The Green Approach of chitosan-Fe2O3-ZnO Nanoparticles For Bioactiivty 2024
The Green Approach of chitosan-Fe2O3-ZnO Nanoparticles For Bioactiivty 2024
Abstract
Biopolymers embedded with nanoparticles of metal oxides (MOs) demonstrate a wide range of bio-functions. Chi‑
tosan-incorporated MOs are an interesting class of support matrices for enhancing the biological function, compared
to other support matrices. Therefore, the importance of this study lies in exploiting chitosan as a carrier not of one
metal as in previous studies, but of two metals in the form of a nanocomposite to carry out several biological func‑
tions. The coprecipitation approach was employed to synthesize chitosan/Fe2O3/ZnO-nanocomposite in the present
research. The characterization of chitosan/Fe2O3/ZnO-nanocomposite was performed to find out the morphology
and dispersion properties of chitosan/Fe2O3/ZnO-nanocomposite. The X-ray diffraction (XRD) investigation revealed
that these were crystalline. Fourier transforms infrared (FTIR) spectrum bands were viewed at 400/cm and 900/cm,
due to the stretching vibration of Fe and Zn oxygen bond. TEM showed that chitosan/Fe2O3/ZnO-nanocomposite
was of 20–95 nm in size. chitosan/Fe2O3/ZnO-nanocomposite exhibited inhibitory potential against Staphylococ-
cus aureus, Bacillus subtilis, Escherichia coli, and Candida albicans with inhibition zones of 25 ± 0.1, 28 ± 0.2, 27 ± 0.1,
and 27 ± 0.2 mm, respectively while didn’t inhibited Aspergillus niger. MIC value of nanocomposite was 15.62 ± 0.33
µg/mL for C. albicans, B. subtilis and E. coli, while it was 62.50 ± 0.66 µg/mL for Pseudomonas aeruginosa. Ranged values
of nanocomposite MBC (15.62 ± 0.33 to 125 ± 1 µg/mL) were attributed to all tested bacteria. Different concentra‑
tions of chitosan/Fe2O3/ZnO-nanocomposite MBC (25, 50, and 75%) reflected anti-biofilm activity against E. coli (85.0,
93.2, and 96.0%), B. subtilis (84.88, 92.21, and 96.99%), S. aureus 81.64, 90.52, and 94.64%) and P. aurogenosa (90.11,
94.43, and 98.24%), respectively. The differences in the levels of antimicrobial activities may depend on the type
of examined microbes. Antioxidant activity of chitosan/Fe2O3/ZnO-nanocomposite was recorded with excellent IC50
values of 16.06 and 32.6 µg/mL using DPPH and ABTS scavenging, respectively. Wound heal by chitosan/Fe2O3/ZnO-
nanocomposite was achieved with 100% compared to the untreated cells (76.75% of wound closer). The cytotoxicity
outcomes showed that the IC50 of the chitosan/Fe2O3/ZnO-nanocomposite was 564.32 ± 1.46 µg/mL normal WI-38
cells. Based on the achieved findings, the chitosan/Fe2O3/ZnO-nanocomposite is a very promising agent for perform
pharmacological activities.
Keywords Coprecipitation, Chitosan, Nanocomposite, Bimetallic, Antimicrobial, Antioxidant, Wound healing
*Correspondence:
Tarek M. Abdelghany
[email protected]
Full list of author information is available at the end of the article
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/.
Al‑Rajhi et al. Applied Biological Chemistry (2024) 67:75 Page 2 of 13
after the incubation period of 15 min. The subsequent nanocomposite necessary to scavenge (50%) of the free
equation was utilized to compute the inhibition of bacte- radicals. Ascorbic acid was used as standard in DPPH and
rial film formation (IBF): ABTS assays with the same concentration of tested sample.
