Malignant transformation of white sponge nevus: a case report of a novel keratin 4 mutation.

BACKGROUND: White Sponge Nevus (WSN) is traditionally considered a benign genetic disorder affecting the oral mucosa, primarily caused by pathogenic mutations in keratin 4 (KRT4) or keratin 13 (KRT13). Despite its benign nature, recent evidence has begun to question the malignant potential of WSN. CASE PRESENTATION: We report a case involving a 70-year-old man who presented with a white lesion on the right floor of his mouth. Initial diagnostic evaluations confirmed the lesion as WSN. Over a one-year follow-up, the lesion underwent malignant transformation, evolving into local epithelial moderate-to-severe dysplasia. Exome sequencing identified a novel insertion mutation in exon 1 of the KRT4 gene, resulting in a deletion-insertion amino acid mutation involving glycine. Single-cell RNA sequencing further revealed altered epithelial proliferation and differentiation dynamics within the lesion. CONCLUSIONS: This case not only expands the known genetic spectrum of KRT4 mutations associated with WSN but also provides preliminary evidence suggesting the malignant potential of WSN. The novel pathogenic mutation in KRT4 is postulated to alter epithelial proliferation and differentiation, thereby raising concerns about the malignant transformation of WSN. Further studies are warranted to confirm these findings.

Collision-attachment simulation of membrane fouling by oppositely and similarly charged colloids.

The fouling propensity of oppositely charged colloids (OCC) and similarly charged colloids (SCC) on reverse osmosis (RO) and nanofiltration (NF) membranes are systematically investigated using a developed collision-attachment approach. The probability of successful colloidal attachment (i.e., attachment efficiency) is modelled by Boltzmann energy distribution, which captures the critical roles of colloid-colloid/membrane interaction and permeate drag. Our simulations highlight the important effects of ionic strength Is, colloidal size dp and initial flux J0 on combined fouling. In a moderate condition (e.g., Is =10 mM, dp=50 nm and J0= 100 L/m2h), OCC mixtures shows more severe fouling compared to the respective single foulant owing to electrostatic neutralization. In contrast, the flux loss of SCC species falls between those of the two single foulants but more closely resembles that of the single low-charged colloids due to its weak electrostatic repulsion. Increased ionic strength Is leads to less severe fouling for OCC but more severe fouling for SCC, as a result of the suppressed electrostatic attraction/repulsion. At a high Is (e.g., 3-5 M), all the single and mixed systems show the identical pseudo-stable flux Js. Small colloidal size leads to the drag-controlled condition, where severe fouling occurs for both single and mixed foulants. On the contrary, better flux stability appears at greater dp for both individual and mixed species, thanks to the increasingly dominated role of energy barrier and thus lowered attachment efficiency. Furthermore, higher J0 above limiting flux exerts greater permeate drag, leading to elevated attachment efficiency, and thus more flux losses for both OCC and SCC. Our modelling gains deep insights into the role of energy barrier, permeate drag, and attachment efficiency in governing combined fouling, which provides crucial guidelines for fouling reduction in practical engineering.