Loading…
Self-assembled insulin and nanogels polyelectrolyte complex (Ins/NGs-PEC) for oral insulin delivery: characterization, lyophilization and in-vivo evaluation
Insulin is given by injection, because when administered orally, it would be destroyed by enzymes in the digestive system, hence only about 0.1% reaches blood circulation. The purpose of the present study was to use pH sensitive polyelectrolyte methyl methacrylate (MMA)/itaconic acid (IA) nanogels a...
Saved in:
Published in: | International journal of nanomedicine 2019-01, Vol.14, p.4895-4909 |
---|---|
Main Authors: | , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c542t-c24c17c7dca662b7639fdb6997e1432a3a8839aa782d9f9cbcc554e599f9c0403 |
---|---|
cites | |
container_end_page | 4909 |
container_issue | |
container_start_page | 4895 |
container_title | International journal of nanomedicine |
container_volume | 14 |
creator | Mudassir, Jahanzeb Darwis, Yusrida Muhamad, Suriani Khan, Arshad Ali |
description | Insulin is given by injection, because when administered orally, it would be destroyed by enzymes in the digestive system, hence only about 0.1% reaches blood circulation. The purpose of the present study was to use pH sensitive polyelectrolyte methyl methacrylate (MMA)/itaconic acid (IA) nanogels as carriers in an attempt to improve absorption of insulin administered orally.
Insulin (Ins) was incorporated into the MMA/IA nanogels (NGs) using the polyelectrolyte complexation (PEC) method to form Ins/NGs-PEC. Several parameters, including Ins:NGs ratio, pH, incubation time and stirring rate were optimized during preparation of InsNGs-PEC. The prepared formulations were characterized in terms of particle size (PS), polydispersity index (PdI), zeta potential (ZP) and percent entrapment efficiency (% EE).
The optimized InF12 nanogels had a PS, PdI, ZP and %EE of 190.43 nm, 0.186, -16.70 mV and 85.20%, respectively. The InF12 nanogels were lyophilized in the presence of different concentrations of trehalose as cryoprotectant. The lyophilized InF12 containing 2%w/v trahalose (InF12-Tre2 nanogels) was chosen as final formulation which had a PS, PdI, ZP and %EE of 430.50 nm, 0.588, -16.50 mv and 82.10, respectively. The in vitro release of insulin from InF12-Tre2 nanogels in the SGF and SIF were 28.71% and 96.53%, respectively. The stability study conducted at 5±3°C for 3 months showed that lnF12-Tre2 nanogels were stable. The SDS-PAGE assay indicated that the primary structure of insulin in the lnF12-Tre2 nanogels was intact. The in-vivo study in the diabetic rats following oral administration of InF12-Tre2 nanogels at a dose of 100 IU/kg body weight reduced blood glucose level significantly to 51.10% after 6 hours compared to the control groups.
