar bears would be devastating. Veterinarians must stay involved in polar bear studies and in multidisciplinary conservation studies dealing with threatened and endangered species worldwide. On account of their training, veterinarians can offer a unique skill set that can provide access to a number of technologies critical to conservation efforts. The oath veterinarians take on graduation from veterinary school charges them to be sworn to the "conservation of animal resources" and in the education of the public. We are only as good as the oaths we keep.

Core environmental proverb If conservation efforts are going to succeed, conservation must be taught and conservation must be learned. Veterinarians must become teachers, students, volunteers, researchers, mentors, and role models in the fight to preserve the biodiversity of our natural world. Who better than veterinarians to help champion threatened and endangered species both worldwide and right in our own backyard? Each form of life on our planet is unique, and each plays a specific role in the web of life. Every time a species is lost, our horizons narrow and the world becomes less grand and special. That is why we cannot merely be observers and watch species disappear. We must be participants in trying to save what is left and to restore as much as we can of what is gone. Who better than veterinarians to get involved and where better to start than mentoring children and instilling in the next generation a regard and reverence for other forms of life. Children become aware of the living world around them very early. From a tender age most are fascinated by animals. This may be genetic, adaptive, and preprogrammed, as we are descendents of early man who was inextricably tied to nature. Our ancestors were hunters who had to mark the movements of the game they chased and to note the presence of dangerous animals that hunted them. Children are inherent naturalists. Give one a pair of binoculars and watch what follows or witness the universal fascination children have with dinosaurs. Where I live in Denver, CO, more children visit the Zoo each year with their parents than adults attending the Broncos (football), Avalanche (hockey), Nuggets (basketball), and Rockies (baseball) games combined. Wildlife and animal shows on television have become so popular that there are at least 3 channels totally devoted to their viewing (Animal Planet, National Geographic, and the Discovery Channel) with many others featuring occasional animal programming. Children are the natural audience for this type of viewing. These children are

The American Psychiatric Association estimates that 3-7% of US school-aged children exhibit attention-deficit/hyperactivity disorder (ADHD). Adderall(®) (amphetamine dextroamphetamine) and a variety of brand names and generic versions of this combination are available by prescription to treat ADHD and narcolepsy. Both immediate and sustained release products are used as are single agent amphetamine medication. Knowing the exact agent ingested can provide information of dose labeled and length of clinical effects. These drugs are used off label by college students for memory enhancement, test taking ability, and for study marathons. These agents are DEA Schedule II controlled substances with high potential for abuse. For humans with ADHD or narcolepsy, standard recommended dosage is 5-60 mg daily. Amphetamine and its analogues stimulate the release of norepinephrine affecting both α- and β-adrenergic receptor sites. α-Adrenergic stimulation causes vasoconstriction and an increase in total peripheral resistance. β-Adrenergic receptor stimulation leads to an increase in heart rate, stroke volume, and skeletal muscle blood flow. Clinical signs of Adderall(®) overdose in humans and dogs include hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, and seizures. In addition, Adderall intoxication in dogs has been reported to cause hyperthermia, hypoglycemia, hypersegmentation of neutrophils, and mild thrombocytopenia. Diagnosis can be confirmed by detecting amphetamine in stomach contents or vomitus, or by positive results obtained in urine tests for illicit drugs. Treatment is directed at controlling life-threatening central nervous system and cardiovascular signs. Seizures can be controlled with benzodiazepines, phenothiazines, pentobarbital, and propofol. Cardiac tachyarrhythmias can be managed with a β-blocker such as propranolol. Intravenous fluids counter the hyperthermia, assist in maintenance of renal function, and help promote the elimination of amphetamine and its analogues. Prognosis after poisoning with Adderall(®) depends upon the severity and duration of clinical signs at presentation. Differential diagnoses that should be considered in cases of suspected amphetamine overdose are any other agents that can cause central nervous system stimulation, tremors, and seizures. This article discusses our present understanding of Adderall(®) intoxication and examines 3 dogs presented to our practice after ingestion of large amounts of the drug.

