Background: Prostate cancer is the most common cancer in Sweden with around 10,000 new cases every year. Kidney and bladder cancer are less common with 1,000 and 2,000 new cases annually, respectively. The incidence of these cancer sites is higher in developed, than in developing countries, suggesting an association between lifestyle and cancer risk. The aims of this thesis were to investigate body mass index (BMI), blood pressure, and blood levels of glucose, total cholesterol, and triglycerides as risk factors for prostate, kidney, and bladder cancer. Furthermore, we aimed at assess probabilities of prostate cancer and competing events, all-cause death, for men with normal and high levels of metabolic factors. Material and methods: This thesis was conducted within the Metabolic Syndrome and Cancer project (Me-Can), a pooled cohort study with data from 578,700 participants from Norway, Sweden, and Austria. Data from metabolic factors were prospectively collected at health examinations and linked to the Cancer and Cause of Death registers in each country.  Results: High levels of metabolic factors were not associated with increased risk of prostate cancer, but high levels of BMI and blood pressure were associated with risk of prostate cancer death. The probability of prostate cancer was higher for men with normal levels of metabolic factors compared to men with high levels, but the probability of all-cause death, was higher for men with high levels than for those with normal levels. For both men and women, high levels of metabolic factors were associated with increased risk of kidney cancer (renal cell carcinoma). Furthermore, blood pressure for men and BMI for women were found as independent risk factors of kidney cancer. High blood pressure was associated with an increased risk of bladder cancer for men. Conclusions: High levels of metabolic factors were associated to risk of kidney and bladder cancer and to death from kidney, bladder, and prostate cancer. Compared to men with normal levels, men with high levels of metabolic factors had a decreased probability of prostate cancer but an increased probability of all-cause death. / <p>Ytterligare forskningsfinansiärer: World Cancer Research Fund (2007/09) och Wereld Kanker Onderzoek Fonds (R2010/247)</p> / Me-Can

Objective: Primary transitional cell carcinoma (TCC) of the upper urinary tract represents 6–8% of all TCC cases. Nephroureterectomy with removal of a bladder cuff is the treatment of choice. The rates of TCC recurrence in the bladder after primary upper urinary tract surgery described in the literature range between 12.5 and 37.5%. In a retrospective analysis we examined the occurrence of TCC after nephroureterectomy for upper tract TCC in patients without a previous history of bladder TCC at the time of surgery. Methods: Between 1990 and 2002, 29 patients underwent primary nephroureterectomy for upper tract TCC. The mean age of the patients was 69.5 years. In 5 cases upper urinary tract tumors were multilocular, in the remaining cases unilocular in the renal pelvis (n = 12) or the ureter (n = 12). The follow-up was available for 29 patients with a mean follow-up of 3.37 (0.1–11.2) years. Results: 11/29 (37.9%) patients had TCC recurrence with 9/11 patients having bladder TCC diagnosed within 2.5 years (0.9–6.0) after nephroureterectomy. 13/29 patients are alive without TCC recurrence, 3/29 patients died due to systemic TCC progression and 5/29 died of unrelated causes without evidence of TCC recurrence. Conclusion: Our data indicate a high incidence of bladder TCC after nephroureterectomy for primary upper tract TCC of up to 6 years after primary surgery. Because of the high incidence of bladder TCC within the first 3 years of surgery, careful follow-up is needed over at least this period. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Transurethral resection leads to characteristic histological changes of tissue repair (’TUR cystitis‘), which also cause non-specific cytological changes. The aim of this study was to investigate the diagnostic sensitivity and specificity of conventional exfoliative urinary cytology in diagnosing residual urothelial carcinoma after differential transurethral resection. Patients and Methods: 417 urinary cytology specimens of all 374 patients undergoing primary (n = 326) or secondary (n = 91) transurethral resection of urothelial carcinoma of the bladder at our institution between June 1996 and December 1997 were examined. The cytology specimens