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| 4. |
- Beral, V, et al.
(author)
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Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58515 women with breast cancer and 95067 women without the disease
- 2002
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In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 87, s. 1234-45
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Journal article (peer-reviewed)abstract
- Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58515 women with invasive breast cancer and 95067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19 - 1.45, P < 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P < 0.00001) for greater than or equal to 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1 % per 10 g per day, P < 0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers= 1.03, 95% CI 0.98 - 1.07, and for current smokers=0.99, 0.92 - 1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. (C) 2002 Cancer Research UK.
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| 5. |
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| 6. |
- Hellsten, Torbjörn, et al.
(author)
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Fast wave current drive in JET ITB-plasma
- 2005
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In: AIP Conference Proceedings. - : AIP. - 0094-243X. ; , s. 273-278
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Conference paper (peer-reviewed)abstract
- Fast wave current drive has been performed in JET plasmas with internal transport barriers, ITBs, and strongly reversed magnetic shear. Although the current drive efficiency of the power absorbed on the electrons is fairly high, only small effects are seen in the central current density. The main reasons are the parasitic absorption of RF power, the strongly inductive nature of the plasma and the interplay between the fast wave driven current and bootstrap current. The direct electron heating in the FWCD experiments is found to be strongly degraded compared to that with the dipole phasing.
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| 7. |
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| 8. |
- Gunnarsdottir, Maria J., et al.
(author)
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Implementing risk-based approaches to improve drinking water quality in small water supplies in the Nordic region – barriers and solutions
- 2023
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In: Journal of Water and Health. - 1477-8920. ; 21:12, s. 1747-1760
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Journal article (peer-reviewed)abstract
- Small water supplies face similar problems worldwide, regardless of ownership or management type. Non-compliance with water quality regulations is more frequent in small supplies than in large ones, as are waterborne disease outbreaks. The new EU Drinking Water Directive requires risk-based approach (RBA) to secure water safety as is recommended in the WHO's Guidelines for drinking water quality through ‘water safety plans’. This is already in regulation in the Nordic countries, although less used in small supplies. In this research, we explore the challenges, barriers and possible solutions to implementing RBA and improving compliance in small supplies. This was achieved by conducting and analysing interviews with 53 stakeholders from all 8 Nordic countries to produce recommendations for action by the different implicated actors. Our findings suggest the centrality of governmental policy, including support for continuous training, provision of simple RBA guidelines and increasing cooperation in the water sector. The Nordic experience reflects global challenges with small water supplies and the trend towards systematic preventive management epitomized in the framework for drinking water safety advocated by the World Health Organization since 2004.
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| 9. |
- Gunnarsdottir, Maria J., et al.
(author)
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Status of risk-based approach and national framework for safe drinking water in small water supplies of the Nordic water sector
- 2020
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In: International Journal of Hygiene and Environmental Health. - : Elsevier BV. - 1438-4639. ; 230
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Journal article (peer-reviewed)abstract
- Reliable safe water supply is a pillar of society and a key to public health. The Nordic countries have an abundance of clean fresh water as a source for drinking water supplies. They have followed developments in safeguarding water, both the recommendations of the World Health Organization framework for safe drinking water and European legislation. Worldwide, including the Nordic countries, small water supplies are less compliant with water safety regulation. The forthcoming EU directive on drinking water require risk-based approaches and improved transparency on water quality. This research looks at the Nordic frameworks for safe water supply, with emphasis on risk-based approaches and smaller systems. We analyzed the legal frameworks for safe water, the structure of the water sector across the Nordic countries and explored how prepared these countries are to meet these requirements. Our findings show that, while legal requirements are mostly in place, delivery of information to the public needs to be improved. Most Nordic countries are in the process of implementing risk-based management in large and medium size water supplies, whereas small supplies are lagging. We conclude that a key to success is increased training and support for small supplies. We suggest wider adoption of the Nordic model of cooperation with benchmarking of safe water for all to transfer knowledge between the countries. This work provides insights into challenges and opportunities for the Nordic countries and provides insights relevant to countries worldwide in their effort towards realization of SDG Target 6.1.
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| 10. |
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| 11. |
- Karakatsanis, Andreas, et al.
