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Summary Background/objective Gastric outlet obstruction can have a large impact on quality of life for patients with upper gastrointestinal cancer or benign obstruction. Partial stomach-partitioning gastrojejunostomy has previously shown promising outcomes compared to conventional gastrojejunostomy in terms of reduced delayed gastric emptying. The objective of the current study was to present outcomes of partial stomach-partitioning gastrojejunostomy in a single high-volume center for upper gastrointestinal cancer. Methods A retrospective cohort study including all consecutive patients who underwent partial stomach-partitioning gastrojejunostomy from 2013 to 2020. The primary outcome was oral intake tolerance. A subgroup analysis was performed in all patients with manifest gastric outlet obstruction comparing partial stomach-partitioning gastrojejunostomy to conventional gastrojejunostomy. Results Partial stomach-partitioning gastrojejunostomy was performed in 32 patients and laparoscopic technique was used in 19 patients (59%). The procedure improved oral intake tolerance defined by gastric outlet obstruction scoring system by 0.63 points on average (P = 0.041). No postoperative complications related to the procedure were observed. Recurrence of gastric outlet obstruction developed in six patients (19%), four patients (13%) required endoscopic reintervention but no patient required surgical reintervention. A comparison between partial stomach-partitioning gastrojejunostomy and conventional gastrojejunostomy showed no statistically significant differences regarding postoperative nutritional status, length of hospital stay, recurrence or reintervention. Conclusion The results of the study show that partial stomach-partitioning gastrojejunostomy can be an effective surgical treatment for patients suffering from gastric outlet obstruction and that the procedure can be safely performed with laparoscopic technique.

Background Laparoscopic gastrectomy (LG) for cancer has been introduced in institutions worldwide in an effort to minimize surgical trauma, while aiming to provide comparable oncological outcomes to conventional open gastrectomy (OG). The aim of this study was to present our results during the period of implementation of the laparoscopic technique. Materials and methods In 2012, LG for the treatment of gastric cancer was introduced at our institution. The results presented are based on a retrospective analysis of data from a cohort of all patients treated with curative intent over the period 2010-2018. Results During the study period, 206 patients underwent surgery for gastric cancer: 129 patients (62.6%) had an OG and 77 patients (37.4%) an LG. The conversion rate due to technical reasons was 2.6%. LG was associated with significantly less intraoperative blood loss [mean (mL), OG 544 versus LG 176] and shorter hospital stay than OG [mean (d), OG 12 versus LG 8], fewer severe complications (Clavien-Dindo grade ≥ IIIb) [OG 29 (22.5%) versus LG 9 (11.7%), P = 0.081], significantly lower anastomotic leak rate [OG 18 (14.0%) versus LG 1 (1.3%)] and no 90-day mortality. The percentage of R0 resections was similar between the two groups (OG 82.2% versus LG 85.7%, P = 0.507), while the mean number of resected lymph nodes was significantly higher in the laparoscopic group [OG 34 versus LG 39, P = 0.030]. Conclusions Our data suggest that similar and, in some aspects, better short-term outcomes can be achieved with LG with maintained oncological quality.

Low socioeconomic status and poor education elevate the risk of developing esophageal- and junctional cancer. High education level also increases survival after curative surgery. The present study aimed to investigate associations, if any, between patient education-level and treatment allocation after diagnosis of esophageal- and junctional cancer and its subsequent impact on survival.A nation-wide cohort study was undertaken. Data from a Swedish national quality register for esophageal cancer (NREV) was linked to the National Cancer Register, National Patient Register, Prescribed Drug Register, Cause of Death Register and educational data from Statistics Sweden. The effect of education level (low; ≤9 years, intermediate; 10-12 years and high12 years) on the probability of allocation to curative treatment was analyzed with logistic regression. The Kaplan-Meier-method and Cox proportional hazard models were used to assess the effect of education on survival.A total of 4112 patients were included. In a multivariate logistic regression model, high education level was associated with greater probability of allocation to curative treatment (adjusted OR: 1.48, 95% CI: 1.08-2.03, p = 0,014) as was adherence to a multidisciplinary treatment-conference (adjusted OR: 3.13, 95% CI: 2.40-4.08, p 0,001). High education level was associated with improved survival in the patients allocated to curative treatment (HR: 0.82, 95% CI: 0.69-0.99, p = 0,036).In this nation-wide cohort of esophageal- and junctional cancer patients, including data regarding many confounders, high education level was associated with greater probability of being offered curative treatment and improved survival.

