Research Article
BibTex RIS Cite
Year 2025, EARLY ONLINE, 1 - 8
https://doi.org/10.18621/eurj.1598227

Abstract

References

  • 1. Von Känel R, Begré S. Depression after myocardial infarction: unraveling the mystery of poor cardiovascular prognosis and role of beta-blocker therapy. J Am Coll Cardiol. 2006;48(11):2215-2217. doi: 10.1016/j.jacc.2006.09.007.
  • 2. Yang W, Wang Y, Li X, et al. Antidepressive and cardioprotective effects of Kai-xin-san via the regulation of HPA axis dysfunction and lipid metabolism in a rat model of depressive-cardiac disease. Brain Res Bull. 2024;219:111126. doi: 10.1016/j.brainresbull.2024.111126.
  • 3. Amare AT, Schubert KO, Klingler-Hoffmann M, Cohen-Woods S, Baune BT. The genetic overlap between mood disorders and cardiometabolic diseases: a systematic review of genome wide and candidate gene studies. Transl Psychiatry. 2017;7(1):e1007. doi: 10.1038/tp.2016.261.
  • 4. Wang Y, Chen Y, Li B, et al. The antidepressant effect of Shexiang Baoxin Pills on myocardial infarction rats with depression may be achieved through the inhibition of the NLRP3 inflammasome pathway. Brain Behav. 2024;14(7):e3586. doi: 10.1002/brb3.3586.
  • 5. Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(14):1827-1845. doi: 10.1016/j.jacc.2019.01.041.
  • 6. Ziegelstein RC. Depression in patients recovering from a myocardial infarction. JAMA. 2001;286(13):1621-1627. doi: 10.1001/jama.286.13.1621.
  • 7. Thombs BD, Bass EB, Ford DE, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21(1):30-38. doi: 10.1111/j.1525-1497.2005.00269.x.
  • 8. Solak H, Gormus ZIS, Koca RO, Gunes CE, Kutlu S. Does Sertraline Affect Hypothalamic Food Intake Peptides in the Rat Experimental Model of Chronic Mild Stress-Induced Depression? Neurochem Res. 2022;47(5):1299-1316. doi: 10.1007/s11064-022-03529-9.
  • 9. Ilgin S, Kilic V, Baysal M, Aydogan-Kilic G, Ucarcan S, Dermenci B, Atli O. Evidence for cardiotoxicity associated with sertraline in rats. Toxicol Res (Camb). 2018;7(5):817-825. doi: 10.1039/c8tx00072g.
  • 10. Zhang LJ, Liu MY, Rastogi R, Ding JN. Psychocardiological disorder and brain serotonin after comorbid myocardial infarction and depression: an experimental study. Neurol Res. 2018;40(6):516-523. doi: 10.1080/01616412.2018.1455460.
  • 11. Kupper N, Gidron Y, Winter J, Denollet J. Association between type D personality, depression, and oxidative stress in patients with chronic heart failure. Psychosom Med. 2009;71(9):973-980. doi: 10.1097/PSY.0b013e3181bee6dc.
  • 12. Yuan Y, Lai S, Hu T, et al. Puerarin pretreatment provides protection against myocardial ischemia/reperfusion injury via inhibiting excessive autophagy and apoptosis by modulation of HES1. Sci Rep. 2025;15(1):794. doi: 10.1038/s41598-024-84808-z.
  • 13. Ott S, Dresen E, Lee ZY, et al. The effect of high-dose selenium on mortality and postoperative organ dysfunction in post-cardiotomy cardiogenic shock patients supported with mechanical circulatory support - A post-hoc analysis of the SUSTAIN CSX trial. J Crit Care. 2024;83:154853. doi: 10.1016/j.jcrc.2024.154853.
  • 14. Shalihat A, Hasanah AN, Mutakin, Lesmana R, Budiman A, Gozali D. The role of selenium in cell survival and its correlation with protective effects against cardiovascular disease: A literature review. Biomed Pharmacother. 2021;134:111125. doi: 10.1016/j.biopha.2020.111125.
  • 15. Solak Gormus ZI, Eker CB, Solak H, Ozen Koca R, Ozdengul F. Does Sertraline Affect Contraction in Endothelium Damaged Aorta? Selcuk Med J. 2024;40(1):8-15. doi: 10.30733/std.2023.01688.
  • 16. Wang Y, Gao X, Zhao Z, et al. The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction. Psychol Med. 2023;53(4):1379-1389. doi: 10.1017/S0033291721002932.
  • 17. Wang Y, Chen Y, Li B, et al. The antidepressant effect of Shexiang Baoxin Pills on myocardial infarction rats with depression may be achieved through the inhibition of the NLRP3 inflammasome pathway. Brain Behav. 2024;14(7):e3586. doi: 10.1002/brb3.3586.
  • 18. Davidson KW, Kupfer DJ, Bigger JT, et al. Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosom Med. 2006;68(5):645-650. doi: 10.1097/01.psy.0000233233.48738.22.
  • 19. Ungvari Z, Pacher P, Koller A. Serotonin reuptake inhibitor fluoxetine decreases arteriolar myogenic tone by reducing smooth muscle [Ca2+]i. J Cardiovasc Pharmacol. 2000;35(6):849-854. doi: 10.1097/00005344-200006000-00004.
