A meta-analysis of the implementation of enhanced recovery after surgery pathways in anterior cervical spine surgery for degenerative cervical spine diseases.

OBJECTIVE: To systematically evaluate the perioperative effects of enhanced recovery after surgery (ERAS) protocol on anterior cervical spine surgery by means of meta-analysis. METHODS: According to the PRISMA guidelines, the article's search on the China National Knowledge Infrastructure (CNKI), Wanfang data resource system, VIP, PubMed database and Cochrane library was conducted to identify clinical studies investigating the effects of ERAS protocols on anterior cervical spine surgery. A quantitative meta-analysis was performed for the clinical outcomes extracted from the studies that met inclusion criteria. RESULTS: Of the 21 studies identified from the article search, 10 studies met inclusion criteria. The meta-analysis showed shorter length of stay (LOS) (MD = -2.16, 95% CI (-2.57, -1.75), P < 0.00001) and higher patient satisfaction for the ERAS protocols (OR = 3.13, 95% CI (1.97, 4.98), P < 0.00001). Furthermore, ERAS programs led to significant decreases in cost (MD = -0.81, 95% CI (-1.08, -0.53), P < 0.00001) and complication rates (OR = 0.15, 95% CI (0.08, 0.27), P < 0.00001), but no difference in 90-day readmission (OR = 0.63, 95% CI (0.30, 1.35), P = 0.24). CONCLUSIONS: The data of this study suggest that the implementation of ERAS protocol decreases LOS, cost and complications rates and improve satisfaction for the patients undergoing anterior cervical spine surgery. To support the practice use of ERAS in anterior cervical spine surgery further, controlled trials will be indispensable.

Determination of 25 polybrominated diphenyl ethers in Chinese mitten crab ecosystems by gas chromatography-mass spectrometry.

A sensitive and reliable method for determining 25 polybrominated diphenyl ethers (PBDEs) in Chinese mitten crabs and their ecosystems ranging from the growing environment to edible feed by gas chromatography coupled to triple quadrupole mass spectrometry with advanced electron ionization (GC-AEI-MS/MS) was developed and validated. Accelerated solvent extraction (ASE) and liquid-liquid extraction were used to extract solid and water samples, respectively. On the basis of a traditional acid-base silica column, deactivated silica was added and n-hexane elution was used to increase the effect of separation and purification. Two oven temperature programs were applied to achieve good separation of low brominated congeners and increase the sensitivity of high brominated congeners. The method provided good linearity (>0.9996). The recoveries of four matrices were in the range of 82-115% and the method quantification limits (MQLs) in crabs, feed, sediment and water ranged from 0.36-6 pg per g wet weight, 0.69-22.29 pg per g dry weight, 1.02-25.26 pg per g dry weight, and 2.43-40.14 pg L-1, respectively. The proposed method was used for ten samples from two aquatic sites and PBDEs were detected in Chinese mitten crabs, commercial feed and sediment, with the highest in crabs. This analytical technique can be used to monitor the content and the accumulation behavior of PBDEs in Chinese mitten crab ecosystems or other aquaculture systems.

New insights into the transfer and accumulation of dioxins and dioxin-like PCBs in the food web of farmed Chinese mitten crabs: A typical case from the Yangtze River area.

Dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) transfer and accumulation behavior remains poorly understood in the farmed Chinese mitten crab (Eriocheir sinensis). In this study, dioxins and DL-PCBs concentration in 48 farming crabs in lower reaches of the Yangtze River was monitored and controlled field design was conducted in a typical farm to dissect the dioxins and DL-PCBs contamination in crab food web (crab, feeds, and environment). Results showed that dioxins and DL-PCBs were ubiquitous in farmed crabs with concentrations ranging from 0.390 to 37.2 pg toxic equivalents (TEQ) g-1 ww and do not present a health risk to general consumers. Of the total dioxins TEQ found in crab in treated farms, 45.6% was attributed to direct transfer from the aquaculture environment and 46.5% to the consumption of snails. Consumption of feed material accounted for nearly all of the total DL-PCBs TEQ, divided as 58.2% from feed and 41.8% from snails. These results demonstrated that dominant routes of dioxins accumulation in crabs were transferred for the sediment-snail-crab and sediment-crab chains, whereas DL-PCBs is mainly transferred through consumption of feeds and snails. To our knowledge, this work is the first report of snails serving as a biomagnification medium that promotes accumulation of dioxins in mitten crabs. This observation provided crucial insight to prevent and reduce contamination of crab by dioxins and DL-PCBs.