Features of portal hypertension are associated with major adverse events in Fontan patients: The VAST study

BACKGROUND: Chronic congestive hepatopathy is known to cause hepatic fibrosis and portal hypertension in patients post-Fontan operation for single ventricle palliation. The clinical significance of these findings is not clear. We hypothesized that features of portal hypertension would be significantly related to major adverse events. METHODS: A retrospective review of 73 adult and pediatric post-Fontan patients referred for a liver evaluation from 2001-2011 was performed. The relationship between features of portal hypertension (VAST score ≥2, 1 point each for Varices, Ascites, Splenomegaly or Thrombocytopenia) and a major adverse event (death, need for transplant, or hepatocellular carcinoma) was examined using logistic regression. RESULTS: 73 post-Fontan patients (30% female, 73% Caucasian, 66% systemic left ventricle (SLV), mean age 24 ±11 years, mean interval from Fontan 17 ±6 years) were included in analysis. Features of portal hypertension (VAST score ≥2) were present in 26 (36%), and there were 19 major adverse events: death (n=12), transplant (n=6), HCC (n=1). A significant relationship was found between VAST score ≥2 and major adverse events (OR=9.8, 95% CI [2.9-32.7]). After adjusting for time since Fontan, SLV, age, hemoglobin and type of failure, VAST score ≥2 remained significant (OR=9.1, 95% CI [1.4-57.6]). CONCLUSION: Fontan patients with features of portal hypertension have a 9-fold increased risk for a major adverse event. Therapies targeted to manage clinical manifestations of portal hypertension, and early referral to heart transplant may help delay major adverse events. Future prospective studies are needed to confirm these findings

Memorials to the victims of Nazism: the impact on tourists in Berlin

This qualitative study explores tourist responses to memorials to the victims of Nazism in Berlin and the impact they have on the tourist experience. The findings are located in the field of study known as dark tourism, of which visiting memorials is a part. The analysis shows that tourists increased their knowledge of the crimes committed by the Nazis, thus fulfilling the educational function of memorials. Tourists were also overwhelmed by their experience; they attested to feelings of sadness, shock, anger, despair and incomprehension. These feelings made it hard for them to resume the role of tourist after their exposure to a memorial. There was acknowledgement of the extent of commemoration practised in Germany

Adorno on Hope

I argue that Theodor W. Adorno’s philosophy articulates a radical conception of hope. According to Lear, radical hope is ‘directed toward a future goodness that transcends the current ability to understand what it is’ (2006:103). Given Adorno’s claim that the current world is radically evil, and that we cannot know or even imagine what the good is, it is plausible that his conception of hope must be radical in this sense. I develop this argument through an analysis of (i) Adorno’s engagement with Kant’s conception of hope, (ii) Adorno’s references to hope, and (iii) his critical diagnosis of a metaphysical need for hope. Having demonstrated that Adorno must reject both ordinary and Kantian hope, I examine why Adorno thinks that we still may have reasons for hope. I also show that Adorno’s conception of hope differs from Lear’s in one important respect

Seroepidemiology of coxsackievirus A6, coxsackievirus A16, and Enterovirus 71 infections among children and adolescents in Singapore, 2008-2010

10.1371/journal.pone.0127999PLoS ONE105e012799

Optical imaging in vivo with a focus on paediatric disease: technical progress, current preclinical and clinical applications and future perspectives

To obtain information on the occurrence and location of molecular events as well as to track target-specific probes such as antibodies or peptides, drugs or even cells non-invasively over time, optical imaging (OI) technologies are increasingly applied. Although OI strongly contributes to the advances made in preclinical research, it is so far, with the exception of optical coherence tomography (OCT), only very sparingly applied in clinical settings. Nevertheless, as OI technologies evolve and improve continuously and represent relatively inexpensive and harmful methods, their implementation as clinical tools for the assessment of children disease is increasing. This review focuses on the current preclinical and clinical applications as well as on the future potential of OI in the clinical routine. Herein, we summarize the development of different fluorescence and bioluminescence imaging techniques for microscopic and macroscopic visualization of microstructures and biological processes. In addition, we discuss advantages and limitations of optical probes with distinct mechanisms of target-detection as well as of different bioluminescent reporter systems. Particular attention has been given to the use of near-infrared (NIR) fluorescent probes enabling observation of molecular events in deeper tissue