High prevalence of long-term olfactory, gustatory, and chemesthesis dysfunction in post-COVID-19 patients: a matched case-control study with one-year follow-up using a comprehensive psychophysical evaluation.

BACKGROUND: Using an age and gender matched-pair case-control study, we aimed to estimate the long-term prevalence of psychophysical olfactory, gustatory , and chemesthesis impairment at least one year after SARS-CoV-2 infection considering the background of chemosensory dysfunction in non-COVID-19 population. METHODOLOGY: This case-controlled study included 100 patients who were home-isolated for mildly symptomatic COVID-19 between March and April 2020. One control regularly tested for SARS-CoV-2 infection and always tested negative was matched to each case according to gender and age. Chemosensory function was investigated by a comprehensive psychophysical evaluation including ortho- and retronasal olfaction and an extensive assessment of gustatory function. Differences in chemosensory parameters were evaluated through either Fisher’s exact test or Kruskal-Wallis test. RESULTS: The psychophysical assessment of chemosensory function took place after a median of 401 days from the first SARS-CoV-2 positive swab. The evaluation of orthonasal smell identified 46% and 10% of cases and controls, respectively, having olfactory dysfunction, with 7% of COVID-19 cases being functionally anosmic. Testing of gustatory function revealed a 27% of cases versus 10% of controls showing a gustatory impairment. Nasal trigeminal sensitivity was significantly lower in cases compared to controls. Persistent chemosensory impairment was associated with emotional distress and depression. CONCLUSION: More than one year after the onset of COVID-19, cases exhibited an excess of olfactory, gustatory , and chemesthesis disturbances compared to matched-pair controls with these symptoms being associated to emotional distress and depression.

Denture-frame modifications in class III patients treated with rapid palatal expansion and facemask: a prospective controlled study.

AIM: The aim of this prospective controlled investigation was to analyze the short-term cephalometric treatment outcomes, according to the denture frame analysis proposed by Sato, of rapid palatal expansion (RPE) and facial mask (FM) therapy. METHODS: A group of 21 patients with Class III malocclusion treated with the RPE and FM (TG) was compared with untreated Class III controls (CG). The mean age of treatment group was 8.8 years; treatment consisted of 4 weeks of RPE activation (0.20 mm/die) followed by 14 hours wear of the FM for a mean of 333.1 days. As CG were used the data published by Tanaka and Sato. Pre- and post-treatment cephalometric values were compared and statistical analyzed with one-sample t-test. A P-value <0.05 was considered statistically significant. RESULTS: For almost all parameters the differences pre and post treatment values resulted significantly different compared to those observed in CG. Regarding conventional occlusal plane (POC) values some differences compared to control group were found but they were not statistically significant (P=0.067) while for aterior occlusal plane (POA) no differences where noticed. CONCLUSION: This study revealed an increase in inter-jaw angle during treatment with FM and RPE, an increase in the inclination of the posterior occlusal plane with respect to the Frankfurt plane and a posterior and lower adaptation of the mandible.

Voltage-activated current properties of male and female mouse vomeronasal sensory neurons: sexually dichotomous?

The vomeronasal organ, the chemosensory organ of the vomeronasal system, is vital in determining sexual and gender-specific behavior in mice. Here, whole-cell voltage-activated currents of individual mouse vomeronasal sensory neurons of two strains (BALB/c and CBA) were measured and correlated to sex in each strain. The average resting membrane potentials, maximal outward current magnitudes, and kinetics of activation and inactivation, were found to be independent of sex. Maximal inward current magnitudes differed significantly across gender in CBA, whereas they did not significantly differ in male and female BALB/c mice: BALB/c males -347+/-45 pA ( n=51), and females -430+/-56 pA ( n=27); CBA males -308+/-36 pA ( n=56) and females -155+/-18 pA ( n=28). These results suggest that some voltage-activated properties may differ slightly according to gender and to strain.

Co-expression of wild-type and mutant olfactory cyclic nucleotide-gated channels: restoration of the native sensitivity to Ca(2+) and Mg(2+) blockage.

