Errata is tipped in behind bibliography. / Bibliography: leaves 191-215. / xiv, 216, [29] leaves, [81] leaves of plates : ill. (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Reports the partial cloning and characterisation of the human uroplakin 1B gene which has allowed analysis and characterisation of the gene with regard to its structure, chromosomal localisation and integrity. / Thesis (Ph.D.)--University of Adelaide, Dept. of Surgery, 1999?

Cancer is one of the greatest causes of death in modern societies, affecting over 350,000 new cases every year in the UK. Although there are currently more than 100 different cancer types, breast and prostate cancer remain the most common types for women and men respectively. A number of different cancer types follow, with bladder cancer being the ninth most significant type, accounting for 3% of the total new cases. The currently employed techniques aim to diagnose the cancer at an early stage, where the symptoms are easier to be treated and the disease more likely to be cured. A further issue is that many cancers diagnosed will not affect a patient in their lifetime. The current gold standard for cancer diagnosis, biopsy followed by histopathology, is an invasive, restrictive technique and the screening tests suffer from low specificity, the need for a novel diagnostic concept is vital. Furthermore, the current clinical approach does not identify those patients most at risk of advancing disease. A promising approach consists of molecular vibrational spectroscopy techniques, which are based on the interactions of light with matter. One of these is Raman spectroscopy, a technique with wide applications in research and industry, which has the advantage of being non-invasive and chemically highly specific. In this thesis we explore the potential of a group of minimally invasive diagnostic techniques, based on Raman scattering, for prostate, breast and bladder cancer. In the case of the two most prevalent types of cancer, prostate and breast cancer, deep Raman spectroscopy has been employed to study the origin of Raman scattering (Chapters 5 and 6) in animal tissue and tissue phantoms, containing highly scattering materials resembling suspicious features found in tissues (calcifications). The spatial distribution of the Raman signal through the sample volume has been studied in relation to the optical properties and the composition of the sample, showing that a couple of transmission measurements would potentially cover the measuring volume of prostate of typical dimensions. Deep Raman measurements were also extended to animal and human tissue samples, in order to investigate the feasibility of collecting Raman scattering from human prostate tissue and its major tissue components (Chapter 6). Further improvements on these measurements were attempted by introducing the ‘’photon diode’’ element (Chapter 7) in order to achieve signal enhancement, which proved to be in the range of ×1-2.4, depending on the optical properties of the tissue and the depth of the probing element. The same ‘’photon diode’’ concept was utilised to attempt depth prediction of a calcification feature in sample volume (Chapter 8). Regarding bladder cancer, the minimally invasive approach adopted was Raman spectroscopy on urine samples, rather than deep Raman spectroscopy. Raman microscopy was employed in order to discriminate pathological features of bladder cancer between healthy and malignant urine samples. For that reason, the potential differences in urea’s distribution and interactions in urine from healthy and patients with bladder cancer were studied, resulting in promising diagnostic values (73% sensitivity, 80% specificity). The results presented in this thesis are expected to lead to a better understanding of the Raman scattering signals collection through biological tissues and help in this way the future design of Raman instruments aiming to target disease specific signals. This study shows promise for future application of Raman spectroscopy and paves the way towards the future integration of Raman spectroscopy in a non-invasive cancer diagnosis.