The presence of Enterobacteriaceae producing extended spectrum beta-lactamases (ESBL) or transferable AmpC beta-lactamases (pAmpC) is increasingly being reported in humans, food-producing animals and food world-wide. However, the occurrence and impact of these so-called extended spectrum cephalosporinase (ESC)-producing Enterobacteriaceae in aquatic environments are poorly documented. This study investigated the occurrence, concentrations and characteristics of ESC-producing E. coli (ESC-Ec) in samples of surface water collected at five Swedish water treatment plants that normally have relatively high prevalence and concentration of E. coli in surface water. ESC-Ec was found in 27 of 98 surface water samples analysed. All but two positive samples were collected at two of the water treatment plants studied. The ESC-Ec concentration, 1-3cfu/100mL, represented approximately 4% of the total amount of E. coli in the respective surface water sample. In total, 74% of the isolates were multi-resistant, but no isolate was resistant to carbapenems. Six types of ESBL/pAmpC genes were found in the 27 E. coli isolates obtained from the positive samples, of which four (blaCTX-M-15, blaCMY-2, blaCTX-M-1 and blaCTX-M-14) were found during the whole sampling period, in samples taken at more than one water treatment plant. In addition, the genes were situated on various types of plasmids and most E. coli isolates were not closely related with regard to MLST types. The combinations of ESBL/pAmpC genes, plasmids and E. coli isolates were generally similar to those found previously in healthy and sick individuals in Sweden. In conclusion, the occurrence of ESC-Ec in Swedish surface water shows that resistant bacteria of clinical concern are present in aquatic environments even in a low-prevalence country such as Sweden.

Objective To compare the incidence and severity of postoperative complications after oesophagectomy for carcinoma of the oesophagus and gastro-oesophageal junction (GOJ) after randomized accrual to neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT). Background Neoadjuvant therapy improves long-term survival after oesophagectomy. To date, evidence is insufficient to determine whether combined nCT, or nCRT alone, is the most beneficial. Methods Patients with carcinoma of the oesophagus or GOJ, resectable with a curative intention, were enrolled in this multicenter trial conducted at seven centres in Sweden and Norway. Study participants were randomized to nCT or nCRT followed by surgery with two-field lymphadenectomy. Three cycles of cisplatin/5-fluorouracil was administered in all patients, while 40 Gy of concomitant radiotherapy was administered in the nCRT group. Results Of the randomized 181 patients, 91 were assigned to nCT and 90 to nCRT. One-hundred-and-fifty-five patients, 78 nCT and 77 nCRT, underwent resection. There was no statistically significant difference between the groups in the incidence of surgical or nonsurgical complications (P-value = 0.69 and 0.13, respectively). There was no 30-day mortality, while the 90-day mortality was 3% (2/78) in the nCT group and 6% (5/77) in the nCRT group (P = 0.24). The median Clavien-Dindo complication severity grade was significantly higher in the nCRT group (P = 0.001). Conclusion There was no significant difference in the incidence of complications between patients randomized to nCT and nCRT. However, complications were significantly more severe after nCRT. Registration trial database The trial was registered in the Clinical Trials Database (registration number NCT01362127 ).

