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Haider S, Kamal MT, Shoaib N, Zahid M. Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023; 49:2389-2400. [PMID: 37347296 DOI: 10.1007/s00068-023-02306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay. METHODS We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI). RESULTS The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83-1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50-6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49-2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance. CONCLUSION The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.
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Affiliation(s)
- Samna Haider
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Mohammed Taha Kamal
- Department of General Surgery, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Navaira Shoaib
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariyam Zahid
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Matuchova I, Kelbich P, Kubalik J, Hanuljakova E, Stanek I, Maly V, Karpjuk O, Krejsek J. Cytological-energy analysis of pleural effusions with predominance of neutrophils. Ther Adv Respir Dis 2021; 14:1753466620935772. [PMID: 32600177 PMCID: PMC7328477 DOI: 10.1177/1753466620935772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The predominance of neutrophils in pleural effusions of patients with
different serious impairments of the pleural cavity organs is often found.
The aim of this study was to identify the type of injury using the
cytological-energy analysis of pleural effusions. Methods: We analysed 635 samples of pleural effusions with predominance of
neutrophils. We compared the values of the coefficient of energy balance
(KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST)
catalytic activities in the following subgroups of patients: with
transudative effusions, purulent pneumonia, chest empyema and after chest
surgery with and without purulent complications. Statistical analysis was
performed using the ANOVA Kruskal–Wallis test (p < 0.05
was considered as significant). Results: We found the lowest KEB values in pleural effusions of patients with chest
empyema and their gradual increases in patients with purulent pneumonia and
with transudative effusions. We observed the highest LDH and AST enzymes
activity in patients with chest empyema and their gradual decrease in
patients with purulent pneumonia and with transudative effusions. LDH and
AST enzymes activity was significantly higher in pleural effusions of
patients after chest surgery with purulent complications compared with
non-purulent cases. Conclusion: The most intensive inflammation and the most extensive tissue destruction in
the pleural cavity were found in patients with chest empyema. Significantly
better parameters were observed in patients with purulent pneumonia. The
absence of serious inflammation and the absence of tissue destruction were
typical for patients with transudative effusions. Finally, our results
confirmed an anticipated higher tissue destruction in patients after chest
surgery. Significantly worse injury was found in surgical patients with
purulent complications compared with non-purulent ones. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Inka Matuchova
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Petr Kelbich
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Socialni pece 3316/12A, 401 13, Usti nad Labem, Czech Republic.,Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Jan Kubalik
- Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic.,Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Eva Hanuljakova
- Biomedical Centre, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, Prague, Czech Republic
| | - Ivan Stanek
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Vilem Maly
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Ondrej Karpjuk
- Department of Thoracic Surgery, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Jan Krejsek
- Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Immunology and Allergology, Charles University in Prague, Hradec Kralove, Czech Republic
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3
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Changchien C, Chen Y, Chang H, Chang S, Tsai W, Tsai H, Wang C, Lee H, Tsai C. Effect of malignant-associated pleural effusion on endothelial viability, motility and angiogenesis in lung cancer. Cancer Sci 2020; 111:3747-3758. [PMID: 32706142 PMCID: PMC7541005 DOI: 10.1111/cas.14584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/30/2022] Open
Abstract
Malignant pleural effusion (MPE) and paramalignant pleural effusion (PPE) remain debilitating complications in lung cancer patients with poor prognosis and limited treatment options. The role of vascular endothelial cells has not been explored in the pleural environment of lung cancer. By integrating MPE and PPE as malignant-associated pleural fluid (MAPF), the current study aimed to evaluate the effect of MAPF on cell proliferation, migration and angiogenesis of HUVEC. First, increased capillaries were identified in the subpleural layer of lung adenocarcinoma. Compatible with pathological observations, the ubiquitous elevation of HUVEC survival was identified in MAPF culture regardless of the underlying cancer type, the driver gene mutation, prior treatments and evidence of malignant cells in pleural fluid. Moreover, MAPF enhanced HUVEC motility with the formation of lamellipodia and filopodia and focal adhesion complex. Tube formation assay revealed angiogenic behavior with the observation of sheet-like structures. HUVEC cultured with MAPF resulted in a significant increase in MAPK phosphorylation. Accompanied with VEGFR2 upregulation in MAPF culture, there was increased expressions of p-STAT3, HIF-1α and Nf-kB. VEGF/VEGFR2 blockade regressed endothelial migration and angiogenesis but not cell proliferation. Our data indicate the angiogenic activities of MAPF on vascular endothelial cells that revealed increased pleural capillaries in lung cancer. Targeting the VEGF/VEGFR2 pathway might modulate the angiogenic propensity of MAPF in future clinical investigations.
