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Zhang Y, Wang S, Wang X, Liu N, Wang L, Wang X, Liang Z, Wang J, Aili A, Cao M. Effectiveness and Determinants of Implementing the "Xinjiang Model" for Tuberculosis Prevention and Control: A Quantitative Study. Infect Drug Resist 2024; 17:2609-2620. [PMID: 38947373 PMCID: PMC11213531 DOI: 10.2147/idr.s459228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024] Open
Abstract
Objective To analyze the effectiveness of the "Xinjiang Model" for tuberculosis prevention and control in Kashgar Prefecture, Xinjiang, and to explore the determinants of the policy implementation effect. Methods The registration data of pulmonary tuberculosis (PTB) patients in Kashgar Prefecture from 2012 to 2021 were collected to describe the temporal trend of registered incidence. A questionnaire survey was conducted among PTB patients registered and treated in the tuberculosis management information system in Zepu and Shache Counties from January 2022 to July 2023 to collect and analyze "Xinjiang model" determinants of effectiveness. Results The PTB registered incidence in Kashgar Prefecture showed a significant increasing trend from 2012 to 2018 (APC=18.7%) and a significant decreasing trend from 2018-2021 (APC=-28.8%). Among the Kashgar Prefecture, compared with average registered incidence in 2012-2017, registered incidence in 2021 in Shufu, Maigaiti, and Zepu Counties had a greater decline rate of 58.68%, 57.16%, and 54.02%, respectively, while the registered incidence in 2021 in Shache County increased by 6.32%. According to the comprehensive analysis of the factors affecting the effect of policy implementation, the proportion of PTB patients in Zepu County whose health status has now significantly improved compared with that before treatment was significantly greater than that in Shache County (P<0.05); patients in Shache County were significantly less aware than those in Zepu County of how to take tuberculosis drugs, precautions, adverse reactions, and regular reviews during treatment; the factors that accounted for the greater proportion of heavy treatment burden in both Shache and Zepu Counties were discomfort caused by taking or injecting drugs, accounting for 12.8% and 8.7%, respectively. Conclusion The "Xinjiang model" can effectively control the epidemic situation of tuberculosis in Kashgar, and the knowledge of tuberculosis treatment, adverse reactions to tuberculosis drugs, and treatment costs were the determinants of the effectiveness of policy implementation.
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Affiliation(s)
- Yan Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Senlu Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Xinqi Wang
- The Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830002, People’s Republic of China
| | - Nianqiang Liu
- The Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830002, People’s Republic of China
| | - Le Wang
- The Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830002, People’s Republic of China
| | - Xiaomin Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Zhichao Liang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Junan Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Abulikemu Aili
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Mingqin Cao
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
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Liang ZY, Zou K, Lin TL, Dong JK, Huang MQ, Zhou SM, Cai PQ, Zhang L, Li LJ. Crucial computed tomography and magnetic resonance imaging findings of fallopian tubal tuberculosis for diagnosis: a retrospective study of 26 cases. Quant Imaging Med Surg 2024; 14:1577-1590. [PMID: 38415138 PMCID: PMC10895117 DOI: 10.21037/qims-23-775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/01/2023] [Indexed: 02/29/2024]
Abstract
Background Fallopian tubal tuberculosis (FTTB), which typically presents with non-specific clinical symptoms and mimics ovarian malignancies clinically and radiologically, often affects young reproductive females and can lead to infertility if not promptly managed. Early diagnosis by imaging modalities is crucial for initiating timely anti-tuberculosis (anti-TB) treatment. Currently, comprehensive radiological descriptions of this relatively rare disease are limited. We aimed to comprehensively investigate the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of FTTB in patients from the Kashi area, which has the highest incidence of TB in China, to extend radiologists' understanding of this disease. Methods We conducted a retrospective cross-sectional study of 26 patients diagnosed with FTTB at the First People's Hospital of Kashi Area. All the patients underwent abdominal and pelvic contrast-enhanced