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Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes/issues, but are citable by Digital Object Identifier (DOI).
Original Article
Chromosome 8 open reading frame 76 (C8orf76) co-expressed with cyclin-dependent kinase 4 (CDK4) as a prognostic indicator of colorectal cancer
Shang Guo, Chengcheng Liu, Zifeng Zhao, Zhongxin Li, Xia Jiang, Zengren Zhao
, Available online  , doi: 10.3967/bes2024.177
  Objective  To explore the correlation between chromosome 8 open reading frame 76 (C8orf76) and cyclin-dependent kinase 4 (CDK4) and the potential predictive effect of C8orf76 and CDK4 on the prognosis of colorectal cancer (CRC).  Methods  We constructed a protein-protein interaction network of C8orf76-related genes and analyzed the prognostic signatures of C8orf76 and CDK4. Clinicopathological features of C8orf76 and CDK4 were visualized using a nomogram.  Results  C8orf76 and CDK4 levels were positively correlated in two independent human CRC cohorts (n = 83 and n = 597). A consistent positive correlation was observed between C8orf76 and CDK4 expression in the CRC cell lines. The nomogram included prognostic genes (C8orf76 and CDK4) and pathological N and M stages. The concordance index (C-index) in our cohort was 0.776, which suggests that the ability of the indicators to predict the overall survival of patients with CRC in our cohort was strong.  Conclusions  We found that C8orf76 was positively correlated with CDK4 in both the cohorts as well as in CRC cell lines. Therefore, C8orf76 and CDK4 can be used as potential biomarkers to predict the prognosis of CRC.
Independent and Interactive Effects of Air Pollutants, Meteorological Factors, and Green Space on Tuberculosis Incidence in Shanghai
Qi Ye, Jing Chen, Yating Ji, Xiaoyu Lu, Jiale Deng, Nan Li, Wei Wei, Renjie Hou, Zhiyuan Li, Jianbang Xiang, Xu Gao, Xin Shen, Chongguang Yang
, Available online  , doi: 10.3967/bes2025.041
  Objective  To assess the independent and combined effects of air pollutants, meteorological factors, and greenspace exposure on new tuberculosis (TB) cases.  Methods  TB case data from Shanghai (2013–2018) were obtained from the Shanghai Center for Disease Control and Prevention. Environmental data on air pollutants, meteorological variables, and greenspace exposure were obtained from the National Tibetan Plateau Data Center. We employed a distributed-lag nonlinear model to assess the effects of these environmental factors on TB cases.  Results  Increased TB risk was linked to PM2.5, PM10, and rainfall, whereas NO2, SO2, and air pressure were associated with a reduced risk. Specifically, the strongest cumulative effects occurred at various lags: PM2.5 (RR = 1.166, 95% CI: 1.026–1.325) at 0–19 weeks; PM10 (RR = 1.167, 95% CI: 1.028–1.324) at 0–18 weeks; NO2 (RR = 0.968, 95% CI: 0.938-0.999) at 0–1 weeks; SO2 (RR = 0.945, 95% CI: 0.894–0.999) at 0–2 weeks; air pressure (RR = 0.604, 95% CI: 0.447–0.816) at 0–8 weeks; and rainfall (RR = 1.404, 95% CI: 1.076–1.833) at 0–22 weeks. Green space exposure did not significantly impact TB cases. Additionally, low temperatures amplified the effect of PM2.5 on TB.  Conclusion  Exposure to PM2.5, PM10, and rainfall increased the risk of TB, highlighting the need to address air pollutants for the prevention of TB in Shanghai.
Disease burden and trends of COPD in the Asia-Pacific region (1990–2019) and predictions to 2034
Jing Ma, Hong Mi
, Available online  , doi: 10.3967/bes2025.040
  Objective  The Asia-Pacific region has a high Chronic obstructive pulmonary disease (COPD) burden, but studies on its trends are limited. Using the Global Burden of Disease (GBD) 2019 data, we analyzed COPD trends in 36 countries from 1990 to 2019 and predicted future incidence trends through 2034.  Methods  COPD data by age and sex from the GBD 2019 database were analyzed for incidence, prevalence, mortality, and disability-adjusted life years (DALY) rates from 1990 to 2019. Joinpoint regression identified significant annual trends, and age-standardized incidence rates were predicted through 2034 using age–period–cohort models.  Results  The incidence, prevalence, mortality, and disease burden of COPD have been decreasing, and the incidence rates will continue to decrease or remain stable until 2034 in most selected countries and territories, except for a few Southeastern Asian countries. The Lao People’s Democratic Republic and Vietnam are projected to experience an increase in COPD incidence from 165.3 per 100,000 in 2019 to 177 per 100,000 in 2034 and from 179.9 per 100,000 in 2019 to 192.5 per 100,000 in 2034, respectively. Older males had a higher incidence than any other sex or age group. The sex gap in incidence rates continues to widen, though it is smaller and less significant in the younger age group than in those in the older one.  Conclusion  COPD rates are expected to decline until 2034 but remain a health risk, especially in countries with rising rates. Urgent action on tobacco control, air pollution, and public education is needed.
