The thickened and hypertrophic mesenteric fat that surrounds the inflamed intestine over 50% in Crohn′s disease (CD) is commonly defined as creeping fat. Most previous studies have focused on the mechanism of interaction between immune cells and translocated bacteria in it. However, the massive non-immune cells, including adipose-derived stem cells, adipocytes, endothelial cells and fibroblasts etc. in the mesenteric fat tissue have often been neglected. With the increasing evidence on non-immune cells in the pathogenesis of CD, their involvement in immune homeostasis and regulation of inflammationis gaining new insights. This review highlights the latest research progress on the impact of non-immune cell components in creeping fat, improving the pathogenesis of CD and explores new strategies based on mesenteric therapy.

The thickened and hypertrophic mesenteric fat that surrounds the inflamed intestine over 50% in Crohn′s disease (CD) is commonly defined as creeping fat. Most previous studies have focused on the mechanism of interaction between immune cells and translocated bacteria in it. However, the massive non-immune cells, including adipose-derived stem cells, adipocytes, endothelial cells and fibroblasts etc. in the mesenteric fat tissue have often been neglected. With the increasing evidence on non-immune cells in the pathogenesis of CD, their involvement in immune homeostasis and regulation of inflammationis gaining new insights. This review highlights the latest research progress on the impact of non-immune cell components in creeping fat, improving the pathogenesis of CD and explores new strategies based on mesenteric therapy.

Objective:To establish a model to predict the maintenance efficacy of anti-tumor necrosis factor (TNF) -α monoclonal antibody in active Crohn′s disease (CD) patients with small intestinal involvement.Methods:A retrospective cohort study was carried out. Ninety-eight CD patients with small intestinal involvement admitted in the Tenth People′s Hospital of Tongji University from January 2017 to December 2020 were consecutively included. All the patients received anti-TNF-α monoclonal antibody induction therapy regularly and the induced remission treatment was effective. The maintenance therapy was followed up for at least 1 year. All patients underwent computed tomography enterography (CTE) before treatment. According to whether therapeutic optimization occurred, the patients were divided into optimization group and maintenance group. Univariate analysis was used to compare the differences of clinical and CTE features between the two groups, and multivariate Logistic regression analysis was performed to select the independent factors for medication optimization. A nomogram based on the established predictive model was drawn and further validated internally.Results:During the follow-up, 40 patients underwent treatment optimization and 58 maintained the original treatment. Univariate analysis showed that compared with the maintenance group, the ages of onset[ (35.7±14.3) years old vs. (29.6±12.3) years old, P = 0.027) ] and diagnosis[ (37.7±17.8) years old vs. (30.6±11.1) years old, P = 0.006) ] were older, the level of hemoglobin [ (112.9±23.2) g/L vs. (126.9±26.5) g/L, P = 0.008] and serum albumin [ (38.1±5.0) g/L vs. (42.5±4.9) g/L, P<0.001] was lower in the optimization group, meanwhile the degree of intestinal wall enhancement (mild: 40.0% vs. 74.1%, moderate and severe: 60.0% vs. 25.9%, P = 0.001) and intestinal stenosis (no or suspicious: 47.5% vs. 87.9%, mild: 17.5% vs. 5.2%, moderate and severe: 35.0% vs. 6.9%, P<0.001) were significantly different between two groups. Multivariate analysis revealed that age at diagnosis ( OR = 1.051, 95% CI: 1.009-1.096, P = 0.018) , degree of intestinal wall enhancement ( OR = 3.807, 95% CI: 1.268-11.428, P = 0.017) and moderate-severe intestinal stenosis ( OR = 6.550, 95% CI: 1.640-26.165, P = 0.008) were the independent risk factors for treatment optimization, and high serum albumin level ( OR = 0.841, 95% CI: 0.747-0.946, P = 0.004) was the protective factor. The area under ROC of the established predictive model was 0.856 (95% CI: 0.779-0.933, P<0.001) with sensitivity of 82.5%, specificity of 81.0%, and accuracy of 95.9%. Conclusion:A model is established based on the CTE features including the degree of intestinal wall enhancement and intestinal stenosis combined with age at diagnosis and serum albumin level, it can predict the efficacy of anti-TNF-α monoclonal antibody in maintenance therapy among CD patients with small intestinal involvement.