Treated Ab − Blank Ab
%IBF = 1 − ×100 Wound healing of nanocomposite via scratch assay
Control Ab − Blank Ab As previously mentioned [31], the scratch wound-healing
Blank indicated the Ab of the media without any com- assess was conducted by minor altering as follow: Five hun-
posite treatment; the Ab of bacteria from the treatment dred HFB4 cells (Cell line of normal human skin which
by composite was represented by treatment with nano- were purchased from VACSERA, Egypt). were sowed in
composite. On the other hand, the control group showed 6-well cell plates, then permitted to grow as a monolayer
the level of bacteria absorption when not treated with until they reached 70–80% confluence. A sterile pipette tip
nanocomposites [28]. of one milliliter was used to gently scrape the monolayer
across the center of the well. To make a cross in each well,
other scratch was made vertical to the first. Following the
Antioxidant potential of nanocomposite via DPPH radical process of scratching, the growth medium was taken out,
scavenging assay then the wells were cleaned twice employing PBS solution.
The antioxidant capacity of the nanocomposite was Each well was filled with fresh medium including 5% V/V
assessed spectrophotometrically at OD517 nm using the heat-inactivated FBS and composite, and the cells were
1,1-diphenylpicrylhydrazyl (DPPH) analysis, with ascor- grown for a full day. Using a fluorescence invert micro-
bic acid serving as a standard. The nanocomposite was scope fitted with a digital camera, imaginings were taken
distributed in methanol at varying doses (10 to 100 μg/ from the fields next the scratching (t0) and immediately
mL), with ascorbic acid serving as the standard drug after 24 h (Nikon Eclipse TE200: Nikon, Tokyo, Japan).
[29]. The next equation was used to decide each sample’s Scratched cells that were not treated served as the control.
capacity to scavenge DPPH free radicals:
Control OD − Sample OD
Percentage of DPPH activity (% scavenging) = × 100
Control OD
Scavenging activity of ABTS radical The wound closure percentage was estimated via the next
With minor adjustments, the 2,2-azino-bis(3-ethylb- equation:
enzothiazoline-6-sulphonic acid) (ABTS) radical scav-
Wound area at t0 − Wound area at t
enging potential of nanocomposite was calculated [30]. Wound closure (%) = × 100
Wound area at t0
ABTS was dissolve in water for concentration of 7 mM.
ABTS stock solution was reacted with 2.45 mM potas-
sium persulfate (final concentration), and letting the Effect of nanocomposite on viability of normal cells
mixture withstand for 15 h in the dark at 25 ℃ before Nanocomposite at different doses was examined against
employing, ABTS radical cation (ABTS. +) was created. viability of normal WI-38 cells (Normal human lung fibro-
H2O was added to the solution of ABTS. + until the Ab at blast cell (American Type Culture Collection, Rockville,
734 nm was reach to 0.70. Three mL of the ABTS radical MD) employing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphe-
and 0.07 mL of the nanocomposite made up the reaction nyltetrazolium bromide (MTT) approach. The treated cells
mixture. The Ab was measured in a spectrophotometer at (2 × 105 cells) by nanocomposite were incubated under
734 nm following a 6-min incubation period. CO2/37 °C/48 h. Once the incubation period ended, the
Via the following equation, the antioxidant potential propagated cells were treated by MTT solution (10 μL of 5
was calculated mg/mL), and then followed continue period of incubation
at above mentioned conditions up to 4 h. The developed
Ab control − Ab sample
%Inhibition = × 100 color from formazone crystals was liquefied employing 100
Ab control μL of DMSO [7]. Finally, at 570 nm, the wavelength was
Abcontrol = Ab of negative control at the moment of measured to determine percentage of cell viability (CV) %
nanocomposite solution preparation. While A bsample = Ab through the subsequent equation:
of reaction mixture after 6 min. The quantities of IC50
Wavelength of treated cells
were estimated via graph which signifies the dose of CV (%) = × 100
Wavelength of untreayted cells
Al‑Rajhi et al. Applied Biological Chemistry (2024) 67:75 Page 5 of 13
Statistical calculations are represented by the band at 3462.37 cm−1, the primary
The programs of Minitab version 19 and Microsoft Excel amide’s C–O stretching is 1639.56 cm−1, the secondary
version 365 were performed for statistical calculations at amide group’s N–H bending is 1553.73 cm−1, and the
level the 0.05 of probability. The analysis of variance, one- C–N axial shift (amine group) is represented by the band
way ANOVA, and post hoc Tukey’s test were employed at 1412.92 cm−1 [34]. The band containing C–O–C glyco-
to investigate quantitative results with a parametric dis- sidic linkages at 1111.05 cm−1 and 1021.35 cm−1 [35]. The
tribution. Standard deviation (SD) was calculated from previous bands refer to chitosan in the composite. The
three replicates of results. compound’s different functional categories and metallic
oxide bonds were observed employing the FTIR spec-
Results and discussion trum. A prominent vibration range in the FTIR spectra,
Characterization of nanocomposite spanning 400 cm−1 to 500 cm−1, is attributed to the dis-
Nanotechnology structures have attracted interest as tinctive extending phase of the ZnO bond [30]. The Fe–O
a rapidly developing class of substances with a diverse group is represented by a number of peaks in the 600–900
variety of applications [32]. When an organic synthesis cm–1 area, including those at 622.07 c m−1, 799.53 c m−1,
operation is carried out, it is required to establish either and 868 c m−1 [36, 37].
