This study was conducted to develop a simplified Chinese version of the central sensitization inventory (CSI-CV) and to evaluate its reliability and validity.The CSI-CV was developed through a process involving the translation and back translation of the original CSI. Subsequently, experts reviewed and revised the content of the items to ensure their appropriateness. A total of 325 patients with knee osteoarthritis (KOA), who were scheduled to undergo total knee arthroplasty (TKA), completed the CSI-CV at a prominent orthopedic center in Xi'an, China. Afterward, a random selection of 100 participants was chosen for retesting after one week. The reliability and validity of the inventory were evaluated through exploratory factor analysis, correlation coefficient calculation and other methods.The CSI-CV consists of 25 items in five dimensions . The cumulative variance contribution rate was 75.3%, the Cronbach's α coefficient was 0.83, the Guttman split-half reliability coefficient was 0.88 and the intraclass correlation coefficient was 0.965. The CSI-CV scores correlated moderately with the total scores of the brief pain inventory (r = 0.506), Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.466) and EuroQoL Group's five-dimension questionnaire (r = 0.576).The findings demonstrate that the CSI was successfully trans-culturally adapted into a simplified Chinese version (CSI-CV) that was reliable and valid for Chinese-speaking patients who awaiting TKA for KOA.The online version contains supplementary material available at 10.1186/s13018-023-04375-3. Knee osteoarthritis (KOA) is one of the most common degenerative diseases in elderly populations, resulting in chronic persistent pain and functional disability . The aveOver the past few decades, the concept of central sensitization (CS) has been developed. It is defined as an enhanced responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input . CS has Several attempts have been made to objectively quantify CS, such as Quantitative Sensory Testing (QST) , 15 and The CSI has been translated and validated in multiple countries for patients with chronic pain resulting from various causes –32. PrevThe medical ethics committee of Honghui Hospital approved this prospective observational study (No. 202105010). All experiments were performed in accordance with the Declaration of Helsinki. All participants provided written informed consent.To culturally adapt the CSI, a translation and back-translation approach was employed . InitialBetween July 2021 and December 2022, patients with end-stage KOA who were scheduled to undergo TKA were recruited from the Department of Knee Joint Surgery at Honghui Hospital in Xi'an City, Shaanxi Province, China. The inclusion criteria for this study were as follows: (a) patients older than 18 years old with end-stage KOA who were scheduled to undergo primary unilateral TKA; (b) whose cognitive level meets the requirements for completing the questionnaire; (c) who were fluent in Mandarin at a conversational level; and (d) who consented to participate. Exclusion criteria were: (a) patients with a history of other vascular, nerve, muscle, and bone diseases that affect movement or produce pain symptoms, such as hemiplegia, fractures, ligament injuries, lower extremity vascular injuries, etc.; (b) Patients who have previously undergone TKA; (c) patients with serious diseases that affect daily life, such as coronary heart disease, asthma, mental illness, etc.The self-assessment questionnaires were administered by a trained interviewer who instructed the participants to independently complete the questionnaire before TKA. After receiving the completed questionnaires, a thorough review was conducted to identify any missing items. In instances where items were found to be missing, participants were kindly requested to provide the necessary answers . To ensuAll patients were required to complete the questionnaires as briefly described below.Every participant was required to fill out the general demographic information questionnaire, which included age, body mass index, gender, employment status, living situation and educational level.The CSI-CV consists of two sections: Part A and Part B . Part A Part B is not scored and focuses on assessing 10 CSS-related diagnoses. Participants are asked two questions: (1) whether they have been previously diagnosed with each of these disorders by a doctor, and (2) the year of diagnosis.The EQ-5D is a self-administered measurement instrument used to assess health-related quality of life. It comprises five domains  and is measured on a five-grade scale: no difficulties, slight difficulties, moderate difficulties, severe difficulties, and extremely severe difficulties , 40.The BPI consists of two main scores: the pain severity score and the pain interference score . The paiThe pain interference score is calculated based on seven items that evaluate the extent to which pain affects various aspects of life. Each item is rated on a scale of 0 to 10, ranging from "no interference" to "complete interference".The WOMAC is divided into three domains: stiffness (two items), pain (five items), and physical function (17 items) . Each itTo determine the appropriate sample size, we followed the recommendations for conducting factor analysis. These recommendations suggest having 4 to 10 participants per item  and a toDescriptive statistics were used to summarize the demographic and clinical characteristics of the participants, with the mean and SD calculated for continuous variables, and percentages calculated for categorical variables. The Kolmogorov–Smirnov test was used to assess the normality of the CSI-CV, EQ-5D, WOMAC, and BPI total scores. T-tests and one-way analysis of variance (ANOVA) with Bonferroni correction were employed to compare CSI-CV scores across subjects with different characteristics. This analysis aimed to assess the discriminant validity of the scale. All statistical analyses were conducted using SPSS 24.0 . The significance level was set at 0.05.Since the factorial structure of the CSI has been shown to vary in different language versions –30, struThe Pearson correlation coefficient was used to test the criterion validity of the CSI-CV with the EQ-5D, WOMAC and BPI. The correlation levels were set as follows: > 0.81, very strong correlation; 0.61–0.80, strong correlation; 0.41–0.60, moderate correlation; 0.21–0.40, weak correlation; and < 0.20, none or very weak correlation . Before Internal consistency indicates how closely related a set of items is as a group, which is usually measured by Cronbach's α coefficients. The coefficient α was set as follows: < 0.70, poor or unacceptable; 0.70–0.79, fair; 0.80–0.89, good; and ≥ 0.90, excellent . Test–reItems were screened based on their factor loadings of item scores and Cronbach's α coefficient. Item deletion was contemplated if the item’s factor loading was less than 0.4, and the Cronbach's α coefficient of the entire scale increased after removing the item compared to before its removal .Standard error of measurement (SEM) is an indicator of absolute reliability . The mosated ICC .95% CI) = 1.96·The smallest detectable change (SDC) reflects the smallest within-person change in score, calculated using the formula SDC.The CSI scores among the 325 patients ranged from 8 to 62, with a mean of 29.6 (SD = 10.1). Of the 325 patients, 168 patients indicated subclinical, 119 patients indicated mild, and 38 patients indicated moderate or higher severity. As shown in Table P < 0.001) confirmed that the data was suitable for factor analysis. EFA and screen plot  and the Bartlett’s test of sphericity P < 0.00 confirmeThe correlations between the CSI-CV and EQ-5D, BPI and WOMAC were showed in Table The CSI-CV exhibited a strong level of internal consistency (Cronbach’s α = 0.83), with individual factor scores ranging from 0.76 to 0.98. Furthermore, the Guttman split-half reliability coefficient was determined to be 0.88, with individual factor scores ranging from 0.59 to 0.92. These findings indicate that each item within the measure showed significant correlation with the overall factor being assessed. Test–retest reliability was excellent with an ICC of 0.965. All factors of the CSI had an excellent ICC greater than 0.90. The SEM was 1.89 points  , JapanesThe CSI-CV exhibited a high level of internal consistency with a Cronbach's alpha of 0.83. Additionally, the 25 sub-items displayed high Cronbach's α values ranging from 0.82 to 0.83. These values were consistent with the English (0.87) , JapanesOnly a few of the initial validation studies , 25, 26 In addition to its psychometric properties, the feasibility of the CSI-CV was also evaluated in this study. The time required to complete the CSI-CV was found to be relatively short, with participants spending an average of 6.4 ± 1.3 min to complete the questionnaire. The brevity of the CSI-CV allows for efficient administration, reducing participant burden and increasing the likelihood of compliance.The CSI scores in the present study ranged from 8 to 62, with a mean of 29.6 ± 10.1. These scores were lower than those reported in Germany (43.6 ± 15.0) , Korea (These variations in CSI scores and the prevalence of CSS diagnoses can be attributed to various factors, such as cultural, racial, and medical differences among the patient populations . CulturaFurthermore, it is important to note that the present study focused specifically on patients undergoing TKA due to KOA. This distinguishes it from previous studies that included a broader range of conditions such as musculoskeletal pain, fibromyalgia, and acute injury pain –30. The The CSI total score exhibits a substantial disparity among individuals with different demographic characteristics. Specifically, women tend to have significantly higher CSI scores compared to men, aligning with previous research findings indicating that women with acute pain are more likely to experience persisting pain , 54. FurNumerous limitations of the present study should be acknowledged. Firstly, all participants were recruited from a single hospital, predominantly representing patients in northwestern China. Given the vast land area of China, the generalizability of the findings to other regions of mainland China may be limited. Secondly, the assessment of CSS was based on self-report questionnaires, which introduces the potential for response bias. Thirdly, we did not directly measure CS using QST in our study. Further research is required to investigate the validation of the CSI-CV, which could involve incorporating QST as a complementary measure. Lastly, the study did not include healthy individuals, warranting future research to investigate whether the CSI-CV can effectively differentiate individuals with and without CS.In conclusion, the linguistic translation and cultural adaptation of the CSI from the original English version to simplified Chinese were successfully completed, ensuring the equivalence of all items. The CSI-CV demonstrated strong psychometric properties, including reliability, validity, and ease of understanding. These findings provide robust evidence supporting the use of the CSI-CV as a reliable instrument for screening CS in Chinese-speaking patients with KOA prior to undergoing TKA.Additional file 1. Simplified Chinese version of the Central Sensitization Inventory.


