Timely identification of atypical acute aortic dissection in the emergency department:a study from a tertiary hospital

Background/aim: Acute aortic dissection (AAD) is a rare but fatal disease if left untreated. Symptoms are often similar to common conditions; therefore, the diagnostic strategy is important. We aimed to identify the atypical symptoms in a timely manner without putting patients at greater risk for undetected AAD. Materials and methods: We conducted a retrospective observational study of 59 AAD patients with both atypical and typical symptoms from January 2012 to December 2016. Patients with atypical symptoms continuing more than 30 min underwent a D-dimer test and computed tomography (CT) or computed tomographic angiography (CTA). Results: Of the 59 AAD patients, 22 were atypical. In the atypical group, the median delay time in our hospital was 3.1 h; average delay time after July 2015 was shorter than average delay time before June 2015 (16.59 ± 24.70 vs. 1.90 ± 0.57 h, P = 0.076). Conclusions: For patients in the emergency department who are suspected of having AAD, incorporating atypical symptoms with high levels of D-dimer into a triage strategy could improve the efficiency of clinical decision making. Furthermore, essential education directed towards the recognition of the atypical symptoms of AAD for front-line physicians may aid in a timely diagnosis, as compared with the usual assessments in the emergency department.

[Discriminant Analysis of Lavender Essential Oil by Attenuated Total Reflectance Infrared Spectroscopy].

This work aimed to use attenuated total reflectance Fourier transform infrared spectroscopy to identify the lavender essential oil by establishing a Lavender variety and quality analysis model. So, 96 samples were tested. For all samples, the raw spectra were pretreated as second derivative, and to determine the 1 750-900 cm(-1) wavelengths for pattern recognition analysis on the basis of the variance calculation. The results showed that principal component analysis (PCA) can basically discriminate lavender oil cultivar and the first three principal components mainly represent the ester, alcohol and terpenoid substances. When the orthogonal partial least-squares discriminant analysis (OPLS-DA) model was established, the 68 samples were used for the calibration set. Determination coefficients of OPLS-DA regression curve were 0.959 2, 0.976 4, and 0.958 8 respectively for three varieties of lavender essential oil. Three varieties of essential oil's the root mean square error of prediction (RMSEP) in validation set were 0.142 9, 0.127 3, and 0.124 9, respectively. The discriminant rate of calibration set and the prediction rate of validation set had reached 100%. The model has the very good recognition capability to detect the variety and quality of lavender essential oil. The result indicated that a model which provides a quick, intuitive and feasible method had been built to discriminate lavender oils.

[The immunogenicity and safety of 10 microg recombination yeast hepatitis B vaccine applied in expanded population].

OBJECTIVE: To assess the feasibility of the 10 microg recombination yeast hepatitis B vaccine in the expanded applicable population group aged 5 - 18. METHODS: People with both HBsAg and anti-HBs negative were selected to take two-stage clinical experiment and the safety and immunogenicity were observed. Safety observation was conducted in 925 subjects, while 568 for immunogenicity. The observation group (aged 5 - 18) included 493 subjects, and (age > 18) 75 enrolled in control group. For the observation group, there were three sub-groups including a child group (141, aged 5 - 6), early youth group (177, aged 12 - 13), and youth group (175, aged 16 - 18). Both groups were administered with 10 microg recombination yeast hepatitis B vaccines with 3 doses at 0 month, 1st month, 6th month. To assess the immunogenicity, the vaccination reactions were observed during the following 4 weeks in order to assess the vaccine safety. The blood samples were taken during 4 - 6 weeks after fully vaccinated, and then anti-HBs were tested with RIA and analyzed by comparing the positive rate of anti-HBs, the geometric mean titer (GMT) and the protective rate between the two groups. RESULTS: Both observation and control group didn't show any general reactions, adverse events following immunization (AEFI) or coincidental cases when observed at 0.5 h, 6 h, 24 h, 48 h, 72 h, 1 week, 2 weeks, 3 weeks, 4 weeks after being vaccinated. The result of serum test showed, the positive rates of child group, early youth group, youth group and control group were respectively 100.00% (141/141), 97.18% (172/177), 98.29% (172/175) and 89.33% (67/75); the GMTs of anti-HBs were respectively 440.28, 875.38, 467.80, 131.06 U/L; the protective rates were respectively 100.00% (141/141), 97.18% (172/177), 97.14% (170/175) and 86.67% (65/75). The positive rate, GMT and protective rate of the experimental group were all higher than that of control group (chi(2)(positive rate) = 12.77, 5.12, 7.99; t(GMT) = 3.89, 4.13, 5.91; chi(2)(protective rate) = 16.81, 8.60, 8.44; P < 0.05). CONCLUSION: This vaccine could be expanded to 5 - 18 year-old population with safety and effectiveness, the positive rate and protective rate of anti-HBs were both higher than that of control group.