Central Stimulation Research Articles

Cognitive Enhancers Consumption: Prevalence, Knowledge, and Determinants of Use Among Medical Students in Egypt, Sudan, and Jordan

Background Cognitive Enhancers (CE) are central nervous system stimulant substances known to improve cognitive functions. Due to high-perceived stress and academic pressure, CEs are becoming increasingly popular among medical students. As a result, they are more likely to misuse these substances. Objectives This study aims to estimate the prevalence of CE consumption, compare the prevalence between countries and genders, and identify characteristics associated with CE consumption among students at medical schools in Egypt, Sudan, and Jordan. Method A population-based survey study was conducted among medical students from Egypt, Sudan, and Jordan. An online self-reported questionnaire was used to collect data. Frequencies and percentages were calculated to represent participant distribution across categories. Chi-square was used for categorical variables comparisons. All tests were two-tailed, considering p < 0.05 statistically significant. Demographic characteristics, reasons for use, types of CE used, and side effects were compared by country and gender. Results A total sample of 1399 participated in the questionnaire, most of whom were females 824 (58.9%). Overall, 1236 (88.3%) were CE consumers, and 163 (11.7%) were non-consumers. Of the respondents who used CE, 814 (58.2%) reported using them daily. There was a statistically significant difference between the consumption of CE and the source of acquisition, nationality, and residence status regarding gender. Conclusions Our findings suggest that CE use is increasing among medical students in Egypt, Sudan, and Jordan. Efficient support, stress management programs, and awareness symposia may help reduce the misuse of these substances. Future longitudinal studies are still required.

Somatosensory integration in robot-assisted motor restoration post-stroke.

Disruption of somatosensorimotor integration (SMI) after stroke is a significant obstacle to achieving precise motor restoration. Integrating somatosensory input into motor relearning to reconstruct SMI is critical during stroke rehabilitation. However, current robotic approaches focus primarily on precise control of repetitive movements and rarely effectively engage and modulate somatosensory responses, which impedes motor rehabilitation that relies on SMI. This article discusses how to effectively regulate somatosensory feedback from target muscles through peripheral and central neuromodulatory stimulations based on quantitatively measured somatosensory responses in real time during robot-assisted rehabilitation after stroke. Further development of standardized recording protocols and diagnostic databases of quantitative neuroimaging features in response to post-stroke somatosensory stimulations for real-time precise detection, and optimized combinations of peripheral somatosensory stimulations with robot assistance and central nervous neuromodulation are needed to enhance the recruitment of targeted ascending neuromuscular pathways in robot-assisted training, aiming to achieve precise muscle control and integrated somatosensorimotor functions, thereby improving long-term neurorehabilitation after stroke.

L-DOPA for the prevention and acceleration of the reversal of neurogenic dystrophic damage to internal organs

This review presents experimental and clinical studies of the effects of the levorotatory isomer of dihydroxyphenylalanine (l-DOPA) on the development and reversal of neurogenic dystrophic changes (neurogenic dystrophy) in the heart, stomach, liver, and pancreas. These changes were induced by stimulation of the reflexogenic zones such as the aortic arch and pyloroduodenal area in rats and rabbits, by tonsillar stimulation in rabbits, by 3-hour electrical stimulation and immobilization in rats, and by central electrical stimulation of the posterior hypothalamus in rabbits. Protective effects of l-DOPA were identified at doses of 30, 50, and 300 mg/kg in terms of the development of biochemical and morphological manifestations of neurogenic dystrophy in the studied organs, including a significant decrease in norepinephrine and creatine phosphate levels and an increase in lactic acid level. The use of l-DOPA during the repair phase accelerated the recovery of adrenergic mediation, energy metabolism, and the resolution of dystrophic morphological manifestations, in particular, hemorrhagic erosions of the gastric mucosa. In clinical settings, preoperative medication of patients with l-DOPA (5 mg/kg) for 3 days before mitral commissurotomy prevented the development of postoperative heart failure. In patients with peptic ulcer disease, the administration of l-DOPA during the early remission phase accelerated the healing of ulcers in the stomach and duodenal wall.