were stained according to Papanicolaou’s method. The sensitivity and specificity of the cytologic diagnosis and of the tumour grading were compared with histological findings. Results: The overall sensitivity of urine cytology in tumour detection was 77.6% for primary lesions and 74.5% in the detection of residual carcinoma after transurethral resection. The diagnostic specificity was 77% and 84.3% respectively. The degree of sensitivity was dependent on tumour grade and was lower for well differentiated tumours. After transurethral resection, the sensitivity for grade 1 residual tumours was 11%, whereas it was 54% for grade 1 tumours before primary transurethral resection. Conclusions: The inflammatory changes following transurethral resection of primary bladder carcinoma cause reactive cytologic changes that make the diagnosis of well differentiated residual carcinoma more difficult. However, urinary cytology after transurethral resection has the same diagnostic accuracy for medium and poorly differentiated tumours as before primary resection and thus remains a very useful diagnostic tool. / Hintergrund: Transurethrale Resektionen von Blasentumoren führen zu histologischen Veränderungen («TUR Zystitis») im Sinne regenerativer Veränderungen, welche urinzytologisch zu diagnostischen Fehleinschätzungen führen können. Das Ziel unserer Untersuchung war der Vergleich der diagnostischen Sensitivität und Spezifität der Urinzytologie vor transurethraler Resektion mit der bei der Diagnose von Residualtumoren nach transurethraler Resektion. Patienten und Methoden: Untersucht wurden 417 urinzytologische Präparate von allen 374 Patienten, die in unserer Einrichtung zwischen Juni 1996 und Dezember 1997 einer primären (n = 326) oder sekundären (n = 91) transurethralen Resektion von Urothelkarzinomen der Harnblase unterzogen wurden. Die zytologischen Präparate wurden nach Papanicolaou gefärbt. Sensitivität und Spezifität der zytologischen Diagnostik und des Tumorgradings wurden mit den histologischen Befunden verglichen. Ergebnisse: Die Sensitivität der Urinzytologie in der primären Tumorerkennung lag bei 77,6% und die für die Diagnose von Residualtumoren nach transurethraler Resektion bei 74,5%. Die diagnostische Spezifität lag bei 77% bzw. 84,3%. Die Sensitivität war abhängig vom Differenzierungsgrad der Urothelkarzinome und war bei gut differenzierten Tumoren am niedrigsten. Nach transurethraler Resektion betrug die Sensitivität der zytologischen Diagnose für G1-Residualtumore lediglich 11%, während sie für G1-Primärtumore bei 54% lag. Schlußfolgerungen: Die entzündlichenVeränderungen nach transurethraler Resektion verursachen Veränderungen exfoliierter Urothelzellen, welche die zytologische Diagnose von residualen G1-Tumoren erschweren. Die Diagnose mäßig und schlecht differenzierter residualer Urothelkarzinome nach transurethraler Resektion hat dagegen die gleiche Sensitivität und Spezifität wie die bei primärer Untersuchung, so daß die Urinzytologie auch bei der Diagnose von Residualtumoren ein wertvolles diagnostisches Verfahren darstellt. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

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Ο καρκίνος της ουροδόχου κύστης αποτελεί την 4η κατά συχνότητα μορφή καρκίνου στους άνδρες στο Δυτικό κόσμο, ακολουθώντας τον καρκίνο του προστάτη, του πνεύμονα και του κόλου. Η επιφανειακή μορφή του καρκίνου της κύστεως έχει το ιδιαίτερο χαρακτηριστικό των πολύ συχνών υποτροπών, οι οποίες ευθύνονται για τη μεγάλη νοσηρότητα της νόσου. Οι πολύ συχνές υποτροπές έχουν, όπως εύκολα γίνεται αντιληπτό, τεράστιο κοινωνικοοικονομικό κόστος, εφ’ όσον ένα σημαντικό τμήμα των πασχόντων αποτελεί μέρος του οικονομικά ενεργού πληθυσμού. Η καρκινογένεση δεν είναι μια απλή διαδικασία, αλλά μια αλληλουχία αλλαγών οι οποίες αφορούν τους κυτταρικούς μηχανισμούς αύξησης, διαφοροποίησης και απόπτωσης και οδηγούν στη μετατροπή ενός φυσιολογικού κυττάρου σε νεοπλασματικό. Ως «Χημειοπρόληψη» ορίζεται η χρήση ειδικών φυσικών ή συνθετικών χημικών ουσιών που μπορούν να παρέμβουν σε κάποια από τα μοριακά αυτά γεγονότα και να προλάβουν, καταστείλουν ή αναστρέψουν, την εξέλιξη προκαρκινικών βλαβών σε διηθητικό καρκίνο. Η διαφορά στην επίπτωση του νεοπλάσματος και τα διαφορετικά κλινικοπαθολογοανατομικά χαρακτηριστικά του καρκίνου της ουροδόχου κύστεως ανάμεσα στα δύο φύλα, υποδεικνύουν ένα σημαντικό ρόλο των ορμονών του φύλου στην παθογένεια του νεοπλάσματος. Υποθέσεις μόνο γίνονται για τη σημασία των οιστρογόνων στην ανάπτυξη