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Aşır F, Korak T, Çankırı Z. Reply to Abid et al. Comment on "Aşır et al. Investigation of Vitamin D Levels in Men with Suspected Infertility. Life 2024, 14, 273". Life (Basel) 2024; 14:914. [PMID: 39063666 PMCID: PMC11277917 DOI: 10.3390/life14070914] [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: 07/10/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024] Open
Abstract
In response to the insightful comments made by Dr. Abid et al. on our article "Investigation of Vitamin D Levels in Men with Suspected Infertility", we address several key points concerning the generalizability and methodology of our study. Dr. Abid et al.'s critique primarily focused on the single-center nature of our research, regional variations in ultraviolet (UV) exposure, dietary factors affecting vitamin D levels, and the sample size of our study. We discuss the inherent value and controlled environment of single-center studies while acknowledging the need for multi-center validation. Additionally, we explain our consideration of sun exposure and dietary intake in our analysis, and recognize the importance of larger, more diverse studies to strengthen our findings. Our response aims to clarify these aspects and emphasize the significance of vitamin D in male infertility, encouraging further research in this field.
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Affiliation(s)
- Fırat Aşır
- Department of Histology and Embryology, Medical Faculty, Dicle University, 21280 Diyarbakır, Turkey
| | - Tuğcan Korak
- Department of Medical Biology, Medical Faculty, Kocaeli University, 41001 Kocaeli, Turkey;
| | - Zuhal Çankırı
- Department of Histology and Embryology, Medical Faculty, Dicle University, 21280 Diyarbakır, Turkey
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Thacharodi A, Hassan S, Acharya G, Vithlani A, Hoang Le Q, Pugazhendhi A. Endocrine disrupting chemicals and their effects on the reproductive health in men. ENVIRONMENTAL RESEARCH 2023; 236:116825. [PMID: 37544467 DOI: 10.1016/j.envres.2023.116825] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023]
Abstract
Endocrine Disrupting Chemicals (EDCs) are harmful compounds that enter the environment naturally or through anthropogenic activities and disrupt normal endocrine functions in humans, adversely affecting reproductive health. Among the most significant sources of EDC contaminants are the pharmaceutical, cosmetic, and packaging industries. EDCs have been identified to have a deteriorating effect on male reproductive system, as evidenced by the increasing number of male infertility cases. A large number of case studies have been published in which men exposed to EDCs experienced testicular cancer, undescended testicles, a decrease in serum testosterone levels, and poor semen quality. Furthermore, epidemiological evidence suggested a link between prenatal EDC exposure and cryptorchidism or undescended testicles, hypospadias, and decreased anogenital distance in infants. The majority of these findings, however, are incongruent due to the lack of long-term follow-up studies that would demonstrate EDCs to be associated with male reproductive disorders. This review aims to provide an overview on recent scientific progress on the association of EDCs to male reproductive health with special emphasis on its toxicity and possible mechanism of EDCs that disrupt male reproductive system.
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Affiliation(s)
- Aswin Thacharodi
- Dr. Thacharodi's Laboratories, Department of Research and Development, Puducherry, 605005, India
| | - Saqib Hassan
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, 600119, India; American Society for Microbiology, Washington, 20036, USA
| | - Gururaj Acharya
- Department of Civil Engineering, NMAM Institute of Technology, NITTE (Deemed to be university), Karnataka, 574110, India
| | - Avadh Vithlani
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Quynh Hoang Le
- School of Medicine and Pharmacy, Duy Tan University, Da Nang, Viet Nam; Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - Arivalagan Pugazhendhi
- School of Medicine and Pharmacy, Duy Tan University, Da Nang, Viet Nam; Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam.
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Abstract
In recent years, a new focus of the Developmental Origins of Health and Disease hypothesis has emerged examining the potential role that paternal health may play in embryo development, fetal growth and long-term offspring health. While the association between male health and sperm quality has been studied in detail, our understanding of the long-term paternal effects on offspring health remains limited. As with studies aimed at understanding maternal programming, animal models are an essential tool with which to define the underlying mechanisms linking paternal health to post-fertilisation development and offspring well-being. Here, new insights into the genetic and epigenetic nature of the sperm, as well as the role seminal plasma plays in modulating the maternal reproductive environment, are demonstrating the significant role a father's wellbeing at the time of conception has for programming the health of his offspring. In this article we will outline the current understanding of the impact of male health on semen quality, reproductive fitness and post-fertilisation offspring development and explore the mechanisms underlying the paternal programming of offspring health.
