Si può desiderare di provare un trattamento naturale disfunzione erettile come un diverso per i problemi di costruzione. Al giorno d oggi ci sono diverse terapie sul mercato, ma un trattamento naturale disfunzione erettile è stato confermato qualche ora e ora di nuovo per dare risultati efficienti e permanenti. Cos è la disfunzione sessuale? L incapacità di sviluppare o sostenere una costruzione abbastanza lungo per fare l amore è chiamato disfunzione erettile, ED https://farmacia-senzaricetta.it/ o (maschio) problemi di erezione. Tutti gli uomini possono avere problemi di costruzione di volta in volta e gli scienziati considerano ED essere presenti se si verificano problemi di costruzione almeno il 25% del tempo. Alcuni fatti duri: ED Può essere dovuto a problemi emotivi. Stress, pressione, giltiness, depressione, bassa autostima e ansia prestazioni può essere la causa dei vostri problemi di costruzione. La ricerca ha confermato che il 90 per cento della disfunzione erettile è fisica in origine, non emotiva. L impotenza colpisce la maggior parte degli uomini durante la loro vita e può essere dovuto a troppo colesterolo, problemi cardiaci, diabete, ipertensione, fumo o alcol. Alcuni rimedi possono essere la ragione. Le questioni legate al movimento sono collegate. Se ti occupi dei tuoi problemi di movimento, hai piu possibilita di risolvere questo problema. Qui ci sono 5 consigli facili su come aumentare la circolazione: 1. Mangia i pasti giusti. Questo ti rendera il flusso sanguigno ovvio. Una grande parte di rimanere sani e anche mantenere il flusso sanguigno ovvio è legato al vostro piano di alimentazione quotidiana e quello che si mangia. Una buona cura per la disfunzione erettile è mangiare un piano a basso contenuto di grassi e grande alimentazione di fibre. Mangiare fibre tutti i giorni e questo viene scoperto in prodotti cerealicoli cereali integrali, frutta e verdura. Evitare il più possibile pasti pronti o pasti non sani. 2. Wonder herbal rimedi. Molti rimedi vegetali per ED eseguire bene come possono migliorare il movimento. Hanno molto meno reazioni avverse rispetto ai farmaci convenzionali e si svolgono in modo efficiente per migliorare hardons e la forza, troppo. Erbe naturali come Ginkgo Biloba sono utilizzati come una strategia per ED. Gli specialisti di erboristeria credono anche che le spezie o le erbe come noce moscata, portano al movimento intorno al corpo, tra cui il pene. 3. Vitamine naturali vitali. Gli scienziati sanitari hanno scoperto che una mancanza di supplemento è tipico tra gli uomini con ED in particolare vitamina A. Se si ha una mancanza del nutriente ossido di zinco, Questo è stato confermato per portare alla disfunzione erettile. Queste inadeguatezze derivano dal fatto che molti valori nutrizionali in quello che mangiamo piano non sono sufficienti. Aggiungere al vostro fabbisogno di nutrienti aumenterà la circolazione del sistema e migliorare questa condizione. Gli integratori alimentari sono completamente naturali, quindi non dovrete preoccuparvi dei rischi di reazioni avverse. Inoltre, queste vitamine naturali sono utili per il vostro benessere over-all. Oltre a questi vantaggi benessere, disfunzione erettile vitamine naturali e integratori costano molto meno di farmaci rimedi. 4. Esercitare. Fai una mossa e non un tablet vibrante. Camminare farà di più per migliorare e sostenere hardons di qualsiasi altra compressa chimica nel lungo periodo. Il fitness fisico manterrà bassi livelli di pressione e mantenere grandi stadi di movimento. Andando per un 20-30 minuti di movimento rapido ogni giorno, può affrontare questo problema e può sostenere la vostra libido senza l uso di qualsiasi farmaco. 5. Sottolineare. Questo è il peggior attaccante per problemi di erezione. Scopri diversi metodi per riposare. Alcuni metodi tipici per riposare includono la lettura di un libro, la meditazione, un bagno rilassante o allenamenti di respirazione. Sto solo imparando alcuni semplici allenamenti di respirazione che possono migliorare significativamente il movimento nel reparto pantaloni. Una naturale disfunzione erettile soluzioni di trattamento stanno diventando sempre più popolare con gli uomini. Questi rimedi a base di erbe sono preferiti perché non hanno reazioni avverse e sono confermati essere efficiente come il farmaco. La maggior parte degli uomini combattere parlano dei loro problemi, in particolare la disfunzione erettile come c è poca discussione sui problemi di erezione. La verita e che ED ha un impatto su piu di dieci milioni di uomini solo negli Stati Uniti. Non siete soli e l aiuto è disponibile.