Many antidepressants inhibit serotonin or norepinephrine reuptake or both to achieve their clinical effect. The selective serotonin reuptake inhibitor class of antidepressants (SSRIs) includes citalopram, escitalopram (active enantiomer of citalopram), fluoxetine, fluvoxamine, paroxetine, and sertraline. The SSRIs are as effective as tricyclic antidepressants in treatment of major depression with less significant side effects. As a result, they have become the largest class of medications prescribed to humans for depression. They are also used to treat obsessive-compulsive disorder, panic disorders, alcoholism, obesity, migraines, and chronic pain. An SSRI (fluoxetine) has been approved for veterinary use in treatment of canine separation anxiety. SSRIs act specifically on synaptic serotonin concentrations by blocking its reuptake in the presynapse and increasing levels in the presynaptic membrane. Clinical signs of SSRI overdose result from excessive amounts of serotonin in the central nervous system. These signs include nausea, vomiting, mydriasis, hypersalivation, and hyperthermia. Clinical signs are dose dependent and higher dosages may result in the serotonin syndrome that manifests itself as ataxia, tremors, muscle rigidity, hyperthermia, diarrhea, and seizures. Current studies reveal no increase in appearance of any specific clinical signs of serotonin toxicity with regard to any SSRI medication. In people, citalopram has been reported to have an increased risk of electrocardiographic abnormalities. Diagnosis of SSRI poisoning is based on history, clinical signs, and response to therapy. No single clinical test is currently available to confirm SSRI toxicosis. The goals of treatment in this intoxication are to support the animal, prevent further absorption of the drug, support the central nervous system, control hyperthermia, and halt any seizure activity. The relative safety of the SSRIs in overdose despite the occurrence of serotonin syndrome makes them more desirable than other antidepressants. The prognosis in animals that receive treatment is excellent. In one retrospective study, there were no deaths in 313 SSRI-poisoned dogs. No characteristic or classic histopathologic lesions result from SSRI toxicosis. Differential diagnoses for SSRI overdose must include ingestions of other serotonergic medications such as phenylpiperidine opioids (fentanyl and tramadol), mirtazapine, buspirone, amitraz, and chlorpheniramine.

Polyurethane adhesives are found in a large number of household products in the United States and are used for a variety of purposes. Several brands of these expanding wood glues (those containing diphenylmethane diisocyanate [MDI]) have the potential to form gastrointestinal (GI) foreign bodies if ingested. The ingested adhesive forms an expanding ball of glue in the esophagus and gastric lumen. This expansion is caused by a polymerization reaction using the heat, water, and gastric acids of the stomach. A firm mass is created that can be 4-8 times its original volume. As little as 2 oz of glue have been reported to develop gastric foreign bodies. The obstructive mass is reported to form within minutes of ingestion of the adhesive. The foreign body can lead to esophageal impaction and obstruction, airway obstruction, gastric outflow obstruction, mucosal hemorrhage, ulceration, laceration, perforation of the esophageal and gastric linings, and death. Clinical signs following ingestion include anorexia, lethargy, vomiting, tachypnea, and abdominal distention and pain, and typically develop within 12 hours. Clinical signs may depend upon the size of the mass. If left untreated, perforation and rupture of the esophagus or stomach can occur. The glue mass does not stick to the GI mucosa and is not always detectable on abdominal palpation. Radiographs are recommended to confirm the presence of the "glue-ball" foreign body, and radiographic evidence of the obstruction may be seen as early as 4-6 hours following ingestion. Emesis is contraindicated owing to the risk of aspiration of the glue into the respiratory tree or the subsequent lodging of the expanding glue mass in the esophagus. Likewise, efforts to dilute the glue and prevent the formation of the foreign body through administration of liquids, activated charcoal, or bulk-forming products to push the foreign body through the GI tract have proven ineffective. Even endoscopy performed to remove the foreign body has been shown to be unreliable. The safest, most effective, and successful therapy is surgical intervention to remove the GI foreign body. If performed early enough, complete recovery of the animal can be expected. Differential diagnoses for polyurethane adhesive ingestion include any potential cause of GI obstruction. The public is largely unaware of the hazards that ingestion of this product may produce. Public education efforts are needed to inform pet owners about the hazards of these glues and the overall importance of providing our companion animals with safe, poison-free environments.

