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Mohamed RS, Mohamed RH, Wehrend A, Tahoun EA, Hussein HA. The effects of saline water consumption on sperm parameters, testicular histopathology, hormonal and antioxidants concentrations in Barki Rams. BMC Vet Res 2024; 20:219. [PMID: 38778406 PMCID: PMC11112924 DOI: 10.1186/s12917-024-04047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
The study aimed to assess the effects of water salinity on the sperm parameters, levels of cortisol, LH, FSH, testosterone and antioxidants as well as the testes' histopathology in Barki rams. Fifteen healthy Barki rams (1-1.5 years) were divided into three equal depending on the type of drinking water for nine months. The rams in the tap water group (TW, water that contained 350 ppm of total dissolved salts (TDS). Males in the high saline water group (HSW) were permitted to consume high saline water with 8,934 ppm TDS, whereas those in the second group were permitted to have moderately saline water (MSW, 4,557 ppm TDS). High salt concentration in drinking water had adverse effect on sperm viability, morphology and sperm cell concertation. Nitric oxide and malondialdehyde concentrations in blood were significantly higher in the MSW and HSW groups than in TW. There was a significant decrease in glutathione concentration as well as superoxide dismutase activity in TDS and HSW. Cortisol was most highly concentrated in the HSW, next in the MSW, and least in TW. The testosterone, LH, and FSH concentrations in the HSW and MSW groups were significantly lower than in TW. As the salt concentration in drinking water increases, damage to testicular tissue. The MSW group demonstrating vacuolation of lining epithelial cells with pyknotic nuclei in the epididymis and necrosis and desquamation of spermatogenic cells in seminiferous tubules while HSW group displaying desquamated necrotic cells and giant cell formation in the epididymis, as well as damage to some of the seminiferous tubules and showed congestion, vacuolation of spermatogenic epithelium of seminiferous tubules, and desquamated necrotic spermatogenic epithelium. In conclusion, the salinity of the water has detrimental impacts on the sperm morphology, viability and concentration, hormones and antioxidant levels in Barki rams.
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Affiliation(s)
- Rasha S Mohamed
- Department of Animal Health, Animal and Poultry Production Division, Desert Research Center, Cairo, Egypt
| | - Ragab H Mohamed
- Department of Theriogenology, Faculty of Veterinary Medicine, Aswan University, Aswan, 81528, Egypt
| | - Axel Wehrend
- Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals with Veterinary Ambulance, Justus-Liebig University, Giessen, Germany
| | - Enas A Tahoun
- Department of Pathology, Faculty of Veterinary Medicine, University of Sadat City, Menofia, 32897, Egypt
| | - Hassan A Hussein
- Department of Theriogenology, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt.
- Faculty of Veterinary Medicine, Sphinx University, New Assiut, Egypt.
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Yao K, Kang Q, Liu W, Chen D, Wang L, Li S. Chronic exposure to tire rubber-derived contaminant 6PPD-quinone impairs sperm quality and induces the damage of reproductive capacity in male mice. JOURNAL OF HAZARDOUS MATERIALS 2024; 470:134165. [PMID: 38574660 DOI: 10.1016/j.jhazmat.2024.134165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
It has been reported that N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine-quinone (6PPD-Q), a derivative of the tire antioxidant, N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine (6PPD), exhibits acute toxicity towards organisms. However, the possible reproductive toxicity of 6PPD-Q in mammals has rarely been reported. In this study, the effects of 6PPD-Q on the reproductive toxicity of C57Bl/6 male mice were assessed after exposure to 6PPD-Q for 40 days at 4 mg/kg body weight (bw). Exposure to 6PPD-Q not only led to a decrease in testosterone levels but also adversely affected semen quality and in vitro fertilization (IVF) outcomes, thereby indicating impaired male fertility resulting from 6PPD-Q exposure. Additionally, transcriptomic and metabolomic analyses revealed that 6PPD-Q elicited differential expression of genes and metabolites primarily enriched in spermatogenesis, apoptosis, arginine biosynthesis, and sphingolipid metabolism in the testes of mice. In conclusion, our study reveals the toxicity of 6PPD-Q on the reproductive capacity concerning baseline endocrine disorders, sperm quality, germ cell apoptosis, and the sphingolipid signaling pathway in mice. These findings contribute to an enhanced understanding of the health hazards posed by 6PPD-Q to mammals, thereby facilitating the development of more robust safety regulations governing the utilization and disposal of rubber products.
