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Sökning: WFRF:(Holmberg Christer)

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1.
  • Adolfsson, Jan, et al. (författare)
  • Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005 : Data from the national prostate cancer register in Sweden
  • 2007
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - Stockholm : Taylor & Francis. - 0036-5599 .- 1651-2065. ; 41:6, s. 456-477
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. Material and methods. Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. Results. In total, 72 028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of >100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score ≤6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged ≥75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. Conclusions. All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer
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  • Adolfsson, Jan, et al. (författare)
  • Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005
  • 2007
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 41:6, s. 456-477
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. MATERIAL AND METHODS: Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. RESULTS: In total, 72,028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of > 100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score <6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged > or =75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. CONCLUSIONS: All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer.
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  • Holmberg, Joakim, et al. (författare)
  • Skiing efficiency versus performance in double-poling ergometry
  • 2013
  • Ingår i: Computer Methods in Biomechanics and Biomedical Engineering. - : Informa UK Limited. - 1025-5842 .- 1476-8259. ; 16:9, s. 987-992
  • Tidskriftsartikel (refereegranskat)abstract
    • This study is on how leg utilisation may affect skiing efficiency andperformance in double-poling ergometry. Three experiments wereconducted, each with a different style of the double-poling technique:traditional with small knee range-of-motion and fixed heels (TRAD);modern with large knee range-of-motion and fixed heels (MOD1) and modernwith large knee range-of-motion and free heels (MOD2). For each style,motion data were extracted with automatic marker recognition ofreflective markers and applied to a 3D full-body musculoskeletalsimulation model. Skiing efficiency (skiing work divided by metabolicmuscle work) and performance (forward impulse) were computed from thesimulation output. Skiing efficiency was 4.5%, 4.1% and 4.1% for TRAD,MOD1 and MOD2, respectively. Performance was 111, 143 and 149Ns forTRAD, MOD1 and MOD2, respectively. Thus, higher lower body utilisationincreased the performance but decreased the skiing efficiency. Theseresults demonstrate the potential of musculoskeletal simulations forskiing efficiency estimations.
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  • Holmberg, L. Joakim, 1971- (författare)
  • Musculoskeletal Biomechanics in Cross-country Skiing
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Why copy the best athletes? When you finally learn their technique, they may have already moved on. Using muscluloskeletal biomechanics you might be able to add the "know-why" so that you can lead, instead of being left in the swells.This dissertation presents the theoretical framework of musculoskeletal modeling using inverse dynamics with static optimization. It explores some of the possibilities and limitations of musculoskeletal biomechanics in cross-country skiing, especially double-poling. The basic path of the implementation is shown and discussed, e.g. the issue of muscle model choice. From that discussion it is concluded that muscle contraction dynamics is needed to estimate individual muscle function in double-poling. Several computer simulation models, using The Anybody Modeling System™, have been created to study different cross-country skiing applications. One of the applied studies showed that the musculoskeletal system is not a collection of discrete uncoupled parts because kinematic differences in the lower leg region caused kinetic differences in the other end of the body. An implication of the results is that the kinematics and kinetics of the whole body probably are important when studying skill and performance in sports. Another one of the applied studies showed how leg utilisation may affect skiing efficiency and performance in double-poling ergometry. Skiing efficiency was defined as skiing work divided by metabolic muscle work, performance was defined as forward impulse. A higher utilization of the lower-body increased the performance, but decreased the skiing efficiency. The results display the potential of musculoskeletal biomechanics for skiing efficiency estimations. The subject of muscle decomposition is also studied. It is shown both analytically and with numerical simulations that muscle force estimates may be affected by muscle decomposition depending on the muscle recruitment criteria. Moreover, it is shown that proper choices of force normalization factors may overcome this issue. Such factors are presented for two types of muscle recruitment criteria.To sum up, there are still much to do regarding both the theoretical aspects as well as the practical implementations before predictions on one individual skier can be made with any certainty. But hopefully, this disseration somewhat furthers the fundamental mechanistic understanding of cross-country skiing, and shows that musculoskeletal biomechanics will be a useful complement to existing experimental methods in sports biomechanics.
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  • Lahermo, P, et al. (författare)
  • A quality assessment survey of SNP genotyping laboratories
  • 2006
  • Ingår i: Human Mutation. - : Hindawi Limited. - 1059-7794 .- 1098-1004. ; 27:7, s. 711-714
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • To survey the quality of SNP genotyping, a joint Nordic quality assessment (QA) round was organized between 11 laboratories in the Nordic and Baltic countries. The QA round involved blinded genotyping of 47 DNA samples for 18 or six randomly selected SNPs. The methods used by the participating laboratories included all major platforms for small- to medium-size SNP genotyping. The laboratories used their standard procedures for SNP assay design, genotyping, and quality control. Based on the joint results from all laboratories, a consensus genotype for each DNA sample and SNP was determined by the coordinator of the survey, and the results from each laboratory were compared to this genotype. The overall genotyping accuracy achieved in the survey was excellent. Six laboratories delivered genotype data that were in full agreement with the consensus genotype. The average accuracy per SNP varied from 99.1 to 100% between the laboratories, and it was frequently 100% for the majority of the assays for which SNP genotypes were reported. Lessons from the survey are that special attention should be given to the quality of the DNA samples prior to genotyping, and that a conservative approach for calling the genotypes should be used to achieve a high accuracy.
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  • Stöggl, Thomas, et al. (författare)
  • Automatic classification of the Sub-Techniques (Gears) used in cross-country ski skating employing a mobile phone
  • 2014
  • Ingår i: Sensors. - : MDPI AG. - 1424-8220. ; 14:11, s. 20589-20601
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of the current study was to develop and validate an automatic algorithm for classification of cross-country (XC) ski-skating gears (G) using Smartphone accelerometer data. Eleven XC skiers (seven men, four women) with regional-to-international levels of performance carried out roller skiing trials on a treadmill using fixed gears (G2left, G2right, G3, G4left, G4right) and a 950-m trial using different speeds and inclines, applying gears and sides as they normally would. Gear classification by the Smartphone (on the chest) and based on video recordings were compared. Formachine-learning, a collective database was compared to individual data. The Smartphone application identified the trials with fixed gears correctly in all cases. In the 950-m trial, participants executed 140 ± 22 cycles as assessed by video analysis, with the automatic Smartphone application giving a similar value. Based on collective data, gears were identified correctly 86.0% ± 8.9% of the time, a value that rose to 90.3% ± 4.1% (P < 0.01) with machine learning from individual data. Classification was most often incorrect during transition between gears, especially to or from G3. Identification was most often correct for skiers who made relatively few transitions between gears. The accuracy of the automatic procedure for identifying G2left, G2right, G3, G4left and G4right was 96%, 90%, 81%, 88% and 94%, respectively. The algorithm identified gears correctly 100% of the time when a single gear was used and 90% of the time when different gears were employed during a variable protocol. This algorithm could be improved with respect to identification of transitions between gears or the side employed within a given gear.
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  • Tinnsten, Mats, et al. (författare)
  • Projekt Davos : hjälper längdlandslaget att åka fortare
  • 2004
  • Ingår i: Svensk Idrottsforskning. - Sth. : Centrum för idrottsforskning. - 1103-4629. ; 13:1, s. 25-27
  • Tidskriftsartikel (refereegranskat)abstract
    • DAVOS – Datorbaserade verktyg för optimering och simulering är ett EU fi nansierat (Mål 1) projekt som handlar om tillämpad teknik och tilllämpad optimering. Projektet omfattar ca 10 personer, ca 20 miljoner kr och kommer att pågå fram till 2004. Projektet drivs av institutionen för informationsteknologi och medier vid Mitthögskolan i Östersund men även personal från institutionen för teknik, fysik och matematik ingår och projektledare är docent Mats Tinnsten. I projektet ingår sex delprojekt varav två har en inriktning mot sport och sportrel aterad utrustning. DAVOS har goda kontakter med den regionala industrin, internationella universitet och forskargrupper, nationella universitet, forskargrupper och projekt. Särskilt goda och givande kontakter har projektet med Nationellt Vintersportcentrum och längdskidlandslaget samt ett antal elitskidåkare som har varit eller är studenter vid någon av teknikinstitutionerna vid campus Östersund. DAVOS handlar alltså om tillämpad teknik och optimering och verksamheten är inriktad på numeriska simuleringar och analyser av tekniska tillämpningar vilket närmast faller inom området maskinteknik och man kan ju fråga sig hur detta kan kopplas till området sport och sportutrustning. På ett alldeles naturligt sätt anser deltagarna i projektet och förhoppningsvis ska detta klarna vid genomläsning av den resterande texten.
