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1.
Braz J Med Biol Res ; 57: e13190, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38896642

RESUMO

The overexpression of the prostate cancer antigen 3 (PCA3) gene is well-defined as a marker for prostate cancer (PCa) diagnosis. Although widely used in clinical research, PCA3 molecular mechanisms remain unknown. Herein we used phage display technology to identify putative molecules that bind to the promoter region of PCA3 gene and regulate its expression. The most frequent peptide PCA3p1 (80%) was similar to the Rho GTPase activating protein 21 (ARHGAP21) and its binding affinity was confirmed using Phage Bead ELISA. We showed that ARHGAP21 silencing in LNCaP prostate cancer cells decreased PCA3 and androgen receptor (AR) transcriptional levels and increased prune homolog 2 (PRUNE2) coding gene expression, indicating effective involvement of ARHGAP21 in androgen-dependent tumor pathway. Chromatin immunoprecipitation assay confirmed the interaction between PCA3 promoter region and ARHGAP21. This is the first study that described the role of ARHGAP21 in regulating the PCA3 gene under the androgenic pathway, standing out as a new mechanism of gene regulatory control during prostatic oncogenesis.


Assuntos
Antígenos de Neoplasias , Proteínas Ativadoras de GTPase , Regulação Neoplásica da Expressão Gênica , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/genética , Neoplasias da Próstata/metabolismo , Proteínas Ativadoras de GTPase/genética , Proteínas Ativadoras de GTPase/metabolismo , Regulação Neoplásica da Expressão Gênica/genética , Linhagem Celular Tumoral , Antígenos de Neoplasias/genética , Antígenos de Neoplasias/metabolismo , Regiões Promotoras Genéticas/genética , Imunoprecipitação da Cromatina , Receptores Androgênicos/genética , Receptores Androgênicos/metabolismo , Ensaio de Imunoadsorção Enzimática
6.
J Proteomics ; 224: 103818, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32434038

RESUMO

Human L-asparaginase-like protein 1 (ASRGL1) has hydrolytic activity against L-asparagine and isoaspartyl dipeptides. As an N-terminal nucleophile hydrolase family member, its activation depends on an intramolecular autoprocessing step between G167 and T168. In vitro, autoprocessing reaches only 50% completion, which restrains the activity and hampers the full understanding of the activation process. The ASRGL1 dimer interface plays a critical role in intramolecular processing, and the interactions within oligomers can offer relevant information about autoprocessing. In this work, a fully processed trimeric conformation of ASRGL1 was observed for the first time, and we combined biophysical and structural proteomics assays to characterize trimeric ASRGL1. Our analyses show that oligomerization is critical for autoprocessing, hydrolytic activity and thermal stability. The newest trimeric ASRGL1 conformation enhances protein activity and presents a melting temperature deviation of 4.33 °C in comparison to the monomeric conformation. The interaction of the third monomer in the trimeric conformation is driven by an α-helix comprising residues KVNLARLTLF (227-236).


Assuntos
Asparaginase , Autoantígenos , Humanos , Hidrólise
7.
Artigo em Inglês | MEDLINE | ID: mdl-32265042

RESUMO

In central Brazil, in the municipality of Faina (state of Goiás), the small and isolated village of Araras comprises a genetic cluster of xeroderma pigmentosum (XP) patients. The high level of consanguinity and the geographical isolation gave rise to a high frequency of XP patients. Recently, two founder events were identified affecting that community, with two independent mutations at the POLH gene, c.764 + 1 G > A (intron 6) and c.907 C > T; p.Arg303* (exon 8). These deleterious mutations lead to the xeroderma pigmentosum variant syndrome (XP-V). Previous reports identified both mutations in other countries: the intron 6 mutation in six patients (four families) from Northern Spain (Basque Country and Cantabria) and the exon 8 mutation in two patients from different families in Europe, one of them from Kosovo. In order to investigate the ancestry of the XP patients and the age for these mutations at Araras, we generated genotyping information for 22 XP-V patients from Brazil (16), Spain (6) and Kosovo (1). The local genomic ancestry and the shared haplotype segments among the patients showed that the intron 6 mutation at Araras is associated with an Iberian genetic legacy. All patients from Goiás, homozygotes for intron 6 mutation, share with the Spanish patients identical-by-descent (IBD) genomic segments comprising the mutation. The entrance date for the Iberian haplotype at the village was calculated to be approximately 200 years old. This result is in agreement with the historical arrival of Iberian individuals at the Goiás state (BR). Patients from Goiás and the three families from Spain share 1.8 cM (family 14), 1.7 cM (family 15), and a more significant segment of 4.7 cM within family 13. On the other hand, the patients carrying the exon 8 mutation do not share any specific genetic segment, indicating an old genetic distance between them or even no common ancestry.


