Ridge Of Tissue Research Articles

Bioengineered skin-substitutes incorporating rete-ridges using a bioprinting process

Abstract Bioprinting is a widely used technique for creating three-dimensional, complex, and heterogeneous artificial tissue constructs that are biologically and biophysically similar to natural tissues. The skin is composed of several layers including the epidermis, basement membrane (BM), and dermis. However, the unique undulating structure of basement membranes (i.e., rete ridges) and the function of BM have not been extensively studied in the fabrication of engineered skin substitutes. In this study, a novel engineered skin substitute incorporating an artificially designed rete ridge (i.e., mogul-shape) was developed using bioprinting and bioinks prepared using collagen and fibrinogen. To mimic the structure of the rete ridges of skin tissue, we developed a modified bioprinting technique, controlling rheological property of bioink to create a mogul-shaped layer. In vitro cellular activities, including the expression of specific genes (those encoding vimentin, laminin-5, collagen IV, and cytokeratins), demonstrated that the engineered skin substitute exhibited more potent cellular responses than the normally bioprinted control owing to the favorable biophysical BM structure and the bioink microenvironment. Additionally, the feasibility of utilizing the bioprinted skin-structure was evaluated in a mouse model, and in vivo results demonstrated that the bioprinted skin substitutes effectively promoted wound healing capabilities. Based on these results, we suggest that bioprinted skin tissues and the bioprinting technique for mimicking rete ridges can be used not only as potential lab-chip models for testing cosmetic materials and drugs, but also as complex physiological models for understanding human skin.

Qualitative Blade Topology in Donor Cornea Punches and Corresponding Endothelial Cell Loss in PK and DMEK Grafts

Purpose: Two commonly used donor cornea punches were assessed using quantification of peripheral endothelial cell loss (ECL) and scanning electron microscopy (SEM) of blade topology and associated features on donor grafts. Methods: Penetrating keratoplasty (PK) (n = 8 pairs) and Descemet membrane endothelial keratoplasty (DMEK) (n = 8 pairs) grafts were prepared from mate donor corneas using Moria Busin or Corza Barron donor cornea punches (all punches were 7.5 mm) and analyzed for global and peripheral ECL. Punches were examined by SEM and subsequently used to prepare PK grafts from mate donor corneas (n = 3 pairs) that were also assessed by SEM. Results: For PK grafts, peripheral ECL caused by Busin and Barron punches was 4.2% ± 0.6% and 4.0% ± 0.9% (P = 0.62), respectively. For DMEK grafts, peripheral ECL caused by Busin and Barron punches was 3.6% ± 1.9% and 3.0% ± 1.3% (P = 0.48), respectively. SEM analysis of the Busin punch identified a rolled blade with a seam; the Barron punch is created from full rod stock and is seamless. Busin punch PK grafts have a ridge of stromal tissue that was not observed in the Barron PK grafts. Both punches exhibit anomalies along the blade edge, and the stroma of both grafts exhibited “drag lines.” Conclusions: Both punches caused similar and minimal ECL. In PK grafts, the seam of the Busin punch may be the source of the observed uneven stromal surface. Striations and debris on the cutting surfaces of both punches may produce drag lines in cut stroma. These topological features may contribute to uneven donor–recipient tissue apposition, leading to astigmatism after PK.

Volumetric Analysis After Modified Pedicle Roll Flap in Soft Tissue Ridge Augmentation in the Maxillary Esthetic Zone

Volumetric Analysis After Modified Pedicle Roll Flap in Soft Tissue Ridge Augmentation in the Maxillary Esthetic Zone

A comparison of rugae pattern in males and females as a samples of Iraqi population

The palatine rugae are irregular fibrous connective tissue ridges located in the anterior third of hard palate that extends bilaterally from the midline behind the incisive papilla. Rugae patterns play a role as positive identification of individuals in suspected cases in forensic dentistry. The aim of the present study is to identify and compare the rugae pattern in a sample of Iraqi population. Materials and method: 120 samples of maxillary casts were selected for 60 males and 60 females their ages ranging between (22-35) years old by using Thomas & Kotze classification for assessment rugae patterns. As a result of this study shows that rugae patterns has a unique individual imprint, differ in the number, symmetry between right and left sides, shape of rugae lines for each person with no significant differences for both sexes. This work conclude that rugae patterns can be used as additional method for identification as a personal print, and considered a characteristic to discriminate between individuals.

