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1.
J Microbiol ; 60(7): 689-704, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35731345

ABSTRACT

Shiga toxin-producing Escherichia coli (STEC) is a foodborne pathogen capable of causing illness in humans. In a previous study, our group showed that a STEC isolate belonging to O22:H8 serotype (strain 154) can interfere with STEC O157:H7 colonization both in vitro and in vivo. Using whole-genome sequencing and genomic comparative, we predicted a subset of genes acquired by O22:H8 strain 154 through horizontal gene transfer that might be responsible for the phenotype previously described by our group. Among them were identified genes related to the pathogenesis of non-LEE (locus of enterocyte effacement) STEC, specific metabolic processes, antibiotic resistance and genes encoding for the T6SS-1 that is related to inter-bacterial competition. In addition, we showed that this strain carries stx1c and stx2dact, a mucus-inducible variant. The results obtained in this study provide insights into STEC genomic plasticity and the importance of genomic islands in the adaptation and pathogenesis of this pathogen.


Subject(s)
Escherichia coli Infections , Escherichia coli Proteins , Shiga-Toxigenic Escherichia coli , Animals , Cattle , Escherichia coli Infections/microbiology , Escherichia coli Infections/veterinary , Escherichia coli Proteins/genetics , Phylogeny , Shiga Toxin/genetics , Shiga-Toxigenic Escherichia coli/genetics , Virulence Factors/genetics , Virulence Factors/metabolism
2.
Front Vet Sci ; 8: 614011, 2021.
Article in English | MEDLINE | ID: mdl-33665217

ABSTRACT

Caseous lymphadenitis (CLA) is a chronic disease that affects small ruminants and causes economic losses in the associated breeding system. The causative agent of CLA is Corynebacterium pseudotuberculosis, a Gram-positive bacterium that exhibits tropism for external and internal lymph nodes and induces abscess formation in the host. Bacterial communities often produce a biofilm matrix that serves various functions, including protection against hostile environmental conditions, antibiotics, and the host immune response. Although biofilm formation has been reported for C. pseudotuberculosis, not all strains demonstrate this property in culture. In this work, we report the first comparative proteomic analysis of one biofilm-forming (CAPJ4) and one biofilm-non-forming strain (CAP3W) of C. pseudotuberculosis isolated from goats. Bacterial whole cell protein extracts were obtained for mass spectrometry analyses. Using LC-MS/MS, our studies reveal three and four proteins exclusively found in the CAPJ4 and CAP3W proteome, respectively. In addition, label-free quantitative analysis identified 40 proteins showing at-least 2-fold higher values in CAPJ4 compared CAP3W proteome Notably, CAPJ4 differentially synthesized the penicillin-binding protein, which participates in the formation of peptidoglycans. CAPJ4 also exhibited upregulation of N-acetylmuramoyl-L-alanine amidase and galactose-1-phosphate uridylyltransferase, which are involved in biofilm formation and exopolysaccharide biosynthesis. Here, we demonstrate that biofilm formation in C. pseudotuberculosis is likely associated with specific proteins, some of which were previously shown to be associated with virulence and biofilm formation in other organisms. Our findings may drive studies related to the bacterial mechanisms involved in the biofilm formation, in addition to providing targets for the treatment of CLA.

3.
Sci Rep ; 10(1): 21535, 2020 12 09.
Article in English | MEDLINE | ID: mdl-33299023

ABSTRACT

The zoonotic enterohemorrhagic Escherichia coli (EHEC) O157: H7 bacterium causes diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS) in humans. Cattle are primary reservoirs and EHEC O157: H7; the bacteria predominately inhabit the colon and recto-anal junctions (RAJ). The early innate immune reactions in the infected gut are critical in the pathogenesis of EHEC O157: H7. In this study, calves orally inoculated with EHEC O157: H7 showed infiltration of neutrophils in the lamina propria of ileum and RAJ at 7 and 14 days post-infection. Infected calves had altered mucin layer and mast cell populations across small and large intestines. There were differential transcription expressions of key bovine ß defensins, tracheal antimicrobial peptide (TAP) in the ileum, and lingual antimicrobial peptide (LAP) in RAJ. The main Gram-negative bacterial/LPS signaling Toll-Like receptor 4 (TLR4) was downregulated in RAJ. Intestinal infection with EHEC O157: H7 impacted the gut bacterial communities and influenced the relative abundance of Negativibacillus and Erysipelotrichaceae in mucosa-associated bacteria in the rectum. Thus, innate immunity in the gut of calves showed unique characteristics during infection with EHEC O157: H7, which occurred in the absence of major clinical manifestations but denoted an active immunological niche.


