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Severe impairment of heat-induced saliva-spreading in rats recovered from lateral hypothalamic lesions.

A method has been devised to record saliva-spreading on fur and skin by rats in the heat. Normal males and females increase saliva-spreading with increasing ambient temperatures. Rats recovered from lateral hypothalamic lesions do not spread saliva in the heat, confirming the inference drawn from studies of their drinking behavior that their saliva production is severely impaired. Recovered lateral rats do produce saliva when injected with pilocarpine. The failure to salivate is, therefore, a result of the lateral hypothalamic lesions and is not due to an incompetence of the glands.

Animals↗

A potent nonpeptide antagonist of the substance P (NK1) receptor.

CP-96,345 [(2S, 3S)-cis-2-(diphenylmethyl)-N-[(2-methoxyphenyl)- methyl]-1-azabicyclo[2.2.2]octan-3-amine] is a potent nonpeptide antagonist of the substance P (NK1) receptor. CP-96,345 inhibited 3H-labeled substance P binding and was a classical competitive antagonist in the NK1 monoreceptor dog carotid artery preparation. CP-96,345 inhibited substance P-induced salivation in the rat, a classical in vivo bioassay, but did not inhibit NK2, NK3, or numerous other receptors; it is thus a selective NK1 antagonist. This compound may prove to be a powerful tool for investigation of the physiological properties of substance P and exploration of its role in diseases.

Animals↗

Pharmacokinetics and bioavailability of spiramycin in pigs.

The pharmacokinetics of spiramycin in pigs were investigated after intravenous and oral administration. The potential therapeutically effective blood level was established after a single administration and examined in a subsidiary five day study. The rapid intravenous injection of 25 mg spiramycin/kg bodyweight produced marked salivation in all the test animals. The elimination half-life (2.3 +/- 1.2 hours) was relatively short, in accordance with the total body clearance rate (27.3 +/- 10.1 ml/minute/kg). The high volume of distribution (5.2 +/- 2.2 litres/kg) was due to the accumulation of the drug in the body tissues. The maximum plasma concentration (4.1 +/- 1.7 micrograms/ml) after oral administration of 85 to 100 mg spiramycin/kg bodyweight was reached after 3.7 +/- 0.8 hours and the half-life of the elimination phase was 6.0 +/- 2.4 hours. The oral bioavailability was 45.4 +/- 23.4 per cent. Ad libitum feeding of a diet containing 2550 mg spiramycin/kg produced a steady state concentration of 0.96 +/- 0.27 micrograms/ml. This plasma concentration would provide a potentially therapeutically effective blood concentration against Mycoplasma species, Streptococcus species and Staphylococcus species.

Administration, Oral↗

Atypical time course of clinical signs in a dog poisoned by strychnine.

The general health of a German shepherd dog had deteriorated slightly when it was found after being loose for one hour. After 10 hours of observation, the dog showed signs of pain for the first time and signs of poisoning, such as tenseness of muscles, slight opisthotonus, regurgitation, salivation, mydriasis, dyspnoea and cyanosis, were observed; it died 15 minutes after showing the first clinical signs but it had no seizures or tetanic spasms at any time. A postmortem examination did not reveal any pathological changes. A screening test for alkaloids was positive for strychnine (strychnidin-10-one). The presence of strychnine was confirmed and its concentration was determined by gas chromatography/mass spectrometry in urine (728.5 ng/ml) and in the stomach contents (44.6m microg/g). No strychnine was detected in the dog's serum, but traces of brucine (2,3-dimethoxystrychnidin-10-one), the dimethoxy derivative of strychnine, were detected. This case was compared with other strychnine poisonings recorded in the authors' laboratory over the previous six years, taking into account the species, type of samples, the clinical signs and their duration, the postmortem findings, and the concentrations of strychnine. This was the only case to show such an atypical time course of clinical signs.

Animals↗

A neurokinin-1 receptor antagonist reduced hypersalivation and gastric contractility related to emesis in dogs.