Assuntos
DNA Polimerase Dirigida por DNA/genética , Haplótipos , Padrões de Herança , Mutação , Isolamento Reprodutivo , Xeroderma Pigmentoso/genética , Brasil/epidemiologia , Consanguinidade , Europa (Continente)/epidemiologia , Éxons , Feminino , Genética Populacional , Heterozigoto , Homozigoto , Migração Humana , Humanos , Íntrons , Masculino , Fenótipo , Xeroderma Pigmentoso/epidemiologia , Xeroderma Pigmentoso/patologia
8.
Biochim Biophys Acta Mol Basis Dis ; 1865(6): 1502-1515, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30853403

RESUMO

Abnormalities in cerebellar structure and function may cause ataxia, a neurological dysfunction of motor coordination. In the course of the present study, we characterized a mutant mouse lineage with an ataxia-like phenotype. We localized the mutation on chromosome 17 and mapped it to position 1534 of the Nox3 gene, resulting in p.Asn64Tyr change. The primary defect observed in Nox3eqlb mice was increased proliferation of cerebellar granule cell precursors (GCPs). cDNA microarray comparing Nox3eqlb and BALB/c neonatal cerebellum revealed changes in the expression of genes involved in the control of cell proliferation. Nox3eqlb GCPs and NSC produce higher amounts of reactive oxygen species (ROS) and upregulate the expression of SHH target genes, such as Gli1-3 and Ccnd1 (CyclinD1). We hypothesize that this new mutation is responsible for an increase in proliferation via stimulation of the SHH pathway. We suggest this mutant mouse lineage as a new model to investigate the role of ROS in neuronal precursor cell proliferation.


Assuntos
Ataxia/genética , Cerebelo/enzimologia , Proteínas Hedgehog/genética , NADPH Oxidases/genética , Células-Tronco Neurais/enzimologia , Transdução de Sinais/genética , Animais , Ataxia/enzimologia , Ataxia/fisiopatologia , Diferenciação Celular , Proliferação de Células , Cerebelo/crescimento & desenvolvimento , Cerebelo/patologia , Mapeamento Cromossômico , Cromossomos de Mamíferos , Ciclina D1/genética , Ciclina D1/metabolismo , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento , Proteínas Hedgehog/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Knockout , Atividade Motora/genética , Mutação , NADPH Oxidases/deficiência , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Células-Tronco Neurais/patologia , Cultura Primária de Células , Espécies Reativas de Oxigênio/metabolismo , Proteína GLI1 em Dedos de Zinco/genética , Proteína GLI1 em Dedos de Zinco/metabolismo , Proteína Gli2 com Dedos de Zinco/genética , Proteína Gli2 com Dedos de Zinco/metabolismo , Proteína Gli3 com Dedos de Zinco/genética , Proteína Gli3 com Dedos de Zinco/metabolismo
9.
Br J Dermatol ; 176(5): 1270-1278, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27664908