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Affiliation(s)
- Kezhen Yao
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Quanmin Kang
- Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenbo Liu
- Key Laboratory of Recycling and Eco-treatment of Waste Biomass of Zhejiang Province, School of Environmental and Natural Resources, Zhejiang University of Science & Technology, Hangzhou, China
| | - Danna Chen
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lefeng Wang
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shun Li
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Zhu P, Bi X, Su D, Li X, Chen B, Li J, Zhao L, Wang Y, Xu S, Wu X. Thiolutin, a selective NLRP3 inflammasome inhibitor, attenuates cyclophosphamide-induced impairment of sperm and fertility in mice. Immunopharmacol Immunotoxicol 2024; 46:172-182. [PMID: 38174705 DOI: 10.1080/08923973.2023.2298894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The activation of the NLRP3 inflammasome has been implicated in male infertility. Our study aimed to investigate the therapeutic role of Thiolutin (THL), an inhibitor of the NLRP3 inflammasome, on oligoasthenospermia (OA) and to elucidate its mechanisms. MATERIALS AND METHODS Semen from 50 OA and 20 healthy males were analyzed to assess the sperm quality and levels of inflammatory markers. Their correlation was determined using Pearson's correlation coefficient. The BALB/c mice were intraperitoneal injected by cyclophosphamide at 60 mg/kg/day for five days to induce OA, followed by a two-week treatment with THL or L-carnitine. Reproductive organ size and H&E staining were determined to observe the organ and seminiferous tubule morphology. ELISA and western blotting were utilized to measure sex hormone levels, inflammatory markers, and NLRP3 inflammasome levels. Furthermore, male and female mice were co-housed to observe pregnancy success rates. RESULTS OA patients exhibited a decrease in sperm density and motility compared to healthy individuals, along with elevated levels of IL-1β, IL-18 and NLRP3 inflammasome. In vivo, THL ameliorated OA-induced atrophy of reproductive organs, hormonal imbalance, and improved sperm density, motility, spermatogenesis and pregnancy success rates with negligible adverse effects on weight or liver-kidney function. THL also demonstrated to be able to inhibit the activation of NLRP3 inflammasome and associated proteins in OA mice. DISCUSSION THL can improve sperm quality and hormonal balance in OA mice through the inhibition of NLRP3 inflammasome activation. Thus, THL holds promising potential as a therapeutic agent for OA.
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Affiliation(s)
- Pengfei Zhu
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Xingyu Bi
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Dan Su
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Xiaoling Li
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Bingbing Chen
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Juhua Li
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Lijiang Zhao
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Yaoqing Wang
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Suming Xu
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
| | - Xueqing Wu
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center, Taiyuan, China
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Banihani SA. Ameliorative effects of propolis upon reproductive toxicity in males. Clin Exp Reprod Med 2023; 50:12-18. [PMID: 36935407 PMCID: PMC10030207 DOI: 10.5653/cerm.2022.05785] [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: 10/31/2022] [Accepted: 01/14/2023] [Indexed: 02/25/2023] Open
Abstract
Propolis is a sticky natural product produced by honeybees. Research studies have discussed the effectiveness of propolis, directly or indirectly, for ameliorating reproductive toxicity in males; however, this research has not yet been reviewed. The current paper presents an integrative summary of all research studies in Scopus and PubMed that investigated the effects of propolis on semen quality, and hence on male fertility, in conditions of reproductive toxicity. The consensus indicates that propolis ameliorates reproductive toxicity and enhances semen quality in vivo in test animals. These effects may be attributable to the ability of propolis to reduce testicular oxidative damage, enhance testicular antioxidant defense mechanisms, increase nitric oxide production, reduce testicular apoptotic injury, and boost testosterone production. However, to generalize these effects in humans would require further research.
