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Li B, Li M, Song Y, Lu X, Liu D, He C, Zhang R, Wan X, Zhang R, Sun M, Kuang YQ, Li Y. Construction of Machine Learning Models to Predict Changes in Immune Function Using Clinical Monitoring Indices in HIV/AIDS Patients After 9.9-Years of Antiretroviral Therapy in Yunnan, China. Front Cell Infect Microbiol 2022; 12:867737. [PMID: 35646738 PMCID: PMC9134793 DOI: 10.3389/fcimb.2022.867737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate trends in clinical monitoring indices in HIV/AIDS patients receiving antiretroviral therapy (ART) at baseline and after treatment in Yunnan Province, China and to provide the basis for guiding clinical treatment to obtain superior clinical outcomes.MethodsA total of 96 HIV/AIDS patients who had started and persisted in highly active ART treatment from September 2009 to September 2019 were selected. Of these, 54 had a CD4 cell count < 200 cells/μl while 42 had a CD4 cell count ≥ 200 cells/μl. Routine blood tests, liver and renal function, and lipid levels were measured before and 3, 6, 9, and 12 months after treatment. Lymphocyte subset counts and viral load were measured once per year, and recorded for analysis and evaluation. Three machine learning models (support vector machine [SVM], random forest [RF], and multi-layer perceptron [MLP]) were constructed that used the clinical indicators above as parameters. Baseline and follow-up results of routine blood and organ function tests were used to analyze and predict CD4+ T cell data after treatment during long-term follow-up. Predictions of the three models were preliminarily evaluated.ResultsThere were no statistical differences in gender, age, or HIV transmission route in either patient group. Married individuals were substantially more likely to have <200 CD4+ cells/μl. There was a strong positive correlation between ALT and AST (r = 0.587) and a positive correlation between CD4 cell count and platelet count (r = 0.347). Platelet count was negatively correlated with ALT (r = -0.229), AST (r = -0.251), and positively correlated with WBCs (r = 0.280). Compared with the CD4 cell count < 200 cells/μl group, all three machine learning models exhibited a better predictive capability than for patients with a CD4 cell count ≥ 200 cells/μl. Of all indicators, the three models best predicted the CD4/CD8 ratio, with results that were highly consistent. In patients with a CD4 cell count < 200 cells/μl, the SVM model had the best performance for predicting the CD4/CD8 ratio, while the CD4/CD8 ratio was best predicted by the RF model in patients with a CD4 cell count ≥ 200 cells/μl.ConclusionBy the incorporation of clinical indicators in SVM, RF, and MLP machine learning models, the immune function and recuperation of HIV/AIDS patients can be predicted and evaluated, thereby better guiding clinical treatment.
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Affiliation(s)
- Bingxiang Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Mingyu Li
- Department of Laboratory Medicine, Yunnan Provincial Institute of Infectious Diseases, Kunming, China
| | - Yu Song
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoning Lu
- Department of Gynecology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dajin Liu
- Department of Medical Records and Statistics, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chenglu He
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruixian Zhang
- Department of Disease Control and Prevention, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xinrui Wan
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Renning Zhang
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ming Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
- *Correspondence: Ya Li, ; Yi-Qun Kuang, ; Ming Sun,
| | - Yi-Qun Kuang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
- Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Ya Li, ; Yi-Qun Kuang, ; Ming Sun,
| | - Ya Li
- Department of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Innovation Team of Clinical Laboratory and Diagnosis, First Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Ya Li, ; Yi-Qun Kuang, ; Ming Sun,
