Lymphangiomas of the tongue are very rare tumors usually diagnosed in infancy and early childhood. Children with Lymphangiomas of the tongue may require multidisciplinary care and a close collaboration between physician and dentist to be able to eradicate any sources of dental infections before undertaking medical treatment.

We present a unique Richter's transformation case in CNS with identical to CLL clonal origin in a patient treated with Venetoclax. With our case we make implications on whether Venetoclax penetrates the blood-brain barrier and we address the debating issue of the appropriate Venetoclax dose in case of drug-drug interactions.

A 68-year-old male presented with a difficult airway secondary to a firm mass at the base of the tongue on intubation for an emergency general surgical procedure. Further workup confirmed a lingual thyroid with previous upper airway obstruction requiring a temporary tracheostomy. The mass was excised using transoral robotic surgery.

Thrombosis within the microvasculature and medium to large vessels is a serious and common complication among critically ill individuals with COVID-19. While children are markedly less likely to develop severe disease than adults, they remain at risk for thrombosis during acute infection and with the post-acute inflammatory illness termed multisystem inflammatory syndrome in children. Significant knowledge deficits in understanding COVID-19 associated coagulopathy and thrombotic risk pose clinical challenges for pediatric providers who must incorporate expert opinion and personal experience to manage individual patients. We discuss clinical scenarios to provide framework for characterizing thrombosis risk and thromboprophylaxis in children with COVID-19.

Background The role of percutaneous repair of functional mitral regurgitation (MR) is evolving. Left ventricle remodeling is known to be different between men and women; however, outcomes following percutaneous repair of functional MR have not considered the impact of sex. Methods Between 2012 and 2018, 175 patients underwent percutaneous repair of functional MR with the Mitra Clip NT/NTR (Abbott, Irvine CA) at our institution. Patients were assessed in a dedicated clinic with a follow-up that averaged 0.7±1.2 years and extended to 5.7 years. Results Men had a larger body surface area than women (p<0.001), whereas women were more likely than men to have diabetes preoperatively (p=0.02). There were no deaths or instances of single leaflet detachment. Immediate post-procedure MR was <2+ in 158 (90%) with a mean trans-mitral valve repair gradient of 3.4±1.0 and 3.5±2.1 mm Hg, respectively for women and men (p=0.8). One- and 2-year freedom from MR >3+ was 86.0±3.5% and 77.6±5.1%, respectively. After adjusting for differences between male and female patients, women were more likely to have recurrent MR >3+ (hazard ratio 4.7, 95% confidence interval 1.2-18.4, p=0.03). Upon adjusted analysis, there was also no association between gender and survival (p=0.2). One- and 2- year survival was 69.8±4.3% and 54.3±5.5%, respectively. Conclusion Women are more likely to have recurrent severe MR after percutaneous repair of functional MR. The mechanism for this remains undetermined.

Hepatorenal syndrome is a rare life-threatening complication of acetaminophen toxicity. It is not responsive to fluid therapy and need performing an emergent liver transplantation. Here, we introduce a 24-year-old woman with a history of chronic high doses of acetaminophen consumption, presenting with nausea, vomiting, lethargy, oliguria, and severe metabolic acidosis.

Background: Congenital pulmonary stenosis (PS) is a progressive disease. Balloon pulmonary valvuloplasty (BPV) is the treatment of choice in valvular PS. Aim: We aim to study the relationship between biomarkers and echocardiographic markers in valvular PS and to assess the impact of BPV on these markers. Patients & Methods Patients with moderate and severe valvular PS amenable for BPV were recruited. Serum troponin I was measured. Echocardiographic assessment of PS and right ventricular (RV)function were done. All patients underwent BPV. Troponin level and echocardiographic data were re-assessed two weeks & six months after BPV. Results: Fifty patients with valvular PS were recruited. There was significant correlation between peak SPG and troponin (p < 0.001). Troponin was significantly decreased 2 weeks after BPV. Similarly, there was an initial improvement in RV function. After 6 months of follow up, we divided patients into 2 groups: Group-A: 36 patients with no restenosis. Group-B: 14 patients with restenosis. There were high significant differences between both groups regarding troponin level and RV functions with re-elevated troponin in group-B that correlated with peak PG (r= 0.9, p < 0.001). RV function parameters in group-B became significantly worse 6 months after BPV than those after the initial 2 weeks. Conclusion Troponin correlates with the severity of PS and associates with RV dysfunction. Both troponin & RV functions improved with BPV. Recurrent elevation of troponin and impairment of RV function are associated with PV restenosis and could be set as an indication for repeated balloon dilatation of PV.