(author)
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SentiNot : A way to avoid sentinel node biopsy (SNB) in patients with a preoperative diagnosis of ductal cancer in situ (DCIS)
- 2017
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In: Cancer Research. - Univ Uppsala Hosp, Sect Endocrine & Breast Surg, Uppsala, Sweden. Univ Uppsala Hosp, Uppsala, Sweden. Vastmanland Cty Hosp, Vasteras, Vasteras, Sweden. Uppsala Clin Res Ctr, Uppsala, Sweden. Kalmar Cty Hosp, Sect Breast Surg, Kalmar, Sweden. Univ Uppsala Hosp, Inst Radiol Oncol & Radiotherapy, Uppsala, Sweden. Norrlands Univ Hosp, Umea, Sweden. : AMER ASSOC CANCER RESEARCH. - 0008-5472 .- 1538-7445. ; 77
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Journal article (peer-reviewed)
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| 12. |
- Reimer, M., et al.
(author)
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Interactive effects of subsidiary crops and weed pressure in the transition period to non-inversion tillage, a case study of six sites across northern and central Europe
- 2019
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In: Agronomy. - : MDPI AG. - 2073-4395. ; 9:9
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Journal article (peer-reviewed)abstract
- Reducing soil tillage can lead to many benefits, but this practice often increases weed abundance and thus the need for herbicides, especially during the transition phase from inversion tillage to non-inversion tillage. We evaluated if subsidiary crops (SCs, e.g., cover crops) can mitigate the effects of non-inversion tillage on weed abundance. Two-year experiments studying SC use, tillage intensity, and nitrogen (N) fertilization level were carried out twice at six sites throughout northern and central Europe. SCs significantly reduced weed cover throughout the intercrop period (−55% to −1% depending on site), but only slightly during the main crops. Overall weed abundance and weed biomass were higher when using non-inversion tillage with SCs compared to inversion tillage without SCs. The effects differed due to site-specific weed pressure and management. With increasing weed pressure, the effect of SCs decreased, and the advantage of inversion over non-inversion tillage increased. N fertilization level did not affect weed abundance. The results suggest that SCs can contribute by controlling weeds but cannot fully compensate for reduced weed control of non-inversion tillage in the transition phase. Using non-inversion tillage together with SCs is primarily recommended in low weed pressure environments. © 2019 by the authors
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| 13. |
- Adam, Birgit, et al.
(author)
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N2-fixation, ammonium release and N-transfer to the microbial and classical food web within a plankton community
- 2016
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In: The ISME Journal. - : Springer Science and Business Media LLC. - 1751-7362 .- 1751-7370. ; 10:2, s. 450-459
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Journal article (peer-reviewed)abstract
- We investigated the role of N2-fixation by the colony-forming cyanobacterium, Aphanizomenon spp., for the plankton community and N-budget of the N-limited Baltic Sea during summer by using stable isotope tracers combined with novel secondary ion mass spectrometry, conventional mass spectrometry and nutrient analysis. When incubated with 15N2, Aphanizomenon spp. showed a strong 15N-enrichment implying substantial 15N2-fixation. Intriguingly, Aphanizomenon did not assimilate tracers of 15NH4+ from the surrounding water. These findings are in line with model calculations that confirmed a negligible N-source by diffusion-limited NH4+ fluxes to Aphanizomenon colonies at low bulk concentrations (<250 nm) as compared with N2-fixation within colonies. No N2-fixation was detected in autotrophic microorganisms <5 mum, which relied on NH4+ uptake from the surrounding water. Aphanizomenon released about 50% of its newly fixed N2 as NH4+. However, NH4+ did not accumulate in the water but was transferred to heterotrophic and autotrophic microorganisms as well as to diatoms (Chaetoceros sp.) and copepods with a turnover time of ~5 h. We provide direct quantitative evidence that colony-forming Aphanizomenon releases about half of its recently fixed N2 as NH4+, which is transferred to the prokaryotic and eukaryotic plankton forming the basis of the food web in the plankton community. Transfer of newly fixed nitrogen to diatoms and copepods furthermore implies a fast export to shallow sediments via fast-sinking fecal pellets and aggregates. Hence, N2-fixing colony-forming cyanobacteria can have profound impact on ecosystem productivity and biogeochemical processes at shorter time scales (hours to days) than previously thought.
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| 14. |
- Bergkvist, C., et al.
