Antimicrobial resistance is a growing public health crisis, propelled by inappropriate antibiotic prescription, in particular the over-prescription of antibiotics, prolonged duration of antibiotic therapy and the overuse of broad-spectrum antibiotics. The paediatric population, in particular, those presenting to emergency settings with respiratory symptoms, have been associated with a high rate of antibiotic prescription rates. Further research has now shown that many of these antibiotic prescriptions may have been avoided, with more targeted diagnostic methods to identify underlying aetiologies. The purpose of this systematic review was to assess the impact of rapid diagnostic testing, for paediatric respiratory presentations in the emergency setting, on antibiotic prescription rates. To review the relevant history, a comprehensive search of Medline, EMBASE and Cochrane Database of Systematic Reviews was performed. Eighteen studies were included in the review, and these studies assessed a variety of rapid diagnostic testing tools and outcome measures. Overall, rapid diagnostic testing was found to be an effective method of diagnostic antibiotic stewardship with great promise in improving antibiotic prescribing behaviours. Further studies are required to evaluate the use of rapid diagnostic testing with other methods of antibiotics stewardship, including clinical decisions aids and to increase the specificity of interventions following diagnosis to further reduce rates of antibiotic prescription. Staphylococcus aureus, and antibiotic-resistant Escherichia coli [Antimicrobial resistance (AMR) is a growing and complex public health concern rendering once successful antimicrobial treatments ineffective . Continuhia coli .There is an abundance of evidence exploring inappropriate antibiotic prescription, in particular, the use of broad-spectrum antibiotics, over-use of antibiotics, excessive antibiotic treatment duration and unnecessary antibiotic prescription, and its contribution to AMR . These iOver-prescription of antibiotics in paediatric population has been identified as a driver in AMR . Within Current research shows that ASPs can be effective in improving antibiotic prescribing behaviours in the paediatric emergency setting . SeveralThis systematic review aimed to assess the efficacy of rapid diagnostic testing in improving antibiotic prescribing behaviours for respiratory presentations in the paediatric emergency setting. The primary outcome of the study was to assess whether the introduction of rapid diagnostic testing for paediatric respiratory presentations in the emergency setting rendered an improvement in antibiotic prescription, in particular reduced rate of prescription, duration of antibiotic therapy and dosing as well as increased use of narrow spectrum antibiotics. We also assessed whether the implementation of rapid diagnostic testing resulted in improved or comparable clinical outcomes in comparison to standard care.A systematic review was performed to identify primary journal articles that assess the efficacy and safety of rapid diagnostic testing in managing antimicrobial stewardship, whilst maintaining patient care. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used as a template when performing the review.Does the implementation of rapid diagnostic tests, for acute respiratory presentations in the paediatric emergency setting, affect prescription rates, duration and dosage of antibiotic prescriptions?P (population): paediatric patients (aged 1 month–18 years old) presenting to the emergency department with respiratory symptoms;I (intervention): rapid diagnostic testing;C (comparison): usual care;O (outcome): appropriate antibiotic prescribing, whilst maintaining patient care.The literature review was conducted on 11 February 2022 across MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for publications from 1 January 2002 to 11 February 2022, including studies from the last twenty years. The search strategy was discussed with a senior librarian and incorporated specific search terms including ‘paediatric’, ‘rapid diagnostic’, ‘emergency department’ and ‘antibiotics’. The complete search strategy utilised for MEDLINE is included as Articles were eligible for full-text review if they were primary articles, conducted in the paediatric population presenting to the ED with respiratory symptoms, with clearly defined rapid diagnostic testing methods as the main intervention and when antibiotic prescribing behaviours were at least one of the reported outcomes. Studies comparing two different rapid diagnostic testing methods were also included. Quantitative studies, such as randomised controlled trials, cohort studies and before-and-after studies, were included, as well as relevant systematic reviews for cross-referencing.Articles were excluded if they were non-primary journal articles or grey literature. Rapid diagnostic testing conducted in paediatric settings other than the ED were excluded. Studies including both adult and paediatric patients were excluded unless paediatric-specific data could be extracted. Qualitative studies were also excluded.The study selection process was conducted over three rounds. First, duplicate articles were excluded. Title and abstracts of all studies were then screened, and for the relevant studies full-text analysis was performed applying inclusion and exclusion criteria. The study selection process was independently conducted by two authors (KW and PM) followed by a meeting to discuss, and resolve, any discrepancies.The quality of included articles was assessed using the Integrated Quality Criteria for Systematic Review of Multiple Study Designs (ICROMS) tool . Only arData extraction was conducted by KW from all included studies using a standardised data extraction form, which summarised important study details including authors, publication year, study duration, study location, objectives, interventions, and key findings.A total of 232 articles were identified across the three databases. Filters limiting the search to studies published in English from 2002 to 2022 were applied. A total of 31 duplicates were removed, leaving a total of 201 articles for title and abstract screening. In total, 159 studies were excluded during this process. Reasons for exclusion included being a non-primary article, not having a clear rapid diagnostic testing intervention, having a non-paediatric population, not addressing respiratory presentations and for being in a non-ED setting. The remaining 42 articles then underwent full-text analysis from which 18 were eligible for final analysis . The datIncluded studies were published between 2002  and 2021The rapid diagnostic testing intervention varied between included studies. Three studies used rapid streptococcal tests, to assess for the presence of group A streptococcal (GAS) ,13,15. CThe primary outcomes varied across the included studies, ranging from antibiotic prescription rate to length of patient admission. All studies reported changes in antibiotic prescription rate before and after intervention ,26,27,28All studies utilising a RDT for GAS specifically observed a significant reduction in antibiotic prescription rates.p < 0.001). Further, the accuracy of the RDT was assessed by obtaining throat cultures of all negative RDT results, and a very low false-negative rate of 0.04% was observed [Two studies assessed the use of GAS RDTs alone. Ayanruoh et al. found a reduction in antibiotic prescription rates for children with symptoms suggestive of pharyngitis, from 41.38% in the pre-RDT period to 22.45% after the introduction of GAS RDT  [p = 0.03) [Of the eight studies assess the use of RDT testing for viruses only, three studies utilised the QuickVue Influenza Test. Esposito et al. found that a positive QuickVue test result showed a significant reduction in antibiotic prescription in comparison to cases with a negative result or no testing at all  . In comp = 0.03) . It was, = 0.03) . Iyer et = 0.03) .p < 0.0001) [p = < 0.001) and increase appropriate antiviral prescription by 13% (p = 0.023) [p = 0.006) was found in the early diagnosis group in comparison to the late diagnosis group [p < 0.0001) [Busson et al. evaluated the Alere i Influenza A&B test and its ability to contributed to patient management. The utilisation of Alere i RDT in the emergency setting lead to a 42.9% reduction in antibiotic prescription . Ozkaya  0.0001) . Rogan e= 0.023) . Sharma = 0.023) . A signiis group . Doan etis group . Finally 0.0001) .Six included studies assessed the efficacy of a BioFire FilmArray Respiratory Panel 2 (BioRP2) as a diagnostic tool in antibiotic stewardship. Three of these studies found a significant improvement in antibiotic prescribing methods after intervention was introduced.p < 0.001) [p < 0.001) [p < 0.001) [p = 0.003) due to the reduced time to result [p = 0.06/0.08) in antibiotic prescription in the RDT arm of the study with a greater reduction seen in paediatric patients (−19%) in comparison to adults (−9%) [Echavarria et al. compared the use of BioRP2 and immunofluorescence assay (IFA) in the emergency setting . Diagnos< 0.001) . Zhu et < 0.001) . In the < 0.001) . BioRP2 < 0.001) . Rogers < 0.001) . This sto result . May et o result . This stts (−9%) . Rao et ts (−9%) . This stts (−9%) . Therefots (−9%) . Finallyts (−9%) . The intts (−9%) .All papers included in this study were assessed for bias using the ICROMS tool. All studies met the minimum score and respective mandatory criteria based on study design, and were, therefore, deemed to be of good quality and included in the review .Antibiotic prescribing behaviours have been described as suboptimal in the emergency setting . InapproDecisions to change clinical management of patients, in particular, the decision to prescribe or not prescribe antibiotics, depends on several factors, including the identification of the pathogen and the patient’s medical history . Of the The success of an antibiotic stewardship intervention, which affects clinical management, cannot be appreciated without assessing clinical outcomes of the patients included in the study population. Of all included studies, two included studies observed whether the patient returned to the ED for the same symptoms following discharge, with both reporting no significant differences between groups ,25. UnfoDiagnosis of bacterial pharyngitis, based on clinical assessment using signs and symptoms alone can be a poor diagnostic tool . TypicalCrook et al. found that the introduction of RDT into diagnostic clinical practice has the most significant clinical impact on infants aged 29–60 days old . TypicalAnother important factor to consider when implementing an intervention that affects clinical workflow and patient management is the acceptability of said intervention among hospital staff and patients. Clinicians interviewed about the effect of RDT on patient management expressed concern about using RDT results alone to make clinical decisions and stated that clinical assessment as well as results from further ancillary testing would be required to modify patient management . This isSeveral factors need to be considered when implementing RDTs into clinical workflow, including the accuracy of the diagnosis, financial burden as well as the improvements with regards to time to result.Previous studies have shown a mixed review of GAS RDTs, with a majority reporting poor sensitivity in detecting GAS pharyngitis . ReporteThe financial burden of antibiotic over-prescription and the flow-on costs stemming from AMR need to be balanced with the introduction of RDTs into clinical practice. The administration of RDTs to all patients in the ED would not be practical financially or technically due to the high cost of each test and the requirement for extra staff and training for RDT administration . HoweverThe importance of time taken to receive a result is emphasised due to the common practice of dispensing empirical antibiotics in ill patients. It has been observed that patients who receive antibiotics on discharge prior to result availability, were often not informed that antibiotics could be discontinued after negative results were received . FurtherThis study has many strengths. The inclusion of only those studies that met the mandatory criteria from the ICROMS risk of bias assessment tool ensured that only high-quality studies were reviewed. Furthermore, a variety of RDT interventions, testing for different pathogens, were included, providing a generalisable overview of this diagnostic method. This provides clinicians and hospital staff ample information for the development and implementation of RDTs in the future.This study also had some limitations. Only three databases were included in the initial search; therefore, some references may have been overlooked. Further, only papers published in English were included, potentially overlooking relevant papers published in other languages. Moreover, the inclusion of a variety of RDTs, assessing multiple pathogens, may have led to an inconclusive overview of each rather than a comprehensive study assessing one type of RDT.We conclude that RDTs are an effective method of diagnostic antibiotic stewardship whilst aiding with appropriate diagnosis and therefore management of paediatric patients with respiratory presentations in the emergency setting. Successful administration of RDTs have shown great promise in improving antibiotic prescribing behaviours by reducing antibiotic prescription rates, duration of antibiotic therapy and promoting the use of appropriate antiviral therapy. Further research is required to assess the effect of RDT implementation with a focus on patient clinical outcomes. We recommend further research into the effectiveness of RDTs supplemented with clinical decision aids and criterion, to increase the specificity of the intervention to ensure appropriate treatment of patients and further reduce unnecessary antibiotic prescription rates.


