2025 Vol. 38, No. 3

Cover
Cover
2025, 38(3)
2025-3 Contents
2025, 38(3): 1-2.
Editorial
The First Imported Case of Lassa Fever in China – Implications for Global Health Surveillance
Qiyong Liu
2025, 38(3): 277-278. doi: 10.3967/bes2025.029
Original Article
Laboratory Diagnosis and Molecular Epidemiological Characterization of the First Imported Case of Lassa Fever in China
Yuliang Feng, Wei Li, Mingfeng Jiang, Hongrong Zhong, Wei Wu, Lyubo Tian, Guo Chen, Zhenhua Chen, Can Luo, Rongmei Yuan, Xingyu Zhou, Jiandong Li, Xiaorong Yang, Ming Pan
2025, 38(3): 279-289. doi: 10.3967/bes2025.014
  Objective  This study reports the first imported case of Lassa fever (LF) in China. Laboratory detection and molecular epidemiological analysis of the Lassa virus (LASV) from this case offer valuable insights for the prevention and control of LF.  Methods  Samples of cerebrospinal fluid (CSF), blood, urine, saliva, and environmental materials were collected from the patient and their close contacts for LASV nucleotide detection. Whole-genome sequencing was performed on positive samples to analyze the genetic characteristics of the virus.  Results  LASV was detected in the patient’s CSF, blood, and urine, while all samples from close contacts and the environment tested negative. The virus belongs to the lineage IV strain and shares the highest homology with strains from Sierra Leone. The variability in the glycoprotein complex (GPC) among different strains ranged from 3.9% to 15.1%, higher than previously reported for the seven known lineages. Amino acid mutation analysis revealed multiple mutations within the GPC immunogenic epitopes, increasing strain diversity and potentially impacting immune response.  Conclusion  The case was confirmed through nucleotide detection, with no evidence of secondary transmission or viral spread. The LASV strain identified belongs to lineage IV, with broader GPC variability than previously reported. Mutations in the immune-related sites of GPC may affect immune responses, necessitating heightened vigilance regarding the virus.
Environmental Temperature and the Risk of Hand, Foot, and Mouth Disease Transmission in the Yangtze River Region of China
Yanqing Yang, Min Chen, Jin Li, Kaiqi Liu, Xueyan Guo, Xin Xu, Qian Liang, Xinglu Wu, Suwen Lei, Jing Li
2025, 38(3): 290-302. doi: 10.3967/bes2025.011
  Objective  To assess health equity in the Yangtze River region to improve understanding of the correlation between hand, foot, and mouth disease (HFMD) and socioeconomic factors.  Methods  From 2014–2016, data on HFMD incidence, population statistics, economic indicators, and meteorology from 26 cities along the Yangtze River were analyzed. A multi-city random-effects meta-analysis was performed to study the relationship between temperature and HFMD transmission, and health equity was assessed with respect to socio-economic impact.  Results  Over the study period, 919,458 HFMD cases were reported, with Shanghai (162,303) having the highest incidence and Tongling (5,513) having the lowest. Males were more commonly affected (male-to-female ratio, 1.49:1). The exposure-response relationship had an M-shaped curve, with two HFMD peaks occurring at 4 °C and 26 °C. The relative risk had two peaks at 1.30 °C (1.834, 95% CI: 1.204–2.794) and 31.4 °C (1.143, 95% CI: 0.901–1.451), forming an M shape, with the first peak higher than the second. The most significant impact of temperature on HFMD was observed between –2 °C and 18.1 °C. The concentration index (0.2463) indicated moderate concentration differences, whereas the Theil index (0.0418) showed low inequality in distribution.  Conclusion  The incidence of HFMD varied across cities, particularly with changes in temperature. Economically prosperous areas showed higher risks, indicating disparities. Targeted interventions in these areas are crucial for mitigating the risk of HFMD.
Impact of Laboratory Analytical Indicators on Positive Blood Culture Detection Rates: A Single Center Study
Di Wang, Lingli Liu, Ruirui Ma, Lijun Du, Guixue Cheng, Yali Liu, Qiaolian Yi, Yingchun Xu
2025, 38(3): 303-312. doi: 10.3967/bes2024.157
  Objective  Blood culture remains the gold standard for diagnosing bloodstream infections. Clinical laboratories must ensure the quality of blood culture processes from receipt to obtaining definitive results. We examined laboratory analytical indicators associated with positive blood culture results.   Methods  Blood cultures collected from Peking Union Medical College Hospital between January 1, 2020, and December 31, 2022, were retrospectively analyzed. The mode of transportation (piping logistics delivery vs. staff), source of blood cultures (outpatient/emergency department vs. inpatient department), rotation of personnel, and time of reception (8:00–19:59 vs. 20:00–07:59) were compared between blood culture-positive and -negative results.  Results  Between 2020 and 2022, the total positive rate of blood culture was 8.07%. The positive rate of blood cultures in the outpatient/emergency department was significantly higher than that in the inpatient department (12.46% vs. 5.83%; P < 0.0001). The time-to-detection of blood cultures was significantly affected by the delivery mode and personnel rotation. The blood culture positive rate of the total pre-analytical time within 1 h was significantly higher than that within 1–2 h or > 2 h (P < 0.0170).  Conclusion  Laboratory analytical indicators such as patient source, transportation mode, and personnel rotation significantly impacted the positive detection rate or time of blood culture.
Comprehensive Analysis of Oncogenic, Prognostic, and Immunological Roles of FANCD2 in Hepatocellular Carcinoma: A Potential Predictor for Survival and Immunotherapy
Mengjiao Xu, Wen Deng, Tingting Jiang, Shiyu Wang, Ruyu Liu, Min Chang, Shuling Wu, Ge Shen, Xiaoxue Chen, Yuanjiao Gao, Hongxiao Hao, Leiping Hu, Lu Zhang, Yao Lu, Wei Yi, Yao Xie, Minghui Li
2025, 38(3): 313-327. doi: 10.3967/bes2024.182
  Objective   Hepatocellular carcinoma (HCC) is sensitive to ferroptosis, a new form of programmed cell death that occurs in most tumor types. However, the mechanism through which ferroptosis modulates HCC remains unclear. This study aimed to investigate the oncogenic role and prognostic value of FANCD2 and provide novel insights into the prognostic assessment and prediction of immunotherapy.  Methods   Using clinicopathological parameters and bioinformatic techniques, we comprehensively examined the expression of FANCD2 macroscopically and microcosmically. We conducted univariate and multivariate Cox regression analyses to identify the prognostic value of FANCD2 in HCC and elucidated the detailed molecular mechanisms underlying the involvement of FANCD2 in oncogenesis by promoting iron-related death.  Results  FANCD2 was significantly upregulated in digestive system cancers with abundant immune infiltration. As an independent risk factor for HCC, a high FANCD2 expression level was associated with poor clinical outcomes and response to immune checkpoint blockade. Gene set enrichment analysis revealed that FANCD2 was mainly involved in the cell cycle and CYP450 metabolism.  Conclusion  To the best of our knowledge, this is the first study to comprehensively elucidate the oncogenic role of FANCD2. FANCD2 has a tumor-promoting aspect in the digestive system and acts as an independent risk factor in HCC; hence, it has recognized value for predicting tumor aggressiveness and prognosis and may be a potential biomarker for poor responsiveness to immunotherapy.
Predicting Postoperative Circulatory Complications in Older Patients: A Machine Learning Approach
Xiaoyun Hu, Weixuan Sheng, Kang Yu, Jietai Duo, Pengfei Liu, Yawei Li, Dongxin Wang, Huihui Miao
2025, 38(3): 328-340. doi: 10.3967/bes2025.005
  Objective  This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications (PCCs) for older patients.  Methods  This secondary analysis of data from a randomized controlled trial involved 1,720 elderly participants in five tertiary hospitals in Beijing, China. Participants aged 60–90 years undergoing major non-cardiac surgery under general anesthesia. The primary outcome metric of the study was the occurrence of PCCs, according to the European Society of Cardiology and the European Society of Anaesthesiology diagnostic criteria. The analysis metrics contained 67 candidate variables, including baseline characteristics, laboratory tests, and scale assessments.  Results  Our feature selection process identified key variables that significantly impact patient outcomes, including the duration of ICU stay, surgery, and anesthesia; APACHE-II score; intraoperative average heart rate and blood loss; cumulative opioid use during surgery; patient age; VAS-Move-Median score on the 1st to 3rd day; Charlson comorbidity score; volumes of intraoperative plasma, crystalloid, and colloid fluids; cumulative red blood cell transfusion during surgery; and endotracheal intubation duration. Notably, our Random Forest model demonstrated exceptional performance with an accuracy of 0.9872.  Conclusion  We have developed and validated an algorithm for predicting PCCs in elderly patients by identifying key risk factors.
Impact of Endometrial Polyps on Pregnancy Outcomes in Patients with Endometriosis and Infertility: A Systematic Review and Meta-analysis
Liang Zhang, Qian Han, Meiru Bao, Ying Wu
2025, 38(3): 341-350. doi: 10.3967/bes2024.175
  Objective   To evaluate the impact of endometrial polyps (EP) on postoperative pregnancy outcomes in infertile women with endometriosis (EMs).   Methods   PubMed, Embase, The Cochrane Library, CNKI, VIP, SinoMed, and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs, published before August 31, 2020. A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature, extracted information, and evaluated the risk of bias of the included studies.   Results   The meta-analysis included ten studies (651 and 1,040 in the combined EP and uncomplicated EP groups, respectively). The spontaneous pregnancy rate, clinical pregnancy rate, and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs [Odd’s ratio (OR) = 0.63, 95% confidence interval (CI): 0.50–0.80, P = 0.0001; OR = 0.63, 95% CI: 0.48–0.84, P = 0.001; OR = 0.63, 95% CI: 0.42–0.96, P = 0.03], and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group [OR = 3.10, 95% CI: 1.52–6.32, P = 0.002].  Conclusion   EP may adversely affect pregnancy outcomes in patients with infertility and EMs. Even after surgical treatment, EP can still reduce natural pregnancy, clinical pregnancy, and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
Association of Loneliness and Social Isolation with Ischemic Heart Disease: A Bidirectional and Network Mendelian Randomization Study
Shuyao Su, Wanyue Wang, Chenxi Yuan, Zhennan Lin, Xiangfeng Lu, Fangchao Liu
2025, 38(3): 351-364. doi: 10.3967/bes2024.170
  Objective  Observational studies have shown inconsistent associations of loneliness or social isolation (SI) with ischemic heart disease (IHD), with unknown mediators.  Methods  Using data from genome-wide association studies of predominantly European ancestry, we performed a bidirectional two-sample Mendelian Randomization (MR) study to estimate causal effects of loneliness (N = 487,647) and SI traits on IHD (N = 184,305). SI traits included whether individuals lived alone, participated in various types of social activities, and how often they had contact with friends or family (N = 459,830 to 461,369). A network MR study was conducted to evaluate the mediating roles of 20 candidate mediators, including metabolic, behavioral and psychological factors.  Results  Loneliness increased IHD risk (OR = 2.129; 95% confidence interval [CI]: 1.380 to 3.285), mediated by body fat percentage, waist-hip ratio, total cholesterol, and low-density lipoprotein cholesterol. For SI traits, only fewer social activities increased IHD risk (OR = 1.815; 95% CI: 1.189 to 2.772), mediated by hypertension, high-density lipoprotein cholesterol, triglycerides, fasting insulin, and smoking cessation. No reverse causality of IHD with loneliness and SI was found.  Conclusion  These findings suggested more attention should be paid to individuals who feel lonely and have fewer social activities to prevent IHD, with several mediators as prioritized targets for intervention.
The Impact of Reproductive Traits on Psoriasis Risk is Mediated by Education Attainment and Body Mass Index: A Mendelian Randomization Study
Yajia Li, Qiangxiang Li, Ziqin Cao, Jianhuang Wu
2025, 38(3): 365-375. doi: 10.3967/bes2024.122
  Objective   To explore the causality between reproductive traits and risk of psoriasis by using a large Mendelian randomization (MR) study.  Methods   A two-sample MR study was performed using summarized statistics from the genome-wide association studies (GWAS) conducted in reproductive traits, as well as GWAS data on overall psoriasis, psoriatic arthritis (PsA), and psoriasis vulgaris (PV). Besides univariable MR (UVMR), multivariable MR and two-step MR was used to calculate the independent effects and quantify the proportion mediated by education or body mass index (BMI).  Results   Genetically predicted early age at first sexual intercourse (AFS) led to an increased risk of overall psoriasis [odds ratio (OR)UVMR: 0.54]; 36.13% of this effect was mediated through BMI and 47.79% through educational attainment. The direct negative casual association between age at first birth (AFB)-PsA was dominant (ORUVMR: 0.76), with 49.61% proportion of the mediation due to BMI. The mediating effect was found for BMI on the AFS-PV relationship, which accounted for 26.27% of the proportion. AFS was inversely associated with the risk of overall psoriasis and PV, with considerable mediation by BMI and educational attainment.  Conclusion   Early AFB may cause a higher risk of PsA, while the AFS-PsA association was fully mediated by BMI.
Letter
A New Classification System for Childhood and Adolescent Obesity: Definition of the BCAMS Classification
Ming Li, Shan Gao
2025, 38(3): 376-378. doi: 10.3967/bes2025.006
Trends of Disease Burden of Pancreatic Cancer Attributed to High Fasting Plasma Glucose in China,1990–2021: Insights from the Global Burden of Disease Study 2021
Xiaochen Chen, Feifei Zhong, Juan Li
2025, 38(3): 379-384. doi: 10.3967/bes2025.027
A Health Economic Evaluation of an Artificial Intelligence-assisted Prescription Review System in a Real-world Setting in China
Di Wu, Yingpeng Qiu, Liwei Shi, Kejun Liu, Xueqing Tian, Ping Ren, Mao You, Junrui Pei, Wenqi Fu, Yue Xiao
2025, 38(3): 385-388. doi: 10.3967/bes2025.025
Short-term Effects of Fine Particulate Matter and its Constituents on Acute Exacerbations of Chronic Bronchitis: A Time-stratified Case-crossover Study
Jingwei Zhang, Jian Zhang, Pengfei Li, Yandan Xu, Xuesong Zhou, Xiuli Tang, Jia Qiu, Zhongao Ding, Mingjia Xu, Chongjian Wang
2025, 38(3): 389-393. doi: 10.3967/bes2025.026
The Role of VSD in Enhancing the Biological Environment of Scarred Skin Incisions in Valve Replacement: A Clinical Study on Postoperative Outcomes in Patients with Extensive Burns and Cardiac Valve Neoplasms
Wei Liu, Ting He, Yang Chang, Longlong Yang, Chuan-an Shen
2025, 38(3): 394-399. doi: 10.3967/bes2025.023