The value of high-frequency 20 MHz ultrasonography for preoperative measurement of malignant melanoma thickness

High-frequency ultrasonography has become an important diagnostic tool in dermatovenerology. It is used for assessment of the cutaneous layers in diverse benign and malignant skin lesions and diseases. Herein we present the practical value of preoperative measurement of cutaneous melanoma thickness, the explanation of the possible reasons for different sonographic and histologic Breslow thickness, and the practical importance of high-frequency 20 MHz ultrasonography in preoperative measurements of cutaneous melanoma thickness. Fifty patients (31 women aged 41.6±15.4 years, 19 males aged 54.5±11.4 year (mean ± Standard Deviation) were examined in the Skin Cancer Clinic from January 2014 to December 2015. Suspected cutaneous melanomas were investigated with skin ultrasound Dermascan C (Cortex Technology, Denmark) before surgical removal. The Breslow thickness of cutaneous melanomas was analyzed by precise pathological examination after extirpation. Statistical analysis revealed a significant positive correlation between ultrasonographic melanoma thickness and Breslow thickness (r=0.92, P&lt;0.001). The mean thickness of invasive tumors evaluated by high frequency ultrasonography was 6.77 % higher compared with the mean Breslow thickness. The high-frequency ultrasonography provides a sensitive, noninvasive and reproducible method of skin evaluation, which enables objective visualization in vivo, providing valuable information, especially about cutaneous melanoma. The results of our study indicate that high frequency ultrasonography may be a useful adjunctive tool in the evaluation of cutaneous melanoma in daily practice.  </p

Pediatric reference values for arterial stiffness parameters cardio-ankle vascular index and CAVI0

The process of arteriosclerosis begins early in life, and cardiovascular risk factors identified in childhood tend to persist into adulthood. Cardio-ankle vascular index (CAVI), a recent parameter of arterial stiffness, is considered an independent predictor of cardiovascular risk. However, there are no studies reporting sex- and age-specific physiological values of CAVI in childhood. We aimed to establish reference values for CAVI and its blood pressure-corrected variant (CAVI0) in 500 healthy children and adolescents aged 7 to 19 years and to study potential relationships with anthropometric indices. Sex- and age-specific distributions of CAVI and CAVI0 values in healthy children and adolescents are presented. Boys aged 15-19 years had lower CAVI than girls, which could result from CAVI's slight blood pressure dependence. CAVI0 did not show such sex difference. Body roundness index-a novel parameter to quantify abdominal fat-was a strong anthropometric predictor of both CAVI and CAVI0. This is the first study providing pediatric age- and sex-specific reference values for arterial stiffness parameters CAVI and CAVI0. The presented data can contribute to the understanding of the evolution of these indices during childhood and adolescence. Under specific conditions, CAVI0 may offer more robust information about arterial stiffness than standard CAVI

COMPARISON OF HEART RATE VARIABILITY IN PATIENTS WITH PANIC DISORDER DURING COGNITIVE BEHAVIORAL THERAPY PROGRAM

Background: Many authors suggest that there is low reactivity of autonomic nervous system and reduced heart rate variability in patients with panic disorder. The patients are therefore exposed to increased cardiac mortality. Power spectral analysis is a successful tool in detecting autonomic instabilities in many disorders. Subjects and methods: The aim of our study is to monitor the activity of the autonomic nervous system through heart rate variability measured in the beginning and end of a therapeutic cognitive behavioral therapy (CBT) program in patients with panic disorder. We measured 31 patients with panic disorder in the beginning (1st measurement) and end of a therapeutic CBT program (2nd measurement). The autonomic nervous system (ANS) has been evaluated in three positions (supine – standing – supine). The evaluated parameters of the HRV linear analysis were: RR interval, HF, LF, VLF band and VLF + LF / HF ratio. Results: Spectral activity in the very low frequency band was significantly higher in the 2nd measurement compared to the 1st measurement in the standing position. The ratio of the spectral activity at lower frequencies (VLF+LF) to high frequency (HF) was significantly lower in the supine position. Conclusion: This study demonstrated an improvement of neurocardiac control regulation after a therapeutic CBT program in patients suffering from panic disorder

Capillaroscopy and Endopat – Helpful Methods for the Early Assessment of Increased Cardiovascular Risk in Anorexia Nervosa?