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C l i n i c a l C a r e / E d u c a t i o n / N u t r i t i o n O R I G I N A L Oral Treatment With ␣-Lipoic Acid Improves Symptomatic Diabetic Polyneuropathy The SYDNEY 2 trial AN ZIEGLER, MD, FRCPE ULLRICH MUNZEL, PHD LEXANDER AMETOV, MD NIKOLAI YAKHNO, MD Atleastoneoffourdiabeticpatients LEXEY BARINOV, MD ITAMAR RAZ, MD ETER J. DYCK, MD MARIA NOVOSADOVA, MD RINA GURIEVA, MD JOACHIM MAUS, MD HILLIP A. LOW, MD RUSTEM SAMIGULLIN, MD
pain and is responsible for both substan-tial morbidity and increased mortality (1–4). Neuropathic pain affects 16% of
OBJECTIVE — The aim of this trial was to evaluate the effects of ␣-lipoic acid (ALA) on
diabetic patients (5) and exerts a substan-
positive sensory symptoms and neuropathic deficits in diabetic patients with distal symmetric
tial impact on the quality of life, particu-
larly by causing interference of sleep and
RESEARCH DESIGN AND METHODS — In this multicenter, randomized, double-
enjoyment of life (6). Pain is a subjective
blind, placebo-controlled trial, 181 diabetic patients in Russia and Israel received once-daily oral
doses of 600 mg (n ϭ 45) (ALA600), 1,200 mg (n ϭ 47) (ALA1200), and 1,800 mg (ALA1800)
of ALA (n ϭ 46) or placebo (n ϭ 43) for 5 weeks after a 1-week placebo run-in period. The
primary outcome measure was the change from baseline of the Total Symptom Score (TSS),
including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. Secondary
end points included individual symptoms of TSS, Neuropathy Symptoms and Change (NSC)
score, Neuropathy Impairment Score (NIS), and patients’ global assessment of efficacy.
nisms of DSP (8), several therapeutic ap-proaches have been developed including
RESULTS — Mean TSS did not differ significantly at baseline among the treatment groups and on average decreased by 4.9 points (51%) in ALA600, 4.5 (48%) in ALA1200, and 4.7 (52%) in
antioxidants such as ␣-lipoic acid (ALA)
ALA1800 compared with 2.9 points (32%) in the placebo group (all P Ͻ 0.05 vs. placebo). The
corresponding response rates (Ն50% reduction in TSS) were 62, 50, 56, and 26%, respectively.
Significant improvements favoring all three ALA groups were also noted for stabbing and burn-
signed to favorably influence the underly-
ing pain, the NSC score, and the patients’ global assessment of efficacy. The NIS was numerically
reduced. Safety analysis showed a dose-dependent increase in nausea, vomiting, and vertigo.
solely to relieve pain. It is likely that in theforeseeable future, near normoglycemia
CONCLUSIONS — Oral treatment with ALA for 5 weeks improved neuropathic symptoms
will not be achievable in the majority of
and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the
pounds could offer the advantage of being
Diabetes Care 29:2365–2370, 2006
effective despite persistent hyperglycemia.
1,258 diabetic patients with symptomaticDSP from four randomized clinical trials(14) including the first Symptomatic Dia-
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
From the 1German Diabetes Clinic, German Diabetes Center, Leibniz Institute at the Heinrich Heine Uni-
versity, Du¨sseldorf, Germany; the 2Russian Medical Academy for Advanced Studies, Moscow, Russia; the3Neurology Clinic, Moscow Medical Academy, Moscow, Russia; the 4Department of Neurology, Mayo
600 mg i.v. as a daily infusion for 3 weeks
Clinic, Rochester, Minnesota; the 5Federal Center for Diabetic Foot, Moscow, Russia; 6MEDA Pharma, Bad
Homburg, Germany; and 7Hadassah University, Jerusalem, Israel.
to a clinically meaningful degree. This ef-
Address correspondence and reprint requests to Prof. Dan Ziegler, MD, FRCPE, Deutsche Diabetes-
Klinik, Deutsches Diabetes-Zentrum, Leibniz-Institut an der Heinrich-Heine-Universita¨t, Auf’m Hen-nekamp 65, 40225 Du¨sseldorf, Germany. E-mail: [email protected].
of neuropathic deficits, assuming a poten-
Received for publication 12 June 2006 and accepted in revised form 26 July 2006.
tial of the drug to favorably influence the
Abbreviations: ALA, ␣-lipoic acid; DSP, distal symmetric polyneuropathy; NIS, Neuropathy Impairment
Score; NSC, Neuropathy Symptoms and Change; TSS, Total Symptom Score.
from a small oral pilot study (ORPIL) us-
D. Z., A.A., A.B., P.J.D., I.G., P.A.L., N.Y., I.R., and M.N. received honoraria for speaking activities and
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
DOI: 10.2337/dc06-1216. Clinical trial reg. no. NCT00328601, clinicaltrials.gov.