(author)
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Dietary exposure to polychlorinated biphenyls is associated with increased risk of stroke in women
- 2014
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In: Journal of Internal Medicine. - : WILEY. - 0954-6820 .- 1365-2796. ; 276:3, s. 248-259
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Journal article (peer-reviewed)abstract
- Objective. The potentially beneficial effects of fish consumption on stroke may be modified by major food contaminants in fish. Polychlorinated biphenyls (PCBs) in particular are proposed to play a role in the aetiology of stroke. The aim of this study was to assess the association between dietary PCB exposure and stroke risk with the intake of long-chain omega-3 fish fatty acids and fish consumption. Design. The prospective population-based Swedish Mammography Cohort was examined. It was comprised of 34 591 women free of cardiovascular diseases and cancer at baseline in 1997 and followed up for 12 years. Validated estimates of dietary PCB exposure were obtained via a food frequency questionnaire at baseline. Incident cases of stroke were ascertained through register linkage. Results. During 12 years of follow-up (397 309 person-years), there were 2015 incident cases of total stroke (1532 ischaemic strokes, 216 intracerebral haemorrhages, 94 subarachnoid haemorrhages and 173 unspecified strokes). Multivariable-adjusted relative risks (RR), controlled for known stroke risk factors and fish consumption, were 1.67 [95% confidence interval (CI), 1.29-2.17] for total stroke, 1.61 (95% CI, 1.19-2.17) for ischaemic stroke and 2.80 (95% CI, 1.42-5.55) for haemorrhagic stroke for women in the highest quartile of dietary PCB exposure (median 288 ng day(-1)) compared with women in the lowest quartile (median 101 ng day(-1)). Conclusion. Dietary exposure to PCBs was associated with an increased stroke risk in women, especially haemorrhagic stroke. The results provide important information regarding the risk-benefit analysis of fish consumption, particularly for cerebrovascular disease prevention.
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| 17. |
- de Boniface, J., et al.
(author)
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Omitting axillary dissection in breast cancer with sentinel-node metastases
- 2024
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In: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 390:13, s. 1163-1175
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Journal article (peer-reviewed)abstract
- BACKGROUND Trials evaluating the omission of completion axillary-lymph-node dissection in patients with clinically node-negative breast cancer and sentinel-lymph-node metastases have been compromised by limited statistical power, uncertain nodal radiotherapy target volumes, and a scarcity of data on relevant clinical subgroups.METHODS We conducted a noninferiority trial in which patients with clinically node-negative primary T1 to T3 breast cancer (tumor size, T1, ≤20 mm; T2, 21 to 50 mm; and T3, >50 mm in the largest dimension) with one or two sentinel-node macrometastases (metastasis size, >2 mm in the largest dimension) were randomly assigned in a 1:1 ratio to completion axillary-lymph-node dissection or its omission (sentinel-node biopsy only). Adjuvant treatment and radiation therapy were used in accordance with national guidelines. The primary end point was overall survival. We report here the per-protocol and modified intention-to-treat analyses of the prespecified secondary end point of recurrence-free survival. To show noninferiority of sentinel-node biopsy only, the upper boundary of the confidence interval for the hazard ratio for recurrence or death had to be below 1.44.RESULTS Between January 2015 and December 2021, a total of 2766 patients were enrolled across five countries. The per-protocol population included 2540 patients, of whom 1335 were assigned to undergo sentinel-node biopsy only and 1205 to undergo completion axillary-lymph-node dissection (dissection group). Radiation therapy including nodal target volumes was administered to 1192 of 1326 patients (89.9%) in the sentinel-node biopsy–only group and to 1058 of 1197 (88.4%) in the dissection group. The median follow-up was 46.8 months (range, 1.5 to 94.5). Overall, 191 patients had recurrence or died. The estimated 5-year recurrence-free survival was 89.7% (95% confidence interval [CI], 87.5 to 91.9) in the sentinel-node biopsy–only group and 88.7% (95% CI, 86.3 to 91.1) in the dissection group, with a country-adjusted hazard ratio for recurrence or death of 0.89 (95% CI, 0.66 to 1.19), which was significantly (P<0.001) below the prespecified noninferiority margin.CONCLUSIONS The omission of completion axillary-lymph-node dissection was noninferior to the more extensive surgery in patients with clinically node-negative breast cancer who had sentinel-node macrometastases, most of whom received nodal radiation therapy. (Funded by the Swedish Research Council and others; SENOMAC ClinicalTrials.gov number, NCT02240472.).
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| 18. |
- Jung, Seungyoun, et al.
(author)
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Alcohol consumption and breast cancer risk by estrogen receptor status : in a pooled analysis of 20 studies.