Several phase I/II studies of chemoradiotherapy for gastric cancer have reported promising results, but the significance of preoperative radiotherapy in addition to chemotherapy has not been proven. In this study, a systematic literature search was performed to capture survival and postoperative morbidity and mortality data in randomised clinical studies comparing preoperative (chemo)radiotherapy or chemotherapy versus surgery alone, or preoperative chemoradiotherapy versus chemotherapy for gastric and/or gastro-oesophageal junction (GOJ) cancer. Hazard ratios (HRs) for overall mortality were extracted from the original studies, individual patient data provided from the principal investigators of eligible studies or the earlier published meta-analysis. The incidences of postoperative morbidities and mortalities were also analysed. In total 18 studies were eligible and data were available from 14 of these. The meta-analysis on overall survival yielded HRs of 0.75 (95% CI 0.65–0.86, P < 0.001) for preoperative (chemo)radiotherapy and 0.83 (95% CI 0.67–1.01, P = 0.065) for preoperative chemotherapy when compared to surgery alone. Direct comparison between preoperative chemoradiotherapy and chemotherapy resulted in an HR of 0.71 (95% CI 0.45–1.12, P = 0.146). Combination of direct and adjusted indirect comparisons yielded an HR of 0.86 (95% CI 0.69–1.07, P = 0.171). No statistically significant differences were seen in the risk for postoperative morbidity or mortality between preoperative treatments and surgery alone, or preoperative (chemo)radiotherapy and chemotherapy. Preoperative (chemo)radiotherapy for gastric and GOJ cancer showed significant survival benefit over surgery alone. In comparisons between preoperative chemotherapy and (chemo)radiotherapy, there is a trend towards improved survival when adding radiotherapy, without increased postoperative morbidity or mortality.

The presence of Enterobacteriaceae producing extended spectrum beta-lactamases (ESBL) or transferable AmpC beta-lactamases (pAmpC) is increasingly being reported in humans and animals world-wide. Their occurrence in food-producing animals suggests that meat is a possible link between the two populations. This study investigated the occurrence and characteristics of Salmonella and ESBL- or pAmpC-producing E. coli in 430 samples of beef, pork and broiler meat imported into Sweden, in order to provide data required for assessing the potential public health risk of these bacteria in food. Depending on region of origin, ESBL/pAmpC-producing E. coli were found in 0-8% of beef samples, 2-13% of pork samples and 15-95% of broiler meat samples. The highest prevalence was in South American broiler meat (95%), followed by broiler meat from Europe (excluding Denmark) (61%) and from Denmark (15%). Isolates from meat outside Scandinavia were generally defined as multiresistant. A majority of the ESBL/pAmpC genes were transferable by conjugation. Bla(CTX-M-2) and bla(CTX-M-8) were the dominant genes in E. coli from South American broiler meat, whereas bla(CMY-2) and bla(CTX-M-1) dominated in European meat. The majority of bla(CMY-2) and bla(CTX-M-1) were situated on plasmids of replicon type incK and incI1, respectively. The same combinations of ESBL/pAmpC genes and plasmids have been described previously in clinical human isolates. Salmonella was found in five samples tested, from European pork and broiler meat. No Salmonella isolate was resistant to third-generation cephalosporins. In conclusion, meat imported into Sweden, broiler meat in particular, is a potential source of human exposure to ESBL- and pAmpC-producing E. coli.

Published models predicting growth and survival capabilities of shiga-toxin-producing Escherichia coli (STEC) under aw and lactic acid stress were validated by performing experiments with fermented sausage associated outbreak strains. Strain variation in inactivation and time to growth (TTG) were investigated for strains representing three serotypes (O103, O111, and O157). The TTG and growth boundaries of each strain were compared with predictions of a model for generic acid adapted E. coli and survival with predictions of two inactivation models. In addition, the influence of strain variation on the performance of the inactivation models, in terms of bias and accuracy factors, was illustrated. Strains with induced acid tolerance were used in broths containing 50 or 110 mM total lactic acid. The concentration of undissociated lactic acid (HLac) was adjusted by setting the pH-value, and water activity (0.900 to 0.995 depending on experiment) was adjusted by adding NaCl. The survival capabilities of the outbreak strains were good compared to the model predictions. The average bias factors of inactivation model predictions were within a factor of 2.2 depending on the strain used to validate the model indicating that inactivation rates of outbreak strains were slower than predicted. However, the observed rates were similar to the rates of a previously studied acid tolerant generic E. coli strain. Similarly, the time to growth of two of the strains (O103 and O157) was comparable with model predictions, whereas the growth capability of the third strain (O111) was lower than predicted. These results suggest that the properties of the most tolerant sausage outbreak strains are comparable to tolerant generic E. coli strains, which imply that suitable non-pathogenic E. coli strains are valid surrogates for fermented sausage outbreak strains. The relative sensitivity of strains depended on the environmental parameters and the response evaluated. The strain with the smallest log reduction at 20 °C was O157, whereas it was strain O103 at 8 °C. Under conditions unfavorable for growth, the time to growth was much shorter for strains O103 and O157 than for strain O111, whereas differences between strains were negligible under conditions favorable for growth. Depending on the response variable and the specific application the limitation of not addressing strain variation may lead to biased, fail-dangerous, predictions. Thus, solutions on how to best address strain variation in the development and validation of predictive models are needed.

