Very early thrombolysis in acute myocardial infarction--a light at the end of the tunnel

Myocardial damage in acute myocardial infarction is a time-dependent process. Thrombolytic therapy effectively opens the coronary artery, restores coronary blood flow and prevents ongoing necrosis. We examined the effect of very early thrombolytic therapy (including prehospital administration) in a consecutive group of 510 patients with myocardial infarction on the following factors: mortality, complications and the preservation of left ventricular function. The treatment was given to 89 at home (time delay to treatment 1.2 +/- 0.6 h) and 421 in hospital (2.0 +/- 1.0 h). Twelve patients died in hospital and major hemorrhage occurred in 10. The arterial patency rate in 416 patients who underwent coronary angiography 6 days later was 82%. Infarct size measured by left ventriculography was determined by the area at risk, the delay time until the initiation of thrombolytic therapy, the total duration of ischemic pain and the degree of restoration of arterial blood flow. We conclude that early thrombolytic therapy, particularly prehospital management, is feasible and safe and reduces infarct size and mortality. A further decrease in the delay to initiation of treatment and more effective thrombolytic therapy will further decrease mortality and myocardial damage.     

Report of the Treasurer, 1975: Light at the end of the tunnel.

Presents the American Psychological Association's (APA's) treasurer's report for 1975. This financial overview includes (a) our audited report of the 1974 results from operations; (b) a look at APA's financial condition as of December 31, 1974; (c) a prediction for 1975; (d) a glance at the 1976 approved budget; and (e) a peek at the association's prospects for 1977. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Light for PM at the end of the tunnel as the China question looms?

With shipments of iron, stainless steel, nickel and tin powders up last year, is the PM industry in the US slowly turning the corner? Does the rapid industrialisation of China represent a threat or an opportunity? The president of the Metal Powder Industries Federation, David Schaefer, and the organisation's executive director, Jim Trombino, shared their thoughts at last month's PM²TEC conference and exhibition, held this year in Chicago…     

Identifying and measuring diversity's payoffs: Light at the end of the affirmative action tunnel.

Because affirmative action is a means for achieving diversity and is, the authors argue, not an end in and of itself, diversity as an end and a concept, along with diversity's payoffs, are highlighted here. Another reason for doing an end-run around affirmative action is that it is a code expression, conjuring up controversial and contentious affect, including reverse discrimination, quotas, and set-asides, which are anathema in the twilight of the 20th century. Hence, the authors' attention is on the bottom line, diversity, as a legitimate end whose payoffs are coveted by employers and institutions of higher learning. They then offer a scheme for selecting employees and students targeted for diversity's payoffs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain control at the end of life

Pain control at the end of life is almost always achievable regardless of the cause. Most of the principles for managing pain at the end of life are derived from cancer practice. However, this knowledge can be extended to patients with pain from other illnesses at the end of life. Pain assessment is the most important step toward achieving optimal analgesia. It determines the appropriate analgesic therapy; drug dose and route of administration; drug dosing intervals; titration of drug doses; control and prevention of analgesic side effects; and application of adjuvant, loco-regional (nonsystemic), and invasive treatments. A comprehensive approach that integrates patient preferences and management of psychosocial and spiritual/existential components of the patient's pain and suffering with physical components will improve analgesia, reduce the burden of the illness and its treatment, and improve the patient's quality of life.     

Ethical care at the end of life

In treating dying patients, who by virtue of their physical and emotional situation are frail and vulnerable, physicians must meet a high standard of professional, ethical care. Such a standard is based upon a philosophy of care that recognizes the patients' inherent worth as human beings and their uniqueness as individuals. The ethical and virtuous physician will practice in accordance with the principles of biomedical ethics that form the foundations of thought and treatment approaches in this area and will seek to do the best for the patient and the family. "Doing the best" includes respecting autonomy through gentle truth-telling, helping the patient and family to set treatment goals, and providing for symptom control, continuing attentive care and accompaniment throughout the course of the illness. Total care includes physical, emotional and spiritual aspects, is sensitive to cultural values and is best provided by an interdisciplinary team. Practices of symptom control in routine care and in crisis situations, as well as the cessation and non-initiation of treatment, will have as their goals the relief and comfort of the patient. The ethical physician will not act with the intention of bringing about the death of the patient, whether by ordering medication in excess of that required for symptom control, administering a lethal injection or any other means.     

Evidence-based care at the end of life

Ascites due to cirrhosis can usually be managed successfully by dietary sodium restriction and carefully monitored diuretic therapy. However, paracentesis with an albumin infusion is a relatively safe alternative that has gained widespread acceptance. Other plasma expanders offer a cheaper alternative to albumin. Other recently developed techniques include peritoneovenous shunt and transjugular intrahepatic portosystemic stent shunt. Each of these is associated with an operative mortality and substantial complications, but for diuretic-resistant ascites a peritoneovenous shunt has comparable results to paracentesis/albumin. For patients with spontaneously occurring renal failure the prognosis is poor. None of the above treatments improves renal function. Management should therefore be symptomatic with paracentesis as necessary.     

存窿放矿末期水力运搬与掘进废石充填空区在堡子湾金矿的应用

通过堡子湾金矿矿体的特殊性介绍了含金角砾岩矿体的残余存窿矿石回收方法，并根据无分布规律矿体的开采实践经验，总结出了空区地压管理的方法。