Trapezial Design Technique for Autogenous Bone Graft in Esthetic Zone Implant Treatment.

We report bone augmentation for alveolar bone loss at the bottom of the nasal cavity in conjunction with simultaneous implant placement in the same operative field in the esthetic zone. The patient was a 33-year-old man who was referred to us requesting implant treatment after undergoing tooth extraction (#12) due to root fracture. An examination was performed using cone beam computed tomography (CT) and simulation software. The results indicated insufficient volume of labial bone for the requested procedure, especially at the planned site of the implant neck. Therefore, bone augmentation was performed at the apical site of the implant socket (alveolar bone at the bottom of the nasal cavity). Because the surgical line of the harvest site formed a trapezoidal shape, the procedure was named the "Trapezial Design Technique". Assessment of complications (Barone & Covane classification), success (Albrektsson classification), and observation of labial bone using cone beam CT were performed postoperatively. No com-plications were observed at 27 months after prosthetic treatment. The implant and the tissue surrounding it were in a stable condition. This indicates that this procedure is effective in placing an implant with simultaneous bone augmentation in the esthetic zone.

Cardiovascular Outcomes after Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent Placement for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, nine (five randomized controlled, two retrospective propensity-score matched, and two retrospective baseline-balanced) studies comparing the midterm clinical and angiographic outcomes after PCB angioplasty and DES placement were included, yielding 974 and 1130 ACS cases in PCB and DES groups, respectively. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality (CM), all-cause mortality (ACM), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR). Late luminal loss (LLL) and bleeding events (BLD) were also estimated. Results: The frequencies of MACE in PCB and DES groups were 8.42% and 10.62%, respectively. PCB angioplasty had no significant impacts on all of MACE (risk ratio: 0.90, 95%CI: 0.68-1.18, p = 0.44), CM, ACM, MI, TVR, TLR, BLD, and LLL, compared to DES placement in random-effects model. Conclusions: The present systematic review and meta-analysis showed the feasibility of PCB angioplasty for the de novo lesions in patients with ACS in comparison with DES placement by the emergent procedures.

Prognostic Impacts of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS Scores on Clinical Outcomes After Elective Drug-Eluting Stent Placement for De Novo Coronary Stenosis.

Background: The prognostic impact of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores on clinical outcomes after drug-eluting stent (DES) placement has not been fully elucidated. Methods and Results: The present study was a retrospective, non-randomized, single-center, and lesion-based study. Target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization, occurred in 7.1% of 872 consecutive de novo coronary lesions in 586 patients. These patients were electively and exclusively treated by DESs from January 2016 to January 2022 until July 2022 with a mean (±SD) observational interval of 411±438 days. Multivariate Cox proportional hazard analysis revealed that CHA2DS2-VASc-HS scores ≥7 (hazard ratio [HR] 1.800; 95% CI 1.06-3.05; P=0.029) was a significant predictor of cumulative TLF among 24 variables evaluated. CHADS2 scores ≥2 (HR 3.213; 95% CI 1.32-7.80; P=0.010) and CHA2DS2-VASc scores ≥5 (HR 1.980; 95% CI 1.10-3.55; P=0.022) were also significant in the multivariate analysis. Pairwise comparisons of receiver operating characteristic curves for CHADS2 score ≥2, CHA2DS2-VASc score ≥5, and CHA2DS2-VASc-HS score ≥7 showed they were equivalent in terms of predicting the incidence of TLF, with areas under the curve of 0.568, 0.575, and 0.573, respectively. Conclusions: All 3 cardiocerebrovascular thromboembolism risk scores were strong predictors of the incidence of cumulative mid-term TLF after elective DES placement, with cut-off values of 2, 5, and 7, respectively, and equivalent prognostic impacts.

Disordered plasticity in the primary somatosensory cortex in focal hand dystonia.

