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Hamidi Madani A, Pakdaman M, Mokhtari G, Kazemnezhad E, Hamidi Madani M, Fathollahi A, Rastjou Herfeh N, Roohinezhad R. Fertility Rate and Sperm DNA Fragmentation Index following Varicocelectomy in Primary Infertile Men with Clinical Varicocele: A Prospective Longitudinal Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2024; 18:167-172. [PMID: 38368521 PMCID: PMC10875314 DOI: 10.22074/ijfs.2023.1990486.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/11/2023] [Accepted: 11/07/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Varicocele is one of the most common treatable causes of male infertility, and its treatment may be beneficial for fertility. This study aimed to evaluate fertility rate and DNA fragmentation index (DFI) following varicocelectomy in primary infertile men with clinical varicocele. MATERIALS AND METHODS This prospective longitudinal study was conducted on primary infertility men, in a tertiary center from December 2018 to December 2019 with one-year follow-up. Data of the semen parameters, DFI (%), and fertility rate were gathered before, as well as 4 and 12 months after undergoing varicocelectomy. For data analysis, SPSS software and analytical test were used. RESULTS Out of 76 patients who were analyzed, 22 (29%) became fertile and 54 (71%) remained infertile. Semen parameters and DFI (%) were improved significantly following varicocelectomy (P<0.001). Smoking history, occupational heated exposure, body mass index (BMI), and infertility duration were determined as predictors associated with fertility status (P<0.05). CONCLUSION Although varicocele repair improved the DFI, the fertility rate was achieved in less than one-third of patients; it seems that the other parameters, such as the history of smoking, occupational heated exposure, overweight, and duration of infertility should be considered as predictors of fertility status, in primary infertile men who are a candidate for varicocelectomy.
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Affiliation(s)
- Ali Hamidi Madani
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Pakdaman
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Hamidi Madani
- Department of Urology, Labbafinejad Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranTehran university of medical science.
| | | | - Nadia Rastjou Herfeh
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Roozbeh Roohinezhad
- Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
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Liu H, Luo Z, Chen J, Zheng H, Zeng Q. Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review. Health Sci Rep 2022; 6:e1019. [PMID: 36582629 PMCID: PMC9793827 DOI: 10.1002/hsr2.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background and Aims Cryptozoospermia is an extreme oligozoospermia with an unsatisfactory treatment effect, with an incidence rate of approximately 8.73% in male infertility, whose effective solution has become the call of the times. Western Medicine has achieved certain effects through drugs, surgery, and assisted reproductive therapy, but this is still not ideal. Traditional Chinese medicine (TCM) has made many achievements in other disciplines; however, there is still a lack of evidence-based medical evidence to improve sperm production. Methods The relevant literatures from the China National Knowledge Internet (CNKI) and PubMed in the past 10 years were collected in this article, of which the mechanisms, advantages, or current controversies of various treatment methods of Western Medicine and TCM were analyzed, to find new treatment methods and research directions. Results With the development of modern science and technology, medical treatments for cryptozoospermia have become increasingly abundant; however, there is still no universally recognized unified and effective guiding plan. Although TCM has not been fully verified by evidence-based medicine, most TCM combined with Western Medicine can achieve unexpected results. Conclusion The combination of TCM and Western Medicine may become a bane for cryptozoospermia and bring good news to infertile men worldwide.
