Concrete as a building material is susceptible to degradation by environmental threats such as thermal diffusion, acid and sulphate infiltration, and chloride penetration. Hence, the inclusion of nanomaterials in concrete has a positive effect in terms of promoting its mechanical strength and durability performance, as well as resulting in energy savings due to reduced cement consumption in concrete production. This review article discussed the novel advances in research regarding C-S-H gel promotion and concrete durability improvement using nanomaterials. Basically, this review deals with topics relevant to the influence of nanomaterials on concrete’s resistance to heat, acid, sulphate, chlorides, and wear deterioration, as well as the impact on concrete microstructure and chemical bonding. The significance of this review is a critical discussion on the cementation mechanism of nanoparticles in enhancing durability properties owing to their nanofiller effect, pozzolanic reactivity, and nucleation effect. The utilization of nanoparticles enhanced the hydrolysis of cement, leading to a rise in the production of C-S-H gel. Consequently, this improvement in concrete microstructure led to a reduction in the number of capillary pores and pore connectivity, thereby improving the concrete’s water resistance. Microstructural and chemical evidence obtained using SEM and XRD indicated that nanomaterials facilitated the formation of cement gel either by reacting pozzolanically with portlandite to generate more C-S-H gel or by functioning as nucleation sites. Due to an increased rate of C-S-H gel formation, concrete enhanced with nanoparticles exhibited greater durability against heat damage, external attack by acids and sulphates, chloride diffusion, and surface abrasion. The durability improvement following nanomaterial incorporation into concrete can be summarised as enhanced residual mechanical strength, reduced concrete mass loss, reduced diffusion coefficients for thermal and chloride, improved performance against sulphates and acid attack, and increased surface resistance to abrasion. Improving concrete durability was and is still a subject of interest for scientists and engineers ,2. Many 3, carbon nanotube, etc., improve concrete microstructure with filling and seeding effects [Incorporating ultra-fine materials  such as nanoparticles is among the most influential methods to increase the mechanical strength of concrete and perfect its microstructure ,12,13,14 effects ,12,13,14 effects , reactiv effects , heavywe effects , marine  effects , shotcre effects , green c effects , recycle effects , lightwe effects , high-vo effects , carbon  effects , and foa effects .2O3, nanoAl2O3, and nanoTiO2, on the properties of concrete was discussed in several published works [The impact of numerous nanomaterials, such as nanosilica, nanoZnO, nanoFeed works ,12,13,14ed works , nanopared works , and naned works . The inced works . This ised works ,12,13,14This review article demonstrates the mechanism of action underlying how nanoparticles improve the durability properties of concrete by improving the hydration of binding gel and other hydration products. The improvement in concrete durability following nanomaterial incorporation can be summarised as enhanced residual mechanical strength, reduced concrete mass loss, reduced diffusion coefficients for thermal and chloride, improved performance against sulphates and acid attack, and increased surface resistance to abrasion. The technological progress in nanoconcrete is in line with the ninth United Nations Sustainable Development Goal, which is ‘Industry, Innovation, and Infrastructure’. This review was performed by referring to the most up-to-date studies and highlighting their results to draw a robust conclusion. It provides useful ideas for future published research works related to the role of nanomaterials in improving concrete durability. Despite the literature having considerable review articles related to the effects of nanoparticles on the durability of cement-based composites, there is a lack of published reviews explaining the efficiency of nanomaterials in promoting C-S-H gel formation, which has a considerable impact on concrete’s resistance to heat, acid, sulphate, chloride, and surface abrasion.3S) found in cement. This is achieved as the C-S-H gel expands into the capillary pores, binding the solid products and sealing any microcracks that may impact the structural integrity of the concrete [Several studies have shown that the addition of nanoparticles can greatly enhance the strength and durability of concrete by improving the hydration of tricalcium silicate  gels following its reaction with various cement components such as Cconcrete  revealedporation . Nanotitporation . The assporation .2 particles [Nanometakaolin can generate additional quantities of C-S-H gel due to nanoparticles’ role in catalysing the cement–water reaction. It was reported that nanometakaolin has the ability to increase the chemical bonding and cohesion forces in the C-S-H structure. Like nanosilica, nanometakaolin is a pozzolanic material that creates more C-S-H gel through a secondary reaction with CH crystals . The incarticles  can alsoarticles  discoverarticles  can alsoarticles  used Si 3 [The addition of nanofillers such as nanosilica has two major effects on the hydration of C-S-H gel. Firstly, they provide nucleation sites and undergo a pozzolanic reaction with CH hydrates. Secondly, their high water absorption capacity reduces the amount of proton water in the C-S-H gel, shortening the distance between the Ca, O, and Si atoms. Additionally, the nanofillers also break the Si-O-Si spatial structure of silicate tetrahedrons in the C-S-H gel and cause hydroxylation of the tetrahedron. These newly produced Si-OH monomers interact with one another and condense to create a higher polymerization silicate tetrahedron. Furthermore, one study found that incorporating fillers into a C-S-H gel reduced the amount of proton water in the gel, which, in turn, increased the strength of the chemical bond  between the gel’s Ca, O, and Si atom structural groups. However, the nanofillers’ excessive absorption of gel water could inhibit further hydration, and this could be indicated as an unfavourable phenomenon. Several comparison studies  confirme3  had no eNumerous microstructure observation techniques  were used to investigate the kinetics of nanomaterials in cementitious materials and their mechanism in densifying and compacting the concrete microstructure ,47. The 3S, and C2S. However, there was an increasing trend in CH crystals as the inclusion of nanomaterials increased due to poor distribution. The EDX analysis revealed that the Ca/Si molar ratio increased with the incorporation of nanomaterials, indicating the positive impact of these materials on the microstructure of cementitious materials. The usage of DSC and TGA [At a temperature of 200 °C, it was observed that nanoconcrete contained smaller CH crystals. The presence of such crystals indicated the pozzolanic reactivity of nanomaterials, while their smaller size and orientation were consistent with past research findings. Incorporating nanoparticles into concrete led to an upsurge in the volume of C-S-H gel, ascribed to their nucleation effect that expedited cement hydration. The high surface area of nanoparticles acted as nuclei for cement hydrates, hence enabling this effect. Additionally, the reaction between nanoparticles and CH crystals brought about significant enhancement in the interfacial transition zone (ITZ) between the hardened cement paste and aggregates. The substitution of CH crystals with C-S-H gel resulted in superior performance. When testing the concrete using XRD, good pozzolanic reactivity was demonstrated through the lower intensity peaks in CH, C and TGA  in therm and TGA  are illuNormal concrete as a building material has appreciable heat resistance with a very low value of thermal conductivity . HoweverSeveral studies confirmed the ability of nanomaterials to improve concrete thermal conductivity. Reddy et al.  observedAccording to Brzozowski et al.  reportedAnother study conducted by Kumar et al.  demonstrIn a study by Mohammed et al. , the imp2O3) was analysed. Tests were conducted on the compressive strength of concrete exposed to high temperatures, and it was found that an increase in the content of nano-bismuth oxide led to a linear increase in the compressive strength. The study also revealed that there was an increase in the compressive strength for all samples as the temperature rose to 200 °C and 400 °C. However, at 600 °C, the compressive strength decreased, with the highest compressive strength seen in the samples containing 6 wt.% nano-bismuth oxide. In general, the study concluded that adding 6% of nano-bismuth oxide particles was the optimum content to enhance the mechanical properties of concrete exposed to high temperatures.In a study by Nikbin et al. , the effIn their study, Sakthieswaran et al.  evaluateOverall, these findings suggest that incorporating nanoalumina into concrete is a promising approach for enhancing the mechanical properties of concrete, particularly when it is expected to be exposed to elevated temperatures.Bastami et al.  conducteShah et al.  performeIncreasing the temperature  can help make the concrete microstructure denser and more homogenous because it accelerates the cement hydration and increases the formed C-S-H gel stiffness. However, microcracks can be formed in plain concrete at temperatures higher than 400 °C, while temperatures above 800 °C cause the decomposition of cement gel. The incorporation of nanomaterials assists in providing a denser and more compacted microstructure even at higher temperatures, such as 400 °C. The improvement can be attributed to the nanoparticle effect on forming high-density C-S-H gel ,75. HighThe sustained attack of acid on concrete can severely harm and degrade its microstructure, ultimately resulting in material destruction . The conCertain techniques and strategies can be used to modify concrete’s resistance to an acid attack, such as concrete surface coating, altering the environment to make it less hostile to the concrete, adding fibres, and enhancing the impermeability of concrete. Incorporating nanomaterials helps increase the mechanical properties of concrete and its durability. Therefore, nanomaterials offer a wide range of applications for improving concrete’s resistance to an acid attack.The effect of nanosilica and nanometakaolin on the resistance of high-strength and high-performance concrete against an acid attack was studied by Diab et al. . The stu2SO4) acid immersion had the greatest weight loss effect on concrete, while hydrochloric (HCl) acid immersion had the least effect when only minimal weight loss was observed. This can be attributed to sulfuric acid’s combined damage from sulphate attack and acid attack. Compared to control concrete, nanomodified concrete had a lower weight loss. According to the study, the decline in the concrete’s residual compressive strength increased with the duration of acid soaking. Acids reduced the residual compressive strength of concrete by increasing the formation of ettringite in the concrete’s microscopic structure as the duration of acid soaking increased. However, adding a higher amount of nanosilica and ultra-fine fly ash worked to reduce the loss in residual compressive strength of concrete during its exposure to HCl and H2SO4. Decreasing residual strength loss was a result of the packing effect of nanomaterials, resulting in a dense microstructure and a reduction in capillary pores due to the higher amount of cement gel that improves the concrete’s resistance against acid attacks.In a study by Mahdikhani et al. , concret2 nanoparticles and rice husk ash. The study revealed that the longer the duration of acid immersion, the greater the weight loss of the concrete. Furthermore, the control concrete exhibited more damage than the concrete with nanomaterials due to acid exposure. The combination of 10% rice husk ash and different nano-TiO2 contents improved the concrete’s resistance to the HCl acid deterioration effect. The results indicated that 3 wt.