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  • Andersson, Erik, et al. (författare)
  • Analysis of sprint cross-country skiing using a differential global navigation satellite system
  • 2010
  • Ingår i: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 110:3, s. 585-595
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose was to examine skiing velocities, gear choice (G2-7) and cycle rates during a skating sprint time trial (STT) and their relationships to performance, as well as to examine relationships between aerobic power, body composition and maximal skiing velocity versus STT performance. Nine male elite cross-country skiers performed three tests on snow: (1) Maximum velocity test (Vmax) performed using G3 skating, (2) Vmax test performed using double poling (DP) technique and (3) a STT over 1,425 m. Additional measurements of VO2max during roller skiing and body composition using iDXA were made. Differential global navigation satellite system data were used for position and velocity and synchronized with video during STT. The STT encompassed a large velocity range (2.9-12.9 m s-1) and multiple transitions (21-34) between skiing gears. Skiing velocity in the uphill sections was related to gear selection between G2 and G3. STT performance was most strongly correlated to uphill time (r = 0.92, P < 0.05), the percentage use of G2 (r = -0.72, P < 0.05), and DP Vmax (r = -0.71, P < 0.05). The velocity decrease in the uphills from lap 1 to lap 2 was correlated with VO2max (r = -0.78, P < 0.05). Vmax in DP and G3 were related to percent of racing time using G3. In conclusion, the sprint skiing performance was mainly related to uphill performance, greater use of the G3 technique, and higher DP and G3 maximum velocities. Additionally, VO2max was related to the ability to maintain racing velocity in the uphills and lean body mass was related to starting velocity and DP maximal speed.
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12.
  • Andersson, Erik, 1984-, et al. (författare)
  • Biomechanical analysis of the herringbone technique as employed by elite cross-country skiers
  • 2014
  • Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley-Blackwell. - 0905-7188 .- 1600-0838. ; 24:3, s. 542-552
  • Tidskriftsartikel (refereegranskat)abstract
    • This investigation was designed to analyse the kinematics and kinetics of cross-country skiing at different velocities with the herringbone technique on a steep incline. Eleven elite male cross-country skiers performed this technique at maximal, high, and moderate velocities on a snow-covered 15° incline. They positioned their skis laterally (25 to 30°) with a slight inside tilt and planted their poles laterally (8 to 12°) with most leg thrust force exerted on the inside forefoot. Although 77% of the total propulsive force was generated by the legs, the ratio between propulsive and total force was approximately fourfold higher for the poles. The cycle rate increased with velocity (1.20 to 1.60 Hz), whereas the cycle length increased from moderate up to high velocity, but then remained the same at maximal velocity (2.0 to 2.3 m). In conclusion, with the herringbone technique, the skis were angled laterally without gliding, with the forces distributed mainly on the inside forefoot to enable grip for propulsion. The skiers utilized high cycle rates with major propulsion by the legs, highlighting the importance of high peak and rapid generation of leg forces.
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  • Andersson, Erik, et al. (författare)
  • Energy contributions and pacing strategies of elite XC skiers during sprint skiing
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • INTRODUCTION: At present, knowledge regarding energy contributions and pacing strategies during successive sprint time-trials (STTs) in cross-country (XC) skiing is limited and, therefore, the current study was designed to examine these parameters. The results shown have recently been published elsewhere (Andersson et al., 2016).METHODS: Ten well-trained male XC skiers performed four self-paced 1300-m STTs on a treadmill, separated by 45 min of recovery. The simulated STT course was divided into three flat (1°) sections (S1, S3 and S5) involving the double poling (DP) sub-technique interspersed with two uphill (7°) sections (S2 and S4) involving the diagonal stride (DS) sub-technique. Treadmill velocity and VO2 were monitored continuously and technique-specific gross efficiency (based on submaximal pre-tests) was used to estimate anaerobic energy production.RESULTS & DISCUSSION: The average STT performance time was 229 ± 9 s and the aerobic energy contribution was 82 ± 5%. A positive pacing strategy was used during all STTs, with 3-9% more time spent on the second half of the course (P < 0.05). In addition, the pacing strategy was regulated to the terrain, with substantially higher (~30%) metabolic rates, due to primarily higher anaerobic energy production, for uphill compared with flat skiing (P < 0.05). The individually fastest STT was more aggressively paced compared to the slowest STT (P < 0.05), which resulted in a higher O2 deficit rate (13 ± 4 versus 11 ± 4 mL/kg/min, P < 0.05), while the VO2 was similar (both 52 ± 3 mL/kg/min). These findings emphasise the importance of a fast start. The within-athlete coefficient of variation (CV) in performance time, VO2 and O2 deficit were 1.3 ± 0.4%, 1.4 ± 0.9% and 11.2 ± 4.9%, respectively, with the CV in O2 deficit explaining 69% of the CV in performance. The pacing strategies were highly consistent, with an average CV in speed of 3.4%.CONCLUSION: The fastest STT was characterized by more aggressive pacing and a greater anaerobic energy production. Although the individual performance time during the four STTs was highly consistent, the small within-athlete variability in performance was related to variations in anaerobic energy production.
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  • Andersson, Erik, 1984-, et al. (författare)
  • Energy system contributions and determinants of performance in sprint cross-country skiing
  • 2017
  • Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 27:4, s. 385-398
  • Tidskriftsartikel (refereegranskat)abstract
    • To improve current understanding of energy contributions and determinants of sprint-skiing performance, 11 well-trained male cross-country skiers were tested in the laboratory for VO2max , submaximal gross efficiency (GE), maximal roller skiing velocity, and sprint time-trial (STT) performance. The STT was repeated four times on a 1300-m simulated sprint course including three flat (1°) double poling (DP) sections interspersed with two uphill (7°) diagonal stride (DS) sections. Treadmill velocity and VO2 were monitored continuously during the four STTs and data were averaged. Supramaximal GE during the STT was predicted from the submaximal relationships for GE against velocity and incline, allowing computation of metabolic rate and O2 deficit. The skiers completed the STT in 232 ± 10 s (distributed as 55 ± 3% DP and 45 ± 3% DS) with a mean power output of 324 ± 26 W. The anaerobic energy contribution was 18 ± 5%, with an accumulated O2 deficit of 45 ± 13 mL/kg. Block-wise multiple regression revealed that VO2 , O2 deficit, and GE explained 30%, 15%, and 53% of the variance in STT time, respectively (all P < 0.05). This novel GE-based method of estimating the O2 deficit in simulated sprint-skiing has demonstrated an anaerobic energy contribution of 18%, with GE being the strongest predictor of performance.
