A case of stercoral colitis with marked elevation of serum carcinoembryonic antigen

Clinical Relevance of Elevated Serum Carcinoembryonic Antigen in Allergic Bronchopulmonary Aspergillosis/Mycosis: A Multicenter Retrospective Study

Background

Allergic bronchopulmonary aspergillosis/mycosis (ABPA/M) is a complex non-infectious pulmonary benign disease characterized by an immune response against aspergillus/fungus. Carcinoembryonic antigen (CEA), typically recognized as a tumor marker, also elevated in certain benign diseases. Few studies on ABPA/M cases presenting with elevated serum CEA levels have been reported.

Patients and Methods

A cohort of 115 patients diagnosed as ABPA/M were divided into two groups (CEA normal and CEA elevated). The characteristics of ABPA/M patients in terms of its demographic profile, clinical symptoms, pertinent clinical laboratory examinations were analyzed. Levels of cytokines (IL-4, IL-5, GM-CSF, IFN-γ) were analyzed by enzyme-linked immunosorbent assay. Comparative evaluation included pre-therapy and post-treatment eosinophil count and total IgE level, to evaluate therapeutic disparities between the two groups.

Results

Among 115 cases of ABPA/M, 32 exhibited elevated serum CEA levels above baseline and 83 were normal. ABPA/M patients with elevated serum CEA tended to be younger (50, IQR [43-56] years vs 59, IQR [47-68] years; P < 0.05) with superior pulmonary function (FEV1/FVC ratio, 65.1% (44.2, 79.6) vs 79.1% (65.2, 84.2), P < 0.05), and showed marginally higher baseline levels of the total IgE (P < 0.05), blood eosinophils counts and ratios (P < 0.01) compared to those with normal CEA. Higher serum levels of IL-4, IL-5, GM-CSF and IFN-γ in ABPA/M patients with elevated serum CEA levels were observed (P < 0.0001). After treatment (at 12w), compared to ABPA/M patients with normal serum CEA, the decrease in eosinophil count and total IgE levels was less pronounced in ABPA/M patients with elevated serum CEA eosinophil count, 523±481.66 vs 267±200.68, P < 0.05; total IgE, 619±680.47 vs 263±400.90, P < 0.05), which indicates a poor response to treatment.

Conclusion

Monitoring serum CEA levels may serve as a supplementary tool in the clinical management of ABPA/M patients.

Robust Detection of Cancer Markers in Human Serums Using All-Dielectric Metasurface Biosensors

One of the most significant characteristics, which biosensors are supposed to satisfy, is robustness against abundant molecules coexisting with target biomolecules. In clinical diagnoses and biosensing, blood, plasma, and serum are used daily as samples. In this study, we conducted a series of experiments to examine the robustness of all-dielectric metasurface biosensors, which comprise pairs of a highly fluorescence-enhancing silicon nanopellet array and a transparent microfluidic chip. The metasurface biosensors were shown to have high performance in detecting various targets from nucleic acids to proteins, such as antigens and antibodies. The present results show almost four-order wide dynamic ranges from 0.16 ng/mL to 1 μg/mL for prostate-specific antigen (PSA) and from 2 pg/mL to 25 ng/mL for carcinoembryonic antigen (CEA). The ranges include clinical criteria for PSA, 4 ng/mL and CEA, 5 ng/mL. To date, a systematic demonstration of robustness has not been reported regarding the metasurface biosensors. In detecting cancer markers of PSA and CEA in human serums, we demonstrate that the metasurface biosensors are robust enough in a wide target concentrations, including the clinical diagnosis criteria.

Non-perforated Stercoral Colitis patients with septic shock have a higher mortality than their perforated counterparts. A case report and review of literature

Introduction and importance

Stercoral colitis is an inflammatory condition caused by fecal impaction; it involves the colonic or rectal wall. It occurs most commonly in nursing home patients, chronic opioid users, and patients with mental impairment.

Case presentation

We present the case of a 36-year-old, obese, African American male with a history of intellectual disability, bipolar disorder, and chronic constipation. Patient presented to the emergency room after an episode of syncope, confusion, 24-hour abdominal pain, nausea, and vomiting. On admission to the ED the patient was found to be in sepsis; within 4 h he developed septic shock. CT scan of the abdomen showed impacted fecal matter in a significantly distended left and sigmoid colon. This was associated with colitis, extensive fat stranding and free fluid, without pneumoperitoneum. The patient was taken to the operating room for exploration where he underwent an extended left colectomy and Hartmann's procedure. Pathology showed acute focal colitis with transmural necrosis. There were no signs of perforation or inflammatory bowel disease. The patient recovered and was discharged home on post-operative day 8. Upon follow up on post-operative day 22, he was doing well.

Clinical discussion

This case illustrates a very rare and challenging scenario. Complications of stercoral colitis include: stercoral ulcer, perforation, ischemic colitis, sepsis and death. Peritonitis, sepsis and bowel necrosis without perforation is extremely rare with very few cases reported in the literature. Colectomy with diversion is the mainstay of therapy.

Conclusion

It is of paramount importance for ED providers and general surgeons to be aware of this condition. It presents a diagnostic challenge and carries an elevated mortality. Elderly patients on chronic opioids and those with mental impairment are at a higher risk.

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Stercoral colitis induced sepsis is a challenging diagnosis.

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Stercoral colitis induced sepsis has a mortality close to 60 %.

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Source control is paramount to avoid fatal outcomes.

All-Dielectric Metasurface Fluorescence Biosensors for High-Sensitivity Antibody/Antigen Detection

Protein biomolecules are used as markers for various diseases and infections and are targets in biosensing research and development. One of the highest-sensitivity biosensing techniques is considered to be fluorescence (FL) sensing. However, to our knowledge, no study has shown that all-dielectric metasurfaces can contribute to highly sensitive FL sensing. Here, we introduce an efficient type of FL-sensing platforms and show that all-dielectric metasurface FL biosensors are able to directly detect a representative antibody, immunoglobulin G, at very small concentrations on the order of pg/mL or tens of femtomolars. Furthermore, it is shown that they work efficiently as an indirect detection platform for standard cancer marker antigens, such as carcinoembryonic antigens, at concentrations well below the medical diagnosis criterion at 5 ng/mL. Importantly, the metasurface biosensors simultaneously suppress inhomogeneous FL responses, exhibit high reproducibility, and retain sensitivity, even in human serum. These results indicate that the present metasurface FL biosensors provide a high-sensitivity practical platform, suggesting that they are a better option than the commercially standard of enzyme-linked immunosorbent assays.