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Journal of Ethnopharmacology 265 (2021) This study used a metabolomics approach based on proton nuclear magnetic resonance (1H NMR) spectroscopy of saliva to identify metabolic biomarkers that indicate mental health risk in refugees from Syria. Zhang L, Liu X, You L, Zhou D, Wang Q, Li F, Cong M, Li L, Zhao J, Liu D. Benzo(a)pyrene-induced metabolic responses in Manila clam Ruditapes philippinarum by proton nuclear magnetic resonance (1H NMR) based metabolomics. In particular, 3 supplements (DS 4, 5 and 7) contained 12 ingredients, of which 9 lacked demonstrated efficacy. The main concern is tissue damage or fibrosis, which can lead to scarring or erectile issues. Many consumers perceive these products as completely safe because they often sold with labelling, suggesting that they are natural ingredients that have been approved by FDA for treating ED (Shamloul, 2010, Shah et al., 2012). The effectiveness of these penis extenders is controversial. 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