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Zhang Y, Wei X, Cao C, Yu F, Li W, Zhao G, Wei H, Zhang F, Meng P, Sun S, Lammi MJ, Guo X. Identifying discriminative features for diagnosis of Kashin-Beck disease among adolescents. BMC Musculoskelet Disord 2021; 22:801. [PMID: 34537022 PMCID: PMC8449456 DOI: 10.1186/s12891-021-04514-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diagnosing Kashin-Beck disease (KBD) involves damages to multiple joints and carries variable clinical symptoms, posing great challenge to the diagnosis of KBD for clinical practitioners. However, it is still unclear which clinical features of KBD are more informative for the diagnosis of Kashin-Beck disease among adolescent. METHODS We first manually extracted 26 possible features including clinical manifestations, and pathological changes of X-ray images from 400 KBD and 400 non-KBD adolescents. With such features, we performed four classification methods, i.e., random forest algorithms (RFA), artificial neural networks (ANNs), support vector machines (SVMs) and linear regression (LR) with four feature selection methods, i.e., RFA, minimum redundancy maximum relevance (mRMR), support vector machine recursive feature elimination (SVM-RFE) and Relief. The performance of diagnosis of KBD with respect to different classification models were evaluated by sensitivity, specificity, accuracy, and the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS Our results demonstrated that the 10 out of 26 discriminative features were displayed more powerful performance, regardless of the chosen of classification models and feature selection methods. These ten discriminative features were distal end of phalanges alterations, metaphysis alterations and carpals alterations and clinical manifestations of ankle joint movement limitation, enlarged finger joints, flexion of the distal part of fingers, elbow joint movement limitation, squatting limitation, deformed finger joints, wrist joint movement limitation. CONCLUSIONS The selected ten discriminative features could provide a fast, effective diagnostic standard for KBD adolescents.
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Affiliation(s)
- Yanan Zhang
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China
| | - Xiaoli Wei
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Chunxia Cao
- Institute of Disaster Medicine, Tianjin University, Tianjin, P.R. China
| | - Fangfang Yu
- Department of Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, P. R. China
| | - Wenrong Li
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Guanghui Zhao
- Xi'an Honghui Hospital, Health Science Center of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Haiyan Wei
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China
| | - Feng'e Zhang
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China
| | - Peilin Meng
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China
| | - Shiquan Sun
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China
| | - Mikko Juhani Lammi
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China.
- Department of Integrative Medical Biology, University of Umeå, 90187, Umeå, Sweden.
| | - Xiong Guo
- School of Public Health, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an, Shaanxi, P.R. China.
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Prevalence of pediatric Kashin-Beck disease in Tibet. Clin Rheumatol 2021; 40:3717-3722. [PMID: 33674987 DOI: 10.1007/s10067-021-05669-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To estimate the prevalence of Kashin-Beck disease (KBD) among children in 2017 in Changdu of Tibet. METHODS We adopted a four-step recruitment to include children aged 7-12 years from seven identified historically endemic counties in Changdu. Posterior-anterior radiographs of right hand and wrist were taken and were graded at four sites (metaphysis, epiphysis, and bony end of phalanges and metacarpal and carpal bones). Two trained researchers independently read the films. Inter-rater reliability was assessed using weighted Kappa and percentage agreement. We fitted logistic regression model to examine the association of age, sex, and altitude of residential village with prevalence of KBD. We examined association between site involvement and severity of KBD using chi-square test. RESULTS We recruited 13,573 children (mean age = 9.3 years, 48.40% girls) with a response rate of 95.81%. The overall prevalence of radiographic KBD was 0.26%. Luolong County had the highest prevalence (0.69%), followed by Bianba (0.26%), Basu (0.24%), Mangkang (0.14%), Zuogong (0.14%), Dingqing (0.07%), and Chaya (0.00%). A higher risk of radiographic KBD was associated with older age (P for trend <0.001) and girls (OR=1.86, 95% CI: 0.94, 3.70), but not the altitude of residential village (P for trend=0.957). Metaphysis was involved in all cases of KBD while lesions in epiphysis and bony end of phalanges and metacarpals were only observed in severe cases. CONCLUSIONS The prevalence of radiographic KBD among children aged 7-12 years was low in Changdu compared with previous census data, suggesting the effectiveness of preventative measures. Key Points • In this study, 13,573 Tibetan children were taken X-ray films of their hands and wrists. • The prevalence of radiographic KBD among children aged 7-12 years was low in Changdu of Tibet. • The preventative measures against KBD launched by Chinese government were effective in decreasing new onsets of KBD among Tibetan children.
