Update on testicular germ cell tumors.

PURPOSE OF REVIEW: This overview discusses several important developments in testicular germ cell tumors (TGCTs) over the past year. RECENT FINDINGS: Genomic studies continue to investigate gene expression as possible markers for disease relapse and metastatic potential. Optimal treatment strategies for early-stage seminomas continue to evolve toward surveillance versus chemotherapy, although developing radiation delivery modalities may ultimately provide a safe alternative. The role of retroperitoneal lymph node dissection in postorchiectomy early-stage nonseminoma germ cell tumors remains a topic of debate. SUMMARY: Treatment paradigms continue to be refined for TGCTs as research in these areas continues.

Testicular germ cell tumors: biology and clinical update.

PURPOSE OF REVIEW: To discuss several important developments in the diagnosis, management, and risk stratification of testicular germ cell tumors (TGCTs) in the past year. RECENT FINDINGS: Germ cell function and tumorigenesis may be influenced by exposure to a variety of agents, including metals and cannabinoids. Genome-wide association studies have identified variants in several genes that may produce susceptibility to the development of testicular malignancies, and expression of certain proteins predicts a poorer prognosis and may, thus, play a role in neoplastic progression. Retroperitoneal lymph node dissection continues to play a crucial role in definitive treatment of patients with nonseminoma germ cell tumor, whereas radiotherapy, as a standard treatment for early-stage seminoma, has been declining due both to the efficacy of platinum-based chemotherapy and to the increased risk of radiation-related secondary malignancies. Advanced and platinum-refractory disease states continue to be challenging entities in terms of optimizing therapy and outcome. SUMMARY: Preclinical and clinical studies continue to enhance our insights into the complex biology of TGCTs, and are helping to further refine risk stratification and optimize treatment of patients with TGCTs.

Gut microbiome in chronic kidney disease: challenges and opportunities.

More than 100 trillion microbial cells that reside in the human gut heavily influence nutrition, metabolism, and immune function of the host. Gut dysbiosis, seen commonly in patients with chronic kidney disease (CKD), results from qualitative and quantitative changes in host microbiome profile and disruption of gut barrier function. Alterations in gut microbiota and a myriad of host responses have been implicated in progression of CKD, increased cardiovascular risk, uremic toxicity, and inflammation. We present a discussion of dysbiosis, various uremic toxins produced from dysbiotic gut microbiome, and their roles in CKD progression and complications. We also review the gut microbiome in renal transplant, highlighting the role of commensal microbes in alteration of immune responses to transplantation, and conclude with therapeutic interventions that aim to restore intestinal dysbiosis.