The value of manure - Manure as co-product in life cycle assessment.

Livestock production is important for food security, nutrition, and landscape maintenance, but it is associated with several environmental impacts. To assess the risk and benefits arising from livestock production, transparent and robust indicators are required, such as those offered by life cycle assessment. A central question in such approaches is how environmental burden is allocated to livestock products and to manure that is re-used for agricultural production. To incentivize sustainable use of manure, it should be considered as a co-product as long as it is not disposed of, or wasted, or applied in excess of crop nutrient needs, in which case it should be treated as a waste. This paper proposes a theoretical approach to define nutrient requirements based on nutrient response curves to economic and physical optima and a pragmatic approach based on crop nutrient yield adjusted for nutrient losses to atmosphere and water. Allocation of environmental burden to manure and other livestock products is then based on the nutrient value from manure for crop production using the price of fertilizer nutrients. We illustrate and discuss the proposed method with two case studies.

Towards quantification of the crucial impact of auger recombination for the efficiency droop in (AlInGa)N quantum well structures.

Recent experimental investigations on the reduction of internal quantum efficiency with increasing current density in (AlInGa)N quantum well structures show that Auger recombination is a significant contributor to the so-called "droop" phenomenon. Using photoluminescence (PL) test structures, we find Auger processes are responsible for at least 15 % of the measured efficiency droop. Furthermore, we confirm that electron-electron-hole (nnp) is stronger than electron-hole-hole (npp) Auger recombination in standard LEDs. The ratio of respective Auger coefficients is determined to be in the range 1 < Cnnp/Cnpp ≤ 12. This asymmetry is shown to limit the detection efficiency of Auger processes in our PL-based approach.

Optical coherence tomography for planning of follicular unit extraction.

BACKGROUND: As the subcutaneous course of the hair follicle cannot be extrapolated from the angle of hair emergence, the follicular unit extraction (FUE) method bears the risk of follicle transsection potentially affecting the success of the whole intervention. Histological examination can provide this angle information but are too time consuming and invasive to be integrated in the workflow. OBJECTIVE: In this work, the authors present an effective and noninvasive way to determine these subcutaneous follicle angles. METHODS AND MATERIALS: For this purpose, the authors use optical coherence tomography to provide images of the first 2 to 3 mm of the surface of the skin. RESULTS: On 3 probands, they scanned 2 regions. We computed the number of hair follicles in a certain angular region around a mean angle, representing an FUE tool, and found a considerable diversity of the angular deviations. CONCLUSION: As this angular distribution massively influences the transsection rate, the authors suggest such a method to be considered as a future improvement of preoperative assessment.

Gonococcal infections in Austria: a long-term observation of prevalence and resistance profiles from 1999 to 2014.

BACKGROUND AND OBJECTIVES: The increase in minimum inhibitory concentrations (MICs) of cephalosporins for Neisseria gonorrhoeae has given rise to concerns regarding potentially untreatable gonococcal infections. The goal was to ascertain the prevalence of gonorrhea in a Viennese patient group and determine resistance patterns. Another objective was to evaluate resistance profiles and MIC values of gonococcal isolates in an Austria-wide surveillance project. PATIENTS AND METHODS: From 1999 to 2014, 350,000 individuals were tested for gonococci at the Viennese Outpatient Clinic. In addition, from 2010 to 2014, the MICs of recommended antibiotics was determined in 3,584 gonococcal isolates, initially by agar dilution and breakpoint determination, and, from 2012 onwards, by Etest®. RESULTS: During the observation period, the prevalence of gonorrhea increased eightfold, with a significantly greater number of quinolone, penicillin, and tetracycline- resistant strains. In gonococcal strains isolated from across Austria, there was an increase in cefixime and ceftriaxone MICs toward breakpoints. Twenty-one isolates showed cefixime resistance, and while there was an increase in azithromycin resistance from 0.9 % (2013) to 3.2 % (2014), no resistance to ceftriaxone was observed. CONCLUSION: Currently, there is no imminent risk of untreatable gonorrhea in Austria. However, continuing the use of gonococcal cultures as a diagnostic tool for establishing resistance profiles is essential in order to monitor trends in the development of Neisseria (N.) gonorrhoeae resistance.

