Detection of axillary lymphadenopathy after Covid-19 vaccination during breast examination: Case series and review of the literature after one year.

OBJECTIVES: The aim of this study is to evaluate accidental findings of axillary lymphadenopathy during breast examination. Postvaccination axillary lymphadenopathy is a possible cause of adenopathies but these findings used to be exceedingly rare. Nowadays, after Covid-19 vaccination it is found more often. Covid-19 vaccination started at the end of December 2020 with two types of vaccine, Moderna and Pfizer-BioNTech in the Czech Republic. The aim of this article is to present a single centre experience with Covid-19 lymphadenopathy during the general vaccination in the Czech population and summarization of recommendations. METHODS: In January to February 2021 ultrasound revealed axillary lymphadenopathy in several patients during breast examination in our certified centre. In four of them it was concluded as lymphadenopathy after Covid-19 vaccination. A search (using databases PubMed and Google Scholar) of the available literature for the years 2020 and 2021 was performed. RESULTS: These four patients were examined during the first two months of 2021. In all of them pathological lymph nodes with typical sonographic signs were seen in the ipsilateral axilla. We searched the literature for follow-up recommendations and summarized them in our article. CONCLUSION: Accidental findings of axillary lymphadenopathy during ultrasound breast examination will be more often. There will be more cases of lymphadenopathy with an increasing number of people being vaccinated against Covid-19.

Influence of female hormones on fascia elasticity: An elastography study.

The aim of this study was to examine the influence of hormonal changes during the menstrual cycle on deep fasciae. A total of 29 women, 17 users, and 12 nonusers of hormonal contraceptives were examined clinically and by ultrasound, including shear wave elastography, at two phases of the menstrual cycle. The thickness and elasticity of the fascia lata, thoracolumbar fascia, and plantar fascia were measured, compared between hormonal contraceptive users and nonusers, and correlated with clinical data. There were statistically significant differences between users and nonusers of hormonal contraceptives: the thoracolumbar fascia was thicker in nonusers (P = 0.011), and nonusers had higher maximal and mean stiffnesses of the fascia lata (P = 0.01 and 0.0095, respectively). Generally, nonusers had a higher body mass index (BMI). The elasticity of the thoracolumbar and the plantar fasciae did not differ significantly between the groups. We found no correlation between thickness and elasticity in the fasciae. There were no statistically significant differences in hypermobility, cephalgia, or dysmenorrhea between users and nonusers of hormonal contraceptives. The results of this pilot study suggest that deep fasciae can be evaluated by shear wave elastography. Nonusers of contraceptives had greater stiffness of the fascia lata and higher BMI. Clin. Anat. 32:941-947, 2019. © 2019 Wiley Periodicals, Inc.

Libet's experiment: A complex replication.

Libet's experiment is an influential classical study, which does not stop provoking heated debates. However, a full-scale replication has not been carried out to this day. Libet-style studies have usually focused on isolated ideas and concepts and never on the whole experiment in all its complexity. This paper presents detailed methodological description and results of a complex replication study. The methodology follows Libet's directions closely in most cases; when it does not, the differences are described and elaborated. The results replicate Libet's key findings, but substantial differences were found in some of the results' categories, such as the introspective reports or the number of readiness-potentials found. The discussion also addresses some current problems pertaining the methodology of the Libet-style experiments and provides some recommendations based on a detailed process evaluation.

Personality disorder in marriage and partnership - a narrative review.

BACKGROUND: Partner conflicts are the most common precipitating factors of decompensation of psychiatric disorders, including personality disorders. Personal characteristics play a fundamental role in both the prediction of marital satisfaction of the individual as well as the satisfaction of the couple as a whole. METHOD: Narrative Review of the articles, books and book chapters within the period 1956 - 2016 using PubMed, Web of Science, and Scopus databases with keywords "personality disorder," "partnership," marital problems," "marital conflicts." Additional references were found using reviews of relevant articles. RESULTS: It is evident that patients with personality disorders can have problems with meeting the criteria that contribute to the marital satisfaction and, on the other hand, easily fulfill the criteria that are related to the causes of the relationship breakups. People with personality disorders have substantial problems with starting and continuing a relationship with a partner. They have an unintentional ability to create and maintain problematic relationships. The association between the dysfunctional marriage and personality problems of the partners may have the basis in the insufficient understanding of the behavior of one or both partners. People with personality disorder experience numerous misunderstandings, misinterpretations, communicate poorly, and they are more alert to verbal and physical aggression in the interpersonal relations. They do not recognize that the basis of experienced struggles has a source in their intrapersonal processes and their relationship with the world. Persons with certain personality disorders tend to seek and create a pathologically stable partnership. To understand the dynamics of such relationships, examining personality traits first should be essential. Understanding the maladaptive personality patterns in the context of the relationship should be beneficial for both partners.

