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With the ongoing public health crisis with prescription opioids, there is a need for safer alternatives for medication management in chronic pain patients. Buprenorphine is a partial mu-opioid agonist which is commonly utilized to treat patients with opioid-use disorders. The purpose of this review is to discuss the potential use of this medication for the treatment of chronic pain instead of resorting to more traditional Schedule II opioids. Buprenorphine offers a safer alternative for patients who require opioids to manage chronic pain, given the unique pharmacological properties that allow it to provide adequate analgesia with less abuse potential.

This essay ventures a post-election reflection on the significance of Clintonʼs defeat by addressing its emblematic representation as Medusaʼs decapitation by the triumphant Perseus. It is not a coincidence, we argue, that Clinton triggered in public imagination the odious image of Medusa, the epitome of female monstrosity of all [patriarchal] times, while Trumpʼs imagery of his rival articulated the ancient angst of man: the fear of woman as a mirror of manʼs own monstrosity, the inability to tolerate ambiguity embedded in woman, the envy of incapacity to create life ("uterus envy"). Thus, Trumpʼs experience of Clinton as Medusa echoes manʼs experience of powerful/ creative woman as a monstrously threatening reminder of his own narcissistic discontents. It also unravels manʼs need to demonize Medusa by victimization and then re-victimize her by demonization. Just as Medusa herself, an innocent beautiful maiden from Ovidʼs story, converts into a petrifying mirror of manʼs own monstrosity, so does the representation of Clinton and Clintonʼs defeat becomes a mirror through which an invisible lens of misogyny manifests itself.

Abstract Background Recently, we demonstrated that human mesenchymal stem cells (hMSC) stimulated with dexamethazone undergo gene focusing during osteogenic differentiation (Stem Cells Dev 14(6): 1608–20, 2005). Here, we examine the protein expression profiles of three additional populations of hMSC stimulated to undergo osteogenic differentiation via either contact with pro-osteogenic extracellular matrix (ECM) proteins (collagen I, vitronectin, or laminin-5) or osteogenic media supplements (OS media). Specifically, we annotate these four protein expression profiles, as well as profiles from naïve hMSC and differentiated human osteoblasts (hOST), with known gene ontologies and analyze them as a tensor with modes for the expressed proteins, gene ontologies, and stimulants. Results Direct component analysis in the gene ontology space identifies three components that account for 90% of the variance between hMSC, osteoblasts, and the four stimulated hMSC populations. The directed component maps the differentiation stages of the stimulated stem cell populations along the differentiation axis created by the difference in the expression profiles of hMSC and hOST. Surprisingly, hMSC treated with ECM proteins lie closer to osteoblasts than do hMSC treated with OS media. Additionally, the second component demonstrates that proteomic profiles of collagen I- and vitronectin-stimulated hMSC are distinct from those of OS-stimulated cells. A three-mode tensor analysis reveals additional focus proteins critical for characterizing the phenotypic variations between naïve hMSC, partially differentiated hMSC, and hOST. Conclusion The differences between the proteomic profiles of OS-stimulated hMSC and ECM-hMSC characterize different transitional phenotypes en route to becoming osteoblasts. This conclusion is arrived at via a three-mode tensor analysis validated using hMSC plated on laminin-5.

DNA barcoding was intended as a means to provide species-level identifications through associating DNA sequences from unknown specimens to those from curated reference specimens. Although barcodes were not designed for phylogenetics, they can be beneficial to the completion of the Tree of Life. The barcode database for Trichoptera is relatively comprehensive, with data from every family, approximately two-thirds of the genera, and one-third of the described species. Most Trichoptera, as with most of life's species, have never been subjected to any formal phylogenetic analysis. Here, we present a phylogeny with over 16 000 unique haplotypes as a working hypothesis that can be updated as our estimates improve. We suggest a strategy of implementing constrained tree searches, which allow larger datasets to dictate the backbone phylogeny, while the barcode data fill out the tips of the tree. We also discuss how this phylogeny could be used to focus taxonomic attention on ambiguous species boundaries and hidden biodiversity. We suggest that systematists continue to differentiate between 'Barcode Index Numbers' (BINs) and 'species' that have been formally described. Each has utility, but they are not synonyms. We highlight examples of integrative taxonomy, using both barcodes and morphology for species description.This article is part of the themed issue 'From DNA barcodes to biomes'., (© 2016 The Authors.)