The roles of tachykinin neurokinin-1 (NK1) receptors in the induction of fictive retching, hypersalivation, and gastric responses associated with emesis induced by abdominal vagal stimulation were studied in paralyzed, decerebrated dogs. Vagal stimulation induced gradual increases in salivary secretion and activity of the parasympathetic postganglionic fibers to the submandibular gland, relaxation of the gastric corpus and antrum, and fictive retching. However, hypersalivation and increased nerve activity were suppressed and antral contractility was enhanced during fictive retching. An NK1 receptor antagonist, GR-205171, abolished the enhancement of antral contractility and fictive retching but had no effect on corpus and antral relaxation. Hypersalivation and increased nerve activity were inhibited by GR-205171 but were not completely abolished. Reflex salivation by lingual nerve stimulation was unaffected. These results suggest that GR-205171 acts on the afferent pathway in the bulb and diminishes hypersalivation and antral contraction related to emesis as well as fictive retching but does not affect gastric relaxation or hypersalivation induced by the vagovagal, vagosalivary, and linguosalivary reflexes.

Animals↗

Lowering of interstitial fluid pressure in rat submandibular gland: a novel mechanism in saliva secretion.

The submandibular gland transports fluid at a high rate through the interstitial space during salivation, but the exact level of all forces governing transcapillary fluid transport has not been established. In this study, our aim was to measure the relation between interstitial fluid volume (V(i)) and interstitial fluid pressure (P(if)) in salivary glands during active secretion and after systemically induced passive changes in gland hydration. We tested whether interstitial fluid could be isolated by tissue centrifugation to enable measurement of interstitial fluid colloid osmotic pressure. During control conditions, V(i) averaged 0.23 ml/g wet wt (SD 0.014), with a corresponding mean P(if) measured with micropipettes of 3.0 mmHg (SD 1.3). After induction of secretion by pilocarpine, P(if) dropped by 3.8 mmHg (SD 1.5) whereas V(i) was unchanged. During dehydration and overhydration of up to 20% increase of V(i) above control, a linear relation was found between volume and pressure, resulting in a compliance (DeltaV(i)/DeltaP(if)) of 0.012 ml.g wet wt(-1).mmHg(-1). Interstitial fluid was isolated, and interstitial fluid colloid osmotic pressure averaged 10.4 mmHg (SD 1.2), which is 64% of the corresponding level in plasma. We conclude that P(if) drops during secretion and, thereby, increases the net transcapillary pressure gradient, a condition that favors fluid filtration and increases the amount of fluid available for secretion. The reduction in P(if) is most likely induced by contraction of myoepithelial cells and suggests an active and new role for these cells in salivary secretion. The relatively low interstitial compliance of the organ will enhance the effect of the myoepithelial cells on P(if) during reduced V(i).

Animals↗

Heat acclimation and hypohydration: involvement of central angiotensin II receptors in thermoregulation.

This investigation attempted to confirm the involvement of central ANG II-ergic signals in thermoregulation. Experiments were conducted on rats undergoing short (STHA)- and long (LTHA)-term heat acclimation, with and without superimposed hypohydration. Vasodilatation (VTsh) and salivation (STsh) temperature thresholds, tail blood flow, and heat endurance were measured in conscious rats during heat stress (40 degrees C) before and after losartan (Los), an ANG II AT(1)-selective receptor antagonist, administration either to the lateral ventricle or intravenously. Heat acclimation alone resulted in decreased VTsh. STsh decreased during STHA and resumed the preacclimation value, together with markedly increased heat endurance on LTHA. Hypohydration did not affect this biphasic response, although STsh was elevated in all groups. The enhanced heat endurance attained by LTHA was blunted. Neither Los treatment affected the nonacclimated rats. In the heat-acclimated, euhydrated rats, intracerebroventricular Los resulted in decreased VTsh, whereas intravenous Los resulted in elevated STsh. Both intracerebroventricular and intravenous Los led to markedly enhanced heat endurance of the LTHA hypohydrated rats. It is concluded that the LTHA group showed a loss of the benefits acquired by acclimation on hypohydration, whereas the STHA rats, which show an accelerated autonomic excitability in that phase, gained some benefit. It is suggested that ANG II modulates thermoregulation in conditions of chronic adjustments. Central ANG II signals may lead to VTsh upshift, whereas circumventricular structures, activated via circulating ANG II, decrease STsh. On hypohydration these responses seem to be desensitized.

Acclimatization↗

Laser-uvulopalatoplasty (LUPP) under local anesthesia: effective, safe and comfortable.