Guided Tissue Healing by Preformed Anatomical Healing Caps in the Edentulous Ridge: A 2-Year Retrospective Case-Control Study.

The present study evaluated the 2-year changes in soft tissue width after implant placement in healed sites, using two different methodologies to obtain tissue healing: preformed and anatomical abutment caps for customized healing (test) vs conventional healing abutments (control). The null hypothesis was that there would be no difference between the test group and the control group. Patients who suffered from a single-tooth edentulous area in the premolar/molar region were included. Both the standard abutments and the preformed and anatomical abutment caps were immediately screwed on the implants. The final crown restoration was fabricated 3 months later. Primary outcomes (changes in the alveolar soft tissue ridge) and secondary outcomes (testing adverse events and measuring implant/prosthesis survival) were evaluated. Thirty-nine patients (24 women) with a mean age of 57.7 ± 7.1 years (range: 42.6 to 72.8 years) were included. Alveolar widths in both groups showed significant increases from baseline to the 3-month follow-up, with augmentations of 3.6 ± 0.7 mm for the test group and 1.1 ± 0.9 mm for the control group. The gain in soft tissue appeared to be statistically different between the two groups (P < .0001). Contrarily, any subsequent change in width from 3 months to 2 years was negligible and insignificant (< 0.33 mm for both groups). The technique described in the present study encourages the potential for alternative healing based on the guided soft tissue concept, as it either eliminated the need for second-stage surgery or it reduced step-by-step peri-implant soft tissue conditioning, obtaining a tissue contour immediately very similar to that of a final prosthesis.

Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions

ABSTRACT Introduction In clitoral adhesions (CA), a closed compartment of space under the clitoral hood can lead to accumulation of squamous cells and smegma, irritation, erythema, and infection. This causes the prepuce to adhere to the glans clitoris and prevents the corona, a ridge of tissue between the glans clitoris and the clitoral body, from being visualized. CA can cause discomfort, hypersensitivity or hyposensitivity, difficulty reaching orgasm, and chronic vulvar pain including clitorodynia. One treatment for CA is a non-surgical lysis procedure that is minimally invasive and stretches the preputial tissue open, yet there is a paucity of data on its effectiveness in treatment of symptoms and restoration of function. Objective To evaluate patient-reported outcomes of the non-surgical lysis procedure in order to determine if this procedure is an appropriate treatment for symptomatic CA that can be performed in the office-based setting. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a chart review and an online survey was sent to patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results There were 41 survey responses (67% response rate). All women that reported the ability to achieve orgasm from external clitoral stimulation maintained this ability after the procedure (n=24), and of the women that could not do so before the procedure (n=16), 6 were able to afterwards. 76% of respondents reported improvement in pain with 44%, 28%, and 4% reporting significant, moderate, and slight improvement. 63% reported improvement in sexual arousal with 25%, 25%, and 13% reporting significant, moderate, and slight improvement. 64% reported improvement in their ability to achieve orgasm with 26%, 18%, and 21% reporting significant, moderate, and slight improvement. 71% reported improvement in their satisfaction with sex with 27%, 17%, and 27% reporting significant, moderate, and slight improvement. 80% of respondents reported they could have comfortable physical/sexual stimulation within one month of the procedure, and 31% of respondents reported that it took one week or less. 93% of participants would recommend the procedure to a friend who also had CA. 65% and 18% of respondents reported being extremely and mostly satisfied with their decision to have the procedure. Conclusions These findings indicate that most patients reported improvement in their pain and sexual functioning, and no participants reported worsening in their pain, sexual arousal, or ability to achieve orgasm. 6 of 16 patients that could not achieve orgasm from external clitoral stimulation prior to the procedure were able to afterwards. Thus, the non-surgical lysis procedure could be considered as a treatment for pain and sexual dysfunction associated with CA. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raliegh, NC), Absorption Pharmaceuticals