the composition or structure of the final result, which TEM is the most efficient method for figuring out the
can be performed using a range of methodologies rang- size and morphological configuration of a created nano-
ing from structural elucidation to verifying the pure state structure. The produced chitosan/Fe2O3/ZnO nano-
of the product under consideration. The XRD pattern for composite was spherical and had diameters between 20
chitosan/Fe2O3/ZnO nanocomposite (Fig. 1) indicates and 95 nm, according to the TEM picture (Fig. 3A). The
the existence of chitosan at 17.8° and 22.6°. Fe2O3 was spherical particles have a thin coating of chitosan encir-
identified by a XRD distribution with peak intensities at cling the composite’s core. Figure 3B displays the area
2θ ~ 26.8°, 36.01°, 40.27°, 53.29°, and 61.3°. The XRD pat- selective diffraction of electrons (SAED) pattern of chi-
tern of ZnO exhibits many peaks, including 31.9, 34.09, tosan/Fe2O3/ZnO nanocomposite, which shows good
36.01, 47.26, 57.61, 66.64, and 71.62. This implies the cre- crisp rings and validates the crystalline structure of the
ation of the chitosan/Fe2O3/ZnO nanocomposite and its Au nanoscale. It’s important to observe that the circular
high purity [33]. shape of the chitosan/Fe2O3/ZnO nanocomposite made
FT-IR analysis was employed to recognize the func- with chitosan is consistent with previous green synthesis
tional groups of the chitosan/Fe2O3/ZnO nanocom- techniques reported in the scientific literature [35].
posite spectra, and the resulting distinctive peaks were SEM, mapping, and EDS were employed to note and
shown in Fig. 2. The stretching vibration of –OH bond analyse the quantity of element as well as arrangement
Fig. 4 SEM (i), EDS (ii), of chitosan/Fe2O3/ZnO nanocomposite, Elemental mapping of C (iii), Elemental mapping of O (iv), Elemental mapping of Fe
(v), Elemental mapping of Zn (vi)
values were less than 4, these values were attributed to Surendra et al. [44] exhibited excellent inhibition of P.
cidal characteristics of nanocomposite. According to aeruginosa and E. coli growth. In the present investiga-
Bhushan et al. [42], Fe/Zn oxide nanocomposite was tion, because the small size of the created nanocom-
efficient and possess bactericidal properties against posite permeates their entry into the bacterial cells
several bacterial species belongs to Gram-positive and leading to injuries, disruption of respiration and ulti-
Gram-negative. Previously, the antimicrobial potential mately cause bacterial cell death. According to other
of Fe/Zn oxide nanocomposites dependent on [Zn]/ investigation, Fe3O4 NPs and ZnO NPs compared
[Fe] ratio, moreover, S. aureus was more affected than with its nanocomposite were experimented against S.
