1.Transfection of stem cells derived from rat dental pulp with green fluorescent protein infection by lentiviral vector
Ruihan ZHANG ; Jia LIU ; Shanshan NIE ; Xuan WANG ; Boqi LI ; Dalei SUN ; Dilimaolati REFUKATI ; Yishan LIU
Chinese Journal of Tissue Engineering Research 2014;(45):7299-7305
BACKGROUND:Stable and efficient labeling of dental pulp stem cel s in vitro is most important in tracer technique, which is also the basis of tooth regeneration in vivo.
OBJECTIVE:To determine the optimal condition and method for transfection of stem cel s derived from rat dental pulp with green fluorescent protein infection by lentiviral vector and to determine whether green fluorescent protein-labeled dental pulp stem cel s maintain their stem cel properties.
METHODS:Rat dental pulp stem cel s were obtained by modified enzyme digestion method, to identify the immune phenotype and differentiation potential. Dental pulp stem cel s were infected with green fluorescent protein by lentiviral vector for 24 and 48 hours at different multiplicity of infection (MOI) (5, 10, 25, 50 and 100). The infection efficiency and fluorescence intensity were analyzed by inverted fluorescent microscopy. The clonal and proliferation ability, cel cycle and the mineralization potential were compared before and after transfection. Based on those mentioned above, we could evaluate the influence of infection on their biological characteristics.
RESULTS AND CONCLUSION:Flow cytometry results showed that rat dental pulp stem cel s expressed STRO-1 and CD146 but not CD34 or CD45. The dental pulp stem cel s could differentiate into osteoblasts and
adipocytes when cultured in specific medium for each lineage differentiation. The highest efficiency of infection and strongest fluorescence expression appeared at 48 hours of infection and MOI 50. There were no significant differences in growth ability, cel colony formation rate and cel cycle before and after transfection (P>0.05). And the alkaline phosphatase expressed positively. Infection for 48 hours at MOI 50 is optimal for transfecting dental pulp stem cel s with green fluorescent protein by a lentiviral vector, thereby providing reliable tracer method for the study of rat dental pulp stem cel s in vivo.
2.Determination of arsenic in urine by hydride generation atomic fluorescence spectrometry with ammonium persulfate digestion
Siwei LIU ; Weidong LI ; Gang DING ; Shudong XU ; Ji'an XIE ; Ying WEI ; Tingting LIU ; Ruihan ZONG ; Kaiqian WANG
Chinese Journal of Endemiology 2022;41(7):585-590
Objective:To establish a hydride generation atomic fluorescence method using ammonium persulfate as the digestion reagent for determination of arsenic in urine (hereinafter referred to as this method).Methods:The collected urine samples with ammonium persulfate were heated and digested on the tubular electric heating automatic control constant temperature digester (60 holes), with 5% hydrochloric acid solution as reaction medium and current carrier and 1.5% potassium borohydride solution as reducing agent. Arsenic content was determined with a four-channel atomic fluorescence spectrometer. The arsenic standard solution of 0 - 10 μg/L was prepared to determine the standard curve of this method, and the method was evaluated from the detection limit, linear range, correlation coefficient, precision, standard addition recovery experiment, and urine arsenic quality control sample detection. The standard method "Determination of Arsenic in Urine by Hydride Generation Atomic Fluorescence Spectrometry" (WS/T 474-2015, referred to as the standard method) was used for comparison experiments.Results:When the sampling volume was 1 ml, the detection limit of this method (digest with 1 ml 1.5 mol/L ammonium persulfate) was 0.03 μg/L. In the range of arsenic content from 0 - 10 μg/L, the linear relationship between arsenic content and fluorescence intensity was good, and the correlation coefficients ( r) were all 0.999 9. The relative standard deviations( RSD) of the three replicates of urine samples with different concentrations were 1.00%, 0.89% and 0.49%, respectively. Urine arsenic quality control samples were tested, and the test results were all within the range of public values; the overall average recovery was 102.29%, and the recovery range was 92.10% - 108.15%. Compared with the standard method in the determination results of 20 urine samples, the difference was not statistically significant ( t = - 0.40, P > 0.05). Conclusions:The hydride generation atomic fluorescence spectrometry using ammonium persulfate as digestion reagent for the determination of arsenic in urine has the advantages of low detection limit, good precision, high accuracy, small amount of sampling and digestion reagent, simple operation, and less harmful gas generation in sample pretreatment. It is suitable for rapid determination of arsenic in urine in large quantities.