Рыбные пудинги для питания детей младшего школьного возраста

Proper nutrition ensures the normal physical development of a person, regardless of age, prevents the devel-opment and growth deviations, helps to increase the resistance of the child's body to infectious diseases and combats alimentary-dependent diseases. There has been studied the possibility of expanding the assortment of fish puddings by modifying their recipes and including them in the diet of primary school children. This goal was achieved by using fish raw materials with lean protein and medium-fat protein, which was considered as an interchangeable fish raw material. Experimental studies were carried out to substantiate prescription compositions of puddings without adding bread previously soaked in milk, but including a structure-forming component from fish bone tissue (heads, ridge and fins) in their composition. The comparative analysis of organoleptic and physicochemical indices of quality, chemical composition and energy value of the obtained products has been carried out. It has been found that puddings based on silver carp or pike perch meat can be attractive for young school children. The part of the structure-forming component should not exceed 14%. For mass nutrition of primary school children there are recommended the puddings produced according to recipes No. 1.2 and 1.3, which include silver carp or pike perch meat (74%), structure-forming component (14%), unsalted butter (4%), raw egg (7.0%) and flavorings. The ratio of these components ensures developing high organoleptic properties and increased nutritional value of the product. Including the fish puddings in the diet of young school children allows balancing their diet in terms of proteins, fats, amino acids, correct their eating behavior and increase the attractiveness of the fish product for the young group of the population of Russia.

PROSTHODONTIC MANAGEMENT OF FLABBY RIDGE: A Review.

'Flabby tissue is defined as excessive, movable tissue'. Flabby tissue or hypermobile ridge tissue is commonly seen in the anterior part of the edentulous maxillary ridge or overlying an atrophic knife-edge mandibular ridge. Dentures on flabby ridges have compromised stability, support, and retention unless adequate measures for its management are employed. Methods applied for flabby ridge management, include surgical removal and augmentation, special impression techniques, balanced distribution of occlusal loads and implant therapy. This article reviews the various prosthodontic treatment modalities regarding the flabby tissue condition such as impression techniques and its modifications, implant supported prosthesis, and other prosthetic options.

Reconstruction of atrophic alveolar edentulous ridge with autologous mandibular symphysis block bone graft for future implant placement

Alveolar ridge resorption after a tooth loss due to disease, atrophy or trauma is a common phenomenon. Often in clinical practice, the loss of a tooth does not coincide with replacement by a dental implant, therefore it is often required that we perform hard tissue ridge augmentation to increase bone volume prior to dental implant placement and restoration so that the implants can be inserted in ideal bucco-lingual and mesio-distal position with good axial inclination and to reshape soft tissue contour. This study demonstrated the amount of resorption of Symphysis Block graft which helps to harvest adequate bone in future to compensate resorption for future implant placement. The accurate graft resorption and required graft harvest was assessed with Cone Beam CT. Five patients underwent harvesting of corticocancellous bone from Mandibular symphysis region for Reconstruction of atrophic alveolar ridge. A tension free closure was obtained. Periosteal scoring was done and flap was closed tension free. We assessed the preoperative available bone and the defect in horizontal and vertical dimensions in the anterior region and evaluated the amount of bone graft necessary to augment the defect.

