Additional Hepatic Arterial Infusion Chemotherapy to Sorafenib Was Cost-Effective for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis

Qi-Feng Chen,1,* Xiong-Ying Jiang,1,2,* Yue Hu,1,* Song Chen,1 Jun-Zhe Yi,1 Sui-Xing Zhong,1 Jiong-Liang Wang,1 Ning Lyu,1 Ming Zhao1 1Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China; 2Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510210, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ming Zhao, Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People’s Republic of China, Tel +862087343272, Email [email protected]: The combination of sorafenib and hepatic arterial infusion chemotherapy (SoHAIC) has shown to enhance overall survival rates in patients with advanced hepatocellular carcinoma and major portal vein tumor thrombosis (HCC-Vp3-4) compared to sorafenib alone. Our objective was to evaluate the cost-effectiveness of SoHAIC versus sorafenib for the treatment of HCC-Vp3-4, taking into account the viewpoint of Chinese healthcare payers.Methods: This pharmacoeconomic study employed a Markov model to assess the cost-effectiveness of treating HCC-Vp3-4 with SoHAIC in comparison to sorafenib. The patient characteristics were drawn from individuals from the trial conducted between June 2017 and November 2019, with cost and health value data sourced from published literature. The primary outcome measure in this research was the incremental cost-effectiveness ratio (ICER), which indicates the additional cost per quality-adjusted life year (QALY). The willingness-to-pay (WTP) threshold per QALY was set at $30,492.00. Furthermore, 1-way sensitivity and probabilistic sensitivity analyses were carried out to validate the consistency of the results.Results: In the baseline scenario, sorafenib resulted in 0.42 QALY at a cost of $10,507.89, while SoHAIC generated 1.66 QALY at a cost of $32,971.56. When comparing SoHAIC to sorafenib, the ICER was $18,237.20 per QALY, which was below the WTP threshold per QALY. Furthermore, the 1-way sensitivity analysis demonstrated that the ICER remained within the WTP threshold despite fluctuations in variables. In the probabilistic sensitivity analysis, SoHAIC had a 98.8% probability of being cost-effective at the WTP threshold, considering a wide range of parameters.Conclusion: In this cost-effectiveness evaluation, SoHAIC demonstrated cost-effectiveness over sorafenib for HCC with major portal vein tumor thrombosis, as observed from the perspective of a Chinese payer.Keywords: HCC, portal vein tumor thrombosis, sorafenib, HAIC, Cost-effectivenes

A Common Origin for Neutrino Anarchy and Charged Hierarchies

The generation of exponential flavor hierarchies from extra-dimensional wavefunction overlaps is re-examined. We find, surprisingly, that coexistence of anarchic fermion mass matrices with such hierarchies is intrinsic and natural to this setting. The salient features of charged fermion and neutrino masses and mixings can thereby be captured within a single framework. Both Dirac and Majorana neutrinos can be realized. The minimal phenomenological consequences are discussed, including the need for a fundamental scale far above the weak scale to adequately suppress flavor-changing neutral currents. Two broad scenarios for stabilizing this electroweak hierarchy are studied, warped compactification and supersymmetry. In warped compactifications and "Flavorful Supersymmetry," where non-trivial flavor structure appears in the new TeV physics, Dirac neutrinos are strongly favored over Majorana by lepton flavor violation tests. We argue that this is part of a more general result for flavor-sensitive TeV-scale physics. Our scenario strongly suggests that the supersymmetric flavor problem is not solved locally in the extra dimension, but rather at or below the compactification scale. In the supersymmetric Dirac case, we discuss how the appearance of light right-handed sneutrinos considerably alters the physics of dark matter.Comment: Comparison with the Froggatt-Nielsen mechanism omitted. Some clarifications added. This is the version accepted by PRL with a longer abstract

Ginsenoside-Rg1 mediates a hypoxia-independent upregulation of hypoxia-inducible factor-1α to promote angiogenesis