Chinese Hamster Ovary (CHO) cell lines are grown in cultures with varying asparagine and glutamine concentrations, but further study is needed to characterize the interplay between these amino acids. By following 13C-glucose, 13C-glutamine, and 13C-asparagine tracers using metabolic flux analysis (MFA), CHO cell metabolism was characterized in an industrially relevant fed-batch process under glutamine supplemented and low glutamine conditions during early and late exponential growth. For both conditions MFA revealed glucose as the primary carbon source to the tricarboxylic acid (TCA) cycle followed by glutamine and asparagine as secondary sources. Early exponential phase CHO cells prefer glutamine over asparagine to support the TCA cycle under the glutamine supplemented condition, while asparagine was critical for TCA activity for the low glutamine condition. Overall TCA fluxes were similar for both conditions due to the trade-offs associated with reliance on glutamine and/or asparagine. However, glutamine supplementation increased fluxes to alanine, lactate and enrichment of glutathione, N-Acetyl-Glucosamine (NAG) and pyrimidine-containing-molecules. The late exponential phase exhibited reduced central carbon metabolism dominated by glucose, while lactate reincorporation and aspartate uptake were preferred over glutamine and asparagine. These 13C studies demonstrate that metabolic flux is process time dependent and can be modulated by varying feed composition.

Hemoglobin S (HBS) and hemoglobin E (HBE) are common hemoglobinopathies, but combined heterozygosity of HBS and HBE (HBSE) is relatively a rare disease. Most reports suggest that HBSE is generally benign condition. In this report we describe a 17-year-old male patient presenting with acute chest syndrome treated with exchange transfusion.

Wind erosion is one of the desertification results and is among the natural processes that mostly occur under dry conditions and high wind velocity. Using oil-mulches is one of the common methods to stabilize sand dunes. The current study aimed to investigate the short-term effects of oil-mulch on vegetation attributes (i.e., cover and diversity) and rangeland condition score (RCS) using integrated ecological and remote sensing-based approaches in arid regions of Southwestern Iran. A vegetation survey was carried out in 2019 in the oil-mulched and control area, and a remotely sensed vegetation index (MSAVI) was calculated for 2017 and 2019. The results indicate that one year after treatment, compared to the control area, vegetation cover (30 ± 17.11 vs. 17 ± 5.44 %) and litter (4.6 ± 2.18 vs. 0.94 ± 1.55 %) increased significantly in the oil-mulched area, while bare soil (65.20 ± 17.34 vs. 82.31 ± 5.84 %) decreased. Further, diversity indices (Species evenness, Shannon, and Simpson indices) declined by applying oil-mulch (88%, 63%, and 71%, respectively). The rangeland condition score was significantly higher in the oil-mulched area than in the control area (22 ± 1.86 vs. 12 ± 0.88; P < 0.001). Comparing MSAVI between 2017 and 2019 showed that vegetation cover increased 44.8%. Based on the results, it can be suggested that planting native palatable species in an oil-mulched area with the exclusion of livestock grazing is likely to increase the benefits of oil-mulch treatment and will lead to better rangeland condition score.

COVID-19 vaccines and the role of other potential allergenic components different from PEG. A reply to: “Other excipients than PEG might cause serious hypersensitivity reactions in COVID-19 vaccines”

Duplications of 3p and deletions of 9p occurring separately are well described; however, there are few reports of individuals with unbalanced translocations resulting in both of these chromosomal abnormalities. We report two siblings with the same unbalanced male karyotype and sex reversal.

Lymphoepithelial cyst (LEC)is a rare disease. Clear diagnostic criteria have not been established, and the number of cases is expected to increase in the future. In particular, LEC in the pancreatic accessory spleen has not been reported in the past, and this report documents it for the first time.

A key step in understanding the genetic basis of different evolutionary outcomes (e.g., adaptation) is to determine the roles played by different mutation types. To do this we must simultaneously consider different mutation types in an evolutionary framework. Here we propose a research framework that directly utilizes the most important characteristics of mutations, their population genetic effects, to determine their relative evolutionary significance. We review known population genetic effects of different mutation types and show how these may be connected to different evolutionary outcomes. We provide examples of how to implement this framework and pinpoint areas where more data, theory and synthesis are needed. Linking experimental and theoretical approaches to examine different mutation types simultaneously is a critical step towards understanding their evolutionary significance.

Treatment-required accidental ingestion and risk factors among nursery children with wheat allergy

Lupus mastitis is an uncommon entity which can easily mimic other breast conditions. The rarity of this disease demands a high degree of suspicion.

This editorial is an invited response to “Adherence to the 2014 American Academy of Pediatrics Palivizumab Prophylaxis Recommendations”

Abstract: Conventional stylet-driven leads with extendable helix can be implanted successfully for Left Bundle Branch Area Pacing (LBBAP) with a low acute complication rate. However, removal and repositioning techniques of these leads haven’t been yet described. We report 2 cases in which lead repositioning after a first unsuccessful attempt to LBBAP was associated with fracture of the helix rotating mechanism and failure to fully extract the pacing lead.