One of the main objectives of capital construction worldwide is to increase the efficiency of construction. To achieve this, a significant improvement in the quality of concrete and reinforced concrete is required. Nowadays, in developed countries, one of the key directions for enhancing the efficiency of concrete and reinforced concrete is reducing their density by using inexpensive and high-quality local porous fillers. In recent years, the use of concrete structures with porous fillers based on ceramporite in load-bearing reinforced concrete structures has allowed for the improvement of their technical and economic indicators and the reduction in their own weight by up to 35%. This, in turn, is considered an essential factor in seismic zones, and therefore, special attention is paid to these issues. This article presents the data of experimental and theoretical studies obtained from investigating the crack resistance of prestressed lightweight reinforced concrete flexural elements with wire rope reinforcement. The main factors influencing crack resistance were considered, including the effects of two types of porous filler (ceramporite), two types of concrete, concrete strength, percentage of reinforcement, and level of precompression. The tests were conducted using short-term and repeated loadings. Based on the analysis of the obtained data, some refinements have been made to the methodology for calculating the crack resistance of such structures according to current design standards. In recent years, the use of concrete structures with porous fillers based on ceramporite  in load-bearing reinforced concrete constructions has allowed for the improvement of their technical and economic indicators and the reduction in their weight by up to 35%. This reduction in weight is considered an important factor in seismic zones, and as a result, special attention is given to these aspects.Bendable elements, which can be flexed until they break, made of cable-reinforced ceramporite concrete, have not been studied in detail up to the present time. This circumstance complicates the comprehensive consideration of their properties during the calculation and design of load-bearing reinforced concrete structures. This primarily applies to the peculiarities of the prestressing effect, resistance of prestressed elements to repeated loads, conditions of crack opening and closing, and other aspects.Research on the stress–strain behavior of bendable prestressed elements has mainly been conducted using various types of lightweight concrete and bar reinforcement. However, specific and targeted studies on the peculiarities of the behavior of bendable prestressed elements made of ceramporite concrete with cable reinforcement have scarcely been conducted.In order to facilitate the wide application of these materials, it is necessary to carry out new experimental and theoretical research to refine and improve the calculation and design requirements of regulatory documents for the design of such prestressed reinforced concrete structures.Despite the availability of experimental research on the crack resistance of prestressed reinforced concrete structures, we believe that their calculation remains insufficiently addressed in current design standards. This is particularly relevant when considering the application of new types of lightweight concrete in combination with wire rope reinforcement.crc during scenarios involving multiple static loadings.It is worth noting that the provisions of (construction norms and regulations) KMK 2.03.01-96 [As is known, the existing norms are primarily based on experimental research conducted on reinforced concrete structures using heavy concrete ,3,4. TheDuring the process of crack formation in reinforced concrete structures, three stages are commonly distinguished: the initiation of cracks, when they may still be invisible; the appearance of cracks, when they become detectable to the naked eye; and crack propagation. According to this theory, the moment of crack appearance coincides with the moment of their initiation. The opinion that the emergence of visible cracks is preceded by an intensive process of microcrack formation has been repeatedly expressed by various researchers ,6,7,8,9.Reducing the self-weight of reinforced concrete structures through the use of various lightweight concretes, including prestressed elements based on them, is effective in seismic regions of Uzbekistan. In this regard, research in this direction will contribute to solving a number of issues related to the application of efficient prestressed elements ,25.Well-founded results were also obtained in another study , which dIn the work , aimed aThe present study is devoted to the experimental and theoretical investigation of the behavior of bendable ceramporite-reinforced concrete elements with cable reinforcement under short-term and repeated loading, followed by the development of suggestions to improve the calculation methodology for such structures.To address the stated objectives, 36 experimental reinforced concrete beams were fabricated. These beams had a rectangular cross-section measuring 12 cm by 24 cm and a length of 320 cm. Two types of lightweight concrete were used in the experimental study: ceramporite concrete, which is a lightweight concrete based on ceramporite , and ordinary heavyweight concrete. As for the longitudinal working reinforcement, wire rope reinforcement of K-7 class with diameters of 9 mm and 12 mm was utilized.2 (55–58%) and Al2O3 (12–25%).To manufacture experimental beams made of ceramporite concrete, two types of ceramporite obtained and local raw materials were used. The optimal compositions for the granulation of ceramporite filler are designated as follows (in %): loess—75; kaolinite—15; coal—10. The primary minerals of the raw components are SiOThe ceramporite filler is produced using the following technology: loess-like clay is sieved through a 2.5 mm sieve, thoroughly mixed with kaolinite and coal that have been sieved through a 2.5 mm sieve, and then moistened to achieve a moisture content of 20–30% by weight. Granules are formed using a disc granulator. The ceramporite was sintered at 1250 °C. The obtained granules are dried to an air-dry state and then directed to be fired in a rotary kiln. The main characteristics of ceramporite porous fillers are presented in 3 and a fineness modulus of 2.2 was used. As a binder, Portland cement from the “Ahangaran Cement Plant” with a strength of 39.5 MPa was applied. The specific surface area of the cement is 3500 cm2 per gram. The normal density of the cement paste is 27%. According to GOST 310.3-76 “Cements. Methods for Determination of Normal Density, Setting Times, and Uniformity of Volume Change” [As a fine filler, quartz sand from the Chinaz quarry with a bulk density of 1450 kg/m Change” , the norThe concrete was prepared using a forced-action concrete mixer and the molds for the twin beams, as well as the corresponding number of control cubes, were filled with a single batch. The poured concrete in the molds was compacted using a deep vibrator. All the experimental beams and cubes were stored under natural conditions after concreting. The transfer of forces from the support to the concrete was carried out at cube strengths of 22–26 MPa and 16–20 MPa, respectively, for lightweight and heavyweight concretes.To conduct the experimental investigations, a testing program was developed, according to which the reinforced concrete beams were divided into three groups based on the types of concrete, reinforcement, and precompression level. The experimental beams were subjected to external static loads through two concentrated forces positioned at a distance of 110 cm from the support on both sides.The force was applied using hydraulic jacks DG-100  see , connectFor the production of experimental specimens, rigid steel molds were used. Two strands were tensioned on each power form in sequence, and on each strand, two twin specimens were fabricated. The tensioning of the reinforcement was carried out using a hydraulic jack DP-30-200  with a manual pumping station drive. The magnitude of the force in the reinforcement during tensioning was monitored using a pressure gauge and by measuring the deformations of the reinforcement.Experimental values of the characteristics of the used reinforcement are provided in In the experimental beams with longitudinal working reinforcement of 2Ø9 K-7, wire reinforcement of Vr-II with a diameter of 5 mm was installed in the compressed zone to prevent crack formation during the release of precompression. In the beams with longitudinal working reinforcement of 2Ø12 K-7, a single wire rope reinforcement with a diameter of 9 mm was installed in the compressed zone for the same purpose. Transverse reinforcement was provided by using wire loop ties of Ø5 Vr-1, placed behind the pure bending zone at a spacing of 10 cm. The experimental moment of crack formation was determined when testing beams visually and using a microscope with a 24-fold increase, and then refined by analyzing the graphs of concrete deformation in the compressed and tension zones, tension reinforcement, and deflections.The strength of ceramporite concrete and heavyweight concrete was determined by testing cubic concrete specimens with 15 cm side length, manufactured from the same concrete mix used for the experimental beams. As a result of the tests, the strength of ceramporite concrete on the day of testing the experimental beams was in the range of 31–33.5 MPa, while for heavyweight concrete, it was in the range of 26–29 MPa.The results of the experimental studies conducted on samples of reinforced concrete columns to determine concrete strength using non-destructive methods were compared with results obtained from the cubic specimens . In thesIn our research, the experimental value of the crack formation moment was determined as an intermediate value between the moment of visible crack formation and the moment at which a significant increase in deformation occurs, as measured by strain gauges attached to the tensioned surface of the beams.The first transverse cracks in the zone of pure bending appeared at different relative loading levels, depending on the percentage of reinforcement and the degree of prestressing.In beams without prestressing and a reinforcement percentage of 0.4%, cracks formed in the zone of pure bending under a load of 0.10–0.12 of the experimental destructive test, and for beams with μ = 0.7% under a load (0.07–0.08) This phenomenon can be explained by the fact that with an increase in the percentage of reinforcement, the breaking load increases to a greater extent than the load at which cracks appear. It should be noted that in beams (without prestressing) both from ceramporite concrete and ordinary heavy concrete, immediately after the appearance of cracks, they develop by 1/2 and 2/3 of the section height. A further increase in the load leads to a slower development of cracks along the height and their opening, the appearance of new cracks in the zone of pure bending and beyond. The cracks that appeared in these sections were initially oriented normally to the axis of the beams, and then, as the load increased, they deviated more and more towards the place of application of the load. The process of their formation and development basically ends at a load of 70–80% of the destructive load.It should also be noted that in beams with a percentage of reinforcement At the time of formation and development of cracks, the stress in the tensile reinforcement is significantly affected: with its increase, later formation of cracks occurs, and their propagation along the height and towards the supports slows down. In prestressed beams with a reinforcement percentage of 0.4%, the first cracks were formed at a moment of (0.33–0.48) n height .The theoretical moments of crack formation were determined in accordance with KMK 2.01.03-21 [r is the distance from the center of gravity of the reduced section to the core point most distant from the tensile zone, the cracking of which is being checked.r for bending prestressed elements is determined by the formula:The value of For specimens with non-stressed reinforcement, the value When comparing the actual moments of cracking with the theoretical ones, calculated according to KMK 2.03.01-21, it turned out that for the prevailing number of samples, it was characteristic that the theoretical moments exceeded