The MAP kinase cascades are the most important oncogenic drivers of human cancers, including gastric cancer, and blocking this pathway with targeted inhibitors is an important antitumor strategy. Tegaserod maleate binds to MEK1 and MEK2, inhibiting kinase activity and thus suppressing the MEK1/2-ERK1/2 signaling pathway. Thus, tegaserod maleate may have potential as a MEK1/2 inhibitor for gastric cancer.Gastric cancer (GC) ranks fifth in global incidence and fourth in mortality. The current treatments for GC include surgery, chemotherapy and radiotherapy. Although treatment strategies for GC have been improved over the last decade, the overall five-year survival rate remains less than 30%. Therefore, there is an urgent need to find novel therapeutic or preventive strategies to increase GC patient survival rates. In the current study, we found that tegaserod maleate, an FDA-approved drug, inhibited the proliferation of gastric cancer cells, bound to MEK1/2 and suppressed MEK1/2 kinase activity. Moreover, tegaserod maleate inhibited the progress of gastric cancer by depending on MEK1/2. Notably, we found that tegaserod maleate suppressed tumor growth in the patient-derived gastric xenograft (PDX) model. We further compared the effect between tegaserod maleate and trametinib, which is a clinical MEK1/2 inhibitor, and confirmed that tegaserod maleate has the same effect as trametinib in inhibiting the growth of GC. Our findings suggest that tegaserod maleate inhibited GC proliferation by targeting MEK1/2. Gastric cancer (GC) is characterized by insidious onset, asymptomatic or minor symptoms at the early stage, causing delayed diagnosis and poor survival for most patients ,2,3. At Patients with GC benefit from adjuvant therapy to reduce recurrence after curative resection . HoweverThe development and approval of new drugs is a difficult and costly task with a high failure rate ,15. RepuHere, we found that tegaserod maleate significantly suppressed the proliferation of GC in vitro and in vivo by inhibiting MEK1/2, and provided reasonable theoretical support for the application of tegaserod maleate in the chemoprevention of gastric cancer.Tegaserod maleate (CAS:189188-57-6) was purchased from Selleck Chemicals LLC . Tegaserod maleate was dissolved with dimethyl sulfoxide to the final concentration 50 mM and stored at −80 °C. The following antibodies were used in the study: anti-phospho-ERK1/2 (Thr202/Tyr204) , anti-ERK1/2 , anti-MEK1 , anti-MEK2 , anti-Ki-67 antibody , anti-Flag .2 humidified incubator. AGS cell line was maintained in F12K medium supplemented with 10% fetal bovine serum and cultured at 37 °C in a 5% CO2 humidified incubator.Human GC cell lines HGC27 and AGS were obtained from the Chinese Academy of Sciences . HGC27 cell line was cultured in RPMI-1640 medium containing 10% fetal bovine serum at 37 °C in a 5% CO3 cells/well; AGS cells: 3 × 103 cells/well) were seeded in 96-well plates. After incubation in the incubator for 16–18 h, the GC cells were treated with tegaserod maleate  for 24 h, 48 h, 72 h and 96 h. MTT (1 mg/mL) was added at a ratio of 1:100. After incubation for 2 h, 100 μL DMSO was added to terminate the reaction, and OD value at 490 nm/570 nm was measured with a microplate analyzer.GC cells (HGC27 cells: 2 × 103 cells/well) were seeded in top layer agar with 0, 0.25, 0.5, 1 or 2 μM tegaserod maleate. The cells were cultured at 37 °C in a 5% CO2 incubator for 14 days. The colonies were counted using IN Cell Analyzer 6000 software. After the base layer agar was prepared with 0, 0.25, 0.5, 1 or 2 μM tegaserod maleate, HGC27 and AGS cells (8 × 10After seeding HGC27 (500 cells/well) and AGS (500 cells/well) in 6-well plates, cells were treated with 0, 0.25, 0.5, 1 or 2 μM tegaserod maleate. Two weeks later, the cells were fixed with 4% paraformaldehyde at 25 °C for 30 min and stained with 0.1% crystal violet for 3 min.The HGC27 and AGS cells were inoculated into 10 cm dish. After 16 h incubation, tegaserod maleate with different concentrations was added and treated cells for 24 h. The cells were harvested and lysed using RIPA lysis buffer to obtain protein samples. Protein concentration was detected using the bicinchoninic acid protein assay kit . Next, 30 μg protein extract was separated using sodium dodecyl sulfate-PAGE and transferred to polyvinylidene fluoride (PVDF) membranes. The membrane was blocked with 5% skim milk for 1 h at room temperature. Next, the membranes were incubated overnight with the primary antibody at 4 °C and then for 2 h with the secondary antibody at room temperature. Protein bands were displayed using the enhanced chemiluminescence (ECL) detection reagent . Original Western Blotting figures shown in Epoxy-activated sepharose 4B conjugated with tegaserod maleate was prepared according to the manufacturer’s instructions . An amount of 200 μL tegaserod maleate-Sepharose 4B beads or DMSO were rotated with cell proteins (500 μg) in the reaction buffer. After rocking gently for 48 h at 4 °C, the conjugated beads and DMSO were washed 4 times in the washing buffer followed by the addition of 30 μL 3× loading buffer at 100 °C for 5 min. The binding was detected using Western blotting.Inactive ERK2 protein (50 ng) was incubated with active MEK1 recombinant protein (200 ng) or MEK2 recombinant protein (300 ng) for in vitro kinase assay. The reaction was run in kinase buffer  for 30 min at 30 °C and stopped using 6 × loading buffer. The protein was assessed using Western blotting.g for 20 min at 4 °C. The supernatants were transferred to the new microtubes and analyzed using Western blotting.MEK1/2 protein was overexpressed in 293F cells. After 16 h incubation, tegaserod maleate was added and treated cells for 24 h. For the cell lysate CETSA, cultured cells were harvested and washed with PBS. The respective lysates were divided into smaller (100 μL) aliquots and heated at different temperatures for 3 min followed by cooling at room temperature for 3 min. The cell suspensions were frozen and thawed twice with liquid nitrogen. The lysate was separated from the cell debris using centrifugation at 12,000× The Schrödinger Suite 2015 software program was used for silico docking. The three-dimensional (3D) structure of tegaserod maleate was derived from PubChem Compound. The Protein Preparation Wizard standard pipeline (Schrödinger Suite 2015) was used to process the structure of MEK1 (PBD:3EQG) and MEK2 (PBD:1S9I).MEK1/2 were deleted in GC cells using the CRISPR/Cas9 system according to the manufacturer’s protocols. Viral plasmids and packaging vectors (pMD2.G and psPAX2) were transfected into 293T cells using Jet Primer . After 4 h transfection, the medium was removed and cells were cultured for 24 h, 48 h and 72 h. Viral particles were harvested and filtered using a 0.22 μm syringe filter. HGC27 and AGS cells were infected with viral mixture . The cells were treated with 2 μg/mL and 1 μg/mL puromycin for 72 h, respectively. The knockout efficacy was detected using Western blotting. The oligonucleotide sequences of MEK1 and MEK2 single guide (sg) RNA are listed in 3, and then the tumor weight was measured.Severe combined immunodeficiency (SCID) mice were used  to investigate the effect of tegaserod maleate on GC PDX tumor growth, GC tissues were cut into about 1–2 mm pieces and planted into the back of the mice. The mice were divided into three groups: vehicle group, low-dose group (2 mg/kg) and high-dose group (10 mg/kg), with ten mice in each group. The vehicle or tegaserod maleate was taken orally once daily. Each mouse was checked twice weekly for tumor volume and body weight. The tumor was extracted until the tumor volume reached 1000 mmThe tumor tissues were extracted and embedded in paraffin blocks for IHC staining. The tissue sections were deparaffinized, hydrated, antigen-repaired and blocked. Sections were incubated at 4 °C with primary antibodies of Ki-67 overnight and then for 15 min with the secondary antibody at 37 °C, followed by diaminobenzidine and hematoxylin staining. Then, the sections were dehydrated and covered with slides. All tissue sections were photographed with a microscope camera and analyzed using TissueFAXS Viewer software.p-Value < 0.05.SPSS statistical software, version 21 (IBM Corp.), was used for all statistical analyses. The results used non-parametric test or one-way analysis of variance (ANOVA) to compare significant differences. Quantitative data were indicated as mean values ± standard deviations. Statistical significance was defined by a Tegaserod maleate was used for the treatment of irritable bowel syndrome in clinic. The chemical structure of tegaserod maleate is shown in Since tegaserod maleate inhibited GC cell proliferation, we screened its target using an in-silico docking assay. Our results predicted that tegaserod