RESUMO

BACKGROUND: Xeroderma pigmentosum (XP) is a rare human syndrome associated with hypersensitivity to sunlight and a high frequency of skin tumours at an early age. We identified a community in the state of Goias (central Brazil), a sunny and tropical region, with a high incidence of XP (17 patients among approximately 1000 inhabitants). OBJECTIVES: To identify gene mutations in the affected community and map the distribution of the affected alleles, correlating the mutations with clinical phenotypes. METHODS: Functional analyses of DNA repair capacity and cell-cycle responses after ultraviolet exposure were investigated in cells from local patients with XP, allowing the identification of the mutated gene, which was then sequenced to locate the mutations. A specific assay was designed for mapping the distribution of these mutations in the community. RESULTS: Skin primary fibroblasts showed normal DNA damage removal but abnormal DNA synthesis after ultraviolet irradiation and deficient expression of the Polη protein, which is encoded by POLH. We detected two different POLH mutations: one at the splice donor site of intron 6 (c.764 +1 G>A), and the other in exon 8 (c.907 C>T, p.Arg303X). The mutation at intron 6 is novel, whereas the mutation at exon 8 has been previously described in Europe. Thus, these mutations were likely brought to the community long ago, suggesting two founder effects for this rare disease. CONCLUSIONS: This work describes a genetic cluster involving POLH, and, particularly unexpected, with two independent founder mutations, including one that likely originated in Europe.


Assuntos
Efeito Fundador , Mutação/genética , Neoplasias Cutâneas/genética , Xeroderma Pigmentoso/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/etnologia , Europa (Continente)/etnologia , Feminino , Heterozigoto , Homozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Células Tumorais Cultivadas , Xeroderma Pigmentoso/etnologia
10.
Genet Mol Res ; 15(4)2016 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-27813588

RESUMO

Coffee, an agronomical crop of great economic importance, is also among the most commonly traded commodities in worldwide markets. Antimicrobial peptides, which play a role in plant defense, have been identified and isolated particularly from seeds. We isolated and immunolocalized Cc-LTP2, a new lipid transfer protein (LTP) from Coffea canephora seeds. We report its antimicrobial activity against various phytopathogenic fungi of economic importance, and against the bacterium Xanthomonas euvesicatoria. Peptides from C. canephora seeds were initially extracted using acid buffer and subjected to ion-exchange and reverse-phase chromatographies. A purified peptide of approximately 9 kDa, which we named Cc-LTP2, was then subjected to amino acid sequencing. The analyses showed that it was similar to LTPs isolated from various plants. The tissue and subcellular localization of C. canephora LTPs indicated that they were located in cell walls and intracellular palisade parenchyma, mainly in large vacuoles. The results of immunohistochemistry and histochemistry superposed from C. canephora seed tissues showed that LTPs and lipid bodies are present in organelles, supporting the hypothesis that LTPs from seeds are involved in lipid mobilization during germination. Cc-LTP2 did inhibit the development of the phytopathogenic fungi Colletotrichum lindemuthianum, Colletotrichum gloeosporioides, Fusarium solani, Fusarium lateritium, and Colletotrichum sp, but did inhibit X. euvesicatoria. Cc-LTP2 also increased membrane permeability and induced endogenous production of reactive oxygen species in all the fungi tested.


Assuntos
Anti-Infecciosos/química , Antifúngicos/química , Proteínas de Transporte/química , Coffea/química , Anti-Infecciosos/isolamento & purificação , Anti-Infecciosos/farmacocinética , Antifúngicos/isolamento & purificação , Antifúngicos/farmacologia , Antioxidantes/química , Antioxidantes/farmacologia , Proteínas de Transporte/genética , Proteínas de Transporte/isolamento & purificação , Proteínas de Transporte/farmacologia , Fusarium/efeitos dos fármacos , Fusarium/patogenicidade , Espécies Reativas de Oxigênio/metabolismo , Xanthomonas/efeitos dos fármacos , Xanthomonas/patogenicidade
11.
Curr Med Chem ; 21(20): 2322-30, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24438525