% nano-TiO2 was the best dosage to improve acid resistance in concrete. Cao et al. [Praveenkumar et al.  studied o et al.  evaluate2−) that react with the source of calcium (Ca2+) and alumina to form ettringite (CaO·Al2O3·3CaSO4·32H2O) and with the source of calcium to form gypsum (CaSO4·2H2O). Ettringite is an expansive component, and its formation in hardened concrete could result in expansion, cracking, and mass loss, particularly when restrained. The formation of gypsum results in the softening of the concrete microstructure and loss of cohesion. A chemical attack by sulphate can involve the destabilisation of C-S-H gel and CH, generating microcracks within the concrete structure. A physical salt attack by sulphate can happen when concrete is in contact with soil. The groundwater contains deleterious ions, mostly sulphate, that infiltrate through concrete pores either by capillary sorption or diffusion. When the water inside the pores is evaporated by the dry air, salt will crystallise in the pores near the surface of the concrete. Salt precipitation and crystal growth exert crystallisation pressure, and whenever that pressure is greater than the tensile strength of the pore wall in which the crystals grow, surface scaling can occur, such as that caused by cycles of freezing and thawing. The most commonly occurring and naturally occurring sulphates that attack concrete are calcium (CaSO4·2H2O), sodium (NaSO4), and magnesium sulphate (MgSO4). The main three forms of damage caused by these salts are (1) the formation of ettringite and gypsum that cause expansion and strength loss; (2) the salt’s physical attack; and (3) thaumasite formation, which causes C-S-H destabilisation.A sulphate attack ,95 has aThe denser microstructure and refined pore structure due to nanomaterial incorporation improve the permeability-related properties of concrete. Many studies revealed that nanomaterial addition to concrete had a huge impact on reducing concrete’s water absorption, providing denser microstructure in the interfacial transition zone (ITZ), and reducing pore connectivity ,96,97. T2), and silica gel. The MgOH2 lowers the pH of the pore solution and causes decalcification of the C-S-H gel by exchanging calcium ions with magnesium ions, forming a weak non-cementitious substance known as magnesium silicate hydrate. Therefore, the destructive effect of a magnesium sulphate attack is associated with both cracking and softening. The longer the immersion duration of concrete in a magnesium solution, the higher the loss in compressive strength. However, the study showed that nanomaterials (nanosilica and nanometakaolin) enhanced the strength of concrete against sulphate attack due to their filling action and pozzolanic reactivity, which contribute to porosity reduction and compacting the microstructure. Multi-walled carbon nanotubes (MWCNTs) [2) on the mechanical properties of concrete was assessed both with and without polypropylene fibres. The results presented in 2 on the residual compressive strength of non-fibrous concrete. The data showed a linear relationship between the amount of nanomaterial added and the reduction in compressive strength loss of the concrete. The improvements in compressive strength loss were due to the ability of ZnO and TiO2 to enhance C-S-H gel formation and increase the bond between aggregate and cement in the concrete.(MWCNTs)  improved(MWCNTs) , the impFaried et al.  performeSeveral studies were also conducted to assess the weight loss of nanomaterial-modified concrete as a result of a sulphate attack ,100,101.2, and nano-CaCO3 compared to fly ash concrete without nanomaterial incorporation when the concrete specimens were subjected to 3% ammonium sulphate. Nano-TiO2-fly ash concrete exhibited higher weight loss than fly ash concrete. However, concrete with fly ash and nano-CaCO3 had the lowest weight loss percentage among other types of concrete. For concrete specimens subjected to a 3% sodium sulphate solution, the nano-TiO2-fly ash concrete had the highest percentage of weight loss, followed by fly ash-nano-CaCO3 concrete. 3A components, reducing the risk of sulphate attack by reducing the potential for formatting ettringite and gypsum.However, a study by Vishwakarma et al.  reported42− apparent diffusion coefficients; however, an excessive nanosilica incorporation had a larger deviation rate of the apparent diffusion coefficients. Reshma et al. [2 on the water absorption and sorptivity of concrete and reported a beneficial outcome. It is clear that the addition of nanomaterials to a cement mixture can enhance the durability of concrete, as it improves its microstructure by filling gaps and increasing pozzolanic reactivity, thus resisting sulphate attacks.The promotion of C-S-H gel formation with the pore refinement effect has been found to have a noteworthy correlation with the improvement in concrete’s mechanical properties and durability when added with nanomaterials. Solid evidence and explanation revealed that the total capillary porosity of concrete is decreased with nanomaterial incorporation due to the nanoparticle filler mechanism and high surface area; moreover, nanoparticles can act as nucleation sites for additional hydrate formation, increasing the C-S-H gel content in the cement matrix. External sulphate ingress through the concrete is controlled by permeability (porosity-dependent) when the phase composition and pore network determine the rate of sulphate ion penetration. In addition, the amount of water absorbed is directly related to the level of porosity in the concrete. Due to their super fineness, nanoparticles, such as nanosilica, have proven to be highly efficient in decreasing the water absorption into concrete. The nanosilica’s ability to densify and improve the microstructure of concrete by filling the porous hydration products and reacting with CH to produce more gel hydrates would block water transport channels and inhibit the diffusion of aggressive ions. On the other hand, Wang et al.  found tha et al.  investigReinforced concrete structures are very vulnerable to chloride ion ingress, which can result in steel corrosion . When stThe addition of nanoparticles to concrete helps to enhance its mechanical characteristics, including compressive strength, by elevating the quantity of C-S-H gel and optimising the structure of the concrete’s pores. This is achieved when the particles react with CH to form a denser microstructure, thus enhancing material durability. Multiple experiments and explanations have confirmed that nanomaterials can improve concrete’s resistance to chloride attacks.−) diffusion in graphene oxide-modified concrete. Various types of concrete were subjected to constant water pressures of 0.3, 0.5, and 0.7 MPa for a duration of 144 h to infiltrate chloride ions. The outcome of the research showed that the rate of chloride penetration was increased by both the water pressure and the depth of immersion in concrete, regardless of the type of concrete. However, the graphene oxide–slag-based, cement-modified concrete displayed improved resistance against ion penetration. The positive impact of nanomaterials on this type of concrete was observed at higher pressure, which caused a significant reduction in the measured diffusion coefficients by a factor of 3. The nanofiller effect of graphene oxide was responsible for blocking the pores and cutting the ions’ diffusion paths in concrete. However, the higher content level of graphene oxide might be detrimental due to the agglomeration effect of concrete, highlighting the importance of caution regarding the use of nanomaterials.Singh et al.  reportedLiu et al.  investig− ions accumulated closer to the concrete surface. Moreover, it can be observed from − ions in nanoconcrete was reduced compared to that of plain concrete. This suggests that the addition of nanomaterials enhanced the concrete’s ability to resist penetration by chloride ions. However, the 2% addition of nanosilica was more effective at increasing the concrete’s resistance to chlorides compared to the 1% nano-ZnO concrete. The carbonation depth of nanoconcrete is lower compared to plain concrete. The optimal performance of concrete regarding anti-carbonation and chloride resistance was achieved by incorporating the proper content of nanoparticles into the concrete, and adding 1% of nano-ZnO and 2% of nanosilica was noted to be the optimum content levels. In contrast, the concrete’s chloride resistance and anti-carbonation performance were reduced by increasing the amount of nanomaterials. The adverse impact of exceeding the optimal content was due to the agglomeration effect and insufficient local cement hydration. Based on XRD test results, it was affirmed that nanosilica is more effective in consuming calcium hydroxide than nano-ZnO because nanosilica has smaller nanoparticles and thereby greater surface activity. By consuming the Ca(OH)2 phase, nanomaterials can drastically improve concrete’s resistance to chlorides due to the phase negative impact by reacting with Cl− to form complexes that facilitate chloride diffusion and reacting with CO2 to form CaCO3, which reduces the concrete pH and accelerates steel corrosion. The incorporation of nanoparticles lowers the CaCO3 amount in concrete and produces a higher C-S-H gel content, thus enhancing the anti-carbonation performance of concrete under chlorine attack. On the other hand, nanosilica can enhance durability in a more functional way than nano-ZnO, due to the former’s advanced effect in promoting the formation of Friedel’s salts and improving the concrete microstructure.Zhang et