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  • Andersson, Erik, 1984-, et al. (författare)
  • Metabolic responses and pacing strategies during successive sprint skiing time trials
  • 2016
  • Ingår i: Medicine & Science in Sports & Exercise. - 0195-9131 .- 1530-0315. ; 48:12, s. 2544-2554
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To examine the metabolic responses and pacing strategies during the performance of successive sprint time trials (STTs) in cross-country skiing. METHODS: Ten well-trained male cross-country skiers performed four self-paced 1300-m STTs on a treadmill, each separated by 45 min of recovery. The simulated STT course was divided into three flat (1°) sections (S1, S3 and S5) involving the double poling sub-technique interspersed with two uphill (7°) sections (S2 and S4) involving the diagonal stride sub-technique. Treadmill velocity and V˙O2 were monitored continuously and gross efficiency was used to estimate the anaerobic energy supply. RESULTS: The individual trial-to-trial variability in STT performance time was 1.3%, where variations in O2 deficit and V˙O2 explained 69% (P < 0.05) and 11% (P > 0.05) of the variation in performance. The first and last STTs were equally fast (228 ± 10 s), and ~ 1.3% faster than the second and the third STTs (P < 0.05). These two fastest STTs were associated with a 14% greater O2 deficit (P < 0.05), while the average V˙O2 was similar during all four STTs (86 ± 3% of V˙O2max). Positive pacing was used throughout all STTs, with significantly less time spent on the first than second course half. In addition, metabolic rates were substantially higher (~_30%) for uphill than for flat skiing, indicating that pacing was regulated to the terrain. CONCLUSIONS: The fastest STTs were characterized primarily by a greater anaerobic energy production, which also explained 69% of the individual variation in performance. Moreover, the skiers employed positive pacing and a variable exercise intensity according to the course profile, yielding an irregular distribution of anaerobic energy production.
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  • Andersson, Erik, 1984- (författare)
  • PHYSIOLOGICAL AND BIOMECHANICAL FACTORS DETERMINING CROSS-COUNTRY SKIING PERFORMANCE
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Cross-country (c.c.) skiing is a complex sport discipline from both physiological and biomechanical perspectives, with varying course topographies that require different proportions of the involved sub-techniques to be utilised. A relatively new event in c.c. skiing is the sprint race, involving four separate heats, each lasting 2-4 min, with diverse demands from distance races associated with longer durations. Therefore, the overall aim of the current thesis has been to examine the biomechanical and physiological factors associated with sprint c.c. skiing performance through novel measurements conducted both in the field (Studies I-III) and the laboratory (Studies IV and V).In Study I sprint skiing velocities and sub-techniques were analysed with a differential global navigation satellite system in combination with video recording. In Studies II and III the effects of an increasing velocity (moderate, high and maximal) on the biomechanics of uphill classical skiing with the diagonal stride (DS) (Study II) and herringbone (HB) (Study III) sub-techniques were examined.In Study I the skiers completed the 1,425 m (2 x 712 m) sprint time trial (STT) in 207 s, at an average velocity of 24.8 km/h, with multiple technique transitions (range: 21-34) between skiing techniques (i.e., the different gears [G2-7]). A pacing strategy involving a fast start followed by a gradual slowing down (i.e., positive pacing) was employed as indicated by the 2.9% faster first than second lap. The slower second lap was primarily related to a slower (12.9%) uphill velocity with a shift from G3 towards a greater use of G2. The maximal oxygen uptake ( O2max) was related to the ability to maintain uphill skiing velocity and the fastest skiers used G3 to a greater extent than G2. In addition, maximal speed over short distances (50 and 20 m) with the G3 and double poling (DP) sub-techniques exerted an important impact on STT performance.Study II demonstrated that during uphill skiing (7.5°) with DS, skiers increased cycle rate and cycle length from moderate to high velocity, while cycle rate increased and cycle length decreased at maximal velocity. Absolute poling, gliding and kick times became gradually shorter with an elevated velocity. The rate of pole and leg force development increased with elevated velocity and the development of leg force in the normal direction was substantially faster during skiing on snow than previous findings for roller skiing, although the peak force was similar in both cases. The fastest skiers applied greater peak leg forces over shorter durations.Study III revealed that when employing the HB technique on a steep uphill slope (15°), the skiers positioned their skis laterally (“V” between 25 to 30°) and planted their poles at a slight lateral angle (8 to 12°), with most of the propulsive force being exerted on the inside forefoot. Of the total propulsive force, 77% was generated by the legs. The cycle rate increased across all three velocities (from 1.20 to 1.60 Hz), while cycle length only increased from moderate to high velocity (from 2.0 to 2.3 m). Finally, the magnitude and rate of leg force generation are important determinants of both DS and HB skiing performance, although the rate is more important in connection with DS, since this sub-technique involves gliding.In Studies IV and V skiers performed pre-tests for determination of gross efficiency (GE), O2max, and Vmax on a treadmill. The main performance test involved four self-paced STTs on a treadmill over a 1,300-m simulated course including three flat (1°) DP sections interspersed with two uphill (7°) DS sections.The modified GE method for estimating anaerobic energy production during skiing on varying terrain employed in Study IV revealed that the relative aerobic and anaerobic energy contributions were 82% and 18%, respectively, during the 232 s of skiing, with an accumulated oxygen (O2) deficit of 45 mL/kg. The STT performance time was largely explained by the GE (53%), followed by O2 (30%) and O2 deficit (15%). Therefore, training strategies designed to reduce energetic cost and improve GE should be examined in greater detail.In Study V metabolic responses and pacing strategies during the four successive STTs were investigated. The first and the last trials were the fastest (both 228 s) and were associated with both a substantially larger and a more rapid anaerobic energy supply, while the average O2 during all four STTs was similar. The individual variation in STT performance was explained primarily (69%) by the variation in O2 deficit. Furthermore, positive pacing was employed throughout all the STTs, but the pacing strategy became more even after the first trial. In addition, considerably higher (~ 30%) metabolic rates were generated on the uphill than on the flat sections of the course, reflecting an irregular production of anaerobic energy. Altogether, a fast start appears important for STT performance and high work rates during uphill skiing may exert a more pronounced impact on skiing performance outdoors, due to the reduction in velocity fluctuations and thereby overall air-drag.
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  • Andersson, Erik, et al. (författare)
  • The effects of skiing velocity on mechanical aspects of diagonal cross-country skiing
  • 2014
  • Ingår i: Sports Biomechanics. - : Informa UK Limited. - 1476-3141 .- 1752-6116. ; 13:3, s. 267-284
  • Tidskriftsartikel (refereegranskat)abstract
    • Cycle and force characteristics were examined in 11 elite male cross-country skiers using the diagonal stride technique while skiing uphill (7.5 degrees) on snow at moderate (3.5 +/- 0.3m/s), high (4.5 +/- 0.4m/s), and maximal (5.6 +/- 0.6m/s) velocities. Video analysis (50Hz) was combined with plantar (leg) force (100Hz), pole force (1,500Hz), and photocell measurements. Both cycle rate and cycle length increased from moderate to high velocity, while cycle rate increased and cycle length decreased at maximal compared to high velocity. The kick time decreased 26% from moderate to maximal velocity, reaching 0.14s at maximal. The relative kick and gliding times were only altered at maximal velocity, where these were longer and shorter, respectively. The rate of force development increased with higher velocity. At maximal velocity, sprint-specialists were 14% faster than distance-specialists due to greater cycle rate, peak leg force, and rate of leg force development. In conclusion, large peak leg forces were applied rapidly across all velocities and the shorter relative gliding and longer relative kick phases at maximal velocity allow maintenance of kick duration for force generation. These results emphasise the importance of rapid leg force generation in diagonal skiing.
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  • Apró, William, et al. (författare)
  • Amino Acid-induced S6K1 Activity In Human Skeletal Muscle Is Mediated By Increased mTor/Rheb Interaction : 128 June 1, 11: 15 AM - 11: 30 AM.
