Purpose: Many observational studies have revealed intriguing connections between multisite chronic pain (MCP) and psychiatric disorders. Yet, the critical question of causality remains elusive. Our aim was to systematically evaluate the causal relationships between MCP and 11 psychiatric disorder subtypes while identifying potential mediators. Methods: We adopted a three-stage two-sample bi-directional Mendelian randomization (MR) analysis to ensure the robustness and reliability of our findings. MCP summary data was sourced from a genome-wide association study with 387,649 individuals in the UK Biobank. The discovery stage used summary statistics mainly from the Psychiatric Genomics Consortium, while validation involved MR analysis with data from the FinnGen consortium. Meta-analysis was conducted to pool MR estimates from the discovery and validation stages. Results: Positive causal relationships were found between MCP and 7 psychiatric disorder subtypes, including depression, panic disorder, anxiety disorders, insomnia, attention deficit hyperactivity disorder, post-traumatic stress disorder, and bipolar disorder, with combined odds ratios ranging from 1.361 ( P < 0.00001) to 3.322 ( P < 0.0045). Reverse MR revealed bidirectional causal associations between depression and MCP, along with anxiety disorders and MCP ( P < 0.05). Additionally, causal links were identified between MCP and smoking initiation, physical activity, body mass index, and changes in human blood cells. Multivariable MR analysis indicated these factors may mediate the relationship between MCP and psychiatric disorders. Conclusion: Our findings provide novel insights into the involvement of MCP in psychiatric disorders, highlighting potential modifiable risk factors to reduce their incidence.

Objective: Free flap reconstruction for head and neck defects is currently a common procedure. This study aimed to create and validate a predictive model for identifying patients at risk of delayed recovery from anesthesia after free flap reconstruction for head and neck defect. Methods: Electronic medical records from all patients were retrospectively collected. The primary outcome variable was delayed recovery from anesthesia. The least absolute shrinkage and selection operator regression model was employed to identify the most relevant features, followed by the construction of a nomogram model using multivariable logistic regression analysis. The discriminatory power, calibration, and clinical utility of the nomogram model were assessed using receiver operating characteristic curve analysis, calibration curve analysis, and decision curve analysis, respectively. Results: This novel nomogram model incorporated 4 predictors for delayed recovery from anesthesia: preoperative albumin, intraoperative fresh frozen plasma infusion, preoperative platelet-to-lymphocyte ratio, and duration of intraoperative hypotension. The area under the receiver operating characteristic curve (area under the curve) for the nomogram model was determined to be 0.821 (95% CI: 0.803–0.836). After internal validation, the corrected area under the curve was found to be 0.768 (95% CI: 0.639–0.812). In addition, the model exhibited well-fitted calibration curves and demonstrated favorable clinical usability as indicated by the calibration curve and decision curve analysis curve. Conclusion: The authors created and validated a novel predictive model utilizing a limited number of 4 predictors, yet exhibiting commendable predictive performance. This innovative tool holds the potential to mitigate delayed recovery from anesthesia and enhance the efficient allocation of medical resources.

Purpose: The aim of this study was to construct and validate a predictive model combined with albumin and neutrophil-to-lymphocyte ratio (NLR) to predict postoperative complications in patients underwent colon cancer resection.Methods: We performed a retrospective cohort study of all patients undergoing resection of colon cancer between January 2019 and June 2021 at Sun Yat-sen Memorial Hospital. The general clinical characteristics and systemic inflammatory marker including lymphocytes and neutrophils were gathered retrospectively. The main outcome variables were postoperative complications. Logistic regression analyses were conducted to identify the in potential risk factors that predicting postoperative complications after resection of colon cancer. Nomograms with or without albumin/neutrophil-to-lymphocyte ratio socre (ANS) for postoperative complications were further constructed according to the results of multivariable logistic regression analysis adopting Akaike information criterion.Results: The preoperative ANS score and intraoperative blood transfusion were determined as independent risk factors predicting postoperative complications. The nomogram including preoperative ANS score had higher C-index (0.821) and also better calibration. Conclusions: The preoperative ANS score is an effective predictor and one of independent potential risk factors for postoperative complications after resection of colon cancer. The nomogram with preoperative ANS score was constructed with better capability predicting postoperative complications.

Introduction: The albumin combined with the neutrophil-to-lymphocyte ratio (NLR) score may be a useful marker of inflammation, but its associations with post-operative complications in colon cancer patients are unknown. Objective: This study aims to construct and validate a predictive model incorporating albumin and NLR to predict post-operative complications in patients who underwent colon cancer resection. Methods: A retrospective analysis was conducted on patients who underwent colon cancer resections between 2019 and 2021 at Sun Yat-sen Memorial Hospital. Clinical characteristics and systemic inflammatory markers, including lymphocytes and neutrophils, were collected. Post-operative complications served as the primary outcome. Logistic regression analyses were performed to identify the potential risk factors for post-operative complications after colon cancer resection. Nomograms with or without albumin and NLR score for post-operative complications were further constructed according to the results of the multivariable logistic regression analysis using the Akaike information criterion. Results: Pre-operative albumin combined with NLR score (p=0.01; odds ratio [OR]: 2.69; 95% confidence interval [CI]: 1.90–8.06), age (p=0.007; OR: 1.05; 95% CI: 1.01–1.09), intraoperative blood transfusion (p=0.002; OR:5.32; 95% CI: 1.87–15.15), and duration of surgery (p=0.001; OR:1.70; 95% CI: 1.24–2.34) were identified as independent risk factors for post-operative complications. The nomogram, which included pre-operative albumin and NLR scores, demonstrated superior predictive performance, with a concordance index of 0.821 (95% CI: 0.758–0.883) and improved calibration. Conclusion: Pre-operative albumin and NLR score are independent risk factors for post-operative complications following colon cancer resection. The developed nomogram incorporating these markers exhibited enhanced predictive capability for post-operative complications.