Heptaminol hair testing to highlight octodrine contamination in supplements, responsible for a doping adverse analytical finding

Octodrine, also known as dimethylhexylamine (DMHA), is a central nervous stimulant. When ingested by humans, octodrine is rapidly metabolized to heptaminol, the main compound present in the blood. Due to their stimulant activities, octodrine and its metabolite are specified substances in section S6b “specified stimulants” of the World Anti-Doping Agency (WADA) Prohibited List, prohibited in competition. But in some cases, they can be responsible for an adverse analytical finding (AAF) following contamination, with a low concentration in the urine. In such cases, a hair test can distinguish doping from contamination according to the concentration measured, or the absence of the target drug. However, no data are available in the literature. The aim of this study was to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of octodrine and heptaminol in hair, and to apply it to an athlete with an AAF with heptaminol (141 and 136 ng/mL in urine samples A and B after correction for specific gravity) and octodrine (16 ng/mL, not given by the WADA laboratory in sample A as being below the minimum request level of 50 ng/mL).All the supplements taken by the athlete were analysed, and pubic hair (black, 1.5–2 cm long, no head hair available) and toenail clippings (0.1 cm) were sampled two months after AAF. A supplement was identified as the source of contamination, containing octodrine at a concentration range 16–34 µg/g. The athlete had taken 13 g daily (0.2–0.4 mg octodrine) for 20 days prior to the AAF (total dose 4–8 mg). His pubic hair and toenail clippings contained only heptaminol (30 pg/mg and 3 pg/mg, respectively). A controlled study was carried out on a volunteer who took a single 13 g dose of the contaminated supplement (single dose of octodrine 0.2–0.4 mg). His urine was positive for both compounds, with concentrations very close to those of the athlete on the day of the AAF after the same delay between intake and sampling (around 4 h). One month later, his head hair and pubic hair showed only heptaminol at 2 and 3 pg/mg, respectively, and toenail clippings were totally negative for both compounds. The contamination was accepted by the WADA commission, but the athlete was still banned for 9 months for having consumed supplements purchased on the internet.

Chocolate toxicosis in pets

Chocolate ingestion is very common in pets, particularly dogs, but has also been reported in other animals including cats and rabbits. Most cases occur around Christmas and Easter, when large amounts of chocolate are often present in the home in the form of chocolate bars, snacks, confectionery, Easter eggs and chocolate figurines. Chocolate-covered raisins, nuts and coffee beans present an additional toxicological hazard in dogs. The type of chocolate is defined in law by the percentage of cocoa solids, with dark (plain) chocolate containing more than milk chocolate. The main toxic component of chocolate is theobromine, a methylxanthine, although caffeine, another methylxanthine, is also present. These cause central nervous system stimulation with cardiac and respiratory hyperactivity. Signs include gastrointestinal effects, excitability, hyperactivity, tachycardia, tremors, hypertension and hyperthermia. Signs of toxicosis generally occur within a few hours of ingestion. The mainstays of treatment are decontamination and supportive care with rehydration, control of central nervous system stimulation and arrhythmias as required. Most pets recover fully, and death is uncommon; however, prognosis is more guarded in pets with seizures or arrhythmias.

The Top 5 Can't-Miss Sport Supplements.

