, Available online , doi: 10.3967/bes2026.073
The “Report on Cardiovascular Health and Diseases in China 2025”, guided by the National Health Commission and compiled under the auspices of the National Center for Cardiovascular Diseases, systematically integrates multi-dimensional data on cardiovascular diseases (CVD) trends, the evolution of risk factors, advances in diagnosis and treatment, rehabilitation management, medical device innovation, and health economics evaluations in China, providing a scientific basis for policy formulation, resource allocation, and intervention prioritization. According to the data, CVD remains the leading cause of death among urban and rural residents in China, accounting for 48.98% of rural deaths and 47.35% of urban deaths in 2021, approximately 2 in every 5 deaths were attributable to CVD. Although the age-standardized mortality rate has declined, the absolute number of CVD cases and deaths continues to rise due to accelerated population aging and the high prevalence of risk factors. In 2024, the crude incidence rate of CVD among Chinese residents aged 18 years and above was 639.46 per 100 000 population, with rates higher in males than in females. The mortality rate in rural areas has consistently remained higher than in urban areas. The Healthy China Action Plan (2019-2030) sets a target to reduce the mortality rate of cardiovascular and cerebrovascular diseases to below 190.7 per 100 000 population by 2030. To achieve this goal, the report calls for a refined monitoring system to continuously track key health indicators, including tobacco use, dietary patterns, physical activity, sleep quality, body mass index, blood pressure, blood lipids, blood glucose, and environmental exposures. This effort aims to facilitate the transition from a “treatment-centered” to a “health-centered” approach.
Huihuan Luo,
Yuanting Xie,
Xinyi Fang,
Bin Pan,
Yalan Xiao,
Jingyu Li,
Xiaoqing Hong,
Dongyang Han,
Wenyue Tu,
Haidong Kan,
Yanyi Xu,
Renjie Chen
, Available online , doi: 10.3967/bes2026.059
Objective Prior epidemiological research demonstrated an association between short-term exposure to fine particulate matter (PM2.5) and acute diabetic events, specifically diabetic ketoacidosis (DKA). However, mechanistic investigations remain lacking to substantiate biological link. Methods Twenty 18-week-old male BKS db/db mice were randomly assigned to two groups (n = 10 per group). Ambient PM2.5 suspension (5 mg/kg in 50 μL) or an equal volume of phosphate-buffered saline was intratracheally instilled once daily for three consecutive days. Within 24 hours after the final instillation (Day 3), serum β-hydroxybutyrate was quantified, and liver tissues were collected for transcriptomic profiling (RNA-seq) to explore potential mechanisms linking PM2.5 to ketone body levels (i.e., β-hydroxybutyrate). Results The PM2.5 group exhibited higher 3-hydroxybutyric acid levels than controls. The liver transcriptome differed significantly between groups. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses indicated differentially expressed genes were primarily associated with lipid metabolism. Further, 43 genes exhibited moderate-to-strong correlations with 3-hydroxybutyric acid (16 positive, 27 negative; coefficients 0.56 – 0.76). These genes are involved in fatty acid oxidation, lipogenesis, lipid transport, glucose metabolism, and inflammation. Conclusion PM2.5 exposure may enhance ketogenesis through disruption of hepatic glucolipid metabolism, providing mechanistic insight into its potential role in acute diabetic metabolic decompensation.
