Hemodialysis is a common treatment for patients with end-stage renal failure. Long-term hemodialysis will lead to a series of complications and reduce the quality of life of patients. At present, routine nursing is only limited to in-hospital patients, whereas continuous nursing is an extension of hospital nursing work, which can solve the follow-up health problems of some patients and meet the health needs of patients in their daily life. A number of clinical studies have shown that continuous nursing can improve the quality of life of hemodialysis patients, but there is a lack of evidence-based medicine. Therefore, the purpose of this study is to explore the effect of continuous nursing on the quality of life of hemodialysis patients through systematic evaluation.The Cochrance Library, PubMed, Embase, Web of Science, CNKI, VP Information Chinese Journal Service Platform (VIP), and Wanfang will be searched by computer. In addition, Baidu academic and Google academic are searched manually, and all randomized controlled trials on the effects of continuous nursing on the quality of life of hemodialysis patients are collected. The retrieval time is of the establishment of the database to January 31, 2021. Two evaluators screens, extract and evaluate the literature, and the data are analyzed by RevMan5.3 software.The purpose of this study is to evaluate the effect of continuous nursing on the quality of life of hemodialysis patients by the MOS item short from health survey, exercise of self-care agency, and the incidence of complications.This study will provide reliable evidence for the application of continuous nursing in hemodialysis patients.DOI 10.17605/OSF.IO/HZKUA When ESRD patients are undergoing hemodialysis in the hospital, nurses give routine care to inform the relevant matters needing attention, but patients spend most of their time outside the hospital, so it is difficult to solve the sudden situation of the disease. At the same time, due to the lack of supervision, poor compliance with drugs or diet may occur, which not only brings difficulties to treatment, but also brings greater economic burden to patients.Chronic kidney disease has become one of the public health problems that endanger global health. In 2011, the extended nursing service project was formally incorporated into the research field of the Ministry of Health, and then put forward that continuing nursing is the key task of the “Twelfth five-year Plan” period, which shows the importance of continuing nursing. Luo et al found that maintenance hemodialysis patients have a strong demand for continuous care, so it is suggested to provide targeted extended nursing services to improve the quality of life of hemodialysis patients. At present, many studies have shown that the application effect of continuous nursing in hemodialysis patients is significant, and the incidence of complications is low, but there are differences in continuous nursing programs and curative effect evaluation in various clinical studies, and the results are uneven. To a certain extent, it affects the reliability of the research results and the promotion of continuous nursing, so this study adopts the method of systematic evaluation. To further clarify the effect of continuous nursing on the quality of life of hemodialysis patients, to provide a reliable reference for hemodialysis patients to receive standardized continuous nursing.Continuous care refers to a series of nursing measures for patients in different health care places  or the same health care places . So that patients receive different levels of continuous care.22.1This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses (PRISMA-P). Moreover, it has been registered on opening science framework (OSF) on November 25th, 2020 (registration number: DOI 10.17605/OSF.IO/HZKUA).2.2Since this is a protocol with no patient recruitment and personal information collection, the approval of the ethics committee is not required.2.32.3.1We will collect the published randomized controlled trials on continuous nursing intervention for hemodialysis patients at home and abroad, regardless of blinding, publication status, region, but Language will be restricted to Chinese and English.2.3.2The nationality, race, age, sex, and course of disease of the patients undergoing hemodialysis are not limited.2.3.3The control group adopt routine nursing, whereas the experimental group adopt continuous nursing on the basis of the control group, which includes setting up a special extended nursing group and making a detailed out-of-hospital nursing plan, including helping patients and their families understand the disease correctly, cultivate good eating habits, guide reasonable exercise, and care of internal fistula, and so on, and conduct regular telephone or WeChat follow-up to know the patient's condition.2.3.41.Primary outcome: the MOS item short from health survey2.Secondary outcomes: exercise of self-care agency; complication rate.2.41.Repeatedly published articles.2.The literature is nonrandomized controlled trial, such as review, case report, lecture, and so on.3.Articles in which the published literature is an abstract or with incomplete data. And the data cannot be obtained after contacting the author.4.There are obvious errors in the data.5.Literature whose outcome index is not clear.6.Literature that randomizes or allocates concealment as a high risk of bias.2.5CNKI, Wanfang Data, VIP, PubMed, Cochrane Library, Embase, Web of Science and other databases will be searched by computer. The key Chinese words are “hemodialysis,” “renal dialysis,” and “continuous care”, and the English key words are “Hemodialysis,” “Renal Dialyses,” “Continuum of Care,” and “Continuous care.” Both Chinese and English are searched by the way of subject words combined with free words, and the search time is from the establishment of the database to January 31, 2021. In addition, a manual search is conducted in Baidu academic and Google academic to collect all the randomized controlled trials of the effects of continuous care on the quality of life of hemodialysis patients. The PubMed is shown in Table 2.6Refer to the method recommended by the Cochrane collaboration Network system evaluator Handbook version 5.0, and follow the PRISMA flow chart. According to the inclusion and exclusion criteria, the 2 researchers independently screen the literature through the document management software, cross-check the results, and ask the third researcher whether there are differences. Excel 2013 will be used to extract relevant information, including: basic information ; intervention measures; outcome indicators; risk bias assessment factors in randomized controlled trials. The literature screening process is shown in Figure 2.7The risk of bias for each eligible study will be assessed by 2 researchers respectively according to the Cochrane Collaboration's tool including 7 terms. According to these criteria , risk of bias is classified into the following levels: unclear, low, and high risk of bias. Any divergences will be solved through discussion by a third researcher.2.82.8.1χ2 and I2 values. If  indicated low heterogeneity. Fixed effect model is used for meta-analysis. If  indicated heterogeneity among studies, and the source of heterogeneity will be explored through subgroup analysis. If there is no obvious clinical or methodological heterogeneity, it will be considered as statistical heterogeneity, and the random-effect model will be used for analysis. Descriptive analysis is used instead of meta-analysis if there is significant clinical heterogeneity between the 2 groups and subgroup analysis is not available.The RevMan 5.3 software is used for statistical analysis. For dichotomous variables, relative risk (RR) is used for statistics. For continuous outcomes, weighted mean difference is selected when the tools and units of measurement indicators are the same, standardized mean difference is selected when the tools and units of measurement indicators are different, and all the above were represented by effect value and 95% confidence interval (CI). Heterogeneity is determined by 2.8.2If there are missing data in the article, contact the author through email to the relevant information. If the author cannot be contacted, or if the author has lost the relevant data, a descriptive analysis is performed, not a meta-analysis.2.8.3According to the different course of continuous nursing, the subgroup analysis will be carried out, and the subgroup analysis will be carried out according to the different ways of continuous nursing.2.8.4To determine the stability of outcome indicators, sensitivity analysis was used to analyze each outcome indicator.2.8.5Funnel plots are used to assess publication bias if no <10 studies are included in an outcome measure. Moreover, Egger and Begg test are used for the evaluation of potential publication bias.2.8.6The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to assess the quality of evidence. It contains 5 domains . And the quality of the evidence will be rated as high, moderate, low, and very low.3 There are many modes of continuous care, and studies have confirmed that guided nursing model, APN continuing nursing model, evaluation and care of the elderly resource model, and continuous nursing model have achieved positive results in clinical application. Rezamand et al found that continuous nursing can improve the self-care ability of patients with heart failure. Siegmann et al showed that the overall health status of patients with diabetes after continuous care was better than that of the routine nursing group. Other studies have shown that continuous care can reduce the rate of rehospitalization and the risk of rehospitalization.,18 Continuous nursing is the connection of hospital nursing plan, which aims to improve patients’ health and quality of life, and can also promote the establishment of a good relationship between doctors and patients.Continuous nursing is a new nursing model, which pays attention to the continuity and integrity of patients’ health guidance, mainly the continuation of patients’ life from hospital to family, and the guide is not interrupted because of the transfer of places. Continuous nursing includes 2 key factors: individual health service and nursing service time continuation, which can be divided into 3 types: the continuation of information, the continuation of management, and the continuation of relationship. found that the level of self-management ability and diet and exercise compliance of maintenance hemodialysis patients is relatively low, and simple health guidance cannot improve the living standards of patients. Therefore, medical staff can carry out effective continuous nursing programs for hemodialysis patients, such as vascular access nursing education and guidance, drug use education and guidance, diet and nutrition nursing education, psychological counseling and emotional support, exercise guidance, to improve patients’ self-management level and quality of life. Borji et al found that continuous nursing can improve the quality of life of patients, but has no significant effect on their blood pressure. Otaghi et al through clinical trials, have found that continuous nursing intervention can improve the sleep quality of hemodialysis patients. Rahimi et al found that continuous nursing has a positive effect on anxiety, depression, and stress of patients with hemodialysis, which is highly practical.ESRD patients have dialysis treatment every week, which cannot be completed at one time by hospitalization. Zhang et alAt present, there are many studies on continuous nursing intervention in hemodialysis, but some studies have some deficiencies in design, which cannot provide a good evidence-based basis for the implementation of extended nursing in hemodialysis patients. Therefore, this study analyzes the existing RCTs test of continuous nursing intervention in hemodialysis patients, objectively evaluates the effect of continuous nursing on the quality of life of hemodialysis patients, and provides evidence-based medical evidence for further development of continuous nursing in hemodialysis patients. This study also has some limitations, because there is no standard scheme for continuing nursing, there may be some clinical heterogeneity. And this study only searches English and Chinese literature, and may ignore studies or reports in other languages, and there is a certain publication bias.Data collection: Ling Yuan and Haitao YuanData curation: Ling Yuan, Haitao Yuan.Funding acquisition: Qingchun Feng, Jinyu Zhao.Funding support: Qingchun Feng and Jinyu ZhaoResources: Jinyu Zhao and Haitao YuanSoftware operating: Qingchun Feng and Jinyu ZhaoSoftware: Qingchun Feng, Jinyu Zhao.Supervision: Haitao Yuan.Writing – original draft: Ling Yuan and Haitao YuanWriting – review & editing: Ling Yuan, Qingchun Feng and Jinyu Zhao


