Time-study research on maxillofacial prosthetic treatment.

Unreasonable medical fees can cause problems such as increased medical costs, greater medical disparities, decreased medical standards, and physician shortages. To prevent such problems, it is important to set appropriate medical fees, ensure their proper use, and improve the efficiency of medical care. The treatment of patients with maxillofacial defects is generally more expensive compared with general prosthodontic treatment because it involves more materials and requires more frequently follow-ups for longer period. However, the actual time required for maxillofacial prosthetic treatment is unclear. Therefore, in this study, we aimed to clarify the amount of time spent treating maxillofacial prosthetic patients. We analyzed clinical data from patients undergoing routine maxillofacial prosthetic treatment, irrespective of difficulty level, at 8 university hospitals and 2 dental clinics. We also collected data from maxillofacial prosthodontists on the treatment time required for various Japanese health insurance items, including the fabrication of maxillofacial prostheses. The results revealed that some aspects of maxillofacial prosthetic treatment may take longer to perform and are more costly to perform than previously thought, suggesting the need for some adjustments to the health insurance reimbursement system. Maintaining an appropriate balance between expenditures and fees will greatly benefit patients and physicians, ensuring positive health outcomes and a healthy society.

Impairment of autonomic emotional response for executive function in children with ADHD: A multi-modal fNIRS and pupillometric study during the Wisconsin Card Sorting Test.

OBJECTIVE: Children with attention deficit hyperactivity disorder (ADHD) often experience difficulties with emotional control and a consequent inability to perform tasks. To clarify the effects of emotional behavior on cognitive functions, we aimed to determine the association between emotional changes and executive functions in children with ADHD by measuring the pupil diameter changes associated with emotional changes. PARTICIPANTS AND METHODS: This study included 14 children with ADHD and 10 typically developing children (TDC) aged between 10 and 16 years. During the Wisconsin Card Sorting Test (WCST), which is related to context formation and task switching among executive functions, changes in pupil diameter and frontal oxygenated hemoglobin (oxy-Hb) using functional near-infrared spectroscopy (fNIRS) were recorded simultaneously. Pupil diameter changes during "cognitive shift" and "consecutive correction" were compared between both groups. RESULTS: During cognitive shift, the pupils of children with ADHD contracted, whereas those of the TDC were mydriatic. During consecutive correction, the pupils of children with ADHD were mydriatic, whereas those of the TDC tended to contract. These results correlated with WCST performance. Moreover, during cognitive shifts, changes in bilateral frontal blood flow were increased in TDC, but not in children with ADHD. CONCLUSION: The locus coeruleus-norepinephrine (LC-NE) system plays an important role in pupillary diameter response. These results suggest that the LC-NE system may be dysfunctional in children with ADHD, and the system's abnormality may lead to affective abnormalities in such patients, which results in poor performance on WCST (i.e., impaired executive functions).

Dental implant status in elderly individuals requiring domiciliary dental care in Japan.

BACKGROUND: The presence of implants is a significant burden not only for dentists but also for caregivers and families of elderly individuals requiring nursing and domiciliary dental care. However, few reports have assessed the status of domiciliary dental care or measures employed to deal with related issues. Hence, we aimed to evaluate the dental implant status in elderly patients requiring nursing and domiciliary dental care and to determine the suitable measures for overcoming the associated limitations. A questionnaire was mailed to 1000 dentists who provided domiciliary dental care in the Tokyo metropolitan area of Japan. The questions were classified into three categories: basic information of the dentists, actual implant status of patients requiring domiciliary dental care, and implants in an aging society. RESULTS: The response rate was 36.5%. Approximately 2% of patients requiring domiciliary dental care were implant patients. Many implant-related problems were associated with insufficiency or difficulty in cleaning around the implant, resulting in peri-implantitis. Prosthetic and more serious complications such as implant body fracture or loss were reported and frequently managed by routine follow-ups, cleaning the area around the implant, scaling and polishing, and/or pharmacological modalities. Oral care mainly involved simple toothbrushing instructions, which was not adequate. CONCLUSIONS: Our findings suggest the necessity of simplifying the oral environment and making oral care a simple task before aging individuals require nursing and domiciliary dental care.

