Infrared Imaging Analysis of Green Composite Materials during Inline Quasi-Static Flexural Test: Monitoring by Passive and Active Approaches

Composite materials have been used for many years in a wide variety of sectors starting from aerospace and nautical up to more commonly used uses such as bicycles, glasses, and so on. The characteristics that have made these materials popular are mainly their low weight, resistance to fatigue, and corrosion. In contrast to the advantages, however, it should be noted that the manufacturing processes of composite materials are not eco-friendly, and their disposal is rather difficult. For these reasons, in recent decades, the use of natural fibers has gained increasing attention, allowing the development of new materials sharing the same advantages with conventional composite systems while respecting the environment. In this work, the behavior of totally eco-friendly composite materials during flexural tests has been studied through infrared (IR) analysis. IR imaging is a well-known non-contact technique and represents a reliable means of providing low-cost in situ analysis. According to this method, the surface of the sample under investigation is monitored, under natural conditions or after heating, by recording thermal images with an appropriate IR camera. Here, the results achieved for jute- and basalt-based eco-friendly composites through the use of both passive and active IR imaging approaches are reported and discussed, showing the possibilities of use also in an industrial environment.

Compact off-axis holographic slide microscope: design guidelines

Holographic microscopes are emerging as suitable tools for in situ diagnostics and environmental monitoring, providing high-throughput, label-free, quantitative imaging capabilities through small and compact devices. In-line holographic microscopes can be realized at contained costs, trading off complexity in the phase retrieval process and being limited to sparse samples. Here we present a 3D printed, cost effective and field portable off-axis holographic microscope based on the concept of holographic microfluidic slide. Our scheme removes complexity from the reconstruction process, as phase retrieval is non iterative and obtainable by hologram demodulation. The configuration we introduce ensures flexibility in the definition of the optical scheme, exploitable to realize modular devices with different features. We discuss trade-offs and design rules of thumb to follow for developing DH microscopes based on the proposed solution. Using our prototype, we image flowing marine microalgae, polystyrene beads, E.coli bacteria and microplastics. We detail the effect on the performance and costs of each parameter, design, and hardware choice, guiding readers toward the realization of optimized devices that can be employed out of the lab by non-expert users for point of care testing.

The role of device-assisted therapies in the management of non-muscle invasive bladder cancer: A systematic review

OBJECTIVE

Despite optimal treatment, patients affected by non-muscle invasive bladder cancer (NMIBC) suffer from high risk of recurrence and progression. Intravescical device assisted therapies such as radiofrequency induced thermochemotherapeutic effect (RITE) and electromotive drug administration (EMDA) have shown promising effect in enhancing the effect of intravescical chemotherapies. The aim of the study was to assess clinical outcomes of these two devices in non-muscle invasive bladder cancer.

METHODS

A systematic literature review was performed in December 2019 using the Medline, Embase, and Web of Science databases. Only articles published in the last 10 years were considered (2009-2019). The articles were selected using the following keywords association: "bladder cancer" AND "EMDA' AND "synergo" AND "hyperchemotherapy" AND "electromotive drug administration", AND "radiofrequency induced thermochemotherapeutic" AND "RITE".

RESULTS

We found 16 studies published in the last ten years regarding the efficacy of RITE (12 studies) and EMDA (4 studies) in the treatment of NMIBC. Both RITE and EMDA showed promising results in the treatment of intermediate and high risk NMIBC as well as in patients affected by recurrent BCa after BCG failure. In high-risk BCG naïve NMIBC patients treated with EMDA recurrence and progression rates were 68% and 95%, respectively. Considering RITE, recurrence and progression range rates were 43%-88% and 62%-97%, respectively. Discordance results were reported regarding its effect on patients with carcinoma in situ. However, only few studies could be compared since differences exist regarding inclusion criteria with high patients' heterogeneity. Considering recurrence after BCG, recurrence and progression range rates were 29%-29.2% and 62%-83% for RITE and 25% and 75% for EMDA, respectively.

CONCLUSION

Delivery of intravescical hyperthermia seems to enhance the normal effect of intravescical chemotherapy instillation. Although prospective trials supported its effect on both BCG naïve and BCG failure patients, data are urgently required to validate these findings and to understand its effect on patients with carcinoma in situ.

LEVEL OF PROOF

3.

