Vascular Responses to Simulated Breath-Hold Diving Involving Multiple Reflexes

Breath-hold diving evokes a complex cardiovascular response. The degrees of hypertension induced by the diving reflex are substantial and accentuated by the underwater swimming. This condition provides a circulatory challenge to properly buffer and cushion cardiac pulsations. We determined hemodynamic changes during the diving maneuver. A total of 20 healthy young adults were studied. Hemodynamics were measured during exercise on a cycle ergometer, apnea, face immersion in cold water (trigeminal stimulation), and simulated breath-hold diving. Dynamic arterial compliance (measured by changes in carotid artery diameter via ultrasound divided by changes in carotid blood pressure as assessed by arterial tonometry) increased with simulated diving compared with rest (p=0.007) and was elevated compared with exercise and apnea alone (p<0.01). A significant increase in heart rate was observed with exercise, apnea, and facial immersion when compared with rest (p<0.001). However, simulated diving brought the heart rate down to resting levels. Cardiac output increased with all conditions (p<0.001), with an attenuated response during simulated diving compared with exercise and facial immersion (p<0.05). Mean blood pressure was elevated during all conditions (p<0.001), with a further elevation observed during simulated diving compared with exercise (p<0.001), apnea (p=0.016), and facial immersion (p<0.001). Total peripheral resistance was decreased during exercise and facial immersion compared with rest (p<0.001) but was increased during simulated diving compared with exercise (p<0.001), apnea (p=0.008), and facial immersion (p=0.003). We concluded that central artery compliance is augmented during simulated breath-hold diving to help buffer cardiac pulsations.

Chewing and Cognitive Improvement: The Side Matters

Chewing improves cognitive performance, which is impaired in subjects showing an asymmetry in electromyographic (EMG) masseter activity during clenching. In these subjects, the simultaneous presence of an asymmetry in pupil size (anisocoria) at rest indicates an imbalance in Ascending Reticular Activating System (ARAS) influencing arousal and pupil size. The aim of the present study was to verify whether a trigeminal EMG asymmetry may bias the stimulating effect of chewing on cognition. Cognitive performance and pupil size at rest were recorded before and after 1 min of unilateral chewing in 20 subjects with anisocoria, showing an EMG asymmetry during clenching. Unilateral chewing stimulated performance mainly when it occurred on the side of lower EMG activity (and smaller pupil size). Following chewing on the hypotonic side, changes in cognitive performance were negatively and positively correlated with those in anisocoria and pupil size, respectively. We propose that, following chewing on the hypotonic side, the arousing effects of trigeminal stimulation on performance are enhanced by a rebalancing of ARAS structures. At variance, following chewing on the hypertonic side, the arousing effect of trigeminal stimulation could be partially or completely prevented by the simultaneous increase in ARAS imbalance.

Peri-threshold Trigeminal Stimulation with Capsaicin Increases Taste Sensitivity in Humans

Introduction Taste perception is affected by trigeminal stimuli, i.e., capsaicin. This has been studied at suprathreshold concentrations. However, little is known about taste perception at threshold level in the presence of low concentration of capsaicin. The aim of the study was to explore whether taste sensitivity for sweet, sour, salt, bitter, and umami is modulated by the presence of capsaicin in the peri-threshold range. Methods Fifty-seven adults (age range 19–85 years; 32 women) with functional gustation participated in the study. Based on their perception of phenylthiocarbamide (PTC), the group was stratified into non-tasters (n = 20) and tasters (n = 37). Threshold for sweet (sucrose), sour (citric acid), salty (sodium chloride), bitter (quinine-hydrochloride), and umami (sodium-glutamate) tastes was estimated using a single-staircase paradigm (3-alternative forced choice; volume per trial 0.1 ml) with or without 0.9-µM capsaicin added. This capsaicin concentration had been determined in pilot studies to be in the range of oral perception thresholds. Results The addition of capsaicin produced lower taste thresholds for sweet, sour, salty, and bitter but not for umami. In contrast, neither PTC taster status nor sex affected these results. Conclusion The current results indicate that a low concentration of capsaicin increases gustatory sensitivity. Implications The current findings provide evidence supporting different effects of capsaicin on taste perception at threshold level. It has implications for boosting taste sensitivity or flavor enjoyment with low concentration of capsaicin.

Possibilities for Maintaining Appetite in Recovering COVID-19 Patients

COVID-19 and sequelae thereof are known to cause chemosensory dysfunction, posing a risk for intake and adequate nutrition for recovery. The overall objective of this study was to investigate the subjective strategies for maintaining appetite applied by patients recovering from COVID-19. The study included 19 in-depth interviews, focusing on patients suffering from long-term effects of COVID-19. The results were analysed using a thematic analysis for qualitative data. Results on strategies for maintaining appetite included four key themes: (1) a focus on well-functioning senses, (2) a focus on familiar foods, (3) a focus on the eating environment, and (4) a focus on post-ingestive well-being. It was found that factors prior to, during and after food intake, as well as the context, could influence desire to eat and pleasure related to food intake. As ageusia and anosmia make characterization of food difficult, being able to recognize and memorize its flavour was important to engage in consumption. Under normal circumstances, the hedonic value of food relies predominantly on the flavour of foods. When suffering from chemosensory dysfunction, shifting focus towards the texture of food, including trigeminal stimulation during consumption, were beneficial for maintaining appetite and food-related pleasure. Furthermore, a focus on the holistic satisfying feelings of choosing healthy food, as well as a focus on other people’s enjoyment during meals were reported to boost well-being around food intake. The study elaborated our understanding of the complex consequences of COVID-19, and can be applied in health promoting initiatives targeted patients recovering from COVID-19.

Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series

BACKGROUND Facial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain. OBJECTIVE To report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes. METHODS A retrospective chart review of 59 patients with refractory facial pain who underwent TG stimulation was conducted. Outcomes following trial period and permanent stimulation were analyzed. Patients with &gt;50% pain relief during trial stimulation received permanent implantation of the stimulation system. RESULTS Successful trial stimulation was endorsed by 71.2% of patients. During the trial period, 1 TG lead erosion was identified. History of trauma (facial/head trauma and oral surgery) was the only predictor of a failed trial compared to pain of idiopathic etiology (odds ratio: 0.15; 95% CI: 0.03-0.66). Following permanent implantation, approximately 29.6% and 26.5% of patients were diagnosed with lead erosion and infection of the hardware, respectively. TG lead migrations occurred in 11.7% of the patients. The numeric rating scale score showed a statistically significant reduction of 2.49 (95% CI: 1.37-3.61; P = .0001) at an average of 10.8 mo following permanent implantation. CONCLUSION TG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.