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Differential Effect of the Route of Inoculation of Rabies Virus on NeuN Immunoreactivity in the Cerebral Cortex of Mice/ Efecto Diferencial de la Via de Inoculacion del Virus de la Rabia sobre la Inmunorreactividad de NeuN en la Corteza Cerebral de Ratones.

INTRODUCTION

Rabies remains a public health problem in developing countries. Rabies can be prevented by the vaccination of pets and people at high risk of contact with the virus. The entire population is not vaccinated because of the high cost associated with the vaccine and other factors. In addition, it is almost impossible to eradicate a virus that has wild vectors. Despite the availability of preventive controls, there are still approximately 55.000 deaths reported yearly due to rabies worldwide. The destruction of natural habitats and climate change are factors that cause vector displacement to areas that are inhabited by humans and domestic animals, increasing the risk of disease transmission (WHO, 2013).

The rabies virus spreads through retrograde axonal transport from the bite of an infected animal. Once the virus enters into the nerve terminals of the new host, it is transported to the motor neurons of the spinal cord and advances to the brain, causing marked neuronal dysfunction with fatal results. Despite the severity of clinical symptoms, rabies produces only a low inflammatory and microglial reaction in the nervous tissue. Only small brain abnormalities and the presence of eosinophilic cytoplasmic inclusions called Negri bodies are observed with conventional anatomical and histopathological analysis methods. Negri bodies are formed by a granular matrix surrounded by viral particles (Iwasaki & Tobita, 2002).

Rabies does not appear to induce massive neuronal loss. However, in some experimental studies that have been performed, apoptosis were reported in some neurons principally when the virus was inoculated intracerebrally (Jackson & Fu, 2013). Therefore, it is important to perform studies about the dynamics of cellular infection using alternative tools as the neuronal markers. These molecules have allowed evaluating parameters as changes in the structure, number and distribution of neurons in the cerebral cortex of rabies-infected mice. (Torres-Fernandez et al, 2004; Torres-Fernandez et al, 2005; Rengifo & TorresFernandez, 2007; Hurtado et al, 2015).

The neuronal nuclear protein (NeuN) has become a widely used neuronal marker for the histopathological diagnosis of nervous system diseases and for research on embryonic development, adult neurogenesis and neuronal loss studies in natural and experimental conditions (Wolf et al., 1996; Sarnat et al., 1998; Gittins & Harrison, 2004; Yang et al., 2011). These features make this protein an excellent marker for the study of neurological diseases that induce morphological changes that are difficult to detect, such as rabies disease. However we don't know previous studies about NeuN in rabies. The distribution of NeuN in the cerebral cortex of mice under normal conditions and the NeuN immunoreactivity in rabies-infected mice was assessed in this work. In addition, the effects of two different pathogen inoculation routes were compared to contribute knowledge about rabies pathogenesis.

MATERIAL AND METHOD

Laboratory animals and viral inoculation. A total of 20 female ICR (Institute of Cancer Research) mice at 28 days old were used. Mice were maintained in the animal facility of the National Institute of Health (Instituto Nacional de Salud, INS) in the high-security area under environmental and nutritional conditions in accordance with the ethical and legal standards required for animal laboratory research approved by the Ethics Committee of the INS and Colombian law (Law 86 of 1989 and resolution No. 008430 of 1993 of the Ministry of Health). Two groups of 5 mice were inoculated with 0.03 ml (each animal) of a solution of the challenge virus standard (CVS) strain of rabies virus by two different infection routes. The first group was inoculated intramuscularly with a viral dilution of 10 (9.1) (LD50), and the second group was inoculated intracerebrally with a dilution of 10 (4.1) (LD50). For each group of infected animals, an equivalent number of control animals inoculated under the same conditions with only the viral carrier (virus-free solution containing 2 % standard horse serum and the antibiotics penicillin and streptomycin at 200 UI/ml and 4 mg/ml, respectively) was used.

Procedure to obtain brain tissue sections. Mice showing signs associated with the rabies terminal phase were selected. Signs were observed for approximately 5 to 7 days after inoculation. Animals were anesthetized by injecting 0.2 ml of 30% chloral hydrate intraperitoneally (350 mg/kg). The animals were then fixed by intracardiac perfusion first with phosphate buffered saline (PBS) solution at pH 7.3 for 5 minutes and then with a 4 % paraformaldehyde fixative solution prepared in phosphate buffer (70 ml of solution for 10 minutes). PBS was allowed to circulate again for one minute after perfusion when the fixation was complete. Brains were carefully extracted and were immersed in the same fixing solution that was used for perfusion. Samples were maintained at 4[degrees]C for a minimum of 20 hours up to two weeks before processing for immunohistochemistry.

