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"Grasso, Marco"
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Legitimacy and procedural justice: how might stratospheric aerosol injection function in the public interest?
The success of stratospheric aerosol injection (SAI) in limiting global heating requires the inclusion and maintenance of the political ideals of legitimacy and procedural justice. Without them, the prospects are slim that this institution can be developed and operated in the public interest in such a way that it will protect and promote social well-being by minimising climate-related harm. Long-term legitimacy and procedural justice are crucial to several sensitive features of SAI. They relate to openness, inclusivity, and independence in dealing both with external issues of concern to stakeholders representing the general public and with internal issues concerning agents directly involved in SAI. This article begins by outlining notions of legitimacy and procedural justice and the criteria appropriate for SAI. Then it investigates how the indications provided by the related standards and the consequent morally sound governance options advanced might warrant that SAI is not distorted in such ways that it serves the vested interests of private parties. Finally, the article outlines two recommendations for ensuring that legitimacy and procedural justice in SAI are achieved and maintained over time, so that it can work continuously in the public interest.
Journal Article
Performance Analysis of Ship Wake Detection on Sentinel-1 SAR Images
A novel technique for ship wake detection has been recently proposed and applied on X-band Synthetic Aperture Radar images provided by COSMO/SkyMed and TerraSAR-X. The approach shows that the vast majority of wake features are correctly detected and validated in critical situations. In this paper, the algorithm was applied to 28 wakes imaged by Sentinel-1 mission with different polarizations and incidence angles with the aim of testing the method’s robustness with reference to radar frequency and resolution. The detection process is properly modified. The results show that the features were correctly classified in 78.5% of cases, whereas false confirmations occur mainly on Kelvin cusps. Finally, the results were compared with the algorithm performance on X-band images, showing that no significant difference arises. In fact, the total false confirmations rate was 15.8% on X-band images and 18.5% on C-band images. Moreover, since the main criticality concerns again the false confirmation of Kelvin cusps, the same empirical criterion suggested for the X-band SAR images yielded a negligible 1.5% of false detection rate.
Journal Article
Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management
Non-alcoholic fatty liver disease (NAFLD) is currently the fastest growing indication to liver transplantation (LT) in Western Countries, both for end stage liver disease and hepatocellular carcinoma. NAFLD/non-alcoholic steatohepatitis (NASH) is often expression of a systemic metabolic syndrome; therefore, NAFLD/NASH patients require a multidisciplinary approach for a proper pre-surgical evaluation, which is important to achieve a post-transplant outcome comparable to that of other indications to LT. NAFLD/NASH patients are also at higher risk of post-transplant cardiovascular events, diabetes, dyslipidemia, obesity, renal impairment and recurrent NASH. Lifestyle modifications, included diet and physical activity, are key to improve survival and quality of life after transplantation. A tailored immunosuppressive regimen may be proposed in selected patients. Development of new drugs for the treatment of recurrent NASH is awaited.
Journal Article
In Situ Monitoring of Powder Bed Fusion Homogeneity in Electron Beam Melting
Increasing attention has been devoted in recent years to in situ sensing and monitoring of the electron beam melting process, ranging from seminal methods based on infrared imaging to novel methods based on backscattered electron detection. However, the range of available in situ monitoring capabilities and solutions is still quite limited compared to the wide number of studies and industrial toolkits in laser-based additive manufacturing processes. Some methods that are already industrially available in laser powder bed fusion systems, such as in situ detection of recoating errors, have not yet been investigated and tested in electron beam melting. Motivated by the attempt to fill this gap, we present a novel in situ monitoring methodology that can be easily implemented in industrial electron beam melting machines. The method is aimed at identifying local inhomogeneity and irregularities in the powder bed by means of layerwise image acquisition and processing, with no external illumination source apart from the light emitted by the hot material underneath the currently recoated layer. The results show that the proposed approach is suitable to detect powder bed anomalies, while also highlighting the link between the severity of in situ detected errors and the severity of resulting defects in the additively manufactured part.
Journal Article
Towards a Moral Compass to Guide Sustainability Transformations in a High-End Climate Change World
High-end climate change (HECC) raises unprecedented challenges for the transformation of society’s governance arrangements. In such potentially dangerous situation, these challenges have profound moral—rather than only scientific, technical, or managerial—implications. Unfortunately, despite the growing recognition of the necessity for morally-grounded, urgent social-ecological reconfigurations in order to sustainably navigate the uncertain landscape derived from HECC, explicit moral guidance to support the transformation of governance arrangements is still lacking. This work, through the metaphor of a moral compass, proposes a normative tool to support an integrated assessment processes in order to confront the moral challenges and dilemmas in governance and thus favour sustainable transformations under conditions of HECC.
