How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

Swallowing, voice disorders, throat discomfort and subjective neck discomfort are usually reported by patients with a known thyroid nodule and are correlated to nodular thyroid disease itself. Moreover, in endemic goitrous areas, total thyroidectomy (TT) is the most frequently performed surgical procedure. We are used to relate swallowing, voice and throat discomfort to the mechanical effects of nodular goiter or to thyroidectomy itself, but in both these cases the relationship between symptoms and the thyroid mass or its removal is not always clear or easily demonstrated. How can we explain the persistence of local neck symptoms after TT? And how can TT worsen the dysphagic or dysphonic disorders attributed to the goiter’s effect over the surrounding structures? During these years, many articles have analyzed the relationship between the thyroid disease and the laryngopharyngeal reflux, finding more and more evidences of their consensuality, leading to important new management considerations and notable medico-legal implications; if the reason of local neck symptoms is not the thyroid disease, we have to study and specially cure the reflux disease, with specific test and drugs. Therefore, the aim of our study, relying on the published literature, was to investigate how, in demonstrated presence of reflux laryngopharyngitis in patients with nodular goiter and local neck symptoms before and after uncomplicated TT, the surgery could influence our anti-reflux mechanism analyzing the anatomical connection as well as the functional coordination; can we play a part in the post-operative persistence of swallowing and voice alterations and throat discomfort

IMMIGRATION AND RESILIENCE: THE CASE-STUDY OF INNER ITALIAN AREAS

The immigration phenomenon is involving the whole national territory with particular effect on small inland areas of the Italian regions and it happens for various reasons. The case-study will concern the observation of the town of Palazzo San Gervasio (Potenza) that, as a reality endowed with an identification and expulsion center (CIE), is evolving into a reality that not only intends to tighten solid and strong alliance for mutual growth, with immigrants, but aims to achieve a level of resilience that can avoid depopula-tion and the consequent disappearance of the same city. The community of Palazzo San Gervasio has found in the migrants a lifeblood able to trigger processes of “improve-ment” of the Community heritage of welcome and tolerance. This allowed the development of an European project designed to identify the causes of the problems before putting reception to discuss with each other, outside of institutional as well as administrative settings, doctors, prefecture, re-gional representatives and state organs with simple citizens, associations and, especially migrants. The first working tables have already shown some problematic processes, for example, in the allocation of recognition documents, beyond, the possibility to move in Europe, would give migrants the possibility to integrate, without legal problems, in the communities cozy and, on the other hand, they have shown that, especially the younger boys have received a non-charitable but absolutely time integration from peers. Therefore, contrary to what one might imagine, it is the youngest and the residents in the inland community to show greater sensitivity to the phenomenon. Of course much remains: to know the needs (housing, the social spaces, prayer space, market areas, etc.) of migrants but the case of small indoor areas, not only, shows a real aptitude of the same to a inherent resiliency, but also, such a sensitivity that you feel “ready to sail” each of the elements of conscious welcoming community that today we could all be forced to become migrants

Aplicación de la metodología de tablero de comando para la mejora en la eficiencia de los servicios prestados por el IPS

Se investiga en el presente trabajo la existencia de posibles sobre prestaciones de servicios por parte de instituciones asociadas con el IPS. Se selecciona un conjunto de indicadores relevantes vinculados con las prestaciones médicas más frecuentes. Se concluye que el grado de sobre prestación de servicios es elevado, salvo en el caso de las radiografías, en el cual se obtuvo un promedio de una radiografía cada 10,7 consultas (próximas al valor de una cada 10, tomado como patrón). Se propone, además, un sistema de Tablero de Comando para el monitoreo continuo de las prestaciones médicas.Research in the present work the existence of possible over provisions of services by part of institutions associated with the IPS. It selects a group of indicators relevant connect with the medical provision more frequent. Conclude that the degree of over provision of services is overhead, save in the case of the radiographies, in which obtained an average of a radiography each 10.7 queries (next to the value of one each 10, taken like pattern). It proposes, besides, a system of Balanced Scorecard for the monitored continuous of the medical provision.Sociedad Argentina de Informática e Investigación Operativ

Motivations of Premium Seat Buyers

As a result of increased operating expenses and decreased football game attendance, a growing number of athletic departments have opted to add or increase premium seating availability in their football stadiums. The purpose of this study is to gain a better understanding of purchase motivations of premium seat holders at collegiate football games, examine the relationship between buyer demographics and motivations to purchase premium seats, and compare perceived motivations of premium seat buyers with actual motivations of premium seat buyers. Premium seat holders from a large, public Atlantic Coast Conference school were surveyed. Descriptive statistics found the most significant motivational factors for premium seat purchases are “upgraded services and amenities,” “brand image of the team,” and “value of exclusivity in the venue.” Data collected also indicated that, overall, sport professionals are wrong in their perception of premium seat buyer motivations.Master of Art

Progetto per il Campus universitario di Matera

Si mostrano i progetti prodotti dal corso di Architettura e composizione III tenuti dall'autore. L'interesse di mostrare questi progetti elaborati nell'ambito della didattica, deriva dal fatto che tutti hanno assunto come fonte ispiratrice dell'ideazione la problematica della città-natura che, in questo caso, si definisce in rapporto all'obiettivo strategico di rigenerare un'area centrale della prima periferia di Matera

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

The evidence from post-mortem biochemical studies conducted on cortisol and catecholamines suggest that analysis of the adrenal gland could provide useful information about its role in human pathophysiology and the stress response. Authors designed an immunohistochemical study on the expression of the adrenal β2-adrenergic receptor (β2-AR), a receptor with high-affinity for catecholamines, with the aim to show which zones it is expressed in and how its expression differs in relation to the cause of death. The immunohistochemical study was performed on adrenal glands obtained from 48 forensic autopsies of subjects that died as a result of different pathogenic mechanisms using a mouse monoclonal β2-AR antibody. The results show that immunoreactivity for β2-AR was observed in all adrenal zones. Furthermore, immunoreactivity for β2-AR has shown variation in the localization and intensity of different patterns in relation to the original cause of death. To the best of our knowledge, this is the first study that demonstrates β2-AR expression in the human cortex and provides suggestions on the possible involvement of β2-AR in human cortex hormonal stimulation. In conclusion, the authors provide a possible explanation for the observed differences in expression in relation to the cause of death

La Città-Natura per il turismo sostenibile: fenomeni e strategie

L’idea di città-natura propone una nuova alleanza tra architettura e godimento dei luoghi, rigenerando la propria esistenza “virtuosa”, tra comprensione dell’eredità culturale ed esigenze di sostenibilità