The pH sensitive MMA/IA nanogels are potential carriers for oral delivery of insulin as they enhanced the absorption of the drug. |
doi_str_mv | 10.2147/IJN.S199507 |
format | article |
fullrecord | <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_45170065504c4022aea2b8f595474e3a</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A602106566</galeid><doaj_id>oai_doaj_org_article_45170065504c4022aea2b8f595474e3a</doaj_id><sourcerecordid>A602106566</sourcerecordid><originalsourceid>FETCH-LOGICAL-c542t-c24c17c7dca662b7639fdb6997e1432a3a8839aa782d9f9cbcc554e599f9c0403</originalsourceid><addsrcrecordid>eNptkk1vEzEQhlcIREvgxB2txKUINrW9tnfNAamKSgmqClLhbHm9s4kjx07t3YjwW_ixOB-EFiEfPB6_fsYzerPsJUZjgml1Pv18M77FQjBUPcpOMa7qgiBcPr4Xn2TPYlwgxKqai6fZSYkp47zkp9mvW7BdoWKEZWOhzY2LgzUuV67NnXJ-BjbmK283YEH3IQU95NovVxZ-5GdTF89vrmLx9XLyJu98yH1Q9showZo1hM37XM9VULqHYH6q3nj3Lrcbv5obezjvyhlXrM3a57BWdtiln2dPOmUjvDjso-z7x8tvk0_F9Zer6eTiutCMkr7QhGpc6arVinPSVLwUXdtwISrAtCSqVHVdCqWqmrSiE7rRmjEKTGwPiKJylE333NarhVwFs1RhI70ycpfwYSZV6I22ICnDFUKcMUQ1RYQoUKSpOyYYrSiUKrE-7FmroVlCq8H1aSYPoA9vnJnLmV_L9HVUE5EAZwdA8HcDxF4uTdRgrXLghygJqXFNa15WSfr6H-nCD8GlUSUVq4XgmNd_VTOVGjCu86mu3kLlBUcEp26SF0bZ-D-qtFpYGu0ddCblHzx4u3-gg48xQHfsESO5NaZMxpQHYyb1q_tjOWr_OLH8De663xc</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2258996168</pqid></control><display><type>article</type><title>Self-assembled insulin and nanogels polyelectrolyte complex (Ins/NGs-PEC) for oral insulin delivery: characterization, lyophilization and in-vivo evaluation</title><source>PubMed (Medline)</source><source>Taylor & Francis Journals Open Access</source><source>Publicly Available Content (ProQuest)</source><creator>Mudassir, Jahanzeb ; Darwis, Yusrida ; Muhamad, Suriani ; Khan, Arshad Ali</creator><creatorcontrib>Mudassir, Jahanzeb ; Darwis, Yusrida ; Muhamad, Suriani ; Khan, Arshad Ali</creatorcontrib><description>Insulin is given by injection, because when administered orally, it would be destroyed by enzymes in the digestive system, hence only about 0.1% reaches blood circulation. The purpose of the present study was to use pH sensitive polyelectrolyte methyl methacrylate (MMA)/itaconic acid (IA) nanogels as carriers in an attempt to improve absorption of insulin administered orally.
Insulin (Ins) was incorporated into the MMA/IA nanogels (NGs) using the polyelectrolyte complexation (PEC) method to form Ins/NGs-PEC. Several parameters, including Ins:NGs ratio, pH, incubation time and stirring rate were optimized during preparation of InsNGs-PEC. The prepared formulations were characterized in terms of particle size (PS), polydispersity index (PdI), zeta potential (ZP) and percent entrapment efficiency (% EE).
The optimized InF12 nanogels had a PS, PdI, ZP and %EE of 190.43 nm, 0.186, -16.70 mV and 85.20%, respectively. The InF12 nanogels were lyophilized in the presence of different concentrations of trehalose as cryoprotectant. The lyophilized InF12 containing 2%w/v trahalose (InF12-Tre2 nanogels) was chosen as final formulation which had a PS, PdI, ZP and %EE of 430.50 nm, 0.588, -16.50 mv and 82.10, respectively. The in vitro release of insulin from InF12-Tre2 nanogels in the SGF and SIF were 28.71% and 96.53%, respectively. The stability study conducted at 5±3°C for 3 months showed that lnF12-Tre2 nanogels were stable. The SDS-PAGE assay indicated that the primary structure of insulin in the lnF12-Tre2 nanogels was intact. The in-vivo study in the diabetic rats following oral administration of InF12-Tre2 nanogels at a dose of 100 IU/kg body weight reduced blood glucose level significantly to 51.10% after 6 hours compared to the control groups.