maleate achieved binding with MEK1 at ASP208, MET146 and ASP152 sites, and with MEK2 at GLY83 and GLY81 sites A. Then, Our above data indicated that tegaserod maleate could bind with MEK1 and MEK2. Then, we investigated whether tegaserod maleate inhibited the kinase activity of MEK1/2 or not. We found that the phosphorylation efficiency of active MEK1 and MEK2 against inactive ERK2 was decreased at 0.25, 0.5, 1 and 2 μM tegaserod maleate . These rTo evaluate the role of MEK1 and MEK2 in GC progression, AGS and HGC27 cell lines were used for the knockout assay. The results indicated that sgMEK1#2 and sgMEK1#4 reduced the protein levels of MEK1 significantly in both HGC27 and AGS gastric cell lines, while sgMEK2#4 and sgMEK2#5 could reduce the protein level of MEK2 . After kIn order to evaluate the antitumor activity of tegaserod maleate in vivo, PDX models of LSG85 and LSG51 cases with high MEK1 levels were established from the GC PDX specimen repository . After tTo confirm whether tegaserod maleate can be used as an inhibitor of MEK1 and MEK2 in gastric cancer, we compared the anti-tumor effects of tegaserod maleate with trametinib, an FDA-approved MEK1/2 inhibitor. The dosages of trametinib were selected based on previous studies . We seleDespite improvements in adjuvant therapies and general progress in oncogenesis mechanism comprehension for gastric cancer in recent years, the long-term survival of gastric cancer patients is not substantially improved due to high recurrence rates and a dismal prognosis ,25. As aThe MAP kinase cascade is the most important oncogenic driver of human cancers, and blocking this signaling module by targeted inhibitors is a promising anti-tumor strategy ,37. SincIn conclusion, our findings attested that MEK1 and MEK2 are promising therapeutic targets for GC. Tegaserod maleate could bind to MEK1 and MEK2 and inhibit its kinase activity. Tegaserod maleate also suppressed GC growth in vitro and in vivo by blocking the MEK1/2-ERK1/2 signaling pathway. Our study suggests that the proper application of tegaserod maleate may be a beneficial therapeutic strategy for GC patients with high MEK1/2 levels.Tegaserod maleate binds with MEK1 and MEK2 and inhibits kinase activity, thereby blocking the MEK1/2-ERK1/2 signaling pathway to inhibit the proliferation of gastric cancer cells in vitro and in vivo.


The intense use and misuse of antibiotics is undoubtedly the main factor associated with the high numbers of antibiotic-resistant pathogenic and commensal bacteria worldwide. In low-income countries, this misuse and overuse is widespread, with great consequences at the personal and global levels. In the context of user fee exemptions in caesarean sections, we performed a descriptive study in women to assess the use of antibiotics on three levels—antenatal, during caesarean section, and postpartum—in four Beninese hospitals. Out of the 141 women included, 56.7% were using antibiotics. More than the half (71.3%) were taking more than one antibiotic, either for a long time or in acute treatment. In prophylaxis, the timing, dose, and duration of administration were not correctly achieved. Only 31.2% of women received optimal antibiotic prophylaxis. Various antibiotics including broad-spectrum molecules were used in the patients after caesarean section. The use of antibiotics was improper on the three levels studied. The high rate of self-administered antibiotics, the poor achievement of antibiotic prophylaxis, and the postpartum overuse of antibiotics showed a poor quality of care provided in pregnancy. A national policy is essential to improve the use of antibiotics by the general public as well as by professionals. The intense use and misuse of antibiotics is undoubtedly the main factor associated with the high numbers of antibiotic-resistant pathogenic and commensal bacteria worldwide . The resAntibiotics in pregnancy are used to treat the infections encountered during this physiological state, such as urinary tract infections, pyelonephritis, sexually transmitted infections, and upper respiratory tract infections . A limitCaesarean section has been known to increase the rates of maternal infectious morbidities fivefold compared to vaginal delivery. Antibiotic prophylaxis can play a major role in improving caesarean-section-associated risks of infections, such as endometritis, surgical site infections, and urinary tract infections ,16. The In 2009, the Government of Benin set up a policy of user fee exemptions for caesarean sections, and an agency was created to manage the policy. A free kit containing the required medicines—including antibiotics —and materials needed for the procedure is available.Unlike in high-income countries, data on the use of antibiotics are scarce in low-income countries, where hygiene conditions are poor and antimicrobial resistance is of great concern . In Benin = 115) were emergency, and 27.60% (n = 39) were referred from another hospital. The median duration of the intervention was 39.20 min, ranging between 13 and 75 min. Among the patients, 8.5% (n = 12) had a chronic disease . Patients’ demographic and clinical characteristics are displayed in In total, 141 women were included in our study. The patients’ age range was 17–42 years, with a median of 28 years; 81.60% of the cases , or combined with metronidazole  or ciprofloxacin . Other antibiotics  were used by 38 of them (47.50%).We interviewed 141 patients about their medication with antibiotics prior to their admission to hospital; 80 (56.70%) of them declared they were using antibiotics. A total of 23 (28.70%) were taking one antibiotic, and more than half  were taking 2–5 antibiotics, either for a long time (more than 15 days) or in acute treatment. The most frequent antibiotic used was amoxicillin in monotherapy  were taking antibiotics under their own initiative. Almost the same proportion  indicated that the antibiotics were prescribed by a healthcare professional, but more than half could not give the precise reason for the prescription. The remaining women  were using antibiotics based on the recommendations of their relatives. In the case of their own initiative, patients declared having the information from a previous medical prescription. This could be due to the fact that the prescribers did not educate patients after prescription to avoid inappropriate use of antibiotics.Nearly half of the patients . The patients did not bring their medicines to the hospital.Among the indications , stomach trouble was the most frequent indication declared by the patients  in the four hospitals. Four of the five criteria were less appropriately achieved. Only 31.2% (44/141) of women received optimal antibiotic prophylaxis, i.e., correct antibiotic prophylaxis according to the five criteria. Sixteen different antibiotic regimens were observed; three of them contained the three molecules of antibiotics from the kit, and were administered in 17.0% of patients (24/141). The most frequent regimen administered was amoxicillin + clavulanic acid combined with metronidazole in 27.0% (38/141), which represented 70.4% (38/54) of patients who received the antibiotics not included in the kit.From the data collected in the four hospitals, the levels of achievement are represented in After caesarean section, all 141 patients received oral antibiotics for 5 to 10 days, depending on the prescriber. The oral antibiotics (amoxicillin + metronidazole) included in the kit were used by 48.2% (68/141) of the women. The others 57.7% (73/141), in addition to metronidazole, received out-of-kit and broad-spectrum antibiotics, such as amoxicillin + clavulanic acid in 43.3% (61/141), lincomycin in 7.8% (11/141), and cefixime in 0.7% (1/141). The broad-spectrum antibiotics used were variable from one hospital to another. Each hospital used the same broad-spectrum antibiotic in all of their patients. We did not record any diagnosis for the use of postpartum antibiotic therapy.Our study describes the perinatal use of antibiotics in women who underwent caesarean section in four different hospitals in Benin.Firstly, the medication history showed the use of antibiotics prior to hospital admission in 56.7% of the women. This rate was higher than that reported in the Democratic Republic of Congo in 2013 (12.3% of patients admitted in emergency) , and repSecondly, our study identified improper practices of antibiotic prophylaxis in caesarean section. Apart from the indication that was conformed to by 99% of the patients, either in the operating room or in the recovery room, the four other criteria  were not appropriately applied in at least 30% of cases. A proportion of 49.30% of patients did not receive the correct dose of antibiotic. The criterion of the dose administered was the least appropriately achieved.Under one-third of women  