| 1. |
- Solberg, Arne, et al.
(författare)
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Residual Prostate Cancer in Patients Treated with Endocrine Therapy with or Without Radical Radiotherapy : A Side Study of the SPCG-7 Randomized Trial.
- 2011
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Ingår i: International journal of radiation oncology, biology, physics. - : Elsevier. - 1879-355X .- 0360-3016. ; 80:1, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The Scandinavian Prostate Cancer Group-7 randomized trial demonstrated a survival benefit of combined endocrine therapy and external-beam radiotherapy over endocrine therapy alone in patients with high-risk prostate cancer. In a subset of the study population, the incidence and clinical implications of residual prostate cancer in posttreatment prostate biopsy specimens was evaluated. METHODS AND MATERIALS: Biopsy specimens were obtained from 120 of 875 men in the Scandinavian Prostate Cancer Group-7 study. RESULTS: Biopsies were performed at median of 45 months follow-up. In 63 patients receiving endocrine treatment only and 57 patients receiving combined treatment, residual cancer was found in 66% (n = 41) and 22% (n = 12), respectively (p < 0.0001). The vast majority of residual tumors were poorly differentiated (Gleason score >/=8). Endocrine therapy alone was predictive of residual prostate cancer: odds ratio 7.49 (3.18-17.7), p < 0.0001. In patients with positive vs. negative biopsy the incidences of clinical events were as follows: biochemical recurrence 74% vs. 27% (p < 0.0001), local progression 26% vs. 4.7% (p = 0.002), distant recurrence 17% vs. 9.4% (p = 0.27), clinical recurrence 36% vs. 13% (p = 0.006), cancer-specific death 19% vs. 9.7% (p = 0.025). In multivariable analysis, biochemical recurrence was significantly associated with residual cancer: hazard ratio 2.69 (1.45-4.99), p = 0.002, and endocrine therapy alone hazard ratio 3.45 (1.80-6.62), p < 0.0001. CONCLUSIONS: Radiotherapy combined with hormones improved local tumor control in comparison with endocrine therapy alone. Residual prostate cancer was significantly associated with serum prostate-specific antigen recurrence, local tumor progression, clinical recurrence, and cancer-specific death in univariable analysis. Residual cancer was predictive of prostate-specific antigen recurrence in multivariable analysis.
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| 3. |
- Ahlgren, Hans, 1984-
(författare)
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Prehistoric human impact on wild mammalian populations in Scandinavia
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to study the interactions of pre-agricultural societies in Scandinavia with wild mammals, for example in terms of hunting and translocation. More specifically, the aim is to investigate the possibility of identifying examples of overexploitation, targeted hunting or translocation of wild mammals in prehistoric Scandinavia, and to discuss the implications this could have had for both the wild animals and the humans. The thesis also studies translocation to evaluate the feasibility of using it as a proxy for prehistoric human mobility, and to understand the motivation for this action. Although the focus is on the animals in this thesis, the ultimate purpose is to study humans and their interactions with animals in prehistory. The thesis applies genetic analyses to zooarchaeological material of various mammalian species from different Scandinavian sites, in order to study whether the genetic structures have changed in these species over time, and to assess whether these changes were induced by different human actions. The species studied in this thesis were selected on the basis of the importance they are considered to have had for prehistoric people.The dissertation comprises five studies. The first study investigates the occurrence of mountain hares on the island of Gotland, and discusses how they got there and where they came from. The second study explores the temporal genetic structure of the grey seal in the Baltic Sea, and discusses whether humans and/or climate were the drivers for the sudden disappearance of grey seals from the island of Stora Karlsö. The third study concerns a shift where moose apparently became less important as prey in northern Sweden at the end of the Neolithic period, and discusses whether humans targeted female moose in hunting. The fourth study analyses and discusses the history of the harp seal in the Baltic Sea. The fifth study is a methodological paper which involves identifying seals according to sex, using the dog genome.The overall result of the different case studies shows that there were major population fluctuations over time in all the species studied, and that in some cases, humans are likely to have contributed to this, e.g. through overhunting and translocation. The study also shows that the population fluctuations often occurred in connection with certain climatic events, though it was not possible to separate climatic effects from human impact in terms of the cause.
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| 4. |
- Ahlgren, Joakim, et al.
