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The rapid increase in telemedicine coupled with recent advances in diagnostic artificial intelligence (AI) create the imperative to consider the opportunities and risks of inserting AI-based support into new paradigms of care. Here we build on recent achievements in the accuracy of image-based AI for skin cancer diagnosis to address the effects of varied representations of AI-based support across different levels of clinical expertise and multiple clinical workflows. We find that good quality AI-based support of clinical decision-making improves diagnostic accuracy over that of either AI or physicians alone, and that the least experienced clinicians gain the most from AI-based support. We further find that AI-based multiclass probabilities outperformed content-based image retrieval (CBIR) representations of AI in the mobile technology environment, and AI-based support had utility in simulations of second opinions and of telemedicine triage. In addition to demonstrating the potential benefits associated with good quality AI in the hands of non-expert clinicians, we find that faulty AI can mislead the entire spectrum of clinicians, including experts. Lastly, we show that insights derived from AI class-activation maps can inform improvements in human diagnosis. Together, our approach and findings offer a framework for future studies across the spectrum of image-based diagnostics to improve human–computer collaboration in clinical practice. A systematic evaluation of the value of AI-based decision support in skin tumor diagnosis demonstrates the superiority of human–computer collaboration over each individual approach and supports the potential of automated approaches in diagnostic medicine.

Whether machine-learning algorithms can diagnose all pigmented skin lesions as accurately as human experts is unclear. The aim of this study was to compare the diagnostic accuracy of state-of-the-art machine-learning algorithms with human readers for all clinically relevant types of benign and malignant pigmented skin lesions. For this open, web-based, international, diagnostic study, human readers were asked to diagnose dermatoscopic images selected randomly in 30-image batches from a test set of 1511 images. The diagnoses from human readers were compared with those of 139 algorithms created by 77 machine-learning labs, who participated in the International Skin Imaging Collaboration 2018 challenge and received a training set of 10 015 images in advance. The ground truth of each lesion fell into one of seven predefined disease categories: intraepithelial carcinoma including actinic keratoses and Bowen's disease; basal cell carcinoma; benign keratinocytic lesions including solar lentigo, seborrheic keratosis and lichen planus-like keratosis; dermatofibroma; melanoma; melanocytic nevus; and vascular lesions. The two main outcomes were the differences in the number of correct specific diagnoses per batch between all human readers and the top three algorithms, and between human experts and the top three algorithms. Between Aug 4, 2018, and Sept 30, 2018, 511 human readers from 63 countries had at least one attempt in the reader study. 283 (55·4%) of 511 human readers were board-certified dermatologists, 118 (23·1%) were dermatology residents, and 83 (16·2%) were general practitioners. When comparing all human readers with all machine-learning algorithms, the algorithms achieved a mean of 2·01 (95% CI 1·97 to 2·04; p<0·0001) more correct diagnoses (17·91 [SD 3·42] vs 19·92 [4·27]). 27 human experts with more than 10 years of experience achieved a mean of 18·78 (SD 3·15) correct answers, compared with 25·43 (1·95) correct answers for the top three machine algorithms (mean difference 6·65, 95% CI 6·06–7·25; p<0·0001). The difference between human experts and the top three algorithms was significantly lower for images in the test set that were collected from sources not included in the training set (human underperformance of 11·4%, 95% CI 9·9–12·9 vs 3·6%, 0·8–6·3; p<0·0001). State-of-the-art machine-learning classifiers outperformed human experts in the diagnosis of pigmented skin lesions and should have a more important role in clinical practice. However, a possible limitation of these algorithms is their decreased performance for out-of-distribution images, which should be addressed in future research. None.

