The implementation of two-child policy has great significance.It can rationalize the population structure,diversify the family model,easethe pension problem significantly,and rationalize parent-child relationships.At the same time,there exist ethical problems in some aspects of society,such as the attribution of female reproductive fights,the anxiety the only child suffered from the second child,the continuing imbalance of gender,the occupational predicament of female reproduction,the effects on women health and family economy.Therefore,the country and society should respect and maintain women's reproductive rights,guarantee women's occupational stability,pay attention to the education of family ethics,promote the traditional values of respecting the old and cherishing the young,and develop the social old-age security system,thus to ensure the effective implementation of the two-child policy and build a harmonious family and society.

Objective To discuss the clinical features of pregnant women with hypertrophic cardiomyopathy (HCM).Methods There were 28 patients with HCM who delivered in Renji hospital of Shanghai Jiaotong University from January 2000 to August 2012.Clinical data were analyzed,including diagnosis,cardiac functional grading,gestational weeks of delivery,delivery mode,birth weight,Apgar scores,etc.Results (1) Of all the 28 patients,14 (50％) were diaguosed before pregnancy and others (50％) were diagnosed during pregnancy.(2) Four cases were obstructive HCM (14％),3 with cardiac function grade Ⅰ and 1 with grade Ⅱ.Twenty four cases were non-obstructive HCM (86％),14 with cardiac function grade Ⅰ,9 with grade Ⅱ and 1 with grade Ⅳ.(3) Of all the 28 patients,4 had family history,18 (64％) had clinical symptoms or signs which occurred in 8-32 gestational weeks.Twenty-three cases had abnormal ECG (82％).Among them 21 had non-obstructive HCM (88％),with average interventricular septal thickness of(22 ± 3) mm.The other 2 patients had obstructive HCM,with average interventricular septal thickness of (23 ± 4) mm.7 patients (7/28,25 ％) had mild-to-moderate pulmonary hypertension [6 with non-obstructive HCM (6/24,25％)],and 10 patients had abnormal myocardial enzyme spectrum or troponin levels [9 with non-obstructive HCM (9/24,38％)].(4) Among all the patients,only one had vaginal delivery and others received cesarean section.Twenty-two patients had term pregnancies and 6 had preterm birth.The average gestational weeks of delivery in non-obstructive HCM and obstructive HCM were (36.5 ± 2.5) and (38.5 ± 0.4) weeks,respectively.The average birth weight of neonates were (2684 ± 563) and (3164 ± 321) g,and Apgar scores were 9.9 and 10 (10 minutes) respectively.Patients transferred to NICU after delivery were 8 and 0.There was 1 maternal death(with nonobstructive HCM whose ejection fraction was only 26％) and no perinatal death.Conclusions More attention should be paid to the clinical signs and abnormal ECG.HCM could be definitely diagnosed by timely echocardiography.Patients with hypertrophic cardiomyopathy were mainly non-obstructive HCM,with cardiac function grade Ⅰ and Ⅱ.Monitoring the change of ejection fraction during pregnancy would help.Perinatal outcomes were fine.

Objective To investigate the efficacy of progressive resistance exercise for improving the lower limb motor function of hemiplegic stroke patients. Methods Eighty-nine hemiplegic patients were randomly divided into a treatment group (n =46) and a control group ( n = 43 ) . Both groups received routine rehabilitation training, while the treatment group also undertook progressive resistance training. The control group received extra quadriceps femoris training. Before and after the treatment, motor function was evaluated with the Fugl-Meyer lower limb assessment, functional ambulation category (FAC) classification and the modified Barthel index (MBI). Results Before intervention, there were no significant differences between the two groups in any of the assessments. Four weeks later, all the assessment scores obtained with the Fugl-Meyer lower limb assessment, FCA classification and MBI in the treatment group were significantly better than those in the control group. Conclusion Progressive resistance training combined with routine rehabilitation treatment can improve motor function in the lower limbs, ambulation and ability in the activities of daily living of hemiplegic patients after stroke.

Objective To evaluate the effect of mouse nerve growth factor on fracture healing.Methods Cochrane library, Pubmed, EMbase, CNKI,VIP,Wanfang Data and CBM were searched for the randomized controlled trials(RCTs)of mouse nerve growth factor on fracture healing from the date of establishment of the databases to May 2014.Three independent rese archers evaluated the included studies using GRADE,according to recommend classification method of GRADE system by three researchers,crtical evaluated and data extracted of the quality of the included studies,which conform to the quality standard of RCT was analyzed by Meta analysis.The extracted data were analyzed by RevMan 5.0 and GRAED proiler.Results A total 5 trials were discovered and all of these were in Chinese.Compared with conventional treatment was improved a lot[MD =-8.74,95%CI( -9.79,-7.68),P<0.0001].However, adverse drug reaction in patients with mouse nerve growth factor were increased[OR =14.66,95%CI(1.89, 113.99),P=0.01].The both outcomes were low quality in the GRADE system.Conclusion Mouse nerve growth factor can improve fracture healing and the side effects will also increase.

OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,scope and purpose and clarityshowed the higher scores in AGREEⅡ,more than 70%,and applicability showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved inrigourandapplicabilityin future.