3.Frailty evaluation and risk factors for older patients with comorbidities: a cross-sectional study
Jiakun LUO ; Ruihan LIU ; Yutong LIU ; Shasha SUN ; Mingyan YANG ; Yan YU ; Bo GUAN ; Xin HUANG ; Li FAN ; Jian CAO
Chinese Journal of Geriatrics 2023;42(5):493-497
Objective:To investigate frailty in older patients with comorbidities and explore related risk factors.Methods:A cross-sectional study was conducted with an enrollment of 746 patients aged 65 years or older with comorbidities in the Wanshoulu Road area of Beijing from April 2019 to December 2020.A total of 617 patients with comorbidities were finally included, aged(85.6±4.8)years, including 358 women(58.0%); According to the FRAIL scale, 617 patients with comorbidities were divided into a frail group(156 cases, 25.3%)and a non-frail group(461 cases, 74.7%). Demographic data and information on comorbidities were collected.Univariate and multivariate Logistic regression analyses of risk factors were conducted.Results:Among 617 patients with comorbidities, the common chronic diseases in descending order were hypertension(497 cases, 80.6%), coronary heart disease(375 cases, 60.8%), osteoporosis(357 cases, 57.9%), osteoarthritis(281 cases, 45.5%), type 2 diabetes(211 cases, 34.2%), stroke and/or transient ischemic attack(193 cases, 31.3%), chronic lung disease(144 cases, 23.3%), tumor(133 cases, 21.6%), chronic kidney disease(92 cases, 14.9%), and heart failure(58 cases, 9.4%). Univariate logistic regression analysis showed that age, type 2 diabetes, coronary heart disease, heart failure, chronic lung disease, stroke/transient ischemic attack, cancer and osteoarthritis were influencing factors for frailty( P<0.05). Multivariate logistic regression analysis showed that age, type 2 diabetes, heart failure, chronic lung disease, cancer and osteoarthritis were risk factors for frailty( OR=1.076, 1.806, 3.275, 3.371, 1.640, 2.227, all P<0.05). Conclusions:Old age, type 2 diabetes, heart failure, chronic lung disease, tumor and osteoarthritis are closely related to frailty in elderly patients with comorbidities.Proactive and effective prevention and intervention should be instituted to target risk factors for frailty to reduce the occurrence of adverse outcomes.
4.CA Ⅸ-targeted Ag2S quantum dots bioprobe for NIR-Ⅱ imaging-guided hypoxia tumor chemo-photothermal therapy
Cui XINYUE ; Hu ZHUANG ; Li RUIHAN ; Jiang PENG ; Wei YONGCHANG ; Chen ZILIN
Journal of Pharmaceutical Analysis 2024;14(6):878-888
Hypoxia is the common characteristic of almost all solid tumors,which prevents therapeutic drugs from reaching the tumors.Therefore,the development of new targeted agents for the accurate diagnosis of hypoxia tumors is widely concerned.As carbonic anhydrase Ⅸ(CA Ⅸ)is abundantly distributed on the hypoxia tumor cells,it is considered as a potential tumor biomarker.4-(2-Aminoethyl)benzenesulfo-namide(ABS)as a CA Ⅸ inhibitor has inherent inhibitory activity and good targeting effect.In this study,Ag2S quantum dots(QDs)were used as the carrier to prepare a novel diagnostic and therapeutic bio-probe(Ag2S@polyethylene glycol(PEG)-ABS)through ligand exchange and amide condensation reaction.Ag2S@PEG-ABS can selectively target tumors by surface-modified ABS and achieve accurate tumor im-aging by the near infrared-Ⅱ(NIR-Ⅱ)fluorescence characteristics of Ag2S QDs.PEG modification of Ag2S QDs greatly improves its water solubility and stability,and therefore achieves high photothermal sta-bility and high photothermal conversion efficiency(PCE)of 45.17%.Under laser irradiation,Ag2S@PEG-ABS has powerful photothermal and inherent antitumor combinations on colon cancer cells(CT-26)in vitro.It also has been proved that Ag2S@PEG-ABS can realize the effective treatment of hypoxia tumors in vivo and show good biocompatibility.Therefore,it is a new efficient integrated platform for the diagnosis and treatment of hypoxia tumors.
