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Grading individual knee osteoarthritis (OA) features is a fine-grained knee OA severity assessment. Existing methods ignore following problems: (1) more accurately located knee joints benefit subsequent grades prediction; (2) they do not consider knee joints’ symmetry and semantic information, which help to improve grades prediction performance. To this end, we propose a SE-ResNext50-32x4d-based Siamese network with adaptive gated feature fusion method to simultaneously assess eight tasks. In our method, two cascaded small convolution neural networks are designed to locate more accurate knee joints. Detected knee joints are further cropped and split into left and right patches via their symmetry, which are fed into SE-ResNext50-32x4d-based Siamese network with shared weights, extracting more detailed knee features. The adaptive gated feature fusion method is used to capture richer semantic information for better feature representation here. Meanwhile, knee OA/non-knee OA classification task is added, which helps extract richer features. We specially introduce a new evaluation metric (top±1 accuracy) aiming to measure model performance with ambiguous data labels. Our model is evaluated on two public datasets: OAI and MOST datasets, achieving the state-of-the-art results comparing to competing approaches. It has the potential to be a tool to assist clinical decision making.

Knee osteoarthritis (OA) is a common musculoskeletal illness. To solve the problem that inaccurate knee joint localization and inadequate knee OA features extracted from plain radiographs affect the accuracy of knee OA diagnosis in X-rays, we propose a novel Two-Stage Convolutional Neural Network (TS-CNN) method, consisting of the KneeDetnet and the KLnet. The KneeDetnet with two small multi-task convolutional neural networks is proposed to locate knee joints, improving the accuracy of knee joint localization. Then KLnet is designed to assess knee OA, where a shared Siamese network via ResNet is used to extract more discriminative deep learning features that are fused with gender information for obtaining richer features. Our method is evaluated on public OAI and MOST datasets. The highest detection accuracy of knee joints can reach 99.93% and 99.02% on two datasets, respectively. The KLnet algorithm achieves 78.85% and 68.20% prediction accuracy on the OAI and MOST datasets, respectively. Experimental results show that our method outperforms the existing workhorse. The proposed approach may become a potentially useful tool for assisting physicians.

Background There is paucity of data on the prevalence of ultrasound-detected synovial abnormalities in the general population, and the relationship between synovial changes and knee pain remains unclear. We examined the prevalence of synovial abnormalities on ultrasound and the relationship of these features with knee pain and radiographic osteoarthritis (ROA) in a community sample. Methods Participants aged 50 years or over were from the Xiangya Osteoarthritis Study, a community-based cohort study. Participants were questioned about chronic knee pain and underwent (1) ultrasonography of both knees to determine presence of synovial hypertrophy (≥ 4 mm), effusion (≥ 4 mm), and Power Doppler signal [PDS; yes/no]; and (2) standard radiographs of both knees (tibiofemoral and patellofemoral views) to determine ROA. Results There were 3755 participants (mean age 64.4 years; women 57.4%). The prevalence of synovial hypertrophy, effusion, and PDS were 18.1% (men 20.2%; women 16.5%), 46.6% (men 49.9%; women 44.2%), and 4.9% (men 4.9%; women 5.0%), respectively, and increased with age (P for trend P for interaction were 0.004 and 0.067, respectively. Conclusions Knee synovial hypertrophy and effusion are more common and increase with age, affecting men more than women. All three ultrasound-detected synovial abnormalities associate both with knee pain and ROA, and knee synovial hypertrophy or effusion and ROA may interact to increase the risk of knee pain.

