Assessment of the Remineralizing Efficacy of Grape Seed Extract vs Sodium Fluoride on Surface and Subsurface Enamel Lesions: An In Vitro Study.

AIM: The aim of this study was to evaluate the efficacy of grape seed extract (GSE) on remineralization of surface and subsurface enamel lesions compared to that of sodium fluoride (NaF). MATERIALS AND METHODS: A total of 20 intact bovine incisor crowns were separated from their roots and immersed in a demineralizing solution for 96 hours at 37°C to create artificial enamel lesions. The specimens were randomly divided into two groups (n = 10): 6.5% GSE solution and 1000 ppm NaF solution. The specimens were subjected to six daily pH cycles for 8 days. The microhardness test was carried out at three different stages: baseline, after artificial caries formation, and after pH cycling. Raman spectroscopy was used to evaluate the depth of enamel remineralization. Surface morphology and elemental analysis were assessed using a scanning electron microscope (SEM) and an energy dispersive X-ray (EDX) spectroscope, respectively. Statistical analysis was performed using SPSS 22.0 at a significance level of p ≤ 0.05. RESULTS: There was a significant increase in the mean values of enamel surface microhardness after pH cycles in the two groups compared to after artificial caries formation, but there was no significant difference between both groups. The B-type carbonate/phosphate (Ca/P) ratio at 10 and 40 µm depth revealed no significant difference between the two groups. Scanning electron microscope micrograph revealed occlusion of porosities and particle precipitation on the enamel surface of the two groups, while EDX results for the Ca/P ratio of the GSE and NaF groups were 1.59 and 1.60, respectively. CONCLUSION: Grape seed extract and NaF are equally effective in remineralizing surface and subsurface artificial enamel lesions. CLINICAL SIGNIFICANCE: Grape seed extract can be considered a promising herbal material and a safe alternative to traditional NaF for the noninvasive treatment of enamel lesions.

The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation.

BACKGROUND: The purpose of the study was to evaluate the role of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnostics and management of abnormal placentation in women with placenta previa and to compare the morbidity associated with that to placenta previa alone. MATERIAL/METHODS: The study includes 100 pregnant women with placenta previa with and without abnormal placentation. The results of MRI and US in abnormal placentation were compared with post-operative data. The patients' files were reviewed for assessment of operative and post-operative morbidity. The results of our statistical analysis were compared with data from the literature. RESULTS: US and MRI showed no significant difference in sensitivity and specificity in diagnosing abnormal placentation (97-100% and 94-100%, respectively). MRI was more sensitive than US for the detection of myometrial invasion and the type of abnormal placentation (73.5% and 47%, respectively). The difference between pre- and post-operative hemoglobin values and estimated blood loss were the most significant risk factors for abnormal placentation, added to risk factors known for placenta previa. Post-partum surgical complications and prolonged hospital stay were more common in the cases of placenta previa with abnormal placentation, however statistically insignificant. CONCLUSIONS: US and MRI are accurate imaging modalities for diagnosing abnormal placentation. MRI was more sensitive for the detection of the degree of placental invasion. The patient's morbidity increased in cases with abnormal placentation. There was no significant difference in post operative-complications and hospitalization time due to pre-operative planning when the diagnosis was established with US and MRI.

Neuronal CBP-1 is required for enhanced body muscle proteostasis in response to reduced translation downstream of mTOR.

Background: The ability to maintain muscle function decreases with age and loss of proteostatic function. Diet, drugs, and genetic interventions that restrict nutrients or nutrient signaling help preserve long-term muscle function and slow age-related decline. Previously, it was shown that attenuating protein synthesis downstream of the mechanistic target of rapamycin (mTOR) gradually increases expression of heat shock response (HSR) genes in a manner that correlates with increased resilience to protein unfolding stress. Here, we investigate the role of specific tissues in mediating the cytoprotective effects of low translation. Methods: This study uses genetic tools (transgenic C. elegans , RNA interference and gene expression analysis) as well as physiological assays (survival and paralysis assays) in order to better understand how specific tissues contribute to adaptive changes involving cellular cross-talk that enhance proteostasis under low translation conditions. Results: We use the C. elegans system to show that lowering translation in neurons or the germline increases heat shock gene expression and survival under conditions of heat stress. In addition, we find that low translation in these tissues protects motility in a body muscle-specific model of proteotoxicity that results in paralysis. Low translation in neurons or germline also results in increased expression of certain muscle regulatory and structural genes, reversing reduced expression normally observed with aging in C. elegans . Enhanced resilience to protein unfolding stress requires neuronal expression of cbp-1 . Conclusion: Low translation in either neurons or the germline orchestrate protective adaptation in other tissues, including body muscle.