  • 20. Shores MM, Pascualy M, Lewis NL, Flatness D, Veith RC. Short-term sertraline treatment suppresses sympathetic nervous system activity in healthy human subjects. Psychoneuroendocrinology. 2001;26(4):433-439. doi: 10.1016/s0306-4530(01)00002-6.
  • 21. Pereira CA, Rodrigues FL, Ruginsk SG, et al. Chronic treatment with fluoxetine modulates vascular adrenergic responses by inhibition of pre- and post-synaptic mechanisms. Eur J Pharmacol. 2017;800:70-80. doi: 10.1016/j.ejphar.2017.02.029.
  • 22. Akinci M, Karadag CH, Huseyin S, et al. Effects of in vitro Amitriptyline, Fluoxetine, Tranylcypromine and Venlafaxine on Saphenous Vein Grafts. Braz J Cardiovasc Surg. 2019;34(3):290-296. doi: 10.21470/1678-9741-2018-0338.
  • 23. Turan B, Désilets M, Açan LN, Hotomaroglu O, Vannier C, Vassort G. Oxidative effects of selenite on rat ventricular contractility and Ca movements. Cardiovasc Res. 1996;32(2):351-361. doi: 10.1016/0008-6363(96)00071-5.
  • 24. Ayaz M, Ozdemir S, Yaras N, Vassort G, Turan B. Selenium-induced alterations in ionic currents of rat cardiomyocytes. Biochem Biophys Res Commun. 2005;327(1):163-173. doi: 10.1016/j.bbrc.2004.12.003.
  • 25. Sayar K, Ugur M, Gürdal H, Onaran O, Hotomaroglu O, Turan B. Dietary selenium and vitamin E intakes alter beta-adrenergic response of L-type Ca-current and beta-adrenoceptor-adenylate cyclase coupling in rat heart. J Nutr. 2000;130(4):733-740. doi: 10.1093/jn/130.4.733.
  • 26. Siepmann M, Grossmann J, Mück-Weymann M, Kirch W. Effects of sertraline on autonomic and cognitive functions in healthy volunteers. Psychopharmacology (Berl). 2003;168(3):293-298. doi: 10.1007/s00213-003-1448-4.
  • 27. Sullivan GM, Kent JM, Kleber M, Martinez JM, Yeragani VK, Gorman JM. Effects of hyperventilation on heart rate and QT variability in panic disorder pre- and post-treatment. Psychiatry Res. 2004;125(1):29-39. doi: 10.1016/j.psychres.2003.10.002.
  • 28. Pousti A, Bakhtiarian A, Najafi R, Deemyad T, Brumand K, Hosseini MJ. Effect of sertraline on ouabain-induced arrhythmia in isolated guinea-pig atria. Depress Anxiety. 2009;26(8):E106-110. doi: 10.1002/da.20407.
  • 29. Fidan E, Gormus ZIS, Kilinc İ, İyisoy MS, Gormus N. Effects of Combined Sertraline and Magnesium in Rat Atrium. Biol Trace Elem Res. 2022;200(2):652-660. doi: 10.1007/s12011-021-02669-3.
  • 30. Becker B, Morel N, Vanbellinghen AM, Lebrun P. Blockade of calcium entry in smooth muscle cells by the antidepressant imipramine. Biochem Pharmacol. 2004;68(5):833-842. doi: 10.1016/j.bcp.2004.05.017.
  • 31. Maniradhan M, Sivagurunathan N, Unnikrishnan AK, Anbiah VS, Calivarathan L. Selenium ameliorates oxidized phospholipid-mediated testicular dysfunction and epididymal sperm abnormalities following Bisphenol A exposure in adult Wistar rats. Reprod Toxicol. 2024;130:108751. doi: 10.1016/j.reprotox.2024.108751.
  • 32. Gunes S, Sahinturk V, Karasati P, Sahin IK, Ayhanci A. Cardioprotective Effect of Selenium Against Cyclophosphamide-Induced Cardiotoxicity in Rats. Biol Trace Elem Res. 2017;177(1):107-114. doi: 10.1007/s12011-016-0858-1.
  • 33. Miller TL, Neri D, Extein J, Somarriba G, Strickman-Stein N. Nutrition in Pediatric Cardiomyopathy. Prog Pediatr Cardiol. 2007;24(1):59-71. doi: 10.1016/j.ppedcard.2007.08.007.
  • 34. Türker Y, Nazıroğlu M, Gümral N, et al. Selenium and L-carnitine reduce oxidative stress in the heart of rat induced by 2.45-GHz radiation from wireless devices. Biol Trace Elem Res. 2011;143(3):1640-1650. doi: 10.1007/s12011-011-8994-0.
  • 35. Zhang L, Gao Y, Feng H, Zou N, Wang K, Sun D. Effects of selenium deficiency and low protein intake on the apoptosis through a mitochondria-dependent pathway. J Trace Elem Med Biol. 2019;56:21-30. doi: 10.1016/j.jtemb.2019.06.019.
  • 36. Mirmohammadsadeghi A, Gharipour M, Roohafza H, Dianatkhah M, Sadeghi M. Effects of selenium supplementation on paraoxonase-1 and myeloperoxidase activity in subjects with cardiovascular disease: the Selenegene study, a double-blind randomized controlled trial. Arch Med Sci Atheroscler Dis. 2018;3:e112-e118. doi: 10.5114/amsad.2018.77820.
  • 37. Dallak M. A synergistic protective effect of selenium and taurine against experimentally induced myocardial infarction in rats. Arch Physiol Biochem. 2017;123(5):344-355. doi: 10.1080/13813455.2017.1347687.