Hemispheres were separated, and tissue slices with a maximum thickness of 1 cm were obtained from each. Slices were made on the coronal plane from a tissue brain fragment between the corpus callosum knee and the dorsal fornix; this area mainly covers the motor cortex according to the Valverde's mouse atlas (Valverde, 1998). These tissue blocks were placed on a vibratome to obtain 50-[micro]m-thick coronal sections that were then transferred to small circular glass boxes with a 1.5 cm radius containing PBS. In each case, the sections were placed and allowed to stir (in a horizontal shaker-rotator) at room temperature (20 [degrees]C) overnight.

Immunohistochemistry protocol. The sections were processed in suspension during all stages of the immunohistochemical protocol to detect NeuN and with constant stirring at room temperature (20[degrees]C). PBS at pH 7.3 was used for the initial wash and for all washes after each stage of the process. After the first wash, the sections were treated with 0.05 M ammonium chloride to counteract the effect of aldehydes and with 3 % hydrogen peroxide to inactivate endogenous peroxidases. The sections were then incubated in normal horse serum and bovine serum albumin.

Three different dilutions of the primary antibody (monoclonal anti-NeuN from Chemicon-Millipore; Germany, Darmstadt) were tested: 1:625, 1:1250 and 1:2500. Incubation with primary antibody was performed overnight (20 hours) due to the thickness of the sections. The next day, after washing with PBS, sections were incubated with the secondary antibody (biotinylated polyclonal anti-mouse IgG from Sigma) for two hours. Two dilutions of the secondary antibody were tested, 1:400 and 1:600, which were prepared in PBS. After washing, the sections were treated with ABC Vector[R] solution (avidin- biotin complex) for two hours. Then, the immunostain were developed using a solution of the diaminobenzidine (DAB) chromogen. Different developing times were tested. Sections were rapidly washed with distilled water and then with PBS to end the reaction. Finally, sections were extended on 1 % gelatin-pretreated glass slides, air dried and mounted with Entellan[R].

Histological and digital image analysis. Initially, qualitative observations of immunohistochemical preparations obtained from control animals were performed to determine the presence of NeuN-immunoreactive (NeuN+) cells and to observe the distribution of NeuN under normal conditions. The same procedure was applied to samples taken from groups of animals inoculated with rabies virus. Panoramic and detailed pictures of histological sections of normal and infected samples were taken to perform quantitative analysis. Three neuron counts from the motor cortex of each sample from control and virusinfected animals were performed using a Zeiss-Netzmiier microscope with a 1 [mm.sup.2] mesh in 10x fields to locate the area of the frontal cortex. Counts were made through all cortical layers of the motor area.

Images of the cerebral cortex from control and infected samples were digitized, and cellular optical densitometry was performed using Q-Capture Pro software. Cerebral cortex images were captured in 40x fields (three sections per sample). Subsequently, the Image J program was used to quantify protein immunostaining, and diameter measurements (in micrometers) were performed in NeuN+ cells with Q-Capture Software following similar protocols to those we published previously. The quantitative analysis was performed on 5 samples of infected animals and their respective controls for each study group. The statistical Wilcoxon-Mann-Whitney test (nonparametric) suitable for a small number of high-variability samples was used (Torres-Fernandez et al, 2004; Rengifo & Torres-Fernandez).

RESULTS

Distribution of neurons immunoreactive for NeuN in the cortex of normal mice. Antibody dilutions for the best obtained immunostaining were 1:1250 for the primary antibody and 1:400 for the secondary antibody. NeuN+ neurons were observed in all cortical layers with an apparently uniform distribution, except for layer I, where a small number of NeuN+ neurons (Figs. 1a and 2 a) was noted. However, the counts performed on each of the layers of the cortex showed a higher concentration of immunoreactive cells in layers III, V and VI in all groups of animals. The morphology exhibited by labeled neurons revealed highly homogeneous cell bodies and no labeling of cellular processes (dendrites) (Fig. 1c).