Direct quantitative imaging of the writing stage in a photosensitive azopolymer by digital holography

In this paper, we demonstrated that the gradual formation of a surface relief grating (SRG) in azopolymer thin films under continuous light exposure could be directly observed in situ and in real-time, allowing full-field characterization with high spatial resolution. We reported here for the first time, to the best of our knowledge, that digital holography (DH) can be adopted for investigating and monitoring an inscribed holographic surface relief grating (SRG) of azopolymers by two-beam laser interference lithography over a wide area. The writing process could be assessed through quantitative phase imaging (QPI). The reported results show that the proposed method is a truly valuable diagnostic tool that can be useful for investigating the spatial distribution of the writing process, which can eventually contribute to shedding light on the still unclear origin and related mechanism of SRG formation in azopolymers.

Pyro-Electrification of Freestanding Polymer Sheets: A New Tool for Cation-Free Manipulation of Cell Adhesion in vitro

Localized electric fields have become, in recent years, a source of inspiration to researchers and laboratories thanks to a huge amount of applications derived from it, including positioning of microparticles as building blocks for electrical, optical, and magnetic devices. The possibility of producing polymeric materials with surface charge thus opens new perspectives for applications where process simplicity and cost-effectiveness of flexible electronics are of fundamental importance. In particular, the influence of surface charges is widely studied and is a critical issue especially when new materials and functional technologies are introduced. Here, we report a voltage-free pyro-electrification (PE) process able to induce a permanent dipole orientation into polymer sheets under both mono- and bipolar distribution. The technique makes use of the pyroelectric effect for generating electric potentials on the order of kilovolts by an easy-to-accomplish thermal treatment of ferroelectric lithium niobate (LN) crystals. The PE allows us to avoid the expensive and time-consuming fabrication of high-power electrical circuits, as occurs in traditional generator-based techniques. Since the technique is fully compatible with spin-coating-based procedures, the pyro-electrified polymer sheets are easily peeled off the surface of the LN crystal after PE completion, thus providing highly stable and freestanding charged sheets. We show the reliability of the technique for different polymers and for different applications ranging from live cell patterning to biofilm formation tests for bacteria linked to food-processing environments.

Maskless Arrayed Nanofiber Mats by Bipolar Pyroelectrospinning

The numerous advantages of micro- and nanostructures produced by electrospinning (ES) have stimulated enormous interest in this technology with potential application in several fields. However, ES still has some limitations in controlling the geometrical arrangement of the fiber mats so that expensive and time-consuming technologies are usually employed for producing ordered geometries. Here we present a technique that we call "bipolar pyroelectrospinning" (b-PES) for generating ordered arrays of fiber mats in a direct manner by using the bipolar pyroelectric field produced by a periodically poled lithium niobate crystal (PPLN). The b-PES is free from expensive electrodes, nozzles, and masks because it makes use simply of the structured pyroelectric field produced by the PPLN crystal used as collector. The results show clearly the reliability of the technique in producing a wide variety of arrayed fiber mats that could find application in bioengineering or many other fields. Preliminary results of live cells patterning under controlled geometrical constraints is also reported and discussed in order to show potential exploitation as a scaffold in tissue engineering.

On the Complex and Reversible Pathways of CdSe Quantum Dots Driven by Pyroelectric-Dielectrophoresis

Electrophoresis (EP) and dielectrophoresis (DEP) are the two well-established methodologies to manipulate nanoparticles (NPs). Recently, DEP by a virtual electrode platform was demonstrated on ferroelectric substrates, where the driving force is due to the strong electric field generated by the pyroelectric effect, thus opening new scenarios for manipulating the matter. Such an innovative approach named pyroelectric-DEP has several advantages over traditional EP and DEP. However, a detailed study on this novel approach is required for understanding the complex pathways traced by NPs under the action of the pyroelectric-driven forces and thus for explaining the final patterns. Here, we investigate experimentally the dynamic behavior of CdSe NPs through time-lapse fluorescence microscopy imaging. Complete visualization and measurement of the directed-assembling process of NPs immersed in polydimethylsiloxane fluid is reported, which shows some unpredicted results with respect to the previous works, thus opening the route for designing in principle a reversible and switchable device allowing two different and reversible final NP-patterned states. The observed phenomena are fully analyzed by experimental and simulated analysis, and the movements of NPs is performed to elucidate in depth the involved processes. The investigation furnishes an interesting result that the complex behavior of the NPs can be fully comprehended and explained by considering the superposition of both EP and DEP forces.

