| 1. |
- Kehoe, Laura, et al.
(författare)
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Make EU trade with Brazil sustainable
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
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| 3. |
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| 4. |
- Chen, Rui, et al.
(författare)
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Prostate Specific Antigen and Prostate Cancer in Chinese Men Undergoing Initial Prostate Biopsies Compared with Western Cohorts
- 2017
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 197:1, s. 90-96
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We determined the characteristics of Chinese men undergoing initial prostate biopsy and evaluated the relationship between prostate specific antigen levels and prostate cancer/high grade prostate cancer detection in a large Chinese multicenter cohort. Materials and Methods This retrospective study included 13,904 urology outpatients who had undergone biopsy for the indications of prostate specific antigen greater than 4.0 ng/ml or prostate specific antigen less than 4.0 ng/ml but with abnormal digital rectal examination results. The prostate specific antigen measurements were performed in accordance with the standard procedures at the respective institutions. The type of assay used was documented and recalibrated to the WHO standard. Results The incidence of prostate cancer and high grade prostate cancer was lower in the Chinese cohort than the Western cohorts at any given prostate specific antigen level. Around 25% of patients with a prostate specific antigen of 4.0 to 10.0 ng/ml were found to have prostate cancer compared to approximately 40% in U.S. clinical practice. Moreover, the risk curves were generally flatter than those of the Western cohorts, that is risk did not increase as rapidly with higher prostate specific antigen. Conclusions The relationship between prostate specific antigen and prostate cancer risk differs importantly between Chinese and Western populations, with an overall lower risk in the Chinese cohort. Further research should explore whether environmental or genetic differences explain these findings or whether they result from unmeasured differences in screening or benign prostate disease. Caution is required for the implementation of prostate cancer clinical decision rules or prediction models for men in China or other Asian countries with similar genetic and environmental backgrounds.
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| 5. |
- Ericsson, Andreas, et al.
(författare)
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Design and Analysis of a Multilayer Meander Line Circular Polarization Selective Structure
- 2017
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Ingår i: IEEE Transactions on Antennas and Propagation. - 0018-926X. ; 65:8, s. 4089-4101
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Tidskriftsartikel (refereegranskat)abstract
- We present a nonresonant circular polarization selective structure (CPSS) based on multiple layers of stacked meander line sheets arranged closely after each other. The structure has a total thickness of 13.5 mm (0.68 wavelengths at center frequency 15 GHz) and is realized by cascading printed circuit boards interspaced with a low-permittivity foam material, and the different layers are bonded together with thin layers of adhesive spray. A design procedure is presented that can be used to optimize the proposed structure based on its target band of operation. Based on this method, an optimized design has been simulated, and the structure shows a return loss and an insertion loss better than 0.5 dB, and axial ratio in transmission and reflection better than 0.78 dB, over a fractional bandwidth of 45.8% at normal incidence, fully covering the Ku-band 12-18 GHz. The functionality of the structure has been verified experimentally through measurements, both in reflection and transmission, with a total bandwidth of 42.0%, covering 86.7% of the Ku band. The simulated performance at oblique angles of incidence shows significant improvements when compared to classical resonant CPSSs.
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| 6. |
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| 7. |
- Helander, Jakob, et al.
(författare)
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A Comparison of Macro Basis Function Methods for Interconnected Endfire Antenna Arrays
- 2017
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Ingår i: IEEE Antennas and Wireless Propagation Letters. - 1536-1225. ; 16, s. 2159-2162
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Tidskriftsartikel (refereegranskat)abstract
- Two approaches to the macro basis function (MBF) method that target interconnected subdomains have been adapted to finite linear arrays, and benchmarked against each other in order to estimate their performance with respect to the strong near field coupling that occurs under the endfire mode operation. The methods, here referred to as methods A and B, are based on the synthetic function and characteristic basis function method, respectively, presented in the previous literature. The occurrence of very strong near-field coupling can be seen to affect the number of MBFs required for a certain level of accuracy, although both approaches perform well under the test scenario. However, method B provides a considerably more efficient compression with respect to a maximum acceptable error level.
