Fungal host specificity is not a bottleneck for the germination of Pyroleae species (Ericaceae) in a Bavarian forest.

Plants that produce dust seeds can recruit fungi to meet their earliest requirements for carbon and other nutrients. This germination strategy, termed initial mycoheterotrophy, has been well investigated among the orchid family, but there are numerous other plant lineages that have independently evolved mycoheterotrophic germination strategies. One of these lineages is the tribe Pyroleae (Ericaceae). While the fungi associated with mature plants in Pyroleae have been fairly well documented, their mycobionts at the germination and seedling stages are largely unknown. Here, we use an in situ seed baiting experiment along with molecular fingerprinting techniques and phylogenetic tests to identify the fungi associated with seedlings of two Pyroleae species, Pyrola chlorantha and Orthilia secunda. Our results indicate that similar to adult plants, Pyroleae seedlings can associate with a suite of ectomycorrhizal fungi. Some seedlings harboured single mycobionts, while others may have been inhabited by multiple fungi. The dominant seedling mycobiont of both Pyroleae species was a fungus of unknown trophic status in the order Sebacinales. This taxon was also the only one shared among seedlings of both investigated Pyroleae species. We discuss these results juxtaposed to orchids and one additional Pyrola species in the context of ontogenetic shifts in fungal host specificity for mycoheterotrophic nutrition

Medicinal cannabis for children with cancer: The MINI trial

IntroductionThe prescribing of medicinal cannabis is becoming more frequent, yet there remains little evidence for the efficacy and safety of these products in patients with advanced cancer, especially the paediatric population.MethodsThe primary aim of this prospective, multicentre, randomised, blinded, two-arm parallel trial, is to establish the tolerable and potentially effective dose of two medicinal cannabis oil investigational products (Little Green Pharma, Australia), for children and young people with advanced cancer. The secondary outcomes are the symptom control of each individual symptom per investigational product, and each child’s total symptom control per investigational product. Participants aged 6 months to 21 years will be randomised to receive a CBD:THC equivalent product (10 mg:10 mg), or a CBD dominant product (100 mg CBD:1 mg THC). Following a 2-week Baseline Phase, participants will slowly titrate the investigational product up over a 2-week period (Titration Phase). The maximum dose achieved during the 2-week Titration Phase will be continued for 4 weeks (Maintenance Phase). Participants will be assessed weekly for symptom control and adverse events.ResultsAs this is an ongoing clinical trial, we will present the study protocol and study progress to date.ConclusionsThis research may benefit children and young people in future as information collected will help us to better understand how medicinal cannabis works, which can help inform prescribing practice

Management of people with a Fontan circulation: a Cardiac Society of Australia and New Zealand position statement

The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival. Keypoints: • Lifelong quality medical care with access to multidisciplinary services, is of prime importance. Care includes regular tests for surveillance of health status. • Transition from paediatric to adult care is an active process that should commence during early adolescence and continue until successful engagement with adult congenital cardiology care. • Children and adults with a Fontan circulation often have reduced peak exercise capacity (on average, 60–65% of predicted values). Increasingly, evidence suggests exercise training may improve exercise capacity and cardiovascular function. • People with a Fontan circulation have higher rates of anxiety and behavioural disorders, and there needs to be a low threshold for the provision of mental health care. • Pregnancy has increased maternal and fetal risks, and pre-conception multidisciplinary assessment and counselling is essential. • Atrial arrhythmias are common, often late after Fontan surgical repair and due to intra-atrial re-entry or “flutter” mediated by atrial stretch and scarring. Some anti-arrhythmic agents, most classically the type IC drugs, may allow haemodynamically unstable, life-threatening 1:1 AV conduction. • Anticoagulation with warfarin is routine care in patients with atrial arrhythmias. • In patients with recurrent atrial arrhythmias, catheter ablation or surgical conversion may be considered. • The Fontan circulation is an ideal substrate for thrombus formation and may result in intracardiac or intravascular thrombosis, ischaemic stroke, or other embolic phenomena. Antiplatelet and anticoagulant agents are commonly prescribed for thromboprophylaxis in patients with a Fontan circulation. Evidence suggests that treatment with one of these agents is advantageous, but there is no consensus on which is optimal. Despite treatment, symptomatic thromboembolic events are associated with significant mortality. • Heart failure is the leading cause of morbidity and mortality. Diuretics provide symptomatic relief, however standard heart failure medical therapy is not of proven benefit. • Though not well understood, there is increasing concern regarding progressive liver disease with a long-term risk of hepatocellular carcinoma. • Despite early higher mortality post heart transplant, these individuals have better long-term survival outcomes compared with many other heart transplant recipients

Effects of warming therapy on pressure ulcers - a randomized trial

Postoperative pressure ulcers are a common and expensive problem. Intraoperative hypothermia also is a common problem and may have a connection with impaired tissue viability. Researchers in this study hypothesized that intraoperative control of hypothermia may reduce the incidence of postoperative pressure ulcers. A randomized clinical trial (n = 338) was used to test the effects of using forced air warming therapy versus standard care. Results indicated an absolute risk reduction in pressure ulcers of 4.8% (ie, 10.4% to 5.6%) with a relative risk reduction of 46% in patients who received warming therapy. Although not reaching statistical significance, the clinical significance of almost halving the pressure ulcer rate is important. A correlation between body temperature and postoperative pressure ulcers was established