Background/Objectives: Sports supplements have become popular among fitness enthusiasts for enhancing the adaptive response to exercise. This review analyzes five of the most effective ergogenic aids: creatine, beta-alanine, nitrates, caffeine, and protein. Methods: We conducted a narrative review of the literature with a focus on the sport supplements with the most robust evidence for efficacy and safety. Results: Creatine, one of the most studied ergogenic aids, increases phosphocreatine stores in skeletal muscles, improving ATP production during high-intensity exercises like sprinting and weightlifting. Studies show creatine supplementation enhances skeletal muscle mass, strength/power, and muscular endurance. The typical dosage is 3-5 g per day and is safe for long-term use. Beta-alanine, when combined with the amino acid histidine, elevates intramuscular carnosine, which acts as a buffer in skeletal muscles and delays fatigue during high-intensity exercise by neutralizing hydrogen ions. Individuals usually take 2-6 g daily in divided doses to minimize paresthesia. Research shows significant performance improvements in activities lasting 1-4 min. Nitrates, found in beetroot juice, enhance aerobic performance by increasing oxygen delivery to muscles, enhancing endurance, and reducing oxygen cost during exercise. The recommended dosage is approximately 500 milligrams taken 2-3 h before exercise. Caffeine, a central nervous system stimulant, reduces perceived pain while enhancing focus and alertness. Effective doses range from 3 to 6 milligrams per kilogram of body weight, typically consumed an hour before exercise. Protein supplementation supports muscle repair, growth, and recovery, especially after resistance training. The recommended intake for exercise-trained men and women varies depending on their specific goals. Concluions: In summary, creatine, beta-alanine, nitrates, caffeine, and protein are the best ergogenic aids, with strong evidence supporting their efficacy and safety.

A Review on Validated RP-HPLC Method for the Simultaneous Estimation of Serdexmethylphenidate and Dexmethylphenidate in Bulk and Pharmaceutical Dosage Form

An ADHD medication called Azstarys was approved by the FDA in March 2021.Because it combined serdexmethylphenidate and dexmethylphenidate for the first time, it is unique. Treatment for Attention Deficit Hyperactivity Disorder (ADHD) begins with a prodrug called serdexmethylphenidate. CNS stimulants include serdexmethylphenidate. People six years of age and older with attention deficit hyperactivity disorder (ADHD) are taken serdexmethylphenidate, a prodrug of dexmethylphenidate, in addition to dexmethylphenidate. Serdexmethylphenidate is a prodrug of the central nervous system stimulant dexmethylphenidate. It alters neurotransmission in the central nervous system by increasing extracellular dopamine and norepinephrine numbers.3[11] As a central nervous system stimulant, serdexmethylphenidate carries a risk of usage, addiction, and abuse that should be monitored. In addition, patients need to be assessed. The accuracy, precision, linearity, robustness, limits of detection and quantitation, system adaptability, robustness, and other factors can all be used to validate the RP-HPLC technology.

High-frequency magnetic paired associated stimulation promotes motor function recovery in ischemic stroke patients: a study protocol for single-center, sham stimulation randomized controlled trials (H2MPAS)

BackgroundNumerous studies have validated the clinical effectiveness of electromagnetic pairing-associated stimulation. Building upon this foundation, we have developed a novel approach involving high-frequency magnetic paired-associated stimulation, aiming to enhance clinical applicability and potentially improve efficacy. However, the clinical effectiveness of this approach remains unclear. Our objective is to demonstrate the therapeutic efficacy of this novel approach by employing high-frequency pairing to intervene in patients experiencing motor dysfunction following a stroke.MethodsThis is a single-center, single-blind, sham stimulation controlled clinical trial involving patients with upper limb motor dysfunction post-stroke. The intervention utilizes paired magnetic stimulation, combining peripheral and central magnetic stimulation, in patients with Brunnstrom stage III–V stroke lasting from 3 months to 1 year. Evaluation of patients’ upper limb motor function occurred before the intervention and after 3 weeks of intervention. Follow-up visits will be conducted after 5 weeks and 3 months of intervention. The primary outcome measure is the Action Research Arm Test, with secondary measures including the Fugl-Meyer Assessment-upper, Modified Barthel Index, modified Tardieu scale, functional near-infrared spectroscopy, and neuroelectrophysiology.DiscussionThe high-frequency magnetic paired associative stimulation used in this study combined high-frequency magnetic stimulation with paired stimulation, potentially facilitating both cortical excitation through high-frequency stimulation and specific circuit enhancement through paired stimulation. As dual-coil magnetic stimulation equipment becomes increasingly popular, magnetic-magnetic paired associated stimulation may offer patients improved clinical outcomes at reduced costs.Trial registrationChinese Clinical Trial Registry,ChiCTR2400083363. Registered on 23 April 2024.

