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Tribulus terrestris versus placebo in the treatment of erectile dysfunction: A prospective, randomized, double-blind study
Tribulus terrestris versus placebo en el tratamiento de la disfunción eréctil: un estudio aleatorizado, prospectivo y doble ciego
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"apellidos" => "Fregonesi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía (Urología), Facultad de Ciencias Médicas, Universidad Estatal de Campinas UNICAMP, São Paulo, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina (Urología), Centro de Ciencias de la Vida, Universidad Católica de Campinas PUC-Campinas, São Paulo, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tribulus terrestris versus placebo en el tratamiento de la disfunción eréctil: un estudio aleatorizado, prospectivo y doble ciego" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tribulus terrestris</span> is a herb belonging to the family Zygophyllaceae,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> mostly from southern temperate zones of Europe. It has been used for centuries in traditional Chinese medicine, and also in Indian system of medicine, in order to improve libido and sexual performance.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Some authors have confirmed this effect in rabbits and primates.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies also show an increase in the level of free testosterone in guinea pigs.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These effects could be due to the presence of saponins and flavonoids in the compound, which would act on the fat-soluble steroids.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dell’Agli et al. tested possible inhibitory effects on the enzyme phosphodiesterase-5.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Rogerson et al. studied the possible increase in human skeletal muscle with supplementation of Tribulus for a period of five weeks.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Other authors have attempted to confirm these effects in humans, but they were unsuccessful, possibly due to limitations in study design and sample size.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The local Ethics Committee approved this prospective, randomized, double-blind and placebo-controlled study. Data collection occurred from September 2009 to April 2010, in a urology outpatient clinic. The subjects were evaluated with history and physical examination directed to the genitals and femoral pulses bilaterally. No patient had abnormal physical examination.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria were as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Male;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Minimum age 40 years;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Erectile dysfunction treatment-naive;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Consenting to participate;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Exclusion criteria were as follows:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Illiterate individuals;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Smoking;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Dyslipidemia (abnormal serum cholesterol or triglycerides);</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Uncontrolled diabetes mellitus (fasting glucose<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg/dl);</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Uncontrolled hypertension (diastolic blood pressure<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg);</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Prior pelvic radiotherapy;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Previous pelvic surgery;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Use of phosphodiesterase-5 inhibitor.</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">All subjects underwent determination of serum total testosterone, fasting glucose, triglycerides, and total cholesterol, and were subsequently weighed and had height measured in order to obtain the Body Mass Index (BMI). Additionally, the International Index of Erectile Function questionnaire (IIEF – 5) was also applied.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Then, all the patients were randomized using a computer program into two groups of fifteen, the intervention (<span class="elsevierStyleItalic">Tribulus terrestris</span>) and control (placebo) groups. Researchers and individuals were blinded for the groups.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The intervention group received sixty capsules containing 400<span class="elsevierStyleHsp" style=""></span>mg of dry extract of <span class="elsevierStyleItalic">Tribulus terrestris</span> in each, being told to take one capsule in the morning, before breakfast, and another capsule after twelve hours without ingesting any food.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The control group received similar sixty capsules containing 400<span class="elsevierStyleHsp" style=""></span>mg of pharmaceutical talc (placebo) in each, with identical orientation of the herbal medicine.</p><p id="par0115" class="elsevierStylePara elsevierViewall">At the end of the treatment, both groups were instructed to collect a new blood sample for total testosterone dosage, and again to respond to the IIEF-5 questionnaire. All were asked about the possible side effects that could have been associated with the treatment they had undergone.