Jianan Li,
Yiqi Qiu,
Mike Z. He,
Jianlong Fang,
Yu Wang,
Chenfeng Li,
Yueqiao Zhou,
Jiaonan Wang,
Chen Chen,
Chen Mao,
Xiaoming Shi
, Available online , doi: 10.3967/bes2026.091
Objectives While climate warming has driven concurrent heatwave-ozone events, the magnitude of their joint health impacts remains insufficiently quantified. Particularly, the specific ozone (O3) thresholds that trigger changes in heatwave mortality risks have not yet been determined. Methods A time-series study was performed using mortality data (2013–2018) from 59 counties across the Beijing-Tianjin-Hebei region and surrounding areas in China. Applying quasi-Poisson generalized linear models, the study quantified exposure-response relationships, additive interactions, and attributable fractions for the concurrent events. Heatwaves and O3 pollution events were classified by intensity and duration and combined to define different types of concurrent events. Results The study found that when O3 levels exceeded 130 μg/m3 for at least two days during heatwaves, significant additive interactions markedly intensified mortality risks, particularly for circulatory diseases. These concurrent events increased non-accidental mortality by 13.5%, along with circulatory (16.9%), respiratory (13.9%), nervous system (24.1%), and type 2 diabetes (27.0%) mortality. However, nervous system mortality exhibited unique sensitivity to O3 concentrations during concurrent exposure, following a distinct upward trend. Women, older adults (≥ 65 years), and individuals with circulatory diseases were identified as vulnerable populations. From 2013 to 2018, 29,730 deaths were attributable to concurrent events (52.8% circulatory), with the attributable fraction rising by 0.15% annually. Conclusions These findings provide essential empirical evidence for developing an integrated smart early-warning framework, establishing feasible protocols for alert grading, and supporting the design of targeted interventions for vulnerable populations.
, Available online , doi: 10.3967/bes2026.090
Background Type 2 diabetes mellitus (T2DM) is linked to social determinants of health (SDOH); however, long-term trends in its prevalence and the association with SDOH remain unclear. Thus, we investigated national trends in T2DM prevalence and the cumulative burden of SDOH. Methods We analyzed data from the Korea National Health and Nutrition Examination Survey (2007–2024), including adults aged ≥ 19 years. T2DM was defined by physician diagnosis, use of anti-diabetic medication, fasting glucose ≥ 126 mg/dL, or hemoglobin A1c ≥ 6.5%. SDOH was assessed across seven key domains—education level, marital status, household income, food security, type of health insurance, employment status, and home ownership— and classified into low- (≤ 2) and high-burden (> 2) groups; the cumulative score was also analyzed as ordinal and continuous variables to evaluate dose-response relationships. Trends were examined using weighted linear regression, and adjusted odds ratios (aORs) were estimated using multivariable logistic regression across pre- (2007–2019), intra- (2020–2022), and preliminary post-pandemic (2023–2024) periods. Age-standardized estimates and sensitivity analyses, including inverse probability weighting and mediation analysis, were performed to ensure robustness. Results A total of 85,695 adults (males; 35,392, 41.30%) were included. The prevalence of T2DM showed increasing trend (8.55%, 95% CI: 7.96% to 9.13% in 2007–2009; 11.66%, 95% CI: 11.11% to 12.22% in 2016–2019), and a surge was observed at the onset of the pandemic in 2020, peaking at 13.66% (95% CI:12.24% to 15.07%) in 2021 before rebounding to 14.19% (12.99% - 15.39%) in 2024. High cumulative SDOH was associated with T2DM (aOR=1.33, 95% CI: 1.25 to 1.41), showing a clear dose-response relationship where the risk progressively escalated with higher SDOH scores (score ≥ 6: 1.79 [1.58 to 2.04]). Among individual components, lack of private health insurance showed the strongest association (aOR, 1.30 [95% CI: 1.22 to 1.39]). Other major risk factors included established demographic and clinical predictors such as older age, male, and obesity. Conclusions T2DM prevalence has increased over time, and a high cumulative burden of SDOH remains consistently associated with this prevalence, highlighting the need for equity-focused public health strategies.
, Available online , doi: 10.3967/bes2026.089
Objective Rescue workers are frequently exposed to traumatic events and are at a high risk of developing post-traumatic stress disorder (PTSD). We developed and compared machine-learning models for PTSD risk and assessed their generalizability. Methods This multicenter cross-sectional study included 13,462 rescue workers from 13 units for model development/internal validation and 8,757 workers from two additional units for external validation. Probable PTSD was defined as a PTSD Checklist for DSM-5 score ≥ 33. Sixteen variables were reduced using principal component analysis (PCA) or exploratory factor analysis (FA). Nine machine-learning algorithms were trained using a stratified 70:30 split, 5-fold cross-validation, and synthetic minority oversampling. Results Among PCA-based models, extreme gradient boosting (XGBoost) achieved the highest external area under the curve (AUC, 0.8931), whereas random forest showed the highest sensitivity. Among the factor-analysis-based models, XGBoost achieved the highest external AUC (0.8832), whereas random forest provided a sensitivity-oriented alternative. Original-variable SHapley Additive exPlanations (SHAP) analysis identified acute stress disorder (ASD), self-rating depression scale (SDS), self-rating anxiety scale (SAS), passive smoking, monthly family income, smoking status, body mass index (BMI), and age as the main contributors. Conclusion Dimensionality-reduced machine-learning models showed measurable discriminatory ability for PTSD risk stratification, and model choice should reflect screening priorities.