καρκίνου της ουροδόχου κύστεως, αφού ακόμα ο ρόλος τους δεν έχει αποσαφηνιστεί. Τα οιστρογόνα ασκούν τη δράση τους μέσω των υποδοχέων τους (ERα, ERβ) οι οποίοι αποτελούν μέλη μιας υπεροικογένειας μεταγραφικών παραγόντων, των πυρηνικών υποδοχέων. Οι πυρηνικοί υποδοχείς ρυθμίζουν τη γονιδιακή έκφραση μέσω θετικής ή αρνητικής παρεμβάσεως στη δράση άλλων μεταγραφικών παραγόντων, όπως του NFκB, με τη βοήθεια ενός μηχανισμού που ονομάζεται cross-talk. Αν και η φλεγμονή με την καρκινογένεση έχουν αναγνωρισμένη σχέση από παλιά, συνδέθηκαν άμεσα με την παρατήρηση ότι υπερέκφραση του γονιδίου για το ένζυμο κυκλοοξυγενάση-2 (COX-2), αποτελεί πρώιμο γεγονός της καρκινογένεσης (Greten et al, 2004). Η COX-2, όπως επίσης και ο μεταγραφικός παράγοντας NFκB, που σχετίζεται με τη φλεγμονή, έχει διαπιστωθεί ότι συμμετέχουν στις διαδικασίες της καρκινογένεσης.. Η σύνδεση των οιστρογόνων στους οιστρογόνικους υποδοχείς επάγει τη δέσμευση συν-ρυθμιστικών παραγόντων, οι οποίοι διακρίνονται σε δύο μεγάλες κατηγορίες τους συν-ενεργοποιητές (coactivators), όπως p300 και τους συν-καταστολείς (corepressors), όπως NCoR. Κατά την παρούσα εργασία μελετήθηκε η μεμονωμένη όσο και η συνδυαστική έκφραση των πέντε παραπάνω μορίων στο φυσιολογικό επιθήλιο και στα καρκινώματα διαφόρων Grade, σε ιστικά δείγματα από 140 ασθενείς που υποβλήθηκαν σε διαγνωστική βιοψία διουρηθρική εκτομή νεοπλάσματος κύστεως ή ριζική κυστεκομή. Η μέθοδος που εφαρμόστηκε ήταν η ανοϊστοχημεία σε τομές παραφίνης, η οποία λόγω του μορφολογικού της χαρακτήρα επέτρεψε τη λήψη δεδομένων για τη σχετική εντόπιση των μορίων στους ενδοκυττάριους χώρους, τις ενδοεπιθηλιακές στιβάδες, τις φυσιολογικές ή παθολογικές ιστολογικές βαθμίδες και το επιθηλιακό ή μεσεγχυματικό διαμέρισμα. Ο παράγοντας NFκB (υπομονάδα p65) εμφάνισε μεικτή υποκυττάρια εντόπιση. Στην παρούσα ανοσοϊστοχημική μελέτη το επίπεδο της έκφρασης του NFκB στον πυρήνα των καρκινικών κυττάρων παρουσίαζε μια στατιστικά σημαντική συνολική αύξηση στα τρία επίπεδα διαφοροποίησης των καρκινωμάτων. Τα καρκινώματα χαμηλής διαφοροποίησης παρουσίαζαν ισχυρότερη ανοσοθετικότητα του NFκB από τα μετρίας και καλής διαφοροποίησης. Η αύξηση της πυρηνικής εντόπισης του NFκB συνδυάζεται με ταυτόχρονη ελάττωση της κυτταροπλασματικής, γεγονός που επιβεβαιώνει τη βιολογική δράση του. Ο πυρηνικός υποδοχέας ERβ, που εντοπίζεται στο πυρήνα των καλώς διαφοροποιημένων καρκινικών κυττάρων, είναι στατιστικά σημαντικά αυξημένος σε σχέση με λιγότερο διαφοροποιημένα νεοπλασματικά κύτταρα. Στην παρούσα ανοσοϊστοχημική μελέτη τα κύτταρα του φυσιολογικού επιθηλίου της ουροδόχου κύστης, εκφράζουν έντονα τον πυρηνικό υποδοχέα και κατά την πρόοδο της καρκινογένεσης η έκφραση του ελαττώνεται, παράλληλα με την απώλεια της διαφοροποίησης των καρκινικών κυττάρων. Στην εξέλιξη της καρκινογένεσης, η COX-2 επάγεται σταθερά, σύμφωνα με τα αποτελέσματα της παρούσας εργασίας, με διαδοχικές αυξήσεις που συνοδεύουν όλα τα στάδια της προοδευτικής αποδιαφοροποίησης των κυττάρων. Η πυρηνική έκφραση του p300 αυξάνεται σταδιακά καθώς τα καρκινώματα αποκτούν χαρακτήρες αποδιαφοροποίησης, συσχέτιση στατιστικώς σημαντική. Η πυρηνική έκφραση του NCoR ελαττώνεται σταδιακά καθώς τα καρκινώματα αποκτούν χαρακτήρες αποδιαφοροποίησης, συσχέτιση στατιστικώς σημαντική, σύμφωνα με τα ευρήματα της παρούσας μελέτης. Στις υπόλοιπες συσχετίσεις μελετήθηκε η συν-έκφραση πλέον των παραγόντων σε κάθε ασθενή, με σκοπό την εξαγωγή συμπερασμάτων για ενδεχόμενη αλληλεπίδραση τους. Αναλυτικότερα, παρατηρήθηκε στα καρκινώματα της ουροδόχου κύστεως ισχυρή θετική συσχέτιση του NFκB με την έκφραση της COX-2, υποδηλώνοντας τον υποστηρικτικό ρόλο των δύο αυτών παραγόντων στην πρόοδο της καρκινογένεσης. Από τη συσχέτιση NFκB και ERβ προέκυψε κατασταλτική επίδραση του πρώτου στην ογκοανασταλτική δράση του δεύτερου, υποδηλώνοντας σχέση ανταγωνισμού στη δέσμευση συνπαραγόντων και κατάληψης ίδιων περιοχών στους υποκινητές γονιδίων, ενώ δεν αναδείχθηκε συνομιλία ανάμεσα στον ERβ και COX-2. Τέλος αποκαλύφθηκε συνεργική δράση του NFκB με τον p300 στην καρκινογένεση, με τον ERβ και NCoR να χάνουν την ικανότητα πρόκλησης κυτταρικής διαφοροποίησης και άρα την προστατευτική επίδρασή τους. Η έκφραση του ERβ συσχετίστηκε με την ιστοπαθολογική βαρύτητα, ανά βαθμό έκφρασης των συνρυθμιστών p300 και NCoR, ώστε να διευκρινιστεί εάν η συγκέντρωση τους στα κύτταρα είναι καθοριστικός παράγοντας για την επίδραση του πυρηνικού υποδοχέα στον ιστολογικό φαινότυπο. Η επεξεργασία των δεδομένων φανερώνει αρνητική συσχέτιση της προόδου της καρκινογένεσης με την