Subject(s)
Escherichia coli Infections/immunology , Escherichia coli O157/metabolism , Gastrointestinal Microbiome/immunology , Adhesins, Bacterial/immunology , Animals , Cattle , Cattle Diseases/immunology , Diarrhea/microbiology , Escherichia coli O157/pathogenicity , Escherichia coli Proteins/immunology , Hemolytic-Uremic Syndrome/microbiology , Ileum/pathology , Rectum/microbiology
4.
J Pept Sci ; 25(3): e3149, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30746861

ABSTRACT

Human pathogenic gram-negative bacteria, such as enteropathogenic Escherichia coli (EPEC), rely on type III secretion systems (T3SS) to translocate virulence factors directly into host cells. The coiled-coil domains present in the structural proteins of T3SS are conformed by amphipathic alpha-helical structures that play an important role in the protein-protein interaction and are essential for the assembly of the translocation complex. To investigate the inhibitory capacity of these domains on the T3SS of EPEC, we synthesized peptides between 7 and 34 amino acids based on the coiled-coil domains of proteins that make up this secretion system. This analysis was performed through in vitro hemolysis assays by assessing the reduction of T3SS-dependent red blood cell lysis in the presence of the synthesized peptides. After confirming its inhibitory capacity, we performed molecular modeling assays using combined techniques, docking-molecular dynamic simulations, and quantum-mechanic calculations of the various peptide-protein complexes, to improve the affinity of the peptides to the target proteins selected from T3SS. These techniques allowed us to demonstrate that the peptides with greater inhibitory activity, directed against the coiled-coil domain of the C-terminal region of EspA, present favorable hydrophobic and hydrogen bond molecular interactions. Particularly, the hydrogen bond component is responsible for the stabilization of the peptide-protein complex. This study demonstrates that compounds targeting T3SS from pathogenic bacteria can indeed inhibit bacterial infection by presenting a higher specificity than broad-spectrum antibiotics. In turn, these peptides could be taken as initial structures to design and synthesize new compounds that mimic their inhibitory pharmacophoric pattern.


Subject(s)
Anti-Bacterial Agents/pharmacology , Enteropathogenic Escherichia coli/drug effects , Enteropathogenic Escherichia coli/metabolism , Peptides/pharmacology , Type III Secretion Systems/drug effects , Anti-Bacterial Agents/chemical synthesis , Anti-Bacterial Agents/chemistry , Circular Dichroism , Enteropathogenic Escherichia coli/growth & development , Humans , Microbial Sensitivity Tests , Models, Molecular , Peptides/chemical synthesis , Peptides/chemistry , Thermodynamics
5.
BMC Genomics ; 20(1): 11, 2019 Jan 07.
Article in English | MEDLINE | ID: mdl-30616502

ABSTRACT

BACKGROUND: Streptococcus agalactiae (GBS) is a major pathogen of Nile tilapia, a global commodity of the aquaculture sector. The aims of this study were to evaluate protein expression in the main genotypes of GBS isolated from diseased fishes in Brazil using a label-free shotgun nano-liquid chromatography-ultra definition mass spectrometry (nanoLC-UDMSE) approach and to compare the differential abundance of proteins identified in strains isolated from GBS-infected fishes and humans. RESULTS: A total of 1070 protein clusters were identified by nanoLC-UDMSE in 5 fish-adapted GBS strains belonging to sequence types ST-260 and ST-927 and the non-typeable (NT) lineage and 1 human GBS strain (ST-23). A total of 1065 protein clusters corresponded to the pan-proteome of fish-adapted GBS strains; 989 of these were identified in all fish-adapted GBS strains (core proteome), and 62 were shared by at least two strains (accessory proteome). Proteins involved in the stress response and in the regulation of gene expression, metabolism and virulence were detected, reflecting the adaptive ability of fish-adapted GBS strains in response to stressor factors that affect bacterial survival in the aquatic environment and bacterial survival and multiplication inside the host cell. Measurement of protein abundance among different hosts showed that 5 and 26 proteins were exclusively found in the human- and fish-adapted GBS strains, respectively; the proteins exclusively identified in fish isolates were mainly related to virulence factors. Furthermore, 215 and 269 proteins were up- and down-regulated, respectively, in the fish-adapted GBS strains in comparison to the human isolate. CONCLUSIONS: Our study showed that the core proteome of fish-adapted GBS strains is conserved and demonstrated high similarity of the proteins expressed by fish-adapted strains to the proteome of the human GBS strain. This high degree of proteome conservation of different STs suggests that, a monovalent vaccine may be effective against these variants.


