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Purpose Adjuvant radiotherapy (RT) for breast cancer is associated with an increased risk of ischemic heart disease. We examined the risk of coronary artery stenosis in a large cohort of women with breast cancer receiving adjuvant RT. Methods A cohort of women diagnosed with breast cancer between 1992 and 2012 in three Swedish health care regions (n = 57,066) were linked to the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify women receiving RT who subsequently underwent a percutaneous coronary intervention (PCI) due to coronary stenosis. Cox regression analyses were performed to examine risk of a coronary intervention and competing risk analyses were performed to calculate cumulative incidence. Results A total of 649 women with left-sided breast cancer and 494 women with right-sided breast cancer underwent a PCI. Women who received left-sided RT had a significantly higher risk of a PCI in the left anterior descending artery (LAD) compared to women who received right-sided RT, hazard ratio (HR) 1.44 (95% confidence interval [CI] 1.21–1.77, p Conclusion Implementing and further developing techniques that lower cardiac doses is important in order to reduce the risk of long-term side effects of adjuvant RT for breast cancer.

Adjuvant radiotherapy (RT) for breast cancer is associated with an increased risk of ischemic heart disease. We examined the risk of coronary artery stenosis in a large cohort of women with breast cancer receiving adjuvant RT.A cohort of women diagnosed with breast cancer between 1992 and 2012 in three Swedish health care regions (n = 57,066) were linked to the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify women receiving RT who subsequently underwent a percutaneous coronary intervention (PCI) due to coronary stenosis. Cox regression analyses were performed to examine risk of a coronary intervention and competing risk analyses were performed to calculate cumulative incidence.A total of 649 women with left-sided breast cancer and 494 women with right-sided breast cancer underwent a PCI. Women who received left-sided RT had a significantly higher risk of a PCI in the left anterior descending artery (LAD) compared to women who received right-sided RT, hazard ratio (HR) 1.44 (95% confidence interval [CI] 1.21-1.77, p 0.001). For the proximal, mid, and distal LAD, the HRs were 1.60 (95% CI 1.22-2.10), 1.38 (95% CI 1.07-1.78), and 2.43 (95% CI 1.33-4.41), respectively. The cumulative incidence of coronary events at 25 years from breast cancer diagnosis were 7.0% in women receiving left-sided RT and 4.4% in women receiving right-sided RT.Implementing and further developing techniques that lower cardiac doses is important in order to reduce the risk of long-term side effects of adjuvant RT for breast cancer.

Background Neuroendocrine tumours of the small intestine (SI-NETs) are rare gastrointestinal neoplasms with an annual incidence of about one per 100 000. Patients with apparently similar tumours have variable outcomes. The aim of this study was to identify postoperative prognostic factors identifiable after initial surgery. Methods This was a nested case-control study of patients with SI-NETs who were treated between 1961 and 2001. Data were retrieved from the Swedish Cancer Registry. Patients who died from the SI-NET and corresponding controls (who outlived cases by at least 1 month), matched by age at diagnosis and calendar period, were included. Sex, postoperative symptoms, postoperative 5-hydroxyindoleacetic acid (5-HIAA) values, European Neuroendocrine Tumor Society (ENETS) stage, insufficiency of the tricuspid valve, radical secondary surgery and secondary malignancy were studied as potential prognostic factors. Results In total, 1122 patients were included (561 cases, 561 controls). Postoperative factors of prognostic importance included hormone-related symptoms, stage IV disease, raised levels of 5-HIAA, insufficiency of the tricuspid valve, secondary surgery not being macroscopically radical and a second malignancy. Conclusion Stage and symptomatic disease are important prognostic factors in SI-NET.

Neuroendocrine tumours of the small intestine (SI-NETs) are rare gastrointestinal neoplasms with an annual incidence of about one per 100 000. Patients with apparently similar tumours have variable outcomes. The aim of this study was to identify postoperative prognostic factors identifiable after initial surgery.This was a nested case-control study of patients with SI-NETs who were treated between 1961 and 2001. Data were retrieved from the Swedish Cancer Registry. Patients who died from the SI-NET and corresponding controls (who outlived cases by at least 1 month), matched by age at diagnosis and calendar period, were included. Sex, postoperative symptoms, postoperativeIn total, 1122 patients were included (561 cases, 561 controls). Postoperative factors of prognostic importance included hormone-related symptoms, stage IV disease, raised levels of 5-HIAA, insufficiency of the tricuspid valve, secondary surgery not being macroscopically radical and a second malignancy.Stage and symptomatic disease are important prognostic factors in SI-NET.