There is no specific treatment against acute pancreatitis (AP). A protective effect by angiotensin II receptor blockers (ARB) on AP has been suggested experimentally, but clinical evidence is scarce.We conducted a population-based case-control study using The Health Improvement Network in the United Kingdom, comprising about 167,000 hypertensive patients in the study period 1996-2005. In multivariate logistic regression analysis, odds ratios were calculated with 95% confidence intervals (CI). Adjustments included sex, age, calendar year, body mass index, tobacco smoking, alcohol, general practitioner visits per year, and various antihypertensive medications with regard to exposure to ARB, and risk of AP.Among 633,281 person-years at risk, 265 new cases of AP were identified. Current users of ARB had a 37% statistically non-significant reduced risk of developing AP as compared to non-users (OR 0.63, 95% CI 0.38-1.02). No clear association was found between use of other antihypertensive drugs and risk of AP.Our study adds some support to previous experimental findings. Use of ARB might be associated with a reduced risk of AP. More research is needed to elucidate the potential role of ARB in the development of AP in the clinical setting.

Epidemiological research has indicated that the anti-oestrogen tamoxifen, used in breast cancer therapy, may increase the risk of gastric adenocarcinoma of the intestinal but not of the diffuse type. To test this hypothesis, and evaluate possible involvement of oestrogen receptors (ERs), we conducted a study amongst tamoxifen users and non-users. The study participants comprised women in the county of Stockholm who in the Swedish Cancer Register were first recorded with breast cancer and subsequently gastric cancer during the period January 1958-August 2005. Medical records were scrutinised to verify the diagnoses and classify into use or non-use of tamoxifen. Tumour material was reviewed histologically to verify gastric adenocarcinoma diagnosis and classify these cancers into intestinal or diffuse type. Intestinal adenocarcinomas were analysed immunohistochemically for the presence of ER alpha, beta and beta cx. Amongst 68 women with verified gastric adenocarcinoma, 30 had been treated with tamoxifen and 38 not. The intestinal type of gastric adenocarcinoma was not more frequent amongst tamoxifen users (27%) than amongst non-users (34%) (p=0.601). There were no material differences between the tamoxifen groups regarding distribution of any of the three ERs of the intestinal adenocarcinoma specimens. Tamoxifen users had a shorter latency between breast cancer and gastric adenocarcinoma (4 versus 13 years) which was similar in the intestinal and diffuse types. This study does not support the hypothesis that tamoxifen increases the isolated risk of the intestinal type, but it indicates that tamoxifen use might accelerate the tumour progression or increase the overall risk of gastric adenocarcinoma.