CT examinations and/or pelvic contrast-enhanced MRI from January 2017 to June 2022. The imaging findings were evaluated in consensus by two experienced radiologists specialized in abdominal and pelvic imaging. The evaluated sites included the fallopian tubes, ovaries, peritoneum, mesentery, retroperitoneal nodes, and parailiac nodes. The patient characteristics are reported using descriptive statistics. The patient imaging results are presented as percentages. The normally distributed continuous variables are reported as the mean ± standard deviation (SD), and otherwise as the median with the interquartile range (IQR). Results The median age of the patients was 27 years (IQR: 25-34 years). Bilateral involvement of the fallopian tubes was observed in all patients. The tubal wall appeared coarse with tiny intraductal nodules in 96% (25 of 26) of the patients. The mean CT value of the tubal contents was 34 Hounsfield units (HUs; SD: 3.3 HUs). Ascites was present in 92% (24 of 26) of the patients, with 20 patients showing encapsulated effusion. Among these patients, 20 exhibited the highest CT values of ascites (>20 HUs). Linear enhancement of the parietal peritoneum was observed in 88% (23 of 26) of the patients, of whom 22 had peritoneal nodules measuring a median diameter of 0.4 cm (IQR: 0.3-0.6 cm). Eight patients had retroperitoneal and parailiac nodal enlargement, of whom two showed nodal necrosis, and none displayed nodal calcification. Conclusions FTTB is consistently accompanied by tuberculous peritonitis. FTTB typically presents with tubal dilation, and coarseness and nodules in the lumen, as well as intraductal caseous material and calcification. Tuberculous peritonitis exhibits high-density ascites, peritoneal adhesion, linear enhancement of the parietal peritoneum, and tiny peritoneal nodules. The co-occurrence of these features strongly suggests a diagnosis of FTTB.
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Affiliation(s)
- Zhi-Ying Liang
- Department of Radiology, The First People’s Hospital of Kashi Area, Kashi, China
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ke Zou
- Department of Radiology, The First People’s Hospital of Kashi Area, Kashi, China
| | - Tao-Lin Lin
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jia-Ke Dong
- Department of Radiology, The First People’s Hospital of Kashi Area, Kashi, China
| | - Man-Qian Huang
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shu-Min Zhou
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pei-Qiang Cai
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ling Zhang
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liang-Jie Li
- Department of Radiology, The First People’s Hospital of Kashi Area, Kashi, China
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Li JX, Luan Q, Li B, Dharmage SC, Heinrich J, Bloom MS, Knibbs LD, Popovic I, Li L, Zhong X, Xu A, He C, Liu KK, Liu XX, Chen G, Xiang M, Yu Y, Guo Y, Dong GH, Zou X, Yang BY. Outdoor environmental exposome and the burden of tuberculosis: Findings from nearly two million adults in northwestern China. JOURNAL OF HAZARDOUS MATERIALS 2023; 459:132222. [PMID: 37557043 DOI: 10.1016/j.jhazmat.2023.132222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
We simultaneously assessed the associations for a range of outdoor environmental exposures with prevalent tuberculosis (TB) cases in a population-based health program with 1940,622 participants ≥ 15 years of age. TB status was confirmed through bacteriological and clinical assessment. We measured 14 outdoor environmental exposures at residential addresses. An exposome-wide association study (ExWAS) approach was used to estimate cross-sectional associations between environmental exposures and prevalent TB, an adaptive elastic net model (AENET) was implemented to select important exposure(s), and the Extreme Gradient Boosting algorithm was subsequently applied to assess their relative importance. In ExWAS analysis, 12 exposures were significantly associated with prevalent TB. Eight of the exposures were selected as predictors by the AENET model: particulate matter ≤ 2.5 µm (odds ratio [OR]=1.01, p = 0.3295), nitrogen dioxide (OR=1.09, p < 0.0001), carbon monoxide (OR=1.19, p < 0.0001), and wind speed (OR=1.08, p < 0.0001) were positively associated with the odds of prevalent TB while sulfur dioxide (OR=0.95, p = 0.0017), altitude (OR=0.97, p < 0.0001), artificial light at night (OR=0.98, p = 0.0001), and proportion of forests, shrublands, and grasslands (OR=0.95, p < 0.0001) were negatively associated with the odds of prevalent TB. Air pollutants had higher relative importance than meteorological and geographical factors, and the outdoor environment collectively explained 11% of TB prevalence.
