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1.
Nat Commun ; 14(1): 3543, 2023 06 19.
Article in English | MEDLINE | ID: mdl-37336883

ABSTRACT

PEAK pseudokinases are molecular scaffolds which dimerize to regulate cell migration, morphology, and proliferation, as well as cancer progression. The mechanistic role dimerization plays in PEAK scaffolding remains unclear, as there are no structures of PEAKs in complex with their interactors. Here, we report the cryo-EM structure of dimeric PEAK3 in complex with an endogenous 14-3-3 heterodimer. Our structure reveals an asymmetric binding mode between PEAK3 and 14-3-3 stabilized by one pseudokinase domain and the SHED domain of the PEAK3 dimer. The binding interface contains a canonical phosphosite-dependent primary interaction and a unique secondary interaction not observed in previous structures of 14-3-3/client complexes. Additionally, we show that PKD regulates PEAK3/14-3-3 binding, which when prevented leads to PEAK3 nuclear enrichment and distinct protein-protein interactions. Altogether, our data demonstrate that PEAK3 dimerization forms an unusual secondary interface for 14-3-3 binding, facilitating 14-3-3 regulation of PEAK3 localization and interactome diversity.


Subject(s)
14-3-3 Proteins , Cytoskeletal Proteins , Cytoskeletal Proteins/chemistry , 14-3-3 Proteins/chemistry , Protein Multimerization
2.
ChemSystemsChem ; 4(5)2022 Sep.
Article in English | MEDLINE | ID: mdl-36337751

ABSTRACT

Lipid rafts are ordered lipid domains that are enriched in saturated lipids, such as the ganglioside GM1. While lipid rafts are believed to exist in cells and to serve as signaling platforms through their enrichment in signaling components, they have not been directly observed in the plasma membrane without treatments that artificially cluster GM1 into large lattices. Here, we report that microscopic GM1-enriched domains can form, in the plasma membrane of live mammalian cells expressing the EphA2 receptor tyrosine kinase in response to its ligand ephrinA1-Fc. The GM1-enriched microdomains form concomitantly with EphA2-enriched microdomains. To gain insight into how plasma membrane heterogeneity controls signaling, we quantify the degree of EphA2 segregation and study initial EphA2 signaling steps in both EphA2-enriched and EphA2-depleted domains. By measuring dissociation constants, we demonstrate that the propensity of EphA2 to oligomerize is similar in EphA2-enriched and -depleted domains. However, surprisingly, EphA2 interacts preferentially with its downstream effector SRC in EphA2-depleted domains. The ability to induce microscopic GM1-enriched domains in live cells using a ligand for a transmembrane receptor will give us unprecedented opportunities to study the biophysical chemistry of lipid rafts.

3.
Nat Commun ; 13(1): 2407, 2022 05 03.
Article in English | MEDLINE | ID: mdl-35504891

ABSTRACT

The Hedgehog (HH) pathway is critical for development and adult tissue homeostasis. Aberrant HH signaling can lead to congenital malformations and diseases including cancer. Although cholesterol and several oxysterol lipids have been shown to play crucial roles in HH activation, the molecular mechanisms governing their regulation remain unresolved. Here, we identify Canopy4 (CNPY4), a Saposin-like protein, as a regulator of the HH pathway that modulates levels of membrane sterol lipids. Cnpy4-/- embryos exhibit multiple defects consistent with HH signaling perturbations, most notably changes in digit number. Knockdown of Cnpy4 hyperactivates the HH pathway in vitro and elevates membrane levels of accessible sterol lipids, such as cholesterol, an endogenous ligand involved in HH activation. Our data demonstrate that CNPY4 is a negative regulator that fine-tunes HH signal transduction, revealing a previously undescribed facet of HH pathway regulation that operates through control of membrane composition.


Subject(s)
Hedgehog Proteins , Sterols , Cholesterol , Hedgehog Proteins/genetics , Hedgehog Proteins/metabolism , Membrane Lipids , Signal Transduction/physiology
4.
Sci Signal ; 15(722): eabm9396, 2022 02 22.
Article in English | MEDLINE | ID: mdl-35192418

ABSTRACT

Pseudokinases are critical signaling hubs that are increasingly appreciated as important disease targets. In this issue of Science Signaling, Hou et al. bring new insights into the signaling mechanisms of the pseudokinase PEAK3 by characterizing its epidermal growth factor-dependent interactome and demonstrating oncogenic effects of PEAK3 overexpression.