Comparative Analysis of Preoperative and Postoperative Tympanometry Findings in Patients with Adenoid in Lagos State University Teaching Hospital, Ikeja

Background: Adenoid is the collection of sub-epithelial lymphoid tissues under the mucosa of the nasopharynx situated at the junction of the roof and posterior wall of the nasopharynx, forming part of the Waldeyer’s ring of lymphoid tissues of the nasopharynx. It is also called Nasopharyngeal Tonsils and is composed of vertical ridges of lymphoid tissue separated by deep clefts, covered by ciliated columnar epithelium. Aim: To identify the Tympanometric findings in patients with Adenoids pre and post Adenoidectomy in LASUTH, Ikeja. Methodology: This is a Prospective interventional hospital-based clinical study was carried out at the Department of Otorhinolaryngology (ORL) of the Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria. A structured questionnaire was distributed to all consecutive eligible patients diagnosed with adenoid hypertrophy seen at the Otorhinolaryngology Clinic who were recruited for the study. Thorough examination of the Ear, Nose and Throat and tympanometry were done a week before the Adenoidectomy and six weeks post-surgery. The analysis of data collected was done using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 103 subjects participated with 59.2% (61) being males and 40.8% females. The male to female ratio was 1:0.7. The most frequently affected age range was ≤ 3 years accounting for 39.8% (41) of cases while the least frequently affected was 7-9 years i.e 21.4% (22) of cases. Tympanometric findings post operatively revealed type B tympanogram (OME) was found in 72.9% of the ears, with the right ear accounting for 35.0% while the left ear was at 37.9% (p = 0.314). Postoperatively, type B tympanogram had reduced to 34% with the right ear accounting for 11.7% while the left ear was 22.3% (p = 0.314). There were also differences between the preoperative and post-operative type A and C tympanometric patterns. These differences were statistically significant (p = 0.002, p = 0.004) on the right and left ear respectively. Conclusion: Adenoid hypertrophy was more prevalent in the ≤ 3 years age range and the reduction in the frequency of type B tympanometry findings in the right and left ears postoperative was significantly less from the preoperative tympanometry findings among the subjects.

3255Characterization of the arrhythmogenic substrate with multimodality imaging in ischemic patients undergoing VT ablation: relationship between cardiac computed tomography and magnetic resonance

Abstract Background Cardiac magnetic resonance (CMR)-aided ventricular tachycardia (VT) substrate ablation has shown to improve VT recurrence-free survival, through a better identification of the arrhythmogenic substrate. However, the access to CMR may be limited in certain centers or sometimes Its use can be contraindicated in patients with cardiac implantable electronic device. Cardiac computed tomography (CT) has shown to improve the results of substrate ablation, correlating with low-voltage areas and local abnormal ventricular activity, and identifying ridges of myocardial tissue (CT-channels) that may be appropriate target sites for ablation. Purpose To evaluate the correlation between CT and CMR imaging in identifying anatomical heterogeneous tissue channels (CMR-channels) or CT-channels in ischemic patients undergoing VT substrate ablation. Methods The study included 30 post-myocardial infarction (MI) patients (mean age 69±10; 94% male, left ventricular ejection fraction 35±10%), who underwent both CMR and cardiac CT before VT substrate ablation. Using a dedicated post-processing software, the myocardium was segmented in 10 layers from endocardium to epicardium both for the CMR and CT, characterizing the presence of CMR-channels and CT-channels, respectively, by two blinded operators, assigned either to CMR or CT analysis. CMR-channels were classified as endocardial (CMR-channels in layer &lt;50%), epicardial (CMR-channels in layers ≥50%) or transmural (in both endo and epicardial layers). Presence and location of CT and CMR-channels were compared. Results In 26/30 patients (86.7%) 91 CT-channels (mean 3.0±1.9 per patient) were identified while 30/30 (100%) showed CMR-channels (n=76; mean 2.4±1.2 per patient). We found 190 CT-channel entrances (mean 6.3±4.1 per patient), and 275 CMR-channel entrances (mean 8.9±4.9 per patient) on cardiac CT and CMR, respectively. There were 47/91 (51.6%) true positive CT-channels. On the contrary, 44/91 (48.4%) CT-channels were considered false positives [19/91 (20.9%) identified out of CMR scar], and 29/76 (38.2%) CMR-channels could not be identified on CT. Thirty-six out of 76 (47.4%) CMR-channels were considered as non-endocardial (epi- or transmural). Twenty-nine out of 36 (80.5%) non-endocardial CMR-channels were coincident with CT-channels. CT and CMR Channels Conclusion CT shows a modest sensitivity in identifying CMR-channels and fails in ascertain their complexity, underestimating the number of entrances; however, channels location at CT fit well with CMR for those classified as transmural or epicardial.