AIM To systematically examine the existing literature on the associations between chondrocalcinosis (CC) and osteoarthritis (OA) at different joints, and to quantify such associations through meta-analysis. METHODS PubMed, Embase and Scopus databases were searched through from inception to June 2017. Cohort, case-control or cross-sectional studies were included if they examined the association between CC and OA. Data on the odds ratios (OR) and their 95% confidence intervals (CI) of the prevalence or progression of OA between the CC group and non-CC group with respect to the same joint were extracted. RESULTS A total of 14 studies were identified. Twelve studies were eligible for assessing the association between knee CC and knee OA. The combined data showed a positive association between them (OR = 2.84; 95% CI, 2.12-3.81; P

ObjectiveTo investigate the efficacy and safety of the pulsed electromagnetic field (PEMF) therapy in treating osteoarthritis (OA).DesignMeta-analysis.Data sourcesPubMed, Embase, the Cochrane Library and Web of Science were searched through 13 October 2017.Eligibility criteria for selecting studiesRandomised controlled trials compared the efficacy of PEMF therapy with sham control in patients with OA.Data extraction and synthesisPain, function, adverse effects and characteristics of participants were extracted. RevMan V.5.2 was used to perform statistical analyses.ResultsTwelve trials were included, among which ten trials involved knee OA, two involved cervical OA and one involved hand OA. The PEMF group showed more significant pain alleviation than the sham group in knee OA (standardised mean differences (SMD)=−0.54, 95% CI −1.04 to –0.04, p=0.03) and hand OA (SMD=−2.85, 95% CI −3.65 to –2.04, p30 min per session. Three trials reported adverse events, and the combined results showed that there was no significant difference between PEMF and the sham group.ConclusionsPEMF could alleviate pain and improve physical function for patients with knee and hand OA, but not for patients with cervical OA. Meanwhile, a short PEMF treatment duration (within 30 min) may achieve more favourable efficacy. However, given the limited number of study available in hand and cervical OA, the implication of this conclusion should be cautious for hand and cervical OA.

This study aimed to examine the associations of dietary magnesium (Mg) intake and serum Mg concentration with the high-sensitivity C-reactive protein (hsCRP) level in early radiographic knee osteoarthritis (OA) patients.Multivariable logistic regression was used to test the associations of dietary and serum Mg with the serum hsCRP in early radiographic knee OA patients after adjustment of a number of potential confounding factors.A total of 936 early radiographic knee OA patients were included. A significant association between dietary Mg intake and hsCRP was observed. The multivariable-adjusted odds ratio (OR) (95% CI) for elevated hsCRP (≥3.0 mg/l) in the second, third, fourth, and fifth dietary Mg intake quintile were 0.44 (95% CI: 0.24-0.82), 0.58 (95% CI: 0.31-1.10), 0.34 (95% CI: 0.15-0.77), and 0.19 (95% CI: 0.06-0.57), respectively, compared with the lowest (first) quintile, and p for trend was 0.01. A significant association between serum Mg concentration and hsCRP was observed. The multivariable-adjusted OR (95% CI) for elevated hsCRP in the second, third, fourth, and fifth serum Mg concentration quintile were 0.63 (95% CI: 0.35-1.12), 0.83 (95% CI: 0.50-1.39), 0.53 (95% CI: 0.31-0.91), and 0.46 (95% CI: 0.25-0.85), respectively, compared with the lowest quintile, and p for trend was 0.01.The present study indicated that both dietary and serum Mg were inversely associated with serum hsCRP in early radiographic knee OA patients.

The purpose of this study was to examine the cross-sectional association between dietary soy milk intake and the prevalence of radiographic knee joint space narrowing (JSN) and osteophytes (OST). Soy milk intake was assessed using a validated semiquantitative food frequency questionnaire and classified into three categories: never

The aim of the study is to examine the cross-sectional associations between dietary antioxidants (carotenoid, vitamin C, E, and selenium) intake and radiographic knee osteoarthritis (OA). A total of 4685 participants were included in this study. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) grade 2 in at least one leg. A multivariable logistic analysis model was established to test the relationship between dietary antioxidants (carotenoid, vitamin C, E, and selenium) intake and radiographic knee OA with adjustment of a number of potential confounding factors. A significant positive association between dietary vitamin C intake (P value for trend was 0.04 in multivariable adjusted analysis) and radiographic knee OA was observed. The relative odds of radiographic knee OA were increased by 0.39 times in the third quintile (OR 1.39, 95 % CI 1.11-1.73), 0.42 times in the fourth quintile (OR 1.42, 95 % CI 1.13-1.79), and 0.33 times in the fifth quintile (OR 1.33, 95 % CI 1.03-1.71). However, radiographic knee OA was not significantly associated with dietary carotenoid, vitamin E, and selenium. Among dietary antioxidants, dietary vitamin C intake was positively correlated with the prevalence of radiographic knee OA, while no significant association was found between dietary intake of carotenoid, vitamin E, and selenium and the prevalence of radiographic knee OA.