[Effect of the liquid milk nutritional supplement with enhanced content of whey protein on the nutritional status of the elderly]. / Vliv podávání tekutého mlécného nutricního doplnku se zvýseným obsahem syrovátkových bílkovin na nutricní stav senioru

AIM: The aim of this study was to evaluate the effect of long-term administration of liquid nutritional supplement with increased amounts of whey protein and reduced amounts of lactose, produced in accordance with a new recipe "Nutrisen" on the elderly living in institutionalized care. METHODS: The study was carried out from May to July, 2013, on 47 retirement home residents, living in Prague, all of which were 65 years or older. Supplemented group (n = 23) consumed (200 ml) milk drinks with three different flavours on a daily basis for eight weeks. The reference group was on a normal diet. There was no significant difference in baseline characteristics between participants in both groups. Anthropometric and biochemical indicators of nutritional status and tolerance of the nutritional supplement during long-term use were evaluated. RESULTS: Both compliance (daily intake program) and tolerance of the nutritionally defined supplement were very good. For the supplemented group, there was an average weight increased of 700 grams after the 8 week nutritional supplement test period. Average levels of albumin and prealbumin increased significantly (from the beginning to the end of the program), 35.5 ± 4.52 g/l vs 36.19 ± 4.1 g/l and 0.160 ± 0.05 vs 0.174 ± 0.04 g/l (p < 0.05), vitamin D levels increased from 31.2 ± 16.4 nmol/l to 36.8 ± 17.7 nmol/l (p < 0.001) and HDL-cholesterol levels increased from 1.29 ± 0.33 mmol/l to 1.35 ± 0.35 mmol/l (p < 0.001). CONCLUSION: The specific nutritionally defined milk drink (Nutrisen), used in this study, was well tolerated by the elderly study participants, over the eight-week clinical study. We observed a positive effect on the participants weight, serum albumin, prealbumin, vitamin D and HDL-cholesterol.

Interaction of the retinoic acid signaling pathway with spicule formation in the marine sponge Suberites domuncula through activation of bone morphogenetic protein-1.

BACKGROUND: The formation of the spicules in siliceous sponges involves the formation of cylinder-like structures in the extraspicular space, composed of the enzyme silicatein and the calcium-dependent lectin. SCOPE OF REVIEW: Molecular cloning of the cDNAs (carotene dioxygenase, retinal dehydrogenase, and BMB-1 [bone morphogenic protein-1]) from the demosponge Suberites domuncula was performed. These tools were used to understand the retinoid metabolism in the animal by qRT-PCR, immunoblotting and TEM. MAJOR CONCLUSIONS: We demonstrate that silintaphin-2, a silicatein-interacting protein, is processed from a longer-sized 15-kDa precursor to a truncated, shorter-sized 13kDa calcium-binding protein via proteolytic cleavage at the dipeptide Ala↓Asp, mediated by BMP-1. The expression of this protease as well as the expression of two key enzymes of the carotinoid metabolism, the ß,ß-carotene-15,15'-dioxygenase and the retinal dehydrogenase/reductase, were found to be strongly up-regulated by retinoic acid. Hence retinoic acid turned out to be a key factor in skeletogenesis in the most ancient still existing metazoans, the sponges. GENERAL SIGNIFICANCE: It is shown that retinoic acid regulates the formation of the organic cylinder that surrounds the axis of the spicules and enables, as a scaffold, the radial apposition of new silica layers and hence the growth of the spicules.

Differential expression of the demosponge (Suberites domuncula) carotenoid oxygenases in response to light: protection mechanism against the self-produced toxic protein (Suberitine).

The demosponge Suberites domuncula has been described to contain high levels of a proteinaceous toxin, Suberitine, that displays haemolytic activityIn the present study this 7-8 kDa polypeptide has been isolated and was shown to exhibit also cytotoxic effects on cells of the same species. Addition of retinal, a recently identified metabolite of ß-carotene that is abundantly present in S. domuncula was found to reduce both the haemolytic and the cell toxic activity of Suberitine at a molar ratio of 1:1. Spectroscopic analyses revealed that the interaction between ß-carotene and Suberitine can be ascribed to a reversible energy transfer reaction. The enzyme that synthesises retinal in the sponge system is the ß,ß-carotene-15,15'-dioxygenase [carotene dioxygenase]. In order to clarify if this enzyme is the only ß-carotene-metabolizing enzyme a further oxygenase had been identified and cloned, the (related) carotenoid oxygenase. In contrast to the dioxygenase, the carotenoid oxygenase could not degrade ß-carotene or lycopene in Escherichia coli strains that produced these two carotenoids; therefore it had been termed related-carotenoid oxygenase. Exposure of primmorphs to light of different wavelengths from the visible spectrum resulted after 3 days in a strong upregulation of the dioxygenase in those 3D-cell aggregates that had been incubated with ß-carotene. The strongest effect is seen with blue light at a maximum around 490 nm. It is concluded that the toxin Suberitine is non-covalently modified by retinal, the cleavage product from ß-carotene via the enzyme carotene dioxygenase, a light inducible oxygenase. Hence, this study highlights that in S. domuncula the bioactive metabolite, retinal, has the property to detoxify its homologous toxin.