Hypoxia-inducible factor (HIF-1) is the key transcription regulator for multiple angiogenic factors and is an appealing target. Ginsenoside-Rg1, a nontoxic saponin isolated from the rhizome of Panax ginseng, exhibits potent proangiogenic activity and has the potential to be developed as a new angiotherapeutic agent. However, the mechanisms by which Rg1 promotes angiogenesis are not fully understood. Here, we show that Rg1 is an effective stimulator of HIF-1α under normal cellular oxygen conditions in human umbilical vein endothelial cells. HIF-1α steady-state mRNA was not affected by Rg1. Rather, HIF-1α protein synthesis was stimulated by Rg1. This effect was associated with constitutive activation of phosphatidylinositol 3-kinase (PI3K)/Akt and its effector p70 S6 kinase (p70S6K), but not extracellular-signal regulated kinase 1/2. We further revealed that HIF-1α induction triggered the expression of target genes, including vascular endothelial growth factor (VEGF). The use of small molecule inhibitors LY294002 or rapamycin to inhibit PI3K/Akt and p70S6K activities, respectively, resulted in diminished HIF-1α activation and subsequent VEGF expression. RNA interference-mediated knockdown of HIF-1α suppressed Rg1-induced VEGF synthesis and angiogenic tube formation, confirming that the effect was HIF-1α specific. Similarly, the angiogenic phenotype could be reversed by inhibition of PI3K/Akt and p70S6K. These results define a hypoxia-independent activation of HIF-1α, uncovering a novel mechanism for Rg1 that could play a major role in angiogenesis and vascular remodeling

Amide-controlled, one-pot synthesis of tri-substituted purines generates structural diversity and analogues with trypanocidal activity

Anovel one-pot synthesis of tri-substituted purines and the discovery of purine analogues with trypanocidal activity are reported. The reaction is initiated by a metal-free oxidative coupling of primary alkoxides and diaminopyrimidines with Schiff base formation and subsequent annulation in the presence of large N,N-dimethylamides (e.g.N,N-dimethylpropanamide or larger). This synthetic route is in competition with a reaction previously-reported by our group1, allowing the generation of a combinatorial library of tri-substituted purines by the simple modification of the amide and the alkoxide employed. Among the variety of structures generated, two purine analogues displayed trypanocidal activity against the protozoan parasite Trypanosoma brucei with IC50 , 5 mM, being each of those compounds obtained through each of the synthetic pathways.J.J.D.M. thanks Spanish Ministerio de Economı´a y Competitividad for a Ramon y Cajal Fellowship. A.U.B. thanks MRC IGMM for an academic fellowship. This work was partially supported by Grant SAF2011-30528 to J.A.G.S.

Spin-Wave Theory On Finite Lattices: Application To The J1-J2 Heisenberg Model

We present a new method for a systematic spin-wave expansion for the quantum fluctuations of a generic spin Hamiltonian in a finite lattice, where the inverse spin magnitude 1/S is a well-defined expansion parameter. The first two leading contributions of the spin-spin correlation function are evaluated for the J1-J2 Heisenberg model. Very good agreement between our finite-size predictions and the exact diagonalization and Monte Carlo results is found for J2/J1 < 0.2 and S = 1/2, thus confirming the existence of antiferromagnetic long-range order in this J region. For J2/J1 > 0.3 the expansion is poorly converging, suggesting a possible breakdown of the spin-wave approximation. Here our calculation seems consistent with a possible spin liquid ground state

REALIZATION OF A SPIN LIQUID IN A 2-DIMENSIONAL QUANTUM ANTIFERROMAGNET

The ground state properties of the two dimensional spatially anisotropic Heisenberg model are investigated by use of field theory mappings, spin-wave expansion, and Lanczos technique. Evidence for a disorder transition induced by anisotropy at about J(y)/J(x) < 0.1 is shown. We argue that the disordered phase is gapless and its long wavelength properties can be interpreted in terms of decoupled one dimensional chains