ABSTRACT
Many clinical trials and natural history studies on nonalcoholic fatty liver disease [NAFLD] and nonalcoholic steatohepatitis [NASH] rely heavily on liver histology to define their endpoints. There are many indications that the liver is not uniformly involved in NAFLD thus sampling error is a major concern. This study aims to evaluate the uniformity of various histologic features in livers affected with NAFLD. Samples from a forensic autopsy series were studied and subjects with NAFLD identified. We took specimens from three different parts of each liver and recorded the degrees of steatosis, hepatocyte ballooning, lobular inflammation, portal inflammation, and fibrosis. A NASH activity index [NAI] which is the sum of scores of histologic features was also calculated. The agreement between the 3 samples from each liver was studied. There were 945 autopsies performed; 896 were suitable for histologic evaluation and 283 had NAFLD. Of these, 146 livers were available to our study from which 438 samples were taken. Fibrosis [intra-class correlation [ICC] = 0.87], lobular inflammation [kappa = 0.83], and portal inflammation [kappa = 0.83] were fairly uniformly distributed in the damaged liver. Steatosis was less uniform [kappa = 0.64], and hepatocyte ballooning was least uniformly distributed [kappa = 0.57]. The ICC for NAI was 0.86, which indicated good agreement. The individual histologic features of NAFLD and NASH are not uniformly distributed in the liver. Hepatocyte ballooning is especially non-uniform. Such non-uniformity should be taken into account when interpreting results of studies that rely on paired biopsies. A summary score such as NAI is less affected by sampling error
Subject(s)
Humans , Male , Female , Selection Bias , Autopsy , Biopsy , Liver/pathologyABSTRACT
Golestan Province, at the western end of the Asian esophageal cancer [EC] belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry [GPCR]. The GPCR collected data from newly diagnosed [incident] cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer [IARC]. Age-standardized incidence rates [ASR] of cancers were calculated using the 2000 world standard population. From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean [SD] age was 55.5 [18.6] years, and 54% were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach [ASR:30.7], esophagus [24.3], and lung [15.4] were the most common cancers in males. In females, breast cancer [ASR:26.9] was followed by malignancies of the esophagus [19.1] and stomach [12.4]. The diagnosis of cancer was based on histopatho-logical reports in 71% and on death certificate only in 9% of cases. The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase
ABSTRACT
In older studies, the seroprevalence of hepatitis A virus infection has been reported to be over 95% in Iranians. Most of these studies were performed on volunteer blood donors. Studies on the general population are sparse. The purpose of this study was to determine the current seroprevalence of hepatitis A virus infection in the general population of Iran. During 2006, 1869 subjects between 18 and 65 years of age were randomly selected from the general population of three Iranian provinces [Tehran, Golestan, and Hormozgan]. Subjects were interviewed and a plasma sample was obtained for serologic testing for anti-hepatitis A virus. Univariate and multivariate analysis was performed to identify risk factors. The seroprevalence of hepatitis A virus in Tehran, Golestan and Hormozgan was 85%, 99%, and 96%, respectively. The overall seroprevalence of hepatitis A virus in the general population of the three provinces studied was 86% and did not differ between the two genders. The prevalence in younger subjects and in urban populations was under 70%. In multivariate analysis, older age, being married, and level of the father's education was associated with hepatitis A virus seropositivity. The seroprevalence of hepatitis A virus still appears to be too elevated for recommending routine vaccination in the general population. However, the trend towards a lower prevalence in younger age groups and people from urban areas points towards the possible benefit of vaccination in these subgroups