To assess the clinical relevance of transforming growth factor-beta 1 (TGF-beta 1) in the urine of patients with hepatocellular carcinoma (HCC), TGF-beta 1 was measured, by radioimmunoassay, in 140 patients with HCC, 50 cirrhotic patients, 30 patients with chronic active hepatitis, and 50 healthy controls. The results indicate that there were significantly increased urinary TGF-beta 1 levels in patients with HCC. Raised TGF-beta 1 levels were associated, in a dose-related fashion, with increased risk for development of HCC (odds ratio, 1.05, 95% confidence interval, 1.03-1.07). HCC patients with raised TGF-beta 1 levels had shorter survival than those with normal TGF-beta 1 levels (p = 0.038). TGF-beta 1 levels decreased after successful anticancer therapy (p < 0.0001). There was an inverse correlation between TGF-beta 1 and serum alpha-fetoprotein (AFP) (r = -0.199, p < 0.04). Receiver operating characteristics (ROC) curve analysis indicated that parallel determination of TGF-beta 1 and AFP significantly increased the sensitivity and diagnostic accuracy, with a high specificity. In conclusion, raised urinary TGF-beta 1 was associated with HCC development. It is a predictor of poor prognosis, and a tumor marker for diagnosis and therapeutic follow-up of HCC.

Summary To evaluate the diagnostic application of urinary transforming growth factor-o1 and serum a-fetoprotein (AFP) levels in hepatocellular carcinoma (HCC), TGF-,B1 and AFP were determined in 94 patients with cirrhotic HCC and in 94 sex-and age-matched patients with cirrhosis alone. TGF-01 and AFP levels in HCC were higher than in cirrhosis alone (P = 0.0001). There is an inverse correlation between TGF-f1 and log AFP (r = -0.292, P = 0.004). Multivariate analysis indicated that TGF-j1 and AFP were closely associated, in a dose-related fashion, with the development of HCC. Receiver-operating characteristic (ROC) curves were used to determine the optimal cutoff values of TGF-01 (50 gg g-1 creatinine) and AFP (100 ng ml-'). Both TGF-p1 and AFP showed a high specificity (99%) and positive likelihood ratio. The sensitivity was 53.1% for TGF-f1 and 55.3% for AFP. The determination of both markers in parallel significantly increased the diagnostic accuracy (90.1%) and sensitivity (84%), with a high specificity (98%) and positive likelihood ratio (40.0). In conclusion, TGF-f1 and AFP are independent tumour markers of HCC and may be used as complementary tumour markers to discriminate HCC from cirrhosis.

Background: There are few reports in the literature of invasive infection caused by Brevundimonas vesicularis in patients without immunosuppression or other predisposing factors. The choice of antimicrobial therapy for bacteremia caused by the pathogen requires more case experience to be determined.

Summary To assess the clinical relevance of transforming growth factor-jl (TGF-jl) in hepatocellular carcinoma (HCC), urinary TGF-jl and serum a-fetoprotein (AFP) were determined in 94 patients with cirrhotic HCC, 94 age-and sex-matched patients with cirrhosis alone and 50 healthy adults. TGF-,1l level in HCC was higher than in cirrhosis alone or in healthy controls (each P = 0.0001). There is an inverse correlation between TGF-j1 and AFP levels (r = -0.292, P = 0.004). Significantly higher TGF-p1 level was found in HCC patients with worsening Child-Pugh stages, diffuse HCC, tumour size 2 3 cm, multilobular tumour and AFP < 20 ng ml-'. TGF-j1 level decreased after complete treatment with transcatheter arterial chemoembolization (P = 0.0001). The median survival in HCC patients with raised TGF-j1 was shorter than those with normal TGF-,lB (P = 0.018). Multivariate analysis indicated that TGF-p1 and AFP were significantly correlated with the presence of HCC. In addition, TGF-p1 could be used as a diagnostic marker for HCC, particularly in tumours with low AFP production. In conclusion, elevated urinary TGF-j1 level is a tumour marker and predictor of poor survival for cirrhotic HCC.