  • 2016
  • Ingår i: Medicine And Science In Sports And Exercise 2016 May; Vol. 48 (5S Suppl 1), pp. 17.. - : Ovid Technologies (Wolters Kluwer Health). ; 48:5 Suppl 1, s. 17-
  • Konferensbidrag (refereegranskat)abstract
    • Cell culture studies have shown that amino acids activate mTORC1 signaling by increasing the interaction between mTOR and its essential activator Rheb. However, the existence of this mechanism in human skeletal muscle remains to be determined.PURPOSE: To determine if increased mTORC1 signaling in response to amino acids in human skeletal muscle is due to an increased interaction between mTOR and Rheb.METHODS: Eight well trained men performed resistance exercise on two separate occasions. In connection with the exercise, subjects were supplemented with flavored water (Pla) and essential amino acids (EAA) in a double-blind, randomized cross-over design. Muscle biopsies were taken in the vastus lateralis muscle before, immediately after and 90 and 180 min post exercise. Activity of the mTORC1 pathway was assessed by a radiolabeled in-vitro kinase assay for its immediate downstream target S6K1. Protein-protein interactions were determined by western blot following co-immunoprecipitation of mTOR with Rheb. Co-immunoprecipitation was performed on pooled muscle samples from three of the eight subjects.RESULTS: Activity of S6K1 remained unchanged immediately after exercise in both trials. However, at 90 min post exercise, S6K1 activity increased by approximately 2- and 8-fold (p<0.05) from baseline the Pla and EAA trials, respectively. At the 180 min time point, S6K1 activity remained elevated in both trials being approx. 3-fold higher in the Pla trial and 5-fold higher (p<0.05) in the EAA trial. The fold-change in mTOR and Rheb interaction largely resembled the activity pattern of S6K1 in both trials; in the Pla trial the fold-change was 0.9, 1.3 and 1.4 while in the EAA trial the fold-change was 1.6, 2.9 and 1.9 immediately after, 90 min after and 180 min after exercise, respectively.CONCLUSIONS: The large increase in S6K1 activity following EAA intake appears to be mediated by an increased interaction between mTOR and its proximal activator Rheb. This is the first time this mechanism has been demonstrated in human skeletal muscle.
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25.
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26.
  • Apró, William, et al. (författare)
  • Is leucine induced p70S6 kinase phosphorylation following resistance exercise dependent on elevated phenylalanine levels in human skeletal muscle?
  • 2010
  • Ingår i: The FASEB Journal. - 0892-6638 .- 1530-6860. ; 24, s. lb273-
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to investigate the specific role ofleucine in the stimulation of the mammalian target of rapamycinsignalling pathway. Six male subjects performed four heavyresistance exercise sessions, each separated by approximately oneweek. Subjects were randomly supplemented with one of fourdrinks: placebo (flavored water), leucine or essential amino acids(EAA) with and without leucine. Immediately following eachexercise session, four subjects were infused with a flooding dose ofL-[2H5] phenylalanine (Inf) while two subjects served as controls(Ctrl). Muscle biopsies were taken before and one hour afterexercise. In the Ctrl group, resistance exercise resulted in asubstantial increase (45-fold) in p70 kinase phosphorylationwhen all EAA were ingested, whereas ingestion of leucine alonehad no greater effect than that of placebo. In the Inf group,however, ingestion of leucine alone and EAA increased p70phosphorylation to a similar extent (35-fold). The divergentsignalling response in the two groups suggests that leucine alone isinsufficient to increase p70phosphorylation. Indeed, in the Infgroup, there was a strong correlation (r=0.91) betweenp70 phosphorylation and the product of muscle leucine andphenylalanine levels. These results suggest that the stimulatoryeffect of leucine on p70 phosphorylation is dependent onelevated muscle phenylalanine levels. Supported by the SwedishNational Centre for Research in Sports 
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27.
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28.
  • Apró, William, et al. (författare)
  • Leucine does not affect mechanistic target of rapamycin complex 1 assembly but is required for maximal ribosomal protein s6 kinase 1 activity in human skeletal muscle following resistance exercise
  • 2015
  • Ingår i: The FASEB Journal. - : Wiley. - 0892-6638 .- 1530-6860. ; 29:10, s. 4358-4373
  • Tidskriftsartikel (refereegranskat)abstract
    • We examined how the stimulatory effect of leucine on the mechanistic target of rapamycin complex 1 (mTORC1) pathway is affected by the presence of the remaining essential amino acids (EAAs). Nine male subjects performed resistance exercise on 4 occasions and were randomly supplied EAAs with leucine, EAAs without leucine (EAA-Leu), leucine alone, or flavored water (placebo; control). Muscle biopsies were taken from the vastus lateralis before and 60 and 90 min after exercise. Biopsies were analyzed for protein phosphorylation, kinase activity, protein-protein interactions, amino acid concentrations, and tracer incorporation. Leucine alone stimulated ribosomal protein s6 kinase 1 (S6K1) phosphorylation similar to 280% more than placebo and EAA-Leu after exercise. Moreover, this response was enhanced by 60-75% after intake of EAAs compared with that of leucine alone (P < 0.05). Kinase activity of S6K1 reflected that of S6K1 phosphorylation; 60 min after exercise, the activity was elevated 3.3- and 4.2-fold with intake of leucine alone and with EAAs, respectively (P < 0.05). The interaction between mammalian target of rapamycin and regulatory-associated protein of mammalian target of rapamycin was unaltered in response to both resistance exercise and amino acid provision. Leucine alone stimulates mTORC1 signaling, although this response is enhanced by other EAAs and does not appear to be caused by alterations inmTORC1 assembly.
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29.
  • Apró, William (författare)
  • Regulation of protein synthesis in human skeletal muscle : separate and combined effects of exercise and amino acids
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Skeletal muscle is a highly plastic tissue which has the ability to adapt to various forms of external stimuli such as diverse modes of contractile activity. Thus, performance of endurance exercise over several of weeks results in increased oxidative capacity. In contrast, prolonged performance of resistance exercise ultimately results in increased muscle mass. These adaptations are brought about by transient alterations in gene expression and mRNA translation which result in altered protein turnover, i.e. the balance between protein synthesis and protein breakdown. Protein synthesis is the major determinant of muscle growth, which at the molecular level, is regulated by the mTORC1 pathway. This pathway is potently activated by resistance exercise and amino acids, but the stimulatory role of individual amino acids in human skeletal muscle is unclear. Muscle adaptations in response to endurance exercise are largely dependent on the PGC-1 α pathway, which regulates mitochondrial biogenesis. Given the different training adaptations after resistance and endurance exercise, it has been suggested that these exercise modalities may be incompatible when combined. Such potential interference could be exerted at the molecular level between the pathways responsible for each adaptive response. AMPK, an enzyme usually activated by endurance exercise and, when pharmacologically activated in cell culture and rodent models, has been shown to inhibit mTORC1 and protein synthesis. However, it is not known if activation of AMPK by endurance exercise inhibits resistance exercise induced signaling through the mTORC1 pathway in human skeletal muscle.Thus, the main objective of this thesis was to examine the molecular mechanisms regulating protein synthesis in response to amino acids and various modes of exercise in human skeletal muscle.In study I, the role of BCAAs in stimulating the mTORC1 pathway was examined in both resting and exercising muscle. BCAA increased mTORC1 activity, as assessed by S6K1 phosphorylation, in both resting and exercising muscle, but more so when exercise and BCAA were combined. In study II, the effect of leucine was compared to that of essential amino acids with or without leucine. It was found that when leucine was combined with the remaining essential amino acids, S6K1 phosphorylation was more pronounced than when leucine was provided alone. Furthermore, when leucine was removed from the essential amino acids, the effect was equal to that of placebo. In study III, the impact of endurance exercise on resistance exercise induced mTORC1 signaling was examined. When performed after resistance exercise, endurance exercise did not inhibit S6K1 phosphorylation compared to when single mode resistance exercise was performed. In study IV, performance of high intensity endurance exercise prior to resistance exercise did not inhibit S6K1 phosphorylation compared to single mode resistance exercise, despite prior activation of AMPK.In conclusion, amino acids and resistance exercise activate mTORC1 signaling, as assessed by S6K1 phosphorylation, in a synergistic manner. Leucine is crucial in mediating the amino acid response, however, additional amino acids appear to be required to induce a maximal response downstream of mTORC1. Activation of the mTORC1 pathway in response to heavy resistance exercise is robust and this activation does not appear to be inhibited by prior or by subsequent endurance exercise. As such, these results do not lend support to the existence of molecular interference when resistance and endurance exercise are combined acutely.
