Objective To investigate whether antihypertensive treatment is beneficial to patients with diabetes mellitus when their blood pressure (BP) is below 140/90 mm Hg(1 mm Hg =0.133 kPa).Methods MEDLINE,EMBASE,IPA database and secondary resources were searched with terms including blood pressure,hypertension and anti-hypertension drug.Inclusion criteria:random control study; subjects were patients with diabetes mellitus or impaired glucose tolerance; endpoint BP ≤ 140/90 mm Hg; endpoint BP between two groups had significant differences.There were 16 studies meet inclusive criteria with a total of 51 470 patients.RR and 95％ CI were used as index to judge the difference of clinical outcomes between aggressive antihypertensive treatment group and standard antihypertensive treatment group.RevMan5.0 software was used for statistical analysis.Results When BP of patients with diabetes mellitus were below 140/90 mm Hg,anti-hypertensive treatment could reduce incidence rate of cardiovascular event (RR 0.91,95％ CI 0.87-0.96,P =0.0004) and stroke (RR 0.75,95 ％ CI 0.63-0.88,P =0.0005),and increased incidence rate of symptomatic hypotension (RR 3.57,95％ CI 1.41-11.20,P =0.03) and hyperpotassemia (RR 1.57,95％ CI 1.05-2.33,P =0.03).There were no significant differences in all-cause mortality (RR 0.94,95％ CI 0.87-1.01,P =0.08),cardiovascular mortality (RR 0.95,95％ CI 0.85-1.08,P =0.05),myocardial infarction (RR 0.93,95％ CI 0.82-1.05,P =0.26),heart failure (RR 0.90,95％ CI 0.76-1.06,P =0.21) between the aggressive antihypertensive treatment group and standard antihypertensive treatment group.Conclusions When blood pressure of patients with diabetes mellitus was below 140 mm Hg,there was little benefit from aggressive antihypertensive treatment,and the risk of serious adverse events even increased.

Percutaneous left atrial appendage occlusion(LAAO)has emerged as a non-pharmacologic alternative for stroke prevention in non-valvular atrial fibrillation patients.Multiple clinical studies have confirmed that LAAO is safe and effective in the prevention of thromboembolic events for atrial fibrillation patients.With the worldwide recognition of LAAO,it obtains rapid development in the prevention of cardioembolic stroke,but there are still questionable issues worthy of further exploration.The aim of this review is to discuss the effect of LAAO on atrial structure and function,the optimal strategy of LAAO and the best antithrombotic treatment after LAAO.

OBJECTIVE： To analyze the characteristics and regularity of new/severe pediatric ADR in Shandong province， and to promote the safe use of drugs in children. METHODS： A retrospective analysis of new/severe pediatric ADR in the Shandong Provincial ADR database 2016-2017 was conducted in respects of children’s gender and age， primary disease， ADR history， family ADR history， dosage form， route of administration， drug type， systems/organs involved in ADR， clinical manifestations， off-label drug use， drug combination， occurrence time， effects of ADR on primary disease， outcome， etc. RESULTS： A total of 44 742 pediatric ADR cases were collected from Shandong province ADR database from 2016 to 2017， including 27 060 male， 17 664 female and 18 gender unknown. 530 cases were diagnosed as new/severe pediatric ADR， including 334 male and 196 female with ratio of male to female 1.70 ∶ 1. New/severe ADR reports of children aged 1-3 took up the highest proportion （158 cases， 29.81％）. Primary diseases were mainly respiratory disease （190 cases， 25.85％）； there were 10 children with ADR history （1.89％）， 2 with family ADR history （0.38％）. Dosage forms were mainly injection （358 cases， 67.55％）. Route of administration were mainly intravenous drip （431 cases， 81.32％）. The drugs that caused ADR included 20 categories and 162 species， mainly including drug for regulating hydroelectric acid-base balance （148 cases caused by 8 kinds of drugs， 27.92％）， antibiotics （89 cases caused by 33 kinds of drugs， 16.79％）， traditional Chinese medicine and its extract （80 cases caused by 24 kinds of drugs， 15.09％）. The systems/organs involved in ADR were mainly systemic injury （201 cases， 37.92％， main clinical manifestations included chills and fever， etc.）， followed by skin and its appendants （99 cases， 18.68％， mainly clinical manifestations included rash and itching， etc.）， respiratory system （76 cases， 14.43％， main clinical manifestations included dyspnea and cough， etc.）. Off-label drug use were found in 41 cases （7.74％）， including the safety of drug use was not clear in drug instructions （20 cases， 3.77％）； no drug testing was carried out and no reliable references were available （13 cases， 2.45％）， that medicine was prohibited was stated in drug instructions （2 cases， 0.38％）. 106 cases （20.00％） had drug combination， including combined use of two drugs， three drugs and four drugs （62， 36， 8 cases）. ADR occurred mainly within 0-5 min （140 cases， 26.42％）. Among 530 children， ADR had no obvious effect on the outcome of the disease in 457 cases （86.23％）； ADR caused longer course of disease in 57 cases （10.75％）. 278 cases （52.45％） were cured and 243 cases （45.85％） were recovered. CONCLUSIONS： It is necessary to strengthen the monitoring of drug use in children， formulate national standards and relevant laws and regulations for children’s rational drug use， improve the awareness of medical staff to children’s ADR， strengthen the education and publicity of the knowledge about safe drug use in children， and to promote rational drug use.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.