The prognostic value and model construction of inflammatory markers for patients with non-small cell lung cancer.

The aim of this study was to investigate and analyse the predictive value of systemic inflammatory markers based on peripheral blood biomarkers for the prognosis of non-small cell lung cancer (NSCLC) patients. Based on a retrospective monitoring cohort of 973 NSCLC patients from an Affiliated Tumor Hospital from 2012 to 2023. The log-rank test and Cox proportional risk regression model were used to identify independent prognostic inflammatory markers. Subsequently, a nomogram prediction model was constructed and evaluated. The results of multivariate Cox regression analysis showed that patients with high NLR group (HR = 1.238, 95% CI 1.015-1.510, P = 0.035), and high CAR group (HR = 1.729, 95% CI 1.408-2.124, P < 0.001) were risk factors affecting the prognosis of NSCLC patients. The nomogram that includes age, tumor stage, smoking history, BMI, NLR, and CAR can effectively predict the prognosis of NSCLC patients.The inflammatory markers NLR and CAR, which combine inflammatory and nutritional status, are effective predictors of the prognosis of NSCLC patients. The combination of clinical information and these easily accessible inflammatory markers has significant research value for prognostic assessment, clinical treatment, and follow-up monitoring of NSCLC patients.

Association Studies of Serum Levels of TNF- α, IL-10, IFN-γ and CXCL 5 with Latent Tuberculosis Infection in Close Contacts.

Purpose: Early recognition and treatment of latent tuberculosis infection(LTBI) is key to tuberculosis(TB) prevention. However, the emergence of LTBI is influenced by a combination of factors, of which the role of individual immune cytokines remains controversial. The aim of this study is to explore the influencing factors of LTBI and their effects with cytokines on LTBI. Patients and Methods: Close contacts of tuberculosis in Urumqi City from 2021 to 2022 were selected for the study to conduct a field survey. It used logistic regression model to analyse the influencing factors of LTBI, principal component analysis to extract a composite indicators of cytokines, and structural equation modelling to explore the direct and indirect effects of cytokines and influencing factors on LTBI. Results: LTBI infection rate of 33.3% among 288 TB close contacts. A multifactorial Logistic model showed that factors influencing LTBI included education, daily contact hours, eating animal liver, and drinking coffee (P<0.05); After controlling for confounding factors and extracting composite indicators of cytokines using principal component analysis, CXCL5 and IFN-γ is a protective factor for LTBI(OR=0.572, P=0.047), IL-10 and TNF-α is a risk factor for LTBI(OR=2.119, P=0.010); Structural equation modelling shows drinking coffee, eating animal liver, daily contact hours, and IL-10 and TNF-α had direct effects on LTBI and educations had indirect effects on LTBI(P<0.05). Conclusion: IL-10 and TNF-α are involved in the immune response and are directly related to LTBI. By monitoring the cytokine levels of TB close contacts and paying attention to their dietary habits and exposure, we can detect and intervene in LTBI at an early stage and control their progression to TB.

Causal association study of the dynamic development of the metabolic syndrome based on longitudinal data.

The dynamic progression of metabolic syndrome (MetS) includes developmental deterioration and reverse recovery; however, the key factors in this bidirectional progression have not been identified. Our study aimed to use the data obtained from the China Health and Retirement Longitudinal Study (CHARLS) and construct a Bayesian network to explore the causal relationship between influential factor and the development and recovery of MetS. Followed up at 4 years, forward progression of MetS occurred in 1543 and reverse recovery of MetS occurred in 1319 of 5581 subjects. Bayesian Networks showed that hyperuricemia and body mass index (BMI) levels directly influenced progression of MetS, and gender, exercise and age play an indirect role through hyperuricemia and BMI levels; high hemoglobin A1c (HbA1c) and BMI levels directly influenced recovery of MetS, and gender and exercise play an indirect role through BMI levels. Bayesian Network inference found that the rate of progression of MetS in subjects with hyperuricemia increases from 36 to 60%, the rate of progression of MetS in subjects with overweight or obese increases from 36 to 41% and the rate of reverse recovery rate of MetS in subjects with high HbA1c decreased from 33 to 20%. Therefore, attention to individuals at high risk of hyperuricemia, high HbA1c levels, and overweight/obesity should be enhanced, with early detection and following healthy behavioral interventions to prevent, control and delay the progression of MetS and its components.

