Î³Î´ T cells Promote Steatohepatitis by Orchestrating Innate and Adaptive Immune Programming
The recruitment and activation of inflammatory cells in the liver delineates the transition from hepatic steatosis to steatohepatitis. We found that in steatohepatitis, Î³Î´T cells are recruited to the liver by CCR2, CCR5, and NOD2 signaling and are skewed towards an IL-17A+ phenotype in an ICOS-ICOSL dependent manner. Î³Î´T cells exhibit a distinct VÎ³4+ , PD1+ , Ly6C+ CD44+ phenotype in steatohepatitis. Moreover, Î³Î´T cells upregulate both CD1d, which is necessary for lipid-based antigens presentation, and the free fatty acid receptor CD36. Î³Î´T cells are stimulated to express IL-17A by palmitic acid and CD1d ligation. Deletion, depletion, and targeted interruption of Î³Î´T cell recruitment protects against diet-induced steatohepatitis and accelerates disease resolution. We demonstrate that hepatic Î³Î´T cells exacerbate steatohepatitis, independent of IL-17 expression, by mitigating conventional CD4+ T cell expansion and modulating their inflammatory program via CD1d-dependent VEGF expression.
Adrenocortical Carcinoma: A 20-Year Multi-Hospital Retrospective Analysis [Meeting Abstract]
New York Physicians' Perspectives and Knowledge of the State Medical Marijuana Program
Introduction: In 2014, New York (NY) became the 23rd state to legalize medical marijuana (MMJ). The purpose of this survey was to collect data about practicing NY physicians' comfort level, opinions, and experience in recommending or supporting patient use of MMJ. Materials and Methods: An anonymous web-based survey was distributed to medical societies and to academic departments in medical schools within NY. Results: A total of 164 responses were analyzed. Physician participants were primarily located in New York City and surrounding areas. The majority (71%) agreed that MMJ should be an option available to patients. Most respondents were not registered to certify MMJ in NY, but were willing to refer patients to registered physicians. Common reasons for not registering included specialty and federal status of cannabis. More than 75% reported having patients who used cannabis for symptom control, and 50% reported having patients who inquired about MMJ within the past year. Most respondents are willing to discuss MMJ with their patients, but had little familiarity with the state program and a modest knowledge of the endocannabinoid system. Pain was a common symptom for which cannabis was recommended by registered physicians (69%) and purportedly used by patients (83%). Most respondents would consider MMJ as an adjuvant to opioids, and 84% believed opioids have greater risks than MMJ. Conclusion: Given that the majority of surveyed physicians support MMJ as an option for patients, few are registered and have adequate knowledge of MMJ. Although our study sample is small and geographically limited, our survey results highlight key physician issues that are likely applicable to practitioners in other states. Concerted efforts are needed at the federal, state, and academic levels to provide practitioners with evidence-based guidelines for the safe use of MMJ.
Cham, Switzerland : Springer, 
Is urine drug testing a good idea for patients on chronic opioid therapy?
Medial branch block and rhizotomy
New Delhi : Jaypee Brothers, 2015
Ultrasound Guidance for Regional Anesthesia
New York : McGraw-Hill Medical, 2013
Abuse deterrent opioids
Prescription opioid abuse is a growing problem that has become a critical public health issue. The development of abuse-resistant opioid formulations is an emerging strategy aimed at curbing the abuse of opioid analgesics. Over the next few months to years, new products within this category will enter the market. This article serves to provide an introduction to many of the upcoming formulations that may find their way into the therapeutic arsenal of pain management practitioners
CANAL OF HERING LOSS: MINIMAL CHANGE DIAGNOSTIC BIOPSIES IN PRIMARY BILIARY CIRRHOSIS? [Meeting Abstract]