Mechanical effects of residual bone mass, a maxillofacial prosthesis, and a reconstruction plate on the mandible after marginal resection.

In this study, analytic models were used to simulate marginal resection in the area of the second premolar to the second molar region, and the mechanical effects on the mandible of residual bone mass, a maxillofacial prosthesis, and a reconstruction plate were evaluated by three-dimensional finite element analysis. As residual bone mass decreased, maximum principal stress increased near the anterior ramus of the mandible, and maximum shear stress increased at the anterior buccal region of the resected area. In the mandible with a maxillofacial prosthesis, the maximum principal stress distribution at the anterior ramus was lower, and the distribution of maximum shear stress at the anterior buccal region of the resected area was higher. When a reconstruction plate was used, maximum principal stress and maximum shear stress were lower. Thus, lower residual bone mass was associated with increased mandible deflection and torsion. In addition, presence of a maxillofacial prosthesis decreased deflection but increased torsion, and presence of a reconstruction plate decreased deflection and greatly decreased torsion. These findings suggest that decreased residual bone mass and maxillofacial prostheses increase fracture risk; however, presence of a reconstruction plate was effective in decreasing torsional stress, thereby reducing fracture risk in the mandible.

Mechanical analysis of the effects of implant position and abutment height on implant-assisted removable partial dentures.

PURPOSE: An increasing number of clinical reports describe the use of dental implants as abutments in implant-assisted removable partial dentures (IARPD). We used three-dimensional finite element analysis to evaluate IARPD as a unilateral mandibular distal extension denture. Specifically, the mechanical effects of implant position and abutment height on the abutment tooth, denture, and denture-supporting tissue were assessed. METHODS: The models analyzed were defects of the left mandibular second premolar and first and second molars prosthetically treated with an IARPD using one implant for each tooth position. There were two abutment heights: one equal to that of the mucosa and another that was elevated 2 mm above the mucosa. Six models were constructed. RESULTS: For mucosal-level abutments, movement of the abutment tooth was lower for implants positioned distal to the abutment tooth than for those positioned medial to the abutment tooth. For elevated abutments, movement of the abutment tooth was lower for implants positioned medial to the abutment tooth than for those positioned distal to the abutment tooth. CONCLUSIONS: The mechanical effects on abutment teeth at the same implant position differed in relation to implant abutment height.

Efficacy of levetiracetam for reducing rolandic discharges in comparison with carbamazepine and valproate sodium in rolandic epilepsy.

PURPOSE: The main purpose of this study was to compare the efficacy of levetiracetam (LEV) with the older antiepileptic drugs (AEDs) for preventing atypical evolution in children with Rolandic epilepsy (RE). Accordingly, the present study compared the efficacy of older AEDs (carbamazepine (CBZ) and valproate sodium (VPA)) with LEV in reducing rolandic discharges (RDs) on interictal electroencephalogram (EEG) in children with RE. METHODS: Patients in this heterogenous study were subdivided into CBZ, VPA and LEV groups in accordance with the initial monotherapy. The CBZ and VPA groups were studied retrospectively, but the LEV group was studied prospectively. Appearances of discharges were counted and these rates were computed. In comparison with the baseline RD frequency, EEG response to AED treatment was classified such as complete disappearance and response (≥50% reduction in RD frequency). The time taken to attain complete disappearance or response in EEG responders was assessed for each AED treatment group. RESULTS: Responders comprised 10 (11.2%) of the 89 patients treated with CBZ, 41 (56.2%) of the 73 patients with VPA, and 25 (71.4%) of the 35 patients with LEV. Mean interval to achievement of EEG response in the CBZ, VPA, and LEV groups were 36.3, 23.1, and 14.7 months, respectively. EEG response was achieved significantly more rapidly with LEV than with CBZ (p < 0.001) or VPA (p < 0.005). Seizure control was not significantly different in all 3 investigated drugs. CONCLUSIONS: LEV seems to be superior to CBZ and VPA in its ability to suppress RDs in children with RE.