al.  evaluate2, nano-Al2O3, and nano-Fe2O3. Their research covered areas such as water penetration and electrical resistivity, as well as the rapid chloride permeability test and the rapid chloride migration test. The study emphasised that nanomaterial-modified concrete had lower permeability and lower water penetration than plain concrete due to the nanoparticles’ role in reducing the pore volume and connectivity. A lower permeability indicates lower chemical attacks due to the inhibition of the ingress of aggressive ions such as chlorides into concrete. The 91-day water penetration depths of 0.32 w/c ratio concrete incorporated with 5% TiO2, Al2O3, and Fe2O3 were found to be 51%, 59%, and 64% lower than the control concrete, respectively. The improvement in water penetration with nanomaterial incorporation was interpreted as the cause of nanoparticle dilution and heterogeneous nucleation effects. Promoting cement hydration through pozzolanic reactivity with nanoparticle addition was expected to result in a higher amount of cement gel, which would reduce the pores connectivity and hinder the water transport within concrete. The electrical resistivity of concrete surfaces increased over time as the hydration process continued. This increase in the solid phase blocks electrical currents. The nanomodified concrete had a greater electrical resistivity than control concrete due to the porosity-refining effect of nanomaterials. The electrical response of concrete is a useful indicator of permeability. A linear correlation between water penetration and surface resistivity tests was established. An increase in electrical resistivity led to a decrease in water penetration depth. Incorporating nanoparticles reduced the concrete’s penetrability, as confirmed using the rapid chloride migration tests. The chloride migration coefficient decreased significantly with the addition of nanoparticles. Electrical resistivity and chloride migration coefficients depended on the water-to-binder ratio and nanomaterial incorporation. These parameters were controlled by concrete porosity, pore size, and pore connectivity. The rapid chloride permeability tests showed decreased charge passing through concrete specimens when the w/b ratio was lowered and when nanoparticles were added. Nanoparticles improved concrete’s resistance to chloride penetration, especially with a higher w/b ratio, due to their porosity-refining effect. Nanotechnology helped to create durable concrete with low permeability and low chloride penetration rates. A linear relationship was found between electrical resistivity and the rapid chloride permeability of the concrete. Joshaghani et al.  conducteA rapid chloride permeability test was carried out by Sujay et al.  on high-3, and multi-walled carbon nanotubes on the chloride permeability and chloride binding capacity of concrete. The study applied rapid chloride migration and equilibrium tests to quantify these properties. The results indicated that the inclusion of 2 wt.% nanosilica proved to be extremely effective at decreasing the chloride diffusion coefficient of the concrete, with the coefficient of nanosilica-enhanced concrete being 85.3% lower than that of plain concrete. The improvement using nanosilica was attributed to the nano-filler effect and its role in blocking the harmful pores and microcracking inside the concrete matrix, intensifying the microstructure, and hindering chloride transport. Furthermore, nanosilica promoted the hydration process with a nucleation effect that leads to the formation of higher amounts of gel-like hydrates, which increase the strength of cement paste and their bond to aggregate. Reducing the CH crystals with the pozzolanic activity of nanosilica was associated with improving the concrete’s strength by forming a denser C-S-H gel and strengthening the interfacial transition zone. These three effects of nanosilica  decreased the pore volume and subsequently lowered chloride diffusion. However, at higher incorporated amounts of nanosilica, such as 4 wt.%, the concrete resistance was less compared to 2 wt.%. The adverse impact was attributed to agglomeration and poor dispersion of nanoparticles owing to the van der Waals force, which causes weak zones and defects in the cement matrix. Regarding the nano-CaCO3 incorporation, the effect was also significant in improving the concrete resistance to chlorides by reducing the diffusion coefficient with a low-dosage addition, due to the nanofiller effect and nucleation effect as well as the chemical effect. The addition of 4 wt.% of nano-CaCO3 had a negative impact on chloride diffusion as compared to plain concrete. The negative impact was attributed to the agglomeration effect of nanoparticles. For the multi-walled carbon nanotube addition, the results showed remarkable improvement in regard to chloride resistance by reducing the chloride diffusion coefficient. The improvement resulted from the chemical effect of absorbing the Ca2+ from the pore solution, promoting the crystallisation and production of hydration products, in addition to the nucleation and bridging effects of bonding the C-S-H and improving the microstructure. The agglomeration effect was also present with a 4 wt.% addition, which reduced the effectiveness of nanomaterial enhancement of chloride resistance. Mercury intrusion porosimetry (MIP) was conducted to link the pore characteristics with concrete resistance to chlorides. The results showed that nanomaterial incorporation reduced the total pore volume of concrete. The content of smaller-diameter pores was increased with nanomaterial incorporation, which was considered harmless. The results indicated a refinement in pore structure with nanomaterials. Small pores are characterised as isolated local pores, while large pores are often connected as interconnected networks in concrete. Nanomaterials, due to their filler effect, turn the large pores into small pores, increasing the tortuosity of the system and hindering chloride transport in concrete. The diffusion coefficient was increased by increasing the capillary pores in the concrete. The increased concrete diffusion caused by increasing porosity was attributed to an increase in connected pores. Chloride binding can mitigate the chloride attack and reduce rebar corrosion in concrete by removing the chloride ions. However, the incorporation of nanomaterials compromises the chloride binding in concrete due to reducing the amount of CH by the pozzolanic reaction and reducing the Ca/Si ratio of C-S-H. By reducing the amount of CH, the pH in concrete would be reduced, the alkalinity would be lowered, and this would lower the chloride binding capacity.Tests were carried out by Li  to evaluRecent studies by Lu et al.  and Liu 2 and nanosilica into concrete enhanced its abrasion resistance compared to concrete containing polypropylene fibres. The effect of nanomaterial incorporation was best observed with 1 wt.% nanosilica or nano-TiO2, which had an index increment of up to 157% and 180%, respectively. These enhancements were due to the nanomaterials’ ability to control crystallisation in cement paste, prompting the formation of more C-S-H gel, and leading to a compacted and homogenous cement matrix. However, the amount of nanoparticles added should be optimum, as higher amounts result in less improvement. A linear relationship between abrasion resistance and compressive strength was identified for plain concrete, concrete with fibres, and concrete with nanomaterials as shown in Concrete durability mainly depends on the abrasion resistance property. Abrasion resistance defines how surfaces resist rubbing and friction . This ch2, and nano-ZrO2. Gao et al.  investig2. The nanomaterial content level for the three concretes was between 1 and 3 wt.%. For room temperature curing, 1 wt.% content was the optimum dosage for the three types of nanomaterials regarding abrasion loss. Nanosilica reactive powder concrete had the best enhancement effect on abrasion loss, whether using room temperature curing or at heat curing, when the enhancement rate reached 39.68% for a 1 wt.% dosage and 37.72% for a 3 wt.% dosage. In ascending order, the wear resistance of room temperature-cured reactive powder concrete was improved by nanoparticles, namely nanoZrO2-3%, nanosilica-3%, nanoTiO2-1%, nanoTiO2-3%, nanoZrO2-1%, and nanosilica-1%. For heat-cured reactive powder concrete, the improvement increased in the order of nanoTiO2-3%, nanoZrO2-1%, nanoTiO2-1%, nanosilica-1%, nanosilica-3%, and nanoZrO2-3%. The improvement in wear resistance with nanomaterials was attributed to their effect on enhancing the interfacial transit zone and structure of cement. The results of the study elucidated that increasing the content of nanoparticles decreased the concrete’s resistance to abrasion due to an increasing trend in CH crystal orientation. Microstructural analysis and surface characteristics of nanoparticle-containing concrete pavements were studied by Ghoddousi et al. [From i et al. . The abrTo evaluate how porosity and the pore size distribution impact abrasion resistance, concrete samples underwent Mercury intrusion porosimetry (MIP) testing. Wang et al.  performeNanoMgO is another nanomaterial used to reduce the surface cracking of concrete caused by autogenous shrinkage and thermal stresses . On the This article concentrates on enhancing the hydration of C-S-H gel while examining the robustness of nanoconcrete. Incorporating nanomaterials into concrete reduces porosity and enhances its microstructure by increasing the content of cement gel. The mechanical strength and permeability of concrete are improved by the nanofiller, pozzolanic, and nucleation effects of nanoparticles. In addition, the nanoparticle effect reduces concrete capillary porosity and total pore volume by promoting the hydration of unhydrated cement particles and pozzolanic reactions with CH crystals. By increasing the amount of C-S-H gel produced with the nanomaterial reaction, the material’s resistance to external attack by sulphates or acids is significantly increased, and the permeability and water absorption of concrete are reduced. The addition of nanomaterials such as nanosilica, nanoclay, and graphene oxide was proven to enhance concrete’s durability against high temperatures as well as acid or sulphate degradation. Furthermore, nanoconcrete exhibits better performance against surface abrasion with the reduction in chloride penetration and wear load sustained. While an optimum amount of nanoparticles provides more durable and robust concrete, a higher amount could cause an adverse impact due to the agglomeration effect. To enhance the performance of nanoconcrete, recommendations include conducting more studies on its durability and resistance to other types of threats, broadening the types of nanomaterials added, and exploring better techniques and approaches for better nanoparticle dispersion in concrete.


