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Furthermore, no evidence has been presented that cigarette smoke directly affects the tissue regeneration-associated functions of endometrial stem cells, and thus, it is difficult to conclude whether these inhibitions of stem cell functions are attributable to the direct suppressive effects of cigarette smoke or smoking-induced secondary (indirect) outcomes, such as chronically elevated levels of pro-inflammatory factors [22, 23] and/or reactive oxygen species (ROS) [24, 25]