Conventional uvulopalatopharyngoplasty has in the last years to an increasing extent been succeeded by a variety of laser procedures for snorers obstructed by lax palates only. These surgical techniques have the advantages of being less traumatic and therefore more suitable for local anesthesia and outpatient surgery. However, to the authors' knowledge, there are no studies on degree of patient discomfort during this type of surgery as well as the value of anticholinergic component in premedication in preventing bradycardia and hypersalivation during the operation. We studied 53 consecutive patients undergoing laser-uvulopalatoplasty (LUPP) under local anesthesia at our day care unit. LUPP is a one-stage operation for rhonchopathy which has been developed at our department. Twenty-five patients received morphine and scopolamine, and 28 morphine alone as premedication. Peroperative salivation, bradycardia and nausea was estimated and recorded for each group. Later the patients were asked to assess mouth dryness both before and after surgery, as well as satisfaction with sedation and pain relief. The great majority of the patients (> 80%) described only insignificant pain, which when occurring was related to subliminal premedication or to the injection of local anesthesia or both. Morphine-scopolamine was significantly better in preventing hypersalivation (p < 0.01) during surgery and also improved sedation and analgesia when compared to morphine alone (p < 0.05). The efficacy of LUPP is compared with various laser procedures for snoring.

Adult↗

Anticholinergic activity of two tricyclic antidepressants.

Using a double-blind crossover Latin square design, the authors evaluated the peripheral anticholinergic and central nervous system effects of three dose levels of two tricyclic antidepressants in female volunteers. Results showed that 5 hours after drug administration, desipramine (50 and 100 mg) caused significantly less reduction in salivation than did amitriptyline. Amitriptyline produced more sedation (Clyde Mood Scale) and a greater number of subjective complaints than did desipramine. These results are consistent with anticholinergic profiles from animal experiments and suggest that clinically meaningful differences may exist among tricyclic antidepressants.

Adult↗

Handling of calcium by the ferret submandibular gland.

The handling of Ca by the submandibular gland of the ferret during stimulation of salivation with pilocarpine was studied using micropuncture and microanalytical, as well as standard, physiological techniques. Concentrations of ionized Ca were measured in the fluid from the intercalated, lobular, and main ducts of the gland. The net transductal fluxes of this divalent ion were calculated.

Animals↗

The effects of tyramine on salivary flow rate and protein secretion by rat submandibular glands.

The effects of different doses of p-tyramine injected i.v. and i.p. on salivary flow rates and proteins secreted by the submandibular glands of rats were studied with and without various types of autonomic blockers and two enzyme inhibitors. The salivary flow rates and the amounts of protein secreted progressively increased with increasing doses injected both i.v. and i.p., whereas they were dramatically reduced with all autonomic blockers except the lowest doses of beta-blockers, atropine, and yohimbine. Salivation in response to p-tyramine injected i.v. and i.p. was completely abolished by simultaneous injections of both prazosin and propranolol. The concentration of protein was not dose-dependent and was not reduced by yohimbine and phenoxybenzamine at almost all doses used. However, prazosin significantly increased the protein concentration. Protease activities were dose-dependent but were significantly reduced with alpha-blockers other than yohimbine, and with most beta-blockers. The proteins secreted in response to p-tyramine at all doses injected i.v. and i.p. were of the alpha-type except with the lowest dose injected i.p. However, the alpha-type was completely replaced by the beta-type in the presence of all alpha-blockers except yohimbine, but not with beta-blockers, atropine, or two enzyme inhibitors. Pargyline, a monoamine-oxidase inhibitor, but not disulfiram, a dopamine-beta-hydroxylase inhibitor, affected all parameters except the type of protein. Thus, p-tyramine may activate both the alpha 1- and beta 1-adrenoceptors in the submandibular glands of rats directly or indirectly.

Adrenergic alpha-Antagonists↗

The effects of p-octopamine on salivary flow rates and protein secretion by rat submandibular glands.