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| 8. |
- Helander, Jakob, et al.
(författare)
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Compressive Sensing Techniques for mm-Wave Non-Destructive Testing of Composite Panels
- 2017
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Ingår i: IEEE Transactions on Antennas and Propagation. - 0018-926X.
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents imaging results from measurements of an industrially manufactured composite test panel, utilizing two introduced algorithms for data post-processing. The system employs a planar near-field scanning set-up for characterizing defects in composite panels in the 50–67 GHz band, and can be considered as a complementary diagnostic tool for non-destructive testing purposes. The introduced algorithms are based on the reconstruction of the illuminating source at the transmitter, enabling a separation of the sampled signal with respect to the location of its potential sources; the scatterers within the device under test or the transmitter. For the second algorithm, a L1-minimization problem formulation is introduced that enables compressive sensing techniques to be adapted for image retrieval. The algorithms are benchmarked against a more conventional imaging technique, based on the Fourier Transform, and it is seen that the complete imaging system provides increased dynamic range, improved resolution and reduced measurement time by removal of a reference measurement. Moreover, the system provides stable image quality over a range of frequencies.
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| 9. |
- Helander, Jakob, et al.
(författare)
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Multi-Port Element for Grating Lobe Suppression in Sparse VHF Phased Array Radars
- 2019
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Ingår i: IEEE Transactions on Antennas and Propagation. - 0018-926X. ; 67:10, s. 6667-6671
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Tidskriftsartikel (refereegranskat)abstract
- A multi-port element approach, engineered to address practical design challenges of very high frequency (VHF) phased array radar systems, is presented in this communication. A cornerstone of the antenna element design is its simplicity, which counteracts the mobility issues of physically large and unavoidably bulky ground-based VHF radar systems. The multi-port element introduces a third dimension in the otherwise planar array configuration. Using a non-linear optimization scheme to realize a set of matching networks for the element, the active loading from surrounding elements in the array environment is suppressed resulting in a non-distorted embedded element pattern. The element is compared to the resembling Yagi-Uda design in terms of standard multi-port and radar metrics. Simulated results indicate that the element enables a significant suppression of grating lobes when beam steering within a limited angular sector, which in turn has an overall positive impact on the array performance.
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| 10. |
- Helander, Jakob, et al.
(författare)
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Synthesis of Large Endfire Antenna Arrays using Convex Optimization
- 2018
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Ingår i: IEEE Transactions on Antennas and Propagation. - 0018-926X. ; 66:2, s. 712-720
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Tidskriftsartikel (refereegranskat)abstract
- An innovative approach utilizing convex optimization to simultaneously conduct pattern synthesis and improve the matching of large scale endfire antenna arrays is proposed in this paper. A fast full-wave analysis tool facilitates the computation of the necessary data for running the optimization routine, and enables analysis on arrays with dimensions 100λ × 6λ for the highest simulated frequency. Simulated results are provided for various array configurations of bowties, and the results show that improved matching can be obtained while maintaining a clear endfire far field pattern analogous to the pattern obtained with the classical Hansen-Woodyard excitation. The spatial dependence on the amplitude of the optimized input waves in the antenna ports indicate that a considerable fraction of the input power is fed to the antennas at the array’s front, in the direction of where the main lobe is launched.
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| 11. |
- Kim, Eric H., et al.