The effect of sertraline-selenium combination on cardiac contractile strength

Year 2025, EARLY ONLINE, 1 - 8
https://doi.org/10.18621/eurj.1598227

Abstract

Objectives: Individuals with myocardial infarction (MI) frequently exhibit a heightened prevalence of depression, which elevates the likelihood of negative cardiovascular outcomes. This study aimed to assess the potential synergistic effects of sertraline, an antidepressant utilised for the prevention and treatment of depression commonly associated with cardiac disorders, and selenium, an antioxidant trace element, on atrial contraction force.

Methods: Thirty-two adult male Wistar albino rats were randomly allocated into four groups. Atrial strips were positioned in the organ bath, and the tension was calibrated to 2 g. In the control group, isometric contractions were elicited using 10-3 M adrenaline, and the contractions were documented. Sertraline (S) was incrementally administered to the S group in dosages of 0.01 mM, 0.1 mM, 1 mM, and 2 mM. In the Selenium (Se) Group, selenium was incrementally administered at concentrations of 0.1, 1, 2, and 4 mmol/L. S+Se group, S cumulative (0.01 mM, 0.1 mM, 1 mM, 2 mM) and Se cumulative (0.1, 1, 2, 4) mmol/L were administered at fifteen-minute intervals.

Results: The S group had a statistically significant reduction in contraction compared to the control group. Statistically substantial inhibition was noted in the Se group relative to the control group. Statistically significant contraction inhibition was noted in the S+Se group relative to the S group and Se group (P=0.035 and P=0.02, respectively).

