Distribution and Identification of Mycobacterium tuberculosis Lineage in Kashgar Prefecture

Objectives In order to understand the composition of Mycobacterium tuberculosis(M.tb) lineage and find specific tags to distinguish lineage of the M.tb in Kashgar prefecture, so as to provide a basis for the prevention of tuberculosis in this area. Methods Whole genome sequencing (WGS) of M.tb clinical strains (161 cases) was conducted. The phylogenetic tree was constructed by Maximum Likelihood (ML) on the basis of single nucleotide polymorphisms (SNPs) and verified via principal component analysis (PCA). The composition structure of M.tb in different regions was analyzed by combining geographic information. Results The M.tb clinical strains were composed of lineage 2 (73/161, 45.34%), lineage 3 (52/161, 32.30%) and lineage 4 (36/161, 22.36%) in Kashgar prefecture. And the 3 lineages were subdivided into 11 sublineages, among which lineage 2 includes lineage 2.2.2/Asia Ancestral 1(9/73, 12.33%),lineage 2.2.1-Asia Ancestral 2(9/73, 12.33%)༌lineage 2.2.1-Asia Ancestral 3(18/73, 24.66%) and lineage 2.2.1-Modern Beijing(39/73, 53.42%).Lineage 3 includes lineage 3.2(14/52, 26.92%)and lineage 3.3(38/52, 73.08%)༌lineage 4 includes lineage 4.1(3/36, 8.33%)༌lineage 4.2(2/36, 5.66%)༌lineage 4.4.2(1/36, 2.78%)༌lineage 4.5(28/36, 77.78%) and lineage 4.8(2/36, 5.66%)༌all of which were consistent with the PCA results. Among the identified 21438 SNPs ,there are 136 markers proposed to discriminate known circulating strains. Reconstruction of a phylogenetic tree using the 136 SNPs for all 161 samples resulted in a tree with the same number of delineated clades. Based on geographical location analysis, the composition of Lineage 2 in Kashgar prefecture (45.34%) is lower than other regions level in China(54.35%-90.27%), and the composition of Lineage 3 (32.30%)is much higher than other regions level in China (0.92%-2.01%), but it is lower than the bordering Pakistan (70.40%). Conclusion In summary, M.tb clinical strains from Kashgar prefecture were identifed 3 lineages and 11 sublineages, with 136 Branch-Specific SNP. Kashgar borders countries with a high incidence of tuberculosis such as Pakistan and India, resulting in a large difference between the M.tb lineage and sublineage distribution in this region and other provinces in China. This research provides a theoretical basis for the prevention and control of tuberculosis in Xinjiang.

Effect of external diaphragmatic pacing therapy on patients with chronic cor pulmonale: a randomized, controlled trial

Objectives This study aimed to evaluate the effects of external diaphragmatic pacing (EDP) on patients with chronic cor pulmonale (CCP). Methods Fifty patients with CCP were enrolled in Kashgar Prefecture Second People’s Hospital in Xinjiang Uygur Autonomous Region of China from 2016 to 2017. The patients were randomized into a group that received anti-CCP therapy (negative control group) or a group that received additional EDP treatment (EDP group). We recorded and compared maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and the 6-minute walking test between the two groups on the first and tenth days of treatment. Results Ten days after treatment began, MIP, FVC, and the 6-minute walking test were significantly improved in both groups. Importantly, MIP and FVC were significantly higher in the EDP group compared with the control group on the tenth day. Conclusion In addition to treatment for CCP, these patients can obtain extra benefit by using EDP treatment.

Mathematical Model Analysis and Simulation of Visceral Leishmaniasis, Kashgar, Xinjiang, 2004–2016

Visceral leishmaniasis (VL), known as kala-azar, is a serious parasitic disease. After malaria, VL is the second largest parasitic killer. This paper focuses on the VL transmission around sandflies, dogs, and people. Kashgar is located on the southwestern edge of Xinjiang, where kala-azar parasite infection occurs every year. According to the cases reported in the Kashgar Prefecture from 2004 to 2016, we proposed a dynamic model based on these three populations. The SEIR model was established for human population, the SI model was established for sandfly population, and the SI model was established for dog population. We fitted the model to cumulative cases from 2004 to 2016 for the epidemic in Kashgar and predicted that the cumulative incidence of kala-azar in Kashgar would continue to increase, but its growth rate would gradually slow down, which means that the number of cases would gradually decrease every year. We also estimated the basic reproduction number R0 = 1.76 (95% CI: 1.49–1.93). The sensitivity analysis shows that the mutual infection between sandfly and dog contributes the most to the basic reproduction number, while the transmission proportion of sandfly to the susceptible person and the mutual infection between sandfly and dog contribute the most to the number of leishmaniasis human cases. Therefore, according to the sensitivity analysis results, reducing the contact between sandflies and dogs is an effective way to reduce kala-azar.

Risk factors and predicted distribution of visceral leishmaniasis in the Xinjiang Uygur Autonomous Region, China, 2005–2015

Background Visceral leishmaniasis (VL) is a neglected disease that is spread to humans by the bites of infected female phlebotomine sand flies. Although this vector-borne disease has been eliminated in most parts of China, it still poses a significant public health burden in the Xinjiang Uygur Autonomous Region. Understanding of the spatial epidemiology of the disease remains vague in the local community. In the present study, we investigated the spatiotemporal distribution of VL in the region in order to assess the potential threat of the disease. Methods Based on comprehensive infection records, the spatiotemporal patterns of new cases of VL in the region between 2005 and 2015 were analysed. By combining maps of environmental and socioeconomic correlates, the boosted regression tree (BRT) model was adopted to identify the environmental niche of VL. Results The fitted BRT models were used to map potential infection risk zones of VL in the Xinjiang Uygur Autonomous Region, revealing that the predicted high infection risk zones were mainly concentrated in central and northern Kashgar Prefecture, south of Atushi City bordering Kashgar Prefecture and regions of the northern Bayingolin Mongol Autonomous Prefecture. The final result revealed that approximately 16.64 million people inhabited the predicted potential infection risk areas in the region. Conclusions Our results provide a better understanding of the potential endemic foci of VL in the Xinjiang Uygur Autonomous Region with a 1 km spatial resolution, thereby enhancing our capacity to target the potential risk areas, to develop disease control strategies and to allocate medical supplies.