(författare)
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Detection of High Grade Prostate Cancer among PLCO Participants Using a Prespecified 4-Kallikrein Marker Panel
- 2016
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We assessed the performance of a 4-kallikrein panel with and without microseminoprotein-β to predict high grade (Gleason 7+/Gleason Grade Group 2+) prostate cancer on biopsy in a multiethnic cohort from PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial). Materials and Methods: Levels of free, intact, total prostate specific antigen, human kallikrein-2 and microseminoprotein-β were measured while blinded to outcomes in cryopreserved serum from men in the intervention arm of PLCO. Marker levels of 946 men, of whom 100 were African American, were incorporated into a prespecified statistical model to predict high grade prostate cancer on biopsy. Results: The detection of high grade prostate cancer in 94 men (10%) was enhanced by the 4-kallikrein panel with an AUC of 0.79 compared to 0.73 for PCPTRC (Prostate Cancer Prevention Trial Risk Calculator), representing a 0.060 increase (95% CI 0.032-0.088, p <0.01). Additionally, the AUC increased from 0.79 to 0.81 when microseminoprotein-β was added to the 4-kallikrein panel. In African American men, the 4-kallikrein panel model also enhanced high grade prostate cancer detection over that of prostate specific antigen (AUC 0.80 vs 0.67). As an illustration of clinical implications, using 1 cutoff point for biopsy (6% risk of high grade prostate cancer) with the 4-kallikrein panel model would have eliminated unnecessary biopsies in 420 per 1,000 men (42%) while detecting high grade prostate cancer in 83 of 93 (88%). Conclusions: In a multiethnic United States population, the 4-kallikrein panel demonstrated improved risk discrimination for high grade prostate cancer over conventional clinical variables (age, prostate specific antigen and digital rectal examination) as well as PCPTRC.
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| 12. |
- Li, Weiqiang, et al.
(författare)
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Genome-wide Scan Identifies Role for AOX1 in Prostate Cancer Survival
- 2018
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 74:6, s. 710-719
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Tidskriftsartikel (refereegranskat)abstract
- We performed genome-wide association studies and found single nucleotide polymorphisms (SNPs) at seven independent loci associated with prostate-cancer-specific survival time. Two SNPs replicated in an independent cohort. The SNP rs73055188 at AOX1 is associated with AOX1 gene expression level, which is correlated with biochemical recurrence.
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| 13. |
- Lundgren, Johan, et al.
(författare)
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Design, Optimization and Verification of a Dual Band Circular Polarization Selective Structure
- 2018
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Ingår i: IEEE Transactions on Antennas and Propagation. - 0018-926X. ; 66:11, s. 6023-6032
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Tidskriftsartikel (refereegranskat)abstract
- We present a non-resonant, dual band circular polarization selective structure (CPSS) for satellite communication applications in the K- and Ka-bands. The structure consists of multiple layers of cascaded anisotropic sheets, with printed meander lines, separated by low permittivity spacers. It reflects right handed circular polarization and transmits left handed circular polarization in the lower frequency band. In the upper frequency band the opposite polarization selectivity is achieved. The theory of dual band circular polarization selectivity from cascaded anisotropic sheets is presented. The separation between the frequency bands of operation is shown to be governed by the relative rotation between subsequent layers. An optimization routine for synthesizing dual band CPSSs from predefined design requirements is introduced, utilizing several different optimization algorithms. A simulated design is presented which fulfills the strict requirements of insertion loss and return loss less than 0.5 dB, and axial ratio less than 0.78 dB, in the frequency bands 17.7–20.2 GHz and 27.5–30.0 GHz. A prototype of the optimized design is fabricated and characterized experimentally, both in transmission and reflection. Good agreement is observed between simulated and experimental results. This type of structure is a potential candidate for implementation in dual band multiple spot beam systems utilizing frequency and polarization reuse schemes.
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| 14. |
- Marconi, Lorenzo, et al.
(författare)
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External validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma
- 2018
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Ingår i: World journal of urology. - : Springer. - 0724-4983 .- 1433-8726. ; 36:12, s. 1973-1980
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionRecent trials have emphasized the importance of a precise patient selection for cytoreductive nephrectomy (CN). In 2013, a nomogram was developed for pre- and postoperative prediction of the probability of death (PoD) after CN in patients with metastatic renal cell carcinoma. To date, the single-institutional nomogram which included mostly patients from the cytokine era has not been externally validated. Our objective is to validate the predictive model in contemporary patients in the targeted therapy era.MethodsMulti-institutional European and North American data from patients who underwent CN between 2006 and 2013 were used for external validation. Variables evaluated included preoperative serum albumin and lactate dehydrogenase levels, intraoperative blood transfusions (yes/no) and postoperative pathologic stage (primary tumour and nodes). In addition, patient characteristics and MSKCC risk factors were collected. Using the original calibration indices and quantiles of the distribution of predictions, Kaplan-Meier estimates and calibration plots of observed versus predicted PoD were calculated. For the preoperative model a decision curve analysis (DCA) was performed.ResultsOf 1108 patients [median OS of 27months (95% CI 24.6-29.4)], 536 and 469 patients had full data for the validation of the pre- and postoperative models, respectively. The AUC for the pre- and postoperative model was 0.68 (95% CI 0.62-0.74) and 0.73 (95% CI 0.68-0.78), respectively. In the DCA the preoperative model performs well within threshold survival probabilities of 20-50%. Most important limitation was the retrospective collection of this external validation dataset.ConclusionsIn this external validation, the pre- and postoperative nomograms predicting PoD following CN were well calibrated. Although performance of the preoperative nomogram was lower than in the internal validation, it retains the ability to predict early death after CN.
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| 15. |
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| 16. |
- Nordebo, Sven, et al.
(författare)
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Parameter studies on optimal absorption and electrophoretic resonances in lossy media
- 2017
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Ingår i: 2017 32nd General Assembly and Scientific Symposium of the International Union of Radio Science, URSI GASS 2017. - : Institute of Electrical and Electronics Engineers (IEEE).
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Konferensbidrag (refereegranskat)abstract
- This paper summarizes and elaborates on some new results on the optimal absorption in small spherical suspensions based on electrophoretic (plasmonic) resonances and lossy surrounding media. The main application here is to study the physical limitations for radio frequency absorption in gold nanoparticle (GNP) suspensions and its potential to achieve GNP targeted hyperthermia in cancer therapy. Numerical parameter studies are included to demonstrate the analysis approach.
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| 17. |
- Ohlsson, Lars, et al.
(författare)
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Mixed-domain gating algorithm for time-domain characterisation of millimetre-wave antennas
- 2017
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Ingår i: European Microwave Week 2017 : "A Prime Year for a Prime Event", EuMW 2017 - Conference Proceedings; 47th European Microwave Conference, EuMC 2017 - "A Prime Year for a Prime Event", EuMW 2017 - Conference Proceedings; 47th European Microwave Conference, EuMC 2017. - 9782874870477 ; 2017-January, s. 256-259
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Konferensbidrag (refereegranskat)abstract
- A mixed-domain device characterisation algorithm with is proposed and evaluated. Wideband signals from a time-domain wavelet generator are applied to millimetre-wave antennas. Deliberately chosen gating techniques in time- A nd frequency-domain are used to relax the calibration effort to one reference measurement. A frequency-domain gate shapes the excitation pulse. Selective removal of setup artefacts and channel reflections is achieved by a time-domain gate. This method is applied to antenna links that demonstrate various gain, dispersion, and bandwidth combinations. The mixed-domain gating results on time-domain wavelets correspond well to those from frequency-domain vector network analysis. This promises simplified future millimetre-wave measurements systems based on methods used in terahertz spectroscopy.
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| 18. |
- Preston, Mark A., et al.
(författare)
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Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men
- 2019
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838. ; 75:3, s. 399-407
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men. Objective: To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men. Design, setting, and participants: Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40–64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment. Outcome measurements and statistical analysis: Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA. Results and limitations: Median PSA among controls was 0.72, 0.80, 0.94, and 1.03 ng/ml for age groups 40–49, 50–54, 55–59, and 60–64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33 ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2–539) for 40–54 yr and 71.7 (95% CI, 23.3–288) for 55–64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3–infinity) for 40–54 yr and 51.8 (95% CI, 11.0–519) for 55–64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation. Conclusions: PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies. Patient summary: Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk. Prostate-specific antigen (PSA) level during midlife strongly predicted total and aggressive prostate cancer among black men. Risk-stratified screening based on midlife PSA might retain the benefits of screening while reducing harms.
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| 19. |
- Preston, Mark A, et al.