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Prevalence of hepatitis B virus infection and its associated factors among 15,461 pregnant women in Yunnan province, China. Ann Epidemiol 2020; 49:13-19. [PMID: 32951803 DOI: 10.1016/j.annepidem.2020.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE China has the world's largest burden of hepatitis B virus (HBV) infection. However, there are few studies reported on the latest prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in China. We aimed to assess the prevalence of HBV infection and its associated risk factors among pregnant women in Yunnan, which is a province with relatively high prevalence of blood-borne viruses. METHODS We conducted a cross-sectional study of 15,641 pregnant women who underwent routine antenatal screening for HBsAg in Yunnan between 2013 and 2016. Logistic regression analyses were used to examine the associations between HBV infection and risk factors. RESULTS Overall, 7.89% (95% confidence interval (CI), 7.47%-8.31%) of the 15,641 pregnant women tested positive for HBsAg. Multivariable logistic regression analysis showed that advanced age (≥35 years old; adjusted odds ratio [aOR], 2.43-2.59), Hani ethnicity (aOR, 1.97; 95% CI, 1.22-3.17), unemployed women (aOR, 1.88; 95% CI, 1.30-2.72), multigravidas (aOR, 1.21; 95% CI, 1.05-1.40), and multiparas (aOR, 1.28; 95% CI, 1.10-1.49) were more likely to be infected with HBV. HBV infection was associated with cesarean section and preterm birth, with aORs of 1.31 (1.17-1.48) and 1.23 (1.00-1.51), respectively. In the subgroup analysis, the association between Hani ethnicity and HBV infection was significantly higher in women aged 35 years or older (aOR = 5.15; 95% CI, 1.51-17.55) than in women younger than 35 years of age (aOR = 1.69; 95% CI, 1.00-2.86). CONCLUSIONS HBV infection among 15,641 pregnant women was of high-intermediate endemicity in Yunnan, China. Advanced age, Hani ethnicity, unemployment, and multigravid and multiparous statuses were associated with an increased prevalence of HBV infection. High-risk pregnant women should be paid more attention during routine antenatal examination.
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Tang JT, Li YY, Zhang Y, Liu J, Guan W, Wang RR, He LP, Zhang JB, Kuang YQ. HIV infection confers distinct mechanisms in severe drug eruption: Endogenous virus activation with aberrant Th2/Th1 and CD8 + T cells function. Clin Exp Pharmacol Physiol 2020; 47:1005-1013. [PMID: 31991490 DOI: 10.1111/1440-1681.13266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022]
Abstract
Severe drug eruption (SDE), a common skin disease, becomes dangerous when it occurs in patients with human immunodeficiency virus (HIV). However, the molecular mechanisms are poorly understood. Forty patients including HIV+ SDE+ (n = 15), HIV- SDE+ (n = 15) and HIV+ SDE- (n = 10) subjects were enrolled in our study. All HIV+ patients were at acquired immune deficiency syndrome (AIDS) stage. Serum levels of TNF-α, IFN-γ, IL-4, IL-13, IL-6, CXCL9, and CCL17 were quantified by ELISA. Epstein-Barr virus (EBV) and cytomegalovirus (CMV) loads were quantified by RT-qPCR. CD4, CD8, Th1, Th2, TNF-α-CD8, and IFN-γ-CD8 T cell populations were measured by flow cytometry. Levels of biochemical indexes in HIV+ SDE+ patients were significantly different from in HIV- SDE+ patients (P < .05). EBV and CMV viral loads were significantly higher in HIV+ SDE+ patients, but not in HIV- SDE+ patients (P < .05). Inflammatory cytokines TNF-α and IFN-γ were significantly elevated in HIV+ SDE+ patients (P < .05). Th2/Th1 populations and TNF-α secreting or IFN-γ secreting CD8+ T cells, were significantly up-regulated in HIV+ SDE+ patients compared to HIV- SDE+ patients (P < .05). Conversely, the CD4/CD8 ratio was significantly down-regulated in HIV+ SDE+ patients compared to HIV- SDE+ patients (P < .05). HIV infection confers distinct clinical phenotypes and immune inflammatory mechanisms in SDE. Sustained EBV and CMV activation, unbalanced Th2/Th1 and overactive CD8+ T cells mediating a pro-inflammatory response could act as distinct mechanisms in the aggravation of SDE in HIV+ SDE+ patients.