Non-invasive central nervous system stimulation to improve bladder and pelvic floor function in the aging population.

The literature was reviewed for all noninvasive central nervous system (CNS) stimulation techniques, which includes transcranial brain or trans-spinal stimulation, in the aging population. Given the rising ubiquity of this technology, noninvasive nature, and low side-effect profile reported, this technology can have a big impact on the aging population. As patients afflicted with neurogenic disorders are living longer lives, a special emphasis is placed on the aging neurogenic population. Noninvasive CNS stimulation techniques have been applied to major bladder and pelvic floor disorders such as voiding dysfunction, chronic pelvic pain, urgency and urge incontinence, lower urinary tract dysfunction, and situational urge incontinence in both the idiopathic and neurogenic populations. Overall, these noninvasive technologies demonstrate effectiveness for the treatment of these conditions with some studies showing effectiveness with longer-term follow-up suggesting lasting CNS remodeling. Most manuscripts had a generally small number of patients and an even smaller number of geriatric patients represented. No studies were specifically designed to investigate geriatric outcomes. It is the hope of this systematic review to help model future studies according to existing literature, but with a focus on the geriatric population as they stand to gain the most from noninvasive technologies with limited adverse events.

Acute Effects of Transcranial Direct Current Stimulation Combined with High-Load Resistance Exercises on Repetitive Vertical Jump Performance and EEG Characteristics in Healthy Men.

Transcranial direct current stimulation (tDCS) is a non-invasive technique known to enhance athletic performance metrics such as vertical jump and lower limb strength. However, it remains unclear whether combining tDCS with the post-activation effects of high-load resistance training can further improve lower limb performance. This study investigated the synergistic effects of tDCS and high-load resistance training, using electroencephalography to explore changes in the motor cortex and vertical jump dynamics. Four experiments were conducted involving 29 participants. Each experiment included tDCS, high-load resistance training, tDCS combined with high-load resistance training, and a control condition. During the tDCS session, participants received 20 min of central stimulation using a Halo Sport 2 headset, while the high-load resistance training session comprised five repetitions of a 90% one-repetition maximum weighted half squat. No intervention was administered in the control group. Electroencephalography tests were conducted before and after each intervention, along with the vertical jump test. The combination of tDCS and high-load resistance training significantly increased jump height (p < 0.05) compared to tDCS or high-load resistance training alone. As for electroencephalography power, tDCS combined with high-load resistance training significantly impacted the percentage of α-wave power in the frontal lobe area (F3) of the left hemisphere (F = 6.33, p < 0.05). In the temporal lobe area (T3) of the left hemisphere, tDCS combined with high-load resistance training showed a significant interaction effect (F = 6.33, p < 0.05). For β-wave power, tDCS showed a significant main effect in the frontal pole area (Fp1) of the left hemisphere (F = 17.65, p < 0.01). In the frontal lobe area (F3) of the left hemisphere, tDCS combined with high-load resistance training showed a significant interaction effect (F = 7.53, p < 0.05). The tDCS combined with high-load resistance training intervention also resulted in higher β-wave power in the parietal lobe area (P4) and the temporal lobe area (T4) (p < 0.05). The findings suggest that combining transcranial direct current stimulation (tDCS) and high-load resistance training significantly enhances vertical jump performance compared to either intervention alone. This improvement is associated with changes in the α-wave and β-wave power in specific brain regions, such as the frontal and temporal lobes. Further research is needed to explore the mechanisms and long-term effects of this combined intervention.

Smartphone-based drug testing in the hands of patients with substance-use disorder-a usability study.

