جستجوی مقالات مرتبط با کلیدواژه « stage » در نشریات گروه « پزشکی »

This study aimed to introduce a biomarker panel to detect pancreatic ductal adenocarcinoma (PDAC) in the early stage, and also differentiate of stages from each other.

PDAC is a lethal cancer with poor prognosis and overall survival.

Gene expression profiles of PDAC patients were extracted from the Gene Expression Omnibus (GEO) database. The genes that were significantly differentially expressed (DEGs) for Stages I, II, and III in comparison to the healthy controls were identified. The determined DEGs were assessed via protein–protein interaction (PPI) network analysis, and the hub-bottleneck nodes of analyzed networks were introduced.

A number of 140, 874, and 1519 significant DEGs were evaluated via PPI network analysis. A biomarker panel including ALB, CTNNB1, COL1A1, POSTN, LUM, and ANXA2 is presented as a biomarker panel to detect PDAC in the early stage. Two biomarker panels are suggested to recognize other stages of illness.

It can be concluded that ALB, CTNNB1, COL1A1, POSTN, LUM, and ANXA2 and also FN1, HSP90AA1, LOX, ANXA5, SERPINE1, and WWP2 beside GAPDH, AKT1, EGF, CASP3 are suitable sets of gene to separate stages of PDAC.

Despite the existence of standard risk classification systems and effective treatment approaches, 34% to 37% of advanced-stage Hodgkin lymphomas (HLs) either relapse or progress. Our goal in our study was to show the relationship between initial lymphocyte count and stage while examining their effects on prognosis. The initial lymphocyte count, which is proven in advanced-stage patients, could be an important factor in terms of showing the prognosis in the early stage.

Our study included 190 patients diagnosed with HL in our hospital between January 2010 and September 2020. HL subtypes, diagnosis stages, presence of bulky or mediastinal masses, lymphadenopathy areas, and demographic data of patients, such as age and sex. The aim was to obtain a cutoff in the statistical analysis performed to explore the relationship between lymphocyte level and stage, which is the main hypothesis of the study.

Of the 190 patients evaluated, 77 were female (40.5%) and 113 were male (59.5%). To obtain a cutoff in terms of lymphocyte level and stage relationship, a value of 2380/mm3 and below was found to be associated with stage 3-4 disease with a sensitivity of 86.44% and a specificity of 33.3% (AUC: 0.613 (0.539-0.682), p<0.007).

This result can be improved in combination with conventional imaging methods used for staging purposes. Further studies may shed light on staging and especially the diagnosis of advanced-stage disease with high sensitivity.

Bladder cancer is among the 10 most common cancers globally and in Iran. The prevalence rate is a crucial metric for both estimating disease burden and policymakers. On the other hand, bladder cancer is a heterogeneous disease with different stages, high recurrence, and progression rate. In planning treatment procedures, it is important to know the prevalence of bladder cancer by stages. In the current study, we aimed to estimate the 5-year prevalence of bladder cancer by stages using the Markov model.    

This was a simulation study. To estimate the 5-year prevalence of bladder cancer by stages, we used the Markov model with a time horizon of 5 years following diagnosis. We simulated the natural history of bladder cancer using a literature review. We extracted survival rate, stage-specific recurrence, and progression rate using local and international publications and expert opinion. In addition, we used the Iranian life table and extracted probabilities of mortality due to other causes of death.  

Five-year prevalence of bladder cancer for the year 2018 was estimated at 21,807 patients. Non- muscle-invasive bladder cancer accounted for around 68% of all cases, with 42% in the Ta low-grade stage. About 32% of bladder cancer prevalent cases were muscle-invasive bladder cancer patients, from which about 8% had metastatic tumors.    

Researchers and policymakers can utilize the findings of this study to conduct economic burden analyses and plan resource allocation.

Breast cancer is the most common cancer among females globally and its toll is rapidly rising in India. Accurate knowledge about prognostic factors could assist oncologists in making correct treatment decisions and acquiring a better understanding of the survival of patients. In patients with hormone receptor-positive, early diagnosis along with socioeconomic factors like education, income, etc., are said to play a vital role. Hence, the present study aimed to analyze the survival pattern depending on hormone receptor status, stages of breast cancer, and socioeconomic status.

An Ambi directional cohort study was conducted among 300 patients with breast cancer registered and treated in a tertiary care hospital in Dakshina Kannada, India, in the last 3 years. A validated proforma was used to collect data. The post-treatment survival was analyzed depending on their income, family history, staging (clinical & histopathological), and hormone receptor status (HER-2/ER).

The pattern of receptor among these patients showed 45% ER, 43% PR, and 14.3% HER2 positivity. Among the patients, 83% had undergone hormonal therapy as per the receptor status. The overall survival rate of breast cancer patients was found to be 81%. The clinical stage of disease had a statistically significant association with survival using the log-rank test. However, monthly income and hormonal status showed no significance.

A 3-year survival rate was 100% for stage Ⅰ patients, 96.6% for stage Ⅱ, 82.1% for stage Ⅲ, and 40% for stage Ⅳ. Hormone receptor positivity is highly predictive for better prognosis in breast cancer patients.

The associations between Helicobacter pylori and human papillomavirus (HPV) with head and neck squamous cell carcinomas (HNSCCs) are approved before. However, the association between demographic, clinicopathological, and histologic characteristics of HNSCC patients and molecular detection of HPV and H. pylori has not been enough investigated.

In this cross‑sectional study,62 patients with HNSCC from January 2016 to February 2020 were entered the study.For H.pylori detection 16S ribosomal RNA and glmM genes and HPV detection, MY09 and MY11 genes were used. P < 0.05 is considered as significant level.

There were 34 patients with advanced‑stage cancer (54.8%). Grade I patients (61.3%) had the highest frequency.There were 20 (32.25%) and 7 (11.29%) patients with positive H. pylori infection among tumor tissue and healthy tissue margins,respectively.Positive HPV infections were in 8 (12.90%) and 3 (4.83%) patients, respectively, in tumor tissue and healthy tissue margins (P = 0.01). There was a significant difference between histological grade and infection to HPV among HNSCC patients (P = 0.01),and most of the positive HPV cases had well‑,moderate‑,and poorly‑differentiated tumors, respectively. Our study showed a significant increase in HPV infection in the advanced‑stage group compared to the early‑stage group (P = 0.05).

Our study findings concluded a significant relationship between HPV infection in HNSCC patients with age, stage, and grade. In summary, our findings based on polymerase chain reaction analysis concluded remarkably a potential role of HPV infection and to some extent H. pylori infection into the contribution of HNSCC malignancies.

Irisin is a myokine that regulates energy metabolism by inducing browning of adipose tissue. The aim of this study was to evaluate the relationship between irisin level and biochemical parameters of chronic kidney disease (CKD) patients in stage 2 and stage 4.
The research was a cross-sectional study; the study population included patients with CKD who were over 18 years of age, included 90 individuals with CKD, of these participants, 45 were in the second stage of the CKD while the other 45 subjects were in the fourth stage. Serum irisin concentration plus the level of glucose (Glu), urea, creatinine (Cr) and hemoglobin (Hb) were measured.
In the present study, the serum irisin level of patients in stage 4 was significantly reduced (13.00 ng / ml) compared with patients in stage 2(21.41 ng / ml).
With the progression of CKD from stage 2 to stage 4, parameters such as serum Cr, TG, LDL, FBS, BUN and urea levels significantly increased. Inversely, factors such as irisin, GFR, Alb, HDL and Hb levels significantly decreased. These findings suggest that irisin may be involved in the regulation of biochemical factor levels in CKD patients through the progression from stage 2 to stage 4.

Lung adenocarcinoma (LUAD) is the most common histological subtype of non-small cell lung cancer with very poor 5-year overall survival (OS) rate. It is histopathologically difficult to predict clinical outcome in early-stage LUAD. Identifying reliable prognostic biomarker is absolutely critical to benefit from early additional treatment for early-stage LUAD patients. The purpose of the current study was to identify critical genes as prognostic biomarkers in early-stage LUAD using gene expression profiles based on the microarray. In this bioinformatics-based cross-study, gene expression profiles from early-stage LUAD, including GSE10072 and GSE19804 genes were integrated using bioinformatics methods, including differentially expressed gene analysis (DEGA), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein-protein interaction (PPI) network construction. Subsequently, the survival analysis of key genes was performed using The Cancer Genome Atlas (TCGA) database and was validated using online Gene Expression Profiling Interactive Analysis (GEPIA) database. A total of 89 up-regulated and 214 down-regulated genes were identified in early-stage LUAD, and the functional changes of 303 differentially expressed genes (DEGs) were mainly related to cell cycle. A PPI network was established by online STRING database with 207 nodes and 775 edges. Centrality analysis showed that CDKN3 and UBE2C genes were identified as key genes implicated in early-stage LUAD. Survival analysis revealed that low mRNA expressions of CDKN3 and UBE2C were significantly associated with longer OS of early-stage LUAD patients. This cross-study found key dysregulated genes involved in early-stage LUAD, which might provide insights into the pathogenesis of early-stage LUAD, and identified UBE2C and CDKN3 might serve as potential diagnostic and prognostic biomarkers and therapeutic targets for early-stage LUAD.