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Affiliation(s)
- Jun-Ting Tang
- Department of Dermatology and Venerology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu-Ye Li
- Department of Dermatology and Venerology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi Zhang
- Department of Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Jun Liu
- Department of HIV/AIDS, Third People's Hospital of Kunming, Kunming, China
| | - Wei Guan
- Department of HIV/AIDS, Third People's Hospital of Kunming, Kunming, China
| | - Rui-Rui Wang
- Department of Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Li-Ping He
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jian-Bo Zhang
- Department of Dermatology and Venerology, Second People's Hospital of Dali, Dali, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Li YY, Yang SH, Wang RR, Tang JT, Wang HM, Kuang YQ. Effects of CD4 cell count and antiretroviral therapy on mucocutaneous manifestations among HIV/AIDS patients in Yunnan, China. Int J Dermatol 2019; 59:308-313. [PMID: 31846069 DOI: 10.1111/ijd.14725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/09/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The affecting factors of mucocutaneous manifestations in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients remain unclear in China. METHODS A retrospective analysis was conducted among HIV/AIDS patients in Yunnan, China. The demographic data, mucocutaneous manifestations, CD4 cell counts, and antiretroviral therapy (ART) regimens were collected. The effects of CD4 cell count and ART on the spectrum of mucocutaneous manifestations were evaluated. RESULTS Among 508 HIV/AIDS patients, 86.0% of cases showed mucocutaneous manifestations. The average CD4 cell count (176 cells/μl) of the patients with manifestations was significantly lower than those without manifestations (328 cells/μl) (P < 0.001). Diseases such as herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, cryptococcosis, and HIV-PPE (pruritic papular eruption) were represented quite frequently in patients with CD4 cell count <200 cells/μl (P < 0.05), but eczema was suffered by those with CD4 cell count ≥200 cells/μl (P < 0.05). ART could decline the incidence of herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, and cryptococcosis (P < 0.05). CONCLUSIONS Mucocutaneous manifestations are closely related to the CD4 cell count and can be used as early predictors of HIV/AIDS and immune status in clinic. ART could reduce the incidence of certain mucocutaneous manifestations.
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Affiliation(s)
- Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Shi-Han Yang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Rui-Rui Wang
- School of Pharmaceutical Sciences, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Jun-Ting Tang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Hong-Mei Wang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Yi-Qun Kuang
- Institute of Infection and Immunity, Henan University & Center for Translational Medicine, Huaihe Clinical College, Huaihe Hospital of Henan University, Kaifeng, 475000, China.,NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
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Chan FL, Shear NH, Shah N, Olteanu C, Hashimoto R, Dodiuk-Gad RP. New Discoveries and Updates on Cutaneous Adverse Drug Reactions Presented at the 24th World Congress of Dermatology, Milan, Italy, 2019. Drug Saf 2019; 43:179-187. [PMID: 31673951 DOI: 10.1007/s40264-019-00880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Felix L Chan
- Mississauga Academy of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nidhi Shah
- Department of Dermatology, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Cristina Olteanu
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rena Hashimoto
- Division of Dermatology, Keio University Hospital, Tokyo, Japan
| | - Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel. .,Department of Dermatology, Emek Medical Centre, Yitshak Rabin Boulevard 21, Afula, 1834111, Israel.