πυρηνική έκφραση του ERβ, αλλά μόνο όταν τα κύτταρα υπερεκφράζουν παράλληλα τον p300. Η απώλεια της έκφρασης του NCoR αναστέλλει την ενεργοποίηση του πυρηνικού υποδοχέα ERβ, γεγονός που διαπιστώθηκε και στην παρούσα μελέτη κατά τη διάρκεια της απώλεια διαφοροποίησης των καρκινικών κυττάρων της ουροδόχου κύστης. Επομένως, το τελικό αποτέλεσμα της δράσης του ERβ εξαρτάται από τον ανταγωνισμό των ενεργοποιητών και καταστολέων για τις ίδιες θέσεις σύνδεσης στο μόριο του ERβ. Συνολικά, η χρήση αγωνιστών των ERβ και NCoR με παράλληλη αναστολή των NFκB, COX2 και NCoR, θα είχε πιθανότατα ευνοϊκό αποτέλεσμα στην αναστροφή της καρκινογένεσης στην ουροδόχο κύστη. Ειδικές παράμετροι του χημειοπροληπτικού σχήματος, θα ήταν ωφέλιμο να τροποποιούνται ύστερα από εξατομικευμένη αξιολόγηση του δικτύου των πέντε παραγόντων. / Backround Bladder cancer is the forth most common malignancy among men in the Western World, following prostate, lung, and colon cancer. However, due to the highly recurrent nature of the disease, bladder cancer is the most prevalent and the most expensive per patient treated. Carcinogenesis is a complicated multistage process that gradually deprives normal cells of their natural phenotype, resulting in tissue disturbance, from which tumors finally emerge. During its lengthy course it is accompanied by an evenly prolonged inflammatory response. Chemoprevention pursues the arrest of both processes, by means of pharmacological targetting key molecules, involved in cell growth, differentiation and apoptosis, as well as in chronic inflammation. Nuclear Hormone Receptors are appropriate targets, as they are induced by ligand binding to mediate gene transcription. Epidemiological and molecular data support the possible role of ERβ and NFκB between the two collateral processes, providing evidence for target-specific chemopreventive strategies. ERβ promotes cellular differentiation and restriction of inflammation. Nuclear receptor coregulators provide a great level of sophistication in the dynamic process of transcriptional regulation. The transcriptional coactivator p300 is a ubiquitous nuclear protein and transcriptional cofactor with intrinsic acetyltransferase activity. NCoR is a protein that contain distinct functional domains responsible for interaction with NRs, and activation of HDAC proteins, ultimately resulting in targeted repression of transcription The inducible transcription factor NF-κB, immediately after being released from a cytoplasmic inhibitor, translocates into nucleus, where it enhances transcription of anti-apoptotic and pro-inflammatory genes. COX-2, an enzyme often induced in neoplastic conditions, perpetuates the chronic inflammatory state in the epithelium and its microenvironment, by means of prostaglandin synthesis. Elucidation of the molecular networks implicated in estrogen signaling is very important in view of the potential use of selective estrogen receptor modulators in chemoprevention and targeted anticancer therapy. Materials and Methods. In our retrospective study we included 111 consecutive patients (74 males and 37 females), aged 23-90 years (mean 70±10) diagnosed with TCC of the bladder by either biopsies, transurethral resection of bladder tumor, or radical cystectomies, between 2000 and 2002 from the Urological Department of Urology of University Hospital of Patras, Greece. None of the patients had received any preoperative intravesical therapy. Bladder tumors were graded and staged according to the World Health Organization (WHO) grading. Paraffin section immunohistochemistry was utilized and relative expression was estimated in intracellular compartments, intraepithelial layers, and histologic categories. NF-κB(p65 subunit) demonstrated mixed subcellular presence, COX2 cytoplasmic whereas ERβ, p300 and NCoR staining patterns were nuclear. NF-κB and COX-2, were constantly upregulated as tumorigenesis progressed. Results NF-κB, COX-2 and p300 expression correlated positively with progression of carcinogenesis, suggesting a potential involvement in bladder tumorigenesis. On the contrary, ERβ and NCoR were severely diminished in cancer, compared to normal epithelium, and they were affected by tumor Grade. The remaining correlations are based on coexpression analysis of the aforementioned factors, individually for each patient, to permit judgement of molecular interactions. In detail, an inverse staining between ERβ and nuclear p65 immunoreactivity was observed and we could suggest that there is a