<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">OALibJ</journal-id><journal-title-group><journal-title>Open Access Library Journal</journal-title></journal-title-group><issn pub-type="epub">2333-9705</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/oalib.1102708</article-id><article-id pub-id-type="publisher-id">OALibJ-69504</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biomedical&amp;Life Sciences</subject><subject> Business&amp;Economics</subject><subject> Chemistry&amp;Materials Science</subject><subject> Computer Science&amp;Communications</subject><subject> Earth&amp;Environmental Sciences</subject><subject> Engineering</subject><subject> Medicine&amp;Healthcare</subject><subject> Physics&amp;Mathematics</subject><subject> Social Sciences&amp;Humanities</subject></subj-group></article-categories><title-group><article-title>
 
 
  Comparative Study on Nigerian Wild and Edible Beans in Reversing Incidence of Colon Cancer in Albino Rats
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>O.</surname><given-names>A. Awoyinka</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>A.</surname><given-names>Ileola</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>C.</surname><given-names>N. Imeoria</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>A.</surname><given-names>E. Omonisi</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>F.</surname><given-names>C. Oladele</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>M.</surname><given-names>F. Asaolu</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff2"><addr-line>Department of Biochemistry, Ekiti State University, Ado Ekiti, Nigeria</addr-line></aff><aff id="aff1"><addr-line>Department of Medical Biochemistry, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria</addr-line></aff><aff id="aff4"><addr-line>Department of Anatomic Pathology, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria</addr-line></aff><aff id="aff3"><addr-line>Department of Science Laboratory Technology, Ekiti State University, Ado Ekiti, Nigeria</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>olayinka.awoyinka@eksu.edu.ng(OAA)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>31</day><month>07</month><year>2016</year></pub-date><volume>03</volume><issue>07</issue><fpage>1</fpage><lpage>7</lpage><history><date date-type="received"><day>4</day>	<month>May</month>	<year>2016</year></date><date date-type="rev-recd"><day>accepted</day>	<month>8</month>	<year>July</year>	</date><date date-type="accepted"><day>11</day>	<month>July</month>	<year>2016</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
   
   This work is an investigation of the curative effects of some edible and wild type beans on colonic inflammation induced by Dextran Sulphate Sodium (DSS) in wister albino rats. Macroscopic examination performed on the colon after s
   even-day exposure of the animals to both DSS and bean sample revealed a high incidence of colonic inflammation in rats fed with 
   macuna 
   compared to other groups. However, from the histological examination, the groups fed with 
   Otili 
   and 
   Feregede
    had a low incidence of dysplasia showing 
   Otili 
   and 
   Feregede
    to be good candidates that could mitigate effect of Dextran Sodium Sulphate. 
  
 
</p></abstract><kwd-group><kwd>Dextran Sodium Sulphate (DSS) &lt;i&gt;Otili&lt;/i&gt;</kwd><kwd> &lt;i&gt;Feregede&lt;/i&gt;</kwd><kwd> &lt;i&gt;Pakala&lt;/i&gt;</kwd><kwd> &lt;i&gt;Mucuna&lt;/i&gt;</kwd><kwd> Colon Cancer</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Diets are known to play a major role in the development of many non-communicable diseases such as colon cancer. Thus, dietary compounds are of special relevance for improving the body’s defenses against such diseases. Information about the role of diet has come from many observational studies around the world across cultures and geographical divides [<xref ref-type="bibr" rid="scirp.69504-ref1">1</xref>] [<xref ref-type="bibr" rid="scirp.69504-ref2">2</xref>] . Foods such as beans are rich in carbohydrate, low in fat and contain large amount of fibre which help attract water to the stool and enhance transit time of waste through the colon [<xref ref-type="bibr" rid="scirp.69504-ref3">3</xref>] [<xref ref-type="bibr" rid="scirp.69504-ref4">4</xref>] . This may help to combat constipation, colon cancer, and other conditions that afflict the digestive tract. Despite the strong relationship of dietary habits to risk of colorectal cancer (CRC), epidemiologic studies are generally insufficient to conclude dry beans decrease CRC risk, although there are some suggestions of a protective effect [<xref ref-type="bibr" rid="scirp.69504-ref5">5</xref>] - [<xref ref-type="bibr" rid="scirp.69504-ref8">8</xref>] .