The effect of rabies virus on the number of NeuN+ cortical neurons. A panoramic view of the microscopically observed histological preparations showed decreased staining of NeuN+ cells in the cerebral cortex of infected animals (Figs. 1b and 1d); in contrast, a loss in the number of NeuN+ neurons was not evident. However, it was found that infection with rabies by either of the two routes of infection decreased the total number of NeuN+ cells in the inoculated animals, but this decrease was only statistically significant for the group inoculated intracerebrally.

The number of neurons NeuN+ was 1754 [+ or -] 69 in the control group and 1568 [+ or -] 72 in the group infected intracerebrally (p = 0.0317) (Table I). In the group infected intramuscularly, the number of neurons NeuN+ was 1407 [+ or -] 144, whereas in controls, it was 1458 [+ or -] 172 (p = 0.7937) (Table II). The loss of neurons (NeuN+) was more pronounced in cortical layer V of animals inoculated intracerebrally, especially in cortical layer Vc (p = 0.008) (Table I, Figs. 1d and 2b), whereas the difference was not statistically significant for any of the cortical layers in animals inoculated intramuscularly (Table II).

Optical densitometry and NeuN+ cell size. A loss of immunostaining was observed in all cortical layers and especially in layer V (Figs. 1 and 2). The optical densitometry analysis showed decreased cell immunolabeling was only statistically significant for the tissues of animals inoculated intracerebrally (p = 0.0079) (Table III), whereas in mice inoculated intramuscularly, the difference was not statistically significant. These results are consistent with the observed neuronal counts. In addition, a decreasing trend in the size of the neurons profiles in both groups of infected animals was found after measuring the diameter of NeuN-immunoreactive neurons (intracerebral, p = 0.0317; intramuscular, p = 0.0546) (Table IV).

DISCUSSION

Standardization of dilutions for NeuN immunohistochemistry. In reviewing the literature, there was no consistent correlation between the methods used and the dilution of anti-NeuN antibody chosen in each case. In the original reference describing NeuN, protein samples were embedded in plastic resin, and the dilution used was 1:100 (Mullen et al., 1992). In most cases, nervous tissue samples were processed by paraffin embedding, and the dilutions used were very diverse: 1: 100 (Gittins & Harrison), 1:500 (Wolf et al.; Unal-Cevik et al, 2004; Collombet et al, 2006), 1:1000 (Gill et al, 2005), 1:1500 (Sarnat et al.) and 1:2000 (Salamon et al., 2006). Additionally, the work performed on sections obtained by cryotomy (sections from frozen tissue), which better preserves the immunoreactivity of antigens, reported dilutions ranging from 1:100 to 1:5000 (Jongen-Relo & Feldon, 2002; Lee et al., 2003; McPhail et al., 2004; Yang et al.). Sections obtained with the vibratome used in this study are also suitable for good preservation of antigens; however, there are few previous reports of using vibratome sections for the study of NeuN (Escobar et al., 2008; Torres-Fernandez et al., 2008), in these studies, a dilution of 1:2500 was reported. The variability in the dilutions cannot be explained by the origin of the antibodies because most studies were performed with a single commercially available antibody; only in recent years have we seen anti-NeuN antibodies available from other brands. Given the above information, it was necessary to perform the assays that led us to establish the dilution of 1:1250 as that with which the best results were observed. The selection criterion was to obtain good labelling of neuronal cell bodies and lower nonspecific background staining.

Distribution of NeuN+ neurons in the normal mouse cortex. The results of this study are consistent with our previous study (Torres-Fernandez et al., 2008) in which NeuN+ neurons were observed to be uniformly distributed in dense layers thorough the mouse cortex, except for in layer I, where there were only a small number of neurons. This distribution of NeuN+ neurons in the cortex of mice is similar to that observed in other studies conducted on mice (Unal-Cevik et al.) and rats (Jongen-Relo & Feldon) and in the human cerebral cortex (Escobar et al.). The shortage of NeuN+ neurons in layer I of the cortex simply reflects the known fact that this layer has few neurons. There are two types of neurons in cortical layer I: Cajal horizontal cells (also called Cajal-Retzius) and other types of smaller neurons (Marin-Padilla, 1998). Some authors have described the lack of NeuN staining in Cajal-Retzius cells. However, in this work and in our previous work the presence of NeuN+ cells in layer I was evident. The results are similar to those reported in mice, rats and humans (Unal-Cevik et al.; Jongen-Relo & Feldon; Escobar et al.). Moreover, these cells are also immunoreactive for the protein calretinin (DeFelipe, 1997). In a previous study, we found the presence of calretinin immunoreactive cells in layer I of the mouse cortex (Torres- Fernandez et al., 2004), and its distribution was highly similar to that observed for NeuN immunostaining. Therefore, at least for the mouse cerebral cortex, cells of the molecular layer (layer I) have both neuronal markers, i.e., NeuN and calretinin.