Inflammation is a well-documented driver of cancer development and progression. However, little is known about its role in prostate carcinogenesis. Thus, we examined the association of C-reactive protein (CRP), haptoglobin, albumin and white blood cells (WBC) with prostate cancer (PCa) severity (defined by PCa risk category and clinicopathological characteristics) and progression (defined by PCa death). We selected 8,471 Swedish men with newly diagnosed PCa who had exposure measurements taken approximately 14 years prior to diagnosis. We calculated odds ratio (OR) and 95% confidence interval (CI) for the associations between the inflammatory markers and PCa severity using logistic regression, while Cox proportional hazard regression was used for the associations with overall and PCa death. Serum CRP levels were associated with increased odds of high risk and metastatic PCa, and high PSA levels (≥20 µg/L) (OR: 1.29; 95% CI: 1.06-1.56, 1.32; 1.05-1.65 and 1.51; 1.26-1.81, respectively). Similarly, higher haptoglobin levels were associated with increased odds of metastatic PCa, high PSA level and possibly high grade PCa (1.38; 1.10-1.74, 1.50; 1.17-1.93 and 1.25; 1.00-1.56, respectively). Albumin was positively associated with Gleason 4 + 3 tumour (1.38; 1.02-1.86) and overall death (HR

In order to obtain a more comprehensive knowledge basis for the supply of essential elements to sheep on pasture in Norway, a systematic, countrywide investigation of element composition of pasture plants was conducted, with emphasis on natural pastures. Samples of pasture grass, herbs, willow shrub leaves and bilberry (N = 575) from 142 locations were analysed for the essential trace elements Se, Co, I, Zn and Mn, and for the major elements Ca, P, Mg, Na and K. A large and systematic geographical variation was observed for Se, I and Na, while concentrations of Zn and of most major elements showed limited variation with sampling site. Se concentrations were inadequate in the majority of samples from all plant species. Marked botanical variation was noted for Co and Zn, and willow shrub leaves were identified as a valuable source of these elements in natural sheep pastures.

To obtain a better knowledge basis for the correct supply of Cu to sheep in Norway, a systematic, countrywide investigation of element composition of pasture plants was conducted, with emphasis on natural pastures. Samples of pasture grass, herbs, willow shrub leaves and bilberry (N = 575) from 142 locations were analysed for Cu, Mo, S and Fe. A large geographical variation was observed for Mo concentration and Cu:Mo ratio, a somewhat smaller variation for Fe, while Cu and S concentrations showed limited geographical variation. The Mo variation led to a Cu:Mo ratio 20 in 62% of samples, confirming that the trace element composition of Norwegian sheep pastures may represent a risk of Cu deficiency as well as Cu overload, depending on location. A considerable botanical variation was also observed, in particular for Cu and Mo.

Survival data analysis becomes complex when the proportional hazards assumption is violated at population level or when crude hazard rates are no longer estimators of marginal ones. We develop a Bayesian survival analysis method to deal with these situations, on the basis of assuming that the complexities are induced by latent cohort or disease heterogeneity that is not captured by covariates and that proportional hazards hold at the level of individuals. This leads to a description from which risk-specific marginal hazard rates and survival functions are fully accessible, 'decontaminated' of the effects of informative censoring, and which includes Cox, random effects and latent class models as special cases. Simulated data confirm that our approach can map a cohort's substructure and remove heterogeneity-induced informative censoring effects. Application to data from the Uppsala Longitudinal Study of Adult Men cohort leads to plausible alternative explanations for previous counter-intuitive inferences on prostate cancer. The importance of managing cardiovascular disease as a comorbidity in women diagnosed with breast cancer is suggested on application to data from the Swedish Apolipoprotein Mortality Risk Study. Copyright © 2017 John WileySons, Ltd.

Radiocaesium concentrations ( 137 Cs) were measured in extrusa from oesophageally fistulated sheep, goats and reindeer grazing alpine summer vegetation in Griningsdalen, Southern Norway in the period 1987–1989. The experiments with sheep and goats were conducted in different subalpine areas. The reindeer were, in addition, grazed in three areas in the low alpine zone. Grazing bouts lasted for 10–20 min and bite selections were recorded every 15 s through the grazing bout. Reindeer and goats had the most diverse food selection whereas sheep fed mainly on grasses, forbs and, to some extent, on leaves of willow. The reindeer extrusa had the highest radiocaesium activity, apparently to a large extent caused by intake of lichens in areas where this type of plants were present. Depending on the type of vegetation in the grazed areas the transfer of radiocaesium from soil to grazed vegetation (Bq kg −1 dry extrusa/Bq m −2 soil) was estimated to 0.02–0.04 in sheep, 0.02–0.05 in goats and 0.02–0.43 in reindeer for 1987.