High-strength steel-fiber-reinforced concrete (HSFRC) has become increasingly popular as a cast-in-place jointing material in precast concrete bridges and buildings due to its excellent tensile strength and crack resistance. However, working conditions such as emergency repairs and low-temperature constructions require higher demands on the workability and mechanical properties of HSFRC. To this end, a novel rapid-hardening HSFRC has been proposed, which is produced using sulphoaluminate cement (SC) instead of ordinary Portland cement. In this study, quasi-static and dynamic tests were carried out to compare the compressive behavior of conventional and rapid-hardening HSFRCs. The key test variables included SC replacement ratios, concrete curing ages, and strain rates. Test results showed: (1) Rapid-hardening HSFRC exhibited high early strengths of up to 33.14 and 44.9 MPa at the curing age of 4 h, respectively, but its compressive strength and elastic modulus were generally inferior to those of conventional HSFRC. (2) The strain rate sensitivity of rapid-hardening HSFRC was more significant compared to its conventional counterpart and increased with increasing curing ages and strain rates. This study highlights the great potential of rapid-hardening HSFRC in rapid bridge construction. As the service life of highway bridges increases and traffic flows become more dramatic, bridge deck pavement inevitably suffers from varying degrees of damage. A common typical disease is the breakage of expansion joints , which rWith the increasing demand for better behavior and lower costs, mounting research has been devoted to upgrading or exploiting the structural mechanical performance by introducing innovative materials, structures, and techniques ,15,16,173) were incorporated into HSFRC to obtain excellent salt-scale resistance and favorable mechanical properties. Rady et al. [Static mechanical properties are the main performance indicators of concrete, which determine the load-bearing capacity of structures such as bridges and pavements. They are also an important basis for structural design and construction and are an essential part of the in-depth study of the dynamic mechanical properties of concrete ,22. Luo y et al.  investigy et al.  conducte−1. When concrete is subjected to short and strong loads, its failure is considerably different from that under quasi-static loads, and the brittleness of concrete under high strain rates of impact loading is more obvious. For this reason, it is also crucial to study the dynamic mechanical properties of HSFRC. It is worth noting that in recent years there have been a large number of studies on the mechanical properties of conventional HSFRC under quasi-static loading. Murali and Vinodha [In addition, pavements and bridges are mainly subjected to dynamic loads during services, for example, the impact friction caused by vehicles coming into direct contact with pavement, which can cause the concrete to deform and crack. Then there are the more destructive earthquakes, which can even cause bridge structures to collapse, resulting in huge losses of life and road safety. Note that the strain rates generated by impacts and earthquakes are generally higher than 100 s Vinodha  carried  Vinodha  investig Vinodha  conducte Vinodha  conclude Vinodha  demonstr Vinodha  used zeo Vinodha ,33. Prev2~104 s−1). Therefore, the dynamic compression tests in this study are carried out based on the SHPB experimental technique.Against the above background, this paper aimed to investigate the effects of SC replacement ratios and concrete curing ages on the failure mode, ultimate condition, and stress–strain response of HSFRC under static and dynamic compression tests. It is noted that the Split Hopkinson pressure bar (SHPB) test can skillfully decouple the inertia effect in the structure and the strain rate effect in the material, which is the typical experimental technique for obtaining the dynamic compressive behavior of concrete at relatively high strain rates  specimens were prepared and tested, including 7 groups of (or 21) cubic specimens with 100 mm sides, 7 groups (or 21) cylindrical specimens with 100 mm diameter and 200 mm height for quasi-static compression tests, and 35 groups of (or 70) flattened Brazilian discs (FBD) with 100 mm diameter and 50 mm height for dynamic compression tests. Each group of quasi-static compression specimens consisted of three nominally identical specimens and two dynamic counterparts. Two series were designed for each type of compression test. Specifically, for the quasi-static compression tests, three groups of cubic specimens and three groups of cylindrical specimens made from conventional HSFRC were tested together as control specimens to form Series I, while Series II comprised the remaining cubic and cylindrical specimens infilled with rapid-hardening HSFRC. It is noted that conventional HSFRC was introduced to better investigate the effect of SC replacement ratios on HSFRC. For the dynamic compression tests, Series I consisted of 15 groups of FBD specimens made of conventional HSFRC, while Series II consisted of 20 groups of FBD specimens made of rapid-hardening HSFRC. Each series  examined the influence of test parameters on the concrete curing age, using 3, 7, and 28 days for the conventional HSFRC and 4 h, 3 days, 7 days, and 28 days for the rapid-hardening HSFRC, to cover the emergency repair work opening time (4 h) and typical concrete curing ages . In addition, the effect of strain rate was investigated in both Series I and II of the dynamic compression test. It should be mentioned here that the strain rate test range was determined by designing the gas pressure for the SHPB technique in the dynamic compression test. Five SHPB gas pressures were used for the dynamic compression tests, 0.5, 0.6, 0.7, 0.8, and 0.9, representing strain rates in the range of 50 to 134 sEach specimen is given a name consisting of 3 or 4 sets of letters and/or numbers (3 sets for the quasi-static compression test and 4 sets for the dynamic compression test), plus a numeral “1, 2, or 3” to distinguish between 2 or 3 nominally identical specimens. The first set consists of the two or three byte letters “CQC, QC, or DC”, representing cubic and cylindrical specimens for quasi-static compression tests , and FBD specimens for dynamic compression tests , respectively. The second set consists of the number “0 or 60” and the unit “%”, representing the type of infilled concrete as conventional or rapid-hardening HSFRC, respectively. The third set consists of the numbers “4, 3, 7, or 28” and the letters “h or d”, representing the curing age of the specimen as 4 h, 3 days, 7 days, or 28 days, respectively. The fourth set of specimens for dynamic compression tests only represents the gas pressure of the SHPB technique in dynamic compression tests. For example, specimen DC-60%-4h-0.5-1 represents one of two identical dynamic compressive specimens infilled with rapid-hardening HSFRC, with a curing age of 4 h and a target SHPB gas pressure of 0.5 MPa.3 = 77:20:3, and the rapid-hardening type using sulphoaluminate concrete: ordinary Portland cement: gypsum: microsilica fume: Nano-CaCO3 = 45:16:16:20:3. A close-up view of the raw materials is shown in The material mass proportion for both types of HSFRC was cementitious material: fine aggregate: steel fiber: water: water reducer = 42:40:6:10:2. Note that the two types of concrete differed only in the mass proportion of cementitious material, with the conventional type using ordinary Portland cement: microsilica fume: Nano-CaCOThe same preparation procedure was used for all specimens, and the key steps are given in −5 s−1. All specimens were loaded in two steps: (1) Each specimen was preloaded to 10% of the expected peak load to verify loading axis alignment and proper instrument operation. (2) After preloading, all specimens were formally loaded until the load dropped to 40% of the measured peak load. In addition, the same linear displacement transducers (LVDTs) and strain gauge arrangement were used for all specimens: (1) two LVDTs installed symmetrically to cover the middle two-fifths of the column height to measure axial shortenings; (2) two strain gauges installed symmetrically in the axial direction with a gauge length of 50 mm to measure axial deformations of the midheight section in the specimen; and (3) two strain gauges installed symmetrically in the hoop direction with a gauge length of 50 mm to measure hoop deformations of the midheight section in the specimen. All test data were automatically collected every second using a data acquisition system.All quasi-static compression tests were carried out in accordance with the American Specification ASTM C469/C469M-14 . The tes3, and 1180 MPa, respectively. According to the definition of the elastic wave velocity of a bar as the square ratio of the elastic modulus to its mass density, the above-mentioned elastic wave velocity of the bar in the used SHPB technique was 5169 m/s. It was noted that wave fluctuations and dispersion would greatly affect the dynamic performance of the specimens during SHPB impact tests. Therefore, two additional measures were routinely taken to ensure uniform forces at both ends of the concrete specimen: (1) the contact surfaces of the incident bar, specimen, and transmitted bar were covered with Vaseline to reduce the frictional resistance of the contact surfaces; and (2) brass pulse shapers of 2 mm thickness and 20 mm diameter were applied between the incident bar and the specimen to retard the slope of the rising phase of the incident wave and increase the reflection time of the gravitational wave inside the specimen. In addition, four strain gauges with a gauge length of 50 mm were installed equally on the incident and transmitted bars on the SHPB technique, which were used to monitor the signals of the incident , all HSFRC specimens will experience macroscopic cracking; when the SHPB gas pressure is greater than 0.8 MPa (corresponding to a strain rate of 81 to 135 s−1), all HSFRC specimens will experience almost complete separation of mortar, aggregate, and steel fibers. Further observations of the specimen’s failure modes were made after testing. Note that a large number of steel fibers were observed to be pulled out as a whole but not broken. This phenomenon indicates that the anchoring capacity of the steel fibers used in this study was poor, i.e., better mechanical properties of HSFRC could be achieved if steel fibers with stronger anchoring capacity were used. In addition, FBD specimens with rapid-hardening HSFRC had significantly fewer cracks than their conventional counterparts, maintaining a higher degree of postfailure integrity. This was more pronounced at the early curing age, suggesting that the introduction of SC favored the dynamic performance of the HSFRC, which may be attributed to the higher early strength.