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Affiliation(s)
- Jia-Xin Li
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Qiyun Luan
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), Kashgar City 844000, China
| | - Beibei Li
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), Kashgar City 844000, China
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Joachim Heinrich
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; Comprehensive Pneumology Center (CPC) Munich, Member DZL, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich, Member DZL, Germany; German Center for Lung Research, Ziemssenstraße 1, 80336 Munich, Germany
| | - Michael S Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Igor Popovic
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton 4343, Australia; Faculty of Medicine, School of Public Health, University of Queensland, Herston, 4006, Australia, School of Veterinary Science, University of Queensland, Gatton 4343, Australia
| | - Li Li
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), Kashgar City 844000, China
| | - Xuemei Zhong
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), Kashgar City 844000, China
| | - Aimin Xu
- Department of Laboratory Medicine, The First People's Hospital of Kashgar, Kashgar 844000, China
| | - Chuanjiang He
- Department of Laboratory Medicine, The First People's Hospital of Kashgar, Kashgar 844000, China; Department of Laboratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Kang-Kang Liu
- Department of Research Center for Medicine, the Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiao-Xuan Liu
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Gongbo Chen
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Mingdeng Xiang
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510080, China
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Guang-Hui Dong
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Xiaoguang Zou
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), Kashgar City 844000, China.
| | - Bo-Yi Yang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
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Chen X, Emam M, Zhang L, Rifhat R, Zhang L, Zheng Y. Analysis of spatial characteristics and geographic weighted regression of tuberculosis prevalence in Kashgar, China. Prev Med Rep 2023; 35:102362. [PMID: 37584062 PMCID: PMC10424202 DOI: 10.1016/j.pmedr.2023.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023] Open
Abstract
Number of cases of tuberculosis (TB) was higher than that of the national level in Kashgar, China. This study aimed to analyze the spatial and temporal distribution of TB and the relationship between TB and social factors, which can provide a reference for the prevention and control of TB. We applied spatial autocorrelation analysis to study the distribution of tuberculosis in Kashgar. We used a geographically weighted regression (GWR) model to analyze the relationship between TB and social factors. A total of 100,330 cases of TB in Kashgar from 2016 to 2021 were analyzed. The number of TB cases in Kashgar was higher in the east, lower in the west, and most elevated in the center. The highest cumulative number of cases was found in Shache county. Global Moran's I ranged from -0.212 to -0.549, and local spatial autocorrelation analysis identified four clusters. According to our analysis, the incidence of tuberculosis was negatively correlated among the regions of Kashgar, and the related causes need to be analyzed in depth in future studies. Per capita gross domestic product (GDP), number of medical institutions per capita, and total population influenced the incidence of tuberculosis in Kashgar. Based on our findings, we suggest some effective measures to reduce the risk of TB infection, such as improving the living standard, developing the regional economy, and distributing health resources rationally.
