Commentary
Comment to “Analysis of predictive factors of success for prostate photovaporization in BPH by greenlight laser”
Comentario a: «Análisis de factores predictivos de éxito para la fotovaporización próstatica en HBP mediante láser verde»
F. Gómez-Sancha
Instituto de Cirugía Urológica Avanzada, Madrid, Spain
Read
743
Timeswas read the article
190
Total PDF
553
Total HTML
Share statistics
array:24 [ "pii" => "S2173578613000322" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2012.05.014" "estado" => "S300" "fechaPublicacion" => "2013-01-01" "aid" => "442" "copyright" => "AEU" "copyrightAnyo" => "2012" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "dis" "cita" => "Actas Urol Esp. 2013;37:25-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 748 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 552 "PDF" => 190 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480612001672" "issn" => "02104806" "doi" => "10.1016/j.acuro.2012.05.001" "estado" => "S300" "fechaPublicacion" => "2013-01-01" "aid" => "442" "copyright" => "AEU" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "dis" "cita" => "Actas Urol Esp. 2013;37:25-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1349 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 995 "PDF" => 347 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comentario editorial</span>" "titulo" => "Comentario a: «Análisis de factores predictivos de éxito para la fotovaporización próstatica en HBP mediante láser verde»" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "26" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Comment to «Analysis of Predictive Factors of Success for Prostate Photovaporization in BPH by Greenlight Laser»" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Gómez-Sancha" "autores" => array:1 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Gómez-Sancha" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578613000322" "doi" => "10.1016/j.acuroe.2012.05.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578613000322?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480612001672?idApp=UINPBA00004N" "url" => "/02104806/0000003700000001/v1_201304251530/S0210480612001672/v1_201304251530/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578613000334" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2012.01.009" "estado" => "S300" "fechaPublicacion" => "2013-01-01" "aid" => "405" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2013;37:27-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 803 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 612 "PDF" => 184 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Clinical characterization of prostate cancer potentially insignificant in the prostate biopsy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "32" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caracterización clínica del cáncer de próstata potencialmente insignificante en la biopsia prostática" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1121 "Ancho" => 1490 "Tamanyo" => 59584 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical stage T (pT) of the sample.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. Hernández-Medina, F. García-Morata, N. Diez-Calzadilla, J.M. Martínez-Jabaloyas, R. Rodriguez-Navarro, P. Soriano-Sarria, P. Chuan-Nuez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Hernández-Medina" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "García-Morata" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Diez-Calzadilla" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez-Jabaloyas" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Rodriguez-Navarro" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Soriano-Sarria" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Chuan-Nuez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480612000307" "doi" => "10.1016/j.acuro.2012.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480612000307?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578613000334?idApp=UINPBA00004N" "url" => "/21735786/0000003700000001/v1_201306251136/S2173578613000334/v1_201306251136/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578613000310" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2012.03.014" "estado" => "S300" "fechaPublicacion" => "2013-01-01" "aid" => "425" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2013;37:20-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 800 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 623 "PDF" => 169 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Analysis of predictive factors of success for prostate photovaporization in benign prostatic hyperplasia by greenlight laser" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "20" "paginaFinal" => "24" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de factores predictivos de éxito para la fotovaporización próstatica en hiperplasia benigna de próstata mediante láser verde" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 333 "Ancho" => 1549 "Tamanyo" => 48535 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evolution of the urinary flow. There is a statistically significant improvement between the mean preoperative <span class="elsevierStyleItalic">Q</span><span class="elsevierStyleInf">max</span> and the controls at 3, 6, 9, and 12 months after the surgery (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Miralles, J.L. Palmero, M. Ramírez-Backhaus, J.M. Osca, A. Benedicto" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Miralles" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Palmero" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ramírez-Backhaus" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Osca" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Benedicto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480612001088" "doi" => "10.1016/j.acuro.2012.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480612001088?