−1 and 51 to 123 s−1 at the concrete curing ages of 3 and 7 days, respectively. Their corresponding peak stresses increased from 35.56 to 54.79 MPa and 40.35 to 62.19 MPa, respectively, and their corresponding ultimate axial strains increased from 0.013 to 0.030 and 0.012 to 0.027, respectively. Meanwhile, the average strain rate of the specimens with rapid-hardening HSFRC increased from 70 to 122 s−1 and 63 to 111 s−1 at the concrete curing ages of 3 and 7 days, respectively. Their corresponding peak stresses increased from 39.04 to 64.53 MPa and 43.33 to 69.21 MPa, respectively, and their corresponding ultimate axial strains increased from 0.023 to 0.028 and 0.029 to 0.030, respectively. However, when the SHPB gas pressure was increased from 0.5 to 0.9 MPa at the concrete curing age of 28 days, the average strain rate of the specimens with conventional and rapid-hardening HSFRC increased from 80 to 133 s−1 and 80 to 126 s−1, respectively, and their corresponding peak stresses increased from 63.68 to 95.34 MPa and 60.13 to 99.86 MPa, respectively. In addition, their corresponding ultimate axial strains increased from 0.027 to 0.047 and 0.029 to 0.044, respectively. The above phenomenon shows that there were some differences in the dynamic compressive performance between the two types of HSFRC at the concrete curing age of 28 days, i.e., when the material properties had stabilized, but that both were generally acceptable. At the same time, rapid-hardening HSFRC has a clear advantage over its conventional counterparts in terms of dynamic compressive performance at early curing ages. These two aspects confirm the potential of rapid-hardening HSFRC for rapid bridge construction.The dynamic compression stress–strain curve for the FBD specimen is shown in −1). Based on the experimental results and discussion presented in this paper, the following main highlights, main findings, limitations, and areas of future research can be drawn.This paper presents an experimental study of the quasi-static and dynamic compressive behavior of conventional and rapid-hardening HSFRCs. The key parameters examined in this study include concrete curing ages (from 4 h to 28 days) and strain rates (from 43 to 133 sMain highlights and findings include the following:(1)Rapid-hardening HSFRC exhibited high early strength characteristics: the quasi-static compressive strengths of the cubes and cylinders at 4 h of curing age reached 45.16 and 33.14 MPa, respectively, which were 55 and 48% of their corresponding 28-day age strengths; in addition, the FBD specimen at 4 days of curing age had a dynamic compressive strength of up to 43.97 MPa, roughly 0.4 times their corresponding 28-day age strength.(2)The introduction of SC resulted in an increase in the strain rate sensitivity of HSFRC, where the strain rate sensitivity of rapid-hardening HSFRC increased with the increasing curing age and strain rate.(3)The compressive strength, elastic modulus, and Poisson’s ratio of rapid-hardening HSFRC were inferior to those of their conventional counterparts in both quasi-static and dynamic compressive loading, but rapid-hardening HSFRC’s postpeak deformation capacity was significantly better than that of the conventional counterparts.(4)The elastic modulus and Poisson’s ratio of HSFRC with different cement types under quasi-static compression increased with increasing curing age; the negative relationship between the elastic modulus and curing ages or strain rates was found under dynamic counterparts.Limitations and areas of future research include the following: Overall, rapid-hardening HSFRC has great potential for rapid bridge construction. In addition, the objective of this research was to verify the application feasibility of rapid-hardening HSFRC in rapid bridge construction through experimental investigations. To this end, this research only investigated the short-term compressive performance of a specific rapid-hardening HSFRC under normal conditions, lacking consideration of the effects of different material compositions, fiber types, and environmental conditions. Furthermore, to fully assess the properties of this innovative type of HSFRC, additional investigations should also be supplemented to determine the skin, the durability under the action of water and frost, the alkaline reactivity of HSFRC concrete with new cement, and so on. Moreover, the quasi-static and dynamic compressive constitutive models of this new type of concrete were unavailable due to the lack of test data on their compressive performance. Therefore, further research in this area is needed to investigate more systematically the compressive performance and mechanical modelling for the engineering application of such novel concrete.


Involvement in scholarly activities is considered to be one of the foundational pillars of medical education.This study aims to investigate publication rates before, during, and after residency to determine whether research productivity throughout medical training correlates with future academic success and research involvement.We successfully identified a list of 296 graduates from 25 US dermatology residency programs from the years 2013-2015. The publication history for each graduate was compiled using Scopus, PubMed, and Google Scholar. The Pearson correlation test and linear regression were used to assess the relationship between research productivity and continued academic success after residency graduation.t294=−4.0; P<.001), more first-author publications , and a higher h-index . Graduates who chose to pursue careers in academic medicine had more mean total publications , more first-author publications , and a higher mean h-index . Graduates with one or more first-author publications before residency were 1.3 times more likely to pursue a career in academic medicine . Graduates who pursued a fellowship were also 1.9 times more likely to pursue a career in academic medicine .Before residency, graduates published a mean of 1.9 (SD 3.5) total publications and a mean of 0.88 (SD 1.5) first-author publications. During residency, graduates published a mean of 2.7 (SD 3.6) total publications and a mean of 1.39 (SD 2.0) first-author publications. Graduates who pursued a fellowship had more total publications (Our results suggest that research productivity before and during residency training are potential markers for continued academic success and research involvement after completing dermatology residency training. Successful matching into selective residency programs, such as dermatology, is multifactorial in nature and requires thoughtful planning by medical students to ensure that they have a competitive, well-rounded application. Previous studies suggest that higher medical licensing exam scores , honor society memberships, and medical school rankings are associated with an increased likelihood of successfully matching into a residency program . A 2011 Since its conception in 1994, the Accreditation Council for Graduate Medical Education (ACGME)  has requHere, we sought to identify whether a correlation exists between research productivity of dermatology residency graduates with continued academic successes and research involvement  or whether those with higher research output elected to pursue a fellowship upon completion of residency training. Thus, we explore current research practices and publication trends of dermatology residency graduates to determine whether research efforts made during medical training are associated with future academic achievements (in the form of peer-reviewed publications). Furthermore, we assess whether higher research output during residency correlated with the pursuit of fellowship training or a career in academic medicine.Our primary objectives are to (1) quantify the number of peer-reviewed publications per resident during the periods before, during, and after residency training and (2) determine whether increased research productivity and academic success  are associated with future academic production .reputation data, which is collected from past and present residents on an annual basis [We used the Doximity Residency Navigator to generate our sample of dermatology residency programs. The Doximity residency ranking is based on subjective reviews of programs that combine objective data, such as alumni research output and board examination pass rate, with subjective data, including current and graduate resident satisfaction scores and al basis .Dermatology specialty search tool. Next, the programs were sorted as A-Z and exported to a Microsoft Excel document. Finally, we assigned a random number to each residency program using Microsoft Excel’s random number generator.To identify top US dermatology residency programs and graduates, we used a search strategy similar to that performed by Yang et al . This prnoncontactable. If no response was received or if the email was returned as inactive, the program was excluded, and a subsequent program was randomly selected from the original list of residency programs, and the above process was repeated until a 50% inclusion rate was met.After randomization, we selected the first 50 residency programs to be included in our sample. Next, we searched for the names of residency graduates  on each program’s institutional website. If this search was unsuccessful, we searched for the name and email address of each residency coordinator using the advanced program search on the ACGME website . We atteTo ensure consistency among investigators, 3 of the authors  completed in-person training before data extraction. During this training session, the following items were addressed and discussed at length: (1) description of study design and objectives, (2) a thorough review of the study protocol, (3) step-by-step instructions on how to use the standardized Google form for extraction, and (4) discussion of specific data points to be extracted. The Google form was pilot-tested by each investigator during training with the help of 3 residency graduates and their publication history as examples. After pilot testing, data were extracted for the next 10 graduates in our sample. Responses were subsequently discussed, and any discrepancies among investigators were resolved before proceeding to the remaining list of graduates.After training, 3 of the authors  extracted data in triplicate, independent, and blinded fashion. Extraction began on October 5, 2019, and concluded on September 10, 2020. To obtain a comprehensive publication history, we searched for each graduate on Scopus using the following demographic information: (1) full name, (2) institution, (3) residency program, (4) fellowship program, and (5) area of interest (dermatology). The list of publications returned for each graduate using this information was subsequently compared with the list of publications generated by searching for authors (using the same demographic information as above) on PubMed and Google Scholar searches. Results from the three individual searches were compared to ensure an accurate record of total publications per resident. More specifically, a publication was included only if it was included in the search return for all three databases. After we compiled a list of publications for each graduate, we extracted the following information from each publication: (1) type of publication, (2) year of publication, and (3) graduate affiliation at the time of