You Can't Run, but You Can Hide: The Skeleton of the Sand-Swimmer Lizard Calyptommatus leiolepis (Squamata: Gymnophthalmidae).

Squamates exhibit a vast diversity of body plans, which directly determines habitat use and preference. Here the skeleton of the sand-swimmer burrower gymnophthalmid, Calyptommatus leiolepis, is analyzed to investigate how its peculiar fossorial locomotion affects its osteology. Calyptommatus leiolepis is a limb-reduced, short-intermediate tailed lizard. Although there are other studies on its general anatomy, we performed a detailed description of its skeleton. Using high-resolution computer tomography, each bone element within the skeleton was digitally segmented and a detailed description rendered. Anatomical features related to burrowing include the head having a shovel-like snout with a well-developed horizontal soft tissue ridge, nasal cartilages that exclude sand from the nostrils, reduced eyes covered by a brille, lack of forelimbs, extreme reduction of hind limbs, and imbricated scales among others. The genus Calyptommatus has unique features such as a triradiate jugal (with digit-like posterior projections), a reduced pectoral girdle and forelimbs, parasternal processes that interconnect the ribs, and a single digit in the hind limbs. When comparing this species with other gymnophthalmid lizards including, fossorial species, it is clear that Calyptommatus exhibits the highest number of structural modifications within the family. Despite its specialized morphology, it still retains characters that link this genus to other members of Gymnophthalmidae when included in a phylogeny based solely on phenotypic data. Anat Rec, 303:1305-1326, 2020. © 2019 American Association for Anatomy.

Modified roll technique for soft tissue augmentation in prosthetic rehabilitation: A case report.

There are various causes for residual alveolar ridge defects, most common being the collapse of the cortical plate during extraction. Localized defects of alveolar ridge affect prosthetic restoration due to poor emergence profile of the pontic. Various soft tissue augmentation procedures have been recommended for the correction of these defects. Abrams’s roll technique has been widely used for soft tissue ridge augmentation in the maxillary anterior region where aesthetics is a prime concern. The original Abrams’s roll technique has been modified and revisited by many authors to overcome the limitations. The present clinical case report discusses the modified roll technique as an option to treat alveolar ridge deformity. The current procedure resulted in expectable ridge augmentation, uneventful healing, and good aesthetic outcome. Hence this modified technique can be selected for the treatment of mild to moderate Seibert class I ridge defects in the aesthetic zone.

17‐Year Follow‐Up of Ridge Augmentation in a Patient With Linear Scleroderma: A Novel Case Report

IntroductionScleroderma is a chronic autoimmune disease associated with connective tissue changes and fibrosis, which often includes oral manifestations. Involvement of the oral mucosa results in gingival recession, loss of alveolar housing, root resorption, gross mobility, and other deleterious side effects. Therefore, patients may require extensive restorative care, but pathology can often prevent optimal delivery.Case PresentationThe following case presents a patient with localized scleroderma requiring a ridge augmentation for the placement of a fixed partial denture. Following the disease diagnosis and treatment planning, the patient received local subcutaneous injections of 25 mg‐methotrexate to halt disease progression. Given the success of the prophylaxis, the patient underwent three extractions followed by two surgical augmentation procedures, including the placement of xenographic bovine matrix and an overlying connective tissue graft. Healing occurred within normal limits, allowing the successful delivery of a permanent prosthesis.ConclusionsThis case presentation is the first to our knowledge to document successful soft tissue ridge augmentation in a patient with localized scleroderma in order to place a fixed bridge; thereby, documenting the feasibility of esthetically restoring patients presenting with said systemic disease. The case uniquely illustrates identification of a rare connective tissue disease that saw successful treatment outcomes due to proper diagnosis, disease management, interprofessional collaboration, and advanced treatment planning.