Objective:To establish a model to predict the maintenance efficacy of anti-tumor necrosis factor (TNF) -α monoclonal antibody in active Crohn′s disease (CD) patients with small intestinal involvement.Methods:A retrospective cohort study was carried out. Ninety-eight CD patients with small intestinal involvement admitted in the Tenth People′s Hospital of Tongji University from January 2017 to December 2020 were consecutively included. All the patients received anti-TNF-α monoclonal antibody induction therapy regularly and the induced remission treatment was effective. The maintenance therapy was followed up for at least 1 year. All patients underwent computed tomography enterography (CTE) before treatment. According to whether therapeutic optimization occurred, the patients were divided into optimization group and maintenance group. Univariate analysis was used to compare the differences of clinical and CTE features between the two groups, and multivariate Logistic regression analysis was performed to select the independent factors for medication optimization. A nomogram based on the established predictive model was drawn and further validated internally.Results:During the follow-up, 40 patients underwent treatment optimization and 58 maintained the original treatment. Univariate analysis showed that compared with the maintenance group, the ages of onset[ (35.7±14.3) years old vs. (29.6±12.3) years old, P = 0.027) ] and diagnosis[ (37.7±17.8) years old vs. (30.6±11.1) years old, P = 0.006) ] were older, the level of hemoglobin [ (112.9±23.2) g/L vs. (126.9±26.5) g/L, P = 0.008] and serum albumin [ (38.1±5.0) g/L vs. (42.5±4.9) g/L, P<0.001] was lower in the optimization group, meanwhile the degree of intestinal wall enhancement (mild: 40.0% vs. 74.1%, moderate and severe: 60.0% vs. 25.9%, P = 0.001) and intestinal stenosis (no or suspicious: 47.5% vs. 87.9%, mild: 17.5% vs. 5.2%, moderate and severe: 35.0% vs. 6.9%, P<0.001) were significantly different between two groups. Multivariate analysis revealed that age at diagnosis ( OR = 1.051, 95% CI: 1.009-1.096, P = 0.018) , degree of intestinal wall enhancement ( OR = 3.807, 95% CI: 1.268-11.428, P = 0.017) and moderate-severe intestinal stenosis ( OR = 6.550, 95% CI: 1.640-26.165, P = 0.008) were the independent risk factors for treatment optimization, and high serum albumin level ( OR = 0.841, 95% CI: 0.747-0.946, P = 0.004) was the protective factor. The area under ROC of the established predictive model was 0.856 (95% CI: 0.779-0.933, P<0.001) with sensitivity of 82.5%, specificity of 81.0%, and accuracy of 95.9%. Conclusion:A model is established based on the CTE features including the degree of intestinal wall enhancement and intestinal stenosis combined with age at diagnosis and serum albumin level, it can predict the efficacy of anti-TNF-α monoclonal antibody in maintenance therapy among CD patients with small intestinal involvement.

Objectives To discuss the clinical characteristic, cause and measures to prevention and control of nosocomial infection in a neonatal intensive care unit (NICU). Methods Retrospectively analyzed an nosocomial infection outbreak of Klebsiella pneumoniae in NICU. Results From Sept. 3, 2010 to Oct. 3, 2010, there were 7 cases of hospital infection in 12 cases of sputum cultured Klebsiella Pneumoniae. The gestational age (GA) of 7 hospital infection cases was 28.5±2.6 week. The birth weight of infection cases was 941.4±309.8 g. The onset of infection was at 31.7±12.8 d of hospitalization. The nosocomial incidence was 2.41%in the hospital, which was 5.79%in preterm infants, 50.00%in GA<28w infants, and 42.86%in extremely low birth weight infant (ELBW). All sputum culture results were displayed as multi-drug resistant of Klebsiella pneumoniae, penicillin and third-generation cephalosporin antibiotic resistance rate of 75%to 100%. The resistance rates to penicillin and cephem antibiotics were 75% -100%, carbapenems was 58.3%, piperacillin/tazobactam was 25.0%. All nosocomial patients were cured. Conclusions GA<28w and ELBW infants are at increased risk of nosocomial infection in NICU. The emergence of carbapenems resistant Klebsiella Pneumoniae has been increasing with the widespread use of carbapenems. Hospital infection can be controlled by standardized medical behavior, which can decline the nosocomial infection incidence and mortality of preterm infants in NICU.

