Neural Correlates of Pain-Autonomic Coupling in Patients With Complex Regional Pain Syndrome Treated by Repetitive Transcranial Magnetic Stimulation of the Motor Cortex.

OBJECTIVES: Complex regional pain syndrome (CRPS) is a chronic pain condition involving autonomic dysregulation. In this study, we report the results of an ancillary study to a larger clinical trial investigating the treatment of CRPS by neuromodulation. This ancillary study, based on functional magnetic resonance imaging (fMRI), evaluated the neural correlates of pain in patients with CRPS in relation to the sympathetic nervous system and for its potential relief after repetitive transcranial magnetic stimulation of the motor cortex. MATERIALS AND METHODS: Eleven patients with CRPS at one limb (six women, five men, aged 52.0 ± 9.6 years) were assessed before and one month after the end of a five-month repetitive transcranial magnetic stimulation (rTMS) therapy targeting the motor cortex contralateral to the painful limb, by means of electrochemical skin conductance (ESC) measurement, daily pain intensity scores on a visual numerical scale (VNS), and fMRI with motor tasks (alternation of finger movements and rest). The fMRI scans were analyzed voxelwise using ESC and VNS pain score as regressors to derive their neural correlates. The criterion of response to rTMS therapy was defined as ≥30% reduction in VNS pain score one month after treatment compared with baseline. RESULTS: At baseline, ESC values were reduced in the affected limb vs the nonaffected limb. There was a covariance of VNS with brain activation in a small region of the primary somatosensory cortex (S1) contralateral to the painful side on fMRI investigation. After rTMS therapy on motor cortex related to the painful limb, the VNS pain scores significantly decreased by 22% on average. The criterion of response was met in six of 11 patients (55%). In these responders, at one month after treatment, ESC value increased and returned to normal in the CRPS-affected limb, and overall, the increase in ESC correlated with the decrease in VNS after motor cortex rTMS therapy. At one month after treatment, there also was a covariance of both variables (ESC and VNS) with fMRI activation of the S1 region previously mentioned. The fMRI activation of other brain regions (middle frontal gyrus and temporo-parietal junction) showed correlation with ESC values before and after treatment. Finally, we found a positive correlation at one month after treatment (not at baseline) between VNS pain score and fMRI activation in the temporo-parietal junction contralateral to painful side. CONCLUSIONS: This study first shows a functional pain-autonomic coupling in patients with CRPS, which could involve a specific S1 region. However, the modulation of sympathetic sudomotor activities expressed by ESC changes was rather correlated with functional changes in other brain regions. Finally, the pain relief observed at one month after rTMS treatment was associated with a reduced activation of the temporo-parietal junction on the side in which rTMS was performed. These findings open perspectives to define new targets or biomarkers for using rTMS to treat CRPS-associated pain. CLINICAL TRIAL REGISTRATION: The Clinicaltrials.gov registration number for the study is NCT02817880.

Shaping the spectral correlation of bi-photon quantum frequency combs by multi-frequency excitation of an SOI integrated nonlinear resonator.

We reveal the generation of a broadband (> 1.9 THz) bi-photon quantum frequency comb (QFC) in a silicon-on-insulator (SOI) Fabry-Pérot micro-cavity and the control of its spectral correlation properties. Correlated photon pairs are generated through three spontaneous four-wave mixing (SFWM) processes by using a co-polarized bi-chromatic coherent input with power P1 and P2 on adjacent resonances of the nonlinear cavity. Adjusting the spectral power ratio r = P1/(P1 + P2) allows control over the influence of each process leading to an enhancement of the overall photon pair generation rate (PGR) µ(r) by a maximal factor of µ(r = 0.5)/µ(r = 0) ≈ 1.5, compared to the overall PGR provided by a single-pump configuration with the same power budget. We demonstrate that the efficiency aND of the non-degenerate excitation SFWM process (NDP) doubles the efficiency a1 ≈ a2 of the degenerate excitation SFWM processes (DP), showing a good agreement with the provided model.

Impact of five floor coverings on the orthostatic balance of healthy subjects.

