Basketball is one of the students' favorite ball games, and it is also one of the most popular sports for college students to carry out after class. Especially in recent years, with the spread of NBA culture around the world and the extensive development of CUBA in domestic colleges and universities, Yao Ming has appeared in China to compete in the NBA and achieve brilliant achievements. With the increasing investment in the number of basketball venues, basketball itself, as a sport with low dependence on venues, equipment, and people, has the characteristics of economy, convenience, and remarkable sports effect compared with other sports. College students' basketball skills, basketball awareness, and love for basketball are increasing day by day. Attribute reduction algorithm is one of the core contents of knowledge discovery, which describes whether every attribute in the attribute set of information system is necessary and how to delete unnecessary knowledge. Based on the attribute reduction algorithm, this paper studies the early warning of basketball injury risk. The basketball injury can not only make athletes unable to participate in training or competition, but even cripple or lose their lives, which hinders the normal development of sports. Therefore, we should make a comprehensive and objective analysis of sports training to find out the causes of sports injuries, so as to prevent sports injuries. This algorithm takes the attribute frequency as the heuristic information and solves the attribute selection problem when the attribute frequency is the same. Basketball is one of the sports with high popularity and is loved by college students in college students' sports activities. It plays a positive role in improving students' physiological function, enhancing students' physique, exercising students' good mood and will quality, and cultivating students' good social interpersonal relationship. Basketball is one of the students' favorite ball games and one of the most popular extracurricular sports for college students. Especially in recent years, NBA culture has spread all over the world, CUBA has been widely carried out in domestic colleges and universities, Yao Ming has entered the NBA and made brilliant achievements in China, and college students' basketball technology, basketball consciousness, and love for basketball are increasing day by day . With thIn view of this, based on the attribute reduction algorithm, this paper studies the screening methods of indicators causing athletes' injuries, and then, after the screening is completed, it can realize the effective early warning of athletes' injuries and reduce the probability of athletes' injuries , 6. ThroThe main advantage of attribute reduction algorithm in basketball injury risk early warning is that it does not need the support of experience and additional data but only needs to mine the potential relationship and rules of the problem based on the classification of data , 13. Thin = 21) and intervention group (n = 21). The intervention group adopts exercise and the control group adopts routine warm-up exercise. After the experiment twice a week for 12 weeks, the research conclusion shows that 12 weeks of practice can significantly improve the power characteristics and dynamic balance ability of men's basketball players, reduce the functional defects related to sports injury, and have a significant effect on reducing the injury risk of men's basketball players. According to Gao et al. [Bittencourt et al.  put forwo et al. , studentBased on attribute reduction algorithm, this paper studies the early warning of basketball sports injury risk. Many college students do not understand or ignore the role of preparation activities because of lack of sports healthcare knowledge, and they do not do enough preparation activities. Some of them simply do not do preparation activities, and they engage in intense basketball activities without fully mobilizing their various functions, which increases the possibility of sports injury. In the research of basketball injury prevention, some scholars have begun to apply some training methods to warm-up activities to verify their effectiveness in preventing basketball injury. And the prevention plan can effectively reduce the incidence of sports injuries. However, the research on sports injury prevention in China mainly finds out the situation and causes of basketball sports injuries through questionnaires, documents, and other methods and puts forward preventive measures, including strengthening self-prevention awareness, improving technical level, and strengthening the management of sports venues and facilities, but does not put forward concrete and substantive exercise methods to prevent sports injuries. This paper explores the effect of injury risk intervention for young basketball players, puts forward new directions and ideas for the development of basketball injury prevention practice methods, achieves the purpose of reducing youth basketball injury, enriching basketball injury prevention methods, and enriching basketball warm-up methods, and provides valuable reference basis and direction for basketball injury prevention in the future.Reduction is one of the important concepts of rough sugar set for data analysis. At present, there are not only a large number of records, but also many fields such as characteristics and variables in various database storage, which leads to high data complexity. The reduction of information system fields in rough set is attribute reduction, while a large number of records are regarded as value reduction. At present, the attribute reduction algorithm of rough set theory has been gradually applied in sports competition, mainly through mining a large number of athletes' competition and training data, so as to analyze and predict athletes' status and training effect and thus provide data support for scientifically and reasonably making training or competition plans. With the increasing amount of data, attribute reduction ratio reduction is more effective. If we want to improve people's understanding of all kinds of knowledge in information system, we must reduce a lot of redundancy and simplify the complexity of database structure before knowledge acquisition. At present, in the field of sports competition, common attribute reduction algorithms include attribute reduction algorithm based on discernibility matrix, attribute reduction algorithm based on dependency, attribute reduction algorithm based on mutual information, and so on. Attribute reduction based on attribute importance is a reduction algorithm proposed to reduce the complexity of reduction results. Based on the general attribute reduction algorithm, that is, the attribute reduction algorithm based on positive domain, it calculates the core attributes of conditional attributes for decision attributes. Then, an attribute importance method is proposed by using the attribute dependence in the rough sugar set. In the process of reduction, the attributes with high importance except the core attributes in the information system are added to the reduction set in turn until the whole information system is traversed. The algorithm flowchart is shown in The idea of the reduction algorithm based on attribute importance is simple. Taking the attribute core as the starting point of reduction, the attributes with high attribute importance are added to the reduction set until the termination conditions are met. The calculation amount of this algorithm is relatively small and the time complexity is relatively low. However, the algorithm can only get a reduction of the information system and can not guarantee that the reduction is the smallest. General reduction algorithm is also called attribute reduction based on positive field. It is the most intuitive algorithm in attribute reduction algorithm; that is, delete an attribute from the decision table and then compare the equivalence relationship between the existing decision table and the original decision table. If it is the same as the original decision table, it is considered that the deleted attribute is an unnecessary attribute and so on. The occurrence of sports injury is not caused by a simple reason but often the result of the joint action of multiple factors. In order to make a more accurate early warning of sports injury, we must first clarify what factors will directly or indirectly lead to sports injury. The risk factors inducing sports injury are generally divided into internal factors and external factors. These factors can also be divided into controllable factors and uncontrollable factors. The internal risk factors are often uncontrollable. The dynamic chain model of sports injury etiology is shown in In the early warning of athletes' injuries and injuries, it is necessary to construct emergency decisions and adopt different methods according to different injuries. Because of the different attributes of the data causing athletes' injuries, the range dimensions of the data are also different, so the interval values between the range values are correspondingly different. Build a mathematical model of quantitative attributes.v′c of the attribute cj can be expressed asThe dimensionless value Formulas  and 2)  2) repreA, where A = .The evaluation index set is expressed by Suppose again:Rj is expressed as membership vector, and data set is expressed asRe hypothesisBi is used as the scale element corresponding to the i-level evaluation in data set B. Through data set B, the data membership vector representing athlete injury can be effectively synthesized into scalar, expressed asV is the quantitative value of qualitative evaluation index of athlete injury data under the given scale B.R.According to the different membership degrees, the Hamming distance of two different fuzzy data set values can be defined, respectively. When the distance is not greater than the threshold of rating the degree of athlete's injury, it is expressed as having a certain correlation with causing athlete's injury, and the correlation value is expressed by xi ∈ U; ∀xα, xb, ∀cj∈ athlete's strain data attribute C, j=1,2,…, m is expressed as the attribute value of the object xi in the data set in the data attribute cj; υij′ represents the quantified value of athletes' injuries. Through the above formula, 1 − α is expressed as the similarity between athlete strain data xα and athlete strain data xb. R is used to express the fuzzy similarity relationship between reflexivity and symmetry of athletes' strain data, and then it is expressed by formula as follows:xi represent that data elements constitute the athlete's strain; R(xi) is expressed as a fuzzy similarity formula with xi.The similarity calculation formula is shown in the following formula:Suppose that the ideal evaluation scheme for athletes' injuries is as follows:In formula (10)gj=1≤xi, G) is expressed as the closeness degree, which is expressed as the weighted Hamming distance between xi and g. When estimating athletes' injuries