Forecast of the Burden of Lower Respiratory Infections in the Elderly Aged 70 and Above in China from 1990 to 2050, GBD2021
Miaomiao Zhang, Ruiyi Zhang, Yuchang Zhou, Maigeng Zhou
, Available online  , doi: 10.3967/bes2025.036
  Objective  This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.  Methods  This study utilized Global Burden of Disease (GBD) 1990-2050 prediction data to analyze changes in mortality rates and disability-adjusted life year (DALY) rates for lower respiratory infections in the elderly population (aged 70 and above) in China from 1990 to 2050. It also discusses future trends in the burden of lower respiratory infections (LRI) in China under different scenarios.  Results  According to GBD predictions, the burden of lower respiratory infections in the elderly aged 70 years and above in China is lower than the global average. The burden has been decreasing from 1990 to 2020, but is projected to increase from 2020 to 2050. Scenario-based predictions suggest that, under scenarios involving improvements in nutrition and vaccination, the burden of lower respiratory infections in the elderly in China is expected to be the lowest in 2050.  Conclusions  This study indicates that the burden of lower respiratory infections in elderly people aged 70 years and above in China remains a significant public health issue and may worsen. The government should consider strengthening the preventive measures and management strategies for respiratory infections in the elderly population.
Deciphering the Role of VIM, STX8, and MIF in Pneumoconiosis Susceptibility: A Mendelian Randomization Analysis of the Lung-Gut Axis and Multi-Omics Insights from European and East Asian Populations
Chenwei Zhang, Binbin Wan, Yukai Zhang, Tao Xiong, Yishan Li, Xuesen Su, Gang Liu, Yangyang Wei, Yuanyuan Sun, Jingfen Zhang, Xiao Yu, Yiwei Shi
, Available online  , doi: 10.3967/bes2025.028
  Background  Pneumoconiosis, a lung disease caused by irreversible fibrosis, represents a significant public health burden. This study investigates the causal relationships between gut microbiota, gene methylation, gene expression, protein levels, and pneumoconiosis using a multi-omics approach and Mendelian randomization (MR).  Methods  We analyzed gut microbiota data from MiBioGen and Esteban et al. to assess their potential causal effects on pneumoconiosis subtypes (asbestosis, silicosis, and inorganic pneumoconiosis) using conventional and summary-data-based MR (SMR). Gene methylation and expression data from Genotype-Tissue Expression and eQTLGen, along with protein level data from deCODE and UK Biobank Pharma Proteomics Project, were examined in relation to pneumoconiosis data from FinnGen. To validate our findings, we assessed self-measured gut flora from a pneumoconiosis cohort and performed fine mapping, drug prediction, molecular docking, and Phenome-Wide Association Studies to explore relevant phenotypes of key genes.  Results  Three core gut microorganisms were identified: Romboutsia (OR = 0.249) as a protective factor against silicosis, Pasteurellaceae (OR = 3.207) and Haemophilus parainfluenzae (OR = 2.343) as risk factors for inorganic pneumoconiosis. Additionally, mapping and quantitative trait loci analyses revealed that the genes VIM, STX8, and MIF were significantly associated with pneumoconiosis risk.  Conclusions  This multi-omics study highlights the associations between gut microbiota and key genes (VIM, STX8, MIF) with pneumoconiosis, offering insights into potential therapeutic targets and personalized treatment strategies.