Evaluation of the Effect of Tissue Compression on the Results of Shear Wave Elastography Measurements.

Shear wave imaging is considered to be more precise and less operator dependent when compared with strain imaging. It enables quantitative and reproducible data (Young's modulus of the imaged tissue). However, results of shear wave imaging can be affected by a variety of different factors. The aim of this study is to evaluate the effect of the pressure applied by the ultrasound probe during examination on the measured values of Young's modulus. The effect of the tissue compression on the results of the real-time shear wave elastography was evaluated via the gelatine phantom measurements, via the ex vivo experiments with pig liver, and via the in vivo measurements of the thyroid gland stiffness on healthy volunteers. The results of our measurements confirmed that the measured value of Young's modulus increases with the increasing pressure applied on the imaged object. The highest increase was observed during the ex vivo experiments (400%), and the lowest increase was detected in the case of the phantom measurements (8%). A two- to threefold increase in Young's modulus was observed between the minimum and maximum pressure in the case of the in vivo elastography measurements of thyroid gland. The Veronda-Westman theoretical model was used for the description of the tissue nonlinearity. We conclude that tissue compression by the force exerted on the probe can significantly affect the results of the real-time shear wave elastography measurements. Minimum pressure should be used when measuring the absolute value of Young's modulus of superficial organs.

Libet's experiment: Questioning the validity of measuring the urge to move.

The time of subjectively registered urge to move (W) constituted the central point of most Libet-style experiments. It is therefore crucial to verify the W validity. Our experiment was based on the assumption that the W time is inferred, rather than introspectively perceived. We used the rotating spot method to gather the W reports together with the reports of the subjective timing of actual movement (M). The subjects were assigned the tasks in two different orders. When measured as first in the respective session, no significant difference between W and M values was found, which suggests that uninformed subjects tend to confuse W for M reports. Moreover, we found that W values measured after the M task were significantly earlier than W values measured before M. This phenomenon suggests that the apparent difference between W and M values is in fact caused by the subjects' previous experience with M measurements.

Borderline personality disorder and unmet needs.

BACKGROUND: Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families. METHOD: A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151). RESULTS: The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy. CONCLUSION: Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social factors. A bigger focus on the patients' needs could be beneficial and should be targeted in the treatment.

Psychosocial aspects of resistance in complex treatment of depressive disorder.

OBJECTIVE: Treatment of major depressive disorder can be affected by a broad range of factors. In our study, we focused on the relationships of demographic, psychological, clinical and social factors to the course of treatment of depression. METHOD: The study included 151 patients (finally 140 patients were evaluated) hospitalized for major depressive disorder. They were assessed for demographic characteristics, the rates of depression and anxiety, quality of life, the rates of dissociation and insomnia, and subjective and objective disease severity at different times during treatment. Patients were treated with standard doses of antidepressants or other psychiatric medication. They also completed a 6-week long daily cognitive-behavioural therapy. Data were statistically analyzed. RESULTS: There were significant decreases in the overall severity of the disorder, anxiety level and depression rate during treatment. Improvement measured by objective Clinical Global Impression (oCGI-I) at the end of treatment was not significantly correlated with any of the measured parameters (age of patient, onset of illness, duration of disease, doses of medication etc.). It only significantly positively correlated with the initial evaluation of the patient by oCGI. However, the improvement in subjective assessment (using sCGI-I) correlated with many parameters (increased age, later onset of the disease, greater disease severity at baseline in both overall and subjective evaluation of the severity, anxiety and depressive symptomatology). Furthermore, it was negatively correlated with most quality of life parameters, such as H (Home), F (Feelings), L (Leisure), Sr (Social relations) and G (General). CONCLUSIONS: The results suggest that individual variables, such as the degree of psychopathology, particularly depression and anxiety, most quality of life parameters, higher patient age and age of disorder onset may be associated with poorer subjective response to complex treatment of patients with major depressive disorder.

Treatment adherence and self-stigma in patients with depressive disorder in remission - A cross-sectional study.

