Cancer is the second most common cause of death among humans in the world, and the threat that it presents to human health is becoming more and more serious. The mechanisms of cancer development have not yet been fully elucidated, and new therapies are changing with each passing day. Evidence from the literature has validated the finding that the composition and modification of gut microbiota play an important role in the development of many different types of cancer. The results also demonstrate that there is a bidirectional interaction between the gut microbiota and radiotherapy treatments for cancer. In a nutshell, the modifications of the gut microbiota caused by radiotherapy have an effect on tumor radiosensitivity and, as a result, affect the efficacy of radiotherapy and show a certain radiation toxicity, which leads to numerous side effects. What is of new research significance is that the “gut-organ axis” formed by the gut microbiota may be one of the most interesting potential mechanisms, although the relevant research is still very limited. In this review, we combine new insights into the relationship between the gut microbiota, cancer, and radiotherapy. Based on our current comprehensive understanding of this relationship, we give an overview of the new cancer treatments based on the gut microbiota. Streptococcus in early gastric cancer (GC) patients significantly increased and has a strong correlation with the occurrence of GC and liver metastases [Currently, the world is experiencing a huge cancer burden that is still growing . Cancer tastases ,6. Ishaqtastases  conductetastases ,9,10. WiRadiotherapy is an effective method by which to treat tumors. The interaction between the gut microbiota and radiotherapy is a bidirectional function . RadiothThere are many factors affecting the development of cancer. In addition to lifestyle, genetic and epigenetic changes, and environmental factors, it is gradually being proven that the composition and changes in the gut microbiota also make a difference . The humH. pylori biofilm [To date, there have also been studies demonstrating a causal relationship between intestinal imbalance and cancer . Therefo biofilm .By consulting and synthesizing the literature, here, we preliminarily summarize the finding that various factors can lead to the dysregulation of microbiota, thereby destroying the biofilms. This may also further affect the occurrence and development of cancer through inflammation and immune regulation, signaling pathway activation, bacterial metabolite production, intestinal metabolism, and other aspects .Bacteroides fragilis and Fusobacterium nucleatum induced a tumorigenic inflammatory environment and increased the numbers of IL-17, IL-23, and neutrophils [S. enterica and Fusobacterium nucleatum (F. nucleatum) were found to cause tumors by affecting the Wnt signaling pathway. Researchers also found that some Helicobacter spp. had pathogenicity that affected the TGF-β signaling pathway. In addition, E. coli and its related toxins were found to be naturally associated with the p53 and Wnt signaling pathways [Helicobacter pylori in accelerating the development of gastric cancer, while the Yes-associated protein 1, a key effector of the Hippo pathway, is also involved in this process [Gut microbiota can promote the development of certain cancers, such as CRC, by stimulating chronic inflammation . At prestrophils . Differetrophils . Howevertrophils . At the pathways ,34. Othe process .Escherichia coli, induced DNA damage and toxin-induced dsDNA breaks [Helicobacter pylori, is a cytotoxin that induces inflammatory pathways in gastric cancer and may also be involved in the tumorigenesis of CRC [Faecalibacterium, was significantly reduced in the feces of patients with acute myeloid leukemia (AML), and that gavage of butyrate or Faecalibacterium delayed AML progression in mice. Studies have also found that the abundance of SCFAs and SCFA-producing bacteria was significantly reduced in CRC [2S in the human gut.In addition, the metabolism of the gut microbiota may also affect the progress of cancer . To sum A breaks ,37. CagAs of CRC . Recentls of CRC ,40. New s of CRC . Furthers of CRC . As the s of CRC . Wang ets of CRC  found thd in CRC . Howeverd in CRC ,45. Trimd in CRC . Recentld in CRC  showed tg_Christenenellaceae_R-7_group). In addition, functional pathways related to steroid biosynthesis and lipid digestion were inhibited in the same group.The host metabolism associated with the gut microbiota has also been proposed to participate in the development of cancer. Emerging evidence suggests that there is a very close relationship between the risk of colorectal cancer and the bile acid (BA)-gut microbiota (GM) axis . It is wThe development of new molecular techniques, such as 16S ribosomal RNA (rRNA) sequencing, DNA sequencing, and metagenomics, and the use of germ-free mice have gradually revealed the greater role of gut microbiota in host homeostasis . DiffereProteobacteria and Fusobacteria), and decreased beneficial microbiota  [Proteobacteria and decreases in Clostridiales, whereas after CRT, the gut microbiome composition changed, with increases in Bacteroides species. Additionally, Goudarzi et al. [The gut microbiota is affected by a variety of factors. As one of these many factors, radiotherapy leads to dysregulation of the gut microbiota, which is often manifested as decreased abundance and diversity of gut microbiota, increased harmful microbiota (cterium) ,58. Becacterium) . At prescterium)  found a i et al.  evaluateRadiotherapy is the cornerstone of modern management methods of malignant tumors, but it can also cause damage to normal tissues and produce a variety of side effects, affecting the treatment results and the quality of life of patients . Cancer Bacteroidetes, Bifidobacteria, Clostridium, Streptococcus, and so on [Pelvic radiotherapy often causes severe gastrointestinal adverse effects, which seriously hamper the long-term application of radiotherapy in tumor treatment . Interesnd so on ,71,72. Ind so on . Radiothnd so on . HoweverProteobacteria and Gamma proteobacteria, and a poorer abundance of Bacteroides. In patients with RE after radiotherapy, Coprococcus was significantly enriched prior to radiotherapy. In addition, studies have shown that high counts of Clostridium IV, Roseburia, and Phascolarctoxin are significantly associated with radiation enteritis. Steady-state intestinal mucosal cytokines related to regulating the gut microbiota and maintaining the intestinal wall are significantly reduced in radiation enteropathy [Radiotherapy for abdominal, pelvic, and retroperitoneal malignant tumors can cause many adverse reactions, among which radiation enteritis (RE) is one of the most serious and common intestinal complications. The intestinal diseases involved are extensive, complex, and persistent, leading to difficult and ineffective treatment . Nowadayeropathy .Dubosiella and Alistipes performs a necessary position in the disorder of lipid metabolism in the process of disease; five pairs of bacterial lipid metabolites manifest the strongest functional correlation with RE. In conclusion, it can be inferred that the dysregulation of the gut microbiota and lipid metabolism may affect the progress of RE. Moreover, the link between microbial bile acid (BA) metabolism and the progression of inflammatory bowel disease (IBD) has recently been revealed by clinical metagenomics and metabolomics [Bacteroides intestinalis, Bacteroides fragilis, and E. coli. When the balance of the microbiome is disturbed, the proportion of primary/secondary bile acids increases [With the increasingly clear relationship between the gut microbiota and radiation enteritis, more and more attention has been paid to the pathogenesis of radiation enteritis induced by radiation therapy in the context of the gut microbiota. The pathophysiological mechanism of gastrointestinal mucositis has been widely accepted as involving five stages . Previoubolomics . Bile acncreases ,82,83. Fncreases  suggesteBifidobacterium, Clostridium cluster XIVa, and Faecalibacterium prausnitzii are reduced, and Enterobacteriaceae and Bacteroidetes are increased, which may especially lead to diarrhea [Actinobacteria and Bacilli levels are increased in patients with diarrhea after radiotherapy [Clostridium strains to adult mice can alleviate the allergic diarrhea of models [In addition to RE, diarrhea is also a common radiation-related intestinal injury. Some studies have observed that pelvic radiotherapy can cause changes in the community composition of the gut microbiota at the level of phyla, order, or genus . Among tdiarrhea . There iotherapy . Some stotherapy ,87,88,89f models , furtherEubacterium, Streptococcus, Adlercreutzia, and Actinomyces in fatigue patients after CRT increased significantly, and the abundances of the microbial sucrose degradation pathways also increased [Bacteroidetes and Blautia2 differed between symptomatic and asymptomatic subjects [Nowadays, more and more studies have proposed that the microbial-mediated disturbance of intestinal mucosal homeostasis (dysregulation) is considered to be one of the pathogenetic factors of CRT-related fatigue. In recent years, some studies have found that compared with non-fatigue patients, the bacterial abundances of ncreased . In addisubjects . At the subjects . It is wsubjects  collectesubjects ,95.