Efficacy of the All-in-One Therapeutic Strategy for Severe Traumatic Brain Injury: Preliminary Outcome and Limitation / 대한신경손상학회지

OBJECTIVE: Despite recent advances in medicine, no significant improvement has been achieved in therapeutic outcomes for severe traumatic brain injury (TBI). In the treatment of severe multiple traumas, accurate judgment and prompt action corresponding to rapid pathophysiological changes are required. Therefore, we developed the “All-in-One” therapeutic strategy for severe TBI. In this report, we present the therapeutic concept and discuss its efficacy and limitations. METHODS: From April 2007 to December 2015, 439 patients diagnosed as having traumatic intracranial injuries were treated at our institution. Among them, 158 patients were treated surgically. The “All-in-One” therapeutic strategy was adopted to enforce all selectable treatments for these patients at the initial stages. The outline of this strategy is as follows: first, prompt trepanation surgery in the emergency room (ER); second, extensive decompression craniotomy (DC) in the operating room (OR); and finally, combined mild hypothermia and moderate barbiturate (H-B) therapy for 3 to 5 days. We performed these approaches on a regular basis rather than stepwise rule. If necessary, internal ecompression surgery and external ventricular drainage were performed in cases in which intracranial pressure could not be controlled. RESULTS: Trepanation surgery in the ER was performed in 97 cases; among these cases, 46 had hematoma removal surgery and also underwent DC in the OR. Craniotomy was not enforced unless the consciousness level and pupil findings did not improve after previous treatments. H-B therapy was administered in 56 cases. Internal decompression surgery, including evacuation of traumatic intracerebral hematoma, was additionally performed in 12 cases. Three months after injury, the Glasgow Outcome Scale (GOS) score yielded the following results: good recovery in 25 cases (16%), mild disability in 28 (18%), severe disability in 33 (21%), persistent vegetative state in 9 (6%), and death in 63 (40%). Furthermore, 27 (36%) of the 76 most severe patients who had an abnormal response of bilateral eye pupils were life-saving. Because many cases of a GOS score of ≤5 are included in this study, this result must be satisfactory. CONCLUSION: This therapeutic strategy without any lose in the appropriate treatment timing can improve the outcomes of the most severe TBI cases. We think that the breakthrough in the treatment of severe TBI will depend on the shift in the treatment policy.

Review of the 3-Chamber Bag Preparations for Total Parenteral Nutrition

Total parenteral nutrition (TPN) therapy has advanced significantly during the recent half a century, from single bottle therapy to the combined therapy including macronutrients and micronutrients. The purposes of 3-chamber bag development are to reduce the restriction of total nutrient admixture, and increase the accessibility of therapy. This is also based on trial and errors during R&D activities, and the clinical experiences at the hospital compounding centers. The 3-chamber bag started with concerns regarding the mixture of fat and glucose and amino acids, but up to the present, it is used widely with clinical experience of more than 15 years. Therefore, it might be reasonable to ensure that its efficacy and safety is confirmed. The physicians have reported that it contributes to the convenient and efficient nutrition therapy, allowing enhanced patient compliance and convenience at hospital. In addition, depending on the further R&D works, 3-chamber bags are expected to advance further, opening a new landscape for advanced nutrition therapy.

Effect of all-in-one nursing intervention on patients with anxiety and depression of esophageal carcinoma negative emotion and immune function / 中国实用护理杂志