In the pore of homomeric cyclic nucleotide-gated (CNG) channels, Ca(2+) and Mg(2+) bind to a set of glutamate residues, which in the bovine olfactory CNG channel are located at position 340. However, native CNG channels from olfactory sensory neurons are composed by the assembly of three different types of subunits, each having a different residue -- glutamate, aspartate or glycine -- at the position corresponding to the binding site for external Ca(2+) and Mg(2+). We co-expressed the wild-type principal alpha subunit with its mutants E340G and E340D in different combinations in Xenopus laevis oocytes, and measured Ca(2+) and Mg(2+) blockage in excised outside-out membrane patches. The comparison between our results and data from native olfactory CNG channels indicates that the presence of all three residues -- glutamate, aspartate and glycine -- in the different subunits, is necessary to restore the sensitivity to external Ca(2+) and Mg(2+) measured in native channels.

A point mutation in the pore region alters gating, Ca(2+) blockage, and permeation of olfactory cyclic nucleotide-gated channels.

Upon stimulation by odorants, Ca(2+) and Na(+) enter the cilia of olfactory sensory neurons through channels directly gated by cAMP. Cyclic nucleotide-gated channels have been found in a variety of cells and extensively investigated in the past few years. Glutamate residues at position 363 of the alpha subunit of the bovine retinal rod channel have previously been shown to constitute a cation-binding site important for blockage by external divalent cations and to control single-channel properties. It has therefore been assumed, but not proven, that glutamate residues at the corresponding position of the other cyclic nucleotide-gated channels play a similar role. We studied the corresponding glutamate (E340) of the alpha subunit of the bovine olfactory channel to determine its role in channel gating and in permeation and blockage by Ca(2+) and Mg(2+). E340 was mutated into either an aspartate, glycine, glutamine, or asparagine residue and properties of mutant channels expressed in Xenopus laevis oocytes were measured in excised patches. By single-channel recordings, we demonstrated that the open probabilities in the presence of cGMP or cAMP were decreased by the mutations, with a larger decrease observed on gating by cAMP. Moreover, we observed that the mutant E340N presented two conductance levels. We found that both external Ca(2+) and Mg(2+) powerfully blocked the current in wild-type and E340D mutants, whereas their blockage efficacy was drastically reduced when the glutamate charge was neutralized. The inward current carried by external Ca(2+) relative to Na(+) was larger in the E340G mutant compared with wild-type channels. In conclusion, we have confirmed that the residue at position E340 of the bovine olfactory CNG channel is in the pore region, controls permeation and blockage by external Ca(2+) and Mg(2+), and affects channel gating by cAMP more than by cGMP.

Calcium signalling and regulation in olfactory neurons.

The odorant-induced Ca(2+) increase inside the cilia of vertebrate olfactory sensory neurons controls both excitation and adaptation. The increase in the internal concentration of Ca(2+) in the cilia has recently been visualized directly and has been attributed to Ca(2+) entry through cAMP-gated channels. These recent results have made it possible to further characterize Ca(2+)'s activities in olfactory neurons. Ca(2+) exerts its excitatory role by directly activating Cl(-) channels. Given the unusually high concentration of ciliary Cl(-), Ca(2+)'s activation of Cl(-) channels causes an efflux of Cl(-) from the cilia, contributing high-gain and low-noise amplification to the olfactory neuron depolarization. Moreover, in combination with calmodulin, Ca(2+) mediates odorant adaptation by desensitizing cAMP-gated channels. The restoration of the Ca(2+) concentration to basal levels occurs via a Na(+)/Ca(2+) exchanger, which extrudes Ca(2+) from the olfactory cilia.

Mechanisms of modulation by internal protons of cyclic nucleotide-gated channels cloned from sensory receptor cells.