Intervention Effect of New Tuberculosis Control Model on Tuberculosis Incidence in Xinjiang.

Objective: To quantitatively evaluate the intervention effect of the "Xinjiang model" policy on pulmonary tuberculosis (PTB) incidence in Xinjiang, and to compare the difference of policy effect between areas with different tuberculosis burdens. Methods: We retrospectively collected data on the registered incidence of PTB patients in 14 prefectures of Xinjiang from January 2012 to December 2021 and used Joinpoint model to describe the time trend of registered incidence, single-group interrupted time series (ITS) model to analyze the dynamics of registered incidence before and after the policy intervention, and controlled interrupted time series (CITS) model to compare the differences in the effects of the policy in different tuberculosis burdened areas. Results: The areas with high registered incidence of PTB in Xinjiang were mainly located in the four prefectures of southern Xinjiang. The time trend of registered incidence of PTB in Xinjiang from 2012 to 2021 showed a general downward trend (AAPC=-3.4%), an upward trend from 2012 to 2018 (APC=12.1%), and a rapid downward trend from 2018 to 2021 (APC=-28.3%). Single-group ITS results showed that registered incidence in Xinjiang increased by 13.806/100,000 one month after policy was implemented (P<0.001); the long-term effect of policy was a downward trend in registered incidence (ß3<0, P<0.001), decreasing by 0.690/100,000 per month. In high-, medium-, and low-burden areas of PTB, the long-term effect of policy was a monthly decrease in registered incidence of 1.460/100,000, 0.227/100,000, and 0.064/100,000, respectively. The long-term effects of policy interventions in high- and medium-burden areas showed a faster decline in registered incidence than in low-burden areas (ß7 was -1.548 and -0.194, respectively, P<0.001). Conclusion: A dynamic causal relationship exists between "Xinjiang model" policy and registered incidence, and its continued implementation is effective in controlling the spread of tuberculosis.

Opening the black box: interpretable machine learning for predictor finding of metabolic syndrome.

OBJECTIVE: The internal workings ofmachine learning algorithms are complex and considered as low-interpretation "black box" models, making it difficult for domain experts to understand and trust these complex models. The study uses metabolic syndrome (MetS) as the entry point to analyze and evaluate the application value of model interpretability methods in dealing with difficult interpretation of predictive models. METHODS: The study collects data from a chain of health examination institution in Urumqi from 2017 ~ 2019, and performs 39,134 remaining data after preprocessing such as deletion and filling. RFE is used for feature selection to reduce redundancy; MetS risk prediction models (logistic, random forest, XGBoost) are built based on a feature subset, and accuracy, sensitivity, specificity, Youden index, and AUROC value are used to evaluate the model classification performance; post-hoc model-agnostic interpretation methods (variable importance, LIME) are used to interpret the results of the predictive model. RESULTS: Eighteen physical examination indicators are screened out by RFE, which can effectively solve the problem of physical examination data redundancy. Random forest and XGBoost models have higher accuracy, sensitivity, specificity, Youden index, and AUROC values compared with logistic regression. XGBoost models have higher sensitivity, Youden index, and AUROC values compared with random forest. The study uses variable importance, LIME and PDP for global and local interpretation of the optimal MetS risk prediction model (XGBoost), and different interpretation methods have different insights into the interpretation of model results, which are more flexible in model selection and can visualize the process and reasons for the model to make decisions. The interpretable risk prediction model in this study can help to identify risk factors associated with MetS, and the results showed that in addition to the traditional risk factors such as overweight and obesity, hyperglycemia, hypertension, and dyslipidemia, MetS was also associated with other factors, including age, creatinine, uric acid, and alkaline phosphatase. CONCLUSION: The model interpretability methods are applied to the black box model, which can not only realize the flexibility of model application, but also make up for the uninterpretable defects of the model. Model interpretability methods can be used as a novel means of identifying variables that are more likely to be good predictors.

Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model.