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Affiliation(s)
- Saleem Ali Banihani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Exposure to acetaminophen impairs gametogenesis and fertility in zebrafish (Danio rerio). Arch Toxicol 2023; 97:263-278. [PMID: 36167911 DOI: 10.1007/s00204-022-03390-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/21/2022] [Indexed: 01/19/2023]
Abstract
Acetaminophen (ACE; paracetamol) is one of the most widely used nonsteroidal anti-inflammatory drugs worldwide and is often found in aquatic systems, where it can act on nontarget species and impair fish reproduction. This study aimed to investigate the effects of chronic exposure to environmentally relevant ACE concentrations (0.5, 5 and 50 µg/L) on multiple reproductive parameters in zebrafish (Danio rerio). Gametogenesis was analyzed using histology, morphometry, cell proliferation, and apoptosis. This study also evaluated sex steroids, and prostaglandin E2 (PGE2) levels, gene expression for sex steroids and PGE2 receptors, fertilization rate, and semen quality. In females, exposure to 5 and 50 µg/L ACE induced larger and more abundant vitellogenic follicles and increased follicular atresia. In these treatments, males showed a lower proportion and proliferation of undifferentiated spermatogonia and a higher proportion of TUNEL-positive differentiated spermatogonia, spermatids, and spermatozoa, resulting in lower sperm production. ACE increased 17β-estradiol (E2) and reduced 11-ketotestosterone levels in the testis, whereas only E2 increased in the ovaries. In both sexes, gonadal PGE2 levels were reduced. ACE at 50 µg/L induced an increase in the gene expression of androgen, estrogen, and PGE2 receptors in the ovaries, and reduced expression in the testes. Results also showed lower egg production and fertilization rate from 28 days of exposure with reduced sperm quality. These results demonstrated that ACE impairs the reproductive performance of zebrafish, affecting multiple reproductive parameters, which may be caused by the synergistic action of the imbalance of sex steroids, with a reduction of PGE2 and its receptors.
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Asadi M, Rahmani M, Samadi A, Kalantari Hesari A. Acetylsalicylic acid-induced alterations in male reproductive parameters in Wistar rats and the effect of sprint interval training. Andrologia 2022; 54:e14339. [PMID: 34862636 DOI: 10.1111/and.14339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
The present study investigated the effect of a 5-week ASA treatment on male reproductive parameters in Wistar rats; moreover, the potential benefits of a 4-week sprint interval training (SIT) on these measures following ASA treatment were investigated. A total of 25 male rats were obtained and randomly assigned to the control group (C, n = 10) and the ASA treatment group (EP, n = 15). After 5 weeks, five rats from each group were killed and the effect of ASA treatment on the reproductive parameters was assessed. Then, the ASA treatment terminated and the remaining 10 ASA-treated rats were divided into the non-treatment group (NT, n = 5) and the exercise training group (ET, n = 5), which performed SIT 3 sessions/week for 4 weeks. Five weeks of ASA treatment resulted in a statistically significant decrease in serum testosterone level, Leydig cell number, sperm count, sperm motility, sperm viability, TDI, SI and RI, and it resulted in a significant increase in sperm nucleus maturity and sperm DNA fragmentation (p ˂ 0.05). Furthermore, 4 weeks of SIT reversed all the ASA-induced changes in male reproductive parameters (p < 0.05), but not the number of seminiferous tubules and the sperm motility (p > 0.05). A subchronic dose of ASA could lead to adverse alterations in male reproductive parameters and SIT is beneficial in reversing those alterations.
