Over three-quarters of patients with hepatocellular carcinoma who have hepatitis C can achieve viral cure with direct-acting antiviral drugs. Among patients with hepatocellular carcinoma who subsequently received liver transplantation, over 90% of patients can achieve viral cure.

We suggest that the application of multi-level analysis and missing-value analysis is a statistical necessity for this study. Firstly, in Beste et al. 1 , 426 patients with HCC were collected from 167 medical centers; therefore, small VA medical centers may have contributed few or no HCC patients. In Table 4 of the paper by Beste et al. 1 , there was no hospital or geographic information variable in the final regression model, which implies that large VA medical centers could over-represent patients or hospitals. This concern can be appropriately adjusted by a hierarchical modeling approach using multi-level analysis at patient, as well as at hospital levels. 9 Secondly, authors used an assumption of randomly missing data (11.6% of HCC patients) based on unclear multiple imputation methods. Randomness of missing data could be raised from not only the amount of missing data but also from a higher discontinuation rate in the missing group that might have resulted from these patients' intention to leave the VA health care system to receive additional or new therapy for any reason. To confirm the absence of missing not at random data, it is necessary to utilize multiple imputation methods by emerging approaches, multiple imputation using chained equations, and a visualization of Monte Carlo simulation results. 10 Conflict of interest The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Cervical dystonia, also called spasmodic torticollis, is a painful condition in which neck muscles contract involuntarily, and may cause abnormal head position or movements. The primary (or first line of) treatment of cervical dystonia is chemodenervation with injection of botulinum toxin into the affected muscles. We report a case of a young man with idiopathic cervical dystonia who developed anterocollis (forward flexion of the neck) not responsive to prior scalene and sternocleidomastoid muscle injections. To safely access the deeper cervical musculature, ultrasound (US) was used in conjunction with electromyography, to inject the longus colli muscles bilaterally. The patient responded well and had no complications. The longus colli has been reported to be injected using electromyography, fluoroscopy, computed tomography, and, less frequently, US. We propose that US guidance is an excellent technique for botulinum toxin injection, especially for deep cervical muscles such as the longus colli.