We have examined the modulation by internal protons of cyclic nucleotide-gated (CNG) channels cloned from bovine olfactory receptor cells and retinal rods. CNG channels were studied in excised inside-out membrane patches from Xenopus laevis oocytes previously injected with the mRNA encoding for the subunit 1 of olfactory or rod channels. Channels were activated by cGMP or cAMP, and currents as a function of cyclic nucleotide concentrations were measured as pHi varied between 7.6 and 5.0. Increasing internal proton concentrations caused a partial blockage of the single-channel current, consistent with protonation of a single acidic site with a pK1 of 4.5-4.7, both in rod and in olfactory CNG channels. Channel gating properties were also affected by internal protons. The open probability at low cyclic nucleotide concentrations was greatly increased by lowering pHi, and the increase was larger when channels were activated by cAMP than by cGMP. Therefore, internal protons affected both channel permeation and gating properties, causing a reduction in single-channel current and an increase in open probability. These effects are likely to be caused by different titratable groups on the channel.

Mechanism of odorant adaptation in the olfactory receptor cell.

Adaptation to odorants begins at the level of sensory receptor cells, presumably through modulation of their transduction machinery. The olfactory signal transduction involves the activation of the adenylyl cyclase/cyclic AMP second messenger system which leads to the sequential opening of cAMP-gated channels and Ca2+-activated chloride ion channels. Several reports of results obtained from in vitro preparations describe the possible molecular mechanisms involved in odorant adaptation; namely, ordorant receptor phosphorylation, activation of phosphodiesterase, and ion channel regulation. However, it is still unknown whether these putative mechanisms work in the intact olfactory receptor cell. Here we investigate the nature of the adaptational mechanism in intact olfactory cells by using a combination of odorant stimulation and caged cAMP photolysis which produces current responses that bypass the early stages of signal transduction (involving the receptor, G protein and adenylyl cyclase). Odorant- and cAMP-induced responses showed the same adaptation in a Ca2+-dependent manner, indicating that adaptation occurs entirely downstream of the cyclase. Moreover, we show that phosphodiesterase activity remains constant during adaptation and that an affinity change of the cAMP-gated channel for ligands accounts well for our results. We conclude that the principal mechanism underlying odorant adaptation is actually a modulation of the cAMP-gated channel by Ca2+ feedback.

Modulation by internal protons of native cyclic nucleotide-gated channels from retinal rods.

Ion channels directly activated by cyclic nucleotides are present in the plasma membrane of retinal rod outer segments. These channels can be modulated by several factors including internal pH (pH(i)). Native cyclic nucleotide-gated channels were studied in excised membrane patches from the outer segment of retinal rods of the salamander. Channels were activated by cGMP or cAMP and currents as a function of voltage and cyclic nucleotide concentrations were measured as pH(i) was varied between 7.6 and 5.0. Increasing internal proton concentrations reduced the current activated by cGMP without modifying the concentration (K(1/2)) of cGMP necessary for half-activation of the maximal current. This effect could be well described as a reduction of single-channel current by protonation of a single acidic residue with a pK(1) of 5.1. When channels were activated by cAMP a more complex phenomenon was observed. K(1/2) for cAMP decreased by increasing internal proton concentration whereas maximal currents activated by cAMP increased by lowering pH(i) from 7.6 to 5.7-5.5 and then decreased from pH(i) 5.5 to 5.0. This behavior was attributed both to a reduction in single-channel current as measured with cGMP and to an increase in channel open probability induced by the binding of three protons to sites with a pK(2) of 6.

Transduction and adaptation in sensory receptor cells.

Sensory transduction shares common features in widely different sensory modalities. The purpose of this article is to examine the similarities and differences in the underlying mechanisms of transduction in the sensory receptor cells for vision, olfaction, and hearing. One of the major differences between the systems relates to the nature of the stimulus. In both the visual and olfactory systems a quantal mechanism of detection is possible, because the absorption of a photon or the binding of an odorant molecule provides an energy change significantly greater than the thermal noise in the receptor molecule. In hearing, on the other hand, the energy of a phonon is far lower, and detection occurs by a "classical" mechanism. For vertebrate photoreceptors and olfactory receptor cells, sensory transduction employs a G protein cascade that is remarkably similar in the two cases, and that is closely homologous to other G protein signaling cascades. For auditory and vestibular hair cells, transduction operates via a mechanism of direct coupling of the stimulus to ion channels, in a manner reminiscent of the direct gating of post-synaptic ion channels in various synaptic mechanisms. The three classes of sensory receptor cell share similarities in their mechanisms of adaptation, and it appears in each case that cytoplasmic calcium concentration plays a major role in adaptation.