received antibiotic prophylaxis with the five conventional criteria correctly properly achieved. The aim is that antibiotic prophylaxis should be correctly achieved in 100% of cases. However, this compliance rate was higher than those reported in a Jordanian study (2.70%)  and in aAlthough all of the patients received a prophylaxis, non-conformities were observed, such as for the timing in 31.10%, versus 0% in a Greek study  and 11.6In addition to the cost the prescription of out-of-kit antibiotics represents , patients have to face the non-availability of these prescribed antibiotics in the hospital pharmacies. Thus, patients were often obliged to buy antibiotics from private pharmacies. In view of the fact that most of the women were presented in an emergency situation (81.6% of cases) and/or often were referred from peripheral health centers, the availability of the required antibiotics in the hospital pharmacy becomes essential. This will be a national challenge for Benin in the coming years, as has been reported in other low-income countries, such as Mozambique .Finally, in the postpartum use, antibiotics were available in Benin’s free kit by providing oral antibiotics (amoxicillin + metronidazole). According to the WHO, the antibiotics recommended are the combination of clindamycin and gentamycin as first-line treatment for postpartum endometritis . In the The global analysis of the use of antibiotics in the patients who underwent caesarean section in the four hospitals chosen, following the three levels of the healthcare system in Benin, highlighted either inappropriate use, misuse, or overuse of antibiotics. Although practices were similar, showing a local consensus within each hospital, the healthcare professionals in high-level hospitals were less adherent to the kit. In sum, we found a poor quality of care provided for pregnancy, since quality of care in obstetrics is a continuum that spans the pre-pregnancy, pregnancy, and postpartum periods. Regarding the context of the increased spread of bacterial resistance, rational use of antibiotics would benefit public health, as well as the patients’ and the hospitals’ finances.To improve the use of antibiotics in Benin, various levels of the healthcare system have to be taken into account. First of all, patients could be educated in hospitals or through mass media by providing information on antibiotics . Secondly, it is important to raise the level of knowledge of the healthcare professionals in terms of the prescription of antibiotics, to conduct audits and feedback in hospitals, and to provide local and consensual guidelines for the use of antibiotics. Setting up a multidisciplinary team in hospitals can also help to improve the use of antibiotics. Thirdly, at the central level, a national policy is essential to coordinate activities by providing data on antibiotics consumption and antimicrobial resistance, along with directives and strategies to improve utilization.To the best of our knowledge, our study is the first to analyze the use of antibiotics before, during, and after caesarean section in Benin and in various types of hospitals. Observations were conducted 24 h a day, 7 days a week. However, this study has some limitations: All of the observed hospitals were from the southern part of the country; thus, they are not entirely representative. The sample size was relatively small. In addition, there was no assessment of factors associated with inappropriate use of antibiotics. Nevertheless, we are confident that our findings will help to raise knowledge about the use of antibiotics in Benin, and help to perform this kind of study in other areas of the country.In obstetrical wards of 4 hospitals located in the south of Benin, we performed a three-level study on antibiotic use in patients who were undergoing caesarean section. Patients were approached in the operating theatre when medical staff were preparing the intervention. The study was briefly explained in the patient’s language. The sampling followed the inclusion and exclusion criteria as described in the document entitled “L’audit clinique: bases méthodologiques de l’évaluation des pratiques professionnelles” , with thWe recorded patients’ medication history by interviewing the patients on their habits of using antibiotics prior to admission, conducting a prospective observation of the antibiotic prophylaxis practices, and determining postpartum antibiotic use from medical charts. The four hospitals have different characteristics, but they are all approved to practice free caesarean section. They included one teaching referral hospital (hosp1: 254 beds), two teaching zonal hospitals (hosp2: 101 beds and hosp3: 116 beds), and one confessional hospital (hosp4: 81 beds). Each hospital included in this study provided written authorization to perform all of the steps of the study. Over a period of 1 month (November to December 2016), observers’ teams collected data from patients undergoing caesarean section with class 2 surgical wound contamination , using two survey forms .’’Form No. 1 was used to collect data on demographic characteristics  and patients’ medication history . The patients’ medication history was recorded after the intervention in the hospitalization rooms.Form No. 2 is divided into two parts: The first part helped to collect data on demographics —in order to be sure that we were collecting data from the same patient as the previous form—intervention date in the operating theatre, dates of admission and intervention, type of procedure (urgent or elective), and antibiotics used for prophylaxis . This part of the form was adapted from those used by the WHO and the Scientific Institute of Public Health, Belgium ,36.In the second part of form No. 2, we collected follow-up data during hospitalization from medical charts, including intravenous antibiotics used after caesarean section , and the postpartum use of oral antibiotics i.e., after delivery .Observers’ teams consisted of four pairs of students of the health science faculty. After a training session with the main researcher, the four pairs tested the applicability of the forms in two other hospitals that were not included in the present study. After the test, a debriefing took place, and some questions were reviewed. During data collection, one observer included patients after obtaining their consent, and recorded data in the operating theatre during the caesarean section procedure using the first part of form No. 2. The second observer recorded data in the hospitalization rooms until the end of the intravenous administration in the second part of form No. 2. Patients were included alternatively in different periods of the day  in order to see whether practices changed from time to time.The practices of antibiotic prophylaxis were assessed based on the following five conventional criteria :Indication: In caesarean section, antibiotic prophylaxis was always considered to be indicated.Choice of antibiotic: The conventional recommended antibiotic is cefazolin. In Benin, cefazolin is not available. The Benin caesarean kit instead contains ampicillin, metronidazole, and/or gentamicin. The choice of antibiotic was considered to be correct if the antibiotics from the kit were used.Timing of administration: Guidelines recommend administration of the first preoperative dose 30–60 min before incision.Accuracy of the first preoperative dose(s): Double the usual adult dose of an antibiotic is recommended for caesarean section. Any necessary subsequent doses are administered at the usual adult dose.Duration of prophylaxis: In caesarean section, antibiotic prophylaxis can be administered in a single dose, or for a period of 24 h maximum.Data were analyzed using IBM Corp . Descriptive statistics presented continuous variables using medians (with 25–75th percentiles), because they were not normally distributed, and categorical variables are presented as numbers and percentages.Caesarean section is a life-saving intervention. The conventional recommended antibiotic use is for prophylaxis, which is an incontestable parameter to ensure quality of life for patients. Despite the availability of a free kit containing the antibiotics required, antibiotic prophylaxis was poorly achieved in Benin. In the use of antibiotics prior to hospital admission, patients were insufficiently informed for the precise reason of their use if they had a medical prescription. In the postpartum period, there was no diagnosis of postoperative infection that could require the use of antibiotics. In sum, self-administered antibiotics require particular attention in order to reduce their rate and long-term consequences. Various measures should be embedded in a national policy to ameliorate the use of antibiotics by the general public and by professionals in Benin.