Symptoms associated with a COVID-19 infection among a non-hospitalized cohort in Vienna.

BACKGROUND: Most clinical studies report the symptoms experienced by those infected with coronavirus disease 2019 (COVID-19) via patients already hospitalized. Here we analyzed the symptoms experienced outside of a hospital setting. METHODS: The Vienna Social Fund (FSW; Vienna, Austria), the Public Health Services of the City of Vienna (MA15) and the private company Symptoma collaborated to implement Vienna's official online COVID-19 symptom checker. Users answered 12 yes/no questions about symptoms to assess their risk for COVID-19. They could also specify their age and sex, and whether they had contact with someone who tested positive for COVID-19. Depending on the assessed risk of COVID-19 positivity, a SARS-CoV­2 nucleic acid amplification test (NAAT) was performed. In this publication, we analyzed which factors (symptoms, sex or age) are associated with COVID-19 positivity. We also trained a classifier to correctly predict COVID-19 positivity from the collected data. RESULTS: Between 2 November 2020 and 18 November 2021, 9133 people experiencing COVID-19-like symptoms were assessed as high risk by the chatbot and were subsequently tested by a NAAT. Symptoms significantly associated with a positive COVID-19 test were malaise, fatigue, headache, cough, fever, dysgeusia and hyposmia. Our classifier could successfully predict COVID-19 positivity with an area under the curve (AUC) of 0.74. CONCLUSION: This study provides reliable COVID-19 symptom statistics based on the general population verified by NAATs.

Comparison of SARS-CoV-2 Antibody Response 4 Weeks After Homologous vs Heterologous Third Vaccine Dose in Kidney Transplant Recipients: A Randomized Clinical Trial.

Importance: Fewer than 50% of kidney transplant recipients (KTRs) develop antibodies against the SARS-CoV-2 spike protein after 2 doses of an mRNA vaccine. Preliminary data suggest that a heterologous vaccination, combining mRNA and viral vector vaccines, may increase immunogenicity. Objective: To assess the effectiveness of a third dose of an mRNA vs a vector vaccine in KTRs who did not have antibodies against the SARS-CoV-2 spike protein after 2 doses of an mRNA vaccine. Design, Setting, and Participants: This was a single center, single-blinded, 1:1 randomized clinical trial of a third dose of vaccine against SARS-CoV-2, conducted from June 15 to August 16, 2021, in 201 KTRs who had not developed SARS-CoV-2 spike protein antibodies after 2 doses of an mRNA vaccine. Data analyses were performed from August 17 to August 31, 2021. Interventions: mRNA (BNT162b2 or mRNA-1273) or vector (Ad26COVS1) as a third dose of a SARS-CoV-2 vaccine. Main Outcomes and Measures: The primary study end point was seroconversion after 4 weeks (29-42 days) following the third vaccine dose. Secondary end points included neutralizing antibodies and T-cell response assessed by interferon-γ release assays (IGRA). In addition, the association of patient characteristics and vaccine response was assessed using logistic regression, and the reactogenicity of the vaccines was compared. Results: Among the study population of 197 kidney transplant recipients (mean [SD] age, 61.2 [12.4] years; 82 [42%] women), 39% developed SARS-CoV-2 antibodies after the third vaccine. There was no statistically significant difference between groups, with an antibody response rate of 35% and 42% for the mRNA and vector vaccines, respectively. Only 22% of seroconverted patients had neutralizing antibodies. Similarly, T-cell response assessed by IGRA was low with only 17 patients showing a positive response after the third vaccination. Receiving nontriple immunosuppression (odds ratio [OR], 3.59; 95% CI, 1.33-10.75), longer time after kidney transplant (OR, 1.44; 95% CI, 1.15-1.83, per doubling of years), and torque teno virus plasma levels (OR, 0.92; 95% CI, 0.88-0.96, per doubling of levels) were associated with vaccine response. The third dose of an mRNA vaccine was associated with a higher frequency of local pain at the injection site compared with the vector vaccine, while systemic symptoms were comparable between groups. Conclusions and Relevance: This randomized clinical trial found that 39% of KTRs without an immune response against SARS-CoV-2 after 2 doses of an mRNA vaccine developed antibodies against the SARS-CoV-2 spike protein 4 weeks after a third dose of an mRNA or a vector vaccine. The heterologous vaccination strategy with a vector-based vaccine was well tolerated and safe but not significantly better than the homologous mRNA-based strategy. Trial Registration: EudraCT Identifier: 2021-002927-39.