</p><p id="par0120" class="elsevierStylePara elsevierViewall">All patients were instructed that they were free to leave the study at any time without any harm.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The Chi-square test or Fisher's exact test was used to compare proportions, and the Mann–Whitney test for comparison of continuous measures between the two groups. The ANOVA was used for comparisons between the groups and times, as well as for repeated measures with post-transformation. The significance level was 5%.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">Among 100 patients screened in a urology outpatient clinic, 30 patients were enrolled and randomized: 15/15 for intervention and placebo groups.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The mean (SD) age was 60 (9.4) and 62.9 (7.9) years, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.36, for intervention and placebo groups, respectively.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding weight, subjects were divided into three groups based on their BMI: normal (18.6–25.0), overweight (25.1–30.0), and obese (>30.0). In the intervention group, four individuals presented normal weight (26.6%), six overweight (40.0%), and five obese (33.3%). In the placebo group, eight were normal (53.3%), five were overweight (33.3%), and two were obese (13.3%). Fisher's test showed no significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.2689). (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Three patients in the intervention group (20.0%) and four in the placebo group (26.6%) had compensated diabetes mellitus. This difference was not significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.0000).</p><p id="par0150" class="elsevierStylePara elsevierViewall">Eight subjects in the intervention group (53.3%) and ten in the placebo group presented controlled hypertension (66.6%), with no significant difference using the Chi-square test (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.4561). (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding the degree of erectile dysfunction (IIEF-5), patients were divided into four levels: Mild, Mild to Moderate, Moderate, and Severe. In the intervention group, we found three patients with mild (20.0%), nine with mild/moderate (60.0%), two with moderate (13.3%), and one with severe (6.6%) erectile dysfunction. In the placebo group, we found three with mild (20.0%), three with mild/moderate (20.0%), seven with moderate (46.6%), and two with severe (13.3%) erectile dysfunction. Applying the Fisher test, no significant difference was found between the groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0841) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the intervention group, the results of the IIEF-5 were: mean 13.2, median 17.0, range 5.0–21.0 points. In the placebo group, we found the following data: mean 11.6, median 14.0, range 6.0–21 points. The groups were homogeneous prior to treatment (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.2463) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">After treatment, the results of the IIEF-5 were as follows:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0170" class="elsevierStylePara elsevierViewall">Intervention group: mean 15.3, median 18.0, range 5.0–21.0 points.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0175" class="elsevierStylePara elsevierViewall">Placebo group: mean 13.7, median 16.0, range 6.0–21.0 points.</p></li></ul></p><p id="par0180" class="elsevierStylePara elsevierViewall">The time factor was significant and caused statistically significant changes in both the groups, and in both the groups the response was better in the second IIEF-5 questionnaire (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0004). When comparing the responses between the two groups, they were not different (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7914) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><p id="par0185" class="elsevierStylePara elsevierViewall">Regarding the initial serum total testosterone, the intervention group showed: mean 417.1<span class="elsevierStyleHsp" style=""></span>ng/dl, median 404.7<span class="elsevierStyleHsp" style=""></span>ng/dl, range 270.7<span class="elsevierStyleHsp" style=""></span>ng/dl – 548.4<span class="elsevierStyleHsp" style=""></span>ng/dl. The placebo group obtained mean 442.7<span class="elsevierStyleHsp" style=""></span>ng/dl, median 419.9<span class="elsevierStyleHsp" style=""></span>ng/dl, range 301.0<span class="elsevierStyleHsp" style=""></span>ng/dl – 609.1<span class="elsevierStyleHsp" style=""></span>ng/dl. The Mann–Whitney test showed no statistical difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.4306) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">After treatment, testosterone in the intervention group showed an average of 409.3<span class="elsevierStyleHsp" style=""></span>ng/dl, median 410.6<span class="elsevierStyleHsp" style=""></span>ng/dl, range 216.9<span class="elsevierStyleHsp" style=""></span>ng/dl – 760.8<span class="elsevierStyleHsp" style=""></span>ng/dl. In the placebo group, the average was 466.3<span class="elsevierStyleHsp" style=""></span>ng/dl, median 421.5<span class="elsevierStyleHsp" style=""></span>ng/dl, range 264.3<span class="elsevierStyleHsp" style=""></span>ng/dl – 934.3<span class="elsevierStyleHsp" style=""></span>ng/dl. There was no difference between the groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.3551) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><p id="par0195" class="elsevierStylePara elsevierViewall">Regarding testosterone, there was no statistically significant difference between the groups before and after treatment (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7775) and no significant time effect either (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.3993).