| Part One:Expression,role and clinical significance of YB-1 and E-cadherin in bladder cancerBackgroundBladder urothelial cancer is one of the most common malignancies in urinary tract,accounting for 900%to 95%of all bladder cancers.Despite advances in the treatment of bladder cancer over the past years,the 5-year survival rate remains low,especially in metastatic bladder cancer,where the 5-year survival rate is lower.It has been found that the prognosis of bladder cancer is related to tumorous grade and stage,so it is very important to find a new biomarker for the diagnosis and treatment of bladder cancer.YB-1(Y-box binding protein-1)is a member of the cold shock protein superfamily,which contains highly conserved nucleic acid sequences and approximately 65 amino acids.YB-1 is a multi-functional protein that plays multiple regulatory roles in the transcription and translation of related genes and proteins in tumor cells,such as regulating the proliferation and progression of tumor cells,cell survival,DNA replication,DNA repair,multi-drug resistance and epithelial-mesenchymal transformation.E-cadherin is a member of the classical family of cadherin proteins.Cadherin plays an important role in embryonic development and adult tissue homeostasis.These transmembrane proteins mediate the formation of calcium-dependent cell adhesion and cellular adhesion,and E-cadherin is a component of adhesion and a major organizer of epithelial phenotype.The cytoplasmic tails of E-cadherin are associated with a variety of catenin proteins(α,βand p120),which are then connected to the cytoskeleton and modulate signal effects.The loss of E-cadherin expression is associated with tumor progression and metastasis.Many studies have reported a link between YB-1 and E-cadherin and various cancers,including bladder cancer.However,the role of YB-1 and E-cadherin in bladder cancer prognosis is not fully understood.ObjectiveThe purpose of this study was to evaluate the value of YB-1 and E-cadherin in bladder cancer.In this study,the expression,role and clinical significance of YB-1 and E-cadherin in bladder cancer tissues were elucidated through molecular biology and other related technical means,providing new targets and basis for molecular diagnosis,prognosis and follow-up treatment of bladder cancer MethodsParaffin embedded specimens of bladder cancer patients with complete follow-up data from the bladder cancer database of our department were collected,and the expressions of YB-1 and E-cadherin in cancer tissues and adjacent tissues of bladder cancer patients were analyzed by immunohistochemistry.In this study,the expression of YB-1 and E-cadherin in 117 patients with bladder cancer was detected by immunohistochemical staining.Univariate and multivariate analysis of the relationship between YB-1 and E-cadherin and bladder cancer prognosisResults1.YB-1 and E-cadherin were differentially expressed in bladder cancer tissues and adjacent tissues2.YB-1 and E-cadherin were significantly correlated with clinical stage,pathological stage and lymph node metastasis of bladder cancer patients3.Univariate analysis showed that patients with high expression of YB-1(HR =2.732).P=0.001),patients with low E-cadherin expression(HR=2.899;P=0.003),and the clinical stage was high(HR= 3.905).P<0.001),high pathological staging(HR=4.199;P<0.001)and lymph node metastasis(HR= 5.267;Patients with P<0.001)had low overall survival rate(OS)and poor prognosis4.Multivariate analysis showed that patients with high expression of YB-1(HR =2.031;P=0.022)and lymph node metastasis(HR＝3.546).Patients with P<0.001)had a worse prognosisConclusion1.Expression of YB-1 and E-cadherin was associated with tumor staging,grading and metastasis in bladder cancer patients2.For patients undergoing radical bladder cancer resection,YB-1 may be a reliable marker for predicting patient survival and prognosisPart Two:Surveillance study of irrigating fluid absorption and bleeding in transurethral resection of the prostateBackgroundEndourological technique is widely applied in urology surgery.For keeping the operation visual field clear,irrigating the burning organization block and bleeding and maintaining endoscopic operation space,we need to use a large number of irrigating fluid in the operation and with a certain velocity and pressure to irrigate,which can lead to a large amount of irrigating fluid absorbed by the