Induction of central venous catheter-associated sepsis (CAS): A novel sheep model simulating the complex pathophysiology observed in humans. A paper to be submitted to Shock.

Catheter-associated blood stream infections (CABSIs) are serious, yet common, outcomes in both human and animals with indwelling catheters. The increasing rate of these infections is partially due to hindered knowledge on how to stop the spred of these pathogens, this due, in part, to inadequate animal models. Current experimental models fail to mimic various aspects of sepsis pathogenesis, diverse clinical symptomology, and in most cases lack the ability to test novel therapies for use in human medicine. In response to the urgent need for a more clinically relevant animal model of CAS, this large animal model was conceptualized and validated through this prospective study. Eight clinically healthy domestic cross-bred mature female sheep were obtained and double-lumen peripherally inserted central catheters (PICCs) were nonsurgically placed in the left jugular veins. A novel inoculation method was developed using a luminal volume of Klebsiella pneumoniae subsp. pneumoniae 43816RifRisolate and blood mixture (1:3). The mixture was injected into the lumen and was allowed to clot where is remainded for the duration of the study, enabling the development of a chronic catheter infection with the slow prolonged release of bacteria. This continual shedding of bacteria more closely mimicks the natural pathogenesis of catheter-associated sepsis (CAS) in clinical settings. A diverse yet dose-dependent host immune response was observed including; tachypneas, tachycardias, pyrexias, leukopeneas, neutrophilias, thrombocytopenias, hyperlacemias, and in some sheep biochemical signs of organ injury/damage with SOFA scores reaching ≥5. Please see paper for full abstract

Gastric Cardia Adenocarcinoma with Metastasis to the Scalp: A Case Report

Cutaneous metastasis is a rare manifestation of advanced gastrointestinal (GI) cancers. Gastric adenocarcinoma rarely presents with cutaneous metastasis, as cutaneous manifestations occur in less than 1% of upper GI tract malignancies. Here, we present the case of a patient with advanced gastric cardia adenocarcinoma with metastasis to the right occipital region of the scalp. Following shave biopsy, the immunohistochemistry (IHC) and molecular profile of the scalp lesion were analyzed, both of which confirmed metastasis and guided the treatment approach. The lesion demonstrated programmed death ligand-1 (PD-L1), an immune checkpoint protein, positivity by IHC, which led to the recommendation for treatment with immunotherapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Clinicians should conduct dermatologic examinations in patients with a history of gastric cancer or who are currently undergoing chemotherapy for gastric cancer in order to monitor for disease progression or metastatic lesions. The aim of this report is to increase awareness of scalp metastasis as an indicator of advanced internal visceral carcinoma for earlier diagnosis and improved management of the condition.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]