Swab sample data from a 13-month microbiological baseline study of swine carcasses at Swedish abattoirs were combined with excision sample data collected routinely at five abattoirs. The aim was to compare the numbers of total aerobic counts, Enterobacteriaceae, and Escherichia coli, recovered by swabbing four carcass sites with gauze (total area 400 cm2) with those obtained by excision at equivalent sites (total area 20 cm2). The results are considered in relation to the process hygiene criteria that are stated in Commission Regulation (EC) No 2073/2005. These criteria apply only to destructive sampling of total aerobic counts and Enterobacteriaceae, but alternative sampling schemes, as well as alternative indicator organisms such as E. coli, are allowed if equivalent guarantees of food safety can be provided. Swab sampling resulted in higher mean log numbers of total aerobic counts at four of the five abattoirs, compared with excision, and lower or equal standard deviations at all abattoirs. The percentage of swab and excision samples positive for Enterobacteriaceae at the different abattoirs ranged from 68 to 100% and 15 to 24%, respectively. Similarly, the percentages of swab samples that were positive for E. coli were higher than the percentages of positive excision samples (range 52 to 84% and 3 to 14%, respectively). Due to the low percentage of positive excision results, the mean log numbers of Enterobacteriaceae and E. coli were only compared at two and one abattoirs, respectively, using log probability regression to substitute censored observations. Higher mean log numbers of Enterobacteriaceae were recovered by swabbing compared with excision at one abattoir, whereas the numbers of Enterobacteriaceae and E. coli did not differ significantly between sampling methods at one abattoir. This study suggests that the same process hygiene criteria as those stipulated for excision can be used for swabbing with gauze without compromising food safety. For monitoring of low numbers of Enterobacteriaceae and E. coli, like those found on swine carcasses at Swedish abattoirs, the results also show that swabbing of a relatively large area is superior to excision of a smaller area.

Aims We aimed to assess whether needle catheter jejunostomy (NCJ) influences the weight development or discharge from hospital after oesophageal cancer surgery in an unselected and prospectively collected series of patients. Methods Data regarding patients who underwent oesophageal cancer surgery between April 2001 and October 2004 and were followed up until April 2005 were collected from the Swedish Esophageal and Cardia Cancer Register. Details of patient characteristics, including preoperative body weight and length, tumour characteristics, surgical procedures, including NCJ insertion, complications and ward time were obtained. Six months postoperatively the patients responded to a questionnaire that gave information about postoperative weight development. Relative risks were estimated as odds ratios (ORs) calculated with 95% confidence intervals (CIs) using multinomial logistic regression, adjusted for patient and tumour characteristics, type of treatment, type of hospital and occurrence of complications. Results A total of 233 patients participated, among whom 48% received NCJ. Patients with NCJ had a 42% statistically non-significantly decreased risk of weight loss compared to those without NCJ after adjustment for covariates (OR 0.58; 95% CI 0.25–1.39). Patients with NCJ had a non-statistically significantly longer hospital stay than patients without NCJ, but were seemingly less often discharged to other care homes than their own home compare to the group without NCJ (OR 0.62; 95% CI 0.28–1.38). Conclusion Use of needle catheter jejunostomy might counteract weight loss and facilitate discharge to home after oesophageal cancer resection.

This 13-month survey was conducted to estimate the prevalence and counts of foodborne pathogenic bacteria and indicator bacteria on swine carcasses in Sweden. A total of 541 swine carcasses were sampled by swabbing prechill at the 10 largest slaughterhouses in Sweden. Pathogenic Yersinia enterocolitica was detected by PCR in 16% of the samples. The probability of finding Y. enterocolitica increased with increasing counts of Escherichia coli. No samples were positive for Salmonella. The prevalences of Campylobacter, Listeria monocytogenes, and verocytotoxin-producing E. coli were low (1, 2, and 1%, respectively). None of the verocytotoxin-positive enrichments, as determined by a reverse passive latex agglutination assay, tested positive for the virulence genes eaeA or hlyA by PCR. Coagulase-positive staphylococci, E. coli, and Enterobacteriaceae were recovered from 30, 57, and 87% of the samples, respectively, usually at low levels (95th percentiles, 0.79, 1.09, and 1.30 log CFU/cm2, respectively). The mean log level of Enterobacteriaceae was 0.35 log CFU/cm2 higher than that of E. coli on carcasses positive for both bacteria. The mean log level of aerobic microorganisms was 3.48 log CFU/cm2, and the 95th percentile was 4.51 log CFU/cm2. These data may be useful for risk assessment purposes and can serve as a basis for risk management actions, such as the use of E. coli as an alternative indicator organism for process hygiene control.