</p><p>In general, the current treatment options for colorectal cancer are surgery, chemotherapy, and biological therapies. The majority of patients with early-stage colorectal cancer will undergo surgery to remove as much of the tumor as possible [<xref ref-type="bibr" rid="scirp.69504-ref9">9</xref>] - [<xref ref-type="bibr" rid="scirp.69504-ref17">17</xref>] . Many people with colorectal cancer initially respond to chemotherapy, but unfortunately, in the majority of cases the disease eventually progresses after first-line treatment. Several types of biological therapy are available to treat metastatic colorectal cancer including anti-angiogenics and the Epidermal Growth Factor Receptor (EGFR) inhibitors. Most often they are given in combination with chemotherapy [<xref ref-type="bibr" rid="scirp.69504-ref10">10</xref>] . Radiotherapy is not often used to treat metastatic colorectal cancer due to side effects, although it can be used after surgery to destroy any residual cancer cells [<xref ref-type="bibr" rid="scirp.69504-ref11">11</xref>] .</p><p>Cost effectiveness analyses of the many interventions (primary prevention, screening or treatment) for reducing the burden of colorectal cancer have usually been restricted to developed country settings and with often considerable variation in the analytical methods used. This limits the value of the existing literature to inform colorectal cancer control policies in low to middle income country settings such as Nigeria. Assessment of costs and effects of different strategies can help guide decisions on the allocation of resources across interventions, as well as between interventions for colorectal cancer. Hence the aim of this present work is to know if the local unexploited wild beans would reverse incidence of colon cancer induced by Dextran Sodium Sulphate (DSS) in wister albino rats and compare the effect with common edible beans.</p></sec><sec id="s2"><title>2. Materials and Method</title>Collection of Cultivar<p>Dry, wild bean―Sphenostyles stenocarpa (Otili), Cajanus cajan (Feregede), Phaseolus lunatus (Pakala), were sourced from the bush of Ado Ekiti environ while the wild type-Mucuna cochindunum (Mucuna), and edible type bean―Phaseolus vulgaris tagged, IT845-2246-4 were brought from International Institute of Tropical Agriculture (IITA), Ibadan Nigeria. They were collected whole, dry and naked (i.e. without pods), with divers colors (off white, gold, navy blue, black and brown respectively). Authentication was carried at the herbarium of the Plant Science Department, Ekiti State University Ado Ekiti before the dried seeds were pulverised.</p></sec><sec id="s3"><title>3. Experimental Animals</title><p>Sixteen male and twelve female albino rats were used in this study. Their weights ranged between 60 g to 100 grams. The rats were fed ad-libitum with pulverized bean samples and 5 mg/Kg of Dextran Sodium Sulphate (DSS) dissolved in water for seven days to induce colonic inflammation. An average of 15 mL of the DSS-water was given to the singly caged rat under group A-E daily. They are Otili, Feregede, Pakala, Mucuna and edible bean cultivar IT845-2246-4 groups respectively. However the Control Group was fed with rat chow and 15 mL of 5 mg/Kg body weight DSS treated water, while the Basal group was fed with rat chow and normal saline daily.</p><sec id="s3_1"><title>3.1. Macroscopic Examination</title><p>The method of Thaker, et al., [<xref ref-type="bibr" rid="scirp.69504-ref12">12</xref>] was adopted. The mouse with its ventral side exposed on a cutting board. 70% ethanol was used to cover the abdomen to prevent hairs from contaminating the abdominal contents during extraction of the colon. Scissors was used to cut through the pelvis so that the colon can be harvested down to the anorectal junction. The flushed colon was placed in phosphate-buffered saline (PBS) in order to maintain the physiologic condition before the macroscopic analysis. However 1% Alcian blue dye was applied to the highlighted tumors when Digital photography was taken in a dark fixated length by Nikon Camera. Tumor burden (%) was calculated as tumor area/total colon area using Image J software [<xref ref-type="bibr" rid="scirp.69504-ref13">13</xref>] .