OBJECTIVE: A wide range of variables may influence the rate of adherence to treatment. These variables can be associated with the disease itself, method of treatment, patient's personality, environmental factors and therapeutic relationship. Self-stigma is one of the possible factors related to poor adherence. The aim of the study was to find out the relationship between current adherence, discontinuation of medication in the past and self-stigma in stable psychiatric outpatients diagnosed with depressive disorder. METHODS: The study included 72 stable outpatients diagnosed with depressive disorder with a mean age of 49.00 ± 12.56. Disorder severity was assessed using the Clinical Global Impression scale. Adherence was measured by the Drug Attitude Inventory - 10 items (DAI-10) scale and self-stigma by the Internalized Stigma of Mental Illness (ISMI) scale. The data were evaluated in 66 patients. Six patients were excluded because of incompletely filled in questionnaires. RESULTS: The rate of adherence was not associated with gender, education, employment, family burden (family history) or partner status. Current adherence did not differ between patients who arbitrarily discontinued their medication in the past and those who did not. Adherence was significantly positively correlated with patient's age, age at disease onset and the level of self-stigma. CONCLUSIONS: The study results suggest that the level of self-stigma and age of the patient can be very important factors associated with adherence in patients with depressive disorder.

Internet psychoeducation for bipolar affective disorder: basis for preparation and first experiences.

There is growing evidence that patients with bipolar affective disorder (BAD), who use medication, respond well to further psychotherapeutic interventions. Internet-based psychoeducation is typically centered on the interaction between a client and therapist via the Internet. Multiple methods were required to investigate existing psychoeducational and psychotherapeutic strategies used on patients suffering from BAD. Systematic reviews and original reports of all trials of psychoeducation in BAD patients were retrieved. Patients with BAD, who were hospitalized in a psychiatric department or attended a day hospital program, were exposed to the first version of the program during the treatment, and then questioned about understandability, comprehensibility, and usefulness of each lecture. Twelve modules of the Internet E-Program for BAD were developed and the intervention was a pilot tested with twelve patients. Internet psychoeducation program for BAD is an intervention designed for universal implementation that addresses heightened learning needs of patients suffering from BAD. It is designed to promote confidence and reduce the number of episodes of the disorder by providing skills in monitoring warning signs, planning daily activities and practicing communication skills.

Self-stigmatization in patients with bipolar disorder.

BACKGROUND: Prejudicial beliefs, emotions, and behaviours cause discrimination against people labeled as mentally ill. This stigmatization is sometimes internalized by the patients, leading to self-stigmatization. Specific features and impacts of stigmatization and self-stigmatization in patients with bipolar illness are the subjects of this review. METHOD: Studies were identified through PUBMED, Web of Science and Scopus databases as well as existing reviews. The search terms included "bipolar disorder", "stigma", "self-stigma" psychoeducation", "psychotherapy", "psychosocial treatment". Key articles listed in reference lists were searched. RESULTS: Considerable recent evidence indicates that bipolar patients and their families are stigmatized, and that this stigmatization affects their quality of life as well as social functioning. The severity of stigmatization in bipolar disorder is greater than that in people with depression. There is also evidence of self-stigmatization which further decreases the quality of life. Stigmatization and self-stigmatization were shown to be one of the barriers that delay or prevent effective treatment, and thus exert adverse effects on the outcomes of bipolar disorder. CONCLUSION: Stigma affects the experience of illness as well as social functioning in patients with bipolar disorder. The impact of stigma on the lives and treatment outcomes of patients with bipolar disorder mandates intensive effort of mental health research and policy to address this problem. Much has been done against the stigmatization of the mentally ill. But the fight against stigma remains a fundamental objective of health programs for mental health.

Development of the internet based psychoeducation for patients with bipolar affective disorder.

OBJECTIVE: Despite pharmacological treatment of bipolar affective disorder has many advantages; only drug treatment remains insufficiently beneficial to many patients. The combination of pharmacotherapy and internet psychoeducation seems to be the effective way how to improve remission. Internet-based therapy programs offer an exclusive chance for large underserved parts of the population to make evidence-based treatment without the need of full-time therapist. Our goal was to create a psychoeducational program for patients suffering from bipolar disorder that can be used in Czech Republic. METHODS: There were identified studies through Web of Science, PUBMED, and Scopus databases as well as existing reviews were used in development of comprehensive internet psychoeducational program for patients with bipolar disorder. The search terms included "bipolar disorder", "psychoeducation", and "internet psychoeducation". The search was performed with no language or time restrictions. RESULTS: The internet psychoeducational program was developed in accordance to the data from the literature review. The aim of the Internet psychoeducational program of the Department of Psychiatry University Hospital in Olomouc is to familiarize patients with the fundamental nature of bipolar affective disorder, the character and principles of pharmacotherapy, the recognition of the warning signs of relapse, inappropriate and stressful stereotypes in communication within families, and finally the practice of social skills. CONCLUSION: Information from studies can help to prepare comprehensive psychoeducational program for bipolar patients.