the Note: The beam codes L and T indicate that they are made of lightweight and heavyweight concrete, respectively. The prestressed reinforcement class is specified.As can be seen from An analysis of the experimental data shows that in beams without prestressing, after the appearance of cracks, they immediately cross the tensile reinforcement and develop upward by (0.46–0.64) h of the beam height.u, 11–12 and 8–9 cracks, respectively, were observed in the “pure” bending zone, which were located in increments of 6–9 cm and 8–12 cm, respectively.In beams made of ceramporite concrete and heavy concrete at a loading level of 0.6 Mu, 8–10 and 7–9 cracks were observed in the “pure” bending zone for ceramporite concrete and heavyweight concrete, respectively. In beams made of ceramporite concrete reinforced with 0.4% and 0.7% reinforcement, the cracks were spaced at intervals of 7–11 cm and 8–13 cm, respectively. In beams made of heavyweight concrete, the distance between cracks was approximately 8–12 cm and 9–14 cm, respectively.In prestressed beams at a load level of 0.6·MIn our experiments, the type and strength of concrete had practically no effect on the crack opening width.As the experimental data show, the determining factors for the width of the crack opening are the level of compression, the percentage of reinforcement and the stress in the tensile reinforcement.As can be seen from these figures, up to the stress in the tensile reinforcement equal to the conditional yield strength, the relationship between the stress in the reinforcement and the crack opening width can be assumed to be linear with great certainty.The ratio of the maximum crack width to the average u, and at a loading level of 0.8 Mu, this ratio is equal to (1.1–1.2) and (1.13–1.27), respectively.Attitude bp/Rbp from 0 to 0.72 in beams with a percentage of reinforcement μ = 0.4% at the loading level M = 0.6 Mu reduces the average crack width from 0.39 mm to 0.033 mm, and in beams with µ = 0.7% this value is 0.26 mm to 0.025 mm.Prestressing has a significant effect on the width of the opening of normal cracks in ceramporite-reinforced concrete beams. Thus, an increase in the level of compression σThe theoretical values of the maximum crack opening width were determined by the KMK 2.03.01-21 formula with the actual characteristics of the materials.At the same time, satisfactory convergence between theoretical and experimental values was achieved. The significant deviation of experimental crack width values from theoretical values at loads close to failure can be explained by the fact that in beams with µ = 0.4%, the reinforcement operates with large plastic deformations (the stress in it exceeds the yield limit), which leads to an increase in the experimental crack width.During the determination of s, into the formula of the design code 2.03.01-21.To improve the convergence of experimental and theoretical values, it is proposed to incorporate the variable modulus of elasticity of the wire rope reinforcement, E’Theoretical values of According to the experimental program, one beam from the twin specimens was subjected to multiple repeated loadings up to the moment value where the crack opening width, In accordance with the recommendations of ,3,4, the0.2, the ratio of the moment at which As experimental data have shown, that with an increase in the prestress value from 0 to 0.9 σrestress .It should be noted that at the same level of the bending moment, the crack opening width during unloading in all cases exceeds the value of In all non-stressed specimens, the upper level of loading was 2–3 times less than in the prestressed specimens. Reloading resulted in an increase in the width of the crack opening compared to the previous loading, but this increase in the width of the crack opening was slightly larger compared to prestressed ones. The crack openings during the load reduction in prestressed beams varied depending on the reinforcement. After the complete removal of the load, beams with a reinforcement percentage of 0.4% exhibited residual crack widths of 0.04–0.05 mm, while beams with µ = 0.7% had slightly smaller widths (0.02–0.04 mm). This can be explained by the fact that elements with lower reinforcement percentages are more sensitive to overloads.In all prestressed beams, crack closure was observed, although some of them experienced losses in the prestressing of the reinforcement due to its relaxation.Stresses in concrete at the level of tensile reinforcement (P—prestressing force at the time of testing beams, accounting for losses; ope—eccentricity of the prestressing force P relative to the centroid of the transformed section; r—distance from the centroid of the transformed section to the core point furthest from the tensioned zone; M3—cracking moment; redW—resistance moment of the transformed section of the element for the extreme tensioned fiber.l depends on the level of external load, the degree of prestressing and other factors. The ratio φl = An analysis of the experimental results  shows thThe formation and development of cracks in bendable elements made of ceramporite concrete with cable reinforcement are similar to those in elements made of heavy concrete;There is a linear relationship between the level of crack formation and the level of compression of prestressed ceramporite concrete bendable elements;Accounting for the influence of prolonged prestressing of ceramporite concrete on its mechanical properties ensures the best convergence of theoretical and experimental cracking moments when using the coefficient When calculating the crack width of ceramporite-reinforced concrete elements under short-term loading, the expression provided by the codes can be used by substituting the variable modulus of elasticity of the reinforcement crc = 0.15 mm to the ultimate moment increases almost linearly;In bendable elements with cable reinforcement, both in heavy concrete and ceramporite concrete, as the level of prestress increases from 0 to 0.9 σ0.2, the ratio of the moment at which acrc = 0.15 mm is lower by 6–12% compared to elements made of heavy concrete, and it depends on the magnitude of prestress;In ceramporite concrete bendable elements with cable reinforcement, the level of moments corresponding to crack opening ab equal to 1.15;The crack width under repeated loading exceeds the crack width under initial loading, which can be determined using the formula provided by the design codes with the coefficient φThe experimental research data confirm the reliability of the code requirements regarding crack closure in bendable elements of the 2nd category of crack resistance made of ceramporite concrete with cable reinforcement.Practical results of the research:New experimental results on the crack resistance of prestressed beams made of ceramporite concrete reinforced with wire rope reinforcement were obtained based on the conducted research;An improved calculation method for flexural elements based on the characteristics of ceramporite concrete and the real deformation diagram, considering the effects of wire rope prestressing, was proposed;Formulas for determining the mechanical properties of concrete and reinforcement, the degree of prestressing of the reinforcement, and the stiffness of crack-free sections taking into account concrete compression were introduced;Formulas for determining the crack resistance of prestressed ceramporite concrete beams reinforced with wire rope reinforcement subjected to short-term and repeated loads were recommended.In our opinion, further experimental and theoretical research on the stress–strain behavior of prestressed flexural elements made of ceramporite concrete with wire rope reinforcement should focus on studying their performance under sustained loading, particularly considering the influence of adverse environmental conditions.


Antimicrobial resistance (AMR) poses a global public health threat, with rates directly linked with consumption. The World Health Organization (WHO)’s AWaRe classification aims to guide antibiotic use, and is influenced by drug availability, affordability, and economic policies. In Jordan, a high proportion of consumed antibiotics belong to the ‘Watch’ category. Data from the WHO’s AWaRe classification, the Essential Medicines List, and the Jordan Food and Drug Administration were analyzed. Antibiotics for adults were classified, their costs per defined daily dose (DDD) were determined and their affordability assessed. In 2023, 43 injectable and 43 oral antibiotics for adults were registered in Jordan. ‘Watch’ antibiotics were the most common. ‘Access’ antibiotics had the lowest cost/DDD. ‘Reserve’ antibiotics were the most expensive, with few generics. Injectable antibiotics had a negative correlation between cost and the number of alternatives. Affordability was higher for oral antibiotics compared with injectable ones. ‘Reserve’ antibiotics were generally unaffordable. This study highlights the need to promote ‘Access’ antibiotics over other categories by encouraging the registration of missing ‘Access’ antibiotics and adjusting the prices of ‘Watch’ and ‘Reserve’ antibiotics. Competition among generics can lead to lower prices, increasing affordability and accessibility. We emphasize the importance of the AWaRe classification in guiding antibiotic use in Jordan. Antimicrobial resistance (AMR), as a seriously identified global public health problem, is becoming an urgent and demanding issue ,2,3. It World Health Organization (WHO) experts have created a classification of antibiotics that is expected to slow down the resistance rates against available antibiotics. This classification is based on the listing of antibiotics into three groups, i.e., ‘Access’, ‘Watch’, and ‘Reserve’ antibiotics (AWaRe). By considering AWaRe classification during antibiotics prescribing practice and antimicrobial stewardship efforts, this tool can help in properly selecting antibiotics with a lesser possibility of causing antibiotic resistance. In other words, considering the AWaRe classification of antibiotics may rationalize antibiotic consumption ,5. The WAntimicrobial stewardship that includes all related dimensions can provide solutions for the fight against AMR . HoweverBetween 1990 and 2010, development of new antibiotics by large pharmaceutical companies was seriously reduced. In fact, the number of companies researching antibiotics dropped from 18 to 4. At the same time, the number of newly approved antibiotics had been affected to such an extent that it reached its low point even as worrying levels of resistance to available antibiotics were reached . Many guAffordability of a drug or treatment can be defined as a measurement of the ease or feasibility of the members of a society to pay for that drug or treatment. It is correlated with drug prices, insurance coverage, a family’s financial status, and, sometimes, the indication of the drug . In 2008Ideally, ‘Access’ antibiotics should have an affordable cost, as to enhance their use as first or second lines of treatment ,16. DiscBroad-spectrum antibiotics are more commonly available in injection rather than in oral dosage forms. Injectable antibiotics have been most commonly administered in hospital settings in west and central Asia, Latin America, and eastern and southern Europe. Jordan is a country located in west Asia, where broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, are frequently prescribed for both treatment and prophylaxis in hospitals. Versporten et al. have stated that, in 2015, more than 80% of inpatients in these areas, including Jordan, had been administered broad-spectrum antibiotics .This study aimed to explore registered antibiotics for adults in Jordan according to their AWaRe classification, and to determine the relationship between cost, availability and affordability, and how the antibiotic was classified.Until the end of August 2023, the total number of injectable antibiotics for adults that had been registered in Jordan by the Jordan Food and Drug Administration (JFDA) was 43, and was also 43 for oral antibiotics. The injectable and oral antibiotics for adults in Jordan, along with their WHO AWaRe groups, listing status on the Essential Medicines List (EML) in 2023, their defined daily dose (DDD), mean cost of the DDD, and number of marketing authorization holders (MAH), are listed in About half of the injectable antibiotics for adults in Jordan (48.8%) belonged to the ‘Watch’ group. ‘Access’ and ‘Reserve’ groups represented 27.9% and 23.3%, respectively. All of the ‘Access’ injectable antibiotics were listed on the EML. The majority of ‘Reserve’ injectable antibiotics (9 out of 10) had only one MAH in the Jordanian market.Gentamycin, an ‘Access’ injectable aminoglycoside, had a mean public cost per DDD equal to 2.20 Jordanian Dinar (JOD)/DDD. It was found to have the lowest cost DDD of the injectable antibiotics. It had three alternative brands in the market and was listed on the EML. The antibiotic with the highest mean public cost per DDD was oritavancin (609.93 JOD/DDD). Oritavancin is a ‘Reserve’ glycopeptide, with only the originator drug, not listed on the EML, available in Jordan.Similar to injectable antibiotics, the majority of the oral antibiotics for adults belonged to the ‘Watch’ group, which represented more than 60% of the total oral antibiotics, followed by ‘Access’ antibiotics (37.3%). Linezolid was the only oral antibiotic for adults in Jordan that belongs to ‘Reserve’ group. It was listed on the EML and had a total of four originator and generic alternatives. Most of the ‘Access’ oral antibiotics were listed in the EML. At the same time, only about 30% of oral ‘Watch’ antibiotics could be found in EML.Doxycycline, an ‘Access’ oral tetracycline, had a mean public cost per DDD equal to 0.24 JOD/DDD. It was found to have the lowest cost of DDD out of the oral antibiotics. It had eight alternative brands in Jordan and was listed in the EML. The antibiotic with the highest mean public cost per DDD was delafloxacin (66.66 JOD/DDD). Delafloxacin is a ‘Watch’ fluoroquinolone for which only the originator is available in Jordan, though it is not listed in the EML.The injectable antibiotic with the highest number of alternatives (originator and generics) was ceftriaxone. Ceftriaxone, a ‘Watch’ group third-generation cephalosporin had 11 MAH in Jordan. It also had the highest cost ratio and % of cost variation, i.e., 6.78 and 577.9%, respectively . On the The means of the costs of DDDs for all registered injectable and oral adult antibiotics in Jordan according to their mean prices for public were notably different according to their AWaRe classification. The difference in costs of DDDs was statistically significant between AWaRe groups  . More spAWaRe groups of antibiotics were also variable regarding number of MAHs. ‘Watch’ injectable and oral antibiotics had the highest mean number of MAHs (4.74), while mean MAH for the ‘Reserve’ antibiotics was 1.36. The difference was statistically significant (ρ = 0.003).The costs of DDDs of adult injectable antibiotics in Jordan were found to inversely correlate with the number of MAHs . Spearman’s rho correlation coefficient was –0.354, and was statistically significant (ρ = 0.020). A similar correlation could not be found upon comparing the costs of DDDs of oral antibiotics with the number of available brands. Although they had an inverse relationship similar to the injectable antibiotics, Spearman’s rho correlation was not statistically significant for the relationship between the oral cost of DDDs and the number of MAHs.A total of 26 injectable antibiotic (60.5%) and 19 oral antibiotic (44.2%) were listed in the EML. However, the difference in percentage of listing in the EML between injectable and oral antibiotics was not found to be statistically significant. At the same time, oral antibiotics were significantly more affordable (ρ < 0.001) than injectable antibiotics .Of those oral antibiotics listed on the EML, the ‘Reserve’ antibiotic linezolid was the only antibiotic considered to be non-affordable. The non-affordable injectable antibiotics that were listed on the EML were four ‘Watch’ antibiotics  and four ‘Reserve’ antibiotics .All injectable and oral antibiotics that belong to the ‘Access’ group were found to be affordable. On the other hand, all of the ‘’Reserve’ group antibiotics for both routes of administration were found to be not affordable. Delafloxacin was the only oral ‘Watch’ antibiotic to be considered not affordable. on the contrary, approximately half of the ‘Watch’ injectable antibiotics (11 antibiotics) were considered affordable. The difference in affordability between all of the adult antibiotics in Jordan according to the AWaRe classification was statistically significant. Affordability ranged from 100% for the ‘Access’ antibiotics to 0% for the ‘Reserve’ antibiotics, with ~75% affordability among the ‘Watch’ antibiotics .By comparing the number of MAHs for all of the antibiotics according to their affordability classification, 64 antibiotics were found to be affordable, with a 4.69 mean number of MAHs . The other 22 non-affordable antibiotics had a mean number of MAHs equal to 1.95. The difference in MAHs was statistically significant (ρ = 0.001) .The injectable and oral antibiotics had a mean cost ratio of approximately 1.9. The mean % cost variation was 92.4 for the injectable and 97.3 for the oral antibiotics. Neither the cost ratio nor the % cost variation were significantly different.This research aimed to draw a picture of the availability of antibiotics for adults in Jordan, with brief cost and regulatory comparisons. All of the included data were extracted from the WHO sources or the JFDA, which is the sole governmental drug regulatory body in Jordan.In addition to the AWaRe classification, the route of administration of the antibiotic was considered a primary classification for the antibiotics. The antibiotics for adults can be given to or administered by patients in different dosage forms via different routes according to the settings, indication, and severity of the condition. Sometimes, injectable and oral antibiotics can be notably different in DDDs and cost.An extensive literature search was conducted to try to find published studies or statistics about prescription or consumption of antibiotics by AWaRe groups in Jordan. There was a shortage of published statistics about the consumption of antibiotics according to AWaRe classification in Jordan at larger scales, including the national scale. An interventional study that was published in 2023 had used a single hospital’s antibiotic prescription data grouped according to AWaRe classification. It calculated antibiotics DDDs for adults and pediatrics that had been dispensed by the hospital . Al-AzzaA considerable number of antibiotics for adults, whether formulated to be taken orally or parenterally, were not found to be registered in Jordan. Many of the ‘missing’ antibiotics from the Jordanian market can be described as older antibiotics that belong to the ‘Access’ group. Regardless of the benefits of their use, older antibiotics lack active marketing and will have relatively low prices and high registration and re-registration fees so that, as a result, MAHs might decide not to keep them available .A great proportion of the registered antibiotics in Jordan belonged to third-generation cephalosporins, fluoroquinolones, and penicillins. Third-generation cephalosporins and fluoroquinolones, in addition to penicillins with β-lactamase inhibitors as pharmacological classes, were among the highest prescribed antibiotics in hospitals in Jordan and worldwide ,17,20,21The reported consumption of ‘Access’ antibiotics in 28 European countries in 2021 was approximately 60% of the total consumed antibiotics in both the community and hospital sectors . It seemWe found that the registered ‘Reserve’ group of antibiotics in Jordan had the highest mean cost/DDD and the lowest mean number of MAHs (originators and generics). The least expensive oral and injectable DDDs of antibiotics  belong to the ‘Access’ group. Generally, the low price of a drug can make it more affordable . Cost-efNone of the ‘Reserve’ antibiotics are considered affordable in Jordan, in contrary with the ‘Access’ antibiotics. Such a finding is in line with the target of keeping ‘Access’ antibiotics more affordable while leaving ‘Reserve’ antibiotics as a last resort choice ,16.This study has limitations that should be addressed. The data that were investigated lacked correlation with real-time antibiotic consumption figures. However, the conducted research can still be conclusive. Restricting the number of available alternatives of the ‘Reserve’ antibiotics could ensure higher prices and reduced affordability and, as a result, hopefully limit consumption and lower resistance rates in the future. Classifying certain ‘Watch’ antibiotics to be ‘Reserve’ can also be suggested. Moreover, the concept of affordability, in terms of the way it was judged, was not the optimal measure by which to reflect the actual affordability of antibiotics. Jordan has a diverse healthcare system with variable health insurance coverage packages. Linking the affordability of antibiotics with their cost/DDD in relation to the minimum daily wage helped in defining a threshold for the cost, above which the DDD would be expensive.1-The WHO AWaRe classification of antibiotics for the evaluation and monitoring of use, 2023. This was downloaded from the 2023 AWaRe classification webpage of the WHO . Informa2-The 23rd EML that was issued in 2023  was util3-An index that uses ATC codes was used to find each antibiotic’s DDD. The ATC/DDD index is a searchable version of the complete ATC index with DDDs provided online by the WHO Collaborating Centre for Drug Statistics Methodology and the Norwegian Institute of Public Health .4-Drug information, prices, and leaflets webpage by JFDA . Prices The data that were collected to conduct this study were extracted from four electronic resources that were available online. The resources were:Each antibiotic mentioned and classified in the WHO AWaRe classification list was searched for its registration in Jordan via the JFDA website. Antibiotics that were included in the study were the antibiotics registered and priced in Jordan in a dosage form for adults  to be given parenterally or orally.The WHO have defined DDD as “the assumed average maintenance dose per day for a drug used for its main indication in adults” . The rouThe highest and lowest cost/DDD for each antibiotic were used to calculate cost ratio and percentage (%) of cost variation. The cost ratio was calculated by dividing the highest cost/DDD on the lowest cost/DDD. The % cost variation was calculated as the percentage difference of the highest and lowest cost/DDD to the lowest cost/DDD . AntibioIn this study, the MAH in Jordan was considered to be the pharmaceutical company or drug store that holds the registration rights and is responsible for the regulatory affairs related to the antibiotic drug. The MAH can register an originator with more than one generic of the same antibiotic, and each type of antibiotic can be available in different dosage forms , different strengths, and different pack size. The number of MAHs is a metric that aims to represent a scale of alternatives to a registered antibiotic, and, indirectly, its availability.® Statistics 24 and underwent descriptive analysis. Pearson’s chi-squared test was used for categorical comparison, based specifically on a drug’s listing in the EML and its affordability. Nonparametric tests were conducted because of the nature of the data. The Kruskal–Wallis test was used to determine the difference in the mean cost of DDDs and the mean number of MAHs according to AWaRe classification. Further determination of the statistical significance of the difference between the categories was undertaken via ANOVA post hoc Tukey HSD. The Mann–Whitney U test was used to determine the difference in mean cost ration and % cost variation according to the route of administration, and the difference in mean number of MAHs according to affordability. For the correlation between costs of the DDDs and the number of MAHs, the test was Spearman’s correlation.All data were transferred to IBM SPSSIn conclusion, a relationship was confirmed between the AWaRe classification of the antibiotic and its cost, availability, and affordability parameters. Availability and affordability of the antibiotic can be enhanced by having a lower price and a higher number of generics. Jordan has more available and affordable ‘Access’ antibiotics for adults than ‘Reserve’ antibiotics. Efforts should be made to enhance antimicrobial stewardship, regulate the dispensing of antibiotics, encourage the registration of the missing antibiotics, grant privileges to the registration of more generics, and increase prices of the ‘Watch’ and ‘Reserve’ antibiotics.


Three device structures, Si FinFET, Si0.8Ge0.2 FinFET, and Si0.8Ge0.2/Si SL FinFET, were comprehensively compared with HfO2 = 4 nm/TiN = 80 nm. The strained effect was analyzed using Raman spectrum and X-ray diffraction reciprocal space mapping (RSM). The results show that Si0.8Ge0.2/Si SL FinFET exhibited the lowest average subthreshold slope (SSavg) of 88 mV/dec, the highest maximum transconductance  of 375.2 μS/μm, and the highest ON–OFF current ratio (ION/IOFF), approximately 106 at VOV = 0.5 V due to the strained effect. Furthermore, with the super-lattice FinFETs as complementary metal–oxide–semiconductor (CMOS) inverters, a maximum gain of 91 v/v was achieved by varying the supply voltage from 0.6 V to 1.2 V. The simulation of a Si0.8Ge0.2/Si super-lattice FinFET with the state of the art was also investigated. The proposed Si0.8Ge0.2/Si strained SL FinFET is fully compatible with the CMOS technology platform, showing promising flexibility for extending CMOS scaling.This research presents the optimization and proposal of P- and N-type 3-stacked Si In 0.8Ge0.2/Si SL FinFET is 92.5 µA/µm, which is 52.7% and 61.1% higher than that of the Si FinFET and Si0.8Ge0.2 FinFET, respectively, for the N-type. 0.8Ge0.2 SL FinFETs exhibit the highest maximum transconductance  of 375.2 µS/µm and Gm,N 235.1 µS/µm at VD = ±0.5V.D-VG characteristics of the CMOS inverter operation using the Si0.8Ge0.2/Si SL FinFETs, with FW = 35 nm and LG = 125 nm for the P-type and FW = 30 nm and LG = 200 nm for the N-type. The Si0.8Ge0.2/Si SL FinFET CMOS inverter exhibits SSavg,P = 87.6 mV/dec, SSavg,N = 96.4 mV/dec, the drain-induced barrier lowering (DIBL) values of DIBLP = 15.6 mV/V, DIBLN = 49.9 mV/V, and high ION/IOFF greater than 106 at VD = ±0.5V. In OV = VD = ±0.7 V) of the Si0.8Ge0.2/Si SL FinFET CMOS inverter is 245.9 µA/µm and 176.8 µA/µm for the P- and N-type Si0.8Ge0.2/Si SL FinFET, respectively. 0.8Ge0.2/Si SL FinFET CMOS inverter, with a maximum gain of 91 v/v by varying the supply voltage from 0.6 V to 1.2 V, as shown in G = 15 nm and FW = 5 nm, were selected based on the current state of the art [2 with a thickness of 4 nm, and the total fin height was set to 48 nm to match the experimental conditions of this study. D-VG characteristic of the Si0.8Ge0.2/Si SL FinFET with LG = 60 nm and FW = 30 nm for both the P- and N-type, between experimental data and the TCAD simulation results. In D-VG characteristics of the Si0.8Ge0.2/Si SL, Si0.8Ge0.2, and Si FinFET devices are compared. The results indicate that compared to the Si FinFET and Si0.8Ge0.2 FinFET, the saturation current of the Si0.8Ge0.2/Si SL FinFET exhibits the highest value of 7.26 × 10−5 for the P-type and 3.8 × 10−5 for the N-type. 0.8Ge0.2/Si SL FinFET, which exhibits SSavg,P = 66.1 mV/dec and SSavg,N = 66.5 mV/dec, with values of DIBLP = 31.8 mV/V and DIBLN = 65.4 mV/V. In OV = VD = ±0.7 V) of the Si0.8Ge0.2/Si SL FinFET is 87.4 µA/µm for the P-type and 52.8 µA/µm for the N-type. While GAAFET has the advantage of better scaling, its complex fabrication and low yield make it less practical for certain applications. As an alternative, the Si0.8Ge0.2/Si SL FinFET can extend FinFET technology to more particle applications.To confirm the potential of the proposed approach in contributing to the development of future technology nodes, the Sentaurus TCAD simulator was applied for simulation. The simulation parameters of the devices, including L the art . The gat0.8Ge0.2/Si SL FinFET and CMOS inverter were both fabricated and characterized to evaluate their high-mobility channel achieved through the strain effect. The crystallinity and strain effect were confirmed through the implementation of NBD, Raman scattering, and XRD RSM. Si0.8Ge0.2/Si SL FinFETs exhibit remarkable electrical characteristics, including SSavg = 88 mV/dec, Gm, max = 375.2 μS/μm, and the highest ION/IOFF, approximately 106, when compared to conventional Si and Si0.8Ge0.2 FinFETs. The Si0.8Ge0.2/Si SL FinFET CMOS inverter exhibits SSavg,P = 87.6 mV/dec, SSavg,N = 96.4 mV/dec, the DIBL values of DIBLP = 15.6 mV/V and DIBLN = 49.9 mV/V, and high ION/IOFF greater than 106 at VD = ±0.5V, with a maximum gain of 91 v/v by varying the supply voltage from 0.6 V to 1.2 V. The simulation of the Si0.8Ge0.2/Si SL FinFET with the state of the art demonstrates the potential for extending FinFET technology. The purposed Si0.8Ge0.2/Si strained SL FinFET is fully compatible with the CMOS technology platform, making it a promising alternative for extending future nanoelectronics applications.The Si


The clinicopathological features of MET‐amplified gastric cancer (GC) and real‐world data on the efficacy of MET‐targeted therapies remain unknown. Pulmonary lymphangitis carcinomatosis (PLC) is a peculiar manifestation of GC, whose management has not been thoroughly described.This study analyzed patients diagnosed with MET‐amplified GC or GC with PLC at any time point of the disease course from 2011 to 2021 in two centers. Clinicopathological features and survival outcomes of MET‐amplified GC were analyzed. The clinical and molecular implications of GC with PLC were discussed.p = 0.010), diagnosed at a younger age (p = 0.002), presented with a higher baseline ECOG PS (p = 0.016), and was more likely to develop lung metastasis (p < 0.001), and serous effusion (p = 0.026) than GC without PLC. Patients with primary MET‐amplified GC had a worse prognosis than those with secondary MET‐amplified GC (p = 0.005). The application of anti‐MET therapy was associated with numerically prolonged survival, but the association was not statistically significant (p = 0.07). MET amplification was concentrated in patients with PLC, in which anti‐MET therapies elicited a high response rate.Fifty‐eight patients with MET‐amplified GC and 20 patients with GC accompanied by PLC were finally enrolled for analysis (including 13 overlapped patients). GC with PLC was more common in female patients (MET‐targeted therapies are efficacious in real‐world populations with MET‐amplified GC. Patients with PLC have distinct clinical and molecular features and might benefit from MET‐targeted therapies. Previous studies have indicated that breast, gastric, and lung cancers are the most common malignancies that give rise to PLC, while the pathogenic mechanisms of PLC are not understood.We sought to investigate the clinicopathological and prognostic features of MET‐amplified GC. Our study also revealed that MET amplification is a molecular event enriched in GC with PLC, which represents a distinct subtype showing responses to molecular targeted therapies.22.1In our two‐center retrospective study, eligible patients were diagnosed with recurrent or metastatic GC that was either MET‐amplified or manifested with PLC at any time point of the disease course from 2011 to 2021 in two medical centers. Tumor samples were generated from all patients by endoscopy, surgery, or needle biopsy at primary and/or secondary tumor sites. Tissues were fixed with formalin and paraffin‐embedded in blocks, which were prepared at the time of biopsy. Patients with available baseline characteristics and clinical data were included in the analysis. All patients were followed until October 2021.2.2MET gene copy numbers in all tumor samples were detected by next‐generation sequencing (NGS). NGS analysis was conducted by Genecast, Inc., a College of American Pathologists (CAP)‐accredited laboratory. A customized 769‐gene panel (Genecast) was employed to detect point mutations, indels, fusions, rearrangements, and CNVs. Targeted sequencing was performed on the NovaSeq 6000 platform (Illumina). The cutoff for MET amplification was 2.0 times . The PLC was determined by two independent radiologists based on chest computed tomography (CT) scans. Typical radiological findings include smooth or nodular thickening of interlobular septa, peribronchovascular interstitium, polygonal arcades with thickened limbs, and ground glass opacities. Clinical manifestations  also assisted in the diagnosis.2.3HER2, programmed death ligand 1 (PD‐L1), and mismatch repair (MMR) status were evaluated through IHC. HER2 expression was analyzed using the anti‐HER‐2 (4B5) rabbit monoclonal primary antibody . HER2 positivity was defined as IHC 3+ or both IHC 2+ and FISH positive. IHC of MLH1, MSH2, MSH6, and PMS2 was performed with a BenchMark ULTRA slide processing system  according to the manufacturer's instructions. Tumors were defined as deficient mismatch repair (dMMR) only if at least one of the proteins was absent of staining in the tumor cells; otherwise, proficient mismatch repair (pMMR) was deemed. PD‐L1 staining was performed using a 22C3 pharmDx kit . A combined positive score  of 1 or higher was considered PD‐L1 positive.2.4HER2 amplification was detected by fluorescence in situ hybridization (FISH) using a PathVysion HER‐2 DNA probe kit . Cases with a HER2:centromere 17 ratio >2.0 were considered FISH positive. The presence of EBV infection was determined by ISH using probes against Epstein–Barr virus‐encoded RNAs (EBER); (Leica Biosystems). Specimens with dark blue staining in tumor cell nuclei were deemed EBV‐positive.2.5p < 0.05.Statistical analyses were performed using SPSS software  and Prism . Categorical variables were evaluated using the chi‐square test or Fisher's exact test, as appropriate. Survival curves were plotted using the Kaplan–Meier method, and survival rates were compared between groups using the log‐rank test. Cox multivariate regression analyses were used to determine factors that affect survival outcomes. Overall survival (OS) was calculated from the time of diagnosis until death or the last observation for surviving patients. Progression‐free survival (PFS) was defined as the interval from the start of therapy to treatment discontinuation for disease progression or death of any cause. All tests were two‐sided, and differences were considered significant when 33.1n = 58, accounted for 6.2% of the total patients), the median age at diagnosis was 53 years , with a male preponderance. Twenty‐eight out of 58 (48.3%) patients had serous effusion. Liver, bone, and lung metastasis occurred in 21 (36.2%), 15 (25.9%), and 21 (36.2%) patients, respectively. GC with PLC was more common in females , diagnosed at a younger age , and presented with a higher baseline ECOG PS  than GC without PLC. Lung metastasis and serous effusion were more frequent in GC with PLC than in GC without PLC . GC with PLC accounted for a higher percentage of bone metastasis and poorly differentiated histology  than GC without PLC, though the differences were not significant. For molecular features, the average MET gene copy number was 7.4 . No difference was found in MET gene copy number according to PLC . One out of 13 GC with PLC and 6 out of 45 GC without PLC were HER2 positive. All patients with detectable pathological specimens had pMMR and EBV‐negative tumors. Thirty‐nine percent of patients (15/38) had PD‐L1‐positive GC, with CPS ranging from 1 to 98.A total of 937 patients diagnosed with stage IV GC were included for eligibility screening. Of these, 65 patients were eligible and had available clinicopathological information. Fifty‐eight patients with MET gene‐amplified GC and 20 patients with GC accompanied by PLC were finally enrolled for analysis (including 13 overlapped patients). A flow diagram is shown in Figure 3.2p = 0.038; p = 0.029; p = 0.016, respectively).  received ≥3 lines of therapies. Twenty‐eight patients received anti‐MET TKIs, of which 13 (46.3%) achieved PR, 4 (14.3%) achieved SD, and 3 (10.7%) achieved non‐CR non‐PD for the best response. The median duration of response was 3.0 months . Most of the patients received anti‐MET therapies as first‐ or second‐line treatment (20/28). In our cohort, patients with PLC received more lines of therapies, with 68.8% (11/16) undergoing ≥3 lines of therapies. In addition, patients with MET‐amplified GC and PLC underwent more intensive treatments, including a higher frequency of anti‐MET therapies, antiangiogenic therapies, and immunotherapies (3.3p = 0.005); ;  were added into the multivariate model. Only secondary MET amplification was a predictive factor of a prolonged OS with statistical significance .In Cox regression analysis, age, gender, and prognostic factors with 3.4A total of 20 patients were diagnosed with PLC and included for analysis. The median age at diagnosis was 42.5 years (range 23–77 years). Eleven out of 20 patients were female. Ten patients had an ECOG PS of 0–1, and the other 10 patients had an ECOG PS of 2–3. Seventeen patients had tumors with assessable MET gene status, of which 13 (76.5%) were confirmed MET‐amplified and otherwise nonamplified. The genomic variation information of 17 patients with PLC is shown in Figure Eleven patients received ≥3 lines of treatment for PLC. Ten patients received anti‐MET therapies. Regarding drug types, 10 patients received anti‐MET therapy with crizotinib, one of whom also received volitinib. Owing to the absence of measurable lesions in a few cases, therapeutic responses were determined from two perspectives . Fourteen patients rapidly alleviated their symptoms  or obtained radiographical remission after systemic therapies. Figure 3.5Temporal and spatial heterogeneity were found in several patients who progressed on anti‐MET therapies Figure . MET cop4MET‐amplified GC is a rare tumor subtype that has shown sensitivity to anti‐MET TKIs in small‐scale studies. However, the reported response rates are diverse. In a phase 2 single‐arm trial, second‐line AMG‐337  resulted in an overall response rate (ORR) of 18% in patients with pretreated MET‐amplified GC, with a median PFS of 3.4 months.We report for the first time the clinicopathological and molecular features of MET‐amplified GC. The absence of an internationally recognized set of standards has led to the investigation of various cutoff values to define MET amplification. We took a cutoff of 2.0  in our study. Our previous research used this cutoff, which mirrored the HER2 amplification cutoff.Importantly, in this study, we identified that PLC is a unique manifestation of GC. According to past literature, PLC denotes an end‐stage condition of malignancy characterized by the infiltration of lymphatic vessels by tumor cells. GC with PLC is a rare condition, with only a few cases reported, and the disease characteristics or management have not been extensively investigated.It is noteworthy that GC with PLC accounts for a considerable proportion of MET‐amplified GC. In our cohort, 16/58 (27.6%) patients developed PLC at any point during the disease course. Among 17 patients with GC and PLC who had assessable MET status, 13 (76.5%) were confirmed to be MET‐amplified, indicating that PLC is enriched in MET‐amplified tumors. It is reasonable to infer that aberrant MET signaling potentially gives rise to PLC, which confers profound clinical implications. In this regard, a patient with PLC should be suspected of having a MET‐amplified tumor and be referred for genetic testing. Conversely, clinicians should be alert to PLC during the subsequent course of MET‐amplified GC for earlier interventions Figure . Given tIn our study, we also revealed that systemic therapies often lead to focal control of lung lesions. For patients with MET‐amplified GC, anti‐MET TKIs are remarkably efficient, indicated by target lesion shrinkage and/or rapid symptom relief. A vast number of patients with PLC do not have antitumour opportunities due to a poor physical state . Nevertheless, once PLC is controlled, patients might regain the opportunity for systemic therapies to diminish tumor burden, therefore improving long‐term survival. In that case, timely molecular diagnosis is crucial. Considering the poor physical condition of patients with PLC, reexamination of tumor tissue is impractical. Liquid biopsy  might be an ideal alternative due to its low invasiveness.We also shed light on the heterogeneity of MET status in GC. MET aberrations could coexist with other driver molecular changes simultaneously, such as FGFR or HER2 amplification. Previous literature has demonstrated inconsistencies in molecular characteristics between primary and metastatic lesions.Our study has several limitations. First, the small‐scale and retrospective nature of this study could be an inherent defect. We acknowledge that it is difficult to interpret the survival data due to the limited number of enrolled patients and the variations in treatments. Further validation is warranted to consolidate the relationship between PLC and MET amplification, although the overall rarity and aggressive nature of GC with PLC make prospective studies challenging. Second, each detection method of MET amplification has its flaws. NGS is less sensitive than FISH, which might affect the detection rate of MET amplification. Third, in our cohort, PLC was diagnosed via CT and clinical manifestations, which might lead to underdiagnosis of very mild cases .5Our study indicates that MET amplification could be enriched in gastric cancer accompanied by pulmonary lymphangitis carcinomatosis, and the latter shows a high response rate to anti‐MET target therapies.Zhening Zhang: Conceptualization ; formal analysis ; investigation ; writing – original draft . Yiyi Yu: Conceptualization ; data curation . Tong Xie: Resources . Changsong Qi: Resources . Xiaotian Zhang: Resources . Lin Shen: Funding acquisition ; writing – review and editing . Zhi Peng: Conceptualization ; funding acquisition ; writing – review and editing .This work was supported by National Natural Science Foundation of China (81602057); Beijing Natural Science Foundation (Z210015); Clinical Medicine Plus X‐Young Scholars Project of Peking University  and the Fundamental Research Funds for the Central Universities.The authors declare that they have no competing interests.The present study was approved by the ethics committee of Peking University Cancer Hospital  and Fudan University Zhongshan Hospital , and conducted in accordance with the Declaration of Helsinki. Written informed consent for the participation of this retrospective study was exempted by the ethics committee of Peking University Cancer Hospital and Fudan University Zhongshan Hospital.Figure S1.Click here for additional data file.Figure S2.Click here for additional data file.Figure S3.Click here for additional data file.Figure S4.Click here for additional data file.Figure S5.Click here for additional data file.Table S1.Click here for additional data file.


Antibiotic misuse can lead to poor patient outcomes, including ineffective treatment of infections, increased adverse effects, and development of antibiotic resistance. Implementing an antimicrobial stewardship program (ASP) is a vital strategy to improve and measure the appropriate use of antibiotics. This study aimed to assess the impact of pediatric ASP implementation on the reduction of restricted antibiotic usage and the improvement of patient outcomes.A single-center retrospective-prospective study was conducted at a children’s hospital and included patients admitted to general pediatric or pediatric intensive care units receiving one or more restricted antibiotics. Prior-authorization of these restricted antibiotics was implemented as the ASP strategy. A three-month pre- and post-implementation chart review was completed. The primary outcome was optimizing restricted antibiotic usage. Secondary outcomes included provider compliance, antibiotic days of therapy (DOT), hospital length of stay (LOS), and readmissions within 30 days.Table 1Restricted antibiotics50 patients were included in the study. Restricted antibiotic orders for 18 out of 24 patients in the post-implementation group (75%) were compliant with obtaining pre-approval. Vancomycin, cefepime, and metronidazole were the most common agents ordered. The most common indications were skin and soft tissue infections, musculoskeletal infections, and preemptive sepsis coverage. Patients receiving restricted antibiotics decreased by two (-7.7%) while total restricted antibiotic orders increased by five (16.7%) following ASP implementation. Mean antibiotic DOT increased by 2.02 days (42.7%) and mean hospital LOS increased by 1.8 days (31.0%) in the post-implementation group. There was no difference in 30-day readmissions.Figure 1Restricted antibiotics ordered post-implementation of a pediatric antimicrobial stewardship program.Figure 2Use of restricted antibiotics pre- and post-implementation of a pediatric antimicrobial stewardship programThe results of this study not only aided in establishing baseline data but also provided a starting point for future efforts concerning the appropriate use of restricted antibiotics. While the findings were inconsistent with those of other institutions, incomplete program compliance and patient complexity in the post-implementation group likely contributed to the increase in DOT and hospital LOS. A longer study duration is needed to assess the true impact of this program.All Authors: No reported disclosures


High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the primary concern. Antimicrobial stewardship (AMS) programs should mainly focus on optimizing antibiotic use, decreasing adverse effects, and improving patient outcomes. There is a limited number of published studies assessing the impact of AMS programs on patients with neutropenia, where early appropriate antibiotic choice can be the difference between life and death. This narrative review updates the current advances in strategies of AMS for bacterial infections among high-risk patients with neutropenia. Diagnosis, drug, dose, duration, and de-escalation (5D) are the core variables among AMS strategies. Altered volumes of distribution can make standard dose regimens inadequate, and developing skills towards a personalized approach represents a major advance in therapy. Intensivists should partner antibiotic stewardship programs to improve patient care. Assembling multidisciplinary teams with trained and dedicated professionals for AMS is a priority. According to the World Health Organization , the overuse and misuse of antibiotics is reflected in the emergence of resistance, posing a threat to global health security. Infections with multidrug-resistant (MDR) microorganisms lead to increased mortality, need for medical assistance, and treatment-related cost.Infections are the most common cause of death in patients with malignancy . UnfortuSince its first use in 1996 by John E. McGowan Jr. and Dale N. Gerding , the terInfections in patients with neutropenia are increasingly challenging, considering recent changes in the resistance patterns of microorganisms. Prolonged neutropenia subsequently leads to the prescription of extended and repeated courses of broad-spectrum antibiotics, contributing to selective pressure on susceptible bacteria and the increase of MDR organisms.Patients with severe immunosuppression have damaged intestinal mucosal surfaces, which facilitates bacterial translocation across intestinal mucosa, resulting in potentially life-threatening infections ,13.Patients with malignancy are susceptible to develop infection, particularly when colonized with MDR pathogens . IsolateS. aureus (VISA) and vancomycin resistant Enterococcus spp. may increase rates of treatment failure [p = 0.016) [Streptococcus pneumoniae have also been associated with higher mortality [Catheter-related, lung, and skin and soft tissue infections are among the most reported ,16,17. G failure ,21. Catt failure . Moreove= 0.016) —a pathogortality .Pseudomonas aeruginosa are increasing; carbapenem-resistant Acinetobacter baumanii and carbapenemase-producing Enterobacterales (CRE) are spreading globally, with some centers reporting carbapenem-resistance rates of 10% in Enterobacterales, and up to 79% in nonfermenters [Of particular concern is the increasing number of invasive Gram-negative bacilli infections, which are associated with higher mortality rates . Importarmenters ,19.AMS programs have several objectives, such as cost reduction, therapeutic optimization, and particularly, promoting actions that ultimately contribute to decreased antibiotic resistance rates .In 2007, the Infectious Diseases Society of America (IDSA) defined AMS as ‘coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug regimen including dosing, duration of therapy and route of administration’ . In 2017The literature on AMS in patients with malignancy is scarce by limited representation or exclusion of these patients in most studies, even though these patients are more vulnerable to MDR infections, and are more often exposed to broad-spectrum antibiotics. Antibiotic optimization is crucial to reduce morbidity and mortality rates in these patients. AMS general interventions such as formulary review, antibiotic restriction, and audit and feedback are effective in patients with