Youzhen Zhang,
Tian He,
Xiaoyu Liu,
Xiya Sun,
Yang Yang,
Richard Saffery,
Jeffrey M Craig,
Nana Huang,
Jinfang Yuan,
Jingyu Liu,
Wenjun Zhou,
Yixin Li,
Yangyu Zhao,
Tingli Han,
Jing Yang
, Available online , doi: 10.3967/bes2026.075
Objective Selective fetal growth restriction (sFGR) in dichorionic-diamniotic (DCDA) twins is associated with the risk of adverse neurodevelopment; however, the underlying metabolic dysregulation remains poorly characterized. We aimed to characterize the neonatal hair metabolome associated with sFGR in DCDA twins and assess its predictive value for long-term neurodevelopment. Methods Forty-two pairs of DCDA twins were stratified into the sFGR-DCDA (twins with birth weight [BW] discordance) and DCDA-C (twins with BW concordance) groups. Neonatal hair metabolites were profiled using gas chromatography-mass spectrometry (GS-MS). Pathway analysis and machine learning were used to identify metabolic signatures predictive of neurodevelopment, which were assessed using the Ages and Stages Questionnaire (Third Edition) at 2–3 and 5–6 years of age. Results The smaller neonates in the sFGR-DCDA group (DCDA-S) showed significant downregulation of cysteine, methionine, glutathione, aminoacyl-tRNA, and nicotinate and nicotinamide metabolism in comparison with the neonates in the DCDA-C group. Reduced glutathione and aminoacyl-tRNA pathway activity correlated with lower problem-solving scores. An exploratory machine learning model incorporating pantothenate and coenzyme A biosynthesis, cysteine and methionine metabolism, and nicotinate and nicotinamide metabolism showed a preliminary discriminatory capacity for low personal-social scores in DCDA-S children at 2–3 years of age. Conclusion Neonatal hair metabolomics in DCDA-S children reflect intrauterine disturbances in antioxidant and protein synthesis pathways associated with later neurodevelopmental outcomes, providing a non-invasive window into metabolic programming in sFGR.
Wan Peng,
Xinqi Zhong,
Yuan Zheng,
Yixiang Huang,
Lv Wang,
Jingjie Fan,
Daner Lin,
Changshun Xia,
Yilin Li,
Xinjie Xiao,
Zhiqing Chen,
Yuwei Fan,
Yiyu Lai,
Qiliang Cui,
Tao Liu
, Available online , doi: 10.3967/bes2026.074
Objective The association between necrotizing enterocolitis (NEC) and prenatal heat exposure has not been adequately studied. We estimated the association of prenatal high ambient temperature (TM) and heatwave exposure with NEC and to identified susceptible exposure windows. Methods Generalized linear models were applied to examine the associations between high TM and heatwaves exposures with NEC. Mediation analysis was used to investigate the role of preterm birth (PTB) in the relationship between high TM and NEC during pregnancy. Results We included 8334 twin pairs and their mothers: 227 (2.72%) twin pairs were NEC cases. Compared to the reference temperature (19.8 °C), prenatal exposure to the 90th percentile TM (24.8 °C) was associated with NEC risk [odds ratio (OR), 2.68; 95% confidence interval (CI): 1.93–3.72]. Trimester-specific ORs were 2.41 (95% CI: 1.63–3.55), 3.30 (95% CI: 2.18–4.99), and 2.06 (95% CI: 1.43–2.98) for the first, second, and third trimesters, respectively. Exposure to heatwaves during the entire pregnancy, first, and second trimesters showed ORs of 1.98 (95% CI: 1.14–3.43), 1.81 (95% CI: 1.26–2.59), and 1.81 (95% CI: 1.19–2.75), respectively. PTB mediated the association between the 90th and 95th percentile TM exposure during the entire pregnancy and NEC, with the mediation proportions of 30.10% (95% CI: 8.57–45.28) and 36.20% (95%CI: 16.18–50.28), respectively. Conclusion Prenatal exposure to high TM levels and heat waves, especially in the first and second trimesters, was positively associated with the risk of NEC. PTB may partially mediate the relationship between high TM exposure and NEC.
