Long-lived lunar volcanism sustained by precession-driven core-mantle friction.

Core-mantle friction induced by the precession of the Moon's spin axis is a strong heat source in the deep lunar mantle during the early phase of a satellite's evolution, but its influence on the long-term thermal evolution still remains poorly explored. Using a one-dimensional thermal evolution model, we show that core-mantle friction can sustain global-scale partial melting in the upper lunar mantle until ∼3.1 Ga, thus accounting for the intense volcanic activity on the Moon before ∼3.0 Ga. Besides, core-mantle friction tends to suppress the secular cooling of the lunar core and is unlikely to be an energy source for the long-lived lunar core dynamo. Our model also favours the transition of the Cassini state before the end of the lunar magma ocean phase (∼4.2 Ga), which implies a decreasing lunar obliquity over time after the solidification of the lunar magma ocean. Such a trend of lunar obliquity evolution may allow volcanically released water to be buried in the lunar regolith of the polar regions. As a consequence, local water ice could be more abundant than previously thought when considering only its accumulation caused by solar wind and comet spreading.

Spin state and deep interior structure of Mars from InSight radio tracking.

Knowledge of the interior structure and atmosphere of Mars is essential to understanding how the planet has formed and evolved. A major obstacle to investigations of planetary interiors, however, is that they are not directly accessible. Most of the geophysical data provide global information that cannot be separated into contributions from the core, the mantle and the crust. The NASA InSight mission changed this situation by providing high-quality seismic and lander radio science data1,2. Here we use the InSight's radio science data to determine fundamental properties of the core, mantle and atmosphere of Mars. By precisely measuring the rotation of the planet, we detected a resonance with a normal mode that allowed us to characterize the core and mantle separately. For an entirely solid mantle, we found that the liquid core has a radius of 1,835 ± 55 km and a mean density of 5,955-6,290 kg m-3, and that the increase in density at the core-mantle boundary is 1,690-2,110 kg m-3. Our analysis of InSight's radio tracking data argues against the existence of a solid inner core and reveals the shape of the core, indicating that there are internal mass anomalies deep within the mantle. We also find evidence of a slow acceleration in the Martian rotation rate, which could be the result of a long-term trend either in the internal dynamics of Mars or in its atmosphere and ice caps.

Postpartum hemorrhage: not only hypertensive disorders in oocyte donation pregnancies.

BACKGROUND: The aim of the study is to compare the obstetric outcome between single pregnancies obtained by medically-assisted procreation using oocyte donors (MAP-E) versus homologous gametes (MAP-O) and single spontaneous conception pregnancies (SC). METHODS: This is a retrospective case-control study on pregnancy outcome of consecutive singleton live birth pregnancies from MAP-E between January 2011 and August 2017 referred to Careggi University Hospital, Florence. The control group includes singleton pregnancies from MAP-O and pregnancies from spontaneous conceptions in the same period. The pregnancy outcomes considered were: postpartum hemorrhage (PPH), cesarean section (CS), gestational diabetes mellitus (GDM), hypertensive disorders including preeclampsia (HDP), preterm birth ≤34 weeks (PTB), and small-for-gestational-age (SGA) fetuses. RESULTS: The study group included 290 MAP-E pregnancies that were compared with 290 MAP-O and 870 singleton spontaneous conception pregnancies. The three groups did not show significant differences in maternal traits except for mean age (43.4±2.9 vs. 37.7±2.4 vs. 33.6±5.5, P<0.001), including a higher percentage of patients over 45 years (41.3% vs. 5% vs. 0.8%, P<0.001) and higher incidence of obesity (7.2% vs. 1.7%, P=0.02) in MAP-E than in MAP-O. The risk of HDP is increased in singleton pregnancies by oocyte donation with a significantly increased risk if compared to MAP-O (12% vs. 1%, P<0.001, OR=12.6). The risk of PPH in singleton pregnancies from oocyte donation is higher than in MAP-O (22% vs. 9% P<0.0001, OR=2.87). When we considered severe PPH (blood loss >1000 mL) the risk for MAP-E was higher if compared to MAP-O (OR=2.1, P=0.2) and mostly to SC (OR=14, P<0.005). Compared to SC, MAP-E pregnancies showed increased OR for all the outcomes: CS (78% vs. 30.8%, P<0.001, OR=7.91); GDM (26.1% vs. 10.8%, P<0.001, OR=2.92); HDP (12% vs. 2.2%, P<0.001, OR=5.99); PPH (22% vs. 8.5%, P<0.0001, OR=3.0); SGA (16% vs. 11%, P<0.05, OR=1.16); PTB ≤34 weeks (9.4% vs. 1%, P<0.001, OR=7.94). CONCLUSIONS: Most women who undergo MAP-E are in advanced age, representing a high-risk population for obstetric complications, like HPD and PPH, which stands as the main worldwide cause of maternal mortality.