(författare)
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Baseline Prostate-Specific Antigen Levels in Midlife Predict Lethal Prostate Cancer
- 2016
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Ingår i: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. - 1527-7755. ; 34:23, s. 2705-11
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Tidskriftsartikel (refereegranskat)abstract
- Prostate-specific antigen (PSA) level in midlife predicted future prostate cancer (PCa) mortality in an unscreened Swedish population. Our purpose was to determine if a baseline PSA level during midlife predicts lethal PCa in a US population with opportunistic screening.We conducted a nested case-control study among men age 40 to 59 years who gave blood before random assignment in the Physicians' Health Study, a randomized, placebo-controlled trial of aspirin and β-carotene among 22,071 US male physicians initiated in 1982 and then transitioned into a prospective cohort with 30 years of follow-up. Baseline PSA levels were available for 234 patients with PCa and 711 age-matched controls. Seventy-one participants who developed lethal PCa were rematched to 213 controls. Conditional logistic regression was used to estimate odds ratios and the area under the receiver operating characteristic curve, with 95% CIs, of the association between baseline PSA and risk of lethal PCa.Median PSA among controls was 0.68, 0.88, and 0.96 ng/mL for men age 40 to 49, 50 to 54, and 55 to 59 years, respectively. Risk of lethal PCa was strongly associated with baseline PSA in midlife: odds ratios (95% CIs) comparing PSA in the > 90th percentile versus less than or equal to median were 8.7 (1.0 to 78.2) at 40 to 49 years, 12.6 (1.4 to 110.4) at 50 to 54 years, and 6.9 (2.5 to 19.1) at 55 to 59 years. A total of 82%, 71%, and 86% of lethal cases occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively.PSA levels in midlife strongly predict future lethal PCa in a US cohort subject to opportunistic screening. Risk-stratified screening on the basis of midlife PSA should be considered in men age 45 to 59 years.
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| 20. |
- Rönnblom, Anders, et al.
(författare)
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Appearance of hepatobiliary diseases in a population-based cohort with inflammatory bowel diseases (Inflammatory Bowel Disease Cohort of the Uppsala Region)
- 2015
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Ingår i: Journal of Gastroenterology and Hepatology. - : Wiley. - 0815-9319 .- 1440-1746. ; 30:8, s. 1288-1292
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Tidskriftsartikel (refereegranskat)abstract
- Background and AimTo prospectively follow the evolution of hepatobiliary diseases in a population-based cohort of patients with inflammatory bowel diseases. MethodsBetween 2005 and 2009, 790 incident cases of ulcerative colitis and Crohn's disease were registered in the Uppsala Health Region, corresponding to an average incidence of 20.0 and 9.9 new cases/100000 inhabitants/year, respectively. Liver function tests were analyzed in 97.1% and the results of ensuing investigations were summarized. ResultsSeventeen patients with primary sclerosing cholangitis were diagnosed corresponding to an overall prevalence of 2.2% (ulcerative colitis 1.7% and Crohn's disease 3.0%, respectively). The median age at diagnosis was 25 years (interquartile range: 17.0-34.0). Among the 92 patients below 17 years of age, three had autoimmune hepatitis and three primary sclerosing cholangitis, summing up to a prevalence of 6.5% immune-mediated hepatobiliary diseases among the pediatric patients. Three patients have undergone liver transplantation and one died of colonic carcinoma. Ten patients have demonstrated persistent elevation of alkaline phosphatases but had a normal magnetic resonance cholangiopancreatography (two patients) or refused further investigation (one patient). ConclusionIn this first large prospective population-based cohort of 526 patients with ulcerative colitis (UC) and 264 with Crohn's disease, 17 cases of primary sclerosing cholangitis were found, among whom three (17%) so far have been liver transplanted and one has died of colon carcinoma. The average age of those affected by primary sclerosing cholangitis is considerably lower than usually reported. Ten patients had or have had elevated alkaline phosphatase without confirmed liver or biliary disease.
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| 21. |
- Rönnblom, Anders, et al.