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30.
  • Apró, William, et al. (författare)
  • Resistance exercise induced S6K1 kinase activity is not inhibited in human skeletal muscle despite prior activation of AMPK by high intensity interval cycling.
  • 2015
  • Ingår i: American Journal of Physiology. Endocrinology and Metabolism. - : American Physiological Society. - 0193-1849 .- 1522-1555. ; 308:6, s. E470-E481
  • Tidskriftsartikel (refereegranskat)abstract
    • Combining endurance and strength training in the same session has been reported to reduce the anabolic response to the latter form of exercise. The underlying mechanism, based primarily on results from rodent muscle, is proposed to involve AMPK-dependent inhibition of mTORC1 signaling. This hypothesis was tested in eight trained male subjects who in a randomized order performed either resistance exercise only (R) or interval cycling followed by resistance exercise (ER). Biopsies taken from the vastus lateralis before and after endurance exercise and repeatedly after resistance exercise were assessed for glycogen content, kinase activity, protein phosphorylation and gene expression. Mixed muscle fractional synthetic rate was measured at rest and during 3h of recovery using the stable isotope technique. In ER, AMPK activity was elevated immediately after both endurance and resistance exercise (~90%, P<0.05) but was unchanged in R. Thr389 phosphorylation of S6K1 was increased several-fold immediately after exercise (P<0.05) in both trials and increased further throughout recovery. After 90 and 180 min recovery, S6K1 activity was elevated (~55% and ~110%, respectively, P<0.05) and eEF2 phosphorylation was reduced (~55%, P<0.05) with no difference between trials. In contrast, markers for protein catabolism were differently influenced by the two modes of exercise; ER induced a significant increase in gene and protein expression of MuRF1 (P<0.05), which was not observed following R exercise only. In conclusion, cycling-induced elevation in AMPK activity does not inhibit mTORC1 signaling after subsequent resistance exercise, but may instead interfere with the hypertrophic response by influencing key components in protein breakdown.
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31.
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32.
  • Azzinnari, M, et al. (författare)
  • Efectos del ejercicio en la señalización de NF-kB durante la restricción calórica severa
  • 2017
  • Konferensbidrag (refereegranskat)abstract
    • El sobrepeso y la obesidad, en crecimiento en todo el mundo, se asocian con una alta tasa de mortalidad e morbilidad[1,2]. La causa principal que conduce a éstas condiciones patológicas es un balance energético positivo sostenido a largo plazo, debido a la inactividad física y la ingesta calórica excesiva[3]. Por lo tanto, ejercicio físico y restricción calórica podrían ser dos estratégias eficaces para prevenir y contrastar el excesivo acumulo de grasa corporal que caracteriza estas patologías. Sin embargo, durante dietas muy bajas en calorías (<800 Kcal/día) se pierde no solo masa grasa sino también masa muscular, reportando efectos negativos para la salud[4]. En dichas condiciones,  el ejercicio físico permite preservar masa muscular de manera local y dosis-dependiente, mientras la ingestión de proteínas no ejerce particulares efectos protectivos sobre el tejido contráctil[5]. Los mecanismos moleculares implicados en la preservación de la masa muscular inducida por el ejercicio durante este tipo de dietas no han sido definidos claramente. NF-kB es un factor de transcripción cuya activación provoca atrofia muscular, y su bloqueo puede parcialmente limitar este fenomeno[6]. NF-kB se ha mostrado activado de manera aguda por el ejercicio y la restricción calorica, sin embargo no ha sido definida su respuesta a la restricción calórica en conjunción con el ejercicio prolongado de baja intensidad. Además, cuando los niveles basales de NF-kB son altos, el ejercicio no parece aumentar ulteriormente su señalización[7]. Por las razones presentadas, NF-kB podría desempeñar un rol en la preservación de masa magra inducida por el ejercicio durante  la restricción calórica.El objetivo del estudio es establecer la respuesta de NF-kB a la restricción calórica severa en conjunción con el ejercicio prolongado de baja intensidad. Las hipótesis fueron las siguientes: 1) la restricción calórica severa activaría la via de NF-kB y 2) dicha activación será atenuada por el ejercicio de manera local y dosis-dependiente.15 sujetos con sobrepeso y obesidad fueron sometidos a tres fases experimentales: fase 1, en la que la dieta y el nivel de actividad física de los participantes fue monitorizado durante una semana (PRE); fase 2, caracterizada por cuatro días de ejercicio prolongado y de restricción calórica severa (RCE); fase 3, caracterizada por tres días de ejercicio reducido y una dieta isoenergética (DC). Durante la fase 2, los sujetos ingeriron hidratos de carbono o proteínas (0.8 g/kg peso corporal/día; 320 kcal/día) y hicieron 45 minutos de pedaleo con un solo miembro superior (15% Ppeak) seguidos de 8 horas de caminata (4.5 km/h; 35 km/día). Las biopsias musculares fueron recogidas de ambos los deltoides y del vasto lateral en la fase 1 y después de la fase 2 y 3. Mediante Western blot, se determinó la expresión de NF-κB p105, NF-κB p50, la fosforilación de la Serina 32/36 de IκBα e IκBα total. La composición corporal se midió mediante DXA. Estadística: ANOVA para medidas repetidas.Durante los 4 días de restricción calórica severa el deficit energético fue de 5500 Kcal. Después de la fase 2 los sujetos perdieron menos masa magra en los miembros inferiores y en el brazo ejercitado respecto al brazo de control: 57% (P<0.05) y 29% (P=0.05), respectivamente. Tras la fase 2 y 3, el contenido de p105 y de p50 fue menor en los miembros inferiores respecto a los superiores: efecto extremidad P=0.003 y P=0.024 para p105 y p50, respectivamente. Tras la fase 3, la fosforilación de la Serina 32/36 de IkBα aumentó únicamente en las piernas, mientras la expresión total IkBα fue mayor solo en los miembros ejercitados (P<0.05).El ejercicio físico atenuó la activación de la señalización de NF-kB durante 4 días de restricción calórica severa, limitando el incremento de la expresión de p50 y p105, que resultó más baja después de la fase 2 y la fase 3 en los miembros inferiores respecto a los miembros superiores, posiblemente debido a la mayor cantidad de ejercicio a la que fueron sometidos. Además, la expresión total de IkBα fue más alta tras la fase 3 solo en los miembros ejercitados, indicando una posible inhibición de la vía de   NF-kB inducida por el ejercicio. Por lo tanto, dado la menor activación de la señalización de NF-kB en los miembros que perdieron menor masa muscular, los resultados sugieren que los efectos protectores del ejercicio físico sobre el tejido contráctil podrían ser mediados a una menor activación de la señalización de NF-kB.El ejercicio físico desempeña una función preservadora sobre la masa muscular durante la restricción calórica severa. La preservación de masa muscular es dosis-dependiente (a mayor volumen, mayor preservación) y está mediada, al menos parcialmente, por una menor activación de la señalización por NF-kB.1.Hill, J. O., H. R. Wyatt, et al. (2012). Circulation 126(1): 126-132.2.Di Angelantonio, E., N. Bhupathiraju Sh, et al. (2016). Lancet 388(10046): 776-786. 3.Chaston, T. B., J. B. Dixon, et al. (2007). Int J Obes (Lond) 31(5): 743-750. 4.Calbet, J. A., J. G. Ponce-Gonzalez, et al. (2017). Front Physiol (Accepted, In press).5.Cai, D., J. D. Frantz, et al. (2004). Cell 119(2): 285-298.6.Tantiwong, P., K. Shanmugasundaram, et al. (2010). Am J Physiol Endocrinol Metab 299(5): E794-801.7.NCD-RisC (2016). Lancet 387(10026): 1377-1396.
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33.
