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| 2. |
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| 3. |
- Beral, V, et al.
(författare)
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Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58515 women with breast cancer and 95067 women without the disease
- 2002
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 87, s. 1234-45
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Tidskriftsartikel (refereegranskat)abstract
- Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58515 women with invasive breast cancer and 95067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19 - 1.45, P < 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P < 0.00001) for greater than or equal to 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1 % per 10 g per day, P < 0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers= 1.03, 95% CI 0.98 - 1.07, and for current smokers=0.99, 0.92 - 1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. (C) 2002 Cancer Research UK.
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| 5. |
- de Boniface, J., et al.
(författare)
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Omitting axillary dissection in breast cancer with sentinel-node metastases
- 2024
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 390:13, s. 1163-1175
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Trials evaluating the omission of completion axillary-lymph-node dissection in patients with clinically node-negative breast cancer and sentinel-lymph-node metastases have been compromised by limited statistical power, uncertain nodal radiotherapy target volumes, and a scarcity of data on relevant clinical subgroups.METHODS We conducted a noninferiority trial in which patients with clinically node-negative primary T1 to T3 breast cancer (tumor size, T1, ≤20 mm; T2, 21 to 50 mm; and T3, >50 mm in the largest dimension) with one or two sentinel-node macrometastases (metastasis size, >2 mm in the largest dimension) were randomly assigned in a 1:1 ratio to completion axillary-lymph-node dissection or its omission (sentinel-node biopsy only). Adjuvant treatment and radiation therapy were used in accordance with national guidelines. The primary end point was overall survival. We report here the per-protocol and modified intention-to-treat analyses of the prespecified secondary end point of recurrence-free survival. To show noninferiority of sentinel-node biopsy only, the upper boundary of the confidence interval for the hazard ratio for recurrence or death had to be below 1.44.RESULTS Between January 2015 and December 2021, a total of 2766 patients were enrolled across five countries. The per-protocol population included 2540 patients, of whom 1335 were assigned to undergo sentinel-node biopsy only and 1205 to undergo completion axillary-lymph-node dissection (dissection group). Radiation therapy including nodal target volumes was administered to 1192 of 1326 patients (89.9%) in the sentinel-node biopsy–only group and to 1058 of 1197 (88.4%) in the dissection group. The median follow-up was 46.8 months (range, 1.5 to 94.5). Overall, 191 patients had recurrence or died. The estimated 5-year recurrence-free survival was 89.7% (95% confidence interval [CI], 87.5 to 91.9) in the sentinel-node biopsy–only group and 88.7% (95% CI, 86.3 to 91.1) in the dissection group, with a country-adjusted hazard ratio for recurrence or death of 0.89 (95% CI, 0.66 to 1.19), which was significantly (P<0.001) below the prespecified noninferiority margin.CONCLUSIONS The omission of completion axillary-lymph-node dissection was noninferior to the more extensive surgery in patients with clinically node-negative breast cancer who had sentinel-node macrometastases, most of whom received nodal radiation therapy. (Funded by the Swedish Research Council and others; SENOMAC ClinicalTrials.gov number, NCT02240472.).
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| 6. |
- de Boniface, J., et al.
(författare)
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The generalisability of randomised clinical trials: an interim external validity analysis of the ongoing SENOMAC trial in sentinel lymph node-positive breast cancer
- 2020
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Ingår i: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 0167-6806 .- 1573-7217. ; 180:1, s. 167-176
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Tidskriftsartikel (refereegranskat)abstract
- Purpose None of the key randomised trials on the omission of axillary lymph node dissection (ALND) in sentinel lymph-positive breast cancer have reported external validity, even though results indicate selection bias. Our aim was to assess the external validity of the ongoing randomised SENOMAC trial by comparing characteristics of Swedish SENOMAC trial participants with non-included eligible patients registered in the Swedish National Breast Cancer Register (NKBC). Methods In the ongoing non-inferiority European SENOMAC trial, clinically node-negative cT1-T3 breast cancer patients with up to two sentinel lymph node macrometastases are randomised to undergo completion ALND or not. Both breast-conserving surgery and mastectomy are eligible interventions. Data from NKBC were extracted for the years 2016 and 2017, and patient and tumour characteristics compared with Swedish trial participants from the same years. Results Overall, 306 NKBC cases from non-participating and 847 NKBC cases from participating sites (excluding SENOMAC participants) were compared with 463 SENOMAC trial participants. Patients belonging to the middle age groups (p = 0.015), with smaller tumours (p = 0.013) treated by breast-conserving therapy (50.3 versus 47.1 versus 65.2%, p < 0.001) and less nodal tumour burden (only 1 macrometastasis in 78.8 versus 79.9 versus 87.3%, p = 0.001) were over-represented in the trial population. Time trends indicated, however, that differences may be mitigated over time. Conclusions This interim external validity analysis specifically addresses selection mechanisms during an ongoing trial, potentially increasing generalisability by the time full accrual is reached. Similar validity checks should be an integral part of prospective clinical trials. Trial registration: NCT 02240472, retrospective registration date September 14, 2015 after trial initiation on January 31, 2015
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| 8. |
- Hellsten, Torbjörn, et al.