Subject(s)
Signal Transduction
5.
bioRxiv ; 2021 May 11.
Article in English | MEDLINE | ID: mdl-34013269

ABSTRACT

The SARS-CoV-2 protein Nsp2 has been implicated in a wide range of viral processes, but its exact functions, and the structural basis of those functions, remain unknown. Here, we report an atomic model for full-length Nsp2 obtained by combining cryo-electron microscopy with deep learning-based structure prediction from AlphaFold2. The resulting structure reveals a highly-conserved zinc ion-binding site, suggesting a role for Nsp2 in RNA binding. Mapping emerging mutations from variants of SARS-CoV-2 on the resulting structure shows potential host-Nsp2 interaction regions. Using structural analysis together with affinity tagged purification mass spectrometry experiments, we identify Nsp2 mutants that are unable to interact with the actin-nucleation-promoting WASH protein complex or with GIGYF2, an inhibitor of translation initiation and modulator of ribosome-associated quality control. Our work suggests a potential role of Nsp2 in linking viral transcription within the viral replication-transcription complexes (RTC) to the translation initiation of the viral message. Collectively, the structure reported here, combined with mutant interaction mapping, provides a foundation for functional studies of this evolutionary conserved coronavirus protein and may assist future drug design.

6.
Res Sq ; 2021 May 19.
Article in English | MEDLINE | ID: mdl-34031651

ABSTRACT

The SARS-CoV-2 protein Nsp2 has been implicated in a wide range of viral processes, but its exact functions, and the structural basis of those functions, remain unknown. Here, we report an atomic model for full-length Nsp2 obtained by combining cryo-electron microscopy with deep learning-based structure prediction from AlphaFold2. The resulting structure reveals a highly-conserved zinc ion-binding site, suggesting a role for Nsp2 in RNA binding. Mapping emerging mutations from variants of SARS-CoV-2 on the resulting structure shows potential host-Nsp2 interaction regions. Using structural analysis together with affinity tagged purification mass spectrometry experiments, we identify Nsp2 mutants that are unable to interact with the actin-nucleation-promoting WASH protein complex or with GIGYF2, an inhibitor of translation initiation and modulator of ribosome-associated quality control. Our work suggests a potential role of Nsp2 in linking viral transcription within the viral replication-transcription complexes (RTC) to the translation initiation of the viral message. Collectively, the structure reported here, combined with mutant interaction mapping, provides a foundation for functional studies of this evolutionary conserved coronavirus protein and may assist future drug design.

7.
J Mol Biol ; 433(13): 167006, 2021 06 25.
Article in English | MEDLINE | ID: mdl-33891904

ABSTRACT

In this work, we put forward the provocative hypothesis that the active, ligand-bound RTK dimers from unrelated subfamilies can associate into heterooligomers with novel signaling properties. This hypothesis is based on a quantitative FRET study that monitors the interactions between EGFR and VEGFR2 in the plasma membrane of live cells in the absence of ligand, in the presence of either EGF or VEGF, and in the presence of both ligands. We show that direct interactions occur between EGFR and VEGFR2 in the absence of ligand and in the presence of the two cognate ligands. However, there are not significant heterointeractions between EGFR and VEGFR2 when only one of the ligands is present. Since RTK dimers and RTK oligomers are believed to signal differently, this finding suggests a novel mechanism for signal diversification.


Subject(s)
Cell Membrane/metabolism , ErbB Receptors/metabolism , Signal Transduction , Vascular Endothelial Growth Factor Receptor-2/metabolism , Algorithms , Epidermal Growth Factor/metabolism , ErbB Receptors/chemistry , ErbB Receptors/genetics , Fluorescence Resonance Energy Transfer , HEK293 Cells , Humans , Ligands , Protein Binding , Protein Multimerization , Spectrometry, Fluorescence , Vascular Endothelial Growth Factor A/metabolism , Vascular Endothelial Growth Factor Receptor-2/chemistry , Vascular Endothelial Growth Factor Receptor-2/genetics
8.
Angew Chem Int Ed Engl ; 60(12): 6503-6508, 2021 03 15.
Article in English | MEDLINE | ID: mdl-33351993

