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Abstract: In the present study an experimental comparison between the standard CO2 expansion valve refrigeration cycle and the ejector refrigeration cycle is presented. High pressure variations for different evaporation pressures and gas cooler outlet temperatures were performed. Additionally, the ejector efficiency, the entrainment ratio, and the pressure recovery by the ejector were investigated at these conditions. Both investigated cycles where realized using the same test rig, thus minimizing comparison errors. Compared to the maximal COP of the expansion valve cycle, COP improvements of the ejector cycle of 17% were reached with ejector efficiencies of up to 22%. [Copyright &y& Elsevier]

Summary: There is some controversial discussion within the therapy of craniomandibular disorders (CMDs) about the mode of action of occlusal splints. Here we present a case report on one CMD-patient measuring cerebral activation changes with functional magnetic resonance imaging (fMRI) before and after therapy with a stabilization splint. Wearing the Michigan splint for 11 nights and partially days resulted in substantial pain relief and changes in occlusal movement performance. Cerebral activation during occlusion was decreased after therapy (PRE–POST) in bilateral sensorimotor regions but also additional areas such as left posterior insula, right superior temporal cortex and bilateral occipital lobe. During the first usage of the splint in the scanner (PRE) increased activation in the left dorsolateral prefrontal lobe (BA 9) was observed. After splint training occlusion with the splint compared to without a splint increasingly involved the left superior parietal lobe (BA 7, POST). Whereas BA 9 might be associated with increasing working memory load due to the manipulation with an unusual object, the BA 7 activation in the POST session might document increased sensorimotor interaction after getting used to the splint. Our findings indicate that wearing an occlusion splint triggers activation in parietal sensorimotor integration areas, also observed after long periods of sensorimotor training. These additional recourses might improve coordination and physiological handling of the masticatory system. [Copyright &y& Elsevier]

Chronic cluster headache (CCH) is a disabling primary headache, considering the severity and frequency of pain attacks. Deep brain stimulation (DBS) has been used to treat severe refractory CCH, but assessment of its efficacy has been limited to open studies. We performed a prospective crossover, double-blind, multicenter study assessing the efficacy and safety of unilateral hypothalamic DBS in 11 patients with severe refractory CCH. The randomized phase compared active and sham stimulation during 1-month periods, and was followed by a 1-year open phase. The severity of CCH was assessed by the weekly attacks frequency (primary outcome), pain intensity, sumatriptan injections, emotional impact (HAD) and quality of life (SF12). Tolerance was assessed by active surveillance of behavior, homeostatic and hormonal functions. During the randomized phase, no significant change in primary and secondary outcome measures was observed between active and sham stimulation. At the end of the open phase, 6/11 responded to the chronic stimulation (weekly frequency of attacks decrease >50%), including three pain-free patients. There were three serious adverse events, including subcutaneous infection, transient loss of consciousness and micturition syncopes. No significant change in hormonal functions or electrolytic balance was observed. Randomized phase findings of this study did not support the efficacy of DBS in refractory CCH, but open phase findings suggested long-term efficacy in more than 50% patients, confirming previous data, without high morbidity. Discrepancy between these findings justifies additional controlled studies (clinicaltrials.gov number NCT00662935). [ABSTRACT FROM AUTHOR]

Migraine is a common and frequently disabling condition. Nevertheless, many migraine sufferers do not consult for migraine, are not medically followed up and self-treat the attacks. “Tour de France of migraine” consisted of free-access conferences held in six large towns in France following a wide public information campaign. This sensitization campaign aimed at providing participants with educational information on migraine disease and on current therapies. Headache sufferers were then invited to respond to two consecutive questionnaires delivered at the end of the conferences and 3 months later to assess the influence of the information delivered on their migraine management. Tour de France of migraine recruited mainly severe migraine sufferers, most of whom had already consulted and were medically followed up. However, migraine management was often suboptimal in these subjects since most of them found their acute treatment of attacks ineffective and only few of them received a prophylactic treatment. Three months after the conferences, more than half of respondents had consulted for headaches. There was a significant improvement in migraine-related disability, as reflected by a significant decrease in mean Headache Impact Test 6-item score, which might have been related to the higher proportion of subjects receiving a prophylactic treatment of migraine. The Tour de France of migraine campaign revealed the difficulty in sensitizing migraine sufferers towards the necessity of being medically followed up. Mainly patients with severe migraine attended the conferences and derived clinical benefit from the educational program. Other strategies should be developed to reach a wider population of migraine sufferers. [ABSTRACT FROM AUTHOR]