publication. In addition, the author h-index was recorded .before residency as these studies were likely started during the before residency time frame, given the length of time required to conduct a research project, complete the peer review process, and see a research question through to publication. The results were presented as frequencies and percentages. We used a Pearson product coefficient to examine the relationships among each publication time frame . An independent sample two-tailed t test was used to compare the mean number of publications for graduates who elected to enter academic medicine with those who entered private practice after completing their residency training. We also used an independent sample two-tailed t test to compare the mean number of publications between those who pursued fellowship training with those who did not. Binary logistic regression was used to analyze the relationship between career type (academic or private practice) and total author publications and fellowships, controlling for gender. Analyses were performed using STATA 15.1 .Data were separated into the following three cohorts of time: before residency , during residency (4 years in duration in the United States), and after residency . The decision was made to include a 6-month overlap period to capture publications that were likely initiated and completed during the previous period. For example, publications that were published in the first 6 months of residency were classified as A total of 100 US dermatology programs were found on the Doximity website. Of the 50 randomly sampled programs, we were able to locate a list of graduates for 17 (34%) programs using institutional websites. For the remaining 66% (33/50) programs, we attempted to obtain this list via email from each program coordinator. An additional 24% (8/33) programs provided a complete list of residency graduates via email correspondence. The remaining 76% (25/33) programs did not respond by the end of the 8-week time frame. Of the 50 sampled programs, 25 (50%) dermatology residency programs were included in total .A total of 296 graduates were included in our final sample. Most graduates were female . Approximately 35.5% (105/296) graduates pursued a fellowship, with the most common being Mohs surgery , pediatric dermatology , dermatopathology , and procedural dermatology . Approximately 25% (74/296) of graduates entered academic medicine. Of the 105 graduates who pursued fellowship training, 45 (42.9%) also went on to pursue a career in academic medicine. The average h-index among all residency graduates was 3.6  and the number of publications obtained during residency and after residency training (r=0.37). A weak correlation was present between publications before residency and total publications after residency (r=0.19).Before residency, graduates had a mean of 1.9 (SD 3.5) total publications and a mean of 0.88 (SD 1.5) first-author publications. During residency, graduates had a mean of 2.7 (SD 3.6) total publications and a mean of 1.39 (SD 2.0) first-author publications . Resident294=−4.0; P<.001), first-author publications , and higher h-index  than graduates who did not pursue fellowship training. In a similar manner, we found that graduates who chose to go into academic medicine had a higher number of mean total publications , first-author publications , and mean h-index  than those going into private practice . Graduates who pursued a fellowship were also 1.9 times more likely to enter into a career in academic medicine than those who did not pursue a fellowship .Our results indicate that the total number of publications, first-author publications, and author h-index scores are highly associated with the pursuit of fellowship training, as well as entering into academic medicine following completion of dermatology residency training. Of the graduates included in our sample, over one-third elected to pursue a career in academic medicine, and one-third pursued fellowship training upon graduation. Residency graduates with at least one first-author publication before starting residency were more likely to pursue a career in academic medicine and continue their postgraduate education through fellowship subspecialty training. This emphasis on research appears to carry over into residency training, as we observed that the highest mean research output among the included dermatology graduates occurred during their years of residency training. Here, we discuss the implications that our findings may have on the dermatology match process for prospective applicants, as well as discuss how research throughout medical training may help open doors to future career opportunities and specialized fellowship training.Our results demonstrate that dermatology residents published, on average, 2.7 (SD 0.54) articles during residency, with an average of 1.3 SD 0.29) first-author publications. The research productivity among residents included in our sample is similar to that of residents in other fields ,9,16. Th first-auResearch productivity in the form of total publications, first-author publications, and higher author h-index scores was associated with the pursuit of fellowship training and academic medicine positions after completion of residency training. A recent study in the field of surgical oncology indicates that, along with research, factors such as attending a university-based residency, attending a residency associated with fellowship programs, and attending an allopathic medical school have an effect on matching into a fellowship . Our resAlthough PDs have many responsibilities, some of the key responsibilities include developing, overseeing, and improving their residency program’s education , as wellIn the 2018 match, dermatology yielded one of the lowest match percentages, with only 81.6% of applicants successfully matching, second only to interventional radiology . OsteopaOur study has both strengths and limitations. In regard to the limitations, a metric used for comparing research production was the author h-index. Although the h-index is considered a robust metric, it does not account for authorship order, which may limit our ability to determine the extent of an author’s involvement in the associated research projects . In addiOur results highlight research productivity before and during residency training as a potential marker for continued academic success in the field of dermatology. In addition, early scholarly involvement may be associated with successful matching into competitive subspecialty fellowships within the field of dermatology, as well as the pursuit of careers in academic medicine.


Staphylococcus aureus . The prevalence of mastitis in breastfeeding women may reach 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of treatment. Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding. Infective mastitis is commonly caused by  This review aims to examine the effectiveness of antibiotic therapies in relieving symptoms for breastfeeding women with mastitis with or without laboratory investigation.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012), contacted investigators and other content experts known to us for unpublished trials and scanned the reference lists of retrieved articles.We selected randomised controlled trials (RCTs) and quasi-RCTs comparing the effectiveness of various types of antibiotic therapies or antibiotic therapy versus alternative therapies for the treatment of mastitis.Two review authors independently assessed trial quality and extracted data. When in dispute, we consulted a third author. Two trials met the inclusion criteria. One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation. Another, older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic. There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. There is an urgent need to conduct high-quality, double-blinded RCTs to determine whether antibiotics should be used in this common postpartum condition.


Next-generation sequencing (NGS) is currently widely used for biomarker studies and molecular profiling to identify concurrent alterations that can lead to the better characterization of a tumor’s molecular landscape. However, further evaluation of technical aspects related to the detection of gene rearrangements and copy number alterations is warranted.ALK rearrangement-positive tumor specimens from patients with non-small cell lung cancer (NSCLC) previously detected via fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and an RNA-based NGS assay, and 26 MET high gene copy number (GCN) cases detected by FISH, selected for this retrospective study. All 38 pre-characterized cases were reassessed utilizing the PGDx™ elio™ tissue complete assay, a 505 gene targeted NGS panel, to evaluate concordance with these conventional diagnostic techniques.There were 12 ALK rearrangements using the DNA-based NGS assay demonstrated excellent sensitivity with the added benefit of characterizing gene fusion partners and genomic breakpoints. MET copy number alterations were also detected; however, some discordances were observed likely attributed to differences in algorithm, reporting thresholds and gene copy number state. TMB was also assessed by the assay and correlated to the presence of NSCLC driver alterations and was found to be significantly lower in cases with NGS-confirmed canonical driver mutations compared with those without (p=0.0019).The detection of Overall, this study validates NGS as an accurate approach for detecting structural variants while also highlighting the need for further optimization to enable harmonization across methodologies for amplifications. Lung cancer is one of the leading causes of cancer-related deaths in the world.  