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(2011), burst firing of VTA dopaminergic neurons may operate as a teaching signal. For example, in the case of food intake, when rats are presented with a highly palatable food for the first time, this triggers dopamine release in the Acc (shell), whereas repeated exposure to the same palatable food blunts the dopamine response despite avid consumption

The risk is minimised when metformin is used appropriately, the dosage is adjusted according to kidney function, and contraindications are considered [198]

Transparent cash-pay pricing can attract patients without coverage