The plant Cannabis sativa has been used for centuries for the effects of its psychoactive resins. The term "marijuana" typically refers to tobacco-like preparations of the leaves and flowers. The plant contains more than 400 chemicals but the cannabinoid δ-9-tetrahydrocannabinol (THC) is the major psychoactive constituent. "Hashish" is the resin extracted from the tops of flowering plants and generally has a much higher THC concentration. Marijuana is the most commonly used illicit drug in the United States. Currently, several states have passed legislation to decriminalize possession of small amounts of marijuana for both medical and personal use and several other states have similar legislation under consideration. The most common form of marijuana use in humans is inhalation of the smoke of marijuana cigarettes, followed by ingestion. In animals, although secondhand smoke inhalation is possible, the most common source of exposure is through ingestion of the owner's marijuana supply. The minimum lethal oral dose for dogs for THC is more than 3 g/kg. Although the drug has a high margin of safety, deaths have been seen after ingestion of food products containing the more concentrated medical-grade THC butter. There are two specific cannabinoid receptors in humans and dogs, CB1 (primarily in central nervous system) and CB2 (peripheral tissues). In animals, following oral ingestion, clinical effects begin within 60 minutes. All of the neuropharmacologic mechanisms by which cannabinoids produce psychoactive effects have not been identified. However, CB1 activity is believed to be responsible for the majority of cannabinoid clinical effects. Highly lipid soluble, THC is distributed in fat, liver, brain, and renal tissue. Fifteen percent of THC is excreted into the urine and the rest is eliminated in the feces through biliary excretion. Clinical signs of canine intoxication include depression, hypersalivation, mydriasis, hypermetria, vomiting, urinary incontinence, tremors, hypothermia, and bradycardia. Higher dosages may additionally cause nystagmus, agitation, tachypnea, tachycardia, ataxia, hyperexcitability, and seizures. Treatment of marijuana ingestion in animals is largely supportive. Vital signs including temperature and heart rate and rhythm must be continually monitored. Stomach content and urine can be tested for cannabinoids. Gas chromatography and mass spectrometry can be utilized for THC detection but usually may take several days and are not practical for initiation of therapy. Human urine drug-screening tests can be unreliable for confirmation of marijuana toxicosis in dogs owing to the interference of a large number of the metabolites in canine urine. False negatives may also arise if testing occurs too recently following THC ingestion. Thus, the use of human urine drug-screening tests in dogs remains controversial. No specific antidote presently exists for THC poisoning. Sedation with benzodiazepines may be necessary if dogs are severely agitated. Intravenous fluids may be employed to counter prolonged vomiting and to help control body temperature. Recently, the use of intralipid therapy to bind the highly lipophilic THC has been utilized to help reduce clinical signs. The majority of dogs experiencing intoxication after marijuana ingestion recover completely without sequellae. Differential diagnoses of canine THC toxicosis include human pharmaceuticals with central nervous system stimulatory effects, drugs with central nervous system depressant effects, macrolide parasiticides, xylitol, and hallucinogenic mushrooms.

Our colleagues at the National Institutes of Health advance a serious argument for loosening the conceptual reins on noninvasive prenatal genetic testing (Chen and Wasserman 2017). Yet they are foc...

Background This paper is based on a theological symposium presented at the International Xenotransplantation Association's 14th Congress held in Baltimore, MD, September, 2017. Methods The information explores the Jewish, Christian and Muslim theological perceptions and perspectives about cross-species (ie pig-to-human) organ transplantation, the genetic alterations required in the organ-source pig, and their potential to influence individual acceptance of the procedure. Results/conclusions This work should not be considered as the ultimate word about individual theological views, but rather as part of an ongoing conversation that will hopefully lead to wider consideration and exploration of these issues as xenotransplantation science advances towards clinical trials.