Aim: Metabolic syndrome (MetS) coexists with the occurrence and even death of cardiovascular disease and diabetes mellitus. It is essential to study the factors in the dynamic progression of MetS in the interest of prevention and control. Purpose: The aim of this study was to analyze the dynamic progression of Mets and explore the potential factors influencing the progression or reversal of MetS. Patients and Methods: This study involved 5581 individuals from two waves of the China Health and Retirement Longitudinal Study: 2011 and 2015. A multistate Markov model containing 4 states (free of metabolic disorder (FMD), mild metabolic disorder (MMD), severe metabolic disorder (SMD) and MetS) was adopted to study the dynamic progression of MetS and its influencing factors. Results: After follow-up, a total of 2862 cases (50.28% of the total number) had disease state transition. The intensity of transition from MetS to SMD is the same as that from SMD to MMD, and is greater than that from MMD to Mets (0.06 vs 0.05). For the MetS state, a mean of 1/0.08=12.5 years was spent in the MetS state before recovery. The exercise, smoke, drink, BMI level, hyperuricemia had statistically significant effects on progression of MetS status (P<0.05). The obesity or overweight, little exercise, smoke, drink and hyperuricemia increased the risk of forward progression of MetS disease status. There were significant nonmodifiable (age, gender) and modifiable factors (exercise, drink, BMI level, or high HbA1c) associated with reversion of MetS state. Conclusion: The likelihood of progression from MMD to MetS is less likely than that of reversion from MetS to SMD and SMD to MMD. Old females were more resistant to recover from worse states than males. Prevention and intervention measures should be adopted early when MMD or SMD onset occurs.

Relationship between vitamin D receptor gene polymorphisms and second acid-fast bacilli smear-positive during treatment for tuberculosis patients.

PURPOSE: Tuberculosis (TB) treatment is associated with Vitamin D. This study aimed to explore the relationship between Vitamin D receptor (VDR) gene polymorphisms and second acid-fast bacilli (AFB) smear-positive during treatment for TB patients. METHODS: This was a cross-sectional study. Seven hundred and thirty-one TB patients whose single nucleotide polymorphism site (SNPs) of VDR gene were detected from December 2019 to December 2020 in XinJiang of China. The genotypic distributions in each group were tested separately for Hardy-Weinberg equilibrium. The tetragram test was used to construct haplotypes to evaluate the association between each haplotype and second AFB smear-positive occurrence. RESULTS: No significant deviations were observed with all the four polymorphism sites in the genotypic distributions (P>0.05). Linkage disequilibrium (LD) analysis showed that there was LD between SNPs of VDR gene (r2=0.74, D`>0.9). Each haplotype was not considered to be the influencing factor of second AFB smear-positive. CONCLUSIONS: There is no association between VDR gene polymorphism (ApaI, BsmI, FokI and TaqI) and second AFB smear-positive.

The relationship between vitamin D level and second acid-fast bacilli (AFB) smear-positive during treatment for TB patients was inferred by Bayesian network.

BACKGROUND: Vitamin D is related to human immunity, so we used Bayesian network model to analyze and infer the relationship between vitamin D level and the acid-fast bacilli (AFB) smear-positive after two months treatment among pulmonary tuberculosis (TB) patients. METHODS: This is a cross-sectional study. 731 TB patients whose vitamin D level were detected and medical records were collected from December 2019 to December 2020 in XinJiang of China. Logistic regression was used to analyze the influencing factors of second AFB smear-positive. Bayesian network was used to further analyze the causal relationship among vitamin D level and the second AFB smear-positive. RESULTS: Baseline AFB smear-positive (OR = 6.481, 95%CI: 1.604~26.184), combined cavity (OR = 3.204, 95%CI: 1.586~6.472), full supervision (OR = 8.173, 95%CI:1.536~43.492) and full management (OR = 6.231, 95%CI:1.031~37.636) were not only the risk factors and can also be considered as the reasons for second AFB smear-positive in TB patients (Ensemnle > 0.5). There was no causal relationship between vitamin D level and second AFB smear-positive (Ensemnle = 0.0709). CONCLUSIONS: The risk factors of second AFB smear-positive were baseline AFB smear-positive, combined cavity, full supervision and full management. The vitamin D level in TB patients was not considered as one of the reasons for the AFB smear-positive.

Construction of Xinjiang metabolic syndrome risk prediction model based on interpretable models.

