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Psychomotor stimulant drugs such as caffeine, nicotine, amphetamine and cocaine, have been shown to improve vigilance in man under conditions of fatigue. Nicotine has also been shown to improve performance in some cognitive tests in patients with Alzheimer's disease. In rodents these drugs increase activity which may confound "performance enhancing effects" in rodent models. However, improvements have been found in a number of tests that do not seem to be directly dependent upon an enhancement of locomotor activation. In one example, Evenden and Robbins (1985) reported consistent improvements in a visual tracking test following amphetamine. The present study was undertaken to determine whether these performance enhancing effects of amphetamine could also be obtained with cocaine and apomorphine, which both have psychomotor stimulant effects through their actions as, respectively, indirect and direct dopamine agonists, and by caffeine and nicotine, which do not have a direct dopaminergic mechanism of action. The results of the study indicate that all five drugs improved tracking performance at one or more doses. The most consistent effects were obtained with amphetamine which, like cocaine and nicotine, improved tracking at a dose which did not produce other changes in behaviour. Taking into account previous studies (Evenden and Robbins 1983, 1985), these results were interpreted as indicating that psychomotor stimulant drugs produce a general activation of behaviour. At all but the highest doses of such drugs, the form of behaviour that is observed depends upon the environment.(ABSTRACT TRUNCATED AT 250 WORDS)

Problem The University of Houston College of Medicine (UH COM) began its first admissions cycle after receiving preliminary accreditation in February 2020. With the advent of remote learning in response to the COVID-19 pandemic, the school moved its admissions process, including multiple mini-interview (MMI), from an in-person to online format in mid-March 2020. Approach The UH COM selected Zoom as the video conferencing platform for its virtual admissions process, including MMI. On each interview day (3–4 hours), 14–16 applicants joined administrators, faculty, and staff in a virtual meeting room. Applicants were divided into 2 groups: one viewed short presentations about the school, curriculum, and departments, while the other participated in 7 MMI stations (one-on-one interactions with interviewers) via virtual breakout rooms; the groups then switched. The MMI stations were the same as those used in-person in early March. Applicants were able to ask questions at multiple points during the day. Technical support was provided for participants with connectivity issues or unfamiliar with Zoom. Outcomes Of the 180 applicants interviewed in March–April 2020, 134 (74%) participated in the virtual process and 46 (26%) in the on-site process. Twenty-five (83%) of the 30 members of the inaugural class of 2024 interviewed virtually. Advantages of the virtual format included ease of access for faculty and more flexibility and less expense for applicants. Challenges included the need for applicants to decide whether to accept an offer of admission from a new school without visiting and missed opportunities for faculty to have relatively unstructured interactions with applicants. Next Steps This virtual admissions process was a feasible alternative for the inaugural class but is not sustainable. UH COM plans to leverage lessons learned to refine the virtual format for use in future admissions cycles, even when in-person interviews are possible.

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), also known as COVID-19 emerged in late 2019 in Wuhan, China and the World Health Organization declared the virus a pandemic on March 11, 2020. Disease progression from COVID-19 infection has increasingly shown significant symptom manifestations within organ systems beyond the respiratory system. In this regard, literature has shown increasing numbers of cardiovascular involvement during disease course and an associated increase in mortality among infected patients. Complications involving the cardiovascular system include myocardial infarction, arrhythmias, shock, and heart failure. In this evidence-based review, we discuss risk factors of cardiovascular involvement in COVID-19 infection, pathophysiology of COVID-19-related cardiovascular infection and injury, COVID-19 effects on the cardiovascular system and corresponding treatments, and hematologic effects of COVID-19 and COVID-19 in heart transplant patients. Clinicians managing COVID-19 patients should appreciate the potential cardiovascular effects related to the disease process.

HTX-011 is an extended-release, dual-acting local anesthetic consisting of liposomal bupivacaine (sodium-channel blocker) and low-dose meloxicam (non-steroidal anti-inflammatory drug [NSAID]) applied needle-free during surgery. Introducing low-dose meloxicam addresses the limited efficacy of liposomal bupivacaine in acidic inflamed tissues and allows enhanced analgesic effects over three days. It has great promise to be an extremely effective postoperative pain regimen and produce an opioid-free surgical recovery, as it has consistently significantly reduced pain scores and opioid consumption through 72 h. This manuscript provides an updated, concise narrative review of the pharmacology, clinical efficacy, safety and tolerability of this drug and its applications to prevent postoperative pain.

Purpose of Review Pain presents a unique challenge due to the complexity of the biological pathways involved in the pain perception, the growing concern regarding the use of opioid analgesics, and the limited availability of optimal treatment options. The use of biomaterials and regenerative medicine in pain management is being actively explored and showing exciting progress in improving the efficacy of conventional pharmacotherapy and as novel non-pharmacological therapy for chronic pain caused by degenerative diseases. In this paper we review current clinical applications, and promising research in the use of biomaterials and regenerative medicine in pain management. Recent Findings Regenerative therapies have been developed to repair damaged tissues in back, joint, and shoulder that lead to chronic and inflammatory pain. Novel regenerative biomaterials have been designed to incorporate biochemical and physical pro-regenerative cues that augment the efficacy of regenerative therapies. New biomaterials improve target localization with improved tunability for controlled drug delivery, and injectable scaffolds enhance the efficacy of regenerative therapies through improving cellular migration. Advanced biomaterial carrier systems have been developed for sustained and targeted delivery of analgesic agents to specific tissues and organs, showing improved treatment efficacy, extended duration of action, and reduced dosage. Targeting endosomal receptors by nanoparticles has shown promising anti-nociception effects. Biomaterial scavengers are designed to remove proinflammatory reactive oxygen species that trigger nociceptors and cause pain hypersensitivity, providing a proactive approach for pain management. Summary Pharmacotherapy remains the method of choice for pain management; however, conventional analgesic agents are associated with adverse effects. The relatively short duration of action when applied as free drug limited their efficacy in postoperative and chronic pain treatment. The application of biomaterials in pain management is a promising strategy to improve the efficacy of current pharmacotherapy through sustained and targeted delivery of analgesic agents. Regenerative medicine strategies target the damaged tissue and provide non-pharmacological alternatives to manage chronic and inflammatory pain. In the future, the successful development of regenerative therapies that completely repair damaged tissues will provide a more optimal alternative for the treatment of chronic pain caused. Future studies will leverage on the increasing understanding of the molecular mechanisms governing pain perception and transmission, injury response and tissue regeneration, and the development of new biomaterials and tissue regenerative methods.

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