Immune checkpoint inhibitors are used for treating patients with metastatic melanoma. Since the response to treatment is variable, biomarkers are urgently needed to identify patients who may benefit from such therapy. Here, we combine single-cell RNA-sequencing and multiparameter flow cytometry to assess changes in circulating CD8 + T cells in 28 patients with metastatic melanoma starting anti-PD-1 therapy, followed for 6 months: 17 responded to therapy, whilst 11 did not. Proportions of activated and proliferating CD8 + T cells and of mucosal-associated invariant T (MAIT) cells are significantly higher in responders, prior to and throughout therapy duration. MAIT cells from responders express higher level of CXCR4 and produce more granzyme B. In silico analysis support MAIT presence in the tumor microenvironment. Finally, patients with >1.7% of MAIT among peripheral CD8 + population show a better response to treatment. Our results thus suggest that MAIT cells may be considered a biomarker for patients responding to anti-PD-1 therapy. Immune checkpoint inhibition (ICI) shows potential for cancer therapies, but response rates vary. Here, the authors use single-cell analyses to show that, in a 28 patient cohort, patients stratified by mucosal-associated invariant T (MAIT) percentages show different response rates, and ICI responders have more MAIT cells expressing CXCR4 and granzyme B.

A 47-year-old woman with metastatic melanoma presented with progressive discoloration of the skin, nails, and oral mucosa and with melanuria.

Marine sponges are recognized as reservoirs of diverse microorganisms that produce bioactive natural compounds. In this study, we conducted a metataxonomic analysis of Geodia cydonium specimens collected from four sites in Italy: Secca delle Fumose (Gulf of Naples, Tyrrhenian Sea), Mar Piccolo of Taranto and an Integrated Multi-Trophic Aquaculture (IMTA) system in Mar Grande of Taranto (both located in the Ionian Sea), and Polignano a Mare (Adriatic Sea). Our results revealed a highly diverse microbial community within the sponges, encompassing 24 bacterial phyla. Among these, Chloroflexota was the most abundant phylum, accounting for an average of 30.2% of the total community across all samples. In addition, the majority of the microbiota was composed of Actinomycetota, Proteobacteria, Acidobacteriota, Poribacteriota, Gemmatimonadota, and Dadabacteria. The sponge sample from Polignano a Mare exhibited the richest and most diverse bacterial community. This observation was supported by phylogenetic analysis, which identified seven bacterial genera, Albidovulum, Filomicrobium, Microtrix, Gaiellales, D90 (Gammaproteobacteria class), and Blastopirellula, exclusive to this site. Several of these taxa are known for their potential biotechnological applications, underlining the significance of site-specific microbial diversity in G. cydonium.

IMTA is one of the most innovative and sustainable farming systems, exhibiting the best technique available in rearing aquatic organisms belonging to different positions along the trophic levels. In the literature and in legislation, the environmental benefits of IMTA protocols have been extensively recognized, mainly for its capability to reduce the ecological footprint of intensive aquaculture systems and concretely address the Sustainable Development Goal no. 14 (SDG 14). However, lesser attention is given to the assessments of its role in enhancing the zootechnical performance, animal welfare, and flesh quality of the species involved. To the best of our knowledge, this is the first review that aims to offer a systematic analysis of the existing literature on the main commercial motivations that could draw the attention of stakeholders, including consumers and fish farmers, towards a greater social acceptability and implementation of the IMTA system on a large scale. The findings suggest that, beyond its environmental advantages, IMTA systems can positively influence the productivity, growth, survival, feed efficiency, and animal health and welfare (AH&W), as well as the nutritional quality of the harvested species, thus offering significant economic and market value both in terms of Environmental, Societal and Governance (ESG) parameters and One Health.