Objective To investigate the effect of all-in-one nursing intervention on esophageal carcinoma patients with bad emotion and immune function. Methods From the October, 2012 to the October, 2013, 102 patients with radical operation of esophageal carcinoma were divided into all-in-one nursing intervention group (research group, 52cases) and routine nursing group (control group, 50 cases) according to the random number table method.Two groups of patients were evaluated before and after operation of anxiety and depression emotion scores, with the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) .At the same time, two groups of patients were detected the stress and immune index before and after the operation. Results Before operation, two groups of patients with anxiety, depression, stress reaction and immune index were not significantly different (P>0.05).After operation, the study group patients with anxiety and depression scores were significantly lower than those in the control group [(34.6+6.7) points vs. (44.8+7.5) points, (33.7+6.9) points vs. (40.6+7.3) points], the difference was statistically significant (t values were 7.234, 4.902, P<0.05). Eighth days after operation, patients in the control group FBG, CRP and Cor levels were significantly higher in the study group [(6.98±1.12)mmol/L vs.(6.09±0.85)mmol/L,(18.11±5.93) mg/L vs.(9.24±3.22)mg/L,(293.98±69.09)nmol/L vs.(221.97±67.94)nmol/L],the difference was statistically significant (t values were 4.532, 9.336, 5.307, P<0.05). Eighth days after operation, two groups of patients with IgA, IgM were higher than first days after operation [(2.41±0.46)g/L vs.(1.89±0.56)g/L,(2.51±0.58) g/L vs.(1.35±0.67)g/L and (2.36±0.53)g/L vs.(1.82±0.46)g/L, (2.34±0.62)g/L vs. (1.37±0.64) g/L], the difference was statistically significant (t values were 5.174, 9.439, 5.549, 7.850, P<0.05).The total number of patients blood lymphocytes (LYM) and cytokines (CD3, CD4, CD8, CD4/CD8) were significantly higher than the control group [(2.87±0.65)×109/L vs.(1.98±0.58)×109/L, 0.62±0.10 vs. 0.57±0.07, 0.41±0.08 vs. 0.35 ±0.08, 0.24 ±0.04 vs. 0.26 ±0.05, 2.06 ±0.44 vs. 1.65 ±0.46], the difference was statistically significant (t values were 7.286, 2.915, 6.942, 2.225, 4.601, P<0.05). Conclusion All-in-one nursing intervention can significantly improve the anxiety and depression in patients with esophageal cancer in bad mood, enhance the immune function of patients, conducive to the rehabilitation of patients.

Analysis on the rationality of using parenteral nutrition preparation in Nanjing General Hospital / 医学研究生学报

Objective Clinical parenteral nutrition( PN) support still lacks in standards on some degree .This paper was to analyze the clinical application of PN support in our hospital in order to provide the basis for clinical rational drug use . Methods Random weighting method was applied to collect 5% hospitalized patients′information from each patient unit each month from April 2012 to March 2013 in Nanjing Gerneral Hospital of Nanjing Military Region .NRS-2002 nutrition risk screening was applied to eval-uate whether the patient needed PN support .Statistical analysis were carried out on patients supported with parenteral nutrition from department distribution, PN detailed components and distribution intervals of aII in one admixture non-protein calorie and nitrogen ra-tio. Results According to the survey, 393 patients had received PN support, including 217 cases′NRS score <3 and 176 cases′NRS score ≥3.General surgery department ranked the first in the cases of usingall in oneadmixture support.Among 133 cases receiving all in one admixture support, the course of 37 cases(27.82%) <7 d.The aII in one admixture non-protein calorie and ni-trogen ratio(100~150∶1) only took up 28.57%. Conclusion Although PN has got wide application in clinical departments, the rationality of prescription should be strengthened .Pharmacists should help doctors set up appropriate prescription from the aspect of pharmacy.

A study on the clinical application of all-in-one-mixed and pre-mixed parenteral nutrition preparations / 中华普通外科杂志