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0200" class="elsevierStylePara elsevierViewall">Despite the great advances made in the treatment of erectile dysfunction after the introduction of phosphodiesterase-5 inhibitors and the increasing knowledge gained about the androgen dysfunction of the aging male, many individuals still seek and believe in the effects of natural and herbal aphrodisiac products.</p><p id="par0205" class="elsevierStylePara elsevierViewall">In this scenario, <span class="elsevierStyleItalic">Tribulus terrestris</span> is a plant of the Zygophyllaceae family, native of tropical regions of southern Europe, southern Asia, Africa, and northern Australia. It can thrive even in desert climates and poor soils.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Tribulus has been used for centuries in traditional Chinese medicine and Indian medicine to improve libido and sexual performance.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Tuncer et al. demonstrated a reduction in lipid levels and also a possible recovery of endothelial dysfunction caused by hyperlipidemia in rabbits fed with a diet rich in Tribulus.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Aggarwal et al. using experimental models suggest that Tribulus is able to reduce calcium oxalate nucleation and crystal growth in the kidney.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Kim et al. demonstrated that the plant extract blocks proliferation and induces apoptosis in human hepatic cancer cells, suggesting that this extract can be used in the treatment of hepatocellular carcinoma.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Its effect is attributed to the presence of a substance called protodioscin.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Protodioscin (5,6-dihydroprotodioscin, neoprotodioscin)<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> is a saponin that can be found in different concentrations in the aerial part of the plant, depending on the place where it is grown.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Additionally, protodioscin may act in improving erection function by being converted into dehydroepiandrosterone (DHEA).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Adaikan et al. showed in an experimental study that protodioscin increased by 24% the relaxation response of rabbit cavernous tissue to stimulation with acetylcholine and nitroglycerin when fed with 5<span class="elsevierStyleHsp" style=""></span>mg/kg of <span class="elsevierStyleItalic">Tribulus terrestris</span>.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Gauthaman et al. reported a significant increase in the intracavernous pressure (PI) of animals receiving <span class="elsevierStyleItalic">Tribulus terrestris</span>. They also described improvement in the sexual behavior of animals through breeding parameters, intromission, ejaculatory latency, and post-ejaculatory interval. The authors concluded that the increase in PI was due to the possible effects of pro-erectile protodioscine and the improvement of other parameters could be linked to pro-androgenic effects.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The same authors conducted a study describing that castrated animals that received testosterone and Tribulus showed a statistically significant increase in intracavernosal pressure measurement, in prostate weight and in intromission and mounts.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">However, Dell’Agli et al. have not demonstrated the inhibitory effect of <span class="elsevierStyleItalic">Tribulus terrestris</span> on the enzyme phosphodiesterase-5,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which contradicts a possible pro-erectile effect.</p><p id="par0245" class="elsevierStylePara elsevierViewall">In the present study, we observed an improvement in the response of both the groups compared with scores obtained in the first IEF-5, before receiving the capsules, <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0004. This result, in our opinion, is due to the strong power of the placebo effect when treating individuals with erectile dysfunction.</p><p id="par0250" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">Tribulus terrestris</span> is the target of numerous experimental studies with favorable results, with several suggested actions from anti-neoplastic, anti-lithiasis to stimulating libido and erection, these data do not have confirmation in well-conducted clinical trials yet.</p><p id="par0255" class="elsevierStylePara elsevierViewall">In the context of male sexual dysfunction, the present study demonstrated only placebo effect for <span class="elsevierStyleItalic">Tribulus terrestris</span> at the studied dose and interval when treating patients with erectile dysfunction.</p><p id="par0260" class="elsevierStylePara elsevierViewall">Although it is a prospective, randomized, double-blinded, and placebo-controlled study using a validated questionnaire to assess sexual function, and accounting for serum testosterone, the present study is preliminary, including a relatively small number of patients.</p><p id="par0265" class="elsevierStylePara elsevierViewall">Future studies are warranted, including more patients and also evaluating those with normal erectile function.