Subject(s)
Fish Diseases/genetics , Proteome/genetics , Streptococcal Infections/genetics , Streptococcus agalactiae/genetics , Animals , Brazil , Cichlids/genetics , Cichlids/microbiology , Fish Diseases/microbiology , Genotype , Humans , Phylogeny , Streptococcal Infections/microbiology , Streptococcus agalactiae/pathogenicity , Virulence/genetics
6.
Gene ; 677: 349-360, 2018 Nov 30.
Article in English | MEDLINE | ID: mdl-30098432

ABSTRACT

Corynebacterium pseudotuberculosis has been widely studied in an effort to understand its biological evolution. Transcriptomics has revealed possible candidates for virulence and pathogenicity factors of strain 1002 (biovar Ovis). Because C. pseudotuberculosis is classified into two biovars, Ovis and Equi, it was interesting to assess the transcriptional profile of biovar Equi strain 258, the causative agent of ulcerative lymphangitis. The genome of this strain was re-sequenced; the reassembly was completed using optical mapping technology, and the sequence was subsequently re-annotated. Two growth conditions that occur during the host infection process were simulated for the transcriptome: the osmotic and acid medium. Genes that may be associated with the microorganism's resilience under unfavorable conditions were identified through RNAseq, including genes present in pathogenicity islands. The RT-qPCR was performed to confirm the results in biological triplicate for each condition for some genes. The results extend our knowledge of the factors associated with the spread and persistence of C. pseudotuberculosis during the infection process and suggest possible avenues for studies related to the development of vaccines, diagnosis, and therapies that might help minimize damage to agribusinesses.


Subject(s)
Corynebacterium pseudotuberculosis/genetics , Stress, Physiological/genetics , Transcriptome/genetics , Animals , Bacterial Proteins/genetics , Corynebacterium Infections/microbiology , Gene Expression Profiling/methods , Genome, Bacterial/genetics , Sheep , Virulence/genetics , Virulence Factors/genetics
7.
PLoS One ; 13(12): e0208520, 2018.
Article in English | MEDLINE | ID: mdl-30596662

ABSTRACT

Enterohemorrhagic Escherichia coli (EHEC) O157:H7 is a human pathogen responsible for diarrhea, hemorrhagic colitis and hemolytic uremic syndrome (HUS). To promote a comprehensive insight into the molecular basis of EHEC O157:H7 physiology and pathogenesis, the combined proteome of EHEC O157:H7 strains, Clade 8 and Clade 6 isolated from cattle in Argentina, and the standard EDL933 (clade 3) strain has been analyzed. From shotgun proteomic analysis a total of 2,644 non-redundant proteins of EHEC O157:H7 were identified, which correspond approximately 47% of the predicted proteome of this pathogen. Normalized spectrum abundance factor analysis was performed to estimate the protein abundance. According this analysis, 50 proteins were detected as the most abundant of EHEC O157:H7 proteome. COG analysis showed that the majority of the most abundant proteins are associated with translation processes. A KEGG enrichment analysis revealed that Glycolysis / Gluconeogenesis was the most significant pathway. On the other hand, the less abundant detected proteins are those related to DNA processes, cell respiration and prophage. Among the proteins that composed the Type III Secretion System, the most abundant protein was EspA. Altogether, the results show a subset of important proteins that contribute to physiology and pathogenicity of EHEC O157:H7.