RESUMO

Anticancer drug research based on natural compounds enabled the discovery of many drugs currently used in cancer therapy. Here, we report the in vitro, in vivo and in silico anticancer and estrogen-like activity of Psidium guajava L. (guava) extracts and enriched mixture containing the meroterpenes guajadial, psidial A and psiguadial A and B. All samples were evaluated in vitro for anticancer activity against nine human cancer lines: K562 (leukemia), MCF7 (breast), NCI/ADR-RES (resistant ovarian cancer), NCI-H460 (lung), UACC-62 (melanoma), PC-3 (prostate), HT-29 (colon), OVCAR-3 (ovarian) and 786-0 (kidney). Psidium guajava's active compounds displayed similar physicochemical properties to estradiol and tamoxifen, as in silico molecular docking studies demonstrated that they fit into the estrogen receptors (ERs). The meroterpene-enriched fraction was also evaluated in vivo in a Solid Ehrlich murine breast adenocarcinoma model, and showed to be highly effective in inhibiting tumor growth, also demonstrating uterus increase in comparison to negative controls. The ability of guajadial, psidial A and psiguadials A and B to reduce tumor growth and stimulate uterus proliferation, as well as their in silico docking similarity to tamoxifen, suggest that these compounds may act as Selective Estrogen Receptors Modulators (SERMs), therefore holding significant potential for anticancer therapy.


Assuntos
Antineoplásicos Fitogênicos/farmacologia , Proliferação de Células/efeitos dos fármacos , Neoplasias/patologia , Extratos Vegetais/farmacologia , Psidium/química , Moduladores Seletivos de Receptor Estrogênico/farmacologia , Animais , Linhagem Celular Tumoral , Biologia Computacional/métodos , Estrogênios , Feminino , Humanos , Camundongos Endogâmicos BALB C , Neoplasias/metabolismo , Extratos Vegetais/química , Folhas de Planta/química , Ensaios Antitumorais Modelo de Xenoenxerto
12.
Protein Sci ; 22(1): 128-32, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23139169

RESUMO

Snake venom serine proteinases (SVSPs) are hemostatically active toxins that perturb the maintenance and regulation of both the blood coagulation cascade and fibrinolytic feedback system at specific points, and hence, are widely used as tools in pharmacological and clinical diagnosis. The crystal structure of a thrombin-like enzyme (TLE) from Bothrops jararacussu venom (Jararacussin-I) was determined at 2.48 Å resolution. This is the first crystal structure of a TLE and allows structural comparisons with both the Agkistrodon contortrix contortrix Protein C Activator and the Trimeresurus stejnegeri plasminogen activator. Despite the highly conserved overall fold, significant differences in the amino acid compositions and three-dimensional conformations of the loops surrounding the active site significantly alter the molecular topography and charge distribution profile of the catalytic interface. In contrast to other SVSPs, the catalytic interface of Jararacussin-I is highly negatively charged, which contributes to its unique macromolecular selectivity.


Assuntos
Serina Endopeptidases/química , Venenos de Serpentes/enzimologia , Trombina/química , Trombina/economia , Venenos de Víboras/química , Animais , Biocatálise , Bothrops , Cromatografia de Afinidade , Cromatografia em Gel , Cristalografia por Raios X , Substâncias Macromoleculares/química , Substâncias Macromoleculares/metabolismo , Modelos Moleculares , Conformação Proteica , Serina Endopeptidases/isolamento & purificação , Serina Endopeptidases/metabolismo , Venenos de Víboras/isolamento & purificação , Venenos de Víboras/metabolismo
13.
Acta Crystallogr D Biol Crystallogr ; 68(Pt 6): 695-702, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22683792

RESUMO

Blood coagulation is an important process in haemostasis, and disorders of blood coagulation can lead to an increased risk of haemorrhage and thrombosis. Coagulation is highly conserved in mammals and has been comprehensively studied in humans in the investigation of bleeding or thrombotic diseases. Some substances can act as inhibitors of blood coagulation and may affect one or multiple enzymes throughout the process. A specific thrombin inhibitor called infestin has been isolated from the midgut of the haematophagous insect Triatoma infestans. Infestin is a member of the nonclassical Kazal-type serine protease inhibitors and is composed of four domains, all of which have a short central α-helix and a small antiparallel ß-sheet. Domains 1 and 4 of infestin (infestins 1 and 4) possess specific inhibitory activities. Infestin 1 inhibits thrombin, while infestin 4 is an inhibitor of factor XIIa, plasmin and factor Xa. Here, the structure determination and structural analysis of infestin 1 complexed with trypsin and of infestin 4 alone are reported. Through molecular modelling and docking, it is suggested that the protein-protein binding site is conserved in the infestin 1-thrombin complex compared with other Kazal-type inhibitors. Infestin 4 is able to bind factor XIIa, and the F9N and N11R mutants selected by phage display were shown to be more selective for factor XIIa in comparison to the wild type.