5.Association between the dental caries and the human leucocyte antigen DQB1 allele polymorphisms among the Uygur and Han children in Xinjiang.
Zhang RUIHAN ; Li XIAOBING ; Wang LIPING ; Liu YISHAN
West China Journal of Stomatology 2018;36(1):4-8
OBJECTIVE:
This study aims to investigate the association between human leucocyte antigen (HLA)-DQB1 allele polymorphisms and the presence dental caries among the Uygur and Han children in Xinjiang.
METHODS:
HLA-DQB1 allele in the Uygur and Han children with dental caries and healthy control in Xinjiang was tested (n=40) using the polymerase chain reaction-sequence specific primer (PCR-SSP) DNA parting technology.
RESULTS:
A total of five specific loci were detected in the HLA-DQB1 locus among the Uygur and Han children. The frequency of the HLA-DQB1*02 allele in the Han group with severe caries (12.5%) was significantly lower than in the control group (32.5%) (P<0.05, OR=0.297). Moreover, the frequency of the HLA-DQB1*05 allele in the Uygur group with severe caries (37.5%) was significantly higher than in the control group (17.5%) (P<0.05, OR=2.829).
CONCLUSIONS
Caries susceptibility among the Uygur and Han children in Xinjiang is related to the HLA-DQB1 allele. The HLA-DQB1*02 allele may protect against caries among the Han children, whereas the HLA-DQB1*05 allele may be responsible for the susceptibility of the Uygur children to caries.
Alleles
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Asian Continental Ancestry Group
;
Child
;
China
;
Dental Caries
;
ethnology
;
genetics
;
Gene Frequency
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Genetic Predisposition to Disease
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HLA-DQ beta-Chains
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genetics
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Humans
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Polymerase Chain Reaction
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Polymorphism, Genetic
6.Clinical Efficacy and Mechanism of Osteoking in Treatment of Knee Osteoarthritis Based on Real-world Data
Ruihan LI ; Jun ZHOU ; Zhi LIANG ; Shuai GAO ; Rui QUAN ; Xisheng WENG ; Yanqiong ZHANG ; Na LIN ; Weiheng CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(24):63-71
ObjectiveTo investigate the clinical efficacy and mechanisms of Osteoking in the treatment of knee osteoarthritis (KOA) in real-world practice, so as to provide a basis for the rational clinical use of Osteoking. MethodFrom the Osteoking for knee osteoarthritis case registration system, 638 KOA cases treated with Osteoking were selected and analyzed in SPSS 26.0. The clinical data were collected from 20 hospitals in China from May 2020 to December 2021. Descriptive analyses of patient age, gender, body mass index, course of treatment and other parameters were performed. The Mann-Whitney U test was performed to compare the visual analogue scale (VAS) and Western Ontario and McMaster universities arthritis index (WOMAC) scores before and after treatment. The integrative pharmacology-based research platform of traditional Chinese medicine (TCMIP) v2.0 was used for network analysis of the core targets of Osteoking in treating knee osteoarthritis. Furthermore, 20 KOA patients treated with Osteoking in the Third Affiliated Hospital of Beijing University of Chinese Medicine from October to December in 2022 were enrolled in the treatment group, and 20 healthy volunteers in the control group. The enzyme-linked immunosorbent assay was employed to measure the serum levels of related indicators to verify the prediction results. ResultA total of 638 KOA patients were treated with Osteoking, including 429 (67.24%) receiving Osteoking alone and 209 (32.76%) receiving Osteoking combined with other therapies. The female patients (415, 65.05%) were more than the male patients (223, 34.95%). The patients showed the mean age of (63.48±13.51) years, mean body mass index of (24.09±2.98) kg·m-2, and mean course of treatment of (15.78±9.66) days. Most of the patients were rated as grades Ⅱ (46.24%) and Ⅲ (34.64%) in Kellgren-Lawrence (K-L) grading and in the relief stage (82.45%) in clinical staging. There was no significant correlation between clinical staging and K-L grading results. The cluster analysis identified three TCM syndromes: Qi stagnation and blood stasis, cold-dampness obstruction, and liver-kidney deficiency. The overall clinical efficacy evaluation showed that VAS score decreased from (6.01±0.85) scores before treatment to (2.54±1.73) scores after treatment (P<0.05), and the WOMAC score decreased from (93.25±25.91) scores before treatment to (50.73±25.14) scores after treatment (P<0.05). The network analysis predicted that Osteoking might regulate the transforming growth factor-beta (TGF-β), tumor necrosis factor-alpha (TNF-α), and nuclear factor-kappa B (NF-κB) signaling pathways to exert the therapeutic effect. The clinical trial showed elevated TGF-β1 level (P<0.01) and lowered NF-κB subunit RELA and tumor necrosis factor receptor superfamily, member 1A (TNFRSF1A) levels (P<0.05) after treatment. The synergistic effects of these changes provide a multidimensional and comprehensive therapeutic efficacy for KOA, alleviating the joint pain and limited mobility in patients. ConclusionOsteoking showed significant therapeutic efficacy in treating KOA. Osteoking may act on multiple pathways involved in cartilage metabolism and inflammation. The findings provide experimental evidence and theoretical support for elucidating the multi-target mechanism of Osteoking in treating KOA.
7.Design and implementation for portable ultrasound-aided breast cancer screening system.
Zhicheng WANG ; Bingbing HE ; Yufeng ZHANG ; Zhiyao LI ; Ruihan YAO ; Kai HUANG
Journal of Biomedical Engineering 2022;39(2):390-397
Early screening is an important means to reduce breast cancer mortality. In order to solve the problem of low breast cancer screening rates caused by limited medical resources in remote and impoverished areas, this paper designs a breast cancer screening system aided with portable ultrasound Clarius. The system automatically segments the tumor area of the B-ultrasound image on the mobile terminal and uses the ultrasound radio frequency data on the cloud server to automatically classify the benign and malignant tumors. Experimental results in this study show that the accuracy of breast tumor segmentation reaches 98%, and the accuracy of benign and malignant classification reaches 82%, and the system is accurate and reliable. The system is easy to set up and operate, which is convenient for patients in remote and poor areas to carry out early breast cancer screening. It is beneficial to objectively diagnose disease, and it is the first time for the domestic breast cancer auxiliary screening system on the mobile terminal.
Breast/pathology*
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Breast Neoplasms/pathology*
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Diagnosis, Computer-Assisted
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Early Detection of Cancer
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Female
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Humans
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Ultrasonography
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Ultrasonography, Mammary/methods*
8.Tenghuang Jiangu Tablets Combined with Non-steroidal Anti-inflammatory Drugs for Osteoarthritis of Knee: A Real-world Study
Shuwen LI ; Ruihan LI ; Yan JIA ; Ruizheng ZHU ; Xiangyu LI ; Zhihong FU ; Zhi LIANG ; Shuai GAO ; Yan YAN ; Xisheng WENG ; Na LIN ; Weiheng CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(15):110-118