• The taxonomic status of Lutzomyia longipalpis has long been an issue of debate. • Gutierrez et al. recently reported eight MOTUs under the name L. longipalpis. • However, the type specimen of L. longipalpis sensu stricto is unavailable. • The designation of a neotype for L. longipalpis sensu stricto is urgently needed. [ABSTRACT FROM AUTHOR]

Summary: Brain imaging based on functional magnetic resonance (fMRI) is a useful tool for examination of neuronal networks and cerebral structures subserving visiospatial function. The purpose of this study was to compare the brain activity during chewing and occlusal function in centric occlusion on natural teeth or on occlusal splints. Four tasks were performed by 13 healthy, fully dentate subjects (21–32 years old, 6 female and 7 male): occlusal tap-tap movements in centric occlusion by natural teeth, after application of a maxillary occlusal splint and chewing movements on left and right sided rubberdam strips. In order to reveal which areas of the brain were more strongly activated, conjunction analyses between the different tasks were performed for each subject and for the average values of brain signal activity of all subjects. Whilst several known foci of activity were subtracted, differences of significant activity rested in areas of the sensorimotor cortex. Mainly ipsilaterality of hemispheres concerned the left and right sided chewing, whereas the conjunction between tap-tap movements on natural teeth and splint occlusion indicated only one weak, but significant activation foci. The study confirms fMRT as one of the most useful developing methods to clear up neuro-cortical effectiveness of occlusion and occlusal therapy. [Copyright &y& Elsevier]

The purpose of this review is to describe strategies for optimizing the use of available agents for acute migraine therapy. Patient satisfaction with migraine therapy depends on obtaining rapid and complete resolution of pain and preventing headache recurrence, making 2-h pain free and sustained pain free more relevant endpoints than 2-h pain relief for assessing acute migraine therapies. Many treatment guidelines recommend a step-care approach to migraine management, that is, starting with a simple analgesic, followed by various combination analgesics, allowing a migraine-specific drug (e.g. a triptan) only after the patient has demonstrated an inadequate response to non-specific treatments. This can result in prolonged morbidity and patients lapsing from care. In the stratified-care approach, the initial treatment is selected according to the individual patient's migraine severity and associated disability, promoting the use of migraine-specific treatments as first-line agents for patients with disabling migraines. Another strategy, triptan treatment during mild headache pain, has been shown to improve treatment success rates compared with treatment delayed until pain is moderate to severe. Treatment before the development of central sensitization is thought to underlie the improvement in outcomes. In conclusion,migraine treatment strategies such as the stratified-care approach and the administration of medication while pain is mild will help increase treatment success rates and substantially reduce patient suffering and disability. [ABSTRACT FROM AUTHOR]

• The taxonomic status of Lutzomyia longipalpis sensu lato is under dispute. • Genetic data from three Brazilian populations disclosed the presence of two groups. • An analysis including other six populations revealed the presence of the two clades. • Genetic differentiation data suggest a limited gene flow between populations from clade I and clade II. Lutzomyia longipalpis sensu lato is a complex of phlebotomine sand fly species, which are widespread in the Neotropics. They have a great medico-veterinary importance due their role as vectors of Leishmania infantum , the causative agent of visceral leishmaniasis. Morphological variations of Lu. longipalpis s.l. males were reported in the late 1960s in Brazil. Male populations can present either one pair of spots on third abdominal tergites or two pairs on third and fourth ones, namely 1S and 2S phenotypes, respectively. Since then, there has been much interest on the taxonomic status of Lu. longipalpis s.l. Thereafter, several lines of evidence have been congruent in suggesting the existence of an uncertain number of cryptic species within Lu. longipalpis s.l. in Brazil. Herein, a 525 bp-fragment of the period gene was used for assessing the genetic structure and phylogenetic relationship of Lu. longipalpis s.l. populations in Brazil. We performed two set of analyses, first we originally sequenced three populations (Passira, Santarém and Teresina) of Lu. longipalpis s.l. and compared them. Thereafter, we performed a global analysis including in our dataset other three pairs of sympatric populations of Lu. longipalpis s.l. from three Brazilian localities available in GenBank. Fixed single nucleotide polymorphisms (SNPs) sharing, maximum likelihood inference, genetic structure and haplotype analyses revealed the presence of two genetic groups, one composed of Teresina population, and the other encompassing Passira and Santarém populations. The global analysis reflected the first of its kind, and two prominent groups were observed: the clade I comprising Teresina 1S, Bodocó 1S, Caririaçu 1S and Sobral 1S; and the clade II encompassing Passira 2S, Santarém 1S, Bodocó 2S, Caririaçu 2S and Sobral 2S. Genetic differentiation data suggested a limited gene flow between populations of the clade I versus clade II. Our results disclosed the presence of two prominent genetic groups, which could reasonably represent populations of Lu. longipalpis s.l. whose males produce the same courtship song. [Display omitted] [ABSTRACT FROM AUTHOR]