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Yang L, Wang D, Li X, Yuan H, Fang H, Guo X. Comparison of the responsiveness of the WOMAC and the 12-item WHODAS 2.0 in patients with Kashin-Beck disease. BMC Musculoskelet Disord 2020; 21:188. [PMID: 32213176 PMCID: PMC7098162 DOI: 10.1186/s12891-020-03210-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Several questionnaires have been used to assess the health status of patients with Kashin-Beck disease (KBD) in clinical trials, but the evidence regarding the responsiveness of these instruments in KBD patients is limited. Therefore, the aim of this study was to evaluate and compare the responsiveness of the Chinese version of the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in KBD patients undergoing intra-articular injection of hyaluronic acid (HA). Methods A sample of 232 KBD patients treated with intra-articular injection of HA completed the WOMAC, 12-item WHODAS 2.0 and joint dysfunction index (JDI) both pre- and post-treatment. Responsiveness was assessed using correlation and receiver operating characteristic (ROC) curve analyses following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results Overall, there were significant improvements in the mean scores on the WOMAC and on the 12-item WHODAS 2.0, except for in the cognition domain. Correlation analysis showed that changes in the WOMAC and 12-item WHODAS 2.0 scores had moderate or weak positive associations with the changes in the JDI. However, acceptable areas under the ROC curve (value > 0.7) were found for all domains and for the total score on the WOMAC, but only for the mobility domain and the total score on the 12-item WHODAS 2.0. Conclusions These results demonstrated that the WOMAC was more responsive than the 12-item WHODAS 2.0 in KBD patients treated with intra-articular injection of HA. Our findings support the continued use of the WOMAC as an outcome measure in assessing disability in KBD patients.
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Affiliation(s)
- Lei Yang
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi'an Jiaotong University, No.76 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Dimiao Wang
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xiuxia Li
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Hangjing Yuan
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Hua Fang
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xiong Guo
- School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi'an Jiaotong University, No.76 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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Fu Q, Cao J, Renner JB, Jordan JM, Caterson B, Duance V, Luo M, Kraus VB. Radiographic features of hand osteoarthritis in adult Kashin-Beck Disease (KBD): the Yongshou KBD study. Osteoarthritis Cartilage 2015; 23:868-73. [PMID: 25623625 PMCID: PMC4769644 DOI: 10.1016/j.joca.2015.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/13/2015] [Accepted: 01/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Kashin-Beck Disease (KBD) is a rare and severe osteoarthropathy endemic to China. We evaluated the frequency and patterns of hand radiographic osteoarthritis (rOA) in adults with and without KBD. METHODS Han Chinese (N = 438) from Yongshou County of central China underwent right hand radiography for determining case status. Presence of KBD was based on characteristic radiographic deformities of articular ends of bones including articular surface depression, carpal crowding, any subchondral bone deformities in the proximal end of phalanges or first metacarpal bone, or the distal ends of metacarpal bones 2-5, and any bony enlargement with deformity of the distal ends of phalanges. Hand rOA severity was determined by osteophyte (OST), joint space narrowing (JSN), and Kellgren and Lawrence (KL) grades. RESULTS This study included 127 KBD and 311 non-KBD adults of similar mean age (39 years) and body mass index (BMI) (21 kg/m(2)). Inter- and intra-rater reliability for radiographic determination of case status and rOA features was high (kappa 0.72-0.96). Compared to non-KBD, KBD adults had significantly more severe hand rOA of the thumb, distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. Only KBD adults had end-stage carpometacapal (CMC) disease. In KBD, DIPs and PIPs were more affected than MCPs and the frequency of OSTs was significantly higher in PIPs than DIPs. CONCLUSIONS Compared with age-matched adults from the same area and farming occupation, KBD hand rOA was more widespread and severe, particularly of PIPs and CMCs. The ability to differentiate adult KBD from non-KBD hand rOA will facilitate genetic analyses of the vast majority of affected individuals.
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Affiliation(s)
- Qiang Fu
- Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi’an, Shaanxi, P.R. China,Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Medical Center, Ministry of Education, Xi’an, Shaanxi, P.R. China,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA,Address correspondence and reprint requests to: Qiang Fu, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi'an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Junling Cao, MD, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi’an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Virginia Byers Kraus, MD, PhD, Department of Medicine, Duke University Medical Center, Box 3416, GSRB1 Building, Durham, NC, 27710, USA. Tel: 1-919-681 6652; Fax: 1-919-684 8907;
| | - Junling Cao
- Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi’an, Shaanxi, P.R. China,Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Medical Center, Ministry of Education, Xi’an, Shaanxi, P.R. China,Address correspondence and reprint requests to: Qiang Fu, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi'an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Junling Cao, MD, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi’an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Virginia Byers Kraus, MD, PhD, Department of Medicine, Duke University Medical Center, Box 3416, GSRB1 Building, Durham, NC, 27710, USA. Tel: 1-919-681 6652; Fax: 1-919-684 8907;
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Medicine and Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bruce Caterson
- Connective Tissue Biology Laboratories, School of Biosciences, Cardiff University, UK
| | - Victor Duance
- Connective Tissue Biology Laboratories, School of Biosciences, Cardiff University, UK
| | - Mingxiu Luo
- Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi’an, Shaanxi, P.R. China,Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Medical Center, Ministry of Education, Xi’an, Shaanxi, P.R. China
| | - Virginia Byers Kraus
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA,Address correspondence and reprint requests to: Qiang Fu, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi'an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Junling Cao, MD, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi’an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Virginia Byers Kraus, MD, PhD, Department of Medicine, Duke University Medical Center, Box 3416, GSRB1 Building, Durham, NC, 27710, USA. Tel: 1-919-681 6652; Fax: 1-919-684 8907;
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