First People's Hospital of Chongqing

This study aimed to make a direct comparison of four tumor burden-related prognostic systems in predicting prognoses in patients with colorectal liver metastasis (CRLM) undergoing hepatectomy. Clinicopathological and survival data of 197 consecutive CRLM patients were extracted from a public database. Clinical Risk Score-derived N1S5 (lesion number of 1 and the largest size of 5cm are cutoffs for risk stratification), tumor burden score (TBS), modified TBS (mTBS) and total tumor volume (TTV) were calculated, and patients were stratified to different risk groups. Kaplan-Meier plots were adopted to depict the survival probabilities. Cox regression analyses were performed to evaluate the association between these systems and overall survival (OS) and disease-free survival (DFS). N1S5 and TTV systems effectively stratified patients into distinct risk groups with significantly different OS and DFS (p<0.05), but TBS and mTBS did not. Multivariable Cox regression analysis demonstrated N1S5 and TTV as independent variables associated with OS (HRs: 1.43 to 1.97, 1.59 to 1.76, respectively) and DFS (HRs: 1.34 to 2.09, and 1.80 to 2.51, respectively) (p<0.05). Compared with the other three systems, TTV showed a relatively higher time-dependent area under the curve (median: 0.60) and C-index (median: 0.64) for predicting OS. N1S5 had the highest C-index (median: 0.63) for predicting DFS. Total tumor volume seems to be a robust and effective tool for risk stratification and prognosis prediction in CRLM patients undergoing liver resection. N1S5 may provide a pragmatic simplified alternative to total tumor volume for prognostic prediction.

Periodontitis is a prevalent chronic inflammatory disease characterized by progressive destruction of periodontal tissues, with alveolar bone defects posing significant challenges for clinical treatment. This research aimed to ascertain the clinical efficacy of minimally invasive bone grafting combined with concentrated growth factor (CGF) for treating periodontitis. Seventy-eight patients with periodontitis and bone defects were randomized into the control group (received guided tissue regeneration (GTR) combined with bone grafting treatment) and the test group (received GTR combined with minimally invasive bone grafting and CGF treatment). Postoperative pain at 1 day, 3 days, and 7 days postoperatively, mucosal healing at 7 days postoperatively, probing depth (PD), clinical attachment level (CAL), gingival recession depth (GRD), bleeding index (BI), gingival index (GI), and the alveolar bone defect depth preoperatively and at 6 months postoperatively were compared, changes in implant new bone thickness and density at 3 and 6 months postoperatively were tested by cone-beam computed tomography (CBCT), and implantation success rate and postoperative complications were compared. The test group exhibited lower pain scores at 3 and 7 days (P < 0.05), improved mucosal healing (P < 0.05), and superior periodontal indicators (PD, CAL, GRD, BI, GI) at 6 months (P < 0.05). CBCT revealed greater bone thickness/density in the test group (P < 0.05). Complication rates were lower in the test group (P < 0.05), with no significant difference in implantation success (P > 0.05). Minimally invasive bone grafting combined GTR with CGF improves periodontal conditions in patients with periodontitis complicated by bone defects, achieves good bone regeneration results, and reduces postoperative complications.

Current frozen shoulder (FS) therapies present a clinical dilemma: although intra-articular corticosteroids with home exercise provide proven medium-term (3-month) benefits, they lack short-term (<4-week) efficacy for rapid recovery; conversely, manipulative treatments achieve faster outcomes but carry invasiveness risks. These limitations highlight the urgent need for developing and validating novel noninvasive approaches with prompt therapeutic effects. To compare the efficacy and safety of ultrasound-guided tendon surface (UGTS) injection versus manipulation under local anesthesia (MULA) and blind tender point (BTP) injection, all combined with intra-articular injection and home exercise. Randomized controlled trial; Level of evidence, 1. The authors first developed a novel ultrasound-based strategy, which they named "ultrasound-guided tendon surface." Then they conducted a multicenter randomized controlled trial (2019-2022). The primary outcome was 4-week shoulder function assessed by the Beijing Friendship Hospital Scale (BFHS), a modified version of the Constant-Murley Score adapted for Chinese populations with demonstrated validity. Secondary outcomes included (1) short-term (1-month) pain (visual analog scale [VAS]) score, active range of motion (ROM), Evaluation Scale of the Shoulder under Ultrasound (ESSU) score, pain relief, treatment sessions, and cartilage thickness; and (2) long-term (2-year) complete remission rates (tele-follow-up). Among 365 screened patients, 139 were enrolled and randomized to receive UGTS (n = 49), MULA (n = 43), and BTP (n = 47). At the 1-week follow-up visit, the UGTS group showed rapid improvement in BFHS scores compared to both the MULA and BTP groups. These early functional advantages were also indicated by the VAS score, ROM, ESSU score, and pain relief. UGTS achieved faster complete remission (1 month: 59.2% vs 31.0% and 34.9% for BTP and MULA, respectively; 3-month: 79.6% vs 53.2% and 69.8% for BTP and MULA, respectively; P < .05), with remission rates converging by 24 months (P = .216), yet retained early rapid response as its key clinical advantage. UGTS showed no significant impact on articular cartilage thickness. Serial ultrasound monitoring demonstrated no rotator cuff injuries attributable to either the UGTS procedure or prescribed exercises. UGTS combined with intra-articular injection and exercise promotes faster recovery without safety concerns, representing an effective noninvasive first-line option for rapid relief in FS. ChiCTR1900025874 (Chinese Clinical Trial Registry number).

The goal of medical image translation tasks is to design models that transform source domain images to target domain images, with the potential to significantly enhance diagnostic accuracy and reduce patient radiation exposure. Current advanced methods employ generative models to characterize the conditional distribution of target domain images, typically incorporating high frequency edge information from source domain images as generation conditions to maintain anatomical consistency between the two domains. However, directly introducing edge information may introduce noise and misleading information, adversely affecting the generative model. To address this issue, we propose a Fast and Slow Diffusion framework with Fuzzy Contextual Representation. Specifically, High-frequency edge images undergo fast diffusion while original images follow a slow diffusion process, coupled by a contextual pool that dynamically stores edge patterns from the fast path. Furthermore, we apply fuzzification to the contextual pool to enhance its expressiveness and use the resulting fuzzy representations to guide the reverse process of the slow diffusion, ensuring the accurate preservation of edge structures. Comprehensive experiments demonstrate that our proposed framework achieves performance comparable to existing state-of-the-art methods in medical image translation tasks. In addition, quantitative experiments demonstrate that fuzzified edge representations enhance generative models' capability in precisely perceiving and retaining high-frequency components.