As a chronic disease that affects the whole world, there is no definite treatment for knee osteoarthritis (KOA). Wu Qin Xi (WQX) is still in preliminary exploration as a traditional Chinese exercise in the treatment of osteoarthritis of the knee. The purpose of this study was to conduct a meta-analysis of previous studies and to investigate the efficacy of the WQX exercises on pain and function in patients with KOA.I2 to show heterogeneity, and, based on that, we chose either a random effects model or a fixed effects model.We searched six databases  for articles on WQX for KOA up to May 10, 2022. Literature search, study selection, data extraction, and quality evaluation were performed by two independent authors. In terms of statistical results, we presented mean differences (MD), 95% CI, and Seven studies were selected for inclusion in this meta-analysis. The WQX intervention group showed statistical differences for both the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and its various bylaws, the Visual Analogue Score (VAS), and the presence of general functional exercise in the control group. We also demonstrated the clinically meaningful efficacy of WQX treatment by calculating minimum clinical importance difference (MCID) values that met the MCID values on the WOMAC score. A sensitivity analysis was also performed in this study by subgroup analysis for greater heterogeneity, and it was inferred that the difference in follow-up time was a likely source of heterogeneity.Despite some limitations, the current study showed a definite effect of WQX in improving pain symptoms and joint function in patients with KOA.https://www.crd.york.ac.uk/prospero/, identifier: CRD42022332209. As a chronic, universal, degenerative joint disease, knee osteoarthritis (KOA) has placed a heavy burden on sufferers, their families, and society . Along wTrials were conducted to incorporate some traditional Chinese aerobic exercises into the treatment of KOA . Tai ChiAll analyses were based on data from previously published studies. Consequently, no ethical approval or patient consent was required. This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines . An a prTwo independent reviewers (Hu and Peng) searched Pubmed, Embase, Cochrane Library, Wanfang, CQVIP, and CNKI databases to identify relevant studies up to 10 May 2022. In Pubmed, we employed this search strategy:  OR ((((Knee Osteoarthritides[Title/Abstract]) OR (Knee Osteoarthritis[Title/Abstract])) OR (Osteoarthritis of Knee[Title/Abstract])) OR (Osteoarthritis of the Knee[Title/Abstract]))) AND (((((wuqinxi[Title/Abstract]) OR (wu qin xi[Title/Abstract])) OR (WQX[Title/Abstract])) OR (wuqinxi qigong[Title/Abstract])) OR ). We use a similar search methodology in other databases as well. The criteria for inclusion from the literature were as follows: (I) All of the included literature contained relevant clinical trials. (II) All participants in the included studies were diagnosed with KOA at a tertiary care hospital and with knee pain symptoms –19. III. (V) No Data extraction and quality assessment from original articles were performed independently by two authors (Hu and Peng). When any information was unclear, we attempted to contact the relevant author of the original article. For data extraction and transformation, the differences were selected by a senior director (Li) with the reference to the original literature. The primary outcome indicator for our meta-analysis was WOMAC, and the secondary outcome indicator was VAS. WOMAC is a self-evaluation scale widely used to assess the severity and treatment efficacy of hip and knee conditions in three major areas: pain, stiffness, and joint function. It has a total of 24 items, including five items for pain assessment, two items for stiffness, and 17 items for joint function. The total score is the sum of the 24 items, with a higher total score representing a more severe disease. WOMAC is available in two formats: visual analog scale and Likert scale, both of which have similar metric properties. If the units of the WOMAC scores differed between the included studies, we translated them into results based on the 100 mm VAS evaluation scale . The VAS is the most commonly used unit measure of pain intensity. The scale consists of a 100 mm straight line with one end of the line indicating “no pain at all” and the other end indicating “extreme pain.” Patients were asked to mark the appropriate location on the line to represent the intensity of pain they are experiencing at that time. The smaller the value of the measurement, the less painful it is, with 0 being no pain and 10 being the most painful. The extracted items included the following: (1) author, (2) time of publication; (3) study location; (4) sample size; (5) mean age; (6) KOA duration; (7) grade of KOA; (8) interventions; (9) controls; (10) duration time; (11) follow-up time; (12) outcome measure. Cochrane Risk of Bias Assessment tool   vin WOMAC  and 1.8 in WOMAC .Through a literature search, we retrieved 68 relevant papers from six databases. After eliminating duplicates, there were remaining 31 papers . From thAll the references were published within 10 years (2012–2021). All the trials were conducted in different parts of China, and participants were Chinese (100%) without mentions of ethnicity. The total sample sizes were 668 participants; of which, 338 were in the experiment group and 330 were in the control group. Most of the included subjects were diagnosed with KOA with chronic pain over 6 months in tertiary hospitals and were older than 50 years. In total, only five trials reported KOA classification, and all were based on the Kellgren-Lawrence scale. Three of these trials had participants in Class I/II and two studies in Class II/III. The intervention was the WQX exercise in all studies while one study included Tui Na  and isokinetic training. The control groups were either blank control or the other physical treatment. The duration of trials ranged between 3 and 6 months, such is the case for follow-up time. WOMAC and VAS were included as outcome measures in this meta-analysis, where six references reported WOMAC and two references reported VAS. Three of the references for WOMAC were based on the VAS 100 mm format , two were based on the Likert scale (0–4) format , and one was based on the VAS 10 mm format . We all transformed them under the same evaluation scale for comparison. The main characteristics of extracted study are shown in The results of the quality assessment are shown in p < 0.01, I2 = 85%, p < 0.00001, I2 = 0%; follow-up time ≥ 3 months: MD = −50.69; 95% CI: −68.73 to −32.66; p < 0.00001, I2 = 0%; total: MD = −105.76; 95% CI: −161.38 to −50.14; p = 0.0002, I2 = 85%; test for subgroup difference: I2 = 96.8%). It showed that the timing of follow-up has contributed to the heterogeneity. For this reason, when we analyzed different control group interventions, we also performed subgroup analysis on the follow-up period. Furthermore, for WOMAC, we calculated an improvement of 16.2%>12% (MCID) relative to baseline values, with a clinical difference. In WOMAC scores, WQX was therefore not only statistically different but also clinically significant.The Western Ontario and McMaster Universities Osteoarthritis Index total score was reported in six studies. This meta-analysis indicated that the WQX exercise has a significant improvement in WOMAC total score regardless of the intervention of control group , joint stiffness , and joint function  of participants.Then, we ran separate analyses of trials using WOMAC-based pain, stiffness, and functional ratings. In total, four studies involving 414 participants reported these indicators, and we put these analyses in the same forest plot, as shown in p = 0.02, I2 = 69%, Our examination of the two studies that reported VAS scores revealed that there was an improvement . The MCID value also demonstrated the exact clinical significance of WQX in knee treatment. We found that the WQX exercise showed better efficacy compared with other conventional exercises (p < 0.01). Moreover, the duration of follow-up may be associated with the symptoms of the participants. In contrast to what we conceived, the subgroup analysis with a follow-up time not exceeding 3 months showed better effects than the subgroup with a longer follow-up. In general, the follow-up results of the WQX exercise should be better for longer workouts than for shorter ones. As we read through the original text of these studies, we noted that none of the studies reported problems with participant adherence or standardization of movements. These are factors that influence the efficacy of the WQX exercise. Since a WQX session takes about 60 min, the motivation of patients to participate is in fact an important problem as time passes. This could be the reason for this outcome.The goal of this meta-analysis was to evaluate the effects of the WQX exercise on pain and function in people with KOA. Our meta-analysis was the first to evaluate the WQX exercise for KOA and found that the WQX exercise is generally effective in patients with KOA  of our meta-analysis. Thus, this suggested that the results of the VAS meta-analysis need to be viewed with more caution.P < 0.01) and enhancing joint function (P < 0.01).This meta-analysis preliminarily demonstrated that the WQX exercise is an available alternative therapy for patients with KOA. WQX was demonstrated to be beneficial in reducing joint discomfort and joint stiffness  was reported. The sixth limitation is that the KOA class characteristics of individuals with KOA are heterogeneous, and the intensity and frequency of interventions vary. These differences may contribute to the appearance of bias.Overall, this meta-analysis found that the WQX exercise was clinically and statistically significant in the treatment of patients with KOA. Despite the limitations of the current study, both in terms of the quality and number of trials, the efficacy of WQX is positive. The current study is only a preliminary exploration of the application of the WQX exercise to the treatment of KOA, and future studies should pay attention to improving the scientific nature of trial design and pursuing high-quality RCTs. Also, adverse events in patients need to be reported for others to objectively assess the safety of the WQX exercise.