Cognitive trajectories in longitudinally trained 3xTg-AD mice.

Preclinical studies in Alzheimer's disease (AD) often rely on cognitively naïve animal models in cross-sectional designs that can fail to reflect the cognitive exposures across the lifespan and heterogeneous neurobehavioral features observed in humans. To determine whether longitudinal cognitive training may affect cognitive capacities in a well-characterized AD mouse model, 3xTg and wild-type mice (n = 20) were exposed daily to a training variant of the Go-No-Go (GNG) operant task from 3 to 9 months old. At 3, 6, and 9 months, performance on a testing variant of the GNG task and anxiety-like behaviors were measured, while long-term recognition memory was also assessed at 9 months. In general, GNG training improved performance with increasing age across genotypes. At 3 months old, 3xTg mice showed slight deficits in inhibitory control that were accompanied by minor improvements in signal detection and decreased anxiety-like behavior, but these differences did not persist at 6 and 9 months old. At 9 months old, 3xTg mice displayed minor deficits in signal detection, and long-term recognition memory capacity was comparable with wild-type subjects. Our findings indicate that longitudinal cognitive training can render 3xTg mice with cognitive capacities that are on par with their wild-type counterparts, potentially reflecting functional compensation in subjects harboring AD genetic mutations.

The impact of body mass index on renal functional outcomes following minimally invasive partial nephrectomy.

OBJECTIVE: To assess the impact of body mass index (BMI) on perioperative and renal functional outcomes in patients undergoing minimally invasive partial nephrectomy (MIPN). MATERIALS AND METHODS: In our IRB-approved, prospectively maintained clinical database, we identified 1206 patients who underwent kidney surgery from 2002 to 2013. Estimated glomerular filtration rate (eGFR) was obtained at baseline and each follow-up visit. From this group, patients who underwent MIPN with more than 12 months of follow-up were selected. Patients were separated into 4 cohorts based on BMI: normal weight (<25 kg/m(2)), preobese (25-30 kg/m(2)), obese class 1 (30-35 kg/m(2)), and obese class ≥2 (>35 kg/m(2)). Change in eGFR was compared across demographic and clinical variables through linear and logistic regression models. RESULTS: A total of 235 patients met inclusion criteria with median follow-up of 29 months (interquartile range [IQR] 19, 45). There were no differences in demographic, perioperative, or pathologic features between BMI groups. While controlling for gender, race, Charlson comorbidity score, tumor size, and ischemia time, obese class 1 (odds ratio [OR] 4.68, p=0.019), obese class ≥2 (OR 4.27, p=0.033), and age (OR 1.06, p=0.014) were associated with increased risk of CKD stage ≥3; however, higher baseline eGFR (OR 0.91, p<0.001) was associated with a reduced risk of CKD stage ≥3. While controlling for the same variables, increasing BMI was associated with a significant absolute reduction in eGFR at 1 year (0.38 mL/minute/1.73 m(2) reduction in GFR per 1 kg/m(2) increase in BMI, p=0.009). CONCLUSIONS: MIPN is technically feasible in obese patients with similar perioperative outcomes to nonobese patients. BMI is an independent risk factor for worsening kidney function following MIPN.

Patient positioning and port placement for robot-assisted surgery.

Abstract The introduction of robotic surgical systems and their integration into minimally invasive procedures have changed the landscape of laparoscopic surgery dramatically. Intuitive Surgical's da Vinci Surgical System was first approved by the Food and Drug Administration for cardiothoracic procedures in the late 1990s. This trend quickly spread through other surgical specialties, with urologists as one of the frontrunners in adoption. Subsequently, pediatric urologists have adopted robot-assisted procedures in selected centers, performing procedures such as pyeloplasty for ureteropelvic junction obstruction, partial and complete nephrectomy, and both intravesical and extravesical ureteral reimplantation. In this article, we will discuss technical considerations related to patient positioning and port placement in pediatric robot-assisted surgery.

Indications for adrenalectomy during radical nephrectomy for renal cancer.

OBJECTIVES: To determine if the selection criteria for ipsilateral adrenalectomy during laparoscopic radical nephrectomy (RN) can be further restricted, with the goal of sparing more patients unnecessary adrenalectomy while preserving the removal of adrenal glands containing malignancy, as recent evidence suggests that adrenalectomy in association with RN for renal cancer can be limited to patients with abnormalities on adrenal imaging or large upper-pole renal tumours. PATIENTS AND METHODS: The cohort consisted of two data sets, each from one institution, i.e., a training set and a validation set. All patients underwent RN for radiographically localised disease. Removal of the adrenal gland was based on the surgeon's preference, related to the presence of a suspect adrenal lesion on preoperative imaging, suspicion for involvement of the adrenal gland intraoperatively, location of the tumour, size of the tumour and local tumour stage. RESULTS: Of 159 patients in the training cohort, three (2%) had metastatic renal cancer in the ipsilateral adrenal gland. All three patients had tumours of >7 cm and either an abnormal radiographic appearance of the adrenal gland or suspect intraoperative findings. In the validation cohort of 74 patients, seven (10%) had adrenal metastasis, of which one had a tumour of <7 cm and the indication for adrenalectomy was the high intraoperative suspicion. CONCLUSION: We recommend performing ipsilateral adrenalectomy in association with RN for renal cancer when there is either abnormal radiographic appearance of the adrenal gland or suspect intraoperative findings, with no regard for primary tumour size.

Critical evaluation of modified templates and current trends in retroperitoneal lymph node dissection.

Retroperitoneal lymph node dissection (RPLND) is a critical aspect of staging and treatment of nonseminomatous germ cell tumors (NSGCTs) of the testis. RPLND achieves cure in a majority of patients with low-volume metastatic disease and minimizes the need for chemotherapy. Initial surgical approaches to RPLND, involving wide limits to dissection, were associated with high rates of retrograde ejaculation and significant overall morbidity. Evolving modified RPLND templates helped reduce rates of retrograde ejaculation but may be associated with a 3 %-23 % risk of unresected metastasis. Modified templates have become a standard of care in primary RPLND with low-volume metastatic disease. Only highly select patients at specialized centers should undergo modified template RPLND in the postchemotherapy setting, because risks of unresected disease are higher than in the primary setting. Bilateral RPLND optimizes cancer control and can preserve antegrade ejaculation if nerve sparing is performed. We also briefly discuss minimally invasive approaches to RPLND.