- 2016
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In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 45:3, s. 916-928
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Journal article (peer-reviewed)abstract
- BACKGROUND: Breast cancer aetiology may differ by estrogen receptor (ER) status. Associations of alcohol and folate intakes with risk of breast cancer defined by ER status were examined in pooled analyses of the primary data from 20 cohorts.METHODS: During a maximum of 6-18 years of follow-up of 1 089 273 women, 21 624 ER+ and 5113 ER- breast cancers were identified. Study-specific multivariable relative risks (RRs) were calculated using Cox proportional hazards regression models and then combined using a random-effects model.RESULTS: Alcohol consumption was positively associated with risk of ER+ and ER- breast cancer. The pooled multivariable RRs (95% confidence intervals) comparing ≥ 30 g/d with 0 g/day of alcohol consumption were 1.35 (1.23-1.48) for ER+ and 1.28 (1.10-1.49) for ER- breast cancer (Ptrend ≤ 0.001; Pcommon-effects by ER status: 0.57). Associations were similar for alcohol intake from beer, wine and liquor. The associations with alcohol intake did not vary significantly by total (from foods and supplements) folate intake (Pinteraction ≥ 0.26). Dietary (from foods only) and total folate intakes were not associated with risk of overall, ER+ and ER- breast cancer; pooled multivariable RRs ranged from 0.98 to 1.02 comparing extreme quintiles. Following-up US studies through only the period before mandatory folic acid fortification did not change the results. The alcohol and folate associations did not vary by tumour subtypes defined by progesterone receptor status.CONCLUSIONS: Alcohol consumption was positively associated with risk of both ER+ and ER- breast cancer, even among women with high folate intake. Folate intake was not associated with breast cancer risk.
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| 19. |
- Karakatsanis, Andreas, et al.
(author)
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Effect of preoperative injection of superparamagnetic iron oxide particles on rates of sentinel lymph node dissection in women undergoing surgery for ductal carcinoma in situ (SentiNot study)
- 2019
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 106:6
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Journal article (peer-reviewed)abstract
- Background: One-fifth of patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) have invasive breast cancer (IBC) on definitive histology. Sentinel lymph node dissection (SLND) is performed in almost half of women having surgery for DCIS in Sweden. The aim of the present study was to try to minimize unnecessary SLND by injecting superparamagnetic iron oxide (SPIO) nanoparticles at the time of primary breast surgery, enabling SLND to be performed later, if IBC is found in the primary specimen. Methods: Women with DCIS at high risk for the presence of invasion undergoing breast conservation, and patients with DCIS undergoing mastectomy were included. The primary outcome was whether this technique could reduce SLND. Secondary outcomes were number of SLNDs avoided, detection rate and procedure-related costs. Results: This was a preplanned interim analysis of 189 procedures. IBC was found in 47 and a secondary SLND was performed in 41 women. Thus, 78.3 per cent of patients avoided SLND (P<0.001). At reoperation, SPIO plus blue dye outperformed isotope and blue dye in detection of the sentinel node (40 of 40 versus 26 of 40 women; P<0.001). Costs were reduced by a mean of 24.5 per cent in women without IBC (3990 versus 5286; P<0.001). Conclusion: Marking the sentinel node with SPIO in women having surgery for DCIS was effective at avoiding unnecessary SLND in this study. Registration number: ISRCTN18430240 (http://www.isrctn.com).
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| 20. |
- Koushik, Anita, et al.
(author)
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Intake of fruits and vegetables and risk of pancreatic cancer in a pooled analysis of 14 cohort studies
- 2012
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In: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 176:5, s. 373-386
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Journal article (peer-reviewed)abstract
- Fruit and vegetable intake may protect against pancreatic cancer, since fruits and vegetables are rich in potentially cancer-preventive nutrients. Most case-control studies have found inverse associations between fruit and vegetable intake and pancreatic cancer risk, although bias due to reporting error cannot be ruled out. In most prospective studies, inverse associations have been weaker and imprecise because of small numbers of cases. The authors examined fruit and vegetable intake in relation to pancreatic cancer risk in a pooled analysis of 14 prospective studies from North America, Europe, and Australia (study periods between 1980 and 2005). Relative risks and 2-sided 95% confidence intervals were estimated separately for the 14 studies using the Cox proportional hazards model and were then pooled using a random-effects model. Of 862,584 men and women followed for 7-20 years, 2,212 developed pancreatic cancer. The pooled multivariate relative risks of pancreatic cancer per 100-g/day increase in intake were 1.01 (95% confidence interval (CI): 0.99, 1.03) for total fruits and vegetables, 1.01 (95% CI: 0.99, 1.03) for total fruits, and 1.02 (95% CI: 0.99, 1.06) for total vegetables. Associations were similar for men and women separately and across studies. These results suggest that fruit and vegetable intake during adulthood is not associated with a reduced pancreatic cancer risk.