malignancy ,28,29,30A survey applied on solid-organ transplant centers in Switzerland exemplifies the lack of AMS implementation in immunosuppressed patients, with only a 29% response . On the Most hospitals do not have dedicated staff working in antimicrobial stewardship ,33, reprThe emergence of resistance in pathogenic bacteria is a serious public health problem; still, prescribers misuse and over-use antibiotics ,34,35,36This narrative review suggests a five-point approach for optimizing antibiotic therapy in high-risk patients with neutropenia .The risk of development and the severity of infections are determined by a complex interplay between the pathogen and its virulence, the degree of impaired immunity, and of the host and the related cancer treatment.Early diagnosis, at a stage when signs and symptoms may be absent and the site of infection may not be evident, is challenging. In patients with neutropenia undergoing chemotherapy, fever may be the only symptom that indicates bloodstream infection, which can result in severe sepsis, septic shock, and death ,37.3) neutropenia and/or comorbidities, should receive IV broad-spectrum empirical antibiotic treatment [Klebsiella spp., and MDR Pseudomonas aeruginosa represented 24.1%, 0.7%, and 24.8%, respectively; Gram-positive bacteria accounted for 10.1% of isolates [Antibiotic decision is based on risk assessment, and high-risk patients, with prolonged (>7 days duration), profound  [Importantly, some studies reported a considerable concordance between BSI isolates and colonization, as high as 80% ,44. Mico < 0.01) .Screening for MDR organisms, particularly CRE and MRSA, as part of institutional policy provides early identification of carriers, and may help guide empirical antibiotic therapy decisions during febrile neutropenia episodes. The appropriate methodology and frequency of screening should be guided by local epidemiology, laboratory turnaround time, testing availability, and cost-effectiveness ,47.When clinical diagnosis is difficult and complex, there is an increased risk of antimicrobial overuse. In this sense, the microbiology laboratory has a major role on AMS providing aetiological diagnosis. Morency-Potvin et al. highlighted the role of microbiology laboratories based on AMS strategies . A closeConventional microbiology tests are the gold standard on diagnosis, yet may require up to 24 h for pathogen identification, and further 24–48 h for antibiotic susceptibility profiles. Timely identification and susceptibility results are the cornerstone for antibiotic optimization. Prescribers rely on susceptibility results; selective antimicrobial susceptibility reports should be used to promote the use of narrower-spectrum antibiotics ,48.Biomarkers may help identify bacterial infections, limiting unnecessary antibiotic use. C-reactive protein and procalcitonin have been investigated as potential biomarkers for sepsis, considering that levels are increased in bacterial sepsis, but these should not be used alone to decide the diagnosis of bacterial infection ,50,51. OCurrently, the focus is on the use of rapid tests; results are obtained in a few hours with microorganism identification and susceptibility tests. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry, usually used to identify pathogens , can be Other automated systems using a modified fluorescent in situ hybridization (FISH) assay for identification and microscopy for analysing bacterial growth rates and minimum inhibitory concentration (MIC) values extrapolated from positive blood cultures can provide results in <7 h .Rapid phenotypic antimicrobial susceptibility testing (AST) is a recent EUCAST  method with an impact on AMS. Rapid AST improves antibiotic optimization in patients with Gram-negative sepsis without mortality differences . Kim et The constant change in the incidence of multidrug-resistance Gram-negative bacteria in patients with neutropenia requires rapid diagnostic tests for resistance identification; extended-spectrum B-lactamases and carbapenemases rapid identification, based on biochemical or fluorescence identification, have high sensitivities and specificities, are easy to perform, and provide results in 10–40 min ,60; presNovel molecular assays for rapid diagnosis directly from blood samples may provide faster results for timely and pathogen-directed antibiotic initiation. Multiplex real-time PCR assays show high specificity, while sensitivity may vary (20–90%) ,62. HoweNext generation sequencing (NGS) approaches allow for nearly universal identification without a priori knowledge of pathogens, and have demonstrated improved pathogen detection in septic patients, surpassing blood cultures . FurtherThe major drawback is susceptibility testing. Molecular detection of resistance is possible for Gram-positive bacteria from positive blood cultures, such as mecA and vanA/vanB gene identification for methicillin-resistance in staphylococcal and vancomycin-resistance in enterococcal infections, respectively ,67. IdenPathogen-directed antibiotic therapy may be achieved, anticipating de-escalation. Still, currently these tests only complement conventional culture-based methods.Choosing the right antibiotic for the right patient requires multidisciplinary collaboration, and is based on multiple factors between the patient, the pathogen, and the drug.The impact of inappropriate antibiotic therapy in critically ill patients is well established: higher mortality, increased duration of hospital stays, and risk of drug resistance ,71,72,73In patients with neutropenia, the choice of the appropriate antibiotic  is of major importance, considering that these patients may not have typical warning signs and symptoms of infection; thus, empirical therapy is mostly based on broad-spectrum antibiotics.The ultimate choice is based on local factors  and patient factors . Facility-specific clinical practice guidelines based on local microbiological data establish clear recommendations for optimal antibiotic use at the hospital.Monotherapy has an equivalent efficacy compared with combination therapy ,81,82. IPseudomonas aeruginosa, broad-spectrum antibiotics are justified for most patients, particularly high-risk patients with neutropenia [Due to the emergence of multidrug-resistant Gram-negative bacilli, ESBL-E, CRE, or MDR tropenia ,86,87,88Empirical therapy  on febriPreventing drug adverse effects is a priority in patient safety. Therapeutic reconciliation is an effective strategy in preventing adverse drug reactions . MedicatThe absence of medication reconciliation is responsible for 46% of medication-related errors, and more than 20% of the adverse effects that occur in hospitals . PolyphaAdequate dosing and administration based on pharmacokinetics/pharmacodynamics (PK/PD) should be a priority. PK/PD describes the relationship between drug dose and pharmacological effects, with changes in drug concentrations leading to different pharmacological effects.Increased volume of distribution requires a loading dose on hydrophilic antibiotics to achieve therapeutic concentrations in the target site ,96,97. AStandard dosage regimens are based on healthy volunteers and do not take into account patient/pathogen characteristics. Underdosing of antibiotics is frequent in patients with sepsis, and is associated with treatment failures and worse outcomes ,97. PatiThe optimal dose  includesPrompt antibiotic administration and administration of a loading dose when indicated are associated with better patient outcomes in patients with septic shock, particularly within the first hour ,96,97,98A recent review  suggestsTherapeutic drug monitoring (TDM) is necessary to achieve the efficacy dose and to avoid overdosing, and consequently, adverse effects. TDM of glycopeptides and aminoglycosides has already been used for a long time; Bayesian statistics utilize measured concentration and clinical covariates, and they are the most accurate estimation of individualized patient dosing ,103,104.Vancomycin is the standard of care for Gram-positive infections due to MRSA. Inappropriate dosing is associated with high failure rates, higher MICs, and toxicity. Adequate vancomycin dosing focused on AUC/MIC improves clinical response in infections due to MRSA ,106. MosAminoglycosides dose adjustment based on TDM did not correlate with better outcomes, but contributed to limiting toxicity; yet, optimal dosing and earlier clinical response was achieved .Beta-lactams are by far the most common used antibiotics and are the cornerstone of therapy of the majority of infections. Patients with neutropenia are a special population where beta-lactam TDM could lead to better outcomes, though their use is still controversial and further studies are needed to demonstrate their benefit . Their eOveruse of antibiotics includes unnecessarily long duration of antibiotics. Long exposure to antibiotics leads to higher side effects, renal or hepatic toxicities, and bacterial resistance due to selective antimicrobial pressure. The traditional 7 to 14-days antibiotic course for most bacterial infections is outdated, and several randomized controlled trials comparing short course vs. traditional course provide evidence of equal efficacy, and fewer adverse effects and diminished emergence of resistance with short courses ,110,111.Discontinuation of empirical antibiotics after 72 h in hemodynamically stable patients with neutropenia in the absence of fever for the past 48 h is recommended by European Conference on infections in Leukemia (ECIL-4) guidelines , but is Discontinuation of antibiotics in patients with persistent neutropenia who fill these criteria seems to be safe, and several studies demonstrated no substantial rates of infection recurrence ,113,114.p = 0.25)) and per-protocol analysis ). However, serious adverse events (16% vs. 10%) and all-cause mortality (3% vs. 1%) were higher in the short treatment group, driven by patients who are persistently febrile [A recent open-label, multicenter, randomized trial of 281 patients with febrile neutropenia who received intensive chemotherapy or hematopoietic stem-cell transplantation between 2014 and 2019 compared short (72 h) vs. extended  carbapenem treatment. Early discontinuation was noninferior (10% margin) to extended treatment regarding treatment failure, both in intention-to-treat analysis (19% vs. 15%, adjusted risk difference 4.0% (90% CI: 1.7–9.5%,  febrile ; this suDe-escalation means implementing a strategy to reduce the spectrum of the initial empirical antibiotic therapy, either by isolating one valuable causal agent, or by excluding others. De-escalation is only manageable for routine bacteriology diagnosis, and contributes to reducing antibiotic exposure to broad-spectrum antibiotics and, so, may have a relevant impact on the emergence of resistance. European ICU practitioners regarded antibiotic de-escalation and discontinuation as the most important intervention, with the potential to prevent MDR development .Martire et al.  implemenDe-escalation appears to be safe and does not have a detriment impact on outcomes ,119. ThiAMS is essential to ensure effective and safe access to antibiotics, regardless of the clinical situation. The scarcity of studies regarding AMS programs on patients with neutropenia limits this narrative review. Antimicrobial stewardship is expanding; there are still many constraints to overcome, such as the resistance of clinicians to limit antibiotic use, and the scarcity of the literature on improving outcomes. These gaps and additional evidence focusing on outcomes represent a research opportunity. There may be a conflict between the recommendations for the empirical prescription of antibiotics and AMS programs. These approach strategies highlight the importance of patient stratification to decide broad-spectrum antibiotics, the need for nonculture diagnostics tests for early diagnosis, the critical first empirical antibiotic dose, and the safety on de-escalation/discontinuation.In patients with neutropenia, right first time is crucial. Screening and molecular diagnostic tests have an important role in early diagnosis or antibiotic discontinuation. Fear of attending clinicians of suboptimal coverage in high-risk neutropenic patients is a major issue. Empowering health professionals with educational activities and a multidisciplinary team with trained and dedicated professionals for antimicrobial stewardship is a priority.


