We report a case of Crohn′s disease complicated by hepatic tuberculosis during the treatment of infliximab. Reporting this rare case aims to make clinicians better understand hepatic tuberculosis, emphasize the proactive screening for tuberculosis, and also raise awareness of extrapulmonary tuberculosis in patients with inflammatory bowel disease during the treatment of biologics.

This article reports a rare Crohn′s disease (CD) case complicated with deep vein thrombosis and Guillain-Barre syndrome (GBS). Through the diagnosis and treatment of the multidisciplinary team, the condition of patient is relieved with no recurrence. Prevention of venous thromboembolism, rare extraintestinal manifestations and rare side adverse of anti-tumor necrosis factor-α monoclonal antibodies and their mechanisms in CD patients were discussed for reference.

Objective:To analyze the relationship between mesenteric fat or creeping fat and bowel stricture or penetrating disease of Crohn's disease (CD).Methods:Clinical data of 101 CD patients undergoing bowel surgery at Department of General Surgery in our hospital between Mar 2021 and Dec 2021 were retrospectively analyzed. The characteristics of mesenteric fat, creeping fat, luminal cross-section diameter, and the intestinal stricture index were analyzed. The Spearman correlation analysis was used to evaluate the correlation between disease behavior and mesenteric fat score or creeping fat score.Results:Totally 101 CD patients were enrolled, with 68 stricturing diseases and 33 penetrating diseases. CD patients with stricturing diseases had higher score of mesenteric disease activity index (4.6±1.9 vs. 3.7±2.0, t=2.212, P=0.029) and creeping fat index (4.2±2.0 vs. 2.9±1.6, t=3.154, P=0.002) than those in patients with penetrating diseases. The mesenteric fat and creeping fat score positively correlated with the intestinal stricture index, C-reactive protein, and fecal calprotectin, and negatively correlated with minimum luminal cross-section diameter. Conclusion:The higher score of mesenteric fat and creeping fat were observed in CD patients with stricturing disease, which were associated with intestinal stricture index and inflammation status.

We report a case of Crohn′s disease complicated by hepatic tuberculosis during the treatment of infliximab. Reporting this rare case aims to make clinicians better understand hepatic tuberculosis, emphasize the proactive screening for tuberculosis, and also raise awareness of extrapulmonary tuberculosis in patients with inflammatory bowel disease during the treatment of biologics.

This article reports a rare Crohn′s disease (CD) case complicated with deep vein thrombosis and Guillain-Barre syndrome (GBS). Through the diagnosis and treatment of the multidisciplinary team, the condition of patient is relieved with no recurrence. Prevention of venous thromboembolism, rare extraintestinal manifestations and rare side adverse of anti-tumor necrosis factor-α monoclonal antibodies and their mechanisms in CD patients were discussed for reference.

Objective:To analyze the risk factors for postoperative surgical site infections (SSIs) in patients with Crohn's disease (CD).Methods:This retrospective observational study included CD patients undergoing bowel resection between July 2015 and July 2018. The prevalence and risk factors of SSIs were evaluated. The microbiological evaluation from patients with SSIs was performed by bacterial culture and drug sensitivity test.Results:There were 66 patients suffering SSIs, with 41 incisional SSIs and 32 organ/space SSIs. Multivariate analysis identified the preoperative infliximab therapy ( OR 2.338,95% CI 1.192-4.587, P=0.013), laparoscopic surgery ( OR 0.460,95% CI 0.226-0.936, P=0.013), and preoperative white blood cell ( OR 2.008,95% CI 1.018-3.961, P=0.044) as independent factors for SSIs. Fifty-nine strains of pathogenic bacteria were detected in 66 cases of CD combined with SSIs, including 36 strains of gram-negative bacteria, 5 strains of gram-positive bacteria, and 2 strains of fungi. Escherichia coli and Klebsiella pneumoniae were main G - bacteria, with high resistance to common used antibiotics. Enterococcus faecalis and Enterococcus faecium were main G -. 62.1% of the SSIs grew extended-spectrum β-lactamase (ESBL)-producing pathogens in their bacteria cultures and 37.9% grew non-ESBL microbes. Conclusion:The incidence of SSIs was higher in CD patients. Preoperative infliximab therapy, preoperative white blood cell, and laparoscopic surgery were predictors of SSIs.