Assuntos
Proteínas de Insetos/química , Triatoma/química , Animais , Proteínas de Insetos/metabolismo , Modelos Moleculares , Ligação Proteica , Domínios e Motivos de Interação entre Proteínas , Homologia Estrutural de Proteína , Trombina/química , Trombina/metabolismo
14.
Int J Biol Macromol ; 51(3): 209-14, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22584077

RESUMO

Catalytically inactive phospholipase A(2) (PLA(2)) homologues play key roles in the pathogenesis induced by snake envenomation, causing extensive tissue damage via a mechanism still unknown. Although, the amino acid residues directly involved in catalysis are conserved, the substitution of Asp49 by Arg/Lys/Gln or Ser prevents the binding of the essential calcium ion and hence these proteins are incapable of hydrolyzing phospholipids. In this work, the crystal structure of a Lys49-PLA(2) homologue from Bothrops brazili (MTX-II) was solved in two conformational states: (a) native, with Lys49 singly coordinated by the backbone oxygen atom of Val31 and (b) complexed with tetraethylene glycol (TTEG). Interestingly, the TTEG molecule was observed in two different coordination cages depending on the orientation of the nominal calcium-binding loop and of the residue Lys49. These structural observations indicate a direct role for the residue Lys49 in the functioning of a catalytically inactive PLA(2) homologue suggesting a contribution of the active site-like region in the expression of pharmacological effects such as myotoxicity and edema formation. Despite the several crystal structures of Lys49-PLA(2) homologues already determined, their biological assembly remains controversial with two possible conformations. The extended dimer with the hydrophobic channel exposed to the solvent and the compact dimer in which the active site-like region is occluded by the dimeric interface. In the MTX-II crystal packing analysis was found only the extended dimer as a possible stable quaternary arrangement.


Assuntos
Proteínas Mutantes/química , Fosfolipases A2/química , Animais , Domínio Catalítico , Etilenoglicóis/química , Ligantes , Modelos Moleculares , Proteínas Mutantes/isolamento & purificação , Fosfolipases A2/isolamento & purificação , Conformação Proteica , Multimerização Proteica , Estrutura Secundária de Proteína
15.
Biochem Biophys Res Commun ; 421(1): 124-8, 2012 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-22490662

RESUMO

L-Amino acid oxidases (LAAOs) are flavoenzymes that catalytically deaminate L-amino acids to corresponding α-keto acids with the concomitant production of ammonia (NH(3)) and hydrogen peroxide (H(2)O(2)). Particularly, snake venom LAAOs have been attracted much attention due to their diverse clinical and biological effects, interfering on human coagulation factors and being cytotoxic against some pathogenic bacteria and Leishmania ssp. In this work, a new LAAO from Bothrops jararacussu venom (BjsuLAAO) was purified, functionally characterized and its structure determined by X-ray crystallography at 3.1 Å resolution. BjsuLAAO showed high catalytic specificity for aromatic and aliphatic large side-chain amino acids. Comparative structural analysis with prokaryotic LAAOs, which exhibit low specificity, indicates the importance of the active-site volume in modulating enzyme selectivity. Surprisingly, the flavin adenine dinucleotide (FAD) cofactor was found in a different orientation canonically described for both prokaryotic and eukaryotic LAAOs. In this new conformational state, the adenosyl group is flipped towards the 62-71 loop, being stabilized by several hydrogen-bond interactions, which is equally stable to the classical binding mode.