ObjectiveTo investigate the clinical efficacy of Tenghuang Jiangu tablets (THJGT) combined with oral non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis of the knee and its applicable stage based on real-world data, and provide a basis for the rational clinical use of THJGT. MethodA total of 218 cases treated with THJGT combined with oral NSAIDs included in the "THJGT for knee osteoarthritis case registry" from September 2019 to January 2021 were selected as the observation group, and 126 cases treated with oral NSAIDs alone as the control group (CG). The data of gender, age, body mass index, Kellgren-Lawrence grading scale (K-L scale) score, visual analogue score (VAS score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, swelling grade, joint fear of cold score, back pain and weakness score, and occurrence of adverse events/reactions of the patients in both groups were used for the evaluation of efficacy with full analysis set. The propensity score matching method was used to exclude the influence of confounding factors between groups, and the sub-data sets were established, with which the repeated measures analysis of variance (ANOVA) was carried out to evaluate the efficacy. Visit points were at registration, 4 weeks and 8 weeks after registration. The data were statistically analyzed in Excel 2019 and SPSS 23.0. ResultThe proportion of females in the observation group was 66.06% (144/218), which was higher than that (58.73%, 74/126) in the control group (χ2=1.846). The average age in the observation group was (61.12±7.01) years, which was higher than that [(59.38±5.99) years] in the control group (W=19 918.50, P<0.05). The remission rate in the observation group was 98.17% (214/218). In the observation group, the proportions of the patients at K-L grades Ⅱ and Ⅲ were 64.22% (144/218) and 25.23% (55/218), respectively. The effect analysis of the whole data set for enrollment and treatment for 8 weeks showed that the VAS score of the experimental group decreased by (3.27±1.24) points on average, which was better than that of the control group [(2.75±1.20), W=34 179.00, P<0.05]. The average WOMAC score decreased (23.43±11.46) points, which was better than that of the control group [(16.71±8.86), W=32 387.00, P<0.05]. The average swelling grade decreased (0.63±0.64), which was better than the control group [(0.33±0.59), W=33 847.50, P<0.05]. The average score of joint chills decreased (1.90±1.84), points, which was better than that of control group [(1.40±1.28), W=35 165.00, P<0.05]. The average lumbar acid fatigue score decreased by (2.02±1.64) points, which was better than that of the control group [(1.10±1.28), W=32 986.50, P<0.05]. Efficacy analysis of subdata sets for enrollment, 4 weeks of medication and 8 weeks of medication showed that VAS scores of both groups showed a downward trend after treatment, and the improvement of experimental group was more significant than that of control group at 4 weeks, with statistical significance (P<0.05). After treatment, the total WOMAC score of both groups showed a downward trend, and the improvement of experimental groups was more significant at 4 weeks and 8 weeks (P<0.05). After treatment, swelling, cold fear grade and lumbar acid fatigue score of both groups showed a decreasing trend,, and the improvement of experimental group was more significant at 8 weeks (P<0.05). The therapeutic effect analysis of patients in the attack stage and remission stage of the experimental group showed that the total WOMAC score of the two groups showed a downward trend after treatment, and the trend was basically the same, and there was no statistical difference between the two groups at enrollment, 4 weeks after treatment, and 8 weeks after treatment (t=1.675, t=2.068, t=2.364). The total WOMAC score of the patients in remission stage in the experimental group with K-L grading between grade 0 and grade Ⅲ had statistical significance at 4 weeks after treatment compared with the time of entry (P<0.05, P<0.01). Group of adverse event rate was 4.13% (9/218), lower than the control group 10.32% (13/126) (χ2= 5.109, P<0.05). ConclusionThe population receiving THJGT combined with oral NSAIDs is mostly female, old, in remission, and with K-L grades Ⅱ and Ⅲ. THJGT can enhance the anti-inflammatory and analgesic effects of oral NSAIDs and keep the drug effect in improving joint function and alleviating fear of cold, swelling, and back pain and weakness. The drug combination can be applied to patients in both attack and remission, and the clinical application should take patient's disease stage and degree of osteoarthritis into account. Furthermore, the combination has the potential to reduce the incidence of adverse events caused by NSAIDs.