Rosacea is a common inflammatory skin disease, characterized by erythema, papules and pustules. The pathophysiology of rosacea remains unclear, but the complex interplay between environmental and genetic factors may act as a trigger to an abnormal innate immune response associated with a multifaceted neurovascular reaction. Increasing evidence suggests that the gut microbiota is significantly involved in the pathogenesis of rosacea, playing an important role in the inflammatory cutaneous response. Dysbiosis, small intestinal bacterial overgrowth, Helicobacter pylori infection and innate immune system dysregulation mutually contribute to the pathophysiology of rosacea, but more extensive future research is needed to better clarify their precise mechanisms of action. Many dietary triggers have been postulated for this disease; however, there is a lack of well-made and controlled studies able to undoubtedly demonstrate a causal relationship between rosacea and diet. We analyzed the available studies on the role of diet and gut microbiome in rosacea and the positive clinical effects reported by the current literature on probiotics, prebiotics, postbiotics and nutrients. Ultimately, this article improves our understanding of the gut–skin axis in rosacea, focusing on how probiotic supplementation and diet could improve the clinical management of patients affected by this common and debilitating disease.

Mesophotic habitats in the Mediterranean Sea host rich and diverse benthic assemblages, dominated by invertebrates alongside sciaphilous algae. Recent findings suggest that certain mesophotic bioconstructions built by invertebrates, while classified under the coralligenous definition, differ significantly in their taxonomic composition. This study investigates diversity patterns in megabenthic assemblages associated with algal and invertebrate bioconstructions along the Apulian coast, using α- and β-diversity metrics derived from an image analysis approach. Across 360 analyzed frames, 81 taxa were identified, revealing distinct coverage patterns that separate mesophotic algal assemblages from both coral and oyster bioconstructions. Morphological seabed features and primary bioconstructors played a key role in shaping the associated communities. These findings highlight the substantial differences between upper and deeper megabenthic assemblages and emphasize the ecological importance of mesophotic bioconstructions as biodiversity hotspots, underscoring their role in supporting Mediterranean marine ecosystems and the need for targeted conservation strategies.

Sentinel lymph node biopsy has been proposed as a diagnostic method for estimation of the malignant potential of atypical Spitz tumours. However, although cell deposits are commonly detected in the sentinel lymph nodes of patients with atypical Spitz tumours, their prognosis is substantially better than that of patients with melanoma and positive sentinel lymph node biopsies. We did a systematic review of published reports to assess the role of sentinel lymph node biopsy as a prognostic method in the management of atypical Spitz tumours. The results of our analysis did not show any prognostic benefit of sentinel lymph node biopsy; having a positive sentinel lymph node does not seem to predict a poorer outcome for patients with atypical Spitz tumours. These findings indicate that, especially in the paediatric population, it might be prudent initially to use complete excision with clear margins and careful clinical follow-up in patients with atypical Spitz tumours.

Background: Rosacea is a common inflammatory disease. Four clinical rosacea subtypes have been described, with the papulo-pustular being the most common. At present, the only FDA-approved treatment for papulo-pustular rosacea is low-dose doxycycline. Retinoids, in particular isotretinoin, have shown for decades positive outcomes in the treatment of rosacea, but due to the lack of robust evidence, they are still considered an off-label treatment for this condition. Objectives: Summarize the current evidence in the literature regarding the role of topical and systemic retinoids in the treatment of papulo-pustular rosacea. Design: Systematic review and meta-analysis. Data source and methods: A systematic MEDLINE, EMBASE, and Cochrane search of relevant publications on this topic was carried out. Randomized and non-randomized studies regarding topical and systemic retinoid treatment for rosacea were included. We excluded not relevant studies, case reports, reviews, and non-English language studies. We have used RoB2 and ROBINS-1 tool for assessing risk of bias in randomized and non-randomized trials, respectively. Results: Due to the heterogeneity in study design and outcomes reporting, the standardization of our results is limited, but the findings from this systematic review with meta-analysis indicate that retinoids, particularly isotretinoin, are a promising treatment option for papulopustular rosacea, with a favorable tolerability and safety profile. On the other hand, available data for topical retinoid therapy are less definitive and more contradictory, with only two randomized studies reporting opposite outcomes. Conclusion: Retinoids may be a valid treatment option for rosacea, but larger, randomized controlled trials are needed to establish standardized dosing regimens and long-term safety profiles.