BACKGROUND: We aimed to construct simple and practical metabolic syndrome (MetS) risk prediction models based on the data of inhabitants of Urumqi and to provide a methodological reference for the prevention and control of MetS. METHODS: This is a cross-sectional study conducted in the Xinjiang Uygur Autonomous Region of China. We collected data from inhabitants of Urumqi from 2018 to 2019, including demographic characteristics, anthropometric indicators, living habits and family history. Resampling technology was used to preprocess the data imbalance problems, and then MetS risk prediction models were constructed based on logistic regression (LR) and decision tree (DT). In addition, nomograms and tree diagrams of DT were used to explain and visualize the model. RESULTS: Of the 25,542 participants included in the study, 3,267 (12.8%) were diagnosed with MetS, and 22,275 (87.2%) were diagnosed with non-MetS. Both the LR and DT models based on the random undersampling dataset had good AUROC values (0.846 and 0.913, respectively). The accuracy, sensitivity, specificity, and AUROC values of the DT model were higher than those of the LR model. Based on a random undersampling dataset, the LR model showed that exercises such as walking (OR=0.769) and running (OR= 0.736) were protective factors against MetS. Age 60 ~ 74 years (OR=1.388), previous diabetes (OR=8.902), previous hypertension (OR=2.830), fatty liver (OR=3.306), smoking (OR=1.541), high systolic blood pressure (OR=1.044), and high diastolic blood pressure (OR=1.072) were risk factors for MetS; the DT model had 7 depth layers and 18 leaves, with BMI as the root node of the DT being the most important factor affecting MetS, and the other variables in descending order of importance: SBP, previous diabetes, previous hypertension, DBP, fatty liver, smoking, and exercise. CONCLUSIONS: Both DT and LR MetS risk prediction models have good prediction performance and their respective characteristics. Combining these two methods to construct an interpretable risk prediction model of MetS can provide methodological references for the prevention and control of MetS.

The association between SLC11A1 gene polymorphism and treatment failure of pulmonary tuberculosis / 预防医学

Objective@#To analyze the association between recombinant solute carrier family 11, member 1 ( SLC11A1 ) rs17235409 polymorphism and treatment failure of pulmonary tuberculosis, so as to provide the basis for the prevention and treatment of pulmonary tuberculosis.@*Methods@#The patients with pulmonary tuberculosis registered for treatment at the Urumqi Center for Disease Control and Prevention in 2019 was recruited and collected demographic, clinical and treatment information from National Infectious Diseases Reporting System. The polymorphism of SLC11A1 rs17235409 was detected by multiple ligase chain reaction and Hardy-Weinberg balance test was performed. The multivariate logistic regression analysis was conducted for the association between rs17235409 and the treatment outcome of tuberculosis.@*Results@#A total of 731 cases of pulmonary tuberculosis patients were enrolled, and 37 cases failed, with a failure rate of 5.06%. The failure rate of the patients with G/A was 8.55%, with G/G was 4.23%. The results of multivariate logistic regression analysis showed that the patients with G/A were more likely to fail in the treatment than those with G/G ( OR=2.213, 95%CI: 1.041-4.702 ). The males with G/A were more likely to fail in the treatment than those with G/G ( OR=2.547, 95%CI: 1.021-6.356 ). @*Conclusion@#The rs17235409 polymorphism of SLC11A1 is associated with the failure of tuberculosis treatment, and the patients with G/A are more likely to fail.

Burden of tuberculosis in Xinjiang between 2011 and 2015: A surveillance data-based study.

BACKGROUND: Despite the reduction in reported incidence of tuberculosis globally, the burden of pulmonary tuberculosis (PTB) remains high in low- and middle- income countries, including China. The current study aims to evaluate the distribution and trend of PTB incidence in Xinjiang, the region with the highest PTB burden in China. METHODS: We identified all confirmed PTB case records reported to the Chinese TB Information Management System (TBIMS) between 2011 and 2015. We analyzed these records to measure the annual incidence of reported smear-positive PTB cases in Xinjiang and its trend over time. We also analyzed incidence by gender, residential area, and region. Spatial analysis was used to describe the inter-regional disparity of the disease burden during the study period. RESULTS: We identified 212,216 smear-positive PTB cases between 2011 and 2015. The reported incidence increased from 180.8 cases in 2011 to 195.8 cases in 2015 per 100,000 population. The southern region of Xinjiang had the highest disease burden (257.8/100,000 in 2011 and 312.7/100,000 in 2015). More than 60% cases occurred in persons >45 years, and 76% of cases lived in rural areas. CONCLUSION: To reach the goal of elimination and control of TB, more comprehensive STOP TB strategies should be implemented in Xinjiang. Residents in the southern region and rural areas of Xinjiang require particular attention.