Objectives. This study is undertaken to investigate the relation between osteopontin (OPN) and Wnt5a expression in the progression and pathogenesis of osteoarthritis (OA).Methods. 50 cartilage tissues from knee OA patients and normal controls were divided into four groups of severe, moderate, minor, and normal lesions based on the modified grading system of Mankin. Immunohistochemistry and real-time PCR were utilized to analyze the OPN and Wnt5a expression in articular cartilage. Besides, the relations between OPN and Wnt5a expression and the severity of OA were explored.Results. OPN and Wnt5a could be identified in four groups’ tissues. Amongst the groups, the intercomparisons of OPN expression levels showed statistical differences (P<0.01). Besides, the intercomparisons of Wnt5a expression degrees showed statistical differences (P<0.05), except that between the minor and normal groups (P>0.05). The scores of Mankin were demonstrated to relate to OPN expression (r=-0.847,P<0.01) and Wnt5a expression in every group (r=-0.843,P<0.01). Also, a positive correlation can be observed between the OPN and Wnt5a expression (r=0.769,P<0.01).Conclusion. In articular cartilage, the expressions of OPN and Wnt5a are positively related to progressive damage of knee OA joint. The correlation between Wnt5a and OPN might be important to the progression and pathogenesis of knee OA.

ObjectivesTo examine the associations between serum magnesium (Mg) concentration with the prevalence of metabolic syndrome (MetS), diabetes mellitus (DM), hypertension (HP) and hyperuricaemia (HU) in patients with radiographic knee osteoarthritis (OA).MethodsThe present study was conducted at the Health Management Center of Xiangya Hospital. Radiographic OA was evaluated for patients aged over 40 years with basic characteristics and blood biochemical assessment. Serum Mg concentration was measured using the chemiluminescence method. MetS, DM, HP and HU were diagnosed based on standard protocols. The associations between serum Mg concentration with MetS, DM, HP and HU were evaluated by conducting multivariable adjusted logistic regression.ResultsA total of 962 patients with radiographic knee OA were included. Compared with the lowest quintile, the multivariable adjusted ORs and related 95% CIs of DM were 0.40 (95% CI 0.23 to 0.70, p=0.001), 0.33 (95% CI 0.18 to 0.60, pConclusionsThe serum Mg concentration was inversely associated with the prevalence of MetS, DM and HU in patients with radiographic knee OA.Level of evidenceLevel III, cross-sectional study.

Objective.To establish whether there is a relationship between serum magnesium (Mg) concentration and radiographic knee osteoarthritis (OA).Methods.There were 2855 subjects in this cross-sectional study. Serum Mg concentration was measured using the chemiluminescence method. Radiographic OA of the knee was defined as changes consistent with Kellgren-Lawrence (K-L) grade 2 on at least 1 side. Mg concentration was classified into 1 of 4 quartiles: ≤ 0.87, 0.88–0.91, 0.92–0.96, or ≥ 0.97 mmol/l. Multivariable logistic analysis was used to test the association between serum Mg and radiographic knee OA after adjustment for potentially confounding factors. The OR with 95% CI for the association between radiographic knee OA and serum Mg concentration were calculated for each quartile. The quartile with the lowest value was regarded as the reference category.Results.Significant association between serum Mg concentration and radiographic knee OA was observed in the model after adjustment for age, sex, and body mass index, as well as in the multivariable model. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth serum Mg concentration quartiles were 0.90 (95% CI 0.71–1.13), 0.92 (95% CI 0.73–1.16), and 0.72 (95% CI 0.57–0.92), respectively, compared with the lowest (first) quartile. A clear trend (p for trend was 0.01) was observed. The relative odds of radiographic knee OA was decreased by 0.72 times in the fourth serum Mg quartile compared with the lowest quartile.Conclusion.Serum Mg concentration may have an inverse relationship with radiographic OA of the knee.