(författare)
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Fast wave current drive in JET ITB-plasma
- 2005
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Ingår i: AIP Conference Proceedings. - : AIP. - 0094-243X. ; , s. 273-278
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Konferensbidrag (refereegranskat)abstract
- Fast wave current drive has been performed in JET plasmas with internal transport barriers, ITBs, and strongly reversed magnetic shear. Although the current drive efficiency of the power absorbed on the electrons is fairly high, only small effects are seen in the central current density. The main reasons are the parasitic absorption of RF power, the strongly inductive nature of the plasma and the interplay between the fast wave driven current and bootstrap current. The direct electron heating in the FWCD experiments is found to be strongly degraded compared to that with the dipole phasing.
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| 9. |
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| 10. |
- Appelgren, M., et al.
(författare)
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Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial
- 2022
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Ingår i: Breast. - : Elsevier BV. - 0960-9776 .- 1532-3080. ; 63, s. 16-23
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND). Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1-2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQC30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.
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| 11. |
- Bergkvist, Jonas, et al.
(författare)
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Miniaturized flowthrough microdispenser with piezoceramic tripod actuation
- 2005
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Ingår i: Journal of Microelectromechanical Systems. - 1057-7157. ; 14:1, s. 134-140
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, the further development of a silicon flowthrough microdispenser is described. Previously reported designs of the dispenser used bimorph, and later multilayered, piezoelectric actuator elements for the generation of droplets. The introduction of a multilayered actuator significantly reduced the voltage amplitude needed to dispense droplets. Dispenser properties relevant for chemical analysis systems, e.g., reduced sample volume, internal surface area, and dispersion, were improved by miniaturization of the device. In this paper, a new actuator design, the tripod, is presented to enable further dispenser miniaturization and to facilitate device assembly. Tripod actuators were manufactured using a prototyping process, based on micromilling, for multilayer piezoceramic components. A building technique for miniaturized electrical interconnects, based on microstructured flexible printed circuits, is also suggested in line with the prospect of future miniaturization. The microfluidic properties of the tripod- actuated dispenser were evaluated. Stable droplet generation in the frequency range from 0 to 3 kHz was demonstrated, providing a maximum dispensed flow rate of 7.8 muL/min.
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| 12. |
- Bergkvist, Tommy, et al.
(författare)
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Non-linear study of fast particle excitation of global Alfvén eigenmodes during ICRH
- 2005
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 45, s. 485-493
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Tidskriftsartikel (refereegranskat)abstract
- High-power ion–cyclotron resonance heating (ICRH) can produce centrally peaked fast ion distributions with wide non-standard drift orbits exciting Alfvén eigenmodes (AEs). The dynamics of the AE excitation depends not only on the anisotropy and the peaking of the fast ion distribution but also on the decorrelation of the AE interactions and the renewal of the fast ions resonant with the AE by ion–cyclotron interactions. A method of self-consistently including the evolution of the distribution function of fast ions during excitation of AEs and ICRH has been developed and implemented in the SELFO code. Numerical simulations of the AE dynamics and ICRH give a variation of the AE amplitude consistent with the experimentally observed splitting of the mode frequency. The experimentally observed fast damping of the mode as the ICRH is switched off is also evident in the simulations.
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| 13. |
- Bergkvist, Tommy, et al.
(författare)
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Nonlinear interaction between RF-heated high-energy ions and MHD-modes
- 2003
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Ingår i: RADIO FREQUENCY POWER IN PLASMAS. - 0735401586 ; , s. 459-462
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Konferensbidrag (refereegranskat)abstract
- Excitation of global Alfven eigenmodes by fast ions during ICRH is frequently observed in tokamaks. The importance of the phasing of the ICRH antennae for the excitation of these modes have been seen in experiments. The Alfven eigenmodes will drive the distribution function of the fast ions towards a state where the gradient in phase space is reduced. In general, the fast ions are displaced outwards, which can have a significant effect on the ICRH power deposition and lead to reduced heating efficiency. To calculate the effect on the heating profiles by the excitation of Alfven eigenmodes and the, effect on the resonating ions the Monte Carlo code FIDO, used for ICRH, has been upgraded to include particle interactions with MHD-waves. This allows self-consistent calculations of the mode amplitude and the distribution function during RF heating.
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| 15. |
- Holmberg, L, et al.