A wild orphaned male American black bear cub ( Ursus americanus ) presented with hind limb gait abnormalities and was found to have bilateral grade 3 laterally luxating patellas. There were no other significant abnormalities detected on neurologic, radiographic, or hematologic examinations. The trochlear grooves were deepened with a chondroplasty, and the redundant soft tissues imbricated. There was a marked improvement in the bear's gait postoperatively, with an apparent full return to function. To the authors' knowledge, patellar luxation has not been reported in the Ursidae family, and the success in this case suggests that this technique may be used in large wild or captive carnivore cubs.

The bacterium Listeria monocytogenes causes disease in a wide variety of mammals including rabbits and hares. We describe naturally acquired metritis and septicemic listeriosis in wild female hares from Saskatchewan, Canada. Between April 2012 and July 2013, two white-tailed jackrabbits (Lepus townsendii) and a snowshoe hare (Lepus americanus) were presented to the Veterinary Medical Centre at the Western College of Veterinary Medicine, Saskatoon, Saskatchewan, Canada with nonspecific neurologic signs. The hares were euthanized and autopsied. Necrotizing fibrinosuppurative metritis was present in all. Additional findings in individual hares included fetal maceration, multifocal necrotizing myocarditis, multifocal hepatic necrosis, and nonsuppurative encephalitis. Listeria monocytogenes was cultured from multiple tissues in each hare. Although listeriosis in pregnant domestic rabbits has been studied, this is the first detailed description in wild North American hares. The epidemiology of listeriosis, including prevalence and the role of environmental sources and coprophagy in transmission among hares, requires further investigation.

This article has been withdrawn at the request of the Publisher. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Case Description: A 3-year-old female domestic ferret (Mustela putorius furo) with an insulinoma was treated because of a hypoglycemic crisis prior to scheduled pancreatectomy with concurrent nodulectomy., Clinical Findings: Previously, the ferret had clinical signs of lethargy and hind limb weakness; at that time, blood glucose concentration was low, and a tentative diagnosis (subsequently confirmed) of insulinoma was made. Prednisolone treatment (0.3 mg/kg [0.14 mg/lb], PO, q 12 h) did not improve clinical signs; the dosage was gradually increased over a 1-month course (1.8 mg/kg [0.82 mg/lb], PO, q 12 h) and maintained for 10 days. Overall, the treatment was ineffective, and the ferret remained lethargic and developed inappetence. At a reevaluation, the ferret had severe weakness and nonresponsiveness nearing a comatose state. Standard treatment with dextrose (1 mL of 50% solution, IV), and dexamethasone (1 mg/kg [0.45 mg/lb], SC) was administered with resultant improvement in mentation. The ferret was discharged from the hospital and then returned 3 days later for stabilization prior to pancreatectomy with concurrent nodulectomy., Treatment and Outcome: The day before surgery, the ferret was administered a glucagon constant rate infusion at a rate of 15 ng/kg/min (6.8 ng/lb/min), which resulted in an increase in blood glucose concentration to a euglycemic state and resolution of clinical signs of hypoglycemia., Clinical Relevance: As illustrated by the case described in this report, a glucagon constant rate infusion can be used successfully for the emergency treatment of hyperinsulinemic-hypoglycemic crisis in insulinomic ferrets.

Electrocardiograms are subject to technical errors that confound interpretation, and although some are readily apparent, others are overlooked by experienced physicians. Thus, failure to recognize a recording error can lead to faulty clinical actions. By exploiting the reciprocal relationship of leads aVR and V6, this article provides a simple and useful way to quickly and confidently determine whether a tracing was properly recorded.