Previous studies have demonstrated that osteopontin (OPN) levels are elevated in the synovial fluid and articular cartilage, and are associated with the severity of knee osteoarthritis (OA). However, the role of OPN in the pathogenesis of OA has yet to be elucidated. The present study aimed to investigate the effects of OPN on the expression of the aggrecanases, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)4 and ADAMTS5, in human OA chondrocytes, as they serve a key function in aggrecan degradation. Human OA chondrocytes were obtained from the knees of 16 patients with OA, and subsequently cultured in a monolayer. The chondrocytes were divided into three groups, which included the control (no treatment), N-OPN (treated with 100 ng/ml OPN, the normal circulating OPN concentration) and the H-OPN groups (treated with 1 µg/ml OPN, a high OPN concentration). Reverse transcription-quantitative polymerase chain reaction was performed to quantify the relative mRNA expression levels of ADAMTS4, ADAMTS5 and aggrecan in the chondrocytes. The mRNA expression levels of ADAMTS4 were significantly reduced in the N-OPN and H-OPN groups when compared with the control group (P0.05). Furthermore, the mRNA expression levels of aggrecan were higher in the N-OPN and H-OPN groups when compared with the control group (P

Objectives High-sensitivity C-reactive protein (hsCRP) is possibly related to osteoarthritis (OA) progression and a variety of OA-related symptoms. This study aimed to examine associations between cigarette smoking, betel quid chewing and alcohol consumption and hsCRP in early radiographic knee OA. Design Cross-sectional health examination survey. Setting This primary study was conducted in a health examination centre in China. Participants 936 (656 men and 280 women) patients with early radiographic knee OA were included in this cross-sectional study. Primary and secondary outcome measures Smoking status was classified into four levels based on daily smoking habit: 0/day, 1–10/day, 11–20/day and >20/day. Betel quid chewing and alcohol consumption status was divided into ‘Yes’ or ‘No’. Early radiographic knee OA was defined as Kellgren Lawrence (K-L) grade 1 or 2 in at least one leg, and elevated hsCRP was assessed as ≥3.0 mg/L. Results After adjustment for a number of potential confounding factors, a significant positive association between cigarette smoking and hsCRP was observed in the multivariable model. The multivariable-adjusted ORs (95% CI) of elevated hsCRP (≥3.0 mg/L) in the second (1–10/day, n=133), third (11–20/day, n=59) and highest (>20/day, n=104) cigarette smoking categories were 1.54 (95% CI 0.91 to 2.61), 1.27 (95% CI 0.57 to 2.79) and 2.09 (95% CI 1.20 to 3.64), respectively, compared with the non-smoker category (n=640). In addition, there was a positive dose–response relationship between cigarette smoking and elevated hsCRP (p for trend=0.01). No significant associations between betel quid chewing and alcohol consumption and hsCRP were observed in the multivariable model. Conclusions This study indicated that cigarette smoking was positively associated with serum hsCRP level in patients with early radiographic knee OA. However, in view of the nature of cross-sectional designs, the results need to be confirmed by further prospective studies.

To examine the relationship between serum calcium (Ca) concentration and radiographic knee osteoarthritis (OA). This study covered a total of 2855 subjects. The serum Ca concentration was detected by the Arsenazo III method. The radiographic OA of the knee was defined as changes equivalent to Kellgren–Lawrence grade 2 on 1 side at least. The serum Ca concentration was categorized into 4 quartiles, which are ≤2.27, 2.28–2.34, 2.35–2.41, and ≥2.42 mmol/L, respectively. The relationship between serum Ca and radiographic knee OA was examined using the multivariable logistic analysis after adjusting a series of potential confounding factors. For each quartile of the relationship between serum Ca concentration and radiographic knee OA, the OR with 95% CI was calculated, and the one with the lowest value was considered to be the reference. An inverse association existed between serum Ca concentration and radiographic OA of the knee in the multivariable model and the model where the factors of age, sex, and BMI were adjusted. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth quartiles of serum Ca concentration were 1.05 (95% CI: 0.83–1.31), 1.01 (95% CI: 0.80–1.27), and 0.79 (95% CI: 0.62–1.00), respectively, in comparison with the reference (first) quartile. A trend approaching to statistical significant (P = 0.06) was observed. Meanwhile, the relative odds of radiographic OA of the knee were decreased by 0.79 times in the fourth quartile in comparison with the reference. There is likely to be an inverse association between serum Ca concentration and radiographic OA of the knee.