</p></sec><sec id="s3_2"><title>3.2. Histological Examinations</title><p>Prior to photomicrograph, small pieces of colon sections were fixed in 10% formalin saline, after which they were cut and stained with haematoxylin and eosin. The stained tissue sections were then observed under a light microscope (Olympus 400&#215; objective) for histological assessment.</p></sec></sec><sec id="s4"><title>4. Results and Discussion</title><p>Experimental studies have been conducted specifically examining the relationship of dry bean consumption to chemically-induced colon cancer in rats. For instance, Hughes et al., [<xref ref-type="bibr" rid="scirp.69504-ref14">14</xref>] fed rats diets containing either pinto beans (59% wt/wt) or casein as the protein source. They found that feeding pinto beans inhibited colon tumor incidence by 52% (50% in casein-fed animals vs. 24% in bean-fed animals) and significantly reduced the number of tumors that developed (1.0 &#177; 0.0 vs. 2.5 &#177; 0.6 tumors/ tumor bearing animal). In a similar design, Hangen and Bennink [<xref ref-type="bibr" rid="scirp.69504-ref15">15</xref>] also reported a protective effect of dry beans on experimental colon cancer. They found that feeding either black beans or navy beans (75% wt/wt) inhibited colon cancer by ~57%, and similar to Hughes et al., [<xref ref-type="bibr" rid="scirp.69504-ref14">14</xref>] , bean-fed rats also developed fewer tumors (1.0 &#177; 0.17 vs. 2.2 &#177; 1.2 tumors/tumor bearing animal). It was on this premise that this present work was set out following the Morton and Griffiths [<xref ref-type="bibr" rid="scirp.69504-ref16">16</xref>] groundwork laid for developing a set of observations for assessing behavioral and physiological changes in laboratory animals.</p><p>Significant changes were observed in all physiological categories but observation recorded in day 1 was insignificant in day 1. As shown in <xref ref-type="fig" rid="fig1">Figure 1</xref> responses to the amount of food consumed by each rat group were encouraging except in group fed with mucuna. The group fed with mucuna experienced a notable reduction in weight just at day 2. This reduction definitely was induced by a loss of appetite and a reduction in food and water-treatment consumed (<xref ref-type="fig" rid="fig1">Figure 1</xref>). While feregede group experienced a slight reduction in weight and heart beat rate although it remained active all day round. Pakala and feregede groups had similar effects with a slight decrease in weight and food consumed while group fed with common edible bean had no noticeable weight</p><fig id="fig1"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref></label><caption><title> Standard curves showing daily weight of rats</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/69504x6.png"/></fig><p>change between day 1 and 2, but experienced a slight decrease in weight on the 5<sup>th</sup> day of the experiment (<xref ref-type="fig" rid="fig2">Figure 2</xref>) At day 4 group fed with Otili experienced a sharp reduction in weight on the fourth day of the experiment this was maintained over the fifth day before decreasing to 75.7 on day 7 of the experiment. This depreciation in weight is also relative to low amount of food consumed at this period.</p><p>Macroscopic result (<xref ref-type="table" rid="table1">Table 1</xref>) before sacrifice on seventh day shows that control had the highest % tumor burden of 64.9% and Otili group had the lowest with 14.3% along with B with 15%. Pakala group had a relatively high percent of 60.3%, preceded by group fe with common edible bean with 58.4% tumor burden. Death was recorded for mucuna group before the seventh day so this measurement was not ascertained for them. Further histological assessment showed dyspepsia observed on the control group (  Picture 1 ). Though the dyspepsia was mild in the Otili group (  Picture 2 ), while that of feregede group was also moderate (  Picture 3 ), however dyspepsia in group fed with pakala (  Picture 4 ) appeared more severe compared to otili, feregede and edible bean IT845-2246-4 (  Picture 5 ). Maximum effect of the DSS was found to be in the Mucuna group with profound lesions showing on the tissues (  Picture 6 ).