body and corresponding complications,such as hyponatremia,pulmonary edema,severe bleeding,arrhythmia,and even life threatening.Due to mixed irrigating fluid and bleeding,it is difficult to accurately monitor the amount of bleeding and fluid absorption.It bring out severe transurethral resection syndrome(TURS)and hemorrhagic shock,which were major clinical problem of Urology Endoscopy Operation(UEO).At present,endoscopic surgical devices at home and abroad do not have the function of intraoperative real-time monitoring of fluid absorption and bleeding.To real-time monitor UEO intraoperative fluid absorption and bleeding,prevent complications,our team has been actively researched and developed a set of domestic endoscopic surveillance system from June 2010,which can be timely and accurate monitoring of fluid absorption and bleeding and to avoid excessive fluid absorption and complications such as bleeding.In this study,we firstly developed a domestic endoscopic surveillance system,and then we studied the accuracy and safety of endoscopic surveillance system from three aspects of in vitro test,preliminary clinical application and clinical application,so as to provide more accurate auxiliary monitoring equipment for surgeons and patients and reduce surgical complications.Objective1.To develop endoscopic surveillance system.2.To evaluate its monitoring function by vitro trials.3.To examine the application effect by Preliminary clinical trials.4.To evaluate the effect of transurethral prostate surgery.Methods1.From June 2010,based on fluid balance,photoelectric principle and computer technology,our team developed the endoscopic surveillance system.2.In vitro trials,we simulated the fluid absorption and hemorrhage in the operation,and detected the accuracy and consistency of the endoscopic surveillance system.3.In preliminary clinical trials,50 cases of BPH were monitored in surgery and the biochemical index,hemodynamics,irrigating fiuid absorption and bleeding were compared.4.In clinical trials,161 cases of BPH were monitored in surgery and the biochemical index,hemodynamics,irrigating fiuid absorption and bleeding were compared.Results1.we developed the endoscopic surveillance system which is original in the world.2.In vitro trials,the error of the measurement was less than 1%(only the error was 1.60 percent in 5 ml)and no significant difference was observed in all groups standard values and measurement values.3.In Preliminary Clinical trials,we compared some preoperative and postoperative indexes:the average blood oxygen saturation were 94.46±2.49 and 92.39+2.77(P<0.01),the average Serum sodium ion concentration were 141.05±2.52mmol/L and 138.06±4.27mmol/L(P<0.01,the average HGB were 143.50±13.43g/L and 137.04±14.25g/L(P<0.01),the average HCT were 42.05±4.09%and 137.04±14.25%(P<0.01),the average HR were 77.89±7.59 beats per minute and 77.93±6.93 beats per minute,the MAP were 90.32±9.75mmHg and 91.07±8.96mmHg,the average serum potassium ion concentration were 4.13±0.53mmol/L and 4.09±0.37mmol/L.the average irrigating fiuid absorption of the group less than 60 minutes and the group equal or more than 60 minutes were 401.83±279.23ml and 885.25±367.68ml(P<0.01),the average blood loss were 64.10±47.47ml and 158.40±65.22ml(P<0.01).4.In clinical trials,the average operation time were 62.45±17.28min,the average irrigating fiuid absorption were 838.48 ±309.95ml,the average bleeding were 240.38 ±71.26ml,and the average postoperative hospital stay were 3.39 +0.583.The difference in serum potassium before and after surgery was statistically significant(P<0.05).Preoperative and postoperative serum calcium and hemoglobin were significantly different(P<0.01).There were no statistically significant differences in serum sodium,serum chlorine and hematocrit before and after surgery(P>0.05).There were 50 cases with monitoring alarm.Prostate size was positively correlated with bleeding and irrigating fiuid absorption,and operation time was positively correlated with bleeding and irrigating fiuid absorption.Conclusion1.The endoscopic surveillance system meet the national certification standards.2.The endoscopic surveillance system was of great safety and accuracy.3.It can offer real-time monitoring data and alarm mechanism for the surgeons that possibly reduce complications and improve operation safety. |
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