(författare)
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Celiac disease, collagenous sprue and microscopic colitis in IBD. Observations from a population-based cohort of IBD (ICURE)
- 2015
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 50:10, s. 1234-1240
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Inflammatory bowel disease (IBD), microscopic colitis and celiac disease are all diseases with worldwide distribution and increased incidence has been reported from many areas. There is a shortage of studies investigating the occurrence of these diseases in the same individual and whether those affected demonstrate any particular phenotype. The aim of the study was to describe the concomitant incidence of microscopic colitis and celiac disease in a population-based IBD cohort. Methods. All 790 individuals in a prospective population-based cohort included 2005-09 from Uppsala region, Sweden, were reviewed regarding the appearance of microscopic or celiac disease before or after IBD diagnosis. Results. Fifty percent (396/790) of the patients had been examined for the possibility of celiac disease. Seventeen patients with celiac disease were found, representing 2.2% of the cohort. Patients with celiac disease were younger compared to the non-celiac patients and those with colitis had more often an extensive inflammation of the colon. Seventy-one percent (12/17) were women. The majority of the patients were diagnosed with celiac disease before IBD. Five patients with IBD had an earlier diagnosis of microscopic colitis or developed it after the IBD diagnosis. One teenager developed collagenous sprue, misinterpreted as a severe relapse of ulcerative colitis (UC) resulting in colectomy. Conclusions. The risk for celiac disease seems not to be increased in IBD, but those affected by both diseases seem to be predominantly women with extensive UC. There is a potential association between microscopic colitis and IBD.
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| 22. |
- Sjoberg, Daniel D., et al.
(författare)
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Twenty-year Risk of Prostate Cancer Death by Midlife Prostate-specific Antigen and a Panel of Four Kallikrein Markers in a Large Population-based Cohort of Healthy Men
- 2018
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838. ; 73:6, s. 941-948
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prostate-specific antigen (PSA) screening reduces prostate cancer deaths but leads to harm from overdiagnosis and overtreatment. Objective: To determine the long-term risk of prostate cancer mortality using kallikrein blood markers measured at baseline in a large population of healthy men to identify men with low risk for prostate cancer death. Design, setting, participants: Study based on the Malmö Diet and Cancer cohort enrolling 11 506 unscreened men aged 45-73 yr during 1991-1996, providing cryopreserved blood at enrollment and followed without PSA screening to December 31, 2014. We measured four kallikrein markers in the blood of 1223 prostate cancer cases and 3028 controls. Outcome measurements and statistical analysis: Prostate cancer death (n = 317) by PSA and a prespecified statistical model based on the levels of four kallikrein markers. Results and limitations: Baseline PSA predicted prostate cancer death with a concordance index of 0.86. In men with elevated PSA (≥2.0. ng/ml), predictive accuracy was enhanced by the four-kallikrein panel compared with PSA (0.80 vs 0.73; improvement 0.07; 95% confidence interval 0.04, 0.10). Nearly half of men aged 60+ yr with elevated PSA had a four-kallikrein panel score of <7.5%, translating into 1.7% risk of prostate cancer death at 15 yr-a similar estimate to that of a man with a PSA of 1.6. ng/ml. Men with a four-kallikrein panel score of ≥7.5% had a 13% risk of prostate cancer death at 15 yr. Conclusions: A prespecified statistical model based on four kallikrein markers (commercially available as the 4Kscore) reclassified many men with modestly elevated PSA, to have a low long-term risk of prostate cancer death. Men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy. Patient summary: Men with elevated prostate-specific antigen (PSA) are often referred for prostate biopsy. However, men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy. Men with elevated prostate-specific antigen (PSA) are often referred for prostate biopsy. However, men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy.
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| 23. |
- Stattin, Pär, et al.