Subject(s)
Escherichia coli O157/metabolism , Escherichia coli Proteins/analysis , Proteomics , Animals , Cattle , Chromatography, High Pressure Liquid , Escherichia coli O157/classification , Escherichia coli O157/isolation & purification , Humans , Metabolic Networks and Pathways/genetics , Proteome/analysis , Tandem Mass Spectrometry
8.
BMC Syst Biol ; 10(1): 103, 2016 11 04.
Article in English | MEDLINE | ID: mdl-27814699

ABSTRACT

BACKGROUND: Corynebacterium pseudotuberculosis (Cp) is a gram-positive bacterium that is classified into equi and ovis serovars. The serovar ovis is the etiological agent of caseous lymphadenitis, a chronic infection affecting sheep and goats, causing economic losses due to carcass condemnation and decreased production of meat, wool, and milk. Current diagnosis or treatment protocols are not fully effective and, thus, require further research of Cp pathogenesis. RESULTS: Here, we mapped known protein-protein interactions (PPI) from various species to nine Cp strains to reconstruct parts of the potential Cp interactome and to identify potentially essential proteins serving as putative drug targets. On average, we predict 16,669 interactions for each of the nine strains (with 15,495 interactions shared among all strains). An in silico sanity check suggests that the potential networks were not formed by spurious interactions but have a strong biological bias. With the inferred Cp networks we identify 181 essential proteins, among which 41 are non-host homologous. CONCLUSIONS: The list of candidate interactions of the Cp strains lay the basis for developing novel hypotheses and designing according wet-lab studies. The non-host homologous essential proteins are attractive targets for therapeutic and diagnostic proposes. They allow for searching of small molecule inhibitors of binding interactions enabling modern drug discovery. Overall, the predicted Cp PPI networks form a valuable and versatile tool for researchers interested in Corynebacterium pseudotuberculosis.


Subject(s)
Bacterial Proteins/metabolism , Computer Simulation , Corynebacterium pseudotuberculosis/metabolism , Protein Interaction Mapping/methods
9.
Vet Microbiol ; 174(1-2): 255-60, 2014 Nov 07.
Article in English | MEDLINE | ID: mdl-25236983

ABSTRACT

Caseous lymphadenitis (CLA) is a highly prevalent disease in goats and sheep worldwide, which is caused by Corynebacterium pseudotuberculosis. Although several prophylactic methods against CLA have been proposed previously, the identification of new C. pseudotuberculosis proteins that are really produced during the infectious process is still needed to improve efficiency and accuracy in vaccines and diagnostics. In this study, we used optimized conditions for serological proteome analysis (SERPA) in order to identify new immune-reactive proteins in C. pseudotuberculosis culture supernatants of two strains, 1002 and C231, isolated from goats and sheep, respectively. Using a sheep and goat serum pool, 13 novel immune-reactive exoproteins common to the two strains were identified. Four of these proteins present known functions and were already described as immune-reactive proteins in other microorganisms, whereas the other nine are of unknown function and show low similarity with proteins from other bacterial species. These data reveal promising targets for immunoprophylactic methods against CLA.


Subject(s)
Bacterial Proteins/therapeutic use , Corynebacterium Infections/veterinary , Corynebacterium pseudotuberculosis/metabolism , Goat Diseases/microbiology , Lymphadenitis/veterinary , Sheep Diseases/microbiology , Animals , Bacterial Proteins/genetics , Corynebacterium Infections/genetics , Corynebacterium Infections/metabolism , Corynebacterium Infections/prevention & control , Corynebacterium pseudotuberculosis/genetics , Drug Discovery/methods , Goats , Lymphadenitis/prevention & control , Proteomics , Sheep , Sheep, Domestic
10.
BMC Genomics ; 15: 14, 2014 Jan 09.
Article in English | MEDLINE | ID: mdl-24405787