A clinical study was performed to test the usability of a smartphone eye-scanning app at a needle exchange facility to detect drug use to support therapy. The study recruited 24 subjects who visited the facility one to three times, making a total of 40 visits. During each visit the subjects underwent testing for non-convergence (NC), nystagmus (NY), and pupillary light reflex (PLR) using a smartphone-based eHealth system. The collected eye data were transformed into key features that represent eye characteristics. During each visit, a time-line follow-back interview on recent drug use and a usability questionnaire were completed. Technical usability of the smartphone eye-scanning app was good for PLR and NC, where key features were generated in 82%-91% of the cases. For NY, only 60% succeeded due to cognitive problems to follow instructions. In most cases, subjects were under the influence of drugs when participating in the tests, with an average of 2.4 different drugs ingested within the last 24 h. The key features from PLR could distinguish use of opioids from central stimulants. The usability questionnaire results indicate that 23 of the 24 subjects could perform the eye-scanning by themselves after a short training, even when under severe influence of drugs. The caregiver assessed that 20 out of the 24 challenging subjects could potentially perform these tests in an indoors, home-like environment. Smartphone-based eye-scanning is functional in a patient population with heavy drug use, also when under the influence of drugs. The use of central stimulants can be distinguished from the use of opioids.

Caffeine Inhibits Both Basal and Insulin-Activated Urate Transport.

Caffeine, an adenosine receptor antagonist, is a potent central nervous system stimulant that also impairs insulin signaling. Recent studies have suggested that coffee consumption lowers serum urate (SU) and protects against gout by unknown mechanisms. We hypothesized that caffeine lowers SU by affecting activity of urate transporters. We examined the effect of caffeine and adenosine on basal and insulin stimulation of net 14C-urate uptake in the human renal proximal tubule cell line PTC-05 and on individual urate transporters expressed in Xenopus laevis oocytes. We found that caffeine and adenosine efficiently inhibited both basal and insulin stimulation of net 14C-urate uptake mediated by endogenous urate transporters in PTC-05 cells. In oocytes expressing individual urate transporters, caffeine (>0.2 mM) more efficiently inhibited the basal urate transport activity of GLUT9 isoforms, OAT4, OAT1, OAT3, NPT1, ABCG2, and ABCC4 than did adenosine without significantly affecting URAT1 and OAT10. However, unlike adenosine, caffeine at lower concentrations (<0.2 mM) very effectively inhibited insulin activation of urate transport activity of GLUT9, OAT10, OAT1, OAT3, NPT1, ABCG2, and ABCC4 by blocking activation of Akt and extracellular signal-regulated kinase. We postulate that inhibition of urate transport activity of the re-absorptive transporters GLUT9, OAT10, and OAT4 by caffeine is a key mechanism in its urate-lowering effects. Additionally, the ability of caffeine to block insulin-activated urate transport by GLUT9a and OAT10 suggests greater relative inhibition of these transporters in hyperinsulinemia.

Utilization of medicinal herbs among soccer athletes in the West Bank of Palestine

