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Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) decrease postoperative pain and opioid consumption. The objective of the study was to determine if postoperative NSAIDs were associated with anastomotic leaks following elective colorectal surgery. Materials and Methods: We used a matched nested case-control study design. Using a prospectively collected database, we identified all patients having elective colorectal surgery between January 2001 and June 2012. Cases and matched controls were identified based on the occurrence of a postoperative anastomotic leak. The primary and secondary exposure variables were, respectively, use of any NSAID and use of ketorolac specifically. Conditional logistic regression was used to determine the unadjusted and adjusted odds ratio. Results: A total of 262 patients were included (65.6 % inflammatory bowel disease, 34.4 % cancer). Use of any NSAID was associated with a non-significant increase in anastomotic leaks (odds ratio (OR) 1.81, 95 % confidence interval (CI) 0.98-3.37, p = 0.06). Use of ketorolac was associated with a significant increase in anastomotic leaks (OR 2.09, 95 % CI 1.12-3.89, p = 0.021). There was no significant association between anastomotic leaks and cumulative NSAID dose. Conclusion: These data suggest that there may be an association between NSAIDs and risk of anastomotic leaks after colorectal surgery. Further research is needed to better elucidate this relationship to clarify the implications for patients. [ABSTRACT FROM AUTHOR]

• Continuous adductor canal block has been proven superior for total knee arthroplasty analgesia. • Safety concerns such as intravascular injection, nerve injury or catheter displacement must always be considered. • I nter-fascial space between the SA rtorius muscle and FE moral artery (ISAFE) approach is effective and potentially safer. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate predictors of desaturation and to identify practice for patient transport following general anesthesia. Design: Observational quality assurance study. Setting: Postanesthesia Care Unit (PACU) of a university-affiliated, tertiary-care hospital. Patients: All adult postsurgical patients who received general anesthesia and who were admitted to the PACU. Measurements: Patients were observed over a three-month study period during transfer to the PACU with or without oxygen supplementation. Sixteen variables related to patient, surgery, and anesthesia were recorded. Results: The study recorded a total of 502 PACU admissions. The practice pattern showed that 57% of patients were transferred without oxygen and 19% of the entire sample had an initial oxygen desaturation of less than 90% on arrival to the PACU. Only 0.8% of patients experienced oxygen desaturation when they were transferred with oxygen supplementation. After logistic regression analysis, the most significant predictor of desaturation was transport without oxygen. Conclusions: The majority of anesthesiologists did not use supplemental oxygen for patient transfer. As a result, a higher incidence of postoperative desaturation was noted in their patients. Significant predictors of desaturation after general anesthesia included patients' sedation score, low respiratory rate, and transport without oxygen. The use of oxygen almost completely prevented desaturation during transport. [ABSTRACT FROM AUTHOR]

Abstract: The in-plane and torsional shear properties directly relevant to specific applications of carbon fiber-reinforced composites (CFRPs), such as sporting goods and wind turbine blades, are studied. Multiscale composites are fabricated using carbon fiber prepregs containing carbon nanotube (CNT) modified epoxy matrix. The interlaminar shear strength (ILSS) of the composites with 0.5wt.% CNTs increases by 12% compared to the neat CFRP composites, whereas the torsional shear modulus and strength determined using tubular specimens present corresponding improvements of 17% and 19.5%, respectively. The enhanced interfacial adhesion between the modified matrix and carbon fibers, and the increases in matrix modulus/strength arising from the well-dispersed functionalized CNTs are mainly responsible for the above observations. An increase in CNT content beyond 0.5wt.% has moderately negative effects on these properties, indicating potential agglomeration at a high CNT content. [Copyright &y& Elsevier]

Abstract: This paper proposes the correlation between the electrokinetic potential, dispersibility in solvents, surface energy and oxygen content of carbon nanotubes (CNTs) affected by functionalization. Colloidal systems consisting of CNTs with varying degrees of dispersion are prepared and characterized to evaluate CNT dispersibility and suspension stability in solvents with different polarities. The results show that an absolute value of zeta potential at about 25mV is closely related to the micro- and macroscopic dispersion of CNTs, whereas a high absolute value of 40mV is regarded as an indication of high quality CNT dispersion with much enhanced suspension stability in solvents. The absolute zeta potential value increases consistently with increasing degree of CNT functionality, the increase being most pronounced in a hydrophilic liquid such as water. A linear correlation is established between the surface energy of a CNT film and the oxygen to carbon ratio of CNT surface. The CNT dispersibility in a liquid is determined not only by their physical states, but also by the hydrophilicity and surface functionality of CNTs, all of which are reflected by zeta potential. [Copyright &y& Elsevier]