Neuronal CBP-1 is Required for Enhanced Body Muscle Proteostasis in Response to Reduced Translation Downstream of mTOR.

BACKGROUND: The ability to maintain muscle function decreases with age and loss of proteostatic function. Diet, drugs, and genetic interventions that restrict nutrients or nutrient signaling help preserve long-term muscle function and slow age-related decline. Previously, it was shown that attenuating protein synthesis downstream of the mechanistic target of rapamycin (mTOR) gradually increases expression of heat shock response (HSR) genes in a manner that correlates with increased resilience to protein unfolding stress. Here, we investigate the role of specific tissues in mediating the cytoprotective effects of low translation. METHODS: This study uses genetic tools (transgenic Caenorhabditis elegans (C. elegans), RNA interference and gene expression analysis) as well as physiological assays (survival and paralysis assays) in order to better understand how specific tissues contribute to adaptive changes involving cellular cross-talk that enhance proteostasis under low translation conditions. RESULTS: We use the C. elegans system to show that lowering translation in neurons or the germline increases heat shock gene expression and survival under conditions of heat stress. In addition, we find that low translation in these tissues protects motility in a body muscle-specific model of proteotoxicity that results in paralysis. Low translation in neurons or germline also results in increased expression of certain muscle regulatory and structural genes, reversing reduced expression normally observed with aging in C. elegans. Enhanced resilience to protein unfolding stress requires neuronal expression of cbp-1. CONCLUSIONS: Low translation in either neurons or the germline orchestrate protective adaptation in other tissues, including body muscle.

Anabolic Function Downstream of TOR Controls Trade-offs Between Longevity and Reproduction at the Level of Specific Tissues in C. elegans.

As the most energetically expensive cellular process, translation must be finely tuned to environmental conditions. Dietary restriction attenuates signaling through the nutrient sensing mTOR pathway, which reduces translation and redirects resources to preserve the soma. These responses are associated with increased lifespan but also anabolic impairment, phenotypes also observed when translation is genetically suppressed. Here, we restricted translation downstream of mTOR separately in major tissues in C. elegans to better understand their roles in systemic adaptation and whether consequences to anabolic impairment were separable from positive effects on lifespan. Lowering translation in neurons, hypodermis, or germline tissue led to increased lifespan under well-fed conditions and improved survival upon withdrawal of food, indicating that these are key tissues coordinating enhanced survival when protein synthesis is reduced. Surprisingly, lowering translation in body muscle during development shortened lifespan while accelerating and increasing reproduction, a reversal of phenotypic trade-offs associated with systemic translation suppression. Suppressing mTORC1 selectively in body muscle also increased reproduction while slowing motility during development. In nature, this may be indicative of reduced energy expenditure related to foraging, acting as a "GO!" signal for reproduction. Together, results indicate that low translation in different tissues helps direct distinct systemic adaptations and suggest that unknown endocrine signals mediate these responses. Furthermore, mTOR or translation inhibitory therapeutics that target specific tissues may achieve desired interventions to aging without loss of whole-body anabolism.

Chorionic Bump: Radiologic Features and Pregnancy Outcomes.

Background Chorionic bump is a rare condition defined as a bulge or protrusion from the choriodecidual surface into the gestational sac. The limited literature on this infrequent entity suggests that the pregnancies with multiple chorionic bumps mostly result in fetal demise. Aims To review the available literature and the patients from our institute having sonographic findings of chorionic bump and making the sonographers and radiologists aware of this known cause of first-trimester pregnancy loss. Study design A retrospective review of the cases diagnosed at our institute during the last four years. Methods and materials Single-center institutional data for four years (January 2016-December 2019) was accessed using ICD codes. IRB approval was waived owing to the anonymized use of patient data. Results Six female patients diagnosed with chorionic bump were included, with a mean age of 29.83±12 years. The average gestational age at the time of diagnosis was 8.16±3 weeks. The most common sonographic findings were a protrusion from the chorionic wall into the gestational sac cavity, having a central hypoechoic region with peripheral hyperechoic rim (isoechoic to the chorion) and having no vascularity (n=5), and the less common finding was a hyperechoic protrusion with no vascularity (n=1). n=5 had a single lesion, and n=1 had two lesions. The average diameter of the lesion in the largest dimension was 18±11 mm. n=3 pregnancies resulted in a first-trimester miscarriage, and n=3 pregnancies delivered healthy babies at term.  Conclusions A chorionic bump significantly increases the risk of a first-trimester miscarriage.

