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The selection criteria complied with age 45 years, body mass index (BMI) in the range of 2535 kg/m 2 , and diagnosis of KOA according to the clinical classification of KOA [22]

Opioids, such as heroin, primarily target the brains reward system and induce oxidative stress, neuroinflammation, and cerebrovascular complications

Furthermore, the problem may be upstream, during spermatogenesis, responsible for the production and maturation of sperm cells