2006 by the American Diabetes Association.
have not yet been established. Therefore,
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be herebymarked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
DIABETES CARE, VOLUME 29, NUMBER 11, NOVEMBER 2006
␣-Lipoic acid in diabetic polyneuropathy
response trial using ALA (600, 1,200, and
ripheral vascular disease severe enough to
ble), and stage 3 (disabling neuropathy).
after a 1-week placebo run-in period.
ulcers or limb ischemia; significant he-patic or renal disease, antioxidant ther-
RESEARCH DESIGN AND METHODS — The SYDNEY 2 trial
blood pressure and heart rate after 3 min
␥-linolenic acid– containing substances of sitting, body weight, and standard lab-
multicenter trial using three oral doses of
Primary outcome measure. The pri-
the comparison of the changes in TSS from
baseline to the end of treatment among the
stabbing pain, burning pain, paresthesia,
effects but no treatment-center interactions.
start of study treatment, and after 1, 2, 3,
4, and 5 weeks of treatment. All other pa-
meaningful response to treatment. For all
screening and at the end of the study.
efficacy variables, the analyses of the in-
Secondary outcome measures. The
tention-to-treat population were primary.
three centers in Russia. All patients were
plied with the baseline as covariate. In the
for 1 week (single-blind run-in phase).
sessment as previously described (15).
5), the last value carried forward principle
action, each time point was analyzed anal-
(0 ϭ normal to 4 ϭ paralyzed), reflexes
(0 ϭ normal to 2 ϭ absent with reinforce-
because, in previous studies, no plateau in
c e n t e r - a d j u s t e d C o c h r a n - M a n t e l -
dality) of the index finger and great toe
and is scored for both sides of the body.
a slower onset of efficacy was assumed for
confirmatory analysis. The level of signif-
Inclusion criteria at the screening visit
icance (two sided) was set at ␣ ϭ 0.05.
1–19; sensation, questions 20 –29; and
tes (type 1 or 2) defined by American Di-
RESULTS — Of the 227 patients
and latency of the sural nerve) were per-
patic or renal disease. Thus, 187 patients
score for lower limbs (NIS[LL]) Ն2 points,
prick test absent or decreased. At the ran-
domization visit after the 1-week run-in,
subjects had to comply with all of the fol-
lowing criteria: TSS Ն5 points; TSS range
efficacy was rated by the patient as very
trial. Most patients (12) discontinued be-
good/good, satisfactory, or insufficient.
cause of adverse events: 1 in the placebo
al. (17,18): stage 0 (no neuropathy), stage
last 3 months, sufficient compliance 85–
plete the trial because of lack of efficacy;
DIABETES CARE, VOLUME 29, NUMBER 11, NOVEMBER 2006
Ziegler and Associates Table 1—Clinical characteristics in the intention-to-treat population
Treatment with oral antidiabetic agents (%)
Data means Ϯ SD unless otherwise indicated. *Smoker within the last 2 years.
compared with the placebo arm (all P Ͻ
the changes in mean TSS at any of the time
0.05) (Table 2). No significant differences
tients are shown in Table 1. As a sign of
pared with 26% after placebo (P Ͻ 0.05).
ment with oral antidiabetic agents (P ϭ
0.018) and BMI (P ϭ 0.036, Table 1).
blind period of the trial are illustrated in
and NIS[LL] at screening and their changes
Table 3. There were no significant differ-
line TSS and its individual subscores.
groups versus placebo at weeks 2–5 (P Ͻ
After 5 weeks of treatment, a significant
placebo at week 1 (P Ͻ 0.05).
scores for stabbing/lancinating and burn-
Table 2—Baseline levels and changes from baseline (negative values correspond to improvement) in the TSS and its individual subscores after 5 weeks of treatment (last value carried forward)
Data are means Ϯ SD. *P Ͻ 0.05 vs. placebo.
DIABETES CARE, VOLUME 29, NUMBER 11, NOVEMBER 2006
␣-Lipoic acid in diabetic polyneuropathy
the ALA1800 group (P Ͻ 0.05 for all ALAdoses vs. placebo).
verse events were 9 (21%) in the placebogroup, 12 (27%) in the ALA600 group(P ϭ 0.53 vs. placebo), 20 (43%) in theALA1200 group (P ϭ 0.03 vs. placebo),and 25 (54%) in the ALA1800 group (P ϭ0.001 vs. placebo). The rates of treat-ment-emergent adverse events in WorldHealth Organization preferred terms(Ͼ10% in any group) increased with es-calating doses and were nausea 0, 6(13%), 10 (21%), and 22 (48%) (P Ͻ 0.05for all ALA groups vs. placebo); vomiting0, 1 (2%), 2 (4%), and 12 (26%) (P Ͻ0.05 for ALA1800 vs. placebo); vertigo 0,2 (4%), 2 (4%), and 5 (11%), respectively(P ϭ 0.056 for ALA1800 vs. placebo). CONCLUSIONS — The results of the
Figure 1—Mean TSS levels on a weekly basis during the placebo run-in and the randomizeddouble-blind period of the trial. *P Ͻ 0.05 for ALA600, ALA 1200, and ALA1800 vs. placebo;**P Ͻ 0.05 for ALA1800 vs. placebo.
proved the positive sensory symptomsscored by the TSS in diabetic patients
cebo group (all P Ͻ 0.05, except for NSC
with DSP. This overall effect was not dose
number in ALA1800: P ϭ 0.08). For the
with placebo (P ϭ 0.09) were noted. No
dependent, as there were no differences in
ment was noted in ALA1200 (P Ͻ 0.05)
ALA1800 versus placebo (P ϭ 0.055). Re-
garding the changes in NIS[LL], a trend for
good/good, satisfactory, and insufficient
ALA600 group (P ϭ 0.07 vs. placebo).
paresthesia and numbness was observed.
the placebo group, 62, 27, and 11% for the
and placebo (P Ͻ 0.05) and a borderline
Table 3—Screening levels and changes from screening in NSC scores, NIS, and NIS͓LL͔ after 5 weeks of treatment (last value carried forward)
Data are means Ϯ SD. Negative values correspond to improvement. *P Ͻ 0.05, †P ϭ 0.08, ‡P ϭ 0.055, §P ϭ 0.07, and ʈP ϭ 0.09 (each vs. placebo).
DIABETES CARE, VOLUME 29, NUMBER 11, NOVEMBER 2006
Ziegler and Associates
formulation. The coefficient of variation
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celerated failure time model. J Clin Epide-
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vasodilation of the brachial artery by 44
dose of oral ALA q.d. is 2.7. Whether the
6. Galer BS, Gianas A, Jensen MP: Painful
placebo treatment after 4 weeks. This ef-
description, and quality of life. Diabetes
7. Finnerup NB, Otto M, McQuay HJ, Jensen
our finding that neuropathic deficits such
proposal. Pain 118:289 –305, 2005
tion via anti-inflammatory and antithrom-
faye S: Vascular factors and metabolic in-
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impairment of nitric oxide–mediated vaso-
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point, acute infusion of ALA improved ni-
that resulting from intravenous treatment
10. Tesfaye S: Symptomatic diabetic periph-
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Acknowledgments — This study was sup-
13. Ziegler D, Sohr CGH, Nourooz-Zadeh J:
many. In addition to the authors listed, thefollowing colleagues contributed equally to
in relation to the severity of diabetic poly-
the study: Natalia Chernikova, MD; Barbara
neuropathy and autonomic neuropathy.
ing 21 and 48%, respectively. The rate of
Ellers-Lenz, Dipl.math.oec; Igor Strokov, MD;
Diabetes Care 27:2178 –2183, 2004
Julio Wainstein, MD; and Hans J. Tritschler,
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DIABETES CARE, VOLUME 29, NUMBER 11, NOVEMBER 2006
Martim de Gouveia e Sousa que «em Lisboa se vendia a sorrelfa» e «onde se abocanhavaSe a obra lírica nada traz de particular, fundando-sea dignidade da rainha» (ver Rego), alude-se « aos amores numa incaracterística toada debutante, a tradução de Lessáficos da rainha D. Amélia, por quem Mouzinho de Civilisés (1906) de Claude Farrère (1876-1957) trouxe-lhe aAlbuquerque
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