In the cALK gene fusions are important predictive biomarkers for targeted tyrosine kinase inhibitor (TKI) efficacy in NSCLC ; however, the approach is laborious, costly, and highly subjective   , 23, 24.hibitors , 26.The comprehensive nature of NGS has also facilitated the creation of novel cancer signatures, previously not possible with conventional techniques, such as tumor mutation burden (TMB) . TMB actGiven the multitude of clinically relevant genomic biomarkers present in NSCLC, we sought to analytically evaluate the level of concordance between conventional molecular pathology approaches and a DNA-based NGS assay. Furthermore, we aimed to elucidate any associations between concomitant driver mutations, co-alterations, and explore correlations to clinical outcomes in specific cases.ALK, ROS1, and MET alterations . Only initial diagnostic samples with remaining FFPE tissue from NSCLC patients were selected for this study. There were 12 samples with known ALK fusion events previously identified by FISH  reviewed to determine the tumor area and screened by IHC  and RNA-based NGS . Furthermore, 26 advanced NSCLC cases screened for MET amplification by FISH using the Cappuzzo score system (MET high gene copy number (GCN) defined as those with a mean of ≥5 copies per cell) (MET/CEP7 ratio ≥4.0), medium-amplification (MET/CEP7 ratio >2.2–<4.0), low-amplification (MET/CEP7 ratio ≥1.8–≤2.2), and non-amplification (MET/CEP7 ratio <1.8) (MET amplification are those with a MET/CEP7 >2.2 (high- and medium-amplification), classifying low-amplified together with non-amplified as negative as no actionability was seen when using MET inhibitors   were recio <1.8)   elio™ tissue complete, a research use only (RUO) comprehensive genomic profiling NGS assay . This NGS panel assesses 505 genes using a minimum starting input of 50 ng (100 ng recommended) DNA from FFPE tumor tissue and identifies key genomic alterations (single-nucleotide variants (SNVs), insertion and deletions (indels), gene rearrangements, and amplifications) and complex genomic signatures including TMB, reported as muts/Mb , and microsatellite instability status. There were 38 specimens from patients with NSCLC utilized in this study, composed of 27 males and 11 females Table 1.EML4::ALK (E13:A20) was found to be the most prevalent ALK fusion comprising 58% of the cases (n=7). Notably, in addition to providing the exact genomic breakpoints for these rearrangements, the PGDx elio tissue complete assay reported the rearrangement types including nine inversions, one duplication within chromosome 2, and two translocations (IRF2BP2 in chromosome 1 and KIF5B in chromosome 10). Notably, the PGDx elio tissue complete identified a novel translocation, IRF2BP2::ALK (I1:A20), which has not been previously described  having no gene amplifications present. However, two ALK-positive cases were found to have gene amplifications: one with amplifications in both FGFR3 and FGFR4 and one with a MYC amplification.The concurrent alterations identified by expanded genomic analysis are shown in MET high GCN samples selected for the PGDx elio tissue complete assay analysis, only eight cases were recategorized as high-amplified (n=2) and medium-amplified (n=6) following the currently accepted FISH criteria. Five out of these eight cases were confirmed as being MET-amplified by the PGDx elio tissue complete. Therefore, we found three discordant cases between FISH and NGS amplification calls , was found to have a concomitant MET exon 14 skipping mutation (KRAS exon 2 mutations and three EGFR sensitizing mutations)  3A.p=0.0019, TMB scores in this NSCLC cohort ranged from 0.7 to 50.5 muts/Mb, with a mean TMB of 8.6 and median of 5.2 muts/Mb  fusion respond better to crizotinib compared with other EML4::ALK fusion variants (IRF2BP2 gene identified as a new translocation partner fused with ALK exon 20 codifies for an IFN regulatory factor binding protein that interacts with IFN regulatory factor 2 (IRF‐2). The IRF2BP2 gene has been described as a fusion partner in acute promyelocytic leukemia when fused to RARA gene and in NSCLC is found to be fused to NTRK1 (IRF2BP2::ALK fusion (Pt. 11) received crizotinib as second-line treatment with lower than expected benefit, although progression was at the central nervous system, confirming the limitation of crizotinib at this anatomical site . Analyzing by NGS with the PGDx elio tissue complete assay, we observed that five of these eight were also considered amplified, with only three discordant cases (discussed later). The other 22 MET high GCN cases analyzed in this study were divided by current FISH criteria into 4 low-amplified and 15 non-amplified. The agreement with the NGS panel in these 22 cases was 100% since MET amplification was not detected in any of them. Even so, the copy number values resulting from NGS of Pt. 29 and Pt. 39 stand out, with a MET copy number adjusted to the tumor of 2.6% and 37.8% of regions amplified, and Pt. 39, with a MET copy number of 4.2% and 15.6% of regions amplified, respectively. Both cases displayed copy number variation but did not reach the calling threshold to indicate an amplification by the PGDx elio tissue complete assay (≥3-fold copy number in at least 25% of the queried regions), which is consistent with heterogeneous copy number events such as MET gene gains or chromosome 7 polysomy  compared with patients with exon 14 skipping mutations in MET in the same scenarios   . These rEGFR mutant lung cancers featured lower overall TMB as compared with EGFR wild‐type cancers (EGFR-positive patients with low/high TMB when treated with TKIs (ALK-fused and MET-amplified cases were pooled together in the driver alteration-detected group. However, this inverse association between high TMB and the presence of an ALK fusion was also observed previously, pointing out its potential interest when designing a precision therapy strategy for these patients (Regarding the inverse relationship between TMB score and the presence of canonical driver alterations, it has been previously described that  cancers . Also, pith TKIs . One limpatients , 59.MET results observed in our study might derive from different technical aspects. The PGDx elio tissue complete assay considers factors such as tumor purity, percent of the sequenced genomic region amplified, and minimum coverage depths in determining whether the observed increase in copy number constitutes a genuine amplification event. Such metrics are not taken into consideration with FISH, instead relying on the subjectivity of the observer when deciding on which areas to assess in identifying copy number changes. Bias generated by FISH count due to tissue heterogeneity could potentially differ between tissue sections as reported to occur in the context of other biomarkers and indication, for example, HER2 assessment in breast cancer (MET focal amplifications could require further assessment by FISH, as these might not be captured by NGS if the majority of cells do not harbor the amplification. There is no specific information of clinical responses in these particular cases.The discordant t cancer . DespiteALK gene rearrangements. Additionally, the DNA-based NGS approach provides far greater insight into the underlying genomic events with the ability to identify exact breakpoints of gene fusions and report the specific loci associated with gene amplifications. Moreover, it provides broader information regarding potentially relevant genomic co-alterations that may impact clinical outcomes. The optimal cutoff point for defining MET amplifications remains to be defined and might be specific to the NGS platform. Further studies with clinical outcome data are needed to further refine MET amplification as a predictive biomarker.The PGDx elio tissue complete assay demonstrated high overall concordance with conventional diagnostic approaches for https://ega-archive.org/datasets/EGAD50000000016. Accession number - EGA50000000010.The original contributions presented in the study are publicly available. This data can be found here: Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the patients/participants or patients/participants’ legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.in situ hybridization and next-generation sequencing. All authors contributed to the article and approved the submitted version.SC, JJ, MS, EK, EW, DN, JS, BB, and EA contributed to conception and design of the study. JJ, JK, KG, EV, EK, EW, JH, GC, DN, and JS organized the database. JJ, EK, and JG performed the statistical analysis. SC and EK wrote the first draft of the manuscript. JJ, MS, JK, KG, EV, LP, BB, and EA wrote sections of the manuscript. MH-W, PR, XR, and ET participate in image acquisition and technical support in immunohistochemistry, fluorescence


In total, 519 individuals completed the survey , with an average age of 32.7, and 52.2% were female. Most citizens correctly identified paracetamol  and ibuprofen  as non-antibiotic medications. A substantial proportion thought antibiotics could treat viral infections, such as a cold  or the flu . Most participants understood that bacteria can become resistant to antibiotics , that unnecessary use can lead to drug ineffectiveness  and that they should always complete the course of antibiotics . Positive attitudes towards antibiotics correlated negatively with knowledge in both samples, indicating that the more people know, the less positive their attitudes towards their use. The RoC appears to have tighter controls of over-the-counter (OTC) sales of antibiotics than TRNC. This study reveals that different communities can have varying levels of knowledge, attitudes and perceptions about antibiotic use. Tighter enforcement of the OTC regulations, educational efforts and media campaigns are needed for enhancing prudent antibiotic use on the island.This study investigated the knowledge, attitudes and behaviours towards antibiotics among the general public living in the Republic of Cyprus (RoC) and the Turkish Republic of Northern Cyprus (TRNC) by using an online questionnaire. Differences were examined using independent samples  According to the European Centre for Disease Control, in 2020, the Republic of Cyprus (RoC) consumed 28.9 defined daily doses (DDD) per 1000 inhabitants, which is the highest in the European Union (EU) and considerably higher than the statistic of 8.5 found in the Netherlands [The island of Cyprus has been divided in two since 1974 based on ethnic identity, with the Greek Cypriots living in the south (Republic of Cyprus) and the Turkish Cypriots living in the northern part of the island (Turkish Republic of Northern Cyprus—TRNC). The north of the island is not covered by the EU statistics or those from the World Health Organization (WHO), and so very little is known about the situation there. Although there are no readily available official statistics on antibiotic use in the TRNC, a 2014 study found that 87% of the 300 patients surveyed had purchased antibiotics without a prescription at least once in their life [The misuse of antibiotics is a global problem that represents one of the largest threats to human health and food security . The WHOInterventions aimed at increasing the level of knowledge regarding the appropriate use of antibiotics among patients and healthcare professionals, as well as improving communication between the two, are important steps towards combating antibiotic resistance . HoweverTwo recent studies have investigated the knowledge, attitudes, and behaviours among those living in Cyprus, one in the TRNC  and the Michaelidou et al. (2020) surveyed 614 people living in the Republic of Cyprus and found that around one-third had used antibiotics in the last 12 months and up to 72.3% had heard about “antibiotic resistant bacteria”. Surprisingly, 70.7% did not understand how antibiotic resistance developed, but most agreed on the usefulness of the suggested actions to address antibiotic resistance. Among respondents, 87% stated that they knew they needed to take the full prescription of antibiotics, and 79.6% understood that it was not acceptable to use the same antibiotics taken from a family member or friend with the same symptoms. When participants were asked to select which medical conditions should be treated with antibiotics, bladder/UTI (81%), skin/wound infections (61.9%) and gonorrhea (23.1%) were correctly identified, but a common cold/flu (36.6%), sore throat (30.0%) and HIV/AIDS (6%) were incorrectly identified. As with the TRNC survey, those with higher education exhibited significantly higher knowledge