Journal Article
Advances and Controversies in Acute Alcohol-Related Hepatitis: From Medical Therapy to Liver Transplantation
Alcohol-related hepatitis (AH) is a clinical syndrome characterized by recent-onset jaundice in the context of alcohol consumption. In patients with severe AH “unresponsive” to steroid therapy, mortality rates exceed 70% within six months. According to European and American guidelines, liver transplantation (LT) may be considered in highly selected patients who do not respond to medical therapy. The aim of this narrative review is to summarize current knowledge from medical therapy to liver transplantation in acute alcohol-related hepatitis. Due to the impossibility to guarantee six-month abstinence, LT for AH is controversial. Principal concerns are related to organ scarcity in the subset of stigma of “alcohol use disorder” (AUD) and the risk of relapse to alcohol use after LT. Return to alcohol use after LT is a complex issue that cannot be assessed as a yes/no variable with heterogeneous results among studies. In conclusion, present data indicate that well-selected patients have excellent outcomes, with survival rates of up to 100% at 24 and 36 months after LT. Behavioral therapy, ongoing psychological support, and strong family support seem essential to improve long-term outcomes after LT and reduce the risk in relapse of alcohol use.
Journal Article
Evolution of Liver Transplantation Indications: Expanding Horizons
Liver transplantation (LT) has significantly transformed the prognosis of patients with end-stage liver disease and hepatocellular carcinoma (HCC). The traditional epidemiology of liver diseases has undergone a remarkable shift in indications for LT, marked by a decline in viral hepatitis and an increase in metabolic dysfunction-associated steatotic liver disease (MASLD), along with expanded indications for HCC. Recent advancements in surgical techniques, organ preservation and post-transplant patients’ management have opened new possibilities for LT. Conditions that were historically considered absolute contraindications have emerged as potential new indications, demonstrating promising results in terms of patient survival. While these expanding indications provide newfound hope, the ethical dilemma of organ scarcity persists. Addressing this requires careful consideration and international collaboration to ensure equitable access to LT. Multidisciplinary approaches and ongoing research efforts are crucial to navigate the evolving landscape of LT. This review aims to offer a current overview of the primary emerging indications for LT, focusing on acute-on-chronic liver failure (ACLF), acute alcoholic hepatitis (AH), intrahepatic and perihilar cholangiocarcinoma (i- and p-CCA), colorectal liver metastasis (CRLM), and neuroendocrine tumor (NET) liver metastases.
Journal Article
Stem cell mobilization with plerixafor and healing of diabetic ischemic wounds: A phase IIa, randomized, double‐blind, placebo‐controlled trial
Bone marrow‐derived cells contribute to tissue repair, but traffic of hematopoietic stem/progenitor cells (HSPCs) is impaired in diabetes. We therefore tested whether HSPC mobilization with the CXCR4 antagonist plerixafor improved healing of ischemic diabetic wounds. This was a pilot, phase IIa, double‐blind, randomized, placebo‐controlled trial (NCT02790957). Patients with diabetes with ischemic wounds were randomized to receive a single subcutaneous injection of plerixafor or saline on top of standard medical and surgical therapy. The primary endpoint was complete healing at 6 months. Secondary endpoints were wound size, transcutaneous oxygen tension (TcO2), ankle‐brachial index (ABI), amputations, and HSPC mobilization. Twenty‐six patients were enrolled: 13 received plerixafor and 13 received placebo. Patients were 84.6% males, with a mean age of 69 years. HSPC mobilization was successful in all patients who received plerixafor. The trial was terminated after a preplanned interim analysis of 50% of the target population showed a significantly lower healing rate in the plerixafor vs the placebo group. In the final analysis data set, the rate of complete healing was 38.5% in the plerixafor group vs 69.2% in the placebo group (chi‐square P = .115). Wound size tended to be larger in the plerixafor group for the entire duration of observation. No significant difference was noted for the change in TcO2 and ABI or in amputation rates. No other safety concern emerged. In conclusion, successful HSPC mobilization with plerixafor did not improve healing of ischemic diabetic wounds. Contrary to what was expected, outside the context of hematological disorders, mobilization of diabetic HSPCs might exert adverse effects on wound healing. We randomized patients with diabetic ischemic wounds to receive stem cell mobilization with the CXCR4 antagonist plerixafor or placebo. Despite the fact that plerixafor successfully mobilized hematopoietic stem cells, no significant difference was observed between the two groups in the rates of wound healing and in surrogate measures of perfusion.
Journal Article
Does the Urinary Proteome Reflect ccRCC Stage and Grade Progression?
Due its ability to provide a global snapshot of kidney physiology, urine has emerged as a highly promising, non-invasive source in the search for new molecular indicators of disease diagnosis, prognosis, and surveillance. In particular, proteomics represents an ideal strategy for the identification of urinary protein markers; thus, a urinomic approach could also represent a powerful tool in the investigation of the most common kidney cancer, which is clear cell Renal Cell Carcinoma (ccRCC). Currently, these tumors are classified after surgical removal using the TNM and nuclear grading systems and prognosis is usually predicted based upon staging. However, the aggressiveness and clinical outcomes of ccRCC remain heterogeneous within each stratified group, highlighting the need for novel molecular indicators that can predict the progression of these tumors. In our study, we explored the association between the urinary proteome and the ccRCC staging and grading classification. The urine proteome of 44 ccRCC patients with lesions of varying severity was analyzed via label-free proteomics. MS data revealed several proteins with altered abundance according to clinicopathological stratification. Specifically, we determined a panel of dysregulated proteins strictly related to stage and grade, suggesting the potential utility of MS-based urinomics as a complementary tool in the staging process of ccRCC.
Journal Article