This study aims to evaluate the cardioprotective effect of metformin on myocardial ischemia–reperfusion injury (MIRI) in rat models at different time points using dynamic 18F-FDG (40Mbq) micro-PET/CT imaging was performed for 10 min at different time points . Volumes of interest were drawn to identify different myocardium regions . Standardized uptake values (SUVs) (SUVmean and SUVmax) were analyzed to evaluate the FDG uptake activity, and then the center/remote ratio was calculated. In addition, the left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV) and LV ejection fraction (LVEF) were obtained. On the 30th day, all rats were scarified and myocardial ischemia was analyzed by HE staining and confirmed by pathology.The I/R injury model in SD rats was established by ligation of left anterior descending coronary artery near the pulmonary arch root for 30 min. SD rats (n = 12) were randomly divided into 2 groups: Control group (n = 6) without any intervention and Met group (n = 6) with oral administration of metformin (50 mg/kg) twice a day. Gated p < 0.05). In the Met group, the center/remote ratio gradually increased with time, there was no significant correlation between center/remote ratio and LV EDV . On the 30th day, the center/remote ratio of the Met group was significantly higher than that of the Control group , while LV EDV in Met group was significantly lower than in Control group . There was no significant difference of LVEF between Met group and Control group at different time points after reperfusion (p < 0.05). HE staining showed that the myocardial infarction and fibrosis in ischemic center area of the Control group was more serious than that of the Met group.In the Control group, the center/remote ratio showed no obvious change trend at each time point after reperfusion, while the LV EDV increased gradually over time, and they were significantly negatively correlated (r = − 0.507, 18F-FDG micro-PET/CT imaging.Met could attenuate the severity of MIRI, delay and prevent the progress of LV remodeling. The cardioprotective progress could be dynamically assessed by  Myocardial infarction (MI) is one of the major cardiovascular diseases that seriously endanger human health . Early rAs a commonly used hypoglycemic agent for patients with type 2 diabetes mellitus (T2DM), the protective effect of metformin (Met) on ischemic myocardium has also attracted much attention –16, but Positron emission tomography/computed tomography (PET/CT) is a highly sensitive and non-invasive molecular imaging modality which provides an opportunity to explore various pathophysiological processes within MI in vivo by using various radiotracers , 22. It 18F-FDG PET/CT myocardial metabolism imaging would be used in the SD rat model to dynamically evaluate the effects of Met intervention on MIRI at molecular level.In this study, 18F-FDG was purchased from HTA Co., Ltd. . The experimental apparatuses mainly included: Inveon Micro-PET/CT scanner , Matrx VMR anesthesia machine , LeicaRM2235 slicer  and immunohistochemical microscope imaging system . The experiments were carried out under the permission of the Project (NO.: AEEI-2019-167) approved by the Animal Care Committee of Capital Medical University, in compliance with the Animal Management Rule of the Chinese Ministry of Health  for the care and use of animals.Male SD rats (4–6 weeks) were purchased from SPF (Beijing) Biotechnology Co., LTD. Rats were maintained in a temperature-controlled room (25 °C) with a natural day/night cycle and fed with a standard rodent diet and water. Photographic developer All rats were anesthetized by intravenous injection of 10% chloral hydrate, and then mechanically ventilated by tracheal intubation. The left anterior descending (LAD) coronary artery was ligated near the root of lung arch for 30 min, and the ischemia–reperfusion injury model was established. Changing gray of myocardium indicated success of ligation. When the color of myocardium from the ligation area returned to normal, it meant the reperfusion was successful.20 rats were randomly divided into two groups: (1) Control group ; (2) Met group (n = 6/11). The Met group was given metformin (50 mg/kg) twice a day from the first day after operation, while the Control group was given the same volume of 0.9% saline.18F-FDG (40Mbq) micro-PET/CT imaging was performed at different time points . Thickness, matrix, acquisition time and energy window of PET scan were 0.78 mm, 128 mm × 128 mm, 20 min and 350–650 keV respectively. Voltage, current, thickness and acquisition time of CT scanning were 80 kV, 500 µA, 0.1 mm and 10 min respectively. After scanning, the iterative reconstruction (4 iterations and 8 subsets) was performed by using OSEM 3D. Volumes of interest (VOIs) were drawn to identify different myocardium regions . We defined apex as ischemia center, the border as peri-ischemia area and the posterior wall as remote area. Here, the target/background ratio (TBR) referred to the center/remote ratio. Standardized uptake values (SUVs) (SUVmean and SUVmax) were analyzed to evaluate the FDG uptake activity. In addition, the LV end-diastolic volume (EDV), end-systolic volume (ESV) and LV ejection fraction (LVEF) were obtained.Rats were anesthetized with isoflurane. Serial gated All rats were sacrificed on the 30th day after PET/CT image acquisition. Thoracic cavity was cut open along the midsternal line. The heart was collected and washed with 0.9% sodium chloride solution. The atrium was cut along the coronal sulcus, and then the interventricular septum and right ventricle were cut along the septum to obtain the left ventricular myocardium. After being fixed with 4% paraformaldehyde and embedded in paraffin, the slices were continuously cut with a thickness of 5 µm. One out of every 5 sections were stained with routine HE.p < 0.05 was considered to be statistically significant.Statistical analyses were carried out by SPSS 26.0 (IBM SPSS® Statistics) software. The measured data conforming to normal distribution were expressed as mean (M) ± standard deviation (SD). Counting data and classification variables were given as frequency or percentage (%). All the results were calculated three times. One-way ANOVA was used for comparison between different groups, and non-parametric T test was used for comparison at different time points within the same group. Pearson's correlation analysis was used to analyze the relationship between TBR and cardiac function parameters. For all the tests, max value in different areas, ratio of SUVmax in central/remote area (TBR) and left ventricular function characteristics were summarized in Table p < 0.05]  vs. (407.53 ± 29.91) mm1 ± 22.62p < 0.05), while there was no significant correlation in Met group   Fig. . This de05) Fig. .Fig. 3CoHE staining of myocardial tissue sections in ischemia center area of rats in both groups showed that myocardial cells were swollen, with uneven distribution of cytoplasm, granular agglutination, eosinophilia and blurred or disappeared stripes Fig. . It was Metformin, as a safe, effective and relatively low-cost drug, was recommended as the first choice in the treatment of T2DM complicated with heart failure by the clinical guidelines of American Diabetes Association in 2014. Interestingly, it has also been documented for cardioprotective effects in animal researches and clinical trials , 25. How18F-FDG PET/CT imaging is internationally recognized as the "gold standard" for evaluating myocardium viability. The information such as myocardial perfusion, myocardial metabolism, myocardial cell activity, local systolic function, left ventricular function and ventricular remodeling can be obtained at the same time [18F-FDG PET/CT technology was used to explore the effect and potential value of Met intervention on MIRI in rats from the perspective of molecular imaging. Our current research was unique in that a serial gated myocardial metabolism imaging by micro-PET/CT was performed in rats I/R injury model in acute phase , subacute phase (day 14th) and chronic phase (day 30th) respectively after modeling. The effects of Met on heart were evaluated dynamically, including the uptake (SUVmax) in different myocardium regions , and left ventricular function. TBR value of Met group gradually increased, and was significantly higher than that of Control group on day 30th. These results showed that Met improved FDG uptake in myocardium in ischemic center and reduced the severity of I/R injury with time. From day 1st to day 30th after operation, the LV EDV values in the Control group gradually increased. On the day 30th, it was more significant than that in Met group, which indicated that Met may prevent or delay the progress of LV remodeling secondary to I/R injury. The key finding was that after 1 month treatment, Met intervention not only reduced the severity of I/R injury but also delayed the ventricular remodeling. For the first time, in vivo molecular imaging proved that Met treatment can improve the glucose metabolic activity of ischemic myocardium, delay the occurrence and development of ventricular remodeling. It was also proved that Met treatment had myocardial protective effect on ischemic myocardium at molecular level.ame time . TherefoThe identification of inflammation and viable myocardium is a common problem . EarlierThere are also some deficiencies in this study. First of all, the end time of Met intervention treatment was only 30 days. Severe I/R injury may not fully develop in such a short period of time, which could explain why the LVEF did not change significantly with the passage of time in this study. Here, research with longer intervention time and larger sample size is needed in the future. Secondly, only one treatment regimen was adopted at the beginning of reperfusion, which might be improved with a more complete regimen, including Met intervention before reperfusion, at the beginning of reperfusion and later after reperfusion. Finally, only a single dose (50 mg/kg twice a day) was used, which resulted in a lack of comparative analysis of high and low dose to evaluate the cardioprotective efficacy with different dosages. These deficiencies will be improved in further research.18F-FDG micro-PET/CT imaging. These findings underscore the potential beneficial effects of Met in MIRI and provide further evidence that Met should be assessed prospectively in a long-term study. In addition, further investigations are needed to evaluate the effects of different dose of Met on MIRI.In summary, our study demonstrated that the Met could attenuate the severity of I/R injury on myocardium and delay or prevent the progress of LV remodeling. The cardioprotective effect could be dynamically evaluated by