IntroductionHerbal supplements are popular among athletes, yet research on their types, purposes, and information sources is limited, particularly for Palestinian soccer players. This study aims to fill this gap by examining the types of herbal supplements used by young soccer athletes in the West Bank, their purposes, and the sources of information influencing their use. Understanding these aspects is crucial for safely and effectively integrating traditional remedies into modern sports nutrition. MethodsIn 2023, we conducted a cross-sectional study with young soccer athletes in the West Bank. We utilized a validated survey to collect data on the types of herbal supplements, their preparation methods, and information sources. We analyzed the data for frequencies and use values (UV). ResultsOut of 165 invited athletes, 155 participated, with 144 confirming their current use of herbal supplements. The participants, aged 18–25 (mean age 20.34), employed a variety of preparation and consumption methods. Information sources comprised traditional knowledge, advice from herbalists ("Attar" in Arabic), and online trends. Herbs that enhance physical endurance and stamina had the highest UV of 3.93, highlighting their critical importance. Herbs for joint and muscle pain and central nervous system stimulation had UV of 2.28 and 2.10, respectively, reflecting their significant roles. Antistress and anabolic herbs had UVs of 1.28 and 1.21, respectively. The total UV of 10.81 indicates a substantial use of herbal supplements. We recorded 1,675 recommendations, with the primary uses being: enhancing physical endurance and strength (36.36 %), reducing joint and muscle pain (21.13 %), acting as a CNS stimulant (19.46 %), alleviating stress (11.82 %), and providing testosterone-like effects (11.22 %). The top 10 herbs were ginseng (7.46 %), small nettle (6.99 %), olive (6.63 %), date (5.85 %), chili pepper (5.43 %), green tea (5.19 %), fenugreek (4.84 %), soy (4.24 %), coffee (4.24 %), and mate (4.12 %), collectively accounting for about 55 % of all recommendations. ConclusionThis study identifies the top 10 herbs used by soccer athletes, as well as their role in modern sports nutrition. Future research should evaluate their effectiveness and safety, focusing on herbs like date and small nettle. Educating athletes on the proper use and risks of herbal supplements is essential.

Exploring Methylphenidate-Induced Intraocular Pressure: A Cautionary Tale in Pediatric ADHD Management.

This case report explores the intricate relationship between methylphenidate (MTX) use and increased intraocular pressure (IOP) in a pediatric patient with a preexisting history of eye disease. Despite existing literature presenting cases of IOP elevation linked to MTX, a significant gap remains in understanding nuanced risk factors. This case study used patients' medical records and a comprehensive literature review. A 6-year-old girl with attention deficit hyperactivity disorder and a family history of eye conditions exhibited elevated IOP after 12 days of MTX use, prompting discontinuation. The patient successfully transitioned to atomoxetine with normalized IOP and improved attention duration. Existing cases emphasize the potential link between sympathetic nerve activity and IOP elevation induced by central nervous system stimulants like MTX. Notably, the patient's high hyperopia contributed to the impact of MTX on IOP, suggesting the need for cautious use in susceptible individuals. This case underscores the importance of individualized treatment strategies, particularly in attention deficit hyperactivity disorder patients with family history and additional eye findings, emphasizing safety and comprehensive patient care.

Interactive Virtual Ankle Movement Controlled by Wrist sEMG Improves Motor Imagery: An Exploratory Study.

Virtual reality (VR) techniques can significantly enhance motor imagery training by creating a strong illusion of action for central sensory stimulation. In this article, we establish a precedent by using surface electromyography (sEMG) of contralateral wrist movement to trigger virtual ankle movement through an improved data-driven approach with a continuous sEMG signal for fast and accurate intention recognition. Our developed VR interactive system can provide feedback training for stroke patients in the early stages, even if there is no active ankle movement. Our objectives are to evaluate: 1) the effects of VR immersion mode on body illusion, kinesthetic illusion, and motor imagery performance in stroke patients; 2) the effects of motivation and attention when utilizing wrist sEMG as a trigger signal for virtual ankle motion; 3) the acute effects on motor function in stroke patients. Through a series of well-designed experiments, we have found that, compared to the 2D condition, VR significantly increases the degree of kinesthetic illusion and body ownership of the patients, and improves their motor imagery performance and motor memory. When compared to conditions without feedback, using contralateral wrist sEMG signals as trigger signals for virtual ankle movement enhances patients' sustained attention and motivation during repetitive tasks. Furthermore, the combination of VR and feedback has an acute impact on motor function. Our exploratory study suggests that the sEMG-based immersive virtual interactive feedback provides an effective option for active rehabilitation training for severe hemiplegia patients in the early stages, with great potential for clinical application.

Electrical stimulation in special clinical situations

Introduction: Neuromodulation is an approach used to treat diseases that are refractory to clinical treatments by employing electrical and chemical stimulation techniques, especially in cardiac, neurological, and psychiatric disorders. Objective: This study aims to provide an overview of the latest developments in neuromodulation therapies that use electrical stimulation. Methods and results: The present study describes the most common neuromodulation techniques. Neuroplasticity is used to adjust the ions and neural excitability in response to central and peripheral nervous system stimulation. The spinal cord, dorsal root, and gastric stimulations are effective treatments for neuropathies, chronic pain, muscle spasticity, epilepsy, depression, cluster headaches, heart failure, and gastroparesis symptoms. Deep brain stimulation and invasive cortical stimulation are medical procedures used selectively to treat Parkinson’s disease, dystonia, obsessive-compulsive disorder, and chronic pain. Barostimulation therapy is beneficial in controlling refractory hypertension, reducing the risk of cardiovascular events, and improving overall quality of life. Repetitive Transcranial Magnetic Stimulation is a recommended treatment option for fibromyalgia, neuropathic pain, chronic headaches, treatment-resistant depression, generalized anxiety disorders, schizophrenia, and attention deficit disorder. While controlling obesity shows promise in regulating appetite and promoting satiety, more research is needed to understand the safety and efficacy of these therapies in various groups. Conclusion: Neuromodulation devices hold promise for treating diseases that do not respond to clinical treatments. Additional clinical trials and studies are required to understand it fully.

TRPA1, TRPV1, and Caffeine: Pain and Analgesia.

Caffeine (1,3,7-trimethylxanthine) is a naturally occurring methylxanthine that acts as a potent central nervous system stimulant found in more than 60 different plants and fruits. Although caffeinated beverages are widely and casually consumed, the application of caffeine beyond dietary levels as pharmacologic therapy has been recognized since the beginning of its recorded use. The analgesic and vasoactive properties of caffeine are well known, but the extent of their molecular basis remains an area of active research. There is existing evidence in the literature as to caffeine's effect on TRP channels, the role of caffeine in pain management and analgesia, as well as the role of TRP in pain and analgesia; however, there has yet to be a review focused on the interaction between caffeine and TRP channels. Although the influence of caffeine on TRP has been demonstrated in the lab and in animal models, there is a scarcity of data collected on a large scale as to the clinical utility of caffeine as a regulator of TRP. This review aims to prompt further molecular research to elucidate the specific ligand-host interaction between caffeine and TRP by validating caffeine as a regulator of transient receptor potential (TRP) channels-focusing on the transient receptor potential vanilloid 1 (TRPV1) receptor and transient receptor potential ankyrin 1 (TRPA1) receptor subtypes-and its application in areas of pain.

Categorical and dimensional aspects of stimulant medication effects in adult patients with ADHD and healthy controls.

Psychiatric disorders are categorized on the basis of presence and absence of diagnostic criteria using classification systems such as the international classification of diseases (ICD) and the diagnostic and statistical manual for mental disorders (DSM). The research domain criteria (RDoC) initiative provides an alternative dimensional framework for conceptualizing mental disorders. In the present paper, we studied neural and behavioral effects of central stimulant (CS) medication in adults with attention deficit hyperactivity disorder (ADHD) and healthy controls using categorical and dimensional stratifications. AX-Continuous Performance Task (AX-CPT) was utilized for the later purpose, and participants were classified as "reactive" or "proactive" based on their baseline proactive behavioral index (PBI). Out of the 65 individuals who participated (33 healthy controls and 32 patients with ADHD), 53 were included in the final analysis that consisted of 31 healthy controls and 22 ADHD patients. For the dimensional stratification, a median split of PBI scores divided participants into "reactive" and "proactive" groups irrespective of whether they had ADHD or not. Participants performed AX-CPT in conjunction with functional magnetic resonance imaging (fMRI) before and after CS medication. We found no significant within or between group CS effect when participants were categorically assigned as healthy controls and ADHD patients. For the dimensional stratification, however, CS selectively increased activation in frontoparietal cognitive areas and induced a shift towards proactive control mode in the reactive group, without significantly affecting the proactive group. In conclusion, the neural and behavioral effects of CS were more clear-cut when participants were stratified into dimensional groups rather than diagnostic categories.

