浅谈多学科因素在化学教学中的意义

化学系统本身是一个开放系统，一方面它本身不断的变化、发展、完善，另一方面它与其他系统之间不断的交换物质、能量、信息．因此化学知识系统与其它科学知识系统之间是相互联系、相互渗透的。中学的化学教学是化学教学的启蒙阶段。它是在小学自然、数学、初中地理、生物、数学、物理等课程的基础上实施的．其内容与这些学科课程有密切联系．深入钻研，准确把握联系内容的深浅，异同点；相互比较，全面理出课程间内容相互联系的程度，是加强课程问的联系，进行教学的关键．

浅议化学与其它学科因素的关联

结合教学经验 ,着重分析其它学科的基础知识和技能在化学中的运用 ,使化学教学既能充分实现化学教学目标 。

多学科多因素综合干预对老年髋部骨折术后谵妄的效果观察

术后谵妄（postoperative delirium,POD）是一种急性意识模糊状态,伴有注意力不集中,记忆障碍、思维混乱、精神状态改变以及睡眠周期障碍的临床综合征,谵妄是老年髋部骨折术后常见的并发症,年龄65岁及以上患者POD的发生率达5%～50%^（[1]）,主要发生在术后2～3天^（[2]）。谵妄可导致患者住院时间延长,住院费用增加,生活质量下降,严重者可诱发痴呆,失去生活自理能力^（[3]）。

Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment

AIM:To investigate the patterns and decisive prognostic factors for local recurrence of rectal cancer treated with a multidisciplinary team(MDT) modality.METHODS:Ninety patients with local recurrence were studied,out of 1079 consecutive rectal cancer patients who underwent curative surgery from 1999 to 2007.For each patient,the recurrence pattern was assessed by specialist radiologists from the MDT using imaging,and the treatment strategy was decided after discussion by the MDT.The associations between clinicopathological factors and long-term outcomes were evaluated using both univariate and multivariate analysis.RESULTS:The recurrence pattern was classified as follows:Twenty-seven(30%) recurrent tumors were evaluated as axial type,21(23.3%) were anterior type,8(8.9%) were posterior type,and 13(25.6%) were lateral type.Forty-one patients had tumors that were evaluated as resectable by the MDT and ultimately received surgery,and R0 resection was achieved in 36(87.8%) of these patients.The recurrence pattern was closely associated with resectability and R0 resection rate(P < 0.001).The recurrence pattern,interval to recurrence,and R0 resection were significantly associated with 5-year survival rate in univariate analysis.Multivariate analysis showed that the R0 resection was the unique independent factor affecting long-term survival.CONCLUSION:The MDT modality improves patient selection for surgery by enabling accurate classification of the recurrence pattern;R0 resection is the most significant factor affecting long-term survival.

Impact of lymphatic and/or blood vessel invasion in stage Ⅱ gastric cancer

AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confirmed primary gas- tric adenocarcinoma were diagnosed with stage 11 gas- tric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node （LN） dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathologicalfindings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure （subtotal resection vs total resection）, and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS： The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years （range： 23-88 years）. The 5-year overall survival rates were 50.7% and the median survival time was 62 too. Stage Ⅱ a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three TIN2, and stage Ⅱb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one TIN3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% （51/269） and 42.5% （71/167） in LN-negative and LN- positive patients, respectively. In 218 patients （50.0%）, there was neither a histopathologically detectable LBVI nor LN metastases （LBVI-/LN-, group I）; in 51 patients （11.7%）, LBVI with no evidence of LN me- tastases was detected （LBVILN-, group 11）. In 167 patients （38.3%）, LN metastases were found. Among those patients, LBVI was not determined in 96 patients （22.0%） （LBVI-γLN, group Ⅲ）, and was determined in 71 patients （16.3%） （LBVI＋LN＋, group Ⅳ）. Correla- tion analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI （P 〈 0.001）. The overall 5-year sur- vival was significantly longer in LN-negative patients compared with LN-positive patients （56.1% vs 42.3%, P = 0.015）. There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI- negative tumors （39.6% vs 54.8%, P = 0.006）. Overall 5-year survival rates in each group were 58.8% （ Ⅰ）, 45.8% （Ⅱ）, 45.7% （Ⅲ） and 36.9% （Ⅳ）, and there was a significant difference in overall survival between the four groups （P=-0.009）. Multivariate analysis in stage 11 gastric cancer patients revealed that LBVI in- dependently affected patient prognosis in LN-negativepatients （P = 0.018） but not in LN-positive patients （P = 0.508）. CONCLUSION： In LN-negative stage 11 gastric cancer patients, LBVI is an additional independent prognostic markeF, and may provide useful information to identify patients with poorer prognosis.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Adalimumab efficacy in enteropathic spondyloarthritis: A 12-mo observational multidisciplinary study

AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was evaluated in the departments of gastroenterology and internal medicine. At baseline, all patients underwent assessment by an integrated gastro-rheumatologic evaluation of articular and gastrointestinal activity, as well patient reported outcomes(PROs) of the HRQo L questionnaires. After this integrated evaluation and following a specific working flowchart, the Ada anti-tumor necrosis factor(TNF)-inhibitor was assigned to a cohort of 30 patients and its clinical efficacy was evaluated at baseline and after 6-mo and 12-mo treatment by the following tests:(1) Ankylosing Spondylitis Disease Activity ScoreC-Reactive Protein(ASDAS-CRP); Bath Ankylosing Spondylitis Disease Activity Index(BASDAI), Bath Ankylosing Spondylitis Functional Index(BASFI) and Bath Ankylosing Spondylitis Metrology Index(BASMI) for articular activity;(2) Inflammatory Bowel Disease Questionnaire(IBDQ), Crohn's Disease Activity Index(CDAI) and partial Mayo(p Mayo) score for gastrointestinal symptoms and activity; and(3) Health Assessment Questionnaire(HAQ), Patient Global Assessment(PGA) and Short Form-36 health survey(SF-36) questionnaires for PROs of the HRQo L.RESULTS Integrated evaluation and management of the patients affected by ES, carried out simultaneously by a gastroenterologist and a rheumatologist, allowed clinicians to choose the optimal therapeutic strategy. In a cohort of 30 ES patients affected by active articular and gastrointestinal disease, or axial active articular inflammation, Ada led to fast and sustained improvement of both articular and gastrointestinal disease activities. In fact, all the clinimetric evaluation tests exploring articular or gastrointestinal activity, as well as all the HRQo L scores, showed a significant improvement having been achieved at the earliest(6-mo) assessment. This important clinical improvement was maintained at the 12-mo follow-up. Importantly, global and gastrointestinal quality of life significantly correlated with articular disease activity, providing evidence to support that the integrated evaluation is the best option to manage patients with ES.CONCLUSION Ada treatment, upon multidisciplinary(gastrorheumatologic) evaluation, significantly improves both articular and gastrointestinal inflammation, thereby improving the HRQo L in patients affected by ES.