(författare)
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Improving the Specificity of Screening for Lethal Prostate Cancer Using Prostate-specific Antigen and a Panel of Kallikrein Markers : a Nested Case-Control Study
- 2015
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Ingår i: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560. ; 68:2, s. 207-213
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Tidskriftsartikel (refereegranskat)abstract
- Background: A disadvantage of prostate-specific antigen (PSA) for the early detection of prostate cancer (PCa) is that many men must be screened, biopsied, and diagnosed to prevent one death. Objective: To increase the specificity of screening for lethal PCa at an early stage. Design, setting, and participants: We conducted a case-control study nested within a population-based cohort. PSA and three additional kallikreins were measured in cryopreserved blood from a population-based cohort in Vasterbotten, Sweden. Of 40 379 men providing blood at ages 40, 50, and 60 yr from 1986 to 2009, 12 542 men were followed for > 15 yr. From this cohort, the Swedish Cancer Registry identified 1423 incident PCa cases, 235 with distant metastasis. Outcome measurements and statistical analysis: Risk of distant metastasis for different PSA levels and a prespecified statistical model based on the four kallikrein markers. Results and limitations: Mostmetastatic cases occurred in men with PSA in the top quartile at age 50 yr (69%) or 60 yr (74%), whereas 20-yr risk of metastasis for men with PSA below median was low (<= 0.6%). Among men with PSA > 2 ng/ml, a prespecified model based on four kallikrein markers significantly enhanced the prediction of metastasis compared with PSA alone. About half of all men with PSA > 2 ng/ml were defined as low risk by this model and had a <= 1% 15-yr risk of metastasis. Conclusions: Screening at ages 50-60 yr should focus on men with PSA in the top quartile. A marker panel can aid biopsy decision making. Patient summary: For men in their fifties, screening should focus on those in the top 10% to 25% of PSA values because the majority of subsequent cases of distant metastasis are found among these men. Testing of four kallikrein markers in men with an elevated PSA could aid biopsy decision making.
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| 24. |
- Vickers, Andrew, et al.
(författare)
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Properties of the 4-Kallikrein Panel Outside the Diagnostic Gray Zone : Meta-Analysis of Patients with Positive Digital Rectal Examination or Prostate Specific Antigen 10 ng/ml and Above
- 2017
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 197, s. 607-613
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The 4-kallikrein panel, commercially available as the 4Kscore™, is a reflex test for prostate cancer early detection that has been extensively validated in multiple international cohorts. It has been suggested that use of such reflex tests be limited to those with prostate specific antigen less than 10 ng/ml and negative digital rectal examination. We aimed to determine the value of the panel in men outside this "diagnostic gray zone.". Materials and Methods: We performed an individual patient data meta-analysis using data from prior studies on the 4-kallikrein panel. We calculated the properties of the panel for predicting high grade (Gleason 7+) cancer in a subgroup of men with either positive digital rectal examination or prostate specific antigen 10 to 25 ng/ml. Results: A total 2,891 men from 8 cohorts were included. An important proportion of patients, including 32% in the United States validation study, had prostate specific antigen 10 to 25 ng/ml or a positive digital rectal examination. For men with prostate specific antigen 10 to 25 ng/ml the fixed-effects estimate for the discrimination of the kallikrein model was 0.84 vs 0.69 for the base model (difference 0.128, 95% CI 0.098-0.159). In the positive digital rectal examination group discrimination was 0.82 vs 0.72 (difference 0.092, 95% CI 0.069-0.115). Decision analysis showed a clinical net benefit for use of the panel in this subgroup with a reduction in biopsy rates of about 20% and only a small number of high grade cancers missed, fewer than 3% of those not biopsied. Conclusion: The use of the kallikrein panel in men with a positive digital rectal examination or prostate specific antigen 10 to 25 ng/ml is justified.
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| 25. |
- Vickers, Andrew, et al.