Low SARS-CoV-2 seroprevalence in the Austrian capital after an early governmental lockdown.

We analyzed SARS-CoV-2 seroprevalence in a large, well-described representative Viennese cohort after an early governmental lockdown with respect to the occurrence of symptoms and household transmission. Participants of the LEAD Study, a population-based cohort study from Vienna, Austria, were invited along with their household members (April 20th to May20th 2020). Sera were analyzed using anti-SARS-CoV-2 immunoassay including a neutralization test as a confirmatory assay. A total of 12,419 individuals participated (5984 LEAD participants; 6435 household members), 163 (1.31%; 59 LEAD cohort members) of whom were SARS-CoV-2 antibody positive. The estimated number of COVID-19 cases projected from our findings by age and sex for Vienna was 21,504 (1.13%). Cumulative number of positively tested cases in Vienna until May 20th 2020 was 3020, hence 7.1 times (95% confidence interval 5.5-9.1) lower than projected. Relative risk (RR) of seropositivity by age was highest for children aged 6-9 years [RR compared to age group 20-49: 1.21 (CI 0.37-4.01)], lowest for ≥ 65 years [RR 0.47 (CI 0.21-1.03)]. Half of the positive individuals developed no or mild symptoms. In a multivariate analysis, taste and smell disturbances were most strongly related to SARS-CoV-2 positivity. Infection probability within households with one confirmed SARS-CoV-2-specific antibody-positive person was 31%. Although seroprevalence was very low (1.13%) for a central European capital city, due to an early governmental lockdown, SARS-CoV-2 infections were more prevalent than officially reported polymerase chain reaction-positive cases. Of note, seroprevalence was highest in young children. Half of SARS-CoV-2 antibody-positive subjects had no or only mild symptoms. Taste and smell disturbances were most prominent, possibly guiding clinicians in diagnosing SARS-CoV-2 infection.

Defying the Rally During COVID-19 Pandemic: A Regression Discontinuity Approach.

Objective: Do people set aside their partisan differences and rally around elected officials during a pandemic? President Trump's delegation of responsibility to the states during the COVID-19 pandemic placed governors on the frontlines of the battle; some have shined and garnered positive national attention, others have wilted under the pressure of the national spotlight. Methods: We use regression discontinuity design and exploit a discontinuity in the state's political events to assess the support of a governor's response to the pandemic. Results: Using survey data from Florida's registered voters, we find that Governor DeSantis's approval dropped by 7 percentage points following his "Safer at Home" order press conference on April 1. Conclusion: Our results suggest that under certain circumstances partisanship can blunt a "rally around the flag" effect. This finding provides context to understanding when and under which circumstances elected officials can expect increases (or decreases) in public support.

A Case Report of Multiple Myeloma Associated With Myeloperoxidase and Proteinase-3 Antibodies Posing a Diagnostic Dilemma.

Multiple myeloma (MM) is a clonal proliferation of antibody-producing plasma cells that can precipitate renal injury through multiple mechanisms. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an inflammatory condition that can result in renal failure through mononuclear cell infiltration and consequent destruction of glomeruli. Several case reports have identified clinical situations where differentiating these entities has been challenging. Renal biopsy is an invaluable tool in differentiating between MM and AAV when clinical uncertainty exists. We report the case of an 85-year-old man who presented with a rapid decline in renal function and serologies positive for both MM and AAV. Renal biopsy findings confirmed the diagnosis of myeloma kidney and excluded vasculitis. This case highlights an unusual clinical scenario in which both proteinase-3 (PR-3) and myeloperoxidase (MPO) antibodies are positive. While these antibodies are both individually associated with ANCA vasculitis, they are seldom simultaneously positive. Our case would suggest that positive PR-3 and MPO antibodies should raise concern for an alternative diagnosis. Indeed, ANCA, PR-3, and MPO antibodies can all be positive in patients with monoclonal gammopathy in the absence of vasculitis. Our case underscores the value of renal biopsy in the setting of MM.