-Bacteroidete, Class-Bacteroidia and Order-Bacteroidales decreased in the CD group, while the levels of Genus-Allobaculum increased after WBRT. Therefore, CD induced by WBRT may be highly correlated with an abnormal composition of the gut microbiota. Furthermore, it has been reported that Rs4702-A is related to the increased expression of FURIN and brain-derived neurotrophic factor (BDNF) in the serum and peripheral blood mononuclear cells (PBMC) of glioma patients after radiotherapy, both of which are closely related to cognitive function. This study also found that Rs4702-A was significantly related to an increase in enterotype type I and a decrease in enterotype type III in the stool samples of glioma patients after radiotherapy [Bacteroidaceae family (Bacteroides genus) in the gut microbiota, it had no effect on gut microbiota diversity, systemic inflammation, and cognitive ability in mouse experiments. Therefore, the causal relationship between cognitive impairment and head irradiation may be much smaller than we have thought; instead, it is more likely to be due to the physiological and psychological effects of the disease itself [Brain metastasis (BM) is a common condition in 20–40% of cancer patients, which seriously affects the quality of life and survival rate of the patients. Nowadays, whole-brain radiotherapy (WBRT) has been widely used in the effective treatment of brain metastases. However, it cannot be ignored that a series of neuropsychiatric adverse reactions will occur in the process of WBRT, such as cognitive dysfunction (CD). Increasing evidence indicates that the pathogenesis of CD may be bound up with the gut microbiota and gut-microbiota-brain axis. Luo et al.  found thotherapy . This ale itself . ConsequBacteroides massiliensis, Muribaculum sp., and Prevotella denticola. The results showed that osteolytic injury caused by radiation was related to the type of bacterial indicator system composed of the gut microbiota [Except for gastrointestinal tract damage and the impact on the brain, radiotherapy can also cause damage and lesions in other organs; relevant studies show that this has a certain relationship with gut microbiota. Radiation pneumonia and fibrosis are very common in patients with chest tumors who are receiving radiotherapy, which can significantly reduce the survival rate and quality of life of patients. Chest irradiation can lead to the disorder of the lung and gut microbiota. It was found that phycocyanin intervention can regulate the pulmonary and intestinal microbiota to their normal state. This is characterized by a significantly decreased abundance of inflammation-related bacteria and the increased abundance of probiotics that produce short-chain fatty acids, which alleviates radiation-induced pneumonia and fibrosis . Hence, crobiota .The complex interactions between the gut microbiota and the host immune metabolic system affect the functions of other organs, forming an “axis” between them. The “gut-organ axis” directly or indirectly regulates physiological metabolic processes, which has an important impact on health and disease. Nowadays, studies have widely counseled that the gut-organ axis may also be a potential mechanism for the occurrence and development of specific cancers and radiation damage, but relevant research is only in the initial stages. The following figure shows a brief description of several gut-organ axes and human diseases .Oral and gut microbes are two major microbial ecosystems in the human body, both of which are physically and chemically linked . The traCurrent studies demonstrate that microbiota-induced peripheral immune responses can be translated into neuroinflammation via the vagus nerve of the gastrointestinal tract and the vasculature throughout the body . It is nBacteroidetes. Currently, psychotropic medications also act on several taxa and then exert their therapeutic effects. Early life trauma may alter the composition of the microbiome, thereby promoting proinflammatory cascades and increasing the risk of developing post-traumatic stress disorder. These findings demonstrate that alterations in the gut microbiota may affect brain function and also confirm the critical role of the gut-brain axis in neurologically related disorders [Recent emerging evidence has highlighted that the gut microbiota takes part in bidirectional communication between the gut and the brain . Studiesisorders .Pseudomonas gingivalis was found to promote the development of nonalcoholic fatty liver disease (NAFLD) and NASH in mice fed a high-fat diet, which may be associated with lipid accumulation, fibrosis, and inflammation in the liver [The available evidence suggests that there is also a close connection between the liver and the gut, with bidirectional communication, which is termed the “gut-liver axis”. Different mechanisms by which gut microbiota dysbiosis leads to liver injury have also been proposed over time. At present, the mechanisms of the relationship between gut microbiota and chronic hepatitis B (CHB) have been reported to include the following three aspects: (a) the increased permeability of the gut to microbiota and its metabolites, such as LPS; (b) normal bile acid metabolism and signaling are disrupted by gut microbiota; (c) colonization of the gut by invasive oral microbiota . Furtherhe liver ,124. It he liver .There is growing evidence that the gut microbiota may affect the body’s resistance to anti-cancer treatments, including chemotherapy, immunotherapy, radiotherapy, and surgery ,127,128.Crawford and Gordon provided a new perspective on the relationship between the gut microbiota and radiosensitivity by reporting that the gut microbiota increased the radiosensitivity of lymphocytes and endothelial cells in the mesenchymal core of small intestinal villi in sterile mice that received whole-body irradiation . A studyAkkermansia muciniphila and reduced the proportion of Firmicutes to Bacteroidetes [F. nucleatum was plentiful in recurrent CRC tissues after chemotherapy, which promoted the resistance of CRC to chemotherapy. In terms of the mechanism, F. nucleatum activates the autophagy pathway and subsequently changes colorectal cancer chemotherapeutic responses by targeting TLR4 and MYD88 innate immune signaling and specific microRNAs [Although there is growing testimony that the human gut microbiota works in radio resistance, in what way the gut microbiota impacts the response to radiotherapy still needs to be further studied and explored. Fast-induced adipokine (Fiaf) is normally secreted from the villous epithelium of the small intestine and is often inhibited by the gut microbiota, resulting in increased fatty acid storage in adipose tissues and the liver. Studies have shown that Fiaf deficiency leads to a loss of resistance to radiation-induced apoptosis in villous endothelial and lymphocyte populations ,137. It roidetes . In concroidetes . WhethericroRNAs . NowadayicroRNAs .Radiotherapy, as a well-recognized treatment and palliative method for cancer, has also been believed to induce an antitumor immune response, so immunomodulation could be one way in which the gut microbiota affects the radiotherapy response . The powRadiotherapy not only affects cancer cells but also the tumor microenvironment (TME), composed of tumor blood vessels and immune system cells. It can cause the destruction of endothelial cells and can trigger an inflammatory response. Damaged vessels inhibit tumor infiltration by CD8+ T lymphocytes and activate the immunosuppressive pathways . InteresIn vivo and clinically, the original immune effects generated by radiation are often much weaker than the immunosuppressive microenvironment characteristic of established cancers, so the original immune effects are overridden ,150. NevFaecalibacterium prausnitzii, Akkermansia muciniphila, and Bacteroides fragilis in the digestive tract can affect the incidence of cancer [Actinobacteria, as well as bacteria that produce butyrate, such as Lachnospiraceae. Many results indicated that the QX capsule may play a dual role in resisting tumors and enhancing immunity via microorganisms. Direct-contact moxibustion (DCM) used to be determined, in order to reduce Ruminococcaceae and Prevotellaceae bacteria (bacteria that produce SCFAs) and promote the growth of probiotic Akkermansia, thereby facilitating gastric mucosa apoptosis and delaying the development of gastric cancer [The intestinal inflammatory and immunosuppressive microenvironment created by oral-gut microbes is a key factor in the development and progression of CRC . Wang etf cancer . Probiotf cancer . Meanwhif cancer . Yang etf cancer  suggestec cancer . This stMucositis and other gastrointestinal symptoms caused by radiotherapy resulted in a decreased appetite and insufficient nutrient intake. This is a non-negligible reason for the lack of nutritional diversity and the increased risk of malnutrition in patients. Multiple nutritional methods based on the regulation of gut microbiota may be a new way to alleviate radioactive gastrointestinal syndrome . The theFirmicutes/Bacteroidetes and increasing the abundance of beneficial bacteria. In addition, EGCG has been proven to alleviate radiation-induced intestinal injury (RIII). The findings have provided new insights into the alleviation of RIII by EGCG, revealing that EGCG can regulate the gut microbiota for the prevention and treatment of RIII. Gastrointestinal damage caused by radiation can also be alleviated by oral gavage of A. muciniphila [Bifidobacterium counts and reduced the frequency of diarrhea after the end of pelvic radiotherapy [Oral mucositis (OM) is a common and unpreventable complication caused by chemoradiotherapy in patients with nasopharyngeal carcinoma. Chen et al.  evaluateiniphila . A cliniotherapy . Photobiotherapy . Kiat etotherapy  elucidatBased on all the above evidence, we have a primary perception of the complicated relationship between the gut microbiota, cancer, and radiotherapy . In viewThe relationship between the gut microbiota and radiotherapy is complex and far more varied than the current studies have shown. Although more and more studies have proved the positive effect of the gut microbiota on the efficacy of radiotherapy, there is still some indirect evidence that a negative effect also exists. Similarly, while it is widely accepted that radiotherapy-induced alterations in the gut microbiota lead to severe side effects, the function of certain unique gut microbiota in protecting against radiation-induced side effects has recently been discovered. Consequently, further in-depth study of the relationship between the two is necessary. Based on the limited research, the way in which the gut microbiota affects the efficacy of radiotherapy and causes various serious side effects are not fully understood. Although some researchers have proposed that the gut microbiota may additionally play a function in RT-related immune responses, there is no direct evidence. Interestingly, several “gut-organ axis” may be associated with radiotherapy-induced side effects. This may be one of the most potential targets in the future on which we can rely to prevent the side effects of radiotherapy, while also broadening the exciting field of gut microbiota-based cancer therapy.