After several weeks of fever and chills, a 31-year-old logger developed pain in his right thigh. Upon examination a tender, pulsating upper thigh mass was found with a long loud bruit arising from it. Severe aortic insufficiency was present; however, blood cultures were negative. An angiogram, captured blood with contrast spewing from the profunda femoral artery to fill a 5 x 10 cm sac. A false aneurysm was diagnosed and resected; numerous gram positive cocci were present in cut sections, but cultures from the cavity grew the gram negative bacteria Salmonella and Alcaligenes. After one month of intravenous ampicillin the aortic valve was replaced after being destroyed by endocarditis. Ampicillin was continued and recovery was uneventful. Mycotic aneurysms are commonly caused by Salmonella (10%), which was second only to Staphylococcus (30%). The femoral artery accounts for 38% of all mycotic aneurysms. They typically present with a pulsatile mass (52%), bruit (50%), and fever (48%). This diagnosis can be supported by leukocytosis (64-71%), positive blood cultures (50-85%), and a history of arterial trauma (51%) (injection drug use, intravascular procedure, or trauma) or endocarditis (10%).

Thromboembolic disease accounts for thousands of hospitalizations every year in the US. Its primary management consists of anticoagulation. However, in certain instances this may be contraindicated or not sufficient. Mechanic occlusion of the inferior vena cava (IVC) becomes then a viable alternative. In this case a 35-year-old man presented with a saddle pulmonary embolus but was unable to be anticoagulated due to intestinal bleed. A removable IVC filter was then placed. The filter spontaneously migrated into the right atrium causing severe tricuspid regurgitation, perforation of the atrial wall, and cardiac tamponade. The device was successfully retrieved percutaneously and the patient discharged from the hospital in stable condition. This case illustrates the potentially lethal complications associated with the use of IVC filters, as well as the possibility to percutaneously recover them from within the right atrium., ((c) 2006 Wiley-Liss, Inc.)

Background: Many in vitro studies have shown that adenosine (Ado) can induce vascular endothelial growth factor (VEGF) mRNA and protein expression and stimulate endothelial proliferation. In the present study, we seek to determine whether Ado can increase circulating levels of VEGF protein in the intact human., Methods: Five outpatients 49.3 +/- 6.7 years of age and weighing 88.2 +/- 8.5 kg were selected. They were given a 6 min intravenous infusion of Ado (0.14 mg kg-1 min-1) in conjunction with sestamibi myocardial perfusion scans. Mean blood pressure (MBP, calculated from systolic and diastolic values) and heart rate (HR) were determined before Ado infusion and every 2 min for the next 10 min. Plasma VEGF concentrations (ELISA) were determined immediately before Ado infusion and 1 h, 2 h, and 8 h after the infusion., Results: Plasma VEGF concentration averaged 20.3 +/- 2.0 pg ml-1 prior to Ado infusion, and increased to 62.7 +/- 18.1 pg ml-1 at 1 h post- infusion (p < 0.01). VEGF plasma concentration returned to basal levels 2 h after infusion (23.3 +/- 3.4 pg ml-1). MBP averaged 116 +/- 7 mmHg and heart rate averaged 70 +/- 7 prior to Ado infusion. MBP decreased by a maximum of approximately 22% and HR increased by a maximum of approximately 17% during the infusion., Conclusion: We conclude from these preliminary findings that intravenous infusion of adenosine can increase plasma levels of VEGF in humans.

The three bipolar leads (I, II, and III) of the 12-lead electrocardiogram are subject to technical errors that not only confound interpretation but may lead to faulty clinical actions. While some errors are readily recognized, even experienced electrocardiographers overlook others. This paper reviews the nature of limb lead errors and offers what we think is a generally useful method to deduce the observed, but erroneous, lead configurations.

Carney complex (CNC) is a familial multiple neoplasia syndrome characterized by cardiac and extracardiac myxomas in the setting of spotty skin pigmentation and endocrinopathy. We previously identified PRKAR1A (regulatory subunit 1alpha of protein kinase A) mutations in CNC. Mutational analyses of the PRKAR1A gene in 51 unrelated CNC probands now detect mutations in 65%. All mutations, except for one unique missense mutation, lead to PRKAR1A haploinsufficiency. Therefore, we studied the consequences of prkar1a haploinsufficiency in mice. Although we did not observe cardiac myxomas or altered pigmentation in prkar1a(+/-) mice, we did observe some phenotypes similar to CNC, including altered heart rate variability. Moreover, prkar1a(+/-) mice exhibited a marked propensity for extracardiac tumorigenesis. They developed sarcomas and hepatocellular carcinomas. Sarcomas were frequently associated with myxomatous differentiation. Tumors from prkar1a(+/-) mice did not exhibit prkar1a loss of heterozygosity. Thus, we conclude that although PRKAR1A haploinsufficiency does predispose to tumorigenesis, distinct secondary genetic events are required for tumor formation.