The pH sensitive MMA/IA nanogels are potential carriers for oral delivery of insulin as they enhanced the absorption of the drug.</description><identifier>ISSN: 1178-2013</identifier><identifier>ISSN: 1176-9114</identifier><identifier>EISSN: 1178-2013</identifier><identifier>DOI: 10.2147/IJN.S199507</identifier><identifier>PMID: 31456636</identifier><language>eng</language><publisher>New Zealand: Dove Medical Press Limited</publisher><subject>Acids ; acrylic monomers ; Biomedical materials ; Blood glucose ; Body weight ; Diabetes ; Diabetes therapy ; Enzymes ; Glucose ; Hypoglycemia ; Hypoglycemic agents ; hypoglycemic effect ; Insulin ; Insulin aspart ; lyophilization ; Nanoparticles ; Original Research ; Peptides ; peptides self assembly ; Pharmacy ; Polyelectrolytes ; Polyesters ; polymeric nanogels ; Polymerization ; Proteins</subject><ispartof>International journal of nanomedicine, 2019-01, Vol.14, p.4895-4909</ispartof><rights>COPYRIGHT 2019 Dove Medical Press Limited</rights><rights>2019. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Mudassir et al. 2019 Mudassir et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c542t-c24c17c7dca662b7639fdb6997e1432a3a8839aa782d9f9cbcc554e599f9c0403</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2258996168/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2258996168?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31456636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mudassir, Jahanzeb</creatorcontrib><creatorcontrib>Darwis, Yusrida</creatorcontrib><creatorcontrib>Muhamad, Suriani</creatorcontrib><creatorcontrib>Khan, Arshad Ali</creatorcontrib><title>Self-assembled insulin and nanogels polyelectrolyte complex (Ins/NGs-PEC) for oral insulin delivery: characterization, lyophilization and in-vivo evaluation</title><title>International journal of nanomedicine</title><addtitle>Int J Nanomedicine</addtitle><description>Insulin is given by injection, because when administered orally, it would be destroyed by enzymes in the digestive system, hence only about 0.1% reaches blood circulation. The purpose of the present study was to use pH sensitive polyelectrolyte methyl methacrylate (MMA)/itaconic acid (IA) nanogels as carriers in an attempt to improve absorption of insulin administered orally.
Insulin (Ins) was incorporated into the MMA/IA nanogels (NGs) using the polyelectrolyte complexation (PEC) method to form Ins/NGs-PEC. Several parameters, including Ins:NGs ratio, pH, incubation time and stirring rate were optimized during preparation of InsNGs-PEC. The prepared formulations were characterized in terms of particle size (PS), polydispersity index (PdI), zeta potential (ZP) and percent entrapment efficiency (% EE).
The optimized InF12 nanogels had a PS, PdI, ZP and %EE of 190.43 nm, 0.186, -16.70 mV and 85.20%, respectively. The InF12 nanogels were lyophilized in the presence of different concentrations of trehalose as cryoprotectant. The lyophilized InF12 containing 2%w/v trahalose (InF12-Tre2 nanogels) was chosen as final formulation which had a PS, PdI, ZP and %EE of 430.50 nm, 0.588, -16.50 mv and 82.10, respectively. The in vitro release of insulin from InF12-Tre2 nanogels in the SGF and SIF were 28.71% and 96.53%, respectively. The stability study conducted at 5±3°C for 3 months showed that lnF12-Tre2 nanogels were stable. The SDS-PAGE assay indicated that the primary structure of insulin in the lnF12-Tre2 nanogels was intact. The in-vivo study in the diabetic rats following oral administration of InF12-Tre2 nanogels at a dose of 100 IU/kg body weight reduced blood glucose level significantly to 51.10% after 6 hours compared to the control groups.