Primary IgG4-related disease (IgG4-RD) of the temporal bone is a rare condition. Unlike typical petrous apicitis or Gradenigo syndrome, our patient presented exclusively with unilateral cranial nerve VI palsy and symptoms of diplopia. Skull base imaging demonstrated a destructive bony lesion in the petrous apex. Imaging and systemic investigations were insufficient to support a diagnosis. The diagnosis was achieved histologically after acquiring the specimen by middle cranial fossa craniotomy and temporal bone biopsy. This case report is thought to be the first published description of a diagnosis of IgG4-RD proven with the middle cranial fossa approach.We describe a 29-year-old female with primary IgG4-RD of the petrous apex of the temporal bone. This patient presented with a few-month history of left-sided headache and recent-onset diplopia due to paralysis of cranial nerve VI. Imaging demonstrated a petrous apex lesion, and comprehensive systemic investigations could not reach a diagnosis. A middle cranial fossa craniotomy and a biopsy of the temporal bone lesion were undertaken to establish the diagnosis. Histological confirmation of IgG4-RD was proven. Following treatment with corticosteroids, the patient experienced complete recovery and resolution of her symptoms.This study describes a case of primary IgG4-RD of the petrous apex of the temporal bone that presented with diplopia and was diagnosed by middle fossa craniotomy and temporal bone biopsy. To the best of our knowledge, this is the first case description where primary diagnosis was made based on middle cranial fossa craniotomy and temporal bone biopsy. IgG4-related disease (IgG4-RD) is a chronic immune-mediated fibro-inflammatory disorder . PerhapsSkull base involvement of IgG4-RD is less commonly noted, with most accounts being an extension from paranasal disease. IgG4-RD should be a consideration when a lesion involves the temporal bone in patients presenting with otalgia and diplopia –17.Recently, a rare case of a patient with IgG4-RD of the temporal bone who presented with otalgia and diplopia due to cranial nerve VI palsy was described . UnsurprIn this report, we present a young patient who had primarily diplopia as a symptom. This case is unique, as to the best of our knowledge, it is the first case of IgG4-RD diagnosed from a biopsy acquired with the middle cranial fossa approach. The serum IgG4 level in this patient was normal.An otherwise healthy 29-year-old female presented to the emergency room with diplopia from isolated cranial nerve VI palsy on the left and a history of left-sided headaches of several-month duration. Associated symptoms included pressure in the left ear and a “blocked” sensation. The patient did not complain of any vestibular symptoms. Otoscopy revealed normal tympanic membranes with no signs of middle ear pathology. Diagnostic audiometry revealed normal hearing and middle ear function. Normal blood investigation findings included fasting glucose, corrected calcium, magnesium, liver functions, thyroid functions, and a complete blood and platelet count. Serological testing, including human immunodeficiency virus (HIV) testing, treponema pallidum antibodies, anti-nuclear antibody (ANA) titers, and antineutrophil cytoplasmic antibody (ANCA) titres, was negative. Erythrocyte sedimentation rate (ESR) was 29, and C-reactive protein (CRP) was 14, mildly raised in both instances.High-resolution computed tomography (HRCT) of the skull base demonstrated an aggressive erosive disease process centered on the left petrous apex involving the petroclival fissure and inferolateral clivus . SubsequThe initial diagnosis favored Gradenigo syndrome, otomastoiditis, lateral rectus palsy, and deep facial pain, with a differential diagnosis of cholesteatoma, cholesterol granuloma, tuberculosis, mucocele formation, and petrous apex air cell effusion. The absence of signs of a systemic disease, clinically and later supported by pathology results, ruled out an infective process. Malignancies considered included chondrosarcoma, chordoma, plasmacytoma, multiple myeloma, paraganglioma, and meningioma. A tissue biopsy was required to make a definitive diagnosis.Surgical access to the petrous apex includes the infracochlear, infralabyrinthine, middle fossa, and transsfenoid approaches. After studying the anatomy on the HRCT scans, the middle fossa approach was chosen as the most appropriate option.Given the epicenter of the lesion, middle fossa craniotomy provided an elegant and effective means of approaching the lesion to obtain tissue for histological analysis. Nevertheless, the middle cranial fossa approach to the temporal bone can be considered invasive and is not without risks. However, by employing the transtemporal supralabyrinthine modification of the middle cranial fossa approach, described by Fisch, minimal retraction is placed on the temporal lobe , 22. In The microscopic examination of the biopsy fragments showed a dense lymphoplasmacytic inflammatory infiltrate with a fibrous background. Strands and vague fascicles of collagen fibers were also seen, as well as regions of focal storiform-type fibrosis. There was no evidence of obliterative phlebitis or granulomata. Fungal, bacterial, and mycobacterial stains were negative. A lymphoproliferative disorder was excluded. Immunohistochemical stains for IgG4 showed greater than 50 IgG4-positive plasma cells in some high-power fields . IgG4/IgOnce the diagnosis was made, the patient was commenced on oral prednisone at 40mg daily to taper over a 6-month interval.One month post-surgery, the patient complained of hoarseness. She was diagnosed with left vocal cord paralysis, with the affected vocal cord in the paramedian position. MRI revealed an extension of the original disease process, and the MRI of the neck was normal. In the light of the MRI findings, the paralysis of the recurrent laryngeal nerve was thought to be due to IgG4-related peripheral axonal neuropathy.Three months after the post-procedure, the patient continued on prednisone. The left cranial nerve VI palsy and vocal cord paralysis have resolved entirely. The patient returned to work with an occasional complaint of blurred vision. Concerns exist that upon discontinuation of prednisone, she will experience symptom recurrence.IgG4-RD is a recently described systemic fibro-inflammatory disease, although it was first diagnosed in salivary glands (Mikulicz's disease) more than 100 years ago . The etith decade  reduction. Imaging features may vary in intensity depending on the degree of fibrosis and lymphoplasmacytic cellular composition. Lesions are typically enhanced homogeneously following contrast administration. HRCT of the skull base is a helpful adjunct to MRI and superior in assessing osseous destruction and erosion –27.IgG4-RD is an immune-mediated inflammatory disorder in multiple organs characterized by abundant infiltration of IgG4-positive plasmacytes and fibrosis in the involved organs. The precise pathogenic mechanism remains unclear. Aberrant innate and adaptive immunity is considered the primary pathogenesis of IgG4-RD.Recent studies have shown that abnormal adaptive immune responses mediated by T-helper type 2 cells, regulatory T lymphocytes, CD4 -positive cytotoxic T lymphocytes, T follicular helper cells, and T follicular regulatory cells are involved in IgG4-RD , 28. In Currently, the standard of care for IgG4-RD worldwide remains to be corticosteroids (prednisone). Treatment usually starts with 40 mg of prednisone daily for 1 month. This dose is then tapered to and maintained at 5 to 10 mg per day. Should the steroids fail, rituximab should be considered as a second-line treatment .Making the diagnosis of IgG4-RD requires tissue sampling; if the petrous apex is the site of infiltration, middle cranial fossa craniotomy can be performed. The middle cranial fossa craniotomy approach may be considered invasive. Temporal lobe epilepsy is a known potential complication. It is based on the author's experience in performing over 150 cases of middle cranial fossa approaches that this is an infrequent occurrence when the modified transtemporal supralabyrinthine approach is employed, as described by Fisch. The technique involves drilling the temporal bone to access the petrous apex rather than retracting the temporal lobe. The technique has been described as “one-third temporal lobe retraction and two-third temporal bone drilling”. The important takeaway message is that middle cranial fossa craniotomy with transtemporal supralabyrinthine modification, as described by Fisch, is a viable, safe, and practical approach to obtain access to the petrous apex , 22.In summary, we describe, to our knowledge, the first case of primary temporal bone IgG4-RD causing cranial nerve VI palsy that has been proven histologically by a middle cranial fosssa craniotomy and temporal bone biopsy. This demonstrates that the middle cranial fossa approach, which is considered invasive, is a practical and viable option to diagnose petrous apex lesions.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.LH: otorhinolaryngologist involved in the middle cranial fossa biopsy, coordinator of contributions, submission, and contact for the manuscript. DR: neurosurgeon involved in the middle cranial fossa craniotomy, preparation, and grammar check of the manuscript. GH: primary treating otorhinolaryngologist. BS: treating rheumatologist. EP: reporting radiologist. KT: reporting histopathologist. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The compaction characteristics of broken rock in a caving zone have a significant impact on the movement law of overburden and the prediction of surface subsidence. The mechanical properties of the broken rock were clearly affected by the original rock strength of the roof. Based on the similarity theory, the ‘quartz sand-gypsum-lime-water’ mixed material was used to make similar samples of original rocks with different strengths, and the compaction mechanical behaviour of broken loose rock masses with different original rock strengths was studied. The results show that (i) the greater the original rock strength of broken rock, the shorter the initial compaction stage, the earlier the transition and stable compaction stages and the lower the degree of compaction; (ii) the initial deformation modulus and ultimate axial strain had a linear relationship with the original strength of the broken rock; and (iii) under different axial pressures, the deformation modulus increased with the increasing original rock strength of the broken rock. The tangent modulus and axial stress change approximately linearly, the secant modulus and stress change linearly, and the tangent modulus and secant modulus exhibit an exponential/hyperbolic relationship with the strain. The research results have high engineering application value for using numerical method to predict the mechanical behaviour of roof rock mass with different strength in coal mining and analysing the surface subsidence. The rock stratum in this area is also known as the caving zone. With increasing mining length, the overlying rock gradually collapses and the broken rock in the caving zone becomes compacted. The compaction mechanical properties of caving rock have a significant impact on the movement law of the overburden  and the permeability characteristics of the goaf ,2. ThereUnder the action of an overlying load, the gap between the broken rocks in the caving zone was small, and the contact increased. Macroscopically, the volume is compressed and the mechanical properties are gradually strengthened ,4. PreviThe experimental study showed that the stress–strain curve of broken rock in the caving zone is exponential , and theAs a mechanical parameter that can be obtained directly from engineering sites, roof strength is widely used in the calculation of roof collapse steps and prediction of fracture zone height. Previous studies on the mechanical properties of broken rocks have mostly used real rock for crushing, and indoor tests have been conducted. Owing to the different mineral contents of the roof rock in different mining areas, there are clear differences in strength. However, to explain the influence of strength on the mechanical properties of broken rocks, a direct comparison is difficult. In this study, the 'quartz sand-gypsum-lime-water' mixed material was used to make similar samples of original rocks with different strengths by controlling the material ratio based on the similarity theory. Taking strength only as the test variable, the influence of different original rock strengths on the compaction characteristics of the broken rock was studied.. 2. 2.1A traditional mixture of quartz sand, gypsum, lime and water was selected as the model material. Quartz sand is the skeleton, and gypsum and lime are cementitious materials. In the cementitious materials, the mass ratios of gypsum and lime were fixed at 7 : 3. The mass of water added to the materials was 10% of the total mass of the quartz sand, lime and gypsum (see a), and three samples were set for each ratio (b). After the sample was prepared, it was dried in indoor ventilation for 15 h, then the quality and size were measured, and a uniaxial compressive test was carried out  the greater the original strength of the broken rock, the faster the curve rises. Under the same strain condition of broken rock, the greater the original rock strength, the greater is the axial load required. (ii) When the axial strain reached approximately 0.18, the broken rock of Case 6 experienced a deformation transition period, and the deformation transition period was completed when the axial strains of Case 1 and Case 2 reached approximately 0.22. (iii) With increasing stress, the broken rock gradually became compacted. The greater the original rock strength, the smaller the axial limit strain and the lower the degree of compaction.According to the test data, the stress–strain curves of broken rocks with different ratio strengths under the same grading conditions were drawn, as shown in figure 3E0 is the initial tangent modulus at the initial stage of loading, εm is the ultimate axial strain of compaction, σ is the axial stress of the specimen, and ε is the axial strain of the sample. The Salamon model was used to fit the stress–strain curves of the broken rock samples with different strength ratios, as shown in figure 4a–f. The Salamon model fits the stress–strain curves of broken rocks with different strengths well. The relationship between the initial deformation modulus and the ultimate axial strain in the fitting parameters and the ratio is shown in figure 4g. With an increasing proportion of cement in the material (from Case 1 to Case 7), the strength of similar materials increased, the ultimate axial strain of the broken rock decreased linearly and the initial deformation modulus increased gradually, which was also approximately linear.The previous study  regarded. 3.2a. With increasing axial stress (greater than 40 kPa), the tangent modulus of the broken rock with a high original rock strength increased faster. Under different axial stress states, the higher the original rock strength of the broken rock, the greater the secant modulus (b). The increase in the secant modulus of the broken rock with different original rock strengths with increasing axial stress was basically the same.When the axial stress is small (10–30 kPa), the tangent moduli of the broken rock with different strengths are equal. Figure 5 modulus b. The inc–f, under the same axial stress or axial strain, the greater the original rock strength of the broken rock, the greater the tangent and secant moduli. The tangent modulus was approximately linear with the stress, but the change relationship exhibited an evident upward trend (figure 5c). The secant modulus has an obvious linear relationship with stress (figure 5e). Both the tangent modulus and secant modulus change exponentially with the strain or can also be called a hyperbolic change relationship .As shown in figure 5. 4 (1)The stress–strain curves of broken rocks with different original rock strengths have three stages: initial compaction, transition compaction and stable compaction. The greater the original rock strength, the shorter the initial compaction stage of the broken rock, the earlier the transition and stable compaction stages, and the lower the degree of compaction. (2)The initial deformation modulus and ultimate axial strain have a linear relationship with the original strength of the broken rock. The stress–strain curves of broken rocks with different strengths can be well fitted by the Salamon model. (3)Under different axial pressure conditions, the deformation modulus increased with increasing original rock strength of the broken rock. During the entire compaction process, the tangent modulus and axial stress changed approximately linearly; however, the curve exhibited an upward trend. The secant modulus changes linearly with the stress. The tangent modulus and secant modulus have an exponential/hyperbolic relationship with the strain.In this study, the model test method was used to prepare broken rock samples with different strengths according to a certain gradation. The influence of the mechanical strength on the compaction characteristics of broken rocks was studied. The main conclusions are as follows:


IgG4-related diseases cause lesions in various organs throughout the body. In otorhinolaryngology, IgG4-related Mikulicz’s disease is suspected and diagnosed based on the presence of lesions of the head and neck, salivary and lacrimal gland enlargement, and bilateral sinus opacity concentrated on the maxillary sinuses. However, in some cases, it is necessary to consider about differentiation between IgG4-related Mikulicz’s disease and Sjögren syndrome.A 75-years-old male patient visited our hospital with bilateral otitis media with effusion, which was resistant to conservative treatment. Other symptoms at presentation included enlarged bilateral submandibular and sublingual glands marked oral dryness, severe decrease in saliva secretion (1 mL/10 minutes), and dry eyes. We conducted a Schirmer’s and fluorescent dye tests, both of which were positive. High serum IgG4 levels were observed, and although the Sjögren syndrome (SS)-A/SS-B antibodies were negative, marked hypolacrimation and tear secretion were observed. Therefore, a detailed examination considering both IgG4-related Mikulicz’s disease and SS was conducted. Salivary gland scintigraphy performed prior to the salivary gland biopsy revealed a marked decrease in uptake, which satisfied the diagnostic criteria for SS; however, it was difficult to diagnose IgG4-related disease based on the diagnostic definition.Although a definitive diagnosis of SS was made, the persistent otitis media with effusion that was resistant to conservative treatment and bilateral mixed hearing loss were confirmed. As mixed hearing loss is considered an otological symptom of IgG4-related disease, oral steroid treatment was administered.Thereafter, marked recovery of hearing and reduced swelling and induration of the bilateral parotid and submandibular glands were observed. Clinically, IgG4-related Mikulicz’s disease was strongly suspected, but a definite diagnosis of SS was made.In the absence of an IgG4-related Mikulicz’s disease diagnosis, careful differentiation between IgG4-related Mikulicz’s disease and 2 diseases and their diagnostic criteria was essential. IgG4-related disease (IgG4-RD) can cause lesions in various organs throughout the body. However, in the field of otorhinolaryngology, clinical findings in the head and neck, such as salivary and lacrimal gland enlargement, and sinus opacity may lead to suspicion of IgG4-RD and ultimately, a diagnosis. Although the disease is not common in the otolaryngology field, IgG4-RD should be kept in mind in daily clinical practice. Additionally, IgG4-related Mikulicz’s disease, which is particularly important in the field of otorhinolaryngology, often needs to be differentiated from Sjögren’s syndrome (SS) due to similarities in their respective clinical symptoms. Careful interpretation of the diagnostic criteria is important to differentiate IgG4-related Mikulicz’s disease and SS. In this report, we discuss our experience of a patient with severe otitis media with effusion (OME) and mixed hearing loss who responded well to oral steroid treatment at our institution. In this research, personal information was anonymized so that individuals could not be identified. This study has been approved by the research ethics committee of Showa University Fujigaoka Hospital (permission number: 22-176-B). Additionally, written informed consent was obtained from the patient and the patients’ guardian for publication of this case report and accompanying images.β2-agonist prescribed by the department of internal medicine at our hospital. Examinations conducted at our department revealed OME with bilateral tympanic membrane depression and a slight yellow middle ear effusion. Audiometry revealed bilateral mixed hearing loss with bone conduction thresholds that were not age-appropriate , symmetrical enlargement of 2 or more pairs of lacrimal, parotid, and submandibular glands” and “A item 2: High serum IgG4 levels (135 mg/dL or higher).” In order to achieve a definite or probable diagnosis in the IgG4-RD follicle diagnostic criteria, pathological evaluation by tissue biopsy is required, as shown in item 3 of the comprehensive criteria .A simple computed tomography scan of the neck, including the hearing apparatus, performed at the first visit to our department showed bilateral ethmoid and sphenoid sinus soft-tissue opacities, bilateral submandibular gland enlargement, and soft-tissue opacities in the bilateral middle ear cavities and mastoid cells were observed Fig. A. The irAfter the oral steroid treatment was initiated, early improvements in hearing and tympanic membrane findings were obtained, and the subjective symptoms of hearing loss were alleviated. The dose was reduced by 5 mg every 4 weeks, but after 16 weeks, when the dose decreased to 10 mg/day, the hearing loss worsened, so the dose was increased again to 15 mg/day which improved and stabilized the hearing Fig. B.Dry mouth symptoms did not improve, but induration enlargement of the bilateral submandibular and sublingual glands improved markedly. The serum IgG4 level also improved markedly from 444 mg/dL before the start of treatment to 183 mg/dL 8 weeks after the start of treatment. Additionally, various blood samples taken before the start of treatment were negative for p-antineutrophil cytoplasmic antibody (ANCA), c-ANCA, serum complement, antinuclear antibody, and sedimentation levels, and serum angiotensin converting enzyme, soluble IL-2R, and squamous cell carcinoma levels were not elevated. There were no signs of granulomatosis with eosinophilic polyangiitis (Churg-Strauss syndrome) or granulomatosis with polyangiitis (Wegener’s granulomatosis), sarcoidosis, Castleman’s disease, and malignant lymphoma or other carcinomas.In this case, air and bone conduction thresholds on audiometric testing were used as an evaluation index of the therapeutic effect of treatment, and the PSL maintenance dose (approximately 15 mg/day) was quite high. The plan is to monitor the patient’s progress, paying attention to the possibility of adrenal insufficiency, steroid-induced DM complications, and osteoporosis. reported the relationship between autoimmune pancreatitis and IgG4. Yamamoto et al reported that Mikulicz’s disease presents with high serum IgG4 levels and IgG4 + plasma cell infiltration of the lacrimal and salivary gland tissues, while SS does not have these pathological findings, indicating the possibility that the 2 are different diseases. Since then, various systemic diseases, such as Küttner’s tumor, sclerosing cholangitis, retroperitoneal fibrosis, periarteritis, hypertrophic meningitis, interstitial pneumonia, and interstitial nephritis have been associated with IgG4. Consequently, it was proposed to collectively name these various organ lesions associated with IgG4 as “IgG4-related disease (IgG4-RD).” After such historical changes, in 2011, Umehara et al in Japan presented comprehensive diagnostic criteria for IgG4-RD , it is possible to confirm the diagnosis using the diagnostic criteria for each organ. Although tissue biopsy has been suggested where possible, there are cases in which a diagnosis can be made without tissue biopsy. Among the diagnostic criteria for each organ, the criteria that we otorhinolaryngologists are most likely to encounter are those in suspected cases of IgG4-related Mikulicz’s disease  and SS. This is based on the premise that IgG4-related Mikulicz’s disease and SS are separate pathologies. However, apart from high serum IgG4 levels, and despite the symptoms similar to those of SS such as dry mouth and hypolacrimation, IgG4-related Mikulicz’s disease is characterized by a good response to treatment with steroids and good recovery of glandular function in some cases. However, in this case, the submandibular gland was significantly reduced, induration disappeared, and air and bone conduction hearing thresholds improved markedly, but dry mouth and salivary secretion did not improve. This difference in symptom improvement  also made us consider the differences and differentiation between IgG4-related Mikulicz’s disease and SS.IgG4-RD is a disease characterized by high serum IgG4 levels, infiltration of IgG4 + plasma cells in 1 or multiple organs, and focal enlargement due to fibrosis, which result in masses, nodules, and hypertrophic lesions. Lacrimal sialadenitis, now known as Mikulicz’s disease, was first described in 1892 by the European surgeon Johann von Mikulicz-Radeki. The distinction between Mikulicz’s disease and SS, which presents with swollen salivary glands, has long been debated. However, in 1953, American pathologists Morgan and Castleman compared Mikulicz’s disease and SS and reported that they were histopathologically identical. For this reason, Mikulicz’s disease was considered a subtype of SS. However, in 2001, Hamano et alThe IgG4-RD comprehensive criteria states that “tissue biopsies should be performed whenever possible.” Therefore, we believe that biopsy of the submandibular gland, paranasal sinus mucosa, and middle ear mucosa may have revealed IgG4 + plasma cell infiltration in this case. However, if no nasal polyps that can be biopsied are found in the nasal cavity, or if consent cannot be obtained for otorrhea eosinophil testing by myringotomy, then obtaining consent for tissue biopsy of the submandibular gland, sublingual gland, and parotid gland tissue is considered even more difficult as a certain degree of invasiveness is required. reported 5 cases of IgG4-RD with otitis media or hearing loss similar to this case . Among these cases, although the age of onset was middle-age and older, there was no clear difference in terms of sex, and serum IgG4 levels were high in all cases. Immunohistological examination of the lesions indicated that 4 of 5 cases had elevated IgG4/IgG levels (>40%). Incidentally, at our institution, we experienced a rare case wherein IgG4 + plasma cell infiltration was localized to the ossicles despite no increase in serum IgG4 level. In this case, the patient refused tissue sampling and consent was thus not obtained for otorrhea or middle ear mucosa sampling. Therefore, it was not possible to determine whether the condition of the middle ear cavity and mastoid cells was due to otological signs of IgG4-RD, eosinophilic otitis media, or a combination of both. Additionally, since the definitive diagnosis of SS was made by relatively minimally invasive examinations prior to biopsy of the submandibular and sublingual glands, it was difficult to actively perform tissue biopsy from the standpoint of defining the diagnosis. Furthermore, systemic steroid administration is considered a basic and effective treatment for symptoms and lesions in the otological region, regardless of whether the treatment is due to otological signs of IgG4-RD, eosinophilic otitis media, or a combination of both. Tissue biopsy remains important in IgG4-RD, SS, and eosinophilic otitis media, and it is highly desirable that tissue biopsy is performed for detailed examination of the pathology. However, in the comprehensive diagnostic criteria for IgG4-RD, a definitive diagnosis can be made when items 1 + 2 + 3 are met, including tissue biopsy, but even if the comprehensive diagnostic criteria are not completely met, satisfying organ-specific diagnostic criteria may enable diagnosis without necessarily requiring a tissue biopsy. In addition, in our country, SS is often diagnosed without tissue biopsy in certain cases using the revised Japanese criteria cases of SS that can be diagnosed without a tissue biopsy for Sjögren’s syndrome. Although this point of discussion remains uncertain, this case presents an opportunity for us to consider the following 2 points: If IgG4-RD  and SS have different pathologies, it may be necessary to exclude cases diagnosed with SS based on the exclusion criteria; In contrast, tissue biopsy  might be necessary to diagnose SS . However, we must always remember that tissue biopsies , and even nasal polyp biopsy and otorrhea by tympanostomy have aspects that impose a burden on the patient to some degree. Admittedly, the diagnostic criteria of the American College of Rheumatology (EULAR) differs from the Revised Japanese criteria for Sjögren’s syndrome, which allows for a definitive diagnosis to be made without a histological diagnosis  and SS should be further elucidated.Clinically, although IgG4-related Mikulicz’s disease may be strongly suspected, it is necessary to distinguish it from SS based on its diagnostic definition. Careful interpretation of the diagnostic criteria is essential. Tissue biopsy may be essential in the diagnostic criteria for both IgG4-RD (including IgG4-related Mikulicz’s disease) and SS. More cases on otologic manifestations in IgG4-RD should be accumulated.www.editage.com) for English language editing.We would like to thank Editage (Investigation: Koichiro Oyake, Shuhei Uruma, Sawa Kamimura, Yojiro Kawamura.Methodology: Koichiro Oyake, Shuhei Uruma, Sawa Kamimura, Yojiro Kawamura.Project administration: Sei Kobayashi.Supervision: Taketoshi Nogaki, Yoichi Ikenoya.Validation: Taketoshi Nogaki, Yoichi Ikenoya.Visualization: Naomi Imaizumi, Yukiko Inoue.Writing – original draft: Yurie Otani, Tomotaka Shimura.Writing – review & editing: Sei Kobayashi.


Background: Significant survival benefit of adjuvant imatinib therapy has been observed in gastrointestinal stromal tumor (GIST). However, the impact of neoadjuvant imatinib on prognosis of GIST remains unclear. This meta-analysis aimed to compare the prognostic impact between upfront surgery and neoadjuvant imatinib plus surgery on GIST.Methods: A comprehensive literature search was performed to identify eligible studies up to 30 Sep 2021, through PubMed, Embase, Web of Science, and Cochrane Library. Studies compared the impact of upfront surgery and neoadjuvant imatinib plus surgery on disease-free (DFS) or overall survival (OS) in patients with GIST were selected.Results: Seven eligible studies with 17,171 patients were included. The reduction rates of tumor size in rectal and mixed site GIST were 33% and 29.8%, respectively. Neoadjuvant imatinib was not significantly associated with DFS compared with no-neoadjuvant therapy in rectal GIST . The OS of rectal GIST was significantly improved by neoadjuvant imatinib compared with no-neoadjuvant therapy .Conclusion: Neoadjuvant imatinib therapy contributed to tumor shrinkage and R0 resection of rectal GIST. Neoadjuvant imatinib plus surgery significantly improved overall survival of rectal GIST in comparison with upfront surgery. Gastrointestinal stromal tumor is one of the most common mesenchymal tumors arising from the gastrointestinal tract (GI), with an annual incidence of 10 cases per million people globally which accounts for 1–3% of cancers in the entire GI . GIST is considered to develop from the gain-of-function mutations of KIT  and plaSurgical resection remains the first choice of curative treatment for primary GIST. Since the first report  of the uA systematic search of literature using keywords as “gastrointestinal stromal tumor,” “GIST,” “neoadjuvant,” “preoperative treatment” and “preoperative therapy,” was carried out by two investigators (ZL and ZZ) through PubMed, Embase, Web of Science and Cochrane Library to identify studies that compared the treatment effect between neoadjuvant therapy and upfront surgery for GIST. The search was updated to 30 Sep 2021. Attempts have been made to get additional eligible studies through searching the references of relevant studies. This study was in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline .Eligible studies were identified by two investigators (ZL and JS) according to the following criteria:  ParticipThe first author, publication year, country, sample size, tumor site, information of neoadjuvant imatinib, surgery, resection margin, adjuvant therapy, follow-up, DFS and OS were extracted independently by two investigators (SWOY and JL). If the hazard ratio (HR) and 95% confidence interval (CI) were not provided in the studies, we either emailed the corresponding author for original results or calculated these data from the Kaplan-Meier survival curves using the methods reported by Tierney et al. . A thirdTwo authors (ZL and ZZ) independently assessed the quality of all included studies using the Newcastle-Ottawa Quality Assessment Scale (NOS)  with the2 statistics. Subgroup analysis was conducted to identify the source of heterogeneity. The random-effects model was used by default because of the nature of these retrospective studies. The estimated results of the fixed-effects model are also provided for reference. Sensitivity analysis was performed to validate the stability of the model by sequentially omitting each study. The publication bias was not performed as fewer than ten studies were included. Statistical analyses were performed using R software 3.6.1  with the meta package (4.13-0) (p < 0.05 was considered significant. The GRADE profiler software (version 3.6) was used to estimate the level of evidence . Statistical heterogeneity was evaluated using the chi-square test and I(4.13-0) . A two-sevidence .As shown in p = 0.99, I2 = 0%; reference: no-neoadjuvant therapy). In the subgroup analysis of rectal GIST, a trend of higher R0 resection rate ranging from 85.3% to 98.8% was observed in neoadjuvant imatinib group compared with the rate ranging from 74.4% to 92.0% in no-neoadjuvant therapy group . py group . But thep = 0.21, I2 = 35%). Sensitivity analysis was performed by omitting each study sequentially, and the estimated results did not differ significantly, indicating the stability of the model . To identify the potential source of heterogeneity, subgroup analysis was performed according to tumor site. A significant decrease of heterogeneity was observed in the subgroup of rectal GIST . In this subgroup, neoadjuvant imatinib was significantly associated with better OS compared with no-neoadjuvant therapy , which was consistent with the estimated results of the fixed-effects model . Neoadjuvant imatinib significantly improved OS in mixed site GIST  but not in gastric GIST .Six studies providing OS data were included . For thep = 0.79, I2 = 0%) indicating the credibility of the result.Sensitivity analysis was performed by omitting each study sequentially in rectal GIST subgroup. The result after omitting Yang 2020 was significantly different from that after omitting other three studies which might weaken the credibility of the model . This miThe present study compared the clinical effect of neoadjuvant imatinib and upfront surgery on GIST. The benefits of tumor shrinkage as well as improvement of R0 resection rate in rectal GIST were observed after the use of neoadjuvant imatinib therapy. Neoadjuvant imatinib was not significantly associated with DFS compared with no-neoadjuvant therapy in rectal GIST. However, neoadjuvant imatinib significantly improved OS of rectal GIST compared with no-neoadjuvant therapy.The use of neoadjuvant imatinib has been reported to yield benefits in downstaging to avoid extensive resection in cases of bulky tumors or tumors in particular site, such as rectum . A previComplete resection is one of the primary concerns in the treatment of GIST . The R0In current meta-analysis, four studies reported the duration of neoadjuvant imatinib which ranged from 6.3 to 10 months (median) indicating a relatively optimal window for tumor response . The parPrognosis is another main indication in the evaluation of efficacy of neoadjuvant therapy which has not been sufficiently reported previously. Hawkins et al.  analyzedIn current meta-analysis, DFS was available in four studies which were all focusing on rectal GIST. The pooled results showed that DFS was not significantly associated with neoadjuvant imatinib in rectal GIST. It is reported that positive margin is possibly associated with the recurrence of GIST but this negative impact disappeared in the era of imatinib due to the use of adjuvant imatinib . This coLimitations existed in current study. Firstly, due to the retrospective nature of these eligible studies, some inherent bias in the study design and process cannot be avoided. Secondly, tumor size and mitotic index as well as their reduction rate after neoadjuvant imatinib were not provided in all eligible studies that an overview of prognostic factors in GIST other than neoadjuvant imatinib was not available. Thirdly, detailed information of tumor rupture and adjuvant therapy were not able to be analyzed which were key factors impacting the prognosis of GIST. Fourthly, five out of the seven studies analyzed rectal GIST so further studies focusing on GISTs in other sites are warranted. Fifthly, a multicenter study including 340 cases of rectal GIST from 11 centers in China were included in this meta-analysis which provided relatively firm results for decision-making of neoadjuvant imatinib therapy. However, randomized controlled trials are still lacking and warranted to clarify the role of neoadjuvant imatinib in treatment of GIST.Rectal GIST benefits from neoadjuvant imatinib regarding to the achievements of tumor shrinkage and R0 resection. Although neoadjuvant imatinib had no significant advantage on the disease-free survival, patients with rectal GIST who received neoadjuvant imatinib plus surgery had better overall survival than those who received upfront surgery.


However, due to the large dose of PEG used in this investigation, a self-curing effect of PEG in concrete was not seen. The findings of this research suggest a novel use for PCMs: PEG may be directly applied to concrete to fulfill both mechanical and thermal requirements. Additionally, the number of hydration products and phase compositions remained almost constant.The use of phase change materials (PCMs) in the construction industry is one of the primary strategies for addressing the building industry’s present excessive energy usage. However, since PCMs must be enclosed before being used in construction, their efficiency is limited and their compatibility with concrete is poor. Thus, polyethylene glycol (PEG), a sequence of PCMs that may be put directly into concrete, is the target of this research. The fluidity, mechanical properties, thermal properties, hydration process, and hydration products of PEG-600 cement slurry were examined by TAM, XRD, FTIR, DSC, MALDI, etc., methods in this study. Furthermore, we tested the thermal properties of PEG-800 to confirm that the same depolymerization of PEG occurred in an alkaline environment. When PEG, with a molecular weight of 600 (PEG-600), dose was increased to 10%, both compressive and flexural strength fell by 19% and 18%, respectively. The phase change points of both PEG-600 cement paste and PEG-800 cement paste decreased to 10~15 °C, and the enthalpy of the phase change was about 6 J/g. Additionally, it was discovered that PEG entered the reaction during the hydration step. PEG underwent depolymerization and subsequently formed a complex with Ca According to CABEE  research, building energy consumption accounts for 51.3% of China’s total carbon emissions, making it a major priority to reduce building energy [Phase change materials (PCMs) are a novel kind of green energy material that leverage the endothermic and exothermic effects of phase change to accomplish energy storage and autonomous release, as well as energy utilization . When apDue to its more suitable phase transition point, at about 20~30 °C, and inexpensive cost, polyethylene glycol (PEG) is one of the most often used PCMs in the construction sector. PEG is often coupled with other porous materials to form stable phase change energy storage technologies. The polyethylene glycol/diatomite system has a maximum mass concentration of 58%, a phase transition temperature of 45~57 °C, and a phase transition enthalpy of 91.72~105.70 J/g . SimilarPEG with a molecular weight of 400 (PEG-400) and PEG with a molecular weight of 600 (PEG-600) are significant self-curing agents in concrete. When the PEG-400 content is kept within 2.4%, it was discovered that the strength of the concrete may be raised by more than 40%, and the mass-loss rate may be lowered from 4.2% to 2.06% . AnotherMost studies on concrete with PEG as a self-curing agent have focused on strength development and durability changes, while ignoring the thermal property changes brought about by PEG itself as a kind of PCM. Moreover, the research on phase change energy storage of PEG has ignored its excellent compatibility with concrete and encapsulation by various methods. As a self-curing agent, the amount of PEG added directly to the concrete is not more than 2%. In contrast to most available research, this study examined the maximum quantity of PEG-600 in the cement paste while also examining the development of the cement paste’s mechanical characteristics and porosity at PEG contents of 0% to 10%. It further examined the microstructure of PEG-600 that exists in cement paste at various doses and water–cement ratios, as well as its effect on energy storage, the cement hydration process, and the hydration products. Following the above investigation, this study concludes that PEG has significant research value as a kind of PCM that may be directly added to concrete and has only minor adverse impacts on the cement matrix.Portland cement P·II52.5, which was produced by Jiangnan Xiaoyetian Cement Co., Ltd. , was used in this study. The chemical and physical characteristics of the cement are shown in Generally, PEG-600 and PEG-800 were used in this study. The vendors and types of PCM are shown in Sand and stones affect many microscopic tests, such as XRD. Therefore, cement paste was used for all experiments in this study.All PCMs were kept warm at 30 °C for about 8 h so that the PCMs were all stable during the process of forming. The liquid PCM was first mixed with water and fully stirred for 1 min and was then subject to further mixing. The solid was first mixed with powder and fully stirred for 1 min and then water was added to the mix. After that, the specimens were molded and then routinely cured at 20 °C and 95% R.H.For the cement paste specimens, after testing of 28 d compressive strength, the hydration of paste samples was terminated with isopropyl alcohol. After drying, the samples were crushed and ground into powder immediately before the relevant test.The compressive strength and flexible strength of the cement paste were tested according to GB/T 17671-1999. Three prismatic specimens, with dimensions of 40 mm × 40 mm × 160 mm, were prepared at each specific experimental age, and, to begin with, the flexural strength was tested at a speed of 50 ± 10 N/s. Then each specimen was broken into two specimens, for a total of 6 specimens, for compressive strength testing at a speed of 2400 ± 200 N/s. The fluidity of the cement paste was tested using a truncated cone with a size of 36 mm at the upper bottom, 60 mm at the lower bottom, and of 60 mm height, according to GB/T 8077-2005,The hydration heat of the cement paste was measured using a TAM air thermostat calorimeter made by the American TA Company. After mixing the cement-based material mixture to be tested, it was added into the sample ampoule and immediately put into the constant temperature calorimeter to start the measurement. During the test, the temperature of the sample was strictly controlled to be the constant temperature required for the test. The cumulative heat release of cement hydration for 72 h was continuously measured, and the heat release rate curve was further analyzed.The crystalline phases of the PCM–cement paste were characterized by X-ray diffraction (XRD). An X-ray diffractometer  was used with measurement conditions of CuKα radiation and 2-theta scanning from 5° to 60°, with a scan speed of 0.15° per second. About 3 g of powder was used in the XRD test.This experiment used a DSC8000 differential scanning calorimetry analyzer produced by the PE company . The temperature range used in the test was −75 °C to 550 °C, with a temperature accuracy of 0.05 °C and a temperature rise rate of 5 °C/min, with a temperature accuracy of 0.008 °C and a sensitivity of 0.18 mW.−1 with a resolution of 4 cm−1 using a Thermo Fisher Nicolet IS50 FTIR spectrometer produced by Thermo Fisher Scientific . The test samples were prepared as a powder, as shown in Fourier transform infrared (FTIR) spectra of the PCM itself and the cement paste containing PCMs were recorded from 4000 to 400 cm2 were recorded to obtain the relative molecular masses of the PCMs after reaction in the alkali environment. PEG-600 was mixed with CaCl2 to keep the concentration of Ca2+ the same in the NaOH and Ca(OH)2 environments. The pH value of PCM with NaOH was 13 and the pH value of PCM with Ca(OH)2 was 11.Matrix-assisted laser desorption/ionization (MALDI) is a mild ionization technique for mass spectrometry, which can obtain mass spectrometry information for complete macromolecules that are easily dissociated into fragments by conventional ionization methods. MALDI spectra of the PCMs with NaOH or Ca(OH)As shown in PEG-600 significantly improved the fluidity of the cement. When the cement paste’s fluidity was excessive, it was difficult to install molds and easy to segregate bleeding. As shown in Ultimately, as shown in As shown in As shown in 2 system was added to the concrete, the 28 d strength of the concrete decreased from 54.4 MPa to 35.3 MPa at a 10% volume admixture, which was about 35% [It should be emphasized that the decrease in 28 d strength, as well as in 56 d strength, was around 50% when PCM with microencapsulation or PCM with lightweight aggregate penetration was added to the concrete with a strength of about 50 MPa . When thbout 35% . In summAs shown in 2 concrete was only 4 J/g, if the concrete was calculated together with the encapsulated PEG mass, while the theoretical phase change enthalpy of concrete is only about 6.5 J/g for the same mass fraction as in this study for the case of the highest encapsulation efficiency previously mentioned [The phase change enthalpy of the PEG cement paste was about 6 J/g. This was because the calculation procedure for the phase change enthalpy of the PEG cement paste took into account the sum of the polyethylene glycol and concrete masses. Similarly, the phase change enthalpy of the PEG/SiOentioned ,13,30. TThe decomposition products of PEG in cement were analyzed. As shown in 2 and form a complex with four PEG structures [As shown in ructures . PEG comAs shown in As shown in +, Cl− or SO42−, so it can be confirmed that PEG-600 reacted with calcium. During the process of depolymerization, the phase change point of PEG decreased significantly. However, the phase change point of the complex of Ca and PEG was much larger than for PEG itself. The melting point of PEG, whose molecular number is less than 200, was about −13 °C, but after the complex reaction with Ca2+, it increased significantly [According to the nucleation and growth theory, the free energy of two-dimensional nucleation is much smaller than the three-dimensional free energy , so thatficantly .To further confirm whether the calcium in the cement matrix is poisoned by alcoholic hydroxyl groups, FTIR tests were carried out. To differentiate the PEG in liquid samples from cement paste and PEG cement paste in solid samples, the absorbance and transmission of the FTIR spectrum were used as the ordinates.−1 was attributed to -CH stretching in PEG-600. Calcium hydroxide had a characteristic peak at 3650 cm−1, which represents the stretching vibration of O-H [−1, which also represented the stretching vibration of O-H. There was also a peak at 1675 cm−1, so it can be inferred that the powder contained water [−1 corresponded to CO2 in air [−1 [−1 [As shown in n of O-H . Furthered water . The abs2 in air ,40,41. T air [−1 . After t [−1 [−1 . However(1)PEG significantly improved the cement matrix’s fluidity. When the content reached 10%, the fluidity increased by 35% at a water–cement ratio of 0.4 and exceeded the measurement limit at a water–cement ratio of 0.5. The strength of cement paste decreased as the PEG dosage increased. When the PEG content increased to 10% under w/c ratios from 0.4 to 0.5, the compressive strength decreased by about 20%, while the flexural strength decreased by 18% and 0%, respectively. It can be inferred that the addition of PEG had a limited effect on the cement matrix’s strength.(2)2 in the cement paste was quite small. Thus, the primary reason for these phenomena was PEG’s toxicity to Ca2+ and the absorption of water.PEG can significantly slow down the process of cement hydration, according to research on the heat of hydration. When the blending percentage of PEG reached 50%, the hydration reaction completely stopped. Additionally, it was discovered during the setting time test that the PEG could significantly delay the hydration process. The XRD analysis revealed that the (001) face of Ca(OH)(3)2 could be identified. Additionally, the molecular weight of the PEG in a strongly alkaline environment containing Ca2+ indicated that the PEG had depolymerized and formed a complex with Ca2+.The PEG phase transition point decreased to 10~15 °C in the cement matrix, and the enthalpy of the phase change decreased slightly. The FTIR spectra indicated that PEG reacted with the cement during the hydration process. In comparison to the control group, a distinct peak corresponding to Ca(OH)(4)While retaining a certain amount of phase change energy storage, the higher doping of PEG had no serious negative effects. Therefore, other thermal properties of this system should be further explored and studied, such as leakage, thermal performance, cyclic stability, and the durability of PEG-cement composites.Polyethylene glycol was directly added to the cement matrix, and it still retained a certain degree of phase changeability, and, at the same time, there was no leakage. The following conclusions were drawn for our study:


Introduction: There is marked heterogeneity in clinicians’ choice of antibiotic duration for pediatric urinary tract infections (UTIs). Most patients with bacterial UTIs still receive between 7 and 10 days of antibiotics. Prolonged antibiotic exposure drives the emergence of resistance and increases the occurrence of adverse effects. There is increasing evidence that shorter antibiotic regimens may be equally effective compared with longer ones. However, studies evaluating shorter therapies in children hospitalized with urinary tract infections have not yet been performed. Methods: We performed a retrospective study comparing children hospitalized with UTIs treated with a short antibiotic (<7 days) or standard antibiotic treatment. The primary aim of our study was to assess the efficacy of a shorter antibiotic therapy for children with UTIs, compared with an historical group of children treated with a standard 7–14 days course. Results: 112 patients, 46 of which were females (41.1%) with a median age 6 months were enrolled. A total of 33 patients (29.5%) underwent a short therapy. All patients were successfully discharged from the acute episode, independently from antibiotic duration. Short therapy was associated with a lower risk of urinary tract relapse (22 relapses (95.6%) in the standard group, 1 (4.4%) in the short group; OR 0.081; 95%CI 0.01–0.63). Conclusions: Short antibiotic therapy was equivalent to standard duration therapy for the cure of UTIs in hospitalized children and was also associated with a lower rate of recurrences. This study provides the basis for a larger prospective randomized study to address the role of short antibiotic therapies in children with UTIs requiring hospitalization Escherichia coli, followed by Klebsiella pneumoniae, Proteus mirabilis, Enterobacter and Citrobacter, while infections due to Gram-positive bacteria are rare [Urinary tract infection (UTI) is a common problem in the pediatric population , with upare rare ,3.Clostridioides difficile infection and other microbiota disruptions, and longer courses of antibiotics are also associated with lengthier hospitalizations and higher costs [To date, there is marked heterogeneity in the clinicians’ choice of antibiotic duration for pediatric UTIs. Most patients with bacterial UTIs still receive between 7 and 10 days of antibiotics, although these durations are based largely on expert opinion, and recent evidence from adult studies and a randomized trial indicate clinical noninferiority between 7-day and 14-day courses . Fixed aer costs ,7. In ader costs .For these reasons, there is a growing interest in shorter antibiotic regimens to treat common infections. A recent pediatric retrospective observational study aimed to evaluate the effectiveness of a short-course antibiotic regimen in children with UTIs . In thisIn our center, since recent improved understanding about the direct and indirect benefits of a shortened antibiotic course , we implThis is a retrospective study of children aged more than 60 days up to 17 years who were admitted in the pediatric wards for at least 3 days with a diagnosis of UTI from March 2017 to April 2022. All patients were followed up, as per routine clinical practice in our center, for a period of ninety days after admission to evaluate for UTI relapses based on clinical and microbiological definitions, in our outpatient service of Pediatric Urologic Disorders. Follow-up data were collected by the outpatient charts of our outpatient service of Pediatric Urologic Disorders. The time for shifting from intravenous to oral antibiotic was subjective according to the attending physician. In our center, local guidance suggests intravenous amoxicillin/clavulanate empiric therapy for children admitted with a UTI, or ceftriaxone for ill-appearing children; once antibiogram is available, antibiotic treatment is decided according to susceptibility and safety/toxicity. Antibiotic duration was calculated by the day that the effective susceptible antibiotic was used . The duration of antibiotic therapy was decided by the evaluating physician in our pediatric ward, which included four pediatricians, two of them being specialized in pediatric infectious diseases and part of the antibiotic stewardship committee of our hospital providing guidance of shortening antibiotic therapies as new evidence is found. We define a short antibiotic duration when it lasts < 7 days, and standard if lasting 7 days or more.In our center, reasons for admission for a UTI are: being unable to retain fluids; dehydration requiring intravenous fluids; ill-appearing/sepsis-like status.-Age > 60 days.-Clinical diagnosis of febrile UTI defined by a fever of ≥38 °C AND:-A positive result of urinalysis (nitrite and/or leukocyte esterase positivity) in one urine sample collected by bladder catheterization or clean-voided urine AND positive urine culture for a single type of bacterium with a charge of >104 CFU/mL .-Positive urine culture for a single type of bacterium with a charge of >104 CFU/mL, even in the case of normal urinalysis if the child had compatible signs and symptoms and blood laboratory findings AND no other alternative diagnoses were obtained AND the treating clinicians considered the case and treated as a UTI AND the child was discharged with only the diagnosis of a UTI.-A clinical diagnosis of afebrile UTI defined by compatible signs and symptoms  AND:A positive result of urinalysis (nitrite and/or leukocyte esterase positivity) in one urine sample collected by bladder catheterization or clean-voided urine AND positive urine culture for a single type of bacterium with a charge of >104 CFU/mL .Admitted because of UTI.No urinary tract abnormalities.Negative blood cultures.-Antibiotic administration in the 3 days prior to admission.-Age > 18 years.-Immune deficiencies.-Unilateral or bilateral renal hypoplasia.Pelvi-caliceal dilatation (2° SFU grade hydronephrosis).Ureteral dilatation.Bladder abnormalities .At least one of the following urinary tract abnormalities:The primary outcome was to address the UTI relapse rate in children treated with a short (<7 days) or long course of antibiotic therapy (≥7 days).To evaluate the impact of clinical, demographic and microbiological characteristics on UTI relapse in the two groups of children treated with a short or long course of antibiotic therapy.To evaluate the impact of a short or long course of antibiotic therapy on a relapse with a similar bacteria or a bug resistant to the originally used antibiotic.To evaluate relapse rates over time during a 90-day period of follow-up.A comparison between the characteristics of relapse patients and non-relapse patients.Secondary outcomes were:t-test or Mann–Whitney U test was used to assess differences in the two groups for continuous variables as appropriate. A p value of <0.05 was considered statistically significant.For continuous variables, the Kolmogorov–Smirnov test was used to assess normal distribution. Categorical variables were reported as count and percentage. Continuous variables with normal distribution were expressed as mean with standard deviation; data with skewed distribution were expressed as median with interquartile range (IQR). Categorical variables were compared by Chi-squared tests or Fisher’s exact tests and the strength of this association, when significant, was evaluated considering the “V” of Cramer. A Student’s To evaluate the impact of the short therapy on the risk of relapse, odds ratio and 95% confidence intervals  were calculated. Kaplan–Meyer curves were built to compare patients who underwent standard therapy and patients who underwent short therapy. A log rank test was performed to evaluate if there was a statistically significant difference between the two curves. The statistical analysis was performed using IBM SPSS Statistics 26.0 software .The study was reviewed and approved by the Human Research Ethics Committee of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome, Italy . The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. No personal or identifiable data were collected during the conduct of this study. During the study period, 181 children were admitted for a clinical diagnosis of a UTI; of them, 37 were excluded due to urological abnormalities, 2 due to age, 21 due to a negative urine culture and 9 due to concomitant bacteremia. Therefore, 112 patients, 46 of which were females (41.1%), were enrolled in our study. Fifteen of these (13.4%) were affected by other comorbidities  and 13 patients (11.7%) had a renal echography pathological (a single patient did not perform the urinary tract echography). Four children (3.6%) had a prenatal echography that reported an alteration. Upon admission, 110 children (98.2%) had fever, 83 (74.1%) had alimentary difficulties, 40 (35.7%) had vomiting, 21 (18.8%) had diarrhea and 33 (29.5%) had other symptoms. The characteristics of the population are reported in Escherichia coli was the most frequently isolated microorganism , followed by Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and Proteus mirabilis. Concerning antibiotic resistance, 19 (17.0%) germs were resistant to amoxicillin-clavulanate, 15 (13.4%) to cephalosporins, 13 (11.6%) to the antibiotic used for the empirical treatment and 39 (34.8%) to another antibiotic.Regarding the method of urine collection, in 102 cases (91.1%) urine was collected by catheterization, in six cases (5.4%) by clean-void catch and in four cases (3.6%) by urinary bag. Urinary test results showed leukocyte esterase in 91 patients (81.3%), nitrites in 49 patients (43.8%) and both leukocyte esterase and nitrites in 45 patients (40.2%). Regarding the urine culture results, Blood exams were performed for most of the patients at admission. White blood cell count resulted abnormal in 99 cases (88.4%). C-reactive protein was dosed in 110 patients (98.2%) and resulted pathological (>5 mg/L) in 100 patients (89.3%), while procalcitonin was dosed in 44 cases (39.3%) and tested positive (>0.05 ng/mL) in 10 cases (8.9%). The median value of CRP was 40.15 (93.4) mg/L, while the median value of PCT was 0.16 (0.78) ng/mL. For the empirical treatment, 83 patients (74.1%) were treated with a single antibiotic, while the remaining 29 (25.9%) underwent a two-fold antibiotic therapy. The antibiotic most frequently administered was amoxicillin-clavulanate in 47 patients (42%); 29 infections (25.9%) were treated with ceftriaxone, 21 (18.8%) with the association of ampicillin and amikacin and 15 (13.4%) with another antibiotic.In our cohort, 35 patients (31.3%) modified the antibiotic therapy in progress due to medical decision . For what concerns the duration of antibiotic therapy, 33 patients (29.5%) underwent a short therapy  were treated for 6 days and the remaining patients for 5 days). The median duration of short therapy was 5 (0) days, while the median duration of standard therapy was 7 (3) days.All patients were successfully discharged from the acute episode, independently from antibiotic duration.A total of 23 relapses (20.5%) were reported during the study period and nine of them required hospitalization (8%). A total of 5 (4.5%) patients presented a relapse within 7 days from discharge, 10 patients (8.9%) within 30 days, 5 patients (4.5%) within 60 days and 3 patients (2.7%) within 90 days. Seventeen of the relapses  were by the same microorganism of the first infection, while six relapses were from a different bacterium. Overall, independently from the bacteria involved in the first UTI and in the relapse, in 11 relapses (47.8%) the infection was due to a microorganism with resistance to the antibiotic administered during the first infection .p = 0.002) with lower association (V = 0.28) in the short therapy group.A comparison between the characteristics of patients with relapse and patients without relapse is reported in p = 0.001). The Mann–Whitney test showed a statistically significant difference in the number of antibiotic therapy days, which was higher in patients who had a relapse .p = 0.004). In this study, we compared two historical cohorts of children with a UTI severe enough to require hospitalization and treated with a short (<7 days) vs. standard length (≥7 days) of antibiotic therapy, showing a lower rate of UTI relapses in children treated with a short course. To our knowledge, this is the first study addressing the role of shorter antibiotic therapy on time-free UTI relapses in young, hospitalized children with UTIs.The duration of antibiotic therapy in pediatric patients due to UTIs is not standardized and, in most cases, is prolonged for up to at least 7 days of treatment, reaching 14 days in severe cases or in patients at a higher risk of complications . HospitaDifferent guidelines on the treatment of pediatric UTIs are not uniform regarding the duration of antibiotic therapy; according to the EAU/ESPU guidelines,  a treatmp = 0.004). Although the different guidelines marginally deal with the role of short therapy, there are few randomized controlled trials in the literature that have tried to evaluate its effectiveness, in terms of the recurrence and antibiotic resistance of future infections.In clinical practice, the average duration of treatment for urinary tract infections is at least 7 days, regardless of the type of antibiotic chosen or the route of administration . In our Desai et al.  comparedA recent review analyzed studies about the difference in UTI recurrence rates after an antibiotic treatment of different duration . CompariOne of the possible explanations for the lower rate of recurrence in children treated with short therapy is the action of systemic antibiotic therapies on the gut microbiota. A study of 35 children under 3 years of age undergoing antibiotics for a UTI  showed tFrom our clinical experience, analyzing the 23 children who had a new UTI, we noticed that 73.9% (17) of the relapses were caused by the same bacteria as the first infection; only in 7/17 cases was the antibiogram of the two events the same, while in four cases the appearance of resistance to amoxicillin-clavulanate (in one case associated with a resistance to other antibiotics), in three cases the appearance of resistance to cephalosporins, and three with new resistance to other antibiotics (in one case associated with a resistance to amoxicillin-clavulanate). In eight cases, there was a new resistance to the antibiotic used during the first UTI episode, even if the bacteria were different. Exposure to prolonged doses of drugs could explain reinfections from a bacterium with a worse resistance profile than the first event, but this consideration needs to be explored through future and larger prospective studies.Importantly, our findings and the other mentioned studies seem to be in line with new evidence about the safety of short therapy in pediatric infectious diseases, such as pneumonia : a recenOur study has some limitations. First, this is a retrospective monocentric study on a relatively small cohort, so the results need to be interpreted cautiously, although they clearly provide a trend worth investigating in larger prospective studies. We also did not perform a subgroup analysis differentiating high from low urinary tract infections, as this is also difficult to establish in young children, although young, hospitalized patients more frequently have a high UTI. The children in our cohort were not randomized and underwent antibiotic therapies of a duration set by physicians. The relatively low number of patients and the single relapse registered in the short therapy group did not allow us to perform a regression analysis. Among the exclusion criteria, we considered patients under one month of age and patients with positive blood culture, thus, not evaluating children who are considered most at risk of developing subsequent complications. We did not run any molecular testing to link the results to trends in antibiotic resistance, and we did not collect data about previous antibiotic exposures earlier in life, which theoretically might have affected the antibiotic sensitivities of the UTI episodes. Finally, due to the small number of relapses in patients with short therapy, we could not compare relapse resistance profiles between the two groups (long versus short), although our results showed that subsequent infections, regardless of the duration of initial therapy, are supported in most cases by germs with a higher antibiotic resistance profile. Last, considering the absence of randomization, Kaplan–Meyer analyses are not the best way to compare those two groups, not considering any other variable. However, it is one of the first studies of its kind involving such a young pediatric population, providing preliminary data that shorter antibiotic regimens may be further studied in larger cohorts of young children admitted with UTIs.In conclusion, we showed that short antibiotic therapy was equivalent to standard duration therapy for the cure of UTI in hospitalized children and was also associated with a lower rate of recurrences. Given the better understanding of the negative effects of exposure to prolonged antibiotic courses, from alterations of microbiota to the induction of antibiotic resistance, our results reinforce the need to challenge current guidelines on the duration of antibiotic therapy in children hospitalized with UTIs through adequately planned prospective, multicenter, randomized, blinded studies. Importantly, a similar study should be designed for those children with less severe UTIs who do not require hospitalization but are treated in the outpatient setting.


The application of brick–concrete recycled aggregates can alleviate the problem of increasing construction waste and increasing scarcity of natural aggregates. The different moisture condition of coarse aggregates can significantly affect the performance of brick–concrete recycled aggregate concrete. In this paper, the additional water quantity of dry and air-dried brick–concrete recycled coarse aggregate concrete was determined. Additionally, the fluidity, rheological parameters, autogenous shrinkage, strength and chloride ion penetration resistance were tested, and compared with saturated surface dry recycled brick–concrete coarse aggregate concrete and natural aggregate concrete. The results showed that the slump of concrete was increased, whereas the plastic viscosity, static and dynamic yield stress were decreased by adding additional water or using saturated surface dry coarse aggregate. Compared with the dry and saturated surface dry state, the air-dried recycled coarse aggregate concrete has the smallest 28 days autogenous shrinkage value, higher compressive strength and splitting tensile strength, and less adverse effects on chloride permeability. It is most beneficial to the performance and economy of concrete to adopt the air-dried state when the brick–concrete recycled coarse aggregate is applied in engineering. With the speedy development of construction projects within cities, there is a growing scarcity of natural aggregates that can be mined around cities. At the same time, in the process of urban construction, random accumulation of construction waste after the demolition of old buildings will cause environmental pollution and occupied arable land problems. In China, construction waste has accounted for 30~40% of urban waste, and the annual discharge of construction waste has reached more than 400 million tons ,2. ThereThe recycled coarse aggregate has high water absorption due to its low density, high porosity, rough interface and mortar adhesion on the surface . When thFerreira  and MeftThe use of saturated surface dry recycled aggregate can reduce the water exchange between the aggregate and the cement paste , resultiIn order to reduce the water absorption of recycled aggregate, scholars have also investigated the modification of the surface of recycled aggregate using physical, chemical or microbial methods in recent years. He  used pasAll of the above measures have certain effects on improving the properties of recycled aggregate concrete. However, baking the recycled aggregate to be complete dry, or pre-saturated by water absorption, as well as using different surface treatment processes, will substantially increase energy and manpower consumption, so that the cost of aggregates increased, which is not conducive to the large-scale application of recycled aggregates. The studies of Brand  and IrisCement is the 42.5 R ordinary Portland cement of Jidong Heidelberg Cement Co, Ltd., , and the chemical composition of cement is listed in The water absorption rate of coarse aggregate was carried out according to Chinese National Standard GB/T 14685-2011. First, soak the aggregate in water for 24 h, take out and dry the off-surface water with a wet towel, weigh the saturated surface dry mass, and then dry it in an oven at 105 °C. Now, weigh the dry mass and calculate the water absorption rate.The slump of fresh concrete was tested with reference GB/T 50080-2016. Mixed concrete mixture in three layers into the slump cylinder , each layer plug pounding 25 times, smoothing the surface and holding the slump cylinder up vertically, measuring the difference between the height of the cylinder and the highest point of the concrete after slumping is the slump.The compressive strength and splitting tensile strength were measured based on GB/T 50081-2019; the size of the specimen is 100 mm × 100 mm × 100 mm, and the compressive strength is tested by standard curing until the specified age. The loading speed of compressive strength test and splitting tensile strength test are 0.5~0.8 MPa/s and 0.05~0.08 MPa/s, respectively.τS0,, see Equation (1).mT is yield torque; D is leaf diameter; H is blade height.The ICAR rheometer  was used to test the fresh concrete; the height and diameter of the blades used are 127 mm, and the inner diameter of the barrel is 286 mm. After the concrete is evenly mixed, put into the rheometer barrel, and the blades are made to rotate at a constant low loading rate (0.025 r/s) to obtain the torque versus time. The concrete presents linear elastic changes before the yield torque. After reaching the yield torque, the fresh concrete structure is destroyed, and flow begins to occur, and the torque value gradually decreases. The yield torque value corresponds to the yield stress that is the static yield stress T is torque, Nm; Y is related to τ0, Nm; V is related to μ, Nm·s; N is the rotational speed, rad/s.The dynamic yield stress and plastic viscosity are obtained by measuring the flow curve of fresh concrete. Firstly, it is loaded at the highest speed of 0.5 r/s for 20 s to destroy the flocculation structure of concrete, and then divide it into 7 test points with equal decreasing speed at each test point, and each test point is loaded continuously at an interval of 5 s. The final end rate was 0.05 rad/s. Fit the torque–speed point obtained to obtain the relationship between torque and speed as Equation (2).T is torque, Nm; H is leaf height, m; R1 and R2 are blade radius and cylinder radius, respectively, m; τD0, is the dynamic yield stress, Pa; μ is the plastic viscosity, Pa·s.Based on the Reiner–Riwlin Equation (3), the slope is linked to plastic viscosity, cylinder height and cylinder radius, while the intercept is related to dynamic yield stress, viscosity and cylinder radius. Therefore, the rheological parameters in Bingham model can be calculated.The autogenous shrinkage of concrete was tested via NELD-NES-type concrete shrinkage deformation measurement, in line with the non-contact method in GB/T 50082-2009, with specimen size of 100 mm × 100 mm × 515 mm, the test temperature of (20 ± 2) °C, relative humidity of (60 ± 50)%. On the basis of the electric flux method in GB/T 50082-2009, the chloride permeability resistance was tested by CABR-RCMP6 concrete chloride diffusion coefficient & electric flux tester.After curing for 28 days, the concrete specimens were crushed, and small piece of concrete containing recycled coarse aggregate were taken and dried to constant weight after termination of hydration. After spraying gold treatment, the micromorphology of the interface area was analyzed by Quanta 650 FEG  scanning electron microscope. Small pieces without coarse aggregate were dried to a constant weight and tested for pore structure using AutoPore V9600 mercury porosimeter .Reasonable determination of additional water is the key to the application of recycled coarse aggregate in concrete. The quality moisture absorption rate of natural coarse aggregate and brick–concrete recycled coarse aggregate was measured separately with time, shown in As shown in The concrete was prepared according to the mix proportion in It can also be seen from From The results of the variation of plastic viscosity of fresh concrete with time are shown in The autogenous shrinkage of concrete refers to the shrinkage attribute to the continuous hydration of cement under absolute humidity, which lead to a decrease in internal humidity and an increase in additional pressure generated by the curved liquid surface in the capillary tube. Due to the different moisture content of brick–concrete recycled coarse aggregate, the changes of internal humidity of concrete under absolute humidity were affected, and thus influence the autogenous shrinkage of the concrete. Four groups of concrete autogenous shrinkage were measured, the test results are represented in From As seen in The influence of brick–concrete recycled coarse aggregate on autogenous shrinkage can also be confirmed by the micro structure of the interface transition zone (ITZ) between coarse aggregate and cement stone. From By comparing The concrete was prepared on the basis of the proportion in In Although the crushing index of brick–concrete recycled coarse aggregate was larger, it was mainly caused by crushed brick particles. Most of brick–concrete recycled coarse aggregate is still broken concrete particles , and crushed brick particles only account for a little portion. Therefore, the compressive strength at 28 days and 60 days can reach about 40 MPa , which iResistance to chloride permeability of brick–concrete recycled coarse aggregate concrete with different moisture conditions was tested using the electric flux method, as shown in As exhibited in In It should be illustrated that the pores in the mortar part were different from those in the interface zone of The durability of concrete is mainly influenced by harmful pores and multi-harmful pores with pore diameter >50 nm . AccordiFrom the previous test results, it can be seen that the concrete formulated with brick–concrete recycled coarse aggregate in the air-dried state is better than the recycled coarse aggregate in the dry and saturated surface-dry state in terms of fluidity, rheological behavior, and strength and durability. At present, many researches still focus on the use of saturated surface drying process , which wOn the other hand, due to the high water absorption of the brick–concrete coarse aggregate, the water absorption effect of the dry aggregate is also very significant, which leads to the obvious deterioration of the fluidity of the concrete mixture over time. Moreover, owing to the excessive competition for water from the paste by aggregate, the ITZ structure between the aggregate and the cement paste becomes worse, which affect the strength and durability. Therefore, it is better to use the air-dried state than the dry and saturated surface dry state for the brick–concrete recycled coarse aggregate.However, it is important to noted that the additional water consumption in the concrete mix proportion should be calculated based on the water absorption rate of about 10 min of immersion, rather than the water adsorption saturation state of 24 h when using the air-dried state recycle aggregate. Otherwise, the concrete mix will be segregated, water secretion phenomenon, and affect the mechanical properties and durability. The research in this paper can provide guidance for the application of brick–concrete recycled coarse aggregate in engineering.In this paper, according to the law of water absorption over time, the mixture ratio of recycled coarse aggregate concrete in dry, air-dried and saturated surface dry state was designed, and the performance of concrete was tested.(1)Compared with the natural aggregate concrete, the initial slump of concrete was promoted by using dry and air-dried brick–concrete coarse aggregate and add extra mixing water, or using saturated surface dry coarse aggregate, but the slump loss of concrete was greater when dry brick–concrete coarse aggregate was used.(2)Compared with dry and saturated surface dry states, the static and dynamic yield stress of the air-dried brick–concrete recycled coarse aggregate concrete increased the least with 60 min and changed steadily. At the same time, the plastic viscosity at 0, 30 and 60 min of the recycled coarse aggregate in air-dried state is the minimum.(3)The autogenous shrinkage was reduced and the structure of ITZ was improved by using saturated or additional water technology for brick–concrete recycled coarse aggregates. Compared with the dry and saturated surface dry state, the autogenous shrinkage of the air-dried brick–concrete recycled coarse aggregate concrete is the smallest within 28 days.(4)The compressive strength and splitting tensile strength of concrete prepared with brick–concrete recycled coarse aggregate concrete were reduced compared to the natural aggregate concrete. In comparison with dry and saturated surface dry states, brick–concrete recycled coarse aggregate in air-dried states has less adverse impact on the compressive strength and splitting tensile strength of concrete at 7, 28 and 60 days.(5)Compared with the dry state and the saturated surface dry state, the amount of harmful pores and multi-harmful pores of concrete prepared by brick–concrete recycled coarse aggregate in air-dried state was the lowest, the 28 days electric flux value was the smallest, and the resistance to chloride ion permeability was best.In summary, compared with the dry state and the saturated surface dry state, the performance of the air-dried brick–concrete recycled coarse aggregate is better. However, the increase is not significant, considering that the drying or water-saturated treatment of the coarse aggregate needs to increase a mass of energy and artificial costs. Therefore, it has the best comprehensive technical and economic benefits to directly use the air-dried brick–concrete recycled coarse aggregate and add extra water reasonably in the project.