Waste elastomer (fractions 0–2 and 2–8 mm) was used as a substitute for sand or fine aggregate in the amount of 2.5, 5.0, 7.5, and 10.0% by weight of cement. For all series, the physical and mechanical properties of concrete , as well as its microstructure, were tested. It has been shown that post-consumer elastomer waste from used car floor mats in the amount of 2.5% of cement weight can replace sand and gravel aggregate in concrete without reducing their mechanical strength and without changing their microstructure. The compressive strength (after 28 days) of concretes in which the waste was introduced as a substitute for sand and aggregate was 57.0 and 57.2 MPa, respectively (the strength of the control sample was 57.0 MPa). The use of post-consumer waste in concrete allows for a reduction in the consumption of natural aggregate (the addition of 2.5% of waste material saves natural aggregate approximately 20 kg/m Currently, there are a large number of polymeric waste materials on the market that have no practical use. This group includes used car floor mats marked with waste code: 16 01 19  . On the Bearing in mind how important the problem for the environment is the management of used car floor coverings, in this work we attempted to determine the possibility of using this type of waste to produce concrete. The basis for this assumption were numerous review papers ,5,6,7,8 Moreover, post-production waste and post-consumer polystyrene waste were used for the production of concrete on a laboratory scale. This material was used both in the form of ball-shaped regranulate ,21,22,23There are also several literature reports on the use of rubber in the production of concrete ,44,45,46Although polymeric materials, such as PET, PS, PP, and rubber, were most often used in testing the mechanical properties of concrete, the literature contains several papers on the use of other polymers for this purpose, including PVC ,51,52,53In conclusion, it should be stated that, in recent years, there has been a clear increase in the interest of scientists in the use of polymer waste for the production of concrete. This trend is in line with the growing demand for sustainable construction. This is evidenced by review papers ,5,7 in wThe properties of concrete were modified by the use of post-consumer waste (used car floor mats). Used automobile floor mats were obtained from the Maderpol automobile dismantling plant in Silesian Province, located in Mokra (Poland). After preshredding, the post-consumer waste  was crusc/w ratio of 2.22 and a consistency class of S2 were assumed. Portland cement CEM I 42.5R, a gravel–sand aggregate mixture with a grain size of 0–16 mm and a sand point of PP = 33.1%, tap water, and plasticizing admixture CHRYSO Plast 331 at 0.35% by weight of cement and aerating admixture CHRYSO Air LB at 0.2% by weight of cement were used for the control concrete. The control concrete (SK) was modified with post-consumer waste thermoplastic elastomer formed from used car floor mats. The material was added in the amount of 2.5, 5.0, 7.5, and 10% by weight of cement, introducing a volumetric adjustment in the weight of sand (series S1–S4) or the weight of gravel aggregate mixture of 2–8 mm (series S5–S8). The concrete series were designated from S1 to S8. The solid components of the concretes were cement (372.5 kg/m3), water , and air-entraining admixture (0.745 dm3/m3), and the content of the variable components is presented in Nine series of concretes were made. An experimental method was used to design the composition of the control concrete (SK) mix. A All tests of both concrete mixes (consistency) and hardened concrete  were carried out per PN-EN standards, described in detail in our previous work . The SEM3/min. The curves were analyzed to identify the composition and degradation temperatures of the components in the waste material. The TG curve showed a one-step degradation of the waste elastomer. Two peaks were observed in the DSC curves, a broad peak was seen around 90 °C to 360 °C with a maximum of 232.4 °C and a narrower peak with a maximum of 501.4 °C. The curve clearly shows the initial phase of volatilization of oils, plasticizers, and fillers with a low molecular weight and low boiling point (below 230 °C), as well as a greater weight loss in the temperature range of 230–500 °C, caused by the decomposition of the polymeric material . Similar thermogravimetric curves were obtained for commercial rubber products [Crushed post-consumer waste of used car mats was used to test the properties of the concretes. Using a WDXRF X-ray spectrometer , the elemental composition of the thermoplastic elastomer waste used in the study was determined, which is shown in products ,57.In the first stage of the research, samples of control concrete (SK) were made, assuming a consistency of S2 (cone slump between 50 and 90 mm) and samples of concretes modified with the post-consumer waste of thermoplastic elastomers. After the concrete mixture was prepared, samples were taken to determine the consistency class and air content of the concrete mixture. For the control mix (SK), the cone slump was 70 mm, which classifies it as S2. The air content of this mix was 3.5%. For concrete mixtures modified with the addition of thermoplastic elastomer waste (S1–S8), a cone slump of 50–75 mm was obtained, which also classifies them in the S2 consistency class . The airThe next stage of the study included the determination of the mechanical strength of concretes modified with waste thermoplastic elastomers. For each series of concrete, 18 cubic specimens of 150 mm sides were made and tested for the compressive strength of the concrete after 7, 28, and 56 days of maturation under laboratory conditions. The standard deviation and 95% confidence interval were determined for the results obtained in each series. The results of compressive strength tests for control and modified concretes are presented in Comparing the strength values obtained for concretes (series S5–S8), in which post-consumer waste of thermoplastic elastomers was used as a substitute for aggregate with a grain size of 2–8 mm, we can conclude that they were comparable to the results obtained previously in , using pThe decrease in the compressive strength of the concrete observed with the increase in the amount of added waste can be explained by the very low bonding force between the surface of waste from thermoplastic elastomers and the cement slurry. Moreover, the hydrophobic nature of polymer waste can inhibit the hydration reaction of cement by limiting the movement (access) of water in the concrete mix. A negative effect on the concrete’s compressive strength parameter was also observed after adding other polymeric materials, such as PET ,14,15,16The addition of waste thermoplastic elastomer to concrete also affects the flexural strength and tensile strength of the concrete . The aveIn the concretes of the S1 and S2 concrete series, where post-consumer waste was dosed as a substitute for sand, there was an increase in the average splitting tensile strength. The increase in the average splitting compressive strength was 9.7 and 0.5%. The other series (S3 and S4) showed a decrease in the tested parameter compared to the SK series, by 14.0 and 19.0%, respectively. For the concretes of the S5 and S6 series, where waste was used as a substitute for the 28 mm grain size aggregate in the amount of 2.5 and 5.0%, the average splitting tensile strength was 4.19 ± 0.6 MPa and 3.88 ± 0.1 MPa, respectively. This means that the increase in the splitting strength parameter compared to the control concrete series, for which the strength was 3.78 ± 0.9 MPa, was 10.9 and 2.6%, respectively. For the other series (S7 and S8), there was a decrease in the tested parameter in relation to the SK series, by 4.5% and 5.3%, respectively. As in the case of the compressive strength, both a decrease and an increase in the tensile strength of concrete were observed in the case of the modification with waste polymers ,59,60. IThe next stage of testing was to determine the absorbability, density, pressurized water penetration, frost resistance, and abrasion resistance of the concrete . The abs3, was classified as ordinary concrete following PN-EN 206 + A1:2016-12. In addition, all concrete modified with thermoplastic elastomer post-production waste were classified as ordinary concrete, as their density was in the range of 2000–2600 kg/m3. The control concrete achieved an average water penetration depth of 65 mm. For the series of concretes modified with waste thermoplastic elastomers, the average depth of the water penetration ranged from 55 mm to 70 mm. The lowest value of the tested parameter (55 mm) was obtained for the S1 series, where 2.5% of post-consumer waste was used, and the highest value (70 mm) was obtained for the S4 series concretes containing 10% of this waste. For the control concrete (SK), the abrasiveness was 7.4 cm3/50 cm2. For concretes modified with thermoplastic elastomer waste, the abrasion resistance was obtained, ranging from 6.5 to 7.5 cm3/50 cm2.The control concrete (SK), due to the fact of its density, which amounted to 2271 kg/mA frost resistance test was conducted for all concretes. For each batch of concrete, 12 cubic specimens of 100 mm sides were made, 6 specimens were subjected to the frost resistance test, and 6 specimens were left in the water as comparison specimens. For the control concrete, the average decrease in the compressive strength after 150 freeze–thaw cycles was 4.4%, while the average weight loss was 0.34% .The average decrease in the compressive strength for the series of S1–S3 concretes modified with post-consumer waste thermoplastic elastomers used, as a substitute for sand, was lower than the average decrease in the compressive strength of the control concrete. The decrease in the compressive strength for these concretes was 1.1, 1.3, and 2.1%, respectively. In contrast, the average weight loss for these modified series ranged from 0.10% to 0.30% and was lower than the average weight loss for the control concrete (0.34%). For all series of concretes (S5–S8) modified with post-consumer waste car floor mats, used as a substitute for gravel aggregate with a grain size of 2–8 mm, a lower decrease in the compressive strength after frost resistance testing was obtained than for the control concrete. In addition, as shown previously , using 2In the next stage of the study, the surface layer of the synthesized composites was analyzed, determining mainly their microstructure and elemental composition. 3, or approximately 5.0%. The microstructure of concretes made based on CEM I 42.5R cement containing the addition of post-consumer waste thermoplastic elastomers in the amount of 2.5% to 10% is characterized by a very similar microstructure to the control concrete made without the addition of waste polymers.The study conducted in this paper on the properties and structure of concrete composites containing post-consumer waste thermoplastic elastomer from used car floor mats and the analysis of the results obtained allows us to conclude that the waste used in the amount of 2.5% can be added as a substitute for sand or as a substitute for gravel aggregate of 2–8 mm grain size for the manufacture of concrete and concrete composites. The addition of waste in this amount does not reduce the parameters of concrete  with respect to the materials produced without the addition of waste thermoplastic elastomer. The use of waste 0–2 mm fraction in the amount of 2.5% by weight of cement as a substitute for sand allows for reducing the consumption of these aggregates by 20 kg/m3, allowing for the concretes to be classified as ordinary concretes. Both the control concrete and the concretes modified with post-consumer waste thermoplastic elastomer obtained a water absorption rate of approximately 5.0%. Concrete modified with thermoplastic waste obtained from used car mats can be used for elements protected against direct exposure to weather conditions . All concrete modified with post-consumer waste of thermoplastic elastomer met the standard requirements. After performing 150 freeze–thaw cycles, the average decrease in the compressive strength did not exceed 20%, and the average weight loss did not exceed 5%. Thus, it can therefore be concluded that the addition (in the amount of 2.5%) to thermoplastic concrete of an elastomer derived from post-consumer waste, which is currently deposited in landfills, as a substitute for gravel aggregate of 2–8 mm is economically justified and also positively affects the protection of natural resources.All the waste-modified concretes achieved a lower density than the control concrete, which ranged from 2000 to 2600 kg/m