A rapid and inexpensive incubation and extraction technique for estimating the available low molecular weight and potentially bioavailable fraction of Cs isotopes in vegetation has been developed. Samples of contaminated vegetation (grass, herbage and fungi) and litter were exposed to remen liquid from sheep, by in vitro incubation or by placing nylon bags in the rumen of sheep (in sacco). The results were compared with laboratory extractions using rumen buffer, NH4OAc, CsCl and de-ionized water. The release of low molecular weight 137Cs species after in vitro incubation with rumen liquid for 4–8 h was 75–85% for grass, herbage and fungi, 30% for lichen and 10% for litter. The reproducibility of the method was 5% for digestible matrices and 10–20% for litter where the fraction of Cs isotopes released was small. Extractions with NH4OAc and CsCl released 75 and 80% of the Cs isotopes in grass, respectively. Significantly lower extraction yields were obtained with de-ionized water and buffer. During in sacco incubation, 90–100% of the Cs isotopes in vegetation was released within 1 h; however, potentially available low molecular weight forms and Cs-bearing colloidal material could not be differentiated. The results obtained by incubation with rumen liquid and by extraction with NH4OAc or CsCl were in good agreement with published data from a 3 week feeding trial. For practical reasons extraction with NH4OAc or CsCl rather than incubation with rumen liquid is recommended for estimating the fraction of available low molecular weight Cs species. Results from incubation with rumen liquid showed that the availability of Cs isotopes in grass collected in 1986 was low (15%), but increased with time up to 1989 (75–80%). It is probable that the high fraction of inert 137Cs species reflects surface contamination in 1986. The increasing fraction of available 137Cs in grass with time indicates a higher degree of root uptake and a reduction in resuspension and surface contamination from soil.

The effect of concentrate supplementation on nitrogen (N) intake and excretion in grazing lactating dairy cows was determined in three herds in Norway. Grazing trials were conducted with each herd in June and August for two consecutive years. The average supplementation was 1.8 (S.D. 2.1) kg DM/day, and the concentrate was based on grain with a N content ranging from 18.7 to 24 g/kg DM. Herbage DM and N intake were reduced with increasing supplementation, but total DM and N intake increased. Milk yield and protein content increased by 1.1 kg milk and 0.28 g protein per kg milk for each kg extra concentrate. Milk N excretion increased with increasing supplementation (6.5 g N/kg DM), and N utilisation improved by 11.7 g N per kg N intake per kg extra concentrate. Excretion of urine N and its share of total excreta N decreased by 4.0 and 9.2 g/kg concentrate, respectively. The reducing effect on urine N excretion of supplementation was, however, numerically low compared with other studies, most likely due to a high crude protein content of the concentrate used.

Grazing experiment with two oesophageally fistulated reindeer were conducted during June to August 1987 in the Jotunheimen mountain range (1000-1400 m). Grazing in 4 different plant communities was compared: Mesotrophic birch forest dominated by heather, Oligotrophic community with poor snow- cover dominated by heather and Dwarf birch, Oligotrophic community with moderate snowcover domi­ nated by lichens and sedges and a snowbed community dominated by Least willow and lichens. The radioactivity in food samples obtained from the fistula changed through the summer and differed be­ tween communities, from 8000 Bq/kg dry matter to 49000 Bq/kg dry matter. The major factor responsible for these changes was variations in the amounts of lichens ingested. Lichens beside mosses had the highest levels of radiocesium and consequently the amount of lichens consumed was the major single food item responsible for high intake of radioactivity.