Generating 3D artificial melanoma tumor tissues using CellMate™ hydrogels.

We have previously reported on the successful use of natural 3D ECM materials as artificial tissue scaffolds to generate tissue‐like constructs of melanoma using the ATCC cell lines B16F1and B16F10. In that earlier work we observed that 3D constructs like these undergo a progressive scaffold colonization, tissue development and maturation in‐vitro which closely parallels tumor progression in‐vivo. Now, we have extended that work by applying a new and unique 3D hydrogel matrix called CellMate™. This material is an embedding hydrogel comprised of hyaluronate and chitosan which crosslink to generate a matrix scaffolding for cell attachment and tissue development. In these new experiments, B16F1 and B16F10 cell lines were each seeded into CellMate™ at densities of 10 and 20 million cells per scaffold. The resulting structures where then maintained for 6 months of continuous culture with periodic new plates and regular media exchanges at 3 day intervals. This approach resulted in even more physiological artificial tumors, than previously developed on ECM scaffolds. As previously seen on natural scaffolds, these new artificial tumors develop two distinct cell populations which closely reflect the normal in‐vivo tumor structures seen in the clinical setting. These two cell types include pigmented cells with a relatively dendritic appearance and non‐pigmented cells with relatively less dendritic and more rounded cell bodies. These cellular phenotypes also gave rise to distinct tissue‐level structural phenotypes as well. Pigmented tissue regions tended to present with less regular surfaces and more tendency to produce branching structures that extend away from the construct. In contrast, non‐pigmented cell regions generated large rounded and bulging features which often resembled ridges of tissue and which had very smooth surface features. Additionally these structures also appeared to be highly friable and prone to peeling off the main pigmented tumor structure. Colonies and later cell‐strains were developed from these shed structures and these retained their non‐pigmented phenotypes through multiple passages in 2D monolayers. Collectively these studies illustrate the efficacy of using 3D artificial tissues to create better in‐vitro tumor models of melanoma.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Correlation between computer tomography-derived scar topography and critical ablation sites in postinfarction ventricular tachycardia.

Myocardial wall thickness (WT) in patients with a prior myocardial infarction has been used to indicate scarring. However, the correlation of WT with sites critical to ventricular tachycardia (VT) has not been previously investigated. The purpose of this study was to correlate electroanatomic mapping data obtained during VT ablation with WT determined by cardiac computed tomography (CT). Cardiac CTs were performed in 15 consecutive patients (mean age 63 ± 10 years, 86% male, left ventricular ejection fraction 27 ± 12%) with a prior infarct referred for VT ablation. The CTs were registered to the electroanatomic maps obtained during the mapping procedure. Pacing was performed throughout the scar at sites with fractionated electrograms and isolated potentials. Ablation sites were identified by pace-mapping or entrainment-mapping and these sites were correlated with WT. Bipolar and unipolar voltage amplitude and bipolar electrogram width correlated with WT (correlation coefficient: 0.63, 0.65, and 0.41, respectively, P<0.001). Ablation target sites were identified for 58 of 113 inducible VTs. The ablation target sites were located on CT-defined ridges (WT: 4.2 ± 1.2mm) bordered by areas of thinning (WT: 2.6 ± 1.1mm, P<0.0001) in 14 of 15 patients. Ablation targets were found on ridges in 49 of 58 VTs (84%) for which target sites were identified. A total of 70 ridges were localized in the 15 patients. VT became noninducible postablation in 11 of 15 patients (73%). WT measured by CT identifies ridges of myocardial tissue that often are critical for postinfarction VT and that can be appropriate target sites for ablation.