A large-scale study of treatment methods for foreign bodies in the maxillary sinus.

Recently, reports regarding a foreign body in the maxillary sinus have considerably increased, with the majority being iatrogenic cases resulting from dental treatment. This study involves an extensive review of the Japanese literature, including 112 papers from 1978 to 2017. These papers documented total 407 cases of a foreign body in the maxillary sinus. Among the 392 cases for which treatment details were available, the Caldwell-Luc approach was used for 216, the alveolar approach for 116, extraction using nasal endoscopy for 15, and extraction using oral endoscopy for eight. Spontaneous passage occurred in 19 cases, follow-up with medication was used in 17, and "other" was noted in one. This study determined that surgical removal remains the most common method for treating both tooth roots and other foreign bodies and that the Caldwell-Luc approach is used in majority of the surgeries. No marked differences were noted among the removal methods used in relation to the foreign body type.

Association between seizure frequency and fatigue levels in children with epilepsy.

AIM: The purpose of this study was to examine the association between seizure-related features and fatigue levels in children with epilepsy. METHODS: All children were classified into three subgroups based on the state of their seizure control: well-controlled epilepsy (WCE; seizure-free), intermediate-controlled epilepsy (ICE; seizure frequency < 1×/month) and uncontrolled epilepsy (UCE; seizure frequency > 1×/month). Participants were asked to rate on a 7-point scale, from 1 (strongly disagree) to 7 (strongly agree), how often they felt the ways described by nine items on the Fatigue Severity Scale (FSS). A higher score is suggestive of greater fatigue. RESULTS: The study participants comprised 58 children with epilepsy and 15 children without seizures, who served as the healthy (non-epilepsy) group. The mean FSS scores of the children with epilepsy were significantly higher than those of the healthy (non-epilepsy) group (4.40 vs. 1.55, respectively; P < 0.0001). Multiple linear regression analysis showed that seizure frequency was the only characteristic significantly associated with fatigue (P < 0.0001). In the three epilepsy subgroups, the mean FSS scores for the WCE, intermediate-controlled epilepsy and UCE groups were 2.30, 3.97 and 6.28, respectively. A higher seizure frequency was associated with more severe fatigue. In particular, children in the UCE group had significantly more severe fatigue than those in the WCE group (P < 0.0001). CONCLUSIONS: The results suggest that seizure frequency is also associated with fatigue in children with epilepsy. Improved control of seizures may help reduce fatigue levels and improve the quality of life of children with epilepsy.

Effect of Levetiracetam Monotherapy in Nonlesional Focal Childhood Epilepsy.

This article compares the efficacy and tolerability of carbamazepine (CBZ) and levetiracetam (LEV) when used as initial monotherapy in children with nonlesional focal epilepsy. Patients with nonlesional focal epilepsy were subdivided into two groups according to the initial monotherapy: a LEV group administered LEV at an initial dose of 5 mg/kg/day and a CBZ group. Seizure response, adverse events, medication dose, reasons for discontinuing medication, adherence, and random serum levels were recorded. The overall percentage of patients who failed initial treatment and reasons for each treatment failure were determined. Data were analyzed from 183 children who received CBZ monotherapy and 46 children who received LEV monotherapy for ≥12 months. Overall, 126 patients (68.9%) became seizure-free with CBZ, compared with 37 patients (80.4%) with LEV. Moreover, four patients in CBZ and four patients in LEV groups showed a >50% reduction in seizure frequency. The efficacy rate was significantly higher and the adverse event rate was significantly lower in the LEV group than in the CBZ group (p = 0.0129 and p = 0.0039, respectively). LEV may offer superior efficacy and a lower risk of adverse effects compared with CBZ. LEV as initial monotherapy may represent a valuable treatment option for children with nonlesional focal childhood epilepsy.

Three-dimensional finite element analysis of the effects of implant diameter and photofunctionalization on peri-implant stress.

