Riconoscere e monitorare la potenziale fragilità dei sistemi commerciali urbani: una proposta per la Regione Lombardia

In Italia l’insieme dei cambiamenti socio-economici e tecnologici recenti hanno contribuito ad una profonda trasformazione dei comportamenti d’acquisto e delle pratiche di consumo tradizionali. Questa si manifesta in modo evidente anche nello spazio, con una pluralità di dinamiche sovrapposte e, a volte, interrelate che marcano il territorio contemporaneo. Fra le altre negli ultimi anni è emersa la dismissione commerciale come fenomeno pervasivo che si presenta, in modo differenziato, sia all’interno dei tessuti densi delle città che negli ambiti extraurbani. In questo quadro, gli enti locali manifestano l’esigenza di un supporto tecnico per la prefigurazione di politiche e strumenti orientati alla costruzione di linee guida e indirizzi qualitativi per l’azione pubblica, sia alla scala regionale che comunale per il rilancio dell'attrattività urbana. L’obiettivo dell’intervento è la presentazione degli esiti di un lavoro di ricerca effettuato per il territorio della regione Lombardia, orientato al riconoscimento degli ambiti urbani potenzialmente soggetti a fragilità commerciale attraverso la definizione di indicatori territoriali atti a realizzare affondi analitici e monitorare le dinamiche in corso. Nelle conclusioni si rilancia il possibile ruolo degli indicatori e, in generale, della produzione di spatial knowledge come elemento di supporto e di rafforzamento per le azioni ed i progetti sviluppati dagli attori pubblici che, in questo caso, sono legati alla rivitalizzazione del commercio come elemento rafforzativo e qualificante della rigenerazione urban

Descrivere e monitorare il commercio urbano

Una recente esperienza di ricerca realizzata dal Laboratorio URB&COM del Politecnico di Milano sull’ambito delle polarità distrettuali del Distretto Urbano del Commercio di Bergamo è l’opportunità per riflettere sui metodi di indagine e descrizione dei sistemi commerciali urbani. La sperimentazione, avviata in collaborazione con gli operatori interessati, prevede un loro coinvolgimento attivo nell’aggiornamento delle informazioni relative alla geografia delle attività insediate, così da poter dotare il DUC di uno strumento utile ed efficace nel supporto alle strategie di rafforzamento del sistema d’offerta e nelle azioni di rilancio dei locali commerciali dismessi o sottoutilizzati

Solitary fibrous tumor of the male breast: a case report and review of the literature

Extrapleural solitary fibrous tumors are very rare and occasionally they appear in extraserosal soft tissues or parenchymatous organs. In such cases the right preoperative diagnosis is often difficult and challenging, because both radiological and cytological examinations are not exhaustive. For these reasons, surgical excision is frequently the only way to reach the correct diagnosis and to achieve definitive treatment. A few cases of solitary fibrous tumors have been also described in the breast. Although rare, this lesion opens difficulties in preoperative diagnosis entering in differential diagnosis with other benign lesions as well as with breast cancer. In this article we describe a case of a solitary fibrous tumor of the breast in a 49-year-old man. Problems related to differential diagnosis and the possible pitfalls that can be encountered in the diagnostic iter of such rare tumor are discussed

Multifocality and multicentricity are not contraindications for sentinel lymph node biopsy in breast cancer surgery