Plantar skin sensitivity contributes to the regulation of postural control and, therefore, changing the characteristics of the plantar support surface can modify this control. This study aimed at assessing the impact of five different floor coverings on the orthostatic balance in 48 healthy subjects. Static posturography was performed with eyes open or closed on a platform in a control condition (no covering) and with five different covering surfaces: foam, silicone, ethyl vinyl acetate, and two textured mats with small (height 2 mm) or large pimples (7 mm). The average velocity of center of pressure (CoP) displacement was the primary endpoint measure and ten other posturographic variables were assessed. Comfort and pain produced by the covering were also scored. In eyes open condition, the average velocity of CoP displacement was increased when subjects stood on the foam mat, the silicone mat, and especially the textured mat with large pimples. Several other posturographic variables showed significant changes with different types of floor coverings with eyes open. These changes were not correlated to the comfort or pain scores associated with the different surfaces. In contrast, no difference was observed compared to the control condition (no covering) with eyes closed. This study shows that adding smooth or textured floor covering can alter balance in eyes open condition. In eyes closed condition, although more disturbing for balance, healthy subjects achieved better postural adaptation, probably by mobilizing more of their proprioceptive resources. This posturographic examination procedure could, therefore, be used to assess "proprioceptive reserve" capacities in clinical practice.

Neuropathic Pain After Dental Implant Surgery: Literature Review and Proposed Algorithm for Medicosurgical Treatment.

The objective of this study is to establish an algorithm for the medicosurgical treatment of dental implant-induced neuropathic pain. The methodology was based on the good practice guidelines from the French National Authority for Health: the data were searched on the Medline database. A working group has drawn up a first draft of professional recommendations corresponding to a set of qualitative summaries. Consecutive drafts were amended by the members of an interdisciplinary reading committee. A total of 91 publications were screened, of which 26 were selected to establish the recommendations: 1 randomized clinical trial, 3 controlled cohort studies, 13 case series, and 9 case reports. In the event of the occurrence of post-implant neuropathic pain, a thorough radiological assessment by at least a panoramic radiograph (orthopantomogram) or especially a cone-beam computerized tomography scan is recommended to ensure that the tip of the implant is placed more than 4 mm from the anterior loop of the mental nerve for an anterior implant and 2 mm from the inferior alveolar nerve for a posterior implant. Very early administration of high-dose steroids, possibly associated with partial unscrewing or full removal of the implant preferably within the first 36-48 hours after placement, is recommended. A combined pharmacological therapy (anticonvulsants, antidepressants) could minimize the risk of pain chronicization. If a nerve lesion occurs in the context of dental implant surgery, treatment should be initiated within the first 36-48 hours after implant placement, including partial or full removal of the implant and early pharmacological treatment.

Amorphous-silicon visible-light detector integrated on silicon nitride waveguides.

Visible-light integrated photonics is emerging as a promising technology for the realization of optical devices for applications in sensing, quantum information and communications, imaging, and displays. Among the existing photonic platforms, high-index-contrast silicon nitride (Si3N4) waveguides offer broadband transparency in the visible spectral range and a high scale of integration. As the complexity of photonic integrated circuits (PICs) increases, on-chip detectors are required to monitor their working point for reconfiguration and stabilization operations. In this Letter, we present a semi-transparent in-line power monitor integrated on Si3N4 waveguides that operates in the red-light wavelength range (660 nm). The proposed device exploits the photoconductivity of a hydrogenated amorphous-silicon (a-Si:H) film that is evanescently coupled to an optical waveguide. Experimental results show a responsivity of 30 mA/W, a sensitivity of -45 dBm, and a sub-µs time response. These features enable the use of the proposed photoconductor for high-sensitivity monitoring and control of visible-light Si3N4 PICs.

High precision integrated photonic thermometry enabled by a transfer printed diamond resonator on GaN waveguide chip.

We demonstrate a dual-material integrated photonic thermometer, fabricated by high accuracy micro-transfer printing. A freestanding diamond micro-disk resonator is printed in close proximity to a gallium nitride on a sapphire racetrack resonator, and respective loaded Q factors of 9.1 × 104 and 2.9 × 104 are measured. We show that by using two independent wide-bandgap materials, tracking the thermally induced shifts in multiple resonances, and using optimized curve fitting tools the measurement error can be reduced to 9.2 mK. Finally, for the GaN, in a continuous acquisition measurement we record an improvement in minimum Allan variance, occurring at an averaging time four times greater than a comparative silicon device, indicating better performance over longer time scales.

AlGaAs-on-insulator waveguide for highly efficient photon-pair generation via spontaneous four-wave mixing.