Environmental deterioration and energy shortage have promoted the emergence of biorefinery. However, in the fermentation process of biorefinery, microbes are usually subjected to adverse environmental stresses, which negatively affect cell growth and productivity, ultimately limiting the development of green biomanufacturing. Therefore, exploration of approaches for stress adaptation and improved metabolism in microorganisms is of great significance. The current research topic aims to reveal the damaging effects of environmental stresses on microbial strains, and more importantly, introduce advanced strategies, including microbial adaptive evolution, fermentation strategy innovation, reprogramming of genetic circuits to improve the tolerance of microorganisms to adverse conditions. Meanwhile, with the development of emerging techniques, multi-omics such as global transcriptome, proteome and metabolome have been used for elucidation of the mechanisms of stress tolerance in microbes. It is therefore vitally important for the rational design and construction of the strains with a desirable phenotype of stress tolerance.Zhou et al., a strategy named microbial microdroplet culture (MMC) was applied for the adaptive evolution of G. oxydans to improve its tolerance to high substrate concentration and temperature. Compared with the traditional cultivation methods, MMC has high throughput, less reagent and labor cost, and superior cultivation properties in mixing and parallelization  conducted a comparative transcriptomic analysis to determine the gene expression profiles of C. glutamicum under high-lysine stress conditions. This study found several possible metabolic pathways that might offer favorable benefits for high-lysine adaptation. In the meanwhile, they identified a GrpE chaperone that confers high-lysine stress tolerance in C. glutamicum and demonstrated the importance of DNA repair component and energy transducing NADH dehydrogenase for protecting cells against the osmotic stress. Taken together, the multi-omics analysis will guide the rational design and construction of the strains against adverse condition stress.The development of multi-omics techniques in recent years have significantly facilitated the studies in engineering of microbial stress resistance. In, You et al., identified a single-point mutation in ClpX could boost the motility of E. coli via mediating the accumulation of the master regulator FlhDC, which might be an optional strategy that strains could take.Apart from the adaptation of adverse conditions, microorganisms evolve strategies to tolerant against the stresses. In the study of, Liu et al. verified the function of a predicted citrate transporter gene JKL54_04345 (citP) in L. plantarum for the first time. In another food industry, amino acid production, a study of was reported by Zhen et al. from South China University of Technology. This study identified a nitrogen consumption regulon AmtR in the industrial producer of L-glutamate, C. glutamicum. The AmtR regulator could enable the strain to grow in medium with creatine, a nitrogen source that could not be consumed originally, as a sole nitrogen source, which provides a strategy for strains to survive in a medium without suitable nutrition. The enhancement of substrate transportation or consumption can enhance the interaction between strains and the surroundings and thus alleviate the environmental stress.In wine production, the metabolism of organic acid by microorganism plays a significant role in cell growth, metabolism, and wine quality improvement. During this process, the uptake of extracellular organic acids by the transporters is the first rate-limiting step. In the study of, Chlorella provides high protein content with a balanced amino acid composition, but suffers from low production rate and high cost owing to its low salt tolerance (Jin et al. reported the ultrahigh-density fermentation of Chlorella sorokiniana with an innovation in nitrogen supply and strict control in fermentation parameters. This may enlighten the heterotrophic cultivation of other freshwater microalgae with similar problems.As an ideal protein source that is consumed, the unicellular green alga olerance . In ordeThere are still technical challenges have proven difficult to overcome, in part, because of inherent limitations in host organisms. Efforts have been made, but success is often limited because these microbes are frequently polygenic, requiring the manipulation of multiple genes to bring about substantial changes. Moreover, the detailed molecular mechanisms underpinning phenotype are not always fully understood. Nevertheless, the development of the multi-omics techniques may contribute to the rational construction of the strains against adverse condition stress from a global pattern.


Ultrasound is one of the most important imaging techniques in medicine and has endless advantages including portability, non-invasiveness, low cost, absence of radiation or contrast, real-time imaging, ease of use, and bedside assessment, in addition to facilitating decisions in medical practice –3. This Advances in technology associated with the growth of medical ultrasound education in undergraduate studies have facilitated the integration of point-of-care ultrasound (POCUS) not only in radiology and cardiology but also into a wider variety of fields such as anesthesia and emergency medicine , 7. In eIt is important to emphasize that this imaging technique is also being used to guide many procedures, biopsies, and surgeries .Experiences and advances in endocrinology point-of-care ultrasound (POCUS)” was to gather original research articles and review illustrations of the recent advances concerning the roles of ultrasound and its support in clinical practice especially in endocrinology. This Research Topic consists of five original articles.The objective of the Research Topic “Yong-ping et al. investigated the efficacy and safety of ultrasound-guided percutaneous laser ablation for treating recurrent papillary thyroid cancer nodules. They showed that the ultrasound-guided laser ablation is minimally invasive and common for patients with thyroid nodules and is a clinically effective, repeatable, and efficient outpatient treatment that is well-tolerated and is associated with a low risk of major complications. They concluded that the procedure appears to be effective and safe in treating unifocal recurrent nodules in selected patients who are ineligible for surgery, which is suitable for clinical application and promotion. Lin et al. investigated the efficacy and safety of radiofrequency ablation among cases attacked by large benign solid thyroid nodules, mainly focusing on volume reduction, complication rate, and thyroid function. They concluded that radiofrequency ablation is an efficient measure to treat large benign solid thyroid nodules, showing minimal invasion and reaching complete ablation to solve compression symptoms. Single or sequential regimen might ablate large nodules with great safety and assurance. The importance of ultrasound was highlighted in the different phases of the process from diagnosis to guide the procedure, assessment of the therapeutic response, and follow-up of patients.Two original articles deal with the theme interventional ultrasound to guide procedures in thyroid. Minimally invasive measures are applied in nodules and tumors like laser ablation, ethanol ablation, and radiofrequency ablation. Both articles highlighted the importance of diagnosing thyroid nodules and predicting the differentiation between benign and malignant lesions and is never too much to emphasize that ultrasound is the first-line imaging examination for the malignancy risk assessment of thyroid nodules . Yong-piNi et al. aimed to investigate the changes in PTH, serum calcium, and volume of ablated lesions in hyperparathyroidism patients, and evaluate skeletal and renal functions to further evaluate the efficacy and safety of ultrasound-guided procedure. They verified that the procedure is a reasonable option in the treatment of PHPT, especially asymptomatic patients with potential target organ damage or a mild condition. They concluded that ultrasound-guided ablation effectively decreases levels of abnormal bone turnover markers and thus improve bone health of these patients. It is important to highlight that the evaluation of the parathyroid glands is even more difficult due to the small size of these anatomical structures, and ultrasound is fundamental in the procedure.The third article deals with the efficacy and safety of ultrasound-guided microwave ablation in the treatment of primary hyperparathyroidism (PHPT). Gao et al. accentuated the ultrasound features like nodule size, boundary, shape, internal echo, aspect ratio, capsular contact, microcalcifications, blood flow, and the procedure guided by ultrasound. They identified the following three significant independent predictors for central cervical lymph node metastasis in papillary thyroid carcinoma: tumor size (measured by ultrasound), US features , and thyroglobulin antibodies (being positive).The fourth article deals with the predictors of central cervical lymph node metastasis for papillary thyroid carcinoma and establishes a prediction model to guide the operation of these patients. As they pointed out in their article, “US features, including spotty microcalcifications and aspect ratio, are vital information for differentiating malignant nodules from benign nodules.” Wang et al. investigated the value of dynamic AI in differentiating benign and malignant thyroid nodules and guiding treatment strategies. They discussed that diagnostic results are affected by several factors such as operator's experience and skills, ultrasound equipment, and thyroid basic lesions, and concluded that the dynamic AI examination has high diagnostic value for benign and malignant thyroid nodules, which can effectively assist surgeons in planning individualized diagnosis and treatment strategies for patients.Finally, the last original article brings innovation, It is an eveolving theme which deals with dynamic artificial intelligence (AI) ultrasound auxiliary diagnosis system. Experiences and Advances in Endocrinology Point-of-Care Ultrasound (POCUS)” provide a useful source of information concerning the role of ultrasound in endocrinology from diagnosis to guide procedures, assessment of the therapeutic response, and follow-up of patients.In summary, the articles presented in the Research Topic “All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.


Infectious diseases have repeatedly reshaped the course of civilization, resulting in significant morbidity and mortality around the world. Infectious diseases respect neither borders nor barriers and 70% of the world is underprepared to prevent, detect, and respond to them quickly and effectively. .SARS-CoV-2 is the example of the latest emerging pathogen resulting in over 426 million cases including 5.9 million deaths across the globe [The crushing demands of the COVID-19 pandemic have strained health care systems and capacity around the world. Many communities have been responding to the pandemic and grappling with the collateral damage of COVID-19 on other public health crises including infectious diseases.Compared with other countries around the world, Pakistan has had a relatively mild experience with the COVID-19 pandemic. On the other hand, Pakistan is endemic to multiple infectious diseases including typhoid, dengue, and Measles, which were already on the rise and have been compounded by the COVID-19 pandemic. Due to the disruption of immunization and other essential services for infectious diseases including Typhoid, Measles, and dengue the un precedential rise in cases was reported in 2021 in Pakistan. As of December 2021, over 174 000 typhoid cases including 15 deaths have been reported in the country as compared to 22 000 cases reported from 2016 to 2020 . SimilarCurrently, Pakistan is facing four  of the biggest public health crises in its history. It is widely accepted that the COVID-19 pandemic is putting a great burden on the strength, capacity as well as capability of the health care system across the globe by demanding financial, laboratory, and trained human resources. Multiple vaccines against COVID-19 are available on the markets but there are worries that the emergence of variants of concern could escape the immunity conferred by the previous COVID-19 infection as well as by the available vaccines. Pakistan is the first county in the world to introduce the typhoid conjugate vaccine in the routine immunization schedule in 2019 . AlthougTo successfully tackle multiple outbreaks, focused interventions such as proper investment in public health, coverage of routine immunization, stringent vector control measures, active laboratory testing, patient isolation, availability of diagnostic kits, awareness campaigns through electronic, print, and social media, vaccination against hesitancy, timely response, stainable strategies are urgently needed.Health authorities and policymakers, especially those in high-risk areas of Pakistan, should fully consider the burden of other infectious diseases in the era of the COVID-19 pandemic by developing sustained policies with a focus on the control, prevention, and elimination of other infectious diseases.Otherwise, the COVID-19 pandemic could derail promising control and elimination efforts for typhoid, dengue, and measles in Pakistan. If the stringent measures are not taken on urgent bases, the derailment of the other infectious diseases control and elimination due to COVID-19 represents a new urgency for Pakistan and its impact will be behind the borders.


In this community case study, we describe the process within an academic-community partnership of adapting UNIDOS, a community health worker (CHW)-led community-clinical linkages (CCL) intervention targeting Latinx adults in Arizona, to the evolving landscape of the COVID-19 pandemic. Consistent with community-based participatory research principles, academic and community-based partners made decisions regarding changes to the intervention study protocol, specifically the intervention objectives, participant recruitment methods, CHW trainings, data collection measures and management, and mode of intervention delivery. Insights from this case study demonstrate the importance of community-based participatory research in successfully modifying the intervention to the conditions of the pandemic and also the cultural background of Latinx participants. This case study also illustrates how a CHW-led CCL intervention can address social determinants of health, in which the pandemic further exposed longstanding inequities along racial and ethnic lines in the United States. The coronavirus disease 2019 (COVID-19) is an unprecedented threat to global public health that has drastically changed public health research agendas, and the ways in which we conduct health intervention research. With the restrictions imposed to mitigate COVID-19 transmission, health intervention research planned prior to the pandemic has become challenged and constrained. Finding ways to modify health intervention delivery has been critical because health promotion, specifically for chronic disease prevention, is paramount due to the known link between chronic disease and increased risk of COVID-19 morbidity and mortality . ResearcCBPR is driven by consistent collaboration between researchers, community members, and community entities to determine the research objectives, collect data, analyze the results, disseminate the results, and create plans for sustainability . Thus, CThe pandemic further clarified the importance of addressing SDOH issues within health promotion interventions. Given the timing of implementing UNIDOS in relation to the pandemic, the intervention needed to be responsive to evolving SDOH needs and COVID-19 safety precautions. In this community case study, we describe the process through which our academic-community partnership used CBPR to adapt the protocol of the UNIDOS intervention (which at the time of writing this article the intervention is ongoing) during COVID-19, focusing on Mexican-origin communities along the U.S.-Mexico border. The description of the adaptation is based upon internal conversations with UNIDOS personnel who represent academic institutions, FQHCs, and LCHDs.The UNIDOS intervention prioritizes adults of Latinx origin residing within four Arizona counties: Yuma County, Pima County, Maricopa County, and Santa Cruz County. These counties are proximal to the U.S.-Mexico border, and are also home to a significant proportion of the Mexican-origin population within Arizona. Prior to the pandemic, residents of the border region were already facing challenges to their SDOH needs which negatively affected their health status. Border residents are twice as likely to live in poverty, face barriers to healthcare access, and experience higher rates of unemployment than the population of any U.S. state . AdditioThe pandemic also impacted the operations of the UNIDOS intervention's community partners. The UNIDOS intervention is facilitated by community health workers (CHWs) situated within FQHCs and LCHDs in each of the counties. At the beginning of the pandemic, patient volumes within some of the partnering FQHCs dropped and clinic personnel, including CHWs, were laid off or furloughed. Additionally, some of the health promotion activities  were paused due to social distancing constraints and personnel changes. Within the LCHDs, CHWs were immediately involved in various COVID-19 response efforts . The UNIDOS intervention was adapted within this landscape of instability experienced by residents and health systems of Southern Arizona.The academic and community partners of the AzPRC have a more than 25 year history of initiatives aimed to enhance the impact of CHWs in community and clinical settings. The activities of the AzPRC are based upon shared leadership with the Community Action Board (CAB), consisting of organizational and community members of Southern Arizona's border region. The overall objectives of the AzPRC in partnership with the CAB are to advance health in border communities, reduce ethnic disparities in health, promote the CHW model for health promotion, study chronic disease interventions with partners in the border region, and interrelate these activities with community development and advocacy of systems or policy change. The collaborative research endeavors of the AzPRC are based upon the tenets of CBPR, which are embedded into our guiding principles. To this end, the AzPRC uses various tools to continuously evaluate its partnership activities and the engagement of community agencies, to ensure equity within the research collaborations . As partUNIDOS is a CHW-led, SDOH-focused intervention based upon a community-clinical linkages (CCL) model within each partnering county. CCL models are a health systems approach to addressing SDOH that extend the continuum of care from clinical settings to the community and are designed to improve patient access to community and public health services . The intThe following section describes how the academic-community partnership, specifically the CAB's research committee, modified the research process and components of the UNIDOS intervention to meet the challenges of the COVID-19 pandemic. As previously mentioned, CBPR necessitated that changes were made in collaboration with the community partners based upon their observations and experiences within the four UNIDOS sites. In response to the pandemic, the CAB's research committee made changes to the intervention objectives, participant recruitment methods, CHW training, intervention delivery, and data collection/management within the research protocol, as summarized in The intensification of COVID-19 transmission and the disproportionate burden of COVID-19 on Latinx communities prompted initial discussions regarding the relevance of UNIDOS during the pandemic. The original objectives of the UNIDOS intervention were to (1) reduce chronic disease risk and (2) enhance social support and strengthen social networks to improve participants' health status. For the first objective, UNIDOS reduces chronic disease risk via CHWs addressing participants' SDOH needs through connections to local services and resources. There was agreement among the community partners that addressing SDOH was fundamental to the intervention. Moreover, the partners recognized that participants were in immediate need of COVID-19 information and education  while also confronting pressing socio-economic challenges  and were unaware of resources that could assist them. Collaborative discussions between the academic and community partners generated consensus that tackling participants' SDOH challenges via the UNIDOS CCL model could simultaneously address participants' pandemic-related challenges and chronic disease risk. Thus, the primary objective of UNIDOS remained the same, but the mechanism through which chronic disease risk would be reduced  would also serve to address participants' pandemic-related needs that either emerged during or were exacerbated by COVID-19. For the second objective, the CAB's research committee felt strongly that enhancing participants' social support (via their interactions with the CHWs) was still a crucial component of the intervention due to increasing isolation experienced by community members as well as the ongoing uncertainties and stressors of the pandemic. Many participants were unable to see family members and friends for prolonged periods of time, and were experiencing anxiety and fear surrounding COVID-19 and economic challenges. As such, increased social support from the CHWs would not only be a mechanism for improved health status but also address an immediate impact of the pandemic and bolster participants' emotional wellbeing. Furthermore, CHW social support was critical given that participants could not tap into their social networks as before and thus could not be a leverageable component of the intervention. In sum, the partners felt that the activities of the UNIDOS intervention  could address participants' pandemic-related needs, and the original objectives of UNIDOS could be applied in the pandemic context.Prior to COVID-19, the CHWs were going to recruit participants solely through in-person interactions in community and clinical settings . However, the CAB's research committee agreed that direct face-to-face contact with participants could no longer continue under the threat of COVID-19. To facilitate participant recruitment safely, each site innovated community-based recruitment strategies. For example, CHWs increasingly relied upon alliances with local agencies who served the target population  to help reach eligible participants, and these agencies also shared information regarding the UNIDOS intervention on their social media and website pages. CHWs also utilized local and bilingual newspaper, radio, and news broadcasts as mediums to disseminate study information within their communities. Another strategy was to pair participant recruitment with COVID-19 efforts. For example, one site distributed UNIDOS flyers with consent forms to individuals being monitored in their cars after receiving COVID-19 vaccinations at vaccine points of distribution (PODs). Additionally, another site followed-up with people who had received a COVID-19 contact tracing call to inform community members regarding UNIDOS and conduct the consent process over the phone if individuals were eligible and interested in participating.The Arizona Community Health Outreach Worker Association (AzCHOW) has been responsible for training CHWs facilitating the UNIDOS intervention. Originally the training was intended to primarily focus on core competencies  and create a peer-support network to allow the CHWs to share best-practices in the field. More experienced CHWs have utilized the training time to mentor newer CHWs, for example through role-playing exercises. The training also includes information on human subjects' protocols, data collection, and data management. Due to COVID-19, AzCHOW has incorporated pandemic-specific trainings on topics such as the impact of COVID-19 on farmworkers and COVID-19 vaccine promotion. The increasing demands placed on CHWs due to participants' complex pandemic-related needs also prompted AzCHOW to include discussions of CHWs' mental health. For example, the AzCHOW facilitators led training sessions on stress management and self-care, avoiding burn out, meditation, and grounding yourself. This CHW training has served as a space for CHWs to discuss the stressors they are experiencing during the pandemic as residents of their communities and facilitators of UNIDOS.The collaborating FQHCs and LCHDs also provided pandemic-related training for the CHWs. As previously mentioned, the CHWs in some counties were mobilized into pandemic-response efforts at the outset of COVID-19, and they underwent contact tracing and isolation guidelines trainings. Also, some of the CHWs received suicide prevention training in response to increased depression and mental health struggles experienced by their community's residents.UNIDOS is based upon a CCL framework where CHWs connect participants to (1) health