ABSTRACT

We introduce concentration-dependent number and brightness (cdN&B), a fluorescence fluctuation technique that can be implemented on a standard confocal microscope and can report on the thermodynamics of membrane protein association in the native plasma membrane. It uses transient transfection to enable measurements of oligomer size as a function of receptor concentration over a broad range, yielding the association constant. We discuss artifacts in cdN&B that are concentration-dependent and can distort the oligomerization curves, and we outline procedures that can correct for them. Using cdN&B, we characterize the association of neuropilin 1 (NRP1), a protein that plays a critical role in the development of the embryonic cardiovascular and nervous systems. We show that NRP1 associates into a tetramer in a concentration-dependent manner, and we quantify the strength of the association. This work demonstrates the utility of cdN&B as a powerful tool in biophysical chemistry.


Subject(s)
Neuropilin-1/analysis , Fluorescence Resonance Energy Transfer , Humans
9.
J Biol Chem ; 295(52): 18494-18507, 2020 12 25.
Article in English | MEDLINE | ID: mdl-33122191

ABSTRACT

Ligand bias is the ability of ligands to differentially activate certain receptor signaling responses compared with others. It reflects differences in the responses of a receptor to specific ligands and has implications for the development of highly specific therapeutics. Whereas ligand bias has been studied primarily for G protein-coupled receptors (GPCRs), there are also reports of ligand bias for receptor tyrosine kinases (RTKs). However, the understanding of RTK ligand bias is lagging behind the knowledge of GPCR ligand bias. In this review, we highlight how protocols that were developed to study GPCR signaling can be used to identify and quantify RTK ligand bias. We also introduce an operational model that can provide insights into the biophysical basis of RTK activation and ligand bias. Finally, we discuss possible mechanisms underpinning RTK ligand bias. Thus, this review serves as a primer for researchers interested in investigating ligand bias in RTK signaling.


Subject(s)
Cell Communication , Receptor Protein-Tyrosine Kinases/metabolism , Signal Transduction , Animals , Enzyme Activation , Humans , Ligands
10.
Biochem J ; 477(23): 4515-4526, 2020 12 11.
Article in English | MEDLINE | ID: mdl-33094812

ABSTRACT

Tropomyosin receptor kinase B (Trk-B) belongs to the second largest family of membrane receptors, Receptor Tyrosine Kinases (RTKs). Trk-B is known to interact with three different neurotrophins: Brain-Derived Neurotrophic Factor (BDNF), Neurotrophin-4 (NT-4), and Neurotrophin-3 (NT-3). All three neurotrophins are involved in survival and proliferation of neuronal cells, but each induces distinct signaling through Trk-B. We hypothesize that the different biological effects correlate with differences in the interactions between the Trk-B receptors, when bound to different ligands, in the plasma membrane. To test this hypothesis, we use quantitative FRET to characterize Trk-B dimerization in response to NT-3 and NT-4 in live cells, and compare it to the previously published data for Trk-B in the absence and presence of BDNF. Our study reveals that the distinct Trk-B signaling outcomes are underpinned by both different configurations and different stabilities of the three ligand-bound Trk-B dimers in the plasma membrane.


Subject(s)
Brain-Derived Neurotrophic Factor/metabolism , Cell Membrane/metabolism , Membrane Glycoproteins/metabolism , Nerve Growth Factors/metabolism , Neurotrophin 3/metabolism , Protein Multimerization , Receptor, trkB/metabolism , Brain-Derived Neurotrophic Factor/genetics , Cell Membrane/genetics , Fluorescence Resonance Energy Transfer , HEK293 Cells , Humans , Ligands , Membrane Glycoproteins/genetics , Nerve Growth Factors/genetics , Neurotrophin 3/genetics , Receptor, trkB/genetics
11.
BMC Vet Res ; 16(1): 348, 2020 Sep 22.
Article in English | MEDLINE | ID: mdl-32962713