Endowing a plain fluidic chip with micro-optics: a holographic microscope slide

Lab-on-a-Chip (LoC) devices are extremely promising in that they enable diagnostic functions at the point-of-care. Within this scope, an important goal is to design imaging schemes that can be used out of the laboratory. In this paper, we introduce and test a pocket holographic slide that allows digital holography microscopy to be performed without an interferometer setup. Instead, a commercial off-the-shelf plastic chip is engineered and functionalized with this aim. The microfluidic chip is endowed with micro-optics, that is, a diffraction grating and polymeric lenses, to build an interferometer directly on the chip, avoiding the need for a reference arm and external bulky optical components. Thanks to the single-beam scheme, the system is completely integrated and robust against vibrations, sharing the useful features of any common path interferometer. Hence, it becomes possible to bring holographic functionalities out of the lab, moving complexity from the external optical apparatus to the chip itself. Label-free imaging and quantitative phase contrast mapping of live samples are demonstrated, along with flexible refocusing capabilities. Thus, a liquid volume can be analyzed in one single shot with no need for mechanical scanning systems.

Light-responsive polymer brushes: active topographic cues for cell culture applications

Azopolymer brushes were patterned using interference lithography and erased using ultrasonication. This substrate was able to induce cell orientation.

Bipolar Patterning of Polymer Membranes by Pyroelectrification

Polymer freestanding membranes with permanent bipolar patterns are fabricated by "pyroelectrification". The thermal stimulation of periodically poled lithium niobate (PPLN) crystals simultaneously generates the pyroelectric effect, the glass transition of the polymer, and therefore the periodic electric poling of the polymer. The reliability of these membranes is demonstrated for applications under both dry and wet conditions, including cell patterning.

Bipolar Patterning of Polymer Membranes by Pyroelectrification

Polymer freestanding membranes with permanent bipolar patterns are fabricated by "pyroelectrification". The thermal stimulation of periodically poled lithium niobate (PPLN) crystals simultaneously generates the pyroelectric effect, the glass transition of the polymer, and therefore the periodic electric poling of the polymer. The reliability of these membranes is demonstrated for applications under both dry and wet conditions, including cell patterning.

Reversible Holographic Patterns on Azopolymers for Guiding Cell Adhesion and Orientation

Topography of material surfaces is known to influence cell behavior at different levels: from adhesion up to differentiation. Different micro- and nanopatterning techniques have been employed to create patterned surfaces to investigate various aspects of cell behavior, most notably cellular mechanotransduction. Nevertheless, conventional techniques, once implemented on a specific substrate, fail in allowing dynamic changes of the topographic features. Here we investigated the response of NIH-3T3 cells to reversible topographic signals encoded on light-responsive azopolymer films. Switchable patterns were fabricated by means of a well-established holographic setup. Surface relief gratings were realized with Lloyd's mirror system and erased with circularly polarized or incoherent light. Cell cytoskeleton organization and focal adhesion assembly proved to be very sensitive to the underlying topographic signal. Thereafter, pattern reversibility was tested in air and wet environment by using temperature or light as a trigger. Additionally, pattern modification was dynamically performed on substrates with living cells. This study paves the way toward an in situ and real-time investigation of the material-cytoskeleton crosstalk caused by the intrinsic properties of azopolymers.

Spontaneous assembly of carbon-based chains in polymer matrixes through surface charge templates

Stable chains of carbon-based nanoparticles were formed directly in polymer matrixes through an electrode-free approach. Spontaneous surface charges were generated pyroelectrically onto functionalized ferroelectric crystals, enabling the formation of electric field gradients that triggered the dipole-dipole interactions responsible for the alignment of the particles, while embedded in the polymer solution. The phenomenon is similar to the dielectrophoretic alignment of carbon nanotubes reported in the literature. However, here the electric fields are generated spontaneously by a simple heat treatment that, simultaneously, aligns the particles and provides the energy necessary for curing the host polymer. The result is a polymer sheet reinforced with well-aligned chains of carbon-based particles, avoiding the invasive implementation of appropriate electrodes and circuits. Because polymers with anisotropic features are of great interest for enhancing the thermal and/or the electrical conductivity, the electrode-free nature of this technique would improve the scaling down and the versatility of those interconnections that find applications in many fields, such as electronics, sensors, and biomedicine. Theoretical simulations of the interactions between the particles and the charge templates were implemented and appear in good agreement with the experimental results. The chain formation was characterized by controlling different parameters, including surface charge configuration, particle concentration, and polymer viscosity, thus demonstrating the reliability of the technique. Moreover, micro-Raman spectroscopy and scanning electron microscopy were used for a thorough inspection of the assembled chains.

