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They can come from several different heart rhythms or even from non-cardiac causes

Endocrinology (1992) 131(5):216572

Beyond direct genotoxic effects, heat stress has also been shown to significantly alter sperm epigenetic profiles, including miRNA expression patterns ( 3 Metabolic characteristics and functional basis of L-citrulline 3.1 The metabolic pivotal role of the arginine-NO pathway L-citrulline serves as a pivotal intermediate in the arginineNO metabolic pathway, functioning as a direct precursor for L-arginine