Appropriate interpretation of kidney function is essential for clinical and therapeutic management of heart failure (HF). We evaluated the prognostic accuracy of 6 glomerular filtration rate estimation (eGFR) formulas in HF patients with reduced ejection fraction (HFrEF) and their impact on the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score prognostic accuracy. We retrospectively analyzed 6933 patients enrolled in the MECKI score database. GFR was estimated using Modification of Diet in Renal Disease (MDRD); MRDR modified (MDRDm); Cockcroft-Gault (CG), CG modified (CGm); Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and the European Kidney Function Consortium (EKFC). Survival was assessed as the composite of cardiovascular death, left ventricular assist device implantation and urgent heart transplantation at 2 years. Each GFR estimation demonstrated similar but moderate prognostic capacity, with the area under the curve (AUC) for predicting survival ranging from 0.6271 (EKFC) to 0.635 (MDRD). For cardiovascular death, the AUC values ranged from 0.668 to 0.677. The prevalence of severe CKD, defined as eGFR <30 mL/min/1.73 m², ranged from 3.2% (MDRD) to 4.5% (EKFC). When included in MECKI score, the 6 formulas showed a MECKI AUC for prognosis ranging from 0.7841 to 0.7883, with the EKFC and CKD-EPI showing the best performance. GFR estimations play a role in HFrEF prognosis without difference among the 6 most frequently used formulas. Furthermore, using eGFR calculated from the 6 different formulas in MECKI score did not significantly alter its strong prognostic power, highlighting MECKI reliability in risk stratification.

Background Following stroke, brain networks can be described by strength of local connections (clustering coefficient [Cw]) and strength of global interconnections (path length [Lw]) between nodes, and their balance (Small-worldness [Sw]). Objective. To identify electroencephalography (EEG) networks predicting clinical evolution in stroke through a multicenter cross-sectional study. Methods We consecutively recruited 87 anterior circulation ischemic stroke patients. We obtained resting-state EEG (31 electrodes, 10-10 system) within 24 hours from stroke (T0) and at discharge from stroke unit (4–10 days after stroke; T1). EEG data were elaborated with EEGLAB and Lagged Linear Coherence among cortical sources of EEG signals was analyzed using eLORETA. We performed a multiple linear regression with National Institutes of Health Stroke Scale (NIHSS) at T0 and T1 as dependent variables and Cw, Lw, and Sw of delta, theta, and alpha networks as independent variables. Results We found a negative association between alpha1 Sw and NIHSS at T0 (β = −.232, P = .04) meaning that the lower is alpha efficiency the higher is clinical severity and a positive association between delta Sw and NIHSS at T1 (β = .423, P < .001) meaning that the higher is delta efficiency the higher is clinical severity. We found positive association between delta Sw at T0 and NIHSS at T1 (β = .259, P = .02), meaning that the higher is delta efficiency in the hyperacute phase the higher is clinical severity at T1. Conclusions A higher delta Sw within 24 hours after stroke is associated to higher NIHSS within 10 days. Delta brain network rearrangement in the hyperacute phase is a potential neurophysiological measure to be integrated in multi-modal prognostic models.

Suicide is a major global public health concern that affects people of all ages, with over 700000 individuals intentionally ending their lives every year. Suicide is a multifactorial event related to multiple risk factors interlocking with each other, among which neurobiological factors are considered to be an objective measure of the incidence of this phenomenon and can be used as a measurable tool for evaluating suicidal tendencies. The aim of this study is to thoroughly examine available data and assess candidate proteins as prospective biomarkers for predicting suicides and ascertaining the manner of death in forensic cases. An electronic search was conducted on PubMed, Science Direct Scopus, and the Excerpta Medica Database. The systematic review adhered to PRISMA guidelines and encompassed case series, prospective and retrospective studies, and short communications published in English. The focus was on proteomics and suicide, specifically, those studies where researchers conducted human proteomic analyses on specimens obtained from individuals who completed or attempted suicide. A total of 14 studies met the inclusion criteria, resulting in a dataset of numerous candidate protein biomarkers. These include tenascin-C, potassium voltage-gated channel subfamily Q member 3, vimentin-immunoreactive astrocytes, glutathione S-transferase theta 1, iron transport proteins, Acrystallin chain B, manganese superoxide dismutase, glial fibrillary acidic protein, various glycolytic pathway proteins, 14-3-3 eta and 14-3-3 theta proteins, specific cytoskeleton proteins, C-reactive protein, serum amyloid A protein 1, extrinsic coagulation pathway proteins, the vacuolar-type proton pump ATPase subunit, plasma apolipoprotein A-IV, and ER stress proteins. These proteins are proposed as a panel of biomarkers to be evaluated in conjunction with other clinical predictors of suicide. This review aims to provide a comprehensive summary of all proteomic studies conducted on cases of attempted or completed suicide. By doing so, it seeks to bridge existing gaps in knowledge and pave the way for future investigations. The ultimate goal is to potentially identify a suicide biomarker.