Conclusions: According to the results of our study, sertraline-selenium combination showed an effect by inhibition of cardiac Ca2+ channels in rat atrium. Additional research is needed to elucidate the mechanism of action of sertraline, which is used in the treatment of depression that often accompanies cardiac disorders, and selenium, an effective trace element with antioxidant properties.

Ethical Statement

The study was approved by Necmettin Erbakan University Animal Experiments Local Ethics Committee (HADYEK, protocol number 047/2021).

References

  • 1. Von Känel R, Begré S. Depression after myocardial infarction: unraveling the mystery of poor cardiovascular prognosis and role of beta-blocker therapy. J Am Coll Cardiol. 2006;48(11):2215-2217. doi: 10.1016/j.jacc.2006.09.007.
  • 2. Yang W, Wang Y, Li X, et al. Antidepressive and cardioprotective effects of Kai-xin-san via the regulation of HPA axis dysfunction and lipid metabolism in a rat model of depressive-cardiac disease. Brain Res Bull. 2024;219:111126. doi: 10.1016/j.brainresbull.2024.111126.
  • 3. Amare AT, Schubert KO, Klingler-Hoffmann M, Cohen-Woods S, Baune BT. The genetic overlap between mood disorders and cardiometabolic diseases: a systematic review of genome wide and candidate gene studies. Transl Psychiatry. 2017;7(1):e1007. doi: 10.1038/tp.2016.261.
  • 4. Wang Y, Chen Y, Li B, et al. The antidepressant effect of Shexiang Baoxin Pills on myocardial infarction rats with depression may be achieved through the inhibition of the NLRP3 inflammasome pathway. Brain Behav. 2024;14(7):e3586. doi: 10.1002/brb3.3586.
  • 5. Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(14):1827-1845. doi: 10.1016/j.jacc.2019.01.041.
  • 6. Ziegelstein RC. Depression in patients recovering from a myocardial infarction. JAMA. 2001;286(13):1621-1627. doi: 10.1001/jama.286.13.1621.
  • 7. Thombs BD, Bass EB, Ford DE, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21(1):30-38. doi: 10.1111/j.1525-1497.2005.00269.x.
  • 8. Solak H, Gormus ZIS, Koca RO, Gunes CE, Kutlu S. Does Sertraline Affect Hypothalamic Food Intake Peptides in the Rat Experimental Model of Chronic Mild Stress-Induced Depression? Neurochem Res. 2022;47(5):1299-1316. doi: 10.1007/s11064-022-03529-9.
  • 9. Ilgin S, Kilic V, Baysal M, Aydogan-Kilic G, Ucarcan S, Dermenci B, Atli O. Evidence for cardiotoxicity associated with sertraline in rats. Toxicol Res (Camb). 2018;7(5):817-825. doi: 10.1039/c8tx00072g.
  • 10. Zhang LJ, Liu MY, Rastogi R, Ding JN. Psychocardiological disorder and brain serotonin after comorbid myocardial infarction and depression: an experimental study. Neurol Res. 2018;40(6):516-523. doi: 10.1080/01616412.2018.1455460.
  • 11. Kupper N, Gidron Y, Winter J, Denollet J. Association between type D personality, depression, and oxidative stress in patients with chronic heart failure. Psychosom Med. 2009;71(9):973-980. doi: 10.1097/PSY.0b013e3181bee6dc.
  • 12. Yuan Y, Lai S, Hu T, et al. Puerarin pretreatment provides protection against myocardial ischemia/reperfusion injury via inhibiting excessive autophagy and apoptosis by modulation of HES1. Sci Rep. 2025;15(1):794. doi: 10.1038/s41598-024-84808-z.
