Minimally invasive puncture with twist intraosseous drill needle combined with hematoma drainage in the treatment of acute epidural hematoma in pediatric patients: A technical note.

OBJECTIVE: The current neurosurgical intervention for treatment of acute epidural hematoma (AEDH) usually involves a craniotomy. Despite its effectiveness, open surgical decompression has several limitations. The twist intraosseous drill needle (TIDN) is considered a feasible alternative in adult patients with AEDH. AEDH treatment with TIDN in pediatric patients has not yet been described. The study aimed to report the efficacy and safety of minimally invasive puncture with a TIDN combined with hematoma drainage for the treatment of AEDH in pediatric patients. METHODS: We retrospectively collected medical records of children with AEDH who underwent TIDN surgery at our institution from January 2017 to May 2021, and analyzed their clinical and imaging results. A detailed step-by-step surgical guide was provided. RESULTS: Three pediatric patients with AEDH received TIDN treatment (including two males and one female; average age 7.66 years, range from 5 to 11 years). There were no intraoperative or postoperative complications in any case; 1 day after the operation, the AEDH was cleared in one of the three patients, and a slight hematoma remained in two patients. The remaining hematoma was evacuated after injecting urokinase into the hematoma cavity during indwelling drainage. CONCLUSION: For pediatric patients with AEDH in a stable condition with a clear consciousness, TIDN puncture combined with hematoma drainage is safe, effective, and less invasive, and may present a viable surgical alternative option.

Twist drill craniostomy for traumatic acute subdural hematoma in the elderly: case series and literature review.

BACKGROUND: A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH). To date, few studies have reported that TASDH could be successfully treated by twist drill craniostomy (TDC) alone or combined with instillation of urokinase. We aimed to define the TDC for the elderly with TASDH and performed literature review. CASE PRESENTATION: A total of 7 TASDH patients, who were presented and treated by TDC in this retrospective study between January 2009 and May 2017, consisted of 5 men and 2 women, ranging in age from 65 to 89 (average, 78.9) years. The patients' baseline characteristics, including age, sex, medical history, received ventriculoperitoneal shunt for hydrocephalus or not, reason for avoiding or refusing large craniotomy, preoperative Glasgow Coma Scale (GCS), suffered from cerebral herniation or not, the location of TASDH, imaging characteristics of TASDH in CT scan, injury/surgery time interval, midline shift, preoperative neurologic deficit, operation time, and infusions of urokinase or not, were collected. The postoperative GCS, postoperative neurologic deficit, rebleeding or not, intracranial infection, and modified Rankin Scale (mRS) at 6 months after surgery were analyzed to access the safety and efficacy of evacuation with TDC. The results showed that the mean time interval from injury to TDC was 68.6 min (30-120 min). The mean distance of midline shift was 14.6 mm (10-20 mm). The preoperative GCS in all patients ranged from 4 to 13(median, 9). The mean duration of the operation was 14.4 min (6-19 min). Postoperative CT scan showed that hematoma evacuation rate was more than 70% in all cases. There were no cases of acute rebleeding and intracranial infection after TDC. No cases presented with chronic SDH at the ipsilateral side within 6 months after being treated by TDC alone or combined with instillation of urokinase. Favorable outcomes were shown in all cases (mRS scores 0-2) at 6 months after surgery. CONCLUSIONS: TASDH in the elderly could be safely and effectively treated by TDC alone or combined with instillation of urokinase, which was a possible alternative for the elderly.

Improved pretreatment (coagulation-floatation and ozonation) of younger landfill leachate by microbubbles.

A novel microbubble air/ozone floatation device, TCRI, was developed to enhance the combination of the coagulation and ozonation processes as the pretreatment of landfill leachate. In the coagulation process, microbubble floatation reduced the coagulant dosage. The removal efficiencies of chemical oxygen demand (COD), color, nitrate, and ammonia for the coagulation microbubble floatation were 97, 20, 47, and 163% higher, respectively, than those of the coagulation-sedimentation process; in the ozonation process, the removal efficiencies of ammonia and COD in microbubble ozonation were increased by 300 and 200%, respectively, compared with a conventional ozonation contactor when the ozonation time was 60 minutes. The results showed that microbubbles could reach a higher ozone-transfer rate (microbubbles = 0.3018 min(-1) > conventional ozone bubbles = 0.2014 min(-1)). Therefore, the application of the microbubble technology in the coagulation and ozonation combination process may provide an effective and low-cost approach for wastewater treatment.

[Extracting techniques for optimizing zi shen granule by orthogonal text].

OBJECTIVE: To optimize the extracting techniques for Zi Shen Granule. METHODS: By taking the rate of extractum and the total of anthraquinone as the indexes components, the extraction techniques were optimized for Zi Shen Granule through L9 (3) 4 orthogonal text. RESULTS: The best condition is twice extraction by 2h or 1.5 h, to add octuple water. Then the water solution was concentrated to relative concentration 1.10, and adds ethanol to 70% alcohol Concentration,then stewing 24h. CONCLUSION: The optemized extraction technique is rational and jarless and ideal for mass production.