  • Bakkman, Linda, et al. (författare)
  • Quantitative and qualitative adaptation of human skeletal muscle mitochondria to hypoxic compared to
  • 2007
  • Ingår i: Acta Physiologica. - : Wiley. - 1748-1708 .- 1748-1716. ; 190:3, s. 243-251
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To investigate if training during hypoxia (H) improves the adaptation of muscle oxidative function compared with normoxic (N) training performed at the same relative intensity. METHOD: Eight untrained volunteers performed one-legged cycle training during 4 weeks in a low-pressure chamber. One leg was trained under N conditions and the other leg under hypobaric hypoxia (526 mmHg) at the same relative intensity as during N (65% of maximal power output, W(max)). Muscle biopsies were taken from vastus lateralis before and after the training period. Muscle samples were analysed for the activities of oxidative enzymes [citrate synthase (CS) and cytochrome c oxidase (COX)] and mitochondrial respiratory function. RESULTS: W(max) increased with more than 30% over the training period during both N and H. CS activity increased significantly after training during N conditions (+20.8%, P < 0.05) but remained unchanged after H training (+4.5%, ns) with a significant difference between conditions (P < 0.05 H vs. N). COX activity was not significantly changed by training and was not different between exercise conditions [+14.6 (N) vs. -2.3% (H), ns]. Maximal ADP stimulated respiration (state 3) expressed per weight of muscle tended to increase after N (+31.2%, P < 0.08) but not after H training (+3.2%, ns). No changes were found in state four respiration, respiratory control index, P/O ratio, mitochondrial Ca(2+) resistance and apparent Km for oxygen. CONCLUSION: The training-induced increase in muscle oxidative function observed during N was abolished during H. Altitude training may thus be disadvantageous for adaptation of muscle oxidative function.
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34.
  • Bauer, Nikolai, et al. (författare)
  • Effects of High-Intensity Interval Training in School on the Physical Performance and Health of Children and Adolescents: A Systematic Review with Meta-Analysis
  • 2022
  • Ingår i: Sports Medicine - Open. - : Springer. - 2198-9761 .- 2199-1170. ; 8:1
  • Forskningsöversikt (refereegranskat)abstract
    • Background Performance of high-intensity interval training (HIIT) by children and adolescents improves physical and health-related fitness, as well as cardiometabolic risk factors.Objectives To assess the impact of HIIT performed at school, i.e. both in connection with physical education (intra-PE) and extracurricular sports activities (extra-PE), on the physical fitness and health of children and adolescents.Methods PubMed and SPORTDiscus were searched systematically utilizing the following criteria for inclusion: (1) healthy children and adolescents (5–18 years old) of normal weight; (2) HIIT performed intra- and/or extra-PE for at least 5 days at an intensity ≥ 80% of maximal heart rate (HRmax) or peak oxygen uptake (VO2peak) or as Functional HIIT; (3) comparison with a control (HIIT versus alternative interventions); and (4) pre- and post-analysis of parameters related to physical fitness and health. The outcomes with HIIT and the control interventions were compared utilizing Hedges’ g effect size (ES) and associated 95% confidence intervals.Results Eleven studies involving 707 participants who performed intra-PE and 388 participants extra-PE HIIT were included. In comparison with the control interventions, intra-PE HIIT improved mean ES for neuromuscular and anaerobic performance (ES jump performance: 5.89 ± 5.67 (range 1.88–9.90); ES number of push-ups: 6.22 (range n.a.); ES number of sit-ups: 2.66 ± 2.02 (range 1.24–4.09)), as well as ES fasting glucose levels (− 2.68 (range n.a.)) more effectively, with large effect sizes. Extra-PE HIIT improved mean ES for neuromuscular and anaerobic performance (ES jump performance: 1.81 (range n.a.); ES number of sit-ups: 2.60 (range n.a.)) to an even greater extent, again with large effect sizes. Neither form of HIIT was more beneficial for parameters related to cardiorespiratory fitness than the control interventions.Conclusion Compared to other forms of exercise (e.g. low-to-moderate-intensity running or walking), both intra- and extra-PE HIIT result in greater improvements in neuromuscular and anaerobic performance, as well as in fasting levels of glucose in school children.
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35.
  • Beaven, Martyn, et al. (författare)
  • Physiological comparison of concentric and eccentric arm cycling in males and females
  • 2014
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 5:9, s. Art. no. e112079-
  • Tidskriftsartikel (refereegranskat)abstract
    • Lower body eccentric exercise is well known to elicit high levels of muscular force with relatively low cardiovascular and metabolic strain. As a result, eccentric exercise has been successfully utilised as an adaptive stressor to improve lower body muscle function in populations ranging from the frail and debilitated, to highly-trained individuals. Here we investigate the metabolic, cardiorespiratory, and energy costs of upper body eccentric exercise in a healthy population. Seven men and seven women performed 4-min efforts of eccentric (ECC) or concentric (CON) arm cycling on a novel arm ergometer at workloads corresponding to 40, 60, and 80% of their peak workload as assessed in an incremental concentric trial. The heart rate, ventilation, cardiac output, respiratory exchange ratio, and blood lactate concentrations were all clearly greater in CON condition at all of the relative workloads (all p<0.003). Effect size calculations demonstrated that the magnitude of the differences in VO2 and work economy between the ECC and CON exercise ranged from very large to extremely large; however, in no case did mechanical efficiency (ηMECH) differ between the conditions (all p>0.05). In contrast, delta efficiency (ηΔ), as previously defined by Coyle and colleagues in 1992, demonstrated a sex difference (men>women; p<0.05). Sex differences were also apparent in arteriovenous oxygen difference and heart rate during CON. Here, we reinforce the high-force, low cost attributes of eccentric exercise which can be generalised to the muscles of the upper body. Upper body eccentric exercise is likely to form a useful adjunct in debilitative, rehabilitative, and adaptive clinical exercise programs; however, reports of a shift towards an oxidative phenotype should be taken into consideration by power athletes. We suggest delta efficiency as a sensitive measure of efficiency that allowed the identification of sex differences.
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36.
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37.
  • Bill-Axelson, Anna, et al. (författare)
  • No increased prostate cancer incidence after negative transrectal ultrasound guided multiple biopsies in men with increased prostate specific antigen and/or abnormal digital rectal examination.
  • 2003
  • Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 170:4 Pt 1, s. 1180-3
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: We investigated the incidence of prostate cancer after negative transrectal ultrasound (TRUS) guided multiple biopsies. Our secondary aim was to calculate the sensitivity of the extended protocol used.MATERIALS AND METHODS: A cohort of 547 men with elevated prostate specific antigen and/or abnormal digital rectal examination but with results negative for prostate cancer on a mean of 9 TRUS guided biopsies was followed through record linkage to the national cancer Registry. The observed number of prostate cancers was compared with the expected number during the same calendar period in an age matched male population to determine the standardized incidence ratio. The sensitivity of TRUS with multiple biopsies after 5 years of followup was calculated. Relative survival was estimated if there was an excess death rate due to undiagnosed prostate cancer.RESULTS: We found 11 men diagnosed with prostate cancer. The expected number in the age standardized male population was 15, resulting in a standardized incidence ratio of 0.8 (95% CI 0.4 to 1.2). Five-year sensitivity of the extended protocol of TRUS guided biopsies was 95.2% (95% CI 93.5 to 96.4) and relative survival was more than 100%, indicating a selection of men deemed candidates for curative treatment.CONCLUSIONS: Men with clinical suspicion of prostate cancer who are examined by an extended protocol of TRUS guided biopsies negative for cancer do not have an increased incidence of prostate cancer within 6 years compared with an age matched male population. Five-year sensitivity of this protocol was high.
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38.