Interventional paired associative stimulation (PAS) can induce plasticity in the cortex, and this plasticity was previously shown to be disordered in the primary motor cortex in focal hand dystonia (FHD). This study aimed to test whether associative plasticity is abnormal in the primary somatosensory cortex (S1) in FHD and whether PAS modulates excitatory or inhibitory interneurons within the cortex. Ten FHD patients and 10 healthy volunteers were studied. We investigated the changes in single- and double-pulse somatosensory-evoked potentials before and after PAS, which consisted of peripheral electrical nerve stimulation and subsequent transcranial magnetic stimulation over S1. Four sessions of somatosensory-evoked potentials recordings were performed: before PAS, and immediately, 15 and 30 min after PAS. We compared the time course of the somatosensory-evoked potentials between the FHD and healthy groups. In the single-pulse condition, the P27 amplitudes were significantly higher in FHD immediately after PAS than before PAS, while no changes were observed in healthy subjects. In the double-pulse condition, significant differences in the suppression ratio of P27 were found immediately after and 15 min after PAS, while there were no significant differences in healthy subjects. The P27 suppression tended to normalize toward the level of the healthy volunteer group. In FHD, PAS transiently induced an abnormal increase in excitability in S1. In addition, intracortical inhibition in S1 was found to increase as well. This abnormal plasticity of the intracortical neurons in S1 may contribute to the pathophysiology of dystonia.

Oral structure representation in human somatosensory cortex.

To clarify the topography of the areas representing whole intraoral structures and elucidate bilateral neuronal projection to those areas in the primary somatosensory (S1) cortex, we recorded somatosensory-evoked magnetic fields (SEFs), which reflect the earliest cortical responses to pure tactile stimulation, using magnetoencephalography and a piezo-driven tactile stimulation device. Subjects consisted of 10 healthy male adults. Following tactile stimulation of 6 sites on the oral mucosa (inferior/superior buccal mucosa, posterior/anterior tongue mucosa, and upper/lower lip mucosa), SEFs with a peak latency of 15 ms (1M) were identified bilaterally. In contrast, SEFs with a peak latency of 30 ms following right index finger tactile stimulation were identified only in the contralateral hemisphere. Equivalent current dipoles (ECDs) generating 15 ms components were found along the posterior wall of the central sulcus, bilaterally. The ECD locations for oral mucosa-representing areas were located inferiorly to those for the index finger, with the following pattern of organization from top to bottom along the central sulcus: index finger, upper or lower lip, anterior or posterior tongue and superior or inferior buccal mucosa, with a wide distribution, covering 30% of the S1 cortex. Source strength for 1M in the ipsilateral hemisphere was weaker than that in the contralateral hemisphere. These results clearly indicate that sensory afferents innervating the intraoral region project to both the contralateral and ipsilateral 3b areas via the trigeminothalamic tract, where contralateral projection is predominant. The results clarify the intraoral structure-representing areas in the S1 cortex, adding those areas to the classical "sensory homunculus".

Evoked magnetic fields following noxious laser stimulation of the thigh in humans.

Primary somatosensory cortex (SI) and posterior parietal cortex (PPC) are activated by noxious stimulation. In neurophysiological studies using magnetoencephalography (MEG), however, it has been difficult to separate the activity in SI from that in PPC following stimulation of the upper limb, since the hand area of SI is very close to PPC. Therefore, we investigated human pain processing using MEG following the application of a thulium-YAG laser to the left thigh to separate the activation of SI and PPC, and to clarify the time course of the activities involved. The results indicated that cortical activities were recorded around SI, contralateral secondary somatosensory cortex (cSII), ipsilateral secondary somatosensory cortex (iSII), and PPC between 150-185 ms. The precise location of PPC was indicated to be the inferior parietal lobule (IPL), corresponding to Brodmann's area 40. The mean peak latencies of SI, cSII, iSII and IPL were 152, 170, 181, and 183 ms, respectively. This is the first study to clarify the time course of the activities of SI, SII, and PPC in human pain processing using MEG.