We report on the generation of correlated photon pairs in AlGaAs-on-insulator (AlGaAs-OI) waveguides through nonlinear spontaneous four-wave-mixing (SFWM). Our measurements reveal an SFWM pair generation efficiency of ∼0.096×1012pairs/(sW2) at a wavelength of 1550 nm. This is one of the highest efficiencies achieved to date for integrated SFWM sources. A maximal coincidence-to-accidental ratio of ∼122 is measured. A spectral characterization of the device's pair emission at the quantum level demonstrates a broad generation bandwidth of 2.0 THz, which is important for frequency multiplexing applications. Our results indicate that AlGaAs-OI is an efficient material platform for integrated quantum photonics at telecom wavelengths.

Trimming of silicon-on-insulator ring-resonators via localized laser annealing.

We propose a post-fabrication trimming method for the silicon-on-insulator photonic platform based on localised laser annealing of hydrogen silsesquioxane (HSQ) cladding. The technique is fast, does not degrade the device performance, does not require additional fabrication steps, and can therefore be implemented at minimal cost. Here we experimentally demonstrated how the spectrum of a ring resonator can be shifted by over 1 nm by annealing a section of the device as short as 30 µm, corresponding to a change in the effective refractive index of ∼10-2. Modifications of both the HSQ refractive index and its chemical structure as a function of the annealing temperature are also discussed. Trimming of multi-ring resonators indicate that this technique can be effectively used for post-fabrication reconfiguration of complex photonic circuits or to compensate for the fabrication tolerances of a typical CMOS process.

1.4 million Q factor Si3N4 micro-ring resonator at 780 nm wavelength for chip-scale atomic systems.

A silicon nitride micro-ring resonator with a loaded Q factor of 1.4 × 106 at 780 nm wavelength is demonstrated on silicon substrates. This is due to the low propagation loss waveguides achieved by optimization of waveguide sidewall interactions and top cladding refractive index. Potential applications include laser frequency stabilization allowing for chip-scale atomic systems targeting the 87Rb atomic transition at 780.24 nm. The temperature dependent wavelength shift of the micro-ring was determined to be 13.1 pm/K indicating that a minimum temperature stability of less than ±15 mK is required for such devices for wavelength locking applications. If a polyurethane acrylate top cladding of an optimized thickness is used then the micro-ring could effectively be athermal, resulting in reduced footprint, power consumption, and cost of potential devices.

Thermo-optic coefficient of PECVD silicon-rich silicon nitride.

The thermo-optic coefficient (TOC) of photonic integrated waveguides fabricated on silicon-rich silicon nitride grown by plasma-enanched chemical vapor deposition is characterized for the first time, to the best of our knowledge. The TOC is found to increase linearly with the fractional composition of silicon over a range from that of silicon nitride to a-Si. This finding is significant for improving the power efficiency of thermally tuned photonic integrated circuits.

Transfer printing of AlGaAs-on-SOI microdisk resonators for selective mode coupling and low-power nonlinear processes.

The transfer printing of aluminum gallium arsenide (AlGaAs) microdisk resonators onto a silicon-on-insulator (SOI) waveguide platform is demonstrated. The integrated resonators exhibit loaded ${Q}$Q-factors reaching $ 4 \times {10^4} $4×104, and the vertical assembly approach allows selective coupling to different spatial mode families. The hybrid platform's nonlinearity is characterized by four-wave mixing with a measured nonlinear coefficient of $ \gamma = 325\;{({\rm Wm})^{ - 1}} $γ=325(Wm)-1, with the devices demonstrating minimal two-photon absorption and free-carrier absorption losses that are inherent to SOI at telecommunications wavelengths.

Design of chirped-coupling sidewall Bragg gratings for narrow linewidth distributed feedback lasers.

A chirped-coupling sidewall Bragg grating is proposed to mitigate the nonlinear effects that deteriorate the linewidth in DFB lasers operating at a high power and current regime. This novel grating geometry is analyzed and simulated to extract the optimal design parameters in terms of intra-cavity field distribution. Compared to lasers with uniform Bragg gratings, devices fabricated with a chirped-coupling grating are shown to operate in stable single mode operation over a wider current and power range and exhibit linewidth as narrow as 100 kHz.

Second-harmonic generation in AlGaAs-on-insulator waveguides.