Telemedically augmented palliative care : Empowerment for patients with advanced cancer and their family caregivers.

BACKGROUND: Studies have shown that initiating early palliative care of patients with end-stage cancer can improve their quality of life and decrease symptoms of depression. The challenge is to find an effective way to care for these patients while minimizing the burden on healthcare resources. Telemedicine can play a vital role in solving this problem. METHODS: A user-friendly telemedical device enabling patients encountering medical problems to send a direct request to a palliative care team was developed. A controlled feasibility study was conducted by assigning 15 patients with advanced cancer and their family caregivers to receive either standard palliative care or telemedically augmented palliative care. Th quality of life (QoL) was assessed using standardized validated questionnaires as well as frequency and duration of hospital admissions and user satisfaction. The primary goal of this study was to increase the QoL of patients and their family caregivers. The secondary goal of this study was to decrease the frequency and duration of hospital admissions. RESULTS: This study showed a good feasibility despite the low overall willingness to participate in a relatively "technical" trial. The hospital anxiety and depression scale (HADS) was significantly lower in the intervention group, suggesting an improved quality of life. Although a decrease in the number of hospital admissions could not be shown, the user satisfaction was very good. CONCLUSION: Telemedicine could be a useful tool to enhance the general well-being of palliative oncology patients. Now that the feasibility of this approach has been confirmed, larger studies are needed to verify its positive impact on the QoL.

Fast Electron and Slow Hole Relaxation in InP-Based Colloidal Quantum Dots.

Colloidal InP-based quantum dots are a promising material for light-emitting applications as an environment friendly alternative to their Cd-containing counterparts. Especially for their use in optoelectronic devices, it is essential to understand how charge carriers relax to the emitting state after injection with excess energy and if all of them arrive at this desired state. Herein, we report time-resolved differential transmission measurements on colloidal InP/ZnS and InP/ZnSe core/shell quantum dots. By optically exciting and probing individual transitions, we are able to distinguish between electron and hole relaxation. This, in turn, allows us to determine how the initial excess energy of the charge carriers affects the relaxation processes. According to the electronic level scheme, one expects a strong phonon bottleneck for electrons, whereas holes should relax easier as their energy levels are more closely spaced. On the contrary, we find that electrons relax faster than holes. The fast electron relaxation occurs via an efficient Auger-like electron-hole scattering mechanism. On the other hand, a small wave function overlap between core and shell states slows the hole relaxation. Additionally, holes can be trapped at the core/shell interface, leading to either slow detrapping or nonradiative recombination. Overall, these results demonstrate that it is crucial to construct devices enabling the injection of charge carriers energetically close to their emitting states in order to maximize the radiative efficiency of the system.

Firearm Violence and Effects on Concealed Gun Carrying: Large Debate and Small Effects.

Research has yet to identify a predictive relationship between crime and the issuance of aggregated concealed gun permits. The present study examines if a macro-level relationship exists between both concealed carry firearm applications and permits and violent crime committed with a firearm. Florida county-level data for concealed carry applications and violent crime are combined with police employment, socioeconomic, political, and firearm subculture variables across two temporal periods using both county and year fixed effects models. Unstandardized negative binomial regressions are employed with multiple alternative model specifications and diagnostic tests. Findings indicate a positive association between crime, especially those committed with a firearm, and concealed carry applications and permits. The effect size of firearm violent crime on concealed carry applications and permits is minimal. There is a demonstrable link between firearm violence and concealed carry applications and permits issued, net all covariates. Findings should be tempered by the minimal effect sizes.

ANCA-Associated Vasculitis Co-Occurrence With Systemic Sclerosis: A Case Report of a Rare Diagnostic Dilemma.