Previous finite element analyses of peri-implant stress assumed a bone-implant contact (BIC) ratio of 100%, even though the BIC ratio is known to be approximately 50% or less. However, the recent development of ultraviolet treatment of titanium immediately before use, known as photofunctionalization, significantly increased the BIC ratio, to 98.2%. We used a unique finite element analysis model that enabled us to examine the effects of different BIC ratios on peri-implant stress. A three-dimensional model was constructed under conditions of vertical or oblique loading, an implant diameter of 3.3, 3.75, or 5.0 mm, and a BIC ratio of 53.0% or 98.2%. Photofunctionalization and larger implant diameters were associated with reduced stress on surrounding tissues. Under vertical loading, photofunctionalization had a greater effect than increased implant diameter on stress reduction. Under oblique loading, increased implant diameter had a greater effect than photofunctionalization on stress reduction.

Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants.

OBJECTIVE: Moderately preterm (MP) (32-33 weeks) and late preterm (LP) (34-36 weeks) infants have higher risks of mortality and growth and developmental problems. We, herein present a new concept of nutritional assessment, total energy intake (TEI), which is the sum total of kilocalories administered in all nutrient forms. METHODS: Fifty-two preterm infants were classified as MP (n = 12), LP/appropriate for gestational age (LP/AGA) (n = 33), or LP/small for gestational age (LP/SGA) (n = 7). All groups received nutrient therapy by the same protocol. The sum of the daily energy intake at 14 and 28 days after birth was determined. RESULTS: TEI was 2822.1 ± 162.1 kcal/kg/28 days in the MP group, 3187.2 ± 265.0 kcal/kg/28 days in the LP/AGA group and 3424.6 ± 210.4 kcal/kg/28 days in the LP/SGA group. In all groups, TEI for 28 days was significantly correlated with body weight gain (r = 0.465, p = 0.006). TEI for 14 days after birth was inversely correlated with the body weight loss rate after birth (r = -0.491, p = 0.0002). CONCLUSION: TEI was well correlated with anthropometric changes after birth. TEI may be used to effectively assess preterm infants' nutritional needs.

Developmental changes in autonomic emotional response during an executive functional task: A pupillometric study during Wisconsin card sorting test.

OBJECTIVE: The autonomic nervous system has a deep relationship with the cognitive network when performing cognitive tasks. We hypothesize that autonomic emotional responses can affect cognitive function, especially executive function. The aim of this study was to clarify the involvement of the autonomic system during an executive functional task via developmental changes assessed using pupillometry. SUBJECTS AND METHODS: Subjects were 16 healthy children and 9 healthy adults. Children were divided into 3 groups (Group A, 7-9years; Group B, 10-14years; Group C, 15-17years). Pupil diameter was recorded using an eye mark recorder during cognitive shift (CS) during the Wisconsin card sorting test (WCST). The rate of pupil variations was integrated and compared within each group, focusing on performance during CS. RESULTS: Categories achieved (CA) in the behavioral results of WCST increased with age, with significant differences between Group A and other groups. The change of pupillary diameter was increased with CS and decreased at the correct answers after CS in adults. Changes of pupillary diameter with CS showed a linear increase with age, and the pattern of the pupillary response at the age of 10-14years was comparable to adults. The integrated rate of pupil diameter with CS increased with age, and there was a significant difference between Group A and adults. In addition, the degree of mydriasis correlated with the number of CA. CONCLUSION: These findings suggest that autonomic emotional response play an important role as a part of the process for executive function.

Seizure severity in children with epilepsy is associated with their parents' perception of stigma.