</p><fig id="fig2"  position="float"><label><xref ref-type="fig" rid="fig2">Figure 2</xref></label><caption><title> Graph of weight of daily food consumed</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/69504x7.png"/></fig><table-wrap id="table1" ><label><xref ref-type="table" rid="table1">Table 1</xref></label><caption><title> Macroscopic assessment of %tumor burden</title></caption><table><tbody><thead><tr><th align="center" valign="middle" >Group</th><th align="center" valign="middle" >% Tumor Burden</th></tr></thead><tr><td align="center" valign="middle" >Control</td><td align="center" valign="middle" >64.9</td></tr><tr><td align="center" valign="middle" >A</td><td align="center" valign="middle" >14.3</td></tr><tr><td align="center" valign="middle" >B</td><td align="center" valign="middle" >15</td></tr><tr><td align="center" valign="middle" >C</td><td align="center" valign="middle" >60.3</td></tr><tr><td align="center" valign="middle" >D</td><td align="center" valign="middle" >N/A</td></tr><tr><td align="center" valign="middle" >E</td><td align="center" valign="middle" >58.4</td></tr></tbody></table></table-wrap><disp-formula id="scirp.69504-formula392"><graphic  xlink:href="http://html.scirp.org/file/69504x8.png"  xlink:type="simple"/></disp-formula><p>Picture 1. Result of histological examination of control group wistar rats.</p><disp-formula id="scirp.69504-formula393"><graphic  xlink:href="http://html.scirp.org/file/69504x9.png"  xlink:type="simple"/></disp-formula><p>Picture 2. Result of histological examination of rats fed with Otili.</p><disp-formula id="scirp.69504-formula394"><graphic  xlink:href="http://html.scirp.org/file/69504x10.png"  xlink:type="simple"/></disp-formula><p>Picture 3. Result of histological examination of rats fed with feregede.</p><disp-formula id="scirp.69504-formula395"><graphic  xlink:href="http://html.scirp.org/file/69504x11.png"  xlink:type="simple"/></disp-formula><p>Picture 4. Result of histological examination of rats fed with pakala.</p><disp-formula id="scirp.69504-formula396"><graphic  xlink:href="http://html.scirp.org/file/69504x12.png"  xlink:type="simple"/></disp-formula><p>Picture 5. Result of histological examination of group E rats.</p><disp-formula id="scirp.69504-formula397"><graphic  xlink:href="http://html.scirp.org/file/69504x13.png"  xlink:type="simple"/></disp-formula><p>Picture 6. Result of histological examination ofrats fed with mucuna.</p></sec><sec id="s5"><title>5. Conclusion</title><p>In this present study, it is justifiable to say that group of rats fed with Mucuna had the least enduring ability to the DSS treatment being induced into it. Rats fed with Otili and Feregede expressed higher resistibility ability to the proliferation of cancer cells.</p></sec><sec id="s6"><title>Acknowledgements</title><p>The present project was partly funded by Tet Fund Individual Based Research grant 2015-2016 session.</p></sec><sec id="s7"><title>Cite this paper</title><p>O. A. Awoyinka,A. Ileola,C. N. Imeoria,A. E. Omonisi,F. C. Oladele,M. F. Asaolu, (2016) Comparative Study on Nigerian Wild and Edible Beans in Reversing Incidence of Colon Cancer in Albino Rats. Open Access Library Journal,03,1-7. doi: 10.4236/oalib.1102708</p></sec></body><back><ref-list><title>References</title><ref id="scirp.69504-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Vucenik, I. and Shamsuddin, A.M. (2006) Protection against Cancer by Dietary IP6 and Inositol. Nutrition and Cancer, 55, 109-125. http://dx.doi.org/10.1207/s15327914nc5502_1</mixed-citation></ref><ref id="scirp.69504-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">Winham, D., Webb, D. and Barr, A. (2008) Beans and Good Health. Nutrition Today, 5, 201-208. http://dx.doi.org/10.1097/01.NT.0000303354.21347.45</mixed-citation></ref><ref id="scirp.69504-ref3"><label>3</label><mixed-citation publication-type="other" xlink:type="simple">De Mejia, E., Guzman-Maldonado, S.H., Acosta-Gallegos, J.A., Reynoso-Camacho, R., Ramirez-Rodriguez, E., Pons-Hernandez, J.L., Gonzalez-Chavira, M.M., Castellanos, J.Z. and Nelly, J.D. (2003) Effect of Cultivar and Growing Location on the Trypsin Inhibitors, Tannins and Lectins of Common Beans (Phaseolus vulgaris L.) Grown in Semiarid Highlands of Mexico. Journal of Agricultural and Food Chemistry, 51, 5962-5966. http://dx.doi.org/10.1021/jf030046m</mixed-citation></ref><ref id="scirp.69504-ref4"><label>4</label><mixed-citation publication-type="other" xlink:type="simple">Oseguera-Toledo, M.E., de Mejia, E.G., Dia, V.P. and Amaya-Llano, S.L. (2011) Common Bean (Phaseolus vulgaris L.) Hydrolysates Inhibit Inflammation in LPS-Induced Macrophages through Suppression of NF-κB Pathways. Food Chemistry, 127, 1175-1185. http://dx.doi.org/10.1016/j.foodchem.2011.01.121</mixed-citation></ref><ref id="scirp.69504-ref5"><label>5</label><mixed-citation publication-type="other" xlink:type="simple">Geil, P.B. and Anderson, J.W. (1994) Nutrition and Health Implications of Dry Beans: A Review. American College of Nutrition, 13, 549-558. http://dx.doi.org/10.1080/07315724.1994.10718446</mixed-citation></ref><ref id="scirp.69504-ref6"><label>6</label><mixed-citation publication-type="other" xlink:type="simple">Koratkar, R. and Rao, A.V. (1997) Effect of Soybean Saponins on Azoxymethane-Induced Prneoplastic Lesions in the Colon of Mice. Nutrition and Cancer, 27, 206-209. http://dx.doi.org/10.1080/01635589709514526</mixed-citation></ref><ref id="scirp.69504-ref7"><label>7</label><mixed-citation publication-type="other" xlink:type="simple">Schatzkin, A., Mouw, T., Park, Y., Subar, A.F., Kipnis, V., Hollenbeck, A., Leitzmann, M.F. and Thompson, F.E. (2007) Dietary Fiber and Whole-Grain Consumption in Relation to Colorectal Cancer. The American Journal of Clinical Nutrition, 85, 1353-1360.</mixed-citation></ref><ref id="scirp.69504-ref8"><label>8</label><mixed-citation publication-type="other" xlink:type="simple">Del Rio, D., Rodriguez-Mateos, A., Spencer, J.P.E., Tognolini, M., Borges, G. and Crozier, A. (2012) Dietary Polyphenolics in Human Health: Structures, Bioavailability, and Evidence of Protective Effects against Chronic Diseases. Antioxidants &amp; Redox Signaling, 12, 5-6.</mixed-citation></ref><ref id="scirp.69504-ref9"><label>9</label><mixed-citation publication-type="other" xlink:type="simple">Labianca, R. (2010) Primary Colon Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Adjuvant Treatment and Follow-Up. Annals of Oncology, 21, v70-v77. http://dx.doi.org/10.1093/annonc/mdq168</mixed-citation></ref><ref id="scirp.69504-ref10"><label>10</label><mixed-citation publication-type="other" xlink:type="simple">John, S.K.P., George, S., Primrose, J.N. and Fozard, J.B.J. (2011) Symptoms and Signs in Patients with Colorectal Cancer. Colorectal Disease, 13, 17-25. http://dx.doi.org/10.1111/j.1463-1318.2010.02221.x</mixed-citation></ref><ref id="scirp.69504-ref11"><label>11</label><mixed-citation publication-type="other" xlink:type="simple">NCCN (2011) National Comprehensive Cancer Network on Clinical Practice Guidelines in Oncology: Colon.</mixed-citation></ref><ref id="scirp.69504-ref12"><label>12</label><mixed-citation publication-type="other" xlink:type="simple">Thaker, A.I., Shaker, A., Rao, M.S. and Ciorba, M.A. (2012) Modeling Colitis-Associated Cancer with Azoxymethane (AOM) and Dextran Sulfate Sodium (DSS). Journal of Visualized Experiments, 67, e4100. http://dx.doi.org/10.3791/4100</mixed-citation></ref><ref id="scirp.69504-ref13"><label>13</label><mixed-citation publication-type="other" xlink:type="simple">Collins, T.J. (2007) Image J for Microscopy. BioTechniques, 43, S25-S30. http://dx.doi.org/10.2144/000112517</mixed-citation></ref><ref id="scirp.69504-ref14"><label>14</label><mixed-citation publication-type="other" xlink:type="simple">Hughes, J.S., Ganthavorn, C. and Wilson-Sanders, S. (1997) Dry Beans Inhibit Azixymethane-Induced Colon Carcinogenesis in F344 Rats. Journal of Nutrition, 127, 2328-2333.</mixed-citation></ref><ref id="scirp.69504-ref15"><label>15</label><mixed-citation publication-type="other" xlink:type="simple">Hangen, L. and Bennink, M.R. (2002) Consumption of Black Beans and Navy Beans (Phaseolus vulgaris) Reduced Azoxymethane-Induced Colon Cancer in Rats. Nutrition and Cancer, 44, 60-65. http://dx.doi.org/10.1207/S15327914NC441_8</mixed-citation></ref><ref id="scirp.69504-ref16"><label>16</label><mixed-citation publication-type="other" xlink:type="simple">Hennessy, B.T., Coleman, R.L. and Markman, M. (2009) Ovarian Cancer. Lancet, 374, 1371-1382. http://dx.doi.org/10.1016/S0140-6736(09)61338-6</mixed-citation></ref><ref id="scirp.69504-ref17"><label>17</label><mixed-citation publication-type="other" xlink:type="simple">Morton, D.B. and Griffiths, P.H.M. (1985) Guidelines on the Recognition of Pain and Discomfort in Experimental Animals and a Hypothesis for Assessment. Veterinary Record, 116, 431-436. http://dx.doi.org/10.1136/vr.116.16.431</mixed-citation></ref></ref-list></back></article>