ObjectiveTo evaluate the parenteral nutrition formula's character of all-in-one-mixed preparation and pre-mixed preparation applied for hospitalized patients in China.MethodsWe collected parenteral nutrition (PN) prescriptions in hospitalized patients with various diseases at dispensing centers of 6 hospitals in different areas of China. Statistic analysis was made by nutrients application, total liquid, nonprotein calories, total nitrogen, ratio of non-protein calories and total nitrogen, and ratio of glucose and fat. A comparison was made between all-in-one-mixed and pre-mixed preparation as to all the indices.Results The nutrients supply in all-in-one-mixed PN preparation, as well as in the pre-mixed PN preparations of 3 different energy degrees can meet the basic nutrition requirements of most patients. The total nitrogen supply in all-in-one-mixed PN prescriptions meets nutrition requirements in most patients, but the ratio of non-protein calories and total nitrogen[( 180-250) : 1]and the ratio of glucose and fat (0. 56-1.26)were significantly different from what a doctor would recommend[( 100-150) : 1, 1.0]. While the ratios in the pre-mixed PN preparation on 3 different energy degrees are more consistent with recommeded values,which are at 167 and 0. 8 respectively.ConclusionsAll-in-one-mixed and pre-mixed PN preparation have their own individual advantages and limits, and both of them can meet the requirements of most hospitalized patients. More attention should be paid to the nutrients proportion when doctors prescribe all-in-one-mixed PN preparations.

Effect of repeated use on dentin bond strength of two adhesive systems: All-in-one and one-bottle.

Aims: To compare the effects of repeated use of two one-bottle adhesives with that of two all- in- one adhesives (with acetone solvent) on bond strength to dentin. Materials and Methods: A flat dentin surface was prepared on 120 bovine incisors using 600- grit abrasive pape. The teeth were randomly assigned into 12 equal groups. The four adhesive systems [Prime and Bond NT (P&B NT), One-Step Plus (OS), iBond (iB), and G-Bond (GB)] were used at baseline, after the lid of the container had been opened 30 times, and after it had been opened 60 times. Before each use of the adhesives, the lids of the containers were left open for 1 min. The resin composites were applied on the dentin in a cylindrical split mold. After thermocycling, shear bond strength test was performed with a universal testing machine at 1 mm/min. We used Kruskal-Wallis and Dunn tests for statistical analysis. Results: There was no statistically significant difference among bond strength (MPa) of the groups of P&B NT (31.9 ± 4.6, 31.8 ± 6.5, 26.1 ± 6.7) and OS (33.2 ± 5.1, 30.9 ± 7, 29.3 ± 5.9), respectively (P > 0.05). The mean of the bond strength of iB and GB after 60 times (15.3 ± 4.1 and 12.2 ± 3.9, respectively) was significantly lower than that of iB and GB at baseline (23.5 ± 4.8 and 22.2 ± 4.5, respectively) (P < 0.05). Conclusions: Repeated use (60 times) of the all-in-one adhesive led to a decline in the dentin bond strength. To avoid this problem it would be advisable to have containers with smaller amounts of adhesive or perhaps those with only a singe dose.

Effects of one or two applications of all-in-one adhesive on microtensile bond strength to unground enamel / 대한치과보존학회지

The purposes of this study were to compare the effects of one or two applications of all-in-one adhesives on microtensile bond strengths (microTBS) to unground enamel and to investigate the morphological changes in enamel surfaces treated with these adhesives using a scanning electron microscopy (SEM). Twenty-five noncarious, unrestored human mandibular molars were used. The unground enamel surfaces were cleansed with pumice. The following adhesives were applied to lingual, mid-coronal surfaces according to manufacture's directions; Clearfil SE bond in SE group, Adper Prompt L-Pop(TM)1 coat in LP1 group, 2 coats in LP2 group, Xeno(R) III 1 coat in XN1 group, and 2 coats in XN2 group. After application of the adhesives, a hybrid light-activated resin composite was built up on the unground enamel. Each tooth was sectioned to make a cross-sectional area of approximately 1.0 mm2 for each stick. The microtensile bond strength was determined. Each specimen was observed under SEM to examine the morphological changes. Data were analyzed with one-way ANOVA. The results of this study were as follows; 1. The microtensile bond strength values were; SE (19.77+/-2.44 MPa), LP1 (13.88+/-3.67 MPa), LP2 (14.50+/-2.52 MPa), XN1 (14.42+/-2.51 MPa) and XN2 (15.28+/-2.79 MPa). SE was significantly higher than the other groups in bond strength (p < 0.05). All groups except SE were not significantly different in bond strength (p < 0.05). 2. All groups were characterized as shallow and irregular etching patterns.