Generalized Functional Linear Models: Efficient Modeling for High-dimensional Correlated Mixture Exposures
Bingsong Zhang, Haibin Yu, Xin Peng, Haiyi Yan, Siran Li, Shutong Luo, Renhuizi Wei, Zhujiang Zhou, Yalin Kuang, Yihuan Zheng, Chulan Ou, Linhua Liu, Yuehua Hu, Jindong Ni
, Available online  , doi: 10.3967/bes2025.024
  Objective  Humans are exposed to complex mixtures of environmental chemicals and other factors that can affect their health. Analysis of these mixture exposures presents several key challenges for environmental epidemiology and risk assessment, including high dimensionality, correlated exposure, and subtle individual effects.  Methods  We proposed a novel statistical approach, the generalized functional linear model (GFLM), to analyze the health effects of exposure mixtures. GFLM treats the effect of mixture exposures as a smooth function by reordering exposures based on specific mechanisms and capturing internal correlations to provide a meaningful estimation and interpretation. The robustness and efficiency was evaluated under various scenarios through extensive simulation studies.  Results  We applied the GFLM to two datasets from the National Health and Nutrition Examination Survey (NHANES). In the first application, we examined the effects of 37 nutrients on BMI (2011–2016 cycles). The GFLM identified a significant mixture effect, with fiber and fat emerging as the nutrients with the greatest negative and positive effects on BMI, respectively. For the second application, we investigated the association between four perfluoroalkyl substances (PFAS) and gout risk (2007–2018 cycles). Unlike traditional methods, the GFLM indicated no significant association, demonstrating its robustness to multicollinearity.  Conclusion  GFLM framework is a powerful tool for mixture exposure analysis, offering improved handling of correlated exposures and interpretable results. It demonstrates robust performance across various scenarios and real-world applications, advancing our understanding of complex environmental exposures and their health impacts on environmental epidemiology and toxicology.
Association between Solid Cooking Fuel Use and Frailty Trajectories: Findings from a Nationwide Cohort in China
Yang Liu, Bingjie Wu, Bingbing Fan, Chunxia Li, Chang Su, Aidong Liu, Tao Zhang
, Available online  , doi: 10.3967/bes2025.022
  Objective   Burning solid cooking fuel contributes to household air pollution and is associated with frailty. However, how solid cooking fuel use contributes to the development of frailty has not been well illustrated.  Methods   This study recruited 8,947 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study, 2011–2018. Group-based trajectory modeling was employed to identify frailty trajectories. Multinomial logistic regression was used to assess the association between solid cooking fuel use and frailty trajectories. Population-attributable fractions were used to estimate the frailty burden from solid fuel use.  Results   We identified three frailty trajectories: low-stable (n = 5,789), moderate-increasing (n = 2,603), and fast-increasing (n = 555). Solid fuel use was associated with higher odds of being in the moderate-increasing (OR: 1.24, 95% CI: 1.08–1.42) and fast-increasing (OR: 1.48, 95% CI: 1.14–1.92) trajectories. These associations were strengthened by longer solid fuel use (P for trend < 0.001). Switching to clean fuel significantly reduced the risk of being in these trajectories compared with persistent solid fuel users. Without solid fuel, 8% of moderate- and 19% of fast-increasing trajectories demonstrated frailty development like the low-stable group.  Conclusion   Solid cooking fuel use is associated with frailty trajectories in middle-aged and older Chinese populations.
Burden of Headache Disorders in China and its Provinces, 1990–2021
Zhe Liu, Xuehua Hu, Lin Yang, Jinlei Qi, Jiangmei Liu, Lijun Wang, Maigeng Zhou, Peng Yin
, Available online  , doi: 10.3967/bes2025.019
  Objective  To analyze the prevalence and burden of headache disorders in China and its provinces from 1990 to 2021.  Methods  Using data from the Global Burden of Disease Study (GBD) 2021, the number of prevalent cases, prevalence rate, disability-adjusted life years (DALYs), and age-standardized DALY rates were analyzed by sex, age group, and province for headache disorders and their subtypes (migraines and tension-type headaches [TTHs]) between 1990 and 2021. Percentage changes during this period were also estimated.  Results  In 2021, approximately 426 million individuals in China were affected by headache disorders, with an age-standardized prevalence rate of 27,582.61/100,000. The age-standardized DALY rate for all headache disorders was 487.15/100,000. Between 1990 and 2021, the number of prevalent cases increased by 37.78%, while the prevalence of all headache disorders, migraines, and TTHs increased by 6.92%, 7.57%, and 7.86%, respectively. The highest prevalence was observed in the 30–34 age group (39,520.60/100,000). Migraine accounts for a larger proportion of DALYs attributable to headache disorders, whereas TTH has a greater impact on its prevalence. In 2021, the highest age-standardized DALY rates for headache disorders were observed in Heilongjiang (617.85/100,000) and Shanghai (542.86/100,000).  Conclusion  The prevalence of headache disorders is increasing in China. Effective health education, improve diagnosis and treatment are essential, particularly for middle-aged working populations and women of childbearing age.