This 1-year study was conducted to estimate the prevalence and concentrations of pathogenic and indicator bacteria on Swedish broiler chickens. A total of 636 chilled carcasses were collected from 10 slaughterhouses and sent to the National Food Administration for analyses of carcass rinses. No carcasses were positive for Salmonella. Campylobacter, predominantly Campylobacter jejuni, were detected on 15% (by enrichment) or 14% (by direct plating) of the carcasses. With one exception, all samples from late December through April were Campylobacter negative. The 10th and 90th percentiles of Campylobacter numbers per carcasses were 3.0 and 5.0 log CFU, respectively, and the maximum was 7.1 log CFU. Coagulase-positive staphylococci were detected on 68% of the carcasses, with a maximum of 3.5 log CFU/cm 2 . The 10th and 90th percentiles were 3.4 and 4.4 log CFU/cm 2 for total aerobic microorganisms, 1.8 and 3.3 log CFU/cm 2 for Enterobacteriaceae, and 2.0 and 3.6 log CFU/cm2 for Escherichia coli. No correlation was found between numbers of any indicator bacteria and numbers of pathogenic bacteria. Subsets of the samples were analyzed for Listeria monocytogenes, Clostridium perfringens, pathogenic Yersinia enterocolitica, and Enterococcus, resulting in prevalence estimates of 29, 18, 9 (as determined by a PCR assay), and 97%, respectively. L. monocytogenes was most common at slaughterhouses with a low prevalence of coagulase-positive staphylococci, and vice versa. These results will improve the ability of researchers to assess the importance of chicken as a source of foodborne pathogens and can serve as a basis for risk management actions.

Summary Background Oesophageal resection alone remains the only potentially curative treatment for oesophageal cancer. However, few population-based studies of survival after surgery have been done. We aimed to assess whether survival after surgery for oesophageal cancer has improved since 1987. Methods We identified from the nationwide cancer register 764 patients in Sweden who had undergone resection alone for oesophageal cancer between Jan 1, 1987 and Dec 31, 2000, and followed up these individuals until Oct 18, 2004, through linkage to the nationwide registers of death, emigration, and total population. Tumour stage, location, and histology were recorded by review of histopathological reports. Hazard ratios, with 95% CI, for death adjusted for age; sex; comorbidity; and tumour stage, location, and histology were calculated by Cox proportional-hazards regression model. Findings Overall, the proportion of deaths up to 30 days after surgery decreased from 10·1% in 1987–91 to 4·9% in 1997–2000. Increased long-term survival was associated with low tumour stage. Survival was 46·5% 1 year after surgery, 24·1% 3 years after surgery, and 19·7% 5 years after surgery in 1987–91; 58·4%, 31·7%, and 24·9%, respectively, in 1992–96; and 61·7%, 39·9%, and 30·7%, respectively, in 1997–2000. The adjusted hazard ratio for death was 0·76 (95% CI 0·62–0·92) in 1992–96 and 0·57 (0·45–0·71) in 1997–2000. Interpretation Survival after surgery for oesophageal cancer has improved substantially since 1987. Because this improvement cannot be explained by a change in patient characteristics or tumour characteristics, it is probably a result of better surgery.

The lack of data on consumer refrigeration temperatures and storage times limits our ability to assess and manage risks associated with microbial hazards. This study addressed these limitations by collecting data on temperatures and storage handling practices of chilled foods. Consumers from 102 households in Uppsala, Sweden, were instructed to purchase seven food items (minced meat, fresh herring fillets, soft cheese, milk, sliced cooked ham, vacuum-packed smoked salmon, and ready-to-eat salad) and to store them using their normal practices. They were interviewed the next day, and food temperatures were measured. In general, there were no significant relations between temperature and characteristics of the respondents (e.g., sex, age, education, age of the refrigerator). Mean storage temperatures ranged from 6.2 degrees C for minced meat to 7.4 degrees C for ready-to-eat salad. Maximum temperatures ranged from 11.3 to 18.2 degrees C. Data were not significantly different from a normal distribution, except for ready-to-eat salad, although distributions other than the normal fitted data better in most cases. Five percent to 20% of the food items were stored at temperatures above 10 degrees C. Most respondents knew the recommended maximum temperature, but less than one fourth claimed to know the temperature in their own refrigerator. Practical considerations usually determined where food was stored. For products with a long shelf life, stated storage times were different for opened and unopened packages. The current situation might be improved if consumers could be persuaded to use a thermometer to keep track of refrigerator temperature.

