Mice that are mutant for Reelin or Dab1, or doubly mutant for the VLDL receptor (VLDLR) and ApoE receptor 2 (ApoER2), show disorders of cerebral cortical lamination. How Reelin and its receptors regulate laminar organization of cerebral cortex is unknown. We show that Reelin inhibits migration of cortical neurons and enables detachment of neurons from radial glia. Recombinant and native Reelin associate with alpha3beta1 integrin, which regulates neuron-glia interactions and is required to achieve proper laminar organization. The effect of Reelin on cortical neuronal migration in vitro and in vivo depends on interactions between Reelin and alpha3beta1 integrin. Absence of alpha3beta1 leads to a reduction of Dab1, a signaling protein acting downstream of Reelin. Thus, Reelin may arrest neuronal migration and promote normal cortical lamination by binding alpha3beta1 integrin and modulating integrin-mediated cellular adhesion.

Robot assisted partial nephrectomy is a safe and viable alternative to laparoscopic partial nephrectomy, providing equivalent early oncological outcomes and comparable morbidity to a traditional laparoscopic approach. Moreover robot assisted partial nephrectomy appears to offer the advantages of decreased hospital stay as well as significantly less intraoperative blood loss and shorter warm ischemia time, the latter of which may help to provide maximal preservation of renal reserve. In addition, operative parameters for robot assisted partial nephrectomy appear to be less affected by tumor complexity compared to laparoscopic partial nephrectomy. Interestingly while the advantages of robotic surgery have historically been believed to aid laparoscopic naïve surgeons, these data indicate that robot assisted partial nephrectomy may also benefit experienced laparoscopic surgeons.

BACKGROUND Most small renal tumors are amenable to partial nephrectomy (PN). Studies have documented the association of radical nephrectomy (RN) with an increased risk of comorbid conditions, such as chronic kidney disease. Despite evidence of equivalent oncologic outcomes, PN remains under used within the United States. In this study, the authors identified the most recent trends in kidney surgery for small renal tumors and determined which factors were associated with the use of PN versus RN within the United States. METHODS A population-based patient cohort was analyzed using the Surveillance, Epidemiology and End Results cancer registry (SEER 1999-2006). The authors identified 18,330 patients ages 40 to 90 years who underwent surgery for kidney tumors ≤4 cm in the United States between 1999 and 2006. RESULTS In total, 11,870 patients (65%) underwent RN, and 6460 patients (35%) underwent PN. The ratio of PN to RN increased yearly (P < .001), representing 45% of kidney surgeries in 2006 for small tumors. There were significant differences in the cohort of patients who underwent PN versus RN, including age, sex, tumor location, marital status, year of treatment, and tumor size. When adjusting for these variables, being a man, age ≤70 years, urban residence, smaller tumor size, and more recent treatment year were predictors of PN. CONCLUSIONS Although the total numbers of PN procedures increased in the United States between 1999 and 2006, there remains a significant under use of PN, particularly among women, the elderly, and those living in rural locations. Further investigation will be required to determine the reasons for these disparities, and strategies to optimize access to PN need to be developed.

The data represent the largest series of its kind and strongly suggest that RPN is a safe, effective, and feasible option for the minimally invasive approach to renal hilar tumors with no increased risk of adverse outcomes compared with nonhilar tumors in the hands of experienced robotic surgeons.

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Current data indicate that robotic assisted partial nephrectomy is safe. Most postoperative complications are Clavien grade I or II, or can be managed conservatively.

variables including an assessment of enuresis, voiding frequency and ultrasonography. The mean (range) follow-up was 25 (1-78) months. One patient was lost after his first follow-up visit, but data were included to that time. RESULTSThe most common presenting symptom was voiding dysfunction; 47 (67%) presented with nocturnal enuresis, 42 (60%) with urinary frequency and 12 (17%) with a history of urinary tract infection. On physical examination 12 (17%) had mild age-corrected hypertension. Microhaematuria was present in 21 (30%) but all patients had normal serum creatinine levels. Ultrasonography showed hydronephrosis in 33 (47%) and a postvoid residual volume in 57 (81%). On VCUG, 52 (79%) patients had clear evidence of PUV, 22 (31%) bladder trabeculation, 11 (16%) vesicoureteric reflux and eight (11%) diverticula. On cystoscopy, 67 (96%) patients presented with the classic sail-shaped PUV and three a ringshaped valve. After surgical ablation of the valve most patients dramatically improved; 31 of 42 (74%) had resolution of urinary frequency, 24 of 33 (73%) of diurnal enuresis and 17 of 47 (38%) nocturnal enuresis. Of 57 patients, 39 (68%) established good bladder emptying. Of 33 affected, 20 (60%) had some reduction of hydronephrosis but 63% continued to have some symptoms of voiding dysfunction.

Background and Purpose: Robot-assisted partial nephrectomy (RPN) has emerged as a viable approach to minimally invasive surgery for small renal tumors. There are few reports of RPN for tumors > 4 cm. Our objective was to evaluate outcomes of RPN for tumors > 4 cm compared with RPN for tumors £ 4 cm in a large multi-institutional study. Patients and Methods: We reviewed data for 445 consecutive patients who underwent RPN by experienced surgeons at four academic institutions from 2006 to 2010. Patients were stratified into two groups according to radiographic tumor size. Patient demographics, perioperative outcomes, and oncologic outcomes were recorded. Results: A total of 83 of 445 (18.7%) patients had tumors > 4 cm with a median radiographic tumor size of 5.0 cm (4.1-11 cm). Patients with tumors > 4 cm had a higher proportion of hilar tumors (9.8% vs 4.7%, P < 0.001), a higher mean R.E.N.A.L. nephrometry score (8.0 vs 6.3, P < 0.01), longer warm ischemia time (WIT) (24 vs 17 min, P < 0.001), and an increased rate of collecting system repair (72.2% vs 51.6%, P = 0.006) compared with patients with tumors £ 4 cm. Functional outcomes and complications were similar between groups. There were no positive margins in patients with tumors > 4 cm and only one recurrence. Conclusions: In the largest multi-institutional series of RPN for tumors > 4 cm, we demonstrate safety, feasibility, and efficacy of RPN for tumors > 4 cm. Patients with tumors > 4 cm had a higher nephrometry score, longer WIT, and slightly higher estimated blood loss compared with patients who had tumors £ 4 cm, but there was no increased risk of adverse outcomes in the hands of experienced surgeons.