Action observation therapy impact on mirror neurons combined with acupuncture for upper limb motor impairment rehabilitation in stroke patients.

Upper limb (UL) dysfunction rehabilitation in stroke patients is complicated in the clinic. Action observation therapy's (AOT) impact on mirror neurons (MNs) has been observed and made applications in related brain disease treatment. Acupuncture mentioned in the present study mainly stimulates peripheral nerves for neuronal plasticity. However, the clinical effect of AOT impact on MNs and acupuncture irritate afferent nerve fibers in combination for UL motor impairment rehabilitation after stroke is still unclear. In the present study, we investigate the central and peripheral neural stimulation meanwhile for UL recovery with stroke patients. In this clinical study, 82 stroke patients recruited with impaired UL were randomly assigned to three groups. Twenty-four cases were in the AOT group, 28 cases were in the AOT combined acupuncture treatment group, and 30 cases were in the acupuncture treatment group. All volunteers were scored for limb function through the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), the Action Research Arm Test, and the modified Barthel Index (BI) before and after a systematic treatment according to the groups. Meanwhile, conventional physical therapy was also implemented for all cases. Before the specific intervention, the scores of FMA-UE, FMA-UE, and BI with all stroke patients have no significant statistical difference (P > 0.05). After the corresponding treatment, we assessed UL function again at 4 and 8 weeks. At 4 weeks, the patients with AOT showed a significant increase in BI scores compared to the acupuncture group (P < 0.05). At 8 weeks, the FMA-UE scores of the patients with AOT combined with acupuncture were significantly increased than acupuncture alone (P < 0.05). We also observed that the BI scores of the combination and the AOT group both were improved compared to the acupuncture group with significant statistical analysis (P < 0.05). Based on the MNs theory, we adopted AOT impact on MNs which would be a promising rehabilitation technique, especially combined with acupuncture treatment in UL recovery of stroke. Mirror therapy seems to be effective for central neuronal plasticity, but for action or AOT, there is still insufficient evidence to recommend its optimal strategy and neuromodulation mechanism. Here, research on the MNs-based AOT technique with acupuncture in UL dysfunction with stroke patients is recommended.TRIAL REGISTRATION: http://www.chictr.org.cn (identifier: ChiCTR2300077010).

Trends in Pediatric Attention-Deficit Hyperactive Disorder Diagnoses and Prescription Utilization: 2016 to 2019.

Attention-deficit hyperactive disorder (ADHD) is one of the most common psychiatric disorders among children, with estimated prevalence of 7% to 15% worldwide. The aim of this analysis was to update and summarize trends in diagnosis, demographics, and drug utilization of pediatric patients with ADHD. We used the Agency for Health care Research and Quality Medical Expenditure Panel Survey (MEPS), a survey of US individuals, families, their medical providers, and employers, using datasets from 2016 to 2019. The data sources from the MEPS database included the full-year consolidated files, medical conditions files, prescribed-medicines files, and condition-event link files for each year. We summarized trends in the proportion of children, ages 17 years and younger, with a diagnosis of ADHD, demographic information and a prescription for medication known to treat ADHD. In addition, we further stratified ADHD medication use by stimulant/nonstimulant categories. There was a 1.6% and 4.7% absolute increase in children with an ADHD diagnosis and those prescribed ADHD medications, respectively, from 2016 to 2019. Most of these children were male, non-Hispanic, and on public insurance. Of the children prescribed an ADHD medication and concomitant behavioral medications, stimulants-only use was the highest (60%-67%), followed by stimulants/nonstimulants (13%-15%), stimulant/antidepressants (6%-9%), and nonstimulants only (5%-9%). The proportion of patients with ADHD in the high-income and near-poor categories increased by 4% from 2016 to 2019. Diagnosis of ADHD among children is trending upward in the United States. Central nervous system stimulants, especially methylphenidate formulations, are the most prescribed ADHD medications for children 17 years and younger.