A New Mutual Information Measure to Estimate Functional Connectivity: Preliminary Study.

Functional Connectivity (FC) is a powerful tool to investigate brain networks both in rest and while performing tasks. Functional magnetic resonance imaging (fMRI) gave good spatial estimation of FC but lacked the temporal resolution. Electroencephalography (EEG) allows estimating FC with good temporal resolution. In this study we introduce a new method based on Mutual Information and Multivariate Improved Weighted Multi-scale Permutation Entropy to estimate FC of brain using EEG. We applied this method on resting-state EEG signals from healthy children. Using network measures of nodes and Wilcoxon signed-rank test, we identified the most important nodes in the estimated networks. Comparing the localization of those outstanding nodes with the regions involved in resting-state networks (RSNs) estimated from fMRI showed that our proposal is efficient in the identification of nodes belonging to RSNs and could be used as a general estimator for FC without having to band-pass the signals into frequency bands.

Multichannel Time-Frequency Complexity Measures for the Analysis of Age-Related Changes in Neuromagnetic Resting-State Activity.

We propose new multichannel time-frequency complexity measures to evaluate differences on magnetoencephalograpy (MEG) recordings between healthy young and old subjects at rest at different spatial scales. After reviewing the Rényi and singular value decomposition entropies based on time-frequency representations, we introduce multichannel generalizations, using multilinear singular value decomposition for one of them. We test these quantities on synthetic data, illustrating how the introduced complexity measures focus on number of components, nonstationarity, and similarity across channels. Friedman tests are used to confirm the differences between young and old groups, and heterogeneity within groups. Experimental results show a consistent increase in complexity measures for the old group. When analyzing the topographical distribution of complexity values, we found clusters in the frontal sensors. The complexity measures here introduced seem to be a better indicator of the neurophysiologic changes of aging than power envelope connectivity. Here, we applied new multichannel time-frequency complexity measures to resting-state MEG recordings from healthy young and old subjects. We showed that these features are able to reveal regional clusters. The multichannel time-frequency complexities can be used to monitor the aging of subjects. They also allow a mutual information approach, and could be applied to a wider range of problems.

Clinical evaluation of a self-etch adhesive in non-carious cervical lesions.

PURPOSE: To evaluate the clinical performance of a self-etching adhesive in Class V non-carious lesions with and without acid etching procedures. METHODS: A total of 125 Class V non-carious cervical lesions (NCCL) with incisal or occlusal margins in enamel and gingival margins in dentin/cementum were selected and restored with Clearfil SE Bond self-etch adhesive and Clearfil APX resin composite. All cavities were restored using two techniques; after etching the whole cavity for 20 seconds and without acid etching (control). The restorations were evaluated at baseline, 1- and 2-year using modified USPHS criteria. RESULTS: No loss of restorations was recorded after 1 and 2 years for the two restorative techniques. There was no significant difference between the baseline and 2-year results for any of the tested technique. However, restorations made after acid etching showed less marginal discoloration at the enamel margins.

Prevalence and characteristics of tricuspid valve endocarditis among patients presented to Ain Shams Hospital echocardiography lab; one year study.

