Objective To explore the impact of executive function intervention on the executive functioning of elderly patients with cerebral infarction,and to seek the best way to improve executive function in such patients.Methods Eighty elderly patients with cerebral infarction were randomly divided into an intervention group and a control group.A series of executive function interventions were administered to those in the intervention group with no intervention in the control group.The two groups were given the same conventional medication.The Behavioral Assessment of the Dysexecutive Syndrome (BADS) was taken before the intervention,then 3 months and 6 months after recruitment.Results In the intervention group the average score and the total standard score had increased significantly after 3 months except for the action program test and the modified six elements test.Both indicators were still significantly increased from the baseline afar 6 months except for the modified six elements test.The average score and the total standard score had increased significantly between 3 months and 6 months except on the key search test.Both the time determination test and the total standard score had statistically significant average differences.The control group showed no significant differences.After 3 months,the average scores and the total test standard scores in the intervention group were signifieantiy higher than those in control group except on the action program test.The rules conversion card test,the time determination test and the total standard score difference all showed statistically significant differences between the groups.After 6 months the intervention group's scores remained significantly higher than those of the control group except on the action program test.Conclusions Executive function interventions are effective in delaying the progress and improving the prognosis of executive dysfunction in elderly patients with cerebral infarction,and the therapy has persistent effects.

Objective To explore the effect of physical condition on autonomous social participation function in stroke patients. Meth-ods A survey was conducted on 283 cases of stroke patients from October, 2014 to September, 2015. They were tested with General Situa-tion Questionnaire, Disease Status Questionnaire, Impact on Participation and Autonomy Questionnaire (IPA), Chinese Stroke Scale (CSS), and Mini-Mental State Examination (MMSE). Results Multivariate regression analysis showed that age, scores of MMSE and CSS, and physical disabilities were the factors related with autonomous social participation function in stroke patients (t>2.513, P<0.05). Conclusion It is needed to prevent and treat the complications of stroke early, which may contribute to the improvement of autonomous social participa-tion in stroke patients.

Objective To review the diagnosis,monitoring,management and perinatal outcomes of monochorionic monoamniotic (MCMA) twin pregnancy.Methods From July 2010 to August 2013,there were 17 MCMA twin pregnancies diagnosed and delivered in Shanghai First Maternity and Infant Hospital.According to the MCMA management protocol,induced abortion,elective fetal reduction,and anticipant pregnancy were optional.For those anticipant pregnancies,fetal lung underwent maturation promotion at gestational weeks 28; hospitalization with 40 min/day continual fetal electronic monitoring and umbilical blood monitoring twice weekly at gestational weeks 28-30; 40 min continual fetal electronic monitoring twice daily and umbilical blood monitoring once every other day at gestational weeks 30-32; and 40 min continual fetal electronic monitoring three times daily and umbilical blood monitoring once daily at gestational weeks 32-34; and pregnancy ended on time.The presence of umbilical cord entanglement,congenital malformation,intrauterine fetal death,complications exclusive to monochorionic twins (e.g.selective fetal growth restriction,twin reversed arterial perfusion sequence and twin-twin transfusion syndrome) and the perinatal outcomes were retrospectively analyzed.Results Average maternal age of women with 17 MCMA twins was (29.0±2.7) years,and all were primiparas.They were diagnosed at (18.6± 5.5) weeks on average (11 +5-28+1 weeks).Umbilical cord entanglements were detected in all cases by ultrasonography and confirmed postnatally.There were three cases of complications specific to monochorionic twins,including two with selective fetal growth restriction and one with twin reversed arterial perfusion sequence.There were seven women with fetal congenital malformation; four of whom chose induced abortion; one case of anencephaly chose radiofrequency ablation fetal reduction,and the remaining two cases with congenital malformation and ten cases without chose anticipant pregnancy,and there were no abnormal ultrasonography signs during pregnancy.Among these 12 cases,intrauterine fetal death of both fetuses occurred in two cases at 16 and 21+1 weeks gestation and they were aborted.Intrauterine fetal death of a single fetus occurred in one case at 30+2 weeks gestation (another fetus was delivered by emergency cesarean section).There were a total of eleven live births delivered by cesarean section (four by emergency cesarean section) at a median gestational age of (32.7± 1.6) weeks.There were 20 live neonates with a mean birth weight of (1 850±496) g.Sixteen neonates were transferred to the neonatal intensive care unit and hospitalized for (37.9± 16.4) days.Nine neonates suffered from respiratory distress syndrome but were eventually cured.Conclusions MCMA twin pregnancy has high morbidity and mortality.Early ultrasonography helps to clarify the diagnosis and enhance the monitoring,thus improving the perinatal outcomes.

Objective To explore the correlation between the reliability and validity of Brunel balance assessment(BBA)with the activities of daily living(ADL).Methods The BBA,ADL and walking ability test were performed on 215 patients conforming to the inclusion standard by two professionals.The Pearson correlation analysis,factor analysis and descriptive statistical analysis were adopted.Results The BBA total score and Cronbach's α coefficient in 3 dimensions was 0.852～0.941(P＜0.01),moreover the relative coefficient of each item with its dimension was higher that that of other dimensions;3 common factors were extracted by the factor analysis,the contribution rate was 83.916％;but BBA had the ceiling effect,the relative coefficient of BBA with ADL and walking ability was 0.284-0.709(P＜0.05).Conclusion BBA has a good reliability and validity and can better reflect the functions of ADL and walk.