Meningiomas are one of the most common primary brain tumors and the most common intradural spinal tumors. Vascular endothelial growth factor has been demonstrated to play an important role in the stimulation of angiogenesis in many types of cancers. Agents that block the vascular endothelial growth factor pathway, such as bevacizumab, have the capability to decrease vascular permeability. The aim of this study is to evaluate vascular endothelial growth factor expression in meningioma patients. This retrospective, cross-sectional study used an immunohistochemical method to assess vascular endothelial growth factor expression in meningioma. We randomly chose 83 paraffin-embedded tissue blocks of meningiomas diagnosed during 2015 from the files of the Pathology Laboratory of Al-Zahra Hospital, affiliated with Isfahan University of Medical Sciences, Iran. All of the meningioma samples (100%) were vascular endothelial growth factor-immunoreactive. There was a vascular endothelial growth factor score of 1 in 6 (7.2%) cases, a score of 2 in 54 (65.1%) cases, and score of 3 in 23 (27.7%) cases. A correlation existed between vascular endothelial growth factor score and tumor grade. However, there was no correlation between vascular endothelial growth factor score and age and sex of patients. Our study demonstrated a significant role of vascular endothelial growth factor expression in the pathogenesis of peritumoral brain edema in low- and high-grade meningiomas as well as in recurrence or malignant transformation. Thus, anti-vascular endothelial growth factor agents such as bevacizumab might be useful as a treatment of this condition.

Periprosthetic hip infections (PHIs) are troublesome complications of hip arthroplasties. The gold standard procedure for treating chronic PHI is a 2-stage approach. Recently, however, more conservative approaches have been developed to spare the osseointegrated components and avoid sequestra, bone loss, devascularization, and difficult reconstructions. The partial two-stage approach, which leaves the well-fixed component in situ and removes the loosened component, may be an effective strategy.
This paper, a narrative mini-review, analyzed the preliminary results of a partial 2-stage approach to treating chronic hip arthroplasty infections.
Pertinent papers describing the partial 2-stage approach (leaving the well-fixed component in situ and removing the loosened component) were collected and evaluated.
Six main case series were selected. A total of 76 patients were included. Many patients were treated with socket removal and stem retention with quite similar surgical techniques. Many cases included highly virulent bacteria, and no pre-operative selection about comorbidities was performed. The first outcomes of this approach were promising, with a rate of infection control ranging from 81.3% to 100% at mid-term follow-up.
This approach proved good at mid-term follow-up; however, many concerns still exist. In particular, the indications are imprecise, and the role of biofilm is still unclear. Despite the first good outcomes, the partial 2-stage approach for chronic PHI should be validated by multicenter prospective studies.

Small cell lung cancer (SCLC) accounts for 20% of lung cancers with aggressive presentation. Therapies for SCLC have lagged behind the current standard treatment, the prevailing state-of-the-art from the early 1980s. The aim of this study is to report the epidemiological, clinical profile, therapeutic protocols, and results of SCLC in Tunisian population.
This is a retrospective study, including 60 patients treated for histologically diagnosed with SCLC between 2011 and 2015. Only patients with eastern cooperative oncology group (ECOG) performance status 0 to 2 were considered.
Sixty patients were enrolled in this study. The mean age was 61.8 years (range 45 - 77 years). Fifty-five (95%) patients were active smokers. The most frequent symptoms were cough, chest pain, and dyspnea. SCLC was staged as extensive disease in 40 patients (66.7%) and limited disease in 20 cases (33.3%). For diffuse stages, chemotherapy was possible in 34 (85 %) of patients. We observed 2 (5%) complete responses, 9 (22.5%) partial responses, 3 (7.5%) stable diseases, and 9 (22.5%) progressions. Only 11 patients (27.5%) received second line chemotherapy with a median time to progression of 2.2 months. Five patients died, 1 had partial response, and 3 had progressive disease. One patient received third line chemotherapy. For localized stages, 7 (35%) patients received concomitant radiochemotherapy, 5 (25%) primary chemotherapy followed by concomitant radiochemotherapy, and 8 (40%) sequential treatment. Two (10%) patients had complete response, 8 (40%) partial response, 3 (15%) stable disease, 4 (20%) progressive disease, and 1 patient died. Twelve patients relapsed (60%) with a median time to progression of 2 months. Ten patients received relapse chemotherapy. Four patients died from their disease and 4 had a progressive disease. The median survival was 10 months for the overall population, 12.5 months, and 9 months for localized stages and diffuse stages, respectively.
In diffuse SCLC and even with ECOG performance status 0 to 2, first line chemotherapy was feasible in only 85% of cases and second line in only 27.5%. In localized disease, upfront therapy and relapse therapy were possible for 100% and 83% of cases, respectively.