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Affiliation(s)
- Adam J Watkins
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK.
| | - Eleonora Rubini
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Elizabeth D Hosier
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Hannah L Morgan
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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Abou Ghayda R, Sergeyev O, Burns JS, Williams PL, Lee MM, Korrick SA, Smigulina L, Dikov Y, Hauser R, Mínguez-Alarcón L. Peripubertal serum concentrations of organochlorine pesticides and semen parameters in Russian young men. ENVIRONMENT INTERNATIONAL 2020; 144:106085. [PMID: 32871379 PMCID: PMC9764548 DOI: 10.1016/j.envint.2020.106085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Epidemiologic literature on the relation of organochlorine pesticides (OCPs) with semen quality among adult men has been inconclusive, and no studies have prospectively explored the association between peripubertal serum OCPs and semen parameters in young men. OBJECTIVE To evaluate prospective associations of peripubertal serum concentrations of hexachlorobenzene (HCB), β-hexachlorocylohexane (β-HCH), and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) with semen parameters among young Russian men. METHODS This prospective cohort study included 152 young men who enrolled in the Russian Children's Study (2003-2005) at age 8-9 years and were followed annually until young adulthood. HCB, β-HCH, and p,p'-DDE concentrations were measured at the CDC by mass spectrometry in serum collected at enrollment. Between 18 and 23 years, semen samples (n = 298) were provided for analysis of volume, concentration, and progressive motility; we also calculated total sperm count and total progressive motile count. Linear mixed models were used to examine the longitudinal associations of quartiles of serum HCB, β-HCH and p,p'-DDE with semen parameters, adjusting for total serum lipids, body mass index, smoking, abstinence time and baseline dietary macronutrient intake. RESULTS Lipid-adjusted medians (IQR) for serum HCB, βHCH and p,ṕ-DDE, respectively, were 150 ng/g lipid (102-243), 172 ng/g lipid (120-257) and 275 ng/g lipid (190-465). In adjusted models, we observed lower ejaculated volume with higher serum concentrations of HCB and βHCH, along with reduced progressive motility with higher concentrations of βHCH andp,ṕ-DDE. Men in the highest quartile of serum HCB had a mean (95% Confidence Interval, CI) ejaculated volume of 2.25 mL (1.89, 2.60), as compared to those in the lowest quartile with a mean (95% CI) of 2.97 mL (2.46, 3.49) (p = 0.03). Also, men in the highest quartile of serum p,ṕ-DDE had a mean (95% CI) progressive motility of 51.1% (48.6, 53.7), as compared to those in the lowest quartile with a mean (95% CI) of 55.1% (51.7, 58.5) (p = 0.07). CONCLUSION In this longitudinal Russian cohort study, peripubertal serum concentrations of selected OCPs were associated with lower ejaculated volume and progressive motility highlighting the importance of the peripubertal window when evaluating chemical exposures in relation to semen quality.
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Affiliation(s)
- Ramy Abou Ghayda
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Oleg Sergeyev
- Group of Epigenetic Epidemiology, A.N. Belozersky Research Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia; Chapaevsk Medical Association, Chapaevsk, Samara Region, Russia.
| | - Jane S Burns
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paige L Williams
- Department of Biostatistics and Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary M Lee
- Department of Pediatrics, Sidney Kimmel Medical College, Philadelphia, PA, USA; Nemours AI duPont Hospital for Children, Wilmington, DE, USA
| | - Susan A Korrick
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yury Dikov
- Group of Epigenetic Epidemiology, A.N. Belozersky Research Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia; Chapaevsk Medical Association, Chapaevsk, Samara Region, Russia
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Fertility and infertility: Definition and epidemiology. Clin Biochem 2018; 62:2-10. [DOI: 10.1016/j.clinbiochem.2018.03.012] [Citation(s) in RCA: 1099] [Impact Index Per Article: 157.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 01/10/2023]
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Vinceti M, Malagoli C, Werler MM, Filippini T, De Girolamo G, Ghermandi G, Fabbi S, Astolfi G, Teggi S. Adverse pregnancy outcomes in women with changing patterns of exposure to the emissions of a municipal waste incinerator. ENVIRONMENTAL RESEARCH 2018; 164:444-451. [PMID: 29574254 DOI: 10.1016/j.envres.2018.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
Municipal solid waste incinerators emissions contain pollutants that, despite their low concentration, might adversely affect reproductive health. In the present study, we examined rates of miscarriage and birth defects among women who resided or were employed in the vicinity of a municipal solid waste incinerator plant from 2003 to 2013. In 2009, a progressive shutdown of the old incineration lines and operation of a new line caused considerably higher atmospheric release of polycyclic aromatic hydrocarbons, particularly of dioxins, due to these irregular operating conditions, technological renovation, and increased capacity. We used dioxin emission levels, based on a dispersion model, to define exposure status of the residing population to air pollutants emitted by the waste incinerator. In women who resided in areas characterized by higher emission exposures compared with a referent area, the relative risk (RR) of miscarriage was 1.04 (95% confidence interval (CI) 0.80-1.32) based on 62 cases overall, with little evidence of a dose-response relation. RRs were similarly null for both 2003-2008 and 2010-2013 periods (RR 1.12 (95% CI 0.80-1.53) and 0.98 (95% CI 0.63-1.48), respectively). Concerning birth defects in the offspring of women residing in the exposed area, no evidence of increased risk emerged, since the prevalence ratio at birth was 0.64 (95% CI 0.29-1.26), with comparable results in the 2003-2008 and 2010-2013 period. Corresponding analyses carried out in municipal residents who worked in the exposed area confirmed these findings. We also did not detect abnormally high rates of miscarriage and birth defects in the exposed cohorts in the single year 2009. Overall, these results do not suggest an effect of exposure to the emissions of the municipal solid waste incinerator we investigated on two indicators of reproductive health. However, the limited statistical stability of the estimates and the absence of individual-based information on some potential confounders suggest caution in the interpretation of study findings.