ABSTRACT

BACKGROUND: The completion of whole-genome sequencing for Corynebacterium pseudotuberculosis strain 1002 has contributed to major advances in research aimed at understanding the biology of this microorganism. This bacterium causes significant loss to goat and sheep farmers because it is the causal agent of the infectious disease caseous lymphadenitis, which may lead to outcomes ranging from skin injury to animal death. In the current study, we simulated the conditions experienced by the bacteria during host infection. By sequencing transcripts using the SOLiDTM 3 Plus platform, we identified new targets expected to potentiate the survival and replication of the pathogen in adverse environments. These results may also identify possible candidates useful for the development of vaccines, diagnostic kits or therapies aimed at the reduction of losses in agribusiness. RESULTS: Under the 3 simulated conditions (acid, osmotic and thermal shock stresses), 474 differentially expressed genes exhibiting at least a 2-fold change in expression levels were identified. Important genes to the infection process were induced, such as those involved in virulence, defence against oxidative stress, adhesion and regulation, and many genes encoded hypothetical proteins, indicating that further investigation of the bacterium is necessary. The data will contribute to a better understanding of the biology of C. pseudotuberculosis and to studies investigating strategies to control the disease. CONCLUSIONS: Despite the veterinary importance of C. pseudotuberculosis, the bacterium is poorly characterised; therefore, effective treatments for caseous lymphadenitis have been difficult to establish. Through the use of RNAseq, these results provide a better biological understanding of this bacterium, shed light on the most likely survival mechanisms used by this microorganism in adverse environments and identify candidates that may help reduce or even eradicate the problems caused by this disease.


Subject(s)
Corynebacterium pseudotuberculosis/genetics , Genes, Bacterial , Stress, Physiological , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Corynebacterium pseudotuberculosis/metabolism , Down-Regulation , Hydrogen-Ion Concentration , Osmotic Pressure , RNA, Untranslated/metabolism , Sequence Analysis, DNA , Sigma Factor/genetics , Sigma Factor/metabolism , Temperature , Up-Regulation
11.
Curr Microbiol ; 67(1): 100-6, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23455494

ABSTRACT

Chromobacterium violaceum is a beta-proteobacterium with high biotechnological potential, found in tropical environments. This bacterium causes opportunistic infections in both humans and animals, that can spread throughout several tissues, quickly leading to the death of the host. Genomic studies identified potential mechanisms of pathogenicity but no further studies were done to confirm the expression of these systems. In this study 36 unique protein entries were identified in databank from a two-dimensional profile of C. violaceum secreted proteins. Chromobacterium violaceum exoproteomic preliminary studies confirmed the production of proteins identified as virulence factors (such as a collagenase, flagellum proteins, metallopeptidases, and toxins), allowing us to better understand its pathogenicity mechanisms. Biotechnologically interesting proteins (such as chitinase and chitosanase) were also identified among the secreted proteins, as well as proteins involved in the transport and capture of amino acids, carbohydrates, and oxidative stress protection. Overall, the secreted proteins identified provide us important insights on pathogenicity mechanisms, biotechnological potential, and environment adaptation of C. violaceum.


Subject(s)
Bacterial Proteins/analysis , Biotechnology/methods , Chromobacterium/chemistry , Chromobacterium/pathogenicity , Industrial Microbiology/methods , Proteome/analysis , Animals , Chromobacterium/isolation & purification , Electrophoresis, Gel, Two-Dimensional , Environmental Microbiology , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/veterinary , Humans , Mass Spectrometry , Virulence Factors/analysis
12.
Microb Biotechnol ; 6(2): 168-77, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23316806

ABSTRACT

Corynebacterium pseudotuberculosis equi is a Gram-positive pathogenic bacterium which affects a variety of hosts. Besides the great economic losses it causes to horse-breeders, this organism is also known to be an important infectious agent to cattle and buffaloes. As an outcome of the efforts in characterizing the molecular basis of its virulence, several complete genome sequences were made available in recent years, enabling the large-scale assessment of genes throughout distinct isolates. Meanwhile, the RNA-seq stood out as the technology of choice for comprehensive transcriptome studies, which may bring valuable information regarding active genomic regions, despite of the still impeditive associated costs. In an attempt to increase the use of generated reads per instrument run, by effectively eliminating unwanted rRNAs from total RNA samples without relying on any commercially available kits, we applied denaturing high-performance liquid chromatography (DHPLC) as an alternative method to assess the transcriptional profile of C. pseudotuberculosis. We have found that the DHPLC depletion method, allied to Ion Torrent sequencing, allows mapping of transcripts in a comprehensive way and identifying novel transcripts when a de novo approach is used. These data encourage us to use DHPLC in future transcriptional evaluations in C. pseudotuberculosis.