Bipolar affective disorder and psychoeducation.

OBJECTIVE: Bipolar affective disorder runs a natural course of frequent relapses and recurrences. Despite significant strides in the pharmacological treatment of bipolar disorder, most bipolar patients cannot be treated only by drugs. The limitations of using medication alone in symptomatic, relapse prevention, and satisfaction/quality of life terms have long prompted interest in wider forms of management. One of the promising way how to enhance remission seems to be combination of pharmacotherapy and psychoeducation. METHODS: Studies were identified through PUBMED, Web of Science and Scopus databases as well as existing reviews. The search terms included "bipolar disorder", "psychoeducation", "psychotherapy", "psychosocial treatment", "family therapy", "individual therapy", "group therapy", and "psychoeducation". The search was performed by repeated use of the words in different combinations with no language or time limitations. This article is a review with conclusions concerned with psychoeducation in bipolar disorder. CONCLUSIONS: Randomized controlled trials of cognitive behavioral therapy, interpersonal and social rhythm therapy, individual, group and family psychoeducation show that these approaches augment stabilizing effect of pharmacotherapy. Patients and their families should be educated about bipolar disorder, triggers, warning signs, mood relapse, suicidal ideation, and the effectiveness of early intervention to reduce complications. Psychosocial approaches are important therapeutic strategies for reducing relapse and rehospitalization in bipolar disorder.

Bipolar disorder and anxiety disorders.

BACKGROUND: Anxiety disorders are common in patients with bipolar disorder and show considerable influence on the course of the disease and response to treatment. METHOD: We conducted a series of literature searches using key words, such as bipolar disorder and anxiety disorders, as items in indexed fields. The studies were obtained through a MEDLINE search from 1970 to 2012. We also examined additional studies cited in articles from these searches or our previous studies. RESULTS: Several studies have shown poorer outcomes for patients with bipolar and comorbid anxiety disorders. Some studies have indicated worse outcomes in patients with bipolar disorder and associated anxiety disorders. Shorter periods of euthymia, increased suicidal thoughts and an increased number of suicide attempts were observed. Whether the effective treatment of anxiety reduces suicide and the severity of bipolar disorder or improves the response to treatment remains unknown. There are no well-designed intervention studies in bipolar patients with anxiety symptoms. CONCLUSION: Further studies concerning the influence of anxiety on the course of bipolar disorder would be useful.

Elasticity of neck muscles in cervicogenic headache.

AIM: To compare the elasticity of the sternocleidomastoid and trapezius muscles in patients with cervicogenic headache and in healthy volunteers. METHODS: The medical history of 23 patients with cervicogenic headache was taken with a focus on pain characteristics. Elasticity of the sternocleidomastoid and trapezius muscles was measured by using shear wave elastography. Results were then compared with 23 healthy volunteers. RESULTS: The sternocleidomastoid muscle was significantly stiffer in patients with cervicogenic headache compared to healthy volunteers. The stiffness increased gradually from the parasternal area, where it was negligible, to the area near the mastoid process where it reached over 20 kPa. There was no difference in the stiffness of the trapezius muscle. The stiffness of the sternocleidomastoid muscle does show a significant dependence on headache characteristics (e.g., laterality, severity, or frequency). CONCLUSION: The results of this pilot study show that patients with cervicogenic headache have a higher stiffness of the sternocleidomastoid muscle than healthy volunteers. These findings suggest that elastography could be used as a diagnostic tool in cervicogenic headache.

Shear wave elastography in diffuse thyroid disease.