Objective To assess the safety of infliximab (IFX) treatment in patients with Crohn's disease(CD).Methods From January 2009 to May 2018,at inflammatory bowel disease (IBD) center of Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,486 CD patients received the treatment of IFX were enrolled and their clinical data were collected.Univariate and multivariate regression of binary logistic were performed for statistical analysis.Results The median follow-up duration was 31.1 months (12.0 months to 40.0 months).The median duration of IFX therapy was 13.0 months (7.0 months to 21.0 months).Among 486 patients,98 (20.16％) patients reported adverse effects,and 12 (2.47％) patients discontinued the therapy because of adverse effects.Acute infusion reaction was the most common adverse effect in CD patients who received IFX treatment accounting for 41.84％ (41/98) of all the adverse effects,and the incidence was 8.44％.Thirty-nine patients had mild and moderate infusion reaction,and all improved after symptomatic treatment (eight patients discontinued IFX therapy because of recurrent infusion reaction).Two patients developed severe infusion reaction as allergic shock,and both relieved after emergency rescue.Four patients developed late-phase allergic reactions.Among 486 patients,39 (8.02％) patients had infections,including infections of Clostridium difficile,cytomegalovirus,herpeszoster virus,Mycobacterium tuberculosis,and other opportunistic pathogens.There was no cases of infection related death.Thirty-six patients continued with IFX treatment after infection controlled.Among 486 patients,14 (2.88％) patients had severe infection,and all the cases improved after anti-infection treatment.Twenty-seven CD patients with hepatitis B virus (HBV) infection received anti-viral treatments,no active HBV infection was observed.Colon adenocarcinoma was found in one patient under colonoscopy at 22 months after discontinuation of IFX therapy.There were six patients with the history of benign tumors,and no evidence of recurrence,progress or malignancy during treatment.In terms of other rare adverse effects in 486 patients,there were eight (1.64％) patients with liver function injury,two (0.41％) patients with anemia,one (0.21％) patient with peripheral neuropathy,and four (0.82％) patients with skin lesion.Prolonged duration of IFX therapy,without combination of immune-suppressors and with increased baseline body mass index (BMI) were the risk factors of acute infusion reactions.Prolonged duration of IFX therapy and with low baseline albumin level were the risk factors of infections.Conclusions IFX is generally safe as the treatment for CD patients,and its adverse effects can be clinically controlled.Screening before therapy and monitoring during therapy may reduce the risks of adverse effects.

Objective: To establish a method for the content determination of naringin and neohesperidin in Weitong pills.Methods: An HPLC method was adopted.The determination was performed on an Agilent TC-C18 column with the mobile phase consisting of acetonitrile-water(20∶80)at the flow rate of 1.0 ml·min-1.The detection wavelength was set at 283nm.The column temperature was 30 ℃.Results: Naringin and neohesperidin respectively within the concentration range of 0.027-4.552 μg (r=0.999 9) and 0.029-4.016 μg(r=0.999 8) had good linear relationship with the peak area, the average recovery was 102.19% and 103.60%,and the RSD was 2.88% and 1.79%(n=9), respectively. Conclusion: The method is simple,accurate and reproducible, and suitable for the content determination of naringin and neohesperidin in Weitong pills.

Objective To investigate the application effect of group therapy in improving the subjective well-being (SWB) of elderly patients with long-term hospitalization. Methods Totally 100 cases of elderly patients admitted in geriatric ward of Ningbo First Hospital for long-time were selected. Newfoundland scale of happiness (MUNSH) scale and the negative life events questionnaire were used to investigate elderly inpatients, and patients with MUNSH ≤12 points received group therapy. Patients were divided into several groups to receive the intervention according to the negative life events. One year after intervention,patients receiving group therapy were evaluated again by using MUNSH scale to evaluate the intervention effect. Results Among 100 elderly patients,there were 32 cases of high SWB,3 cases of low SWB,and 65 cases of medium SWB. 53 cases of patients had sleep disorders,and 62.26% of them had low SWB. After intervention,the scores of negative experience and emotion of elderly patients were lower than those before intervention (P<0.05);the scores of positive emotion and positive experience and the total MUNSH score were higher than those before intervention (P < 0.05). Conclusions According to the different influencing factors,group interventions can significantly improve the SWB level of elderly patients with long-term hospitalization,so as to improve their quality of life.

Objective To investigate the efficacy of short-term biological agent infliximab and immunosuppression combined therapy in patients with active ileocolonic Crohn′s diseases (CD)and to evaluate the mucosal healing.Methods From January 2013 to July 2014,forty hospitalized patients with active ileocolonic CD received at least six times scheduled infliximab injection were enrolled.At week 0, second,and sixth,infliximab 5 mg/kg was administered to induce remission.From the second week, immunosuppression was added.After that,infliximab 5 mg/kg was administered every eight weeks for maintenance treatment.The 36th week after treatment was the end point of follow-up.Before treatment and at the end point of follow-up,the levels of C-reactive protein (CRP),hemoglobin (Hb),clinical remission Crohn′s disease activity index (CDAI)< 150 points,mucosal healing simplified endoscopic activity score for Crohn′s disease (SES-CD)was 0 to 2,partial mucosal healing (SES-CD decreased,but>2 ) and deep remission (achieved both clinical remission and mucosal healing)were compared.T test and Wilcoxon rank sum test were performed for comparison before and after treatment.Results At the 36 th week after treatment,the clinical remission rate was 95 .0% (38/40 ),mucosal healing rate,partial mucosal healing rate and deep remission rate were 62.5 % (25/40),35 .0% (14/40)and 62.5 % (25/40), respectively.The mucosal inflammation of only one case (2.5 %)was not improved.After treatment,the CDAI was 99.3 ±29.3,which was lower than that before treatment (301 .3 ±73.1 )and the difference was statistically significant (t = 17.2,P <0.01 ).Median blood CRP level was 0.8 mg/L(0.1 mg/L, 8.1 mg/L),which was lower than that before treatment (26.8 mg/L(16.1 mg/L,61 .0 mg/L)),the difference was statistically significant (Z = - 5 .3,P < 0.01 ).However,the level of Hb ((134.0 ± 16.0)g/L)was higher than that before treatment ((117.0 ±20.0)g/L),the difference was statistically significant (t=-6.3,P <0.01 ).The median SES-CD was 0 (0,5 ),which was lower than that before treatment (14(8,24)),and the difference was statistically significant (Z =-5 .4,P <0.01 ).Conclusion The short-term (36 weeks)infliximab and immunosuppression combined therapy can achieve high mucosal healing rate and deep remission rate in active ileocolonic CD patients.