Wheat dwarf is a potentially severe disease of winter wheat. The causal agent is wheat dwarf virus (WDV), a geminivirus transmitted by the leafhopper Psammotettix alienus . Field surveys of WDV incidence and vector occurrence were conducted for 4 years in winter wheat fields in central Sweden. The objective was to estimate the extent of primary spread of WDV in autumn, by adult leafhoppers migrating into the fields, and the secondary spread in the following early summer, by the progeny of the immigrants. We also related the rate of virus spread in early summer to the phenological development of the vector and the host plant. Furthermore, the development of mature plant resistance was assessed by inoculating winter wheat plants in various growth stages with infectious leafhoppers. Field survey data indicate that the rate of primary infections did not exceed 5%, and that infection rates increased to up to 50% during the summer. Infection rates ceased to increase as the crops reached the end of stem elongation, and virus transmission experiments showed that plants became resistant to infection at growth stage DC 31 (first node detectable).

Wheat dwarf is a relatively uncommon, but potentially serious, disease of winter wheat. It is caused by wheat dwarf virus (WDV), a leafhopper-transmitted geminivirus. In 1997, an epidemic occurred in Central Sweden for the first time in 50 years. Farmers were requested to estimate yield losses and provide field data from infested fields. By analysing questionnaire data and results from field trials, the influence of various agronomic factors on disease intensity was assessed. Mean yield losses due to wheat dwarf reached 35%, with loss estimates up to 90%. The results show that early sown fields suffered more from wheat dwarf than fields sown at the normal time. A few other agronomic factors were also related to higher yield loss, e.g. presence of crop residues at sowing and irregular seedling emergence. Field trial data indicated a higher occurrence of disease symptoms in thin stands compared to dense crop stand canopy with differences in disease severity among cultivars. The study demonstrated the value of combining data from surveys and field trials for disease management studies, especially in the case of disease epidemics occurring infrequently.

Aiming to improve forecasts of frit fly ( Oscinella frit ) damage, field experiments were conducted where infestation rates of oats were assessed in relation to plant growth stages and daily weather conditions. Oat seedlings were most susceptible to infestation during growth stages DC 11 and 12 (one and two leaves unfolded, respectively). Susceptibility decreased in DC 13, but significant damage could still arise at this stage if the infestation pressure was high. In later stages seedlings were almost completely resistant. Temperature affected daily infestation rates most, whereas sunshine and wind conditions were less important. No infestations occurred at daily maximum temperatures lower than 15°C, whereas high infestation rates occurred at maximum temperatures of 17°C and higher.

Background & Aims: There are contradictory results regarding the association between angiotensin-converting enzyme (ACE) inhibitors and cancer. We aimed to investigate whether ACE inhibitors protect against esophageal and gastric cancer. Methods: We conducted a population-based case-control study nested within the General Practitioners' Research Database in the United Kingdom. All individuals in the General Practitioners' Research Database aged 40–84 years between 1994 and 2001 were followed up until detection of an esophageal or gastric cancer (cases), other cancer, age of 85 years, death, or end of study period. Results: Among 4.34 million person-years, 909 cases of esophageal and 1023 cases of gastric cancer were identified, and 10,000 matched controls were selected at random. Adjustments included smoking, body mass index, concurrent medication, and gastrointestinal disorders. Current use of ACE inhibitors decreased the risk of esophageal adenocarcinoma by 29% (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.43–1.17), but not of squamous-cell carcinoma (OR, 1.27; 95% CI, 0.71–2.28) compared with nonusers. A high daily dose of ACE inhibitors decreased the risk of both adenocarcinoma and squamous-cell cancer of the esophagus and rendered a 45% decrease of total esophageal cancer (OR, 0.55; 95% CI, 0.33–0.93). Our data showed no clear association between the use of ACE inhibitors and risk of gastric cancer (OR, 1.07; 95% CI, 0.84–1.36). Conclusions: The use of ACE inhibitors may decrease the risk of developing esophageal cancer, particularly among users with a high daily dose. No association was found between gastric cancer and ACE inhibitors.