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.JG: conceptualization, writing—original draft preparation, and writing—review and editing. JG, CP, and ZH: methodology, software, formal analysis, and investigation. CP and ZH: validation and resources. YL, CP, and ZH: data curation. JG and YL: visualization and project administration. YL and RD: supervision. RD and LG: review and editing. RD: manuscript proof-reading. All authors have read and agreed to the published version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The purposes of this study are to explore (1) whether comorbid depressive symptoms in patients with chronic back pain (CBP) affect the pain matrix. And (2) whether the interaction of depression and CBP exacerbates impaired brain function.Thirty-two patients with CBP without comorbid depressive symptoms and thirty patients with CBP with comorbid depressive symptoms were recruited. All subjects underwent functional magnetic resonance imaging (fMRI) scans. The graph theory analysis, mediation analysis, and functional connectivity (FC) analysis were included in this study. All subjects received the detection of clinical depressive symptoms and pain-related manifestations.t = −2.175, p = 0.034), gamma , and local efficiency  in the CBP-D group were significantly lower. The nodal efficiency in the ventral posterior insula (VPI) , and the network efficiency values  in the pain matrix were significantly lower in the CBP-D group. Both the topological properties and the FC values of these brain regions were significantly correlated with self-rating depression scale (SDS) scores  but not with pain intensity. Further mediation analyses demonstrated that pain intensity had a mediating effect on the relationship between SDS scores and Pain Disability Index scores. Likewise, the SDS scores mediated the relationship between pain intensity and PDI scores.Compared with the CBP group, subjects in the CBP with comorbid depressive symptoms (CBP-D) group had significantly increased FC in the left medial prefrontal cortex and several parietal cortical regions. The results of the graph theory analyses showed that the area under the curve of small-world property (Our study found that comorbid depressive symptoms can aggravate the impairment of pain matrix function of CBP, but this impairment cannot directly lead to the increase of pain intensity, which may be because some brain regions of the pain matrix are the common neural basis of depression and CBP. Chronic pain is a debilitating disease that affects physiology and psychology. The World Health Organization’s large-scale survey found that the prevalence of chronic pain is very high in both developed (37%) and developing (41%) countries , so it gThere is strong evidence that pain is a major risk factor for depression and that depressive symptoms aggravate the progression of chronic pain . When paSome previous preclinical and clinical studies have already paid some attention to the potential neural mechanism of the interaction between depression and chronic pain. For example, a preclinical study has identified a novel neural pathway from the dorsal raphe nucleus (involving 5-hydroxytryptamine projections) to the central nucleus of the amygdala (somatostatin-expressing neurons) that not only mediates depressive symptoms, but also affects painful symptoms . A neuroOver the past decade, a great deal of studies have been devoted to understanding how the brain responds to pain and have already demonstrated altered brain structure and function in patients with acute and chronic pain . These wBased on the above description, resting-state functional magnetic resonance imaging (fMRI), a recognized objective and non-invasive measure of brain activity, has also been used as a measure of potential biomarkers for detecting various types of pain , and was2. This experiment was approved by the ethics committee of Zhujiang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese medicine. The clinical registration number is ChiCTR2200056929. The research purpose of this manuscript is a part of the whole clinical research project. All participants signed informed consent. We explained the detailed instructions, experimental procedures, possible risks, and discomforts of the study to all subjects, as well as answered their questions in detail.To control the covariates, all the subjects were patients with chronic musculoskeletal back pain. Patients with a SDS score ≥ 50 were considered to have comorbid depressive symptoms . All sub∗-weighted, single-shot, gradient-recalled echo planar imaging sequence, TR/TE = 2000/30 ms; field of view (FOV) = 224 mm × 224 mm; matrix size = 64 × 63; flip angle = 90°; 3.5 mm × 3.5 mm in-plane resolution; slice thickness = 3.5 mm; 33 slices; slice gap = 0.7 mm; number of signals averaged (NSA) = 1.All image data were collected by a Philips 3.0 T Ingenia magnetic resonance imager in Zhujiang Hospital, Southern Medical University, and scanned in a standard radio-frequency head coil. Structure data were acquired with a high resolution 3D T1-weighted sequence: repetition time (TR)/echo time (TE) = 7.2/3.3 ms; flip angle = 7°; field of view (FOV) = 256 mm × 256 mm; matrix size = 256 × 256; 1 mm × 1 mm in-plane resolution; slice thickness = 1 mm; 176 slices; slice gap = 0 mm. Functional MRI data were acquired using a T2The PDI is a self-rating scale that contains seven items that can evaluate the extent to which pain affects seven categories of life activity. Each item is scored on a scale of 0 to 10, with 0 representing no pain induced disability at all and 10 representing that daily life has been totally disrupted by the pain. The SDS is a 20-item self-assessment scale that is easy to use and visually reflects the patient’s subjective feelings. Each item is divided into 4 levels: no or little time, little time, quite a lot of time, and most of the time or all the time. The level of each item refers to the frequency with which the subject experiences the item.1. This procedure included data format conversion, discarding the first 10 volumes, slice timing correction, realignment, nuisance covariates regressors, spatial normalization, smoothing, linear de-trending, and filtering  correction . After the correction, the results of the seeds-to-whole-brain  was generated for each subject and the statistical analysis of the inter group was carried out . The FC map and the correlation coefficient between the significant brain areas were shown by the heat map of the FC correlation coefficient and BrainNet Viewer , with N representing the number of nodes (brain regions) and K representing the number of edges   . In the  present . To aver present . In this2 .We computed five main topological metrics  by using the GRETNA toolbox3  that does not include zero.The Pearson correlation analyses were used to calculate the correlation between the neuroimaging data with the clinical characteristics results. Spearman correlation analyses were used for correlation analysis of non-normally distributed data. The boxplot method was used to identify outliers of the clinical characteristics and then eliminate them. To further test the summary of the relationships among the pain, the comorbid depressive symptoms, and the neuroimaging findings, mediation analyses were conducted based on the results of correlation analyses. In this study, we designed two main mediating models, in which the mediating variable (M) in model 1 was the ROI-ROI FC, and the purpose of designing this model was to analyze whether FC could mediate the relationship between pain and comorbid depressive symptoms. Model 2 made pain and comorbid depressive symptoms mutually mediating variables, which was designed to analyze whether the reciprocal interaction between depressive symptoms and pain would affect the clinical characteristics or neuroimaging findings of patients. The mediation analyses were performed using the PROCESS macro for SPSS3 . The boot-tests were employed to conduct the group differences in demographic data by SPSS22.0  software. The Shapiro–Wilk test was used to assess the normality of distribution of the data. The Mann–Whitney U test was used to compare non-normal distribution data. Analysis of covariance was used to determine whether the difference in pain intensity between groups affected the difference in FC results between groups. All statistical assessments were two-tailed, and the significance threshold was p = 0.05.The Chi-squared and two-independent sample t = 10.360, p < 0.001) scores, self-report pain intensity , and PDI scores   .r = 0.4387, p-FDR < 0.05, p-uncorrected = 0.0004) and PDI scores . Pain intensity was also significantly positively correlated with PDI scores   .Compared with the CBP group, subjects in the CBP-D group had significantly increased right postcentral gyrus  FC to the right posterior parietal cortex (PPC), right inferior parietal lobule (IPL), and right superior parietal lobule (SPL). The CBP-D group also showed significantly increased left postcentral gyrus  FC to the right PPC, and significantly decreased right postcentral gyrus  FC to the left medial prefrontal cortex (mPFC) .t = −3.581, p = 0.0007) and had lower network efficiency values  and network local efficiency values  in the pre-determined pain matrix , gamma  in the CBP-D group were significantly lower, but the global efficiency was not included  (one of the brain regions of the pain matrix) after multiple comparison correction , PG2-PPC connectivity , PG1-PPC connectivity , and PG2-IPL connectivity . The SDS scores were also showed significantly negatively correlated with PPC-mPFC connectivity . At the same time, there was no significant correlation between pain intensity and FC (p-FDR > 0.05). We also carried out the correlation analysis of the results of the graph theory analyses with SDS scores and pain intensity, respectively. The results revealed that the most results of the graph theory analyses were significantly negatively correlated with SDS scores . Likewise, the SDS scores mediated the relationship between pain intensity and PDI scores  . No mediSome researchers have studied the relationship between chronic pain and depression, but most of these studies are controlled by patients and healthy individuals . The paiWith the development of the graph network theory in neuroimaging, we can explore the topological properties of complex networks. As a complex network, the brain has the characteristics of high information transmission efficiency and high anti-interference ability . PreviouAfter identifying depressive symptoms can exacerbate functional impairment of the pain matrix, we next analyzed which brain regions and which functions of the pain matrix are specifically impaired by depressive symptoms in patients with CBP. We found that the nodal efficiency in the VPI showed significant between-group differences (FDR corrected), and the FC results also showed significant between-group differences in the FC of several brain regions of the pain matrix, including the mPFC, SPL, IPL, and PPC, and both this topological property and the FC values of these brain regions were significantly correlated with SDS scores  but not with pain intensity.Previous studies have revealed that enhancing the basal neuronal activity of the prefrontal cortex (PFC) enhances its modulation of nociception, whereas patients with chronic pain show reduced neuronal projections from the PFC to the periaqueductal gray matter, decreased PFC glutamate levels, and reduced PFC gray matter density. Our study found that compared with the CBP group, the CBP-D group showed a significantly decreased FC pathway between the left mPFC and the right postcentral gyrus. This suggested that comorbid depressive symptoms aggravate the ability of pain regulation in patients with CBP. However, this FC pathway was significantly negatively correlated with SDS scores but not with pain intensity. It is commonly believed that the diminished prefrontal cortex activity is accompanied by complementary changes in brain regions associated with