Diabetes is a chronic and debilitating disease that affects nearly half a billion people worldwide with the vast majority of diabetics suffering from Type 2 diabetes mellitus (T2DM), a disease characterized by insulin insensitivity that often requires pharmacotherapy to effectively maintain target blood sugar levels. The thiazolidinedione (TZD) class of drugs consists of oral hypoglycaemic agents used alone or in combination with other antidiabetic drugs to treat T2DM. The drugs within this class, which include rosiglitazone and pioglitazone, were originally heralded as providing novel first and second-line treatment of T2DM with glycaemic control and physiological effects comparable to, and in some cases, better than, first-line treatments such as metformin. However, over time they have also been associated with adverse cardiovascular, osteological, and carcinogenic effects in some, but not all clinical trials, observational studies, and meta-analyses. Given the conflicting evidence to date on the safety of TZD drugs, their role in the treatment of T2DM continues to be debated and epidemiological gaps remain. The objectives of this doctoral research are fourfold: 1) to conduct an in-depth review of the epidemiology of TZD pharmacotherapy including pharmacokinetics and modes of action, the results of previous studies investigating health risks and benefits associated with TZD treatment, and new and future uses for this class of drugs; 2) to determine whether diabetic patients treated with TZDs are at increased risk of adverse cardiovascular outcomes; 3) to assess whether TZD pharmacotherapy is associated with an increased risk of bone fractures and whether risks differ depending on fracture site and patient sex; and, 4) to investigate associations between TZD use and risk of bladder cancer. Specific research questions were investigated using nested case-control analyses designed to capture incident users of antidiabetic drugs and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records from more than 480 contributing hospitals throughout the United States. Findings from this work are reported in a series of manuscripts, including a published review paper. Key findings include: 1) TZD use was associated with an increased risk of incident myocardial infarction and congestive heart failure compared to never use of TZD drugs with a trend towards a potential early treatment effect within the first year of exposure to pioglitazone; 2) TZD use was associated with an increased risk of closed bone fractures among Type 2 diabetics with use of pioglitazone or rosiglitazone associated with an increased risk across multiple fracture sites in women, but only rosiglitazone use in men and only at peripheral fracture sites; 3) use of either pioglitazone or rosiglitazone were associated with an increased risk of incident bladder cancer compared to never users, however, a low number of bladder cancer cases resulted in underpowered analyses; and, 4) insulin use in a hospital setting may replace a patient's normal course of antidiabetic therapy which, when combined with other potential sources of bias in traditional nested case-control studies using hospital-based data, may lead to overestimation or underestimation of adverse health risks associated with non-insulin antidiabetic therapies. Although these findings warrant replication, the results of the research contained within this dissertation suggest that caution should be exercised when prescribing diabetic patients TZD drugs if they have cardiovascular, osteological, or carcinogenic risk factors. Additional pharmacovigilance studies should also continue to strive to better understand the health risks related to TZD therapy, especially as new therapeutic roles for TZDs in the prevention and treatment of some cancers, inflammatory diseases, and other conditions in non-diabetic populations are being explored.

Made available in DSpace on 2015-08-20T17:10:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-17. Added 1 bitstream(s) on 2015-08-20T17:26:56Z : No. of bitstreams: 1 000840998_20151016.pdf: 568585 bytes, checksum: e8f035e4f942fd75fc6ad38083a8fd0d (MD5) Bitstreams deleted on 2015-10-16T13:54:07Z: 000840998_20151016.pdf,. Added 1 bitstream(s) on 2015-10-16T13:54:48Z : No. of bitstreams: 1 000840998.pdf: 3047380 bytes, checksum: 4f011bacf1f109d530d0cddd6178474e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Agonistas dos receptores Toll-like (TLRs) podem representar candidatos promissores a serem desenvolvidos como medicamentos contra o câncer. Atualmente, a terapia mais eficaz para o câncer de bexiga urinária não-músculo invasivo (CBNMI) é a imunoterapia com BCG (Bacillus Calmette-Guerin), embora sua utilização esteja limitada a efeitos colaterais de intensidades variadas. Diante deste cenário destaca-se o P-MAPA, que por sua grande versatilidade e mínima citoxicidade, abre uma nova perspectiva para o combate de alguns tipos de cânceres, incluindo o CBNMI. Assim, os objetivos principais deste estudo foram caracterizar os efeitos histopatológicos e moleculares da imunoterapia intravesical com P-MAPA envolvendo as vias de sinalização dos TLRs 2 e 4 no tratamento do CBNMI induzido quimicamente em camundongos selvagens (wild type - WT) e knockouts (-/-) para TLR4 e MyD88. Os efeitos da imunoterapia com P-MAPA foram comparados com o tratamento com BCG. Foram utilizados 20 camundongos fêmeas de cada linhagem (WT, TLR4-/- e MyD88-/-), todos com 60 dias de idade e mantidos no Centro de Medicina Nuclear da Faculdade de Medicina/USP - São Paulo. Os animais foram divididos em 4 grupos de 5 animais, para cada linhagem: Grupo Controle (CTL): recebeu uma dose intravesical de solução fisiológica por 3 semanas consecutivas; Grupo MNU: recebeu uma dose intravesical de N-metil-N-nitrosouréia (MNU) a cada 15 dias, totalizando 3 doses; Grupo MNU+BCG: recebeu uma dose intravesical de BCG por 3 semanas consecutivas; Grupo MNU+P-MAPA: recebeu uma dose intravesical de P-MAPA por 3 semanas consecutivas. Após 09 semanas de experimento, as bexigas urinárias foram coletadas e submetidas às análises histopatológicas e Western Blotting. O presente trabalho demonstrou que a imunoterapia com P-MAPA promoveu distinta ativação do sistema imune inato mediada por TLRs 2 e 4 em relação ao BCG, resultando no aumento da via de sinalização para... / Compounds that are able to act as Toll-like receptors (TLRs) agonists may represent promising candidates to be developed as drugs against cancer. Currently, the most effective therapy for non-muscle invasive bladder cancer (NMIBC) is immunotherapy with BCG (Bacillus Calmette-Guerin) associated with transurethral resection. However, the use of BCG is associated with side effects of varying strengths and in this scenario highlights the P-MAPA, which in great versatility and minimal cytotoxicity, opens a new perspective for fighting certain types of cancers, including NMIBC. Thus, the main objectives of this study were to characterize the histopathological and molecular effects of intravesical immunotherapy with P-MAPA involving the signaling pathways of TLRs 2 and TLR4 in the NMIBC treatment chemically induced in Wild Type mice (Wild Type - WT) and knockouts (-/-) for TLR4 and MyD88. The effects of P-MAPA immunotherapy were compared with BCG treatment. It were utilized 20 female mice of each strain (WT, TLR4 -/- and MyD88 -/-), all with 60 days of age and kept in the Nuclear Medicine Center, School of Medicine / USP - São Paulo. The animals were divided into 4 groups of 5 animals for each strain: Control Group (CTL): received intravesical dose of saline for 3 consecutive weeks; MNU Group: received a intravesical dose of N-methyl-N-Nitrosourea (MNU) every 15 days, a total of 3 doses; MNU+BCG Group: received received intravesical dose of BCG for 3 consecutive weeks; MNU+P-MAPA Group: received intravesical dose of P-MAPA for 3 consecutive weeks. After 09 weeks of experiment, urinary bladders were collected and submitted to histopathological and Western blotting analysis. The present study showed that P-MAPA immunotherapy led to distinct activation of the innate immune system TLR2 and 4-mediated when compared to BCG, resulting in increased signaling pathway for interferon (TRIF, IRF3, IFN-α and IFN-γ ) and restoration of the p53 protein ...

Orientador: Wagner José Fávaro / Banca: Cintia Yuri Matsumura / Banca: Flávio de Oliveira Lima / Resumo: Agonistas dos receptores Toll-like (TLRs) podem representar candidatos promissores a serem desenvolvidos como medicamentos contra o câncer. Atualmente, a terapia mais eficaz para o câncer de bexiga urinária não-músculo invasivo (CBNMI) é a imunoterapia com BCG (Bacillus Calmette-Guerin), embora sua utilização esteja limitada a efeitos colaterais de intensidades variadas. Diante deste cenário destaca-se o P-MAPA, que por sua grande versatilidade e mínima citoxicidade, abre uma nova perspectiva para o combate de alguns tipos de cânceres, incluindo o CBNMI. Assim, os objetivos principais deste estudo foram caracterizar os efeitos histopatológicos e moleculares da imunoterapia intravesical com P-MAPA envolvendo as vias de sinalização dos TLRs 2 e 4 no tratamento do CBNMI induzido quimicamente em camundongos selvagens (wild type - WT) e knockouts (-/-) para TLR4 e MyD88. Os efeitos da imunoterapia com P-MAPA foram comparados com o tratamento com BCG. Foram utilizados 20 camundongos fêmeas de cada linhagem (WT, TLR4-/- e MyD88-/-), todos com 60 dias de idade e mantidos no Centro de Medicina Nuclear da Faculdade de Medicina/USP - São Paulo. Os animais foram divididos em 4 grupos de 5 animais, para cada linhagem: Grupo Controle (CTL): recebeu uma dose intravesical de solução fisiológica por 3 semanas consecutivas; Grupo MNU: recebeu uma dose intravesical de N-metil-N-nitrosouréia (MNU) a cada 15 dias, totalizando 3 doses; Grupo MNU+BCG: recebeu uma dose intravesical de BCG por 3 semanas consecutivas; Grupo MNU+P-MAPA: recebeu uma dose intravesical de P-MAPA por 3 semanas consecutivas. Após 09 semanas de experimento, as bexigas urinárias foram coletadas e submetidas às análises histopatológicas e Western Blotting. O presente trabalho demonstrou que a imunoterapia com P-MAPA promoveu distinta ativação do sistema imune inato mediada por TLRs 2 e 4 em relação ao BCG, resultando no aumento da via de sinalização para... / Abstract: Compounds that are able to act as Toll-like receptors (TLRs) agonists may represent promising candidates to be developed as drugs against cancer. Currently, the most effective therapy for non-muscle invasive bladder cancer (NMIBC) is immunotherapy with BCG (Bacillus Calmette-Guerin) associated with transurethral resection. However, the use of BCG is associated with side effects of varying strengths and in this scenario highlights the P-MAPA, which in great versatility and minimal cytotoxicity, opens a new perspective for fighting certain types of cancers, including NMIBC. Thus, the main objectives of this study were to characterize the histopathological and molecular effects of intravesical immunotherapy with P-MAPA involving the signaling pathways of TLRs 2 and TLR4 in the NMIBC treatment chemically induced in Wild Type mice (Wild Type - WT) and knockouts (-/-) for TLR4 and MyD88. The effects of P-MAPA immunotherapy were compared with BCG treatment. It were utilized 20 female mice of each strain (WT, TLR4 -/- and MyD88 -/-), all with 60 days of age and kept in the Nuclear Medicine Center, School of Medicine / USP - São Paulo. The animals were divided into 4 groups of 5 animals for each strain: Control Group (CTL): received intravesical dose of saline for 3 consecutive weeks; MNU Group: received a intravesical dose of N-methyl-N-Nitrosourea (MNU) every 15 days, a total of 3 doses; MNU+BCG Group: received received intravesical dose of BCG for 3 consecutive weeks; MNU+P-MAPA Group: received intravesical dose of P-MAPA for 3 consecutive weeks. After 09 weeks of experiment, urinary bladders were collected and submitted to histopathological and Western blotting analysis. The present study showed that P-MAPA immunotherapy led to distinct activation of the innate immune system TLR2 and 4-mediated when compared to BCG, resulting in increased signaling pathway for interferon (TRIF, IRF3, IFN-α and IFN-γ ) and restoration of the p53 protein ... / Mestre