Background Major reports have suggested that bone mineral density (BMD) is higher in patients with osteoarthritis (OA), while other studies do not agree. Our aim was to examine the cross-sectional association between phalangeal BMD and radiographic knee OA. Methods A total of 2855 participants were included in this study. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) Grade ≥ 2 in at least one leg. BMD scans of the middle phalanges of the second, third and fourth digits of the nondominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). A multivariable logistic analysis model was applied to test the relation between phalangeal BMD with radiographic knee OA, the presence of knee osteophytes (OSTs), and knee joint space narrowing (JSN) after adjusting for a number of potential confounding factors. Results The multivariable-adjusted odds ratios with 95 % confidence intervals [ORs (95 % CI)] of radiographic knee OA across phalangeal BMDs were 1.08 (95 % CI 0.89–1.32) and 0.62 (95 % CI 0.45–0.86), respectively. The P for trend was 0.09. For the female population, the multivariable-adjusted ORs (95 % CI) of radiographic knee OA across phalangeal BMD were 1.01 (95 % CI 0.73–1.37) and 0.58 (95 % CI 0.38 − 0.87), respectively. The P for trend was 0.02. This positive finding, however, did not exist in the male subgroup. There was a significantly lower prevalence of OST in the osteoporosis (OP) group than in the normal group (OR = 0.59, 95 % CI 0.40–0.88; P for trend was 0.01). In contrast, the prevalence of JSN was significantly higher in the osteopenia group (OR = 1.22, 95 % CI 1.00–1.48) and the OP group (OR = 1.35, 95 % CI 1.00–1.84) than in the normal group. The P for trend was 0.02. Conclusions This study observed lower odds for the presence of radiographic knee OA and OST in OP patients than in normal subjects. The prevalence of JSN was higher in the osteopenia and OP groups than in normal subjects. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0918-x) contains supplementary material, which is available to authorized users.

To examine the cross-sectional associations of the serum uric acid level and hyperuricemia (HU) with the radiographic features of osteoarthritis (OA), including osteophytes (OST) and joint space narrowing (JSN), a total of 4685 subjects were included in this study. Blood samples were drawn from all subjects. Serum uric acid and some other indexes were detected. OST and JSN were assessed for each subject according to the Osteoarthritis Research Society International (OARSI) atlas. A multivariable logistic analysis model was applied to test the target associations after adjusting a number of potential confounding factors. The prevalence of OST was increased in the highest tertile of uric acid compared to the lowest in female subjects (OR 1.46, 95 % CI 1.07-1.99, P for trend = 0.02). Meanwhile, a positive association between OST and HU was observed in female subjects (OR 1.43, 95 % CI 1.01-2.03, P = 0.05). However, serum uric acid and HU were not significantly associated with JSN in male subjects. The findings of this study indicated that the serum uric acid concentration and prevalence of HU are positively associated with OST of the knee in the female population. Level of evidence Cross-sectional study, Level III.