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| 21. |
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| 25. |
- Westerståhl, M., et al.
(author)
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Longitudinal changes in physical capacity from adolescence to middle age in men and women
- 2018
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In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 8
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Journal article (peer-reviewed)abstract
- The aim was to investigate how physical capacity changes from adolescence through early adulthood to middle age with focus on early aging. The aim was also to study if physical capacity in middle age could be predicted by factors in adolescence or early adulthood. A cohort of men and women in Sweden (SPAF-1958, n = 425) have been followed for 36 years, at 16, 34, and 52 years of age. The study includes, among other variables, objective measures of physical capacity. At age 52, 50% of the original cohort participated in exercise testing. Physical capacity increased from 16 to 34 years. From 34 to 52 years, physical capacity decreased in both genders by 15-20% in all but one test. Physical capacity at 16 and 34 years of age were better predictors of physical capacity at age 52 than body dimensions, school grades and life style factors. In conclusion, present data confirm earlier cross-sectional studies regarding the decrease in aerobic capacity and muscular strength during the early ageing period in both genders. The study has also generated novel data that show a smaller decline in muscular endurance than previously reported. Finally, physical capacity is fairly stable from adolescence to middle age.
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| 26. |
- Aasa, Ulrika, et al.
(author)
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Muscle strength assessment from functional performance tests : role of body size
- 2003
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In: Journal of Strength and Conditioning Research. - 1064-8011 .- 1533-4287. ; 17:4, s. 664-670
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Journal article (peer-reviewed)abstract
- The aim of the study was to test the hypothesis that the body size plays an important role in assessment of muscle ability to exert force by standard functional performance tests. Twenty-one male students were tested on maximal isometric lift, one leg rising, vertical jump, and box lift tests, and the maximal isokinetic strength of hip and knee extensors was also recorded. When indices of the 4 functional performance tests were related to the strength of each of the 2 leg extensor muscle groups, only maximal isometric lift demonstrated positive correlation with knee extensors strength. When muscle strength was corrected for body mass, however, the aforementioned relationship became insignificant, but the 1 leg rising performance demonstrated a positive relationship with knee extensor strength. In addition, maximal isometric lift and 1 leg rising test performance provided positive and negative correlation, respectively, with body mass. The obtained findings were in line with the effects of scale applied on the tested performance. We generally conclude that the assessment of muscle capability to exert force based on some standard functional performance tests could be confounded by the body size effect.
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| 27. |
- Amato, Alberto, et al.
(author)
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Grazer-induced transcriptomic and metabolomic response of the chain-forming diatom Skeletonema marinoi
- 2018
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In: ISME Journal. - : Springer Science and Business Media LLC. - 1751-7362 .- 1751-7370. ; 12, s. 1594-1604
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Journal article (peer-reviewed)abstract
- Diatoms and copepods are main actors in marine food webs. The prey-predator interactions between them affect bloom dynamics, shape marine ecosystems and impact the energy transfer to higher trophic levels. Recently it has been demonstrated that the presence of grazers may affect the diatom prey beyond the direct effect of grazing. Here, we investigated the response of the chain-forming centric diatom Skeletonema marinoi to grazer cues, including changes in morphology, gene expression and metabolic profile. S. marinoi cells were incubated with Calanus finmarchicus or with Centropages typicus and in both cases responded by reducing the chain length, whereas changes in gene expression indicated an activation of stress response, changes in the lipid and nitrogen metabolism, in cell cycle regulation and in frustule formation. Transcripts linked to G protein-coupled receptors and to nitric oxide synthesis were differentially expressed suggesting involvement of these signalling transduction pathways in the response. Downregulation of a lipoxygenase in the transcriptomic data and of its products in the metabolomic data also indicate an involvement of oxylipins. Our data contribute to a better understanding of the gene function in diatoms, providing information on the nature of genes implicated in the interaction with grazers, a crucial process in marine ecosystems.
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| 28. |
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| 29. |
- Andersson, Y., et al.