Increased Tertiary Lymphoid Structures are Associated with Exaggerated Tissue Damage in the Lung of Smoker Patients with Pulmonary Tuberculosis
Yue Zhang, Liang Li, Zikang Sheng, Yafei Rao, Xiang Zhu, Yu Pang, Mengqiu Gao, Xiaoyan Gai, Yongchang Sun
, Available online  , doi: 10.3967/bes2025.020
  Objective   Cigarette smoking exacerbates progression of pulmonary tuberculosis (TB) . The role of tertiary lymphoid structures (TLS) in chronic lung diseases has gained attention, but it remains unclear whether smoking-exacerbated lung damage in TB is associated with TLS. This study aims to analyze the characteristics of pulmonary TLS in smoking TB patients and therefore to explore the possible role of TLS in smoking-related lung injury in TB.  Methods   Lung tissues from 36 male patients (18 smokers and 18 non-smokers) who underwent surgical resection due to pulmonary TB were included in this study. Pathological and immunohistological analysis was conducted to evaluate the quantity of TLS, and chest CT was used to assess the severity of lung lesions. The correlation between TLS quantity and TB lesion severity scores was analyzed. Immune cells and chemokines for TLS formation were also evaluated and compared between smoker and nonsmoker patients.  Results   Smoking TB patients had significantly more TLS than non-smokers (P < 0.001). TLS quantity in both lung parenchyma and peribronchial regions correlated with TB lesion severity on chest CT (parenchyma: r = 0.5767; peribronchial: r = 0.7373; both P < 0.001). Immunohistochemical analysis showed increased B cells, T cells, and CXCL13 expression in smoker patients with TB (P < 0.001).  Conclusion   Smoking TB patients exhibited increased pulmonary TLS, which was associated with exacerbated lung lesions on chest CT, suggesting that cigarette smoking may exacerbate lung damage by promoting TLS formation.
Changes in Esophageal Cancer Survival: A Global Review of Survival Analysis from Cancer Registration Data over the Past three Decades
Zhuojun Ye, Danni Yang, Yu Jiang, Yuxuan Xiao, Zhuoying Li, Yuting Tan, Huiyun Yuan, Yongbing Xiang
, Available online  , doi: 10.3967/bes2025.018
  Objective  To describe survival trends and global patterns of esophageal cancer (EC) using survival data from population-based cancer registries.  Methods  We systematically searched PubMed, EMBASE, Web of Science, SEER, and SinoMed databases for articles published up to 31 December 2023. Eligible EC survival estimates were evaluated according to country or region, period, sex, age group, pathology, and disease stage.  Results  After 2010, Jordan exhibited the highest age-standardized 5-year RSRs/NSRs at 41.1% between 2010 and 2014, while India had the lowest, at 4.1%. Survival rates generally improved with diagnostic age across most countries, with significant increases in South Korea and China, of 12.7% and 10.5% between 2000 and 2017, respectively. Survival was higher among women compared to men, ranging from 0.4%-10.9%. Survival rates for adenocarcinoma and squamous cell carcinoma were similar, differing by about 4%. In China, the highest age-standardized RSRs/NSRs was 33.4% between 2015 and 2017. Meanwhile, the lowest was 5.3%, in Qidong (Jiangsu province) between 1992-1996.  Conclusion  Global EC survival rates have improved significantly in recent decades, but substantial geographical, sex, and age disparities still exist. In Asia, squamous cell carcinoma demonstrated superior survival rates compared to adenocarcinoma, while the opposite trend was observed in Western countries. Future research should clarify the prognostic factors influencing EC survival and tailor prevention and screening strategies to the changing EC survival patterns.
Re-exploration for Dietary Iodine Intake in Chinese Adults Using the Obligatory Iodine Loss Hypothesis
Xiaobing Liu, Jun Wang, Yajie Li, Hongxing Tan, Deqian Mao, Yanyan Liu, Weidong Li, Wei Yu, Junan Yan, Jianhua Piao, Chongzheng Guo, Xiaoli Liu, Xiaoguang Yang
, Available online  , doi: 10.3967/bes2025.017
  Objective  This study aimed to explore minimum iodine excretion and to build a dietary iodine recommendation for Chinese adults using the obligatory iodine loss hypothesis.  Methods  Data from 171 Chinese adults (19–21 years old) were collected and analyzed based on three balance studies in Shenzhen, Yinchuan, and Changzhi. The single exponential equation was accordingly used to simulate the trajectory of 24 h urinary iodine excretion as the low iodine experimental diets offered (iodine intake: 11−26 μg·day−1) and to further deduce the dietary reference intakes (DRIs) for iodine, including estimated average requirement (EAR) and recommended nutrient intake (RNI).  Results  The minimum iodine excretion was estimated as 57, 58, and 51 μg·day−1 in three balance studies, respectively. Moreover, it was further suggested as 57, 58, and 51 μg·day−1 for iodine EAR, and 80, 81, and 71 μg·day−1 for iodine RNI or expressed as 1.42, 1.41, and 1.20 μg·day−1·kg−1 of body weight.  Conclusion  The iodine DRIs for Chinese adults were established based on the obligatory iodine loss hypothesis, which provides scientific support for the amendment of nutrient requirements.