Effect of rabies virus on NeuN immunoreactivity in mouse cortical neurons. Infection by intracerebral inoculation of rabies virus decreased NeuN immunoreactivity in the cerebral cortex of mice, as established by fewer NeuN+ cells as well as a decrease in immunostaining calculated by optical densitometry and the size in the profile of neurons. Whether this may be related to neuronal death or whether infection with rabies virus affects the expression of the protein or only its immunoreactivity is still undefined. The use of NeuN immunohistochemistry in studies that require neuronal counts is the more reliable alternative to the traditional method based on Nissl staining with cresyl violet or thionine because NeuN more readily distinguishes between small neurons and glia (Gittins & Harrison). However, the usefulness of NeuN staining was interrogated for this purpose in a study which showed loss of immunoreactivity of the protein, but no neuronal death (Unal-Cevik et al.). A subsequent investigation criticized this earlier study and supported the usefulness of NeuN for neuronal counts, suggesting that a reasonable time should elapse before the effect of a disease on a neuronal population was assessed (Collombet et al.).

The loss of NeuN immunoreactivity induced by rabies virus intracerebral inoculation could occur because this type of experimental infection in mice induces neuronal death by apoptosis (Jackson & Fu). However, studies that correlate neuronal count with Nissl staining, quantify neuronal death by apoptosis and label cells with NeuN are needed to definitively establish whether this protein is a good marker for studies of rabies-induced neuronal loss in different areas of the nervous system. Moreover, no loss in the number of NeuN+ cells in the cortex of animals intramuscularly inoculated with rabies virus was found. This observation could indicate that in this condition, there is no neuronal death and no effect on protein expression. We should keep in mind that this experimental model more closely simulates what happens during natural infection. It has been established in rabies infections of both humans and other animals that under natural conditions, this viral infection does not induce neuronal death by apoptosis (Jackson et al., 2008; Suja et al., 2011). Similarly, apoptosis was not observed in mice intramuscularly inoculated with rabies virus except in special experimental conditions (Jackson & Fu).

The decrease of NeuN+ immunoreactivity in layer V was more dramatic in animals inoculated intracerebrally. Studies on other diseases have reported similar effects on pyramidal neurons. In patients with head trauma, a decrease in NeuN+ neurons was found in cortical layers III and V (Escobar et al.). This susceptibility may occur because the pyramidal cells in layers III and V are part of large interconnected networks with other areas of the nervous system (DeFelipe). Finally, the susceptibility of pyramidal neurons to rabies infection has also been demonstrated in other studies we have conducted (Hurtado et al.). On the other hand, the difference in NeuN immunoreactivity in animals infected by both routes of inoculation confirms that it is necessary to interpret with caution the findings obtained in experiments with rabies where the intracerebral inoculation route was used. The results obtained by intramuscular infection with rabies better reflect the natural conditions of the disease and thus offer more realistic approaches to understanding the physiopathological mechanisms of this viral disease.

ACKNOWLEDGEMENTS.

We thank to our colleague Jorge Alonso Rivera for advice and support in the processing and presentation of images.

REFERENCES

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Correspondence to:

Orlando Torres-Fernandez

Grupo de Morfologia Celular

Instituto Nacional de Salud (INS)

Av. Calle 26 No. 51-20

Bogota DC

COLOMBIA

Received: 11-12-2015

Accepted: 10-08-2016

Email: otorresf@ins.gov.co

Aura Caterine Rengifo *; Vanessa Jazmin Umbarila *; Mary Janeth Garzon * & Orlando Torres-Fernandez *

* Grupo de Morfologia Celular, Instituto Nacional de Salud (INS), Bogota, Colombia. This work was funded by Departamento Administrativo de Ciencia, Tecnologia e Innovacion COLCIENCIAS and Instituto Nacional de Salud (INS, Colombia). Code of Grant 210465740573, Contract 639/2014.