Cyclic nucleotide-gated channels in visual and olfactory transduction.

Rod and cone photoreceptors are the light detectors in the visual system whereas olfactory receptor cells are the odorant detectors in the olfactory system. Despite the two very different types of stimuli, light in photoreceptors, and odorant molecules in olfactory receptor cells, the mechanisms of visual and olfactory transduction appear to have many homologies. Both stimuli trigger a chain of enzymatic events that terminates in a change in the concentration of a cyclic nucleotide: a decrease in the concentration of cGMP in photoreceptors, and an increase in the concentration of cAMP in olfactory receptor cells. These cyclic nucleotides directly gate cation channels and therefore a change in their concentration induced by the external stimulus is converted into an electrical signal. The analysis of the ionic selectivity properties of cyclic nucleotidegated channels in retinal rods, cones and in olfactory receptor cells shows that there are many similarities between these channels. They do not appreciably select between alkali monovalent cations and can be permeated and blocked by divalent cations. Their ionic permeation properties are consistent with the presence of a cation-binding site of high-field strength in the pore.

Quantal-like current fluctuations induced by odorants in olfactory receptor cells.

Many sensory systems have evolved signal detection capabilities that are limited only by the physical attributes of the stimulus. For example, 'hair' cells of the inner ear can detect displacements of atomic dimensions. Likewise, both in vertebrates and in invertebrates photoreceptors can detect a single photon. The olfactory stimulus also has a quantal unit, the single odorant molecule. Insects are reportedly able to detect a single pheromone molecule, whereas quantal responses in vertebrate olfactory receptor cells have not been reported yet. Psychophysical measurements indicate that a minimum of 50 odorant molecules are necessary for human olfactory detection, suggesting that an individual receptor may be activated by a single odorant molecule. We report here measurements of current fluctuations induced by odorants that suggest a quantal event of about 0.3-1 pA, presumably triggered by the binding of a single odorant molecule.

The relation between stimulus and response in olfactory receptor cells of the tiger salamander.

1. Olfactory receptor cells were isolated from the adult tiger salamander Ambystoma tigrinum and the current in response to odorant stimuli was measured with the whole-cell voltage-clamp technique while odorants at known concentrations were rapidly applied for controlled exposure times. 2. Three odorants, cineole, isoamyl acetate and acetophenone, were first applied at 5 x 10(-4) M. Out of forty-nine cells tested, 53% responded to one odorant only, 22% to two odorants and 25% to all three odorants. 3. The amplitude of the current in response to a given odorant concentration was found to be dependent on the duration of the odorant stimulus and reached a saturating peak value at 1.2 s of stimulus duration. 4. The current measured at the peak of the response for odorant steps of 1.2 s as a function of odorant concentration was well described by the Hill equation for the three odorants with Hill coefficients higher than 1 and K1/2 (odorant concentration needed to activate half the maximal current) ranging from 3 x 10(-6) to 9 x 10(-5) M. 5. It is concluded that olfactory receptor cells are broadly tuned and have a low apparent affinity for odorants, integrate stimulus information over time, and have a narrow dynamic range.

The permeability of the cGMP-activated channel to organic cations in retinal rods of the tiger salamander.