Objective To observe the effect of somatosensory interactive technology of Kinect on post-stroke depression (PSD). Methods 60 patients with PSD were divided into control group (n=30) and experimental group (n=30), who accepted routine rehabilitation and Kinect in addition, respectively. They were assessed with Zung's Self-rating Depression Scale (SDS) before and 4 weeks after intervention. Results The scores of SDS was (43.25±10.11) in the experimental group, which was less than that in the control group (55.67±8.80) after intervention (P<0.01). Conclusion Rehabilitation with somatosensory interactive technology of Kinect may improve the efficiency on PSD.

To evaluate the reliability and accuracy of MRI-guided stereotactic biopsy for supratentorial brain lesions. Method: A total of 103 cases of MRI-guided biopsy were performed between November 2009 and December 2013. Patients' pathological results and postoperative rehabilitation courses were analyzed. Results: A total of 102 patients (99.0%) had pathological results, of which 97 cases were brain tumors (86.0%), including 36 cases of astrocytoma, 9 cases of anaplastic astrocytoma, 10 cases of oligoastrocytoma, 4 cases of anaplastic oligoastrocytoma, 4 cases of anaplastic ligodendroglioma, 3 cases of glioblastoma multiforme, 27 cases of lymphoma, 3 cases of germcell tumors, and 1 case of rhabdomyosarcoma. Inflammatory lesions were found in 3 cases (2.9%). Displacement of brain gray matter was reported in 2 cases (2.0%), and 1 case (1.0%) of cerebral infarction existed. A total of 3 patients suffered intracranial hematoma after biopsy, and 1 patient underwent craniotomy to remove the hematoma. No death or intracranial inflammation occurred after biopsy.Conclusion: MRI-guided stereotactic biopsy is a safe and reliable method in qualitative diagnosis. It is a very important tool for diagnosis and treatment selection for intracranial lesions.

Objective To explore the correlation between polarization status of microglia/macrophages(MG/MP)in brain tissue and edema around hematoma in patients with acute cerebral hemorrhage.Methods A total of 52 patients with acute intracerebral hemorrhage admitted to Anyang People's Hospital from December 2020 to November 2022 were selected as the research subjects.All patients underwent craniotomy to remove hematoma,and the normal brain tissue in the cortical area that was not invaded by the hematoma and the fragmented brain tissue around the hematoma(brain tissue around the hematoma)on the surgical pathway were obtained.The expression levels of inflammatory factors such as interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),IL-10 and transforming growth factor-β(TGF-β)protein in brain tissue were detected by Western blot.The expression levels of IL-1 β,IL-6,TNF-α,IL-10 and TGF-β mRNA in brain tissue were detected by fluorescence quantitative polymerase chain reaction.The levels of M1-type and M2-type MG/MP in brain tissue was detected by immunofluorescence confocal technique.CT images data of patients before operation were collected and the relative-erihema-tomal edema(r-PHE)was calculated.The patients were divided into high r-PHE group(2.0≤ r-PHE＜2.5)and low r-PHE group(1.5＜r-PHE＜2.0)according to r-PHE.The relative expression of IL-1 β,IL-6,TNF-α,IL-10 and TGF-β mRNA in brain tissue around the hematoma of patients between the high r-PHE group and the low r-PHE group was compared.Results The relative expressions of IL-1 β,IL-6,TNF-α protein and mRNA in brain tissue around the hematoma were significantly higher than those in the normal brain tissues(P＜0.05),but there was no significant difference in the relative expressions of IL-10 and TGF-β protein and mRNA between the brain tissue around the hematoma and the normal brain tissue(P＞0.05).The levels of M1 type and M2 type MG/MP in the brain tissue around the hematoma were significantly higher than those in normal brain tissue(P＜0.05).The relative expressions of IL-1β,IL-6 and TNF-α mRNA in the brain tissue around the hematoma of patients in the high r-PHE group were significantly higher than those in the low r-PHE group(P＜0.05),and there was no significant difference in the relative expressions of TGF-β and IL-10 mRNA in the brain tissue around the hematoma of patients between the two groups(P＞0.05).Conclusion The levels of pro-inflammatory factors and M1-type MG/MP are increased in the brain tissue around the hematoma in patients with acute cerebral hemorrhage,and the degree of polarization of M1-type MG/MP is consistent with the degree of edema around hematoma after cerebral hemorrhage.

Objective:To explore the demand and mode of palliative care for emergency dying patients by analyzing the case data of emergency death and cardiopulmonary resuscitation.Methods:The data of 776 cases of emergency clinical death and cardiopulmonary resuscitation in the Second Affiliated Hospital of Soochow University from 2017 to 2020 were retrospectively analyzed.Results:A total of 687 patients were included with (70.38 ± 16.57) years old, and 49.8% (342/687) of them were 75 years old and above; among them, 36.0% (247/687) patients or their families chose not to give cardiopulmonary resuscitation (DNR) in the last stage of their lives,and 63.2%(156/247) of DNR patients were 75 years old and above. The top four etiology of DNR were cerebral hemorrhage, respiratory failure, multiple organ dysfunction syndrome and out of hospital cardiac and respiratory arrest.After successful cardiopulmonary resuscitation, 37.5% (45/120) of the patients' family members chose to give up treatment again. The median stay time of DNR patients in the emergency room was 738.7 minutes.Conclusions:The patients who choosed DNR were mainly 75 years old and above, with cerebral hemorrhage, respiratory failure, multiple organ failure and cardiac and respiratory arrest. The detention of these patients in the emergency room increases the congestion of the emergency room, and at the same time, they can not get a peaceful palliative care environment. It is suggested that emergency medical staff should strengthen the awareness and improve the ability of palliative care. A relative independent area and corresponding soothing palliative treatment and nursing should be given to the DNR patients.