AIMS: To develop and implement interventions to improve the quality of life (QOL) in children with epilepsy, it is important for clinicians and researchers to understand the effects of the children's parents' perception of stigma. The purpose of this study was to identify a relationship between patient clinical characteristics and perception of stigma in the parents of children with epilepsy. METHODS: Parents of children with epilepsy were recruited from our university hospital between April 1, 2005 and March 31, 2012. Items for the Parent Stigma Scale were developed from the literature and open-ended interviews with parents of children with epilepsy about their concerns and fears, including those related to stigma. Parents were asked to respond to five items, each on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree). Assessments were performed for each clinical characteristic, such as child's sex, age at seizure onset, family history of epilepsy, seizure frequency, presence of status epilepticus (SE), presence of treatment-related adverse events, and the scores of each scale. RESULTS: A total of 52 parents of children with epilepsy and 10 parents of healthy children were enrolled in the study. Parents of children with epilepsy showed significantly higher scores on the questionnaire than parents of healthy children. In multiple regression analysis, greater perceptions of stigma were associated with a seizure frequency of more than one per month (p=0.0036, B=1.104, ß=0.402). In contrast, the presence of prior febrile seizures (p=0.0034, B=-1.297, ß=-0.308) and family history of epilepsy (p=0.0066, B=-1.613, ß=-0.277) were associated with lower perceptions of stigma. Greater parental perceptions of stigma were seen with the presence of monthly seizures. CONCLUSIONS: Parents of children with epilepsy are at risk of significant perceptions of stigma. Seizure severity, indicated by the presence of monthly seizures, was associated with greater perceptions of stigma in parents. In addition, the presence of prior febrile seizures and family history of epilepsy were associated with fewer perceptions of stigma. The findings of this study emphasize the importance of acknowledging and addressing parental perceptions of stigma.

Correlation between perceived stigma and EEG paroxysmal abnormality in childhood epilepsy.

AIMS: We investigated the relationship between abnormal electroencephalogram (EEG) findings such as localized EEG paroxysmal abnormality (PA) and the perception of stigma to determine EEG factors associated with perceived stigma in childhood epilepsy. METHODS: Participants comprised 40 patients (21 boys, 19 girls; mean age, 14.6 years) with epilepsy at enrollment. The criteria for inclusion were as follows: 1) age of 12-18 years, inclusive; 2) ≥6 months after epilepsy onset; 3) the ability to read and speak Japanese; and 4) the presence of EEG PA. Fifteen healthy seizure-free children were included as a control group. Participants were asked to rate how often they felt or acted in the ways described in the items of the Child Stigma Scale using a 5-point scale. Electroencephalogram paroxysms were classified based on the presence of spikes, sharp waves, or spike-wave complexes, whether focal or generalized. RESULTS: Participants showed significantly higher stigma scores than healthy subjects (p<0.01). A higher score reflects a greater perception of stigma. The average total scores of patients presenting with EEG PA at generalized, frontal, RD, midtemporal, and occipital regions were 2.3, 4.0, 2.4, 3.2, and 2.2, respectively. The scores of all questions were higher in the frontal group than those in other regions (p<0.01). Children presenting with frontal EEG PA perceived a greater stigma than children presenting with nonfrontal EEG PA (p<0.01). CONCLUSION: A relationship was identified between frontal EEG PA and a greater perception of stigma. Further studies are needed to confirm whether frontal EEG PA may function as a mediator of emotional responses such as perceived stigma in childhood epilepsy.

EEG characteristics predict subsequent epilepsy in children with their first unprovoked seizure.

One of the most important risk factors for seizure recurrence is the electroencephalogram (EEG) characteristics of children with a first unprovoked seizure. However, the nature of the relationship between the risk factors for subsequent epilepsy and EEG characteristics, especially the localization of EEG paroxysmal abnormalities (PAs), remains unclear. The importance of EEG characteristics, especially the localizations of PAs, as predictors for subsequent epilepsy in children with a first unprovoked seizure was investigated. The participants were recruited from University of Yamanashi Hospital between July 1, 1997 and June 30, 2010 and followed until December 31, 2014. Eligible candidates were children between 1 month and 15 years old who presented with their first unprovoked non-febrile seizure. Awake and sleep EEGs were performed on a 12- or 16-channel machine 7-20 days after a first unprovoked seizure. Agreement regarding the presence of a PA was required for inclusion of the patient in the study. EEG PAs were classified based on the presence of spikes, sharp waves, or spike-wave complexes, whether focal or generalized, that were considered abnormal for age and state. All subjects were followed for more than 4 years. Of 87 subjects, 48 (55.2%) experienced recurrence. On the other hand, of 87 subjects, 52 (59.8%) showed an EEG PA. Of 18 patients with paroxysms in the frontal region, 17 (94.4%) developed epilepsy. Patients with frontal EEG paroxysms had a significantly higher risk of developing epilepsy than those with focal paroxysms in other regions of EEG foci (p<0.05). Moreover, compared with generalized EEG foci, the odds ratios for patients with frontal, RD, occipital, and mid-temporal EEG foci were 85.0 (95% CI: 4.5-1617.1), 9.3 (0.9-96.0), 2.5 (0.1-62.6), and 7.5 (0.5-122.7), respectively. Children with a first unprovoked seizure presenting with frontal paroxysmal EEG abnormalities may be at risk for the development of epilepsy later in life.