1. The permeability of the channel activated by guanosine 3',5'-cyclic monophosphate (cGMP) to many organic monovalent cations was determined by recording macroscopic currents in excised inside-out patches of plasma membrane from isolated retinal rod outer segments of the tiger salamander. 2. Current-voltage relations were measured when the NaCl of the bathing medium was replaced by salts of organic cations. Permeability ratios relative to Na+ ions were calculated with the Goldman-Hodgkin-Katz potential equation from the measured changes of reversal potentials. 3. Hydroxylammonium+, hydrazinium+ and methylammonium+, which are molecules of very similar shape and size, permeate the channel with very different permeability ratios: 5.92, 1.99 and 0.60 respectively. 4. Methylated and ethylated ammonium+ compounds were investigated. It was found that, not only methylammonium+, but also dimethylammonium+ and ethylammonium+ were permeant with permeability ratios of 0.6, 0.14 and 0.16 respectively. Trimethylammonium+, tetramethylammonium+, diethylammonium+, triethylammonium+, and tetraethylammonium+ were not permeant. 5. Guanidinium+ and its derivatives formamidinium+, aminoguanidinium+, acetamidinium+ and methylguanidinium+ were all permeant with permeability ratios 1.12, 1.00, 0.63, 0.36 and 0.33 respectively. 6. The cGMP-activated channel was found to be permeable to at least thirteen organic cations. Molecular models of the permeant cations indicate that the cross-section of the narrowest part of the pore must be at least as large as a rectangle of 0.38 x 0.5 nm dimensions.

Blockage and permeation of divalent cations through the cyclic GMP-activated channel from tiger salamander retinal rods.

1. Blockage and permeation of divalent cations through channels activated by guanosine 3',5'-cyclic monophosphate (cyclic GMP) were studied in membrane patches excised from retinal rods of the tiger salamander Ambystoma tigrinum by rapidly changing the ionic medium bathing the intracellular side of the excised membrane. 2. The Na+ current, observed when 110 mM-NaCl was present on both sides of the membrane patch, was reduced by the addition of 1 mM of the chloride salts of Ca2+, Mg2+, Sr2+, Ba2+ or Mn2+ to the bathing medium. The sequence of blocking potency at +60 mV was Mg2+ greater than Mn2+ approximately Ba2+ greater than Ca2+ greater than Sr2+, while at -60 mV it was Ba2+ greater than Ca2+ greater than Sr2+ greater than Mn2+ approximately Mg2+. For all divalent cations the blocking effect depended, in a complex way, on the membrane potential. 3. The blocking effect of Ca2+ and Mg2+ increased when the concentration of cyclic GMP was reduced from 100 to 5 microM. At -60 mV 1 mM-Ca2+ blocked about 34% of the Na+ current in the presence of 100 microM-cyclic GMP, while in the presence of 5 microM-cyclic GMP, 1 mM-Ca2+ blocked about 56% of the Na+ current. 4. When, in the presence of 100 microM-cyclic GMP, 110 mM-NaCl at the intracellular side was replaced by equiosmolar amounts of chloride salts of divalent cations (73.3 mM) a small outward current carried by divalent cations could be observed at large positive membrane potentials. At +60 mV the ratio between the current carried by Na+, Sr2+, Ca2+, Ba2+, Mg2+ and Mn2+ was 83.3:1.4:1:0.58:0.33:0.25. 5. In agreement with previous observations the dependence of the Na+ current on the concentration of cyclic GMP shows a clear co-operativity among cyclic GMP molecules.4+ cyclic GMP-gated channel in excised patches is similar to but not identical to the selectivity sequence of divalent cations through the channel in intact rods.

Currents carried by monovalent cations through cyclic GMP-activated channels in excised patches from salamander rods.