BACKGROUND: Isolated Tricuspid valve infective endocarditis is an infrequent diagnosis, the incidence of Tricuspid valve infective endocarditis accounts for 5% and up to 15% of IE cases. AIM: To assess the prevalence and the echocardiographic characteristics of tricuspid valve endocarditis among patients presented to the echo lab of Ain Shams hospital from 1-1-2016 to 1-1-2017. METHODS: This is a retrospective study which included all patients presented to the echo lab of Ain Shams university hospital from 1st January 2016 to 1st January 2017, the total number of patients were 8376, patients with infective endocarditis were 278, and patients with tricuspid valve endocarditis were 51 patients respectively. Complete transthoracic echocardiography was done for all patients and data was retrieved from a locally designed electronic database of cardiology department at Ain shams hospitals. RESULTS: The incidence of TVIE was (17.7%) of all cases of IE, and (0.67%) of all cases attending the echo lab during the study period. The mean age group in our study was (31.1 ±â€¯7.8) and about 84.3% of patient's age was between 20 and 40 years. Higher incidence of IE was in males (90.2%) than in females (9.8%) with a ratio of 9:1. The vegetations were detected in one leaflet in 33 patients (64.7%), two leaflets in 9 patients (17.6%) and in the three TV leaflets in 7 patients (13.7). The most affected leaflet was the anterior leaflet that was affected in 38 patients constituting about 74.5% of patients. The size of vegetations was large >15 mm in 40 patients (78.4%).The most encountered echocardiographic complication was severe TR, detected in 40 patients (78.4%) and abscess formation was the least present, detected in only 2 patients (3.9%). CONCLUSION: The incidence of TV IE is increasing with male gender predominance, and affects mainly young age groups. TV IE represented 0.6% of all patients, and 17.7% of IE cases. The main echocardiographic feature of TV IE is vegetations which were characterized by being large, highly mobile, and affecting mainly anterior TV leaflet. The main echocardiographic complication is severe TR, but abscess formation was infrequent.

Clinical study of different composite resin systems in Class I cavities (an 18-month randomized clinical trial) / Estudo clínico de diferentes sistemas de resina composta em cavidades de Classe I (um ensaio clínico randomizado de 18 meses)

Objective: this double-blind randomized clinical trial evaluate the clinical performance of Thermo-Viscous Bulk Fill composite, Self-Adhesive Flowable composite, and Filtek Bulk Fill Composites restorations in Class I cavities over a period of 18 months. Material and Methods: twenty individuals between the ages of 30 and 45 participated in this research. Each patient should have at least three occlusal Class I carious lesions on their molars. They were dispersed at random, with n=20 teeth representing each tested material. Group I (Futurabond M+ and VisCalor Bulk Fill which heated in a viscolar dispenser at 68 °C for 30s and placed in a 4 mm thickness), Group II (Fusio Liquid Dentin self-adhesive composite which put in a thin layer (1mm increment)), and Group III (Single Bond Universal and Filtek Bulk Fill Posterior composite which applied in 4 mm thickness without heating). Using (USPHS) criteria, all restorations were assessed clinically at baseline, 6 months, 12 months, and 18 months. Using an inverse replica, the marginal seal of the investigated restorations was further evaluated under SEM. Statistical analysis was performed with Chi-square test for all USPH parameters. Results: the three tested groups recorded a one hundred percent retention rate after 18 months follow up period. Concerning marginal adaptation, marginal discoloration, anatomical form, surface texture, and color matching, there was a significant difference (p˂0.05) between the three tested groups after 12 & 18 months. After 12 & 18 months, SEM analysis of the marginal seal revealed a statistically significant difference between the three groups. Conclusion: Bulk fill resin composite restorations showed satisfactory acceptable clinical performance after 18 months of clinical service compared to self-adhesive flowable composites, and Viscalor Bulk Fill composite demonstrated excellent results with considerable changes in marginal integrity as a consequence of thermal viscous technology and increased adaptability of restorations toward cavity walls and margins (AU)