The pH sensitive MMA/IA nanogels are potential carriers for oral delivery of insulin as they enhanced the absorption of the drug.</description><subject>Acids</subject><subject>acrylic monomers</subject><subject>Biomedical materials</subject><subject>Blood glucose</subject><subject>Body weight</subject><subject>Diabetes</subject><subject>Diabetes therapy</subject><subject>Enzymes</subject><subject>Glucose</subject><subject>Hypoglycemia</subject><subject>Hypoglycemic agents</subject><subject>hypoglycemic effect</subject><subject>Insulin</subject><subject>Insulin aspart</subject><subject>lyophilization</subject><subject>Nanoparticles</subject><subject>Original Research</subject><subject>Peptides</subject><subject>peptides self assembly</subject><subject>Pharmacy</subject><subject>Polyelectrolytes</subject><subject>Polyesters</subject><subject>polymeric nanogels</subject><subject>Polymerization</subject><subject>Proteins</subject><issn>1178-2013</issn><issn>1176-9114</issn><issn>1178-2013</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptkk1vEzEQhlcIREvgxB2txKUINrW9tnfNAamKSgmqClLhbHm9s4kjx07t3YjwW_ixOB-EFiEfPB6_fsYzerPsJUZjgml1Pv18M77FQjBUPcpOMa7qgiBcPr4Xn2TPYlwgxKqai6fZSYkp47zkp9mvW7BdoWKEZWOhzY2LgzUuV67NnXJ-BjbmK283YEH3IQU95NovVxZ-5GdTF89vrmLx9XLyJu98yH1Q9showZo1hM37XM9VULqHYH6q3nj3Lrcbv5obezjvyhlXrM3a57BWdtiln2dPOmUjvDjso-z7x8tvk0_F9Zer6eTiutCMkr7QhGpc6arVinPSVLwUXdtwISrAtCSqVHVdCqWqmrSiE7rRmjEKTGwPiKJylE333NarhVwFs1RhI70ycpfwYSZV6I22ICnDFUKcMUQ1RYQoUKSpOyYYrSiUKrE-7FmroVlCq8H1aSYPoA9vnJnLmV_L9HVUE5EAZwdA8HcDxF4uTdRgrXLghygJqXFNa15WSfr6H-nCD8GlUSUVq4XgmNd_VTOVGjCu86mu3kLlBUcEp26SF0bZ-D-qtFpYGu0ddCblHzx4u3-gg48xQHfsESO5NaZMxpQHYyb1q_tjOWr_OLH8De663xc</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Mudassir, Jahanzeb</creator><creator>Darwis, Yusrida</creator><creator>Muhamad, Suriani</creator><creator>Khan, Arshad Ali</creator><general>Dove Medical Press Limited</general><general>Taylor & Francis Ltd</general><general>Dove</general><general>Dove Medical Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190101</creationdate><title>Self-assembled insulin and nanogels polyelectrolyte complex (Ins/NGs-PEC) for oral insulin delivery: characterization, lyophilization and in-vivo evaluation</title><author>Mudassir, Jahanzeb ; Darwis, Yusrida ; Muhamad, Suriani ; Khan, Arshad Ali</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c542t-c24c17c7dca662b7639fdb6997e1432a3a8839aa782d9f9cbcc554e599f9c0403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acids</topic><topic>acrylic monomers</topic><topic>Biomedical materials</topic><topic>Blood glucose</topic><topic>Body weight</topic><topic>Diabetes</topic><topic>Diabetes therapy</topic><topic>Enzymes</topic><topic>Glucose</topic><topic>Hypoglycemia</topic><topic>Hypoglycemic agents</topic><topic>hypoglycemic effect</topic><topic>Insulin</topic><topic>Insulin aspart</topic><topic>lyophilization</topic><topic>Nanoparticles</topic><topic>Original Research</topic><topic>Peptides</topic><topic>peptides self assembly</topic><topic>Pharmacy</topic><topic>Polyelectrolytes</topic><topic>Polyesters</topic><topic>polymeric nanogels</topic><topic>Polymerization</topic><topic>Proteins</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mudassir, Jahanzeb</creatorcontrib><creatorcontrib>Darwis, Yusrida</creatorcontrib><creatorcontrib>Muhamad, Suriani</creatorcontrib><creatorcontrib>Khan, Arshad Ali</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Health & Medical Complete</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Research Library (ProQuest)</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of nanomedicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mudassir, Jahanzeb</au><au>Darwis, Yusrida</au><au>Muhamad, Suriani</au><au>Khan, Arshad Ali</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Self-assembled insulin and nanogels polyelectrolyte complex (Ins/NGs-PEC) for oral insulin delivery: characterization, lyophilization and in-vivo evaluation</atitle><jtitle>International journal of nanomedicine</jtitle><addtitle>Int J Nanomedicine</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>14</volume><spage>4895</spage><epage>4909</epage><pages>4895-4909</pages><issn>1178-2013</issn><issn>1176-9114</issn><eissn>1178-2013</eissn><abstract>Insulin is given by injection, because when administered orally, it would be destroyed by enzymes in the digestive system, hence only about 0.1% reaches blood circulation. The purpose of the present study was to use pH sensitive polyelectrolyte methyl methacrylate (MMA)/itaconic acid (IA) nanogels as carriers in an attempt to improve absorption of insulin administered orally.