Interest in sustainable learning has been growing over the past 20 years but it has never been determined whether students—whose learning we are trying to sustain—can perceive either the sustainability of their learning or any of the features of this construct. A four-item survey was developed based on a published definition of “sustainable learning”, and was sent to the 12 graduate students who have completed a new seminar in ethical reasoning. A thematic analysis of the narrative responses was submitted to a degrees-of-freedom analysis to determine the level and type of evidence for student perception of sustainability. Respondents (n = 9) endorsed each of the four dimensions of sustainable learning—and each gave examples for each dimension outside of, and after the end of, the course. One respondent endorsed all dimensions of sustainable learning, but was uncertain whether the course itself led to one particular sustainability dimension. While these results must be considered preliminary because our sample is small and the survey is the first of its kind, they suggest that graduate students can and do perceive each of the four features of sustainability. The survey needs refinement for future/wider use; but this four-dimensional definition could be useful to develop and promote (and assess) sustainable learning in higher education.

On account of their unique anatomy, physiology, natural history, ecology, and behavior, rattlesnakes make ideal subjects for a variety of different scientific disciplines. The prairie rattlesnake (Crotalus viridis) in Colorado was selected for investigation of its relationship to colonies of black-tailed prairie dogs (Cynomys ludovicianus) with regard to spatial ecology. A total of 31 snakes were anesthetized and had radiotransmitters surgically implanted. In addition, at the time of their capture, all snakes underwent the following: (1) they had bacterial culture taken from their mouths for potential isolation of pathogenic bacteria; (2) similarly, they had cloacal bacterial cultures taken to assess potentially harmful bacteria passed in the feces; and (3) they had blood samples drawn to investigate the presence of any zoonotic agents in the serum of the snakes. The results of the study and their implications are discussed here. Traditionally, a low incidence of bacterial wound infection has been reported following snakebite. Nevertheless, the oral cavity of snakes has long been known to house a wide variety of bacterial flora. In our study, 10 different bacterial species were isolated from the mouths of the rattlesnakes, 6 of which are capable of being zoonotic pathogens and inducing human disease. More studies are necessary to see why more rattlesnake bites do not become infected despite the presence of such pathogenic bacteria. The results of fecal bacteria isolated revealed 13 bacterial species, 12 of which can cause disease in humans. Of the snakes whose samples were cultured, 26% were positive for the presence of the pathogen Salmonella arizonae, one of the causative agents of reptile-related salmonellosis in humans. It has long been reported that captive reptiles have a much higher incidence than wild, free-ranging species. This study shows the incidence of Salmonella in a wild, free-ranging population of rattlesnakes. In addition, Stenotrophomonas maltophilia was isolated. This bacterium is associated with wound and soft tissue infections that can lead to sepsis, endocarditis, meningitis, and peritonitis. In addition, this bacterium has been increasingly implicated as an opportunistic pathogen to humans during pregnancies, hospitalizations, malignancies and chemotherapy, chronic respiratory diseases, and presurgical endotracheal intubation. Furthermore, S. maltophilia has an intense resistance to broad-spectrum antibiotics, the results of our study showed the bacterium was resistant to multiple antibiotics. Our results indicate that anyone working with snake feces, dead skin, or their carcasses must follow reasonable hygiene protocols. Rattlesnakes tested for West Nile antibodies had positive results but these were invalidated owing to possible cross-reactivity with other unknown viruses, interference with snake serum proteins, and the fact that the test was not calibrated for rattlesnake serum. Still, the interesting implication remains, should we be regularly testing these animals as sentinels against potentially zoonotic diseases. The results of this study clearly show the value of veterinarians in a multidisciplinary study of this sort and the particular skill set they can offer. Veterinarians must get involved in conservation studies if the biodiversity of the planet is to be preserved.