Impaired intracortical inhibition in the primary somatosensory cortex in focal hand dystonia.

Somesthetic temporal discrimination (STD) is impaired in focal hand dystonia (FHD). We explored the electrophysiological correlate of the STD deficit to assess whether this is due to dysfunction of temporal inhibition in the somatosensory inhibitory pathway or due to dysfunction in structures responsible for nonmodality-specific timing integration. Eleven FHD patients and 11 healthy volunteers were studied. STD threshold was investigated as the time interval required for perceiving a pair of stimuli as two separate stimuli in time. We also examined the somatosensory-evoked potential (SEP) in a paired-pulse paradigm. We compared STD threshold and recovery function of SEP between the groups. STD thresholds were significantly greater in FHD than in healthy volunteers. The amount of P27 suppression in the 5 ms-ISI condition was significantly less in FHD. It was also found that the STD threshold and P27 suppression were significantly correlated: the greater the STD threshold, the less the P27 suppression. Significantly less suppression of P27 with a lack of significant change in N20 indicates that the impairment of somatosensory information processing in the time domain is due to dysfunction within the primary somatosensory cortex, suggesting that that the STD deficit in FHD is more attributable to dysfunction in the somatosensory pathway.

Objective examination for two-point stimulation using a somatosensory oddball paradigm: an MEG study.

OBJECTIVE: To establish an objective two-point discrimination test using magnetoencephalography (MEG). METHODS: First, we determined the discrimination threshold (DT) of the two-points. In the first experiment, we applied 0.9DT as standard stimuli, and 0.8DT, 1.1DT and 2DT as deviant stimuli in Conditions 1, 2 and 3, respectively. In the second experiment, we used 2DT and 0.9DT as the standard and deviant stimuli, respectively, in Condition 1. We applied two-stimuli that subjects felt as definitely one point or two-points in Condition 2 and 3, respectively. RESULTS: In the first experiment, the components peaking around 30-70 and 150-250ms following deviant stimuli were significantly larger than those following standard stimuli. Considering the peak latency, these components seem consistent with the magnetic mismatch field (MMF). In the second experiment, the MMF was recorded only in Condition 1. Therefore, it is considered that the MMF was recorded only when subjects automatically discriminate one point from two-points stimuli. CONCLUSIONS: This novel method can be used in neurophysiological two-point discrimination tests without the need to rely on the examiners' skills and subjects' reactions. SIGNIFICANCE: We confirmed that our new method could be used for the objective examination of two-point spatial discrimination.

Higher anticipated force required a stronger inhibitory process in go/nogo tasks.

OBJECTIVE: We investigated the effect of the inhibitory process with increasing muscle force on event-related potentials (ERPs) and motor evoked potentials (MEPs). METHODS: The subjects performed a S1-S2 paradigm with go/nogo tasks. S1 was an auditory tone burst, and S2 was an electrical stimulation applied to the second (go stimuli) or fifth digit (nogo stimuli) of the left hand. The recordings were conducted at 3 force levels; 10, 30 and 50% maximal voluntary contraction (MVC). After the presentation of S2, the subjects were instructed to adjust their force level to match the target line with a force trajectory line in only the go trials. RESULTS: Nogo-N140 was significantly more negative in amplitude than go-N140 in all conditions, and became larger with increasing muscle force. The MEP, which was recorded at 150 ms after S2, became significantly smaller with increasing muscle force in nogo trials, whereas it became larger in go trials. CONCLUSIONS: Our results indicated that stronger inhibitory cerebral activity was needed for a nogo stimulus, in the case where a stronger response was needed for a go stimulus. SIGNIFICANCE: The present study showed a significant relationship between cortical inhibitory process and muscle force.

The characteristics of the nogo-N140 component in somatosensory go/nogo tasks.

