Innovazioni terapeutiche nella proctite attinica cronica: valutazione della radiofrequenza endoscopica come alternativa alle tecniche tradizionali.

1. Abstract Introduction Chronic actinic proctitis is a late complication of pelvic radiotherapy, caused by ischemic microvascular lesions that lead to chronic rectal bleeding, anemia, and a reduction in quality of life. Traditional therapies, including argon plasma coagulation (APC), although effective, are burdened by ulcerations and stenosis. Materials and Methods Radiofrequency ablation (RFA), already successfully used for esophageal lesions, provides controlled and superficial necrosis, promoting mucosal re-epithelialization. The aim of the study is to evaluate the efficacy and safety of RFA in the treatment of refractory chronic actinic proctitis, comparing it with conventional endoscopic techniques. Selected patients were treated with a BarrxTM through-the-scope catheter, applying an energy of 10 J/cm2 (300 W). Endoscopic follow-up, using white light and narrow-band imaging (NBI), monitored re-epithelialization and the onset of complications. Results: Between January 1, 2023, and October 31, 2024, 15 patients with symptomatic CRP refractory to conventional medical therapy were enrolled. All patients underwent endoscopic treatment with RFA and subsequent follow-up until October 31, 2025. Control of rectal bleeding was achieved in thirteen patients (86.6%) after 1 or 2 sessions. In the remaining two cases, a significant reduction in bleeding was observed, although not complete remission. Ten patients received a single session (66.6%), while five patients required a second application after 6-8 weeks (33.3%). The complete remission of bleeding observed in 86.6% of patients and partial remission in the remaining 13.4% confirm the hemostatic efficacy of RFA, in line with the findings of major international trials. The progressive improvement in hemoglobin levels and the elimination of transfusion requirements within the first few months after treatment indicate an early and lasting clinical response. Endoscopically, the complete re-epithelialization of the rectal mucosa, with regression of telangiectasias and normalization of the vascular pattern, documented in all patients at the 24-month follow-up, demonstrates that the healing achieved is not only morphological but also functional. The complete absence of ulcerations, stenosis, or late fibrosis confirms the precision and selectivity of radiofrequency-induced superficial ablation, which allows for the preservation of the structural integrity of the rectal wall. Discussion This study represents one of the most recent experiences of the application of endoscopic radiofrequency (RFA) in the treatment of refractory chronic actinic proctitis (CRP), a complex and highly disabling clinical condition that can arise in patients undergoing pelvic radiotherapy for prostate, rectal, endometrial, or cervical cancer. The results obtained in our series highlight the high efficacy of RFA in controlling rectal bleeding and mucosal regeneration, with an excellent safety profile and significant clinical improvement maintained over time. Conclusions Endoscopic radiofrequency has been confirmed as an effective, safe, and minimally invasive method for chronic actinic proctitis, capable of ensuring long-lasting bleeding control and excellent mucosal healing

Inclusive Marketing, Value Creation Strategies, and Social Sustainability

What is inclusive marketing and why has it become so important for marketers? Inclusive marketing is speaking to a diverse audience and learning that new language makes it possible to address also vulnerable and marginalised groups. Brands act as cultural agents, shaping the experiences people encounter daily and inclusive marketing is a tool to build corporate identity, helping firms differentiate themselves while aligning with broader societal goals. Inclusive marketing can unlock new market opportunities and foster equality and social inclusion. However, authentic inclusive marketing strategies are essential to avoid backlash and accusations of “woke-washing.” Grounded in rigorous academic and multidisciplinary research, this book combines theory analysis, case studies, firsthand experiences, and essays from international scholars, professionals, and experts. It explores opportunities, challenges, and practical approaches to inclusive marketing strategies that benefit businesses and society. A valuable resource for academics, researchers, and students on Advanced Marketing, Business Strategy, and Communication courses, it also serves professionals wishing to enhance their strategies and contribute to a socially inclusive future

Raphael seen through MA-XRF: understanding the master and his atelier by studying the Capodimonte collection

Raphael’s paintings in the Capodimonte collection, ‘Museo e Real Bosco di Capodimonte’ in Naples, offer the opportunity to describe the master’s great career and technical evolution from the earliest production, as in the Baronci Panel, to the mature collaboration with his pupil and successor Giulio Romano for the Madonna of the Cat. At the same time, coeval and later copies describe the impressive favour Raphael gained, yet when he was alive and in the following centuries. Studying the materiality of Raphael’s paintings in the Capodimonte collection brings more extensive knowledge on his technique, but also gives a sense of how his pupils and followers imitated or distanced themselves from him, participating to the discussion on the role of copies in the fifteenth and sixteenth century. MA-XRF scanning of Raphael’s works in the collection, and the analysis of artworks attributed to his workshop or identified as later copies assisted in the redefinition of the master’s material peculiarities. Beyond offering insights into the conservation history of the paintings, chemical data chiefly allowed the description of: (1) the master’s early technique in the Baronci panel, (2) the master’s practice, his material experimentation and conceptual setting up in works attributed to his workshop

Driving Credit Access Through ESG Performance: A European Perspective

This paper analyzes whether there is any relationship between sustainability performance and access to bank loans by firms. More specifically, we explore the link between sustainability performance and credit access in the European context. We found that the level of ESG score has a beneficial effect on credit access. Our results provide evidence that the banks are more likely to incorporate environmental and social indicators in the decision-making process