and injuries, the probability of each type of reduction sets is almost the same. The total closeness indicates the weighted sum of closeness of different technical schemes in the reduction sets. The calculated value of the weighted sum is inversely proportional to the superiority of the schemes. Specifically, the smaller the calculated value of the weighted sum, the better the superiority of the schemes.Dis(In the theoretical model, external factors are defined as “initiating factors.” When it appears, athletes with injury tendency with internal injury factors will be called “injury prone people,” and they will be more prone to injury. However, only the appearance and interaction of internal and external factors alone are not enough to induce athletes to have injuries but to make them become “susceptible people.” Under certain conditions, they will have sports injuries. In this paper, the attribute reduction algorithm is applied to the athlete training information system, which can effectively obtain the internal or external parameters of athletes in sports. These parameters are analyzed through the injury early warning model to prevent the occurrence of athletes' injuries to the greatest extent. The system includes four layers: data layer, feature layer, attribute reduction algorithm layer, and decision layer. The evaluation of athletes' muscle strain degree is based on the information acquisition and processing of athletes' human movement process. Therefore, the main research of this paper is how to use attribute reduction algorithm to evaluate athletes' muscle strain. The overall system architecture design is shown in In the data layer, it mainly realizes the collection of athletes' parameter information. The information collected is diverse, including internal factors and external factors. Internal factors include athletes' mood, physical condition, physique, improvisation, sports skills, and other parameters. External factors include parameters such as competition venue, on-the-spot accidents, weather, environment, competition order, competition rules, equipment, and so on. The reduction algorithm based on discernibility matrix is to filter out the attributes with only unique elements by constructing discernibility matrix, take this attribute as the core, judge other sets containing several attribute items, and then further construct the discernibility function on this basis, and make disjunction and conjunction.Strengthen college students' learning of basketball healthcare knowledge, make college students fully realize the role of preparatory activities in the prevention of sports injury by attribute reduction algorithm, and cultivate college students' good habit of preparatory activities before basketball. At present, in the field of sports competition in China, after collecting the relevant data of injury and early warning of basketball players, we mainly use the methods of questionnaire, referring to expert experience and consulting relevant literature to analyze the data, so as to determine the potential factors causing injury and injury of athletes and evaluate the early warning level of these factors, as a basis for further determining the potential relationship between these factors and early warning level. Focus on the parts with injury history, vulnerable parts, and parts with large local load. At the same time, based on attribute reduction algorithm, in order to recover fatigue quickly, we should carry out effective relaxation activities in time after exercise and strengthen nutrition and rest at the same time, so as to quickly recover the body state and avoid the accumulation of exercise fatigue. In this regard, in order to find different injury investigation indicators of athletes, taking track and field athletes in a city as a case, the injury early warning indicators for track and field athletes are determined by consulting data and literature and referring to expert experience. For this, this paper selects 21 indicators, including age, physical fitness index, and subjective emotion. See In the above indicators, all factors that may affect athletes' injuries and injuries are involved, so as to summarize them comprehensively. Through the above selection, it lays a foundation for the subsequent judgment of athletes' injuries and injuries. In this paper, 10 basketball players in a city were randomly selected as test source data, and then the simulation test results were compared with the actual values to verify the feasibility of the method proposed in this paper. The final output of the simulation test is shown in From the simulation test results shown in the table, it can be seen that the prediction results with small error with the actual value can be obtained through the method proposed in this paper, which meets the accuracy requirements of basketball players' injury early warning in the field of sports competition. It also shows that the test results are more accurate in terms of accuracy. It can be concluded that, in the evaluation of athletes' injuries, the main judgment indicators are the intensity of training, the degree of injury recovery, psychological state, and so on. These indicators are consistent with the interview records of athletes' injuries, which shows that the indicators obtained by the attribute reduction algorithm are consistent with the reality, feasible, and accurate. As basketball has certain requirements for all aspects of college students' physical quality, we should comprehensively develop college students' physical quality to meet the requirements of basketball in terms of speed, strength, endurance, and flexibility and strengthen the practice of muscle strength and joint flexibility in vulnerable parts, to avoid sports injury caused by poor physical fitness.Strengthen safety education and enhance the awareness of the significance of injury prevention. Teachers should fully understand the importance of injury prevention and take necessary measures to strengthen safety education. Teachers are not only the organizers of teaching, but also the transmitters of sports knowledge, technology, and skills. If teachers themselves lack knowledge of injuries, do not pay attention to students' safety, and take an irresponsible attitude, they will not only fail to complete the teaching tasks well, but also be prone to injuries. The key to prevent sports injuries lies in PE teachers. Therefore, it is necessary to improve PE teachers' awareness of safety precautions, make full use of various forms to enable students to master reasonable methods of preparation activities, guide students to do full preparation activities, and cultivate students' good habit of doing preparation activities before sports. In the experiment, the test within a certain time range was selected, assuming that the test was carried out within 95 s, and three experiments were carried out for comparison, through machine learning algorithm, decision tree algorithm, genetic algorithm, and this algorithm. During the test, a wounded person was selected to have poor performance due to the weather. The experimental results are shown in Figures 4Through the comparison of the above algorithms, for different basketball player injury data sets, a number of reduction condition attributes of the above four different algorithms are used. Under the same circumstances and at the same time, the error data are different. The algorithm error data in this study is the smallest and the error data is small, which indicates that the sensitivity of early warning is high. In the process of basketball competition, it needs strong outbreak and speed. In order to deal with emergencies on the basketball court and give timely and effective response, we need high sensitivity and so on. At the same time, poor flexibility is often prone to muscle and ligament strain during exercise. As college students come from different regions, their physical quality will also be uneven, some even poor, which will cause damage in the relatively fierce confrontational basketball game. The purpose of preparatory activities is to improve the excitability of the central nervous system and overcome the inertia of human function through a variety of exercises. Teachers should choose some targeted preparation activities according to the characteristics that basketball is easy to cause injury and let students understand the significance of doing preparation activities.Next, we will compare and analyze the sensitivity of early warning after adopting this research scheme. Assuming that the abnormality is set in 10 aspects such as joint flexibility, joint protection measures, mental state, joint stability, and training load, machine learning algorithm, decision tree algorithm, genetic algorithm, and the algorithm in this paper are used for two comparative analysis, respectively, to observe the curve of sensitivity change at any time, as shown in Figures As shown in Figures Basketball players will suffer from injuries due to many factors in training and competition. Aiming at this problem, this paper proposes a combination of attribute reduction algorithm and basketball injury risk early warning method. This method can extract the key indicators of athletes' injury factors efficiently and accurately and evaluate their early warning level, so as to effectively obtain the injury situation of athletes and reduce the probability of basketball players' injuries again, which provides a reference for the current scientific and information analysis of athletes' injuries. In order to speed up the scientific basketball training, from the perspective of multidisciplinary, based on the systematic understanding of the characteristics of basketball training, this paper defines the influence of various elements causing basketball players' sports injury on sports injury and realizes a reasonable and effective reduction algorithm combined with the attribute reduction method in rough set theory. It is used to reduce the injury indicators affecting the injury of basketball players, mine the factors with high contribution rate to basketball injury, and apply it to the establishment of track and field injury early warning model, which provides a new method for the prevention of sports injury of basketball players. At the same time, based on attribute reduction algorithm, in order to recover fatigue quickly, we should carry out effective relaxation activities in time after exercise and strengthen nutrition and rest at the same time, so as to quickly recover the body state and avoid the accumulation of exercise fatigue. In major sports events, coaches can use the method of this study to quickly make judgments from complex sports events. Therefore, it is necessary to improve PE teachers' awareness of safety precautions, make full use of various forms to enable students to master reasonable methods of preparation activities, guide students to do full preparation activities, and cultivate students' good habit of doing preparation activities before sports.