(författare)
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A search for recall bias in a case-control study of diet and breast cancer
- 1996
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Ingår i: INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. - : OXFORD UNIV PRESS UNITED KINGDOM. - 0300-5771. ; 25:2, s. 235-244
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Tidskriftsartikel (refereegranskat)abstract
- Background. In retrospective studies of dietary habits and breast cancer risk, recall bias is a concern since diet has been publicized as a cause of breast cancer. Methods, In a case-control study of diet and breast cancer risk nested within a cohort of w
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| 18. |
- Suzuki, R., et al.
(författare)
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Dietary lignans and postmenopausal breast cancer risk by oestrogen receptor status : a prospective cohort study of Swedish women
- 2008
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 98:3, s. 636-640
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Tidskriftsartikel (refereegranskat)abstract
- Among the 51 823 postmenopausal women in the Swedish Mammography Cohort, we investigated breast cancer risk in relation to the FFQ-based estimated lignan intake by oestrogen receptor (ER) and progesterone receptor (PR) subtypes. A significant 17% risk reduction for breast cancer overall in the high lignan quartile was observed, especially among PMH user (P-interaction < 0.010), but no heterogeneity across ER/PR subtypes.
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| 19. |
- Söderström, Lisa, et al.
(författare)
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A high energy intake from dietary fat among middle-aged and older adults is associated with increased risk of malnutrition 10 years later
- 2015
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Ingår i: British Journal of Nutrition. - : Cambridge University Press. - 0007-1145 .- 1475-2662. ; 114:6, s. 915-923
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Tidskriftsartikel (refereegranskat)abstract
- A higher fat content in the diet could be an advantage for preventing malnutrition among older adults. However, there is sparse scientific evidence to determine the optimal fat intake among older adults. This prospective cohort study examined whether a high energy intake of dietary fat among middle-aged and older adults is associated with the risk of malnutrition 10 years later. The study population comprised 725 Swedish men and women aged 53-80 years who had completed a questionnaire about dietary intake and lifestyle factors in 1997 (baseline) and whose nutritional status was assessed when admitted to the hospital in 2008-2009 (follow-up). At the follow-up, 383 (52.8 %) participants were identified as being at risk of malnutrition and fifty-two (7.2 %) were identified as malnourished. Multinomial logistic regression models were used to analyse the association between previous dietary fat intake and nutritional status later in life. Contrary to what was expected, a high energy intake from total fat, saturated fat and monounsaturated fat among middle-aged and older adults increased the risk of exhibiting malnutrition 10 years later. However, this applied only to individuals with a BMI<25 kg/m(2) at the baseline. In conclusion, these findings suggest that preventive actions to counteract malnutrition in older adults should focus on limiting the intake of total fat in the diet by reducing consumption of food with a high content of saturated and monounsaturated fat.
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| 20. |
- Tidåker, P., et al.
(författare)
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Rotational grass/clover for biogas integrated with grain production - A life cycle perspective
- 2014
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Ingår i: Agricultural Systems. - : Elsevier. - 0308-521X .- 1873-2267. ; 129, s. 133-141
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Tidskriftsartikel (refereegranskat)abstract
- Rotational perennial grass/clover has multiple effects in cropping systems dominated by cereals. This study evaluated the environmental impact of rotational grass/clover ley for anaerobic digestion in a cereal-dominated grain production system in Sweden. Life cycle assessment (LCA) methodology was used to compare two scenarios: (i) a cropping system including only spring barley and winter wheat; and (ii) a cropping system including 2-year grass/clover ley in combination with spring barley and winter wheat. The functional unit was one tonne of grain. The two main functions of the grass/clover crop were to provide feedstock for biogas production and to act as an organic fertiliser for allocation among the cereal crops in the rotation. Special consideration was given to nitrogen (N) management and the rotational effects of the grass/clover ley. In total, 73% of the N requirement of cereals in the ley scenario was met through symbiotic N fixation. Replacing diesel with biogas and mineral fertiliser with digested grass/clover biomass (digestate) reduced the use of fossil fuels substantially, from 1480. MJ per tonne in the reference scenario to -2900. MJ per tonne in the ley scenario. Potential eutrophication per tonne grain increased in the ley scenario, mainly owing to significantly higher ammonia emissions from spreading digestate and the larger area required for producing the same amount of grain. Potential acidification also increased when N mineral fertiliser was replaced by digestate. Crops relying on symbiotic N fixation are a promising feedstock for reducing the use of non-renewable energy in the production chain of farm-based bioenergy, but careful handling of the N-rich digestate is required. Replacing cereals intended for feed or food with bioenergy crops leads to indirect land use changes (iLUC) when the displaced crops must be produced elsewhere and the benefits obtained when biofuels replace fossil fuels may thereby be outweighed. In this study, the iLUC factor assumed had a critical effect on global warming potential in the ley scenario. However, carbon sequestration and the higher yield potential of subsequent cereal crops can mitigate greenhouse gas emissions from iLUC to a varying extent. We recommend that crop sequences rather than single crops be considered when evaluating the environmental impact of production systems that include perennial legumes for food, feed and bioenergy.
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