Direct and indirect effects of glomalin, mycorrhizal hyphae, and roots on aggregate stability in rhizosphere of trifoliate orange.

To test direct and indirect effects of glomalin, mycorrhizal hyphae, and roots on aggregate stability, perspex pots separated by 37-µm nylon mesh in the middle were used to form root-free hyphae and root/hyphae chambers, where trifoliate orange (Poncirus trifoliata) seedlings were colonized by Funneliformis mosseae or Paraglomus occultum in the root/hyphae chamber. Both fungal species induced significantly higher plant growth, root total length, easily-extractable glomalin-related soil protein (EE-GRSP) and total GRSP (T-GRSP), and mean weight diameter (an aggregate stability indicator). The Pearson correlation showed that root colonization or soil hyphal length significantly positively correlated with EE-GRSP, difficultly-extractable GRSP (DE-GRSP), T-GRSP, and water-stable aggregates in 2.00-4.00, 0.50-1.00, and 0.25-0.50 mm size fractions. The path analysis indicated that in the root/hyphae chamber, aggregate stability derived from a direct effect of root colonization, EE-GRSP or DE-GRSP. Meanwhile, the direct effect was stronger by EE-GRSP or DE-GRSP than by mycorrhizal colonization. In the root-free hyphae chamber, mycorrhizal-mediated aggregate stability was due to total effect but not direct effect of soil hyphal length, EE-GRSP and T-GRSP. Our results suggest that GRSP among these tested factors may be the primary contributor to aggregate stability in the citrus rhizosphere.

Japanese encephalitis risk and contextual risk factors in southwest China: a Bayesian hierarchical spatial and spatiotemporal analysis.

It is valuable to study the spatiotemporal pattern of Japanese encephalitis (JE) and its association with the contextual risk factors in southwest China, which is the most endemic area in China. Using data from 2004 to 2009, we applied GISmapping and spatial autocorrelation analysis to analyze reported incidence data of JE in 438 counties in southwest China, finding that JE cases were not randomly distributed, and a Bayesian hierarchical spatiotemporal model identified the east part of southwest China as a high risk area. Meanwhile, the Bayesian hierarchical spatial model in 2006 demonstrated a statistically significant association between JE and the agricultural and climatic variables, including the proportion of rural population, the pig-to-human ratio, the monthly precipitation and the monthly mean minimum and maximum temperatures. Particular emphasis was placed on the time-lagged effect for climatic factors. The regression method and the Spearman correlation analysis both identified a two-month lag for the precipitation, while the regression method found a one-month lag for temperature. The results show that the high risk area in the east part of southwest China may be connected to the agricultural and climatic factors. The routine surveillance and the allocation of health resources should be given more attention in this area. Moreover, the meteorological variables might be considered as possible predictors of JE in southwest China.

The incidence of liver injury in Uyghur patients treated for TB in Xinjiang Uyghur autonomous region, China, and its association with hepatic enzyme polymorphisms nat2, cyp2e1, gstm1 and gstt1.

BACKGROUND AND OBJECTIVE: Of three first-line anti-tuberculosis (anti-TB) drugs, isoniazid is most commonly associated with hepatotoxicity. Differences in INH-induced toxicity have been attributed to genetic variability at several loci, NAT2, CYP2E1, GSTM1and GSTT1, that code for drug-metabolizing enzymes. This study evaluated whether the polymorphisms in these enzymes were associated with an increased risk of anti-TB drug-induced hepatitis in patients and could potentially be used to identify patients at risk of liver injury. METHODS AND DESIGN: In a cross-sectional study, 2244 tuberculosis patients were assessed two months after the start of treatment. Anti-TB drug-induced liver injury (ATLI) was defined as an ALT, AST or bilirubin value more than twice the upper limit of normal. NAT2, CYP2E1, GSTM1 and GSTT1 genotypes were determined using the PCR/ligase detection reaction assays. RESULTS: 2244 patients were evaluated, there were 89 cases of ATLI, a prevalence of 4% 9 patients (0.4%) had ALT levels more than 5 times the upper limit of normal. The prevalence of ATLI was greater among men than women, and there was a weak association with NAT2*5 genotypes, with ATLI more common among patients with the NAT2*5*CT genotype. The sensitivity of the CT genotype for identifying patients with ATLI was 42% and the positive predictive value 5.9%. CT ATLI was more common among slow acetylators (prevalence ratio 2.0 (95% CI 0.95,4.20) )compared to rapid acetylators. There was no evidence that ATLI was associated with CYP2E1 RsaIc1/c1genotype, CYP2E1 RsaIc1/c2 or c2/c2 genotypes, or GSTM1/GSTT1 null genotypes. CONCLUSIONS: In Xinjiang Uyghur TB patients, liver injury was associated with the genetic variant NAT2*5, however the genetic markers studied are unlikely to be useful for screening patients due to the low sensitivity and low positive predictive values for identifying persons at risk of liver injury.

