A Case of Aplasia Cutis Congenita in the Setting of Maternal Carbimazole Use in the First Trimester.

Aplasia cutis congenita (ACC) is one of several congenital malformations associated with antithyroid/thiourylene drug use in pregnancy. While uncommon among the general population (1-3/100 000 cases), the risk among those on thiourylenes is between 1.6% and 3%. The scalp is the most common site for this congenital anomaly. We present the case of a male infant with multifocal ACC of the scalp discovered at birth and born to a mother with Graves disease that was controlled during pregnancy using carbimazole. Thyroid function tests were normal throughout the pregnancy. There was no involvement of underlying subcutaneous tissue or structures. At age 18 months, the single largest lesion remained with only partial coverage. Prospective management involved periodic surveillance with planned 2-stage repair. This case reinforces the association between the antithyroid drugs carbimazole (CMZ) and methimazole (MMI) and supports the proposition of an MMI/CMZ embryopathy. It adds to a literature of case reports in which malformations arise in offspring of such mothers whose thyrotoxicosis is controlled antenatally, thereby challenging the suggestion that ACC is attributable to poorly controlled disease rather than thiourylenes. As yet the underlying mechanism is not understood, nor is it known why MMI and CMZ may cause potentially significant embryopathy while congenital defects attributable to the structurally similar propylthiouracil are typically less severe.

Survival of direct resin composite onlays and indirect tooth-coloured adhesive onlays in posterior teeth: a systematic review.

Objective To compare the survival of direct resin-composite used as onlays and indirect tooth-coloured adhesive onlays in posterior teeth, along with modes of failure, deterioration and variables affecting survival.Materials and methods PubMed, Embase, The Cochrane Library, Web of Science and Scopus were searched systematically up to 16 October 2020. In total, 3,768 studies were screened, with their results for survival, failure mode, deterioration and variables affecting survival.Results In total, 30 studies were selected. Survival rates in included studies greater than three years in length were 73.1-100%, with a median survival of 92.5% and median follow-up length of 5.1 years. The most prevalent failure mode was fracture, followed by pulpal episodes, debonding and caries. The most prevalent deterioration criteria were loss of marginal integrity and discolouration.Conclusions Survival of direct resin composite onlays and indirect tooth-coloured adhesive onlays in posterior teeth is acceptable (73.1-100%) in the medium-term. There is a need for more studies on direct cusp covering resin composite restorations, zirconia onlays and studies comparing material types. Fracture was the most prevalent failure mode. Restoration margins were the most prevalent area of deterioration.Clinical significance Direct and indirect tooth-coloured adhesive onlays can be a reliable and more conservative way to restore posterior teeth across a range of material options.

Effect of Baseline Anxiety and Depression Symptoms on Selected Outcomes Following Pulmonary Rehabilitation.

PURPOSE: Anxiety and depression are prevalent comorbidities in people with chronic respiratory diseases (CRDs). This study sought to quantify the influence of varying degrees of anxiety and depression on functional performance and disease impact in a population with CRDs following pulmonary rehabilitation (PR) intervention. METHODS: The Hospital Anxiety and Depression Scale (HADS), the 6-Minute Walk Test (6MWT), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) were assessed pre- and post-PR. Participants were categorized into 3 groups (None, Probable, and Present) based on their level of anxiety and depression. Functional performance and disease impact outcomes were compared pre- and post-PR. RESULTS: Patients consisted of a total of 134 program completers (72 males, 62 females; mean age = 67.8 years). Significant improvements in functional performance with regard to 6MWT scores were observed across all groups postintervention (P < .05). The Present group, in both the anxiety and depression domains, failed to reach a minimally clinically important difference postintervention. The Probable and Present groups achieved a significant improvement in CAT scores postintervention (P < .05). CONCLUSIONS: This study showed that symptoms of anxiety and depression in people with CRDs were significantly related to lower exercise tolerance levels and higher levels of disease impact. People with increased levels of anxiety and depression have the potential to significantly improve disease impact outcomes post-PR. The results demonstrated that the detection and treatment of anxiety and depression symptoms in people with CRDs are likely to be clinically important.

Interaction dynamics of X-waves in waveguide arrays.

The interaction dynamics of X-waves in an AlGaAs waveguide array is theoretically considered. The nonlinear discrete diffraction dynamics of a waveguide arraymediates the generation of spatio-temporal X-waves from pulsed initial conditions. The interactions between co-propagating and counter-propagating X-waves are studied. For the co-propagating case, the initial phase relation between the X-waves determine the attractive or repulsive behavior of the X-wave interaction. For the counter-propagating case, the collisions between X-waves generate a nonlinear phase-shift. These dynamics show that X-waves interact in a manner similar to solitons.

Light-bullet routing and control with planar waveguide arrays.

Spatial mode-locking in three dimensions can be achieved in a slab waveguide array architecture. This study focuses on using the resulting robust and self-starting light bullet formation for photonics applications. Specifically, light bullets can be manipulated through a simple electronically addressable spatial gain dynamics. By applying gain ramps in time and/or space via electronics technology, complete control and manipulation of the light bullets can be achieved, thus allowing for the construction of the master logic gates of NAND and NOR. Its robustness, self-starting behavior and easy addressability suggest that the slab waveguide array mode-locking merits serious consideration as a next generation photonics device.