Congenital foramen of the left parietal pericardium is uncommon. The condition has the potential to cause angina pectoris, myocardial infarction, or even death. Forty-three confirmed cases have been retrieved from the English language literature, and a case report of "life-threatening" herniation of the heart is here added. The diagnosis, made at a mean age of 20 years (range 2 to 48), was five times more common in men. In 5 fatal cases, the heart had become incarcerated. In the remainder of cases, one-third were asymptomatic, and two-thirds suffered a chest complaint that prompted diagnosis. Chest discomfort, dyspnea, and syncope were the most common symptoms. The most common finding at surgery, which 34 patients underwent, was a foramen at the base of the heart through which the left atrial appendage had herniated. In eight instances, the rim of the defect lay upon and compressed the coronary circulation. Measures to remedy the disorder have included a variety of operations, some to enlarge the defect, others to close it, amputation of the atrial appendage, and, in two cases, myocardial revascularization. Surgery is appropriate in the majority of symptomatic patients and in all who are at risk for ventricular herniation.

A 53 year-old-man developed classical angina pectoris, presumably the result of coronary atherosclerosis. Thirty-two years before, an abnormality on a chest film had been described as a "prominence of the upper portion of the left cardiac border." The "prominence" was actually an angiosarcoma, which eventually compromised blood flow in the left coronary system.

Experiments were designed to evaluate acute and chronic effects of sodium on glomerular size distributions and kidney function of Single Comb White Leghorns. Chicks were raised on either tap water (control) or .6% NaCl (saline) drinking water. Kidney function studies were conducted when the birds reached 14 to 16 weeks of age. Saline-adapted birds had significantly lower glomerular filtration rates and significantly higher sodium and potassium excretion rates when compared with birds raised on tap water. Acute effects of sodium on kidney function were assessed by infusing 25 mM tetrasodium pyrophosphate unilaterally into the renal portal system. For birds raised on tap water, unilateral sodium infusion caused a significant unilateral reduction in the glomerular filtration rate. However, neither the acute nor the chronic reductions in glomerular filtration rates in response to sodium were associated with a reduction in the number of filtering nephrons. Saline-adapted birds had significantly hypertrophied glomeruli.

A trial was designed to test the efficacy of ibuprofen in controlling post-operative pain and swelling following the surgical removal of lower third molar teeth. Because of the rigid criteria imposed on the trial it was not satisfactorily completed but the method of measuring the volume of the swelling by stereometric photogrammetry, which is reproducible, versatile and non-invasive, was considered to be worth reporting in context.

Twenty rhesus monkeys had one kidney irradiated (after undergoing unilateral nephrectomies) with one of four doses: 960 or 1080 rads of 50 MeVd leads to Be neutrons, or 2350 or 2700 rads of 60Co. Whereas animals treated with the lower dose of neutrons or 60Co are alive with relatively normal renal function, those treated with the higher dose of neutrons died of radiation nephritis. Animals treated with the higher dose of 60Co developed radiation nephritis but survived. The physiological and histopathological changes of radiation nephritis secondary to neutron irradiation are not qualitatively different from those reported for radiation nephritis secondary to photon irradiation.

Eighty-four university cardiovascular laboratories responded to a questionnaire concerning premedication practice and observation of noncatheter-induced coronary artery spasm during routine coronary angiography. Half of the laboratories stated that they had not observed the phenomenon. The data suggest that premedication practice may account in part for the relative rarity of this phenomenon.

Least-squares regression analysis was computerized to provide functional color images of myocardial perfusion patterns. In 8 of the 9 patients studied, changes in pattern indicated that the revascularization procedure speeded the appearance time and/or net rate of 43K uptake. The functional images correlated well with coronary arteriograms made before and after surgery. This noninvasive isotope technique may prove to be clinically useful in (a) evaluating coronary artery disease, (b) defining the remaining viable myocardium when an aneurysm is present, and (c) determining the effectiveness of the revascularization procedure.