Fascia lata as an alternative in dental treatments

Introduction: Fascia lata is the most extreme section of the thigh’s aponeurosis. It is a thick and resistant membrane possessing elasticity, flexibility and memory. It is presently used in the medical world to treat abdominal defects, urinary incontinence, and palpebral ptosis. In dentistry it is used in guided tissue regeneration, root coverage, ridge increase and socket (alveolus) preservation. Method: An electronic search was conducted in the following databases: Medline, PubMed and SciELO, with the term fascia lata. Full texts in English and Spanish were included in timeline spanning from 1983 to 2015. Main characteristic selected for these texts was they explored use of fascia lata and medical and dental areas. Discussion: Limiting situations arose during the execution of this project due to the scarcity found in articles and research papers and documented clinical cases targeting use of fascia lata ion dental areas. Conclusions: Fascia lata is a resorbable, biocompatible material, well tolerated by the recipient bed; when used in medical and dental specialties it exhibits characteristics of accuracy (security) and long duration.

Gynecomastia in Infants, Children, and Adolescents.

Gynecomastia may occur physiologically in the neonatal period, during puberty, and in old age. It may also develop in association with various pathologic states. The challenge for the physician is to distinguish physiological gynecomastia from those with an underlying pathology. To review in depth the pathophysiology, clinical manifestations, and treatment of gynecomastia. A PubMed search was completed in Clinical Queries using the key term "gynecomastia". Patents were searched using the key term "gynecomastia" from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Gynecomastia is caused by an imbalance between the stimulatory effect of estrogen and the inhibitory effect of androgen at the breast tissue level. Clinically, gynecomastia is characterized by the presence of a firm or rubbery, discrete, subareolar ridge of glandular tissue that is symmetrical in shape, freely movable, and nonadherent to skin or underlying tissue. Since most cases of physiological gynecomastia regress spontaneously with time, reassurance is all that is necessary. For pathological gynecomastia, treatment should be directed at the underlying cause, if possible. If gynecomastia persists in spite of the above measures, pharmacologic therapy and reduction mammoplasty may be considered. Recent patents related to the management of gynecomastia are discussed. The majority of cases are physiological and do not require treatment other than reassurance. For pathological cases, the underlying cause should be treated if possible. If gynecomastia persists in spite of the above measures and treatment becomes necessary, tamoxifen is the treatment of choice. Reduction mammoplasty may be considered for resistant cases.

Coexistence of apical hypertrophic cardiomyopathy and endomyocardial fibrosis with calcification: diagnosis using multimodality imaging.

A 48‐year‐old man from West Africa was evaluated for dyspnea. Echocardiography showed an echolucent mass at the left ventricular apex surrounded by a dense ridge of tissue, suggesting endomyocardial fibrosis (EMF). Doppler echocardiography showed restrictive hemodynamics and intramyocardial coronary blood flow at the hypertrophied apex, suggesting apical hypertrophic cardiomyopathy (ApHCM) with calcified thrombus. Cardiac magnetic resonance imaging showed a thickened myocardium with apical cavity obliteration and endomyocardial calcification, and gadolinium contrast demonstrated marked bright subendocardial and diffuse patchy intramyocardial hyperenhancement in the hypertrophied apical wall segment, confirming coexistence of EMF and ApHCM. Workup for known disorders of calcification was negative.

&lt;p class="MsoTitle"&gt;&lt;span lang="EN-US"&gt;Scleria pantadenia&lt;/span&gt;&lt;span lang="EN-US"&gt; and Scleria tricristata: Two new species of Scleria subgenus &lt;/span&gt;&lt;span lang="EN-US"&gt;Hypoporum&lt;/span&gt;&lt;span lang="EN-US"&gt; (Cyperaceae, Cyperoideae, Sclerieae) from Tanzania&lt;/span&gt;&lt;p class="MsoNormal"&gt;

Scleria pantadenia Meganck &amp; Bauters and Scleria tricristata Meganck &amp; Bauters are presented as new species of Scleria (Cyperaceae) from Tanzania. Scleria pantadenia is a small, tufted annual sedge species characterized by its delicate, brittle appearance and its small nutlets with gland-like tubercules and basal rim of swollen tuberculate cells. Scleria tricristata is a small, tufted annual sedge species characterized by a single, terminal unbranched spike and its remarkable nutlets with three protruding dentate ridges of translucent tissue. Both species are described, illustrated and compared with their closest relatives.