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MESH Headings
- Aged
- Cell Line, Tumor
- Cell Movement/genetics
- Cell Proliferation/genetics
- Cell Survival/genetics
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Female
- Human Umbilical Vein Endothelial Cells
- Humans
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Lung Neoplasms/complications
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Male
- NF-kappa B/genetics
- Neovascularization, Pathologic/complications
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/pathology
- Pleural Effusion/genetics
- Pleural Effusion, Malignant/complications
- Pleural Effusion, Malignant/genetics
- Pleural Effusion, Malignant/pathology
- STAT3 Transcription Factor/genetics
- Vascular Endothelial Growth Factor A/genetics
- Vascular Endothelial Growth Factor Receptor-2/genetics
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Affiliation(s)
- Chih‐Ying Changchien
- Department of Internal MedicineTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
- Department of Biology and AnatomyNational Defense Medical CenterTaipeiTaiwan
| | - Ying Chen
- Department of Biology and AnatomyNational Defense Medical CenterTaipeiTaiwan
| | - Hsin‐Han Chang
- Department of Biology and AnatomyNational Defense Medical CenterTaipeiTaiwan
| | - Shan‐Yueh Chang
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
| | - Wen‐Chiuan Tsai
- Department of PathologyTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
| | - Hao‐Chung Tsai
- Division of Chest MedicineDepartment of Internal MedicineTri‐Service General Hospital Songshan Branch, National Defense Medical CenterTaipeiTaiwan
| | - Chieh‐Yung Wang
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
| | - Herng‐Sheng Lee
- Department of Pathology and Laboratory MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Chen‐Liang Tsai
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
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Comment on "Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial". Pulm Med 2020; 2020:7437019. [PMID: 32518696 PMCID: PMC7260645 DOI: 10.1155/2020/7437019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/08/2020] [Indexed: 11/18/2022] Open
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5
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Wojahn I, Lüdtke TH, Christoffels VM, Trowe MO, Kispert A. TBX2-positive cells represent a multi-potent mesenchymal progenitor pool in the developing lung. Respir Res 2019; 20:292. [PMID: 31870435 PMCID: PMC6929292 DOI: 10.1186/s12931-019-1264-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background In the embryonic mammalian lung, mesenchymal cells act both as a signaling center for epithelial proliferation, differentiation and morphogenesis as well as a source for a multitude of differentiated cell types that support the structure of the developing and mature organ. Whether the embryonic pulmonary mesenchyme is a homogenous precursor pool and how it diversifies into different cell lineages is poorly understood. We have previously shown that the T-box transcription factor gene Tbx2 is expressed in the pulmonary mesenchyme of the developing murine lung and is required therein to maintain branching morphogenesis. Methods We determined Tbx2/TBX2 expression in the developing murine lung by in situ hybridization and immunofluorescence analyses. We used a genetic lineage tracing approach with a Cre line under the control of endogenous Tbx2 control elements (Tbx2cre), and the R26mTmG reporter line to trace TBX2-positive cells in the murine lung. We determined the fate of the TBX2 lineage by co-immunofluorescence analysis of the GFP reporter and differentiation markers in normal murine lungs and in lungs lacking or overexpressing TBX2 in the pulmonary mesenchyme. Results We show that TBX2 is strongly expressed in mesenchymal progenitors in the developing murine lung. In differentiated smooth muscle cells and in fibroblasts, expression of TBX2 is still widespread but strongly reduced. In mesothelial and endothelial cells expression is more variable and scattered. All fetal smooth muscle cells, endothelial cells and fibroblasts derive from TBX2+ progenitors, whereas half of the mesothelial cells have a different descent. The fate of TBX2-expressing cells is not changed in Tbx2-deficient and in TBX2-constitutively overexpressing mice but the distribution and abundance of endothelial and smooth muscle cells is changed in the overexpression condition. Conclusion The fate of pulmonary mesenchymal progenitors is largely independent of TBX2. Nevertheless, a successive and precisely timed downregulation of TBX2 is necessary to allow proper differentiation and functionality of bronchial smooth muscle cells and to limit endothelial differentiation. Our work suggests expression of TBX2 in an early pulmonary mesenchymal progenitor and supports a role of TBX2 in maintaining the precursor state of these cells.
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Affiliation(s)
- Irina Wojahn
- Institut für Molekularbiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Timo H Lüdtke
- Institut für Molekularbiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Vincent M Christoffels
- Department of Anatomy, Embryology and Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mark-Oliver Trowe
- Institut für Molekularbiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Andreas Kispert
- Institut für Molekularbiologie, Medizinische Hochschule Hannover, Hannover, Germany.