pain  when negative emotions regulate pain , and a pOur study also found that, compared with the CBP group, there was an enhancement of FC in some parietal brain regions in the CBP-D group, including the SPL, IPL, and PPC. These brain regions are all related to attention, spatial discrimination, and awareness . They arPrevious studies have shown that posterior insula activity can characterize pain to some degree  and thatEven if our study found some evidence that comorbid depressive symptoms can aggravate the functional changes of the pain matrix in patients with CBP, we must point out some shortcomings of this study to avoid them in the future. Firstly, due to the limited study time and subject population, our sample size is relatively small, which may lead to some evidence not being found. Secondly, anxiety symptoms and some other pain-related clinical characteristics may act as confounders or mediators to influence the study results and need to be included in subsequent in-depth studies in the future. Thirdly, we did not conduct hierarchical analysis on the duration of pain, which is a deficiency of this manuscript, and we hope to include it in the study in the future. Fourthly, excessive inter-individual variation in pain duration is also one of the limitations of this study, and we will analyze subgroups with excessive range of pain duration in future studies. Fifthly, healthy subjects were not included in this study.This study draws a preliminary conclusion that some brain regions of the pain matrix may be the common neural basis of depression and CBP. Comorbid depressive symptoms do interact with CBP, but depression does not aggravate pain intensity by directly affecting the function of the pain matrix. These results can enrich the theoretical system of chronic pain affected by different comorbid symptoms. Moreover, we hope that our research can stimulate more humanistic care for patients with chronic pain, and pay more attention to the recovery of psychosocial function.The original contributions presented in this study are included in the article/The studies involving human participants were reviewed and approved by Zhujiang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese medicine. The patients/participants provided their written informed consent to participate in this study.All authors had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. GZ and WW: conceptualization. GZ, JM, WRL, XW, and WW: methodology. GZ, JM, WRL, XZ, and YH: investigation. JM, HZ, and KW: formal Analysis. QC and WL: experimental technology and equipment support. GZ, WRL, HZ, and WL: resources. JM, WRL, and XZ: data curation. GZ, JM, and XZ: writing – original draft. WP, SY, QC, and WL: writing review. QC, WL, and WW: supervision. HZ and WW: funding acquisition.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The research aims to investigate the mechanism of action of aspirin in the treatment of Kawasaki disease.  We predicted the targets of aspirin with the help of the Drugbank and PharmMapper databases, the target genes of Kawasaki disease were mined in the GeneCards and Disgenet databases, the intersection targets were processed in the Venny database, and the gene expression differences were observed in the GEO database. The Drugbank and PharmMapper databases were used to predict the target of aspirin, and the target genes of Kawasaki disease were explored in the GeneCards and Disgenet databases, and the Venny was used for intersection processing. We observed the gene expression differences in the GEO database. The disease-core gene target-drug network was established and molecular docking was used for verification. Molecular dynamics simulation verification was carried out to combine the active ingredient and the target with a stable combination. The supercomputer platform was used to measure and analyze the binding free energy, the number of hydrogen bonds, the stability of the protein target at the residue level, the radius of gyration, and the solvent accessible surface area.  Aspirin had 294 gene targets, Kawasaki disease had 416 gene targets, 42 intersecting targets were obtained, we screened 13 core targets by PPI; In the GO analysis, we learned that the biological process of Kawasaki disease involved the positive regulation of chemokine biosynthesis and inflammatory response; pathway enrichment involved PI3K-AKT signaling pathway, tumor necrosis factor signaling pathway, etc. After molecular docking, the data showed that CTSG, ELANE, and FGF1 had the best binding degree to aspirin. Molecular dynamics was used to prove and analyze the binding stability of active ingredients and protein targets, and Aspirin/ELANE combination has the strongest binding energy.  In the treatment of Kawasaki disease, aspirin may regulate inflammatory response and vascular remodeling through CTSG, ELANE, and FGF1. Yersinia pseudotuberculosis and Staphylococcus aureus [Kawasaki disease (KD) is an acute self-limited vasculitis of unknown etiology, also known as mucocutaneous lymph node syndrome. The predisposing group of KD is infants and young children under 5 years of age . The clis aureus . This fis aureus , 7. Paths aureus . At the s aureus . We can Aspirin is widely used as an anti-inflammatory analgesic. It can relieve fever, relieve pain, and reduce inflammation. The purpose is to prevent inflammatory cells from causing excessive damage to the body and avoid the occurrence of other complications. Mechanism of action ASA blocks the synthesis of prostaglandin E2 from arachidonic acid, thereby exerts its anti-inflammatory effect, but also inhibits platelet aggregation by blocking the synthesis of thromboxane A2 by cyclooxygenase , 11. DosMolecular dynamics (MD) is an interdisciplinary subject based on the knowledge of physics, chemistry, life science, materials, and other disciplines. It aims to obtain the microstructure and physicochemical properties of the complex by calculation . It is aIn combination with previous studies, we found that the clinical problems of Kawasaki disease include unclear pathogenesis and lack of effective treatment options. However, clinical retrospective studies have shown that the use of gamma globulin combined with aspirin in the treatment of KD has a certain therapeutic effect. This study used bioinformatics methods to analyze the potential targets and pathways involved in aspirin treatment of Kawasaki disease, and molecular docking and molecular dynamics were used to validate the analytical results. We explored the potential mechanism of action of aspirin in the treatment of Kawasaki disease to provide the necessary theoretical basis for the clinical treatment of Kawasaki disease.https://www.lilab-ecust.cn/pharmmapper/). The Drugbank database (https://www.drugbank.ca/) was used to obtain the target of aspirin. Through the two databases of GeneCards (https://www.genecards.org/) and DisGeNET (https://www.disgenet.org/web/DisGeNET/menu/home), the target genes of Kawasaki disease were searched with the keyword “Kawasaki disease,” and the disease targets of Kawasaki disease were similarly integrated. The target genes of aspirin and Kawasaki disease were imported into the Venny website (https://bioinfogp.cnb.csic.es/tools/venny/) to draw a Venn diagram to obtain the intersection targets of aspirin and Kawasaki disease. The differential expression of genes between convalescent Kawasaki disease subjects and health control subjects was obtained by GEO database (https://www.ncbi.nlm.nih.gov/geoprofiles).We obtained the 3D structure of aspirin in PubChem and predicted the potential targets of aspirin in the PharmMapper database (https://string-db.org/) to construct a protein-protein interaction network map of key targets and imported the intersection targets in the String database. We obtained the core targets by rescaling the confidence level to 0.97.In order to analyze the interaction between Kawasaki disease and aspirin intersection targets, we used the String database (https://david.ncifcrf.gov/). We entered the intersection targets in the David database, set the species as Homo sapiens, and searched for the results of GO and KEGG enrichment analysis.GO and KEGG enrichment analysis was performed on the intersection target genes of Kawasaki disease and aspirin by using the David database (https://www.bioinformatics.com.cn/) to obtain the KEGG pathway bubble map and the histogram of the GO analysis results. The GO and KEGG data in the David database were preprocessed according to the size of the p-values. The main components of BP, CC, and MF in the GO data were visually displayed through the histogram.The GO and KEGG enrichment analysis results were imported into the Bioinformatics online mapping tool |>1. The information of healthy control subjects and subjects with Kawasaki disease in convalescence was selected, and the cross-target heat map was drawn according to the condition of Padj<0.05, shown in Two hundred and ninety-four aspirin targets were obtained from the PharmMapper database and the Drugbank database, and 416 Kawasaki disease targets were screened through the GeneCards and DisGeNET databases. We obtained 42 intersection targets in the Venny software. Data for GSE109430 were retrieved from the GEO database; we selected volcano plots of detectable genome-wide mRNA profiles in healthy control subjects and recovering KD subjects. Blue and red plots represent abnormally expressed mRNAs, The 42 intersecting protein targets were imported into the String database to construct the intersecting protein target interaction network, shown in The 42 intersection gene targets were imported into DAVID, and GO enrichment analysis and KEGG enrichment analysis were performed. The results included 58 biological processes, 15 molecular functions, and 9 cellular components. The results of GO enrichment analysis indicated that the biological processes of aspirin-Kawasaki disease intersection target genes were mainly positive regulation of angiogenesis and immune response. The cellular components involved in the intersection target genes are mainly extracellular regions and extracellular matrix; the molecular functions affected by the intersection target genes include heparin binding and protein binding. The results of KEGG enrichment analysis mainly involved signaling pathways such as VEGF signal regulation pathway and renin-angiotensin activation system, shown in The drug-disease-pathway target network diagram was constructed by Cytoscape 3.7.2 software. The relationship among aspirin, Kawasaki disease, and the intersection target pathway could be clearly seen in the figure. The intricate connection showed that aspirin had multiple ways to act on targets and multiple mechanisms to treat Kawasaki disease, shown in The top 8 targets were screened through the PPI interaction network for molecular docking. According to the docking results, the top 3 molecules with the best binding degree were selected, namely, CTSG, ELANE, and FGF1. The binding energy of docking was −7.17 kcal/mol, −6.23 kcal/mol, and −5.81 kcal/mol, shown in The RMSD results indicated that the Aspirin/CTSG complex was very stable. Although the RMSD of the complexes fluctuated during the simulation, the