Objetivo: este ensaio clínico randomizado duplo-cego avaliou o desempenho clínico de restaurações de resina Bulk Fill Termo-Viscosa, resina autoadesiva Flowable e Filtek Bulk Fill Composites em cavidades Classe I durante um período de 18 meses. Material e Métodos: 20 indivíduos com idade entre 30 e 45 anos participaram da pesquisa. Cada paciente deveria ter pelo menos três lesões de cárie oclusais de Classe I nos molares. Eles foram divididos aleatoriamente, com n=20 dentes representando cada material testado. Grupo I (Futurabond M+ e VisCalor Bulk Fill aquecido em dispensador viscolar a 68 °C por 30s e colocado em uma espessura de 4 mm), Grupo II (resina composta autoadesiva Fusio Liquid Dentin colocada em uma camada fina (incremento de 1 mm)) e Grupo III (resina composta Single Bond Universal e Filtek Bulk Fill Posterior aplicado em espessura de 4 mm sem aquecimento). Usando os critérios (USPHS), todas as restaurações foram avaliadas clinicamente no início, 6 meses, 12 meses e 18 meses. Usando uma réplica inversa, o selamento marginal das restaurações investigadas foi avaliado em MEV. A análise estatística foi realizada com o teste qui-quadrado para todos os parâmetros USPH. Resultados: os três grupos testados registraram uma taxa de retenção de cem por cento após um período de acompanhamento de 18 meses. Em relação à adaptação marginal, descoloração marginal, forma anatômica, textura da superfície e combinação de cores, houve uma diferença significativa (p˂0,05) entre os três grupos testados após 12 e 18 meses. Após 12 e 18 meses, a análise SEM do selamento marginal revelou uma diferença estatisticamente significativa entre os três grupos. Conclusão: as restaurações de resina composta Bulk Fill apresentaram desempenho clínico aceitável satisfatório após 18 meses de atendimento clínico em comparação com as resinas compostas fluidas autoadesivas, e a resina composta Viscalor Bulk Fill demonstrou excelentes resultados com mudanças consideráveis na integridade marginal, como consequência da tecnologia viscosa térmica e maior adaptabilidade de restaurações nas paredes e margens da cavidade (AU)

Time-Varying Time-Frequency Complexity Measures for Epileptic EEG Data Analysis.

OBJECTIVE: Our goal is to use existing and to propose new time-frequency entropy measures that objectively evaluate the improvement on epileptic patients after medication by studying their resting state electroencephalography (EEG) recordings. An increase in the complexity of the signals would confirm an improvement in the general state of the patient. METHODS: We review the Rényi entropy based on time-frequency representations, along with its time-varying version. We also discuss the entropy based on singular value decomposition computed from a time-frequency representation, and introduce its corresponding time-dependant version. We test these quantities on synthetic data. Friedman tests are used to confirm the differences between signals (before and after proper medication). Principal component analysis is used for dimensional reduction prior to a simple threshold discrimination. RESULTS: Experimental results show a consistent increase in complexity measures in the different regions of the brain. These findings suggest that extracted features can be used to monitor treatment. When combined, they are useful for classification purposes, with areas under ROC curves higher than 0.93 in some regions. CONCLUSION: Here we applied time-frequency complexity measures to resting state EEG signals from epileptic patients for the first time. We also introduced a new time-varying complexity measure. We showed that these features are able to evaluate the treatment of the patient, and to perform classification. SIGNIFICANCE: The time-frequency complexities, and their time-varying versions, can be used to monitor the treatment of epileptic patients. They could be applied to a wider range of problems.

Diagnostic Value of Glypican-3 for Hepatocellular Carcinomas

Background: Hepatocellular carcinoma (HCC) is a common and dangerous malignancy in many parts of the world, and especially in Egypt. Early diagnosis is the most important step in successful HCC management. However most cases are detected at late stage making effective intervention impossible. Aim: The aim of this study was to evaluate the potential of Glypican-3 (GPC-3) to aid in diagnosis of HCC, especially in patients with low serum alpha-fetoprotein (AFP). Subjects and methods: Serum GPC-3 was assessed by flow-cytometry and serum AFP by enzyme-linked immunosorbent assay (ELISA) in 40 HCC patients with AFP< 400ug\l. (GI), 40 HCC patients with AFP> 400ug\l. (GII) and 20 healthy controls (GIII). Results: GPC-3 was found to be significantly elevated in HCC as compared to healthy subjects (GI 38.2±22. 5, GII 50.2±22.6, and GIII 2.24±1.19), with sensitivities of 85% for GI and 84% for GII and specificities of 95% for GI and 92% for GII. AFP showed respective sensitivities of 50% and 79%, and specificities of 80% and 90%, for HCC diagnosis. The combination of GPC-3 with AFP achieved the highest sensitivity (98.5%) and specificity (97.8%). Conclusion: Serum GPC-3 has a better sensitivity than AFP for the diagnosis of HCC. Combination of two markers appears warranted for greatest accuracy.

Proteinuria in Egyptian renal transplant recipients.