Conservation biology is a relatively new (began in the 1980s), value-based discipline predicated on the belief that biological diversity—from genes to populations to species to communities to ecosystems—is good and extinction is bad. Conservation biology grew from the recognition that the Earth has entered its sixth great extinction event, one that differs from previous great extinctions in that a single species— Homo sapiens —has caused this biodiversity crisis. A diverse, interacting set of variables drive current extinctions. As such, to succeed, conservation efforts usually require broad-based, interdisciplinary approaches. Conservationists increasingly recognize the importance of contributions by veterinary science, among many other disciplines, to collaborative efforts aimed at stemming the loss of biodiversity. We argue that, to improve success rates, many wildlife conservation programs must incorporate veterinarians as part of an interdisciplinary team to assess and address problems. Ideally, veterinarians who participate in conservation would receive specialized training and be willing to work as partners as part of a larger team of experts who effectively integrate their work rather than work independently (i.e., work as interdisciplinary, as opposed to multidisciplinary, teams, respectively). In our opinion, the most successful and productive projects involve interdisciplinary teams involving both biological and nonbiological specialists. Some researchers hold multiple degrees in biology and veterinary medicine or the biological and social sciences. These experts can often offer unique insight. We see at least 3 major areas in which veterinarians can immediately offer great assistance to conservation efforts: (1) participation in wildlife capture and immobilization, (2) leadership or assistance in addressing wildlife health issues, and (3) leadership or assistance in addressing wildlife disease issues, including using wildlife as sentinels to identify new and emerging diseases or epidemics of old diseases. We cover each of these main topics in detail.

Emerging technologies have gained notoriety as a catalyst of socioeconomic progress, but have also inspired a revolution in ethics. Here, we provide an overview of ethics in stem cell-based therapies and offer a compelling argument for a need to establish an Ethics Research Consortium that will be tasked to assemble an interdisciplinary panel of experts who will apply ethical principles to analyze the social merit relative to the economic incentives of this emerging technology. Milestone studies on cell therapy in Parkinson's disease and stroke over the last two decades were the focus of this commentary. The major criterion for study selection was based on public opinion, scientific discussion, and government reactions generated by these pioneering studies. Original data from the selected studies are presented. Interpretation and discussion of data captured the prevailing views of the public and scientific community, as well as the government regulatory and oversight decisions (i.e., ban on embryonic stem cell research funding). Lessons learned from two decades of cell-based therapies indicate that poor management of the public discourse of ethics concerning emerging technologies might have contributed to misperceptions within both the public and the research community that have hindered the progress of scientific innovation and even delayed the clinical application of potentially life-saving treatments to critically ill patients. We propose the creation of a Consortium that will evaluate how these novel ethical issues in emerging technologies are addressed under current oversight and regulatory structures and where there may be gaps and need for revised or new public policy approaches.

Lilies are commonly kept flowering ornamental plants that are used in holiday celebrations, weddings, and funerals, and in various floral arrangements. Lilies of genera Lilium and Hemerocallis (day lilies) have been shown to cause nephrotoxicity in cats. Confusion arises because so many different plants are called lilies. Members of the genus Convallaria (lily of the valley), while sparing on the kidneys, elicit toxic effects because they possess potent cardiac glycosides similar to digitalis. Even more confusing as to which lilies are toxic is the fact that many hybrids exist. The majority of the public do not know that lilies can be dangerous to cats and, in fact, cannot correctly identify the plants in their own homes. Cats have been shown to be extremely sensitive to the toxic effects of lilies. As little as 2 leaves or part of a single flower have resulted in deaths. It should be pointed out that the whole plant—petals, stamen, leaves, and pollen are toxic. The exact toxic dose and the precise toxins responsible for renal damage are currently unknown. The quick onset of clinical signs suggests a rapid absorption rate of the toxin. The renal tubular epithelium appears to be the target of the toxin. Studies indicate that it is the water-soluble fraction of the lily that is nephrotoxic. In cats, clinical signs of lily intoxication include salivation, vomiting, anorexia, and depression. Polyuric renal failure leads to dehydration and anuric renal failure and death results. No analytic verification of lily ingestion is currently available. Successful treatment includes initiation of fluid diuresis before the onset of anuric renal failure. Once anuria develops, peritoneal dialysis or hemodialysis is the only potential treatment. Differential diagnoses of lily poisoning include any potential cause of acute renal failure in a cat. Prognosis is excellent if fluid diuresis is started before anuric renal failure has developed. The public must be made aware of potentially toxic ornamental house plants.

