Robotic assisted laparoscopic extravesical ureteral reimplantation appears to be a safe and efficacious option for repair of vesicoureteral reflux. This early series shows success rates similar to the open approach. We observed decreased length of stay and use of postoperative narcotics. These findings may serve to justify further exploration of this technology and to provide data for design of a prospective trial, although the relative value of specific reductions in morbidity will need to be defined.

The major histocompatibility complex class I molecules consist of three subunits, the 45-kDa heavy chain, the 12-kDa ␤ 2 -microglobulin (␤ 2 m), and an ϳ8 -9-residue antigenic peptide. Without ␤ 2 m, the major histocompatibility complex class I molecules cannot assemble, thereby abolishing their transport to the cell membrane and the subsequent recognition by antigen-specific T cells. The human leukocyte antigen (HLA) 4 class I molecules, encoded by the genes located in the major histocompatibility complex, are composed of three subunits including a 45-kDa HLA class I heavy chain (HC), a 12-kDa ␤ 2 -microglobulin (␤ 2 m), and an ϳ8 -9-residue peptide (1). Expression of these molecules on the cell surface requires the stepwise assembly of HCs, ␤ 2 m, and peptides in the endoplasmic reticulum (ER) followed by the transport of the trimeric molecule to the plasma membrane. These processes are dependent on a functional antigen processing machinery (APM), which includes the proteasome subunits, the peptide transporters TAP1 and TAP2, and a number of ER-resident chaperons such as calnexin, calreticulin, ERp57, and tapasin (2, 3). ␤ 2 m plays an integral part in the assembly and transport of HLA class I molecules because it stabilizes the HC-␤ 2 m heterodimer through noncovalent protein-protein interactions, thereby allowing binding of endogenous antigenic peptides with the help of TAP and tapasin (4). As a result, the assembled HC-␤ 2 m-peptide trimeric complexes can travel to the cell surface, where they are recognized by HLA class I-restricted, antigen-specific cytotoxic T lymphocytes (CTLs).The lack of HLA class I molecule expression on the cell surface usually reflects defects in ␤ 2 m protein synthesis caused by mutations in the ␤ 2 m gene, as has been found mostly in malignant cells thus far (5). This abnormality renders tumor cells resistant to tumor antigenspecific CTLs and may have a negative impact on the elimination of tumor cells by host CTLs. The defects underlying ␤ 2 m loss have thus far been found to be structural in nature, involving lack of translation because of small deletions or point mutations in most cases and lack of transcription because of large deletions in a few cases (5). Because of a lack of ␤ 2 m expression, the resulting HLA class I loss cannot be corrected by interferon (IFN-␥), a cytokine that up-regulates the expression of most of the molecules participating in the assembly and transport of HLA class I molecules. On the other hand, a low level of HLA class I expression on cells usually reflects nonstructural defects in the APM components because this abnormality can be corrected by .In the present study, we have elucidated the mechanism underlying HLA class I down-regulation identified in a melanoma cell line and in the metastasis from which the cell line was derived (7). This HLA class I down-regulation phenotype cannot be corrected by IFN-␥ and was unexpectedly found to be caused by an abnormal full-length ␤ 2 m protein that can neither form stable complexes with HCs nor assist in...

Almost a third of the patients in our study were obese. More than 40% of the children had a psychiatric disorder and/or recent life stressor. Younger age, an underweight or obese body mass index and a recent stressful life event or psychiatric disorder correlated with a higher lower urinary tract symptom score. This study supports previous recommendations to screen for psychosocial comorbidities and obesity during the evaluation of pediatric lower urinary tract dysfunction.

No abstract