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Affiliation(s)
- Xiaodie Chen
- College of Public Health, Xinjiang Medical University, Urumqi 830017, China
| | - Mawlanjan Emam
- Center for Disease Control and Prevention, Kashgar 844000,China
| | - Li Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Ramziya Rifhat
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi 830017, China
| | - Liping Zhang
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi 830017, China
| | - Yanling Zheng
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi 830017, China
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Combining metabolome and clinical indicators with machine learning provides some promising diagnostic markers to precisely detect smear-positive/negative pulmonary tuberculosis. BMC Infect Dis 2022; 22:707. [PMID: 36008772 PMCID: PMC9403968 DOI: 10.1186/s12879-022-07694-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) had been the leading lethal infectious disease worldwide for a long time (2014–2019) until the COVID-19 global pandemic, and it is still one of the top 10 death causes worldwide. One important reason why there are so many TB patients and death cases in the world is because of the difficulties in precise diagnosis of TB using common detection methods, especially for some smear-negative pulmonary tuberculosis (SNPT) cases. The rapid development of metabolome and machine learning offers a great opportunity for precision diagnosis of TB. However, the metabolite biomarkers for the precision diagnosis of smear-positive and smear-negative pulmonary tuberculosis (SPPT/SNPT) remain to be uncovered. In this study, we combined metabolomics and clinical indicators with machine learning to screen out newly diagnostic biomarkers for the precise identification of SPPT and SNPT patients. Methods Untargeted plasma metabolomic profiling was performed for 27 SPPT patients, 37 SNPT patients and controls. The orthogonal partial least squares-discriminant analysis (OPLS-DA) was then conducted to screen differential metabolites among the three groups. Metabolite enriched pathways, random forest (RF), support vector machines (SVM) and multilayer perceptron neural network (MLP) were performed using Metaboanalyst 5.0, “caret” R package, “e1071” R package and “Tensorflow” Python package, respectively. Results Metabolomic analysis revealed significant enrichment of fatty acid and amino acid metabolites in the plasma of SPPT and SNPT patients, where SPPT samples showed a more serious dysfunction in fatty acid and amino acid metabolisms. Further RF analysis revealed four optimized diagnostic biomarker combinations including ten features (two lipid/lipid-like molecules and seven organic acids/derivatives, and one clinical indicator) for the identification of SPPT, SNPT patients and controls with high accuracy (83–93%), which were further verified by SVM and MLP. Among them, MLP displayed the best classification performance on simultaneously precise identification of the three groups (94.74%), suggesting the advantage of MLP over RF/SVM to some extent. Conclusions Our findings reveal plasma metabolomic characteristics of SPPT and SNPT patients, provide some novel promising diagnostic markers for precision diagnosis of various types of TB, and show the potential of machine learning in screening out biomarkers from big data. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07694-8.
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Nijiati M, Ma J, Hu C, Tuersun A, Abulizi A, Kelimu A, Zhang D, Li G, Zou X. Artificial Intelligence Assisting the Early Detection of Active Pulmonary Tuberculosis From Chest X-Rays: A Population-Based Study. Front Mol Biosci 2022; 9:874475. [PMID: 35463963 PMCID: PMC9023793 DOI: 10.3389/fmolb.2022.874475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
As a major infectious disease, tuberculosis (TB) still poses a threat to people’s health in China. As a triage test for TB, reading chest radiography with traditional approach ends up with high inter-radiologist and intra-radiologist variability, moderate specificity and a waste of time and medical resources. Thus, this study established a deep convolutional neural network (DCNN) based artificial intelligence (AI) algorithm, aiming at diagnosing TB on posteroanterior chest X-ray photographs in an effective and accurate way. Altogether, 5,000 patients with TB and 4,628 patients without TB were included in the study, totaling to 9,628 chest X-ray photographs analyzed. Splitting the radiographs into a training set (80.4%) and a testing set (19.6%), three different DCNN algorithms, including ResNet, VGG, and AlexNet, were trained to classify the chest radiographs as images of pulmonary TB or without TB. Both the diagnostic accuracy and the area under the receiver operating characteristic curve were used to evaluate the performance of the three AI diagnosis models. Reaching an accuracy of 96.73% and marking the precise TB regions on the radiographs, ResNet algorithm-based AI outperformed the rest models and showed excellent diagnostic ability in different clinical subgroups in the stratification analysis. In summary, the ResNet algorithm-based AI diagnosis system provided accurate TB diagnosis, which could have broad prospects in clinical application for TB diagnosis, especially in poor regions with high TB incidence.
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Affiliation(s)
- Mayidili Nijiati
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, China
- *Correspondence: Mayidili Nijiati, ; Guanbin Li, ; Xiaoguang Zou,
| | - Jie Ma
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Chuling Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Abudouresuli Tuersun
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, China
| | | | - Abudoureyimu Kelimu
- Department of Radiology, Kashi Area Tuberculosis Control Center, Kashi, China
| | - Dongyu Zhang
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Guanbin Li
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Mayidili Nijiati, ; Guanbin Li, ; Xiaoguang Zou,
| | - Xiaoguang Zou
- Clinical Medical Research Center, The First People’s Hospital of Kashi Prefecture, Kashi, China
- *Correspondence: Mayidili Nijiati, ; Guanbin Li, ; Xiaoguang Zou,
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