Severe Babesia microti Infection in an Immunocompetent Host in Pennsylvania.

Babesiosis, due to infection by a tick-borne protozoan (predominantly Babesia microti in North America), is an emerging health risk that is expanding into new areas and may be unfamiliar to clinicians in locations not previously considered endemic. Manifestations of infection can range from asymptomatic to life threatening, with severe disease more likely in those who have had a splenectomy, are immunocompromised, have chronic medical conditions, or are over 50 years of age. In this article, we describe an elderly but otherwise healthy man from an area not generally considered endemic for babesiosis who presented with severe hemolysis, acute renal failure, and high-level Babesia microti parasitemia; serological results suggestive of possible coinfection by Borrelia burgdorferi (the agent of Lyme disease, which is carried by the same tick as is Babesia microti) also was found. This report highlights that severe babesiosis can occur in an apparently normal host and underscores the continued geographic expansion of this pathogen and the need for early recognition and therapy.

Human chorionic gonadotropin discriminatory zone in ectopic pregnancy: does assay harmonization matter?

OBJECTIVE: To determine the effect that lack of hCG assay harmonization has on the interpretation of a serum hCG concentration with regards to the hCG discriminatory zone. DESIGN: A multisite method comparison study. SETTING: Clinical laboratories. PATIENT(S): Eighty serum samples containing various concentrations of hCG. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Concentrations of hCG obtained from seven hCG reagent platforms. RESULT(S): The hCG concentrations were significantly different across hCG reagent platforms. Seventy-one percent of assay pairs showed significant differences with samples selected based on hCG concentrations between 1,500 and 3,500 IU/L as determined by a comparative method. Relative to the comparative method, the calculated hCG discriminatory zones for five assays were within 9%, and one assay was within 40% of the target concentrations of 1,500 and 3,500 IU/L. CONCLUSION(S): Despite significant differences in hCG concentrations across hCG immunoassays, an hCG concentration within a discriminatory zone of 1,500-3,500 IU/L can be used for all but one commonly used hCG reagent platform.

Dynamic Regulation of Integrin α6ß4 During Angiogenesis: Potential Implications for Pathogenic Wound Healing.

OBJECTIVE: Angiogenesis is an essential component of normal cutaneous wound repair, but is altered in pathogenic forms of wound healing, such as chronic wounds and fibrosis. We previously reported that endothelial expression of integrin α6ß4 is developmentally regulated, with α6ß4 expression correlating with tissue maturation and further showed that endothelial α6ß4 is downregulated in explant angiogenesis assays. These data support the hypothesis that dynamic regulation of α6ß4 may play an important role during new vessel formation in healing wounds. APPROACH: To test this hypothesis, we examined the endothelial expression of α6ß4 using a murine model of cutaneous wound healing and in vitro cultures of primary human dermal microvascular endothelial cells (HDMECs). RESULTS: Expression of α6ß4 is downregulated during early stages of wound healing; angiogenic vessels in day 7 wounds do not express α6ß4. Endothelial expression of α6ß4 is resumed in day 14 wounds. Moreover, explanted HDMECs do not express α6ß4, but expression is induced by treatment with histone deacetylase inhibitors. INNOVATION: We provide in vivo data supporting a role for the dynamic regulation of α6ß4 during vessel formation and remodeling during cutaneous wound repair and in vitro findings that suggest endothelial ß4 expression is regulated transcriptionally, providing an important foundation for future studies to understand the transcriptional mechanisms involved in endothelial cell maturation during normal wound repair. CONCLUSION: Our data indicate that α6ß4 is dynamically regulated during angiogenesis and vessel maturation and suggest that disruption of this regulation may contribute to defective angiogenesis associated with diabetic wounds or cutaneous fibrosis.

Curved stylet core biopsy results in larger cores.

OBJECTIVE: The purpose of this study was to compare the size of biopsy cores obtained using a biopsy needle before and after manual curving of its inner stylet. MATERIALS AND METHODS: A total of 40 open renal biopsies were randomly performed on two ex vivo beef kidneys using four different semiautomated cutting needles. Two 18-gauge and two 20-gauge needles were used; one needle of each gauge had its inner stylet manually curved. Ten biopsy specimens were obtained using each needle and then were put into four different formalin containers, one for each needle, and sent to the pathology laboratory. Two pathologists who were blinded to the corresponding needles reviewed the samples in consensus and measured the dimensions of obtained cores. RESULTS: The mean diameter of the cores was larger when curved needles were used: for the 18-gauge needles, the core diameters were 0.866 mm for the curved needle and 0.688 mm for the straight needle, and for the 20-gauge needles, the core diameters were 0.522 mm for the curved needle and 0.480 mm for the straight needle. The length of the samples was also longer when they were obtained using the curved needle. When we considered the cores as cylinders, the calculated volumes of samples obtained using the curved needles were significantly larger. CONCLUSION: Manually curving of the inner stylet of the cutting biopsy needle results in larger cores, in terms of diameter and length, and results in significantly larger overall volume.

Multifocal extra-adrenal myelolipoma arising in the greater omentum.

Myelolipomas are rare benign tumors composed of mature fat and hematopoietic elements. They are most often discovered incidentally within the adrenal glands, with extra-adrenal myelolipomas being extremely rare tumors. We report a case of multifocal omental extra-adrenal myelolipoma in a patient who had undergone bilateral adrenalectomy. To our knowledge, this is the first reported case of an intraperitoneal extra-adrenal myelolipoma.