Sant'Anna School of Advanced Studies

Construction and demolition waste (CDW) management activities have had wide‐ranging adverse impacts on the Earth's climate. Addressing the problems of construction and demolition waste production requires a comprehensive and multifaceted approach and specific attention to the development of sustainable circular on‐site practices. This study compares recycled products against conventional products already available on the market. This study applied a life cycle assessment (LCA) to evaluate the benefits of secondary raw material (SRM)‐based products compared to conventional virgin raw materials. Focusing on a Spanish case study that had foreseen the revitalization of a degraded area, the construction of a small utility building, and road construction, this analysis also assessed the overall environmental footprint of the overall construction work. The results showed that, despite the impact savings achieved by opting for SRM‐based products rather than conventional solutions, the production stages still have the greatest impact on the scale of construction, with the sole exception of the construction of small facilities where the construction itself was the largest contributor. Climate change; water scarcity; freshwater eutrophication; resource use, energy carriers; and resource use, minerals and metals were the most significant impact categories both in the analysis of the construction products and the overall construction work. An LCA is vital in the construction and demolition sector because it provides a holistic understanding of the environmental impacts associated with the different stages of a project's life cycle fostering the implementation of circular on‐site practices.

Our study aimed to investigate the correlation between skin cancer and anti-interleukin (IL) therapy in patients with moderate-to-severe psoriasis. This was an observational monocentric study in which we enrolled a total of 235 patients in which 127 patients were affected by moderate-to-severe psoriasis and treated with anti-IL monoclonal antibodies (mAbs) for at least 6 months, whereas 108 patients affected by mild psoriasis were treated with topical therapies. Afterward, we performed a dermatologic visit to all the subjects, collecting anamnestic information including risk factors for skin cancer. We examined the skin lesions on their entire body by polarized and nonpolarized dermoscopy. A total of 21 suspicious lesions in the first group and 17 in the second one were removed and histologically analyzed. Twelve (9.4%) cancerous or precancerous lesions were found in the first group: seven (5.5%) basal cell carcinoma (BCC) and five actinic keratosis. The mean time to cancer onset was identified as 22 months after the start of four therapy, with an SD of 18 months, suggesting an earlier onset with respect to the start of therapy in our population. On univariate analysis, age ( P = 0.001) and age of psoriasis onset (0.009) were statistically significant. Nine of 17 were skin cancers in the second group. Our study provided real-life evidence of the percentage of patients with skin cancers during therapy with anti-IL mAbs, demonstrating a good safety profile of the investigated drugs.

Sustainability awards are often seen as a mark of credibility and can help companies attract new customers, investors and partners. However, there is some question as to whether the companies that win sustainability awards-and therefore who ought to be genuinely committed to sustainability-correctly communicate their environmental performances according to internationally recognised principles for the fair use of environmental labels and claims such as those set by ISO standards. This study examined the web communication practices of a sample of 100 Italian companies that had won a sustainability award. Our findings showed that, while most of these companies boasted their environmental performance in several ways, they did not always follow the above-mentioned communication principles. This suggests that companies need further training and education on how to communicate their environmental performance correctly and in a substantiated manner, thus preventing the risk of greenwashing.

Problems with dominant advection, discontinuities, travelling features, or shape variations are widespread in computational mechanics. However, classical linear model reduction and interpolation methods typically fail to reproduce even relatively small parameter variations, making the reduced models inefficient and inaccurate. This work proposes a model order reduction approach based on the Radon Cumulative Distribution Transform (RCDT). We demonstrate numerically that this non-linear transformation can overcome some limitations of standard proper orthogonal decomposition (POD) reconstructions and is capable of interpolating accurately some advection-dominated phenomena, although it may introduce artefacts due to the discrete forward and inverse transform. The method is tested on various test cases coming from both manufactured examples and fluid dynamics problems.

The sixth IPCC report states that a proper conception of climate justice that can address the complexity of the phenomenon of anthropogenic climate change as a whole requires considering not only one but rather three dimensions of justice today: redistributive, procedural, and recognition dimensions. In this article, my focus is on exploring the latter dimension, drawing special attention to climate policies addressing cultural-identity issues. In the first section, I illustrate how climate policies can be connected to discriminatory practices against minority cultures and their identities. To do so, I take the struggles of Black movements against environmental racism and the struggles of Indigenous peoples against a colonialist cultural heritage as case studies. In the second section, I look into the most advanced normative model to address the dimension of recognition, its advantages, and how it addresses the so-called 'institutionalization of cultural patterns' in climate policies: the Nancy Fraser model. Finally, in the third section, I investigate an aspect that remains open. It concerns the matter of how to use institutional authority to 'deinstitutionalize' non-ecological cultural patterns, while respecting pluralism and avoiding falling into the risks of institutional paternalism.

