Progress in clinical application of topical anesthesia / 中国临床药理学与治疗学

Topical anesthesia are being widely used in clinical diagnostic or therapeutic fields such as ophthalmology, ENT, dermatology, urology. It is defined as superficial loss of sensation in mucous membranes or skin, produced by direct application of penetrating local anesthetics. Topical anesthesia has the advantages of simple performance, high safety, quick recovery, which can effectively improve patient's satisfaction. In recent years, more and more attention has been paid to the concept of comfortable diagnosis and treatment. The new drugs and application methods of topical anesthesia are emerging constantly, special attention must be paid to their pharmacological characteristics and possible adverse reactions when using them. This article reviews the research progress of topical anesthesia in clinical application in order to provide reference for clinical practice.

A multi-center survey on the therapeutic status of patients with acute myocardial infarction in Wuxi city of China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the characteristics and therapies of patients with acute myocardial infarction (AMI) in Wuxi city, China.</p><p><b>METHODS</b>A network was established to obtain information of patients with AMI who were admitted to 9 designated hospitals between 2011 and 2012. A total of 1 714 patients were enrolled (1 334 males, 754 smokers, 1 076 hypertension, 270 hyperlipidemia and 398 diabetes) including 1 410 patients with acute ST-segment elevation myocardial infarction (STEMI) and 304 patients with acute non ST-segment elevation myocardial infarction (NSTEMI). Patients' characteristics, therapies, the incidence of major adverse cardiovascular events (MACEs) and all-cause mortality were analyzed.</p><p><b>RESULTS</b>(1) Medication therapy was as follows: antiplatelet therapy 98.3% (1 685 cases) , beta-blockers 59.1% (1 013 cases) , ACEI or ARB 67.6% (1 159 cases) , statins 98.1% (1 682 cases) , and nitrates 71.1% (1 218 cases) . Of the patients, 7.1% (132 cases) received temporary pacemakers, 34.0% (480 cases) with acute STEMI underwent reperfusion [direct PCI 18.4% (260 cases) and thrombolysis 15.6% (220 cases)]. (2) According to the hospital admission data, patients were divided into three groups: group A, transported to the hospital by ambulance (n = 361); group B, transported to the hospital by private vehicles (n = 1 318); and group C, AMI occurred in the hospital (n = 35). The median time of AMI onset to physician contact of the 3 groups was 178 min, 368 min, and 9 min, respectively. The median time from AMI onset to the first ECG was 181 min, 379 min, and 10 min, respectively. The median time from AMI onset to cardiology specialist consultation was 187 min, 431 min, and 69 min, respectively. AMI onset-to-physician contact, AMI onset-to-first ECG, and AMI onset-to-specialized treatment time was the shortest in group C, followed by group A and group B. For patients with STEMI underwent reperfusion therapy, the median AMI onset-to-reperfusion therapy time was significantly shorter in group A patients than group B patients [thrombolysis group: 224(171, 514) min vs. 378 (158, 785) min, PCI group: 318 (154, 674) min vs. 489 (143, 816) min, all P < 0.05]. (3) The total incidence of MACEs was 16.3% (279/1 714), the all-cause in-hospital mortality rate was 13.1% (224/1 714). According to the AMI onset-to-physician contact, patients were divided into 4 groups: <3 h, 3-6 h, 6-12 h, and >12 h. The incidence of MACEs [4.4% (23/517), 13.3% (60/451), 19.1% (77/404) and 34.8% (119/342),χ(2) = 114.36, P < 0.01] and all-cause in-hospital mortality rate [4.1% (21/517) , 10.4% (47/451), 18.6% (75/404), 23.7% (81/342), χ(2) = 84.36, P < 0.01] increased in proportion to the time of AMI onset-to-physician contact. Among STEMI patients, the incidence of MACEs [5.8% (15/260) , 12.3% (27/220) , 20.9% (194/930) ,χ(2) = 39.93, P < 0.01] and all-cause in-hospital mortality [1.5% (4/260) , 10.0% (22/220) , 18.2% (170/930) ,χ(2) = 50.90, P < 0.01] was the lowest in the primary PCI group, followed by thrombolysis group and was the highest in the early conservative treatment group.</p><p><b>CONCLUSIONS</b>Guideline is well followed in terms of drug treatments of AMI in this cohort, but only a small proportion of AMI patients in Wuxi received reperfusion therapy. There is a considerable out-of-hospital time delay for AMI patients in this cohort which is shorter in group A than in group B. All-cause in-hospital mortality and MACEs is the lowest in AMI patients underwent primary PCI.</p>

Transcatheter closure of perimembranous and muscular ventricular septal defects using the new Amplatzer VSD occluder and the effect of cardiac conductive system / 中国实用内科杂志

Objective To evaluate the feasibi1ity and efficacy of transcatheter closure of perimembranous and muscular ventricular septal defects (VSD) using the new Amplatzer membranous and muscular VSD occluder and observe the effect of membranous VSD occluding procedure on atrioventricular(AV) conductive system.Methods Twelve patients (7 males,5 females) with perimembranous VSD and two patients (1 male,1 female) with muscular VSD underwent an catheter closure using the new Amplatzer membranous and muscular VSD occluder.All patients who were eligible for device closure by means of cardiac Doppler echocardiography were routinely measured the parameters of blood dynamics before catheter closure. Artery-venous track was set up under the X-ray fluoroscopy,transesophageal (TEE) or transthoracic echocardiography (TTE) guidance. Devices were released in the right ventricular side.Twelve patients with perimembranous VSD underwent the cardiac electrophysiologic examination,including atrioventricular conductive time (AV interval) and atrioventricular nodal refractory time,before and after catheter closure.A11 patients were followed up at 2 weeks,1 month,3 months and 6 months after the procedures.Results The devices were deployed successfully in 14 patients.There was complete closure in 12 patients immediately,and tiny (