As part of the study project of the pictorial cycle, attributed to Saturnino Gatti, in the church of San Panfilo at Villagrande di Tornimparte (AQ), image analyses were performed in order to document ...the general conservation conditions of the surfaces, and to map the different painting materials to be subsequently examined using spectroscopic techniques. To acquire the images, radiation sources, ranging from ultraviolet to near infrared, were used; analyses of ultraviolet fluorescence (UVF), infrared reflectography (IRR), infrared false colors (IRFC), and optical microscopy in visible light (OM) were carried out on all the panels of the mural painting of the apsidal conch. The Hypercolorimetric Multispectral Imaging (HMI) technique was also applied in selected areas of two panels. Due to the accurate calibration system, this technique is able to obtain high-precision colorimetric and reflectance measurements, which can be repeated for proper surface monitoring. The integrated analysis of the different wavelengths’ images—in particular, the ones processed in false colors—made it possible to distinguish the portions affected by retouching or repainting and to recover the legibility of some figures that showed chromatic alterations of the original pictorial layers. The IR reflectography, in addition to highlighting the portions that lost materials and were subject to non-original interventions, emphasized the presence of the underdrawing, which was detected using the spolvero technique. UVF photography led to a preliminary mapping of the organic and inorganic materials that exhibited characteristic induced fluorescence, such as a binder in correspondence with the original azurite painting or the wide use of white zinc in the retouched areas. The collected data made it possible to form a better iconographic interpretation. Moreover, it also enabled us to accurately select the areas to be investigated using spectroscopic analyses, both in situ and on micro-samples, in order to deepen our knowledge of the techniques used by the artist to create the original painting, and to detect subsequent interventions.
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Italy was the first European country hit by the COVID-19 pandemic and has the highest number of recorded COVID-19 deaths in Europe.
This prospective cohort study of the correlates of ...the risk of death in COVID-19 patients was conducted at the Infectious Diseases and Intensive Care units of Luigi Sacco Hospital, Milan, Italy. The clinical characteristics of all the COVID-19 patients hospitalised in the early days of the epidemic (21 February -19 March 2020) were recorded upon admission, and the time-dependent probability of death was evaluated using the Kaplan-Meier method (censored as of 20 April 2020). Cox proportional hazard models were used to assess the factors independently associated with the risk of death.
Forty-eight (20.6 %) of the 233 patients followed up for a median of 40 days (interquartile range 33–47) died during the follow-up. Most were males (69.1 %) and their median age was 61 years (IQR 50–72). The time-dependent probability of death was 19.7 % (95 % CI 14.6–24.9 %) 30 days after hospital admission. Age (adjusted hazard ratio aHR 2.08, 95 % CI 1.48−2.92 per ten years more) and obesity (aHR 3.04, 95 % CI 1.42−6.49) were independently associated with an increased risk of death, which was also associated with critical disease (aHR 8.26, 95 % CI 1.41−48.29), C-reactive protein levels (aHR 1.17, 95 % CI 1.02−1.35 per 50 mg/L more) and creatinine kinase levels above 185 U/L (aHR 2.58, 95 % CI 1.37−4.87) upon admission. Case-fatality rate of patients hospitalized with COVID-19 in the early days of the Italian epidemic was about 20 %. Our study adds evidence to the notion that older age, obesity and more advanced illness are factors associated to an increased risk of death among patients hospitalized with COVID-19.
Among the possible variants of X-Ray Fluorescence (XRF), applications exploiting scanning Macro-XRF (MA-XRF) are lately widespread as they allow the visualization of the element distribution ...maintaining a non-destructive approach. The surface is scanned with a focused or collimated X-ray beam of millimeters or less: analyzing the emitted fluorescence radiation, also elements present below the surface contribute to the elemental distribution image obtained, due to the penetrative nature of X-rays. The importance of this method in the investigation of historical paintings is so obvious—as the elemental distribution obtained can reveal hidden sub-surface layers, including changes made by the artist, or restorations, without any damage to the object—that recently specific international conferences have been held. The present paper summarizes the advantages and limitations of using MA-XRF considering it as an imaging technique, in synergy with other hyperspectral methods, or combining it with spot investigations. The most recent applications in the cultural Heritage field are taken into account, demonstrating how obtained 2D-XRF maps can be of great help in the diagnostic applied on Cultural Heritage materials. Moreover, a pioneering analysis protocol based on the Spectral Angle Mapper (SAM) algorithm is presented, unifying the MA-XRF standard approach with punctual XRF, exploiting information from the mapped area as a database to extend the comprehension to data outside the scanned region, and working independently from the acquisition set-up. Experimental application on some reference pigment layers and a painting by Giotto are presented as validation of the proposed method.