Nuclear energy offers a wide range of applications, which include power generation, X-ray imaging, and non-destructive tests, in many economic sectors. However, such applications come with the risk of harmful radiation, thereby requiring shielding to prevent harmful effects on the surrounding environment and users. Concrete has long been used as part of structures in nuclear power plants, X-ray imaging rooms, and radioactive storage. The direction of recent research is headed toward concrete’s ability in attenuating harmful energy radiated from nuclear sources through various alterations to its composition. Radiation shielding concrete (RSC) is a composite-based concrete that was developed in the last few years with heavy natural aggregates such as magnetite or barites. RSC is deemed a superior alternative to many types of traditional normal concrete in terms of shielding against the harmful radiation, and being economical and moldable. Given the merits of RSCs, this article presents a comprehensive review on the subject, considering the classifications, alternative materials, design additives, and type of heavy aggregates used. This literature review also provides critical reviews on RSC performance in terms of radiation shielding characteristics, mechanical strength, and durability. In addition, this work extensively reviews the trends of development research toward a broad understanding of the application possibilities of RSC as an advanced concrete product for producing a robust and green concrete composite for the construction of radiation shielding facilities as a better solution for protection from sources of radiation. Furthermore, this critical review provides a view of the progress made on RSCs and proposes avenues for future research on this hotspot research topic. In recent times, nuclear energy has come from the splitting of atoms through a fission or fusion reaction or through the decaying process. This energy can be used to generate steam that powers turbines, which have become a promising alternative to hydrocarbon or fossil fuel power-generating plants . The hea3, which is much higher than that of concrete made with ordinary aggregates), is a cement-based composite prepared with water, cement, and heavy weight aggregates . Th. Th2O3 hn curves  was used Baratta .2 and 13.612% Al2O3 . Ho. Ho67]. Colemanite replacement in ordinary concrete achieved a 14.51–51.61% reduction in compressive strength. The reduction is due to the replacement of the natural aggregate by 10–50% of the volume with colemanite . The higThis weakness at the interfacial transition zone is also reported for goethite and serpentine concrete, which leads to the reduced compressive strength of the sample. The use of goethite as a coarse aggregate resulted in a compressive strength of 39–42 MPa, which is about 38% lower than that of magnetite concrete . For conμ value, the compressive strength was reduced by 12.6%. This condition may be due to the smooth surface of the tube, which provides less traction and adhesion with the binder and other aggregates .,46.18,46The flexural strength of a waste aggregate such as amang and lead glass also shows a reduction in comparison with that of the natural aggregate of silica sand. Amang RSC and lead glass RSC recorded a 6.2% and 7.8% lower flexural strength compared with that of silica sand RSC, respectively . On the The durability of RSC has been tested against elevated temperatures, freeze–thaw cycles, and chemical attacks. Other research also investigated the effect of aging on RSC, which is also an indicator of its durability. Studying the behavior of RSC at elevated temperatures provides indications of its durability. A primary containment concrete structure in a nuclear ionizing facility or the secondary containment of nuclear power generation is always exposed to elevated temperatures. A boiling water reactor typically operates at 287–304 °C; increasing the operating temperature would increase the thermal efficiency of the reactor in power generation [μ value at 0.662 MeV of gamma ray exposure and temperature based on previous studies. In general, a temperature increase beyond 100 °C resulted in the reduced μ of concrete. Barite concrete recorded a 12.5% and 6.4% reduction in the μ value after being exposed to 450 °C and 800 °C, respectively [ectively ,67  value is recorded by RSC, with the coarse barite aggregate exposed to 600 °C [R (En) reduction of 21% was recorded for the sample with the natural aggregate, followed by the sample with the siderite aggregate at 27.5% [R (En) value due to a loss of hydrogen is also reported in serpentine and goethite concrete. RSC with goethite as the coarse aggregate, which recorded the largest percentage of weight loss due to heat in the study, reported a 35.3% reduction in the ∑R (En) value after exposure to 450 °C [R (En) value in the study at 0.0717 cm−1, which is due to a loss of hydrogen nuclei in goethite from the evaporation of water and transformation to ferric oxide. Serpentine RSC, which recorded about a 15% weight loss at exposure to temperatures above 500 °C, indicated 0.07 cm−1 of a residual ∑R (En) value based on exposure to the same temperature [R (En) value based on exposure to an Am–Be source.In term of neutron attenuation, a maximum loss of 30% in the ∑o 600 °C . The lowat 27.5% . The stuat 27.5% ,186,187.at 27.5% ,189. Theo 450 °C . It is tperature . This vaHigh-temperature exposure reduces not only the shielding property of RSC, but also its mechanical properties. Exposure to 800 °C caused 79.6% and 84.8% losses in the compressive strength of barite RSC and natural aggregate RSC, respectively . The resμ value is the highest among the reviewed studies. Hence, further research toward producing a higher residual compressive strength and radiation attenuation coefficient is required. RSC should be able to withstand external deteriorating elements and internal heat or combustion caused by any mishaps, while containing the radiation. Ultra-high-strength concrete such as UHPC outperforms normal-strength concrete under impact and blast, but suffers more spalling incidents at elevated temperatures, thus making it a suitable candidate as an RSC [Even though UHPRSC has a higher residual compressive strength after heat treatment, the loss in the s an RSC ,193,194.μ value after 50 freeze–thaw cycles on barite RSC [μ value is based on exposure to a Co-60 source of 1.25 MeV of average energy on barite RSC, which is produced based on a water-to-cement ratio of 0.43–0.65. This result is almost similar to the natural aggregate concrete performance, which reported a 25–43% reduction in the μ value in the same range of water-to-cement ratio. On the basis of the study, the highest residual μ value recorded after 50 cycles by natural aggregate concrete was 0.07 cm−1, while barite concrete recorded 0.1 cm−1. This study found that a higher water-to-cement ratio could minimize the adverse effects of freeze–thaw cycles on the μ value. This finding is based on the lower reduction in the μ value in the sample with a higher water-to-cement ratio. A high water-to-cement ratio in concrete resulted in a high amount of free water in the capillary and porosity of concrete. The freezing of concrete caused water in the pores to freeze and expand. Concrete is commonly used as the main material in the construction of buildings. Therefore, concrete production is important for critically vital buildings, such as hospitals and nuclear power stations. The freeze–thaw resistance of RSC is evaluated based on its residual linear attenuation coefficient after being exposed to freeze–thaw cycles. rite RSC . The μ vThe expansion of water creates internal hydraulic pressure, which can be dissipated through the nearest voids. If this pressure exceeds the tensile strength of the paste, then cracks will appear from the point of failure . Cracks µ (cm−1), which is defined as the possibility of a radiation interaction with a material per unit path length, must be determined to evaluate the radiation shielding characteristics of building materials. The µ value is affected by the atomic number, incident photon energy, and shielding material density (ρ) [Moreover, barite is recognized as an excellent mineral for shielding γ-rays; however, with the difficulty of locating adequate barite deposits, barite is utilized only as an aggregate in concrete ,198. Howsity (ρ) . A variesity (ρ) . Anothersity (ρ) . The linsity (ρ) ,197. Altsity (ρ) ,200,201,μ value after being immersed in sodium hydroxide solution for 6 months. The μ value of 0.35 cm−1 is based on 662 keV of a Cs−137 source. Sodium sulfate also had a slightly greater adverse effect on the shielding properties of barite RSC, as indicated by the 28.6% reduction in the μ value to about 0.25 cm−1. The study concludes that intrusive chemical media adversely affect RSC. However, a detail that is worth noting is that the samples that were used in the study were produced with a water-to-cement ratio of 0.5, which is high and thus resulted in more porous concrete and a susceptibility to chemical attack with the variation of the linear attenuation coefficients with distinct chemical environments at 662, 1332, and 1773 keV energies . Calcite crystallites develop into a porous structure, reducing their size and destroying the tobermorite gel, a calcium silicate hydrate mineral liable for concrete strength, through crystallization pressure.Experimental works on concrete under gamma irradiation allows investigators to conclude that interactions with the shielding material reduce both the porosity and strength of the material . The mec2O/SiO2 ratio. The swelling pressure of ASR in relation to the ASR chemical composition has also been investigated [More recent research appears to support the radiolytic process , benefitstigated . Althougstigated .RSC is a basic material for radiation protective shields because it has a good shielding ability, high durability, low cost, and high versatility, thus having the capacity to have structural functions that outperform the design standard . RSC is RSC is also used in managing the spent nuclear fuel of nuclear power plants. Spent nuclear fuel is either treated as waste, which needs to be securely stored, or reprocessed to recover to any plutonium or uranium ,222. SpeSpent fuel in dry cask storage is cooled passively by air convection. Dry cask storage is constructed with RSC, and it provides more mobility and radiation shielding than wet storage does. Dry cask storage will not generate liquid waste due to exposure to decaying spent fuel, thus making maintenance easy. Recent research on dry cask storage with RSC aimed at designing and measuring its durability against aging and untoward events ,222.In India, trenches for near-surface disposal facilities are made of RSC, with the wall thickness ranging from 350–750 mm . This thRSC is also used as a “hot cell”, which refers to an area that is designated to handle irradiated elements or waste ,223. HotIn the health care sector, RSC is used to construct walls for radiotherapy rooms. A radiotherapy room is a facility that serves cancer patients and uses high-energy photons or protons . A protoBased on previous work, RSC is a durable, functional, and cost-efficient material for radiation shielding infrastructures. It has been utilized for a variety of applications, including nuclear power plants, particle accelerators, research reactors, and high-level radioactive research facilities. However, there challenges regarding RSC that require future research; for example, it segregates easily as a result of the high density of the aggregates used. Improving the radiation shielding properties of RSC requires the incorporation of heavyweight material and substances that contain a neutron absorber. This replacement of a lightweight aggregate has an adverse impact on the mechanical strengths, especially compressive strength. The overall tensile and flexural strength is almost similar across many types of minerals, but the incorporation of steel fiber greatly improves these strengths. Exposure of RSC to a high temperature resulted in a minimal reduction of photon attenuation, but reduced the neutron attenuation coefficient significantly due to the desiccation of hydrogen. Mechanical strengths are also adversely affected by high temperatures, especially beyond 300 °C, because of the physical changes of the materials in the matrix of concrete. RSC experienced a reduction in the shielding efficiency and mechanical strengths due to the freeze–thaw cycles. Exposure to chemical attacks reduced the shielding properties