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578613000310?idApp=UINPBA00004N" "url" => "/21735786/0000003700000001/v1_201306251136/S2173578613000310/v1_201306251136/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Commentary</span>" "titulo" => "Comment to “Analysis of predictive factors of success for prostate photovaporization in BPH by greenlight laser”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "26" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "F. Gómez-Sancha" "autores" => array:1 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Gómez-Sancha" "email" => array:1 [ 0 => "fgomsan@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Instituto de Cirugía Urológica Avanzada, Madrid, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario a: «Análisis de factores predictivos de éxito para la fotovaporización próstatica en HBP mediante láser verde»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The search for a minimally invasive alternative to the transurethral resection of the prostate and open prostatectomy has recently culminated in the use of different types of lasers. The prostate enucleation with Holmium laser (2140<span class="elsevierStyleHsp" style=""></span>nm) has proved to be an excellent choice to conventional techniques, but its spread has been limited by its great technical complexity. The photovaporization by greenlight laser (532<span class="elsevierStyleHsp" style=""></span>nm) has been consolidating as a safe and effective option for the treatment of BPH, and it is now accepted as a surgical treatment option in the latest guidelines of the EAU<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the AUA.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There are 9 randomized trials comparing it to the TUR and a meta-analysis thereof will be published shortly, so we can no longer say that there is no scientific evidence that supports it.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since the introduction of the greenlight laser in 2003, there have been two developments: one in technology, with three successive generations of lasers, of 80, 120, and 180<span class="elsevierStyleHsp" style=""></span>W, with better vaporization capacity and improved safety and efficiency in each generation; another in the anatomical knowledge and surgical technique. At the time of release of this laser in the U.S. market, it was essential to the manufacturer that this procedure could be performed in the urologists’ offices, with sedation and local anesthesia, as done in this way, the reimbursement for the urologist by American insurance companies would be very substantial, and so, urologists would welcome it with open arms. That is why, a mere adenoma tunneling was promoted, with good short-term but unconvincing results to most European urologists, more concerned about the durability of the procedure. The idea that it was an easy technique to learn, with virtually no learning curve, was also falsely promoted.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Today, thanks to current technology and new knowledge, it is perfectly possible to perform a total vaporization of the adenoma localization using the capsular location technique and intraoperative transrectal ultrasound scan.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is also possible to perform a transurethral enucleation of the adenoma followed by intravesical morcellation in large prostates.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These techniques are unfortunately still little known.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This logical evolution in technology and technique resembles that occurred in the years following the introduction of the transurethral resection of the prostate and, undoubtedly, will help to progressively improve the efficiency and reduce the morbidity of this form of treatment, as a greater “culture” or a deeper knowledge on the use of lasers for the treatment of BPH among urologists becomes widespread.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors of this article have retrospectively reviewed their series of 179 patients treated over a period of 3 years and a half with two different lasers (80 and 120<span class="elsevierStyleHsp" style=""></span>W), not evenly distributed among 9 surgeons. They operated on patients with medium-sized prostates. They arbitrarily define the success of the intervention as the absence of reconversion to TUR, the subjective improvement of the patient, and the absence of reintervention. They subsequently conducted a univariate and multivariate analysis to identify factors significantly associated with thus defined success. They conclude that the surgeon's experience is a success factor.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This article<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">5</span></a> reflects the learning curve of 9 different surgeons who divided 179 cases. The most expert surgeon in the group accumulated 65 cases and the least experienced surgeon managed only 3 cases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Honestly described late morbidity in this series of patients with 15 reinterventions, 7 due to incomplete treatment (a typical problem of the lack of experience), 5 due to neck sclerosis (higher than in the rest of the published literature, probably reflecting an inappropriate use of technology), and 2 cases of incontinence on minimum effort that requires the implantation of artificial sphincter, constitute, in my view, a painful price for the introduction of a new technology, which in theory is minimally aggressive, in a Urology Department.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The successful adoption of this technology goes through proper and progressive training, based on several steps: first, the acquisition of a solid knowledge of the physical basis of the use of this laser, essential and mandatory for any surgeon, who should know what is at hand; second, the apprentice should see several surgical procedures and understand the dynamics of these interventions; third, we should exploit the use of surgical simulators (there is already an excellent simulator manufactured by American Medical Systems<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>); fourth, the apprentice should be observed by an expert trainer who can take on and solve the intraoperative problems and complete the treatment when necessary, and who must decide when the apprentice can operate independently; and fifth, once the apprentice is independent, they must consolidate their learning curve performing many cases in little time. It is important that the prostate size is small-medium during the learning curve.