The effects of p-octopamine injected i.v. and i.p on salivary flow rates and proteins secreted by the submandibular glands of rats were studied with and without various types of autonomic blockers at different doses, and with two enzyme inhibitors. The salivary flow rates and the amounts of protein secreted progressively increased with increasing doses injected both i.v. and i.p., whereas they were dramatically reduced with almost all autonomic blockers and disulfiram, a dopamine-beta-hydroxylase inhibitor. Salivation was completely abolished in response to p-octopamine in combination with metoprolol or phenoxybenzamine at high doses, and simultaneous injections of prazosin and propranolol. The concentration of protein in submandibular saliva in response to p-octopamine injected i.v. and i.p. was not dose-dependent and significantly increased with all of the alpha-blockers except yohimbine, and with atropine and disulfiram. The protease activity was dose-dependent but was reduced significantly with alpha-blockers except yohimbine and with two enzyme inhibitors. The alpha-type of protein was secreted in response to p-octopamine injected i.v. and i.p. at all doses except with the lowest dose i.p., which caused the beta-type to be secreted. The alpha-type was completely replaced by the beta-type with all alpha-blockers at all doses, except with yohimbine, but no change was observed with various types of beta-blockers, yohimbine, atropine, and two enzyme inhibitors. Thus, p-octopamine could stimulate both the alpha- and beta-adrenoceptors in the submandibular glands of rats.

Adrenergic alpha-Antagonists↗

Effects of clonidine and diazepam on prepulse inhibition of the acoustic startle response and the N1/P2 auditory evoked potential in man.

Contraction of the orbicularis oculi muscle in response to a sudden loud sound (acoustic startle response) and the N1/P2 component of the auditory evoked potential are both attenuated when a brief low-intensity stimulus is presented 30-500 ms before the 'startle-eliciting' stimulus (prepulse inhibition). We examined the effects of two sedative/anxiolytic drugs, diazepam and clonidine, on prepulse inhibition of these two responses in healthy volunteers. Fifteen males (aged 18-35 years) participated in three sessions in which they received oral doses of placebo, diazepam 10 mg and clonidine 0.2 mg according to a balanced double-blind protocol. Thirty-minute simultaneous recordings of the electromyographic (EMG) responses of the orbicularis oculi muscle of the right eye and the vertex auditory evoked potentials took place 120 min after ingestion of clonidine and 60 min after ingestion of diazepam. Sound stimuli (1 kHz) were presented in 60 trials separated by variable intervals (mean 25 s): (i) 40-ms 115-dB ('pulse alone', 20 trials); (ii) 40-ms 85-dB (20 trials); (iii) 40-ms 85-dB, followed after 120 ms by 40-ms 115-dB ('prepulse/pulse', 20 trials). Mean amplitudes of the EMG response and the N1/P2 potential were derived from the pulse-alone trials and, in each case, percentage prepulse inhibition was calculated. The amplitude of the EMG response was significantly reduced both by diazepam and by clonidine; neither drug significantly altered prepulse inhibition of the EMG response. Diazepam, but not clonidine, significantly reduced the amplitude of the N1/P2 potential; neither drug significantly affected prepulse inhibition of the N1/P2 potential. Both drugs reduced self-rated alertness and anxiety, and systolic blood pressure; clonidine, but not diazepam reduced diastolic blood pressure and salivation. The results confirm previous findings that sedative drugs can suppress the startle response without affecting prepulse inhibition of this response, and provide new information on the effects of these drugs on the N1/P2 potential and its inhibition by prepulses.

Acoustic Stimulation↗

Effects of ketanserin and haloperidol on prepulse inhibition of the acoustic startle (eyeblink) response and the N1/P2 auditory evoked response in man.