reciprocal transactivation between ERβ and activated NFκB. COX-2 was positively associated in bladder carcinomas with NFκB, a finding which may denote the nuclear factor contribution to the enzyme induction. A correlation has been established, when correlating the expression of ERβ with the coregulators, positive with NCoR and negative with p300, indicating a potential role of these key molecules in bladder carcinogenesis. Furthermore, p300 and NCoR, may not be strictly segregated and in bladder cancer cells interact directly, since, according to biochemical purification studies, p300 is capable of directed negative interaction with NCoR. Conclusions The inhibition of ERβ in combination with the antiapoptotic properties of NFκB may contribute to the pathogenesis of TCC. Selective ERβ and NCoR agonist and agents-inhibitors of NFκB, COX2 and p300 may represent a possible new treatment strategy, by virtue of their role in bladder carcinogenesis. Subtle variations in the chemopreventive regimen, based on personalized molecular profiling, would hopefully achieve a patient-tailored therapeutic approach.

Lower urinary tract disorders are significant prognostic indicators of institutionalisation and lower quality of life in the elderly and their incidence increases with age. Urodynamics, the gold standard in diagnosis, replicates symptoms to assess functionality through controlled filling and voiding of the bladder but its interpretation is subjective and may be inconclusive; often requiring further testing or leading to inappropriate treatment. Normal filling and voiding biomechanics of the bladder relate directly to the structural composition of the bladder wall. Alterations to tissue composition in aging and pathology have significant impacts on biomechanics but are yet to be fully described. The aim of this thesis was to gain insight into the individual microstructural components of the bladder wall and how they relate to the gross mechanical response. Additionally, representation of these observations in a mathematical model that can be used to improve our understanding of urodynamic data. This aim was achieved through a combination of in situ mechanical testing and the development of a microstructural constitutive model, which was then included within an overall micturition framework to simulate filling and voiding functions, and evaluated with clinical data. Coupled systems of multiphoton microscopy and uniaxial, biaxial and inflation testing were used to correlate extra cellular matrix interactions with the mechanical response of young and aged murine bladder. Wall-layer specific collagen fibre orientation, dispersion and recruitment were quantified and implemented into a novel microstructural constitutive model. The bladder was modelled as a nonlinear elastic, constrainedmixture planar membrane with contribution from smooth muscle and collagen fibres in the detrusor. Collagen recruitment in the detrusor was observed to occur at a finite stretch; correlated with a steep increase in stiffness of the tissue, while collagen of the lamina propria plays a capacitance role. Collagen recruitment was modelled using a triangular probability density function; quantified from sequential microscopy images and fitted to mechanical data. Increased collagen area fraction and changes in dominant fibre orientation were attributed to reduced compliance in aged bladder. This behaviour was captured by the model. The microstructural model was modified to an isotropic thin-walled spherical membrane for the filling phase of a micturition model framework, consisting of a bladder outlet relation and urethral resistance relation. A contractile smooth muscle element was included in the active response. In the first steps towards clinical application the model was applied to male and female 'normal' patient urodynamic data to observe quality of model fit and estimate baseline parameter values. The model simulated key filling and voiding features seen in normal male and female clinical data. Mechanobiological modelling combined with clinically relevant micturition modelling has the potential to quantify bladder dysfunction. Moreover, improved understanding of how the microstructure influences macroscopic mechanics will yield improved understanding of how changes to the bladder impair its functionality. We predict that modelling will become a clinically relevant tool in urodynamics; leading to new options for diagnosis and management of patients with bladder dysfunction.

Electronic medical record databases (e.g. the Clinical Practice Research Datalink, CPRD) are increasingly used in epidemiological research. The CPRD has two formats of data: coded, which is the sole format used in almost all research; and free-text (or ‘hidden’), which may contain much clinical information but is generally unavailable to researchers. This thesis examines the ramifications of omitting free-text records from research. Cases with bladder (n=4,915) or pancreatic (n=3,635) cancer were matched to controls (n=21,718, bladder; n=16,459, pancreas) on age, sex and GP practice. Coded and text-only records of attendance for haematuria, jaundice and abdominal pain in the year before cancer diagnosis were identified. The number of patients whose entire attendance record for a symptom/sign existed solely in the text was quantified. Associations between recording method (coded or text-only) and case/control status were estimated (χ2 test). For each symptom/sign, the positive predictive value (PPV, Bayes' Theorem) and odds ratio (OR, conditional logistic regression) for cancer were estimated before and after supplementation with text-only records. Text-only recording was considerable, with 7,951/20,958 (37%) of symptom records being in that format. For individual patients, text-only recording was more likely in controls (140/336=42%) than cases (556/3,147=18%) for visible haematuria in bladder cancer (χ2 test, p<0.001), and for jaundice (21/31=67% vs 463/1,565=30%, p<0.0001) and abdominal pain (323/1,126=29% vs 397/1,789=22%, p<0.001) in pancreatic cancer. Adding text records reduced PPVs of visible haematuria for bladder cancer from 4.0% (95% CI: 3.5–4.6%) to 2.9% (2.6–3.2%) and of jaundice for pancreatic cancer from 12.8% (7.3–21.6%) to 6.3% (4.5–8.7%). Coded records suggested that non-visible haematuria occurred in 127/4,915 (2.6%) cases, a figure below that generally used for study. Supplementation with text-only records increased this to 312/4,915 (6.4%), permitting the first estimation of its OR (28.0, 95% CI: 20.7–37.9, p<0.0001) and PPV (1.60%, 1.22–2.10%, p<0.0001) for bladder cancer. The results suggest that GPs make strong clinical judgements about the probable significance of symptoms – preferentially coding clinical features they consider significant to a diagnosis, while using text to record those that they think are not.

Submitted by Mirian Yoshiko Matsumoto (mirian_matsumoto@hotmail.com) on 2018-09-13T03:42:01Z No. of bitstreams: 1 Tese de Doutorado BGA Mirian Matsumoto.pdf: 5590776 bytes, checksum: 35a18a86dcfd4a42e7e9c40dbce00a94 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-09-14T16:51:20Z (GMT) No. of bitstreams: 1 matsumoto_my_dr_bot.pdf: 5590776 bytes, checksum: 35a18a86dcfd4a42e7e9c40dbce00a94 (MD5) / Made available in DSpace on 2018-09-14T16:51:20Z (GMT). No. of bitstreams: 1 matsumoto_my_dr_bot.pdf: 5590776 bytes, checksum: 35a18a86dcfd4a42e7e9c40dbce00a94 (MD5) Previous issue date: 2017-05-30 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O câncer de bexiga (CB) é a segunda malignidade geniturinária mais comum. A maioria (75%) dos CBs são primeiramente diagnosticados como não-músculo invasivos (CBNMIs) nos estádios Ta, T1, e carcinoma in situ (CIS). Atualmente, o tratamento mais utilizado contra CBNMIs envolve a imunoterapia com Bacillus Calmette-Guérin (BCG) associada à ressecção transuretral (RTU). No entanto, a utilização de BCG pode causar graves efeitos colaterais e está associada com uma elevada taxa de recorrência após o tratamento. Por conseguinte, várias abordagens têm sido investigadas, incluindo o desenvolvimento de novas moléculas, assim como a melhoria da terapia com medicamentos convencionalmente utilizados no tratamento de tumores e a incorporação de sistemas de carreamento de fármacos. Considerando o uso de novas moléculas, complexos metálicos derivados de bases de Schiff (BSs) são compostos versáteis que apresentam atividade antitumoral, fornecendo assim novas perspectivas para a terapia do CBNMI. Em relação ao carreamento de fármacos, ao longo dos últimos anos, carreadores lipídicos nanoestruturados (CLNs) têm atraído considerável interesse como veículos alternativos para produtos farmacêuticos antitumorais. Assim, com o intuito de adquirir maior conhecimento a respeito da química dos complexos derivados da BS N-Salicilideno anilina (Salan) e também seus efeitos na progressão