(author)
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Causes of false-negative sentinel node biopsy in patients with breast cancer
- 2013
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 100:6, s. 775-783
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Journal article (peer-reviewed)abstract
- Background: Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection as the routine staging procedure in clinically node-negative breast cancer. False-negative SLN biopsy results in misclassification and may cause undertreatment of the disease. The aim of this study was to investigate whether serial sectioning of SLNs reveals metastases more frequently in patients with false-negative SLNs than in patients with true-negative SLNs. Methods: This was a case-control study. Tissue blocks from patients with false-negative SLNs, defined as tumour-positive lymph nodes excised at completion axillary dissection or a subsequent axillary tumour recurrence, were reassessed by serial sectioning and immunohistochemical staining. For each false-negative node, two true-negative SLN biopsies were analysed. Tumour and node characteristics in patients with false-negative SLNs were compared with those in patients with a positive SLN by univariable and multivariable regression analysis. Results: Undiagnosed SLN metastases were discovered in nine (18 per cent) of 50 patients in the false-negative group and in 12 (11.2 per cent) of 107 patients in the true-negative group (P = 0.245). The metastases were represented by isolated tumour cells in 14 of these 21 patients. The risk of a false-negative SLN was higher in patients with hormone receptor-negative (odds ratio (OR) 2.50, 95 per cent confidence interval 1.17 to 5.33) or multifocal tumours (OR 3.39, 1.71 to 6.71), or if only one SLN was identified (OR 3.57, 1.98 to 6.45). Conclusion: SLN serial sectioning contributes to a higher rate of detection of SLN metastasis. The rate of upstaging of the tumour is similar in false-and true-negative groups of patients.
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| 30. |
- Appelgren, M., et al.
(author)
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Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial
- 2022
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In: Breast. - : Elsevier BV. - 0960-9776 .- 1532-3080. ; 63, s. 16-23
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Journal article (peer-reviewed)abstract
- Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND). Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1-2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQC30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.
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| 31. |
- Barnekow-Bergkvist, M, et al.
(author)
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Adolescent determinants of cardiovascular risk factors in adult men and women
- 2001
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In: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 29:3, s. 208-217
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Journal article (peer-reviewed)abstract
- Aims: To investigate how physical activity, physical performance and sociodemographic characteristics at the age of 16 are related to adult health habits (physical activity, dietary intake, smoking) and biological risk factors for cardiovascular diseases (being overweight, low aerobic fitness, unfavorable levels of serum lipids, high blood pressure). Methods: A randomly selected group of 220 male and 205 female students at 16 years of age was tested in 1974, and reinvestigated 18 years later. Results: The predictive health profiles for adult lifestyle and biological risk factors were different in men and women. Leisure sports activity along with high performance in the nine-minute run among the boys and in the two-hand lift test among the girls were significant predictors of adult physical activity. A positive attitude to aerobic exercise and high performance in the nine-minute run test among the boys and high marks in physical education among the girls decreased the risk of smoking. Leisure sports activities together with body mass index at young ages were the most powerful predictors of adult biological risk factors, but attitudes to sports and educational level were also significant determinants. Conclusion: These results contribute to the knowledge of which factors at young ages may promote adult healthy habits in particular physical activities.
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| 35. |
- Bergfors, M, et al.
(author)
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Short-term effects of repetitive arm work and dynamic exercise on glucose metabolism and insulin sensitivity.
- 2005
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In: Acta Physiologica Scandinavica. - 0001-6772 .- 1365-201X. ; 183:4, s. 345-356
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Journal article (peer-reviewed)abstract
- Aim: To detennine whether repetitive ann work, with a large component of static muscle contraction alters glucose metabolism and insulin sensitivity. Methad: Euglycemic clamps (2h) were started in ten healthy individuals 15 minutes after 37 minute periods of: 1) repetitive ann work in a simulated occupational setting; 2) dynamic concentric exercise on a cycle ergometer at 60% OfVO2 max and 3) a resting regime as a control. During the experimental periods, blood samples were collected, blood pressure was measured repeatedly and electrocardiogram (ECG) wasrecorded continuously. During the clamps, euglycemia was maintained at 5 mmo1/l and insulin was infused at 56 mU/m2/min for 120 min. Results: The insulin-mediated glucose disposal rate (M-value) for the steady state period (60- 120 min) of the clamp, tended to be lower following ann work than for both cycling and resting regimes. When dividing the steady state period into 20-minute intervals, the insulin sensitivity index, (ISI) was significantly lower for ann work compared with the resting control situation between 60-80 minutes (p=0.04) and 80-100 minutes (p=0.01) respectively. Catecholamines increased significantly for ann work and cycling compared with resting regime. .Data from heart rate variability (HRV) me asurements indicated significant sympathetic activation during repetitive ann work test. Canelusian: The results indicate that repetitive ann work might acutely promote insulin resistance, whereas no such effect on insulin resistance was produced by dynamic concentric exercise.
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| 40. |
- Bergkvist, Karin, et al.