of RSC due to internal expansion, which also negatively impacted the mechanical properties of RSC.Recent research has focused on concrete’s ability to attenuate harmful energy that radiates from nuclear sources through various alterations to its composition. The last few decades have seen the development of RSC as a composite-based concrete with heavy natural aggregates such as magnetite or barites. RSC is deemed a superior alternative to many types of traditional normal concrete, having exceptional properties such as a high content of crystallized water and high density, and can thus be potentially applied to shield against various radiations such gamma rays, alpha rays, X-rays, and beta rays. In addition, RSC is less expensive, easier to mold into complicated shapes, and can be used for proton and neutron shielding. Given the merits of RSCs, this article presents a comprehensive review on the subject, considering the classifications, alternative materials, additives, and type of heavy aggregates used. This literature review also provides critical reviews on the RSC’s performance in terms of radiation shielding characteristics, strengths, and durability properties. Development research trends toward a broad understanding of the application possibilities of RSCs as advanced concrete products for producing a robust and green concrete composite for the construction of radiation shielding facilities are also extensively reviewed. Furthermore, this critical review provides a view of the progress made on RSCs and proposes avenues for future research with respect to this hotspot topic, including improving the durability of UHPRSC, which is imperative to producing superior and sustainable RSC. Moreover, it is also found that RSC decreases the intensity of radiation, relying on the density and thickness of the concrete structure, exhibiting that a higher density material can lower the radiation faster. In conclusion, this comprehensive review study was mainly written for engineers, and deals with the development and construction of concrete shielding; however, the manuscript also summarizes widely-dispersed data and information accessible on this subject, as an inclusive insight that must, therefore, be beneficial to scholars and to those interested in conducting value-added research in this hotspot research topic.−UHPRSC using artificial and sustainable aggregate needs to be developed to broaden its application, especially in efficient nuclear power generation.−More research is needed to determine the influence of binding materials, particularly active mineral additives, on shielding characteristics.−Research on the influence of freeze–thaw cycles on radiation shielding properties is lacking. Therefore, further study on the detrimental effects of freeze–thaw cycles on RSC is highly needed.−2 in UHPRSC to further improve its shielding without compromising the high mechanical performance needs to be investigated. The usage of a shielding-improving additive such as nano-TiO−Research is lacking on the durability and any possibility of the crack-sealing property in UHPRSC, which provides an advantage to resist aging and extend its service period as a shielding structure. −Development of sustainable RSC, such as geopolymer RSC, with various types of additives and aggregates to optimize its shielding and mechanical performance is highly needed.−RSC has a higher demand for a pile foundation and has a negative influence on earthquake resistance due to its large dead weight.−Development of an aging simulation on RSC that can precisely measure its reaction due to a long aging period, which is beneficial in mitigating structure failure and providing a rehabilitation program for aged structures, is highly imperative.−An urgent investigation on sustainable heavyweight and neutron-absorbing additives, especially from processed waste or refined industrial by-products, is required. −The long-term characteristics of RSC after exposure to various rays are critical to safety and must be thoroughly explored.On the basis of this comprehensive review, RSC requires more work to further improve its performance. This includes its mechanical, radiation shielding and sustainability. Current research recorded a lower mechanical strength compared to advance concrete such as UHPFRC. Hence, several hotspot research topics are inspired and recommended for further consideration in future studies and investigations by researchers worldwide:


MET oncogene’s most frequent mutation is exon14 deletion. The resulting MET∆14 kinase is not constitutively active but requires HGF. The response to the ligand is stronger and long-lasting, protecting cancer cells from apoptosis and driving invasive growth.The  MET is an oncogene encoding the tyrosine kinase receptor for hepatocyte growth factor (HGF). Upon ligand binding, MET activates multiple signal transducers, including PI3K/AKT, STAT3, and MAPK. When mutated or amplified, MET becomes a “driver” for the onset and progression of cancer. The most frequent mutations in the MET gene affect the splicing sites of exon 14, leading to the deletion of the receptor’s juxtamembrane domain (MET∆14). It is currently believed that, as in gene amplification, MET∆14 kinase is constitutively active. Our analysis of MET in carcinoma cell lines showed that MET∆14 strictly depends on HGF for kinase activation. Compared with wt MET, ∆14 is sensitive to lower HGF concentrations, with more sustained kinase response. Using three different models, we have demonstrated that MET∆14 activation leads to robust phosphorylation of AKT, leading to a distinctive transcriptomic signature. Functional studies revealed that ∆14 activation is predominantly responsible for enhanced protection from apoptosis and cellular migration. Thus, the unique HGF-dependent ∆14 oncogenic activity suggests consideration of HGF in the tumour microenvironment to select patients for clinical trials. MET is an oncogene encoding the tyrosine kinase receptor for hepatocyte growth factor (HGF)  . Upon lior (HGF) . Upon gee growth . Surprise growth . It was e growth . Therefo results . SpecifiMET amplification/activating mutations do. Upon HGF binding, the pathways triggered by MET∆14 and the transcriptional response are different from those elicited by ligand stimulation or amplification of wt MET. Hence, MET∆14 acts as an HGF-dependent gain-of-function mutation driving a robust and selective AKT activation, rendering cancer cells more prone to survival and migration. These observations may have important mechanistic implications for cancer with MET∆14 mutation.Here we show that deletion of exon 14 does not result in constitutive activation of the kinase as MET oncogene is mutated in multiple cancer types, highlighting its critical role in cancer progression and invasion , EKVX cMET gene amplification status of wt or ∆14 were comparable (MET—and not MET∆14 displayed STAT3 and ERK1/2 (MAPK) activation. Moreover, transfection of TOV112D cells—known not to express endogenous MET—with either wt MET-Flag or MET∆14-flag vectors further confirmed the ∆14-specific activation of the AKT pathway , AKT (for the PI3K pathway), and STAT3  Ponzett. Intrigumparable . Strikin pathway . These r pathway . AKT act pathway . TherefoMET wt cells . RegardCollectively, these results suggest that in MET∆14-expressing cells, the PI3K/AKT pathway is selectively activated upon HGF stimulation. Accordingly, the transcriptomic profile altered by MET∆14 supports an HGF-dependent inhibition of apoptosis and enhanced survival and migration capabilities.We have then directly tested the aforementioned assumptions. First, we performed a viability assay in the absence of serum and showed that MET∆14—and not wt MET–induced serum-independent growth . NotablyVideo 1Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 2Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 3Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 4Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 5Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 6Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 7Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 8Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 9Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 10Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 11Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 12Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 13Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 14Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 15Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Video 16Download video Representative wound healing videos in cells expressing wt MET, MET∆14, wt MET–amplified, or MET∆14-amplified. Cells were grown in the presence of the indicated drugs. Videos were recorded every 2 h for 5 d (N = 6/condition).Increased viability and faster wound healing may result from MET∆14-induced cell proliferation. To explore a potential MET∆14-induced cell proliferation, cell cycle progression was assessed by EdU/PI labelling in MET∆14 and wt cells in concert with increasing concentrations of HGF . In lineThus, MET∆14 seems to act as a ligand-dependent gain-of-function enhancing cancer cell survival and migration capabilities. When activated by HGF released by the tumour microenvironment , MET∆14 activates the PI3K/AKT pathway without inducing STAT3 (differentiation) or MAPK (proliferation) phosphorylation. Thus, cancer cells increase their probability of survival within the tumour pseudo-organ, which possesses a myriad of unfavourable conditions, including shortage of nutrients, hypoxia, radiotherapy, and chemotherapy. We hypothesize that an enhanced migratory potential conferred by the MET∆14/PI3K/AKT axis allows cells to escape this hostile environment and form distal metastasis. Consequently, cells harbouring MET∆14 may choose to “fly” instead of “fight” locally by proliferation. Besides, migrating instead of dividing may constitute a shrewd strategy to escape an adverse local micromilieu for cell survival because most cancer drugs are designed to destroy actively dividing cells.MET∆14 appears to be central to tumour cell survival. Hence in-depth understanding of the advantages it provides to cancer cells may be therapeutically exploited to target their vulnerability. However, the response to MET inhibitors is observed only in a fraction of ∆14 patients. Our present results suggest that the resistance to targeted therapy may result from the absence of HGF in the tumour microenvironment or from activating mutations in the PI3K/AKT axis. Interestingly, the latter have been reported to coexist with MET exon 14 skipping in 14.2% of lung cancer patients .Overall, our findings enlighten the mechanism of HGF-dependent MET∆14 activation and show that conditions other than mutations of the splicing site of exon 14 should be considered. Further preclinical and clinical work, including endogenous HGF levels and the mutational status PI3K/AKT axis, is required to justify the stratification of patients for clinical trials.Tepotinib (S7067), JNJ-38877605 (S1114), and etoposide (S1225) were purchased from Selleckchem. Recombinant HGF (294-HGN-025/CF) was bought from R&D Systems.3XFlag Tag was inserted into the pCDNA3.1+ vector between the HindIII and BamHI restriction sites. wt_MET or MET∆14 cDNA were inserted into pCDNA-3XFlag vector between NheI and HindIII restriction sites. Plasmids used in this study are available on Addgene with Addgene IDs 182494, 182495, and 182496.NCI-H596, HS746T, and TOV112D cells were purchased from ATCC. EKVX and MKN45 were obtained from the Cell Culture facility of Istituto Fondazione di