9.Real-world Study of Medication Characteristics and Clinical Efficacy of Tenghuang Jiangu Tablets in Treatment of Knee Osteoarthritis in Remission Stage
Zhihong FU ; Shuwen LI ; Ruihan LI ; Yan JIA ; Ruizheng ZHU ; Xiangyu LI ; Zhi LIANG ; Shuai GAO ; Zhuoyun WU ; Lin CHEN ; Weiheng CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(6):120-127
ObjectiveTo explore the medication characteristics and clinical efficacy of the Tenghuang Jiangu tablets in the treatment of knee osteoarthritis (KOA) in the remission stage in the real world,providing references for rational clinical use of this prescription. MethodBased on the "registration system of KOA treated with Tenghuang Jiangu tablets",2 439 KOA cases in the remission stage were analyzed by SPSS 25.0,IBM SPSS Modeler18.0,and Apriori algorithm. To be specific,the age,body mass index (BMI),and course of treatment were described in the form of x̄±s. The information on gender,K-L grade,daily dose,and frequency of drug use was described by frequency analysis. The number of cases,course of treatment,daily dose,and drug use frequency of the single-use group and the combined-use group were described by frequency analysis,and the combination of drugs was described by frequency analysis and Apriori algorithm. Mann-Whitney U test was employed to compare the scores of Visual Analogue Scale (VAS),Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC),pain,stiffness,and joint function between the single-use group and the combined-use group. ResultThe results of clinical treatment showed that 2 439 patients with KOA in the remission stage were treated with Tenghuang Jiangu tablets,with 1 432 (58.71%) in the single-use group and 1 007 (41.29%) in the combined-use group. The average daily dose of Tenghuang Jiangu tablets was (3.90±1.44) g,and the majority of the patients were at grade Ⅱ (54.47%). The daily average daily dose of Tenghuang Jiangu tablets in the single-use group was (3.64±1.35) g,which was lower than that in the combined-use group [(4.26±1.48) g,P<0.05]. In the combined use,the top three western medicines were glucosamine (270 times,14.68%),sodium hyaluronate (126 times,6.85%),and imrecoxib (116 times,6.31%),and the top three Chinese medicines were Huoxuezhitong capsules/tablets/ointments (31 times,1.69%),Biqi capsules (25 times,1.36%),and Maizhiling (23 times,1.25%). As for the overall clinical efficacy,the VAS score was (5.13±0.93) score before treatment and (2.22±1.18) score after treatment (P<0.05),with an overall average decrease of (2.91±1.14) score, and the average decrease in the single-use group was (2.76±1.43) score, which was lower than that in the combined-use group [(3.12±1.36) score,(P<0.01)]. The WOMAC score was (31.05±11.84) score before treatment and (13.55±9.91) score after treatment (P<0.05). The overall average decrease was (17.50±11.79) score, and the average decrease in the single-use group and combined-use group was (16.39±11.14) score and (19.08±12.50) score,respectively (P<0.01). The patients with KOA>grade Ⅱ accounted for 91.34%(1 308/1 432) and 93.55%(942/1 007) in the single-use group and combined-use group,respectively (χ2=80.026,P<0.05). A total of 43.37%(621/1 432) of the patients in the single-use group had other complications,lower than that in the combined-use group [54.92%(553/1 432),(χ2=20.087,P<0.01)]. ConclusionMore than half of the patients with KOA in the remission stage are treated with Tenghuang Jiangu tablets alone,and the combination therapy is mainly applied in patients with severe conditions or other complications. In relieving knee joint pain and improving joint stiffness and joint function,both the Tenghuang Jiangu tablets alone and the combination therapy are effective.
10.A Real-World Clinical Study of Osteoking Combined with Intra-Articular Injection of Sodium Hyaluronate in Treatment of Knee Osteoarthritis
Rui QUAN ; Jun ZHOU ; Yan JIA ; Yan YAN ; Shuai GAO ; Zhi LIANG ; Ruihan LI ; Shuwen LI ; Yanqiong ZHANG ; Xisheng WENG ; Na LIN ; Baohong MI ; Weiheng CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(24):72-79
ObjectiveTo investigate the improvement of the efficacy of Osteoking in patients with knee osteoarthritis in the onset and remission stage and to systematically explore its potential intervention mechanism, so as to provide a certain reference for improving the clinical application value of Osteoking and guiding its clinical rational drug use. MethodThrough the real-world study of the treatment of knee osteoarthritis with Osteoking, the data was obtained and entered into the "Osteoking for the treatment of knee osteoarthritis case registration system", and 105 patients with episodic and remission knee osteoarthritis from the outpatient or inpatient orthopedic department of 20 medical institutions, including the Third Affiliated Hospital of Beijing University of Chinese Medicine, Peking Union Medical College Hospital, Wangjing Hospital of the Chinese Academy of Chinese Medical Sciences and Hunan Aerospace Hospital, from May 1, 2020 to December 31, 2021, were selected in the system. It included 60 patients treated with Osteoking and joint injection, and 45 patients treated with joint injection alone. The WOMAC osteoarthritis index score, visual analogue (VAS) pain score, individual types of pain symptoms (cold pain, hot pain, tingling, dull pain, soreness) and other TCM symptoms were observed and compared between the two groups, and statistically analyzed. In order to further elucidate the potential molecular mechanism of Osteoking combined with joint injection in the treatment of knee osteoarthritis in the treatment of onset and remission, this study used the "Bone Injury Cross Database (