(författare)
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Value of Intact Prostate Specific Antigen and Human Kallikrein 2 in the 4 Kallikrein Predictive Model : An Individual Patient Data Meta-Analysis
- 2018
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 199:6, s. 1470-1474
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The 4 kallikrein panel, commercially available as the 4Kscore®, is a statistical model that has been shown to accurately predict Gleason Grade Group 2 or greater (high grade) cancer on biopsy and the long-term risk of distant prostate cancer metastases. The panel includes 2 novel markers, namely intact prostate specific antigen and hK2. It has been questioned whether these 2 additional markers add discrimination to the clinical predictors of patient age, digital rectal examination and prior biopsy, and the established molecular markers total and free prostate specific antigen. Materials and Methods: We performed an individual patient data meta-analysis of published studies in which the 4 kallikrein panel was measured in men undergoing prostate biopsy. We assess the improvement in discrimination associated with including intact prostate specific antigen and hK2 along with total and free prostate specific antigen in the statistical model. Results: Included in analysis were 14,510 men from a total of 10 studies. The fixed effects meta-analytical estimate of the discrimination of the model without intact prostate specific antigen and hK2 was 0.742 (95% CI 0.727–0.756) compared to 0.813 (95% CI 0.801–0.825) for the full kallikrein model. The 95% CIs did not overlap and the difference in discrimination was highly statistically significant (0.069, 95% CI 0.057–0.080, p <0.0001). Intact prostate specific antigen (increase in discrimination 0.059, 95% CI 0.050–0.069) and hK2 (increase in discrimination 0.024, 95% CI 0.020–0.029, each p <0.0001) added independently to the model. Conclusions: The clinical value of the panel could not be replicated using data readily available to urologists without measuring intact prostate specific antigen and hK2.
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| 26. |
- Winer, Andrew G, et al.
(författare)
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Prognostic value of lymph node yield during nephroureterectomy for upper tract urothelial carcinoma.
- 2017
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Ingår i: Urologic oncology. - : Elsevier BV. - 1873-2496. ; 35:4
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Tidskriftsartikel (refereegranskat)abstract
- Lymph node dissection (LND) performed during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) remains controversial and difficult to evaluate. The aim of this study was to investigate whether removal of more lymph nodes during RNU is safe and improves oncologic outcomes.We evaluated 422 patients who underwent RNU with concomitant LND for upper tract urothelial carcinoma between 1976 and 2015, assessing for an association between total nodes removed, recurrence-free survival, and cancer-specific survival using Cox proportional hazards models. We also investigated the relationship between nodal yield and perioperative metrics and intersurgeon variability using linear regression.In our cohort of 442 patients, 239 developed recurrences and 94 patients died of disease. Median follow-up among survivors was 3.7 years (interquartile range: 1.2, 7.4). The median nodal yield was 9 (interquartile range: 4, 16). Among patients with node-positive disease (pN1), we observed a significant improvement in recurrence-free survival (hazard ratio = 0.84 per 5 nodes removed, P = 0.039) and a nonsignificant improvement in cancer-specific survival with an increase in the nodal yield (hazard ratio = 0.90 per 5 nodes removed, P = 0.2). There was no evidence of an association between node yield and operative time, estimated blood loss, or 30-day complications on multivariable analysis. There was significant heterogeneity among surgeons regarding the extent of LND (P<0.0001).We found that a more extensive node dissection may improve oncologic outcomes in a subset of high-risk patients without significantly increasing operative time or serious complications. Additionally, we identified considerable intersurgeon heterogeneity regarding the extent of LND furthering the notion of surgeon variability as a nonstandardized factor.
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| 27. |
- Xu, Bo, et al.
(författare)
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Analysis of Impacts of Expected RF EMF Exposure Restrictions on Peak EIRP of 5G User Equipment at 28 GHz and 39 GHz Bands
- 2019
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Ingår i: IEEE Access. - : IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC. - 2169-3536. ; 7, s. 20996-21005
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Tidskriftsartikel (refereegranskat)abstract
- Above 6 GHz, radio frequency (RF) electromagnetic field (EMF) exposure from the mobile communication user equipment (UE) should be assessed in terms of incident power density, rather than specific absorption rate as below 6 GHz. Such regulatory RF EMF restrictions will constrain the transmit power of the UE and its peak equivalent isotropically radiated power (EIRP). This paper provides an analysis of the peak EIRP levels of UE containing code-book-based beamforming arrays at 28 GHz and 39 GHz. Different types of antenna elements, incremental element spacing, 4- and 8-element array configurations, and realistic housing integration are considered. The analysis and results show that in realistic housing integration, the 3GPP requirements on minimum peak EIRP can be generally met under the expected RF EMF exposure restrictions.
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