Contraction of the orbicularis oculi muscle in response to a sudden loud sound (acoustic startle response) and the N1/P2 component of the auditory evoked potential are both attenuated when a brief low-intensity stimulus is presented 30-500 ms before the 'startle-eliciting' stimulus (prepulse inhibition). Here, we report the effects of the serotonin (5-HT)2 receptor antagonist ketanserin and the D2 dopamine receptor blocking antipsychotic drug haloperidol on these responses. Fifteen males (aged 18-35 years) participated in four sessions at 7-day intervals, in which they received ketanserin 20 mg, ketanserin 40 mg, haloperidol 3 mg and placebo, according to a balanced double-blind design. Electromyographic (EMG) responses of the orbicularis oculi muscle and N1/P2 auditory evoked potentials were recorded in a 20-min session, 3 h after ingestion of haloperidol or 1 h after ingestion of ketanserin. Subjects received 40 trials in which 1-kHz sounds were presented: (i) 40 ms, 115 dB ('pulse alone' trials), and (ii) 40 ms, 85 dB, followed after 120 ms by 40 ms, 115 dB ('prepulse/pulse' trials). Mean amplitudes of the EMG response and the N1/P2 potential were derived from the pulse-alone trials and, in each case, percentage prepulse inhibition was calculated. Serum prolactin was measured after each treatment, and autonomic (heart rate, blood pressure, salivation) and psychological (visual analogue self-ratings of mood and alertness, critical flicker fusion frequency) measures were taken before and after each treatment. Ketanserin 40 mg significantly reduced the amplitude of the EMG response and both doses of ketanserin significantly suppressed prepulse inhibition of the response; haloperidol had no effect on EMG response amplitude or prepulse inhibition. Neither drug affected N1/P2 amplitude or prepulse inhibition of this response. Ketanserin, but not haloperidol, reduced subjective alertness and critical flicker fusion frequency. Haloperidol, but not ketanserin, elevated serum prolactin level. These results confirm that prepulse inhibition of the startle response and of the N1/P2 complex have different pharmacological sensitivities. The ability of ketanserin to attenuate the startle response may reflect its sedative action, as other drugs with sedative properties have also been found to attenuate the startle response in man. The ability of ketanserin to suppress prepulse inhibition of the startle response is consistent with previous evidence for the involvement of 5-HTergic mechanisms in the regulation of prepulse inhibition in man.

Acoustic Stimulation↗

Effects of quetiapine and haloperidol on prepulse inhibition of the acoustic startle (eyeblink) response and the N1/P2 auditory evoked response in man.

Contraction of the orbicularis oculi muscle in response to a sudden loud sound (acoustic startle response) and the N1/P2 component of the auditory evoked potential are both attenuated when a brief low-intensity stimulus is presented 30-500 ms before the 'startle-eliciting' stimulus (PPI). Here, we report the effects of the 'atypical' antipsychotic drug quetiapine and the 'conventional' antipsychotic haloperidol on these responses. Sixteen males (aged 19-38 years) participated in four sessions at 7-day intervals, in which they received quetiapine 12.5 mg, quetiapine 25 mg, haloperidol 3 mg and placebo, according to a balanced double-blind design. Electromyographic (EMG) responses of the orbicularis oculi muscle and N1/P2 auditory evoked potentials were recorded in a 20-min session, 2 h after treatment. Subjects received 40 trials in which 1-kHz sounds were presented: (i) 40 ms, 115 dB ('pulse alone' trials) and (ii) 40 ms, 85 dB, followed after 120 ms by 40 ms, 115 dB ('prepulse/pulse' trials). Mean amplitudes of the EMG response and the N1/P2 potential were derived from the pulse-alone trials and, in each case, percentage PPI was calculated. Serum prolactin was measured after each treatment, and autonomic (heart rate, blood pressure, salivation) and psychological (visual analogue self-ratings of mood and alertness, critical flicker fusion frequency) measures were taken before and after each treatment. Quetiapine 12.5 mg and 25 mg significantly reduced the amplitude of the EMG response without altering its inhibition by prepulses; haloperidol had no effect on EMG response amplitude or PPI. Neither drug affected N1/P2 amplitude or PPI of this response. Quetiapine, but not haloperidol, reduced subjective alertness and critical flicker fusion frequency. Haloperidol, but not quetiapine, elevated serum prolactin level. The ability of quetiapine to attenuate the startle response may reflect its sedative action.

Acoustic Stimulation↗

Comparison of pramipexole and modafinil on arousal, autonomic, and endocrine functions in healthy volunteers.

The noradrenergic locus coeruleus is a major wakefulness-promoting nucleus of the brain, which is also involved in the regulation of autonomic and endocrine functions. The activity of the locus coeruleus is believed to be tonically enhanced by a mesocoerulear dopaminergic pathway arising from the ventral tegmental area of the midbrain. Both modafinil, a wakefulness-promoting drug, and pramipexole, a D(2)/D(3)receptor agonist with sedative properties, may act on this pathway, with modafinil increasing and pramipexole decreasing locus coeruleus activity. The aim of this study was to compare the two drugs on alertness, autonomic and endocrine functions in healthy volunteers. Pramipexole (0.5mg), modafinil (200mg), and their combination were administered to 16 healthy males in a double-blind, placebo-controlled design. Methods included tests of alertness (pupillographic sleepiness test, critical flicker fusion frequency, visual analogue scales), autonomic functions (resting pupil diameter, light and darkness reflex responses, heart rate, blood pressure, salivation, core temperature), and endocrine functions (blood concentrations of prolactin, growth hormone, and thyroid stimulating hormone). Data were analysed by ANOVA. Pramipexole reduced alertness, caused pupil dilatation, increased heart rate, reduced prolactin and thyroid stimulating hormone, and increased growth hormone level. Modafinil caused small increases in blood pressure and core temperature, and reduced prolactin levels. The sedative effect of pramipexole and the autonomic effects of modafinil are consistent with altered activity in the mesocoerulear pathway; the pupil dilatation following pramipexole suggests reduced dopaminergic excitation of the Edinger-Westphal nucleus.

