Primary Headaches and their Relationship with the Autonomic Nervous System

Headache disorders, described as early as 3000 BC, represent both a treatment challenge and a serious public health concern, with impact on the individual and society. Existing research in primary headache syndromes (not being caused by any underlying problem) focuses mainly on pain mechanisms. However, the painful symptomatology is the main encounter for the decreased quality of life and discomfort, the vegetative manifestations that frequently accompany the cephalalgic syndromes represent an important source of distress. Despite the advancement of the understanding of the molecular basis of headache disorders and neurovascular complex interactions, there is still lack of a cohesive understanding of the neurovegetative modulation in different types of primary cephalalgic syndromes. The aim of this chapter is to present an overview of the neurochemical mechanisms and pathways, which subtend dysautonomic manifestations in headache

Cardiac autonomic modulation in drug-resistant epilepsy patients after vagus nerve stimulation therapy

The positive effect of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy is considered to be mediated by the afferent pathways of the vagus nerve, but the efferent pathways may influence the cardiac autonomic activity.Aim of the study. To assess the effects of VNS on cardiac autonomic modulation in epilepsy patients, over three months of neurostimulation.Clinical rationale for the study. Linear and non-linear heart rate variability (HRV) analysis can provide information on the sympathovagal balance and reveal particularities of the central control of the autonomic cardiovascular function.Materials and Methods. Using Biopac Acquisition System, we analysed HRV parameters in resting condition and during sympathetic and parasympathetic activation tests in five patients with drug-resistant epilepsy, who underwent VNS procedure.Results. During the sympathetic and vagal activation tests, all five patients presented normal responses of cardiac autonomic activity, reflected in RMSSD, HFnu and LF/HF dynamics in both HRV evaluations. No bradycardia, cardiac arrhythmia or orthostatic hypotension was registered during the two evaluations.Conclusions. Our results indicate that VNS appears not to alter the cardiac autonomic function after three months of neurostimulation. HRV analysis is a useful tool for evaluating cardiac autonomic modulation in epilepsy patients during VNS therapy.Clinical Implications. Patients with decreased HRV should be periodically monitored. Cardiac changes in patients with epilepsy are important because of the additional risk of arrhythmias mediated through the autonomic dysfunction

The alcmaeon project: bringing humanities, the arts and medical education together

The article is a systematic reflection on the Alcmaeon European project (2018-ES01-KA203-050606), which puts forth an alternative model for integrating the history of medicine into medical education. The project is developed within a partnership between education organizations, museums and universities from Spain, Great Britain, Italy, Greece and Romania. The project aims at shifting the focus of teaching the history of medicine from simply chronicling events to examining the process of medical development over time and studying it as a continuous inquiry by providing medical professionals with structured and harmonized online materials available in its own virtual museum and library. In addition, the arts can be used as a means to educate students of medicine in an agreeable atmosphere by means of focused interpretation and discussion with a view to developing their professionalism, selfawareness and communication skills, increasingly important assets for physicians. Bringing these disciplines together enables students to form deeper connections with patients and develop empathy and creativity. Overall, the focus group analysis highlighted that integrating the history of medicine into medical education is necessary as it gives students insights into past procedures and achievements, raises their awareness about the importance of medical and social ethics, provides lessons in medical education, empathy, charity work, community involvement, ethical standards, and laboratory research

Water quality assessment in a river-sea transition zone. Recent results from distinct aquatic environments of the danube delta biosphere reserve area, Romania

This study aims to compare the water quality in distinct aquatic systems, situated in different representative areas of the Danube Delta Biosphere Reserve, Romania - a unique natural area of national and international importance. These areas are largely populated by a vast diversity of aquatic organisms, including rare species of plants, animals, aquatic birds and fish, many of them being endangered species. Any imbalances in these ecosystems, owing to natural and human-induced changes in the water quality may affect aquatic life. In this sense, water samples were collected from the surface layer of a freshwater environment (i.e., Babina, Rădăcinoasele and Ciorticuț lakes), as well as from mixed environments (i.e., Musura and Sahalin Bays) during August 2018. The following water quality indicators were considered: temperature, pH, dissolved oxygen, nitrite-nitrogen, nitrate-nitrogen, ammonium-nitrogen, orthophosphates, chlorophyll a, total organic carbon, silica, electrical conductivity, total dissolved solids, sulphates, turbidity, total suspended solids, transparency and oxido-reduction potential. These parameters were analysed and discussed in relation to national and international environmental standards. Maps of spatial distribution of some quality parameters were obtained, showing variation as a result of local specific environmental circumstances, which change in time and space. These results suggest that the environmental indicators measured in drought conditions and low water levels showed generally good to moderate water quality status, in spite of many local triggers associated with natural and anthropogenic causes that can alter or impair the quality of the water. After this investigation performed during August 2018, it can be appreciated that the analysed water samples maintain appropriate levels that are suitable for the ecological status of the investigated aquatic systems, and, as expected, the aquatic habitats are ecologically balanced environments. The paper recommends the routine monitoring and periodical testing of the water quality to create and develop a database to reflect the natural variation and human related implications for water quality within these areas, and their short, medium and long-term evolution trends. The present work is important for water quality assessment to detect changes in water quality under human pressures and climate change and to protect and conserve these natural water resources