[The role of Proxelan in the treatment of chronic prostatitis. Results of a randomized trial]

AIM

Inflammatory diseases of the prostate are one of the most difficult problems to manage in the fertile male aged between 20 and 50. Antibiotics are the gold standard for the treatment of both bacterial (category II-NIH) and non bacterial prostatitis (category III-NIH). However, antibiotics need to be associated with other therapies focused on reducing symptoms and providing a better quality of life. In the present study we sought to test the effectiveness of antibiotics and the medical device Proxelan suppositories taken together.

METHODS

Starting in January 2011, we conducted a randomized controlled trial involving 60 subjects with bacterial and non bacterial chronic prostatitis, who were divided into two groups. Subjects allocated in group A received only antibiotics for 28 days; subjects in group B received antibiotics + Proxelan, for 28 days as well. Before randomization all subjects underwent Meares-Stamey test, IPSS and NIH-CPSI questionnairs. All of those were repeated 60 and 120 days after randomization. Microbiological and clinical efficacy were compared using specific statistical analyses.

RESULTS

Data were obtained from 29 subjects allocated in group A and 31 in group B. Minor side effects were observed which did not cause study interruption in any case. Of the total population, 68,3% resulted positive to the Meares-Stamey test at study start. Proxelan was not better than antibiotics alone under a microbiological point of view (OR)=0.9; (IR) 0.3-2.8; P=0.46. According to the answers provided at the NIH-CPSI questionnaire, subjects in the group B obtained a better score compared to group A, either after 2 months (OR:2.8; 95%IC 1.2-4.1; P=0.017) and after 4 months (OR:1.67; 95%IC 0.9-2.9; P=0.04). With regards to the IPSS questionnaire, 2 months after treatment start, subjects in the group A had a probability of having urinary symptoms 2 times higher compared to subjects in group B (OR:1.9; 95%IC 1.0-3.5; P=0.028). Although Proxelan seems to improve IPSS also after 4 months, the difference does not reach the level of statistical significance.

CONCLUSION

Compared to antibiotics alone, the combination of antibiotics and Proxelan improve both symptoms associated to chronic prostatitis and urinary symptoms, however microbiological results are not different. Future studies may be required to confirm our results and to explain the mechanism of action of Proxelan.

Elderly patients with metastatic castrate-resistant prostate cancer (mCRPC): Safety and efficacy of docetaxel retreatment

161

Background: Comorbidities are considered a therapeutically limiting problem in elderly patients (pts) with mCRPC. We analysed correlations between comorbidity, toxicity and efficacy of docetaxel re-treatment in pts ≥ 70 years with mCRPC.

Methods: Pts were evaluated according to comprehensive geriatric assessment (CGA). From 2003 to 2010, 70 pts ≥ 70 years with mCRPC received 3-wk first line docetaxel therapy followed by retreatment on biochemical disease progression. Each patient was assessed according the Cumulative Illness Score Rating-Geriatrics (CISR-G) manual. The score was 0-4. The median age was 77 (70-84), ECOG PS 0-2, median baseline PSA 180 ng/ml (15-1200). The more frequent comorbidities were hypertension, diabetes, arrhythmias, chronic obstructive pulmonary disease. The endpoints were: PSA response proportion to first-second-third line chemotherapy, median survival in responding patients and toxicity.