Microtensile bond strength of all-in-one adhesive to caries-affected dentin / 대한치과보존학회지

The purpose of this study was to evaluate the effect of multiple application of all-in-one dentin adhesive system on microtensile bond strength to caries-affected dentin. Twenty one extracted human molars with occlusal caries extending into mid-dentin were prepared by grinding the occlusal surface flat. The carious lesions were excavated with the aid of caries detector dye. The following adhesives were applied to caries-affected dentin according to manufacturer's directions; Scotchbond(TM) Multi-Purpose in SM group, Adper Prompt L-Pop(TM) 1 coat in LP1 group, 2 coats in LP2 group, 3 coats in LP3 group, Xeno(R) III 1 coat in XN1 group, 2 coats in XN2 group, and 3 coats in XN3 group. After application of the adhesives, a cylinder of resin-based composite was built up on the occlusal surface. Each tooth was sectioned vertically to obtain the 1 x 1 mm2 sticks. The microtensile bond strength was determined. Each specimen was observed under SEM to examine the failure mode. Data were analyzed with one-way ANOVA. The results of this study were as follows; 1. The microtensile bond strength values were; SM (14.38 +/- 2.01 MPa), LP1 (9.15 +/- 1.81 MPa), LP2 (14.08 +/- 1.75 MPa), LP3 (14.06 +/- 1.45 MPa), XN1 (13.65 +/- 1.95 MPa), XN2 (13.98 +/- 1.60 MPa), XN3 (13.88 +/- 1.66 MPa). LP1 was significantly lower than the other groups in bond strength (p 0.05). 2. In LP1, there were a higher number of specimens showing adhesive failure. Most specimens of all groups except LP1 showed mixed failure.

The effect of multiple application on microtensile bond strength of all-in-one dentin adhesive systems / 대한치과보존학회지

The purpose of this study was to evaluate the effect of multiple application of all-in-one dentin adhesive system on microtensile bond strength using confocal laser scanning microscope and microtensile bond strength test. Flat occlusal dentin surfaces were prepared using low-speed diamond saw. In group I, Scotchbond Multipurpose (SM) was applied by manufacturer's recommendation. In group II, after Adper Prompt L-Pop was applied for 15s and light cured for 10s, the second coat was re-applied and light-cured. In group III, after light-curing the second layer, the third coat was re-applied and light-cured. Specimens bonded with a resin-composite were sectioned into resin-dentin stick for measuring the adhesive layer thickness by confocal laser scanning microscope and evaluating micro-tensile bond strength. The adhesive layers of three-step dentin adhesive system, 3 coats of Adper Prompt L-Pop had significantly thicker than SM, 2 coats of Adper Prompt L-Pop (p 0.05). And SM, 3 coats of Adper Prompt L-Pop had significantly higher than 2 coats of Adper Prompt L-Pop in bond strengths (p < 0.05).

A quantitative analysis about microleakage of all-in-one adhesives / 대한치과보존학회지

All-in-one adhesives were recently developed for reducing the techique sensitivity and chair time, but lots of concerns were made on bondability, longevity, and microleakage. The object of this study was to evaluate microleakage and marginal quality of all-in-one adhesives using electrochemical method and SEM analysis quantitatively. After making Class V cavities, they were bulk filled with Heliomolar(#A1) after surface treatment with three adhesives: Adper Prompt (Group A), One up bond F (Group O), Xeno III (Group X). Electrical conductivity (microamphere, microA) was checked two times: before and after cavity filling. Percentage of leaky margin was estimated from SEM image (x1,000). The data were statistically analysed: ANOVA and Paired T test for electrical conductivity, Kruskal-Wallis and Mann-Whitney test for marginal quality, Spearman's rho test for checking of relationships between 2 methods. The result were as follows: 1. There was no difference in microleakage between adhesive systems and every specimen showed some of microleakage after filling. 2. Microleakage was reduced about 70% with composite resin filling. 3. Marginal quality was the best in group A, decreasing among groups in the following order: group O, followed by group X. There were significant differences between group A and group X (p=0.015), and between group O and group X (p=0.019). 4. There was no relationship between the microleakage measured by electrochemical method and marginal quality measured by SEM analysis. Within the results of this study, there was no difference in microleakage among groups by electrical conductivity. However, significant difference in marginal quality was seen among groups. It was believed that these dissimilar results might be induced because of their own characteristics. Analysis of microleakage needs various methods for accuracy.