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0270" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres337387" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Design and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec318933" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres337386" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Diseño y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec318934" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-08-05" "fechaAceptado" => "2013-09-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec318933" "palabras" => array:7 [ 0 => "Impotence" 1 => "Sexual dysfunction" 2 => "Herbal medicine" 3 => "Alternative medicine" 4 => "Testosterone" 5 => "Libido" 6 => "Placebo and Chinese medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec318934" "palabras" => array:7 [ 0 => "Impotencia" 1 => "Disfunción sexual" 2 => "Fitoterapia" 3 => "Medicina alternativa" 4 => "Testosterona" 5 => "Libido" 6 => "Placebo y medicina china" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the possible effects of <span class="elsevierStyleItalic">Tribulus terrestris</span> herbal medicine in the erectile dysfunction treatment and to quantify its potential impact on serum testosterone levels.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Design and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective, randomized, double-blind and placebo-controlled study including 30 healthy men selected from 100 patients who presented themselves spontaneously complaining of erectile dysfunction, ≥40 years of age, nonsmokers, not undergoing treatment for prostate cancer or erectile dysfunction, no dyslipidemia, no phosphodiesterase inhibitor use, and no hormonal manipulation, and if present, hypertension and/or diabetes mellitus should be controlled. International Index of Erectile Function (IIEF-5) and serum testosterone were obtained before randomization and after 30 days of study. The patients were randomized into two groups of fifteen subjects each. The study group received 800<span class="elsevierStyleHsp" style=""></span>mg of <span class="elsevierStyleItalic">Tribulus terrestris</span>, divided into two doses per day for 30 days, and the control group received placebo administered in the same way.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The groups were statistically equivalent in all aspects evaluated. The mean (SD) age was 60 (9.4) and 62.9 (7.9) years, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.36, for intervention and placebo groups, respectively. Before treatment, the intervention group showed mean IIEF-5 of 13.2 (5–21) and mean total testosterone 417.1<span class="elsevierStyleHsp" style=""></span>ng/dl (270.7–548.4<span class="elsevierStyleHsp" style=""></span>ng/dl); the placebo group showed mean IIEF-5 of 11.6 (6–21) and mean total testosterone 442.7<span class="elsevierStyleHsp" style=""></span>ng/dl (301–609.1<span class="elsevierStyleHsp" style=""></span>ng/dl). After treatment, the intervention group showed mean IIEF-5 of 15.3 (5–21) and mean total testosterone 409.3<span class="elsevierStyleHsp" style=""></span>ng/dl (216.9–760.8<span class="elsevierStyleHsp" style=""></span>ng/dl); the placebo group showed mean IIEF-5 of 13.7 (6–21) and mean total testosterone 466.3<span class="elsevierStyleHsp" style=""></span>ng/dl (264.3–934.3<span class="elsevierStyleHsp" style=""></span>ng/dl). The time factor caused statistically significant changes in both the groups for IIEF-5 only (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0004); however, there was no difference between the two groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7914).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">At the dose and interval studied, <span class="elsevierStyleItalic">Tribulus terrestris</span> was not more effective than placebo in improving symptoms of erectile dysfunction or serum total testosterone.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar los posibles efectos de la fitoterapia con tribulus terrestris en el tratamiento de la disfunción eréctil y cuantificar su impacto potencial en los niveles de testosterona sérica.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Diseño y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo, aleatorizado, doble ciego y controlado con placebo incluyendo 30 hombres sanos seleccionados entre 100 pacientes que se presentaron espontáneamente con disfunción eréctil, ≥40 años de edad, no fumadores, no sometidos a tratamiento para el cáncer de próstata o disfunción eréctil, sin dislipidemia, sin uso de inhibidores de la fosfodiesterasa, sin manipulación hormonal y si presentaban hipertensión y/o diabetes mellitus debían ser controlados. El índice internacional de función eréctil (IIFE-5) y la testosterona sérica se obtuvieron antes de la aleatorización y después de 30 días de estudio. Los pacientes fueron divididos aleatoriamente en 2 grupos de 15 sujetos cada uno. El grupo de estudio recibió 800<span class="elsevierStyleHsp" style=""></span>mg de Tribulus terrestris, divididos en 2 dosis al día durante 30 días y el grupo control recibió placebo administrado de la misma manera.