Abstract: Exposure to surgery and general anesthesia (GA) has been hypothesized to be a potential risk factor for the development of Alzheimer's disease (AD). Some basic science research studies have demonstrated AD pathology in animals following exposure to inhalational anesthetics. However, controversy exists as to whether GA is associated with an elevated risk of developing AD in human populations. While randomized controlled clinical trials would provide the strongest evidence for a causal relationship between exposure to surgery under GA and the subsequent development of AD, to date there have not been any trials to address this important question. Therefore, a potential relationship between GA and AD must currently be examined using observational methods. A recent meta-analysis of case–control studies (N=15) did not find that AD was associated with prior exposure to GA (OR=1.05, 95% CI: 0.93–1.19, p=0.4). A limited number of retrospective cohort studies have likewise not provided definitive information supporting an association. Therefore, at the present time there is limited information to support the hypothesis of AD developing as a consequence of GA, although there are few high quality studies in this area. Given the high prevalence and impact of AD, and the relatively frequent exposure of large populations to surgical procedures, the association between AD and GA requires further study. [Copyright &y& Elsevier]

Abstract: Vibration damping characteristic of nanocomposites and carbon fiber reinforced polymer composites (CFRPs) containing multiwall carbon nanotubes (CNTs) have been studied using the free and forced vibration tests. Several vibration parameters are varied to characterize the damping behavior in different amplitudes, natural frequencies and vibration modes. The damping ratio of the hybrid composites is enhanced with the addition of CNTs, which is attributed to sliding at the CNT–matrix interfaces. The damping ratio is dependent on the amplitude as a result of the random orientation of CNTs in the epoxy matrix. The natural frequency shows negligible influence on the damping properties. The forced vibration test indicates that the damping ratios of the CFRP composites increase with increasing CNT content in both the 1st and 2nd vibration modes. The CNT–epoxy nanocomposites also show similar increasing trends of damping ratio with CNT content, indicating the enhanced damping property of CFRPs arising mainly from the improved damping property of the modified matrix. The dynamic mechanical analysis further confirms that the CNTs have a strong influence on the composites damping properties. Both the dynamic loss modulus and loss factor of the nanocomposites and the corresponding CFRPs show consistent increases with the addition of CNTs, an indication of enhanced damping performance. [Copyright &y& Elsevier]

Study Objective: There exists no commonly accepted regimen for an intravenous lidocaine infusion (IVLI). This study aims to determine an appropriate end time for an IVLI during bowel surgery.Design: A systematic search for randomized controlled trials assessing IVLI for bowel surgery was conducted using Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Google Scholar, hand-searching references, and grey literature. Data were pooled for studies that stopped IVLI ≤60 minutes (intraoperative IVLI) after skin closure and where IVLI continued >60 minutes after surgery (postoperative continued IVLI). Quantitative analysis was done using the random-effects model.Main Results: Seven studies (n = 362) were identified after the systematic search. Three studies (n = 160) and 4 studies (n = 202) used an intraoperative and postoperative continued IVLI, respectively. An intraoperative IVLI significantly reduced pain scores at rest for 48 hours (standardized mean difference on a 0-10 scale, -1.24; 95% confidence interval, -1.93 to -0.56) and 72 hours (standardized mean difference, -1.12; 95% confidence interval, -1.79 to -0.44) compared with postoperative IVLI (test for interaction: P < .001 and P = .003, respectively). Although intraoperative IVLI reduced 24-hour pain scores on movement, this was not statistically different than pain scores in the postoperative IVLI group (test of interaction: P = 0.68). There were no differences between intraoperative IVLI and postoperative IVLI for postoperative in-hospital nausea, vomiting, time to bowel movement, and length of hospital stay.Conclusion: Continuing an IVLI beyond 60 minutes after surgery has no added analgesic or gastrointestinal benefit. Further research is needed to clarify an optimal IVLI regimen and end time. [ABSTRACT FROM AUTHOR]