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BACKGROUND: Nucleos(t)ide analogs (NUCs) are the standard of care for chronic hepatitis B (CHB). The present analysis aimed to determine the cost effectiveness of NUCs in Chinese healthcare settings. METHODS: A Markov model was used to simulate two therapeutic strategies for a hypothetical patient cohort diagnosed with hepatitis B e antigen-positive CHB, unwilling or unable to receive interferon therapy, and about to start treatment with any NUC. The first strategy included NUC monotherapy without sequencing (telbivudine [LDT], entecavir [ETV], tenofovir [TDF], lamivudine [LAM], adefovir dipivoxil [ADV], and combination therapies of either LDT and ADV or LDT and TDF, followed by best supportive care [BSC]). The second strategy included sequential therapies of individual NUCs: LAM â†’ ADV, ADV â†’ LAM, LDT â†’ ADV, and ETV â†’ ADV, followed by BSC. The analysis included two scenarios: with and without costs due to nephrotoxicity. Renal impact was quantified as costs alone, without consideration for quality of life decrements. RESULTS: When renal impact was not considered, without treatment sequencing, LDT was cost effective compared with other NUCs. Amongst the strategies with sequencing, LDT â†’ ADV was cost effective. The results were similar when renal impact was considered. However, LDT strategy demonstrated better cost effectiveness. In probabilistic sensitivity analysis, in both scenarios, LDT â†’ ADV sequence was cost effective with 51 % probability even at willingness to pay of $20,000. CONCLUSION: Use of LDT, as compared with other NUCs, is cost effective in CHB treatment in Chinese healthcare settings. Considering the detrimental renal impact, overall costs for all treatment options were increased. However, the increase for LDT was comparatively small.

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Previous work with subcutaneous implants in a rat animal model has shown that pillarlike surface microstructure will reduce fibrosis and enhance blood vessel approximation to the implant surface when compared with nontextured controls. This study was designed to determine the effect of microtissue anatomy and implant site on the observed response, as well as the effect of implant fixation. The lateral posterior sites were found to contain a fat pad which produced a dramatically reduced fibrosis for the micro-structured implants compared with smooth controls. Although significant differences between pillar-micro-structured implants and controls were found for most sites, neither fascia nor muscle reduces the level of cellular response to the same degree as fat. Suture fixation of the implants did not produce a significantly different response in these tests. The occupation of the interpillar spaces by fat and moderation of interfacial shear forces is proposed as a mechanism to explain these results.

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We report a case of acromegaly diagnosed in the second trimester of pregnancy. Bromocriptine (7.5 mg per day) corrected visual field defects and suppressed prolactin secretion but did not reduce fasting growth hormone levels. We propose that suppression of physiologic lactotroph hyperplasia by bromocriptine may permit noninvasive management of pituitary adenomas during pregnancy.

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A prerequisite for the development of an implantable artificial pancreas is the availability of a stable, long-life glucose sensor. Platinum (Pt) catalyzed electrodes have been demonstrated in vitro to show high sensitivity to glucose and long cycle life but are more sensitive to co-reactants compared with enzymatic methods. The authors developed a special data processing method (compensated net charge ratio, or CNCR) in which the measured electrode response is very sensitive to glucose, completely insensitive to urea, and only moderately sensitive to amino acids. Other endogenous and exogenous co-reactants show only minor interferences. The CNCR method involves the determination of the ratio of net oxidation charge to total charge during one complete cycle of a cyclic voltammogram. Prototype electrodes tested in vitro in spiked plasma have shown typical sensitivities of greater than 2 x 10(-4) CNCR units per 1 mg/dl change in glucose concentration, with linear response up to 400 mg/dl. For in vivo testing, a modified 5 F vascular catheter with membrane covered surface mounted electrodes was used at a vena cava site in swine. Several sensor designs were tested in vivo, with sensitivities of 1-5 x 10(-4) CNCR units (mg/dl).

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High surface area platinum subjected to the appropriate electrical potential cycling regimes exhibits considerable electrocatalytic activity towards glucose oxidation. We have developed a special data processing method, the compensated net charge (CNC) method, to take advantage of the electrocatalytic activity of platinum. This method involves the determination of the net oxidation charge during one complete cycle of a cyclic voltammogram applied to the platinum electrode in a potentiodynamic mode. Under these conditions, the electrode response is very sensitive to glucose, completely insensitive to urea, and only moderately sensitive to amino acid concentration changes. Earlier work with other endogenous and exogenous potential co-reactants shows little interference. Data obtained in vitro and in vivo will be presented and discussed.

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