Sequential prefrontal lobe volume changes and cognitive dysfunctions in children with Panayiotopoulos syndrome presenting with status epilepticus.

Panayiotopoulos syndrome (PS) is usually not associated with neurodevelopmental problems. However, neuropsychological impairments may also be present in at least some of the patients with PS. On the other hand, several degrees of neuronal damage due to status epilepticus (SE) may occur in the cortex. We prospectively measured frontal and prefrontal lobe volumes using three-dimensional magnetic resonance imaging (3D-MRI)-based volumetry in patients with PS with and without SE. Moreover, the neuropsychological outcome in relation to the presence of SE in children with PS is also discussed. We studied six patients with a final diagnosis of PS, including three cases with SE and cognitive impairments/behavioral problems (SE group) and three cases without SE (non-SE group). Serial 3D-MRI studies were performed five times (at onset of clinical symptoms and 1-4 years after onset) in both the SE and non-SE patients. All patients were studied with a set of Wechsler Intelligence Scale for Children, version III (WISC-III) or Wechsler Preschool and Primary Scale of Intelligence tests and the Kaufman Assessment Battery for Children (K-ABC). Growth of the frontal and prefrontal lobes was slightly decreased for some time after SE episodes in the SE patients. Moreover, the prefrontal-to-frontal lobe volume ratio was stagnant for some time after SE in the SE patients. The scores on the neuropsychological tests were decreased in the SE patients. Moreover, the average WISC and K-ABC scores in the SE group remained low and did not reach the levels of the initial examinations. Occurrence of SE in patients with PS at least in some patients may be associated with retarded prefrontal lobe growth, which was related to neuropsychological problems and ultimately, neuropsychological outcomes. Treatment management may be required to prevent SE as much as possible to achieve optimal prognosis in PS at least in some patients.

Sequential EEG characteristics may predict seizure recurrence in rolandic epilepsy.

PURPOSE: The prognosis of rolandic epilepsy (RE) is considered favorable. Since a moderate proportion of cases presents with isolated seizures, continuous treatment should be considered only for frequent seizures. Clinical and electroencephalogram (EEG) markers to predict seizure recurrence need to be identified. The purpose of this study was to identify EEG criteria related to seizure recurrence in RE. METHODS: There were 10 children (aged 3-10 years; 6 males, 4 females) in the recurrence group and 12 (aged 4-7 years; 6 males, 6 females) in the isolated group. Occurrences of the number of spikes were scored, and the presence of rolandic discharges (RD) in the awake record was evaluated. All patients were evaluated longitudinally, clinically and by EEG, with repeated EEG recordings every 3 months. Clinical and EEG follow-up was performed for ≥4 years. RESULTS: Seizure recurrence and extended periods of high-frequency paroxysmal EEG abnormalities (>6 months after onset) were significantly correlated (p<0.001). Moreover, the appearance of RD in awake recordings tended to be more prevalent in the recurrence group than in the isolated group (odds ratio 4.714). CONCLUSION: In addition to RD in the awake record, a combination of spike rate and extended periods of high-frequency paroxysmal EEG abnormalities may predict seizure recurrence in RE.