Le cancer est une maladie multifactorielle définie par un développement rapide de cellules anormales. Les cellules malignes acquièrent des avantages compétitifs qui permettent une croissance et prolifération anormales, grâce à un large spectre de changements génétiques et épigénétiques conduisant à des changements majeurs dans les profils de transcriptome et protéome et ainsi des modifications dans des voies de signalisation, le trafic intracellulaire et le métabolisme. Des nombreuses voies cellulaires ont été étudiées dans le contexte du cancer, y compris la signalisation, la migration, la perte de la polarité cellulaire apico-basale et l'adhésion cellulaire, cependant très peu est connu sur les altérations au niveau des organelles. Cette thèse a comme objectif d'identifier des altérations dans les compartiments intracellulaires et d'étudier leurs corrélations avec la progression du cancer. Dans la culture cellulaire classique, l'étude systématique de l'organisation du positionnement relatif des organelles est difficile en raison des fortes hétérogénéités morphologiques des cellules. Pour contourner ce problème, nous avons utilisé l’innovante technique des micro-patrons combinée à des cartes de densité des organelles. Après une analyse systématique de différentes lignées cellulaires représentant différents grades du cancer de la vessie, nous avons identifié des changements dans le positionnement de plusieurs organelles. Le changement de position le plus important a été observé pour les lysosomes, dont la distribution était plus périphérique dans les cellules représentant des grades plus avancées du cancer de la vessie. Ceci suggère que le positionnement des lysosomes pourrait être potentiellement important dans la progression du cancer. Par conséquent, nous avons cherché à caractériser l'impact de l’altération des lysosomes sur le comportement des cellules transformées. Nous avons constaté que les changements dans le positionnement des lysosomes jouent un rôle dans l'invasion des cellules cancéreuses de la vessie. En effet, le transport antérograde des lysosomes est en corrélation avec l’invasion 3D, contrairement au transport rétrograde qui corrèle avec une diminution de l’invasion cellulaire. Enfin, nous avons étudié les mécanismes moléculaires par lesquels les altérations du lysosome ont un impact sur l'invasion cellulaire. / Cancer is a multifactorial disease defined by a rapid development of abnormal cells. Malignant cells acquire competitive advantages for growth and proliferation through a big spectrum of genetic and epigenetic changes leading to major changes in the transcriptome and proteome profiles and thus to alterations in multiple signaling pathways, intracellular trafficking and metabolism. Although many cellular pathways have been studied in the context of cancer, including signaling, migration, loss of apical-basal cell-polarity and cell adhesion, little is known about cancer-related alterations on the sub-cellular, organelle level. This PhD thesis aimed to identify alterations in intracellular compartments and to study how these changes correlate with cancer progression. In classical culture, the systematic study on the organization and relative positioning of organelles is challenging because of the strong morphological cell-to-cell variations. To overcome this problem, we used innovative micro-patterning technique in combination with quantitative, probabilistic mapping of cell organelles. Using a systematic analysis of different cell lines representing different stages of bladder cancer, we identified several changes in the positioning of organelles. The most striking phenotype was revealed by lysosomes, whose distribution was more peripheral in cells representing higher grades of bladder cancer. This suggested that lysosome positioning could be potentially relevant in cancer progression. Therefore, we aimed to characterize the impact of lysosome alteration on cell behavior in transformed cells. We found that changes in lysosome positioning played a role on bladder cancer cell invasion. Indeed, anterograde transport of lysosomes correlate with 3D invasion behavior, contrary to retrograde transport that correlated with decreased cell invasion. Finally, we studied about the molecular mechanisms by which lysosome alterations impact cell invasion.