Yue Chen,
Wanying Shi,
Huijie Chang,
Liang Ding,
Chen Chen,
Yingli Qu,
Zhenyi Yin,
Yongmei Wang,
Zhanhong Xue,
Fanye Long,
Luxi Wei,
Caihong Jiang,
Peipei Dong,
Ying Zhu,
Yuebin Lyu,
Xiaoming Shi
, Available online , doi: 10.3967/bes2026.086
Objective The prospective cohort study aimed to examine the link between blood Manganese (Mn) concentrations and incident cognitive impairment risk in Chinese elderly individuals. Methods This study enrolled 6,868 individuals aged 60 years and above from two cohort studies from 2017 to 2024. High-resolution inductively coupled plasma mass spectrometry was employed to quantify blood Mn concentrations. Cognitive function was evaluated by Mini-Mental State Examination (MMSE). Cox proportional hazards models were used to assess the association between blood Mn levels and risk of cognitive impairment, while linear mixed-effects models were used to examine their associations with MMSE and domain-specific cognitive scores. Restricted cubic spline (RCS) was confirmed to explore the dose-response relationship. Results During an average follow-up of 4.00 years, 1,138 developed cognitive impairment. The mean blood Mn concentration across all participants was 11.297 ± 3.763 µg/L. After full adjustment for covariates, higher blood Mn levels (per interquartile range [IQR] increase) were significantly associated with greater declines in MMSE score (β = −0.033, 95% confidence interval [CI]: −0.048, −0.018) and in multiple domain-specific scores, including orientation, attention and calculation, language, naming, and recall, with the strongest associations observed for naming (β = −0.043, 95% CI: −0.070, −0.015) and recall (β = −0.047, 95% CI: −0.064, −0.030). Individuals in the highest quartile (Q4) of blood Mn levels exhibited a 28.5% greater risk of cognitive impairment (Adjusted hazard ratio [HR] =1.285, 95% CI: 1.081, 1.526) versus the lowest quartile (Q1) of blood Mn levels. The risk of cognitive impairment was 13.1% higher for each IQR increase in blood Mn (HR = 1.131, 95% CI: 1.051, 1.217). A positive and linear dose-response pattern was confirmed by the RCS model (P for non-linearity > 0.05). Conclusions In this population-based prospective cohort study of older adults, higher blood Mn levels were significantly associated with poorer cognitive performance and an increased risk of cognitive impairment, with the most pronounced associations observed for naming and recall ability, suggesting that reducing Mn exposure could serve as a modifiable target for cognitive health protection among older adults.
, Available online , doi: 0.3967/bes2026.084
Objective To investigate the epidemiology and risk factors for chronic urticaria (CU) in Chinese adults with cardiometabolic diseases (CMDs), and its effect on CMD recognition and management. Methods We conducted a nationwide cross-sectional analysis using data from the 2018–2019 China Chronic Disease and Risk Factor Surveillance, which included 118,036 adults with CMDs. Weighted CU prevalence and CMD awareness, treatment, and control rates (stratified by CU status) were estimated using a complex survey design, whereas risk factors for CU were identified using multivariable logistic regression. Results The weighted CU prevalence among patients with CMDs was 2.90%, peaking at 3.94% in 60–69-year-old individuals, and was higher in females (3.41%) than in males (2.56%), especially in rural areas. Key risk factors included current smoking (odds ratio [OR] 1.17, 95% confidence interval [CI]: 1.06–1.29) and abnormal sleep duration (<5 h: OR 1.79, 95% CI: 1.61–1.99; >10 h: OR 1.39, 95% CI: 1.19–1.61). Patients with CU showed stronger association with improved CMD awareness (hypertension: 50.71% vs. 40.27%; diabetes: 47.14% vs. 36.21%; dyslipidemia: 30.71% vs. 17.12%) and treatment rates (hypertension: 41.37% vs. 34.22%; diabetes: 41.31% vs. 32.52%; dyslipidemia: 18.29% vs. 9.94%) than non-CU patients but with comparable control rates. Conclusion CU is prevalent in patients with CMD and associated with distinct demographic and lifestyle risk factors. Although CU facilitates earlier detection of CMD, it does not improve disease control, indicating the need for integrated dermatology-cardiometabolic care.
Qiao Song,
Wen Li,
Yang Liu,
Sigen Li,
Leyang Ju,
Jingrong Cao,
Shuo Gao,
Zhichen Liao,
Yaqi Wang,
Yuli Hou,
Haixia Ma,
Yunxiu Zhang,
Diandian Chen,
Wenshuo Yang,
Xiang Yang,
Qiliang Li,
Peichang Wang
, Available online , doi: 10.3967/bes2026.083
Objective Reduced brain energy metabolism is a key feature of Alzheimer's disease (AD); however, lactate dehydrogenase (LDH)-related metabolic changes in AD are not fully understood. This study aimed to evaluate serum LDH activity in patients with mild cognitive impairment (MCI) and AD. We used public transcriptomic datasets to explore the features of LDHA and LDHB across brain regions, cell types, and co-expression networks. Method In a retrospective clinical cohort of 132 healthy controls (HC), 87 patients with MCI, and 103 patients with AD, we compared serum LDH activity after adjusting for major clinical covariates. Next, we used public transcriptomic datasets (AlzData, Agora, CELLxGENE, and genotype-tissue expression (GTEx)) to evaluate regional and cell-type-specific expression patterns of LDHA and LDHB. We also characterized LDH-associated functional networks using GTEx normal brain data for baseline co-expression analysis and AD-related weighted gene co-expression network analysis (WGCNA). Results Clinical cohort analysis showed that serum LDH activity was significantly decreased in patients with MCI and AD. Serum LDH activity did not significantly correlate with mini-mental state examination (MMSE) or montreal cognitive assessment (MoCA) scores. Brain transcriptomic analysis revealed that LDHA expression was significantly downregulated in AD-related regions (entorhinal cortex, hippocampus, and temporal cortex), whereas LDHB showed a downward trend in several AD-related regions. Both genes were detectable across multiple brain cell types with relatively prominent expression in neurons. Functional analysis showed that, under normal conditions, LDHA-correlated genes were broadly involved in glycolysis, vesicle trafficking, autophagy, and proteostasis, whereas LDHB-correlated genes were highly concentrated in mitochondrial oxidative phosphorylation and the citric acid (TCA) cycle. AD-related WGCNA showed region-dependent organization of LDHA- and LDHB-containing modules, with repeated enrichment in synaptic vesicle-related processes, mitochondrial respiration, autophagy, and proteostasis-related pathways. Conclusion This study provides clinical and transcriptomic evidence of LDH-related metabolic alterations in patients with AD. Reduced serum LDH activity in MCI and AD, together with decreased LDHA/LDHB expression in AD-related brain regions and region-dependent LDH-associated co-expression networks, supports a potential link between LDH-related metabolism and mitochondrial energy metabolism, synaptic function, and proteostasis in AD. These findings should be interpreted as exploratory, and require validation through paired prospective and mechanistic studies.
, Available online , doi: 10.3967/bes2026.076
Objective We aimed to investigate the independent and combined associations of grip strength and chair-rising time with cardiovascular disease (CVD) risk among middle-aged and older adults across different glycemic status groups. Methods This study included 7,258 CVD-free middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS). Muscle strength was assessed based on grip strength and chair-rising time. Incident CVD was defined as a physician-diagnosed heart disease and/or stroke. Cox proportional hazard models and restricted cubic spline analyses were used to quantify the association between muscle strength and CVD. Results During a mean follow-up of 7.8 years, 1,785 participants (24.6%) developed incident CVD. Both lower normalized grip strength and longer chair-rising time were independently associated with increased CVD risk in a dose-dependent manner (P for trend < 0.001), with adjusted hazard ratios (HRs) of 1.37 (95% CI: 1.17–1.61) for the lowest vs. highest grip strength quartile and 1.53 (95% CI: 1.32–1.77) for the longest vs. shortest chair-rising time quartile. The combination of weakest grip and slowest chair-rising time conferred the highest risk (HR = 2.12; 95% CI: 1.65–2.73). Lower grip strength and prolonged chair-rising time were associated with elevated CVD risk across all glycemic status groups. The association with grip strength reached statistical significance in the normal glucose regulation and prediabetes groups, with a similar point estimate observed in the diabetes group (P for interaction = 0.622). Conclusion This study revealed a dose-dependent association between muscle strength and the incidence of CVD. The associations between lower grip strength and prolonged chair-rising time with higher CVD risk were directionally consistent across the glycemic status groups, although not all strata reached statistical significance.
Zhilei Xu,
Ruiling Liu,
Yuling Hu,
Quanzi Yao,
Xin Luo,
Jialiang He,
Lihong Geng,
Lijuan Fu,
Zhaohui Zhong,
Yubin Ding,
Xingyu Lyu
, Available online , doi: 10.3967/bes2026.072
Objective Fine particulate matter (PM2.5) may impair follicular development; however, the roles of its chemical components and their time-specific effects remain unclear. This study examined how PM2.5 and its major components are related to oocyte-related outcomes among women undergoing assisted reproductive technology (ART) and identified critical exposure windows. Methods A total of 51,122 ART cycles were analyzed. Individual exposures to PM2.5 and its components, sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM), and black carbon (BC), were estimated for three periods: recent (0–3 months), distal (4–12 months), and cumulative (0–12 months). Associations between total, mature, and normally fertilized oocytes were assessed using negative binomial regression. Distributed lag non-linear models (DLNM) identified sensitive windows, and mixture models evaluated joint effects. Results Higher PM2.5 and component exposures were consistently associated with poorer oocyte outcomes, with stronger effects for distal exposure. Two sensitive windows, 1 month and 6–11 months before retrieval, were identified. Mixture analyses indicated SO42- and NH4+ as the dominant contributors. Conclusion Exposure to PM2.5 showed component-specific and time-dependent reproductive toxicity. Both short- and long-term exposure may reduce oocyte quantity and quality, highlighting the importance of improving air quality to support female reproductive health and ART success.
, Available online , doi: 10.3967/bes2026.070
Objective Evidence regarding the association between long-term ozone exposure and chronic obstructive pulmonary disease (COPD) has primarily originated from high-income countries, with limited studies in China. Methods This nationwide cross-sectional study included 66,752 Chinese adults. Patients with COPD were identified using post-bronchodilator spirometry. Long-term ozone exposure was estimated using the average ozone concentrations in the grid cells covering the participants’ residential counties. Logistic regression was used to analyze the ozone–COPD association, adjusting for individual-level risk factors and socioeconomic factors. Additive interaction models were employed to assess the modification of the ozone–COPD association by county-level gross domestic product (GDP) per capita and temperature. Results Each 10-µg/m3 increase in annual ozone exposure was significantly associated with a higher risk of COPD (odds ratio [OR]: 1.172, 95% confidence interval [CI]: 1.039−1.322). In comparison with counties in the highest quartile of GDP per capita, the association between ozone exposure and COPD was stronger in counties in the lowest quartile of GDP per capita (P < 0.05). Counties with lower winter temperatures exhibited a stronger ozone–COPD association than those with warmer winters (P < 0.05). The relative excess risks due to the interaction of ozone with GDP per capita and winter temperature were 0.219 (95% CI: 0.095–0.344) and 0.254 (95% CI: 0.103–0.404), respectively. Conclusion Socioeconomically disadvantaged and colder regions exhibited greater susceptibility to ozone-related COPD. Targeted interventions aimed at these vulnerable countries are needed to mitigate inequalities in ozone-related COPD.