Mucus is present throughout the gastrointestinal tract and is essential for regulating gut microbiota homeostasis and preventing disease by protecting the gastrointestinal barrier from microorganisms, pathogens and toxins or other irritants. Mucin (MUC)-2 is a secreted protein produced by epithelial goblet cells as the main component of mucus. Defects in the gastrointestinal tract, such as inflammation and ulcers, cause damage to the mucus barrier, which can worsen mucus quality and reduce mucus production. Therefore, we would like to review the characteristics of MUC2 and its role in intestinal disorders and highlight the importance of further studies. We also investigated whether the role of MUC2 differs between children and adults, ulcerative colitis (UC) and Crohn's disease (CD). Inflammatory bowel disease (IBD) is a digestive disorder in which chronic inflammation repeats exacerbation and improvement. The two main types of IBD are ulcerative colitis (UC) and Crohn's disease (CD). IBD is a multifactorial disease, with both genetic and environmental factors contributing to the disease. In particular, loss of intestinal epithelium completeness plays a very important role in IBD , 2. DysfGiven the role of the mucus layer, there is growing interest in it because loss of intestinal barrier integrity can cause or exacerbate the progression of inflammatory diseases of the gastrointestinal tract, such as IBD. Although the prevalence is continuously increasing, the cause and treatment are still difficult to identify . In partEarly diagnosis and treatment of pediatric patients with IBD is very important because children and adolescents are often accompanied by symptoms such as growth retardation and depression due to the characteristics of growth and puberty. In addition, since it requires active treatment from the early stage of diagnosis, high medical costs cannot be ignored. Therefore, to identify differences between adult and pediatric patients with IBD and to enable them to be applied to treatment and prevention, this review highlights the characteristics of MUC2 mucin and its role in IBD, factors affecting MUC2, and differences between IBD in adults and children.From MUC1 to MUC22, up to 22 distinct mucin genes have been identified in the sequence of discovery. They are expressed according to tissues and cell types and they are broadly categorized into two types: secretory and membrane related –23. MUC2MUC2 is expressed early in fetal development and is detected in the colon at 12 weeks of gestation and is expressed by individual cells that are goblet cell precursors . And mosAbsorption of nutrition is an important function of the small intestine, and the mucous system facilitates this by lubricating and protecting against endogenous enzymes and microorganisms. Mucus entirely covers the surface of the epithelium . The intMUC2 plays a significant role in the pathogenesis of IBD, and deficiency of MUC2 mucin can change the composition of the mucus, which can affect the pathogenesis of IBD. UC is a disease of the inner colonic mucous layer, and the host's immune response to the microbiome increases with increased exposure to bacteria.UC was observed to be thinner and more discontinuous in mucus than CD, and less MUC2 was excreted during the active phase of UC. The decreased secretion of MUC2 may be attributed to the translational or post-translational modifications, and it is also associated with a decrease in goblet cells , 48. MorCD affects all parts of the intestine but is most common in the small intestine. CD, as opposed to UC, is characterized by increased mucus production and discontinuous inflammation. Mucus in the small intestine serves as a diffusion barrier, and mucus secretion occurs primarily in the crypt entrance. Genetic associations are more evident in CD than in UC, involving genes, such as nucleotide binding oligomerization domain containing (NOD)-2, autophagy related 16 like 1 (ATG16L1), immunity related GTPase M (IRGM), and X-box binding protein (XBP)-1 associated with autophagy, unfolded protein responses, and bacterial detection and defense –56.The failure to restrict bacterial access to the epithelium despite increased levels of mucus production in CD patients indicates that mucus level and secondary structural modifications are critical for mucus barrier function. The viscoelastic function of mucus depends on proper glycosylation, sulfation, and sialylation , 49. PeoThe glycosylation degree of mucus is essential for its mucosal protective role, and the MUC2 protein core is generally proteolytic resistant because of glycosylation. Bacteria have exoglycosidase, which releases monosaccharide residues and uses them as an energy source. Under normal conditions, the mucus broken down by bacteria is balanced with the new mucus production. However, altered glycosylation can affect this balance, causing glycans to be shortened and digested faster, exposing the protein core and thereby breaking down the mucus barrier faster. Mucus glycosylation defects reduce the mucus layer, placing germs and hosts closer together , 62, 63.Since tight junction (TJ) is interdependent with the mucus barrier, the loss of one decreases the other. Mice deficient in Claudin 7, hepatocyte nuclear factor 4 alpha (Hnf4a), and Muc2 develop spontaneous colitis , 65, 66.We reviewed a number of papers to identify differences in MUC2 expression in UC and CD as well as in adult and pediatric patients. We summarized the MUC and TFF expression characteristics of adult and pediatric IBD patients in A paper by Bankole et al.  publisheWhile the correlation between UC and the mucous layer is relatively well-established, it remains controversial in CD. According to the results of the initial study, the thickness of the mucus layer increased in adult CD patients , but a rShaoul et al.  and HensAlterations in MUC2 amount and quality, and changes in intestinal trefoil factor expression during inflammation, may upregulate MUC5AC and TFF1 expression to compensate for the impaired barrier and repair functions. MUC5AC and TFF1 are not expressed in normal colonic tissue. MUC5AC was sporadically expressed in goblet cells expressing MUC2 in both UC and CD. This pattern was not limited to a specific region of the colon and was not affected by disease severity or local inflammation. It has also been observed in colonic biopsy specimens of autologous restrictive colitis and solitary rectal ulcer syndrome, but unrestricted to IBD. Some of the goblet cells expressing MUC5AC showed expression of TFF1. This change in expression of MUC5AC and TFF1 was suggested to be a non-specific repair function to compensate for the impairment of colonic barrier function .Mucin acts as an innate host defense mechanism by forming a mucus layer that protects the host from pathogenic microflora invasion and is vital for intestinal microflora formation. Defects in the mucosal barrier result in abnormal bacterial symbiosis and defects in the host's innate and adaptive immune responses, resulting in intestinal inflammatory responses and damage . TherefoMucin genes were identified from MUC1 to MUC22 in the order of discovery, and are largely divided into secretory and membrane-related types. Among them, MUC1, 2, 3 and 4 are mucins detected in the colorectal, and MUC2 is the main mucin produced specifically in goblet cells. MUC2 is expressed in colon goblet cells of UC and CD patients as well as healthy individuals. When the colon is depleted of goblet cells due to IBD and other inflammatory conditions, the expression of MUC2 is also reduced and remains in a relatively immature state. This mucus loses its barrier function and exposes the mucous membrane to inflammatory substances. The factors that cause IBD and inflammatory disease are very diverse, but when the integrity of the mucus barrier is lost, it can be a key factor in exacerbating the disease state.When reviewing the results of various researchers, there are not many studies targeting pediatric IBD patients and many contradictory results have been reported in adult IBD patients, so it is difficult to clearly conclude that the pattern between adults and children is the same. However, at least according to our investigation, it can be suggested that MUC2 expression is decreased and goblet cell decrease is the same in both adults and children in CD and UC in acute inflammatory state. In addition, in the tissues of CD or UC patients, the opposite expression levels may be observed depending on the state of the tissue with or without inflammation or the degree of remission of inflammation, and these results can be considered as a compensatory repair mechanism for mucosal barrier healing and regeneration.When IBD occurs, pediatric patients need active treatment with biological agents from the beginning, unlike adult patients. As such, pediatric patients have different symptoms or treatment methods from adult patients, but the level of MUC expression is similar. Most of the experimental systems show reproducible results, but for patients, some studies have weak correlations. This is because the factors involved are very diverse and complex. In addition, MUC expression patterns may vary depending on the presence or absence of inflammation and the degree of inflammation in the tissue sample.Overall, the complexity and heterogeneity of both MUC and TFF makes it difficult to decipher their diverse roles in the pathophysiological process as either a cause or a consequence of IBD. Although many researchers analyzed the results of IBD patient samples, many were excluded when they attempted to draw conclusions by comparing them to each other under similar conditions. Although some studies have documented detailed conditions, many studies have been conducted under relatively broad conditions. In the case of pediatric IBD patients, the number of studies is very limited, regardless of study comparison conditions. This is probably because the patient's age is very young or the sample volume is small, making it very difficult to obtain sufficient samples for the study. To overcome these problems, it is necessary to analyze the sample by subdividing it under more various conditions, and accordingly, it is believed that more consistent results can be derived. In addition, if the criteria for comparative conditions are established and shared, clinical results will be much richer and comparative analysis will be possible for each researcher under the conditions they want. More clinical findings and further studies in pediatric IBD and other inflammatory diseases continue to be needed in the future to determine immune function and potential interaction partners.YK and HP contributed in the acquisition, analysis and interpretation of data, and drafting of the initial manuscript. B-HC contributed in the acquisition, analysis and interpretation of data, and critical revision for important intellectual content. BK contributed in the conception of the study, acquisition, analysis and interpretation of data, and critical revision for important intellectual content. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.This work was supported by the following grants: National Research Foundation of Korea (NRF) grant funded by the Korea Government (MSIT) (No. 2021R1C1C2005429).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.


For patients who are often embarrassed and uncomfortable when exposing their breasts and having them touched by physicians of different genders during auscultation, we are developing a robotic system that performs auscultation over clothing. As the technical issue, the sound obtained through the clothing is often attenuated. This study aims to investigate clothing-induced acoustic attenuation and develop a suppression method for it. Because the attenuation is due to the loss of energy as sound propagates through a medium with viscosity, we hypothesized that the attenuation is improved by compressing clothing and shortening the sound propagation distance. Then, the amplitude spectrum of the heart sound was obtained over clothes of different thicknesses and materials in a phantom study and human trial at varying contact forces with a developed passive-actuated end-effector. Our results demonstrate the feasibility of the attenuation suppression method by applying an optimum contact force, which varied according to the clothing condition. In the phantom experiments, the attenuation rate was improved maximumly by 48% when applying the optimal contact force (1 N). In human trials, the attenuation rate was under the acceptable attenuation (40%) when applying the optimal contact force in all combinations in each subject. The proposed method promises the potential of robotic auscultation toward eliminating gender bias. Since the 1800s, auscultation has been a crucial aspect of clinical examination. It is a cost-effective screening method for detecting abnormal signs . AdditioDuring auscultation, patients must expose their chests fully, as doctors need to place the stethoscope directly on the skin for accurate diagnostic results. However, this can cause embarrassment and discomfort for patients when exposed to doctors of the different gender and being physically touched, which may also affect the diagnostic quality . In addiAlthough many robotic systems for assisting diagnoses, such as ultrasonography, have been developed, there are few studies focusing on auscultation. Falleni et al. developed a tele-operated robotic interface for remote auscultation . The robAs the limitation of those studies, auscultation was performed on subjects without their clothing. In order to completely address the issue of gender bias, auscultation should be performed without the need for patients to remove their clothes in terms of their privacy. Additionally, if auscultation can be performed over clothing with a robot, it would provide the benefit of reducing the examination time because it does not require time to change clothes. Casual observation reveals that doctors often auscultate the heart and lungs of the patient through clothing such as a hospital gown. Although the quality of sounds may be decreased by the presence of clothes, this can potentially be improved by adjusting the contact pressure of the stethoscope . AdditioTo eliminate gender bias during auscultation exams, we aimed to develop a robotic platform that enables performing automated auscultation over clothes. Our previous works have developed a prototype of the robotic auscultation platform and have demonstrated the feasibility of auscultation over clothing in a phantom study ,18. MoreThe contribution of this paper is that it addresses those shortcomings and consists of the following three points. First, we analyzed the relationship between acoustic attenuation and clothing condition when performing auscultation over clothing, and we developed a robot system with an end-effector adjusting the contact force safely. Second, we conducted phantom experiments with various types of clothing, which included thickness, material and layering combination. Finally, we performed human trials in several clothing combinations to validate the feasibility of auscultation over clothing.P is the acoustic pressure, The power level of the obtained sound is known to be decreased due to clothing experimentally. This phenomenon may be caused by acoustic attenuation when transmitting the sound through clothing, as shown in  as bone . Fabric  as bone ,23. ThenIn order to suppress the aforementioned acoustic attenuation, it is necessary to decrease the wave propagation distance ted work  applied ted work ,25. In aTo achieve the requirements, a robot system with a unique end-effector with a spring-based passive-actuated mechanism was developed. ous work .In this study, we quantitatively evaluated the effect of adjusting the contact force to improve the acoustic attenuation caused by clothing. The degree of improvement in acoustic attenuation is defined as the ratio of the amplitude spectrum when auscultated in the naked and clothed state. The amplitude spectrum in each frequency The procedure for sound acquisition is as follows: (i) a certain contact force is applied to the body; (ii) sound pressure data are acquired for 5 s and are digitized at 44,100 Hz by using an electrical stethoscope; (iii) the amplitude spectrum in each frequency is calculated with the acquired pressure data, and a moving average filter is applied to the calculated amplitude spectrum; and (iv) the applied contact force is changed in a certain range, and (ii)–(iii) are repeated.In this study, we performed four experiments. First, in order to determine an acceptable acoustic attenuation in terms of diagnosis, a subjective evaluation with physicians was conducted. We asked four physicians to score 20 samples of data of abnormal cardiac and respiratory sounds, which were generated by artificially attenuating the source audio file. The acoustic attenuation ratio used in this experiment ranged from 0% to 90%. The score was between 0 and 10. A score of 0 shows that the sound cannot be used for diagnosis at all, and 10 shows that the sound can be heard clearly and can be used for diagnosis.Next, we investigated the effect of clothing thickness on the acoustic attenuation. In this experiment, shirts of two different materials (cotton and polyester) were prepared with four different thicknesses . A commercial auscultation simulator  was utilized to generate cardiac sounds in this experiment. To the simulator covered with the prepared clothes, six-way contact forces  were applied by using the developed end-effector.In the third experiment, several clothing combinations assumed for daily life were prepared. The prepared clothing included shirts, hoodies, and coats, and the combinations used in this experiment were as follows: (i) only a shirt; (ii) shirt + hoodie; and (iii) shirt + hoodie + coat. Similar to the previous experiment, six-way contact forces were applied by using the developed end-effector.Finally, human trials were performed with four male volunteers. The prepared clothing included a shirt and hoodie, and the experimental scenario was as follows: (i) no clothing; (ii) only the inner shirt; and (iii) inner shirt + hoodie. A six-way contact force  was applied around the body surface on the mitral valve. The study protocol was approved by the Institutional Review Board of National Institute of Advanced Industrial Science and Technology (No. 2022-1231), and informed consent was obtained from each volunteer.In all combinations in each subject, the attenuation rate was under acceptable attenuation (40%) when applying the optimal contact force. Especially, in case of wearing only inner shirt, there was little difference in the attenuation rate compared to the case of the no-clothing condition. The maximum attenuation rate under applying the optimum contact force was 8%, which the physicians recognized with difficulty.The results of this study demonstrate the feasibility of robotic auscultation over clothing through the validation of a phantom study and human trials. Although the sound obtained over the clothing was attenuated, especially when increasing the number of layers of clothing, the diagnosable sound could be obtained by adjusting the contact force in some cases. This may be because the wave propagation distance is reduced by compressing the clothing materials, as hypothesized in the Materials and Methods section. It is, of course, difficult to obtain a qualified sound in the case of extreme layering, such as a combination of a shirt, hoodie and coat, but it can be acceptable to have auscultation while wearing a light shirt in terms of acoustic attenuation due to clothing. This finding contributes to the gender-related issues mentioned in the introduction. Prior studies have found that gender can impact the performance of an examination. For example, a study found that male medical students performed worse than female peers in cardiac and pulmonary examinations on female patients . AnotherComparing the results of the cotton and polyester shirts, there was a difference in the obtained amplitude spectrum between those materials. This may be due to the difference in the attenuation coefficients of the materials. Because fiber materials with sound-absorbing properties are known from the perspective of soundproofing ,23, it mIn this study, we used the sum of the amplitude spectrum as the metric of acoustic attenuation due to clothing. This metric simply represents the volume of the obtained sound. We assumed that the volume sound is related to audibility during auscultation, but it may be possible to focus on sounds in specific frequency bands that are directly related to the diagnosis. For example, heart murmurs have spectral components very concentrated in the band around 600 Hz . In addiUnlike the related papers regarding robotic auscultation ,13,14,15There are several limitations in this study. First, the number of subjects in the human trials was very limited. Although we confirmed the feasibility, it is necessary to perform large-scale human trials to show the efficacy of using this system in clinical situations. Particularly, we did not address the case of female subjects specifically in this study. Because female subjects wear bras, it is necessary to know the effects of straps, underwires and other bra components on acoustic attenuation and noise in order to apply this system to subjects of various genders. Moreover, regarding experiments with female subjects, because this study reveals the feasibility of auscultation over clothing without physical contact by physicians using a robot, it would lower the bar for experiments with female subjects. In addition, it may be worth comparing skinny and fatty subjects because the acoustic propagation distance differs between them. In the case of fatty subjects, compression may contribute to decreases in the acoustic propagation distance because the thoracic surface can be largely deformed by the contact force. After validation with healthy subjects, we need to conduct a clinical trial. In addition, we did not implement an autonomous search algorithm to determine the optimum contact force based on the feedback of the obtained sound in the robotic system. Through the findings in this study, we recognize that the optimum contact force is different due to the thickness and material of clothing and individual difference in subjects. In order to develop practical applications dealing with various conditions, we will implement the online contact force adjustment system based on the obtained sound.For patients who are often embarrassed and uncomfortable when exposing their breasts and having them touched by physicians of different genders during auscultation, we are developing a robot for auscultation over clothing. This paper investigates clothing-induced acoustic attenuation quantitively and develops a suppression method for it. Acoustic attenuation can be suppressed by applying an optimal contact force and compressing the clothing, which was validated through phantom and human experiments. In the phantom experiments of 1 mm thick cotton and polyester shirts, the attenuation rate was improved maximumly by 48% and 38% when applying the optimal contact force (1 N) compared to the insufficient force. In the human trials, the attenuation rate was also under acceptable attenuation (40%) when applying the optimal contact force in all combinations in each subject. The findings in this study have the potential to address gender-related issues in auscultation.For the limitations, the number and variety of subjects were limited, and an autonomous search algorithm to determine the optimum contact force based on feedback of the obtained sound in the robotic system was not implemented. In the future, we plan to increase the number of trials, include female subjects, adopt a hardware configuration closer to that of clinical practice and incorporate a control algorithm that searches for optimal sounds.


The increasing damage caused by disasters is a major challenge for disaster management authorities, especially in instances where simultaneous disasters affect different geographical areas. The uncertainty and chaotic conditions caused by these situations combined with the inherent complexity of collaboration between multiple stakeholders complicates delivering support for disaster victims. Decisions related to facility location, procurement, stock prepositioning and relief distribution are essential to ensure the provision of relief for these victims. There is a need to provide analytical models that can support integrated decision-making in settings with uncertainty caused by simultaneous disasters. However, there are no formulations tackling these decisions combining multiple suppliers, multiple agencies, and simultaneous disasters. This article introduces a novel bi-objective two-stage stochastic formulation for disaster preparedness and immediate response considering the interaction of multiple stakeholders in uncertain environments caused by the occurrence of simultaneous disasters. At the first stage, decisions related to the selection of suppliers, critical facilities, agencies involved, and pre-disaster procurement are defined. Resource allocation, relief distribution and procurement of extra resources after the events are decided at the second stage. The model was tested on data from the situation caused by simultaneous hurricanes and storms in Mexico during September of 2013. The case is contrasted with instances planning for disasters independently. The results show how planning for multiple disasters can help understand the real boundaries of the disaster response system, the benefits of integrated decision-making, the impact of deploying only the agencies required, and the criticality of considering human resources in disaster planning. The COVID-19 pandemic shed some light on the complexity of handling multiple co-occurring disasters. For instance, while managing the pandemic, authorities in Louisiana faced two hurricanes within 36 h, unprecedented wind speeds, and storms 2020  it provides a novel stochastic formulation considering multiple responding agencies and multiple suppliers in humanitarian operations to manage simultaneous disasters, and (ii) it provides evidence about the impact on performance of neglecting simultaneous disasters.The article is structured as follows. Section This article is looking at the combination of procurement with other logistics activities in a multi-agency environment during situations caused by simultaneous disasters. Recently, there has been a surge of articles looking at procurement to account for the impact of supply chain actors in relief operations. To understand the contribution of this article in the current state of knowledge, the literature review will look at articles focused on procurement, the evolution toward the integration of multiple participants, and at the inclusion of simultaneous disasters. Finally, it will elaborate on the research gap.Disaster procurement models include decisions about the suppliers required, pre-disaster products to acquire (often prepositioned), and/or post-disaster products bought and delivered. Falasca and Zobel  develop Articles in this section show the importance of linking pre-disaster and post-disaster procurement with other logistics activities such as relief distribution and facility location. The connection between these activities is important because of the availability of supply or supply chain constraints affecting the performance of humanitarian operations. Looking at the different formulations, the value of two-stage formulations to tackle these problems becomes evident. Nevertheless, these formulations are often designed to provide support for one organization facing a single disaster. Neglecting the interaction between stakeholders can have a steep effect on the support given to affected communities Haimes , especiaConsidering the preference of governments to avoid a dependence on single suppliers for reasons of cost, image, and supply failure risk  to engage in simultaneous disasters, because of the importance of incorporating to introduce multiple stakeholders in the optimization of humanitarian operations ..13).With the additional constraint:The single-objective problem is solved parametrically for different values of minimize  for Φ itHurricanes and tropical storms are a significant problem in the country, as shown by the 58 disasters caused by storms from 2000 to 2018 EM-DAT . HoweverDecision-making in disaster situations in Mexico is centralized, with the National System for Civil Protection (SINAPROC) as the coordinating entity in charge of articulating activities from different participants (Sosa-Rodríguez Data were collected from secondary sources through reports and freedom of information (FOI) requests. Freedom of information requests are submitted electronically through the Mexican transparency system including the type of request, the information required and the responsible agency. Information was gathered from eight agencies in health services (IMSS), DICONSA, relief activities (Red Cross), family services (DIF), police (SSM), military (SEDENA and SEMAR) and civil protection (Civil Protection), as well as the Mexican National Institute of Statistics and Geography (INEGI).Information about suppliers, facilities and costs was collected from DICONSA. SINAPROC provided data about demand, relief distributed and emergency declarations. Geographical information was obtained from INEGI. Regulations from FONDEN were used to gather the characteristics of the different relief items considered. Transparency websites from the Mexican government were used to gather information about budgets and wages, whereas SEDENA provided information about the number of employees required for distribution. Each organization provided information about their employees and vehicles available, including their characteristics. The information can be classified into five categories: demand areas, procurement and relief, relief agencies, distribution network, scenario development.The regions were obtained from emergency declarations made by the Mexican government including the period from September 16th to September 30th of 2013. The areas were clustered, based on their geographical location, into three regions shown in Table The summarized demand can be seen in Table The 39 suppliers that have participated in previous disasters were incorporated into the analysis. The cost per relief item per supplier at stage one was obtained from records of previous purchases, while the cost of purchase at stage two was assumed to be 20% more expensive. The cost of partnering with a supplier during disaster relief was assumed based on the frequency of participation in previous disasters as the information was privileged. Minimum order size was assumed to be only 1% of the supply capacity of the organization and procurement budget was obtained from reports from previous disasters SEGOB . Table 5The relief items are the components of the food kit distributed by authorities in disasters for four people for four days SEGOB .Human and material resources available for disaster response were collected from FOI requests, transparency websites and reports from Red Cross. Table The facilities used were obtained from DICONSA, geo-referenced and identified using Google Earth®, and they were located in the network of the country using TransCAD® as shown in Fig. Similarly, supplier warehouses were mapped using layers from INEGI with TransCAD®. The main supplier warehouses were used because these facilities were expected to be used to consolidate the volume of relief items required. Network analysis was performed to calculate distances between facilities, which were used to estimate transportation costs using fuel requirements.The scenarios were based on information of the disasters affecting Mexico in September 2013. The simultaneous impact of Hurricane Ingrid, Hurricane Manuel, and heavy rainfall was reflected in the emergency declarations of Mexico from September 16th until the end of the month.The potential scenarios were planned considering three hazards with different impact on different regions. Three levels of impact were included: regular impact (based on emergency declarations of the disasters from FONDEN ), increaThe model introduced was programmed on GAMS 23.5.1® using the ε-constraint method with the COST objective function turned into a constraint. The model was solved using Cplex® for 100 iterations. The stopping criterion was a relative optimality gap smaller than 0.1 or after 14,400 s , whereas ND18 has the largest number of items procured prior to the disaster of all the non-dominated points . The former increases procurement cost but reduces transportation cost, as opposed to ND18. Service-oriented solutions require the involvement of more agencies, facilities, and suppliers, as expected. Overall, it would be complicated to satisfy the needs of the different disasters with the resources available, as the model was unable to provide solutions without shortage.The model selected suppliers based on the demand, supplier characteristics and overall supply capacity. None of the solutions included all the suppliers available, showing preferences for some of them. Most solutions selected suppliers located toward the center of the country such as 4, 7, 29, and 33. The general frequency can be seen in Fig. Figure Figure There are some interesting results in the second-stage variables as well. The restriction in the number of employees available forces the model to balance resources between distribution centers and relief distribution as shown in Fig. The magnitude of delivery to each region can be seen in Fig. That range is reflected on the number of items procured at the second stage as well with a significant variation across scenarios as shown in Fig. Expected Value of Perfect Information (EVPI) and the Value of the Stochastic Solution (VSS). These measures are used to explore the performance of the results of the model using the results of the recourse problem (RP). This section presents the results of the EVPI and VSS analysis.The use of a two-stage stochastic approach is based on its benefits to provide reliable solutions considering the conditions of disaster management operations. This approach is commonly evaluated using deterministic approaches such as the EVPI is based on the idea of having accurate information about the situation, which in this case involves knowledge about the surge in demand caused by the different hazards. Assuming the availability of perfect information, it is possible to solve one optimization model for each scenario. The Wait-and-See (WS) solution is obtained by aggregating the expectation of all the scenarios given by WS Birge .The expected value problem (EV) is obtained when the stochastic parameters are replaced by their average values of to simplify the analysis. The problem becomes easier to solve, but the probability and information from the different scenarios is neglected. To evaluate the use of the EV solution, VSS is calculated , worst-case  and best-case scenario (345). The reason some EEV values go below the RP values is related to the optimality gap. In instances where the difference between the optimality gap of the RP problem and the optimality gap of the EEV problem was 12.4% or higher, that behavior was observed. That suggests the need to develop algorithms that can reduce the optimality gap in sensible solution times. Overall, the analysis shows that uncertainty is an important factor in the problem.Most models in the literature consider single disasters managed by a single organization, which ignores the challenges associated with having multiple agencies involved in different events. The case study presented in Sect. The underpinning assumption in several disaster management models is that there is a focal disaster requiring all the support. That assumption can tempt regional civil protection authorities to produce plans looking at single disasters. Planning for each disaster independently, without considering other events, can affect the availability of resources that need to be shared. To explore those challenges, the first experiment is assuming each one of the hazards is planned for and managed independently. In the same way, all the resources are available to support in the focal disaster when authorities assume the occurrence of a single disaster, the first experiment involved creating one model for each disaster  and solving it under the assumption that all the resources are available. One model per region was solved for 50 iterations under the same conditions as the original model for comparability. The results of the three models were aggregated and are presented in Table For further analysis, it is possible to look at a combination between integrated planning and independent response. This combination would allow collaborative planning to define the relief network considering the possibility of having multiple disasters but managing the response looking at the needs of individual local authorities. This can be achieved by solving the integrated model first to fix the results of the first-stage variables and then solving one model for each region to determine the value of the second-stage variables. That way, the same relief network is used to optimize independent second-stage decisions. The results of the analysis are shown in Table As the solutions above would be difficult to use in practice, the next test was to allocate a part of the resources a priori to each area for comparison. Each disaster was assumed to be independent, but the split of resources was made before any decisions were defined. As each disaster is considered as an independent event, one model is solved for each disaster. Assuming that each disaster was equally important for authorities, each region was allocated a third of the resources including budget, vehicles, human resources, and quantity of relief items that could be obtained from suppliers. The comparison between the Pareto front of the model and the results of splitting results a priory for independent disasters can be seen in Fig. Table Figure Overall, the results show a good level of performance of the model balancing resources for higher and lower levels of demand, trying to use them according to the magnitude, something that is not easily achievable with independent decision-making.This article argues that humanitarian logistics formulations need to incorporate human resources because these affect operations performance in practice. To further understand the effect of that component, a sensitivity analysis is included to discuss its impact using the number of employees to show the effect of varying the level of staff on the performance of the system. Figure The availability of extra staff has an impact in the level of shortage, as evidenced by the potential reduction in more than half of shortage when human resources are increased by 90% compared to the current situation. This result highlights that human resources are one of the critical factors that can affect the delivery of relief to disaster areas, a dimension commonly overlooked in the literature. In simultaneous disasters, the decision about the allocation of staff evolves from establishing who to send, to determine where to send them as well.This article proposes a formulation integrating multiple suppliers, multiple agencies and simultaneous disasters, an area currently understudied. The bi-objective model provides support for decision-making for logistics activities in settings with stochastic demand capable of optimizing the number of agencies deployed to reduce supply congestion in an environment subject to simultaneous disasters.Planning for simultaneous disasters requires sharing suppliers, resources, and facilities. There is evidence of the benefits of sharing resources among multiple stakeholders  to leverage the interaction of different stakeholders.Relief delivery must look at the combination of human and material resources. Neglecting to consider any of them can lead to wasted or insufficient resources.Agency deployment requires planning. The deployment of participants must be based on the situation(s) and requirements to avoid overcrowding and duplication of efforts, as human resources have a direct impact on the capabilities of the system and its performance.The formulation proposed can serve as basis to inform disaster managers in countries similar to Mexico. The analysis of the case presented provides a set of implications for managers, such as:Despite the growing literature in humanitarian logistics, only a handful of articles are looking at the possibility of simultaneous disasters. This paper introduces a novel formulation incorporating the participation of multiple agencies and suppliers for the delivery of relief to disaster victims in multiple regions affected simultaneously, an approach never undertaken before. Although there are formulations emphasizing the importance of multiple suppliers or multiple participants, this is the first formulation integrating multiple suppliers, multiple agencies, and simultaneous disasters in the same model. The application to a case study in Mexico showed the capacity of the model to provide support, tailoring the response based on the scale of the disasters.The ideas and rationale from this model can be used as the foundation for the development of new holistic decision-support systems integrating different logistics decisions in such a complex environment. Additionally, the results of the case study show the importance of considering suppliers, human resources, and critical facilities to achieve a satisfactory level of service for the victims. Disaster managers can benefit from this research through a well-defined disaster management structure and the impact of supplier selection and management. Aligned with current practices from countries such as the USA, practitioners can use this research to justify the analysis of simultaneous disasters as part of standard practice to have more robust disaster management systems.Solving the model in a few hours because of the use of discrete variable is feasible at the preparedness stage, but it is desirable to reduce solution times through the development of heuristic algorithms in future work. The model introduced in this article provides support for decisions at the planning stage looking at participant, supplier, and facility selection; thus, it could be coupled with models for logistics decisions to provide integrated support for disaster response for multiple periods. In fact, the development of a dynamic model for multiple disasters to support disaster preparedness and response could help managing subsequent, compound, and simultaneous disasters. Given the uncertainty of simultaneous disasters, new formulations should explore the impact of stochastic supply. This article has shown the importance of looking at human resources for relief operations and the next step should consider incorporating uncertainty in the availability of these resources. The integration of technology with operational research is another interesting stream of research.


Epilepsy is a common neurological disease, and patients with epilepsy are a huge group. Their quality of life is not only affected by various comorbidities that follow epilepsy, but also the risk of comorbidities such as anxiety and depression is several times higher than that of people without epilepsy, which makes the comorbidity of epilepsy more and more difficult to ignore. In order to further expand the understanding of epilepsy comorbidities and gain a deeper understanding of their pathogenesis, diagnosis, prevention, and treatment, we have collected 14 pieces of literature related to epilepsy comorbidities, hoping to provide more hints for future research in this direction.Rocamora et al. analyzed 493 patients in their hospital who underwent long-term video EEG monitoring and found that anxiety and depression were more prevalent in female patients, Hospital Anxiety and Depression Scale for anxiety (HADS-A), and Beck Depression Inventory (BDI) > 13. The study revealed the factors affecting patients' quality of life in the epilepsy monitoring unit and pointed out that specific treatment methods should be adopted according to the patient's condition in clinical work.People with epilepsy are more likely to feel anxious than the general population or people with other chronic diseases. Forthoffer et al. argue that newly diagnosed epilepsy patients must be prospectively assessed and screened for anxiety and depression to determine whether anxiety and depression will have an impact on the future course of care.Similarly, Rauh et al. searched a series of epilepsy anxiety assessment tools through PubMed to understand how the previous literature assessed the anxiety of epilepsy patients and analyzed what aspects these self-assessment questionnaires covered. Overall, they found that various questionnaires were used for anxiety assessment of different patients, but there is still a lack of validated assessment tools that can broadly cover epilepsy-related anxiety phenomenology in patients with epilepsy.Zhong et al. followed up 157 newly diagnosed adult epilepsy patients for 12 months, two important predictors of anxiety disorders were screened from a variety of demographic characteristics such as seizure type, income, and educational background, namely the depression level at baseline and the number of anti-seizure medication (ASM) during follow-up. To a certain extent, it provides a theoretical basis for preventing psychological disorders in patients with epilepsy.However, how to avoid anxiety in patients requires the identification of risk factors for anxiety in patients with epilepsy. Sun et al. used EEG microstate analysis for the first time to present the temporal fluctuations of the EEG topography in comorbid depression in patients with TLE and found that TLE patients with the depressive disorder had a shorter microstate time course and more high incidence per second, and compared with the normal group, there was no difference in the coverage of microstate A-D between the two groups, which strongly confirmed alterations in a specific subset of the subsecond functional states of the brain. Chang et al. Using resting-state functional magnetic resonance imaging to observe brain functional connectivity (FC) and degree centrality (DC) in TLE with ictal panic (IP). Compared with TLE without IP and healthy people, TLE patients with IP had significantly higher DC values and increased FC. This opens new doors for further exploration of the neuroimaging mechanisms of IP in TLE patients.Depressive disorders are less common than anxiety, but not uncommon in patients with temporal lobe epilepsy (TLE). Studies have shown that epilepsy and depression have similar networks in neuropsychiatric disorders, which provides a theoretical basis for the high incidence of epilepsy comorbid depression. Therefore, Wu et al. investigated epilepsy stigma attitudes in 310 Chinese native-speakers by using the Simplified Chinese Mandarin version of the Stigma Scale of Epilepsy and subsequently verified the scale's accuracy. To some extent, the degree of disease stigma is quantified, and it provides direction for the development of effective public interventions in the future. Seizures can also be psychologically traumatic for the patient. Using a scale to assess traumatic experienced seizures in patients with pharmacoresistant focal epilepsy, Mariotti et al. found that seizures are the source of the development of postepileptic seizure-posttraumatic stress disorder (PS-PTSD) and noted that early identification and treatment could improve patients' quality of life.In addition, not only does epilepsy comorbidity bring psychological barriers to patients, but uncontrollable seizures in public places may expose patients to social discrimination. Operto et al. surveyed 103 children with different forms of epilepsy and 93 in a control group and found that compared with their peers, children with epilepsy were more likely to have emotional and behavioral problems, and the stress of parents in the epilepsy group was significantly higher than that in the control group. Therefore, it is essential to identify emotional and behavioral problems in children with epilepsy early and support their parents accordingly. This is similar to the study by Wei et al. who pointed out that the incidence of depression among primary caregivers of children with epilepsy was close to 70%, and the degree of depression in caregivers was positively correlated with the severity of epilepsy in children; the study by Zhang et al. found that the caregivers' anxiety status, sleep quality, family role dimension, family general function dimension, and the number of co-caregivers were predictors of depression status in caregivers. João et al. assessed anxiety and depression in adults with epilepsy and their caregivers, and although epilepsy patients were more likely than their caregivers to experience depression and suicidal ideation, the proportion and intensity of clinical anxiety symptoms were similar. All three studies point to concern not only for the psychological problems of people with epilepsy but also for their caregivers.Children with epilepsy are a particularly distinct group of patients with epilepsy. The disease itself will harm children's psychology and adversely affect the quality of life of their families. Niimi et al. speculated that psychological differences might exist between patients with epilepsy who underwent epilepsy surgery before and during the COVID-19 pandemic, and used the Zung Self-Rating Depression Scale (SDS) to evaluate the difference in depression between the two groups of patients. The results showed that the SDS score was higher in the pre-pandemic group than in the within-pandemic group, indicating that patients with less positive outlooks may be less likely to seek medical attention during periods of societal or personal stress.Due to the coronavirus disease 2019 (COVID-19) pandemic, all patients' medical examinations have been delayed, which may worsen patients' diseases. Therefore, Dono et al. retrospectively analyzed 28 patients with brain tumors and found that prophylactic use of levetiracetam had a higher incidence and severity of psychiatric symptoms than controls. Accurate epileptological evaluations in patients with brain tumors are mandatory to select who would benefit most from ASM.Due to the high cost of surgery, some patients still prefer drug therapy. Levetiracetam is considered one of the first-choice drugs for patients with brain tumor-related epilepsy, but side effects come with it. ZX, XT, XW, YC, QX, and GA organized this Research Topic and wrote the editorial. All authors have approved the final version of the editorial.We thank the authors for contributing their valuable work to this Research Topic and the reviewers for their constructive comments. We are also grateful to the editorial board for approving this topic and we hope this issue will advance the state of research on the comorbidities of epilepsy.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.


Assessing the ethical, legal, and social implications related to the numerous issues that have arisen in the short history of the virus is a hugely valuable effort that was the goal of this special Research Topic, especially as we are likely to experience additional pandemics or pandemic-like medical events in the foreseeable future. Indeed, on 23 July 2022, monkeypox was declared a global health emergency by the World Health Organization (WHO) .Beauvais and Maria Knoppers; Song et al.), uncertainty regarding the vaccine , and other prophylactic containment measures and tentative therapeutics , triage guidelines  and government guidelines , and many more.The numerous articles in this Research Topic are testament to the diversity of ethical, legal, and social implications (ELSI) raised by COVID and approaches proposed to address them. They relate to concerns regarding privacy (Lack of transparency and the lack of trust that this engenders regarding: 1) vaccine approvals by national healthcare authorities; 2) undisclosed contracts between governments and vaccine manufacturers; and 3) prioritization of vulnerable populations, were among the many drivers for vaccine hesitancy or worse in many countries . As suchHowever, it is not just past instances relating to COVID vaccination at this intersection of science and society that carry challenging ethical, legal and social implications, but also the permanent or semi-permanent societal and even institutional changes that have been brought on by this pandemic, and that will also create future ELSI. As such, even as most societies have evolved significantly since the first outbreak of this virus, those changes still create issues that ought to be analyzed under the ELSI rubric.Consider for example the extensive genetic testing infrastructure that has been set up at points of entry around the globe. Most countries have stopped conducting PCR tests on incoming travelers. Eventually all jurisdictions will no longer test for COVID-19 at their borders. At that point, ought we be concerned that this expensive technological infrastructure and their supporting organizational backbones will be repurposed to conduct other forms of genetic testing on incoming foreigners?This isn’t far-fetched. Recall the shuttle diplomacy that preceded the Russian invasion of Ukraine. The media often presented us with Russian President Vladimir Putin sitting at the head of a comically large table while in discussion with foreign leaders. International reporting confirmed that with foreign leaders unwilling to subject themselves to Russian COVID DNA testing, other appropriate social distancing methods had to be employed, hence the continued use of the long table. . These lWith DNA and RNA PCR testing costs continuing to plummet , it may If this is the case, then we should work now to expand genetic privacy protection regimes, even as other areas of privacy are being whittled away . Thus, wOur privacy is not only at risk at the borders though. COVID has also brought extensive informative surveillance of wastewater as another tool to assess the level of COVID infections within a given population and the detection of emerging SARS-CoV-2 mutations in the community . And likHowever, not all is bad. There are positive externalities resulting from the pandemic. Consider the potential for a drastic evolution in healthcare data sharing and prevention. Heretofore, the human response to such a global peril has been uncoordinated and slow, even as this is clearly not our first rodeo: the first documented human pandemic, the Antonine Plague, dates back almost 2000 years .Since then, medical knowledge and technologies have grown exponentially, and modern communication technologies have revolutionized human relations. Yet, even after two millennia, when COVID-19 struck, the world was again caught unprepared: news of the existence of the disease was slow to circulate; information about the virus, including data on its genetics, evolution, and characteristics of affected patients were unevenly shared . The resA chain of important developments that should have prepared us for a public health challenge of this magnitude began unfolding in the middle of the 20th century. The creation of the WHO in 1948 and, the same year, the adoption in the Universal Declaration on Human Rights of Article 27 affirming the right of everyone to enjoy the benefits of scientific progress created both a legal foundation and an international organisation to advocate for health data sharing in a pandemic context . Other iThe current WHO system represented by the IHR has proven insufficient to ensure that national governments comply with their international data sharing responsibilities and reporting obligations . The draAn important failure in data sharing for COVID-19 has been the general incapacity of national jurisdictions to engage LMIC countries and vulnerable population groups through enlisting their participation as active partners in international data sharing efforts . The relUltimately concrete solution will need to be implemented to build LMIC countries’ capacity to carry out effective pandemic surveillance and to develop their own data repository. The objective of this strategy is to provide necessary guarantees to obtain access to diverse representative data in terms of gender, ethnic and geographical origin, socio-economic status, etc. So that these data can be used for research to the benefit of the groups having contributed them as well as other populations.A determining element of success of the global data sharing strategy we envision here will be the capacity of the WHO and other international organizations, NGOs, and policymakers to propagate an extensive and lasting change of culture towards data sharing. While investigators and data producers in some research fields such as informatics, bioinformatics, and large-scale genomic research have, to a large extent, embraced the open science ethos and are developing incentives and standards to facilitate the process, the same cannot be said of other stakeholders involved in pandemic response. For example, national public health agencies and related departments, pharmaceutical companies, and researchers interested in the socio-economic determinants of health, are less familiar with data sharing requirements, or believe they have little to gain from participating in the process. Proper incentives, beyond the moral duty to contribute to the public good, are necessary to ensure significant buy-in to global data-sharing regulations. Similarly, processes to meaningfully identify and address instances of non-compliance to data sharing policies will need to be devised.After over 2 years of the COVID-19 pandemic, with populations across the world having felt the negative impacts on population health of pressures on healthcare systems, restrictions on personal freedoms, international travel, and impacts on economic activities, there should be no excuse to further delay the adoption of pandemic data sharing regulations. Such regulations are clearly a necessity to ensure our response to emerging pandemics is well coordinated, meaningful and scientifically optimal. Considerations of equity and solidarity demand that we engage LMIC and other vulnerable groups early in this process to ensure such a framework will address their pandemic needs, not only those of G20 countries. Finally, to be truly effective, the regulations will need to trigger a broad, lasting culture change in favor of rapid data sharing for the benefit of humanity as a whole.In summary, even as we head into the third year of this pandemic, there remains much to be learned, considered and dealt with, particularly in the areas relating to ethics, law and society. This Research Topic scratched only the surface of the myriad concerns, past, present and future. As we continue facing this global challenge, let us hope that debate and dialogue on these issues will result in policy reforms that will modernise and coordinate the global community capacity to respond to such public health crises in the future. Better harmonization of national public health policies during pandemics will help improve humanity’s preparedness for the forthcoming climate change, already felt in Europe and North America in summer 2022.


We propose a randomized controlled pilot study for an acupuncture protocol regarding the management of PCOS symptoms based on TCM diagnosis; (2) Methods: We will randomly allocate 120 women diagnosed with PCOS into two groups. The study group will be treated with acupuncture for points known to act upon the autonomous regulation of the hormonal, metabolic and emotional components. (3) Results and Conclusions: We expect to provide evidence of high methodological quality related to the effects and safety of an acupuncture protocol based on the perspective of a TCM diagnostic. Polycystic ovary/ovarian syndrome (PCOS) is considered the most frequent endocrine pathophysiology among women of fertile age, displaying a prevalence between 5 and 15% relative to the clinical diagnostic criteria . In 2003According to what was mentioned before, it would be an important contribution for PCOS patient treatment to perform an acupuncture randomized controlled trial according to TCM diagnosis of the condition. In this sense, we made a revision of the literature produced during the last five years on TCM PCOS management (data not shown), and we found important limitations that we will try to overcome with the proposed study. So, we designed an acupuncture RCT study according to the TCM pathomechanism associated with PCOS proposed by Lyttleton (2013). According to this proposed mechanism, impairment of the Conception and Governing vessels is a common denominator to gynecological problems. Moreover, Conception and Governing vessel deficiencies are closely related to kidney deficiency. Most women diagnosed with PCOS according to the Rotterdam criteria show Phenotype A or 1 and Phenotype C or 3 , which aWe propose a randomized, sham-controlled, single-blinded trial that aims to ameliorate PCOS symptoms, namely, clinical and biochemical hyperandrogenism, ovulation rate, glucolipidic profile, IR, metabolic syndrome, and mental health-related parameters such as anxiety, depression, and quality of life in women diagnosed with this condition. The proposed study trial follows the SPIRIT guidelines and checklist.n = 60): kidney deficiency associated with phlegm-dampness syndrome and/or spleen deficiency or liver stasis and group B (n = 60): kidney deficiency with main symptoms of blood stasis. Each group should have a total of 60 participants to achieve statistical difference in the case of 20% withdrawal of the participants ) will be used if the data do not obey the normal distribution and count data will be expressed in terms of the number of cases. We will use chi-square tests for categorical data and two sample t-tests or Wilcoxon rank sum tests for continuous data, according to whether the data are normally distributed or not. The variance analysis will be performed for the difference between groups and within the group. The stratified analysis will be performed to control the confounding factor if necessary.All data will be entered into a predesigned, password protected electronic database by two independent researchers who will be blinded to the allocation groups. All statistical analyses of the data will be performed using the SPSS program V.21.0. A http://www.chiati.org.cn/index.aspx, accessed on 4 January 2021). A written informed consent will be obtained from each participant. Ethical approval will be obtained from the Ethics Committees of all involved institutions. All procedures performed in this study will be in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration and its later amendments. Any changes that need to be made in the trial protocol will be communicated to all investigators, the ethics committees, and the trial registry. The results obtained will be disseminated in peer-reviewed journals and presented at international conferences.This trial will be registered in the WHO International Clinical Trials Registry Platform (ICTRP) As we mentioned before, from a previous revision of the literature, we concluded that for an accurate assessment of acupuncture as a valuable tool in PCOS syndrome treatment, more blinded RTC studies with larger samples are necessary. Moreover, we think that future studies should include adequate controls and the study designs should follow STRICTA recommendations. To make it possible for interstudy comparison, we think that it would also be important that the PCOS diagnostic criteria should meet the latest Rotterdam criteria with the discrimination of the types of PCOS phenotypes  since thTo overcome the described limitations found in the literature on PCOS women studies, we propose an RCT with a sample of 120 women. This large sample would be important to increase the probability of including participants from all 4 phenotypes of latest Rotterdam criteria. Additionally, we will include a control group. Not all the previous studies presented blank controls ,56 whichWith the proposed trial, we expect to validate an acupuncture protocol in terms of efficacy and safety that can be a useful tool in the management of symptoms associated with PCOS. With this study design, we expect to find evidence that active acupuncture can be more helpful for promoting follicular development, adjusting the menstrual cycle, and increasing ovulation rate in women with PCOS than sham acupuncture and the long-term effect of the treatment. After active acupuncture treatment, it is expected to find a relative reduction of the biomarkers when comparing to baseline values regarding LH, LH/FSH, total free testosterone, androstenedione, estradiol, BMI, waist circumference, WRH, modified Ferriman–Gallwey score, and Ludwig visual score. We expect an improvement of biochemical hyperandrogenism and HPG axis imbalance, a decrease of androstenedione and sex-hormone-binding globulin, besides the expected decrease in the levels of LH, LH/FSH ratio, total testosterone, estradiol, and on the scoring of the modified Ferriman–Gallwey and Ludwig scales. We expect a possible increase in FSH, progesterone, and the ovulation rate after active acupuncture. With respect to secondary outcomes, we will explore the effect of the acupuncture treatment on metabolic symptoms and expect to describe the metabolic profile of each phenotype before and after the respective treatment. We will adopt international measures as a gold standard for assessing the metabolic status criteria. Besides HOMA-IR improvement, we expect to find a positive correlation between active acupuncture and reduction of the levels of triglycerides, total cholesterol, LDL-C, LDL/HDL, fasting glucose, fasting insulin, and serum insulin and an overview improvement of the metabolic syndrome development. In addition to that, we will try to understand the efficacy of the treatment on exploratory parameters related to the quality of life of the patient, many times disregarded in this type of treatment, especially in anxiety and depression scoring. In this regard, we expect to find a better scoring in the respective questionnaires  after active acupuncture intervention, particularly in phenotypes where liver fire associated with kidney deficiency originates a lack of mental presence or easy loss of temper. With the results of the study, we also expect to obtain evidence on the possible correlation of phenotypes based on the Rotterdam criteria and those based on the TCM diagnosis proposed by Wang et al., 2017.The expected results of the proposed RCT study could provide evidence of high methodological quality related to the effect and safety of an acupuncture protocol based on the perspective of a TCM diagnostic, with the evaluation of improvement in hormonal, metabolic, and emotional symptoms associated with PCOS.