Nogo-related brain potentials may not be dependent on sensory modalities but reflect common neural activities specific to the inhibitory process. Recent studies reported that nogo potentials were elicited by not only visual and auditory but also somatosensory stimulation. However, the characteristics of this nogo potential evoked by somatosensory stimulation have been unclear because of the small number of reports. In the present study, therefore, to determine the characteristics of this potential, the effects of stimulus site and response hand were investigated. Electrical stimulation was delivered to the second and fifth digit of one hand, and the subjects had to respond to a go stimulus by pushing a button with the thumb contralateral to the stimulated side as quickly as possible. The amplitudes of the nogo-N140 component (N140 evoked by the nogo stimuli), which is very similar to the nogo-N2 components following visual and auditory stimulation, were unrelated to the stimulated digits, the second and fifth digit of the left and right hand. However, differences between go and nogo ERPs were significantly larger in the hemisphere contralateral to the response hand than the ipsilateral hemisphere. This result was inconsistent with visual and auditory go/nogo studies showing a right-hemisphere dominance or bilateral activities in nogo trials. Therefore, nogo-N140 should be considered to reflect the inhibitory process especially in the hemisphere contralateral to the response hand and the sensory modality dependency of nogo potentials.

Electrophysiological studies on human pain perception.

OBJECTIVE: We reviewed the recent progress in electrophysiological studies using electroencephalography (EEG), magnetoencephalography (MEG) and repetitive transcranial magnetic stimulation (rTMS) on human pain perception. METHODS: For recording activities following A delta fiber stimulation relating to first pain, several kinds of lasers such as CO2, Tm:YAG and argon lasers are now widely used. The activity is frequently termed laser evoked potential (LEP), and we reviewed previous basic and clinical reports on LEP. We also introduced our new method, epidermal stimulation (ES), which is useful for recording brain activities by the signals ascending through A delta fibers. For recording activities following C fiber stimulation relating to second pain, several methods have been used but weak CO2 laser stimuli applied to tiny areas of the skin were recently used. RESULTS: EEG and MEG findings following C fiber stimulation were similar to those following A delta fiber stimulation except for a longer latency. Finally, we reviewed the effect of rTMS on acute pain perception. rTMS alleviated acute pain induced by intracutaneous injection of capsaicin, which activated C fibers, but it enhanced acute pain induced by laser stimulation, which activated A delta fibers. CONCLUSIONS: One promising approach in the near future is to analyze the change of a frequency band. This method will probably be used for evaluation of continuous tonic pain such as cancer pain, which evoked response studies cannot evaluate.

Movements modulate cortical activities evoked by noxious stimulation.

To evaluate the effects of movement on cortical activities evoked by noxious stimulation, we recorded magnetoencephalography following noxious YAG laser stimulation applied to the dorsum of the left hand in normal volunteers. Results of the present study can be summarized as follows: (1) active movement of the hand ipsilateral to the side of noxious stimulation resulted in significant attenuation of both primary and secondary somatosensory cortices (SI and SII) in the hemisphere contralateral to the stimulated hand (cSI and cSII). Activity in the hemisphere ipsilateral to the side of stimulation (iSII) was not affected. (2) Active movement of the hand contralateral to the side of noxious stimulation resulted in significant attenuation of cSII. Activity in cSI and iSII was not affected. (3) Passive movement of the hand ipsilateral to the side of noxious stimulation resulted in significant attenuation of cSI. Activity in cSII and iSII was not affected. (4) Visual analogue scale (VAS) changes showed a similar pattern to the amplitude changes of cSII. These results suggest that activities in three regions are modulated by movements differently. Inhibition in cSI was considered to be mainly due to an interaction in SI by the signals ascending from the stimulated and movement hand. Inhibition in cSII was considered to be mainly due to particular brain activities relating to motor execution and/or movement execution associated with a specific attention effect. In addition, since VAS changes showed a similar relationship with the amplitude changes of cSII, cSII may play a role in pain perception.