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los grupos fueron estadísticamente equivalentes en todos los aspectos evaluados. La media de edad (DE) fue de 60 (9,4) y 62,9 (7,9) – p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,36 – para la intervención y los grupos de placebo, respectivamente. Antes del tratamiento el grupo de intervención mostró una media de IIFE-5 de 13,2 (5–21) y la media de testosterona total de 417,1<span class="elsevierStyleHsp" style=""></span>ng/dl (270,7–548,4<span class="elsevierStyleHsp" style=""></span>ng/dl); el grupo de placebo mostró una media de IIFE-5 de 11,6 (6–21) y una media de testosterona total de 442,7<span class="elsevierStyleHsp" style=""></span>ng/dl (301–609,1<span class="elsevierStyleHsp" style=""></span>ng/dl). Después del tratamiento el grupo de intervención mostró una media de IIFE-5 de 15,3 (5–21) y una media de testosterona total de 409,3<span class="elsevierStyleHsp" style=""></span>ng/dl (216,9–760,8<span class="elsevierStyleHsp" style=""></span>ng/dl); el grupo placebo mostró una media de IIFE-5 de 13,7 (6–21) y una media de testosterona total de 466,3<span class="elsevierStyleHsp" style=""></span>ng/dl (264,3–934,3<span class="elsevierStyleHsp" style=""></span>ng/dl). El factor tiempo causó cambios estadísticamente significativos en ambos grupos solo para IIFE-5 (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0004), sin embargo no hubo ninguna diferencia entre los 2 grupos (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,7914).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A la dosis y el intervalo estudiado Tribulus terrestris no fue más eficaz que el placebo en la mejora de los síntomas de la disfunción eréctil o la testosterona sérica total.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos Jr CA, Reis LO, Destro-Saade R, Luiza-Reis A, Fregonesi A. Tribulus terrestris versus placebo en el tratamiento de la disfunción eréctil: un estudio aleatorizado, prospectivo y doble ciego. Actas Urol Esp. 2014;38:244–248.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Intervention (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Placebo (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overweight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obese \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2689 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes (+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes (−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension (+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension (−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.4561 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild/moderate ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0841 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab497334.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patients baseline characteristics.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Min. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Max. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placebo baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2463 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention final \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placebo final \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7914 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab497335.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Erectile function (IIEF-5).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Min. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Max. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">417.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">404.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">270.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">548.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placebo baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">442.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">419.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">301.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">609.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.4306 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intervention final \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">409.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">410.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">216.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">760.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placebo final \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">466.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">421.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">264.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">934.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3551 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab497333.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Serum testosterone.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 0 | 2 |
| 2022 July | 1 | 2 | 3 |
| 2019 January | 0 | 1 | 1 |
| 2018 November | 0 | 1 | 1 |
| 2018 February | 3 | 3 | 6 |
| 2018 January | 9 | 2 | 11 |
| 2017 December | 6 | 6 | 12 |
| 2017 November | 12 | 7 | 19 |
| 2017 October | 5 | 5 | 10 |
| 2017 September | 18 | 7 | 25 |
| 2017 August | 29 | 6 | 35 |
| 2017 July | 18 | 6 | 24 |
| 2017 June | 15 | 9 | 24 |
| 2017 May | 16 | 8 | 24 |
| 2017 April | 29 | 39 | 68 |
| 2017 March | 45 | 26 | 71 |
| 2017 February | 42 | 3 | 45 |
| 2017 January | 45 | 4 | 49 |
| 2016 December | 36 | 7 | 43 |
| 2016 November | 26 | 4 | 30 |
| 2016 October | 34 | 8 | 42 |
| 2016 September | 22 | 13 | 35 |
| 2016 August | 17 | 14 | 31 |
| 2016 July | 15 | 7 | 22 |
| 2016 June | 11 | 11 | 22 |
| 2016 May | 11 | 18 | 29 |
| 2016 April | 0 | 5 | 5 |
| 2016 March | 0 | 10 | 10 |
| 2016 February | 0 | 9 | 9 |
| 2016 January | 0 | 13 | 13 |
| 2015 December | 0 | 6 | 6 |
| 2015 November | 0 | 9 | 9 |
| 2015 October | 0 | 4 | 4 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 0 | 1 | 1 |
| 2014 August | 0 | 1 | 1 |
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