Physical Therapy and Dry Needling for Erectile Dysfunction and Impaired Penile Sensation Following Reconstructive Surgeries of the Penis; A Case Report

Peyronie’s disease (PD) is a connective tissue disorder resulting from abnormal development of fibrotic and non-expandible thickened scar tissue in the penis. Surgical intervention might lead to other complications, including decreased sensation in the penis, persistent pain after surgery, and less-rigid erections. This study presents the physiotherapeutic assessment and management of a 33-year-old man with erectile dysfunction and impaired penile sensation following reconstructive surgeries of the penis. The patient was given physiotherapeutic interventions including dry needling (DN) and subcision of the scar and stretching exercise of the penis. After the 5th visit, the patient reported improvement in symptoms. This case report suggests that dry-needling and subcision techniques can improve pain and sexual well-being in patients with post-plication surgery problems

Introduction to Neurocircuitry and Neurobiology of Anxiety

Context: Nowadays, experiencing occasional anxiety is a common part of each person’s life. The number of anxious people has increased in this modern life style. This study aimed to review some researches as to accelerate searching for new anxiolytic treatments. Evidence Acquisition: Related articles were extracted from databases including PubMed, Google Scholar, Springer, Science Direct and Wiley. Forty-eight articles were chosen. The articles were carefully considered, and after extracting information, they were categorized and integrated in the appropriate sequences to meet the needs of this study. Results: This review mentions the important brain regions involved in anxiety; it then continues with encapsulating some of the neurotransmitters’ and neuropeptides’ functions that cope with anxiety-like behaviors. Conclusion: With regard to the results, it is suggested that anxiety can be caused by change in the brains’ neurotransmitters level but more studies are needed to identify its exact mechanism

The level of urinary endothelin in patients with urinary reflux

Background: In different tissues, the endothelin is produced by vascular endothelium. They are potent vasoconstrictor peptides. There is a little information about the role of endothelin in reflux nephropathy. Objectives: The aim of this study is to evaluate urinary levels of endothelin in patients with vesicoureteral reflux (VUR). Patients and Methods: It was a cross-sectional study that conducted on 81 children who received voiding cystourethrogram (VCUG). Based on VCUG reports, patients were divided into two groups; with reflux (40 persons) and without reflux (41 persons). We got a urine sample from patients with mid-stream or urine bag method. The endothelin level was assessed with ELISA immunoassay. Data was analyzed using SPSS 16. Results: Based on VCUG reports, 40 patients (49.4%) had urinary reflux, of them 20 cases suffered from unilateral urinary reflux and others from bilateral. Of 40 patients with reflux, 23 cases (57.5% of reflux group) had kidney scar and seven individuals (17.5%) had abnormal kidney sonography. Of patients with urinary reflux, 13 cases (32.5%) had grade1 urinary reflux, 8 cases (20%) grade 2, and 5 cases (12.5%) grade 3 and finally 14 cases (35%) grade 4. The UET-1 levels were significantly higher in VUR patients compared to the control group (P < 0.001). Comparison of mean endothelin levels between two groups was done using Mann-Whitney U test and was statistically significance (P < 0.001). We used Kruskal-Wallis for comparison of endothelin levels in different grades of reflux (P < 0.001). Conclusions: Urine endothelin-1 level can be considered as an alternative to VCUG for screening vesicourethral reflux

Sinonasal Adenosquamous Carcinoma-Morphology and Genetic Drivers Including Low- and High-Risk Human Papillomavirus mRNA, DEK::AFF2 Fusion, and MAML2 Rearrangement

BackgroundSinonasal adenosquamous carcinoma is rare, and there are almost no studies detailing morphology or characterizing their genetic driver events. Further, many authors have termed sinonasal tumors with combined squamous carcinoma and glands as mucoepidermoid carcinoma but none have analyzed for the presence of MAML2 rearrangement.MethodsCases from 2014 to 2020 were collected and diagnosed using World Health Organization criteria. They were tested for p16 expression by immunohistochemistry (70% cut-off), DEK::AFF2 fusion by fluorescence in situ hybridization (FISH) and AFF2 immunohistochemistry, MAML2 rearrangement by FISH, and low- and high-risk HPV by RNA ISH and reverse transcription PCR, respectively. Detailed morphology and clinical features were reviewed.ResultsThere were 7 male (64%) and 4 female (36%) patients with a median age of 69 years, most Caucasian (10 of 11 or 91%). Most had tobacco exposure (8/11, 73%) and most presented with epistaxis, a visible nasal mass, and/or facial pain. Several had a precursor papillomas (3 of 11, 27%). The squamous component had variable keratinization, 5 of 11 (46%) of which would be described as keratinizing, 3 non-keratinizing, and 2 with mixed features. All had gland formation, by definition, and 2 of 11 (18%) had ciliated tumor cells. None of the 11 cases had MAML2 rearrangement and one had DEK::AFF2 fusion with associated positive nuclear AFF2 protein immunostaining. Most were p16 positive (7 of 11, 64%) and all 7 of these were hrHPV positive either by RNA ISH or RT-PCR. Two of the p16-negative tumors were positive for lrHPV by RNA ISH. Treatment included surgery alone (4 of 11, 36%), surgery with adjuvant radiation (5 of 11, 45%), and surgery with radiation and chemotherapy (2 of 11, 18%). Four of 11 patients (36%) suffered disease recurrence, two requiring re-operation and who were disease free at last follow-up, one receiving additional chemotherapy and who was alive with disease. The other elected to undergo palliative therapy and died of disease.ConclusionSinonasal adenosquamous carcinoma is a somewhat heterogeneous tumor not infrequently arising ex papilloma and having various drivers including high- and low-risk HPV and rarely DEK::AFF2 fusion. The prognosis appears favorable when proper treatment is possible