Cognitive impairment in older patients undergoing colorectal surgery

Background: With increasing numbers of older people being referred for elective colorectal surgery, cognitive impairment is likely to be present and affect many aspects of the surgical pathway. This study is aimed to determine the prevalence of cognitive impairment and assess it against surgical outcomes. Methods: The Montreal Cognitive Assessment (MoCA) was carried out in patients aged more than 65 years. We recorded demographic information. Data were collected on length of hospital stay, complications and 30-day mortality. Results: There were 101 patients assessed, median age was 74 years (interquartile range = 68–80), 54 (53.5%) were women. In total, 58 people (57.4%) ‘failed’ the Montreal Cognitive Assessment test (score ≤ 25). There were two deaths (3.4%) within 30 days of surgery in the abnormal Montreal Cognitive Assessment group and none in the normal group. Twenty-nine (28.7%) people experienced a complication. The percentage of patients with complications was higher in the group with normal Montreal Cognitive Assessment (41.9%) than abnormal Montreal Cognitive Assessment (19.9%) (p = 0.01) and the severity of those complications were greater (chi-squared for trend p = 0.01). The length of stay was longer in people with an abnormal Montreal Cognitive Assessment (mean 8.1 days vs. 5.8 days, p = 0.03). Conclusion: Cognitive impairment was common, which has implications for informed consent. Cognitive impairment was associated with less postoperative complications but a longer length of hospital stay

Capitalism in Australia: New histories for a reimagined future

The Author(s) 2020. Capitalism is back. Three decades ago, when all alternatives to liberal democracy and free markets appeared discredited, talk of capitalism seemed passé. Now, after a decade of political and economic turmoil, capitalism and its temporal critique of progress and decline again seems an indispensable category to understanding a world in flux. Among the social sciences, historians have led both the embrace and critique of this \u27re-emergent\u27 concept. This roundtable discussion between leading and emerging Australian scholars working across histories of economy, work, policy, geography and political economy, extends this agenda. Representing the outcome of a workshop convened at La Trobe University in November 2018 and responding to questions posed by conveners Huf and Rees, five participants debate the nature, utility and future of the new constellation of \u27economic\u27 historical scholarship. While conducted well before the outbreak of COVID-19, the ensuring discussion nevertheless speaks saliently to the crises of our times

Regulation of CD38 in proliferating chronic lymphocytic leukaemia cells stimulated with CD154 and IL-4

Background and Objectives Chronic lymphocytic leukemia (CLL) cells, like normal B-cells, exist in two populations in vivo : quiescent cells in the peripheral circulation and proliferating cells in lymph nodes. The surface marker CD38 has roles in cell adhesion and signaling. Its expres- sion correlates with poor clinical outcome and is associated with expression of the signaling intermediate ZAP-70, which is also a marker of poor prognosis. We investi- gated the regulation of CD38 and ZAP-70 in proliferating CLL cells. Design and Methods W e cultured CLL cells on a stromal cell la yer that maintains viability and also with some stromal cells expressing CD40 ligand (CD154) in order to measure changes in expression of CD38 and ZAP-70. Results W e demonstrated up-regulation of CD38 expression b y CD154. The degree of up-reg - ulation did not cor relate with clinical stage or mutational status. In addition in the majority of cases tested ZAP-70 expression increased in parallel with up-regulation of CD38 although discordant cases were also observed. Interpretation and Conclusions Overall w e demonstrated that regulation of CD38 in CLL is dynamic and dependent on signals from CD154 and a stromal cell la yer . W e speculate that CD38 and ZAP-70 are expressed in lymph node leukemic cells in both good and poor prognosis patients, but, in cases with good clinical outcome, these molecules are down-regulat- ed in the peripheral blood whereas in cases with poor prognosis their expression is maintaine