Introduction: Les données des analyses génomiques des tumeurs de vessie ont défini des sous-groupes qui présentent une agressivité et une réponse à la chimiothérapie différents. Notre but était d’identifier des marqueurs moléculaires prédictifs de l'évolution tumorale.Matériels et méthodes: Les ADNs de 54 tumeur solides et de 50 échantillons d’ urines de patients avec une tumeur de vessie ont été hybridés sur la puce CGH (Comparative Genomic Hybridization) BCA-oligo. Des TMAs (Tissue Micro Array) de 140 tissus paraffinés de tumeurs primitives et métastatiques, ont été analysés en immunohistochimie pour les marqueurs impliqués dans: stabilité de l’ADN, prolifération cellulaire et définition de sous-groupe basal ou luminal. Des corrélations avec les données cliniques ont été recherchées à tous les niveaux d’analyse.Résultats: Le nombre d'altérations chromosomiques augmentait significativement avec le stade tumoral. La distribution de ces altérations était cohérente entre les ADNs extraits de tissu tumoral et de prélèvements urinaires. Si aucun marqueur immunohistochimique ne permettait de différencier les patients métastatiques ou non, des profils de marquage similaires ont été observés entre tumeurs primitives et métastases. La présence d'emboles tumoraux lymphatiques était prédictive du statut métastatique. Conclusion: l’utilisation dans la pratique clinique de la puce BCA-oligo pour prédire une évolution d'une tumeur de vessie vers un stade ou un grade plus élevé peut être envisagée, et réalisée sur un simple prélèvement urinaire. La recherche systématique d’emboles lymphatiques sur tumeurs primitives peut être utilisée pour prédire une évolution métastatique. / Introduction: Recent data from genomic analysis of bladder tumors have identified subgroups with different aggressiveness patterns and chemotherapy response profiles. The aim of our study was to identify molecular markers that can be used in clinical practice, to predict the evolution of these tumors in order to personalize their management.Materials and Methods: DNAs extracted from 54 solid tumors and 50 urine samples from patients with bladder cancer were hybridized on the BCA-oligo CGH (Comparative Genome Hybridization) chip. TMAs (Tissue Micro Array) from 140 paraffine-embedded tissues of primary and metastatic tumors, were analyzed in immunohistochemistry with antibodies directed against proteins involved in DNA stability, cell proliferation and the definition of basal or luminal subgroup. Correlations with clinical data were sought at all levels of analysis.Results: The number of chromosomal alterations increased significantly with the tumor stage. In addition, the distribution of these alterations was consistent between the DNAs extracted from tumor tissue and those from urinary samples. If no immunohistochemical marker differentiated between metastatic and non-metastatic patients, similar labeling patterns were observed between primary tumors and metastases. Notably, the presence of lymphatic emboli was predictive of metastatic status.Conclusion: The use in clinical practice of the BCA-oligo chip to predict a progression of a bladder tumor to a higher stage or grade may be considered. This analysis is feasible on urine sample. The systematic search for lymphatic emboli on primary tumors can be used in clinical practice to predict a metastatic evolution.

L'activation constitutive de FGFR3 par mutation ou translocation est l'un des évènements les plus fréquents dans le cancer de la vessie. Une dérégulation de RAB25,une protéine impliquée dans le processus de recyclage des récepteurs de surface, a été montrée dans différents cancers. Des données du transcriptome des cancers de vessie ont montré que RAB25 est surexprimé dans les tumeurs présentant des altérations de FGFR3. L'objectif de cette thèse a été d'étudier l'implication possible de RAB25, des protéines de la même famille, RAB11A et RAB11B, et leur effecteurs RAB11FIP2 et MYO5B dans 1) la tumorigénèse des tumeurs altérées pour FGFR3 et 2) le trafic et la signalisation de FGFR3. Nos résultats montrent que l'extinction de ces protéines par des siARNs induit une diminution significative de la viabilité cellulaire des cellules exprimant des formes constitutivement activées de FGFR3. Les effets de la déplétion de RAB25 et RAB11 sur le recyclage de FGFR3, sur les voies de signalisation de FGFR3 et sur l'expression des gènes cibles de FGFR3 suggèrent que le recyclage de FGFR3 régulé par RAB25 et RAB11 peut prolonger le signal de FGFR3 