Subject(s)
Chromatography, High Pressure Liquid/methods , Corynebacterium pseudotuberculosis/metabolism , High-Throughput Nucleotide Sequencing/methods , Nucleic Acid Denaturation/genetics , RNA, Ribosomal/chemistry , Transcriptome , Animals , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Corynebacterium Infections/microbiology , Corynebacterium Infections/veterinary , Corynebacterium pseudotuberculosis/classification , Corynebacterium pseudotuberculosis/genetics , Horse Diseases/microbiology , Horses/microbiology , RNA, Bacterial/genetics , RNA, Bacterial/metabolism , RNA, Ribosomal/genetics , RNA, Ribosomal/metabolism , Species Specificity
13.
Integr Biol (Camb) ; 4(7): 789-94, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22641428

ABSTRACT

Corynebacterium pseudotuberculosis is a bacterium which causes diseases such as caseous lymphadenitis in small ruminants, resulting in large-scale economic losses for agribusiness worldwide. Consequently, this bacterium including its transcriptional profile analysis has been the focus of various studies. Identification of the transcripts that appear under conditions that simulate the environment encountered by this bacterial species in the host is of great importance in discovering new targets for the production of more efficient vaccines. We sequenced the cDNA of Corynebacterium pseudotuberculosis strain 1002, using the SOLiD V3 system, under the following conditions: osmotic stress (2 M), acidity (pH), heat shock (50 °C) and control condition (N). To identify the transcripts shared among the stimulons and integrate this information with the results from BLAST and BLAST2GO, we developed the software CoreStImulon (CSI) which allows the user to individually distinguish the genes in terms of their participation in biological processes, their function and cellular location. In the biosynthetic processes, eleven genes represented in the core stimulon and twenty genes in the control were observed. This validates the hypothesis that the organisms strategy for surviving in a hostile environment is through growth reduction. The oxidation reduction process, response to stress process, and cell adhesion are controlled by genes that contribute to bacterial cell maintenance under stress conditions; these could be involved in their pathogenicity. The methodology for identification of transcripts obtained by ab initio assembly and shared among the stimulons permitted candidates selection for vaccine studies. CSI is available at https://sourceforge.net/projects/corestimulon/.


Subject(s)
Computational Biology/methods , Corynebacterium pseudotuberculosis/genetics , Corynebacterium pseudotuberculosis/metabolism , Gene Expression Regulation, Bacterial , Bacterial Adhesion , DNA/metabolism , DNA, Complementary/metabolism , Gene Expression Profiling , Hydrogen-Ion Concentration , Osmosis , Oxidation-Reduction , Programming Languages , RNA, Messenger/metabolism , Software , Temperature , Transcription, Genetic
14.
Rev. méd. Minas Gerais ; 20(n.esp)nov. 2010. ilus
Article in Portuguese | LILACS | ID: lil-568296

ABSTRACT

Adenocarcinoma colorretal com células em anel de sinete é uma variante do adenocarcinoma mucinoso. Esse tipo de neoplasia é comum em pacientes com idade avançada, sendo raro em crianças, sendo geralmente diagnosticado em estágios avançados. Apresenta pior prognóstico e baixa taxa de sobrevida em cinco anos. O diagnóstico é realizado por exame anatomopatológico associado a exames de imagem e quadro clínico evolutivo. Apresenta-se e discute-se um caso de adenocarcinoma colorretal com células em anel de sinete em um paciente de 14 anos.


Colorectal Adenocarcinoma with signet-ring cells is a mucinous variant of adenocarcinoma. This type of neoplasm is common in patients with advanced age, being sufficiently uncommon in children and diagnosied in advanced periods of training already, presenting one worse prognostic and supervened tax of below five year. The diagnostic is carried through anatomy-pathological examination, associate the image examinations and picture physician-evolution. We present and we argue a case report of colorectal adenocarcinoma with signet-ring cells in a patient of fourteen years.


Subject(s)
Humans , Male , Adolescent , Carcinoma, Signet Ring Cell , Colorectal Neoplasms/diagnosis , Laparoscopy
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