E. coli [43]. The biocreated Z
nFe2O4 NPs according to aureus where the zones of inhibition were 10, 15, and
Al‑Rajhi et al. Applied Biological Chemistry (2024) 67:75 Page 8 of 13
Fig. 5 Antimicrobial characteristics of nanocomposite (N), positive control (PC), and negative control (NC) against (1) P. aeruginosa, (2) E. coli, (3) S.
aureus, (4) B. subtilis, (5) C. albicans, and (6) A. niger
Table 1 Antimicrobial potential of nanocomposite, besides MIC, MBC, MFC and Index of MBC or MFC/MIC
Utilized microorganisms Inhibition zones (mm) MIC MBC or MFC MBC or
(µg/mL) (µg/mL) MFC/
Nanocomposite *Control MIC
Index
16 mm, correspondingly and versus E. coli where the 0.5 and 0.2 mm, respectively using F e2O3- NPs without
zones of inhibition were 14, 15, and 26 mm, corre- chitosan.
spondingly [45]. Bharathi et al. [46] mentioned that chi- The formation of biofilm in the lifestyle of microor-
tosan incorporated with Zn–O to form nanocomposite ganism represents a vital stage for resistance to several
reflected inhibitory potential against several bacteria. antibiotics, moreover it linked to approximately 80% of
E. coli, K. pneumoniae, S. aureus, and B. subtilis were microbial; infectious diseases [48]. From the obtained
more affected by chitosan-ZnO nanocomposite than data, destruction of bacterial biofilm was observed but
unloaded ZnO by chitosan with inhibition zone 25.5, with different percentage of inhibition. Nanocomposite
24.5, 22.5, and 21 mm, respectively [46]. According to at different doses (25, 50, and 75% MBC) reflected lower
Kavitha [47], Fe2O3-chitosan nanocomposite caused anti-biofilm activity against C. albicans (66.80, 74.38,
inhibition growth of E.coli and S.aureus with 18, and and 88.60%) than other tested microorganisms includ-
12 mmof clear zone while very negligible clear zones ing B. subtilis (84.88, 92.21, and 96.99%), S. aureus 81.64,
Al‑Rajhi et al. Applied Biological Chemistry (2024) 67:75 Page 9 of 13
Fig. 6 A Inhibitory potential of nanocomposite against tested microorganisms, B Microtiter plate offered color shift as a sign of declined biofilm
formation. Media + (0%), 25%, 50% and 75% of MBC of nanocomposite. B. subtilis (BS) S. aureus (SA), E. coli (EC), P.aeruginosa (PA), C. albicans (CA),
and Control (C)
Al‑Rajhi et al. Applied Biological Chemistry (2024) 67:75 Page 10 of 13
Fig. 9 Scratch assay illustrate the effect of nanocomposite on the wound area at 0 and 48 h compared to untreated cells
Table 3 Normal cell (WI-38 cells) sensitivity to nanocomposite this nanocomposite might be employed to create effec-
Dose (µg/mL) Nanocomposite
tive wound heals without side effects. Hamouda et al. [53]
decide that Au/cellulose nanocomposites possess non-
Viability (%) Toxicity (%) toxic effect on normal lung fibroblasts because their IC50
0.0 100a 0.0 ± 0.0 was 182.75 ± 6.45 µg/µL. Also, from another study on chi-
31.25 100a 0.0 ± 0.0 tosan Mg0.5Co0.5Fe2O4- 5-fluorouracil nanocomposite,
62.5 97.86cde 2.14 ± 0.50 the authors mentioned this composite lacking to toxicity,
125 97.72cde 2.28 ± 0.25 where the normal human embryonic kidney not affected
250 96.91cde 3.09 ± 0.33 with recorded high quantity of IC50 (200 μg/mL) [54].
f
500 48.01 51.99 ± 0.2.66 Acknowledgements
1000 2.83g 97.17 ± 3.33 The authors would like to acknowledge Princess Nourah bint Abdulrahman
IC50 564.32 ± 1.46 µg/mL University Researchers Supporting Project number (PNURSP2024R217), Prin‑
cess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
Values of the same column with the different letter are significantly different;
however same letters are not significantly different by post hoc Tukey’s test at Author contributions
P < 0.05 A.M.H.A. and T.M.A. Conceptualization and methodology; M.S.A. and M.H.A.;
investigation and formal analysis; S.K.A. and S.S. writing—review and editing.
All authors agreed to the published version of the manuscript.