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Li Y, He C, He Z, Zhong M, Liu D, Liu R, Fan R, Duan Y. AIDS prevention and control in the Yunnan region by T cell subset assessment. PLoS One 2019; 14:e0214800. [PMID: 30998710 PMCID: PMC6472762 DOI: 10.1371/journal.pone.0214800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Prior to being spread throughout broader China, multiple human immunodeficiency virus (HIV)-1 genotypes were originally discovered in the Yunnan Province. As the HIV-1 epidemic continues its spread in Yunnan, knowledge of the influence of gender, age, and ethnicity to instances of HIV reservoirs will benefit monitoring the spread of HIV. Methods The degree to which T cells are depleted during an HIV infection depends on the levels of immune activation. T-cell subsets were assessed in newly-diagnosed HIV/AIDS patients in Yunnan, and the influence of age, gender, and ethnicity were investigated. Patients that were newly diagnosed with the HIV-infection between the years 2015 and 2018 at the First Affiliated Hospital of Kunming Medical College were selected for this study (N = 408). The lymphocyte levels and T cell subsets were retrospectively measured in whole blood samples by FACS analysis. Results The median CD4 count was 224 ± 191 cells/μl. Significantly higher mean frequencies and absolute numbers were observed in CD3+, CD3+CD4+, CD3+CD8+, CD45+, and CD3+CD4+/CD45+ in females compared to males. Han patients showed a higher total number of CD3+T cells and the ratio of CD3+ /CD45+ cells compared to any other ethnic minority (P < 0.001). The numbers of CD3+ T-cells, CD3+CD8+ T cells, and CD45+ T cells were highest in the age group ≥ 60. Significant differences were observed in the counts of CD3+, CD3+CD8+, and CD45+ cells and the ratio of CD3+/CD45+ and CD3+CD4+/CD45+ cells between the ≤ 29 and 30–59 age groups. Conclusion This study has revealed that low levels of CD4+ T cells can be observed in newly-diagnosed HIV/AIDS patients in the Yunnan province. It has also been demonstrated that gender, age, and ethnicity have a significant association with the ratio of T-cell subsets that may contribute to virus progression and disease prognosis in individuals belonging to certain subsets of the population. This study has highlighted the importance of HIV/AIDS screening in at-risk populations to ensure timely and adequate clinical management in Yunnan.
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Affiliation(s)
- Ya Li
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Chenglu He
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Zengpin He
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Min Zhong
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Dajin Liu
- Department of Medical Records and Statistics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Ruiyang Liu
- Department of Standardized Training, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Ruixuan Fan
- Department of Infectious Diseases, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Yong Duan
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
- * E-mail:
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Ma P, Gao L, Zhang D, Yu A, Qiu C, Li L, Yu F, Wu Y, You W, Guo Y, Ning X, Lu W. Trends in the incidence of AIDS and epidemiological features in Tianjin, China from 2005 to 2016. Oncotarget 2017; 8:102540-102549. [PMID: 29254269 PMCID: PMC5731979 DOI: 10.18632/oncotarget.21016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/27/2017] [Indexed: 01/12/2023] Open
Abstract
The objective of this study was to assess the epidemiological trends among patients with AIDS in Tianjin, China. A long-term surveillance study was conducted from 2005 to 2016 in Tianjin, China. All patients with AIDS registered in Tianjin from 2005 to 2016 were recruited to this study. Demographic information and clinical features were recorded. A total of 3062 patients with AIDS who were treated with antiretroviral therapy were included in this study. Among AIDS patients, men were more likely to be younger than women (age, 37.84 years vs. 43.27 years; P < 0.001). The incidence of AIDS increased by 39.6% annually over the past 12 years overall. There was the greatest increase (by 44.7%) for homosexual route. Moreover, the proportion of patients aged < 30 years increased considerably over the 12-year study period, while there was a decrease in the proportion of patients aged ≥ 35 years. The frequency of homosexual transmission increased by 86% from before 2011 to 2016, but the frequency of heterosexual transmission decreased by 49%. The frequency of transmission through intravenous drug use decreased in men and patients aged 25–29 years. For those infected through homosexual transmission, there was a significant increase in the numbers of patients aged 20–24 years and 25–29 years. It is important for developing countries to effectively prevent and control the transmission of HIV/AIDS; in particular, it is crucial to promote disease education and sexual protection among young men.
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Affiliation(s)
- Ping Ma
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Liying Gao
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Defa Zhang
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Aiping Yu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Chunting Qiu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Lei Li
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Fangfang Yu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yue Wu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Wei You
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yanyun Guo
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Xianjia Ning
- Center of Epidemiology and Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China.,Department of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China
| | - Wei Lu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin 300192, China
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