Insulin (Ins) was incorporated into the MMA/IA nanogels (NGs) using the polyelectrolyte complexation (PEC) method to form Ins/NGs-PEC. Several parameters, including Ins:NGs ratio, pH, incubation time and stirring rate were optimized during preparation of InsNGs-PEC. The prepared formulations were characterized in terms of particle size (PS), polydispersity index (PdI), zeta potential (ZP) and percent entrapment efficiency (% EE).
The optimized InF12 nanogels had a PS, PdI, ZP and %EE of 190.43 nm, 0.186, -16.70 mV and 85.20%, respectively. The InF12 nanogels were lyophilized in the presence of different concentrations of trehalose as cryoprotectant. The lyophilized InF12 containing 2%w/v trahalose (InF12-Tre2 nanogels) was chosen as final formulation which had a PS, PdI, ZP and %EE of 430.50 nm, 0.588, -16.50 mv and 82.10, respectively. The in vitro release of insulin from InF12-Tre2 nanogels in the SGF and SIF were 28.71% and 96.53%, respectively. The stability study conducted at 5±3°C for 3 months showed that lnF12-Tre2 nanogels were stable. The SDS-PAGE assay indicated that the primary structure of insulin in the lnF12-Tre2 nanogels was intact. The in-vivo study in the diabetic rats following oral administration of InF12-Tre2 nanogels at a dose of 100 IU/kg body weight reduced blood glucose level significantly to 51.10% after 6 hours compared to the control groups.
The pH sensitive MMA/IA nanogels are potential carriers for oral delivery of insulin as they enhanced the absorption of the drug.</abstract><cop>New Zealand</cop><pub>Dove Medical Press Limited</pub><pmid>31456636</pmid><doi>10.2147/IJN.S199507</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1178-2013 |
ispartof | International journal of nanomedicine, 2019-01, Vol.14, p.4895-4909 |
issn | 1178-2013 1176-9114 1178-2013 |
language | eng |
recordid | cdi_doaj_primary_oai_doaj_org_article_45170065504c4022aea2b8f595474e3a |
source | PubMed (Medline); Taylor & Francis Journals Open Access; Publicly Available Content (ProQuest) |
subjects | Acids acrylic monomers Biomedical materials Blood glucose Body weight Diabetes Diabetes therapy Enzymes Glucose Hypoglycemia Hypoglycemic agents hypoglycemic effect Insulin Insulin aspart lyophilization Nanoparticles Original Research Peptides peptides self assembly Pharmacy Polyelectrolytes Polyesters polymeric nanogels Polymerization Proteins |
title | Self-assembled insulin and nanogels polyelectrolyte complex (Ins/NGs-PEC) for oral insulin delivery: characterization, lyophilization and in-vivo evaluation |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T01%3A57%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Self-assembled%20insulin%20and%20nanogels%20polyelectrolyte%20complex%20(Ins/NGs-PEC)%20for%20oral%20insulin%20delivery:%20characterization,%20lyophilization%20and%20in-vivo%20evaluation&rft.jtitle=International%20journal%20of%20nanomedicine&rft.au=Mudassir,%20Jahanzeb&rft.date=2019-01-01&rft.volume=14&rft.spage=4895&rft.epage=4909&rft.pages=4895-4909&rft.issn=1178-2013&rft.eissn=1178-2013&rft_id=info:doi/10.2147/IJN.S199507&rft_dat=%3Cgale_doaj_%3EA602106566%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c542t-c24c17c7dca662b7639fdb6997e1432a3a8839aa782d9f9cbcc554e599f9c0403%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2258996168&rft_id=info:pmid/31456636&rft_galeid=A602106566&rfr_iscdi=true |