ABSTRACT

BACKGROUND: Echocardiography is commonly used for assessing cardiac structure and function in various species including non-human primates. A few previous studies reported normal echocardiographic reference intervals of clinically healthy rhesus macaques under sedation. However, these studies were under-powered, and the techniques were not standardized. In addition, body weight, age, and sex matched reference intervals should be established as echocardiographic measurements are commonly influenced by these variables. The purpose of this study was to establish reference intervals for complete echocardiographic parameters based on a large cohort of clinically healthy rhesus macaques with wide ranges of weight and age distributions using allometric scaling. RESULTS: A total of 823 rhesus macaques (ages 6 months to 31 years old; body weights 1.4 to 22.6 kg) were enrolled. Of these rhesus macaques, 421 were males and 402 were females. They were assessed with a complete echocardiographic examination including structural and functional evaluation under sedation with ketamine hydrochloride. The reference intervals of the key echocardiographic parameters were indexed to weight, age, and sex by calculating the coefficients of the allometric eq. Y = aMb. On correlation matrix, body weight, age, sex, and heart rate were significantly correlated with various echocardiographic parameters and some of the parameters were strongly correlated with body weight and age. Multiple regression analysis revealed that heart rate and body weight statistically significantly predicted several echocardiographic parameters. Valve regurgitation including tricuspid, aortic, pulmonic, and mitral regurgitations without other cardiac structural and functional abnormalities are common in clinically healthy rhesus macaques under ketamine sedation. CONCLUSIONS: In this study, the reference intervals of echocardiographic parameters were established by performing complete echocardiographic examinations on a large number of clinical healthy rhesus macaques. In addition, allometric scaling was performed based on their weight, and further indexed to age and sex. These allometrically scaled reference intervals can be used to accurately evaluate echocardiographic data in rhesus macaques and diagnose structural and functional evidence of cardiac disease.


Subject(s)
Echocardiography/veterinary , Macaca mulatta/physiology , Age Factors , Animals , Body Weight , Female , Heart Rate , Hypnotics and Sedatives/administration & dosage , Ketamine/administration & dosage , Male , Reference Values
12.
J Biol Chem ; 295(29): 9917-9933, 2020 07 17.
Article in English | MEDLINE | ID: mdl-32467228

ABSTRACT

Receptor tyrosine kinases (RTKs) are single-pass membrane proteins that control vital cell processes such as cell growth, survival, and differentiation. There is a growing body of evidence that RTKs from different subfamilies can interact and that these diverse interactions can have important biological consequences. However, these heterointeractions are often ignored, and their strengths are unknown. In this work, we studied the heterointeractions of nine RTK pairs, epidermal growth factor receptor (EGFR)-EPH receptor A2 (EPHA2), EGFR-vascular endothelial growth factor receptor 2 (VEGFR2), EPHA2-VEGFR2, EPHA2-fibroblast growth factor receptor 1 (FGFR1), EPHA2-FGFR2, EPHA2-FGFR3, VEGFR2-FGFR1, VEGFR2-FGFR2, and VEGFR2-FGFR3, using a FRET-based method. Surprisingly, we found that RTK heterodimerization and homodimerization strengths can be similar, underscoring the significance of RTK heterointeractions in signaling. We discuss how these heterointeractions can contribute to the complexity of RTK signal transduction, and we highlight the utility of quantitative FRET for probing multiple interactions in the plasma membrane.


Subject(s)
Fluorescence Resonance Energy Transfer , Receptor Protein-Tyrosine Kinases/metabolism , Signal Transduction , HEK293 Cells , Humans , Receptor Protein-Tyrosine Kinases/chemistry , Receptor Protein-Tyrosine Kinases/classification
13.
Cytokine Growth Factor Rev ; 49: 23-31, 2019 10.
Article in English | MEDLINE | ID: mdl-31711797

ABSTRACT

Here, we discuss the transition model of receptor tyrosine kinase (RTK) activation, which is derived from biophysical investigations of RTK interactions and signaling. The model postulates that (1) RTKs can interact laterally to form dimers even in the absence of ligand, (2) different unliganded RTK dimers have different stabilities, (3) ligand binding stabilizes the RTK dimers, and (4) ligand binding causes structural changes in the RTK dimer. The model is grounded in the principles of physical chemistry and provides a framework to understand RTK activity and to make predictions in quantitative terms. It can guide basic research aimed at uncovering the mechanism of RTK activation and, in the long run, can empower the search for modulators of RTK function.


