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Although neglected in previous studies, tourist-to-tourist interaction (TTI) is a core part of festival experience. It is widely acknowledged that interactions between tourists significantly influence behavioral reactions such as desire to stay, satisfaction, and loyalty, which are important for tourism destination marketing. This study used grounded theory to obtain insights into onsite interactions between tourists and to propose a conceptual model of TTI on the Midi Music Festival in China. The model constitutes the types, drivers, and influence of TTI. Compared with mutual assistance and conflict, entertainment interaction plays an essential role in the overall evaluation of the festival experience. Individual characteristics are the internal drivers of interactions between tourists. Environmental elements including the festivalscape and social festivalscape are influential exogenous factors. Additionally, spatial locations of tourists at the venue play mediating roles between the driving elements and TTI. Since entertainment incidents construct the essential part of onsite interactions at festivals, managers can shape the atmosphere to encourage tourists to engage in interactive entertainment with others tourists. This should improve participants’ overall evaluations of the festival experience as well as the sustainable development of destinations where festivals are held.

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Rationale:Esophageal carcinosarcoma (ECS) is defined as a relatively rare malignant neoplasm with both epithelial carcinomatous and sarcomatous components. Besides, there were so many various controversies in ECS. This article describes a case of ECS that was effectively treated with radical esophagectomy and adjuvant chemotherapy. Also, we discuss the presentation, differential diagnosis, treatment, and prognosis of ECS.Patient concerns:A 58-year-old man presented with a history of progressive dysphagia and precordial pain after swallowing for 1 month.Diagnosis:Esophagogastroduodenoscopy (EGD) revealed a large polypoid neoplasm that occupied the esophageal lumen 30 to 34 cm from the incisors. On the characteristic morphology, clinical symptom and biopsy findings, the ECS was the primary considerated. Computed tomography (CT) examination demonstrated no radiological evidence of metastatic disease.Interventions:The patient underwent an Ivor Lewis esophagectomy, coupled with adequate lymph node dissection (2-field lymphadenectomy). ECS was confirmed by pathology report of postoperative. Then, the patient underwent adjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine.Outcomes:The patient remained alive without tumor recurrence at 24 months after multidisciplinary therapy.Lessons:It is generally treated by surgery, radiotherapy, and chemotherapy according to the protocols used for other esophageal cancers (EC). However, there is no recommended clinical treatment for ECS because of the rarity of the disease. Esophagectomy with extended lymphadenectomy followed by adjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine may be recommended treatment for ECS. Chemotherapy regimen with docetaxel, oxaliplatin, and capecitabine may be a suitable adjuvant therapy for ECS.