Assuntos
Bothrops , Venenos de Crotalídeos/enzimologia , L-Aminoácido Oxidase/química , Sequência de Aminoácidos , Animais , Cristalografia por Raios X , Estabilidade Enzimática , Interações Hidrofóbicas e Hidrofílicas , Dados de Sequência Molecular , Estrutura Secundária de Proteína
16.
PLoS Comput Biol ; 7(11): e1002233, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22072951

RESUMO

Theoretical and empirical investigations of search strategies typically have failed to distinguish the distinct roles played by density versus patchiness of resources. It is well known that motility and diffusivity of organisms often increase in environments with low density of resources, but thus far there has been little progress in understanding the specific role of landscape heterogeneity and disorder on random, non-oriented motility. Here we address the general question of how the landscape heterogeneity affects the efficiency of encounter interactions under global constant density of scarce resources. We unveil the key mechanism coupling the landscape structure with optimal search diffusivity. In particular, our main result leads to an empirically testable prediction: enhanced diffusivity (including superdiffusive searches), with shift in the diffusion exponent, favors the success of target encounters in heterogeneous landscapes.


Assuntos
Comportamento Animal , Ecossistema , Animais , Biologia Computacional , Conservação dos Recursos Naturais/estatística & dados numéricos , Comportamento Alimentar , Modelos Biológicos
17.
Protein J ; 29(5): 328-35, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20544379

RESUMO

Mammalian septins comprise a family of 14 genes that encode GTP-binding proteins involved in important cellular processes such as cytokinesis and exocytosis. Expression of three different constructs encoding human septin 8 were analyzed and the results show that SEPT8GC, a clone expressing the conserved domain plus C-terminal domain of human septin 8 yields the highest amount of recombinant protein. This protein was purified by affinity chromatography followed by a gel filtration chromatography. CD spectrum of SEPT8GC is characteristic of folded proteins and it presents a transition profile with a T (m) of 54 degrees C. Fluorescence emission spectra, analytic gel filtration and DLS reflect the sample oligomeric heterogeneity with the predominance of dimers in solution. Homology models indicate clearly that the preferred dimer interface is the one comprising the GTP binding site.


Assuntos
Proteínas do Citoesqueleto , Proteínas de Ligação ao GTP , Sequência de Aminoácidos , Cromatografia em Gel , Dicroísmo Circular , Clonagem Molecular , Proteínas do Citoesqueleto/química , Proteínas do Citoesqueleto/genética , Proteínas do Citoesqueleto/metabolismo , Escherichia coli/genética , Proteínas de Ligação ao GTP/química , Proteínas de Ligação ao GTP/genética , Proteínas de Ligação ao GTP/metabolismo , Humanos , Dados de Sequência Molecular , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Septinas , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Espectrometria de Fluorescência , Temperatura
18.
Sci. med ; 16(2): 86-91, 2006.
Artigo em Português | LILACS | ID: lil-456140

RESUMO

Este trabalho tem o objetivo de divulgar um recurso terapêutico da epilepsia do lobo por esclerose hipocampal: a cirurgia. Aproximadamente vinte e cinco mil pacientes com esta patologia refratários aos tratamentos medicamentosos sul do país e muitos chegam


Assuntos
Humanos , Masculino , Feminino , Epilepsia , Lobo Temporal/cirurgia
19.
Qual Manag Health Care ; 8(3): 42-64, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10947384

RESUMO

Care for low back pain remains a clinical enigma. Its high prevalence and cost to the system warrants attention for improvement. Although, no major recent clinical breakthroughs for resolving back pain have emerged, reducing unnecessary tests, eliminating useless or harmful practices, preventing care dependence, and enhancing coping skills can be useful goals for improving patient outcomes. Quality Improvement (QI) approaches can serve as bridge between clinical intuition and large scale science. Three chiropractic delivery settings including two teaching clinics and one large multidisciplinary spine care center incorporated QI approaches as part of an initiative to improve low back pain care. All clinics were able to implement sustainable process and outcomes improvements.


Assuntos
Quiroprática , Inovação Organizacional , Clínicas de Dor/organização & administração , Gestão da Qualidade Total/organização & administração , Adulto , Idoso , Feminino , Humanos , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade
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