Central sleep apnea (CSA), a rare polysomnographic finding in the general population, is prevalent in certain cardiovascular conditions including systolic and diastolic left ventricular dysfunction, atrial fibrillation, coronary artery disease, carotid artery stenosis, stroke and use of certain cardiac-related medications. Polysomnographic findings of CSA with adverse cardiovascular impacts include nocturnal hypoxemia and arousals, which can lead to increased sympathetic activity both at night and in the daytime. Among cardiovascular diseases, CSA is most prevalent in patients with left ventricular systolic dysfunction; a large study of more than 900 treated patients has shown a dose dependent relationship between nocturnal desaturation and mortality. Multiple small randomized controlled trials have shown mitigation of sympathetic activity when CSA is treated with nocturnal oxygen, continuous positive airway pressure and adaptive servoventilation. However, two early randomized controlled trials with positive airway pressure devices have shown either neutral effect on survival or excess premature mortality in the active treatment arm, compared to untreated CSA. In contrast, the results of the most recent trial using an advanced adaptive servoventilation device showed improved quality of life and no signal for mortality suggesting that treatment of CSA was at least safe. In addition to positive airway pressure devices, multiple medications have been shown to improve CSA, but no long-term trials of pharmacologic therapy have been published. Currently, phrenic nerve stimulation is approved for treatment of CSA, and the results of a randomized controlled trial showed significant improvement in sleep metrics and quality of life.

Lentils are a vital staple crop in a world seeking sustainable and secure food, but their cultivation face a threat due to yield instability, mainly arising from a lack of genetic diversity in breeding programmes. In this study, we assembled and characterized the genetic and phenotypic diversities of a collection of 106 lentil genotypes, to evaluate their breeding and cropping potential. Lentil landraces from Italy and beyond, either abandoned or still cultivated, were collected from genebanks, seed savers, universities and farmers. We characterized their phenotypic diversity with an augmented block design, using a control plot enabling a spatial analysis. We phenotyped the collection during two cropping seasons for its agronomic performance, involving local practitioners in a participatory variety evaluation. Meanwhile, we genotyped the landrace collection with a DNA sequencing approach, obtaining 91,136 high quality single nucleotide polymorphisms (SNPs). We used SNPs to describe the phylogenetic relation among landraces, unveiling their uniqueness, and combined SNP data with measured traits to conduct a genome-wide association study (GWAS) that led to the identification of 32 unique marker-trait associations highlighting lentil genomic loci related with adaptation and performance. The results of this study offer new tools to unlock agrobiodiversity for lentil breeding in the Mediterranean, towards the identification of genetic factors responsible for traits of agronomic interest and providing possible sources of parental material.

Amyloidosis diseases are characterized by protein misfolding, which forms insoluble beta-sheet fibrils progressively deposited in tissues. Deposition in the form of amyloid aggregates can occur in various organs, damaging their structure and function. The hallmark of amyloidosis is aberrant interactions leading to protein aggregation and proteotoxicity. Accordingly, amyloidosis-related samples represent a valuable source of information to generate new knowledge useful for diagnostic, prognostic, and therapeutic purposes. In this scenario, we outline the path to apply computational methods and strategies based on the combination of proteomics and systems biology approaches. In addition to algorithms useful for subtyping amyloid deposits or assessing proteome recovery after drug treatment, our chapter provides workflows based on protein-protein interaction and protein co-expression network models. In particular, the main steps to reconstruct and analyze them at both functional and topological levels are described. Our chapter aims to provide tools and instructions to identify and monitor prognostic, diagnostic, and therapeutic markers and to shed light on the processes, pathways, and functions affected by amyloidogenic proteins.

Background and Aims The positron emission tomography (PET) tracer 18F-florbetaben is a promising diagnostic tool for light-chain cardiac amyloidosis (AL-CA). A greater cardiac uptake might signal more amyloid burden and a worse outcome. We aimed to assess the prognostic significance of 18F-florbetaben uptake in AL-CA. Methods Consecutive patients with AL-CA underwent 18F-florbetaben PET scans. Total amyloid burden (TAB; calculated as mean standardized uptake value multiplied by molecular volume) was assessed in the left and right ventricles (LV/RV) in early (5-15’) and late (50-60’) acquisitions. The endpoint was all-cause mortality. Results Forty patients (median age 69 years, 73% males, Mayo 2004 stage III in 80%) underwent 18F-florbetaben PET with a median time from tissue biopsy of 21 days (interquartile range, IQR 7-83). Late LV TAB, but not early LV TAB, correlated with N-terminal pro-BNP (NT-proBNP) and hs troponin T. Over 13 months after the PET scan (IQR 5-21), 65% of patients died. A late LV TAB ≥273 cm3 (cut-off derived from spline curve analysis) predicted 18- and 24-month all-cause mortality independently from baseline variables, including NT-proBNP, hs-troponin T, and Mayo 2004 stage. Late RV TAB ≥135 cm3 independently predicted 18- and 24-month all-cause mortality. Patients with both late LV and RV TAB ≥cut-offs had a shorter survival than those with only LV TAB ≥cut-off and those with TAB in both ventricles <cut-offs (Log-rank 16.52, p<0.001). Conclusions 18F-florbetaben PET imaging offers valuable prognostic information in AL-CA. Values of late TAB measured in the LV and RV are strong predictors of all-cause mortality.

Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting hair follicles, causing recurrent abscesses and nodules in intertriginous regions. The International HS Severity Score System (IHS4) is widely used to assess HS severity by counting inflammatory nodules, abscesses, and draining fistulas/tunnels. However, traditional clinical examinations may underestimate HS severity due to the presence of subclinical lesions. This study aims to enhance the accuracy of HS severity assessment by incorporating ultra‐high frequency ultrasound (UHFUS) to detect subclinical lesions, such as microtunnels. Methods A cohort of 122 patients with HS (75 females and 47 males) was evaluated. Clinical severity was assessed using the IHS4 scoring system. UHFUS assessments were performed using a 70 MHz probe for patients with mild and moderate IHS4 scores. Statistical tools were used to assess the significance of UHFUS in detecting additional lesions not identified during clinical examinations. Results The study found that 23% of patients had mild HS, 58.2% had moderate HS, and 18.9% had severe HS according to IHS4. Among the 28 patients with mild IHS4, 14 had microtunnels detected by UHFUS, leading to a change in disease staging: 11.5% of patients were reclassified as mild, while 69.7% were reclassified as moderate. A statistically significant difference in the distribution of severity classifications before and after UHFUS examination was observed ( χ ² = 5.11, P = .0238). Conclusion The study underscores the critical role of UHFUS as a non‐invasive technique for the precise assessment of HS. The integration of UHFUS with a 70 MHz probe significantly enhances the detection of subclinical lesions, such as microtunnels, enabling timely intervention and potentially preventing disease progression. Despite the study's limitations, including its monocentric design and small sample size, the findings support the use of UHFUS in improving the accuracy of HS severity assessment.

Transcription factors belonging to the large Ethylene Responsive Factor (ERF) family are involved in plant responses to biotic and abiotic stresses. Among the ERFs, OCTADECANOID-RESPONSIVE ARABIDOPSIS 59 (ORA59) integrates ethylene and jasmonic acid signaling to regulate resistance to necrotrophic pathogens. The ERF group ERFVII encodes oxygen-labile proteins that are required for oxygen sensing and are stabilized by hypoxia established at the site of Botrytis (Botrytis cinerea) infection. Here, we show that ORA59 represses ERFVII protein activity to induce the expression of hypoxia-responsive genes in Arabidopsis (Arabidopsis thaliana). Moreover, inhibition of ethanol fermentation enhances plant tolerance to Botrytis, indicating a trade-off between the hypoxia and defense responses. In addition, ERFVII members and ORA59 are both involved in the downregulation of hypoxia-responsive genes during reoxygenation. Taken together, our results reveal that the ERFVII transcription factor–ORA59 module ensures that the multiple roles of ERFVII proteins are correctly balanced to favor plant tolerance to biotic or abiotic stresses.

Background Little evidence is available about heart rate (HR) response to exercise as well as its relationship with functional capacity in amyloid cardiomyopathy. Then, in a multicentre cohort of patients with amyloid cardiomyopathy, we investigated the prevalence of chronotropic incompetence (CI) and its relationships with cardiopulmonary exercise testing (CPET) variables. Methods Data from 172 outpatients with amyloid cardiomyopathy who performed a maximal CPET and who had no significant rhythm disorders were analysed. Results The prevalence of CI differed depending on the age-predicted peak HR (pHR%) cut-off value adopted, ranging from 16% to 59%. pHR% correlated non-linearly with peak oxygen uptake (pVO 2 ), either as expressed as a percentage of the maximum predicted or as mL/kg/min (p<0.001). Although to a lesser extent, pHR% correlated inversely with ventilatory efficiency (p<0.001). A pHR%≤75% resulted in the most accurate cut-off value in identifying a moderate-to-severe exercise impairment (sensitivity 72%; specificity 73%; area under the curve 77.2%). Conclusions CI is prevalent in patients with amyloid cardiomyopathy in sinus rhythm, its percentage varying according to the pHR% cut-off value. A blunted exercise-induced HR response correlated with a poor exercise capacity even in this setting of patients, a pHR%≤75% cut-off value being possibly useful in centres without CPET availability to identify a significant exercise impairment.

