Oncological and functional outcomes after testis-sparing surgery in patients with germ cell tumors: a systematic review of 285 cases.

INTRODUCTION AND OBJECTIVES: In several urogenital cancers, organ-preserving surgery represents the preferred treatment approach, but in patients with testicular germ cell tumors (tGCTs), radical orchiectomy represents the standard of care. This study aimed to summarize published case series assessing oncological and functional outcomes after testis-sparing surgery (TSS) in patients with tGCTs. MATERIALS AND METHODS: A systematic literature review and individual patient data meta-analysis were conducted of published cases with tGCT treated with TSS. RESULTS: Of 2,333 reports, we included 32 reports providing data on 285 patients, including 306 testicles treated with TSS. Adjacent germ cell neoplasia in situ (GCNIS) was described in 43%. Hypogonadism and infertility after TSS were diagnosed in 27% and 18%. In patients undergoing adjuvant testicular radiotherapy, hypogonadism was diagnosed in 40%. Patients treated with adjuvant testicular radiotherapy after TSS exhibited a significantly lower incidence of local recurrence (2% vs. 50%, p < 0.001). Distant metastases after TSS were observed in 2%. CONCLUSION: The current data questions the benefits of TSS in tGCT patients. If at all, TSS should only be offered to well-informed patients with a singular testicle, excellent compliance, a singular tumor less than 2 cm located at the lower pole of the testicle, and normal preoperative endocrine function. Unless patients plan to father a child within a short time frame, adjuvant testicular radiotherapy should be recommended after TSS. Radical orchiectomy remains the standard of care, but future studies may support the use of TSS in selected men.

Embracing your emotions: affective state impacts lateralisation of human embraces.

Humans are highly social animals that show a wide variety of verbal and non-verbal behaviours to communicate social intent. One of the most frequently used non-verbal social behaviours is embracing, commonly used as an expression of love and affection. However, it can also occur in a large variety of social situations entailing negative (fear or sadness) or neutral emotionality (formal greetings). Embracing is also experienced from birth onwards in mother-infant interactions and is thus accompanying human social interaction across the whole lifespan. Despite the importance of embraces for human social interactions, their underlying neurophysiology is unknown. Here, we demonstrated in a well-powered sample of more than 2500 adults that humans show a significant rightward bias during embracing. Additionally, we showed that this general motor preference is strongly modulated by emotional contexts: the induction of positive or negative affect shifted the rightward bias significantly to the left, indicating a stronger involvement of right-hemispheric neural networks during emotional embraces. In a second laboratory study, we were able to replicate both of these findings and furthermore demonstrated that the motor preferences during embracing correlate with handedness. Our studies therefore not only show that embracing is controlled by an interaction of motor and affective networks, they also demonstrate that emotional factors seem to activate right-hemispheric systems in valence-invariant ways.