et peut fournir une plateforme pour la signalisation de FGFR3. Nous avons également comparé la distribution cellulaire des formes sauvage et muté (S249C) de FGFR3 portant une étiquette GFP dans des cellules HeLa. Les deux formes de FGFR3 se trouvent dans plusieurs compartiments intracellulaires mais FGFR3 muté se localise préférentiellement dans le compartiment de recyclage. Ce projet nous a permis de mieux caractériser la trafic de FGFR3 dans le cancer de la vessie et son lien avec la signalisation et l'activité de FGFR3. / Activation of FGFR3 by point mutation, translocation and overexpression is one of the most frequent events in bladder cancer. The dysfunction of RAB25, a GTPase involved in endocytic recycling of transmembrane receptor, has been shown in many cancers. Gene expression data in bladder cancer indicates that RAB25 expression is significant higher in tumors carrying altered FGFR3. The thesis project aimed to investigate the potential role of RAB25, proteins from the same family (RAB11A and RAB11B) and their effectors RAB11FIP2 and MYO5B in 1) the tumorigenesis of tumors carrying altered FGFR3 and 2) the trafficking and the signaling of FGFR3. Our results demonstrate that depletion of these proteins by siRNA significantly reduces cell viability in cells expressing constitutively activated forms of FGFR3. The effects of RAB25 and RAB11 silencing on FGFR3 trafficking and signaling and the expression of FGFR3 target genes suggest that the RAB11- and RAB25-mediated recycling can sustain the signaling by protecting altered FGFR3 from the degradation pathway, and can provide a platform for FGFR3 signaling We also compared the subcellular distribution of wild type and mutant (S249C) forms of FGFR3. These two forms localize to different compartments including early endosomes, late endosomes and recycling compartments. The S249C FGFR3 mutant preferentially localizes to the endocytic recycling compartment. Our findings shed light to the molecular mechanisms underlying the relationships between the trafficking and signaling of FGFR3 in the context of bladder cancer.

Background Waiting times of the fast-track of bladder cancer in Sweden are prolonged compared with set lead times.Aim To investigate if stage and grade of tumor affects waiting times.Method Retrospective single center observational study, Örebro University Hospital, Sweden. All patients who underwent resection of tumor or cystoscopy with biopsy via the fast-track between July 1st 2017 and December 31st 2018 were included, n=119.Result The waiting times of muscle invasive tumors were in general longer than for non-invasive tumors. Referral to TURBT - twelve days (p=0.047), referral to information of diagnosis to patient - seven days (p=0.04) and cystoscopy to TURBT - eleven days (p=0.041.Conclusion MIBC had longer waiting times to most steps of the fast-track. There are conflicting results in previous studies regarding whether extended waiting times result in worse outcomes in those with higher stage and grade of tumors or not. It is known that long waiting times results in higher mortality and psychological stress among the patients why reorganizations at the department should take place.

This thesis is focused on immunochemical determination of concentration of active and inactive form of cathepsin B in patients with bladder cancer in order to compare diagnostic efficiency of methods for their possible use for routine diagnosis. Cathepsin B and procathepsin B were measured in serum and urine in 82 patients with bladder cancer (47 men and 35 women), with the average age of 66.5 year. The control group contain of 72 healthy subjects (31 men and 41 women), with the average age of 58.5 year. The concentration of cathepsin B and procathepsin B in the urine were corrected to creatinine, which was determined by the enzymatic creatinase method. The concentrations of cathepsin B in urine were singnificantly elevated in patients than in control group (median = 3.5 µg/l vs. 0.9 µg/l, P = 0.01), similarly the results of the cathepsin B/creatinine ratio were elevated (median = 0.4 µg/mmol vs. 0.1 µg/mmol, P = 0.01). There were no significant difference in concentration in serum between patients and control group (median = 4.8 µg/l vs. 4.2 µg/l, P = 0.8). The concentration values of procathepsin B were significantly higher in patients compare to control group both in urine (median = 3.9 µg/l vs. 1.4 µg/l, P < 0.0001), in serum (median = 73.3 µg/l vs. 58.7 µg/l, P = 0.0005) and similarly in...