An epidemic not attributable to plague caused thousands of deaths in Milan in the summer of 1629, a time of war and famine that immediately preceded the even more fatal Great Plague of 1630 that ...killed an estimated ten of thousands of people. The 5,993 deaths of 1629 recorded in the Liber Mortuorum of Milan (a city with an estimated population of 130,000 inhabitants at the time) were 45.7% more than the average number recorded between 1601 and 1628. Registered deaths peaked in July, and 3,363 of the deaths (56,1%) were attributed to a febrile illness which, in most cases (2,964, 88%), was not associated with a rash or organ involvement. These deaths involved 1,627 males and 1,334 females and occurred at a median age of 40 years (range 0-95). In this paper, we discuss the possible cause of the epidemic, which may have been an outbreak of typhoid fever.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV suppression rates in people living with HIV (PLWH) attending a large Italian HIV clinic.
The HIV outpatient clinic of ...the Infectious Diseases Department of Luigi Sacco Hospital, Milan, Italy, which serves more than 5000 PLWH per year.
A before and after quasi-experimental study design was used to make a retrospective assessment of the monthly trend of HIV-RNA determinations of ≥50 among the PLWH attending our clinic, with "before" being the period from January 1, 2016 to February 20, 2020, and "after" being the period from February 21, 2020 to December 31, 2020 (the COVID-19 period). Interrupted time series analysis was used to evaluate any changes in the trend.
During the study period, 70,349 HIV-RNA viral load determinations were made, and the percentage of HIV-RNA viral load determinations of <50 copies/mL increased from 88.4% in 2016 to 93.2% in 2020 (P < 0.0001). There was a significant monthly trend toward a decrease in the number of HIV-RNA determinations of ≥50 copies/mL before the pandemic (β -0.084; standard error 0.015; P < 0.001), and this did not significantly change after it started (β -0.039, standard error 0.161; P = 0.811).
A high prevalence of viral suppression was maintained among the PLWH referring to our clinic, despite the structural barriers raised by the COVID-19 pandemic. The use of simplified methods of delivering care (such as teleconsultations and multiple antiretroviral treatment prescriptions) may have contributed to preserving this continuum.
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SARS-CoV-2 is causing an increasing number of deaths worldwide because no effective treatment is currently available. Remdesivir has shown in vitro activity against coronaviruses and ...is a possible antiviral treatment for SARS-CoV-2 infection.
This prospective (compassionate), open-label study of remdesivir, which was conducted at Luigi Sacco Hospital, Milan, Italy, between February 23 and March 20, 2020, involved patients with SARS-CoV-2 pneumonia aged ≥18 years undergoing mechanical ventilation or with an oxygen saturation level of ≤94 % in air or a National Early Warning Score 2 of ≥4. The primary outcome was the change in clinical status based on a 7-category ordinal scale (1 = not hospitalised, resuming normal daily activities; 7 = deceased).
The 35 patients enrolled from February 23 to March 20, 2020, included 18 in intensive care unit (ICU), and 17 in our infectious diseases ward (IDW). The 10-day course of remdesivir was completed by 22 patients (63 %) and discontinued by 13, of whom eight (22.8 %) discontinued because of adverse events. The median follow-up was 39 days (IQR 25–44). At day 28, 14 (82.3 %) patients from IDW were discharged, two were still hospitalized and one died (5.9 %), whereas in ICU 6 (33.3 %) were discharged, 8 (44.4 %) patients died, three (16.7 %) were still mechanically ventilated and one (5.6 %) was improved but still hospitalized. Hypertransaminasemia and acute kidney injury were the most frequent severe adverse events observed (42.8 % and 22.8 % of the cases, respectively).
Our data suggest that remdesivir can benefit patients with SARS-CoV-2 pneumonia hospitalised outside ICU where clinical outcome was better and adverse events are less frequently observed. Ongoing randomised controlled trials will clarify its real efficacy and safety, who to treat, and when.
