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PurposeIn this article, a practical design methodology is proposed for discrete sizing optimization of high-rise concrete buildings with a focus on large-scale and real-life structures.Design/methodology/approachThis framework relies on a computationally efficient approximation of the constraint and objective functions using a radial basis function model with a linear tail, also called the combined response surface methodology (RSM) in this article. Considering both the code-stipulated constraints and other construction requirements, three sub-optimization problems were constructed based on the relaxation model of the original problem, and then the structural weight could be automatically minimized under multiple constraints and loading scenarios. After modulization, the obtained results could meet the discretization requirements. By integrating the commercially available ETABS, a dedicated optimization software program with an independent interface was developed and details for practical software development were also presented in this paper.FindingsThe proposed framework was used to optimize different high-rise concrete buildings, and case studies showed that material usage could be saved by up to 12.8% compared to the conventional design, and the over-limit constraints could be adjusted, which proved the feasibility and effectiveness.Originality/valueThis methodology can therefore be applied by engineers to explore the optimal distribution of dimensions for high-rise buildings and to reduce material usage for a more sustainable design.

The scope of this paper is to present a novel design methodology that relies on the tabu search (TS) algorithm and aims to optimize the shear wall layout of high-rise buildings. By discretizing the distributable area of a shear wall into wall elements, different possible shear wall layouts can be described by binary code where ‘0’ and ‘1’ indicate the absence or presence of a wall element respectively. Furthermore, the conceptual design is combined with the optimization algorithm to play a guiding role in the optimization, and the surrogate model is built through support vector machine (SVM) to drive the optimization process with historical data and reduce the cost of the real model’s evaluation. Then, the structural weight can be automatically minimized with constraints on the story drift and period ratio and an optimization program with an independent interface is compiled in this paper. This method was used to optimize the layouts of different shear wall structures, which proved the feasibility and effectiveness.

Many literatures focus on the biological relevance and the identification of biomarkers for disease activity assessment while less attention has been paid to the development of standard procedures for sample preparation and storage based on liquid chromatography technique. The influencing factors including protein precipitation, storage temperature, storage time, and reconstitution by ultra pure water were analyzed employing HPLC-DAD. The effects were investigated from five participants over three months by principal components analysis (PCA) and the values of percent changes (PC). The samples with protein precipitation might slow the rate of bacterial enzymatic conversion. After protein precipitation, the average PC of urine samples (0.136 ± 0.013, n = 5) is relatively less than that of the serum samples (0.173 ± 0.026, n = 5) for three months. Minimal effects on metabolic profiles of serum and urine (PC < 0.15) are reasonable for metabolomic studies after protein precipitation and storage at -20 ℃ for two months.

To evaluate whether targeting IGF-IR therapeutic can increased chemosensitivity of squamous cell carcinomas of the head and neck (SCCHN) to doxorubicin and cisplatin, Insulin-like growth factor type I receptor (IGF-IR) expression was down-regulated by treatment with AS[S]ODN. Different doses of AS[S]ODN with doxorubicin or cisplatin were tested in TU159 and 183A SCCHN cell lines. Compared to phosphorothioate sense oligonucleotides (SS[S]ODN), AS[S]ODN treatment inhibited cancer cell proliferation and attenuated activation of IGF-IR. AS[S]ODN treatment was shown to enhance the sensitivity of SCCHN cell lines to doxorubicin and cisplatin. This observation correlated closely with the induction of apoptosis as measured by Annexin-V/PI and caspase activation assays. The in vivo results showed that treatment with AS[S]ODN/doxorubicin in combination also resulted in a significant suppression in TU159 xenografts. In conclusion, this study provides evidence for the efficacy of IGF-IR down-regulation combined with chemotherapy and raises the possibility that SCCHN treatment may be improved by pharmaceutical strategies directed towards the IGF-IR.

Pain is one of the main postoperative adverse outcomes. Single analgesics, either opioid or nonsteroidal antiinflammatory drugs (NSAIDs), are not able to provide effective pain relief without side effects such as nausea, vomiting, sedation, or bleeding. A majority of double or single-blind studies investigating the use of NSAIDs and opioid analgesics with or without local anesthetic infiltration showed that patients experience lower pain scores, need fewer analgesics, and have a prolonged time to requiring analgesics after surgery. This review focuses on multimodal analgesia, which is currently recommended for effective postoperative pain control.

Background Currently, the manufacturer of the laryngeal mask airway (LMA; Laryngeal Mask Company, Ltd., Northfield End, Henley on Thames, Oxon, United Kingdom) recommends using as large a mask size as possible. The aim of this study was to compare the incidence of pharyngolaryngeal morbidity after the use of a large (size 5 in males and size 4 in females) or small (size 4 in males and size 3 in females) LMA in spontaneously breathing patients. Methods A total of 258 male and female patients were randomly assigned to insertion of a large or small LMA while breathing spontaneously during general anesthesia. After insertion of the LMA, a "just-seal" cuff pressure was obtained, and intracuff pressure was measured at 10-min intervals until just before removal of the LMA. The 2- and 24-h incidence of postoperative sore throat, pain, hoarseness, dysphagia, and nausea and vomiting was assessed. Complications after LMA removal, including body movement, coughing, retching, regurgitation, vomiting, biting on the LMA, bronchospasm, laryngospasm, or the presence of blood on the LMA, were recorded. Results The use of a large LMA was associated with a higher incidence of sore throat in both sexes (20% vs. 7% in men, 21% vs. 5% in women; P < 0.05) and a higher incidence of hoarseness in male patients at 2 h postoperatively (21% vs. 9%, P < 0.05). There was a higher incidence of sore throat in male patients at 24 h postoperatively with the use of a large LMA (26% vs. 12%, P < 0.05). There was no difference in the incidence of complications of LMA removal orother pharyngolaryngeal morbidity, such as difficulty swallowing, drinking, and eating, or nausea and vomiting, between male or female groups at any time period with the use of a large LMA. Conclusions Selection of a small laryngeal mask airway (size 4) in spontaneously breathing male patients may be more appropriate to limit the occurrence of sore throat on the first postoperative day. All patients had a fourfold increased risk of developing sore throat when a large LMA was used.

We studied 726 consenting patients to determine whether withholding oral fluids from adult ambulatory surgical patients before discharge would decrease the incidence of postoperative nausea and vomiting (PONV) and shorten the duration of stay in the ambulatory surgery unit (ASU). Patients were randomly assigned to the drinking or nondrinking group. Both groups received a standard regimen of general anesthesia, fluid replacement, and analgesia. In the ASU, patients in the drinking group were given mandatory oral fluids to drink before discharge. Nausea and pain were assessed by using a visual analog scale 15, 30, 60, 90, 105, 120, 150, and 180 min postoperatively. The time to drink, sit up, void, and ambulate, and the time until discharge were recorded. Patients were interviewed by telephone 24 h postoperatively. There was no significant difference in the frequency of PONV between the drinking and the nondrinking groups either in the hospital or after discharge. Patients in the drinking group required more time to begin ambulating (105 +/- 38 vs 98 +/- 34 min; P0.02) and to void (112 +/- 40 vs 105 +/- 37 min; P0.01). Patients in the drinking group also stayed in the ASU longer (85 +/- 49 vs 81 +/- 47 min; P0.03). Time to postanesthetic discharge was also significantly longer in the drinking group than the nondrinking group (106 +/- 40 vs 98 +/- 36 min; P0.015). A similar percentage of patients in both groups were "very satisfied" with their ambulatory surgical care. There was no difference in postoperative complications and need for medical help. Withholding early postoperative oral fluids facilitated earlier ambulation and decreased the stay in the ASU but did not decrease the incidence of PONV. Thus, in this ambulatory surgical population, there does not seem to be justification to require drinking before discharge.To answer the question of whether adult outpatients should drink before discharge after minor surgical procedures, 726 patients were randomized to either drink approximately 150 mL of liquid or not to drink. Neither drinking nor nondrinking worsened postoperative nausea or vomiting or prolonged hospital stay. Therefore, patients should be allowed to choose whether they drink before discharge.

ITH the development of minimally invasive surgical procedures, ambulatory surgery in North America has grown remarkably over the last two decades. 1 This growth is also attributed to the effort of anaesthetists to prevent and treat postoperative adverse outcomes with new drugs and techniques, thus ensuring the safety and satisfaction of patients. With these changes, a wider variety of patients and procedures are shifting into the ambulatory area, and the incidence of postoperative adverse outcomes will increase. Pain is one of the main postoperative adverse outcomes that causes distress to patients, 2 prolongs their stay in the ambulatory care unit, s and increases the incidence of unanticipated admission after surgery. 4 How far have we gone in controlling postoperative pain? Are patients satisfied with the pain treatment they receive? What improvementscan we make in the future? In this issue, Beauregard and coUeagues s report on a study they conducted in a large teaching hospital on 89 ambulatory surgical patients to assess the intensity, duration, and impact of pain during their hospital stay and on the first, second and seventh postoperative days. More than 40% of the patients reported moderate to severe pain during their hospitalisation. Our study on 10,008 consecutive patients undergoing ambulatory surgery showed that severe pain was suffered by 5.3% of patients in the Postanaesthesia Care Unit and 1.3% of patients in the Ambulatory Surgery Unit. 6 These results indicated that there was still a high incidence of severe pain after routine postoperative pain treatment during the hospital stay. In another study, a 24-hr telephone interview with the parents of 84 paediatric patients who underwent tonsillectomy indicated that pain control was inadequate in 25% of the patients. 2 Beauregard and colleagues s extended their investigation to the seventh postoperative day and found that the pain decreased with time but was still considerable. Postoperative pain affected the patients' return to normal functioning. These results indicated that routine management of post-discharge pain could not eliminate the pain completely. Effective postoperative pain control for patients with severe pain is needed, and take-home analgesia protocols need to be developed. Some factors can predict the occurrence of postoperative pain. More men than women experience intense postoperative pain. s,6 The patients with a higher body mass index had a high incidence of severe pain postoperatively, because the dose of opioid (fentanyl or alfentanil) administered during the surgical procedure was inadequate. 6 The anaesthetist should pay more attention to increasing the dose ofopioid properly during surgical procedures. In addition, lengthy surgical procedures and certain types of operations (orthopaedic, urological, general, plastic, neurosurgical, and ENT/dental) are predictors of severe pain. 6 Successful postoperative pain control also depends on the knowledge and demands of the patient. A questionnaire for evaluating the general public's perception of postoperative pain revealed that almost 50% of patients were prepared to suffer pain rather than to complain. 7 They knew little about postoperative pain and were confident in the ability of doctors and nurses to treat it. High satisfaction with a relatively high pain level was also found in Beauregard's study, s Postoperative pain can have a deteriorative effect on the recovery of the patient from surgery, whereas multimodal balanced analgesia can accelerate postoperative rehabilitation and reduce hospital stay. Therefore, patient education is required for optimal pain management after ambulatory surgery. Patients should be given a full explanation of the need to minimise or reduce postoperative pain, and they should be informed of the various methods available to treat it. They should be assured that any pain that does occur will be properly and prompdy treated. 7 The continued training of doctors, nurses, and medical students in the prevention and proper management of postoperative pain is necessary, s,9 Beauregard and colleagues s found that many instructions given to