To evaluate the prevalence, risk factors, possible etiology, prognosis and management of proteinuria in renal transplant recipients, we studied 435 adult renal transplant recipient patients randomly selected from our center; 394 patients were reviewed retrospectively and 41 patients were followed-up prospectively for a period of one year. The patients were classified into three groups according to the results of urinalysis and spot urinary albumin creatinine ratio: Group A patients with normoalbuminuria; Group B patients with microalbuminuria; and Group C patients with macroalbuminuria. Persistent post-transplantation proteinuria was detected in 125 (28.8%) patients. The etiology of post-transplantation proteinuria included chronic allograft dysfunction in 44 (35.2%) patients, acute rejection in 40 (32%) patients, transplant glomerulopathy in eight (6.4%) patients, glomerular disease in 16 (12.8%) patients and other etiology in 17 (13.6%) patients. Proteinuric patients demonstrated significantly lower graft survival rates than did those without proteinuria (48.3% versus 51.7%, respectively; P = 0.017; Risk Ratio = 0.403; 95% confidence interval 0.188-0.862). We conclude that proteinuria is prevalent after kidney transplant in our population, and that it is most commonly associated with chronic allograft nephropathy, transplant glomerulopathy, glomerulonephritis and acute rejection. Post-transplant proteinuria is associated with decreased allograft survival.

Predictive accuracy of serum hyaluronic acid as a non-invasive marker of fibrosis in a cohort of multi-transfused Egyptian children with ß-thalassaemia major.

BACKGROUND AND STUDY AIM: Liver disease remains a major cause of morbidity and mortality in patients with ß-thalassaemia major (ß-TM); therefore, its identification at an early stage is of great significance. Serum hyaluronic acid (HA) is considered as a non-invasive marker that appears early before pathological changes occur. We aim to determine the predictive accuracy of HA in detecting and staging hepatic fibrosis in ß-TM patients. PATIENTS AND METHODS: 30 Egyptian children with ß-TM, and 15 age and sex-matched controls were studied. All had abdominal ultrasonography (US), measurement of serum amino-transferases (ALT, AST); hepatitis C, B and human immunodeficiency viruses (HCV, HBV, HIV) sero-markers, serum ferritin and HA. Liver biopsy was done for patients and fibrosis was scaled using Metavir scoring system and liver iron concentration (LIC) was measured. RESULTS: Twenty patients (67.7%) had sero-markers of HCV, none had HBV or HIV. Serum HA was significantly higher in patients (90.78±28.79 ng/ml) compared to controls (21.1±13.24 ng/ml) with p<0.05. No difference between HCV infected and non-infected patients was detected. Positive significant correlation was detected between serum HA and stages of fibrosis by histopathology and US. No correlation was found between serum HA and age, sex, weight, height, haemoglobin level, platelet count, AST, serum ferritin, necro-inflammatory grade, and LIC. CONCLUSIONS: Serum HA is a valuable non-invasive marker that may contribute to the assessment of liver fibrosis in multi-transfused children and adolescents with ß-TM, irrespective of concomitant HCV infection.

Noninvasive assessment of hepatic fibrosis and necroinflammatory activity in Egyptian children with chronic hepatitis C virus infection using FibroTest and ActiTest.

BACKGROUND: Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatic fibrosis. Liver biopsy, because of its limitations and risks, might be considered an imperfect gold standard for assessing the severity of chronic liver diseases. In this study, we aimed to prospectively validate FibroTest (FT) and ActiTest (AT) as noninvasive serum biochemical markers for assessment of the degree of hepatic fibrosis and necroinflammatory activity respectively, in pediatric patients with chronic HCV infection and compare them to liver biopsy. METHODS: Fifty patients, aged 2 to 18 years, with chronic HCV infection were prospectively enrolled. Two assessments were carried out, within 24-h duration, one of a liver biopsy specimen and the other FT and AT measured in serum sample. FINDINGS: A highly significant linear trend and correlation were found between FT-related fibrosis and fibrosis stage by METAVIR scoring on histopathological examination. A highly significant correlation was also found between AT and necroinflammatory histological activity using METAVIR as well. The FT area under the receiver operating characteristic curve (AUROC) is 0.97, SE=0.02 which can diagnose patients with mild stage of fibrosis, thus discriminating them from those with no (or minimal) fibrosis. The AT can successfully discriminate between patients with moderate activity and those with mild activity with AUROC=0.93, SE=0.06. CONCLUSION: FT and AT are potential noninvasive methods for assessment of hepatic fibrosis and necroinflammatory activity in pediatric patients with chronic HCV infection in comparison with liver biopsy.