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Affiliation(s)
- Huang Liu
- The First School of Clinical MedicineNanjing University of Chinese MedicineNanjingChina,NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital)Human Sperm Bank of Guangdong ProvinceGuangzhouChina
| | - Zefang Luo
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital)Human Sperm Bank of Guangdong ProvinceGuangzhouChina
| | - Jinghua Chen
- Reproductive Medical Centre of Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Houbin Zheng
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital)Human Sperm Bank of Guangdong ProvinceGuangzhouChina
| | - Qingqi Zeng
- The First School of Clinical MedicineNanjing University of Chinese MedicineNanjingChina,Department of Integrated Chinese and Western MedicineJiangsu Health Vocational CollegeNanjingChina
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Liu H, Huang Z, Zheng H, Zhu Z, Yang H, Liu X, Pang T, He L, Lin H, Hu L, Zeng Q, Han L. Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study. Front Pharmacol 2022; 13:945949. [PMID: 36016555 PMCID: PMC9395676 DOI: 10.3389/fphar.2022.945949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of the study was to explore the evidence of JWRJD in the treatment of cryptozoospermia. Methods: A total of 162 cryptozoospermia patients with varicocele who refused to undergo surgery were included from January 2021 to December 2021. They were divided into the Jiawei Runjing Decoction group (group A), tamoxifen group (group B), and no treatment group (group C), and after the follow-up for 3 months, therapeutic effectiveness was compared. Network pharmacology was used to analyze and validate the effects and mechanisms of JWRJD. Results: Fifty-eight patients were treated with JWRJD, 55 with tamoxifen, and 49 without any treatment. After treatment, five patients were lost: one in group A, one in group B, and three in group C. The sperm count and the decrease of FSH in group A were significantly higher, but the degree of decline in the testicular volume and the degree of vein expansion have decreased significantly, which were closely related to the testicular volume (TV) [especially changes in the left testicular volume (ΔL-TV)], citric acid (CC) and its changes (ΔCC), and the vein width (VW) [especially left spermatic vein width (L-VW) and mean vein width (M-VW) and their changes (ΔL-VW and ΔM-VW)], as well as the sperm count before the treatment (bSC), which were the significant indexes to predict the therapeutic effect, especially for patients >35 years old and with grade III varicoceles. Network pharmacological analysis verifies that it can be regulated by fluid shear stress and the atherosclerosis pathway to improve the testicular microenvironment for spermatogenesis. Conclusion: JWRJD may promote spermatogenesis in cryptozoospermia patients with varicocele, which may be closely related to improving the testicular microenvironment, especially for >35 year olds and grade III varicocele patients.
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Affiliation(s)
- Huang Liu
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Zhongwang Huang
- Department of Andrology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Houbin Zheng
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Zhiyong Zhu
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Hui Yang
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Ultrasonography, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Xingzhang Liu
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Tao Pang
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Liping He
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Clinical Laboratory, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Hai Lin
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Lei Hu
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Qingqi Zeng
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Integrated Chinese and Western Medicine, Jiangsu Health Vocational College, Nanjing, China
- *Correspondence: Qingqi Zeng, ; Lanying Han,
| | - Lanying Han
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Traditional Chinese Medicine, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
- *Correspondence: Qingqi Zeng, ; Lanying Han,
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Abstract
Importance Recurrent spontaneous abortion (RSA) is a distressing condition experienced by approximately 1% of women trying to conceive. However, the treatment of RSA is a challenge both for clinicians and patients. Objective The aim of this review is to discuss the medical and surgical approach to the management of RSA, including those caused by anatomical, genetic, male, infectious, endocrine, and immune factors. Evidence Acquisition A literature search using MeSH terms for each topic was undertaken using PubMed, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Results Available treatments target hypothetical risk factors for RSA, although the effectiveness of many treatment options is controversial. Intervention should depend on the benefit-to-risk ratio of the proposed treatment. Conclusions and Relevance The etiology of RSA is heterogeneous, and patients often lack specific clinical manifestations, which has hindered the progress in predicting and preventing RSA to some extent. Despite intensive workup, at least 50% of couples do not have a clear underlying pathology. In addition, an evidence-based treatment is not available in most patients even if abnormal test results are present. Many new treatment directions are also still actively exploring; empirical and combined multiple treatments are still the main methods. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to describe common risk factors for RSA; formulate individualized treatment plans to improve pregnancy outcomes; and propose supportive treatment recommendations for patients with unclear causes.