Objective To observe the effects of systems of progressive resistance exercise on lower limb extensors （quadriceps femoris） of stroke patients. Methods 89 stroke patients with weak lower limbs were randomly divided into progressive resistance exercise group (n=46) and control group (n=43), both receiving corresponding treatment for 4 weeks. They were assessed with Manual Muscle Test (MMT), integrated electromyogram (iEMG) and root mean square (RMS) of surface electromyography on quadriceps femoris before and after the treatment. Results The incidence of improvement with MMT was 94.3% in progressive resistance exercise group, and 63.8% in control group （P<0.01）. The iEMG and RMS of the exercise group was significantly higher than that of the control （P<0.01）. Conclusion The systems of progressive resistance exercise could improve the muscle strength of lower limbs extensors of stroke patients more effectively.

To study the implementation of the epidemic prevention by the authorities of the concession and late Qing dynasty through investigation of the prevention and treatment of pestilence in Shanghai from 1872 to 1911, this paper analyzes the issues concerning municipal administration, inspection and disinfection, food sanitation, vaccination, regulatory legislation and health promotion, etc. The experiences are summarized in the study. The lessons drawn from what the concession authority did to prevent pestilence imply that the implementation of health promotion should be carried out according to the variation of the time, location and population, and that traditional Chinese medicine should be involved in the prevention and treatment of pestilence.

ObjectiveTo verify the reliability of the mouse model of cerebral cortical microinfarct induced by two-photon microscopy and to explore its pathological changes.MethodsSeventeen male C57BL/6J mice were randomly divided into a microinfarct group (n=11) or a sham operation group (n=6).A thinned cranial window of 3 mm diameter was performed over the cerebral cortex with a high-speed micro-drill until the small blood vessels were clearly observed under a dissecting microscope.Then, a permanent single cortical penetrating arteriole occlusion was induced with a gradually enhanced ultrashort laser irradiation through the thinned cranial window with two-photon microscopy.At 7 days after modeling, the cerebral microinfarct volume was measured with HE staining, and the neuron loss, activation of glial cells and deposition of 3-nitrotyrosine were assessed using immunohistochemistry.ResultsThe target vessels of cerebral cortex in 8 (72.7%) mice were occluded and the microinfarcts formed in the microinfarct group, and the average microinfarct volume was 317.23±20.29 μm3.There were remarkable neuron loss and microglia infiltration in the infarcted core, a large number of reactive astrocytes surrounding the infarcted lesion, and massive deposition of 3-nitrotyrosine in the peri-infarct area.No infarcts were observed in the sham operation group.The deposition of 3-nitrotyrosine in the sham operation group was significantly less than that in the microinfarct group (8.00±1.48 vs.98.38±9.10;t=23.962, P<0.001).Conclusions The mouse model of cerebral cortical microinfarct induced by two-photon microscopy is reliable, and its histopathologic changes are consistent with the pathologic features of cerebral microinfarct.

Objective:To study the relationship between compartmental kneeosteoarthritis (KOA) and osteoporosis (OP).Methods:A total of 118 KOA patients with 50~80 years old and 16.5~38 of body mass index (BMI) were selected as the KOA group, in which the patient with OP caused by secondary factors were excluded. 42 patients who did not suffer from KOA who matched the age of patients in the KOA group were selected. The age, BMI, bone mineral density (BMD) and other data of the two groups of patients were collected. The correlation analysis between KOA and OP was conducted to determine the degree of correlation, so as to reveal the relationship between the incidence, progression, prognosis of KOA and OP.Results:BMD was correlated with BMI. BMD was negatively correlated with age. The incidence of KOA and OP was correlated with age. There is a large correlation between KOA and OP, and the probability of KOA associated with OP is high. For KOA patients, OP is less likely to be accompanied by a higher BMI, while OP is more likely to be accompanied by a lower BMI.Conclusions:OP is one of the pathogenic factors of KOA. KOA patients should be treated with anti-OP before and after surgery.

OBJECTIVE： To provide reference for optimizing the treatment of children with infective endocarditis. METHODS： Clinical pharmacists provide whole process pharmaceutical care for a child with congenital heart disease and infective endocarditis admitted to our hospital in April 2017.  According to the individual situation of child， when therapy efficacy was poor， medication suggestions were put forward by timely referring to the guide and literature as well as combined with pharmacists’ work experience. RESULTS： After treatment with vancomycin at normal dose of 38 mg/（kg·d）， the vancomycin blood concentration （1.3 μg/mL） was low， and the treatment effect was poor. Clinical pharmacist made two suggestions to adjust the dose of vancomycin. The first dose was 45 mg/（kg·d）， the second dose was 60 mg/（kg·d）； pediatrician adopt clinical pharmacist recommendations completely. After treatment， the child’s body temperature was normal； vancomycin blood trough concentration increased to 5.8-6.5 μg/mL， and the disease was controlled. CONCLUSIONS： During vancomycin treatment of infective endocarditis in children， clinical pharmacists should provide pharmaceutical care throughout the course and pay close attention to the blood trough concentration of vancomycin in order to ensure the rational use of drugs in children.