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Affiliation(s)
- Marco Vinceti
- CREAGEN Research Center of Environmental, Genetic and Nutritional Epidemiology and Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Carlotta Malagoli
- CREAGEN Research Center of Environmental, Genetic and Nutritional Epidemiology and Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Tommaso Filippini
- CREAGEN Research Center of Environmental, Genetic and Nutritional Epidemiology and Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianfranco De Girolamo
- Unit of Epidemiology and Risk Communication, Department of Public Health, Local Health Unit of Modena, Modena, Italy
| | - Grazia Ghermandi
- School of Environmental Engineering and Department of Engineering 'Enzo Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Fabbi
- School of Environmental Engineering and Department of Engineering 'Enzo Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - Gianni Astolfi
- IMER Registry, Department of Biomedical and Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Sergio Teggi
- School of Environmental Engineering and Department of Engineering 'Enzo Ferrari', University of Modena and Reggio Emilia, Modena, Italy
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Rehman S, Usman Z, Rehman S, AlDraihem M, Rehman N, Rehman I, Ahmad G. Endocrine disrupting chemicals and impact on male reproductive health. Transl Androl Urol 2018; 7:490-503. [PMID: 30050807 PMCID: PMC6043754 DOI: 10.21037/tau.2018.05.17] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Endocrine disrupting chemicals (EDCs) have been known to adversely affect the endocrine system leading to compromised functions of hormones. The presence of these compounds in everyday products such as canned food, water bottles, plastics, cosmetics, fertilizers, kid’s toys and many others goods is a greater concern for general population. The persistent and long-term use of EDCs has deleterious effects on human reproductive health by interfering with the synthesis and mechanism of action of sex hormones. Any change during the synthesis or action of the sex hormones may result in abnormal reproductive functions which includes developmental anomalies in the reproductive tract and decline in semen quality. The present paper provides an overview of the EDCs and their possible impact on male reproductive health with major focus on semen quality which leads to male infertility.
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Affiliation(s)
- Saba Rehman
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Zeenat Usman
- Department of Physiology, University of Health Sciences, Lahore, Pakistan
| | - Sabeen Rehman
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, USA
| | | | - Noor Rehman
- Department of Biological Sciences, Binghamton University, NY, USA
| | - Ibraheem Rehman
- Department of Biological Sciences, Cornell University, Ithaca, NY, USA
| | - Gulfam Ahmad
- Department of Physiology, University of Health Sciences, Lahore, Pakistan.,Human Reproduction Unit, Kolling Institute, Sydney Medical School, Sydney University, Sydney, Australia
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Relationship between serum dioxin-like polychlorinated biphenyls and post-testicular maturation in human sperm. Reprod Toxicol 2017; 73:312-321. [DOI: 10.1016/j.reprotox.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 06/05/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
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Pilsner JR, Parker M, Sergeyev O, Suvorov A. Spermatogenesis disruption by dioxins: Epigenetic reprograming and windows of susceptibility. Reprod Toxicol 2017; 69:221-229. [PMID: 28286111 DOI: 10.1016/j.reprotox.2017.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 02/24/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023]
Abstract
Dioxins are a group of highly persistent chemicals that are generated as by-products of industrial and natural processes. Reduction in sperm counts is among the most sensitive endpoints of dioxin toxicity. The exact mechanism by which dioxins reduce sperm counts is not known. Recent data implicate the role of epididymal factors rather than disruption of spermatogenesis. Studies reviewed here demonstrate that dioxins induce the transfer of environmental conditions to the next generation via male germline following exposures during the window of epigenetic reprogramming of primordial germ cells. Increased incidence of birth defects in offspring of male veterans exposed to dioxin containing, Agent Orange, suggest that dioxins may induce epigenomic changes in male germ cells of adults during spermatogenesis. This is supported by recent animal data that show that environmental conditions can cause epigenetic dysregulation in sperm in the context of specific windows of epigenetic reprogramming during spermatogenesis.