Background In the context of post-traumatic hand rehabilitation, stiffness of the hand joints limits the range of motion (ROM), grip strength, and the possibility of performing simple grasps. Robotic rehabilitation has been widely adopted for hand treatment with neurological patients, but its application in the orthopaedic scenario remains limited. In this paper, a pilot study targeting this population is presented, where the rehabilitation is performed using a powered finger exoskeleton, namely I-Phlex. The device aims to mobilize the metacarpal-phalangeal joint (MCP) in flexion-extension movements. The objective of the study was to verify the short-term efficacy, experience of use, and safety of I-Phlex in a clinical setting. As a secondary objective, the study verified the device’s capability to measure clinically relevant variables. Methods Six subjects with trauma-related illnesses of the right hand took part in the experiment. Passive and active range of motion (PROM and AROM) were recorded at the beginning and the end of the session by the therapist and by the exoskeleton. Experience of use was assessed through ad-hoc questionnaires and a numerical pain rate scale (NPRS). Safety was assessed by computing the number of adverse events during the operation. Results Median increases in the PROM and AROM of 5.88% and 11.11% respectively were recorded among subjects. The questionnaires reported a median score of 93.83; IQR (85.01–100) and 80.00; IQR (79.79–93.75) respectively. No increase in the median NPRS was recorded among subjects between pre-and post-treatment. No major adverse event or injury to the patients was recorded. Only one malfunction was reported due to the brake of a transmission cable, but the patient reported no injury or discomfort. No statistical significance was observed between the ROM measurement recorded using the exoskeleton and the ones taken by the therapist using the goniometer. Conclusions The device and related rehabilitation exercises can be successfully used in the clinical rehabilitation of the MCP joint. The device measurements are in line with the goniometer assessment from the therapist. Future studies will aim to reinforce the results obtained, introducing a control group to conclude on the specific contribution of the technology compared to conventional therapy. Trial registration Hand Motor Rehabilitation Using a Wearable Robotic Device (WRL HX MCP), Clinicaltrials.gov ID NCT05155670, Registration date 13 December 2021, URL https://clinicaltrials.gov/ct2/show/NCT05155670.

Recent observations have found a large number of supermassive black holes already in place in the first few hundred million years after the Big Bang, many of which seem to be overmassive relative to their host galaxy stellar mass when compared with local relation1, 2, 3, 4, 5, 6, 7, 8–9. Several different models have been proposed to explain these findings, ranging from heavy seeds to light seeds experiencing bursts of high accretion rate10, 11, 12, 13, 14, 15–16. Yet, current datasets are unable to differentiate between these various scenarios. Here we report the detection, from the JADES survey, of broad Hα emission in a galaxy at z = 6.68, which traces a black hole with a mass of about 4 × 10⁸M⊙ and accreting at a rate of only 0.02 times the Eddington limit. The black hole to host galaxy stellar mass ratio is about 0.4—that is, about 1,000 times above the local relation—whereas the system is closer to the local relations in terms of dynamical mass and velocity dispersion of the host galaxy. This object is most likely an indication of a much larger population of dormant black holes around the epoch of reionization. Its properties are consistent with scenarios in which short bursts of super-Eddington accretion have resulted in black hole overgrowth and massive gas expulsion from the accretion disk; in between bursts, black holes spend most of their life in a dormant state.

Background: Vascular calcification (VC) is a dynamic, tightly regulated process driven by cellular activity and resembling the mechanisms of bone formation, with specific molecules playing pivotal roles in its progression. We aimed to investigate the involvement of the bone morphogenic proteins (BMP-2, BMP-4, BMPR-1a/1b, and BMPR-2) system in this process. Our study used an advanced in vitro model that simulates the biological environment of the vascular wall, assessing the ability of a phosphate mixture to induce the osteoblastic switch in human coronary artery smooth muscle cells (HCASMCs). Methods: HCASMCs were grown in mono- and co-culture with human coronary artery endothelial cells (HCAECs) in a double-flow bioreactor (LiveBox2 and IVTech), allowing static and dynamic conditions through a peristaltic pump. The VC was stimulated by incubation in a calcifying medium for 7 days. A BMP system Real-Time PCR was performed at the end of each experiment. Results: In monocultures, BMP-2 expression increased in calcified HCASMCs in static (p = 0.01) and dynamic conditions. BMP-4 and the biological receptors were expressed in all the experimental settings, increasing mainly in dynamic flow conditions. In co-cultures, we observed a marked increase in BMP-2 and BMP-4, BMPR-1a (p = 0.04 and p = 0.01, respectively), and BMPR-2 (p = 0.001) in the calcifying setting mostly in dynamic conditions. Conclusions: The increase in BMP-2/4 in co-culture suggests that these genes might promote the switch towards an osteogenic-like phenotype, data also supported by the rise of both BMPR-1a and BMPR-2. Thus, our findings provide insights into the mechanisms by which dynamic co-culture modulates the BMP system activation in an environment mimicking in vivo VC’s cellular and mechanical characteristics.