OBJECTIVE To systematically identify the dilemmas in value assessment of antitumor combination therapies， and to provide evidence for health insurance coverage， drug pricing， and clinical decision-making. METHODS The concept of “surplus value space” was introduced to cons truct a value assessment framework， under which the dilemmas in three assessment scenarios were analyzed. Optimization recommendations were proposed by drawing on international research addressing similar challenges. RESULTS & CONCLUSIONS The core dilemma of value assessment for antitumor combination therapies lies in insufficient surplus value space. When the cost of the backbone therapy exceeds its corresponding health value， the add-on drug encounters a “free but uneconomical”problem. Existing international value assessment methods have limitations such as flawed evaluation frameworks， difficulty in operationalizing the quality-adjusted life year allocation framework， and frequent occurrence of the “free but uneconomical”problem， rendering them inadequate for the complex scenarios of antitumor combination therapies. To address these dilemmas， strategies such as adjusting payment thresholds， exploring discounted pricing， conducting multi-product linkage negotiations， and delaying insurance access are recommended to improve the rationality and feasibility of value assessment for antitumor combination therapies.

Objective To evaluate the feasibility and efficacy of the three-guidewire technique for retrograde stent placement in the treatment of ureteral mucosal sleeve avulsion (UMSA). Methods A retrospective analysis was conducted on the clinical data of 12 patients with UMSA secondary to ureteroscopic lithotripsy for ureteral calculi in our hospital during Jul. 2010 and Oct. 2023. The three-guidewire technique was employed for retrograde stent placement during the procedure. A secondary ureteroscopic lithotripsy was performed one month postoperatively.Results Double-J stent was successfully placed in all 12 patients, with a mean stent insertion time of 23.3(16-30)minutes. No intraoperative exacerbation of mucosal avulsion occurred. One patient was lost to follow-up. At the one-month postoperative ureteroscopic examination and lithotripsy, 81.8% (9/11) cases exhibited unobstructed ureters, while 18.2%(2/11) developed annular membranous strictures, which were resolved following dilation. During subsequent follow-up, the postoperative creatinine level after double-J stent removal showed a mild decrease compared to the preoperative level [87.9(72-100)μmol/L vs. 90.1(69-108)μmol/L]. Up to 90.9%(10/11) patients remained free of hydronephrosis, with only 1 case (9.1%) requiring laparoscopic ureterovesical reimplantation for hydronephrosis 4 months postoperatively. Conclusion The three-guidewire technique for retrograde stent placement in the treatment of UMSA demonstrates strong operability, high success rates, favorable outcomes, and a low incidence of ureteral stricture, which warrant wide clinical promotion.

Objective:To implement an overview of systematic reviews on the effects of brain-computer interface training on upper limb functional rehabilitation in stroke patients.Methods:The systematic review/Meta-analysis of the effect of brain-computer interface training on upper limb functional rehabilitation in stroke patients was electronically retrieved in PubMed, Web of Science, Cochrane Library, Embase, CINAHL, Embase, Joanna Briggs Institute Evidence-Based Health Care Center Database, China National Knowledge Infrastructure, Wanfang Data, VIP and China Biology Medicine disc. The search period was from database establishment to November 2024. Two researchers independently performed literature screening and data extraction and evaluated the quality of methodology, reporting, and evidence.Results:A total of 14 systematic reviews/Meta-analyses were included. The results showed that brain-computer interface training helped to improve upper limb motor function, muscle strength and activities of daily living in stroke patients, but the rehabilitative effect on muscle spasm needed to be further confirmed.Conclusions:Brain-computer interface training helps to improve upper limb motor function, muscle strength and activities of daily living in stroke patients. However, the methodological quality and reporting quality of the current studies are poor, and there is still a need for high-quality studies with rigorous design and standardized process to provide reference for clinical practice.

Objective To explore the independent risk factors of bladder stones(BS)in patients with benign prostatic hyperplasia(BPH),and to construct a predictive model and an easy-to-use website.Methods The clinical data of 460 BPH patients treated during Jan.2022 and Jan.2025 in the First Affiliated Hospital of Shihezi University were retrospectively analyzed.The independent risk factors of BS in the training set were identified with univariate logistic regression and the Boruta algorithm,based on which a nomogram was constructed.The predictive performance of the model was evaluated with receiver operating characteristic(ROC)curve,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),F1 index,calibration curve and clinical decision curve analysis(DCA).The contribution of different variables to BS was evaluated with SHapley Additive exPlanations(SHAP)algorithm.A web page was established.Results Among the 460 BPH patients,144(31.3％)had BS,and 6 independent risk factors were identified,including neutrophil level,urine culture results,intravesical prostatic protrusion(IPP),urine nitrite test results,urine leukocytes test results,and urine occult blood results.In the test set,the area under the ROC curve(AUC)was 0.887(95％CI:0.816-0.947),sensitivity 0.705,specificity 0.968,PPV 0.912,NPV 0.876,and F1 score 0.795.Calibration and DCA indicated good discrimination and clinical applicability.SHAP results showed that the risk factors mentioned above were the most important for concurrent BS.The resulting website(https://wutiaowu2.shinyapps.io/bladderrrr/)was publicly accessible.Conclusion The neutrophil level,urine culture results,IPP,urinary nitrite test results,urinary leukocytes test results,and urinary occult blood test results were identified as the independent risk factors of BPH complicated with BS.The model and website developed based on these factors demonstrate high usability and accuracy,possessing significant clinical value.

Objective To explore the independent risk factors of bladder stones(BS)in patients with benign prostatic hyperplasia(BPH),and to construct a predictive model and an easy-to-use website.Methods The clinical data of 460 BPH patients treated during Jan.2022 and Jan.2025 in the First Affiliated Hospital of Shihezi University were retrospectively analyzed.The independent risk factors of BS in the training set were identified with univariate logistic regression and the Boruta algorithm,based on which a nomogram was constructed.The predictive performance of the model was evaluated with receiver operating characteristic(ROC)curve,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),F1 index,calibration curve and clinical decision curve analysis(DCA).The contribution of different variables to BS was evaluated with SHapley Additive exPlanations(SHAP)algorithm.A web page was established.Results Among the 460 BPH patients,144(31.3％)had BS,and 6 independent risk factors were identified,including neutrophil level,urine culture results,intravesical prostatic protrusion(IPP),urine nitrite test results,urine leukocytes test results,and urine occult blood results.In the test set,the area under the ROC curve(AUC)was 0.887(95％CI:0.816-0.947),sensitivity 0.705,specificity 0.968,PPV 0.912,NPV 0.876,and F1 score 0.795.Calibration and DCA indicated good discrimination and clinical applicability.SHAP results showed that the risk factors mentioned above were the most important for concurrent BS.The resulting website(https://wutiaowu2.shinyapps.io/bladderrrr/)was publicly accessible.Conclusion The neutrophil level,urine culture results,IPP,urinary nitrite test results,urinary leukocytes test results,and urinary occult blood test results were identified as the independent risk factors of BPH complicated with BS.The model and website developed based on these factors demonstrate high usability and accuracy,possessing significant clinical value.

Objective:To implement an overview of systematic reviews on the effects of brain-computer interface training on upper limb functional rehabilitation in stroke patients.Methods:The systematic review/Meta-analysis of the effect of brain-computer interface training on upper limb functional rehabilitation in stroke patients was electronically retrieved in PubMed, Web of Science, Cochrane Library, Embase, CINAHL, Embase, Joanna Briggs Institute Evidence-Based Health Care Center Database, China National Knowledge Infrastructure, Wanfang Data, VIP and China Biology Medicine disc. The search period was from database establishment to November 2024. Two researchers independently performed literature screening and data extraction and evaluated the quality of methodology, reporting, and evidence.Results:A total of 14 systematic reviews/Meta-analyses were included. The results showed that brain-computer interface training helped to improve upper limb motor function, muscle strength and activities of daily living in stroke patients, but the rehabilitative effect on muscle spasm needed to be further confirmed.Conclusions:Brain-computer interface training helps to improve upper limb motor function, muscle strength and activities of daily living in stroke patients. However, the methodological quality and reporting quality of the current studies are poor, and there is still a need for high-quality studies with rigorous design and standardized process to provide reference for clinical practice.

AIM: To delineate the specific mutation responsible for retinitis pigmentosa(RP)in a Yi pedigree, and to analyze the correlation of RHO gene mutation with clinical phenotype.METHODS:A comprehensive clinical evaluation was conducted on the proband diagnosed with RP and other familial members, complemented by a thorough ophthalmic examination. Peripheral blood samples were obtained from the proband and familial members, from which genomic DNA was extracte. Subsequent whole exome sequencing(WES)was employed to identify the variant genes in the proband. The identified variant gene was validated through Sanger sequencing, then an in-depth analysis of the mutation genes was carried out using genetic databases to ascertain the pathogenic mutation sites. Furthermore, an exhaustive analysis was performed to delineate the genotype and phenotype characteristics.RESULTS:The RP pedigree encompasses 5 generations with 42 members, including 19 males and 23 females. A total of 13 cases of RP were identified, consisting of 4 males and 9 females, which conforms to the autosomal dominant inheritance pattern. The clinical features of this family include an early onset age, rapid progression, and a more severe condition. The patients were found to have night blindness around 6 years old, representing the earliest reported case of night blindness in RP families. The retina was manifested by progressive osteocytoid pigmentation of the fundus, a reduced visual field, and significantly decreased or even vanished a and b amplitudes of ERG. The combined results of WES and Sanger sequencing indicated that the proband had a heterozygous missense mutation of the RHO gene c.1040C>T:p.P347L, where the 1 040 base C of cDNA was replaced by T, causing codon 347 to encode leucine instead of proline. Interestingly, this mutation has not been reported in the Chinese population.CONCLUSION:This study confirmed that the mutant gene of RP in a Yi nationality pedigree was RHO(c.1040C>T). This variant leads to the change of codon 347 from encoding proline to encoding leucine, resulting in a severe clinical phenotype among family members. This study provides a certain molecular, clinical, and genetic basis for genetic counseling and gene diagnosis of RHO.

AIM: To delineate the specific mutation responsible for retinitis pigmentosa(RP)in a Yi pedigree, and to analyze the correlation of RHO gene mutation with clinical phenotype.METHODS:A comprehensive clinical evaluation was conducted on the proband diagnosed with RP and other familial members, complemented by a thorough ophthalmic examination. Peripheral blood samples were obtained from the proband and familial members, from which genomic DNA was extracte. Subsequent whole exome sequencing(WES)was employed to identify the variant genes in the proband. The identified variant gene was validated through Sanger sequencing, then an in-depth analysis of the mutation genes was carried out using genetic databases to ascertain the pathogenic mutation sites. Furthermore, an exhaustive analysis was performed to delineate the genotype and phenotype characteristics.RESULTS:The RP pedigree encompasses 5 generations with 42 members, including 19 males and 23 females. A total of 13 cases of RP were identified, consisting of 4 males and 9 females, which conforms to the autosomal dominant inheritance pattern. The clinical features of this family include an early onset age, rapid progression, and a more severe condition. The patients were found to have night blindness around 6 years old, representing the earliest reported case of night blindness in RP families. The retina was manifested by progressive osteocytoid pigmentation of the fundus, a reduced visual field, and significantly decreased or even vanished a and b amplitudes of ERG. The combined results of WES and Sanger sequencing indicated that the proband had a heterozygous missense mutation of the RHO gene c.1040C>T:p.P347L, where the 1 040 base C of cDNA was replaced by T, causing codon 347 to encode leucine instead of proline. Interestingly, this mutation has not been reported in the Chinese population.CONCLUSION:This study confirmed that the mutant gene of RP in a Yi nationality pedigree was RHO(c.1040C>T). This variant leads to the change of codon 347 from encoding proline to encoding leucine, resulting in a severe clinical phenotype among family members. This study provides a certain molecular, clinical, and genetic basis for genetic counseling and gene diagnosis of RHO.

Objective To systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. Results A total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). Conclusion PG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.

Digital technology has revolutionized the traditional model of quality evaluation for traditional Chinese medicine(TCM).This article systematically reviews the research hotspots and practical applications of digital-driv-en quality evaluation of TCM.Simultaneously,this paper analyzes and assesses the challenges faced by the digitiza-tion of TCM quality evaluation from multiple perspectives,including data acquisition,model construction,applica-tion promotion and market acceptance,and puts forward targeted strategies.Addressing the existing issues in the field of TCM quality,this paper proposes a series of innovative concepts,including the mining and application of TCM property data,the construction of a large database of TCM components,the integration of digital technology and emerging biotechnology for biological effect evaluation of TCM and clinical intelligent evaluation based on real-world data.Based on these,it further proposes a multi-dimensional quality analysis model for grading TCM,which encompasses TCM property data,chemical composition analysis,biological effect assessment and clinical evalua-tion.It aims to provide a useful reference for the modernization,scientification,and standardization of TCM quality evaluation.