Diagnosing facial melanoma, specifically lentigo maligna (LM) and lentigo maligna melanoma (LMM), is a daily clinical challenge, particularly for small or traumatized lesions. LM and LMM are part of the broader group of atypical pigmented facial lesions (aPFLs), which also includes benign look-alikes such as solar lentigo (SL), atypical nevi (AN), seborrheic keratosis (SK), and seborrheic-lichenoid keratosis (SLK), as well as pigmented actinic keratosis (PAK), a potentially premalignant keratinocytic lesion. Standard dermoscopy with handheld devices is the most widely used diagnostic tool in dermatology, but its accuracy heavily depends on the clinician's experience and the perceived difficulty of the case. As a result, many benign aPFLs are excised for histological analysis, often leading to aesthetic concerns. Reflectance confocal microscopy (RCM) can reduce the need for biopsies, but it is limited to specialized centers and requires skilled operators. This study aimed to assess the impact of personal skill, diagnostic confidence, and perceived difficulty on the diagnostic accuracy and management in the differential dermoscopic diagnosis of aPFLs. A total of 1197 aPFLs dermoscopic images were examined on a teledermoscopic web platform by 155 dermatologists and residents with 4 skill levels (<1, 1-4, 5-8, >8 years). They were asked to give a diagnosis, to estimate their confidence and rate the case, and choose a management strategy: "follow-up", "RCM" or "biopsy". Diagnostic accuracy was examined according to the personal skill level, confidence level, and rating in three settings: (I) all seven diagnoses, (II) LM vs. PAK vs. fully benign aPFLs, (III) malignant vs benign aPFLs. The same analyses were performed for management decisions. The diagnostic confidence has a certain impact on the diagnostic accuracy, both in terms of multi-class diagnosis of six aPFLs in diagnostic (setting 1) and in benign vs malignant (setting 3) or benign vs. malignant/premalignant discrimination (setting 2). The perceived difficulty influences the management of benign lesions, with easy ratings predominantly matching with "follow-up" decision in benign cases, but not that of malignant lesions assigned to "biopsy". The experience level had an impact on the perception of the number of real easy cases and had no to minimal impact on the average diagnostic accuracy of aPFLs. It, however, has an impact on the management strategy and specifically in terms of error reduction, namely the lowest rates of missed malignant cases after 8 years of experience and the lowest rates of inappropriate biopsies of benign lesions after 1 year of experience. The noninvasive diagnosis and management of aPFLs rest on a daily challenge. Highlighting which specific subgroups of lesions need attention and second-level examination (RCM) or biopsy can help detect early malignant cases, and, in parallel, reduce the rate of unnecessary removal of benign lesions.

BACKGROUNDHigh-resolution optical coherence tomography (HR-OCT) has become an essential instrument in the screening and diagnosis of ocular surface neoplasms. Research demonstrates that HR-OCT possesses a diagnostic sensitivity ranging from 85% to 90% for ocular surface squamous neoplasia (OSSN). The connections between HR-OCT features and histological findings have consistently shown robustness, hence increasing the reliability of clinical diagnosis.AIMTo examine the existing HR-OCT indicators employed in the identification of common non-benign ocular surface tumors, namely, basal cell carcinoma, OSSN, and melanocytic conjunctival lesions, and to assess their diagnostic efficacy, benefits, and prospective developments.METHODSA thorough literature review was performed to assess the published research on HR-OCT in the diagnosis of ocular surface cancers. Significant attention was given to research that compares HR-OCT characteristics with histopathologic validation, as well as on publications addressing the integration of emerging technologies and artificial intelligence in ocular oncology imaging.RESULTSHR-OCT exhibits elevated diagnostic sensitivity (85%-90%) for identifying OSSN and presents distinct imaging patterns that align closely with histology results. This approach has substantial clinical advantages due to its non-invasive characteristics, improved axial resolution, and real-time imaging capabilities. HR-OCT has demonstrated potential in assessing various lesions, including basal cell carcinoma and melanocytic conjunctival malignancies.CONCLUSIONHR-OCT assumes an increasingly vital role in the early identification and clinical management of ocular surface malignancies. With advancements in imaging technology and the integration of artificial intelligence, HR-OCT is anticipated to enhance individualized diagnosis and treatment planning in ocular oncology, hence improving patient outcomes.

Peritoneal carcinomatosis represents an exceptionally rare metastatic pattern of cutaneous malignant melanoma, occurring in fewer than 1% of cases with distant spread and typically within the first few years after primary treatment. This report presents an unusual case with a markedly prolonged disease-free interval, clinically mimicking advanced ovarian carcinoma. We report the case of a 53-year-old woman treated more than 10 years ago for stage IIB nodular melanoma with surgery and adjuvant therapy. The patient presented with progressive abdominal bloating. Imaging revealed bilateral adnexal masses, ascites, peritoneal carcinomatosis, and multiple pulmonary nodules, initially suggestive of advanced ovarian cancer. Diagnostic laparoscopy demonstrated diffuse peritoneal lesions with an atypical yellowish, soft, and nonpigmented appearance. Histology and immunohistochemistry confirmed metastatic melanoma. This case is among the few reports of peritoneal carcinomatosis from melanoma after more than a decade of remission. The prolonged disease-free interval and atypical presentation underline the heterogeneous behavior of melanoma and the need for long-term vigilance and multidisciplinary evaluation.