levels. A better understanding of the knowledge and attitudes about antibiotic and antibiotic resistance in the general population of both parts of Cyprus may be helpful for identifying the problematic attitudes, beliefs and behaviours that exist in Cyprus. The purpose of the present study was to investigate the current level of knowledge about antibiotic use and antibiotic resistance among the general public in the two ethnic communities living on the island of Cyprus. This information could help guide future interventions to improve awareness and reduce unnecessary antibiotic use in both communities.The data included answers from 267 respondents from the Republic of Cyprus (RoC) and 252 respondents from the Turkish Republic of Northern Cyprus (TRNC). The sample characteristics are described in The respondents were asked about their previous experiences with antibiotic use . Almost Participants were asked questions about the development of antibiotic resistance , the RoC participants were more likely to answer ‘yes’ (51.3%) than those from the TRNC (46.8%).t-tests). Respondents from the TRNC agreed more often with statements 1, 3, 4 and 6 than the RoC respondents, while the RoC participants agreed more often with statements 2, 5 and 9. Items 1, 3 and 6 reflect a negative or strict attitude to antibiotic use, while items 2, 5 and 9 reflect a more relaxed attitude towards antibiotic use. Interestingly, TRNC residents scored higher on both items 3 and 4, even though they reflect somewhat opposite attitudes. It should be noted that among both RoC (t(251) = −10.80, p < 0.001) and TRNC (t(265) = −11.47, p < 0.001) samples, respondents found it more important that the GP does not prescribe an antibiotic when he/she thinks that they are not needed than prescribing them when the patient requests them. Based on group comparisons in attitude items, it can be concluded that TRNC citizens preferred a stricter control of antibiotic use than the RoC citizens.Attitudes towards antibiotics use were measured using ten statements, and the answers were recorded with a 5-point Likert scale from “strongly disagree” (1) to “strongly agree” (5). Public awareness of the causes and consequences of antibiotic resistance is critical for the mitigation of the inappropriate use of antibiotics. Therefore, the assessment of the awareness, knowledge and attitude regarding antibiotic use and antibiotic resistance represents an important tool for identifying areas within populations for the implementation of targeted interventions and initiatives for increasing public awareness. In the current study, the knowledge, attitudes and behaviour regarding antibiotic and antibiotic resistance were examined in the two different communities living on the island of Cyprus in order to determine similarities and differences between the communities.The restriction of antibiotic dispensing without a prescription is among the most important measures against non-prudent antibiotic use in a given country. In EU member states, the sale of antibiotics without a prescription is prohibited by law. Nevertheless, an increase in the use of antibiotics without a prescription in Cyprus, Bulgaria, Croatia, Finland, Germany, Latvia, Lithuania and Poland was reported between 2013 and 2016, with the prevailing source being a pharmacy . This imIn an effort to evaluate the knowledge level of those living in the two communities in Cyprus, we assessed their ability to recognize antibiotics from five given pharmaceuticals . The study results showed that overall, TRNC citizens were better able to recognize the medications than citizens from RoC, and they were more able to recognize amoxicillin and penicillin as antibiotics. Among the RoC participants, 22.5% incorrectly identified paracetamol as an antibiotic, which was much lower (3.6%) for TRNC participants. These rates were lower than in low-income countries, such as Indonesia and Nepal, where 41.2% and 28.5% of the population identified paracetamol as an antibiotic, respectively ,19,20. IAs an individual or a parent, it is important to know against which microorganisms antibiotics are effective or not. Indeed, this knowledge level correlates with the rates of antibiotic resistance in a community. In the current study, RoC respondents were found to have a considerably lower level of knowledge regarding the effectiveness of antibiotics. Among the RoC respondents, 50.4% of them believed that antibiotics were effective against the flu, and 40.8% believed they were effective against colds. In such a situation, the misuse and overuse of antibiotics in the community is very likely. Similar persisting misconceptions regarding the effectiveness of antibiotics can exist in communities living in different geographical locations. A 2021 study in Turkey revealed that 37% of parents with a child under 18 years old believed that antibiotics could cure infections caused by viruses . In FranThe knowledge of the mechanisms of the development of antibiotic resistance can be a driver of better attitudes regarding antibiotic use. In general, most participants in both communities were aware of the risk of antimicrobial resistance (64.4% in the RoC and 71.4% in the TRNC having a correct answer), the risk of the unnecessary use of antibiotics (86.1% in the TRNC and 72.3% in the RoC) and the need of completing the full course of antibiotics, even if feeling better (85.7% in the TRNC and 64.0% in the RoC). These rates are higher than those in previous studies undertaken in different countries. For example, in a study by Pogurschi et al., the authors reported that the Romanian population was not disciplined enough when it comes to completing antibiotic treatments, as 29.2% of the respondents indicated they would stop the course of antibiotics if their symptoms improved . In a crIn the current study, both RoC and TRNC respondents found it more important that the GP does not prescribe an antibiotic when he/she thinks that they are not needed than prescribing them when the patient requests them. Based on group comparisons in attitude items, our study revealed that TRNC citizens preferred a stricter control of antibiotic use than RoC citizens did. In a similar study in Lebanon, the authors reported that almost half of the respondents (48.4%) expected their doctors to prescribe antibiotics to treat a common cold, with 15.4% of these respondents having asked their physicians to prescribe antibiotics when they suffered from common cold symptoms . In a meNotably, the differences in self-medication with antibiotics between Cyprus and other countries observed in this study are due to the availability of OTC sales of antibiotics on the island, in particular in the TRNC region. In many countries, including Cyprus, OTC sales of antibiotics are prohibited by law; yet, this does not necessarily mean that antibiotics are not sold OTC in those countries. Strategies to enforce regulations prohibiting OTC sales of antibiotics, such as retention of the prescriptions by pharmacies, government inspections, educational activities for healthcare workers and media campaigns for the general public, are among the approaches that should be implemented in both parts of Cyprus. Nevertheless, law enforcement requires resources for effective medicine registration systems, a good capacity for inspections and a legal system to impose penalties for breaches of regulations, none of which are in place in the TRNC. The results revealed that the recognition of antibiotics and their effectiveness, as well as the mechanisms of antibiotic resistance development, should be improved via educational efforts targeting both adults and children. Furthermore, a multifaceted approach should be conducted that combines education for school children, campaigns for the adult population and antibiotic stewardship programs for medical professionals. Appropriate curricula should be developed for medical and nonmedical undergraduate students about general medicines, the virulence of microorganisms, mechanism of antibiotic resistance and prudent antibiotic prescribing.The results of our study should be interpreted in the context of several limitations. The majority of the respondents from the RoC and TRNC were higher education graduates, with either a university/college degree ≤ 4 years or a university/college degree > 4 years. This could indicate that the accessibility of the survey was lower in certain geographical areas, such as rural areas, which may have introduced sampling bias. The study was based on a self-administered online survey in which the results were based on the honest feedback of the participants. This limitation was minimized by the anonymous nature of the study, as no personal identifiers were collected.This study also has several strengths. To the best of our knowledge, this is the first study to investigate and compare the knowledge and attitudes regarding antibiotics and antibiotic resistance among citizens of the RoC and TRNC. Hence, it provides important information and insights into the similarities and differences between the two populations living on this divided island. This study also contributes to our understanding of the issues in each of the two populations regarding antibiotic knowledge and use, which can be used by government agencies to implement strategies to address them, with a potential impact on healthcare in both Cypriot communities.The study design was a cross-sectional survey because the aim was to describe different aspects of antibiotic use, knowledge and attitudes in the Republic of Cyprus (RoC) and in the Turkish Republic of Northern Cyprus (TRNC). The populations chosen for the study were people living or studying in the RoC or TRNC.Sample size estimation with G*Power 3.1 application   at the University of Nicosia (SSERB 00137) approved the study.The questionnaire consisted of six sections. In t-tests, chi-square tests and Mann–Whitney U statistics. A p value of 0.05 or less was considered to be significant.All analyses were performed using IBM SPSS for Windows, version 27 . The knowledge, attitudes and practices of participants from the different communities were compared using independent samples In conclusion, the current study reveals that despite the less-controlled OTC sales and consumption of antibiotics in the TRNC, the citizens were more educated and knowledgeable about antibiotics, their effects, the risks of antibiotic resistance and its prevention compared to RoC citizens. This further highlights that within the same island, different communities can have varying levels of knowledge, attitude and perceptions regarding antibiotic use and antibiotic resistance. As TRNC and RoC citizens can freely visit both parts and interact with each other, the implementation of interventions should be targeted at both communities in order to ensure the appropriate control of antibiotic resistance on the island. These interventions should primarily include enforcing the existing legislation prohibiting over-the-counter (OTC) sales and multifaceted educational campaigns both at the community level and for community pharmacists in order to increase awareness and improve antibiotic use.