Results: All pts received a standard 3-wk regimen, dose was reduced by 25% for pts score 4. The incidence of adverse events was relatively low and no pts died on therapy. There were no episodes of neutropenic fever. Pts with score 1-2 were 70% (49 pts); pts with score 3 were 20% (14); pts with score 4 were 10% (7). 70 pts (score 0-4) received first line docetaxel chemotherapy with a median no of cycles 14 (6-18), a median survival of 18 months (mos), PSA response 70%. Of these pts 26 (score 0-3) were re-treated with the same regimen with no of cycles 12 (8-18), a median survival of 14 mos, PSA response 45%, duration of first chemotherapy holiday 5 mos (median). Of these pts, 4 (score 0-3) received third line treatment with no of cycles 10 (6-14), a median survival of 10 mos, PSA response 22%, duration of second chemotherapy holiday 4 mos (median). Of these pts only 1 (score 1) received third re-treatment with 8 cycles, PSA response 20%, third chemotherapy holiday 4 mos. 80% of symptomatic pts reported an improvement in symptoms control with docetaxel chemotherapy.

Conclusions: Re-treatment with docetaxel is safe in mCRPC elderly pts despite the association of important comorbidities. Median survival in responding pts was approximately 40 mos from the first to the third line.

No significant financial relationships to disclose.

Comorbidity and sorafenib (SOR) therapy in elderly patients with metastatic renal cell carcinoma (mRCC)

398

Background: SOR is a multikinase inhibitor with activity in mRCC. Older patients (pts) benefit from SOR as reported in the subgroup analysis of the TARGET study populations. We evaluated the efficacy and safety in elderly pts (≥ 70) with comorbidities.

Methods: A comprehensive geriatric assessment (CGA) was used in older mRCC pts. From 2007 to 2010, 30 pts (23 males and 7 females) received SOR 400 mg BID continuous dosing. Comorbidities were evaluated using the cumulative illness rating scale for geriatrics (CIRS-G). The total score was 0–4. 10 pts with CIRS-G 1, 12 pts with CIRS-G 2, 8 pts with CIRS-G 3/4. Median age was 76 (70–84), ECOG PS 0–2, 24/30 had undergone prior nephrectomy. The most frequent comorbidities were arrhythmias, hypertension, chronic bronchitis, diabetes mellitus, neurological disease. The endpoints were response rate (RR) evaluated by RECIST criteria and correlations between comorbidities and toxicity.

Results: Dose reduction (400–600 mg/die) were required for pts with CIRS-G 3–4. No correlations were found between comorbidities (CIRS-G) and response to SOR. 18 pts (14 pts CIRS-G 1/2, 4 pts CIRSG 3/4) had partial response (PR)with a duration of 24 months (9-30) and 12 pts (8 pts CIRS-G 1-2, 4 pts CIRS-G 3/4) stable disease (SD) for 24 months (7–32). 17/30 pts (12 pts CIRS-G 1/2, 5 pts CIRS-G 5) remain on therapy. Drug related adverse events were mainly grade 1 and 2 and were medically manageable. 4 pts required dose interruption (3 pts CIRS-G 1/2, 1 pt CIRS-G 3/4). Pts with CIRS-G score 3–4 had poorer quality of life but the clinical benefit achieved with SOR therapy was high.

Conclusions: Comorbidities in pts with mRCC ≥ 70 years did not result in increased incidence of toxicity on SOR treatment. These data suggest that SOR is effective and safe in elderly pts with an overall clinical benefit rate (PR + DS) particularly high.

No significant financial relationships to disclose.

Prognostic role of somatostatin receptor subtypes in human prostate cancer

e16120

Background: Neuroendocrine differentiation (NED) in prostate carcinoma (PC) is frequently detected by immunohistochemistry as single cells in conventional adenocarcinoma. NED of PC correlates with poor prognosis and tumor progression during androgen-deprivation therapy. The aim of our study was to correlate the expression of somatostatin receptor (SSTR) 1, 2, 3, 4, 5 subtypes in primary PC with NED pattern and Overall Survival (OS). Methods. PC tissues were reviewed from 100 pts who had undergone biopsy or radical prostatectomy for previously untreated advanced or metastatic PC from 2002 to 2007. 24 samples expressed hystologically chromogranin A (CgA), a marker of NED expression. Patient characteristics included: median age 68 years (range 45–83), median baseline PSA: 70 ng/ml (range 0.3–200), median ECOG Performance Status: 1 (range 0–2), Gleason score ≥ 7, medium serum level of CgA was 56.2 nmol/L (range 0.5–120). Results: The expression of SSTR subtypes (1, 2, 3, 4, 5) were investigated and our data identified four histological features. SSTR1 was expressed in 4/24 samples, SSTR 5 was detected in 2/24 samples, both SSTR1 and SSTR5 were found in 6/24 samples. OS at last follow up on July 2008 was 60%. SSTR 1–5 were undetectable in 12/24 pts with more aggressive clinical course and the OS was < 10%. The PSA and CgA levels were not correlated with clinical outcome. SSTR subtypes 2, 3 an 4 were not expressed in all 24 samples. Conclusions: SSTRs expression significantly correlated with OS. The absence of SSTR 1 and 5 in more aggressive disease could represent a growth advantage in NED prostate cancer. SSTRs and somatostatin analogs are potential targets for prostate cancer treatment.