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Sidhom K, Panchendrabose K, Mann U, Patel P. An update on male infertility and intratesticular testosterone-insight into novel serum biomarkers. Int J Impot Res 2022; 34:673-678. [PMID: 34987179 DOI: 10.1038/s41443-021-00507-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/24/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Intratesticular testosterone is vital for spermatogenesis, male fertility, and virility. Currently the only method to assess levels of intratesticular testosterone is to perform testicular biopsy which is invasive and can lead to several complications. Approaches to assess intratesticular testosterone have been understudied but hold promise as future male contraceptive agents and may grant the ability to monitor patients undergoing hormonal changes from therapeutic and diagnostic perspectives. Previous studies have sought to assess the utility of 17-hydroxyprogesterone (17-OHP) and insulin-like factor 3 (INSL3) as accurate surrogate biomarkers of intratesticular testosterone. The aim of this review is thus to highlight the importance of intratesticular testosterone and the consequent advances that have been made to elucidate the potential of biomarkers for intratesticular testosterone in the context of male infertility.
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Affiliation(s)
- Karim Sidhom
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Uday Mann
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Premal Patel
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada. .,Section of Urology, University of Manitoba, Winnipeg, MB, Canada.
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Mostafa T, El-Taweel AEAI, Rashed LA, Mohammed NAM, Akl EM. Assessment of seminal cystatin C levels in infertile men with varicocele: A preliminary study. Andrologia 2021; 54:e14278. [PMID: 34676572 DOI: 10.1111/and.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
Varicocele has been raised as a contributor to male infertility supported by the improvement of sperm parameters after varicocelectomy. Cystatin C (Cys C) has been linked to several cellular changes that are common in male infertility cases associated with varicocele such as apoptosis and autophagy. This preliminary study aimed to assess the seminal levels of Cys C in infertile oligoasthenoteratozoospermic (OAT) men associated with varicocele that have been shown to have spermatic vein vasodilation and active death pathway. Overall, 60 men were investigated being divided into two equivalent groups-infertile OAT men with varicocele who underwent varicocelectomy and healthy fertile men as a control group. These men were subjected to history taking, clinical examination, semen analysis and assessment of seminal Cys C pre and 6 months post-varicocelectomy. The results showed a significant increase of seminal Cys C in infertile OAT men with varicocele than the fertile control (55.57 ± 25.6 ng/ml versus 10.78 ± 1.88 ng/ml, p = .001). Seminal Cys C was a significantly decreased post-operative than its pre-operative level (34.69 ± 14.02 versus 55.57 ± 25.6 ng/ml, p = .01). These results show a potential role of Cys C in varicocele-induced infertility.
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Affiliation(s)
- Taymour Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abd El-Aziz I El-Taweel
- Department of Dermatology & Andrology, Faculty of Medicine, Benha University, October 6 University, Benha, Egypt
| | - Laila Ahmed Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nayera A M Mohammed
- Dermatology & Andrology specialist, Ministry of Health and Population, Cairo, Egypt
| | - Essam Mohamed Akl
- Department of Dermatology& Andrology, Faculty of Medicine, Benha University, Benha, Egypt
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Ok F, Erdogan O, Durmus E. Can preoperative gonadotropin and testosterone levels predict the success of varicocelectomy? Andrologia 2020; 52:e13887. [PMID: 33125763 DOI: 10.1111/and.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/26/2022] Open
Abstract
We examined the effects of preoperative hormonal values on varicocelectomy success. A total of 136 patients who underwent varicocelectomy for infertility in our clinic were analysed retrospectively. Improvement in semen quality was defined as >50% increase in post-operative total motile sperm count (TMSC) in those with preoperative TMSC >5 million and at least 100% increase in those with <5 million. The patients were divided into two groups as benefiting from the treatment (Group A) and no benefits (Group B). The best cut-off value for follicle-stimulating hormone (FSH) and the luteinising hormone/testosterone ratio (LTR) that can predict varicocelectomy success were 7.01 and 0.016 with an area under the curve of 0.844 and 0.856 respectively. The highest sensitivities and specificities of FSH and LTR were 0.845 and 0.788 and 0.821 and 0.846 respectively. Binary logistic regression analysis showed FSH (odds ratio [OR]: 3.7; p < .001) and LTR (OR: 5.2; p < .001) as independent predictive factors in predicting varicocelectomy success. Our study demonstrated that low FSH (7.01 IU/L) and LTR (<.016) can be a useful preoperative predictive tool to help identify men who benefit most from varicocelectomy in infertile patients with varicocele.