Systemic sclerosis (SSc) is a rare autoimmune disorder that is typically divided into limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis. Scleroderma renal crisis (SRC) is a severe complication of SSc and typically presents with new-onset hypertension and a reduction in renal functioning. In patients presenting with typical features of SRC, treatment with an angiotensin-converting enzyme inhibitor along with dialysis as needed is typically initiated empirically. Renal biopsy is not recommended in patients with SSc presenting with typical features of SRC. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare co-occurrence with SSc, in around 2.5% to 9% of patients. AAV is an inflammatory condition that can result in renal failure due to mononuclear cell infiltration and destruction of blood vessels. Treatment of AAV is drastically different from SRC and typically consists of immunosuppressants and dialysis if needed. SRC and AAV can only reliably be distinguished by renal biopsy. We present a rare case of a 70-year-old female with limited cutaneous systemic sclerosis who presented to the emergency department with new-onset renal failure. Her serology was found to be positive for antinuclear antibodies and myeloperoxidase antibodies, resulting in a renal biopsy, which revealed an acute necrotizing vasculitis consistent with AAV. We suggest consideration of a renal biopsy in patients with SSc who present with new-onset renal failure, especially with nonresponse to SRC treatment or positive serology.

Executable medical guidelines with Arden Syntax-Applications in dermatology and obstetrics.

INTRODUCTION: Clinical decision support systems (CDSSs) are being developed to assist physicians in processing extensive data and new knowledge based on recent scientific advances. Structured medical knowledge in the form of clinical alerts or reminder rules, decision trees or tables, clinical protocols or practice guidelines, score algorithms, and others, constitute the core of CDSSs. Several medical knowledge representation and guideline languages have been developed for the formal computerized definition of such knowledge. One of these languages is Arden Syntax for Medical Logic Systems, an International Health Level Seven (HL7) standard whose development started in 1989. Its latest version is 2.10, which was presented in 2014. In the present report we discuss Arden Syntax as a modern medical knowledge representation and processing language, and show that this language is not only well suited to define clinical alerts, reminders, and recommendations, but can also be used to implement and process computerized medical practice guidelines. METHODS: This section describes how contemporary software such as Java, server software, web-services, XML, is used to implement CDSSs based on Arden Syntax. Special emphasis is given to clinical decision support (CDS) that employs practice guidelines as its clinical knowledge base. RESULTS: Two guideline-based applications using Arden Syntax for medical knowledge representation and processing were developed. The first is a software platform for implementing practice guidelines from dermatology. This application employs fuzzy set theory and logic to represent linguistic and propositional uncertainty in medical data, knowledge, and conclusions. The second application implements a reminder system based on clinically published standard operating procedures in obstetrics to prevent deviations from state-of-the-art care. A to-do list with necessary actions specifically tailored to the gestational week/labor/delivery is generated. DISCUSSION: Today, with the latest versions of Arden Syntax and the application of contemporary software development methods, Arden Syntax has become a powerful and versatile medical knowledge representation and processing language, well suited to implement a large range of CDSSs, including clinical-practice-guideline-based CDSSs. Moreover, such CDS is provided and can be shared as a service by different medical institutions, redefining the sharing of medical knowledge. Arden Syntax is also highly flexible and provides developers the freedom to use up-to-date software design and programming patterns for external patient data access.

Limitations of dermoscopy in the recognition of melanoma.

OBJECTIVE: To compare dermoscopic features of melanocytic nevi with those of early melanomas that were not excised initially because of their uncharacteristic clinical and dermoscopic appearance. DESIGN: Retrospective study of the baseline images of 325 melanocytic skin lesions that were observed by digital dermoscopy and finally excised because of changes over time. SETTING: A dermatologic clinic and a dermatologic department at a university hospital. MAIN OUTCOME MEASURES: Comparison of baseline images of melanomas and melanocytic nevi by pattern analysis, the ABCD rule of dermoscopy, and the 7-point checklist. RESULTS: Baseline dermoscopic images of 262 melanocytic nevi and 63 melanomas from 315 patients were included in the analysis. The patterns of dermoscopic features observed in the baseline images of melanocytic lesions finally diagnosed as melanomas during follow-up did not differ substantially from the patterns observed in the baseline images of melanocytic nevi. Pattern analysis, the ABCD rule of dermoscopy, and the 7-point checklist failed to achieve adequate diagnostic accuracy for melanoma. In retrospect, no dermoscopic feature or pattern of features could be identified that reliably differentiated between melanomas and melanocytic nevi at the time of the first presentation. CONCLUSION: Dermoscopy depends on the appearance of classic dermoscopic features and is therefore limited in the diagnosis of very early and mainly featureless melanomas.