Low Weight Child: Can It Be Considered a Limit of Robotic Surgery? Experience of Two Centers.

Purpose: Robotic surgery should be considered a technical opportunity for many procedures in pediatric age. The purpose of this study is to verify the correlation between robotic procedures and low weight. Materials and Methods: It is a retrospective study (2013-2017). We included all patients who underwent robotic assisted surgery for major procedures in two Italian centers for pediatric surgery. All patients were divided into two groups (group A ≤15 kg and group B > 15 kg). Parameters considered were as follows: time to console, average time procedures, time of hospitalization, and minor/major complications. Statistical test used was Wilcoxon-Mann-Whitney test. Results: We enrolled 83 patients. Group A: 28 patients, medium weight 11.2 kg (range: 7-15 kg). Group B: 55 patients, average weight 40.8 kg (range: 15.2-120 kg). In relation to the outcomes considered, we found statistical significance in relation to surgical time and time at the console. Conclusions: The retrospective analysis of our case found that body weight cannot be considered an absolute contraindication for the execution of surgical procedures in robotics. The improvement of instruments permits to perform complex surgical procedures in low-weight children without additional difficulties. However, it is important to point out that the youngest child of our case had a weight of 7 kg.

Impact-induced changes in source depth and volume of magmatism on Mercury and their observational signatures.

Mercury's crust is mostly the result of partial melting in the mantle associated with solid-state convection. Large impacts induce additional melting by generating subsurface thermal anomalies. By numerically investigating the geodynamical effects of impacts, here we show that impact-generated thermal anomalies interact with the underlying convection modifying the source depth of melt and inducing volcanism that can significantly postdate the impact depending on the impact time and location with respect to the underlying convection pattern. We can reproduce the volume and time of emplacement of the melt sheets in the interior of Caloris and Rembrandt if at about 3.7-3.8 Ga convection in the mantle of Mercury was weak, an inference corroborated by the dating of the youngest large volcanic provinces. The source depth of the melt sheets is located in the stagnant lid, a volume of the mantle that never participated in convection and may contain pristine mantle material.

Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study.

The changes in testosterone and gonadotropin levels in patients who have undergone radical prostatectomy (RP) for clinically localized prostate cancer (PCa) remain unclear. The aim of the present study was to prospectively evaluate the changes in serum testosterone (Te), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the early months after RP for PCa and the correlation between these hormones at various follow-up times. A total of 100 male patients with clinically localized PCa were consecutively included in the study. The serum levels of Te, LH and FSH were measured prior to RP (baseline) and at 1 and 3 months post-operatively. Changes in the levels of Te, LH and FSH between the baseline and at 1 and 3 months after RP were analyzed with paired sample t-tests. The correlations between LH and Te levels at the various follow-up times were evaluated with a Spearman's rank correlation coefficient. At 1 month subsequent to RP, the Te levels were significantly decreased (baseline vs. 1 month, P=0.021) and subsequently recovered to the pre-operative value at 3 months (baseline vs. 3 months, P=0.372). The mean Te level at baseline was 15.3 nmol/l, while at 1 and 3 months it was 13.8 and 14.4 nmol/l, respectively. By contrast, the levels of LH and FSH were significantly increased at 1 and 3 months post-surgery, compared with the baseline value (baseline vs. 1 or 3 months, P<0.0001). The pre-operative correlation between LH and Te was lost 1 month after RP and recovered after 3 months. Notably, the LH level at 1 month was markedly correlated with the Te levels recorded after 3 months. In the present study, patients developed compensated hypergonadotropic hypogonadism 3 months after RP.