  • Bill-Axelson, Anna, et al. (författare)
  • Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer
  • 2014
  • Ingår i: New England Journal of Medicine. - Waltham : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 370:10, s. 932-942
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundRadical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. MethodsBetween 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. ResultsDuring 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04). ConclusionsExtended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.) The randomized Swedish trial of prostatectomy versus watchful waiting in disease detected mainly clinically (not by PSA screening) continues to show a benefit for early prostatectomy. The number of men younger than 65 needed to treat to prevent one death is now four. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of prostate-specific antigen (PSA) testing, showed a survival benefit of radical prostatectomy as compared with observation at 15 years of follow-up.(1) By contrast, the Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of PSA testing, showed that radical prostatectomy did not significantly reduce prostate cancer-specific or overall mortality after 12 years.(2) PSA screening profoundly changes the clinical domain of study. Among other considerations, the substantial additional lead time ...
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39.
  • Bill-Axelson, Anna, et al. (författare)
  • Radical Prostatectomy or Watchful Waiting in Prostate Cancer-29-Year Follow-up
  • 2018
  • Ingår i: New England Journal of Medicine. - : Massachussetts Medical Society. - 0028-4793 .- 1533-4406. ; 379:24, s. 2319-2329
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term followup is sparse. METHODS We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model. RESULTS By December 31, 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died; 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to prostate cancer (relative risk, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001; absolute difference in risk, 11.7 percentage points; 95% CI, 5.2 to 18.2). The number needed to treat to avert one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life were gained with radical prostatectomy. Among the men who underwent radical prostatectomy, extracapsular extension was associated with a risk of death from prostate cancer that was 5 times as high as that among men without extracapsular extension, and a Gleason score higher than 7 was associated with a risk that was 10 times as high as that with a score of 6 or lower (scores range from 2 to 10, with higher scores indicating more aggressive cancer). CONCLUSIONS Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer.
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40.
  • Bill-Axelson, Anna, et al. (författare)
  • Radical prostatectomy versus watchful waiting in early prostate cancer.
  • 2011
  • Ingår i: The New England journal of medicine. - : Massachussetts Medical Society. - 1533-4406 .- 0028-4793. ; 364:18, s. 1708-17
  • Forskningsöversikt (refereegranskat)abstract
    • In 2008, we reported that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, we now report estimated 15-year results.
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41.
  • Bill-Axelson, Anna, et al. (författare)
  • Radical prostatectomy versus watchful waiting in early prostate cancer
  • 2005
  • Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 352:19, s. 1977-1944
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results.METHODS:From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; the secondary end points were death from any cause, metastasis, and local progression.RESULTS:During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test).CONCLUSIONS:Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial.
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42.
  • Bill-Axelson, Anna, et al. (författare)
  • Radical prostatectomy versus watchful waiting in localized prostate cancer : the Scandinavian prostate cancer group-4 randomized trial
  • 2008
  • Ingår i: Journal of the National Cancer Institute. - : Oxford University Press. - 0027-8874 .- 1460-2105. ; 100:16, s. 1144-1154
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The benefit of radical prostatectomy in patients with early prostate cancer has been assessed in only one randomized trial. In 2005, we reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. We now report results after 3 more years of follow-up.METHODS: From October 1, 1989, through February 28, 1999, 695 men with clinically localized prostate cancer were randomly assigned to radical prostatectomy (n = 347) or watchful waiting (n = 348). Follow-up was complete through December 31, 2006, with histopathologic review and blinded evaluation of causes of death. Relative risks (RRs) were estimated using the Cox proportional hazards model. Statistical tests were two-sided.RESULTS: During a median of 10.8 years of follow-up (range = 3 weeks to 17.2 years), 137 men in the surgery group and 156 in the watchful waiting group died (P = .09). For 47 of the 347 men (13.5%) who were randomly assigned to surgery and 68 of the 348 men (19.5%) who were not, death was due to prostate cancer. The difference in cumulative incidence of death due to prostate cancer remained stable after about 10 years of follow-up. At 12 years, 12.5% of the surgery group and 17.9% of the watchful waiting group had died of prostate cancer (difference = 5.4%, 95% confidence interval [CI] = 0.2 to 11.1%), for a relative risk of 0.65 (95% CI = 0.45 to 0.94; P = .03). The difference in cumulative incidence of distant metastases did not increase beyond 10 years of follow-up. At 12 years, 19.3% of men in the surgery group and 26% of men in the watchful waiting group had been diagnosed with distant metastases (difference = 6.7%, 95% CI = 0.2 to 13.2%), for a relative risk of 0.65 (95% CI = 0.47 to 0.88; P = .006). Among men who underwent radical prostatectomy, those with extracapsular tumor growth had 14 times the risk of prostate cancer death as those without it (RR = 14.2, 95% CI = 3.3 to 61.8; P < .001).CONCLUSION: Radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery. 
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43.
  • Bjurberg, Maria, et al. (författare)
  • Primary treatment patterns and survival of cervical cancer in Sweden : A population-based Swedish Gynecologic Cancer Group Study
  • 2019
  • Ingår i: Gynecologic Oncology. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 0090-8258 .- 1095-6859. ; 155:2, s. 229-236
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Survival in cervical cancer has improved little over the last decades. We aimed to elucidate primary treatment patterns and survival. Methods: Population-based study of patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed 2011-2015. Main outcome was 5-year relative survival (RS). Age-standardised RS (AS-RS) was estimated for the total cohort and for the pooled study population of squamous, adenosquamous-, adenocarcinoma. Results: Median follow-up time was 4.6 years. The study population consisted of 2141 patients; 97% of the 2212 patients in the total cohort and the 5-year AS-RS was 71% and 70%, respectively. RS stage IB1: surgery alone 95% vs. 72% for definitive chemoradiotherapy (CT-RT) (p < 0.001). In stage IIA1 74% had CTRL, and 47% of operated patients received adjuvant (CT)-RT. RS stage IB2: surgically treated 81% (69% received adjuvant (CT)-RT) vs. 76% for (CT)-RT (p = 0.73). RS stage IIB: 77% for CT-RT + brachytherapy BT), 37% for RT + BT (p = 0.045) and 27% for RT-BT (p < 0.001). Stages III-IVA; <40% received CT-RT + BT, RS 45% vs. 18% for RT-BT (RR 4.1, p < 0.001). RS stage IVB 7%. Conclusion: Primary treatment of cervical cancer in Sweden adhered to evidence-based standard of care. Areas of improvement include optimising treatment for stages III-IVA, and avoiding combining surgery and radiotherapy. (C) 2019 Elsevier Inc. All rights reserved.
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44.
  • Björklund, Glenn, et al. (författare)
  • A comparison between elite and well trained cross-country skiers in physiological response to variations in intensity during prolonged exercise
  • 2008
  • Ingår i: 13th Annual Congress of the European College of Sports Science. - Cologne : Sportools. - 9789727351565 ; , s. 522-
  • Konferensbidrag (refereegranskat)abstract
    •   Introduction: Cross-country ski racing includes continual variations in intensity due to terrain and tactics {Mygind et al 1994; Norman et al 1989). Consequently, the recovery between periods with higher intensity might affect the outcome of the race. Both blood metabolites and respiratory variables are used for standard performance evaluations for endurance athletes, although there is a lack information if respiratory variables respond similar to blood lactate and acid/base values during prolonged variable exercise. Therefore, the aims with the present study were to 1) evaluate whether respiratory variables are associated with blood lactate and acid/base variables, 2) how/if these variables might predict physical performance and 3) whether a calculated heart rate-oxygen uptake (HR-VO2) relationship is valid during variable intensity exercise. Methods: 12 cross-country skiers classified as elite (E, n=6) and formerly well-trained (FWT, n=6) performed two roller ski tests. 1) An incremental test to establish maximal oxygen uptake (VO2max), maximum heart rate (HRmax) and lactate threshold (LT). Submaximal and maximal VO2 and HR during the incremental test were used for calculating the individual HR-VO2 linear relationship and 2) a 48-min long variable intensity protocol (VIP) at alternating exercise intensities, 90% (HI90) and 70% (MI70) of VO2max. Cardio-respiratory variables and venous blood samples were continuously collected throughout the VIP. Comparisons between E and FWT were performed using a two-tailed unpaired Student’s t-test and a ANCOVA analysis was used to determine which physiological variable best could prognosticate time to exhaustion (TTE). A simple linear regression was used to establish the relationship between HR and VO2. Results: Blood lactate concentrations [La] were higher and base excess [BE] lower for FWT from the first MI70 (P<0.05). FWT had augmented RER during all HI90 and an elevated VE/VO2 during the second and third HI90 in comparison to E (P<0.05). The expected HR were higher during the MI70 exercise intensities regardless of group affiliation (P<0.05). The blood [La] response predicted time to exhaustion earlier than respiratory variables (P<0.05). Discussion: Blood lactate and acid/base fluctuations were not reflected by RER and the ventilatory equivalents. Furthermore, blood lactate is to prefer, in comparison to ventilatory variables, to study performance related recovery processes during endurance exercise with variations in intensity. The expected HR-VO2 relationship was not valid during VIP.  