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6
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Skok K, Hladnik G, Grm A, Crnjac A. Malignant Pleural Effusion and Its Current Management: A Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E490. [PMID: 31443309 PMCID: PMC6723530 DOI: 10.3390/medicina55080490] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/17/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
Malignant pleural effusion (MPE) is an exudative effusion with malignant cells. MPE is a common symptom and accompanying manifestation of metastatic disease. It affects up to 15% of all patients with cancer and is the most common in lung, breast cancer, lymphoma, gynecological malignancies and malignant mesothelioma. In the last year, many studies were performed focusing on the pathophysiological mechanisms of MPE. With the advancement in molecular techniques, the importance of tumor-host cell interactions is becoming more apparent. Additionally, the process of pathogenesis is greatly affected by activating mutations of EGFR, KRAS, PIK3CA, BRAF, MET, EML4/ALK and RET, which correlate with an increased incidence of MPE. Considering all these changes, the authors aim to present a literature review of the newest findings, review of the guidelines and pathophysiological novelties in this field. Review of the just recently, after seven years published, practice guidelines, as well as analysis of more than 70 articles from the Pubmed, Medline databases that were almost exclusively published in indexed journals in the last few years, have relevance and contribute to the better understanding of the presented topic. MPE still presents a severe medical condition in patients with advanced malignancy. Recent findings in the field of pathophysiological mechanisms of MPE emphasize the role of molecular factors and mutations in the dynamics of the disease and its prognosis. Treatment guidelines offer a patient-centric approach with the use of new scoring systems, an out of hospital approach and ultrasound. The current guidelines address multiple areas of interest bring novelties in the form of validated prediction tools and can, based on evidence, improve patient outcomes. However, the role of biomarkers in a clinical setting, possible new treatment modalities and certain specific situations still present a challenge for new research.
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Affiliation(s)
- Kristijan Skok
- Faculty of Medicine, University of Maribor, Institute of Biomedical Sciences, Taborska Ulica 8, SI-2000 Maribor, Slovenia.
| | - Gaja Hladnik
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, SI-2000 Maribor, Slovenia
| | - Anja Grm
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, SI-2000 Maribor, Slovenia
| | - Anton Crnjac
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, SI-2000 Maribor, Slovenia.
- Department of thoracic surgery, University Medical Centre Maribor, Ljubljanska 5, SI-2000 Maribor, Slovenia.
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7
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Choi J, Ahn HY, Kim YD, Hoseok, Cho JS, Lee J. Location of Ruptured Bullae in Secondary Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:424-429. [PMID: 29234608 PMCID: PMC5716644 DOI: 10.5090/kjtcs.2017.50.6.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
Abstract
Background The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. Methods The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). Conclusion The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.
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Affiliation(s)
- Jinseok Choi
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Pusan National University School of Medicine
| | - Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Pusan National University School of Medicine
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Pusan National University School of Medicine
| | - Hoseok
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Pusan National University School of Medicine
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Pusan National University School of Medicine
| | - Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine
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Paris ND, Coles GL, Ackerman KG. Wt1 and β-catenin cooperatively regulate diaphragm development in the mouse. Dev Biol 2015; 407:40-56. [PMID: 26278035 DOI: 10.1016/j.ydbio.2015.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 01/19/2023]
Abstract
The developing diaphragm consists of various differentiating cell types, many of which are not well characterized during organogenesis. One important but incompletely understood tissue, the diaphragmatic mesothelium, is distinctively present from early stages of development. Congenital Diaphragmatic Hernia (CDH) occurs in humans when diaphragm tissue is lost during development, resulting in high morbidity and mortality postnatally. We utilized a Wilms Tumor 1 (Wt1) mutant mouse model to investigate the involvement of the mesothelium in normal diaphragm signaling and development. Additionally, we developed and characterized a Wt1(CreERT2)-driven β-catenin loss-of-function model of CDH after finding that canonical Wnt signaling and β-catenin are reduced in Wt1 mutant mesothelium. Mice with β-catenin loss or constitutive activation induced in the Wt1 lineage are only affected when tamoxifen injection occurs between E10.5 and E11.5, revealing a critical time-frame for Wt1/ β-catenin activity. Conditional β-catenin loss phenocopies the Wt1 mutant diaphragm defect, while constitutive activation of β-catenin on the Wt1 mutant background is sufficient to close the diaphragm defect. Proliferation and apoptosis are affected, but primarily these genetic manipulations appear to lead to a change in normal diaphragm differentiation. Our data suggest a fundamental role for mesothelial signaling in proper formation of the diaphragm.
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Affiliation(s)
- Nicole D Paris
- Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Garry L Coles
- Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Kate G Ackerman
- Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; Department of Pediatrics, Center for Pediatric Biomedical Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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