Subject(s)
Cell Membrane/metabolism , Receptor Protein-Tyrosine Kinases/chemistry , Signal Transduction , Humans , Ligands , Mutation , Protein Binding , Protein Multimerization , Thermodynamics
14.
Proc Natl Acad Sci U S A ; 116(2): 413-421, 2019 01 08.
Article in English | MEDLINE | ID: mdl-30538202

ABSTRACT

Electronic pacemakers can treat electrical conduction disorders in hearts; however, they are invasive, bulky, and linked to increased incidence of infection at the tissue-device interface. Thus, researchers have looked to other more biocompatible methods for cardiac pacing or resynchronization, such as femtosecond infrared light pulsing, optogenetics, and polymer-based cardiac patches integrated with metal electrodes. Here we develop a biocompatible nongenetic approach for the optical modulation of cardiac cells and tissues. We demonstrate that a polymer-silicon nanowire composite mesh can be used to convert fast moving, low-radiance optical inputs into stimulatory signals in target cardiac cells. Our method allows for the stimulation of the cultured cardiomyocytes or ex vivo heart to beat at a higher target frequency.


Subject(s)
Cardiac Pacing, Artificial/methods , Extracellular Matrix/chemistry , Infrared Rays , Myocardium/metabolism , Myocytes, Cardiac/metabolism , Nanowires/chemistry , Silicon/chemistry , Animals , Myocardium/cytology , Myocytes, Cardiac/cytology , Optogenetics/methods , Rats
15.
Chem Rev ; 119(9): 5881-5921, 2019 05 08.
Article in English | MEDLINE | ID: mdl-30589534

ABSTRACT

Receptor tyrosine kinases (RTKs) play important roles in cell growth, motility, differentiation, and survival. These single-pass membrane proteins are grouped into subfamilies based on the similarity of their extracellular domains. They are generally thought to be activated by ligand binding, which promotes homodimerization and then autophosphorylation in trans. However, RTK interactions are more complicated, as RTKs can interact in the absence of ligand and heterodimerize within and across subfamilies. Here, we review the known cross-subfamily RTK heterointeractions and their possible biological implications, as well as the methodologies which have been used to study them. Moreover, we demonstrate how thermodynamic models can be used to study RTKs and to explain many of the complicated biological effects which have been described in the literature. Finally, we discuss the concept of the RTK interactome: a putative, extensive network of interactions between the RTKs. This RTK interactome can produce unique signaling outputs; can amplify, inhibit, and modify signaling; and can allow for signaling backups. The existence of the RTK interactome could provide an explanation for the irreproducibility of experimental data from different studies and for the failure of some RTK inhibitors to produce the desired therapeutic effects. We argue that a deeper knowledge of RTK interactome thermodynamics can lead to a better understanding of fundamental RTK signaling processes in health and disease. We further argue that there is a need for quantitative, thermodynamic studies that probe the strengths of the interactions between RTKs and their ligands and between different RTKs.


Subject(s)
Receptor Protein-Tyrosine Kinases/metabolism , Animals , Cell Membrane/chemistry , Cell Membrane/enzymology , Cell Membrane/metabolism , Humans , Ligands , Protein Multimerization , Receptor Cross-Talk , Receptor Protein-Tyrosine Kinases/chemistry
16.
Biochim Biophys Acta Mol Cell Res ; 1864(1): 31-38, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27776928

ABSTRACT

All members of the Eph receptor family of tyrosine kinases contain a SAM domain near the C terminus, which has been proposed to play a role in receptor homotypic interactions and/or interactions with binding partners. The SAM domain of EphA2 is known to be important for receptor function, but its contribution to EphA2 lateral interactions in the plasma membrane has not been determined. Here we use a FRET-based approach to directly measure the effect of the SAM domain on the stability of EphA2 dimers on the cell surface in the absence of ligand binding. We also investigate the functional consequences of EphA2 SAM domain deletion. Surprisingly, we find that the EphA2 SAM domain inhibits receptor dimerization and decreases EphA2 tyrosine phosphorylation. This role is dramatically different from the role of the SAM domain of the related EphA3 receptor, which we previously found to stabilize EphA3 dimers and increase EphA3 tyrosine phosphorylation in cells in the absence of ligand. Thus, the EphA2 SAM domain likely contributes to a unique mode of EphA2 interaction that leads to distinct signaling outputs.