overall RMSD values were all below 1 nm, and the fluctuations of each residue in the RMSF were basically within 0.5 nm, indicating a stable binding conformation. Aspirin/FGF1 and Aspirin/ELANE all have abnormal fluctuations during the simulation. This abnormal fluctuation may also be caused by the polypeptide chain in the protein, shown in The experimental results were shown that Aspirin/CTSG, Aspirin/FGF1, and Aspirin/ELANE were −43.443 ± 0.669 kcal/mol, 9.287 ± 3.695 kcal/mol, and −83.601 ± 1.616 kcal/mol, respectively. A negative value indicated that the two molecules had binding affinity to the protein target. Among them, the Aspirin/ELANE combination had the strongest binding energy, followed by Aspirin/CTSG. Aspirin/ELANE and Aspirin/CTSG had binding energy values below −40 kcal/mol. Furthermore, we found that the binding energy of these complexes was always dominated by van der Waals energy, followed by electrostatic energy and then nonpolar solvation energy, shown in The results suggested that the RMSF, SASA, and Rg values of Aspirin/CTSG were relatively stable. In the presence of compounds that reached stable equilibrium in Rg, no structural changes were observed in the proteins. The results indicated the stability of the protein-ligand complexes throughout the simulation, which further illustrated the stability of the complexes. The RMSF, SASA, and Rg values of Aspirin/FGF1 and Aspirin/ELANE were compared, and it was found that the high volatility and abnormal fluctuation of several values could show the instability of the protein. The high fluctuation of residues in Aspirin/FGF1 and Aspirin/ELANE may be due to the influence of their own multiple peptide chains, shown in α1-protease inhibitor and prevents the function of CTSG to amplify inflammation. Secondly, aspirin degrades leukotoxins and reduces inflammation through ELANE. Finally, aspirin regulates endothelial cell migration, proliferation, and angiogenesis through FGF1.This study explored the mechanism of aspirin in the treatment of Kawasaki disease through bioinformatics analysis, molecular docking, and molecular dynamics simulation. We find that aspirin treats Kawasaki disease through CTSG, ELANE, and FGF1. Aspirin treats Kawasaki disease by inhibiting the inflammatory response, modulating endothelial cell and blood vessel growth. Firstly, aspirin inhibits the activity of serum proteases by In the study, 13 core targets  highly related to Kawasaki disease and aspirin were identified by bioinformatics method. Molecular docking indicated that aspirin had close binding sites to CTSG, Elane, and FGF1 in Kawasaki disease. Molecular dynamics confirmed that the three protein-ligand complexes of Aspirin/CTSG, Aspirin/FGF1, and Aspirin/ELANE had good stability. Cathepsin G (CTSG) is found in the asplenophilic granulocytes of neutrophilic polymorphonuclear leukocytes. CTSG is involved in the killing and digestion of pathogens by immune cell phagocytosis. Elastase Neutrophil Expressed (ELANE) may play a role in degenerative and inflammatory diseases through the protein hydrolysis of collagen-IV and elastin. Fibroblast Growth Factor 1 (FGF1) acts as a regulator of endothelial cell migration and proliferation, as well as an angiogenic factor. Because FGF1 acts as a mitogen for a variety of mesodermal and neuroectodermal-derived cells in vitro, it is thought to be involved in organogenesis. Analysis of protein interaction network PPI suggested that CTSG, ELANE, and FGF1 were closely related to inflammatory and proliferation targets. KEGG pathway analysis found that CTSG, ELANE, and FGF1 played a role in immunity, endothelial growth, and other pathways. Molecular docking showed that the binding energy of CTSG, ELANE, and FGF1 reached −7.17, −6.23, and −5.81. The binding free energy results showed Aspirin/CTSG, Aspirin/ELANE, and Aspirin/FGF1 were −43.443 kcal/mol, −83.601 kcal/mol, and 9.287 kcal/mol, respectively. The Aspirin/ELANE combination had the strongest binding energy. In the molecular dynamics simulation, the RMSD of aspirin bound to CTSG increased by 1 Å at 30 ns, indicating that a weak conformational change occurred at this time, and then the RMSD remained stable, meaning that aspirin maintained the changed conformation. Aspirin bound to FGF1 and ELANE showed abnormal fluctuations during the simulation, but the value of ELANE was higher. Such abnormal fluctuations may also be caused by polypeptide chains in proteins.Firstly, molecular dynamics solves the equations of motion for many-body systems consisting of nuclei and electrons; we present the microscopic evolution of the complex system from the residue level of the small molecule Aspirin and the protein targets . Secondly, molecular dynamics can not only directly simulate the macroscopic evolution characteristics of matter, but also obtain calculation results that are consistent with or similar to the experimental results. The simulation results show the binding states of Aspirin/CTSG, Aspirin/FGF1, and Aspirin/ELANE. Finally, molecular dynamics can give the microscopic evolution process of the system from the atomic level and intuitively show the mechanism and laws of small molecules and proteins.Therefore, the study used molecular docking and molecular dynamics to comprehensively demonstrate the binding free energy of the binding complex, the number of hydrogen bonds, the stability of the protein target at the residue level, the radius of gyration and solvent accessible surface area. The experimental results suggested that aspirin can treat Kawasaki disease by regulating inflammatory response by acting on CTSG, FGF1, and ELANE.The clinical features of Kawasaki disease include acute onset, fever, and rash. Systemic vasculitis is the main lesion , and theCathepsin G (CTSG) is an important factor leading to inflammation of Kawasaki disease and is an antibacterial protein present in neutrophils. CTSG increases lymphocyte infiltration by inducing the expression of protease-activated receptor 2 . The resELANE is a key factor in maintaining the stability of the body's internal environment during the inflammatory response. ELANE encodes neutrophil elastase (NE). NE is a cytotoxic serine protease, and it is stored in asplenophilic granulocytes and released upon neutrophil activation . GO dataβ-adrenergic, thereby regulating the vasoconstriction and relaxation function [FGF1 can remodel damaged blood vessels at sites of inflammation. Moreover, FGF1 is a member of the fibroblast growth factor family and participates in biological processes such as cell growth and tissue repair through endothelial cell and vascular factor migration and proliferation . David dfunction . Intracefunction . Phosphofunction . Suzuki function . TherefoIn conclusion, bioinformatics analysis and computer simulation research indicated that CTSG, ELANE, and FGF1 were key targets of aspirin in Kawasaki disease. CTSG and ELANE play important roles in inflammatory diseases by regulating inflammatory processes and reducing leukocyte toxicity. FGF1 induces endothelial cell growth and promotes angiogenesis by providing mitochondrial energy. And FGF1 may lead to the occurrence of severe complications of Kawasaki disease such as coronary artery aneurysm and thromboembolism. The results of this study will provide a theoretical basis for the clinical use of aspirin in the treatment of Kawasaki disease.


Because of the growing incidence of obesity, the use of synthetic antiobesity medicines as weight-loss agents has grown in popularity, although their usefulness has yet to be established. Two of such medicines are Aplex and Venera. This study is designed to determine the potential dangers of Aplex and Venera on certain biochemical and physiological indicators in obese adult male rats.  Twenty-one obese male albino rats (9 weeks old and having a body mass of 220 ± 20 g) were divided into three equal groups: the control group (vehicle treatment), the Aplex group (0.1 mg/kg/day) for 30 days, and the Venera group (0.1 mg/kg/day) for 30 days.  The values of serum glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), total protein, total cholesterol (TC), high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), TC/HDL ratio, testosterone, thyroxine (T4), and leptin did not differ significantly between the treated and control groups. In contrast, the treated groups had substantial changes in bodyweight, serum alanine aminotransaminase (ALT), aspartate aminotransaminase (AST), albumin, globulin, albumin/globulin ratio (A/G ratio), triglycerides (TG), low-density lipoproteins (LDL), LDL/HDL ratio, urea, creatinine, and triiodothyronine (T3) levels.  The findings indicate that Aplex and Venera have negative impacts on crucial biochemical and physiological indicators, particularly liver and kidney functioning. Obesity is a major worldwide health issue that can affect both sexes during childhood, adolescence, and adulthood . 600 milOver the last few years, the use of antiobesity medicines to lower bodyweight by reducing food consumption or absorption or boosting energy expenditure has garnered attention . The curAplex is a popular slimming medication with an apple flavor. It comprises psyllium husk powder, apple juice, grapefruit juice, chromium, vitamin C, apple flavor, and sucralose. Psyllium husk, the main component of Aplex, has been utilized since prehistoric times throughout the world. Psyllium husk is the cleansed, dried seed coat separated from the seeds of Forska's Plantago ovate by winnowing and thrashing . PsylliuVenera is another slimming medicine with a pineapple flavor and a dietary fiber supplement (psyllium husk) that is high in chromium and vitamin C. Chromium, the main component of Venera, is a trace mineral that has a function in carbohydrate, lipid, and protein metabolism .The purpose of the current study is to see if the slimming medications Aplex and Venera have any detrimental impact on various biochemical and physiological markers that represent the metabolic condition of obese adult male albino rats.Due to the variable nature of female data caused by hormonal fluctuations associated with the female estrous cycle, the current study was conducted on male rats only. Twenty-one male albino rats weighing 220 g with an average age of 9 weeks were used in this investigation. Rats were acquired from the Nile Pharmaceutical Company's animal house . They were kept in well-aerated polypropylene clear cages with seven rats in each cage, in a room with controlled conditions . For two weeks, they were provided with free access to a standard laboratory diet  and water before the commencement of the experiment, allowing them to adjust to the new habitat and detect any apparent signs of pathology.All experimental procedures were performed in conformity with the principles and guidelines of the Ethics Committee of the Faculty of Science, Al-Azhar University, Cairo, Egypt, that conformed to the “Guide for the Care and Use of Laboratory Animals” published by the US National Institutes of Health  for the use and welfare of experimental animals.Aplex in the form of sachets (10 g/ sachet) was purchased from MedCare for Pharma Clinic Co. Registration number 6604/2016; while, Venera sachets (7 g/ sachet) were purchased from Pharma Zad, Industrial Area, Badr City, Cairo, for Advocure Pharmaceuticals.  