Reptiles are increasingly being kept as pets in American households. The basic principles of emergency medicine are the same for all species, but reptilian species present special diagnostic challenges to veterinary clinicians when they become ill. Reptiles in captivity can become accidentally poisoned in a variety of ways. Veterinarians treating small animal emergencies must make an effort to familiarize themselves with the large body of literature and resources that are developing regarding both nontraditional exotic companion species and advances in toxicology.

Unfortunately, fires are common events both in urban and rural portions of the United States. Smoke inhalation is the leading fire-related cause of death. The elemental combustion products of fire are light, heat, and smoke. Smoke is a very complex mixture of potentially harmful substances. Although a relatively rare presenting event to small animal hospitals, when animal fire victims do appear, clinicians must know how to recognize the signs of smoke inhalation and how to successfully deal with them. This discussion will investigate the toxic nature of fire smoke, its mechanism of action upon respiratory tissues, the clinical signs displayed, and its diagnosis and treatment. Differential diagnoses of smoke inhalation and prevention and prognosis will also be explored. Veterinary hospitals should have set protocols in place for managing animal victims of smoke inhalation in order to ensure a successful outcome.

Toxicology is the medical discipline that studies the often dramatic effects that poisons can have on living organisms. The body of toxicological information that the practicing veterinarian must deal with is growing exponentially. The veterinary clinician must come to understand the source of potential toxicants, circumstances leading up to poisoning episodes, must recognize the clinical signs of a wide variety of poisons, be able to diagnose intoxications, successfully treat and manage exposed animals, and institute strategies that educate the public and help prevent future poisonings. This is a tremendously tall order and can be not a little bit overwhelming. Fortunately, the clinicians are not alone and have tremendous resources in their corner, including veterinary schools, regional poison and drug centers, national veterinary hot lines utilizing board-certified veterinary toxicologists, local toxicologists and an ever-growing body of literature concerning small animal poisoning management. This discussion will investigate ways in which to make this seemingly daunting field much more palatable to small animal practitioners.

The medically important groups of Hymenoptera are the Apoidea (bees), Vespoidea (wasps, hornets, and yellow jackets), and Formicidae (ants). These insects deliver their venom by stinging their victims. Bees lose their barbed stinger after stinging and die. Wasps, hornets, and yellow jackets can sting multiple times. Most deaths related to Hymenoptera stings are the result of immediate hypersensitivity reactions, causing anaphylaxis. Massive envenomations can cause death in nonallergic individuals. The estimated lethal dose is approximately 20 stings/kg in most mammals. Anaphylactic reactions to Hymenoptera stings are not dose dependent or related to the number of stings. Bee and wasp venoms are made up primarily of protein. Conversely, fire ant venoms are 95% alkaloids. Four possible reactions are seen after insect stings: local reactions, regional reactions, systemic anaphylactic responses, and less commonly, delayed-type hypersensitivity. Clinical signs of bee and wasp stings include erythema, edema, and pain at the sting site. Occasionally, animals develop regional reactions. Onset of life-threatening, anaphylactic signs typically occur within 10 minutes of the sting. Diagnosis of bee and wasp stings stem from a history of potential contact matched with onset of appropriate clinical signs. Treatment of uncomplicated envenomations (stings) consists of conservative therapy (antihistamines, ice or cool compresses, topical lidocaine, or corticosteroid lotions). Prompt recognition and initiation of treatment is critical in successful management of anaphylactic reactions to hymenopteran stings. Imported fire ants both bite and sting, and envenomation only occurs through the sting. Anaphylaxis after imported fire ant stings is treated similarly to anaphylactic reactions after honeybee and vespid stings. The majority of Hymenopteran stings are self-limiting events, which resolve in a few hours without treatment. Because life-threatening anaphylactic reactions can progress rapidly, all animals stung should be closely monitored and observed. In the following review article, we will examine the sources and incidence, toxicokinetics, pathological lesions, clinical signs, diagnosis, treatment, and prognosis for dogs and cats suffering Hymenoptera stings.