(författare)
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Orsaker till minskande syrehalter i Bottenhavet
- 2017
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Rapport (refereegranskat)abstract
- Resultat från den nationella miljöövervakningen visar att syrehalterna i Bottenhavet har minskat sedan 1970-talet, en minskning som accelererat från 1990. För att ha möjlighet att på något sätt kunna åtgärda denna försämring av den marina miljön är det nödvändigt att identifiera orsakerna till denna syreminskning, eftersom olika orsaker kan kräva olika former av åtgärder. Om orsaken till exempel är ökad syreförbrukning beroende på regional övergödning, skulle detta innebära ökat behov av regionala reningsåtgärder. Målsättningen med projektet var därmed att ge en tillförlitlig förklaring till de sjunkande syrehalterna i Bottenhavet under de senaste 20 åren genom att använda data från de nationella miljöövervakningsprogrammen. De huvudhypoteser som undersöktes som orsaker till de sjunkande syrehalterna var: • Ökad regional gödning av Bottenhavet och därmed ökad produktion. • Tillförsel av syrefattigt och fosfatrikt från Egentliga Östersjön. • Starkare haloklin och försämrad ventilation av Bottenhavets djupvatten. • Ökad temperatur och ökad tillförsel av löst organiskt kol. Analys av tidsserier och modellanalyser utifrån miljöövervaknings- och forskningsdata visade att den observerade syrehaltsminskningen i Bottenhavets djupvatten främst beror på en ökning av vattentemperaturen och delvis på en ökning av löst organiskt kol i vattnet, samt tillflöde från Egentliga Östersjön. Dataanalysen visade däremot inget tydligt stöd för att ökad produktion av biomassa i Bottenhavet orsakat de minskande syrehalterna. Detta gäller indikatorer för växtplankton, sedimentation och bakterieplankton som alla förväntas öka vid ökad produktion och det finns således inga direkta indicier för att stödja hypotesen om ökad gödning av Bottenhavet. Sammantaget visar de analyser som gjorts inom projektet att Bottenhavets framtida hälsa främst gynnas av en kombination av åtgärder för att motverka globala klimatförändringar, samt åtgärder för att förbättra vattenkvaliteten i Egentliga Östersjön. Näringstillförsel från Bottenhavets avrinningsområden bedöms främst ha haft betydelse för syresituationen i kustnära vattenförekomster. Den bedöms därför inte i betydande omfattning ha orsakat de minskande syrehalterna i Bottenhavets utsjöområden.
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| 5. |
- Ahlgren, Joakim, et al.
(författare)
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Temperature, DOC level and basin interactions explain the declining oxygen concentrations in the Bothnian Sea
- 2017
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Ingår i: Journal of Marine Systems. - : Elsevier BV. - 0924-7963 .- 1879-1573. ; 170, s. 22-30
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Tidskriftsartikel (refereegranskat)abstract
- Hypoxia and oxygen deficient zones are expanding worldwide. To properly manage this deterioration of the marine environment, it is important to identify the causes of oxygen declines and the influence of anthropogenic activities. Here, we provide a study aiming to explain the declining oxygen levels in the deep waters of the Bothnian Sea over the past 20 years by investigating data from environmental monitoring programmes. The observed decline in oxygen concentrations in deep waters was found to be primarily a consequence of water temperature increase and partly caused by an increase in dissolved organic carbon (DOC) in the seawater (R-Adj(2). = 0.83) as well as inflow from the adjacent sea basin. As none of the tested eutrophication-related predictors were significant according to a stepwise multiple regression, a regional increase in nutrient inputs to the area is unlikely to explain a significant portion of the oxygen decline. Based on the findings of this study, preventing the development of anoxia in the deep water of the Bothnian Sea is dependent on the large-scale measures taken to reduce climate change. In addition, the reduction of the nutrient load to the Baltic Proper is required to counteract the development of hypoxic and phosphate-rich water in the Baltic Proper, which can form deep water in the Bothnian Sea. The relative importance of these sources to oxygen consumption is difficult to determine from the available data, but the results clearly demonstrate the importance of climate related factors such as temperature, DOC and inflow from adjacent basins for the oxygen status of the sea.
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| 8. |
- Solberg, Arne, et al.