Physical-chemical properties of the surface water from shallow lakes of the Matita-Merhei Unit, Danube Delta, Romania: current state and environmental significance

This study aimed to assess the water quality of certain lakes (Bogdaproste, Trei Ozere and Radacinos) belonging to the Danube Delta, Romania. Deltaic ecosystems are subject to natural and man-made environmental stressors. If in the past these ecosystems were largely threatened by eutrophication and organic/inorganic pollution, nowadays, we must focus on hydro morphological impact. This refers to the physical character and water content of the aquatic environment, impoundment (dams and flood gate), channelization and embankments, as well as clog/siltation of lakes. Environmental parameters are those physical, chemical and biological indicators used to characterize a freshwater body, and, which vary in time and space. In this regard, 44 water samples were collected in the dry season from the three lakes, for analysis of physical-chemical quality indicators. A series of physical (T, EC, TDS, turbidity, TSS, transparency) and chemical parameters (pH, DO, nutrients, SiO2, TOC, SO42-, ORP, technophilic elements) were considered. The results obtained in the physical-chemical analyses revealed that the majority of parameters were found in line with enforcing environmental regulations. Despite that, P-PO43- and Cd concentration results of some samples were found above certain permissible limits set by the normative. Probably, these inadvertences can be associated with local conditions of the transitional deltaic environment. Further analysis is required conducting repeated measurements with the same question, meaning a routine monitoring, especially P-PO43- and Cd. Finally, it was concluded that the results of this study showed a good quality of water in investigated lakes that did not pose potential health and environmental problems related to the biota

The role of capsule endoscopy in the diagnosis of digestive haemorrhage

Gastrointestinal bleeding is a common cause of hospitalization, with a high hospital morbidity and mortality rate, but decreasing compared to previous years due to an important progress in therapeutic endoscopic techniques. It is estimated that 5-7% of gastrointestinal bleedings are of obscure origin, with a normal upper and lower gastrointestinal endoscopy. The capsule endoscopy is the state-of-the-art, non-invasive procedure, providing a fine diagnosis of intestinal lesions, especially those found in the small bowel, difficult to address by other methods. Many studies have been published during the past years regarding the sensibility and outcome of capsule endoscopy in patients with gastrointestinal bleeding, but few underline its definitive role in the diagnosis of digestive bleeding. This review looks at the role of capsule endoscopy in the evaluation of patients with gastrointestinal bleeding from the small bowel and the therapeutic options available

A century of human interventions on sediment flux variations in the Danube-Black Sea transition zone

Many deltas around the world have recorded a decreasing sediment input, mostly due to retention in dams constructed on the river or in the river basin. The Danube River has recorded a significant decrease of its sediment supply to the Danube Delta and the NW Black Sea. This study uses 210Pb and 137Cs dating, to investigate the effects of the decreasing sediment flux in lakes, lagoons, delta front and prodelta area. Both the effects of the Iron Gate I and II dams and other local factors are discussed. These results define the period of 1960-1990 as the ‘major anthropic interventions period’ in the Danube Delta. Results show a decrease in siliciclastic flux, especially in lakes, the Sahalin lagoon and the prodelta area and a general increase in the Musura lagoon and the delta front area. Sand content is also shown to decrease in most areas and is replaced by silt. The changes in sediment accumulation rates depend mostly on the hydrological connectivity of the area and the local hydrotechnical works. Overall, the local anthropic interventions in the delta affect sediment flux in the subaerial delta and the delta front, while the prodelta is affected by the overall decrease caused by interventions in the river basin. This study can contribute to improving management strategies in the area and to a better understanding of future research needs in the Danube Delta-Black Sea system

Evidence for the Re-Enactment of a Recently Learned Behavior during Sleepwalking

Animal studies have shown that sequenced patterns of neuronal activity may be replayed during sleep. However, the existence of such replay in humans has not yet been directly demonstrated. Here we studied patients who exhibit overt behaviors during sleep to test whether sequences of movements trained during the day may be spontaneously reenacted by the patients during sleep

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements