The viable but nonculturable (VBNC) state is a survival strategy for bacteria when encountered with unfavorable conditions. Under favorable environments such as nutrient supplementation, external stress elimination, or supplementation with resuscitation-promoting substances, bacteria will recover from the VBNC state, which is termed “resuscitation”. The resuscitation phenomenon is necessary for proof of VBNC existence, which has been confirmed in different ways to exclude the possibility of culturable-cell regrowth. The resuscitation of VBNC cells has been widely studied for the purpose of risk control of recovered pathogenic or spoilage bacteria. From another aspect, the resuscitation of functional bacteria can also be considered a promising field to explore. To support this point, the resuscitation mechanisms were comprehensively reviewed, which could provide the theoretical foundations for the application of resuscitated VBNC cells. In addition, the proposed applications, as well as the prospects for further applications of resuscitated VBNC bacteria in the food industry are discussed in this review. Escherichia coli and Vibrio cholerae in 1982, the viable but nonculturable (VBNC) state has been a widely known phenomenon adopted by microorganisms when confronted with stressful environments . Previous studies have indicated that the QS system was involved in the activation of superoxide or catalase to regulate the antioxidation activities in Pseudomonas aeruginosa [S. typhimurium [rpoS mutant of V. vulnificus, whose production of catalase was suppressed [rpoS expression and subsequently induces the expression of catalase (KatG) [2O2 and revive to a culturable state [QS signaling in bacteria can orchestrate an adaption to stressful conditions, and it has been reported to play a role in the resuscitation of VBNC cells. Ayrapetyan et al. discovered that the bacterial cell-free supernatants of ruginosa . Furtherhimurium . In accoppressed . Hence, ppressed ,117. Basppressed . With a e (KatG) . Throughle state . To sum 2O2-degrading compound that could facilitate the resuscitation of VBNC cells under prolonged stress or the effects of toxic chemicals, such as H2O2 produced in a culture media during autoclaving [2O2- or reactive oxygen-degrading effect [Sodium pyruvate (SP), a well-known intermediate key metabolite in glycolysis, is known to be functional in the resuscitation of VBNC cells. VBNC cells are able to grow on standard media, but they can revive on media supplemented with SP . SP has oclaving ,120,121.2O2-degrading compound, pyruvate is also a kind of carbon source that can be utilized by bacterial cells. Morishige et al. found that pyruvate and its analogue α-ketobutyrate both showed restoration activities; however, other well-known antioxidant or radical-scavenging reagents such as N-acetyl-L-cysteine, α-lipoate, and D-mannitol were ineffective in resuscitating VBNC Salmonella Enteritidis cells induced by H2O2 [E. coli cells through the high-affinity pyruvate/H+ symporter BstT/YhjX, which was regulated by two pyruvate-sensing hidtidine kinase response regulator systems, BtsS/BtsR and YpdA/YpdB, respectively [btsT expression [More opinions have emerged recently. Apart from being an H by H2O2 . Through by H2O2 . It was ectively . BtsSR apression ,124. WitOn most occasions, the reported studies on resuscitation mechanisms were based on the role of specific proteins or pathways, which may result in a less systematic and comprehensive investigation. With the extensive application of high-throughput sequencing technologies in biomolecular frontiers, more research based on omics analysis has emerged in the investigation of not only the VBNC-formation mechanism, but also the resuscitation mechanism.Acidovorax citrulli was reported, indicating that protein expression varied in the different resuscitation processes [V. parahaemolyticus was compared with the VBNC state and the exponential phase cells, revealing that the metabolic activity of resuscitated cells shared minor differences with exponential phase cells, but when compared with VBNC cells, the differently expressed cells were comprehensively upregulated, which mainly involved protein synthesis, secretion system, trans-membrane transport, adhesion, movement, and other vital processes [V. cholerae showed a combination mode of adaptive and survival responses under conditions of nutrient limitation [Up to now, most omics studies on resuscitation from the VBNC state were conducted based on proteomics analysis. A thorough iTRAQ-based proteomic profile analysis of VBNC and resuscitating cells of the plant-pathogenic bacterium rocesses . In the rocesses . From throcesses . Debnathmitation . For examitation . The anaUnculturable microorganisms exist as “dark matter” in ecological environments, which greatly affects the exploration and utilization of microbial resources. This unculturability is largely derived from the adverse natural habitat conditions of bacteria, since they are always inconstant, and their inherent characteristics such as the oligotrophy of water, desiccation of soil, and existence of pollutants greatly limit the normal growth of bacteria, many of which are functional species. Therefore, resuscitating VBNC bacteria could provide huge candidates for obtaining high-value strains.Sphingomonas and Pseudomonas genera [Micrococcus luteus or the heterologous expression of the Micrococcus luteus gene [At present, the resuscitation of VBNC bacteria has been proved to be effective in shaping bacteria populations. With the resuscitation-promoting ability of the Rpf protein, the abundance of specific taxa was significantly increased and 51 potentially novel bacterial species were isolated from a nutrient-rich compost soil . Su et as genera . In addis genera . Therefoeus gene ,91,130. rpf gene (or Rpf protein), so that the strains could be adopted to increase microbial diversity in the samples, through which the source of the Rpf protein can be enriched.The resuscitation and separation of VBNC cells in foods seems meaningful in another aspect as well. For example, in fermentative foods, the lowered pH, lack of oxygen, and particular metabolites may pose negative impacts on the normal growth of bacteria, and some of them may enter the VBNC state. The resuscitation of the VBNC-state functional strains such as flavor-producing strains, fermentation strains, and probiotics, through adding resuscitation-promoting stimuli, is of great significance, and can be a research aspect in the future . TherefoThe formation of VBNC-state pathogenic bacteria is a great threat to food safety and public health. However, when it comes to functional bacteria, entering a VBNC state makes them become a hidden resource for potential industrial application. In this article, aspects of the resuscitation of VBNC cells, including the definition and confirmation of resuscitation, promoting factors, and the mechanisms of resuscitation, are thoroughly reviewed, which could lay a firm theoretical foundation for the isolation and application of VBNC-state functional populations, as well as the prevention of risks arising from VBNC-state pathogenic bacteria. Attempts to resuscitate VBNC bacteria and the specific roles of the resuscitated cells have been studied in various environments in recent years, the effects of which have been proved to be profound. However, such studies in the food area are rare. Regarding the universality of the emergence of the VBNC phenomenon in the food industry, waking up the dormant and functional population may provide a new approach to obtaining valuable microbial resources, which may have great value for the food industry. However, care should be taken regarding the corresponding concerns. The microbial communities in food products, especially in fermented foods, are always complicated, and whether the resuscitation process restores some “unfavorable” microorganisms at the same time is unknown. Therefore, we think that the resuscitation of VBNC cells may be beneficial for the isolation of rare species or functional populations from foods, but the direct supplementation of resuscitation-promoting substances into foods should be rigorously evaluated to avoid the occurrence of food safety events and serious alterations to foods.


Body fat percentage was estimated using anthropometry, BIA, and DXA. Correlations between anthropometric methods and DXA, as well as BIA and DXA, were determined using Spearman's rank correlation. Sixteen out of seventeen estimates of body fat percentages using existing anthropometric equations showed strong positive correlation with the values derived from DXA measurements (r = 0.569 − 0.909). The highest correlation was observed using the equation derived by Yuhasz, r = 0.909, followed by the equations from Oliver et al., Evans et al., Faulkner, and Thorland et al. (r ≈ 0.9). Statistical analysis of body fat percentages from DXA and BIA measurements also showed high positive correlation (r = 0.710). Correlation of seventeen anthropometric equations with BIA and DXA methods revealed that equations by Yuhasz, Oliver et al., Evans et al., Faulkner, and Thorland et al. are suitable alternative for assessing body fat percentage among male athletes from combat sports, showing even stronger correlation than BIA method.Multiple anthropometric equations have been developed aiming to provide accurate and affordable assessment of body fat composition in male athletes. This study examined correlations of values obtained from seventeen different anthropometric equations to DXA as well as BIA and DXA values. Male athletes ( Body composition of athletes has a paramount effect on physiology and physical performance and provides information on the overall health . The bodBody composition can be quantified at multiple levels: atomic level , molecular level , cellular level (assessment of extracellular fluid and body cell mass), and at the tissue level  . AccuratWrestling, judo, and kickboxing are classified as weight-sensitive sports, in which athletes tend to undergo extreme dieting associated with extreme dehydration in order to reduce body mass, more specifically %BF, aiming to be moved to a lower weight category . TherefoThe aim of this study was to explore the correlations of different developed anthropometric equations with DXA measurements as well as the correlations of BIA with DXA measurements in determining the percentage of body fat in male athletes.The study was designed as a cross-sectional observational analysis of competitive, successful, and world-class elite male athletes competing in wrestling, judo, and kickboxing . All parN = 101), 17-33 years of age, recruited from three different combat sports: wrestling (n = 33), judo (n = 35), and kickboxing (n = 33). Recruited athletes showcased similarities related to their body composition, preparation, and monitoring prior to attending and during competitions. Inclusion criteria consisted of athletes who fulfilled classification criteria for “eliteness” or expertise defined by Swann et al. [Analyzed population sample consisted of 101 athletes , and hydrated state before testing. Moreover, they were asked not to perform any physical activity prior to their evaluations and to bring light cotton clothing. Complete testing of every individual athlete was conducted on the same day. Participants were evaluated by BIA, anthropometric measurement, and a whole body DXA scan, respectfully. All the equipment was calibrated each morning on the day of analysis prior to measurements.Anthropometric measurement of skinfolds, circumferences, and joint bone diameters was conducted according to ISAK guidelines and recommendations . Body we2, and reading accuracy of 0.2 mm. The height was measured using roll-up measuring tape  with measuring range of 0-220 cm (1 mm graduation). Circumferences were determined using a flexible steel tape calibrated in centimeters with millimeter graduations . Small sliding caliper (Rosscraft) was used to measure biepicondylar breadths of humeri and femurs. The instrument has a branch length of 10 cm, an application face width of 1.5 cm, and an accuracy of 0.05 cm.Firstly, skinfolds , abdominal, biceps, triceps, suprailiac, supraspinale, quadriceps, and medial calf) were located and labeled with a marker as determined by ISAK guidelines . Then, sR), or the largest variance in dependent variable by using independent variables (R2) , when correlated with referent methods. Furthermore, the Siri equation was used to convert body density to body fat percentage in cases where anthropometric equations estimated only body density [Seventeen anthropometric methods , 14–21 d density . The tes density .Upon arrival, participants were subjected to the bioelectrical impedance analysis (BIA) for measurement of the body fat percentage and body weight as described in our previous study . The meaDXA scanning was performed for each participant on Lunar iDXA scanner  according to the current guidelines for best practice . Qualityr), where values of r = 0.0–0.09 were considered trivial, r = 0.10–0.29 small, r = 0.30–0.49 moderate, r = 0.50–0.69 high, r = 0.70–0.89 very high, r = 0.90–0.99 almost perfect, and r = 1 perfect correlation [p values) was set at 0.05. Confidence interval was set at 95%. Graphs were created using GraphPad Prism 7.04.Statistical analysis was conducted using SPSS statistical program, package version 26 . Assessment of linearity for model validity, outliers, and data normality distribution was performed using scatter plot graph, Q-Q plot, histogram, skewness and kurtosis, and the Kolmogorov-Smirnov test. Based on the information obtained by these tests, assessment of the correlation of estimates obtained using anthropometric equations and BIA measurement was conducted using Spearman's rank correlation (relation . DescripCharacteristics of participants are presented in r = 0.569 − 0.909) with the values derived from DXA measurements (r = 0.909) was observed using the equation derived by Yuhasz et al. [r values over 0.9); only the r value obtained from the equation by Zuti and Golding was smaller than 0.6 [p < 0.001. In addition, the 95% confidence intervals showed wide ranges and overlap than 0.6 . Statist overlap .r = 0.710, p < 001)  .The aim of this study was to compare the accuracy of body fat assessment by anthropometric measurements and BIA, using DXA as a criterion , in male athletes from combat sports. Furthermore, the ultimate objective was to uncover the most precise existing anthropometric equation developed using specific anatomical landmarks for skinfolds, circumferences, joint diameters, and basic physical measurements and characteristics  applicable to the male athletes from combat sports. Correlation results of seventeen anthropometric equations with BIA and DXA methods revealed that equations by Yuhasz, Oliver et al., Evans et al., Faulkner, and Thorland et al. showed very high correlation with the values obtained by DXA method, even stronger than the BIA values. Therefore, these equations are considered as a suitable alternative for assessing body fat percentage in male athletes from combat sports.To date, many studies proposed novel anthropometric measurements and equations for body fat assessment. However, these methods are mostly population-specific developed for a particular sports or nation-specific, i.e., applicable to anthropometric characteristics of a particular nation studied , 28–33. Prior to choosing the adequate anthropometric measurement for their athletes, the coaches/sports experts should take into account gender, race, age, nation, condition and competition level, protocols for skinfolds, and other anthropometric measurements as well as other specific characteristics of athlete population used for the development of the chosen method. Even if all the criteria are met, it is not a guarantee that the selected method would be accurate enough for their particular athletes, most likely affected by slight or more significant differences between the athlete sample used for anthropometric method development and their athletes. This suggests that practically every coach should develop an equation specific for his team which is cumbersome and time-consuming task. Therefore, for athlete body composition assessment, DXA is still the “gold standard” method, while BIA has been the preferred field method over anthropometry. However, anthropometric measurements still have significant advantages over DXA and BIA, since anthropometric instruments take up less space, are not performed in specialized facilities, do not have complicated electronics prone to damage, and cannot be affected by potential physiological oscillations in human body caused by air travel or change of time zone. Moreover, anthropometric measurements do not require strict preparation protocols prior to testing (BIA) or highly skilled operator to perform the measurement (DXA). Taking into account all the above, this study was aimed at assessing which of the existing anthropometric measurements and equations has the correlation coefficient closest to both BIA and DXA, which are second-level validity referent methods, and thus be suggested as an accurate alternative in the field practice. To the best of our knowledge, more than hundreds of anthropometric methods and equations have been developed to date. In this study, estimates obtained by using seventeen well-known methods/equations used for a number of decades were correlated with DXA. Sixteen estimates of %BF showed strong positive correlation with the values derived from DXA measurements. This is an intriguing finding considering that the anthropometric methods/equations analyzed in this study have been diverse. They were developed over more than a fifty-year span either for athletes from different sports or on more general athlete population, using different references and criterion methods or applying different models for body composition assessment. Therefore, greater variability in correlation coefficients with DXA method was expected. Surprisingly, the majority of the correlation coefficients of anthropometric measurements were higher than the correlation coefficient of BIA with DXA method. However, considering relatively wide ranges and overlap between the 95% confidence intervals, the comparison between the correlation coefficients should be done with special attention.The study has several limitations. For example, even though widely used as a reference method in estimation of body fat content, DXA method is known to have moderate precision and accuracy in assessing percentage of body fat . Also, DThe aim of this study was to find which of the existing anthropometric equations can be used as an accurate yet affordable replacement for BIA and more importantly DXA method in male athletes from combat sports. The highest correlation was observed using the equation derived by Yuhasz; however, the equations from Oliver et al., Evans et al., Faulkner, and Thorland et al. showed very similar correlation coefficients. Moreover, all the equations with exception of Zuti and Golding seem to be more reliable than BIA method. Therefore, anthropometric equations derived by Yuhasz , Oliver


The incidence of needle breakage is estimated to be 0.000007%, and most needle breaks occur during inferior alveolar nerve block (IANB) administration and are localized to the pterygomandibular space. Although immediate surgical intervention is recommended for the removal of the fracture needles, intraoperative localization of a broken injection needle fragment can be challenging. Here, we present the case of a 36-year-old woman who underwent dental extraction of the left lower wisdom tooth under local anesthesia at a private office. At that time, a disposable 33G needle was broken and accidentally inserted into the pterygomandibular space during IANB. A broken injection needle was presented at the base of the left coronoid process of the mandible on computed tomography (CT). We successfully removed the broken injection needle using fluoroscopy and assisted endoscopy under general anesthesia. Local dental anesthesia via injection is a technique that is performed in daily dental practice. A very rare occurrence is a broken injection needle and accidental insertion. The incidence of needle breakage has been estimated to be 0.000007%, and most needle breaks (70%) occur during inferior alveolar nerve block (IANB) administration and are localized to the pterygomandibular space . Needle A 36-year-old woman was referred to our department for removal of a broken injection needle from the site of a left mandibular third molar extraction. She underwent dental extraction of the left lower third molar under local anesthesia at the private office one month ago. At that time, a disposable 33G needle was broken and accidentally inserted into the pterygomandibular space during IANB. The patient had mild trismus, but no inferior alveolar nerve paralysis, and the extracted site was clearly cured. Mild tenderness was noted in the left submandibular and upper internal deep cervical lymph nodes (LNs). The mucosa on the medial side of the left mandible, which was accidentally inserted with a broken injection needle, was smooth and normal. Panoramic and lateral radiographs revealed the broken injection needle at the base of the left coronoid process . ComputeThe plan was to remove the broken injection needle via an intraoral approach using fluoroscopy and endoscopy under general anesthesia. First, the position of the broken injection needle was examined using X-ray fluoroscopy . An inciIn a meta-analysis, Ho et al. reviewed 78 articles of ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation during dental local anesthesia , and estThe timing of surgical removal of the needle fragment was reported to be 73% within 2 days after the incident . In the Although the success rate of removal is 95% . RecentlNeedle breakage prevention is based on three main principles: proper equipment, techniques, and patient care. Most broken needles occur during the administration of IANB. To avoid breakage, long needles, no smaller than 27G, should be used without bending the needle before insertion and without inserting into hub to the tissue. When working with anxious patients, clinicians should be cognizant of sudden or rapid movements .


This paper aims at solving the material durability problem caused by spraying deicing salt on pavement concrete in the northern winter. Super absorbent polymer (SAP) was adopted as an internal curing agent to enhance the durability of pavement concrete. Curing parameters including particle size and dosage of SAP and curing condition were optimized based on mortar tests by means of the grey target decision method. The deterioration rule of durability and mechanical properties of pavement concrete internally cured by different SAP dosages after salt freeze–thaw cycles were explored through rapid freeze–thaw test. Combined with the characteristics of pore structure, hydration and microstructure, the influence mechanism of SAP on the salt freeze–thaw resistance of pavement concrete was revealed. The experimental results showed that: (i) The reduction in mass loss rate and relative dynamic modulus was significantly improved by SAP internal curing with moderate dosage; (ii) The more freeze–thaw cycles the specimen underwent, the greater the increase in strength; (iii) After 75 cycles, the chloride ion erosion depth could be decreased by approximately 23.18%. Moreover, the addition of SAP could refine the pore size, inhibit the generation of shrinkage microcracks, and promote the degree of cement hydration in the late stage, which improved the internal density of the cement concrete structure. Therefore, the deterioration of pavement under the coupling effect of salt freeze–thaw was reduced. In order to improve the safety of driving on icy roads in the northern winter, de-icing salt (sodium chloride) is usually sprayed to melt the snow and ice. However, the values of surface chloride deposition may increase in winter; meanwhile, salt solution may penetrate into the internal structure of pavement concrete through cracks and pores, which probably causes the salt-freeze erosion disease .In fact, more than 80% of the structural cracks in pavement are contributed by non-loaded cracks. Non-loaded cracks are generated frequently due to the water consumption during the hydration process and the water evaporation of concrete in the early stage of curing, which provide several channels for chlorine ions to enter the internal structure. In the meantime, the durability of pavement is probably affected by the pore structure characteristics of concrete. Therefore, an effective method is urgently needed to inhibit microcracks and optimize the pore structure of concrete to enhance the salt freeze–thaw resistance of pavement concrete.Internal curing technology can reduce cracks due to shrinkage and improve the durability of cement-based materials ,3. SAP iMost studies have shown that SAP internal curing can improve the mechanical and impermeability properties of cement-based materials, and there is an optimal dosage of SAP. It indicates the feasibility of studying the durability of SAP-concrete in experiencing environmental effects ,10,11. RThe above studies indicated that the addition of SAP could bring a positive effect on the freeze–thaw resistance of concrete, which is attributed to the optimization of pore structure. The effect of internal curing by SAP on pore structure mainly contains the following two aspects. The first was the appropriate increase of porosity. Related studies demonstrated that a quantity of closed spherical pores inside the structure would be produced by SAP gels that had released water. In this case, the air content of concrete was increased, which could protect concrete from freezing damage ,15,16,172 absorption peak in the Fourier transform infrared spectroscopy (FTIR) spectrum of SAP-concrete was 3.38 times higher than that of the control group [Moreover, it is meaningful to explore the impact of SAP internal curing on the hydration characteristics of cementitious materials. Li et al.  researchol group . The amool group ,28,29. Qol group  found thIn summary, SAP internal curing is beneficial to improve the characteristics of pore structure and hydration of cement-based materials, which may help to mitigate the damage of concrete under the coupling effect of salt and freeze–thaw. Meanwhile, previous studies have shown that the internal curing effect of SAP on concrete was highly sensitive to the amount of internal curing water that additional added, which was also affected by raw materials and the engineering environment. Consequently, optimal performance might not necessarily be achieved while choosing the theoretical amount of internal curing water, which could possibly have an influence on the exploration of the performance deterioration rule of pavement concrete under the coupling effect of salt and freeze–thaw. Therefore, it is necessary to find the optimum amount of internal curing water and dosage of SAP through reliable methods. At the same time, to evaluate the results more objectively, mathematical methods are applied, which also can be seen in the existing literature . OtherwiIn this work, curing parameters were optimized based on the grey target decision method via the mortar tests. The internal curing effect of SAP is greatly affected by its amount. When the dosage is insufficient, the curing effect is not obvious, but when the dosage is too much, it will produce more pores. To get the SAP optimal dosage more accurately, the performance of SAP-concrete was studied by reducing the dosage range of SAP after optimization. A rapid freeze–thaw test adopting NaCl solution was carried out to simulate the salt freeze–thaw coupling environment the pavement concrete undergoes. The performance deterioration of SAP-concrete with different SAP dosages under the coupling effect was evaluated by the indicators of mass loss rate, relative dynamic elastic modulus, flexural strength, compressive strength and chloride ion erosion depth. In particularly, the pore structure characteristics of concrete were studied by mercury intrusion porosimetry (MIP). In addition, isothermal titration calorimetry (ITC) and FTIR were conducted to research the hydration characteristics of internal curing concrete at different environmental erosion stages. Furthermore, scanning electron microscopy (SEM) was used to analyze the microstructure of the concrete before and after undergoing the salt freeze–thaw cycles. At the same time, the pores in the micromorphology were quantitatively analyzed by the Image J software. Based on the characteristics of pore structure, hydration and microstructure, the influence mechanism of SAP on the salt freeze–thaw resistance of pavement concrete was revealed.W/C (water–cement ratio) of 0.4 at 30 min of SAP are illustrated in Polyacrylate-sodium SAP from Shandong Huadi Co., Ltd. in Shandong Province of China was used as internal curing agent in this study, which included two particle sizes of 100–120 mesh (SAP-100) and 150–200 mesh (SAP-200). The macroscopic appearance and morphology of SAPs before and after absorbing water are presented in 2, Al2O3, Fe2O3, CaO, MgO and SO3 compositions of the cement was 24.99%, 8.26%, 4.03%, 51.42%, 3.71%, 2.51% by mass, respectively. To meet the requirements of gradation design and reach a better compactness, the coarse aggregate (granite) was divided into two particle sizes of 5–10 mm and 10–20 mm, which proportionally was 30% and 70%, respectively. In addition, river sand was employed as fine aggregate with the fineness modulus of 2.80.Polycarboxylate-type high-performance water-reducing agent with the reduction rate of 26% and the recommended dosage of 0.8% to 1.2% was employed, which could improve the workability of cement-based materials. Experimental water was Foshan tap water.W/C)IC is the additional water–cement ratio required for internal curing.The theoretical amount of internal curing water (IC water) and theoretical dosage of SAP (by mass of cement) could be determined both by the SAP’s liquid absorption Step 2. Adding SAP powder and dry-mixing the mixture. (30 s)Step 3. Adding water, water reducer and internal curing water, then wet mixing the mixture. (90 s)In order to make sure that the SAP was dispersed uniformly in mortar, the mixing steps were as follows:The mortar specimens were prepared according to the mixing proportions illustrated in The shrinkage performance of mortar was determined based on the dry shrinkage test method of cement mortar in JTG 3420-2020 , the sizThe specimens with the curing age of 24 days were immersed in 4% NaCl solution with the temperature of 20 ± 2 °C for 4 days to prepare for the salt freeze–thaw cycle test. Based on the fast freezing method in GB/T 50082-2009 , the tesniW is the mass loss rate (%) of the ith concrete specimen after n freeze–thaw cycles, accurate to 0.01; Wi0 is the mass (g) of the ith concrete specimen before salt freeze–thaw test; niW is the mass (g) of the ith concrete specimen after n freeze–thaw cycles.iP is the relative dynamic elastic modulus (%) of the ith concrete specimen after n freeze–thaw cycles; nif is the transverse fundamental frequency (Hz) of the ith concrete specimen after n freeze–thaw cycles; fi0 is the initial value of transverse fundamental frequency (Hz) of the ith concrete specimen before salt freeze–thaw test.In the process of salt freeze–thaw cycles, the external damage of cement concrete was characterized by mass loss, which was caused by the spalling of specimen surface, and its development of internal microcracks could be reflected by the dynamic elastic modulus. Therefore, the mass loss rate and relative dynamic elastic modulus calculated via Equation (2) and Equation (3) were adopted to evaluate the external and internal damage degree of cement concrete after salt freeze–thaw cycles.fiL is the residual flexural strength of the ith concrete specimen after n freeze–thaw cycles; fi0 is the initial value of flexural strength (MPa) of the ith concrete specimen before salt freeze–thaw test; nif is the flexural strength (MPa) of the ith concrete specimen after n freeze–thaw cycles. fiL = 0 means there is not any damage and fiL = 1 means unstable fracture occurred in the concrete specimen.To investigate the damage of salt freeze–thaw cycles on flexural strength of cement concrete, four-point bending test was conducted using the universal testing machine. The upper and lower spans between supports were 100 mm and 300 mm, respectively. Loading control with the speed range of 0.05 MPa/s−0.08 MPa/s was set in the test. To better investigate the deterioration rule of pavement concrete after salt freeze–thaw cycles, the residual flexural strength was defined and calculated using the following Equation.In order to ensure that the mechanical properties damage of cement concrete under coupling effect was evaluated more comprehensively, the compressive strength was also regarded as an indicator. According to JTG 3420-2020 , the com3 chromogenic method of rapid chloride ion migration coefficient method (RCM) in GB/T 50082-2009 [3 solution color indicator was immediately sprayed on the split section. (2) After about 15 min, the section of the specimen was divided into 10 equal parts along its diameter and the penetration contour line should be traced by waterproof pen. (3) The distance between the color boundary and the bottom of the specimen was measured, ignoring the measuring points blocked by the aggregate. The final calculation of chloride erosion depth is shown in Equation (5).id is the erosion depth of the measuring point (mm); n is the total number of measuring points. The resistance to chloride ion erosion of cement concrete was explored by studying the erosion depth of chloride ion in specimens after salt freeze–thaw cycles. On the basis of the AgNO082-2009 , the sizThe MIP test was conducted to investigate the pore structure characteristics of concrete using the PoreMaster-60 mercury injection instrument with the measurable pore size of 7 nm–100μm. The size of sample was about 1 cm×1 cm×1 cm.The internal structure of cement concrete might be affected by the early hydration process, which was most studied from the two aspects of hydration heat release curves and hydration degree. Considering the rapid progress of hydration reaction of cement in the first 3 days, the heat of hydration was constantly recorded by isothermal calorimeter on cement hydration heat tester to help characterize the hydration progress of cement. Hydration heat release rate and cumulative heat release quantity could be calculated with the guidance of the cement hydration heat test method (direct method) of GB/T 12959-2008 . The tes−1 and resolution was 4.0 cm−1. Potassium bromide tabletting method was adopted to produce the observation samples.The hydration degree of concretes internally cured by SAP at final stage of curing age (day 28) and different times of salt freeze–thaw cycles could be evaluated by FTIR-960 Fourier transform infrared spectrometer. Scanning wave number range was 4000–400 cmThe resistance mechanism to salt freeze–thaw coupling effect of concrete internally cured by SAP was closely related to its microstructure, which would also help to explain the macroscopic properties. Thus, SEM was conducted to characterize the microstructure of cement concrete before and after salt freeze–thaw cycles. SU-1500 scanning electron microscope produced in Japan was used in this test, with the secondary electron resolution of 3.0 nm.To more intuitively investigate the deterioration of concrete with the times of salt freeze–thaw cycles, the pores of the microstructure were quantitatively calculated via Image J software in this test.The flexural strength and compressive strength on day 28, shrinkage rate on day 3 and shrinkage interval length in the range of day 14 to day 28 were selected as evaluation indices. The specific experimental data are shown in The scheme could be optimized with the condition of uncertain weight information through the grey target theory applied in this paper. The target degree information of each scheme in the associated difference space was calculated and compared with the constructed standard model. The greater the targeting, the closer to the ideal solution.(1)Gray mode is constituted.Based on the results of the above mortar performance test, the grey target decision method calculation steps are as follows:iw is defined as a multilevel indicator sequence and iw(k) is the date for indicator k of pattern i, which can be expressed as:w(k) is the index pattern sequence, which can be given by:(2)A standard model is built.The comprehensive performance of mortar is determined according to the maximum and minimum values of different indexes. Among them, flexural strength and compressive strength are endowed with the maximum polarity; on the contrary, shrinkage rate and shrinkage interval length are endowed with the minimum. Then the standard model is built as:(3)Grey target transformation is conducted.The target is defined as:X composed of T can be obtained from Equation (9), which is shown as:The matrix (4)Grey relational difference information space is determined.Difference information set is defined as:The matrix Thus, it can be obtained that:(5)Target coefficient is calculated.Y is defined as:Target coefficient Y is got as:Based on the matrix (6)The weight coefficient is determined by the entropy weight method.ith model on the kth evaluation index is calculated as:In this part, regarding the X decision matrix as a risk assessment matrix, the normalized processing of data is carried out. The characteristic proportion of the kH of index k is calculated as:Information entropy kα of each index is obtained using entropy as:Objective weight Results of weight are as:Finally, the calculation results of the target center are shown in From the above table, it can be seen that the order of mortar target degree from highest to lowest was SAP-1-0.15%, WRA-1-0.15%, WRA-2-0.15%, SAP-1-0.10%, SAP-2-0.15%, SAP-2-0.10%, control group, SAP-1-0.20% and SAP-2-0.20%. The control group was ranked in 7th position, indicating that the addition of SAP could balance well the relationship between shrinkage performance and mechanical properties of cement-based materials; thus, the better curing effect was achieved.According to the experimental results, it can be found that the performance of SAP-mortar with the particle size of 100 mesh was better than 200 mesh with the same SAP dosage. It could be analyzed that the water conservation ability of 100 mesh is more powerful, for its liquid absorption rate is slightly higher than 200 mesh. During the curing process, SAP gels of 100 mesh particle size can release more internal curing water, which may expand the region of curing and promote the hydration of cement, and thereby, the performance of SAP-mortar is improved. As for the curing effect of SAP dosage, the order of SAP-mortar performance from large to small was 0.15%, 0.10% and 0.20% with the same SAP particle size, whether it was 100 mesh or 200 mesh. This phenomenon may also relate to the water conservation ability. There are more particles in the SAP dosage of 0.15% than 0.10%, which will absorb more internal curing water; therefore, a better curing effect is achieved.There is no doubt that the curing effect will improve with the increase of dosage based on the above analysis, but it was interesting to note that the mortar internally cured by SAP dosage of 0.20% was inferior to the control group. This is because it is easy for the phenomenon of ‘micro-agglomeration’ to occur during the progress of cement mortar mixing, which leads to the hindering of internal curing moisture release and the weakening of the curing effect, and in this case, the target degree of the mortar was reduced.It can be known from the test results that the use of water-resisting agent could reduce the shrinkage of the mortar to some extent, but the mechanical properties were not improved, which was reflected in the fact that the target degree of SAP-1-0.15% was greater than that of WRA-1-0.15%. The above results could be interpreted as showing that water-resisting agent may reduce the loss of the inside water of the mortar and increase the internal humidity, and consequently, the plastic shrinkage caused by hydration water consumption and water evaporation of the cement itself is restrained. However, the humidity of mortar in a certain range from the surface layer decreases due to the lack of sprinkling curing, and it may promote the generation of drying shrinkage microcracks, which has a negative impact on the mechanical properties.In summary, the optimized results of SAP particle size, dosage and curing condition were 100 mesh, 0.15% and natural curing. The results showed that SAP has an optimal dosage, which was consistent with the findings in the literature . ConsideThe mass loss rate and relative dynamic elastic modulus of test groups of different salt freeze–thaw cycle times are shown in From Nevertheless, the salt freeze–thaw resistance of SAP-concrete did not necessarily improve with the increase of SAP dosage. It is difficult to ignore the phenomenon that in the concrete internally cured by 0.175% SAP, the mass loss rate was higher than the control group and the relative dynamic elastic modulus was lower than the control group during the salt freeze–thaw cycles. It is speculated that there are more SAP pores remaining in the cement concrete cured with a higher SAP dosage, which is detrimental to salt freeze–thaw resistance. However, in the last 25 cycles, the mass loss rate of the control group was 2.71 times that of the SAP-0.175%. At the same time, the decrease of relative dynamic elastic modulus in the control group was 10.77% while it was only 4.57% in SAP-0.175%. The above performance demonstrated that the effect of salt freeze–thaw resistance of SAP-0.175% was gradually improved with the extension of the cycles. Based on the above results, it can be speculated that the SAP gels can absorb salt solution and hinder further penetration of chloride ions, and therefore, the deterioration of the cement concrete was eased.The flexural strength and relative flexural strength of cement concrete under different salt freeze–thaw cycles times are described in As seen in It could also be observed that the flexural strength of the concrete internally cured by the 0.175% SAP was always lower than that of the control group before and after the test. The flexural strength reduction of SAP-0.175% could be explained by the following two aspects. On the one hand, more honeycomb holes are formed with the more dosage of SAP when the SAP has released water and returns to a dry state. At the same time, the liquid water gradually froze in the freezing stage, and the volume increased, resulting in more cracks . TherefoTo further explore the effect of SAP dosage on the mechanical properties of cement concrete during salt freeze–thaw cycles, the compressive strength of the test block was measured after the flexural strength test was carried out. The compressive strength and its loss rate are presented in 2 are generated to fill the pores, thus, the internal structure of the cement concrete is compacted. The more hydration products may be produced with the a higher dosage of SAP, resulting in the better salt freeze–thaw resistance in SAP-0.150% than SAP-0.125%.According to Unlike the representation of the above SAP-concrete, the compressive strength of SAP-0.175% was always lower than the control group before and after salt freeze–thaw cycles. The reason here is similar to the analysis in flexural strength. The concentrated stress generated at the holes affects the compressive strength of the concrete when the specimen is compressed. Otherwise, the compressive strength loss rate of SAP-0.175% was almost the same as the control group during the progress of test, which was 31.99% in 75 cycles and was 2.44% lower than the control group. The result shows that salt freeze–thaw cycles did not aggravate the damage to the compressive strength of concrete internally cured by high SAP dosage, which was the same as the experimental results of flexural strength.Although the chloride ion erosion depth of SAP-0.175% was greater than the control group in the first 50 salt freeze–thaw cycles, it was 6.28% lower than that of the control group at 75 times. This phenomenon might be related to the lower cement matrix density and higher microstructure connectivity (higher porosity) of the concrete with the relatively high SAP dosage; as a result, more opportunities for external corrosive ions to invade and transfer into the concrete interior are provided .D is the damage degree; E0 is the initial dynamic elastic modulus of concrete before salt freeze–thaw test; nE is the dynamic elastic modulus of concrete after n freeze–thaw cycles.The external destruction of concrete might be caused by the internal damage, which is comparatively difficult to measure directly. To better reflect the damage decay inside the concrete, the damage degree of the specimen is defined by the relative dynamic elastic modulus according to the Equation (18).Considering that the flexural strength is an important index to evaluate the performance of pavement concrete, the fitting of the damage degree and relative flexural strength of the specimens was conducted, as shown in From the curve in An MIP test was carried out to investigate the pore structure between the control group and SAP-concrete. As is described in From the point of view of pore size, it can be discovered that the total pore area of the internal curing group was higher than that of the control group, while the average pore size of SAP-0.125%, SAP-0.150% and SAP-0.175% were 95.66%, 80.57% and 78.53% of the control group, which implied that the addition of SAP could refine the pore size. It can be known based on the osmotic pressure theory that the freezing point of the solution in pores grows with the increase of pore diameter. Particularly, salt solution has high moisture absorption and water retention, which would greatly improve the pore saturation, accelerating salt freeze–thaw damage. Meanwhile, the peak value of the pore size distribution curve of the SAP-concrete moved forward, compared with the control group. It could be interpreted that the SAP internal curing may reduce the most probable pore size of cement concrete  and connected pores cannot be formed when the pore size is smaller than that. The above analysis demonstrates that the addition of SAP can improve the pore structure of cement concrete to resist the salt freeze–thaw.To find the influence of SAP internal curing on the pores inside cement concrete during salt freeze–thaw process, the control group and SAP-0.150%  were selected. The cumulative pore volume percentages are shown in As seen in The variation curves of the hydration heat release rate and the cumulative heat release quantity of mortars with SAPs of different dosage are presented in It is clear in −1·h−1, 7.333 J·g−1·h−1, 12.091 J·g−1·h−1 and 12.164 J·g−1·h−1. It could be concluded that the peak time of hydration heat release rate moved forward, and the peak value increased in the internal curing group with the increase of SAP dosage. This is because the actual amount of internal curing water absorbed by SAPs was less than the theoretical values, resulting in the internal curing water participating in the hydration of cement in the form of mixed water, which increased the hydration rate. Among the internal curing group, SAP-0.175% had the largest contribution to the water of the hydration reaction system for it had the most additional water diversion. Accordingly, its hydration heat release rate peak appeared earliest with the largest peak.−1), SAP-0.175% (190.675 J·g−1), SAP-0.150% (149.091 J·g−1) and SAP-0.125% (129.857 J·g−1). The early hydration degree of cement-based materials could be characterized by the cumulative heat release quantity to a large extent. Obviously, the control group had the highest degree of hydration at 75 h among the test groups. As for the internal curing group, hydration degree rose with the increase of the SAP dosage. This is because more SAP dosage is widely and uniformly distributed in the mortars and more intensive hydration reaction can be carried out, thus, the degree of hydration is improved.Given the above results, although the early hydration degree of SAP-0.175% was the highest in the internal curing group, it was not conducive to reducing microcracks caused by temperature deformation because of the early arrival of the exothermic rate and higher peak value. Oppositely, SAP-0.125% greatly reduced the peak heat release rate, but its early hydration degree was the lowest in the test group. In summary, SAP-0.150% could better balance the relationship between the time as well as the value of peak heat release rate and early hydration degree, which might better inhibit early temperature shrinkage cracks.To better understand the hydration degree of internal curing concrete, the comparison of the FTIR spectrum of the control group and SAP-concrete after 75 cycles is depicted in 2 (about 3642 cm−1) of SAP-concrete was greater than that of the control group, and its content could directly reflect the hydration degree of pavement concrete. The Ca(OH)2 absorption peaks of SAP-0.125% and SAP-0.150% were close, and both were higher than that of SAP-0.175%, denoting that the curing effect of the two former was better. In particular, the peak area of Ca(OH)2 in SAP-0.150% was 2.10 times that of the control group, which could also help explaining that it had the best macroscopic performance after 75 cycles. The peaks of 1081 cm−1 as well as 1024 cm−1, 692 cm−1 and 463 cm−1 correspond to the characteristic peaks of C-S-H gel, which represented the main hydration products and cementitious materials of Portland cement. Compared with the peaks of 1081 cm−1 as well as 1024 cm−1, the characteristic peaks of C-S-H gel at 692 cm−1 and 463 cm−1 changed obviously, hence, the two peak areas were quantified. The sum of the small peak areas of SAP-0.125% and SAP-0.150% at these two sites was greater than that of the control group, signifying a higher degree of polymerization of the silicate grid. Furthermore, ettringite is also an important hydration product of cement, which is related to the characteristic peak of AFt or AFm (about 874 cm−1). It can be found that the peak areas of AFt or AFm in SAP-concrete were increased compared to the control group. It is worth noting that the peak areas of AFt or AFm of SAP-0.150% were 2.89 times that of the control group, indicating that the amount of hydration product could be increased to some extent with the internal curing of an appropriate amount of SAP.It can be observed from In order to clarify the effect of SAP on cement hydration during salt freeze–thaw cycles, the FTIR spectrum of SAP-0.150% and the control group was selected for comparison, as shown in 2 of SAP-0.150% was larger than the control group before testing, indicating that the hydration degree at the end of the curing age was promoted, contributed by SAP internal curing. In the progress of the salt freeze–thaw cycles, the absorption peak area of Ca(OH)2 in the control group gradually decreased, for the reason that the NaCl solution reacted with Ca(OH)2 to form a salt expansion product. Notably, the peak area of Ca(OH)2 of SAP-0.150% decreased first and then increased, which reached the minimum value at 50 cycles. It could be speculated that SAP can play a role of ‘re-absorption’, that is to say, SAP has released water and turn back to dry state at the end of curing period, and it will continue to absorb water in the early stage of salt freeze–thaw testing. In the later stage of the test, the internal curing water can be gradually released, whereby, the secondary hydration of the unhydrated cement is promoted, consuming part of Ca(OH)2, and the content of it degrades. The corresponding macroscopic test results showed that the performance damage degree of the internal curing group was lower than the control group in 50 to 75 cycles. In the meantime, it can be seen that during the process of the salt freeze–thaw cycles, the sum of the C-S-H absorption peak areas at 463 cm−1 and 692 cm−1 of the internal curing group was larger than that of the control group, indicating that the amount of hydration product was more, which might produce a denser internal structure.From The deterioration law of macroscopic performance can be better explained with the aid of microscopic morphology; furthermore, the effect of SAP addition on the salt freeze–thaw resistance of cement concrete can be analyzed. Through macroscopic experiments, it was found that the SAP internal curing effect with the dosage of 0.150% was more significant. In order to further study its influence mechanism, SEM technology was used to observe the microstructure of the cement matrix of the control group and SAP-0.150% internal curing group before and after the salt freeze–thaw cycles.Furthermore, as for the quantitative analysis of microscopic morphology, the existing literature has tried to measure the pore size . In thisCompared with the microstructure of the internal curing group a before It can also be recognized from To better study the relationship between SAP dosage and internal curing effect, the parameters of the pores of the pavement concrete after 75 cycles were compared. The calculation results are shown in It can be seen from The particle size, dosage and curing condition of SAP were optimized as 100 mesh, 0.150% and natural curing based on the grey target decision method via the mortar test.The reduction in mass loss rate and relative dynamic elastic modulus were improved and the resistance to chloride ion erosion was enhanced by SAP internal curing. After 75 cycles, the mass loss rate and the relative dynamic elastic modulus of SAP-0.150% were 65.76% and 1.12 times of the control group, respectively. Furthermore, the chloride ion erosion depth of SAP-0.150% was 23.18% lower than the control group.The strength of the specimen improved more significantly as the cycles of salt freeze–thaw increased. The mathematical relationship between relative flexural strength and damage degree was an upward opening quadratic function.The influence mechanism of the salt freeze–thaw resistance of SAP internal curing was as follows: Firstly, SAP refined the pore structure. Secondly, the microcracks were decreased with the effect of SAP internal curing. Finally, the hydration degree was improved, which was conducive to increasing the compactness of the internal structure.W/C of 0.4.The research results might lay a foundation for further revealing the improving mechanism of SAP internal curing concrete in actual working environments, and also provide a theoretical basis for enhancing the durability of pavement concrete. The appropriate dosage of SAP was 0.150% with the The aim of this research was to optimize the SAP parameters and investigate the performance deterioration as well as the improving mechanism of the concrete internally cured by SAP under the coupling effect of salt freeze–thaw. The conclusions are summarized as follows:In order to predict the service life of SAP-concrete under the coupling effect of salt freeze–thaw, a life prediction model can be established with multiple parameters. What is more, to better fit the actual engineering conditions, the characteristics of the soil, such as saline soil areas, can be taken into account. Further research of the performance degradation and influencing mechanism of SAP internal curing cement-based materials under multiple coupling environments such as sulfate dry–wet and salt freeze–thaw can be carried out.


The study aims to demonstrate a combination of superselective catheterization and electrochemotherapy as a feasible and effective new technological approach in treating high-flow vascular malformations of the head and neck region.In the patient with high-flow arteriovenous malformation of the lower lip, superselective catheterization was performed under general anesthesia. The microcatheter was used to administer 750 IU BLM intra-arterially into the feeding vessel. The whole malformation surface was then covered with 15 applications of electric pulses using the plate electrode.Excellent response, without functional or aesthetic deficits, was obtained in 10 weeks. During this period, debridement and necrectomy were performed regularly on follow-up visits. The pain was managed with oral paracetamol and sodium metamizole.Combining electrochemotherapy using bleomycin with superselective catheterization and arteriography is a feasible treatment option for high-flow vascular malformations in the head and neck region and could play a significant role in managing these challenging lesions. Vascular malformations represent a heterogeneous group of vessel disorders, of which arteriovenous malformations (AVMs) are the rarest and the most resistant to treatment, despite different available treatment techniques –4. CurreIn addition to the direct cytotoxic effect, the mode of action of ECT is also mediated by its impact on tumoral blood vessels. Electroporation, i.e., application of electric pulses provokes immediate but short-lasting vasoconstriction (vascular lock effect), which entraps BLM in the tumor vessels. Later, a more pronounced vascular disrupting effect occurs due to the cytotoxic effect of BLM on endothelial cells , 12, 13.There are several reports on good treatment outcomes of different vascular malformations: venous and arterial malformations, high- and low-flow, treatment-resistant venous malformations and capillary malformations , 14–16. Our study aimed to combine superselective catheterization and ECT as a new technological approach in the treatment of high-flow vascular malformations. The feasibility and effectiveness of this concept were demonstrated in the case of a patient with one AVM localized on the lower lip.A 64-year-old female patient with a 10-year history of slow-growing red mass on the right side of the lower lip was hospitalized in the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Slovenia, because of severe bleeding from the mass. In addition to regular therapy due to other comorbidities , the patient had regularly taken warfarin because of previous mitral and aortic valve replacement. Bleeding was managed with compression, and warfarin was replaced with low-molecular weight heparin to prevent thromboembolic events.A clinical exam revealed a 40 x 30 mm elastic malformation with palpable pulsation and central ulceration on the right side of the lower lip. A computed tomography angiography (CTA) scan demonstrated a 42 x 15 x 15 mm oval-shaped vascularized formation on the right side of the lower lip with a large and tortuous labial artery, feeding the malformation. The labial and facial artery diameters were 2.5 and 3.0 mm, respectively. A single vein exiting the nidus was seen. According to clinical and radiological characteristics, the vascular malformation was diagnosed as an AVM 2.The patient was offered ECT combined with superselective catheterization as the potentially curative treatment option, and after detailed information about its advantages and drawbacks, she signed informed consent for treatment and publication of the data. This approach was proposed as treatment option based on reports of successful vascular malformation treatments with electrosclerotherapy , 16, 18.via a 6 Fr vascular sheath, right external carotid artery angiography was performed using a 5 Fr Infinity catheter . The procedure continued with selective catheterization and angiography of the right facial artery to adequately visualize AVM vascularization. Based on angiographic findings, superselective catheterization of the right labial artery was performed using a 2.6 Fr Headway27 microcatheter . A Scepter C occlusion balloon  was inflated 2 cm proximal to AVM in the inferior labial artery to achieve low-flow conditions. At that point, a microcatheter was used to administer 750 IU BLM directly into the feeding vessel. Thereafter, without delay, the whole malformation’s surface was covered with 15 applications of electric pulses using plate electrodes with an 8 mm gap between them. Each application consisted of 8 electric pulses with an amplitude of 1300 V/cm and a duration of 100 μs at a repetition frequency of 5 kHz delivered by the electric pulse generator Cliniporator Vitae® . After ECT completion, balloon was deflated and electroporation related vasoconstriction was observed on angiography  . DebrideSeveral classification systems for vascular malformations have been proposed. The most comprehensive is the International Society for the Study of Vascular Anomalies (ISSVA) classification, which divides them into two main categories: tumors (true proliferative neoplasms) and malformations (morphogenetic defects) . MalformAVMs, as high-flow vascular malformations, are the most challenging type of vascular malformations to manage, as they are associated with high recurrence rates and local destruction of surrounding tissues . A complIn a recently published study, BLM was effectively used to treat early-stage AVMs. BLM was injected intralesional rather than intravascularly since BLM cannot induce vascular disruption immediately, and its accumulation inside the vessels could be hampered in high-flow AVMs . In our We can hypothesize that BLM remained entrapped inside the AVM vessels because of the antivascular effects of electroporation. Vasoconstriction was clearly observed on arteriogram immediately after the procedure. In tumoral vessels stimulating the sympathetic nervous system and precapillary sphincters leads to an immediate vasoconstrictive response (“vascular lock effect”) lasting several hours. The vascular lock effect is followed by a delayed vascular disrupting effect , 34. EleThe high sensitivity of endothelial cells to ECT was already demonstrated in preclinical and clinical studies , 40, 41.3 tumor volume. In our study the tumor volume was 5 cm3. Since the patient was old with several comorbidities and BLM was injected intra-arterially, we additionally reduced the recommended dose by 40% to avoid significant necrosis of the treated area and pulmonary fibrosis. This decision was based on our previous studies on elderly patients treated with ECT in combination with a reduced dose of intravenously administered BLM (It is important to emphasize that we used 750 IU of BLM only once, in contrast to a study where up to 15 000 IU of intralesional BLM was used without electroporation every month for a total of 6 months in treating venous malformations . Accordiered BLM , 44, 45.It should be noted that the patient has no functional deficits, such as oral incompetence. Even the final aesthetic result was excellent, despite the prolonged healing interval. Good functional and aesthetic outcomes are essential in the head and neck area. Furthermore, the good therapeutic outcome demonstrated in our study on small lower lip AVM confirms the efficacy of the combination of ECT and superselective catheterization in the treatment of this type of high-flow AVM. Compared with multiple treatments using BLM as an embolic agent without electroporation, our approach might allow a single treatment with a lower BLM dose to achieve a good clinical outcome. However, further studies on the application of our approach in AVM of different location and size are needed to confirm this approach compared with other embolization techniques. With this approach the possibility of adverse effects referring to BLM toxicity are significantly reduced. Nevertheless, it is important to emphasize the potential swelling after ECT. This could be relevant in the treatment of mucosal vascular malformations in the head and neck region, where oedema could pose serious health risks. We are aware that our procedure has several limitations, but on the other hand arises some relevant clinical questions such as what are optimal BLM concentrations in vascular malformations and still sufficient electric field to obtain complete response of vascular malformations with minimal intensive healing process. All these questions need to be addressed in further clinical studies.In conclusion, the technical advancements described in our study may improve the results of the high-flow vascular malformation treatment approach. Furthermore, with this technological advancement, cutaneous high-flow vascular malformations of the head and neck could be placed as an indication for ECT.However, it is important to understand the healing process after ECT, since swelling and consequently feeding difficulties may occur when treating AVMs in the head and neck area. It is also important to note that this procedure can only be performed in centers where both ECT and experienced interventional radiologists are available.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Slovenian National Medical Ethics Committee. The patients/participants provided their written informed consent to participate in this study.Conceptualization: AG and AK; Methodology: AG, DL, MC, CJ, and AK; Investigation: AK, AG, GS, and CJ; Data curation: AK, AG, and GS; Writing original draft: AK and AG; Writing, review and editing: AG and GS; Visualization: AK and AG; Supervision: AG and GS; Project administration: AK. All authors contributed to the article and approved the submitted version.This work was financially supported by the state budget by the Slovenian Research Agency, program no. P3-0003 and program no. P3-0307.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.


In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from the French National Health Data System, we described and compared the individual characteristics of patients with and without an antibiotic prescription. The prescribed antibiotics (ATC-J01) were detailed and compared between 2019 and 2020. Antibiotic prescribing indicators that take prescriber activity into account were estimated and compared. Patients who were female, advanced age, and the presence of comorbidities were associated with antibiotic prescriptions. The overall prescription rate was estimated at 134 per 1000 consultations and 326 per 1000 patients seen in 2019. General practitioners (GPs), dentists and paediatricians were associated with 78.0%, 12.2% and 2.2% of antibiotic prescriptions, respectively, with high prescription rates . In comparison with 2019, this rate decreased in 2020 for paediatricians (−30.4%) and GPs (−17.9%) whereas it increased among dentists (+17.9%). The reduction was twice as high among the male prescribers than among their female counterparts . The reduction in prescriptions observed in 2020 (−18.2%) was more marked in children (−35.8%) but less so among individuals ≥65 years (−13.1%) and those with comorbidities (−12.5%). The decrease in penicillin prescriptions represents 67.3% of the overall reduction observed in 2020. The heterogeneous decrease in prescriptions by age and antibiotic class could be explained by the impact of COVID-19 control measures on the spread of respiratory viruses; thus, a substantial proportion of the prescriptions avoided in 2020 is likely inappropriate, particularly among children. In order to keep the rate of prescriptions comparable to that observed in 2020, male prescribers, paediatricians and GPs should be encouraged to maintain that level, while a campaign to raise awareness of the appropriate use of antibiotics should be aimed at dentists in particular. Excessive antibiotic use has largely contributed to the emergence and global spread of increasingly difficult-to-treat resistant bacteria . In 2019Studies have shown that over 50% of outpatient prescriptions are issued inappropriately , mostly Since 2018, the monitoring of antibiotic use in France has been carried out under the auspices of the French National Public Health Agency (Santé Publique France). This monitoring is used to define awareness-raising strategies aimed at the public and healthcare professionals (HCPs). For sound, evidence-based planning, it is important to identify new levers for action in order to better target the relevant populations. To our knowledge, no studies have examined the individual factors associated with antibiotic prescription in France. The primary objective of this study is to describe the epidemiology of physicians’ prescriptions of antibiotics in the outpatient setting and identify the associated individual characteristics of the patients and prescribers. Finally, the impact of the COVID-19 pandemic and associated control measures on outpatient antibiotic prescriptions was analysed.In 2019, more than 58 million patients received at least one reimbursement for outpatient medical care for a total of almost 50 million antibiotic prescription reimbursements. Over 15% of these patients (and the same percentage of antibiotic prescriptions) were excluded because they were not affiliated to the general scheme (GS), were not residing in mainland France, or died during the year . The excOf the selected patients, 41.4% were reimbursed for at least one antibiotic prescription (With-Atb) in 2019. The majority were female (58.9%), of a working age between 15–65 years (60.4%) and residing in urban areas (68.6%). In terms of health status, 20.4% had at least one long-term illnesses (LTI), mostly chronic respiratory diseases, cardiovascular diseases, diabetes and cancer. Among those aged under 60, 13.2% were recipients of complementary universal health insurance (CMUc). In terms of healthcare system use, 63.6% of the patients With-Atb had at least five visits and 42.6% received at least two antibiotic prescriptions throughout the year. Compared to patients Without-Atb, they were more often female, aged under 5 or over 65 years, more likely to reside in the northern region of Hauts-de-France and less likely to reside in the southern Auvergne-Rhône-Alpes . They weIn 2020, 34.7% of the analyzed population received at least one antibiotic prescription . Their sIn 2019, 136,380 (68.8%) of the 198,135 prescribers identified were selected. They prescribed 81.9% of reimbursed antibiotic prescriptions to the selected patients . The majIn 2019, 34 million outpatient antibiotic prescriptions were issued in the selected population. The majority of these prescriptions were for female patients or those aged 15–65 . ApproxiIn 2020, less than 28 million outpatient antibiotic prescriptions were issued , correspThe overall prescription rate was 754 per 1000 patients in 2019, compared to 597 per 1000 in 2020 a. This rIn 2020, despite an overall reduction in consultations (9.4%) and antibiotic prescriptions (18.2%) compared to 2019, the change in indicators was heterogeneous between specialties b. Among This study provides an overview of outpatient antibiotic prescription in France, an essential step for understanding outpatient prescription practices, specifically the individual characteristics of the patients and prescribers associated with these prescriptions. Our analyses show that antibiotic prescription recipients are more often female, belong to extreme age groups (<5 years or ≥65 years) and often have comorbidities, being twice as likely to suffer from chronic respiratory diseases. Among those under the age of 60, antibiotic prescription recipients are more often vulnerable (CMUc). These results are consistent with the literature ,30,31,32GPs and dentists are associated with over 90% of outpatient antibiotic prescriptions. In proportion, GPs are the primary prescribers followed by dentists and other medical specialties . The prescription rate for dentists was 447 per 1000 patients, while that of GPs was 391 per 1000. Relative to their activity, dentists are thus the highest prescribers of antibiotics in the primary care sector, issuing an antibiotics prescription to almost one in two patients on average. A recent systematic review reports that the majority of dentists routinely prescribe antibiotics for patients who require dental implant surgery . HoweverFurthermore, despite the overall reduction in prescriptions in 2020 for all medical subspecialties, dentists appear to have maintained or even increased their level of prescriptions. Indeed, prescriptions of amoxicillin alone (J01CA) and in combinations (J01CR) by dentists increased by 3.8% and 8.2%, respectively, compared to 2019 . SimilarIn 2019, the annual prescription rate was 754 per 1000 patients and 134 per 1000 consultations. The most commonly prescribed antibiotics were penicillins, macrolides and other beta-lactams (primarily 3GCs). A liberal prescription of broad-spectrum antibiotics was also observed in most European countries  and is lWe estimated the reduction in the number of antibiotic prescriptions and of the number of patients exposed to these prescriptions at −18.2% and −13.5% in 2020 as compared with 2019, respectively. Similar results were observed in Europe where, in terms of prescription, reductions of 24% and 13.5% were observed in Spain and the United Kingdom, respectively ,38. The This study is based on data from the SNDS, which include all outpatient care subject to reimbursement for the entire population. Thus, due to the high statistical power related to the large number of subjects, we did not use statistical tests to compare proportions or ratio. In fact, very marginal differences were statistically significant and a multivariate analysis did not provide additional information. Nevertheless, this database has some limitations, in particular the absence of reliable indicators of precariousness, which meant we were unable to conduct an in-depth study of the effect of social inequalities on antibiotic use. In addition, this study was restricted to recipients affiliated to the main public health insurance scheme and strictly to outpatient antibiotic prescriptions, because the specialty of HCPs is not recorded for the vast majority of hospital-based outpatient’s medical services. Indeed, hospital prescriptions of antibiotics are not negligible and certainly affect a specific population. Finally, the reason for the prescription or duration of treatment are not available. Therefore, it is not possible to discuss the clinical relevance of the prescriptions or whether the antibiotics dispensed are appropriate for the conditions treated or not. However, this analysis remains important as a first step in identifying the priority targets (patients/prescribers) to be explored and towards whom awareness-raising efforts should be directed.The SNDS is a medical-administrative data warehouse fuelled by a prospective and almost exhaustive collection of all the services reimbursed by the national health insurance . It essentially contains the individual data used for the billing and reimbursement of outpatient care services and public and private hospital data collected in the medicalisation of the information systems programme PMSI by the Agence technique de l’information sur l’hospitalisation [the technical agency for information on hospital care—ATIH] . It alsoBy means of its permanent access to data from the SNDS, Santé Publique France has the authorisation from the Commission Nationale Informatique et Libertés [French Data Protection Authority—CNIL] requested to conduct this study.Patients who received at least one reimbursement for outpatient medical services in 2019 and in 2020 were identified. Patients not affiliated to the main public health insurance scheme [general scheme—GS], were not residing in metropolitan France and who died during the year of interest were excluded. This selection covered approximately 76% of the French population in 2015 .The prescribing physicians selected were GPs, other medical subspecialists or dentists. They were required to be in actual practice, under 75 years of age and to have a reasonable annual number of consultations (<9600 consultations/year). Midwives were excluded due to the specificity of their patients and prescriptions. HCPs unrecorded in the database were also excluded .Among all medical services received by the selected patients, those associated with an unselected or unknown HCP were excluded. As a result, patients who did not receive all of their outpatient medical services from a selected prescriber were also excluded.The selected patients were then classified into two groups: those without reimbursement for antibiotic prescriptions (Without-Atb) and those with at least one reimbursement for antibiotic prescriptions (With-Atb). Only antibiotics for systemic use  were considered.The following socio-demographic characteristics of the patients were considered: sex, age , region of residence (n = 13), area of residence , complementary universal health insurance (CMUc: yes/no among those aged <60 years) and social deprivation index of the town of residence estimated in 2015 (quintiles: Q1—least disadvantaged to Q5—most disadvantaged)  see sup. The heaThe prescribers were characterised by sex, age , subspecialty , years of experience , type of practice , and conventional status within the healthcare system  see . The annAntibiotics were categorised into eight levels according to the level 3 ATC classification: tetracyclines (J01A); penicillins (J01C); other beta-lactam antibacterials (J01D); sulphonamides and trimethoprim (J01E); macrolides (J01F); quinolones (J01M); combinations of antibacterials (J01R) and other antibacterial drugs (J01X). Additionally, penicillins with extended-spectrum (J01CA), combinations of penicillins (J01CR), third-generation cephalosporins (J01DD) and azithromycin (J01FA10) were singled out.Three prescribing indicators were developed. The number of prescriptions was standardized by: (1) total number of patients selected (With-Atb and Without-Atb), (2) number of consultations, and (3) number of patients seen. These indicators were estimated overall and for selected characteristics of patients and prescribers. For the dentists, the number of patients seen was preferred to the number of consultations. Indeed, the concept of consultation alone does not reflect the activity of dentists because they carry out far more routine dental procedures than consultations.For each year studied, the socio-demographic characteristics of patients and antibiotic prescribers are described. Qualitative variables are reported as frequencies (percentages) and quantitative variables as mean and standard deviation (SD) or median and interquartile range (IQR). The characteristics of patients With-Atb were compared to those Without-Atb. However, due to the size of the population, no statistical tests were performed and the different rates are reported without their confidence interval . AntibioAll analyses were performed using the SAS GUIDE software .The recipients of antibiotic prescriptions in France are more often female, children or with complementary universal health insurance. At the provider level, GPs, dentists, male prescribers and those over 50 years of age were associated with a higher rate of antibiotic prescription. Regarding COVID-19 impact, a relatively large decrease in prescribing among children than the rest of the population was observed from 2019 to 2020. The COVID-19 pandemic helped to achieve the objectives of reducing antibiotic prescribing in the community in an unexpected way. However, additional studies are needed to better understand drivers of such a reduction and sustained antimicrobial stewardship actions, such as the ones planned in the new French national strategy for preventing antimicrobial resistance [


While adding superabsorbent polymer hydrogel particles to fresh concrete admixtures, they act as internal curing agents that absorb and then release large amounts of water and reduce self-desiccation and volumetric shrinkage of cement that finally result in hardened concrete with increased durability and strength. The entrainment of microscopic air bubbles in the concrete paste can substantially improve the resistance of concrete. When the volume and distribution of entrained air are adequately managed, the microstructure is protected from the pressure produced by freezing water. This study addresses the design and application of hydrogel nanoparticles as internal curing agents in concrete, as well as new findings on crucial hydrogel–ion interactions. When mixed into concrete, hydrogel particles produce their stored water to power the curing reaction, resulting in less volumetric shrinkage and cracking and thereby prolonging the service life of concrete. The mechanical and swelling performance qualities of the hydrogel are very sensitive to multivalent cations found naturally in concrete mixes, such as aluminum and calcium. The interactions between hydrogel nanoparticles and alkaline cementitious mixes are described in this study, while emphasizing how the chemical structure and shape of the hydrogel particles regulate swelling behavior and internal curing efficiency to eliminate voids in the admixture. Moreover, in this study, an artificial neural network (ANN) was utilized to precisely and quickly analyze the test results of the compressive strength and durability of concrete. The addition of multivalent cations reduced swelling capacity and changed swelling kinetics, resulting in fast deswelling behavior and the creation of a mechanically stiff shell in certain hydrogel compositions. Notably, when hydrogel particles were added to a mixture, they reduced shrinkage while encouraged the creation of particular inorganic phases within the void area formerly held by the swelled particle. In missions ,18,19,20missions . Reducedmissions ,23,24,25missions ,29,30,31missions . Self-demissions . Signifimissions ,36,37,38missions . During missions  for intemissions . Hydrogemissions . The capmissions ,44. A demissions ,47,48,49missions ,52,53,54missions . During missions  for intemissions . Hydrogemissions ,57,58. Tmissions , and sizmissions . A deficThe tight microstructure produces a sturdy and long-lasting structure  with min2 production [2 emissions, HPC is a more durable and strong replacement for traditional concrete [Portland cement is the most frequently used construction material on the planet, with its manufacture accounting for five to ten percent of global yearly COoduction . In 2015oduction ,37,38,72concrete . In compconcrete . HPC is concrete . HPC hasconcrete . The incconcrete . HPC comconcrete ,75,76,77concrete . As wateconcrete . These pconcrete ,81,82,83concrete . Althougconcrete . Controlconcrete , and sizconcrete . During concrete ,89,90,91concrete . SAP is According to the literature, the swelling ratio of SAP in deionized water can be larger than 500 g/g, whereas in a traditional concrete pore solution, it can be as low as 10 to 20 g/g. Whenever the external humidity levels drop, the enlarged SAP acts as a flow obstacle, slowly releasing absorbed water ,95,96,97The technique of limiting the volume of voids in aggregate mixtures for attaining the appropriate qualities of fresh and hardened product can be defined as mix proportioning of materials made up of cement, e.g., paste such as cement and water, as well as concrete ,106,107.In this work, packing principles were used to estimate the paste volume required to fill aggregate void space in order to estimate the void ratio of various aggregates. Lastly, theoretical approaches for cement content, slump, and compressive strength were established. Subsequently, the void content density and fineness modules of the aggregate were estimated, the slump cone test was employed to estimate the needed volume of cement paste, and the concrete compressive strength was calculated. ANN was utilized to improve the accuracy of the test by increasing the analysis duration and decreasing the ratio of error. Polyelectrolyte molecules are covalently cross linked to produce a three-dimensional polymer network, which is employed as an internal curing agent. Due to the presence of very alkaline pore fluids (pH greater than 12), hydrogel particles are not chemically inactive in cement mixes . As pKa Hydrogel particles are often utilized in extremely small quantities when added with cement . In the lab, cement and hydrogel are combined dry, the needed volume of superplasticizer and water are introduced, and the mix is vacuum or hand combined (or even machine-mixed at the field). A vacuum mixer can provide more consistent mixing while also assuring that any porosity is caused by hydrogel particles and capillary water rather than non-uniformity as a result of the manual mixing process. As the cement paste for HPC has a very small w/c ratio, the superplasticizer, which is usually a water reducing additive, is included to provide adequate workability. When water is added to the mix, hydrogel particles instantly swell, and by the time the cement mix is applied, hydrogel particles are probably fully expanded (such as in a cast). The interplay between hydrogel particles and cement paste is of primary importance because hydrogel particles are needed for maintaining adequate hydration of the cementitious matrix; coarse aggregate  and fine aggregate  have been excluded from the illustrative example for convenience. It is also assumed that a comparable hydration process would take place in concrete as well as mortar specimens. Concrete mixture data were taken from  Table 1Table 1.ASTM C29 was used to determine the total aggregate void content. The amount of oven dry coarse and fine aggregate needed to maintain the chosen aggregate ratio was calculated. The fine and coarse aggregates were combined together in a pan using a scoop. The blended mixed aggregate was layered thrice in a 0.33 cubic foot vessel, with each layer being rodded twenty-five times. The void content was determined using the bulk density and aggregate relative density measurements. The test was carried out thrice with different batches each time. The mixed aggregate’s average void content was determined to be 25.4 percent. Many various molarity aluminum solutions were created, and gravimetric measurements were made to further explore the impacts of aluminum on swelling responses along with hydrogel mechanics. Lastly, the elastic modulus of hydrogels expanded in 0.025 M aluminum solution was calculated as a function of time. The kinetics of swelling was also altered. At a concentration of 0.005 M, all hydrogels exhibited a brief peak of swelling (5 min) followed by consistent deswelling for the rest of the experiment. Artificial neural networks (ANNs) have lately received a lot of attention as a novel way of processing data ,119,120.RMSE), the coefficient of determination (R2), and the mean absolute error (MAE) were applied for verification of the exactness of values in the testing and training phases of the model for foreseeing compressive strength and durability of concrete and assessing voids of concrete while using the hydrogel. The following is how the indices are calculated:For this work, three regression formulas for the root mean square error . In Upon assessing the ANN’s included parameters, its performance in terms of previously defined performance measures was evaluated during the training and testing stages . The gooR2 and RMSE findings showed that ANN is a reliable technique for these analyses. Hydrogel compressive strength was studied as a function of immersion period and hydrogel chemistry, along with aluminum solution concentration. Aluminum ions seem to tightly connect with the polymer network, increase the elastic modulus (showing an increased level of crosslinking), and cannot be rinsed off with water, but calcium ions do not create persistent bridges among charged moieties on the polymer backbone. The coiling and shielding properties of aluminum form a structurally strong outer shell and hollow down the core of most acrylic acid hydrogels, indicating that aluminum ions may be harming the polymer network, but additional research is required.This research investigates the relationship amongst concrete strength growth and void distribution pattern utilizing hydrogel. The void structure of the concrete section is seen as a sign of bleeding. The void volume fracture of concrete samples is estimated using an image analysis technique. Upon first look, the obtained data appeared to show a direct relationship between concrete specimen strength growth and void distribution patterns when hydrogel was not present. The inclusion of slag in the combinations, on the other hand, changed the situation inversely. We created two different hydrogel formulations and tested swelling kinetics in calcium, aluminum, and sodium solutions in this work. Since sodium ions generated electrostatic shielding inside the polymer network, the swelling capacity was lowered. Calcium and aluminum ions were capable of forming ionic complexes with the polymer network, resulting in decreased swelling capacity, deswelling of the hydrogel over time, and the creation of a mechanically rigid outer shell in the instance of trivalent aluminum ions. Concrete’s compressive strength, durability, and density were all examined. The test data were analyzed using ANN, which performed admirably.