Effect of Electrolytes on the Stability of Fat Emulsion in ALL IN ONE / 中国药房

OBJECTIVE:To observe the effect of electrolytes on the stability of fat emulsion in ALL IN ONE.METHODS: The size of fat emulsion particulates was observed under microscope in 400 - fold magnification.The oil - water demixing was observed with naked eye.RESULTS:The higher the concentration of electrolytes,the stronger the influence on the fat emulsion particulates aggregation and the easier the oil - water demixing appeared.The influence of bivalent ions was stronger than that of monovalent ones.The longer the mixture stored the stronger the influence.CONCLUSION:In order to keep the stability of ALL IN ONE,the concentrations of electrolytes should not be too high,and ALL IN ONE must be used up in 24 hours.

Stability of Total Nutrient Admixtures

PURPOSE: Conventional intravenous nutrition has been given as a solution of amino acids combined with dextrose and a separate line delivering a lipid emulsion. This technique was unsatisfactory, however, because of difficulties in managing technical and metabolic complications. Since the first clinical use of a single solution containing all the necessary nutrients was introduced in 1976, the total nutrient admixture (TNA) system has been used. However, despite the numerous advantages of this TNA system, it has not been used worldwide because of an assumption about unstability of this admixture. This study was conducted to compare the physical stability of TNA systems using two different 2 commercially available amino acid solutions and fat emulsions. METHODS: Each group contained 600 ml of 20% dextrose, 250 ml of 10% amino acid solution, 250 ml of 10% fat emulsion, 0.2 ml of heparin, and 20 ml of electrolyte solution was investigated for 7 days while being stored 4oC and at ambient temperature. The stabilities of these admixtures were compared by noting changes in macroscopic appearance, pH, osmolarity, Zeta-potential, peroxide value, particle size and distribution, and fat composition. RESULTS: When an amino acid solution containing P 2 was used, a supernatant yellow band was observed from the 3rd day at ambient temperature. The pH and peroxide value also showed significant changes, but these changes did not exceed the product-specifications. When an amino acid solution without P 2 was used, no significant change was observed. CONCLUSION: TNA systems are physically stable at 4oC temperature for at least 7 days, but TNA systems prepared with amino acid solution containing P 2 are not stable at ambient temperature from the 3rd day. On the other hand, TNA systems prepared with an amino acid solution without P 2 are stable at ambient temperature for 7 days. Various commercially available fat emulsions containing 10% soybean oil did not affect the stability of TNA systems.

All-in-one parenteral nutrition in surgical neonates.

During 1982-1990, we gave peripheral parenteral nutrition (PPN) using “single bottle technique” to 130 neonates with very satisfactory results. After following some experimental works from literature on lipid emulsion stability, we have developed total nutritional admixtures (all-in-one) that incorporate fat, aminoacids, dextrose, minerals, trace elements and vitamins in one container. Since 1993, all-in-one PN has been given to 27 neonates. The majority of cases suffered gastroschisis, omphalocele, tracheo-esophageal fistula, intestinal atresia and necrotizing enterocolitis. Duration of all-in=one feeding ranged from 5 to 46 days (60% were within 8-15 days). Complications ere minimal, phlebitis occurred only in 2 cases and cholestasis in one case. No precipitation or bacterial growth was detected. Five babies died from the severity of their conditions not from PPN. Compared with 51 neonates who received the old conventional method in the same period f time, there were no difference in the result. The all-in-one admixture ad administration of nutrition is simpler for the nurses, allowing more time for other activities and only one infusion pump is used. The cost of the conventional parenteral nutrition in the neonate is well tolerated, effective and safe.