do CBNMI, esta tese descreve a síntese e caracterização de complexos N-Salicilideno anilina(níquel) [Salan(Ni)] e N-Salicilideno anilina(platina) [Salan(Pt)]. A estrutura proposta desses compostos foi estabelecida por análise elementar (CHN), FTIR, TG, RMN de 1H e 13C. As atividades citotóxicas dos compostos sintetizados [Salan, NiCl2 e Salan(Ni)] foram avaliadas por ensaio MTT e os dados obtidos indicaram que Salan(Ni) demonstrou atividade citotóxica significativa contra linhagens celulares de leucemia e câncer de fígado. Além disso, neste estudo os efeitos histopatológicos e moleculares dos compostos sintetizados [Salan, Salan(Ni) e Salan(Pt)] foram caracterizados e comparados com o tratamento com BCG em um modelo animal de CBNMI. Os resultados obtidos indicaram que o grupo Salan(Ni): apresentou melhor recuperação histopatológica quando comparado ao grupo Câncer; aumentou os níveis da proteína UPIII; aumentou a expressão dos genes supressores de tumor PTEN e p53; causou inibição da angiogênese devido aos níveis proteicos elevados de endostatina e níveis mais baixos da proteína VEGF. No entanto, durante a instilação dos tratamentos, observou-se a precipitação dos compostos. Então, testes utilizando 2% de DMSO em óleo de milho como veículo para complexos do tipo Salan [Salan(Ni) e Salan(Pt)] foram realizados. Adicionalmente, o complexo Salan(Pt) foi incorporado a um carreador lipídico nanoestruturado (CLN) derivado de murumuru. O CLN carregado com Salan(Pt) [Salan(Pt)-CLN] foi preparado através do sistema de agitação mecânica e apresentou diâmetro médio de 165,4 nm e potencial zeta -34,4 mV. Por fim, os compostos obtidos [Salan(Ni), Salan(Pt), CLN livre, Salan(Pt)-CLN] foram administrados in vivo para avaliar seus efeitos contra CBNMI. A análise histológica revelou que o grupo Salan(Ni) apresentou melhor recuperação histopatológica. Análises de Western blotting (WB) indicaram que os tratamentos com Salan(Ni), Salan(Pt) e Salan(Pt)-CLN provavelmente ativam a via p53 diminuindo os níveis proteicos de Akt e PI3K. Em conclusão, os resultados indicaram que o complexo Salan(Ni) apresentou melhores efeitos na redução da agressividade do CBNMI comparado aos demais complexos e BCG. / Bladder cancer (BC) is the second most common genitourinary malignancy. Most (75%) BCs are non–muscle invasive (NMIBC) at first diagnosis [Ta, T1, and carcinoma in situ (CIS)]. Currently, the most used treatment against NMIBC involves the immunotherapy with BCG (Bacillus Calmette-Guérin) associated with the transurethral resection. However, the use of BCG can cause severe side effects and it is associated with high recurrence rate after treatment. Therefore, several approaches have been investigated, including the development of new molecules and also the improvement of the therapy with drugs conventionally used to treat cancers by using drug delivery systems. Considering the use of new molecules, metal complexes derived from Schiff bases (SBs) are versatile molecules with anticancer activity, providing new perspectives for the therapy of NMIBC. Regarding the drug delivery, over the past few years, nanostructured lipid carriers (NLCs) have been attracting considerable interest as alternative carriers for anticancer pharmaceuticals. Thus, in order to acquire more information about the chemistry of the complexes derived from the SB of N-Salicylidene aniline (Salan), as well as its effects on the progression of NIMBC, the present thesis describes the synthesis and characterization of N-Salicylidene aniline(nickel) [Salan(Ni)] and N-Salicylidene aniline(platinum) [Salan(Pt)] complexes. The proposed structure of these compounds was established by elemental analysis (CHN), FTIR, TG, 1H and 13C NMR. Cytotoxic activities of the synthesized compounds [Salan, NiCl2 and Salan(Ni)] were evaluated by the MTT assay and the obtained data indicated that Salan(Ni) showed significant cytotoxic activity against leukemia and liver cancer cells lines. Furthermore, in this study the histopathological and molecular effects of the synthesized compounds [Salan, Salan(Ni) and Salan(Pt)] were characterized and compared with BCG treatment in an animal model of NMIBC. Our results demonstrated that the Salan(Ni) group: improved histopathological recovery when compared with Cancer group; increased UPIII protein levels; increased expression of tumor suppressors genes PTEN and p53; inhibited of angiogenesis assigned to elevated levels of endostatin and lower levels of VEGF. However, during the instillation of treatments, compounds precipitation were observed. Then, tests using 2% DMSO in corn oil as vehicle for Salan-type complexes [Salan(Ni) and Salan(Pt)] were performed. Additionally, Salan(Pt) complex was incorporated into nanostructured lipid carrier (NLC) derived from murumuru. The NLC loaded with Salan(Pt) [Salan(Pt)-NLC] was prepared by using mechanical agitation method and had an average diameter of 165,4 nm as well as zeta potential of -34,4 mV. Ultimately, the obtained compounds [Salan(Ni), Salan(Pt), free NLC, Salan(Pt)-NLC] were administered in vivo to evaluete their effects against NMIBC. The histological analysis revealed that Salan(Ni) group Abstract MATSUMOTO, M. Y. Tese de Doutorado em Biologia Geral e Aplicada – UNESP – Botucatu showed bestter histopathological recovery. Western blotting (WB) analysis indicated that Salan(Ni), Salan(Pt) and Salan(Pt)-NLC treatments probably activate the p53 pathway by decreasing the protein levels of Akt and PI3K. In conclusion, the results showed the Salan(Ni) has better effects in reduction of NMIBC aggressiveness compared to the other complexes and BCG / 2013/04708-8

Orientador: Wagner José Fávaro / Resumo: O câncer de bexiga (CB) é a segunda malignidade geniturinária mais comum. A maioria (75%) dos CBs são primeiramente diagnosticados como não-músculo invasivos (CBNMIs) nos estádios Ta, T1, e carcinoma in situ (CIS). Atualmente, o tratamento mais utilizado contra CBNMIs envolve a imunoterapia com Bacillus Calmette-Guérin (BCG) associada à ressecção transuretral (RTU). No entanto, a utilização de BCG pode causar graves efeitos colaterais e está associada com uma elevada taxa de recorrência após o tratamento. Por conseguinte, várias abordagens têm sido investigadas, incluindo o desenvolvimento de novas moléculas, assim como a melhoria da terapia com medicamentos convencionalmente utilizados no tratamento de tumores e a incorporação de sistemas de carreamento de fármacos. Considerando o uso de novas moléculas, complexos metálicos derivados de bases de Schiff (BSs) são compostos versáteis que apresentam atividade antitumoral, fornecendo assim novas perspectivas para a terapia do CBNMI. Em relação ao carreamento de fármacos, ao longo dos últimos anos, carreadores lipídicos nanoestruturados (CLNs) têm atraído considerável interesse como veículos alternativos para produtos farmacêuticos antitumorais. Assim, com o intuito de adquirir maior conhecimento a respeito da química dos complexos derivados da BS N-Salicilideno anilina (Salan) e também seus efeitos na progressão do CBNMI, esta tese descreve a síntese e caracterização de complexos N-Salicilideno anilina(níquel) [Salan(Ni)] e N-Sa... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bladder cancer (BC) is the second most common genitourinary malignancy. Most (75%) BCs are non–muscle invasive (NMIBC) at first diagnosis [Ta, T1, and carcinoma in situ (CIS)]. Currently, the most used treatment against NMIBC involves the immunotherapy with BCG (Bacillus Calmette-Guérin) associated with the transurethral resection. However, the use of BCG can cause severe side effects and it is associated with high recurrence rate after treatment. Therefore, several approaches have been investigated, including the development of new molecules and also the improvement of the therapy with drugs conventionally used to treat cancers by using drug delivery systems. Considering the use of new molecules, metal complexes derived from Schiff bases (SBs) are versatile molecules with anticancer activity, providing new perspectives for the therapy of NMIBC. Regarding the drug delivery, over the past few years, nanostructured lipid carriers (NLCs) have been attracting considerable interest as alternative carriers for anticancer pharmaceuticals. Thus, in order to acquire more information about the chemistry of the complexes derived from the SB of N-Salicylidene aniline (Salan), as well as its effects on the progression of NIMBC, the present thesis describes the synthesis and characterization of N-Salicylidene aniline(nickel) [Salan(Ni)] and N-Salicylidene aniline(platinum) [Salan(Pt)] complexes. The proposed structure of these compounds was established by elemental analysis (CHN), FTIR, TG... (Complete abstract click electronic access below) / Doutor