Barriere e Facilitatori nella Maturità dei Processi per la Promozione sul Web delle Destinazioni Turistiche Italiane

Despite the growing importance of Information and Communication Technologies (ICTs) in the tourism domain, the opportunities offered by the web to promote tourist destinations seem to be not yet fully exploited by destination marketing organizations. This study seeks to extend the eTourism Communication Maturity Model (eTcoMM), which is based on stage models of online communication in tourism. The model focuses on identifying processes involved in tourism web marketing activities, from awareness by tourism boards to implementation. The study aims to contribute to the definition of maturity in online promotion by Italian tourism boards, identifying and discussing factors that aid and limit the transition, from awareness to implementation of strategic web marketing.Nonostante la crescente importanza delle Information and Communication Technologies (ICTs) nel mondo del turismo, le opportunità offerte dal web per la promozione del territorio sembrano non essere ancora adeguatamente sfruttate da parte degli enti turistici. Il contesto teorico di questo studio è dato dal modello eTcoMM – eTourism Communication Maturity Model (Marchiori et al, 2012), basato sugli stages models applicati in ambito di comunicazione online e dedicato all’identificazione dei processi di evoluzione dalla consapevolezza all’implementazione di attività di web marketing da parte di enti turistici. Lo studio qui presentato sulle destinazioni turistiche italiane, si propone di estendere tale modello, contribuendo alla definizione della maturità nella promozione online del territorio degli enti turistici italiani, individuando in particolare quali siano gli elementi che possono limitare il passaggio dalla consapevolezza all’implementazione strategica delle attività di web marketing e quelli che, al contrario, ne spingono con successo il passaggio evolutivo

Fulvestrant and trastuzumab in patients with luminal HER2-positive advanced breast cancer (ABC): an Italian real-world experience (HERMIONE 9)

Purpose The most appropriate therapy for HR+/HER2-positive (HER2+) advanced breast cancer (ABC) is a matter of debate. Co-targeting of both receptors represents an attractive strategy to overcome the cross-talk between them. Methods The HERMIONE 9 is an observational retrospective multicentric study which aimed to describe the clinical outcome of patients with HR+/HER2+ABC who received the combination of Fulvestrant (F) and Trastuzumab (T) as part of their routine treatment at 10 Italian Institutions. Results Eighty-seven patients were included. Median age was 63 (range, 35–87) years. The median number of previous treatments was 3 (range, 0–10) and F and T were administered as≥3rd line in 67 patients. Among the 86 evaluable patients, 6 (6.9%) achieved CR, 18 (20.7%) PR, and 44 (50.6%) had SD ≥24 weeks with an overall CBR of 78.2%. At a median follow-up of 33.6 months, mPFS of the entire cohort was 12.9 months (range, 2.47–128.67). No diference was observed in mPFS between patients treated after progression or as maintenance therapy (mPFS 12.9 and 13.9 months in 64 and 23 patients, respectively), neither considering the number of previous treatment lines (≤3 or<3). Conclusion The combination of F and T was active in this cohort at poor prognosis and deserves further investigations possibly in combination with pertuzumab in patients with high ER expression

Metal concentrations in the blood and tissues after implantation of titanium growth guidance sliding instrumentation

BACKGROUND: Growth guidance sliding treatment devices such as Shilla (Medtronic, USA) or LSZ-4D (Conmet, Russia) used for the treatment of scoliosis in children who have high growth potential have unlocked fixtures allowing rods to slide during growth of the spine which avoids periodical extensions. However, the probability of clinical complications associated with metallosis after the implantation of such devices is poorly understood. The content of metal ions in the blood and tissues of pediatric patients treated for scoliosis using fusionless growth guidance sliding instrumentation, have not yet been investigated. PURPOSE: The aim of this study was to measure the content of metal ions in blood and tissues surrounding implanted growth guidance sliding LSZ-4D devices made of titanium alloy (Ti6Al4V) and to identify the incidence of metallosis associated clinical complications in some patients with these devices. STUDY DESIGN: One center case-control retrospective study. PATIENTS SAMPLE: Study group included 25 patients with high growth potential (3 males, 22 females, average age at primary surgery for scoliosis treatment is 11.4±1.2 years old) who had sliding growth guidance instrumentation LSZ-4D (Conmet, Moscow, Russia) implanted on 13 (range 10-16) spine levels for 6±2 years. The LSZ-4D device was made from titanium alloy Ti6Al4V and consisted of two rectangular section rods and fixture elements. Locked fixtures were used on one spinal level, while the others were unlocked (sliding). The control group consisted of 13 patients (12 females and 1 male, 11±1.2 years old) without any implanted devices. OUTCOME MEASURES: The content of Ti, Al and V metal ions in the whole blood and tissues around the implanted device was measured. Incidence of metallosis associated complications in the study group were recorded. METHODS: Metal ion content was measured by ICP-MC on quadrupolar Nexion 300D (Perkin Elmer, USA). RESULTS: 5 of 25 patients in the study group developed metallosis associated complications (two sinuses and three seromas in the lumbar part of the spine). Revisions were carried out in two of these patients. 90% of patients in the study group had increased content of Ti and V ions in the blood (2.8 and 4 times respectively). Median content of Ti ions in soft tissues adjacent to implanted sliding device was more than 1,500 fold higher compared with the control group. These levels are much higher than previously reported for spinal instrumentation. CONCLUSION: Increased content of Ti and V ions in the blood and especially in tissues around the titanium growth guidance sliding device LSZ-4D accompanied by clinical manifestations (seromas and sinuses) indicate the importance of improving of wear resistance of such instrumentation with the coatings and the necessity to exchange sliding instrumentation once the child is fully grown

Gastrointestinal presentation of kawasaki disease: A red flag for severe disease?

Background Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease. Objective To evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions. Methods Retrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases. Results 302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009). Conclusions This is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population

Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience

: Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC

Ciclo Reprodutivo De Tadarida Brasiliensis (I. Geoffroy, 1824)

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