(author)
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Support in the context of allogeneic hematopoietic stem cell transplantation : The perspectives of family caregivers
- 2020
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In: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 46
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM: Family caregivers are often involved in helping recipients during allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the distress that often arises along the trajectory is evident to family caregivers, research on their perceptions of providing and receiving support is limited. The aim of this study was to explore family caregivers' experiences of providing and receiving support during allo-HSCT.METHOD: Data were collected through semi-structured interviews with fourteen family caregivers 16 weeks after the recipient's allo-HSCT. Inductive qualitative content analysis was used to analyse the data.RESULTS: The analysis revealed four generic categories that focus on prerequisites for family caregivers' ability to provide support: Individual characteristics influence the ability to be supportive, Social context influences the ability to be supportive, Medical information provides knowledge and a sense of participation and Interaction with the healthcare organization provides a sense of participation. These prerequisites are linked in the fifth generic category: Family caregivers' support is multifaceted and dependent on the recipient's health.CONCLUSIONS: Family caregivers' risk of experiencing a stronger sense of uncertainty and lack of participation is higher in the absence of the above-mentioned prerequisites. Professional support is thus required, which implies that the healthcare organization is responsible for identifying the needs of each family caregiver and delivering individualized support.
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| 41. |
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| 42. |
- Bergkvist, L, et al.
(author)
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Multicentre study of detection and false-negative rates in sentinel nodebiopsy for breast cancer
- 2001
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 88:12, s. 1644-1648
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Journal article (peer-reviewed)abstract
- BACKGROUND: Sentinel node biopsy has recently evolved as a means of staging the axilla in breast cancer with minimal surgical trauma. The aim of this prospective multicentre study was to identify factors that influenced the detection and false-negative rates during the learning phase.METHODS: Data on all 498 sentinel node biopsies performed between August 1997 and December 1999 in Sweden were collected.RESULTS: A sentinel node was found in 450 patients (90 per cent). Preoperative scintigraphy visualized 83 per cent of all sentinel nodes. The detection rate was higher with same-day injection of tracer than with injection the day before (96 versus 86 per cent; P < 0.01). Dye injected less than 5 min or more than 30 min before the start of the operation lowered the detection rate (less than 60 per cent versus more than 65 per cent; P = 0.02). The detection rate varied from 61 to 100 per cent between surgeons. The false-negative rate was 11 per cent. The presence of multiple tumour foci and a high S-phase fraction increased the risk of a false-negative sentinel node, whereas the number of operations performed by each surgeon was less important.CONCLUSION: Training of the individual surgeon influenced the detection rate, as did timing of tracer and dye injection. The false-negative rate seemed to be related to biological factors.
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| 43. |
- Bergkvist, My, et al.
(author)
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No evidence for genetic linkage between development of multiple sclerosis and components of the IFN system and the JAK-STAT pathway.
- 2004
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In: Multiple Sclerosis Journal. - : SAGE Publications. - 1477-0970 .- 1352-4585. ; 10:1, s. 87-88
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Journal article (peer-reviewed)abstract
- Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system (CNS). Several observations suggest that the interferon system may be of interest in the study of MS development. To investigate whether polymorphism in components of the IFN system and the JA K-STAT pathway influence susceptibility to MS, we performed a linkage analysis between polymorphic loci in or close to the IFN gamma, IFN gamma recepto r, IFN alpha/beta recepto r, JA K 1, STAT 1 and STAT 3 genes in 27 Swedish families with at least two members having MS. Tests for transmission disequilibrium and nonparametric linkage analysis gave negative results. We found no evidence for linkage between MS and any of these loci.
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| 45. |
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| 46. |
- Bergkvist, Sharon W, 1973, et al.
(author)
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Lactic acid decreases Fe (II) and Fe (III) retention but increases Fe (III) transepithelial transfer by Caco-2 cells
- 2005
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In: Journal of Agricultural and Food Chemistry. - : American Chemical Society (ACS). - 0021-8561 .- 1520-5118. ; 53:17, s. 6919-6923
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Journal article (peer-reviewed)abstract
- Lactic acid (LA) has been proposed to be an enhancer for dietary iron absorption, but contradictory results have also been reported. In the present study, fully differentiated Caco-2 cell monolayers were used to evaluate the effects of LA (1-50 mmol/L) on the cellular retention and transepithelial transport of soluble non-heme iron (as ferric nitrilotriacetate). Our data revealed a linear decline in Fe(III) retention with respect to the concentration of LA added. In the presence of 50 mmol/L LA, retention of Fe(111) and Fe(II) decreased 57% and 58%, respectively. In contrast, transfer of Fe(111) across the cell monolayer was doubled, while Fe(II) transfer across the cell monolayer decreased 35%. We conclude that LA reduces cellular retention and transepithelial transport of Fe(l I) by Caco-2 cells in a dose-dependent manner. However, while LA also reduces retention of Fe(111) by Caco-2 cells, the transfer of Fe(III) across cell monolayers is enhanced, possibly due to effects on paracellular transport.