1. Ionic selectivity and affinity for monovalent cations of channels activated by guanosine 3',5'-cyclic monophosphate (cyclic GMP) were studied in excised inside-out patches of plasma membrane from retinal rods of the tiger salamander. Channels were activated by addition of cyclic GMP to the medium bathing the cytoplasmic side of the membrane. The ionic solution at the cytoplasmic side was rapidly changed using the method of Nunn (1987 a). 2. Permeability ratios were calculated with the Goldman-Hodgkin-Katz potential equation from reversal potential measurements for alkali monovalent cations in bi-ionic conditions. The permeability sequence was: Li+:Na+:K+:Rb+:Cs+ = 1.14:1:0.98:0.84:0.58. 3. The selectivity sequence obtained from macroscopic current measurements in bi-ionic conditions at +100 mV was: Na+:K+:Rb+:Li+:Cs+ = 1:1:0.67:0.36:0.25. 4. The organic cations tetramethylammonium (TMA+), choline and tetraethylammonium (TEA+) were not permeant through the cyclic GMP-activated channels and caused a reduction of the Na+ inward current. At -100 mV the current ratio for inward current was 1:0.75:0.58:0.2 in the presence, at the cytoplasmic side, of 110 mM-Na+, TMA+, choline or TEA+ respectively. 5. The concentration dependence of the macroscopic current and the reversal potential was studied by changing the internal concentration of Na+ or K+ or Li+ from 5 mM to 500 mM. The permeability ratios were nearly constant regardless of the permeant ion concentration. 6. The current as a function of internal ion activity could be described by a Michaelis-Menten relation with a half-saturating activity, Km, at +90 mV equal to 249, 203 and 160 mM for Na+, K+ and Li+ respectively. The ratio of the extrapolated saturating current Imax at +90 mV was 1:0.86:0.26 for Na+, K+ and Li+ respectively. 7. The outward currents and the reversal potentials measured in different mixtures of Na+ and Li+ were monotonic function of the mole fraction. 8. These results can be explained by assuming that, at least in a narrow region, the cyclic GMP-activated channel is a one-ion channel, possibly with other poorly voltage-dependent binding sites in a large inner vestibule.

[Spontaneous esophageal rupture or Boerhaave's syndrome. Presentation of a case]. / La sindrome da rottura spontanea dell'esofago o di Boerhaave. Presentazione di un caso.

A case of spontaneous oesophageal rupture or Boerhaave syndrome is described. The absence of the typical initial vomiting together with a clinical picture that successively indicated repeated myocardial infarction, pancreatitis and pulmonary abscess delayed diagnosis by 4 days, after which emergency thoracotomy, performed on the identification of extravisceral overflow by contrast radiography using a water-soluble medium, revealed necrotic inflammation of the oesophagus, mediastinum and left lung that was so severe that only thoracic drainage was possible. After an initial improvement the patient died of septic shock on the 16th postoperative day.

Kinetics of phototransduction in retinal rods of the newt Triturus cristatus.

1. The kinetics of photoresponses to flashes and steps of light of rods, from the retina of the newt Triturus cristatus, were analysed by recording the membrane current with a suction electrode. 2. In dark-adapted conditions the relation between the normalized amplitude of the photoresponse at a fixed time 1 s after the onset of light and the light intensity could be fitted by an exponential or a polynomial relation. In the presence of a steady bright light the same relation could be fitted by a Michaelis-Menten relation. 3. The kinetics of photoresponses to light stimuli was reconstructed using a model in which: (i) three molecules of guanosine 3'.5'-cyclic monophosphate (cyclic GMP) open a light-sensitive channel; (ii) light activates the enzyme phosphodiesterase, which hydrolyses cyclic GMP, thus closing light-sensitive channels: (iii) Ca2+ ions permeate through light-sensitive channels: and (iv) intracellular Ca2+ inhibits, in a co-operative way, the enzyme cyclase, which synthesizes cyclic GMP. 4. The model reproduces the shortening of the time to peak of brief flash photoresponses from about 1080 ms to about 690 ms with brighter lights. The model also explains the shortening of the time to peak to 350 ms observed in the presence of a steady light and the lack of a further acceleration with brighter flashes of lights. 5. The presence in the model of an intracellular calcium buffer accounts for the partial reactivation of the photocurrent following a step of light, lasting several seconds. The time course of this reactivation is not accelerated by a steady bright light both experimentally and in the model. 6. After the extinction to a long step of light the photocurrent showed a rapid partial reactivation, which was followed by a slow component of the photoresponse which extinguished with a rate constant of about 0.05 s-1. The model explains the origin of this slow component by assuming that the inactivation of excited rhodopsin is partially reversible. 7. The model is also able to explain the particular changes of kinetics when different amounts of exogenous calcium buffers are incorporated into rods (Torre, Matthews & Lamb, 1986).