Second-harmonic generation is demonstrated in AlGaAs-on-insulator waveguides at telecom wavelengths. Using this material platform, a maximum internal normalized efficiency of 1202±55% W-1 cm-2 is achieved for a 100 fs pulsed excitation wavelength at 1560 nm. This finding is important towards enabling new chip-scale devices for sensing, metrology, and quantum optics.

High accuracy transfer printing of single-mode membrane silicon photonic devices.

A transfer printing (TP) method is presented for the micro-assembly of integrated photonic devices from suspended membrane components. Ultra thin membranes with thickness of 150nm are directly printed without the use of mechanical support and adhesion layers. By using a correlation alignment scheme vertical integration of single-mode silicon waveguides is achieved with an average placement accuracy of 100±70nm. Silicon (Si) µ-ring resonators are also fabricated and show controllable optical coupling by varying the lateral absolute position to an underlying Si bus waveguide.

Orbital angular momentum vector modes (de)multiplexer based on multimode micro-ring.

Orbital angular momentum (OAM) multiplexing has emerged as an important method to increase the communication capacities in future optical information technologies. In this work, we demonstrate a silicon integrated OAM (de)multiplexer with a very simple structure. By simply tapping the evanescent wave of two different whispering gallery modes rotating inside a multimodal micro-ring resonator, four in-plane waveguide modes are converted to four free-space vector OAM beams with high mode purity. We further demonstrate chip-to-chip OAM multiplexing transmission using a pair of silicon devices, which shows low-level mode crosstalk and favorable link performance.

Experimental investigation on feedback insensitivity in semiconductor ring lasers.

The insensitivity to optical feedback is experimentally measured for a semiconductor ring laser (SRL) and compared to that of a Fabry-Perot laser (FPL) fabricated with the same technology and on the same material. An analysis of the optical spectra reveals that the SRL remains nearly unaffected for values of optical feedback as strong as -23 dB. Furthermore, through both optical linewidth and self-mixing measurements, we show that the tolerance to feedback in SRLs is 25-30 dB stronger than in FPLs. This property makes SRLs very interesting candidates for the development of feedback-insensitive optical sources.

Silicon photonic filters with high rejection of both TE and TM modes for on-chip four wave mixing applications.

Wavelength selective filters represent one of the key elements for photonic integrated circuits (PIC) and many of their applications in linear and non-linear optics. In devices optimised for single polarisation operation, cross-polarisation scattering can significantly limit the achievable filter rejection. An on-chip filter consisting of elements to filter both TE and TM polarisations is demonstrated, based on a cascaded ring resonator geometry, which exhibits a high total optical rejection of over 60 dB. Monolithic integration of a cascaded ring filter with a four-wave mixing micro-ring device is also experimentally demonstrated with a FWM efficiency of -22dB and pump filter extinction of 62dB.

High-extinction-ratio TE/TM selective Bragg grating filters on silicon-on-insulator.

We report on the design and fabrication of TE and TM polarization selective Bragg grating filters in the form of sinusoidal perturbations on the waveguide sidewall and etched holes on the top of the waveguide, respectively. Combining the two geometries on a silicon-on-insulator waveguide resulted in Bragg grating filters with high extinction ratios of approximately 60 dB.

High-directional vortex beam emitter based on Archimedean spiral adiabatic waveguides.

Integrated devices that emit light beams with orbital angular momentum (OAM) are becoming key components for wide-ranging applications. Here we propose and demonstrate a highly directional silicon photonic vortex beam emitter based on a 3-turn Archimedean spiral adiabatic waveguide integrated with an angular grating. Such a compact emitter is capable of generating vortex beams with small divergence angles and high directivity. Various orders of OAM modes can be selectively generated by the emitter at different wavelengths with a side-mode suppression ratio as large as 13.6 dB.

3 × 3 optical switch by exploiting vortex beam emitters based on silicon microrings with superimposed gratings.

A silicon-on-insulator microring with three superimposed gratings is proposed and characterized as a device enabling 3×3 optical switching based on orbital angular momentum and wavelength as switching domains. Measurements show penalties with respect to the back-to-back of <1 dB at a bit error rate of 10-9 for OOK traffic up to 20 Gbaud. Different switch configuration cases are implemented, with measured power penalty variations of less than 0.5 dB at bit error rates of 10-9. An analysis is also carried out to highlight the dependence of the number of switch ports on the design parameters of the multigrating microring.