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| 48. |
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| 49. |
- de Boniface, Jana, 1971-
(author)
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Sentinel Node Biopsy in Breast Cancer : Clinical and Immunological Aspects
- 2007
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Doctoral thesis (other academic/artistic)abstract
- The most important prognostic factor in breast cancer is the axillary lymph node status. The sentinel node biopsy (SNB) is reported to stage the axilla with an accuracy > 95 % in early breast cancer. Tumour-related perturbation of T-cell function has been observed in patients with malignancies, including breast cancer. The down-regulation of the important T-cell activation molecules CD3-ζ and CD28 may cause T-cell dysfunction, anergy, tolerance and deletion.The expression of CD3-ζ and CD28 was evaluated in 25 sentinel node biopsies. The most pronounced down-regulation was seen in the paracortical area, where the best agreement between both parameters was observed. CD28 expression was significantly more suppressed in CD4+ than in CD8+ T-cells.From the Swedish sentinel node database, 109 patients with breast cancer > 3 cm planned for both SNB and a subsequent axillary dissection were identified. The false negative rate (FNR) was 12.5%. Thirteen cases of tumour multifocality were detected on postoperative pathology. The FNR in this subgroup was higher (30.8%) than in patients with unifocal disease (7.8%; P = 0.012).From the Swedish SNB multicentre cohort trial, 2246 sentinel node-negative patients who had not undergone further axillary surgery were selected for analysis. After a median follow-up time of 37 months (range 0-75), 13 isolated axillary recurrences (13/2246; 0.6%) were found. In another 14 cases, local or distant failure preceded or coincided with axillary relapse (27/2246; 1.2%). In conclusion, the immunological analysis of the sentinel node might provide valuable prognostic information and aid selection of patients for immunotherapy. SNB is encouraged in breast cancer larger than 3 cm, if no multifocal growth pattern is present. The axillary recurrence rate after a negative SNB in Sweden is in accordance with international figures. However, a longer follow-up is mandatory before the true failure rate of the SNB can be determined.
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| 50. |
- de Boniface, J., et al.
(author)
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The generalisability of randomised clinical trials: an interim external validity analysis of the ongoing SENOMAC trial in sentinel lymph node-positive breast cancer
- 2020
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In: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 0167-6806 .- 1573-7217. ; 180:1, s. 167-176
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Journal article (peer-reviewed)abstract
- Purpose None of the key randomised trials on the omission of axillary lymph node dissection (ALND) in sentinel lymph-positive breast cancer have reported external validity, even though results indicate selection bias. Our aim was to assess the external validity of the ongoing randomised SENOMAC trial by comparing characteristics of Swedish SENOMAC trial participants with non-included eligible patients registered in the Swedish National Breast Cancer Register (NKBC). Methods In the ongoing non-inferiority European SENOMAC trial, clinically node-negative cT1-T3 breast cancer patients with up to two sentinel lymph node macrometastases are randomised to undergo completion ALND or not. Both breast-conserving surgery and mastectomy are eligible interventions. Data from NKBC were extracted for the years 2016 and 2017, and patient and tumour characteristics compared with Swedish trial participants from the same years. Results Overall, 306 NKBC cases from non-participating and 847 NKBC cases from participating sites (excluding SENOMAC participants) were compared with 463 SENOMAC trial participants. Patients belonging to the middle age groups (p = 0.015), with smaller tumours (p = 0.013) treated by breast-conserving therapy (50.3 versus 47.1 versus 65.2%, p < 0.001) and less nodal tumour burden (only 1 macrometastasis in 78.8 versus 79.9 versus 87.3%, p = 0.001) were over-represented in the trial population. Time trends indicated, however, that differences may be mitigated over time. Conclusions This interim external validity analysis specifically addresses selection mechanisms during an ongoing trial, potentially increasing generalisability by the time full accrual is reached. Similar validity checks should be an integral part of prospective clinical trials. Trial registration: NCT 02240472, retrospective registration date September 14, 2015 after trial initiation on January 31, 2015
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