A randomized, placebo-controlled study to assess safety and efficacy of vardenafil 10 mg and tamsulosin 0.4 mg vs. tamsulosin 0.4 mg alone in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

INTRODUCTION: Safety and efficacy of tamsulosin and vardenafil are well established: however, there is no report regarding combined therapy with these drugs for lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). AIM: To compare the safety and efficacy of tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus vardenafil 10 mg/day in patients with LUTS/BPH in a randomized trial with 12-week follow-up. METHODS: We conducted a randomized, double-blind, placebo-controlled study on 60 men with persistent storage LUTS after 2-week run-in with tamsulosin. MAIN OUTCOME MEASURES: International Prostate Symptom Score (IPSS), IPSS-bother, International Index of Erectile Function, Version 5 (IIEF-5) and Over Active Bladder questionnaire (OAB-q) scores, uroflowmetry data (Qmax, Qave), and postvoiding residual urine were recorded after run-in (baseline), and 2 and 12 weeks after treatment. Differences between vardenafil and placebo at different times were calculated with unpaired samples t-test. Between-group differences in change from baseline to 2 and 12 weeks were evaluated with analysis of variance. RESULTS: We found a between-group significant difference from baseline to 12 weeks in the following: (i) Qmax (placebo: +0.07, vardenafil: +2.56, P = 0.034); (ii) Qave (placebo: -0.15, vardenafil: +1.02, P = 0.031); (iii) irritative-IPSS subscores (placebo: -1.67, vardenafil: -3.11, P = 0.039); and (iv) IIEF (placebo: +0.06, vardenafil: +2.61, P = 0.030). No patient reported any serious (grade ≥ 2) adverse event (AE). There were no differences in the incidence of common, treatment-related AEs between men undergoing combined therapy or tamsulosin alone. CONCLUSIONS: The combination of tamsulosin and vardenafil for 12 weeks was well tolerated and more effective to improve both LUTS and erectile function, as compared with tamsulosin alone. Further studies are needed to assess the role of combined therapy of phosphodiesterase type 5 inhibitors and alpha blockers in treating LUTS/BPH.

Blue nevus of the prostate: incidental finding in radical prostatectomy specimen with a pre-operative echographic image of peripheral hypoechogenic nodule.

Blue nevus is a stromal melanin deposition, which is microscopically characterized by deeply pigmented melanin-filled spindle cells within the fibromuscular stroma. Cases with prominent melanosis such as those with grossly visible pigment are uncommon. Melanocytic lesions of the prostate are incidental findings with no evidence of malignant transformation. There have only been very few reports of a malignant melanoma of primary prostatic origin. We report an incidental finding of a blue nevus of the prostate, in a radical prostatectomy specimen, in a 64-years-old man with a pre-operative ecographic image of peripheral hypoechogenic nodule. The are very few reports of blue nevi associated to prostatic adenocarcinoma, but none has been evidentiated before surgery as a distinct ultrasound lesion interpreted as adenocarcinoma, therefore inducing the clinician to perform biopsies and consequently a radical prostatectomy.

Prognostic role of perineural invasion in 239 consecutive patients with pathologically organ-confined prostate cancer.