Adolescent↗

Effects of clonidine and diazepam on the acoustic startle response and on its inhibition by 'prepulses' in man.

This experiment examined the effects of two sedative/anxiolytic drugs, diazepam and clonidine, on the eyeblink component of the acoustic startle response in healthy volunteers. Twelve males (18-30 years), screened for normal hearing thresholds, participated in three sessions in which they received oral doses of placebo, diazepam 10mg and clonidine 200 microg according to a balanced double-blind protocol. Thirty-minute electromyographic recordings from the orbicularis oculi muscle of the right eye were carried out 120 min after ingestion of clonidine and 60 min after ingestion of diazepam. Subjects received 36 40-msec sound pulses (115 dB), separated by variable intervals (mean 25 sec); in 24 of the trials the pulse was preceded by a 40-msec prepulse (75 dB in 12 trials and 85 dB in 12 trials; prepulse-pulse interval, 120 msec). The amplitude of the startle response was significantly reduced both by diazepam (mean+/-SEM: -43.9+/-7.4%) and by clonidine (-75.7+/-4.7%). Under the placebo condition, the 75 and 85dB prepulses inhibited the startle response by 38.6+/-6.5 and 70.3+/-2.9%, respectively. Neither drug significantly altered the degree of prepulse inhibition. Both drugs reduced self-rated alertness; clonidine reduced systolic blood pressure and salivation. The results confirm the suppressant effect of clonidine on the startle response and show a qualitatively similar effect of diazepam; the results also demonstrate the insensitivity of prepulse inhibition of the startle response to doses of sedative drugs that are sufficient to attenuate the startle response itself.

Acoustic Stimulation↗

Effects of bromocriptine and haloperidol on prepulse inhibition of the acoustic startle response in man.

Experiments with animals have shown that D2 dopamine (DA) receptors are involved in prepulse inhibition of the acoustic startle reflex (suppression of the reflex response evoked by a loud sound by prior presentation of a low-intensity stimulus). The present experiment attempted to extend this observation to man. Twelve healthy males (18-30 years), screened for normal hearing thresholds, participated in four sessions in which they received oral doses of placebo, bromocriptine 1.25 mg (a D2 receptor agonist), haloperidol 3 mg (a D2 receptor antagonist) and combined treatment with bromocriptine 1.25 mg+haloperidol 3 mg, according to a balanced double-blind protocol. Thirty-minute electromyographic recordings from the orbicularis oculi muscle of the right eye were carried out 120 min after ingestion of haloperidol and/or 90 min after ingestion of bromocriptine. Subjects received 36 40-msec sound pulses (115 dB), separated by variable intervals (mean 25 sec); in 24 of the trials the pulse was preceded by a 40-msec prepulse (75 dB in 12 trials and 85 dB in 12 trials; prepulse-pulse interval, 120 msec). The amplitude of the startle response was not significantly altered by any of the active treatments. Under the placebo condition, both 75- and 85-dB prepulses inhibited the startle response. Bromocriptine significantly attenuated this prepulse inhibition; haloperidol also produced a small but statistically significant attenuation of prepulse inhibition. Haloperidol significantly antagonized the attenuation of prepulse inhibition produced by bromocriptine. Neither drug altered self-rated alertness, physiological finger tremor, systolic or diastolic blood pressure or salivation. Bromocriptine significantly suppressed and haloperidol significantly elevated serum prolactin levels, these changes being absent when the two drugs were given in combination. The results provide evidence for the involvement of D2 DA receptors in prepulse inhibition of the startle reflex in man.

Acoustic Stimulation↗