Effects of 1-Hz repetitive transcranial magnetic stimulation on acute pain induced by capsaicin.

The aim of this study is to investigate the efficacy of 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) on acute pain induced by intradermal capsaicin injection and to elucidate its mechanisms by single-photon emission computed tomography (SPECT). We compared time courses of a subjective scale of pain induced by intradermal capsaicin injection in seven normal subjects under three different conditions: rTMS over M1, sham stimulation, and control condition (natural course of acute pain without any stimulation). In ten normal subjects, using SPECT, we also studied differences in regional cerebral blood flow (rCBF) after capsaicin injection between two conditions: rTMS over M1 and the control condition. rTMS over M1 induced earlier recovery from acute pain compared with the sham or control conditions. Under rTMS over the right M1 condition compared with the control condition, the SPECT study demonstrated a significant relative rCBF decrease in the right medial prefrontal cortex (MPFC) corresponding to Brodmann area (BA) 9, and a significant increase in the caudal part of the right anterior cingulate cortex (ACC) corresponding to BA24 and the left premotor area (BA6). A region-of-interest analysis showed significant correlation between pain reduction and rCBF changes in both BA9 and BA24. We conclude that rTMS over M1 should have beneficial effects on acute pain, and its effects must be caused by functional changes of MPFC and caudal ACC.

Sensory perception during sleep in humans: a magnetoencephalograhic study.

We reported the changes of brain responses during sleep following auditory, visual, somatosensory and painful somatosensory stimulation by using magnetoencephalography (MEG). Surprisingly, very large changes were found under all conditions, although the changes in each were not the same. However, there are some common findings. Short-latency components, reflecting the primary cortical activities generated in the primary sensory cortex for each stimulus kind, show no significant change, or are slightly prolonged in latency and decreased in amplitude. These findings indicate that the neuronal activities in the primary sensory cortex are not affected or are only slightly inhibited during sleep. By contrast, middle- and long-latency components, probably reflecting secondary activities, are much affected during sleep. Since the dipole location is changed (auditory stimulation), unchanged (somatosensory stimulation) or vague (visual stimulation) between the state of being awake and asleep, different regions responsible for such changes of activity may be one explanation, although the activated regions are very close to each other. The enhancement of activities probably indicates two possibilities, an increase in the activity of excitatory systems during sleep, or a decrease in the activity of some inhibitory systems, which are active in the awake state. We have no evidence to support either, but we prefer the latter, since it is difficult to consider why neuronal activities would be increased during sleep.

Cognitive processes in two-point discrimination: an ERP study.

OBJECTIVE: To elucidate the temporal features of the cognitive process in two-point discrimination (TPD). METHODS: We measured somatosensory event-related potentials (ERPs) in 9 subjects during the TPD task, in which we provided a pair of electrical pulses simultaneously, altering the distance between the electrodes. We analyzed the TPD-related ERPs and investigated the relationship between the potentials and the subjects' judgments. RESULTS: During the TPD task, a negative potential approximately 140 ms after the stimulation (N140) was enhanced as compared to a stimulus counting task. Two late positive components, LPC-1 and LPC-2, whose peak latencies were 300 and 500 ms, respectively, were identified only in the TPD task. The LPC-1 was recorded dominantly in the fronto-central area, while the LPC-2 was detected dominantly in the centro-parietal area. The amplitude of the LPC-2 was significantly modulated by the degree of consistency in the subjects' judgment. On the other hand, these ERP components did not show significant difference between the alternate judgments, i.e. 'one-point' or 'two-point' judgment. CONCLUSIONS: Our results suggest that the N140 is related to the attention toward the stimulation. The LPC-1 and LPC-2 are likely to correspond to the processes represented by P3a and P3b, based on their temporal and spatial behavior.

Central mechanisms for two-point discrimination in humans.