The objective of this study was to evaluate the efficacy and safety of topical diclofenac therapy for osteoarthritis (OA). A meta-analysis of randomized controlled trials was conducted. A comprehensive literature search, covering the databases of Medline, the Cochrane Central Register of Controlled Trials, and EMBASE, was conducted in September 2014 to identify the randomized controlled trials which adopted the topical diclofenac therapy for OA. A total of nine papers were included in this meta-analysis. Topical diclofenac appears to be effective in both pain relief (standard mean differences (SMD) = 0.40; 95 % confidence interval (CI) 0.19 to 0.62; P = 0.0003) and function improvement (SMD = 0.23; 95 % CI 0.03 to 0.43; P = 0.03) when compared with the control group. The sensitivity analysis and subgroup analysis showed that the result of pain intensity was stable and reliable, while the result of physical function improvement was vague. With respect to safety, topical diclofenac demonstrated a higher incidence of adverse events such as dry skin, rash, dermatitis, neck pain, and withdrawal. Topical diclofenac is effective in pain relief as a treatment of OA. It may also have a potential effect in function improvement, which needs further studies to be explored. Although, some adverse effects were observed in the application of topical diclofenac, none of them was serious.

The purpose of this paper was to estimate the cross-sectional association between cigarette smoking and radiographic knee Osteoarthritis (OA) in Chinese population. A total of 3,789 subjects (1,796 females and 1,993 males) participated in this study. A subject was diagnosed with radiographic knee OA if Kellgren–Lawrence (K–L) grade ≥2 in at least one leg. The smoking status was classified into four levels based on the daily smoking habit: (1) 0/day; (2) 1–10/day; (3) 11–20/day; and (4) >20/day. Linear trend and multivariable logistic regression were conducted for statistical analysis. The prevalence of radiographic knee OA was 28.4 % among the subjects of this study. An inverse association was observed between cigarette smoking and radiographic knee OA in the linear trend test. Such association remained valid after adjusting the factors of age, gender, body mass index, betel quilt chewing status, physical activity, alcohol drinking status, mean total energy intake and educational level in the multivariable logistic regression. This study suggested a negative association between cigarette smoking and radiographic knee OA in the Chinese population. The findings of this study need to be confirmed by further prospective research.

Objectives A meta-analysis was conducted to examine the effect of mud therapy on pain relief in patients with knee osteoarthritis (OA). Methods A detailed search of PubMed®/MEDLINE® was undertaken to identify randomized controlled trials and prospective comparative studies published before 9 March 2013 that compared mud therapy with control group treatments in patients with knee OA. Results A quantitative meta-analysis of seven studies (410 patients) was performed. There was a significant difference between the groups in the visual analogue scale pain score (standardized mean difference [SMD] −0.73) and Western Ontario and McMaster Universities Osteoarthritis Index pain score (SMD −0.30), with differences in favour of mud therapy. Conclusions Mud therapy is a favourable option for pain relief in patients with knee OA. Additional high-quality randomized controlled trials need to be conducted to explore this issue further and to confirm this conclusion.

To investigate the effects of 5-Aza-CdR (methylation transferase inhibitor)on the expression levels of leptin gene in chondrocytes and methylation states of leptin promoter region between osteoarthritis (OA) group and control.The chondrocytes in osteoarthritis group were treated with 5-Aza-CdR with different doses and time-points, and the expression level of leptin was detected by real-time polymerase chain reaction for picking up the optimum dose and time-point. Next, the chondrocytes in 5 osteoarthritis patients and 5 control patients (amputation due to severe trauma) were treated with 5-Aza-CdR. Lastly, leptin mRNA expression levels in the four groups osteoarthritis and control chondrocytes treated with/without 5-Aza-CdR were measured by real-time PCR and the methylation state of promoter region (-280 - +79) was detected by epitope quantitative DNA methylation analysis.(1) After treating the chondrocytes in OA groups with 10 µmol/L 5-Aza-CdR for 72 h, the mRNA expression levels of leptin were increased significantly. (2) The mRNA expression levels of leptin were significantly different among the four groups (P0.05), and the chondrocytes in osteoarthritis groups treated with 5-Aza-CdR showed a marked induction of leptin mRNA expression. (3) Analysis of quantitative methylation data using an unsupervised hierarchical clustering algorithm, showed that methylation patterns of leptin promoter was different between control and osteoarthritis chondrocyte treated with/without 5-Aza-CdR.Demethylation of leptin promoter might up-regulate leptin gene expression level and it might contribute to osteoarthritis.