The project FUXYA2020 was intended to design and prototype a low-cost basic energy dispersive X-ray fluorescence spectrometer for all those cases where there is not enough financial support to buy a ...commercial device. Indeed, home-made instruments are ideal when funds are low but constant over the years, as this approach allows the costs to be spread over a longer period of time. The FUXYA2020 was intended mostly for cultural heritage (CH) applications: we optimized the geometry to meet the requirements for both low Z matrix objects, such as glasses and ceramics, and medium-high Z materials, such as metals; besides, we designed a positioning system through Arduino components to obtain good results and repeatability for samples with a complex geometry. The FUXYA2020’s performance was tested both for qualitative and quantitative analyses, the former on pigment layers, and the latter on gold-based certified alloys, exploiting Axil-QXAS software for data elaboration. The classification of ancient ceramics based on multivariate analysis obtained through R environment was also carried out. The qualitative data on pigments have also been compared with the same data obtained by a commercial XRF spectrometer, demonstrating how our very simple and inexpensive prototype can be of great help for a rapid and reliable characterization of cultural heritage materials whenever commercial devices are unaffordable.
This paper presents the results obtained for the mural paintings (XV century CE) in the church of San Panfilo in Villagrande di Tornimparte (AQ, Italy) by means of noninvasive spectroscopic ...techniques; this research is a part of the project on the Saturnino Gatti pictorial cycle, promoted and coordinated by the AIAr (the Italian Archaeometry Association). Digital optical microscopy (OM), X-ray fluorescence spectroscopy (XRF), fiber optics reflectance spectroscopy in the UV–Vis–NIR range (FORS), Fourier transform infrared spectroscopy in the external reflection mode (ER-FTIR), and Raman spectroscopy were performed on the points selected based on the image analysis results and the few available records on previous intervention, with the aim of characterizing both the original and restoration organic and inorganic materials. The synergic application of complementary techniques allowed us to obtain a complete picture of the palette and the main alteration products and organic substances (of rather ubiquitous lipid materials and less widespread resin and proteinaceous materials in specific points). The identification of modern compounds permitted the individuation of restoration areas; this was confirmed by the comparison with multiband imaging results, as in the case of specific green and blue pigments, strictly related to the presence of high signals of zinc. This analytical protocol left only very few ambiguities and allowed to minimizing the number of samples taken to clarifying, by sample laboratory analyses, the few doubts still open.
Figure 4 modified: A curves showing survival of participants with severe COVID-19 pneumonia treated with tocilizumab: B. Kaplan-meier survival curves in patients with severe COVID-19 stratified ...according to ventilation ststus at baseline. B. Incidence of bloodstream infections over the study period. Display omitted
Tocilizumab, a humanized monoclonal antibody, targets IL-6 receptors blocking downstream pro-inflammatory effects of IL-6. In preliminary reports it was suggested to be beneficial in patients with severe COVID-19.
In this open-label prospective study we describe clinical characteristics and outcome of 51 patients hospitalized with confirmed and severe COVID-19 pneumonia treated with tocilizumab intravenously. All patients had elevated IL-6 plasma level (>40 pg/mL) and oxygen saturation <93% in ambient air. Clinical outcomes, oxygen support, laboratory data and adverse events were collected over a follow-up of 30 days.
Forty-five patients (88%) were on high-flow oxygen supplementation, six of whom with invasive ventilation. From baseline to day 7 after tocilizumab we observed a dramatic drop of body temperature and CRP value with a significant increase in lymphocyte count (p<0.001). Over a median follow-up time of 34 days from tocilizumab, 34 patients (67%) showed an improvement in their clinical severity class; 31 were discharged; 17 (33%) showed a worsening of their clinical status, of these 14 died (27%). The mortality rate was significantly associated with mechanical ventilation at baseline (83.3% vs 20% of patients on non-invasive oxygen support; p=0.0001). The most frequent side effects were an increase of hepatic enzymes (29%), thrombocytopenia (14%), and serious bacterial and fungal infections (27%).
Tocilizumab exerts a rapidly beneficial effect on fever and inflammatory markers, although no significant impact on the clinical outcome can be inferred by our results. Critically ill patients seem to have a high risk of serious infections with this drug.
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