Oncologia Molecolare (IFOM). Cells were cultured according to manufacturer’s instructions and regularly verified for the absence of mycoplasma contamination. Experiments were performed before passage number 20. For HGF treatments, cells were serum-deprived for 24 h and treated with indicated time and concentrations of HGF. TOV112D cells were transfected with indicated quantity of DNA in 6-cm-diameter dishes using Lipofectamine2000 reagent  according to the manufacturer’s instructions.MET gene  with the Phusion High-Fidelity DNA Polymerase . The PCR product was sequenced by Sanger sequencing to assess MET mutational status. Besides, MET amplification status was evaluated using the MET Taqman probes (Hs04957390_cn and Hs05011082_cn). TERT (Hs02088500_cn) and RNAseP (Hs05182199_cn) genes were used as internal control for the assay.Genomic DNA was extracted from cells using phenol/chloroform extraction. DNA was treated with RNase, and PCR reaction was performed using primers flanking the exon 14 of the Total RNA was extracted using QIAGEN RNeasy Mini Kit (Cat. no. 74106). For RNAseq experiments, quality assessment and library preparations were carried out as previously described . Reads wCells were lysed in Laemmli buffer as previously described . ProteinList of antibodies used in the study.Table S1 Cells were plated in chamber slides . Immunostainings were performed as previously described . AntibodCells were plated in 96-well plates at a density of 5,000 cells/well. After 24-h starvation, the cells were treated with ± HGF ± indicated MET inhibitors. Cell viability was assessed using CellTiter 96 Non-Radioactive Cell Proliferation Assay  every day for 80 d. The culture medium was renewed every 3 d.Cells were plated in 96-well plates at a density of 40,000 cells/well. After 24-h starvation, the cells were treated with ± HGF ± indicated MET inhibitors. After the wound generation, the relative wound density was measured by Incucyte (Sartorius) according to the manufacturer’s instructions.Cells were treated for 18 h with 10 μM etoposide ± HGF. Apoptosis was assessed by immunoblotting using antibodies against cleaved PARP.https://github.com/Altintas-D/MET-14-promotes-a-ligand-dependent-AKT-driven-invasive-growth.Data were analysed using R version 4.1.2. Codes are available at: 1 μg of total RNA was reverse transcribed using Superscript III Reverse Transcriptase  and relative gene expression levels were assessed using Taqman probes (Table S2). TBP and 18S were used as normalisation genes.List of TaqMan probes used in the study.Table S2 Cells were treated for 18 h with 10 μM etoposide ± HGF. Apoptosis was assessed by flow cytometry using the Violet Ratiometric Membrane Asymmetry Probe/Dead Cell Apoptosis Kit .Cell proliferation was assessed by measuring EdU incorporation by flow cytometry. Briefly, cells were treated with indicated concentrations of HGF. After 2 h of EdU treatment, cells were pelleted and fixed, labelled with anti-EdU-Alexa Fluor647 and propidium iodide (DNA) using the Click-iT EdU Flow Cytometry Assay kit .https://www.ncbi.nlm.nih.gov/geo/) and assigned the identifier GSE194382.The RNAseq data from this publication have been deposited to Gene Expression Omnibus database (


This study performed a scientometric-based examination of the literature on steel fiber-reinforced concrete (SFRC) to identify its key elements. Typical review papers are limited in their capacity to link distinct segments of the literature in an organized and systematic method. The most challenging aspects of current research are knowledge mapping, co-occurrence, and co-citation. The Scopus search engine was used to search for and obtain the data required to meet the goals of the study. During the data evaluation, the relevant publication sources, keyword assessment, productive authors based on publications and citations, top papers based on citations received, and areas vigorously involved in SFRC studies were recognized. The VOSviewer software tool was used to evaluate the literature data from 9562 relevant papers, which included citation, abstract, bibliographic, keywords, funding, and other information. Furthermore, the applications and constraints related to the usage of SFRC in the construction sector were examined, as well as potential solutions to these constraints. It was determined that only 17 publication sources  had published at least 100 articles on SFRC up to June 2022. Additionally, the mostly employed keywords by authors in SFRC research include steel fibers, fiber-reinforced concrete, concrete, steel fiber-reinforced concrete, and reinforced concrete. The assessment of authors revealed that 39 authors had published at least 30 articles. Moreover, China, the United States, and India were found to be the most active and participating countries based on publications on SFRC research. This study can assist academics in building collaborative initiatives and communicating new ideas and techniques because of the quantitative and graphical depiction of participating nations and researchers. Concrete is a composite, brittle material utilized in a variety of engineering structures, including foundations, pavements, tunnels, bridges, walls, reservoirs, and dams ,2,3. BecAs scientists conduct more investigation on the SFRC in response to rising concerns about the brittle nature of concrete, researchers confront knowledge restraints that may inhibit new academic and research partnerships. Hence, it is critical to build and execute a system that allows academics to acquire crucial knowledge from the best reputable sources available. A scientometric technique using the software application may assist in solving this problem. Recently, several review studies have been performed on SFRC ,54,55,56This work used scientometric evaluation of bibliometric data ,61,62 toThe Scopus analyzer was used to find the most pertinent research fields for this assessment. Engineering and Materials Science were judged to be the top two document-generating fields, with about 52% and 31% of papers, respectively, providing a total of 83% of documents in the SFRC study, as shown in A VOSviewer software was used to evaluate publication outlets  based on bibliographic data. A minimum of 100 articles limit for a source was set, and 17 of the 1115 sources met this condition. Keywords are important in research since they differentiate and highlight the primary subject of the research area . The lowCitations demonstrate a scientist’s significance in a certain field of research . The minThe number of citations received by an article indicates its significance in a certain academic topic. Papers with a high number of citations are considered to be pioneering in their respective academic fields. The minimum number of citations for a document was set at 150, and 123 of 9562 publications satisfied this requirement. Various states have participated with more materials in the present research topic than others, and they intend to continue doing so. The systematic graph was built so that readers may look at areas dedicated to SFRC research. The minimum number of papers that a country may possess was set at 50, and 35 countries met this requirement. This systematic study performed statistical analysis and mapping of the SFRC research using bibliographic data. Previous manual review studies lacked the ability to link distinct regions of the literature entirely and accurately. This study found the publication’s sources  that published the most documents, the most often used keywords in publications, the documents and researchers with the greatest citations, and the nations that were actively engaged in SFRC research. According to keyword analysis, the incorporation of steel fibers in concrete has mostly been explored to improve the mechanical and durability performance of concrete, especially to reduce brittleness, resist fracture propagation by crack bridging, and increase ductility. Furthermore, the literature and its citations were analyzed to identify highly devoted and participating nations based on publication count. The graphical depiction and quantitative analysis of participating nations and researchers will aid young scientists in making scientific collaborations, instituting joint ventures, and exchanging new methodologies and concepts. Scholars from nations intent on extending research on the use of SFRC can cooperate with experts in the field and benefit from their knowledge.SFRC has been utilized in a variety of applications, including bridges, tunnel linings, retaining walls, road pavements, slabs, hydraulic structures, shotcrete, foundations, and precast members ,90,91,92An assessment of publishing sources , including articles on SFRC research, revealed that “CBM”, Engineering structures”, and “American concrete institute, ACI special publication” are the top three sources, with 877, 420, and 403 publications, respectively. In terms of total citations, the top three publishing sources are “CBM” with 29,863, “Cement and concrete research” with 29,863, and “Cement and concrete composites” with 9708 citations.Keywords analysis on the SFRC research revealed that steel fibers, fiber-reinforced concrete, concrete, steel fiber-reinforced concrete, and reinforced concrete are the five most often occurring terms. The keyword analysis found that steel fibers incorporation in concrete has mostly been investigated to improve the mechanical and durability performance of concrete, especially to control the brittleness resisting the crack propagation through cracks bridging and improve ductility.Analysis of authors in the current study field showed that 39 authors had published at least 30 articles up to June 2022. Based on the number of publications, total citations, and average citations, the leading researchers were categorized. According to the evaluation, Zhang Y. is the most productive researcher with 86 publications, followed by Yoo D.-Y. with 66 and Li J. with 63 publications. Yoo D.-Y. leads the field in total citations with 2944 overall citations, Banthia N. is second with 2689, and Naaman A.E. is third with 2269 citations in the present research domain. Moreover, when the average number of citations is compared, Naaman A.E. may be at the top with almost 71 average citations, Shah S.P. may be second with about 47, and Yoo D.-Y. may be third with around 45 average citations.An evaluation of published articles comprising data on SFRC research discovered that Song P.S.’s  paper “MThe top countries were evaluated on their contribution to SFRC research, and it was revealed that only 35 countries produced at least 50 documents. China, the United States, and India each provided 1607, 1139, and 923 papers. Furthermore, the United States received 24,770 citations, China received 22,924 citations, and Italy received 12,190 citations, and might be placed in the top three based on citations.SFRC has been utilized in a variety of engineering applications, including bridges, tunnel linings, retaining walls, road pavements, slabs, hydraulic structures, shotcrete, foundations, and precast members.The major challenges to the use of SFRC include high cost, corrosion of steel fibers, and uniform dispersion of fibers in the mix. However, when using recycled steel fibers, especially from the waste tires, coating steel fiber with zinc/brass/copper can be better solutions to these challenges.The goal of this study was to carry out a scientometric-based review of the current literature on SFRC research in order to evaluate several criteria. Scopus was searched for 9562 relevant articles, and the records were assessed using the VOSviewer tool. This research yielded the following findings: