Efficacy and cost-effectiveness of antiviral regimens for entecavir-resistant hepatitis B:A systematic review and network meta-analysis

Background:Chronic hepatitis B(CHB)patients who had exposed to lamivudine(LAM)and telbivudine(LdT)had high risk of developing entecavir(ETV)-resistance after long-term treatment.We aimed to conduct a systematic review and a network meta-analysis on the efficacy and cost-effectiveness on antiviral regimens in CHB patients with ETV-resistance.Data sources:We searched PubMed,EMBASE and Web of Science for studies on nucleos(t)ide analogues(NAs)treatment[including tenofovir disoproxil fumarate(TDF)-based rescue therapies,adefovir(ADV)-based rescue therapies and double-dose ETV therapy]in CHB patients with ETV-resistance.The network meta-analysis was conducted for 1-year complete virological response(CVR)and biological response(BR)rates using GeMTC and ADDIS.A cost-effective analysis was conducted to select an economic and effective treatment regimen based on the 1-year CVR rate.Results:A total of 6 studies were finally included in this analysis.The antiviral efficacy was estimated.On network meta-analysis,the 1-year CVR rate in ETV-TDF[odds ratio(OR)=22.30;95%confidence interval(CI):2.78-241.93],LAM-TDF(OR=70.67;95%CI:5.16-1307.45)and TDF(OR=16.90;95%CI:2.28-186.30)groups were significantly higher than that in the ETV double-dose group;the 1-year CVR rate in the LAM-TDF group(OR=14.82;95%CI:1.03-220.31)was significantly higher than that in the LAM/LdTADV group.The 1-year BR rate of ETV-TDF(OR=28.68;95%CI:1.70-1505.08)and TDF(OR=21.79;95%CI:1.43-1070.09)therapies were significantly higher than that of ETV double-dose therapy.TDFbased therapies had the highest possibility to achieve the CVR and BR at 1 year,in which LAM-TDF combined therapy was the most effective regimen.The ratio of cost/effectiveness for 1-year treatment was 8526,17649,20651 Yuan in the TDF group,TDF-ETV group,and ETV-ADV group,respectively.Conclusions:TDF-based combined therapies such as ETV-TDF and LAM-TDF therapies were the first-line treatment if financial condition is allowed.

Nomograms for Predicting Cancer-Specific Survival of Patients with Gingiva Squamous Cell Carcinoma:A Population-Based Study

The use of the traditional American Joint Committee on Cancer(AJCC)staging system alone has limitations in predicting the survival of gingiva squamous cell carcinoma(GSCC)patients.We aimed to establish a comprehensive prognostic nomogram with a prognostic value similar to the AJCC system.Methods:Patients were identified from SEER database.Variables were selected by a backward stepwise selection method in a Cox regression model.A nomogram was used to predict cancer-specific survival rates for 3,5 and 10 years in patients with GSCC.Several basic features of model validation were used to evaluate the performance of the survival model:consistency index(C-index),receiver operating characteristic(ROC)curve,calibration chart,net weight classification improvement(NRI),comprehensive discriminant improvement(IDI)and decision curve analysis(DCA).Results:Multivariate analyses revealed that age,race,marital status,insurance,AJCC stage,pathology grade and surgery were risk factors for survival.In particular,the C-index,the area under the ROC curve(AUC)and the calibration plots showed good performance of the nomogram.Compared to the AJCC system,NRI and IDI showed that the nomogram has improved performance.Finally,the nomogram's 3-year and 5-year and 10-year DCA curves yield net benefits higher than traditional AJCC,whether training set or a validation set.Conclusion:We developed and validated the first GSCC prognosis nomogram,which has a better prognostic value than the separate AJCC staging system.Overall,the nomogram of this study is a valuable tool for clinical practice to consult patients and understand their risk for the next 3,5 and 10 years.

Sirolimus treatment for neonate with blue rubber bleb nevus syndrome:A case report

BACKGROUND Blue rubber bleb naevus syndrome(BRBNS)is a rare disease that usually presents with multiple venous malformations in the skin and gastrointestinal tract.Lesions located in the gastrointestinal tract always result in chronic gastrointestinal bleeding and severe anemia.The successful management of BRBNS with sirolimus had been reported in many institutions,due to its impact on signaling pathways of angiogenesis.However,the experience in treatment of neonates with BRBNS was limited.CASE SUMMARY A 38-day-old premature female infant born with multiple skin lesions,presented to our center complaining of severe anemia and hematochezia.Laboratory examination demonstrated that hemoglobin was 5.3 g/dL and contrast-enhanced abdominal computed tomography showed multiple low-density space-occupying lesions in the right lobe of the liver.She was diagnosed as having BRBNS based on typical clinical and examination findings.The patient was treated by transfusions twice and hemostatic drugs but symptoms of anemia were difficult to alleviate.A review of BRBNS case reports found that patients had been successfully treated with sirolimus.Then the patient was treated with sirolimus at an average dose of 0.95 mg/m2/d with a target drug level of 10-15 ng/mL.During 28 mo of treatment,the lesion was reduced,hemoglobin returned to normal,and there were no adverse drug reactions.CONCLUSION This case highlights the dosing regimen and plasma concentration in neonates,for the current common empiric dose is high.

Predictive value of lipocalin 2 and cystatin C for acute kidney injury in patients with cirrhosis

To the E ditor:Acute kidney injury(AKI)is a common complication in patients with liver cirrhosis and with a high mortality[1];early diagnosis and treatment improve survival.Lipocalin 2(NGAL)and cystatin C have been identified as early biomarkers of AKI.However,controversy remains regarding the utility of NGAL and cystatin C for the early diagnosis of AKI in patients with liver cirrhosis.This study aimed to evaluate the performance of NGAL and cystatin C in diagnosing AKI in patients with liver cirrhosis and predicting their clinical outcomes.