Lumbar Spondylolysis in Chinese Adults: Prevalence and Musculoskeletal Condition
Dong Yan, Yandong Iiu, Ling Wang, Kai Li, Wenshuang Zhang, Yi Yuan, Jian Geng, Kangkang Ma, Fengyun Zhou, Zitong Cheng, Xiaoguang Cheng
, Available online  , doi: 10.3967/bes2025.043
  Objective   To determine the prevalence of lumbar spondylolysis (LS) and the proportion of spondylolytic spondylolisthesis (SS) in China. To evaluate the musculoskeletal status of patients with LS and SS.  Methods   Spine Computed Tomography (CT) images were collected from community populations aged 40 and above in a nationwide multi-center project. LS was diagnosed, and SS was graded by an experienced radiologist. Bone mineral density (BMD) and paraspinal muscle parameters were quantified based on CT images.  Results   117 patients of a total of 3,317 individuals were diagnosed with LS, corresponding to a prevalence rate of 3.53%. 63 of the 1,214 males (5.18%) and 54 of the 2,103 females (2.57%) were diagnosed with LS. SS occurred in 64/121 vertebrae (52.89%). BMD was not associated with LS (P = 0.341). The L5 extensor paraspinal muscle density was higher in the LS group than in the non-LS group. In the LS group, patients with SS had a lower L5 paraspinal extensor muscle cross-sectional area than those without SS (P = 0.003).  Conclusion   The prevalence of LS in Chinese adults was 3.53%, with prevalence rates of 5.18% in males and 2.57% in females. Patients with LS have higher muscle density, whereas those with SS have smaller muscle cross-sectional areas at the L5 level.
Original Aritcle
The Disease Burden of Asthma in China, 1990 to 2021 and Projections to 2050: Based on the Global Burden of Disease 2021
Ruiyi Zhang, Miaomiao Zhang, Yuchang Zhou, Jiahuan Guo, Xuankai Wang, Maigeng Zhou
, Available online  , doi: 10.3967/bes2025.042
  Objective  Asthma imposes a significant global health burden. This study examines changes in the asthma-related disease burden from 1990 to 2021 and projects future burdens for 2050 under different scenarios.  Methods  Using data from the Global Burden of Disease 2021 study, we analyzed asthma incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. We projected the disease burden for 2050 based on current trends and hypothetical scenarios in which all risk factors are controlled. Temporal trends in age-standardized incidence, prevalence, mortality, and DALY rates were explored using Annual Percent Change.  Results  In 2021, the age-standardized rates for asthma incidence, prevalence, mortality, and DALYs in China were 364.17 per 100,000 (95% uncertainty interval [UI]: 283.22–494.10), 1,956.49 per 100,000 (95% UI: 1,566.68–2,491.87), 1.47 per 100,000 (95% UI: 1.15–1.79), and 103.76 per 100,000 (95% UI: 72.50–145.46), respectively. A higher disease burden was observed among Chinese men and individuals aged 70 years or older. Compared to the current trend, a combined scenario involving improvements in environmental factors, behavioral and metabolic health, child nutrition, and vaccination resulted in a greater reduction in the disease burden caused by asthma.  Conclusion  Addressing modifiable risk factors is essential for further reducing the asthma-related disease burden.
Letter
Global Burden of Clostridium difficile Infection-Related Diarrhea Mortality from 1990 to 2021: A Study Based on the 2021 Global Burden of Disease Database
Ying Li, Jie Li, Hesheng Chang, Yuehua Hu, Chengdong Xu
, Available online  , doi: 10.3967/bes2025.039
Factors in Work-related Musculoskeletal Disorders in Dentists: A Structural Equation Model
Shunhang Li, Jian Li, Xin Xu, Yushan Huang, Yilin Zhang, Xiaoshuang Xu, Weizhen Guan, Xiaoping Liu, Jing Li
, Available online  , doi: 10.3967/bes2025.037
Perioperative Cardiac Arrest in Mechanically Ventilated Older Patients Undergoing Thoracic Surgery
Wenjun Liu, Shuyu Zhang, Sheng Wang
, Available online  , doi: 10.3967/bes2025.035
Future Projections of Temperature-related Excess Morbidity Due to Influenza Under Climate Change Scenarios: A Case Study in a Temperate Japanese City
Keita Wagatsuma
, Available online  , doi: 10.3967/bes2025.034