Anorexia nervosa (AN) as a life-threatening eating disorder is linked to a high mortality risk with many deaths attributable to cardiovascular etiology. Cardiovascular complications in AN include structural as well as functional cardiac alterations, hemodynamic changes, and peripheral vascular abnormalities. Despite the fact that peripheral vascular abnormalities are not identified as a major AN complication, several manifestations of peripheral vascular dysregulation including Raynaud's phenomenon and endothelial dysfunction have been described and, therefore, warrant attention. This article briefly summarizes so far findings of microvascular alterations in AN patients and presents easily accessible and non-invasive procedures for a microvascular evaluation such as capillaroscopy and endothelium-related peripheral arterial tone (EndoPAT) which could be involved in the clinical diagnostic process for the earliest identification of an increased risk of later cardiovascular complications

Novel Insight into Neuroimmune Regulatory Mechanisms and Biomarkers Linking Major Depression and Vascular Diseases: The Dilemma Continues

Major depressive disorder (MDD) represents a serious health problem estimated to affect 350 million people globally. Importantly, MDD has repeatedly emerged as an etiological or prognostic factor in cardiovascular disease (CVD) development, including vascular pathology. Several linking pathomechanisms between MDD and CVD involve abnormal autonomic regulation, inflammation, and endothelial dysfunction as an early preclinical stage of atherosclerosis. However, the cause of accelerated atherosclerosis in MDD patients remains unclear. Recently, the causal relationships between MDD and mediator (e.g., inflammation and/or endothelial dysfunction), as well as the causal pathways from the mediator to atherosclerosis, were discussed. Specifically, MDD is accompanied by immune dysregulation, resulting in increased production of proinflammatory cytokines (e.g., interleukin (IL)-6 and tumor necrosis factor (TNF)-&alpha;), which could lead to depression-linked abnormalities in brain function. Further, MDD has an adverse effect on endothelial function; for example, circulating markers of endothelial dysfunction (e.g., soluble adhesion molecules, von Willebrand factor) have been linked with depression. Additionally, MDD-linked autonomic dysregulation, which is characterized by disrupted sympathovagal balance associated with excessive circulating catecholamines, can contribute to CVD. Taken together, activated inflammatory response, endothelial dysfunction, and autonomic dysregulation could affect gradual atherosclerosis progression, resulting in a higher risk of developing CVD in MDD. This review focused on the pathomechanisms linking MDD and CVD with respect to neuroimmune regulation, and the description of promising biomarkers, which is important for the early diagnosis and personalized prevention of CVD in major depression

Entropy Analysis of Neonatal Electrodermal Activity during the First Three Days after Birth

The entropy-based parameters determined from the electrodermal activity (EDA) biosignal evaluate the complexity within the activity of the sympathetic cholinergic system. We focused on the evaluation of the complex sympathetic cholinergic regulation by assessing EDA using conventional indices (skin conductance level (SCL), non-specific skin conductance responses, spectral EDA indices), and entropy-based parameters (approximate, sample, fuzzy, permutation, Shannon, and symbolic information entropies) in newborns during the first three days of postnatal life. The studied group consisted of 50 healthy newborns (21 boys, average gestational age: 39.0 &plusmn; 0.2 weeks). EDA was recorded continuously from the feet at rest for three periods (the first day&mdash;2 h after birth, the second day&mdash;24 h after birth, and the third day&mdash;72 h after birth). Our results revealed higher SCL, spectral EDA index in a very-low frequency band, approximate, sample, fuzzy, and permutation entropy during the first compared to second and third days, while Shannon and symbolic information entropies were lower during the first day compared to other periods. In conclusion, EDA parameters seem to be sensitive in the detection of the sympathetic regulation changes in early postnatal life and which can represent an important step towards a non-invasive early diagnosis of the pathological states linked to autonomic dysmaturation in newborns

Delivery Mode Affects the Sympathetic Nervous System in Healthy Term Newborns

Spontaneous delivery represents an important way triggering the physiological mechanisms essential for a proper postnatal adaptation of a newborn. Autonomic nervous system (ANS) plays a crucial role in this process. There is insufficient data concerning the impact of different delivery mode on ANS in newborns. Therefore, we aimed to study the effect of delivery mode on sympathetic nervous system (SNS) in healthy term newborns measured by electrodermal activity (EDA)