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Affiliation(s)
- Mehdi Asadi
- Department of Physical Education and Sport Sciences, Shahed University, Tehran, Iran
| | - Mohammad Rahmani
- Department of Physical Education and Sport Sciences, Shahed University, Tehran, Iran
| | - Ali Samadi
- Department of Physical Education and Sport Sciences, Shahed University, Tehran, Iran
| | - Ali Kalantari Hesari
- Department of Pathobiology, Faculty of Veterinary Science, Bu-Ali Sina University, Hamadan, Iran
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Boursier A, Dumont A, Boitrelle F, Prasivoravong J, Lefebvre-Khalil V, Robin G, Barbotin AL. Necrozoospermia: The tree that hides the forest. Andrology 2022; 10:642-659. [PMID: 35246969 DOI: 10.1111/andr.13172] [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: 10/24/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Necrozoospermia is a condition found in 0.2 to 0.4 % of male infertility cases. The causes of necrozoospermia are multiple: they can be related to testicular and/or post-testicular damage. Additionally, these causes most often involve the production of reactive oxygen species (ROS) and/or sperm DNA fragmentation (SDF) which can reduce the chances of spontaneous pregnancy or affect the outcome of assisted reproductive technologies. OBJECTIVE To focus on potential etiologies of necrozoospermia, its diagnosis and its therapeutic management especially before the employment of ICSI. METHODS Authors searched PubMed/Medline, Web of Science, Cochrane Library, Google and Institutional websites for medical subheading terms and free text words referred to "necrozoospermia", "sperm vitality", "sperm viability", "sperm DNA fragmentation" and "ICSI". RESULTS We identified twelve main etiologies of necrozoospermia responsible for either a decrease of sperm vitality, a mild a moderate or a severe necrozoospermia. In case of a confirmed decreased vitality, a thorough check-up should be conducted and if available, etiological treatment should be proposed. Therapeutic management could also include repeated ejaculations, drug treatments, the use of ICSI with ejaculated or surgically extracted spermatozoa in case of a non-treatable necrozoospermia. DISCUSSION AND CONCLUSION The potential causes of necrozoospermia should be investigated because many of them could be corrected, thus avoiding the use of ICSI. Moreover, if ICSI procedure remains necessary, the therapeutic management of necrozoospermia could also improve the chances of success by reducing oxidative stress and/or sperm DNA fragmentation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Angele Boursier
- Institut de Biologie de La Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, CHU Lille, Lille, F-59000, France
| | - A Dumont
- Service de Gynécologie Endocrinienne et Médecine de La Reproduction, Assistance Médicale à La Procréation et Préservation de La Fertilité, Hôpital Jeanne de Flandre, Avenue Eugène Avinée, CHU Lille, Lille, F-59000, France
| | - F Boitrelle
- Service de Biologie de la Reproduction et de Cytogénétique, Centre Hospitalier Poissy-Saint-Germain-en-Laye, Poissy, 78303, France
| | | | - V Lefebvre-Khalil
- Institut de Biologie de La Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, CHU Lille, Lille, F-59000, France
| | - Geoffroy Robin
- Service de Gynécologie Endocrinienne et Médecine de La Reproduction, Assistance Médicale à La Procréation et Préservation de La Fertilité, Hôpital Jeanne de Flandre, Avenue Eugène Avinée, CHU Lille, Lille, F-59000, France.,Service d'Andrologie, Hôpital Huriez, CHU Lille, Lille, F-59000, France.,EA 4308 Gamètogenèse Et Qualité du Gamète, Université de Lille Et CHU de Lille, Lille, F-59000, France
| | - Anne-Laure Barbotin
- Institut de Biologie de La Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, CHU Lille, Lille, F-59000, France.,EA 4308 Gamètogenèse Et Qualité du Gamète, Université de Lille Et CHU de Lille, Lille, F-59000, France
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Luo Y, Zhu Y, Basang W, Wang X, Li C, Zhou X. Roles of Nitric Oxide in the Regulation of Reproduction: A Review. Front Endocrinol (Lausanne) 2021; 12:752410. [PMID: 34867795 PMCID: PMC8640491 DOI: 10.3389/fendo.2021.752410] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
Nitric oxide (NO) has attracted significant attention as a stellar molecule. Presently, the study of NO has penetrated every field of life science, and NO is widely distributed in various tissues and organs. This review demonstrates the importance of NO in both male and female reproductive processes in numerous ways, such as in neuromodulation, follicular and oocyte maturation, ovulation, corpus luteum degeneration, fertilization, implantation, pregnancy maintenance, labor and menstrual cycle regulation, spermatogenesis, sperm maturation, and reproduction. However, the mechanism of action of some NO is still unknown, and understanding its mechanism may contribute to the clinical treatment of some reproductive diseases.