promotion classes offered by LCHDs , (2) SDOH services within the community , and (3) CHW-facilitated social support. Due to COVID-19, modifications were made to the intervention delivery as well as the resources that participants were being referred to. For service referral, the available health promotion classes that CHWs were linking participants to transitioned to a virtual format in some sites . Also, the SDOH services expanded as needs emerging from the pandemic proliferated and/or were exacerbated, and local, state, and federal relief resources were created in response. Relief resources included services such as emergency housing, food banks, workforce development, and free internet access. The CHWs also provided participants with information regarding COVID-19 testing sites, safety precautions , and how to access COVID-19 vaccines. In some instances, the CHWs helped participants directly make COVID-19 vaccination appointments once they were eligible. Linking participants to health promotion classes, SDOH services, and/or COVID-19 resources required the CHWs to spend time coaching individuals on how to utilize virtual technologies such as email, Zoom, or telehealth platforms. Lastly, the social support activities of UNIDOS had to be restricted to individual interactions between the CHW and participant , as in-person one-on-one and peer support groups did not allow for maintaining adequate social distancing. Within the monthly follow-up visits, CHWs continued to discuss participants' abilities to access resources but have given increased focus to providing emotional support to help participants cope with the additive stressors related to COVID-19 . In some cases, CHWs also provided support around grieving when a participant experienced the loss of a friend or family member from COVID-19.To assess the efficacy of and fidelity to the UNIDOS intervention, CHWs facilitated a questionnaire encompassing a variety of qualitative and quantitative indicators. CHWs administered the questionnaire with participants at baseline, 3, and 6-months, and also completed a follow-up form at each monthly visit (baseline−6 months) to document participants' health status, their challenges and/or progress made regarding their wellness goals, and the action plan to address their needs. CHWs input data into the REDCap database. The questionnaire, prior to any changes, assessed participants' demographics, physical and emotional health, social support and social networks, sociocultural resilience and SDOH needs. CHWs also noted participants' engagement in referred SDOH services at each follow-up visit. Given that the focus of the UNIDOS intervention had shifted to helping participants navigate the COVID-19 landscape, study assessments were both added and modified. The academic researchers recommended questions that were being used in other COVID-19 research projects to the CAB's research committee, and the research committee members provided input and revised the new study assessments to ensure that the questions reflected the challenges experienced by community residents.First, a COVID-19 questionnaire was added to the questionnaire to document participants' concerns and needs regarding COVID-19, encompassing health concerns , social concerns , economic concerns , and internet access. Secondly, per the suggestion of the community partners, we integrated information regarding relevant SDOH services and resources into the COVID-19 questionnaire and Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) instruments . In this way, we transformed the UNIDOS database into not only a tool to collect data but also an active resource hub. In REDCap, our team applied branching logic to the COVID-19 and PRAPARE questionnaires so that resources  appeared on the screen based on participants' responses. Because the resources were often county-specific as community-level organizations and institutions  sought to address local needs, we created two separate databases for each set of counties , with each database containing resources specific to those counties. Because resource information was rapidly changing, the CHWs, UNIDOS program coordinator, and the AzPRC database manager communicated regularly to update the database. The flow of the resource instruments (COVID-19 and PRAPARE forms) within the REDCap databases was structured as follows: If a participant responded in a manner indicating needing a resource , county-specific and/or state- wide and/or national resources would then populate underneath the question. In this example, the CHW would see a list of rent assistance or shelter resources appear within the database. The CHW would then indicate whether a specific resource was provided to the participant by clicking a “Yes” or “No” radio button to facilitate more robust action planning detailed in subsequent notes and record keeping. This responsive format had two advantages: (1) it gave CHWs the ability to immediately provide and document needed referrals and (2) it saved CHWs' time because they did not need to search for resources or sift through unapplicable information .At the time of writing this article, the UNIDOS intervention remains ongoing. To date, CHWs in Pima and Yuma counties have successfully navigated a cohort of participants through the full 6-months of the adapted intervention. Maricopa and Santa Cruz counties have recently initiated implementing UNIDOS (December 2021). Additionally, while the intervention continues to be implemented, the process of adapting UNIDOS provides important lessons learned for practitioners and researchers.As of December 2021, 125 participants had enrolled in the UNIDOS intervention across Pima and Yuma counties. By this date, CHWs in Yuma and Pima counties had made service referrals across a broad spectrum of needs based upon participants' responses to the PRAPARE and COVID-19 forms. For example, in response to housing needs, the CHWs made 48 referrals to housing shelters, and 59 referrals to eviction/rent/utility assistance services. CHWs also made 15 referrals to unemployment services . To address food insecurity, CHWs made 26 referrals to local food pantries. Overall, CHWs made 197 service referrals across Yuma and Pima counties for mental health , representing the most prevalent service referral.Successfully adapting the UNIDOS intervention required overcoming several challenges, which stemmed from uncertainties regarding the relevance of UNIDOS and difficulties in its implementation during the pandemic. These challenges, the facilitators/assets utilized to overcome them, and key lessons learned are summarized in Once the CAB's research committee determined that UNIDOS needed to be conducted online and/or over the phone, the CHWs were able to develop alternative strategies to continue participant recruitment while maximizing participant benefit of the adapted virtual intervention. Additionally, the academic researchers needed to be flexible with the UNIDOS protocol, given the demands placed on community partners as they were responding to and/or being impacted by COVID-19 in real time. In other words, due to the pandemic, strict fidelity to the original UNIDOS protocol was not practical. Lastly, the CCL model positioned CHWs to effectively link community residents to a network of service providers to address pandemic-related challenges. To that end, partnerships with local agencies, developed by the CHWs and their supervisors, have been crucial to participant recruitment and service referral within the intervention. For example, one CHW supervisor had a relationship with an emergency housing organization which a CHW leveraged to provide housing to a participant facing eviction.Also, while CHWs have been able to effectively establish rapport with participants, the CHWs initially felt challenged by the socially-distanced interactions with participants which were primarily over the phone. If a participant was in emotional distress, the CHWs were not able to see participants' facial expressions (if speaking via phone), nor hug or touch them. Some CHWs were concerned that this degree of separation might result in participants perceiving the interaction with the CHW as cold, especially given the importance of interpersonal warmth in Latinx cultures. To better gauge the emotional state of the participant, some CHWs adapted by paying close attention to the tone of the participants' voices and listening for verbal cues. One CHW has also increasingly focused on the way in which she verbally responds to participants over the phone to ensure that participants are feeling supported despite the lack of in-person interaction. In spite of these communication barriers, UNIDOS CHWs have been able to provide participants with ongoing social support during the pandemic despite not being able to meet face-to-face with them. The UNIDOS CHWs and their supervisors note that participants greatly appreciate the phone calls from the CHWs and having someone check-in on them, especially as the pandemic was intensifying and family visitation was restricted. There were instances when the follow-up phone calls were participants' only source of social interaction that particular day, increasing the importance and impact of CHW follow-up.Another issue CHWs encountered was participants' unfamiliarity with internet and computer technology, especially among older participants. Many participants did not know how to use and/or have access to a computer, tablet, or smart phone. If they did have computer access, CHWs noted that elderly participants were intimidated by using Zoom, and sometimes were hesitant to learn how to use it. Also, during the pandemic, accessing services increasingly moved to online platforms, and CHWs took on the additional task of providing intensive coaching on how to use the internet or create an email account so participants could successfully utilize a resource . However, in other instances, the CHWs have acknowledged that virtual programming has been useful in reaching participants who normally confront transportation or childcare barriers. At the time of writing this article, the UNIDOS community partners are considering offering face-to-face CHW-participant interactions when safety permits, while continuing to offer remote participation options .Lastly, a unique feature of the UNIDOS intervention is the dual use of the REDCap database as a data collection platform and active resource hub. CHWs used the data collected from the COVID-19 and PRAPARE assessments specifically to document participants' pandemic and broader SDOH-related needs, as well as to guide service referral. Capturing data on CHWs' referrals to specific services was challenging at times because of the dynamically changing landscape of COVID-19 relief resources. The database manager continuously modified the REDCap database based upon the creation and termination of relief services, most of which were specific to a UNIDOS county site. Available resources were consistently in flux over the course of the pandemic as new services were created or not sustained. Keeping the database up to date so that CHWs could refer participants to active services required constant communication between the CHWs, the AzPRC program coordinator, and the database manager. Thus, in essence, the REDCap database served as an active resource hub for the CHWs as they assisted participants in navigating the COVID-19 landscape by linking them to service providers. Also, given the success and adoption of the REDCap databases for UNIDOS, it is acting as a template for future CBPR projects.The emergence of COVID-19 necessitated adapting the protocol and delivery