[Investigation of ophthalmic resources in Xinjiang Uyghur Autonomous Region in China].

OBJECTIVES: To explore ophthalmic resources and existing problems in Xinjiang Uyghur Autonomous Region, and to provide reasonable developing configuration for the future. METHODS: It was a population-based cross-section study. By using questionnaire to collect data from all eye units (national and private) which were registered in Xinjiang area. Investigation included: (1) ophthalmic medical unit of name, structure type, departments constitute; (2) the ophthalmic medical work; (3) the number of ophthalmology health technicians and distribution; (4) ophthalmic devices usage; (5) carry out the problems and difficulties encountered in ophthalmic work. Descriptive statistic method was used to analyze the structure of ophthalmic material, the availability of resource, the medical institution of different regions and types. RESULTS: One hundred and thirty questionnaire were filled out and 110 questionnaire were recovery. There were 107 eye units, 1709 beds for ophthalmic, 1672 employees, including 525 doctors, the ratio of doctors and nurses was 1.0:1.3. And the ophthalmic resources mainly distributed in northern Tianshan, very few in the eastern area in Xinjiang; ophthalmic units were denser in general hospitals which were above the county level. There were 43 580 ophthalmic surgeries in all, the main eye operation carried out was cataract surgery, including 20 303 (counted 46.59%) cataract operation. CONCLUSIONS: The ophthalmic units distribution is unbalanced, which is short of ophthalmologists. It provides base for government to arrange ophthalmic resources reasonably, to enhance the research motivation and to cultivate more professors, and to increase the number of ophthalmic specialists in the general hospitals, and eventually to maximize the benefit of ophthalmic service in Xinjiang.

Clinicopathologic correlations between human papillomavirus 16 infection and Beclin 1 expression in human cervical cancer.

Our earlier study showed that the autophagy gene Beclin 1 could affect cell proliferation in a cervical cancer HeLa cell line. In this study, we examined Beclin 1 protein expression in 81 specimens of cervical squamous carcinoma by immunohistochemistry. Meanwhile, we detected E6 and E7 genes of human papillomavirus 16 in these tissues by polymerase chain reaction. Beclin 1 expression significantly decreased in samples of malignant cervical cancer tissues than in those of normal or cervical intraepithelial neoplasia tissues. The expression of Beclin 1 was associated with pelvic lymph node metastasis and histological grade, but did not correlate with International Federation of Gynecology and Obstetrics stage, age, depth of cervical infiltration, tumor size, and gross type of cervical lesion. The expression of Beclin 1 was not obviously correlated with E6 and E7 genes statistically. Therefore, decreased expression of Beclin 1 may be related to tumorigenesis and the development of cervical cancer, but is not significantly relevant with human papillomavirus 16 infection.

Contextual risk factors for regional distribution of Japanese encephalitis in the People's Republic of China.

OBJECTIVE: To investigate the contextual risk factors for the regional distribution of Japanese encephalitis (JE) in the People's Republic of China to enhance the prevention and control of JE. METHODS: A multilevel Poisson regression model was used to analyse the association between the epidemic of JE and its contextual risk factors with an emphasis on the proportion of rice-planting area, the extent of pig rearing and the proportion of rural population. RESULTS: The highest risk of JE was observed in the southwestern and the central areas of P.R. China, characterized by high proportions of rice-planting area, rural population and extent of pig rearing. These contextual determinants seem to govern the risk of JE. CONCLUSION: In P.R. China, an effective surveillance system should be established in the high-risk regions of JE; immunization coverage for the prevention of JE should be expanded in rural areas, and mosquito-control efforts should be made to enhance the prevention and control of JE.