  • 13. Ott S, Dresen E, Lee ZY, et al. The effect of high-dose selenium on mortality and postoperative organ dysfunction in post-cardiotomy cardiogenic shock patients supported with mechanical circulatory support - A post-hoc analysis of the SUSTAIN CSX trial. J Crit Care. 2024;83:154853. doi: 10.1016/j.jcrc.2024.154853.
  • 14. Shalihat A, Hasanah AN, Mutakin, Lesmana R, Budiman A, Gozali D. The role of selenium in cell survival and its correlation with protective effects against cardiovascular disease: A literature review. Biomed Pharmacother. 2021;134:111125. doi: 10.1016/j.biopha.2020.111125.
  • 15. Solak Gormus ZI, Eker CB, Solak H, Ozen Koca R, Ozdengul F. Does Sertraline Affect Contraction in Endothelium Damaged Aorta? Selcuk Med J. 2024;40(1):8-15. doi: 10.30733/std.2023.01688.
  • 16. Wang Y, Gao X, Zhao Z, et al. The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction. Psychol Med. 2023;53(4):1379-1389. doi: 10.1017/S0033291721002932.
  • 17. Wang Y, Chen Y, Li B, et al. The antidepressant effect of Shexiang Baoxin Pills on myocardial infarction rats with depression may be achieved through the inhibition of the NLRP3 inflammasome pathway. Brain Behav. 2024;14(7):e3586. doi: 10.1002/brb3.3586.
  • 18. Davidson KW, Kupfer DJ, Bigger JT, et al. Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosom Med. 2006;68(5):645-650. doi: 10.1097/01.psy.0000233233.48738.22.
  • 19. Ungvari Z, Pacher P, Koller A. Serotonin reuptake inhibitor fluoxetine decreases arteriolar myogenic tone by reducing smooth muscle [Ca2+]i. J Cardiovasc Pharmacol. 2000;35(6):849-854. doi: 10.1097/00005344-200006000-00004.
  • 20. Shores MM, Pascualy M, Lewis NL, Flatness D, Veith RC. Short-term sertraline treatment suppresses sympathetic nervous system activity in healthy human subjects. Psychoneuroendocrinology. 2001;26(4):433-439. doi: 10.1016/s0306-4530(01)00002-6.
  • 21. Pereira CA, Rodrigues FL, Ruginsk SG, et al. Chronic treatment with fluoxetine modulates vascular adrenergic responses by inhibition of pre- and post-synaptic mechanisms. Eur J Pharmacol. 2017;800:70-80. doi: 10.1016/j.ejphar.2017.02.029.
  • 22. Akinci M, Karadag CH, Huseyin S, et al. Effects of in vitro Amitriptyline, Fluoxetine, Tranylcypromine and Venlafaxine on Saphenous Vein Grafts. Braz J Cardiovasc Surg. 2019;34(3):290-296. doi: 10.21470/1678-9741-2018-0338.
  • 23. Turan B, Désilets M, Açan LN, Hotomaroglu O, Vannier C, Vassort G. Oxidative effects of selenite on rat ventricular contractility and Ca movements. Cardiovasc Res. 1996;32(2):351-361. doi: 10.1016/0008-6363(96)00071-5.
  • 24. Ayaz M, Ozdemir S, Yaras N, Vassort G, Turan B. Selenium-induced alterations in ionic currents of rat cardiomyocytes. Biochem Biophys Res Commun. 2005;327(1):163-173. doi: 10.1016/j.bbrc.2004.12.003.
  • 25. Sayar K, Ugur M, Gürdal H, Onaran O, Hotomaroglu O, Turan B. Dietary selenium and vitamin E intakes alter beta-adrenergic response of L-type Ca-current and beta-adrenoceptor-adenylate cyclase coupling in rat heart. J Nutr. 2000;130(4):733-740. doi: 10.1093/jn/130.4.733.
  • 26. Siepmann M, Grossmann J, Mück-Weymann M, Kirch W. Effects of sertraline on autonomic and cognitive functions in healthy volunteers. Psychopharmacology (Berl). 2003;168(3):293-298. doi: 10.1007/s00213-003-1448-4.
  • 27. Sullivan GM, Kent JM, Kleber M, Martinez JM, Yeragani VK, Gorman JM. Effects of hyperventilation on heart rate and QT variability in panic disorder pre- and post-treatment. Psychiatry Res. 2004;125(1):29-39. doi: 10.1016/j.psychres.2003.10.002.