BACKGROUND: After the availability of the results of validation studies, the sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection (AD) as the new standard of care in early unifocal breast cancers. Multifocal (MF) and multicentric (MC) tumors have been considered a contraindication for this technique due to the possible incidence of a higher false-negative rate. This prospective study evaluates the lymphatic drainage from different tumoral foci of the breast and assesses the accuracy of SLNB in MF-MC breast cancer. PATIENTS AND METHODS: Patients with preoperative diagnosis of MF or MC infiltrating and clinically node-negative (cN0) breast carcinoma were enrolled in this study. Two consecutive groups of patients underwent SLN mapping using a different site of injection of the radioisotope tracer: a) "2ID" Group received two intradermal (ID) injections over the site of the two dominant neoplastic nodules. A lymphoscintigraphic study was performed after each injection to evaluate the route of lymphatic spreading from different sites of the breast. b) "A" Group had periareolar (A) injection followed by a conventional lymphoscintigraphy. At surgery, both radioguided SLNB (with frozen section exam) and subsequent AD were planned, regardless the SLN status. RESULTS: A total 31 patients with MF (n = 12) or MC (n = 19) invasive, cN0 cancer of the breast fulfil the selection criteria. In 2 ID Group (n = 15) the lymphoscintigraphic study showed the lymphatic pathways from two different sites of the breast which converged into one major lymphatic trunk affering to the same SLN(s) in 14 (93.3%) cases. In one (6.7%) MC cancer two different pathways were found, each of them affering to a different SLN. In A Group (n = 16) lymphoscintigraphy showed one (93.7%) or two (6.3%) lymphatic channels, each connecting areola with one or more SLN(s). Identification rate of SLN was 100% in both Groups. Accuracy of frozen section exam on SLN was 96.8% (1 case of micrometastasis was missed). SLN was positive in 13 (41.9%) of 31 patients, including 4 cases (30.7%) of micrometastasis. In 7 of 13 (53.8%) patients the SLN was the only site of axillary metastasis. SLNB accuracy was 96.8% (30 of 31), sensitivity 92.8 (13 of 14), and false-negative rate 7.1% (1 of 14). Since the case of skip metastasis was identified by the surgeon intraoperatively, it would have been no impact in the clinical practice. CONCLUSION: Our lymphoscintigraphic study shows that axillary SLN represents the whole breast regardless of tumor location within the parenchyma. The high accuracy of SLNB in MF and MC breast cancer demonstrates, according with the results of other series published in the literature, that both MF and MC tumors do not represent a contraindication for SLNB anymore

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

A GIS Approach to Supporting Nightlife Impact Management: The Case of Milan

Following the increasing liberalisation of commercial activities, which have taken place in the last few decades, the power of municipal authorities to schedule retail and leisure-based businesses has been reduced in its spatial extent; it now applies only to specific ‘Protection Zones’ (Zone da sottoporre a tutela). In these areas, due to environmental, social and/or traffic sustainability reasons, the freedom of private business is limited by the need to respect the right of residents to normal liveability and mobility standards. This paper describes a research by Laboratorio URB&COM (Politecnico di Milano), aimed at supporting the City of Milan in detecting those spatial contexts whose conditions suggest the application of a specific regulation, in order to control nightlife leisure’s negative externalities. A GIS-based analysis approach has proved fundamental in defining an objective and transparent evaluation path, towards the mapping of critical areas where regulation is needed.  In addition, within the proposal of policy monitoring methods, a particular approach has been suggested, based entirely on the use of Information and Communication Technology (ICT)

A GIS Approach to Supporting Nightlife Impact Management: The Case of Milan

Following the increasing liberalisation of commercial activities, which have taken place in the last few decades, the power of municipal authorities to schedule retail and leisure-based businesses has been reduced in its spatial extent; it now applies only to specific ‘Protection Zones’ (Zone da sottoporre a tutela). In these areas, due to environmental, social and/or traffic sustainability reasons, the freedom of private business is limited by the need to respect the right of residents to normal liveability and mobility standards. This paper describes a research by Laboratorio URB&COM (Politecnico di Milano), aimed at supporting the City of Milan in detecting those spatial contexts whose conditions suggest the application of a specific regulation, in order to control nightlife leisure’s negative externalities. A GIS-based analysis approach has proved fundamental in defining an objective and transparent evaluation path, towards the mapping of critical areas where regulation is needed.  In addition, within the proposal of policy monitoring methods, a particular approach has been suggested, based entirely on the use of Information and Communication Technology (ICT)