</p><p id="par0045" class="elsevierStylePara elsevierViewall">I believe that in a Urology Department, one or two urologists who amply consolidate their surgical capacity and then are able to teach their colleagues to perform the procedure safely, being able to redirect a difficult case and ensure a good surgical outcome, thus avoiding that the patient suffers the learning curve, should accumulate the initial experience.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gómez-Sancha F. Comentario a: «Análisis de factores predictivos de éxito para la fotovaporización prostática en HBP mediante láser verde». Actas Urol Esp. 2013;37:25–6.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU guidelines on laser technologies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.R.W. Herrmann" 1 => "E.N. Liatsikos" 2 => "U. Nagele" 3 => "O. Traxer" 4 => "A.S. Merseburger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2012.01.010" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2012" "volumen" => "61" "paginaInicial" => "783" "paginaFinal" => "795" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22285403" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on AUA guideline on the management of benign prostatic hyperplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.T. McVary" 1 => "C.G. Roehrborn" 2 => "A.L. Avins" 3 => "M.J. Barry" 4 => "R.C. Bruskewitz" 5 => "R.F. Donnell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2011.01.074" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2011" "volumen" => "185" "paginaInicial" => "1793" "paginaFinal" => "1803" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21420124" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of real time transrectal ultrasonography to monitor the Greenlight XPS(<span class="elsevierStyleSup">®</span>) (180<span class="elsevierStyleHsp" style=""></span>W) laser prostatectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Fournier" 1 => "M-A. Perrouin-Verbe" 2 => "G. Papin" 3 => "C. Deruelle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.purol.2010.12.002" "Revista" => array:6 [ "tituloSerie" => "Prog Urol" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "383" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21620297" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transurethral Green Light laser enucleation of the prostate – a feasibility study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Brunken" 1 => "C. Seitz" 2 => "S. Tauber" 3 => "R. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/end.2010.0550" "Revista" => array:6 [ "tituloSerie" => "J Endourol" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "1199" "paginaFinal" => "1201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21612434" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0035" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de factores predictivos de éxito para la fotovaporización próstatica en HBP mediante láser verde" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Miralles" 1 => "J.L. Palmero" 2 => "M. Ramírez-Backhaus" 3 => "J.M. Osca" 4 => "A. Benedicto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2012.03.004" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "20" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22728021" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laser surgery simulation platform: toward full-procedure training and rehearsal for benign prostatic hyperplasia (BPH) therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Shen" 1 => "V. Konchada" 2 => "N. Zhang" 3 => "S. Jain" 4 => "X. Zhou" 5 => "D. Burke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stud Health Technol Inform" "fecha" => "2011" "volumen" => "163" "paginaInicial" => "574" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21335859" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003700000001/v1_201306251136/S2173578613000322/v1_201306251136/en/main.assets" "Apartado" => array:4 [ "identificador" => "6274" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003700000001/v1_201306251136/S2173578613000322/v1_201306251136/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578613000322?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2018 February | 0 | 1 | 1 |
| 2018 January | 4 | 1 | 5 |
| 2017 December | 4 | 0 | 4 |
| 2017 November | 4 | 0 | 4 |
| 2017 October | 4 | 1 | 5 |
| 2017 September | 4 | 0 | 4 |
| 2017 August | 9 | 2 | 11 |
| 2017 July | 10 | 0 | 10 |
| 2017 June | 11 | 2 | 13 |
| 2017 May | 6 | 1 | 7 |
| 2017 April | 18 | 3 | 21 |
| 2017 March | 21 | 45 | 66 |
| 2017 February | 6 | 1 | 7 |
| 2017 January | 7 | 1 | 8 |
| 2016 December | 14 | 3 | 17 |
| 2016 November | 18 | 1 | 19 |
| 2016 October | 19 | 2 | 21 |
| 2016 September | 41 | 3 | 44 |
| 2016 August | 16 | 1 | 17 |
| 2016 July | 8 | 2 | 10 |
| 2016 June | 8 | 6 | 14 |
| 2016 May | 11 | 14 | 25 |
| 2016 April | 11 | 6 | 17 |
| 2016 March | 15 | 9 | 24 |
| 2016 February | 19 | 10 | 29 |
| 2016 January | 14 | 10 | 24 |
| 2015 December | 15 | 5 | 20 |
| 2015 November | 8 | 1 | 9 |
| 2015 October | 14 | 8 | 22 |
| 2015 September | 19 | 3 | 22 |
| 2015 August | 5 | 2 | 7 |
| 2015 July | 2 | 5 | 7 |
| 2015 June | 1 | 1 | 2 |
| 2015 May | 8 | 1 | 9 |
| 2015 April | 16 | 3 | 19 |
| 2015 March | 16 | 12 | 28 |
| 2015 February | 9 | 3 | 12 |
| 2015 January | 32 | 6 | 38 |
| 2014 November | 0 | 1 | 1 |
| 2014 September | 1 | 2 | 3 |
| 2014 August | 2 | 0 | 2 |
| 2014 July | 1 | 1 | 2 |
| 2014 June | 3 | 1 | 4 |
| 2014 May | 6 | 3 | 9 |
| 2014 April | 1 | 0 | 1 |
| 2014 January | 5 | 0 | 5 |
| 2013 December | 12 | 1 | 13 |
| 2013 November | 11 | 1 | 12 |
| 2013 October | 38 | 4 | 42 |
| 2013 September | 22 | 0 | 22 |
| 2013 July | 3 | 1 | 4 |
Show all