(författare)
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Side-effects of post-treatment biopsies in prostate cancer patients treated with endocrine therapy alone or combined with radical radiotherapy in the Scandinavian Prostate Cancer Group-7 randomized trial
- 2011
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 45:4, s. 233-238
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Post-treatment prostate biopsy side-effects were evaluated in patients with locally advanced prostate cancer on endocrine therapy alone or combined with radiotherapy in the Scandinavian Prostate Cancer Group-7 randomized trial. Material and methods. One-hundred and twenty patients underwent transrectalultrasound-guided biopsy, and were requested to complete a questionnaire on side-effects occurring within 7 days' follow-up. Results. The questionnaire was returned by 109 patients (91%) (endocrine therapy only 52%, combined endocrine therapy and radiotherapy 48%). Previous therapy had no significant influence on pain, urinary flow, haematuria or haematospermia. Pain at biopsy was reported in 63% (mild, 57%; moderate, 5.6%; severe, one patient) and pain at follow-up in 31% (mild, 27%; moderate, four patients). Haematuria (mean duration 2.2 days) was reported in 41%, and reduced urinary flow in 20% (mild, 18%; severe: four patients; no patient had urinary retention). Haematospermia was scarce. No patient reported urinary tract infection. Rectal bleeding occurred in 18% in the endocrine and 35% in the combined therapy group (p = 0.047), with a mean duration of 1.6 and 2.2 days, respectively (p = 0.031). In logistic regression analysis, a trend towards increased rectal bleeding was found in patients on combined endocrine therapy and radiotherapy (odds ratio 2.4, p = 0.050). Conclusion. Patient-reported post-treatment prostate biopsy side-effects were mild and self-limiting.
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| 9. |
- Wahlin, Anders, et al.
(författare)
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Results of risk-adapted therapy in acute myeloid leukaemia. A long-term population-based follow-up study
- 2009
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Ingår i: European Journal of Haematology. - : Wiley. - 0902-4441 .- 1600-0609. ; 83:2, s. 99-107
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Tidskriftsartikel (refereegranskat)abstract
- In 1997-2003, a protocol for treatment of acute myeloid leukaemia (AML) (except promyelocytic leukaemia) was activated in four Swedish health care regions covering 50% of the national population. Based on cytogenetics and clinical findings, patients aged 18-60 yr were assigned to one of three risk groups. In this report we account for the long-term clinical outcome of enrolled patients. Patients received idarubicin and cytarabine in standard doses as induction therapy and consolidation courses included high-dose cytarabine. Allogeneic stem cell transplantation (allo-SCT) from an human leucocyte antigen-identical sibling was recommended in standard and poor-risk patients, whereas unrelated donor transplant was reserved for poor-risk patients. Autologous (auto-SCT) was optional for standard or poor risk patients not eligible for allo-SCT. Two hundred seventy-nine patients with de novo or secondary (9%) AML, median age 51 (18-60) yr, corresponding to 77% of all patients in the population, were included. Twenty (7%) patients were assigned to the good risk group, whereas 150 (54%) and 109 patients (39%) were assigned to standard- and poor-risk groups, respectively. Induction failures accounted for 55 patients; 16 early deaths eight of whom had white blood cell (WBC) >100 at diagnosis, and 39 refractory disease. Thus, complete remission (CR) rate was 80%. At study closure, the median follow-up time of living patients was 90 months. Median survival time from diagnosis in the whole group was 27 months and 4-yr overall survival (OS) rate was 44%. In good, standard, and poor risk groups, 4-yr OS rates were 60, 57 and 24%, respectively. Median relapse-free survival (RFS) time in CR1 was 25 months and RFS at 4 yr was 44%. Four-year RFS rates were significantly (P < 0.001) different between the three risk groups; 64% in good risk, 51% in standard risk and 27% in poor risk patients. One hundred-ten transplantations were performed in CR1; 74 allo-SCT (50 sibling, 24 unrelated donor), and 36 auto-SCT. Non-relapse mortality was 16% for allo-SCT patients. Outcome after relapse was poor with median time to death 163 d and 4-yr survival rate 17%. Three conclusions were: (i) these data reflect treatment results in a minimally selected population-based cohort of adult AML patients <60 yr old; (ii) a risk-adapted therapy aiming at early allogeneic SCT in patients with a high risk of relapse is hampered by induction deaths, refractory disease, and early relapses; and (iii) high WBC count at diagnosis is confirmed as a strong risk factor for early death but not for relapse.
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