Caption: Fig. 1. Distribution of NeuN immunoreactivity in the cerebral cortex of mice. (a) Panoramic view of the cerebral motor cortex of a control mouse showing NeuN labeling. (b) Panoramic view of the cerebral cortex of a rabies-infected mouse inoculated intracerebrally. Note the decrease in NeuN immunoreactivity. (c) Magnification of layer V from the image in (a), where a high density of neurons with strong staining is observed. (d) Magnification of layer V of the image in (b) shows the lower cell density. Layer IV is not included in this picture because this layer is thought to be absent in the agranular motor cortex (Valverde, 1998). DAB stain. Scale bar, 60 [micro]m (figs. a y b); scale bar, 15 [micro]m (figs. c y d).

Caption Fig. 2. Distribution of NeuN immunoreactivity in the mouse cortex. (a) NeuN+ cells in a sample of the motor cortex from a control mouse; note the strong staining through all cortical layers. (b) NeuN+ cells in the motor cortex of a mouse inoculated with rabies virus intracerebrally; note the decreased staining, especially in layer V. The loss of NeuN-immunoreactive neurons is evident, and the immunostaining also exhibits a lower intensity. DAB stain. Scale bar, 200 mm.
Table I. Distribution of the number of NeuN+ cells observed in a 1-mm
cortical column in different layers of the motor area. Mice
intracerebrally inoculated with rabies virus and their controls. For
each sample, the mean of the number of neurons per layer is given.

Layer              Control samples          Mean # of cells
                                            per layer

         1      2      3      4      5
I        21     32     16     26     19     23   [+ or -]  6
II       149    162    136    135    158    148  [+ or -]  12
III      430    444    468    459    475    455  [+ or -]  18
Va       146    143    101    138    123    130  [+ or -]  19
Vb       134    121    108    143    133    128  [+ or -]  14
Vc       131    126    118    159    151    137  [+ or -]  17
Vd       146    127    125    162    171    146  [+ or -]  21
VIa      151    124    142    170    184    154  [+ or -]  23
VIb      176    140    148    162    112    148  [+ or -]  24
VIc      170    138    132    114    119    135  [+ or -]  22
VId      156    167    153    122    156    151  [+ or -]  17

Total    1810   1724   1647   1790   1801   1754  [+ or -]  69

Layer               Infected samples       Mean # of cells
                                           per layer           p value

         1      2      3      4      5
I        24     19     13     28     26    22    [+ or -]  6   0.999
II       138    115    134    135    137   132   [+ or -]  10  0.111
III      429    474    486    464    449   460   [+ or -]  22  0.310
Va       106    99     98     99     131   107   [+ or -]  14
Vb       115    106    113    96     114   109   [+ or -]  8   0.056
Vc       108    104    112    110    114   110   [+ or -]  4
Vd       113    112    105    113    137   116   [+ or -]  12
VIa      116    118    101    142    161   128   [+ or -]  24  0.111
VIb      136    126    118    144    153   135   [+ or -]  14  0.421
VIc      119    108    118    124    119   118   [+ or -]  6   0.222
VId      121    132    130    137    143   133   [+ or -]  8   0.087
Total    1525   1513   1528   1592   1684  1568  [+ or -]  72  0.0317**

(**) Statistically significant; ([+ or -]) Standard deviation.

Table II. Distribution of the number of NeuN+ cells observed in a 1 mm
cortical column in different layers of the motor area. Mice
intramuscularly inoculated with rabies virus and their
controls. In each sample, the mean of the number of
neurons per layer is given.

Layer              Control samples          Mean # of cells
                                            per layer
         1      2      3      4      5

I        17     16     59     13     19     25   [+ or -]  19
II       108    94     156    118    117    119  [+ or -]  23
III      322    332    329    377    321    336  [+ or -]  23
Va       100    106    140    110    86     108  [+ or -]  20
Vb       99     95     140    117    100    110  [+ or -]  19
Vc       111    120    145    127    114    123  [+ or -]  14
Vd       141    130    153    156    141    144  [+ or -]  10
VIa      140    140    164    158    147    150  [+ or -]  11
VIb      132    80     147    142    101    120  [+ or -]  29
VIc      106    120    166    94     100    117  [+ or -]  29

VId      114    95     136    101    80     105  [+ or -]  21

Total    1390   1328   1735   1513   1326   1458  [+ or -]  172

Layer            Infected samples          Mean # of cells      P value
                                           per layer
         1      2      3      4      5