Group I (control group): throughout the experiment, each rat was given daily deionized distilled water (vehicle of Aplex and Venera) in the same manner as the treated groups  Group II (Aplex group): each rat was treated orally with Aplex at a dosage of 0.1 mg/kg/12 hours for 30 days.  Group III (Venera group): for 30 days, each rat was given Venera orally at a rate of 0.1 mg/kg/12 hours.All rats utilized in this study were obese, with an average weight of 220 ± 20. They were separated into three equal groups of seven animals each, as follows:Based on normalization of dosage to the body surface area, an allometric scaling approach was applied to convert the pharmacological dose of Aplex and Venera from human to rat species .The animals were weighed each week of the experiment, and the initial and final assessments were determined. The following formula was used to calculate the percentage (%) change in bodyweight (BW):The animals were starved overnight at the end of the treatment period and afterwards anesthetized by light pentobarbitone anesthesia. Capillary tubes were used to obtain blood samples from the retroorbital venous plexus. The serum was separated by centrifuging the collected blood for 10 minutes at 5000 rpm, and the separated serum was aliquoted in an Eppendorf tube and kept frozen at −20°C until analysis.Serum glucose concentrations were assayed following the glucose oxidase method . WhereasUsing BioMerieux kits from France, total protein and albumin levels were assessed, and the concentration of serum globulin was calculated applying the following formula:Total cholesterol (TC), triglycerides (TG), and high-density lipoprotein (HDL) were measured according to the procedure describe by Allain et al. , FossatiMeasuring the activities of aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) were based on protocols previously described by Tietz , using cSpecific markers related to renal function including levels of urea and creatinine in the sera were assessed spectrophotometrically using commercial diagnostic kits (BioMerieux).The level of serum testosterone was measured according to Vermeulen et al. , whereast-test using IBM SPSS Statistics for Windows, version 22 .The biochemical data were expressed as mean ± SD (7 rats/group). The statistical variations between the control and test groups were evaluated by the independent samples P < 0.01) in the percentage of bodyweight change was observed after 30 days when compared to control animals  impact on the assessed glycemic indices.P < 0.05) in the activity of AST and a highly significant increase (P < 0.01) in the activity of ALT in comparison with the control.The data in P < 0.05) in albumin and A/G ratio and a highly significant rise (P < 0.01) in globulin when compared with the control group.In the current study, serum protein profile characteristics  were estimated in control, Aplex, and Venera-treated rats, and the obtained results are given in P < 0.05) in triglyceride levels in serum of rats given Aplex and a highly significant decrease (P < 0.01) in the case of the Venera group. LDL and LDL/HDL ratio decreased significantly (P < 0.05) in the Venera group compared with the control group.P < 0.05) higher amounts of urea and creatinine. In the case of Venera-treated animals, the reported rise in these renal markers became more evident in a highly significant manner (<0.01).P > 0.05) effects on the levels of testosterone, T4, and leptin comparable with the control values. Meanwhile, T3 concentration was significantly elevated (P < 0.05) in Aplex and Venera groups compared with the values of control animals.Obesity is a cosmopolitan health problem caused by an imbalance between food intake and energy expenditure, resulting in exaggerated fat deposition in adipocytes, hepatocytes, muscles, pancreas, and other organs engaged in the metabolism, resulting in dyslipidemia, glucose intolerance, diabetes, hypertension, nonalcoholic fatty liver disease coronary heart disease, renal illnesses, and cancer , 22.There are numerous antiobesity medications available; however, they have dangerous adverse effects . The curOur findings show that there was a considerable decrease in bodyweight gain in rats administered Aplex or Venera in comparison with the control group. This may be attributed to the dietary fiber supplement psyllium (one of the major components of Aplex and Venera), which is a soluble fiber that suppresses appetite. These findings are consistent with Pal et al.  who discThe current study's findings manifested that Aplex and Venera had no adverse effects on the measured pancreatic function biomarkers. In the same line, Hashem et al.  proved tP < 0.05) increase in the activity of AST and a highly significant (P < 0.01) increase in the activity of ALT relative to the corresponding control, which are the most suggestive indicators of hepatocyte structural degradation since these enzymes are found in the cytoplasm and are liberated into blood as a result of functional membrane integrity loss and cellular leaking [The liver is crucial in detoxification of endogenous waste products and exogenous substances . Accordi leaking . Many su leaking . In the  leaking  discover leaking . Our fin leaking , 33 whic leaking .Treatment of rats with either Aplex or Venera caused disturbances in the protein profile pattern as reflected by the decline of albumin levels, A/G ratio, and elevation of globulin. This disturbance is a direct result of the liver tissue deterioration caused by the essential elements  and (chromium and psyllium) found in Aplex and Venera, respectively. These findings are in line with those of other researchers , 30.α), which increases the production of lipoprotein lipase. Furthermore, PPAR-γ activation in adipose tissue promotes triglyceride accumulation [The present results revealed a significant decrease in TG in the sera of rats receiving Aplex and a highly significant decrease in the Venera group. Moreover, LDL and LDL/HDL ratio showed a significant decrease in the Venera group compared with the corresponding control group. The decrease in TG may be due to the presence of chromium in Aplex and Venera. The potentials of chromium to boost insulin sensitivity, reduce the hydrolysis of TG in adipocytes, and lower the amount of nonesterified fatty acids in blood are some of the hypotheses that have been proposed to explain the impact of chromium on lipids . Furthermulation .Because the kidneys are engaged in purifying and concentrating many chemicals and substances that may reach high concentrations and become poisonous, they are extremely susceptible to the negative effects of chemicals and medicines . The mosAmongst the evaluated hormones, T3 elevated markedly in the sera of rats subjected to either Aplex or Venera. Hyperthyroidism is caused by a high proportion of chromium in Aplex and Venera, which leads to harmful weight loss. These alterations in thyroid hormones might potentially be linked to a shift in the pituitary-thyroid axis as a result of chromium's stressful action , 42.In conclusion, the findings of this study show that Aplex and Venera are capable of altering bodyweight and some crucial biochemical and physiological indicators, such as serum ALT, AST, albumin, globulin, A/G ratio, triglycerides, LDL, LDL/HDL ratio, urea, creatinine, and T3 levels.


Adequate bowel preparation before colonoscopy is crucial. Unfortunately, 25% of colonoscopies have inadequate bowel cleansing. From a patient perspective, bowel preparation is the main obstacle to colonoscopy. Several low-volume bowel preparations have been formulated to provide more tolerable purgative solutions without loss of efficacy.Investigate efficacy, safety, and tolerability of Sodium Picosulphate plus Magnesium Citrate (SPMC) vs. Polyethylene Glycol plus Ascorbic Acid (PEG-ASC) solutions in patients undergoing diagnostic colonoscopy.In this phase 4, randomized, multicenter, two-arm trial, adult outpatients received either SPMC or PEG-ASC for bowel preparation before colonoscopy. The primary aims were quality of bowel cleansing  and patient acceptance . The study was open for treatment assignment and blinded for primary endpoint assessment. This was done independently with videotaped colonoscopies reviewed by two endoscopists unaware of study arms. A sample size of 525 patients was calculated to recognize a difference of 10% in the proportion of successes between the arms with a two-sided alpha error of 0.05 and 90% statistical power.P = 0.49). Acceptance and willing to repeat colonoscopy were significantly better for SPMC with all the scales. Compliance was less than full in 6.6 and 9.9% of cases with PEG-ASC and SPMC, respectively (P = 0.17). Nausea and meteorism were significantly more bothersome with PEG-ASC than SPMC. There were no serious adverse events in either group.Overall 550 subjects (279 assigned to PEG-ASC and 271 assigned to SPMC) represented the analysis population. There was no statistically significant difference in success rate according to BBPS: 94.4% with PEG-ASC and 95.7% with SPMC (SPMC and PEG-ASC are not different in terms of efficacy, but SPMC is better tolerated than PEG-ASC. SPMC could be an alternative to low-volume PEG based purgative solutions for bowel preparation.ClinicalTrials.gov], Identifier [NCT01649674 and EudraCT 2011–000587–10].[ The goal of colonoscopy should be safe, accurate, and complete examination of the entire colon. Therefore, colon cleansing before colonoscopy is crucial. Unfortunately, up to 25% of all colonoscopies have an inadequate bowel cleansing, which is due to different factors ranging from patient-related variables  to scheduling of colonoscopy  –3.The ideal preparation for colonoscopy should clean the colon, with no alteration of colonic mucosa and without causing patient discomfort or shifts in fluids, as well as electrolytes –4. High This paper reports the results of a large, phase 4, randomized, multicenter study that investigated efficacy, safety, and tolerability of SPMC vs. PEG-ELS plus ascorbic acid (PEG-ASC) solutions in patients undergoing colonoscopy.ClinicalTrials.gov (NCT01649674) and EudraCT (2011—000587—10).This non-profit multicenter, phase 4, randomized, two-arm trial compared SPMC versus PEG-ASC, in patients undergoing colonoscopy. The primary aim was to compare the quality of bowel preparation. The co-primary aim was to evaluate patient acceptance of the purgative solutions. The secondary aim was to compare patient compliance for bowel preparation. The study protocol was approved by the Ethics Committee of the coordinating center , and by the Ethics Committees of the other participating centers. The study was conducted in accordance with the Principles of the Declaration of Helsinki, Good Clinical Practice, and applicable regulatory requirements. All participants provided written informed consent at the time of the enrollment and randomization, which were coincident with the booking of colonoscopy. The trial was registered at via a web platform1 at the Clinical Trial Unit of the coordinating center which collected all the data. Randomization was performed by using a minimization procedure that included center, indication for colonoscopy , previous colonoscopy (no vs. yes), and modality of assumption (standard vs. split), as stratification variables. Sample size was calculated with the aim of recognizing a difference of 10%  in the proportion of successes (adequate bowel preparation) between the two purgative solutions. Considering a success rate in the less effective arm equal to 80%, and a two-sided alpha error of 0.05, the study was going to guarantee 90% power in highlighting the expected difference of 10%, with the enrollment of 525 patients. With this sample size, and the same alpha error, the study has more than 99% power to recognize a difference of 1 point on the patients’ acceptance scale.The study was open for the treatment assignment (both the endoscopist and the patient were aware of the type of preparation), but it was blind for the independent assessment of the primary end-point (reviewers were unaware of the bowel preparation assumed by patients). Patients were registered and randomized Patients, aged 18 years or older, were eligible if they were scheduled for a colonoscopy due to screening, diagnosis and follow-up after polypectomy. Subjects who had previously undergone bowel resection or had severe inflammatory bowel disease, renal failure, heart failure (NYHA classes III and IV), hepatic insufficiency , severe dehydration, as well as, pregnant women, individuals assuming lithium, and subjects with other known contraindications, either to bowel preparation  or to execution of colonoscopy, were excluded.The purgative solutions used for bowel preparation were respectively PEG-ASC and SPMC. Both bowel preparations were used in clinical practice at the time of the study. PEG-ASC  is composed of PEG-3350, sodium sulfate, sodium chloride and ascorbic acid , 21. AscThe primary end-point of the study was the quality of bowel preparation. This was assessed according to the “Boston Bowel Preparation Scale” (BBPS), whose rating scale is between 0 and 3. The assessment was carried out prior to water flushing for the following colonic segments: right colon (caecum and ascending colon); transverse colon (including hepatic flexure and splenic flexure); left colon . Consequently, the total score (0 to 3 for each segment) ranged from 0 to 9. Success was a total score between 6 and 9, with at least a score of 2 for each colonic segment , 25.Colonoscopy was performed according to standard of practice of each participating center. All the exams were videotaped in their entirety with HD recorders and the CDs obtained were collected by the data manager of the Clinical Trial Unit for central blinded review. Five endoscopists  acted as blinded reviewers for the assessment of bowel preparation of the recorded colonoscopies in their totality. Each CD was reviewed and the quality of the bowel preparation was scored independently by two of them, who were selected by the trial coordinator at the Clinical Trial Unit. The chosen reviewers were unaware respectively of the bowel preparation assumed by the patient and the results of each other evaluation. Success was defined as a BBPS score ≥ 6, with at least a score of two for each colonic segment. In case of contrasting evaluation, a third reviewer was involved. In any case, a reviewer could not review an exam performed by her/himself. The outcome of each colonoscopy was described according to completeness of exploration (complete vs. incomplete) and duration time; causes of incomplete exploration were described.Evaluation of patient acceptability of each bowel preparation was a co-primary end-point. The patients were provided a diary that was completed and returned to the research nurse before colonoscopy. The diary included visual analogic scales (VAS) from 0 to 10 (lower score representing a better outcome) and regarded the impact of purgative solutions on the following items: food intake (no impact up to inability to eat), taste (no impact up to very bad taste), simplicity of assumption (very simple up to very difficult), personal activity , work activity (no effect up to inability to perform work activities), general perception (excellent up to very bad). Patients were also required to record whether all the purgative solution was assumed within the required time period and whether the correct amount of clear liquids was consumed. Finally, patients were asked if they were willing to repeat the same bowel preparation (no/yes). Compliance was calculated from patient diaries that inquired about the adherence to the prescribed diet, timing of assumptions, assumed volumes of both purgative solutions and clear liquids. Compliance was defined as full , or less-than-full (one or more prescriptions not respected).Statistical analysis was based on a modified intention-to-treat strategy (mITT), excluding patients who did not actually start bowel preparation. Success rate in the two arms was compared using the chi-square test. In the primary analysis, cases in which colonoscopy was interrupted for reasons other than bowel cleansing were considered failures. A sensitivity analysis was planned excluding those cases in which colonoscopy was interrupted before the evaluation of all three colonic segments for reasons independent of bowel cleansing . Success rate in the two arms was described for the subgroups defined according the meaningful clinical characteristics . No cutoff score for acceptability was defined in the protocol, outcomes of the scales in the two arms were compared as central measures by the Wilcoxon rank sum test. General perception was considered as a global outcome measure and the individual scores of the different dimensions were considered as secondary outcome measures. Compliance rate in the two arms was compared using the chi-square test.n = 407) or SPMC (n = 407): they represented the ITT population. Overall, 264 subjects were excluded because they were lost before starting bowel preparation and the remaining 550 cases represented the modified ITT (mITT) population . In the mITT population, 522 cases were assessible for efficacy evaluation because colonoscopy was not videotaped in 28 cases. There was no statistically significant difference in the rate of bowel cleansing according to BBPS between the two arms: in 252/267 (94.4%) subjects of PEG-ASC arm and 244/255 individuals (95.7%) of SPMC group overall colon cleansing was successful with a BBPS > 6, and a minimum score of 2 in each bowel segment (P = 0.86). These results were independent of the assumption modality of both bowel preparations. Among subjects assuming purgative solutions with standard modality, there was a success rate of 93.0% with PEG-ASC and 95.2% with SPMC, respectively; among subjects receiving the split dose, PEG-ASC was effective in 96.8% of cases and SPMC in 96.7% of patients, respectively. In the two arms, the duration of colonoscopy was comparable, with a median time of 21 min (interquartile range [IQR] 16—30) for procedure. Similarly, the withdrawal time of the scope during colonoscopy was equivalent with a median duration of 10 min in both study groups (IQR 8—15).Colonoscopy was reported less than complete in 40 cases, respectively 21/267 (8.0%) and 19/255 (7.7%) in the two arms (P < 0.0001), respectively for PEG-ASC and SPMC. Details of mean (SD) scores for patient-reported effect on food intake, taste, ease of administration, working activities are summarized in P < 0.001).The impact of bowel preparation on patient acceptance was significantly better with SPMC in all the explored scales. Perception of preparation had a mean score of 3.7 (SD ± 0.2) vs. 2.8 (SD ± 0.1) (P = 0.17).Compliance with assumption of purgative solutions and the subsequent amount of clear liquids was less than complete, respectively, in 18/274 (6.6%) subjects assuming PEG-ASC and in 26/264 (9.9%) individuals using SPMC bowel preparation . We acknowledge that there are data showing that compliance may not be linked with the volume of purgative solutions but the routine use of low volume purgative solutions for bowel preparation in clinical practice supports our results . Volume In the current study, the type and the incidence of adverse events were similar to those reported in other studies and they were independent of the modality of assumption. The most frequent adverse events were gastrointestinal symptoms, with nausea and meteorism being significantly bothersome in patients assuming PEG-ASC. No patients reported adverse events resulting from dehydration, which can result in electrolyte imbalance and hypotension in elderly and/or frail subjects assuming SPMC , 19, 20.Our study has some strengths that are worth emphasizing. First, this is one of the largest trial comparing PEG-ASC with SPMC, and its results are comparable in terms of efficacy and safety with those of other smaller randomized trials conducted in both Eastern and Western countries –18. SecoOn the other hand, our study has several limitations that merit discussion. First, this study was affected by a larger 30%) than expected dropout of enrolled subjects due to the fact that at the time of the study patients were allowed to book the colonoscopy simultaneously at different institutions and subsequently decide where to undergo the procedure, on the basis of the fastest waiting list. This caused a longer than planned duration of enrollment and forced us to apply a modified-intention-to-treat strategy for the analysis. Second, we are publishing our data quite late after the end of the enrollment: this was substantially due to the time necessary for collecting the blinded revisions required by the study design, and the subsequent delay in the evaluation of the data. Third, we did not randomize the modality of assumption of bowel preparation; the majority of our patients received the bowel preparation in standard modality and this is not consistent with the routine use of split regimen. The latter has been shown to be superior, regardless of type of bowel preparation and dose . Our cho% than exIn conclusion, the most significant finding of this study is the validation of previous results by means of a large, prospective, randomized, multicenter trial which confirms that SPMC is equally effective and shows increased tolerability in comparison with PEG-ASC. Therefore, SPMC could be used as an alternative to standard low-volume PEG based purgative solutions for bowel preparation in adult, healthy outpatients who do not tolerate either high or low-volume purgative solutions.10.5281/zenodo.6957443.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: The studies involving human participants were reviewed and approved by Comitato Etico dell ‘IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale di Napoli. The patients/participants provided their written informed consent to participate in this study.VDA, MDM, MCP, and MDB managed the overall project. FP and CG analyzed all the data. MDB and FP prepared the first draft and finalized the article on the basis of comments from the other authors. CG, MDM, MCP, and VDA reviewed the first draft. All other authors provided data, reviewed results and contributed to the final version of the article.


To compare the value of contrast-enhanced CT (CECT) and non-contrast-enhanced CT (NCECT) radiomics models in differentiating tuberculosis (TB) from non-tuberculous infectious lesions (NTIL) presenting as solid pulmonary nodules or masses, and develop a combine radiomics model (RM).This study was a retrospective analysis of 101 lesions in 95 patients, including 49 lesions (from 45 patients) in the TB group and 52 lesions (from 50 patients) in the NTIL group. Lesions were randomly divided into training and test sets in the ratio of 7:3. Conventional imaging features were used to construct a conventional imaging model (IM). Radiomics features screening and NCECT or CECT RM construction were carried out by correlation analysis and gradient boosting decision tree, and logistic regression. Finally, conventional IM, NCECT RM, and CECT RM were used for combine RM construction. Additionally, we recruited three radiologists for independent diagnosis. The differential diagnostic performance of each model was assessed using the areas under the receiver operating characteristic curve (AUCs).The CECT RM  outperformed the conventional IM , the NCECT RM , and three radiologists. The diagnostic efficacy of the combine RM  was best in the training and test sets.The diagnostic efficacy of the CECT RM was superior to that of the NCECT RM in identifying TB from NTIL presenting as solid pulmonary nodules or masses. The combine RM had the best performance and may outperform expert radiologists. In 2020, approximately 9.9 million people worldwide fell ill with tuberculosis (TB), equivalent to 127 cases per 100,000 population. The majority of these patients are located in the WHO regions of South-East Asia 43%), Africa 25%) and the Western Pacific 18%) .This study was approved and exempted the informed consent of patients by the ethics committees of the three hospitals.Inclusion criteria: (1) TB was confirmed by sputum testing or pathology combined with DNA testing, clinical symptoms, medical history, and tuberculin testing, and NTIL was confirmed by pathology or effective anti-inflammatory therapy; (2) lesions located in the peri-pulmonary field; (3) CECT images with layer thickness ≤ 2.5 mm on initial examination; (4) lesions presenting as solid nodules or masses without internal calcification; (5) patients with no history of lung surgery, radiotherapy or chemotherapy. According to the inclusion criteria, 73 patients from the First Affiliated Hospital of Dalian Medical University (Center 1) from January 2010 to February 2022, 25 patients from the Second Affiliated Hospital of Dalian Medical University (Center 2) from April 2019 to February 2022, and 15 patients from Dalian Public Health Clinical Center (Center 3) from December 2017 to July 2021 were collected retrospectively. The exclusion criteria were as follows: (1) Artifacts in CT images had an impact on evaluation. (2) Patients did not have NCECT images with slice thickness ≤ 2.5 mm. Eighteen patients were excluded according to the exclusion criteria.The patient selection process is shown in Two demographic characteristics (gender and age), two clinical characteristics , and five hematological examination indices  were recorded at the time of patient admission.Chest CT scans were performed using multi-slice spiral CT (16 or more) from three companies . The patient was routinely scanned from the tip of the lung to the base under inspiration. Scanning parameters: tube voltage, 120–140 kVp; tube current, 140–630 mA or automatic adjustment; matrix, 512 × 512; reconstruction thickness, 1–2.5 mm; reconstruction interval, 1–2.5 mm. CECT scans were performed using a non-iodine ion contrast agent, with an injection rate of 2.5–3.0 mL/s, and scanned at 55–60 s after contrast injection.CT imaging analysis was done jointly by two thoracic diagnostic radiologists (A and B) without knowing the type of lesions, and different opinions were discussed and agreed upon. Each lesion was observed in the lung window , mediastinal window , axial, sagittal, and coronal views. The conventional imaging features of each lesion were analyzed, including (1) semantic features: lobulation, spiculation, cavity, pleural traction, and location; and (2) quantitative features: axial position maximum diameter. The apical and posterior segments of the upper lobe (S1 and S2), as well as the superior segment of the lower lobe (S6), are TB predilection sites . Therefohttp://slicer.org/) by radiologist A. The regions of interest (ROIs) were outlined layer by layer on the entire lesion from NCECT and CECT images respectively under a mediastinal window  and the cavity areas were removed. Radiologist A blinded the pathological diagnosis of the lesions.The original images were imported into the open source software 3D slicer , gray-level dependence matrix (GLDM), gray-level run length matrix (GLRLM), gray-level size zone matrix (GLSZM), and neighborhood gray-tone difference matrix (NGTDM).Assessment of intra- and inter-group agreement was performed by randomly selecting 32 lesions from 101 lesions, and independent measurements were completed by radiologist A and radiologist B with unknown final pathological results. And independent measurements of data were completed again by radiologist A 1 month after the first measurement. Inter- and intra- class correlation coefficients (ICCs) were used to assess the inter- and intra- observer agreement of feature extraction, with ICC > 0.75 indicating good to excellent agreement  .via a linear combination of selected features that were weighted by their respective coefficients.Firstly, the radiomics feature data of the training and test sets were normalized respectively. Secondly, the radiomics features were screened in the training set using correlation analysis  and gradient boosting decision tree (GBDT). Differences in conventional imaging characteristics of TB and NTIL groups were compared by univariate analysis. Finally, logistic regression was used to establish four models, i.e., conventional imaging model (IM), NCECT RM, CECT RM, and combine RM. The combine RM was formed by the combination of conventional IM, NCECT RM, and CECT RM. The radscore was calculated for each patient The receiver operating characteristic (ROC) curves were performed to evaluate the discriminative performance of the models. The areas under the ROC curves (AUCs), sensitivities, specificities, and accuracies were calculated. The calibration curves were plotted, and the fits of the models were estimated by the Hosmer-Lemeshow (H-L) test. The decision curve analysis (DCA) was performed to estimate the clinical utility of the models.We invited a senior radiologist C (with 25 years of diagnostic chest imaging experience), a Mid-level radiologist D (with 12 years of diagnostic chest imaging experience), and a junior radiologist E (with 4 years of diagnostic chest imaging experience) to diagnose all lesions independently. Their diagnostic ability in identifying TB from NTIL presenting as solid pulmonary nodules or masses was assessed. The value of RMs was further clarified by comparison with radiologists.t-test was used; when they did not conform to the normal distribution, they were expressed as median  and Mann-Whitney U test was used. A two-tailed p-value < 0.05 indicated statistical significance.All statistical analyses of the data were performed using R (version 4.1.1). Categorical variables were expressed as the “number of cases (percentage)” and the chi-square test or Fisher's exact test was used to evaluate differences between the TB and NTIL groups. When continuous variables conformed to the normal distribution, they were expressed as mean ± standard deviation and There were 45 patients (49 lesions) in the TB group , and 50 patients (52 lesions) in the NTIL group . The patients in the NTIL group included 7 cases of pulmonary fungal infection, 11 cases of organized pneumonia, 9 cases of inflammatory granuloma, and 23 cases of pulmonary inflammation.P > 0.05). In the test set, more patients in the TB group had a history of smoking than in the NTIL group (P = 0.025).The clinical data of patients in the training and test sets are shown in P = 0.001). In the test set, the differences in all features were not significant (P > 0.05).The comparison of conventional imaging features between two groups in the training and test sets is shown in The radiomics feature selection processes were the same for both the NCECT and CECT RMs. A total of 107 radiomics features were extracted. First, 17 features with ICC < 0.75 were excluded. The consistency assessment showed the ranges of the inter- and intra-class correlation coefficient values for the remaining 90 radiomics features were 0.765–0.994 and 0.853–1.000, respectively. This indicated good to excellent inter- and intra-observer agreement for the 90 radiomics features. Then, after filtering by correlation analysis, 28 NCECT radiomics features and 29 CECT radiomics features were retained. Finally, the GBDT algorithm selected 11 NCECT radiomics features and 10 CECT radiomics features from them as the best features.All conventional imaging features were used to establish the conventional IM. The modeling formulas of the NCECT and CECT RMs are shown in In the training set, the AUCs of NCECT RM and CECT RM were higher than that of the conventional IM . CompareIn this study, the best performance was achieved with the combine RM in the training and test sets, with AUCs of 0.922  and 0.833 , accuracies of 0.829 and 0.774 .P > 0.05, In the training set, the H-L test showed no significant difference between the four models and the ideal model .Our results showed that cavity was the only conventional imaging feature that differed significantly between the two groups in the training set, and it was more common in TB lesions, accounting for 32.35%. An analysis of the imaging presentation of pulmonary granulomatous lesions also mentioned that cavity was highly suggestive of Mycobacterium tuberculosis infection . The proGiven that there was only cavity with the discrepancy, we decided to use all conventional imaging features for modeling to avoid missing important information. However, even though conventional IM integrated all conventional imaging features, its diagnostic power is unsatisfactory .Essentially, CT images provide much more information than the macroscopic appearances we can see with the naked eye. Radiomics then provides us with a large number of quantitative features that reflect the microstructure of the lesion, mainly including intensity histogram, shape-based features, and texture features, and the extraction process of these features is automatic , 25. TheWang et al.'s RM based on NCECT to identify TB and community-acquired pneumonia in children was also quite effective, the AUC reached 0.837 . In addiCECT scan is a commonly used auxiliary examination method in clinical diagnosis and treatment. The results of several studies have shown that the radiomics characteristics of tumors are altered after the uptake of contrast agents, particularly first-order histogram features and textural features –32. SeveThe AUC  and accuracy  of the combine RM were the highest among all models, and all indicators were relatively balanced in the training and test sets. This study also found that radiologists were not able to distinguish well between TB and NTIL presenting as solid pulmonary nodules or masses, even for experienced radiologists . Moreover, there is a great deal of subjectivity and fortuity in the diagnosis of radiologists with different qualifications. Computer-aided diagnosis has become an irreversible trend in clinical work, and artificial intelligence has great prospects in the field of thoracic radiology . The comThere are some limitations to our study. Firstly, this is a retrospective study with unavoidable selection bias. Secondly, after strict inclusion and exclusion criteria, our sample size was small, so a larger sample is needed to validate this study in the future. Thirdly, the NTIL group in this study has a large variety of diseases, and the value of using radiomics to help differential diagnosis of one of these diseases with TB will be discussed in the future. Fourthly, only CECT images scanned 55–60 s after contrast agent injection were selected in this study, the influence of different delayed scanning times on CECT's differential diagnostic ability can be further studied in the future. Fifthly, the use of multiple CT scanners in this study affected the reproducibility of the radiomics data. Although we used resampling for correction, we still need to use batch correction to minimize acquisition-related radiomics variability and verify the generality of the final model by stress testing in future studies. Finally, we used the rather time-consuming manual method of outlining ROIs. Compared with it, semi-automatic measurements are not only convenient and fast but also may have a better inter-observer agreement .In conclusion, radiomics helped to differentiate TB from NTIL presenting as solid pulmonary nodules or masses, and CECT may be a better choice. Combine RM we built obtained the best diagnostic efficacy and may outperform expert radiologists.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Approval was obtained from the Ethics Committee of the First Afliated Hospital of Dalian Medical University, the Ethics Committee of the Second Hospital of Dalian Medical University, and Dalian Public Health Clinical Center Ethics Committee. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.WZ: conceptualization, methodology, investigation, data curation, writing—original draft, and writing—review and editing. ZX: investigation, writing—original draft, and writing—review and editing. DT: validation, investigation, and data curation. KW, XL, and DQ: resources and data curation. MZ: software, visualization, and formal analysis. ZL: conceptualization, investigation, writing—review and editing, supervision, and project administration. All authors contributed to the article and approved the submitted version.Author MZ was employed by GE Healthcare. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


To understand the current working ability of coal chemical workers in Xinjiang, and analyze the impact of occupational stress, mental disorders, and their interaction on work ability. To provide a scientific basis for improving the working ability and quality of life of coal chemical workers.In this study, a stratified random sampling method was used to conduct a questionnaire survey of 1,400 workers in six coal mining enterprises from June to December 2019. The Effort-Reward Imbalance Questionnaire (ERI), the Symptoms Checklist 90 (SCL-90), and the Work Ability Index Scale (WAI) were used to evaluate the level of occupational stress, mental disorders, and the ability to work as coal chemical workers.P < 0.05). The ability to work and its dimensions were inversely correlated with occupational stress, and mental disorders (P < 0.001). Occupational stress and mental disorders are risk factors affecting the ability to work. Workers with high occupational stress* mental disorders  are 10.666 times more likely to be at risk for developing poor work ability than low occupational stress* no mental disorders. Structural equation models show that occupational stress and mental health conditions had a direct impact on work ability, and mental health conditions were the mediators of the relationship between occupational stress and work ability.The results showed that WAI scores had statistically significant differences between gender, age, length of service, shift, education, marital status, and monthly income (Occupational stress, mental disorders, and their interaction are risk factors affecting the ability of coal chemical workers to work. Occupational stress can indirectly affect the ability to work through mental health conditions. It shows that the occupational stress of the coal chemical industry can directly act on work ability, and can also indirectly act on work ability through mental health status as an intermediary variable. Occupational stress is a psychological and physiological reaction that occurs when the individual's work ability and work requirements are not equal . In geneIn addition to causing damage to physical health, occupational stress also has an impact on mental health, including cognitive ability and emotional states . The mental effects of occupational stress can range from mild subjective symptoms to significant mental abnormalities and even psychosis, with common symptoms, such as irritability, decreased job satisfaction, depression, nervousness, and anxiety –16. MentDue to the long-term existence of stress factors that lead to individual occurrences, the psychological and physical health levels of the occupational population decline, showing a series of negative physiological, psychological, and behavioral effects that have a negative impact on the working ability of workers . This siCoal chemical workers operate in a special nature, and their workplaces are often accompanied by various types of occupational hazards, such as high temperatures, coal soot, radiation, and toxic and harmful gases . Coal chXinjiang coal chemical workers as the target group of this study. This study used a stratified cluster random sampling method from June 2019 to December 2019. According to the annual output, Xinjiang coal chemical enterprises are divided into three production levels: high , medium , and low , and 2 coal chemical enterprises are randomly selected for investigation at each level. A total of 1,400 coal chemical workers were surveyed in this study, and a total of 1,286 questionnaires were recovered by excluding those whose questionnaire quality was unqualified, with a recovery rate of 91.86%. Inclusion criteria: (1) Age ≥18 years; (2) length of service ≥ 1 year; (3) Workers provide informed consent and voluntarily participate in the study after investigators have informed the purpose and significance of the study. The research proposal was approved by the Ethics Committee of Xinjiang Medical University . Prior to the start of the survey, all respondents voluntarily provided written informed consent forms. The flowchart is shown in uestionnaire (ERI) was used to measure the occupational stress of survey respondents. This scale was proposed by Siegrist (* C), where constant C = 6 / 11. An ERI ≤ 1 represents a low pay-high return, which indicates low-level occupational stress; an ERI > 1 represents a high pay-low return, indicating high-level occupational stress  and showed high reliability and validity among all groups , 35. ThiThe use of the Work Ability Index Scale (WAI) to measure the transformation of the work ability of the study subjects is currently an effective method for evaluating the individual's work ability . The WorStructural Equation Modeling (SEM) treats constructs that cannot be directly observed as latent variables , and directly observable as observed variables, using covariance matrices to identify, estimate, and verify the multi-cause and multi-effect relationship between latent variables and observed variables . On the All questionnaires were distributed to the coal chemical workers who were identified as the study subject and collected on-site. The questionnaire was completed anonymously within 15 min. At the initial stage of the survey, the trained investigators instructed the participants on how to complete the questionnaire, so that they could fully understand the significance of the research and ensure their active cooperation, which also encouraged the participants to truthfully and accurately complete each item of the questionnaire. During the investigation, two investigators conducted a comprehensive review of the completed questionnaires to ensure that any errors in the questionnaires were corrected promptly and that the missing items were added and completed in time, which also safeguarded the authenticity and effectiveness of the respondents' answers. During the data entry stage, this questionnaire was independently recorded and checked by two people, and relevant logical checks were carried out. After the data were inputted, statistical software was used to randomly check and recheck the database  to ensure its accuracy.x ± s, two independent samples were compared to the t-test, and three and more sets of means were compared using one-way ANOVA. If there was a difference in the population, the SNK-q test was used for two-to-two comparisons. In the event that there was non-conformity with normality, non-parametric variance-based methods were used for the statistical analysis. The bias distribution is described in M . Pearson correlation coefficients were used to analyze the correlation between occupational stress, mental health and work ability of coal chemical operators. Multi-factor analysis: The influence of general demographic factors, occupational stress and work burnout on work ability, and the interaction of occupational stress and mental disorders on work ability were analyzed using binary logistic regression. The AMOS 26.0 software was used to analyze the relationship between occupational stress, psychological disorder and work ability of coal chemical workers, and to fit the optimal structural equation model. The significance level is α = 0.05.All data is entered into the Epi Data 3.1 database and analyzed using the SPSS 25.0 package. All metrological data were statistically described using?P < 0.05). SCL-90 scores were statistically different between different demographic characteristics (P < 0.05). The WAI scores varied significantly between age, length of service, education, marital status and monthly income (P < 0.05)  and female 275 (21.38 %). ERI scores were statistically significantly different between sex, age, length of service, education, shift work and monthly income ( < 0.05) .2 = 234.622, P < 0.001)  and 426 people in ERI >1 (high-stress group). The incidence of poor working ability in the high occupational stress group of coal chemical workers was higher than that in the low occupational stress group (χ< 0.001) .2 = 225.806, P < 0.001)  .P < 0.001). The ability to work and its dimensions were positively correlated with reward (P < 0.05)  .* no mental disorders as a control, the two-by-two interaction between different occupational stress and mental disorders groups is included in the equation. The results showed that the interaction of occupational stress and mental disorders had a significant effect on sleep quality (p < 0.001). Workers with high occupational stress* mental disorders  are 10.666 times more likely to be at risk for developing poor work ability than low occupational stress* no mental disorders . The results of structural equation modeling indicate that occupational stress has a direct negative effect  on work ability and also an indirect effect on mental health. The intermediate effect was 0.56 × −0.40 = −0.224, accounting for 42.75% of the total effect.Using AMOS 26.0 software for maximum likelihood estimation testing, through the continuous modification of the model, the following model is selected according to the principles of accuracy and simplicity. Throughout the sample, the mediation effect model fit for mental health was satisfactory in the process of working stress to work capacity . The modThe results of this study showed that the working ability score of Xinjiang coal chemical workers was 43.00 40.00, 46.00), and 1,055 people with excellent and good working ability, accounting for 82.04%, of which were women. Studies have shown that women score relatively higher on work ability than men, unlike Fischer and Martinez  study. I.00, and This study aimed to explore the relationship between occupational stress, psychological disorders and work ability among coal chemical workers in Xinjiang. The results showed that coal chemical workers in the low-level occupational stress group had higher work ability than in the high-level occupational stress group. Studies have shown that prolonged occupational stress depletes workers' motivation, leading to a decrease in work capacity and lowering the productivity of the company , 52. Occ* mental disorders  are 10.666 times more likely to develop poor work ability than low occupational stress* no mental disorders. Research by Lindegård et al.  were used, which minimized bias. However, this study also had some limitations. First, the causal relationship cannot be determined for the current investigation of this study; future studies should further select methods such as cohort studies. Second, some of the findings in this paper are different from the results of previous scholars, which may be related to the selection of samples, especially the proportion of male workers and female workers. The inclusion of future study subjects should be balanced to make them more representative. This study used the SCL-90 for the assessment of mental disorders, and the participants were not actually examined by a certified psychiatrist, so there may be some bias or other errors in accurately reporting mental status, psychological characteristics, etc. Finally, due to a large number of coal chemical enterprises in Xinjiang, the research objects have not been fully covered, and the results of this study cannot represent the mental health and working ability of all coal chemical workers in Xinjiang, so in the future, the research should investigate the workers of various coal chemical enterprises, minimize the deviation, and verify the conclusions of this study.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The research proposal was approved by the Ethics Committee of Xinjiang Medical University. Prior to the start of the survey, all respondents voluntarily provided written informed consent forms. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.XY, JY, XG, and FL conceived and designed the study, contributed to the acquisition, analysis, interpretation of data, were involved in drafting the manuscript, and revising it for important intellectual content. All authors contributed substantially to the work presented in this paper, reviewed, and approved the final manuscript.This work was funded by the National Natural Science Foundation of China (Grant Numbers: 81660533 and 82060590) and the Key Discipline of the 13th 5-Year Plan in Xinjiang Uygur Autonomous Region-Public Health and Preventive Medicine.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.