There is no clinically applicable biomarker for surveillance of hepatocellular carcinoma (HCC), because the sensitivity of serum alpha-fetoprotein (AFP) is too low for this purpose. Here, we determined the diagnostic performance of a panel of urinary metabolites of HCC patients from West Africa. Urine samples were collected from Nigerian and Gambian patients recruited on the case-control platform of the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) program. Urinary proton nuclear magnetic resonance ( 1 H-NMR) spectroscopy was used to metabolically phenotype 290 subjects: 63 with HCC; 32 with cirrhosis (Cir); 107 with noncirrhotic liver disease (DC); and 88 normal control (NC) healthy volunteers. Urine samples from a further cohort of 463 subjects (141 HCC, 56 Cir, 178 DC, and 88 NC) were analyzed, the results of which validated the initial cohort. The urinary metabotype of patients with HCC was distinct from those with Cir, DC, and NC with areas under the receiver operating characteristic ( Metabolites that were significantly increased in urine of HCC patients, and which correlated with clinical stage of HCC, were NAA, dimethylglycine, 1-methylnicotinamide, methionine, acetylcarnitine, 2-oxoglutarate, choline, and creatine. Conclusion: The urinary metabotyping of this West African cohort identified and validated a metabolite panel that diagnostically outperforms serum AFP. (HEPATOLOGY 2014;60:1291-1301

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This paper explores how criticism surrounding the ethics and safety of biomedical technologies circulates and ‘converts’ through global–local religious encounters, producing new claims of moral opposition and rights to religious freedom. The paper is concerned with the question of what rhetorical devices make vaccine safety doubt relevant to religiously Orthodox settings and what implications arise? Based on an ethnographic study of vaccine decision-making and non-vaccination advocacy in Jerusalem, the paper examines how opposition is forged amidst evolving global–local encounters and relations. The data reveal how Christian activists attempt to engender ethical and moral opposition to vaccination among American Orthodox Jews in Jerusalem by ‘converting’ public criticism around safety into a religious discourse of bodily governance. Pinpointing how critiques of biomedical technologies discursively ‘convert’ offers a conceptual template in anthropology to chart how counter-positions are formed and transformed amidst evolving tensions between biomedical and religious cosmologies.