I        24     28     15     16     22    21   [+ or -]  5     0.7381
II       142    140    122    142    137   137  [+ or -]  8     0.1349
III      373    339    330    313    344   340  [+ or -]  22    0.6905
Va       134    105    88     88     102   103  [+ or -]  19    0.6508
Vb       123    105    84     89     110   102  [+ or -]  16    0.6905
Vc       134    95     90     97     101   103  [+ or -]  18    0.0952
Vd       156    100    95     136    134   124  [+ or -]  26    0.2302
VIa      158    93     98     137    138   125  [+ or -]  28    0.0714
VIb      124    102    111    150    134   124  [+ or -]  19    0.8413
VIc      116    117    118    114    112   115  [+ or -]  2     0.6905
VId      151    129    96     83     103   112  [+ or -]  27    0.6905

Total    1635   1353   1247   1365   1437  1407  [+ or -]  144  0.7937

Table III. Optical densitometry of NeuN immunoreactivity per cell in
cerebral cortex from mice inoculated with rabies virus intracerebrally
or intramuscularly. Each value corresponds to the mean of the reading
of 20 cells. Reading scale (0-255 grey levels); the higher the value,
greater light transmittance and, lower optical density, therefore
lower immunoreactivity. Measurements at 40X.

Sample           Optical density. Mice inoculated
                          intracerebrally

                Controls                  Infected

1        104.12  [+ or -]  12.99   125.65  [+ or -]  6.73
2        108.38  [+ or -]  1.30    127.67  [+ or -]  13.17
3        106.11  [+ or -]  10.58   127.62  [+ or -]  6.20
4        114.07  [+ or -]  3.89    127.77  [+ or -]  2.11
5        112.54  [+ or -]  2.52    125.43  [+ or -]  8.76
Mean     109.05  [+ or -]  4.21    126.83  [+ or -]  1.18
                            p = 0.0079**

Sample         Optical density.  Mice inoculated
                         intramuscularly

                Controls                  Infected

1        117.17  [+ or -]  5.68    97.08   [+ or -]  9.94
2        101.51  [+ or -]  5.95    114.04  [+ or -]  12.19
3        97.92  [+ or -]  5.56     122.61  [+ or -]  1.75
4        11.95  [+ or -]  4.46     109.19  [+ or -]  12.56
5        103.80  [+ or -]  3.19    102.15  [+ or -]  9.68
Mean     106.47  [+ or -]  7.90    109.01  [+ or -]  10.0
                            p = 0.8413

(**) Statistically significant; ([+ or -]) Standard deviation.

Table IV Diameter (in micrometers) of NeuN+ cells in cerebral cortex
of mice inoculated with rabies virus by intracerebral or intramuscular
route and their controls. Each value corresponds to the mean of 20
cells per section in three sections. Measurements were performed with
a 40X objective.

                    Diameter of NeuN+ cells.
Sample          Mice inoculated intracerebrally

               Controls                Infected

1        10.92  [+ or -]  0.08   8.70  [+ or -]  0.38
2        12.35  [+ or -]  0.19   9.80  [+ or -]  0.61
3        12.17  [+ or -]  0.21   10.78 [+ or -]  1.20
4        10.26  [+ or -]  2.39   9.93  [+ or -]  0.10
5        10.38  [+ or -]  0.19   9.36  [+ or -]  0.10
Mean     11.21  [+ or -]  0.10   9.71  [+ or -]  0.76
                            p = 0.0317**

                   Diameter of NeuN+ cells.
Sample           Mice inoculated intramuscularly

               Controls                 Infected

1        10.39  [+ or -]  0.38   7.91  [+ or -]  0.63
2        9.42   [+ or -]  1.50   7.44  [+ or -]  0.05
3        10.57  [+ or -]  0.40   8.72  [+ or -]  0.37
4        9.66   [+ or -]  2.09   10.11 [+ or -]  2.06
5        9.53   [+ or -]  0.88   8.77  [+ or -]  0.05
Mean     9.92   [+ or -]  0.53   8.59  [+ or -]  1.02
                             p = 0.0546

(**) Statistically significant;  [+ or -]  Standard deviation.
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Author:Rengifo, Aura Caterine; Umbarila, Vanessa Jazmin; Garzon, Mary Janeth; Torres-Fernandez, Orlando
Publication:International Journal of Morphology
Date:Dec 1, 2016
Words:4958
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