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Affiliation(s)
- J Richard Pilsner
- Department of Environmental Health Sciences, University of Massachusetts Amherst, 686 N. Pleasant St., 171 Goessmann, Amherst, MA 01003-9303, USA.
| | - Mikhail Parker
- Department of Environmental Health Sciences, University of Massachusetts Amherst, 686 N. Pleasant St., 171 Goessmann, Amherst, MA 01003-9303, USA.
| | - Oleg Sergeyev
- Department of Genomics and Human Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina St., 119991 Moscow, Russia; Chapaevsk Medical Association, 3a Meditsinskaya St., 446100 Chapaevsk, Samara Region, Russia.
| | - Alexander Suvorov
- Department of Environmental Health Sciences, University of Massachusetts Amherst, 686 N. Pleasant St., 171 Goessmann, Amherst, MA 01003-9303, USA.
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Mínguez-Alarcón L, Sergeyev O, Burns JS, Williams PL, Lee MM, Korrick SA, Smigulina L, Revich B, Hauser R. A Longitudinal Study of Peripubertal Serum Organochlorine Concentrations and Semen Parameters in Young Men: The Russian Children's Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:460-466. [PMID: 27713107 PMCID: PMC5332179 DOI: 10.1289/ehp25] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/25/2016] [Accepted: 08/20/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Exposures to endocrine-disrupting chemicals during critical phases of testicular development may be related to poorer semen parameters. However, few studies have assessed the association between childhood organochlorine (OC) exposure and adult semen parameters. OBJECTIVE We examined whether peripubertal serum OC concentrations are associated with semen parameters among young Russian men. METHODS From 2003 through 2005, 516 boys were enrolled at age 8-9 years and followed for up to 10 years. Serum OCs were measured in the enrollment samples using high-resolution mass spectrometry. At 18-19 years, 133 young men provided 1 or 2 semen samples (256 samples) collected approximately 1 week apart, which were analyzed for volume, sperm concentration, and motility. Unadjusted and adjusted linear mixed models were used to examine the associations of quartiles of lipid-standardized concentrations of dioxins [2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), polychlorinated dibenzo-p-dioxins (PCDDs)], furans, polychlorinated biphenyls (PCBs), and corresponding toxic equivalents (TEQs) with semen parameters. RESULTS The median (range) for TCDD was 2.9 (0.4-12.1) pg/g lipid and PCDD TEQ was 8.7 (1.0-36.0) pg TEQ/g lipid. Higher quartiles of TCDD and PCDD TEQs were associated with lower sperm concentration, total sperm count, and total motile sperm count (p-trends ≤ 0.05). The highest quartile of peripubertal serum TCDD concentrations was associated with a decrease (95% CI) of 40% (18, 66%), 29% (3, 64%), and 30% (2, 70%) in sperm concentration, total sperm count, and total motile sperm count, respectively, compared with the lowest quartile. Similar associations were observed for serum PCDD TEQs with semen parameters. Serum PCBs, furans, and total TEQs were not associated with semen parameters. CONCLUSION Higher peripubertal serum TCDD concentrations and PCDD TEQs were associated with poorer semen parameters. Citation: Mínguez-Alarcón L, Sergeyev O, Burns JS, Williams PL, Lee MM, Korrick SA, Smigulina L, Revich B, Hauser R. 2017. A longitudinal study of peripubertal serum organochlorine concentrations and semen parameters in young men: the Russian Children's Study. Environ Health Perspect 125:460-466; http://dx.doi.org/10.1289/EHP25.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Oleg Sergeyev
- Department of Genomics and Human Genetics Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia
- Chapaevsk Medical Association, Chapaevsk, Samara Region, Russia
| | - Jane S. Burns
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Paige L. Williams
- Department of Biostatistics, and
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary M. Lee
- Pediatric Endocrine Division, Departments of Pediatrics and Cell & Developmental Biology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Susan A. Korrick
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Boris Revich
- Institute for Forecasting, Russian Academy of Sciences, Moscow, Russia
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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