Objective To investigate the epidemic characteristics and trends of incidence and mortality of prostate cancer in cancer registration areas in Zhejiang province from 2000 to 2009.Methods Clinical data incidence and mortality of prostate cancer were collected from 6 cancer registration areas in Zhejiang province,including Hangzhou,Jiaxing,Jiashan,Haining,Shangyu and Xianju.Crude rates,standardized rate and change trend,age-specific rates and annual percent change (APC,95％ CI) of prostate cancer were checked,sorted and analyzed in Zhejiang Cancer Center.Results The prostate cancer incidence rate from 2000 to 2009 was 9.79/100 000,age-standardized incidence rates by world standard population (ASIRW) was 6.39/100 000,and the incidence cumulative risk of males aged 0-74 was 0.72％ ; while the mortality rate was 2.73/100 000,age-standardized mortality rates by world standard population was 1.74/100 000,and the mortality cumulative risk of males aged 0-74 was 0.14％.Age-specific incidence of prostate cancer remained low before 50,years old and peaked at over 85-year-old group (130.30/100 000).Age-specific mortality of prostate cancer increased after 55,and also peaked at over 85-year-old group (81.19/100 000).The annual prostate cancer incidence rate generally grew from 1.39/100 000 (2000) to 13.89/100 000 (2009),and the APC was 14.18％ (95％ CI,9.68％-18.98％).Meanwhile,the prostate cancer mortality rate also increased from 1.52/100 000 (2000) to 3.58/100 000 (2009),and the APC was 11.83％ (95％ CI,5.69％-18.33％).Conclusion Prostate cancer incidence and mortality in Zhejiang cancer registration areas increased sharply,and the prevention and treatment of prostate cancer should be strengthened.

Objective To investigate the incidence and mortality of brain tumor in Zhejiang cancer registration areas from 2000 to 2009.Methods Data from 6 Cancer registration areas of Zhejiang province were collected.Number of cases,crude rates,proportions,age standardized rates,cumulate rates,cut rates,age-specific rates and annual percentage change (APC,95％ CI) of brain tumor incidence and mortality were analyzed.Results There were 5 123 new diagnosed brain tumor cases in Zhejiang cancer registration areas,accounting for 3.14％ of all the new cancer cases.The incidence rate of brain tumor was 8.53/100 000,and the standardized incidence rate by Chinese population was 5.72/100 000,ranking the 7th in cancer incidence spectrum of anatomic sites.Agespecific incidence of brain tumor increased along with age,and peaked among 70-74 age groups (24.09/100 000).The annual incidence rate of brain tumor increased from 2000 (6.87/100 000) to 2009 (8.35/ 100 000),with APC as 1.58％ (95 ％ CI:-2.17％-5.47％,no statistical significance).A total of 2 357 deaths caused by brain tunor were reported from 2000-2009,accounting for 2.47％ of all the cancer death cases.Mortality rate on brain tumor appeared to be 3.92/100 000,with the standardized mortality rate by Chinese population as 2.45/100 000,ranking the 7th in cancer mortality spectrum of anatomic sites.The age-specific mortality of brain tumor remained low among 0-39 year-olds,and reached the peak at 80-84 age groups (17.64/100 000).The annual mortality rate of brain tumor decreased from 2000 (4.30/100 000) to 2009 (3.83/100 000) with minor fluctuation,and the APC was-0.65％ (95％CI:-3.35％-2.12％,no statistical significance).Conclusion Brain tumors incidence and mortality in Zhejiang cancer registration areas were at a relatively high level.People who were at middle-age,especially above 70 years old should be the key targets for protection on this disease.Brain tumor incidence rates increased annually in Zhejiang,which should be called for attention.

Objective To investigate the incidence and mortality rates of thyroid cancer in Zhejiang province during 2000 to 2009.Methods The data of thyroid cancer were collected from six cancer registries in Zhejiang province and the incidence and mortality rates of thyroid cancer were analysed.Results The mean annual incidence rate of thyroid cancer in Zhejiang cancer registration areas was 6.93/100 000 during 2000 to 2009,and male/female ratio was 1: 3.43.The incidence rate was 3.62/100 000 in 2000 and it increased to 11.42/100 000 in 2009,with the annual percent change (APC) of 16.32％ (95％ confidence interval:12.90％-19.85％).The mean annual mortality rate of thyroid cancer was 0.27/100 000 during 2000 to 2009,and male/female ratio was 1: 1.12.The mortality showed a rising trend without a distinct fluctuation from 2000 to 2009,the APC was 2.14％ (95％ confidence interval:from-7.10％ to 12.30％).The incidence showed a rising trend with the increase of ages after 15 years old,and peaked at 55-60 years old.The mortality was low before 54 years old,but showed a rising trend with a distinct fluctuation after 55 years old,and peaked at 85-90 years old.Conclusion The prevention and control of risk factors for thyroid cancer in young and middle-aged people is key to decrease the incidence and mortality of thyroid cancer.