of the UNIDOS intervention. This case study exemplifies how an academic-community partnership utilized CBPR to successfully modify UNIDOS to meet the challenges created or worsened by the COVID-19 landscape. Because the design and procedures of UNIDOS were dynamically changing alongside the conditions of the pandemic, the academic team and community partners continuously reevaluated the study objectives, participant recruitment methods, CHW training modules, intervention procedures, and study assessments to adequately respond to COVID-19. Moreover, during the pandemic CHWs successfully linked participants to a variety of SDOH resources, suggesting their effectiveness within pandemic settings.Our case study underscores the centrality of CBPR for successfully adapting health intervention studies during the COVID-19 pandemic. Per CBPR, communities co-design the intervention and the process of intervention design can be flexible and iterative. These two methodological aspects of CBPR were critical in modifying UNIDOS during the pandemic. CBPR elevated the community partners as leaders within the research team, which was important for adapting UNIDOS as the community partners possessed expertise on participants' needs and the realities of COVID-19 on the ground. Additionally, CBPR provided the space from which the academic-community partnership could jointly assess the relevance and practicality of the UNIDOS intervention as the pandemic evolved, and make ongoing changes to the intervention protocol. Thus, to maximize the responsiveness of community-based interventions to the pandemic and beyond as communities recover, participatory research methods will remain a critical tool for research teams engaged in these types of health intervention studies.The case study also emphasizes the importance of having CHWs implement health promotion strategies as part of pandemic response. Within UNIDOS, the CHWs' connections with local agencies were critical to addressing participants' SDOH needs which were caused or worsened by COVID-19. CHWs' position as trusted members within their communities was essential to reaching and engaging Latinx adults in the CCL model. By cultivating strong rapport with participants, the CHWs were able to provide needed education on COVID-19 transmission, mitigation strategies, testing, and vaccines (among other activities). This is noteworthy given that ethnic-minority populations have been disproportionately affected by the pandemic, both in terms of COVID-19 infection/death as well as the pandemic's socioeconomic effects. As a result, there has been a need for public health professionals who can successfully reach vulnerable communities to disseminate COVID-19 information and connect them to resources addressing their SDOH needs; our case study suggests that the CHW workforce is ideally suited to fulfill these gaps in the pandemic response. Echoing this observation, the Centers for Disease Control and Prevention (CDC) has recognized that CHWs are well positioned to assist communities most impacted by COVID-19  and their involvement could be expanded to help these communities move toward health equity .The UNIDOS intervention, based upon a CHW-led CCL model, was originally designed to address chronic disease risk and emotional wellbeing among Latinx communities in the border region of Arizona. The COVID-19 pandemic necessitated the adaptation of UNIDOS, and this case study demonstrates the importance of CBPR in modifying a health intervention to address SDOH needs created or worsened by the global pandemic. Because of the trusting relationships within the longstanding academic-community partnership, the academic team and community partners were able to make needed changes to the intervention objectives, methods of participant recruitment, CHW training, intervention delivery, and data collection/data management practices in order to successfully respond to COVID-19. This case study also exemplifies how a CHW-led CCL intervention was leveraged as a means of pandemic-response to tackle participants' SDOH needs, which were caused or exacerbated by COVID-19. Because COVID-19 further exposed longstanding inequities along racial and ethnic lines in the U.S., elevating interventions like UNIDOS is necessary to more intentionally connect ethnic-minority communities to needed SDOH services and resources.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by University of Arizona. The patients/participants provided their written informed consent to participate in this study.KC led the development of the manuscript and conducted the interviews with the academic and community partners involved in implementing the UNIDOS intervention. KC and MI collaborated on the conceptualization of the community case study. KC, MI, and AW-L developed the interview guide utilized to interview the academic and community partners. AL, CF, GC, CE, ME, SM, MV, LI-K, and MB participated in the interviews and provided their insights regarding the process of adapting UNIDOS and specific modifications that were made given their role in the research project. All authors contributed to the article and approved the submitted version.This publication is a product of a Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number (DP19-001) from the Centers for Disease Control and Prevention.The findings and conclusions in this report manuscript are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Mobility and migration of plants are highly restricted. To maintain cellular homeostasis, plants have to coordinate various endogenous and external signals, with autophagy playing a critical role in those processes. Autophagy is a programmed cellular mechanism that can deliver unwanted targets  for degradation in the lytic organelle (the vacuole in plants). In addition to sustaining a basal low level of autophagy for plant growth, different environmental stresses, biotic (pathogen or virus infection etc.), or abiotic , can trigger autophagy induction to counteract stresses for survival.Wang et al. comprehensively reviewed the mechanism, activation, and signaling pathways of autophagy in plants. The authors introduced the three major types of autophagy found in plants, namely microautophagy, macroautophagy, and megaautophagy, and their mechanisms. Among them, macroautophagy, referred to as autophagy from here on, is the most described and well-studied. The authors went on to describe the activation of plant autophagy, mainly the initiation of autophagy by Target of Rapamycin (TOR) kinase, in greater detail.In the scope of this Research Topic, Autophagy was shown to be induced by nutrient starvation. The manuscript describes the various nutrients whose deprivation induces autophagy, such as nitrogen, carbon, sulfur, and phosphorus. Autophagy also plays a vital role in response to biological factors such as pathogens or viruses that adversely affect the growth of plants, which has been described well in this review. On the one hand, autophagy can promote the hypersensitive response (HR) to prevent the invasion of pathogens. On the other hand, autophagy is also affected by the pathogens, thereby facilitating their invasion.Autophagy is also induced by plant abiotic stress. The authors introduced the adverse effects of various stresses, providing recent examples of the role of autophagy in plant stress tolerance. In the last part of the review, the authors made great efforts to describe the regulation of autophagy by hormonal signals such as abscisic acid, ethylene, brassinosteroids, auxin, and jasmonic acid, which can indeed induce the autophagy to help plants cope with stress. Overall, the authors reviewed many studies on autophagy, thus conveying essential information to researchers and exploring the content of follow-up research.via an autophagic route in adjacent aleurone cells. In this Research Topic, Ding et al. showed that prolamins were directly taken up by vacuoles in aleurone cells via a process resembling microautophagy. They further identified 143 candidate proteins involved in microautopahgy in aleurone cells by transcriptomic and proteomic approaches. Two listed proteins, namely phospholipase-Dα5 and a putative Euonymus lectin (EUL)-related protein were shown to alter tonoplast morphology and promote vacuolar invagination when overexpressed in Arabidopsis thaliana leaf protoplasts. They also accumulate specifically at the tonoplast surfaces involved in the engulfment of protein bodies, thus implying their potential roles in membrane modification and/or microautophagy. This study represents an important contribution for future dissecting the mechanism of microautophagy in plants.The underlying mechanism of microautophagy remains largely unknown in most organisms, especially in plants. During maize endosperm development, the main storage proteins prolamins in starchy endosperm cells accumulate directly in protein bodies within the endoplasmic reticulum (ER). In contrast, they are transported to vacuoles Liu et al. comprehensively summarized and classified the AIM or UIM motif-containing proteins in plants. More importantly, they discussed the conserved and diversified functions of these proteins in the regulation of various types of selective autophagy and other biological processes. The manuscript provides a sound basis for the future functional study of AIM or UIM motif-containing proteins in plants.Selective autophagy is an important mechanism that helps selectively remove cellular components such as protein aggregates or damaged organelles through the autophagy pathway. In this process, autophagy receptors containing ATG8-interacting motif (AIM) or ubiquitin-interacting motif (UIM) can bind to both the cargo molecules and ATG8, thereby facilitating autophagosome formation or recruitment of autophagy substrates. Compared with selective autophagy research in mammalian and yeast systems, studies regarding the autophagy receptors involved in the regulation of selective autophagy in plants are more scarce. In this Research Topic, Shiraishi and Sakai discussed the strategies (with a particular focus on autophagy) that eukaryotic microbes leverage to propagate in the phyllosphere. Candida boidinii is a methylotrophic yeast that can live and grow on the leaf surface of Arabidopsis. Using this unique system, it was found that daily methanol fluctuation in the phyllosphere was critical for pathogen survival. In line with this finding, studies in Komagataella phaffii showed that a family of Wsc family proteins could sense the levels of extracellular methanol and regulate pexophagy in a negative manner. In addition to autophagy, the Cvt (cytoplasm-to-vacuole targeting) pathway was also found to be required for yeast nitrogen homeostasis. The underlying mechanisms regarding the interactions between Cvt and autophagy in plant-microbe interactions warrant further investigation.As mentioned above, autophagy has been extensively studied in plant-microbe interactions. However, from the perspective of microbes, the role of autophagy in their host colonization is less touched. Thanthrige et al. summarize the current knowledge regarding the role of autophagy in plant stress response, particularly focusing on stresses encountered under field conditions. They also touch upon the function of autophagy in nutrient remobilization, also affecting plant growth and yield. Interestingly, the authors highlight the possible role of autophagy in plant-symbiont interaction, a fascinating research topic that should be further explored.As autophagy has been shown to impact plant growth and yield, specifically during biotic and abiotic stress, it has been postulated that manipulating autophagy may positively affect plant growth under field conditions. In their review manuscript featured as part of this research topic, ATG genes has been shown to alleviate abiotic stress in many plant species and possibly promote pathogen resistance. In addition, several transcription factors were shown to influence autophagy activation. These can also be considered as targets for autophagy enhancement. Apart from its activation for increased stress tolerance, autophagy can also be used to improve nutrient remobilization to seeds and biofuel crops, specifically under non-favorable conditions. Although transgenic approaches demonstrate promising results, non-tersgenic approaches for autophagy induction are also being sought out. The authors describe the current efforts made today and point to interesting new avenues to be explored in that field.The authors go on to describe the possible ways in which autophagy can be manipulated in crops to improve plant stress tolerance. Transgenic over-expression of Finally, the authors raise the issue of selective autophagy and crop improvement. Until now, studies focused on enhancing general autophagic flux, rather than focusing on the selective degradation of stress-specific targets. Modulating selective autophagy may confer higher precision to autophagy modulation, circumventing trade-offs between growth and stress response. The authors point to several exciting directions to be explored regarding plant autophagy and crop improvement in the following years.All authors contributed to the drafting of this Editorial. YB and TA-W revised the Editorial. YB, CG, TA-W, JZ, and FL approved it for publication. All authors contributed to the article and approved the submitted version.Research in the lab of YB was supported by the National Natural Science Foundation of China (32170282) and China Agriculture Research System of MOF and MARA. Research in the lab of CG was supported by grants from the National Natural Science Foundation of China (32061160467 and 31870171). Research in the lab of TA-W was supported by the Israel Science Foundation (ISF), grant number 1942/19. Research in the lab of JZ was supported by the Fundamental Research Funds for the Central Universities (226-2022-00122). Research in the lab of FL was supported by National Natural Science Foundation of China (31970307).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Previous research on corporate governance has extensively explored the motives of corporate fraud. However, this research has paid little attention to employees, the real executors of fraud, resulting in the psychological and behavioral decision-making process of employees who commit fraud in enterprises becoming a “black box” that has not yet been opened. Based on the theory of planned behavior, our study integrates the existing research findings on driving factors of employee fraud and anti-fraud practical experience, extracts the key factors of employee fraud motive, and develops a multidimensional scale of employee fraud motive. The exploratory factor analysis (EFA) generates three subscales, comprising 14 items, measuring attitude, subjective norm and perceived behavioral control of employee fraud motive. The confirmatory factor analysis (CFA) supports the reliability, discriminant validity and convergent validity of the new scale. The multiple regression results show that the score of employee fraud motive is positively correlated with the amount of employee fraud occurrence, indicating that the predictive validity of the scale holds. Overall, the scale developed in our study displays good reliability and validity, and is worth spreading. Occupational Fraud 2022, published by the Association of Certified Fraud Examiners (ACFE), the economic loss from fraud in all types of organizations, including governments and businesses, is about 5% of their total annual revenue, with an average loss of $1,783,000 per case. The former UN Secretary-General Ban Ki-moon characterized corruption as a “global threat” on the same level as terrorism and climate change. The empirical research has found that fraud causes the firm to suffer direct losses and penalty losses, leads to serious damage to reputation, and adversely affects both the capital and product markets of the firm  defines fraud as an act in which the perpetrator intentionally deceives and damages others for his or her own personal benefit. Employees are the executors of corporate fraud, meaning that every employee has the potential to become a fraudster. The study of the motives of employee fraud plays a vital role in identifying potential perpetrators, blocking potential perpetrators from evolving into real perpetrators, and preventing the occurrence of corporate fraud .Occupational Fraud 2022, 86% of fraud case types are asset misappropriation and only 9% of financial statement fraud. Second, correspondingly, current research has limited the search for the antecedents of fraud to firm-level factors . The Fraud Auditing Standard uses the fraud triangle theory, which considers the three dimensions of fraud motive, including pressure, opportunity, and rationalization, and lists the precursor manifestations of perpetrators under each dimension. However, the employee fraud motives in these findings have not yet been integrated, resulting that the question of which of the many fraud motives are most important remain unanswered.The research findings on unethical behavior and white-collar crime and experience working in anti-fraud practice provide a rich set of individual-level motives for fraud. The literature in the area of unethical behavior and white-collar crime delve into the motives of fraud at the individual level, finding partial psychological variables associated with fraud, such as job satisfaction , MachiavTherefore, our study considers employees as the executors of corporate fraud, summarizes the motives of fraud at the employee level, and develops the employee fraud motive scale. In the scale development process, we form the initial scale based on the theory of planned behavior, integrating the research findings of unethical behavior and white-collar crime as well as the experience of anti-fraud practice work.Specifically, we first integrate the research findings of unethical behavior and white-collar crime as well as the experience of anti-fraud practice work to form the initial employee fraud motive scale. Then, using questionnaire data from corporate anti-fraud leaders, we implement exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) based reliability and validity tests to extract the key factors of employee fraud motive and develop the final scale. The final scale includes three subscales of attitudes, perceived behavioral control, and subjective norm, with 14 items. Finally, we use the questionnaire data of the final scale to verify the predictive validity of the scale and to analyze the internal structure of the employee fraud motive.The main contributions of our research are as follows. Firstly, based on the behavioral perspective, we summarize the fraud motives at the employee level and develop the employee fraud motive scale, enriching the research on corporate fraud motives. Secondly, our study theoretically and quantitatively integrates the existing research findings and practice experience to identify the key factors of fraud motive, which not only implicate researchers to focus on the important issues, but also help anti-fraud practitioners to save costs. Thirdly, our research comprehensively and directly measures the employee fraud motive by developing a scale, providing a quantitative basis for empirical research on employee fraud motive. Finally, our study provides an operational tool for corporate anti-fraud practitioners to diagnose the causes of fraud and to prevent fraud in a more targeted manner.We adopt the definition of ACFE for employee fraud: the use of one’s occupation for personal enrichment through the deliberate misuse or misapplication of the employing organization’s resources or assets. This definition has three advantagesOccupational Fraud 2022, frauds committed by staff-level perpetrators in the number of perpetrators and the number of cases accounted for a greater proportion, while frauds committed by higher-level perpetrators typically take longer to detect and cause larger losses. In addition to causing more direct losses, such as money losses, management fraud also causes more indirect losses, such as inducing subordinates to fraud. According to the ethical leadership theory, unethical behaviors of leaders can also be learned and imitated by subordinates, which seriously damage the ethical climate of the organization  Their motives are different. Unethical behavior is not necessarily self-interest, but also includes the violation of ethics for the benefit of the organization, such as unethical pro-organizational behavior , while eFrom the above analysis, it can be seen that the extension of unethical behavior is the widest, followed by employee fraud, and white-collar crime is the narrowest. Moreover, unethical behavior includes employee fraud, and employee fraud includes white-collar crime. Therefore, as for the motives of white-collar crime, we can safely incorporate them as the motives of employee fraud, and as for the motives of unethical behavior, we need to choose the motives of behaviors in line with the definition of employee fraud. There are abundant researches on the motives of unethical behaviors and white-collar crimes at the individual level , providiMotive is defined as a reason for doing something, especially one that is hidden or not obvious. Then, the motives of employee fraud refer to the reasons for employee fraud, especially the hidden or not obvious reasons. Motive has two measuring dimensions: quantity and intensity. We develop the scale of employee fraud motive, which fix the number of employee fraud motives through theoretical and data analysis, and form a special tool to measure the intensity of employee fraud motive. At that time, the higher the enterprise score measured by this scale, the higher the motive intensity of employee fraud, meaning that the enterprise will have more frauds.In order to ensure that the scale of employee fraud motive does not omit important factors, we sort out the existing mainstream fraud motive theory. At present, the mainstream fraud motive theory includes fraud triangle theory, GONE theory and diamond theory. In recent years, scholars have begun to explore the motive of fraud from the perspective of behavioral psychology, such as the use of theory of planned behavior to explain the occurrence of fraud.Fraud triangle theory is the most widely used fraud motivation theory at present . CresseyAccording to the GONE theory, the motives of fraud are composed of G (Greed), O (Opportunity), N (Need) and E  Attitude can be divided into cognitive component and affective component . The cogAccordingly, we can divide the scale of employee fraud motive into three first-level dimensions and seven second-level dimensions. The details are shown in Based on the theory of planned behavior, we incorporate the research findings on the motive of unethical behavior and white-collar crime as well as the practical experience of anti-fraud as the items of our new scale.The research findings on the motive of unethical behavior come from the classic reviews . TreviñoThe research findings on the motive of white-collar crime also come from the classic reviews . ColemanFraud Auditing Standards. The Fraud Auditing Standards uses the fraud triangle theory, which considers the three dimensions of fraud motive, including pressure, opportunity, and rationalization, and lists the precursor manifestations of perpetrators under each dimension.The practice experience of anti-fraud comes from Based on the above sources, we refined and generated 48 primary items. Among them, the attitude dimension contains nine indicators and 19 items, the subjective norm includes eight indicators and 17 items, and the perceived behavioral control includes eight indicators and 12 items. These items are specified in Strongly Disagree to 7 = Strongly Agree. The questionnaires were collected on 17 November, 2021. A total of 514 questionnaires were collected, and 504 were finally valid. Among the 504 samples, there are 153 listed companies, accounting for 30.36%, and 351 unlisted companies, accounting for 69.64%. In that year, the number of sample enterprises with fraud was 371, accounting for 73.61%, and the number of sample enterprises without fraud was 133, accounting for 26.39%. Since only enterprises with fraud can fill out the employee fraud motive scale, we mainly analyzed 371 samples with fraud.We sent questionnaires online to 908 member companies of the Enterprise Anti-Fraud Alliance (EAFA)N = 371) into two groups with similar numbers and conducted exploratory factor analysis (N = 185) and confirmatory factor analysis (N = 186), respectively. Among them, the exploratory factor analysis helps us to filter out the items with high information content and generate the final employee fraud motive scale. The confirmatory factor analysis helps us to test the reliability and validity of the employee fraud motive scale. Subsequently, the regression results of fraud occurrence and scale score are used to verify the predictive validity of the scale. Finally, a mean score analysis is used to show the internal structure of employee fraud motive.We randomly divide the sample firms in which fraud occurred  with an oblique rotation (direct) oblimin allowing for correlations among factors. During the exploratory factor analysis, items with factor loadings less than 0.4 or multiple loadings on different factors are gradually removed. After repeated factor analysis and deletion of items, 14 items remain on the employee fraud motive scale, as shown in N = 186). Confirmatory factor analysis mainly examines the discriminant validity, convergent validity and reliability of the employee fraud motive scale.On the basis of exploratory factor analysis, we perform confirmatory factor analysis on another group of samples  to compare with the basic three-factor model to determine the optimal model. The results of the comparison of the goodness of fit metrics of the three models  show thaSecond, we compare the square root of the average variable extracted (AVE) for each dimension of employee fraud motive with the correlation coefficient between the dimensions . The squα) for the scale and the α for each subscale exceed 0.8, and the composite reliability (γ) for the scale and the γ for each subscale exceed 0.7, supporting the reliability of the scale.Loss), the total duration of frauds (Duration), the number of frauds (Frauds), and the number of perpetrators (Perpetrators) on the score of employee fraud motive (Motive). In the regression model, the control variables include registered capital , number of employees (Employees), firm age (Firm_age), whether the firm is listed or not (List), the shareholding ratio of the first largest shareholder (Top1), whether the firm is registered in one of the developed provincesDeveloped), whether the fraud involves the management (Management), and industry fixed effects (Industry). See The results so far are necessary but not sufficient to demonstrate the utility of the new measure of employee fraud motives. Predictive validity also has to be established in the construct validation process. We match the questionnaire data with the corporate basic information data and finally obtain 298 valid samples. Using these samples, we run linear regressions of the amount of fraud losses  from fraud on average. The mean of Duration is 3.985, suggesting that in a firm all frauds in total last 53.785 (e3.985) months on average. The mean of Frauds is 8.698, suggesting that a firm discovers approximately 8.698 fraud cases on average. The mean of Perpetrators is 14.205, suggesting that a firm discovers approximately 14.205 perpetrators on average. The mean of Motive is 4.219, indicating that the employee fraud motive in the sample tends to show a right-leaning normal distribution.To ensure that the sample of predictive validity is appropriate, descriptive statistics have been performed on variables participating in the regression to test for the presence of outliers in these samples. The descriptive statistics  show thaLoss on Motive is significantly positive at 1% level, which shows that the employee fraud motive significantly increases the fraud losses. As shown in column (2), the coefficient of Duration is significantly positive at 1% level, which shows that the employee fraud motive significantly increases the duration of frauds. As shown in column (3), the coefficient of Frauds is significantly positive at 1% level, which shows that the employee fraud motive significantly increases the number of frauds. As shown in column (4), the coefficient of Perpetrators is significantly positive at 1% level, which shows that the employee fraud motive significantly increases the number of perpetrators. Overall, the results support the predictive validity of the scale.The regression results  show thaN = 371), the analysis results , Philosophy and Social Science Foundation of Guangdong Province (grant number GD21TW07-01), Famous Accounting Training Project of China Ministry of Finance (grant number [2016] No.15), and Science and Technology Plan Project of Guangzhou (grant number 202200110001).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.https://www.frontiersin.org/articless/10.3389/fpsyg.2022.1026519/full#supplementary-materialThe Supplementary material for this article can be found online at: Click here for additional data file.


Rice is one of the most consumed food worldwide and is the first crop to have a complete genome sequence  regulating gene expression in rice and how their targeting via genome editing techniques can be exploited to improve rice grain quality while increasing our understanding of gene expression regulatory networks. In the present issue, several studies focused on embryo development, and its impact on endosperm quality as these are determining features for size and grain quality in rice. The study by Hu et al. identified genes involved in the regulation of embryo size, such as the GIANT EMBRYO (GE) gene. The authors showed that a “giant embryo” phenotype was due to a single nucleotide deletion in the first exon of the GE. Furthermore, a comparison of the gene expression and metabolite accumulation in two cultivars differing in the size of their embryo suggested an increase in biosynthesis of L-Aspartic acid and L-Tryptophan in the giant embryo cultivar. The study by Tao et al. emphasized the role played by the embryo in the formation of the chalky endosperm, which is a key desired quality trait of the rice grain. Non-targeted metabolomics and NGS RNAseq were performed in a notched-belly (NB) mutant which is exhibiting a distinct separation between the translucent and chalky regions of the endosperm. Data showed that the embryo negatively regulates the accumulation of sucrose, amino acid, starch, and storage proteins in the chalky region of the endosperm by reducing the expression of starch, prolamin, and glutelin synthesis-related genes, suggesting that the embryo induces a metabolic shift in the endosperm which is important in developing high-quality rice by balancing embryo-endosperm interaction.Improvement of grain quality and yield is a key goal governing rice research as exemplified by the following papers published in the present issue. A mini-review by Andrew-Peter-Leon et al. focused on the identification of gene loci responsible for controlling yield, following the mutagenization of an Improved White Ponni (IWP) variety. One of the mutant lines, WP-22-2, exhibited semi-dwarfism, early flowering, and higher yield without alteration of grain quality. Whole-genome sequencing identified large-scale deletions and single nucleotide polymorphism (SNP), including mutations that lead to the functional disruption of OsGA2oox2 and OsFBX267. These results suggest that both of these genes can be exploited for the development of early maturing and semi-dwarf varieties of rice. Bhatta et al. used and showed the efficacy of an image-based geometric traits phenotyping method for selecting rice genotypes tolerant to low phosphorus conditions.In another study, Zargar et al.) and other abiotic and biotic stresses , to catalog the key components involved in trait management and yield enhancement under stress conditions. In an original, study, Chutimanukul et al. utilized an integrated genome and gene co-expression network analysis to identify candidate genes potentially involved in the salinity stress response in rice, such as OsNodulin, OsBTBZ1, OsPSB28, OsERD, OsSub34, peroxidase precursor genes, as well as investigating gene co-expression network (GCN) involved in the regulation of salinity stress response in rice. Likewise, in the study by Sonsungsan et al., transcriptome profiling of a salt-tolerant rice variety identified 107 salinity responsive genes related to the sensing of salt stress, signaling, hormone response, and gene regulation. Lee et al. investigated the effects of salinity stress on developing rice seeds using a RNASeq-based study comparing the transcriptome of the Samgwang rice cultivar cultivated in reclaimed and normal land. It was shown that this rice cultivar “Samgwang” showed higher sensitivity to salinity stress when cultivated in the reclaimed land, showing adverse effects such as decreased yield, grain weight, palatability, and amylose content, and this was associated with upregulation of genes related to the biosynthesis of ABA, trehalose, raffinose, and maltose under salinity stress conditions. Interestingly, Khan et al. reported that the impact of salinity stress in rice can be significantly reversed by the application of sugarcane press-mud. It was shown that the application of press mud induced the activity of antioxidant enzymes and promoted the growth, yield, total soluble proteins, free amino acids, and soluble sugars, thus mitigating the negative effects of salinity stress. Similarly, Huang et al. reported that biochar application can protect rice against heat-induced damage possibly via alteration of the soil properties and its microbiome in the root zone environment. Decreased heat damage following biochar treatment was associated with decreased abundance of heat stress markers such as heat-shock proteins.Plant growth and crop yield are severely constrained under stress conditions. Thus, understanding plant responses to stress are instrumental for engineering stress-tolerant rice cultivars. In this issue, two reviews describe multi-omics studies describing rice responses to drought (Altogether, the review articles and original studies reported in this Research Topic are contributing to the general understanding of the molecular mechanisms regulating rice development and responses to environmental stresses, in particular for their impact on grain quality and crop yield and such information will be instrumental for engineering new rice varieties, with improved grain quality, yield, and stress tolerance.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.