We studied the cognitive mechanisms for two-point discrimination (TPD) in 11 normal subjects, using electrical pulses. We used six ball-shaped electrodes placed in line on the dorsal surface of the left hand, and two-point was stimulated by two electrodes randomly selected. We measured the reaction time for TPD and calculated the percentage of correct responses for each two-point stimulation. The subjects' response was significantly affected by the preceding stimuli as well as the distance of the stimuli: for a two-point stimulus condition, subjects tended to feel the stimuli as two-point when the distance between the stimuli was longer than that of preceding stimuli, whereas they felt the stimuli as one-point when the distance was shorter than that of the preceding stimuli. The present results indicate that the TPD process involved evaluation of the distance between the stimuli relatively to that of the preceding stimuli, as well as evaluation of absolute distance between the stimuli.

Immune-mediated myositis in Crohn's disease.

We report a patient with uncontrolled Crohn's disease who presented with progressive weakness of proximal muscles and a marked elevation of serum creatine kinase. Muscle biopsy from the left deltoid exhibited myositic changes with inflammatory infiltrates in the perimysium, endomysium, and perivascular locations. Most were stained as CD68-positive macrophages, whereas some were CD4- and CD8-positive T lymphocytes. Due to uncontrolled bowel inflammation, several fistulae were found in the descending colon, and partial colectomy was performed. An examination of the resected colon exhibited inflammation of the bowel structure surrounded mainly by CD68-positive macrophages. The histopathological findings of the descending colon were analogous to those of the muscle. After an increased dose of mesalazine and partial colectomy, her muscle symptoms improved. These findings suggest that the myositis in Crohn's disease is immune-mediated and that treatment of bowel inflammation should be emphasized as opposed to steroid or other immunosuppressive therapy.

Brain processing of the signals ascending through unmyelinated C fibers in humans: an event-related functional magnetic resonance imaging study.

Event-related functional magnetic resonance imaging was used to investigate brain processing of the signals ascending from peripheral C and Adelta fibers evoked by phasic laser stimuli on the right hand in humans. The stimulation of both C and Adelta nociceptors activated the bilateral thalamus, bilateral secondary somatosensory cortex, right (ipsilateral) middle insula, and bilateral Brodmann's area (BA) 24/32, with the majority of activity found in the posterior portion of the anterior cingulate cortex (ACC). However, magnitude of activity in the right (ipsilateral) BA32/8/6, including dorsal parts in the anterior portion of the ACC (aACC) and pre-supplementary motor area (pre-SMA), and the bilateral anterior insula was significantly stronger following the stimulation of C nociceptors than Adelta nociceptors. It was concluded that the activation of C nociceptors, related to second pain, evokes different brain processing from that of Adelta nociceptors, related to first pain, probably due to the differences in the emotional and motivational aspects of either pain, which are mainly related to the aACC, pre-SMA, and anterior insula.

Effects of ISI and stimulus probability on event-related go/nogo potentials after somatosensory stimulation.

The present study investigated the characteristics of the middle-latency negative potential of event-related potentials (ERPs) using somatosensory go/nogo tasks. We manipulated interstimulus interval (ISI) in Experiment 1 and stimulus probability in Experiment 2 and analyzed the subtracted difference waveform resulting from subtraction of the ERP evoked by the go stimulation from that evoked by the nogo stimulation. In Experiment 1, the peak latency of negativity became significantly longer as the ISI increased, but the peak amplitude was unchanged. The reaction time (RT) was longer with increasing ISI. In Experiment 2, manipulation of the stimulus probability yielded an increase in peak amplitude with decreasing probability of the nogo stimulus, but did not affect the latency. The RT increased as the probability of a nogo stimulus rose. Because manipulation of the ISI and stimulus probability elicited different brain activities, we hypothesized that manipulation of the ISI elicited a delay of the stimulus evaluation process including response inhibition, and that stimulus probability significantly affected the strength of the response inhibition process.