Subject(s)
Amino Acid Sequence , Cell Membrane/metabolism , Ephrin-A1/metabolism , Receptor, EphA2/metabolism , Sequence Deletion , Sterile Alpha Motif , Cell Membrane/chemistry , Cell Movement , Ephrin-A1/genetics , Fluorescence Resonance Energy Transfer , Gene Expression , HEK293 Cells , Humans , Kinetics , Phosphorylation , Protein Binding , Protein Isoforms/genetics , Protein Isoforms/metabolism , Protein Multimerization , Receptor, EphA2/genetics , Recombinant Proteins/genetics , Recombinant Proteins/metabolism , Tyrosine/metabolism
17.
Biochemistry ; 56(1): 14-21, 2017 Jan 10.
Article in English | MEDLINE | ID: mdl-28005342

ABSTRACT

DNA is rapidly cleaved under mild alkaline conditions at apyrimidinic/apurinic sites, but the half-life is several weeks in phosphate buffer (pH 7.5). However, abasic sites are ∼100-fold more reactive within nucleosome core particles (NCPs). Histone proteins catalyze the strand scission, and at superhelical location 1.5, the histone H4 tail is largely responsible for the accelerated cleavage. The rate constant for strand scission at an abasic site is enhanced further in a nucleosome core particle when it is part of a bistranded lesion containing a proximal strand break. Cleavage of this form results in a highly deleterious double-strand break. This acceleration is dependent upon the position of the abasic lesion in the NCP and its structure. The enhancement in cleavage rate at an apurinic/apyrimidinic site rapidly drops off as the distance between the strand break and abasic site increases and is negligible once the two forms of damage are separated by 7 bp. However, the enhancement of the rate of double-strand break formation increases when the size of the gap is increased from one to two nucleotides. In contrast, the cleavage rate enhancement at 2-deoxyribonolactone within bistranded lesions is more modest, and it is similar in free DNA and nucleosome core particles. We postulate that the enhanced rate of double-strand break formation at bistranded lesions containing apurinic/apyrimidinic sites within nucleosome core particles is a general phenomenon and is due to increased DNA flexibility.


Subject(s)
Apurinic Acid/chemistry , DNA Breaks, Double-Stranded , DNA/chemistry , Nucleosomes/chemistry , Apurinic Acid/metabolism , DNA/genetics , DNA/metabolism , DNA Repair , DNA, Single-Stranded , Histones/chemistry , Histones/metabolism , Models, Chemical , Models, Molecular , Molecular Structure , Nucleic Acid Conformation , Nucleosomes/genetics , Nucleosomes/metabolism , Protein Domains
18.
J Pediatr Surg ; 46(6): 1140-3, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21683212

ABSTRACT

PURPOSE: The critical management decision in pediatric pancreatic injuries involves whether or not to operate on patients with grade II or III injuries. Because of the rarity of these injuries, no one hospital cares for enough patients to determine the outcome of this decision. Given this, the American Pediatric Surgical Association accrued a series of patients with pancreatic injuries from the members of its Trauma Committee. METHODS: A retrospective review of concurrent pancreatic injuries from 9 level 1 pediatric trauma centers was performed. RESULTS: Data on 131 children were submitted. Forty-three patients suffered grade II or grade III injuries. Twenty patients underwent an operation, and 23 were observed. Patients who underwent an operation had an average length of stay of 16.1 days compared with 14.2 days. Two in the operative group received total parenteral nutrition compared with 12 in the nonoperative group. Eight in the nonoperative group developed a pseudocyst compared with 3 in the operative group. CONCLUSIONS: Children with grade II or grade III pancreatic injuries managed nonoperatively had a higher rate of pseudocyst, lower rate of reoperation, and a comparable length of stay compared with those who underwent surgery. These data will be used to help design a prospective study of pancreatic injury management.


Subject(s)
Abdominal Injuries/therapy , Observation/methods , Pancreas/injuries , Pancreatectomy/methods , Abdominal Injuries/diagnostic imaging , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Humans , Injury Severity Score , Male , Pancreas/surgery , Pancreatectomy/adverse effects , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/physiopathology , Parenteral Nutrition/methods , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Retrospective Studies , Risk Assessment , Tomography, X-Ray Computed/methods , Trauma Centers , Treatment Outcome
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