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Affiliation(s)
- Fesih Ok
- Urology Department, Siirt Training and Research Hospital, Siirt, Turkey
| | - Omer Erdogan
- Urology Department, Siirt Training and Research Hospital, Siirt, Turkey
| | - Emrullah Durmus
- Urology Department, Siirt Training and Research Hospital, Siirt, Turkey
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Fraczek M, Wojnar L, Kamieniczna M, Piasecka M, Gill K, Kups M, Chopyak V, Havrylyuk A, Nakonechnyy J, Nakonechnyy A, Wozniak T, Kurpisz M. Seminal Plasma Analysis of Oxidative Stress in Different Genitourinary Topographical Regions Involved in Reproductive Tract Disorders Associated with Genital Heat Stress. Int J Mol Sci 2020; 21:ijms21176427. [PMID: 32899311 PMCID: PMC7504043 DOI: 10.3390/ijms21176427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
The pathophysiological mechanisms responsible for male subfertility/infertility caused by or complicated by genital heat stress remains unclear in many respects. Because seminal plasma creates the environment for the proper functioning of spermatozoa, in this study, we verified the associations among standard spermiograms, seminal biochemical parameters (neutral alpha-glucosidase, fructose, and citric acid) and oxidative stress markers (total antioxidant capacity, catalase activity, superoxide dismutase activity, and malondialdehyde concentration) in distinct entities associated with male infertility with and without long-time exposure to local hyperthermia. We demonstrated that men exposed to prolonged environmental or clinically recognized local heat stress in adulthood may suffer from dysregulation of seminal antioxidant components, which can be directly associated with epididymal and prostate function. The comparative analysis of the studied parameters showed numerous correlations among all biochemical parameters (particularly neutral alpha-glucosidase) with low standard semen quality in almost all the investigated infertile groups. In light of the data obtained in this originally designed study, we conclude that more attention should be paid to the epididymis and accessory gland function in subfertile and infertile men exposed to genital heat stress, especially in the context of novel treatment algorithms (targeted therapies).
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Affiliation(s)
- Monika Fraczek
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland; (M.K.); (T.W.)
- Correspondence: (M.F.); (M.K.)
| | - Lukasz Wojnar
- Clinic of Urology and Oncological Urology, Poznan University of Medical Sciences, 61-285 Poznan, Poland;
| | - Marzena Kamieniczna
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland; (M.K.); (T.W.)
| | - Malgorzata Piasecka
- Department of Histology and Developmental Biology, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.P.); (K.G.); (M.K.)
| | - Kamil Gill
- Department of Histology and Developmental Biology, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.P.); (K.G.); (M.K.)
| | - Michal Kups
- Department of Histology and Developmental Biology, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.P.); (K.G.); (M.K.)
- Department and Clinic Urology and Oncological Urology, Regional Specialist Hospital in Szczecin, 71-455 Szczecin, Poland
- VitroLive Fertility Clinic in Szczecin, 70-483 Szczecin, Poland
| | - Valentina Chopyak
- Department of Clinical Immunology and Allergology, Danylo Halytskyy Lviv National Medical University, 79008 Lviv, Ukraine; (V.C.); (A.H.)
| | - Anna Havrylyuk
- Department of Clinical Immunology and Allergology, Danylo Halytskyy Lviv National Medical University, 79008 Lviv, Ukraine; (V.C.); (A.H.)
| | - Jozef Nakonechnyy
- Department of Urology, Danylo Halytskyy Lviv National Medical University, 79010 Lviv, Ukraine;
| | - Andrij Nakonechnyy
- Department of Paediatric Surgery, Danylo Halytskyy Lviv National Medical University, 79059 Lviv, Ukraine;
| | - Tomasz Wozniak
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland; (M.K.); (T.W.)
| | - Maciej Kurpisz
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland; (M.K.); (T.W.)
- Correspondence: (M.F.); (M.K.)
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