Gastric cancer is one of the most common cancers in the world. There are many genomic and molecular factors that cause gastric cancer to occur. Also, many markers that associate with tumor invasiveness have been known.
E-Cadherin is a calcium- mediated cell adhesion molecule. In some studies, abnormal expression of E-Cadherin has been seen in gastric carcinoma. However, in the studies done there has been some conflicting information about abnormal expression of this marker in a variety of gastric carcinoma and also about the expression of this marker and its correlation with various clinicopathologic factors of tumor.
Subjects and A case control study was performed on total or partial gastrectomy tissue samples obtained from 70 patients with gastric cancer and adjacent non-neoplastic tissues. The immunohistochemistry was used to assess E-Cadherin expression. The correlation between abnormal E-Cadherin expression and tumor histopathology was evaluated in all patients.
Among 70 patients who were analyzed, 48.6% showed abnormal E-Cadherin expression. A significant correlation was seen between abnormal E-Cadherin expression and tumor stage, grade, lymph node metastasis, tumor phenotype, tumor type, depth of invasion and age.
Abnormal E-Cadherin expression is a common phenomenon in gastric cancer. Because there was a strong correlation between abnormal E-Cadherin expression and tumor stage, tumor grade, depth of invasion and regional lymph node involvement, this marker may be used as a predictive factor for tumor invasiveness in gastric cancer.

Despite many advances in the treatment of breast cancer, it is still the second most common cause of death in women in the United States. It has been shown that inflammation plays a major role in the treatment of these cancers and inflammatory factors enhance tumor growth, invasion, metastasis, and vascularization. In this study, we would like to analyze peripheral blood neutrophil-lymphocyte ratio (NLR) in breast cancer patients and its correlation with disease staging. This cross-sectional analytic study was conducted in Imam Hospital, affiliated with Tehran University of Medical Sciences; a total of 195 female patients with breast cancer met the inclusion criteria. All of the patients had a complete blood count with leukocyte differential performed before chemotherapy. Medical records including pathology reports were also available. Data for all patients were collected prior to any surgical intervention. Exclusion criteria included clinical evidence of active infection, presence of hematological disorders, acute as well as chronic inflammatory or autoimmune diseases, or prior steroid therapy. Higher platelet count was significantly associated with the higher stage. The stage was not associated with the hemoglobin level. There was no association between the tumor size and age of patients with NLR. There was a significant relationship between NLR and IDC. There was a significant relationship between IDC and NLRs of less than 8.1 and greater than 3.3. There was a significant relationship between NLR and vascular invasion. There was no association between NLR and estrogen receptor and HER2. There was no significant relationship between the PLR and the cancer stage. In this study, NLR showed a significant relation with the disease staging. As the NLR increases the stage increases as well. Therefore, this ratio may be helpful in the preoperative evaluation of patients with breast cancer.

Chronic hepatitis B infection (CHB) is a major global health problem. Hepatitis B e antigen (HBeAg)-negative is a common type of CHB in Iran. Liver damage in HBeAg-negative CHB leads to progressive form of the liver disease with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings. The aim of this study was to evaluate the association between the biochemical, virologic and histologic features in HBeAg-negative CHB. Furthermore, we assessed the application of new cut-off values for alanine aminotransferase in HBeAg-negative CHB patients.
HBeAg- negative CHB patients referring to hepatology clinics at Ghaem and Imam Reza hospitals during two years period were enrolled. Patients with alcohol consumption, liver mass, fatty liver and whom with positive results of Anti HDV, Anti HCV or Anti HIV were excluded. Liver enzymes were requested and Hepatitis B viral loads were measured by real time polymerase chain reaction (RT-PCR) in all patients. Liver biopsies were assessed by two expert pathologists. The relationship between viral loads, liver enzymes and histopathological features was analyzed using descriptive and analytic statistical methods.
One hundred and fifty HBeAg-negative and HBe Ab-positive CHB patients (males=110, mean age=38.44±11.34 years) were assessed. Serum ALT levels had a significant relation with the logarithm of serum HBV-DNA levels (P In HBeAg-negative CHB patients, serum AST levels had a better predicting value for liver necrosis and inflammation. Moreover, age could be regarded as an independent predictor of the stage of liver fibrosis. This study revealed that the new cutoff values for ALT had superiority over the conventional values to identify patients with a higher risk of liver fibrosis.

Cancer antigen 125 (CA-125) is a glycoprotein biomarker that is used in women with pelvic masses such as endometriosis and maybe is useful in practice of patients suspicious to endometriosis.

The aim of this study was to evaluate the association between preoperative serum CA-125 levels and clinic pathological characteristic in women with endometriosis, and find out the best serum CA-125 levels cut-off in pre and post menopause women.

Serum CA-125 levels in 87 women aged 21-54 years suspected to endometriosis with pelvic pain, dysmenorrhea, or dyspareunia were measured preoperatively. Also the association between clinic pathological characteristic and serum CA-125 level were analyzed.

The mean age of women was 32.22±6.91. The mean serum CA-125 level was 49.93±4.30 U/mL. There was a significant correlation between the endometriosis stage, lesion size, adhesion score and preoperative CA-125 plasma concentration. However, we did not found significant differences in age, marital status, patient’s complaints, and pelvic pain associated to Ca125 serum level. The suggested preoperative serum cut-off levels in premenopausal and postmenopausal patients were 37 U/ml and 35 U/ml, respectively.

According to the results, preoperative serum CA-125 is an important predictor for patients with endometriosis and it should be taken into consideration when surgical management is suspected, especially if stage of disease, lesion size and adhesion score are undertaken.

Bone marrow has recently been recognized as a novel source of stem cells for the treatment of wide range of diseases. A number of studies on murine bone marrow have shown a homogenous population of rare stage-specific embryonic antigen 1 (SSEA-1) positive cells that express markers of pluripotent stem cells. This study focuses on SSEA-1 positive cells isolated from murine bone marrow in an attempt to differentiate them into insulin-secreting cells (ISCs) in order to investigate their differentiation potential for future use in cell therapy. This study is an experimental research. Mouse SSEA-1 positive cells were isolated by Magnetic-activated cell sorting (MACS) followed by characterization with flow cytometry. Induced SSEA-1 positive cells were differentiated into ISCs with specific differentiation media. In order to evaluate differentiation quality and analysis, dithizone (DTZ) staining was use, followed by reverse transcription polymerase chain reaction (RT-PCR), immunocytochemistry and insulin secretion assay. Statistical results were analyzed by one-way ANOVA. The results achieved in this study reveal that mouse bone marrow contains a population of SSEA-1 positive cells that expresses pluripotent stem cells markers such as SSEA-1, octamer-binding transcription factor 4 (OCT-4) detected by immunocytochemistry and C-X-C chemokine receptor type 4 (CXCR4) and stem cell antigen-1 (SCA-1) detected by flow cytometric analysis. SSEA-1 positive cells can differentiate into ISCs cell clusters as evidenced by their DTZ positive staining and expression of genes such as Pdx1 (pancreatic transcription factors), Ngn3 (endocrine progenitor marker), Insulin1 and Insulin2 (pancreaticβ-cell markers). Additionally, our results demonstrate expression of PDX1 and GLUT2 protein and insulin secretion in response to a glucose challenge in the differentiated cells. Our study clearly demonstrates the potential of SSEA-1 positive cells to differentiate into insulin secreting cells in defined culture conditions for clinical applications.