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45.
  • Björklund, Glenn, 1972-, et al. (författare)
  • Biomechanical influenced differences in O2 extraction in diagonal skiing: arm versus leg
  • 2010
  • Ingår i: Medicine & Science in Sports & Exercise. - : Lippincott Williams & Wilkins. - 0195-9131 .- 1530-0315. ; 42:10, s. 1899-1908
  • Tidskriftsartikel (refereegranskat)abstract
    • Biomechanically Influenced Differences in O-2 Extraction in Diagonal Skiing: Arm versus Leg. Med. Sci. Sports Exerc., Vol. 42, No. 10, pp. 1899-1908, 2010. Purpose: This study aimed to determine whether the differences in oxygen extraction and lactate concentration in arms and legs during cross-country skiing are related to muscle activation or force production and how these differences are influenced by a reduction in exercise intensity. Methods: Nine well-trained male cross-country skiers (age = 22 +/- 3 yr, (V) over dotO(2max) = 5.3 +/- 0.3 L.min(-1) and 69 +/- 3 mL.kg(-1).min(-1)) performed diagonal skiing on a treadmill for 3 min at 90% followed by 6 min at 70% of (V) over dotO(2max). During the final minute of each workload, arterial, femoral, and subclavian venous blood was collected for determination of blood gases, pH, and lactate. EMG was recorded from six upper-and lower-body muscles, and leg and pole forces were measured. Cardiorespiratory variables were monitored continuously. Results: Oxygen extraction in the legs was higher than that in the arms at both 90% and 70% of (V) over dotO(2max) (92% +/- 3% vs 85% +/- 6%, P < 0.05 and 90% +/- 3% vs 78% +/- 8%, P < 0.001). This reduction with decreased workload was more pronounced in the arms (-9.8% +/- 7.7% vs -3.2% +/- 3.2%, P < 0.01). EMGRMS for the arms was higher, and pole ground contact time was greater than the corresponding values for the legs (both P < 0.01). At both intensities, the blood lactate concentration was higher in the subclavian than that in the femoral vein but was lowered more in the subclavian vein when intensity was reduced (all P < 0.001). Conclusions: The higher muscle activation (percentage of maximal voluntary isometric contraction) in the arms and the longer ground contact time of the poles than the legs contribute to the lower oxygen extraction and elevated blood lactate concentration in the arms in diagonal skiing. The better lactate recovery in the arms than that in the legs is aided by greater reductions in muscle activation and pole force when exercise intensity is reduced.
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46.
  •  
47.
  • Björklund, Glenn, et al. (författare)
  • The effects of prior high intensity double poling on subsequent diagonal stride skiing characteristics
  • 2015
  • Ingår i: SpringerPlus. - : Springer Science and Business Media LLC. - 2193-1801. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To investigate the influence of prior high intensity double poling (DP) on physiological and biomechanical responses during subsequent diagonal stride (DIA). Methods: Eight well-trained male cross-country skiers (age 22 ± 3 yr; VO2max 69 ± 3 ml · kg−1 · min−1) roller-skied on a treadmill sequentially for 3 min at 90% DIA VO2max (DIA1), 3 min at 90% DP VO2peak and 3 min at 90% DIA VO2max (DIA2). Cardio-respiratory responses were monitored continuously and gases and metabolites in blood from the a. femoralis, v. femoralis and v. subclavia determined. Pole and plantar forces and EMG from 6 lower- and upper-body muscles were measured. Results: VO2 decreased from DIA1 to DP and increased again to DIA2 (both P < 0.05), with no difference between the DIA sessions. Blood lactate rose from DIA1 to DP to DIA2. O2 extraction was attenuated during DP (P < 0.05), but was the same during DIA1 and DIA2. EMGRMS for arm muscles during poling phase, as well as peak pole force and cycle rate were higher, while leg muscle activity was lower during DP than both sessions of DIA (all P < 0.05). The ratio of upper-/whole-body EMGRMS correlated negatively with O2 extraction in the arms during both sessions of DIA (P < 0.05). Conclusions: In well-trained skiers skiing at high-intensity DP prior to DIA did not influence VO2, muscle activation or forces in the latter. At race intensity DP does not influence the distribution of work between upper- and lower-body during a subsequent bout of DIA. O2 extraction is coupled to technical skills during skiing.
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48.
  •  
49.
  • Bolger, Claire, et al. (författare)
  • Urinary cc16 levels in winter versus summer sport athletes after eucapnic voluntary hyperpnoea
  • 2009
  • Konferensbidrag (refereegranskat)abstract
    • Exercise induced bronchoconstriction (EIB) is highly prevalent in elite athletes, especially in those training in cold dry environments. Dehydration of the airways plays a key role in this process. EIB has recently been linked to airway epithelial injury in asthmatic individuals. The aim of the study is to determine whether a short period of hyperpnoea of dry air causes airway epithelial disruption in winter and/or summer sport athletes. We hypothesise that urinary level of the Clara cell protein (CC16) – an indirect marker of permeability/cellular integrity of the lung epithelial barrier – will be increased after a eucapnic voluntary hyperpnoea (EVH) test and that this increase will be larger in winter compared to summer athletes. Forty two female athletes – 28 summer athletes (age 31.1+/-1.7yr (SEM), training volume 9+/-1.1h/wk) and 14 winter athletes (age 21.4+/-0.8yr, training volume 12.0 ± 1.10h/wk) – took part in this study. They all performed an 8-min EVH test at a target ventilation rate of 30 times their baseline forced expiratory volume in one second (FEV1). After the challenge, FEV1 was measured in duplicate at 2, 5, 10, 15, 20, 30, 60 and 90min. A sustained decrease in FEV1 of at least 10% from baseline was considered positive. Urine samples were collected at baseline and at 30, 60 and 90min recovery. CC16 concentration was measured by enzyme immunoassay. Ten summer athletes had a positive test (max FEV1 fall = 19.6+/-2.4%), whilst eighteen of the summer athletes and all the winter athletes were negative (max FEV1 fall = 5.7+/-0.7% and 5.3+/-0.7%, respectively). CC16 increased significantly after the challenge in all three groups (P<0.01) with no difference between groups: delta CC16 (max post-EVH minus baseline) in summer EVH negative athletes was 0.241+/-0.1 ng/μmol creatinine, 0.292+/-0.085 ng/μmol creatinine in summer EVH positive athletes, and 0.123+/-0.047ng/μmol creatinine in winter EVH negative athletes (P=0.415)In conclusion, a short period of hyperpnoea of dry air is associated with an increased rate of CC16 excretion in urine in both winter and summer athletes. This suggests that the integrity of the airway epithelium might be compromised by loss of airway surface lining fluid when athletes inhale dry air at high flow rates. This appears to occur irrespective of the degree of bronchoconstriction or regular training environment.
  •  
50.
  • Borgfeldt, Christer, et al. (författare)
  • Survival in endometrial cancer in relation to minimally invasive surgery or open surgery : a Swedish Gynecologic Cancer Group (SweGCG) study
  • 2021
  • Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy).MethodsA population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses.ResultsIn univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival.ConclusionThe minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.
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