At the same time the recorded value of I C50 Funding
(564.32 ± 1.46 µg/mL) indicated that nanocomposite This research was funded by Princess Nourah bint Abdulrahman University
possess low toxicity on normal cells. The present result Researchers Supporting Project number (PNURSP2024R217), Princess Nourah
bint Abdulrahman University, Riyadh, Saudi Arabia.
certificated the biological application of this nanocom-
posite. Moreover these investigation showed that nano- Availability of data and materials
composite are nontoxic to normal cells, demonstrating All data that support the findings of this study are available within the article.
Al‑Rajhi et al. Applied Biological Chemistry (2024) 67:75 Page 12 of 13
30. Re R, Pellegrini N, Proteggente A, Pannala A, Yang M, Rice-Evans C (1999) 48. Joo HS, Otto M (2012) Molecular basis of in vivo biofilm formation by bac‑
Antioxidant activity applying an improved ABTS radical cation decoloriza‑ terial pathogens. Chem Biol 19(12):1503–1513. https://doi.org/10.1016/j.
tion assay. Free Radic Biol Med 26(9–10):1231–1237. https://doi.org/10. chembiol.2012.10.022
1016/s0891-5849(98)00315-3 49. Sharma RP, Raut SD, Kadam AS et al (2020) In-vitro antibacterial and anti-
31. Chiocchio I, Poli F, Governa P, Biagi M, Lianza M (2018) Wound healing and biofilm efficiencies of chitosan-encapsulated zinc ferrite nanoparticles.
in vitro antiradical activity of five Sedum species grown within two sites Appl Phys A 126:824. https://doi.org/10.1007/s00339-020-04007-1
of community importance in Emilia Romagna (Italy). Plant Biosyst. 45:23 50. Elbrolesy A, Elhussiny FA, Abdou Y et al (2024) Facile synthesis and
32. Khan Y, Sadia H, Ali Shah SZ, Khan MN, Shah AA, Ullah N, Ullah MF, Bibi H, biophysical characterization of novel zinc oxide/Fe3O4 hybrid nano‑
Bafakeeh OT, Khedher NB, Eldin SM (2022) Classification, synthetic, and composite as a potentially active agent in sunscreens. Arab J Sci Eng
characterization approaches to nanoparticles, and their applications in 49:1083–1093. https://doi.org/10.1007/s13369-023-08082-3
various fields of nanotechnology: A review. Catalysts 12(11):1386 51. Ouyang QQ, Zhao S, Li SD, Song C (2017) Application of chitosan, chi‑
33. Serouti A, Eddine LS, Meneceur S, Hasan GG, Mohammed HA, Salmi C, tooligosaccharide, and their derivatives in the treatment of Alzheimer’s
Iman K, Ferhat MF, Ali OB, Abdullah JAA (2024) Biogenic ZnO/CuO/Fe2O3 disease. Mar Drugs 15(11):322. https://doi.org/10.3390/md15110322
nanocomposite: A groundbreaking approach for enhanced degradation 52. Ye L, He X, Obeng E, Wang D, Zheng D, Shen T, Deng H (2023) The CuO
capabilities and reusability in dye removal applications. Arab J Sci Eng and AgO co-modified ZnO nanocomposites for promoting wound
49(1):753–764 healing in Staphylococcus aureus infection. Materials Today Bio 18:100552.