• In a General Population Study, prevalence of visible potentially malignant disordersof the mucosa (PMD) was 0.9%. • Male sex, periodontitis, type 2 diabetes mellitus, smoking and obesity were identified as potential risk factors for PMD. • This is clinically relevant for primary and secondary prevention of PMD in dental practice. Oral cancer mostly develops from oral mucosa regions with morphological alterations transforming malignant. These visible precancerous mucosa lesions are named potentially malignant disorders (PMD). We aimed to analyze the prevalence of PMD and its risk factors for PMD in a population-based sample in Northern Germany. Data of 6078 individuals from the population-based Study of Health in Pomerania (SHIP) was used. PMD were photographically documented and periodontal health was assessed in a standardized procedure. PMD were observed in 54 individuals (0.9%). The most prevalent PMD was homogenous leukoplakia (n = 37) followed by Lichen ruber (n = 9). Smoking (Odds Ratio (OR) 2.70; 95% confidence interval (CI): 1.24–5.87), male sex (OR 3.32; 95%-CI: 1.77–6.21), type 2 diabetes mellitus (OR 2.07; 95%-CI: 1.08–3.98) and body mass index (OR 1.09; CI 1.04–1.14) were significantly associated with PMD, with the corresponding area under the curve (AUC) being 0.696 (CI: 0.655; 0.737). Our results suggest a clinically relevant prevalence of PMD in the population. We identified male sex, type 2 diabetes mellitus, current smoking, and obesity as risk factors. We recommend photographic documentation and intensified training of medical and dental staff to detect and monitor PMD. [ABSTRACT FROM AUTHOR]

Background: Varied responses to acute migraine medications have been observed, with over one‐third (34.5%) of patients reporting insufficient headache relief. Sumatriptan‐naproxen sodium, a single, fixed‐dose combination tablet comprising sumatriptan 85 mg and naproxen sodium 500 mg, was developed with the rationale of targeting multiple putative mechanisms involved in the pathogenesis of migraine to optimise acute migraine care. Methods: A narrative review of clinical trials investigating sumatriptan‐naproxen sodium for both adults and adolescents was performed in March 2024. Results: Across a total of 14 clinical trials in nine publications, sumatriptan‐naproxen sodium offered greater efficacy for 2‐h pain freedom (14/14) and sustained pain‐free response up to 24 h (13/14) compared with monotherapy and/or placebo for both adult and adolescent study participants with an acceptable and well‐tolerated adverse effect profile. Clinical trial data also demonstrates the effectiveness of sumatriptan‐naproxen sodium in participants with allodynia, probable migraine, menstrual‐related migraine and those with poor responses to acute, non‐specific, migraine medication. Conclusions: Multi‐mechanistic therapeutic agents offer an opportunity to optimise acute medications by targeting multiple mediators involved in the pathogenesis of migraine. Sumatriptan‐naproxen sodium resulted in greater initial and sustained pain freedom, compared with either sumatriptan, naproxen‐sodium and/or placebo, for the treatment of single or multiple attacks of migraine across both adult and adolescent study populations. [ABSTRACT FROM AUTHOR]