The Ducal Palace in Parete (Italy): evolution of a Norman fortification Tower

The Ducal Palace in Parete is a historical monument in the centre of the homonymous district in south Italy. The structure in the current configuration originates from the stratification over centuries of successive intervention. The original urban layout is Roman, and the main roads, Vittorio Emanuele II and Roma, probably overlap the ancient Cardo and Decumano. In the beginning, the human settlement was agricultural, with several farmhouses, among which was the primary structure of the Ducal Palace. During the next centuries, various dominations have succeeded. In the eleventh century, the crisis for dukedoms and historic dynasties allowed the Normans to manage their power throughout southern Italy. In this context, the foundation of the city of Aversa marked the starting point of the Normans’ military ascendancy. With the foundation of the County of Aversa, all the hamlets and villages in the area, including the Parete, fell under the direct control of the Counts of Aversa. Parete was involved in some fortification works whose function was not merely the defence of the village but was part of a broader and more complex defensive system. Thus, a networked defensive system was established, whose mainstays were towers or similar structures throughout the Aversa territory, situated between the Princedome of Capua and the Dukedome of Naples. In Parete, a fortified tower was constructed as one of the mainstays of the network. Between the 12th and 13th centuries, the tower was expanded into a house tower, which constitutes the core of the present shape of the Ducal Palace. The building has a star-shaped structure with four angular and four connecting units, masonries are in grey tuff, and the roof is in chestnut wood. The study focuses on the analysis of such a peculiar transformation from the structural point of view, highlighting on the restoration and consolidation design. So the paper, taking into account that the whole structure born from a single free tower and had to transform into a complex system, shows the manner in which the interventions allowed the recovery and the re-use of the manufact

Real-Life Experience with Tildrakizumab in Plaque Psoriasis with Palmoplantar Involvement: A Multi-Center Retrospective Italian Study

Introduction: Palmoplantar psoriasis (PPp) has a profound negative impact on patients’ quality of life, and it represents a therapeutic challenge, as palms and soles are difficult to treat area. Although the efficacy profile of tildrakizumab has been well evaluated in the literature, data on its use for PPp are still limited. The objective of the study was to evaluate the efficacy and safety of tildrakizumab on moderate-to-severe plaque psoriasis with involvement of the palmoplantar area. Methods: A multicenter, retrospective, real-life study was performed enrolling patients with moderate-to-severe plaque psoriasis involving the palmoplantar area undergoing treatment with tildrakizumab with a follow-up of at least 52 weeks. At baseline, demographic and clinical data were assessed. Psoriasis severity was evaluated by using Psoriasis Activity Severity Index (PASI), body surface area (BSA), Psoriasis Global Assessment (PGA), Pruritus-Numerical Rating Scale (P-NRS) and Dermatology Life Quality Index (DLQI). Palmoplantar PASI (ppPASI) was used to evaluate psoriasis severity in the palmoplantar region. Clinical improvement was evaluated at each follow-up visit [week (W) 4, 16, 52]. Results: A total of 99 patients were enrolled. A reduction in PASI, BSA, PGA, P-NRS and DLQI was observed at each time point. Mean ppPASI at baseline was 16.9 ± 13.2, which started to improve at W4 (8.9 ± 9.1) and continued to decrease at W16 (2.1 ± 3.1) and W52 (0.5 ± 1.0). Moreover, a sub-analysis showed that the probability of achieving ppPASI50 at W4 increased in case of nail psoriasis (p < 0.05) and decreased in bio-experienced patients (p < 0.001). Similarly, the probability of achieving ppPASI75 at W4 decreased in the case of prior biologic exposure (p < 0.05). Finally, patients with nail psoriasis showed a higher probability of reaching ppPASI75 at W16 (p < 0.05), whereas patients previously treated with systemic therapies for psoriasis reported a reduced probability of ppPASI75 achievement at this time point (p < 0.05). Conclusion: Tildrakizumab was shown to be a fast and effective treatment for patients with PPp, being able to achieve significant results already after only 4 weeks of treatment. Moreover, the identification of potential clinical factors predictive of response may improve the selection of the best treatment in patients with PPp

Analytical Solutions for Lateral Bearing Capacity of Piles in Nonhomogeneous Soil

In routine design, the lateral bearing capacity of a single pile is commonly evaluated using analytical expressions which are derived under the hypothesis of rigid-plastic behavior of both the foundation soil and the pile cross section. Existing solutions are available for a limited number of lateral soil resistance distributions, namely constant and linearly increasing variations with depth. However, in real-world applications the profiles for the ultimate soil reaction can be significantly different from available idealized distributions. This study provides a design tool for a wide range of geotechnical scenarios encountered in engineering practice. Analytical solutions were developed for the lateral bearing capacity of piles for two types of generalized distributions of soil resistance with depth, extending those already available in literature. Furthermore, the new developments provide insight into the soil resistance mechanism occurring along the pile, and its effect on the bearing capacity considering pertinent failure modes. A rational manner to apply the solutions in routine engineering is also proposed. The predictions were validated against results obtained from available full-scale pile tests