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Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure used in the treatment of a range of biliary and pancreatic disorders. Despite advances in technique and equipment, ERCP complications continue to occur and can be significant. ERCP is tradi-tionally performed with patients in prone position (PP) to improve visu-alization and to optimize position of the ampulla of Vater, which is thought to reduce cannulation time and the need for a pre-cut sphincterotomy, provide better anatomical differentiation of biliary and pancreatic ductal systems, and minimize the need for patient reposi-tioning. However, the PP potentially increases the risk of anesthetic com-plications due to poor airway access for anesthetists. An alternative position is the left lateral decubitus (LL) position, which is the most common position for endoscopic procedures. There are currently no data comparing LL with PP during ERCP and the subsequent success and complication rates. Method(s): We conducted a prospective randomized trial on all adult patients with native papillae undergoing ERCP at a single health service between March 2017 and May 2018. All patients over 18 years of age requiring an ERCP were considered for analysis and randomized in a 1:1 ratio via a sealed envelope. Exclusion criteria were patients unable to provide informed consent; critically unwell patients; those with a previous sphincterotomy; and those with physical limitations preventing adequate positioning. All patients received anesthetist-controlled intravenous sedation. All endoscopists were experienced and competent in performing ERCP in both positions. The primary endpoint was time to cannulation. Secondary endpoints included pancreatitis rates, periopera-tive cardiorespiratory anesthetic complications, and other procedural complications. Result(s): A total of 189 patients with native papillae were considered for the study; of these, 38 patients met exclusion criteria, so 151 patients were rand

The aim of this paper was to investigate the association of three well-recognised dietary patterns with cognitive change over a 3-year period. Five hundred and twenty-seven healthy participants from the Australian Imaging, Biomarkers and Lifestyle study of ageing completed the Cancer Council of Victoria food frequency questionnaire at baseline and underwent a comprehensive neuropsychological assessment at baseline, 18 and 36 months follow-up. Individual neuropsychological test scores were used to construct composite scores for six cognitive domains and a global cognitive score. Based on self-reported consumption, scores for three dietary patterns, (1) Australian-style Mediterranean diet (AusMeDi), (2) western diet and (3) prudent diet were generated for each individual. Linear mixed model analyses were conducted to examine the relationship between diet scores and cognitive change in each cognitive domain and for the global score. Higher baseline adherence to the AusMeDi was associated with better performance in the executive function cognitive domain after 36 months in apolipoprotein E (APOE) ɛ4 allele carriers (P<0.01). Higher baseline western diet adherence was associated with greater cognitive decline after 36 months in the visuospatial cognitive domain in APOE ɛ4 allele non-carriers (P<0.01). All other results were not significant. Our findings in this well-characterised Australian cohort indicate that adherence to a healthy diet is important to reduce risk for cognitive decline, with the converse being true for the western diet. Executive function and visuospatial functioning appear to be particularly susceptible to the influence of diet.

Introduction: Self expanding metal stents (SEMS) are widely used to alleviate patient suffering from malignant gastrointestinal obstructions. We report a large, multicentre experience with endoscopic SEMS placement for malignant gastroduodenal outlet obstruction. Method(s): An 8 year multicentre clinical audit of all patients undergoing endoscopic stent placement for palliation of gastric outlet or duodenal obstruction was conducted. SEMS placement was performed using endoscopic and fluoroscopic guidance. Main outcome measures were technical success (defined as adequate endoscopic and fluoroscopic position of the stent), time to resumption of oral intake, and patient survival. Result(s): From 2001 to 2009, we treated 65 patients with malignant gastric outlet obstruction. The primary site of malignancy was pancreatic (30), gastric (22), breast (3), duodenum (4), gall bladder (2) and other (4; colon, cervix, melanoma, sarcoma). The most proximal site of obstruction was pylorus and gastric antrum (28), duodenum (33), and jejunum (4). A total of 71 SEMS were deployed (36 Wallstent, 33 Wallflex, 2 other). Technical success rate was 97%. 5 patients underwent subsequent therapy (4 stent blockage secondary to tumour ingrowth, 1 tumour related bleeding). Perforation rate after SEMS was 3%. 95% of patients were able to resume oral intake within 24 hours. Average patient survival after SEMS placement was 4.5 months (0.03-48 months). Conclusion(s): Endoscopic SEMS is an effective method to palliate gastroduodenal outlet obstruction. Our results highlight a favourable technical success rate and excellent palliation of symptoms of outlet obstruction with minimal adverse outcomes.

The size of the soil microbial biomass carbon (SMBC) has been proposed as a sensitive indicator for measuring the adverse effects of contaminants on the soil microbial community. In this study of Australian agricultural systems, we demonstrated that field variability of SMBC measured using the fumigation-extraction procedure limited its use as a robust ecotoxicological endpoint. The SMBC varied up to 4-fold across control samples collected from a single field site, due to small-scale spatial heterogeneity in the soil physicochemical environment. Power analysis revealed that large numbers of replicates (3-93) were required to identify 20% or 50% decreases in the size of the SMBC of contaminated soil samples relative to their uncontaminated control samples at the 0.05% level of statistical significance. We question the value of the routine measurement of SMBC as an ecotoxicological endpoint at the field scale, and suggest more robust and predictive microbiological indicators.