  • 28. Pousti A, Bakhtiarian A, Najafi R, Deemyad T, Brumand K, Hosseini MJ. Effect of sertraline on ouabain-induced arrhythmia in isolated guinea-pig atria. Depress Anxiety. 2009;26(8):E106-110. doi: 10.1002/da.20407.
  • 29. Fidan E, Gormus ZIS, Kilinc İ, İyisoy MS, Gormus N. Effects of Combined Sertraline and Magnesium in Rat Atrium. Biol Trace Elem Res. 2022;200(2):652-660. doi: 10.1007/s12011-021-02669-3.
  • 30. Becker B, Morel N, Vanbellinghen AM, Lebrun P. Blockade of calcium entry in smooth muscle cells by the antidepressant imipramine. Biochem Pharmacol. 2004;68(5):833-842. doi: 10.1016/j.bcp.2004.05.017.
  • 31. Maniradhan M, Sivagurunathan N, Unnikrishnan AK, Anbiah VS, Calivarathan L. Selenium ameliorates oxidized phospholipid-mediated testicular dysfunction and epididymal sperm abnormalities following Bisphenol A exposure in adult Wistar rats. Reprod Toxicol. 2024;130:108751. doi: 10.1016/j.reprotox.2024.108751.
  • 32. Gunes S, Sahinturk V, Karasati P, Sahin IK, Ayhanci A. Cardioprotective Effect of Selenium Against Cyclophosphamide-Induced Cardiotoxicity in Rats. Biol Trace Elem Res. 2017;177(1):107-114. doi: 10.1007/s12011-016-0858-1.
  • 33. Miller TL, Neri D, Extein J, Somarriba G, Strickman-Stein N. Nutrition in Pediatric Cardiomyopathy. Prog Pediatr Cardiol. 2007;24(1):59-71. doi: 10.1016/j.ppedcard.2007.08.007.
  • 34. Türker Y, Nazıroğlu M, Gümral N, et al. Selenium and L-carnitine reduce oxidative stress in the heart of rat induced by 2.45-GHz radiation from wireless devices. Biol Trace Elem Res. 2011;143(3):1640-1650. doi: 10.1007/s12011-011-8994-0.
  • 35. Zhang L, Gao Y, Feng H, Zou N, Wang K, Sun D. Effects of selenium deficiency and low protein intake on the apoptosis through a mitochondria-dependent pathway. J Trace Elem Med Biol. 2019;56:21-30. doi: 10.1016/j.jtemb.2019.06.019.
  • 36. Mirmohammadsadeghi A, Gharipour M, Roohafza H, Dianatkhah M, Sadeghi M. Effects of selenium supplementation on paraoxonase-1 and myeloperoxidase activity in subjects with cardiovascular disease: the Selenegene study, a double-blind randomized controlled trial. Arch Med Sci Atheroscler Dis. 2018;3:e112-e118. doi: 10.5114/amsad.2018.77820.
  • 37. Dallak M. A synergistic protective effect of selenium and taurine against experimentally induced myocardial infarction in rats. Arch Physiol Biochem. 2017;123(5):344-355. doi: 10.1080/13813455.2017.1347687.
There are 37 citations in total.

Details

Primary Language English
Subjects Physiopathology, Systems Physiology, Medical Physiology (Other)
Journal Section Original Articles
Authors

Hatice Solak 0000-0002-3554-3051

Z. Işık Solak Görmüş 0000-0001-6762-6225

Raviye Özen Koca 0000-0001-6295-5548

Merve Akkuş 0000-0003-3046-2815

Niyazi Görmüş 0000-0002-8264-3653

Early Pub Date February 4, 2025
Publication Date
Submission Date December 8, 2024
Acceptance Date January 13, 2025
Published in Issue Year 2025 EARLY ONLINE

Cite

AMA Solak H, Solak Görmüş ZI, Özen Koca R, Akkuş M, Görmüş N. The effect of sertraline-selenium combination on cardiac contractile strength. Eur Res J. Published online February 1, 2025:1-8. doi:10.18621/eurj.1598227

e-ISSN: 2149-3189 


The European Research Journal, hosted by Turkish JournalPark ACADEMIC, is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

by-nc-nd.png

2025