AIM: Our aim was to examine the contribution of shear wave elastography to ultrasonographic assessment in diffuse thyroid disease, specifically to evaluate the stiffness of the thyroid gland in diffuse thyroid disease and compare it with healthy controls. METHODS: A total of 46 patients with diffuse thyroid disease were examined clinically, by conventional ultrasound, and shear wave elastography. The conventional ultrasound parameters followed were: volume, margin quality, presence of nodules, and vascularisation. We measured the mean, minimum, and maximum stiffnesses by shear wave elastography. Results were correlated with values in 128 healthy subjects. RESULTS: Patients with diffuse thyroid disease had significantly higher mean and maximal stiffnesses of the thyroid gland: 12.5 ± 5 kPa and 35.3 ± 12.8 kPa, respectively, and lower minimal stiffness: 0.5 ± 0.6 kPa than the healthy control group with mean, maximal, and minimal values of 9.5 ± 3.6 kPa, 22.5 ± 7.3 kPa, and 2.2 ± 2.1 kPa (P<0.001). Stiffness values were positively correlated with BMI and volume of the thyroid; they did not correlate with margin quality, presence of nodules nor vascularisation. Compared with healthy volunteers, thyroid glands of patients with diffuse thyroid disease had a blurred margin more frequently and the amount of nodules and vascularisation were higher. Patients with Graves-Basedow disease did not have significantly different mean, maximal, nor minimal stiffnesses than those with thyroiditis. CONCLUSION: Both mean and maximal stiffness of the thyroid gland are significantly higher in diffuse thyroid disease than in the healthy population, while minimal stiffness is lower.

Brain Imaging Findings and Response to Intravenous Thrombolysis in Posterior Circulation Stroke.

INTRODUCTION: Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischaemic stroke (ACIS) and posterior circulation ischaemic stroke (PCIS). Our aim was to evaluate the predictors for a good clinical outcome and intracerebral haemorrhage (ICH) in patients undergoing posterior circulation IVT based on the initially performed CT or MR imaging. METHODS: The study cohort consisted of 1643 consecutive patients with acute ischaemic stroke (1440 ACIS, 203 PCIS cases) who underwent IVT. ICH was classified according to the European Cooperative Acute Stroke Study (ECASS) I protocol. Clinical outcome was assessed using the modified Rankin scale (mRS). Early ischaemic signs and pre-existing structural signs were assessed. RESULTS: Good clinical outcomes (mRS 0-1) were noted in 45.3% of patients with PCIS, with a mortality rate of 14.8%. ICH was noted in 8.3%, and a large haemorrhage was found in 2.4% of patients. Some early ischaemic signs and pre-existing structural signs on initial CT/MR imaging correlated significantly with the 90-day clinical outcome. CONCLUSIONS: Early ischaemic signs and pre-existing structural signs should be considered during the assessment of patients with PCIS eligible for IVT. Tissue hypoattenuation on initial CT scans correlates with an increased risk of death. Similarly to anterior circulation, atrophy on initial MRI may negatively predict good clinical outcome in posterior circulation.

The Role of Ultrasound and Shear-Wave Elastography in Evaluation of Cervical Lymph Nodes.

AIM: To evaluate the prognostic value of ultrasound and shear-wave elastography (SWE) in diagnosing malignant cervical lymph nodes. METHODS: A total of 99 patients with enlarged lymph nodes (99 lymph nodes presenting as a neck mass) were examined clinically with conventional ultrasound including Doppler examination and shear-wave elastography. The results of the examinations were compared with the final diagnosis. RESULTS: There were 43 benign and 56 malignant lymph nodes in our cohort. Age and sex were significant predictors of malignancy. The standard ultrasound parameters-node size, long/short axis ratio, hilum, vascularization, and the presence of microcalcifications-were also statistically significant. Lymph node volume combined with age showed the best predictive power. The maximum stiffness found on SWE was also a significant predictor of malignancy. The combination of epidemiologic, classic ultrasound, and elastographic parameters yielded the highest sensitivity and specificity in the prediction of malignancy; however, the additional impact of elastographic parameters was low. CONCLUSION: A combination of epidemiologic and classic ultrasound parameters can discriminate between malignant and benign lymph nodes with satisfactory sensitivity and specificity. Examining the stiffness of lymph nodes by means of SWE does not add much new predictive power.

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study.

OBJECTIVES: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. METHODS: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). RESULTS: Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). CONCLUSION: This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

EEG data and introspective reports from the Libet׳s experiment replication.

This article provides data from a contemporary replication of Libet׳s experiment. For the methodology, results and discussion of the replication, see the article "Libet׳s Experiment: A Complex Replication" (Dominik et al., 2018). Three types of data are presented in this article: (1) introspective reports (M, W and S), (2) EMG onset times relative to a mouse click or to the target time in tasks with a movement at pre-set time and (3) relevant averaged EEG data.