OBJECTIVE: The aim of our study was to analyze the role of perineural invasion (PNI) as a predictive parameter of outcome after radical prostatectomy (RRP) in pathologically organ-confined prostate cancer (PCa) and to assess its possible correlation with other well-known prognostic features. PATIENTS AND METHODS: At our institution between January 2000 and December 2007, we prospectively collected data from 251 consecutive patients with pathologically localized PCa after antegrade RRP. In our analysis 239 patients were included. PNI was defined as adenocarcinoma within the perineural space adjacent to a nerve. We evaluated the biochemical progression-free survival rate using the Kaplan-Meier method to establish the correlation between PNI and prognosis, the log-rank test to verify the statistical significance, and χ(2) test to investigate the correlation between PNI and other clinicopathological parameters. RESULTS: We found intraprostatic PNI in 157 patients (65.7%). The PNI rate was 73% (149/204) in pT2b-c vs. 26% (8/35) in pT2a surgical specimens (p < 0.001), and it was 78.5% (73/93) in patients with a Gleason score of 7-10 vs. 57% (84/146) in a Gleason score of 2-6 (p < 0.01). The mean follow-up was 65.4 (median 62, range 24-118) months. Overall, 11/239 (4.6%) patients presented biochemical recurrence after surgery and 7 (63.6%) of these patients showed PNI, but this was not statistically higher than in patients free from progression (150/228, 65.7%). The actuarial biochemical progression-free survival rate for all patients was 96.9 and 93.5% at 60 and 84 months, respectively, and the stratification based on the presence or absence of PNI did not allow us to identify different prognostic groups. CONCLUSIONS: Perineural infiltration frequently takes part in the pathway of extraprostatic extension. In our series, patients with pathological T2 stages and PNI were found to present a higher pT2 stage and Gleason score, even though our early biochemical-free outcome was not significantly higher than in patients without PNI.

Review of the current status of tumor enucleation for renal cell carcinoma.

Tumor enucleation consists of excising the tumor by blunt dissection following the natural cleavage plane between the peritumoral pseudocapsule and the renal parenchyma without removing a visible rim of healthy renal tissue. In the very recent years, the urological current opinion have changed from a wide skepticism against tumor enucleation to a wider level of acceptance based on the lack of correlation between the width of the resection margin and the risk of disease progression/local recurrence and on larger retrospective series on tumor enucleation with longer follow up. The aim of the present review is to report the technique of tumor enucleation, discuss some technical aspects that can vary between centers and to summarize the oncological and surgical results of this technique for the conservative treatment of RCC in the last 10 years; finally, to briefly present the pathological findings on pseudocapsule and surgical margins prospectively evaluated after tumor enucleation.

Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma.

BACKGROUND: The oncologic safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor and on the possibility of obtaining negative surgical margins (SMs). OBJECTIVE: To investigate the PS and SMs after TE to define the real need to take a rim of healthy parenchyma around the tumor to avoid the risk of positive SMs. The risk of PS invasion related to other clinical and pathologic variables was also evaluated. DESIGN, SETTING, AND PARTICIPANTS: Between September 2006 and December 2007, data were gathered prospectively from 187 consecutive patients who had kidney surgery. Overall, 90 consecutive patients who had TE for RCC were eligible for the study. All specimens were evaluated using an image analyzer by a dedicated uropathologist. INTERVENTION: TE was done by blunt dissection using the natural cleavage plane between the tumor and the normal parenchyma. MEASUREMENTS: PS, SM, and routinely available clinical and pathologic variables were recorded. RESULTS AND LIMITATIONS: In 60 RCC tumors (67%) the PS was intact and free from invasion (PS-) while in 30 (33%) there were signs of penetration within its layers, with or without invasion beyond it. Indeed, 26.6% had PS that had been penetrated on the parenchymal side and 6.6% had penetration on the perirenal fat tissue side. The odds of having PS penetration increased significantly with an increase in clinical tumor size. PS penetration was also significantly associated with pathologic tumor dimensions and grade. In all cases the SMs were negative after TE. The present patients, followed for >2 yr, will enable us to correlate the risk of local recurrence with PS status. CONCLUSIONS: The risk of PS penetration is associated with clinical and pathologic tumor dimensions and grade. If there is PS invasion into normal parenchyma, the presence of a thin layer of tissue allows for negative SM even if a TE is performed.