No significant financial relationships to disclose.

Prognostic role of chromogranin A expression for docetaxel response in hormone-refractory metastatic prostate cancer

15528

Background: The neuroendocrine (NE) cells in prostate cancer are indistinguishable from non-NE cancer cells morphologically and are usually detected by immunohistochemical study for NE markers. We analyzed the expression of Chromogranin A (Chr A) in malignant prostate tissue as prognostic factor for docetaxel response in metastatic HRPC. Methods: From January 2003 to December 2006, 40 patients with metastatic HRPC received a median of 12 cycles (range 2–18) of Docetaxel 75 mg/mq every 21 days and 5 mg of prednisone twice daily as initial therapy. Tissue blocks from primary prostate cancer tissues were obtained and immunostaining for Chr A was performed. The median age was 70 years (range 46–82); median baseline PSA: 310 ng/ml (range 0.15–700); median ECOG Performance Status: 1 (range 0- 2). PSA level was measured every 4 weeks and the treatment was considered effective if a rate of PSA-decline > 50% from baseline was found. TTP was the preliminary end point. Results: Response to Docetaxel was assessed at every 3 cycles of treatment. The Chr A expression was found in 19/40 patients with Gleason = 7, PSA < 20, bone and soft tissue metastasis; 10 of them showed PR (decrease in PSA < 50%), 4 SD and TTP was 9.2 months. Moreover they received second line chemotherapy without significant efficacy. 5/19 patients with Chr A expression showed PD, the PSA level was not correlated with clinical outcome, TTP was 5 months and were chemoresistant to different line treatment. Besides, Chr A was not detected in 21/40 patients with Gleason = 7, PSA > 20 and bone metastasis; 10 of them showed CR (PSA normalized) and 11 PR, TTP was 20 months. Conclusions: NE differentiation do not constituite a different histopathological category of prostate cancer but the NE phenotype can be correlated with poorly differentiated adenocarcinoma. NE differentiation can be considered a factor that influences prognosis and treatment in advanced prostate cancer; cases with Chr A expression did not benefit from Docetaxel and had poor prognosis. These preliminary data indicate that initial therapeutic approach should be different according to Chr A expression.

No significant financial relationships to disclose.

Sexual dysfunction in patients under dialytic treatment

AIM

Erectile dysfunction (ED) is very common in patients with renal failure, probably as a side effect of long-term treatments and dialysis, among other etiologic factors. Over the last few years, new highly effective oral treatments for ED have been introduced in the market. We designed a prospective trial in 42 dialytic patients with ED, focusing on the therapeutic effect of syldenafil and apomorphine.

METHODS

Forty-two patients aged 57 years (range 34-71), [40 on hemodialysis (HD) and 2 on peritoneal dialysis (PD)] were enrolled in a prospective study comparing sildenafil with apomorphine. After a careful nephrologic anamnesis and uroandrological examination, all patients underwent, before and after each treatment, the International Index Erectile Function (IIEF) test, and the Life Satisfaction test. Expert opinion was based on grading of evidence based medical literature, widespread internal committee discussion, public presentations and debates.

RESULTS

The 2 patients on PD were the only responders to 25 mg sildenafil; 25 patients on HD had a clear improvement of the IIEF score after 50 mg sildenafil administration; finally, 11 patients on HD would benefit only from 100 mg sildenafil; the nonresponders to sildenafil were only 4 patients, having to switch to PgE1. When apomorphine was tested on the same patients, a mild response was seen only in 6 patients at the 3 mg dose. No response was seen in the 2 patients on PD.

CONCLUSIONS

There was a statistically significant difference in the therapeutic role of sildenafil versus apomorphine, the first producing an overall improvement of the IIEF in 90.5% of patients, compared to 14% of the same patients receiving apomorphine (P<0.001).