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42, P .001) than did NAC nonusers. Also, in analyses stratified by age group and sex, all subgroups exhibited a significantly higher incidence of knee osteoarthritis (P .0001) among NAC users than among NAC nonusers. The use of oral NAC was associated with nearly four-fold increased the risk of knee OA in the young age group. Long-term use of oral NAC is associated with a higher risk of knee OA. Long-term use of oral NAC is associated with a higher risk of knee OA. Chinese Medicine education is part of professional medical training i