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Affiliation(s)
- Yuxin Luo
- College of Animal Science, Jilin University, Changchun, China
| | - Yanbin Zhu
- State Key Laboratory of Hulless Barley and Yak Germplasm Resources and Genetic Improvement, Lhasa, China
| | - Wangdui Basang
- State Key Laboratory of Hulless Barley and Yak Germplasm Resources and Genetic Improvement, Lhasa, China
| | - Xin Wang
- College of Animal Science, Jilin University, Changchun, China
| | - Chunjin Li
- College of Animal Science, Jilin University, Changchun, China
| | - Xu Zhou
- College of Animal Science, Jilin University, Changchun, China
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Caglar O, Firinci B, Aydin ME, Arslan R, Kanat A, Demirci T, Aydın MD, Karadeniz E, Yigiter M, Akca N. First emerging evidence of the relationship between Onuf's nucleus degeneration and reduced sperm number following spinal subarachnoid haemorrhage: Experimental study. Andrologia 2021; 53:e14030. [PMID: 33755239 DOI: 10.1111/and.14030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/25/2022] Open
Abstract
Lumbosacral pathologies can lead to infertility. Onuf's nucleus changes in these pathologies may have a role in low sperm number. This study aims to investigate the relationship between Onuf's nucleus degeneration and sperm number following spinal subarachnoid haemorrhage. 22 rabbits were used. They were divided into three groups; five of them were used as the control (GI), five as the SHAM (GII) and twelve as the study groups (GIII). The study group received 0.7 ccs autologous blood into the spinal subarachnoid space at the T12-L1 level. After two weeks, all animals were decapitated, and S1-S3 laminectomy was done. Neurodegenerative changes of Onuf's nucleus, pudendal ganglia (S3) following two weeks after spinal SAH, were examined; sperm numbers were calculated. Degenerated neuron density of the Onuf's nucleus (n/mm3 ), the pudendal ganglia (S3) (n/mm3 ) and mean sperm numbers were calculated as 5 ± 2, 8 ± 3/mm3 and 98.345 ± 12.776/mm3 in the control (GI), 20 ± 5/mm3 , 243 ± 66/mm3 and 91.841 ± 9.654/mm3 in the SHAM (GII), 143 ± 39/mm3 , 2,350 ± 320/mm3 and 68.549 ± 5.540/mm3 in the study group (GIII). In conclusion, there were statistically significant differences between groups. Onuf's nucleus may be responsible for decreased sperm number following spinal SAH.
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Affiliation(s)
- Ozgur Caglar
- Department of Pediatric Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Binali Firinci
- Department of Pediatric Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Muhammed Enes Aydin
- Department of Anesthesiology, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Remzi Arslan
- Department of Pathology, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Ayhan Kanat
- Department of Neurosurgery, Medical Faculty of Recep Tayyip Erdogan University, Rize, Turkey
| | - Tuba Demirci
- Department of Histology, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Mehmet Dumlu Aydın
- Department of Neurosurgery, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Murat Yigiter
- Department of Pediatric Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey
| | - Nezih Akca
- Department of Urology, Medical Faculty of Recep Tayyip Erdogan University, Rize, Turkey
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