34. Gamboa-Solana CDC, Chuc-Gamboa MG, Aguilar-Pérez FJ, Cauich- https://doi.org/10.1016/j.mtbio.2023.100552
Rodríguez JV, Vargas-Coronado RF, Aguilar-Pérez DA, Herrera-Atoche JR, 53. Hamouda RA, AbdElMaksoud AI, Wageed M, Alotaibi AS, Elebeedy D,
Pacheco N (2021) Zinc oxide and copper chitosan composite films with Khalil H, Hassan A, Abdella A (2021) Characterization and anticancer
antimicrobial activity. Polymers 13(22):3861 activity of biosynthesized Au/Cellulose nanocomposite from Chlorella vul-
35. Thanh VM, Huong NT, Nam DT, Dung NDT, Nguyen-Le MT (2020) Syn‑ garis. Polymers (Basel). 13(19):3340. https://doi.org/10.3390/polym13193
thesis of ternary Fe3O4/ZnO/Chitosan magnetic nanoparticles via an 340
ultrasound-assisted coprecipitation process for antibacterial applications. 54. Mngadi S, Mokhosi S, Singh M, Mdlalose W (2020) Chitosan-function‑
J Nanomater 2020(1):8875471 alized Mg0.5Co0.5Fe2O4 magnetic nanoparticles enhance delivery of
36. Noukelag SK, Cummings F, Arendse CJ, Maaza M (2023) Physical and 5-fluorouracil in vitro. coatings 10(5):446. https://doi.org/10.3390/coati
magnetic properties of biosynthesized ZnO/Fe2O3, ZnO/ZnFe2O4, and ngs10050446
ZnFe2O4 nanoparticles. Results in Surfaces and Interfaces 10:100092
37. Sarala E, Madhukara Naik M, Vinuth M, Rami Reddy YV, Sujatha HR (2020)
Green synthesis of Lawsonia inermis-mediated zinc ferrite nanoparticles Publisher’s Note
for magnetic studies and anticancer activity against breast cancer (MCF- Springer Nature remains neutral with regard to jurisdictional claims in pub‑
7) cell lines. J Mater Sci: Mater Electron 31:8589–8596 lished maps and institutional affiliations.
38. Zhang T, Li W, Guo Q, Wang Y, Li C (2022) Preparation of a heterogeneous
catalyst CuO-Fe2O3/CTS-ATP and degradation of methylene blue and
ciprofloxacin. Coatings 12(5):559
39. Toropova YG, Golovkin AS, Malashicheva AB, Korolev DV, Gorshkov AN,
Gareev KG et al (2017) In vitro toxicity of FemOn, FemOn-SiO2 composite,
and SiO2-FemOn core-shell magnetic nanoparticles. Int J Nanomed
12:593–603. https://doi.org/10.2147/IJN.S122580
40. Bisht GS, Rayamajhi BKC, Paudel SN, Karna D, Shrestha BG (2016) Syn‑
thesis, characterization, and study of in vitro cytotoxicity of ZnO-Fe3O4
magnetic composite nanoparticles in human breast cancer cell line
(MDA-MB-231) and mouse fibroblast (NIH 3T3). Nanoscale Res Lett
11:537. https://doi.org/10.1186/s11671-016-1734-1739
41. Abbas HS, Krishnan A (2020) Magnetic nanosystems as a therapeutic tool
to combat pathogenic fungi. Adv Pharm Bull. 10:512–523. https://doi.
org/10.34172/apb.2020.063
42. Bhushan M, Kumar Y, Periyasamy L, Viswanath AK (2018) Facile synthesis
of Fe/Zn oxide nanocomposites and study of their structural, magnetic,
thermal, antibacterial and cytotoxic properties. Mater Chem Phys
209:233–248. https://doi.org/10.1016/j.matchemphys.2018.02.002
43. Gordon T, Perlstein B, Houbara O, Felner I, Banin E, Margel S (2011) Syn‑
thesis and characterization of zinc/iron oxide composite nanoparticles
and their antibacterial properties. Colloids Surf, A 374(1–3):1–8. https://
doi.org/10.1016/j.colsur fa.2010.10.015
44. Surendra BS, Nagaswarupa HP, Hemashree MU, Khanum J (2020) Jatropha
extract mediated synthesis of ZnFe2O4 nanopowder: Excellent perfor‑
mance as an electrochemical sensor, UV photocatalyst and an antibacte‑
rial activity. Chem Phys Lett 739:136980
45. Rajan S (2019) Synthesis of ZnO/Fe3 O4/rGO nanocomposites and evalu‑
ation of antibacterial activities towards E coli and S aureus. IET Nanobio‑
technol 13(7):682–687
46. Bharathi D, Ranjithkumar R, Chandarshekar B, Bhuvaneshwari V (2019)
Preparation of chitosan coated zinc oxide nanocomposite for enhanced
antibacterial and photocatalytic activity: As a bionanocomposite. Int J
Biol Macromol 129:989–996. https://doi.org/10.1016/j.ijbiomac.2019.02.
061
47. Kavitha AL (2017) Synthesis and Characterization of Iron Oxide-Chitosan
Nano Composite. Mech Mater Sci Eng J. https://doi.org/10.2412/mmse.
92.76.971