, Available online , doi: 10.3967/bes2026.058
Background Traditional Health Technology Assessments (HTAs) commonly overlook the broader societal and economic externalities of vaccines, leading to systematic undervaluation and suboptimal resource allocation. This study aimed to develop and validate a comprehensive vaccine value framework and prioritize individual elements for future HTA integration. Methods A two-phase mixed-methods approach was employed for framework development. Phase 1 involved a systematic literature review of major databases to construct an initial conceptual framework. Phase 2 utilized a two-round modified Delphi study involving a multidisciplinary expert panel to validate and refine the framework. Six evaluative criteria, categorized under the dimensions of "Relevance" and "Feasibility," were weighted and applied to score each value element. Finally, a comparative analysis of the raw and weighted scores was conducted to identify five priority value elements for future integration into HTAs. Results The final validated framework comprised 5 value categories, 21 value elements, and 75 actionable value items. Although traditional metrics achieved the highest consensus, the following five "broader" elements emerged as top priorities for future inclusion: (1) Enhancement of Health System Security, (2) Macroeconomic Gains, (3) Social Equity and Ethics, (4) Prevention of Institutional Disruptions, and (5) Value to Other Interventions. Conclusion This study established a standardized multitiered roadmap to capture the multifaceted value of vaccines. By introducing actionable Tier-3 indicators, the framework operationalizes the assessment of broader vaccine benefits and offers a practical tool to support equitable and comprehensive evidence-based policymaking. Furthermore, the identification of the five priority value elements provides a feasible pathway for integrating extended vaccine externalities into future HTAs. Ultimately, this standardized framework will facilitate holistic decision-making and support the optimal allocation of resources within national immunization programs.
Qingyin Bu,
Qian Wang,
Gang Zhang,
Yifan Wang,
Longhu Sun,
Shuang Liang,
Fan Yang,
Zhazheng He,
Honggang Yi,
Zhening Pu,
Juncheng Dai
, Available online , doi: 10.3967/bes2026.069
Objective To investigate the effects of metabolic syndrome (MetS) and its interaction with genetic factors on lung cancer incidence and mortality. Methods The cohort analysis included 355,344 participants from the UK Biobank. MetS was defined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Cox proportional hazards models were used to evaluate the associations between MetS-related variables, their interactions with genetic factors, and lung cancer outcomes (incidence and mortality). Results MetS was associated with increased risks of lung cancer incidence (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.22–1.42) and mortality (HR: 1.35, 95% CI: 1.24–1.48). Risk increased proportionally to the number of metabolic abnormalities. Increased waist circumference, reduced high-density lipoprotein cholesterol, and elevated glycated hemoglobin were independently associated with both outcomes. Participants with both high genetic risk and MetS had the highest risk of lung cancer incidence (HR: 2.07, 95% CI: 1.82–2.35) and mortality (HR: 2.12, 95% CI: 1.83–2.45) compared with those with low genetic risk and no MetS. A significant positive additive interaction was observed between waist circumference and genetic risk. Conclusion Metabolic abnormalities are important modifiable risk factors for lung cancer. Integrating metabolic health assessment with genetic risk profiling may improve risk stratification and targeted prevention of lung cancer.
, Available online , doi: 10.3967/bes2026.057
Objective This study aimed to comprehensively characterize the genomic diversity, evolutionary dynamics, pathogenic potential, antimicrobial resistance, and secondary metabolite capacity of the Nocardia genus using whole-genome analyses. Methods We analyzed 751 publicly available Nocardia genomes using genome-based species delineation, phylogenomics, pangenome analysis, and comparative functional profiling to assess taxonomy, virulence, antibiotic resistance genes (ARGs), and biosynthetic gene clusters (BGCs). Results Phylogenomic analyses resolved five major clades: N. farcinica, N. carnea, N. asteroides, N. transvalensis, and N. otitidiscaviarum groups. The pangenome is open, comprising 467,566 gene clusters and reflecting extensive genomic diversity. Virulence factors and ARGs exhibit clade-specific patterns: the N. farcinica group harbors the most complete virulence repertoire and diverse resistance determinants, whereas the N. carnea and N. asteroides groups carry fewer genes. Analysis of 10,196 BGCs across 46 classes revealed conserved clusters of non-ribosomal peptide synthetases, terpenes, and type I polyketide synthases, with higher biosynthetic potential in the N. farcinica, N. transvalensis, and N. otitidiscaviarum groups. Several genomes encode BGCs associated with antibacterial or anticancer compounds. Conclusion This comprehensive genome analysis of Nocardia, representing the most complete sampling to date, clarifies phylogeny, reclassifies misassigned strains, identifies potential novel species, and reveals clade-specific patterns of virulence, resistance, and secondary metabolism.
, Available online , doi: 10.3967/bes2026.043
Objective Immunoglobulin G (IgG) N-glycosylation is associated with mild cognitive impairment through the regulation of inflammatory balance; however, the underlying mechanisms remain unclear. Methods Our study utilized a post-genome-wide association studies (GWAS) method that integrated GWAS data for cognitive function with gene expression quantitative trait loci (eQTL), protein QTL (pQTL), and IgG N-glycan-QTL data. Results Mendelian randomization (MR) analyses suggested bidirectional causalities between glycan peaks (GPs) and cognitive function, with GP7, GP12, and GP19 showing a causal effect on cognitive function, while cognitive function conversely showed a causal effect on GP1 and GP8. Two proteins and 10 genes were implicated in the regulation of IgG N-glycosylation. Furthermore, multivariable MR results suggested complex causalities between genes/proteins and IgG N-glycans, which jointly promote or independently affect cognitive function. Conclusion Our study reveals a novel mechanism by which genes, proteins, and modified IgG N-glycans converge to pathologically affect cognitive function.
Fengjie Wang,
Yutong Zhou,
Ri De,
Runan Zhu,
Yu Sun,
Dongmei Chen,
Liping Jia,
Qi Guo,
Yao Yao,
Zhen Zhu,
Naiying Mao,
Linqing Zhao
, Available online , doi: 10.3967/bes2026.032
Objective LLC-MK2/TMPRSS2 cells constitutively express TMPRSS2, eliminating the requirement for additional trypsin during HPIV3 culture. The efficiency of LLC-MK2/TMPRSS2 for isolating HPIV3 from respiratory specimens was evaluated in comparison with Madin-Darby Canine Kidney (MDCK). Methods HPIV3-positive respiratory specimens from children with acute respiratory infections (February-June 2025) were inoculated into LLC-MK2/TMPRSS2 and MDCK. The cytopathic effect (CPE) was monitored microscopically, and the proportion of positive cells was evaluated using direct immunofluorescence assay (DFA). Viral infection dynamics were assessed using the cycle threshold (Ct) values obtained by qPCR. Results Among 50 specimens, 35 strains (35/50, 70%) were successfully isolated using LLC-MK2/TMPRSS2, while 14 strains were isolated using MDCK (14/50, 28%). More pronounced CPE and a higher number of virus-infected positive cells were shown in LLC-MK2/TMPRSS2 compared to that in MDCK (P < 0.001 and P = 0.001, respectively). Among specimens with an initial Ct < 27, the isolation rate of LLC-MK2/TMPRSS2 was higher and the Ct values were lower (< 27) (82.6%, 19/23). Among specimens with an initial Ct of 23 ≤ Ct < 27, the number of specimens with a supernatant Ct ≥ 27 (63.6%, 7/11) was significantly less than that in MDCK (P = 0.003). Conclusion LLC-MK2/TMPRSS2 exhibits superior adaptability and replication efficiency in the isolation of HPIV3 from respiratory specimens.
, Available online , doi: 10.3967/bes2026.088
, Available online , doi: 10.3967/bes2026.087
Zijian Jin,
Meina Ji,
Qi Meng,
Qi Jin,
Hexi Zhang,
Fei Li,
Pengxin Li,
Yantong Liu,
Duan Li,
Yidan Wei,
Wenxing Guo,
Wanqi Zhang
, Available online , doi: 10.3967/bes2026.079
, Available online , doi: 10.3967/bes2026.085
, Available online , doi: 0.3967/bes2026.080
Mamoud Alieu Jalloh,
Yuxin Liu,
Qi Xi,
Jing Wei,
Cong Liu,
Hong Lv,
Tao Jiang,
Rui Qin,
Xin Xu,
Yuanyan Dou,
Yue Jiang,
Bo Xu,
Jiaping Chen,
Hongxia Ma,
Jiong Li,
Zhibin Hu,
Yuan Lin,
Jiangbo Du
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, Available online , doi: 10.3967/bes2026.077
, Available online , doi: 10.3967/bes2026.082
, Available online , doi: 10.3967/bes2026.081
, Available online , doi: 10.3967/bes2026.071
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