In the late summer and fall of 1988 mushrooms were precent i n abundance i n Scandinavia and concomitant ly increased levels of radiocaesium were observed i n both domestic and w i l d grazing animals. Subsequent studies revealed high concentrations of radiocaesium i n several species of mushrooms highly sought by reindeer and other ruminants. In August the intake of radiocaesium by oesophageally fistulated reindeer grazing i b i rch forest amounted to as much as 1.9-5.7 k B q per feeding bout of 10 m i n . A major component of the ingesta was mushrooms. In sacco studies was showed a rapid release of radiocaesium from mushroom tissue into the rumen. Feeding trials w i t h contaminated mushrooms to goats also showed that radiocaesium was easily available and behaved s imilar ly to oral doses of ionic Cs . Radiocaesium f rom mushrooms was rapidly transfered to m i l k . It can be assumed that the higher activity found in reindeer calves than i n females partly can be explained by intake of m i l k and partly by larger intake of food per unit of body weight than in adult animals. Recent studies have shown that o ld bomb test fallout of radiocaesium can be mobi l i zed into the food chain by mushrooms. A l t h o u g h the general level of radiocaesium in reindeer forages decrease s lowly , radiocaesium f rom the Chernob y l accident can, when there is a large mushroo m crop, probably cause serious problems to the reindeer industry in the years to come. Rangifer, Special Issue No . 4,1990 37

Transfer of radiocesium from vegetation to milk was studied in dairy goats grazing heavily contaminated mountain pasture in southern Norway in the years following the Chernobyl accident. Radiocesium activity in milk and green vegetation remained stable throughout 1986 and 1987. In 1988, a sudden three- to fivefold increase in milk radioactivity occurred during the second half of the summer. Whole-body content of radioactivity in sheep and reindeer also increased rapidly. This coincided with an abundant growth of fungal fruit bodies with radiocesium levels up to 100 times higher than green vegetation. Fungal radiocesium was found to be highly available in a digestibility study with goats. Milk radioactivity levels in the field could be accounted for by consumption of as little as 20-100 g d-1 of fungal dry matter (DM). The importance of fungal fruit bodies in transferring radiocesium to ruminants was further substantiated by comparing meat activities in grazing ruminants in 1988 and 1989. Fungal fruit bodies were present in minor quantities in 1989, and radioactivity levels in sheep and reindeer in August-September were only 28-35% of those in 1988. This ability of fungi to mobilize radiocesium from natural soils and transfer the isotopes into the human food chain greatly enhances the vulnerability of food production in natural ecosystems to radiocesium pollution.

The contents of copper (Cu), molybdenum (Mo), sulphur (S), zinc (Zn), selenium (Se), iron (Fe), manganese (Mn) and the Cu/Mo ratio were determined in different native plant species from a mountain area of central southern Norway. The overall mean values and ranges (mg/kg DM) were Cu: 6.0, 0.9–27.2; Mo: 0.25, 0.01–3.57; Zn: 77, 8–320; Se: 0.05, less than 0.01–0.32; Fe: 208, 15–2245; Mn: 338, 31–3784; S: (g/100 g DM) 0.20, 0.03–0.56; Cu/Mo: 79, 1–795. Levels of the individual elements showed considerable variability, both between and within plant groups. Mineral contents were compared with the established requirements for sheep and cattle, the following conclusion being drawn: Most of the mountain pasture plants investigated were deficient in copper and marginally low and partly deficient in molybdenum. The Cu:o ratios were generally high, and may explain the occurrence of chronic copper poisoning in sheep after grazing such pastures. All plant groups except lichens and sedges were found to contain...

Rumen Na+ and K+ concentrations in reindeer were manipulated by introducing 4 M KC1 or 4 M NaCl into the reindeer rumen. A positive correlation was found between salivary and ruminal concentrations of Na+ and K+. Decreased ruminal Na+ concentrations seemed to decrease dry matter digestibility in nylon bags incubated in the rumen.Om manipulering av natrium og kalium konsentrasjoner i vomma hos rein og om de mulige effekter på fordøyeligheten.Abstract in Norwegian / Sammendrag: Na+ og K+ konsentrasjoner i vomma hos rein ble regulert ved å gi reinen 4 M KC1 eller 4 M NaCl direkte i vomma. Det ble funnet en positiv korrelasjon mellom spytt og vomkonsentrasjoner av Na+ og K+. Redusert Na+ konsentrasjon i vomma synes å redusere tørrstoff-fordøyelighet i nylonposer plassert i vomma.Poron pötsin natrium- ja kaliumkonsentraation kokeellisesta mu-uttamisesta ja tämän mahdollisesta vaikutuksesta sulavuuteen.Abstract in Finnish / Yhteenveto: Poron potsin natrium- ja kaliumkonsentraatioita muutettiin antamalla 4 M KC1 tai 4 M NaCl suo-raan potsiin. Syljen ja potsin Na ja K -konsentraatioiden vålillå todettiin positiivinen korrelaatio. Alentunut Na -konsentraatio potsisså nåyttåå våhentåvån kuiva-aineen sulavuutta potsiin sijoitetuissa nailonpusseissa.