Feedback from the heart: emotional learning and memory is controlled by cardiac cycle, interoceptive accuracy and personality

Feedback processing is critical to trial-and-error learning. Here, we examined whether interoceptive signals concerning the state of cardiovascular arousal influence the processing of reinforcing feedback during the learning of ‘emotional’ face-name pairs, with subsequent effects on retrieval. Participants (N = 29) engaged in a learning task of face-name pairs (fearful, neutral, happy faces). Correct and incorrect learning decisions were reinforced by auditory feedback, which was delivered either at cardiac systole (on the heartbeat, when baroreceptors signal the contraction of the heart to the brain), or at diastole (between heartbeats during baroreceptor quiescence). We discovered a cardiac influence on feedback processing that enhanced the learning of fearful faces in people with heightened interoceptive ability. Individuals with enhanced accuracy on a heartbeat counting task learned fearful face-name pairs better when feedback was given at systole than at diastole. This effect was not present for neutral and happy faces. At retrieval, we also observed related effects of personality: First, individuals scoring higher for extraversion showed poorer retrieval accuracy. These individuals additionally manifested lower resting heart rate and lower state anxiety, suggesting that attenuated levels of cardiovascular arousal in extraverts underlies poorer performance. Second, higher extraversion scores predicted higher emotional intensity ratings of fearful faces reinforced at systole. Third, individuals scoring higher for neuroticism showed higher retrieval confidence for fearful faces reinforced at diastole. Our results show that cardiac signals shape feedback processing to influence learning of fearful faces, an effect underpinned by personality differences linked to psychophysiological arousal

Oxytocin attenuates the perception of cardiac signals and reduces fear learning at systole.

Objectives: Encoding of fear stimuli is enhanced at heightened states of cardiovascular arousal (at cardiac systole). Oxytocin is a neuropeptide that selectively reduces fear memory through innervation of the amygdala. Here, we examined whether oxytocin could reduce learning and/or memory of fear stimuli for which feedback was provided at cardiac systole in a trial-and-error learning fMRI-paradigm. We further examined the modulatory effects of interoception (e.g. the detection of heartbeat signals) on fear learning and memory. Design: We used a double-blind, placebo-controlled within-subject design, testing for two levels of emotion (fear, neutral), cardiac timing (systole, diastole), and drug (oxytocin, placebo). Method: Participants (N = 30) inhaled 40 IU of oxytocin and placebo in two counterbalanced sessions prior to engaging in an fMRI trial-and-error learning task of fearful and neutral face-name pairs. Auditory feedback was delivered either at cardiac systole (on the heartbeat, when baroreceptors signal the contraction of the heart to the brain), or at diastole (between heartbeats during baroreceptor quiescence). Retrieval was tested after scanning. Results: A significant four-way interaction between drug, emotion, cardiac cycle and heart beat counting accuracy demonstrated that good heartbeat counters encoded fearful face-name pairs better during oxytocin than placebo when feedback was delivered at diastole relative to systole. No effects of drug were observed on intentional retrieval. However, post-hoc attractiveness ratings revealed a drug*emotion*cardiac timing interaction, showing that participants rated fearful faces as more attractive in the oxytocin relative to the placebo condition when they were initially reinforced at diastole relative to systole. FMRI data are currently being analysed. Conclusions: Oxytocin enhances the emotional sensitivity to socially relevant stimuli in individuals with higher interoceptive accuracy. Specifically, better encoding and higher attractiveness of fearful face-name pairs was observed with feedback delivered at diastole, suggesting that the anxiolytic effect of oxytocin might be the consequence of adequate feedback processing at lower levels of cardiovascular arousal

Covid-19 and Ukrainian Crisis Exponentiates the Need for the Inclusion of Conflict and Disaster Medicine in Medical Curriculum

© The Author(s) 2022.Conflict medicine is an age-old branch of medicine which focuses on delivering healthcare services to the injured in the setting of conflicts, wars, disasters, and/or other calamities. The course in its purest form has been traditionally given only in military medical schools while civilian medical students are usually taught parts of the course in other overlapping subjects like surgery, infectious diseases, etc. However, in a crisis situation, civilian doctors are expected to double up as military doctors, which leads to emotional, mental, and physical stress for the civilian doctors along with logistical and organizational challenges. The current Covid-19 pandemic and the Russo-Ukrainian conflict have highlighted once again the emergent need for the implementation of conflict medicine courses in regular medical curricula, so as to make the medical students situation-ready. With our present discussion, we aim to provide a brief overview of the course, its core modules, challenges to its implementation, and possible solutions. We believe that the complex management skills gained by this course are not only useful in conflict scenario but are also valuable in managing day-to-day medical emergencies.publishersversionPeer reviewe

ERS International Congress 2022: highlights from the Respiratory Clinical Care and Physiology Assembly

It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of the laboratory-based science, clinical trials and qualitative research that were presented during the 2022 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, mobile/electronic health (m-health/e-health), clinical respiratory physiology, exercise and functional imaging

European Respiratory Society International Congress, Barcelona, 2022: Highlights from the Respiratory clinical care and physiology assembly

It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, clinical trials and qualitative research that were presented during the 2022 European Respiratory Society International Congress within the sessions from the five groups of the Assembly 1 – Respiratory clinical care and physiology. Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging

Contemporary management of primary parapharyngeal space tumors

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.Peer reviewe