The objective of this study was to investigate the fatigue status and related factors in patients with early-stage non-small cell lung cancer (NSCLC) 1-5 years after surgery. This cross-sectional study included 254 patients with stage IA or IB NSCLC, who had undergone surgery. They completed several surveys, including the Brief Fatigue Inventory, Karnofsky Performance Scale, Physical Activity Questionnaire, Baseline Dyspnea Index, Hospital Anxiety and Depression Scale. The association between fatigue and functional status was assessed using Chi-square analysis. Spearman rank correlation and multivariate logistic regression analysis were used to assess the correlation between fatigue and various other factors. The overall incidence of postoperative fatigue was 59.8%. Among patients with moderate to severe fatigue,21.1% had obvious dysfunction, whereas only 9.6% of patients with mild or no fatigue (?2 = 5.369; P = 0.02) showed obvious dysfunction. Multivariate logistic regression analysis showed that functional status (odds ratio [OR]: 3.57; 95% confidence interval [CI]: 1.17-6.19), concurrent lung disease (OR: 2.34; 95% CI: 1.08-4.99), depression (OR: 6.39; 95% CI: 2.42-17.35), and anxiety (OR: 2.45; 95% CI: 1.13-4.87) were independent risk factors for fatigue, whereas physical activity (OR: 0.27; 95% CI: 0.11-0.73) could prevent fatigue. More than half of the patients with early-stage NSCLC experienced fatigue 1-5 years after surgery, and moderate to severe fatigue was often associated with obvious dysfunction. The strong association of fatigue with anxiety, depression, and lung complications suggests that fatigue and other symptoms constitute a symptom cluster. Therefore, comprehensive treatment methods may achieve better therapeutic results.

Chronic hepatitis is specified as inflammatory disease of the liver lasting for more than six months. Role of noninvasive fibrosis markers as prognostication factors of the presence or absence of significant fibrosis on liver biopsy of patients with chronic hepatitis is the aim of this study. Two hundred twenty-one patients with chronic hepatitis involved in the study between 2011 and 2013. Routine biochemical indices and serum fibrosis markers such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet ratio index (APRI) and Fibrosis 4 score (FIB-4) were evaluated, and the histological grade and stage of the liver biopsy specimens were scored according to the Ishak scoring system. Diagnostic accuracies of these markers for prediction of significant fibrosis were assessed by Receiver Operating Characteristic (ROC) curve analysis. Contemporaneous laboratory indices for imputing AAR, APRI, and FIB-4 were identified with liver biopsies. From all, 135 males (61.1%) and 86 females (38.9%), with mean age of 39.6±14.4 were studied. Significant correlation between stages of fibrosis and FIB-4, APRI and AAR were detected, with a correlation coefficient higher than that of other markers in the patients with Hepatitis B (r = 0.46), C (r = 0.58) and autoimmune hepatitis (r = 0.28). FIB-4 (AUROC = 0.84) and APRI (AUROC = 0.78) were superior to AAR at distinguishing severe fibrosis from mild tomoderate fibrosis and gave the highest diagnostic accuracy. Application of these markers was good at distinguishing significant fibrosis and decreased the need for staging liver biopsy specimens among patients with chronic hepatitis.

Hepatitis activity index (HAI) and fibrosing stage are two important findings during the evaluation of liver samples in patients with chronic hepatitis B. The aim of this study was to determine the HAI and fibrosing stage in patients with anti-HBe positive chronic hepatitis B. Liver biopsy slides of 72 patients were evaluated at the Department of Pathology in two teaching hospitals of Babol University of Medical Sciences, Iran, from April 2006 to August 2011. Total HAI or grading as well as its components including piecemeal necrosis, confluent necrosis, spoty necrosis, portal inflammation and fibrosis scores or staging in considering with viral loads more or less than 105 copies/ml were enumerated according to Ishak scoring system. The mean age of these patients was 34.4±12 years. Fifty-six patients had viral load> 105 copies/ml. Piecemeal necrosis and grading scores with viral load (103,103-105 and >105 copies/ml) were 0.8±0.7, 0.9±0.4, 1.8±1 and 3.8±1.9, 4.4±2, 5.9±2.6, respectively (p=0.005 and p=0.04, respectively). There was not any significant difference with fibrosis stage regarding different viral loads. In total, 18 cases had fibrosis scores > 1 and 24 cases had confluent necrosis. HAI?4 was seen in 29 (60.4%) of the 48 cases without confluent necrosis and in 23 out of 24 cases with confluent necrosis (p=0.007). The results show that piecemeal necrosis and higher grading scores are associated with higher viral loads. The presence of confluent necrosis is associated with more severe diseases.