Bovine Aortic Arch with an Aberrant Left Vertebral Artery in a 3-Year-Old Boy with VACTERL Association: A Case Report.

BACKGROUND The VACTEREL association is an acronym that includes vertebral malformations (V), anal atresia (A), cardiac defects (C), tracheoesophageal fistula (TE), renal defects (R), and limb malformations (L). The aortic arch is the section between the ascending aorta and the descending aorta, where some variants have been described, such as the right aortic arch and bovine aortic arch, among others. A rare presentation in the Natsis classification is the "type X" where a bovine aortic arch and anomalous origin of the left vertebral artery are present. Several structural cardiac malformations have been described in the VACTEREL association. Still, there is no bovine arch or an anomalous left vertebral artery. CASE REPORT Our patient was a 3-year-old boy with a diagnosis of VACTEREL association (type III esophageal atresia, congenital hip dislocation, scoliosis, bilateral clubfoot, and grade IV biliary ureteral reflux). Echocardiographic findings showed changes in the aortic arch, and angiotomography and magnetic resonance angiography showed a bovine aortic arch and an anomalous left vertebral artery. At the time of diagnosis, there were no clinical manifestations or complications due to the anomalous origin of the left vertebral artery. CONCLUSIONS This is the first description of a bovine type X arch according to the Natsis classification in a VACTEREL association. In general, knowledge of the anatomical variants of the aortic arch and the origin and course of the vertebral arteries is of great clinical and interventional importance, mainly because of the risk of cerebral ischemia.

Supercritical CO2 extraction of naringenin from Mexican oregano (Lippia graveolens): its antioxidant capacity under simulated gastrointestinal digestion.

A supercritical CO2 method was optimized to recover naringenin-rich extract from Mexican oregano (Lippia graveolens), a flavanone with high antioxidant and anti-inflammatory activity. The effect of the extraction parameters like pressure, temperature, and co-solvent on naringenin concentration was evaluated. We used response surface methodology to optimize the naringenin extraction from oregano; the chemical composition by UPLC-MS of the optimized extract and the effect of simulated gastrointestinal digestion on its antioxidant capacity and total phenolic content were also evaluated. The optimum conditions were 58.4 °C and 12.46% co-solvent (ethanol), with a pressure of 166 bar, obtaining a naringenin content of 46.59 mg/g extract. Also, supercritical optimized extracts yielded high quantities of cirsimaritin, quercetin, phloridzin, apigenin, and luteolin. The results indicated that the naringenin-rich extract obtained at optimized conditions had higher total phenolic content, antioxidant capacity by TEAC and ORAC, and flavonoid content, compared with the methanolic extract, and the simulated gastrointestinal digestion reduced all these values.

Clinical relevance of resistance training in women with fibromyalgia: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: There has been an increase in the number of papers assessing the effects of resistance training (RT) in patients with fibromyalgia. Therefore, the objective of our study was to evaluate the clinical relevance and effectiveness of RT for pain intensity, functionality and severity of the disease specifically in women with fibromyalgia through a systematic review with meta-analysis. DATABASES AND DATA TREATMENT: Seven databases were searched. Randomized controlled trials conducted in women over 18 years of age with fibromyalgia were included. Fifteen trials were included in the systematic review and 14 of these studies were included in the three meta-analyses performed. Study quality assessment was performed using the PEDro scale. In addition, the GRADE recommendations were used. RESULTS: The global meta-analysis revealed statistically significant differences in the RT group versus the control group on pain intensity (SMD = -0.49; 95% CI [-0.74, -0.24], p = 0.0001), functionality (SMD = -0.23; 95% CI [0.01, 0.45], p = 0.04) and on severity of the disease (SMD = -0.58; 95% CI [-0.90, -0.26], p = 0.0005). Clinically relevant improvements in the overall outcome of the three variables studied in favour of RT were obtained. CONCLUSIONS: RT is effective to improve pain intensity, functionality and severity of the disease in women with fibromyalgia. These improvements are clinically relevant. More clinical trials of RT are needed in women with fibromyalgia to support our results due to the low strength of evidence. SIGNIFICANCE: This systematic review with meta-analysis provides evidence that RT produces clinically relevant improvements in women with fibromyalgia. The absence of immediate benefit is often a major barrier to adherence to treatment. Our findings will help clinicians to empower patients that if they continue treatment, they will achieve improvement in their disease.

Tire Slip H∞ Control for Optimal Braking Depending on Road Condition.

Tire slip control is one of the most critical topics in vehicle dynamics control, being the basis of systems such the Anti-lock Braking System (ABS), Traction Control System (TCS) or Electronic Stability Program (ESP). The highly nonlinear behavior of tire-road contact makes it challenging to design robust controllers able to find a dynamic stable solution in different working conditions. Furthermore, road conditions greatly affect the braking performance of vehicles, being lower on slippery roads than on roads with a high tire friction coefficient. For this reason, by knowing the value of this coefficient, it is possible to change the slip ratio tracking reference of the tires in order to obtain the optimal braking performance. In this paper, an H∞ controller is proposed to deal with the tire slip control problem and maximize the braking forces depending on the road condition. Simulations are carried out in the vehicular dynamics simulator software CarSim. The proposed controller is able to make the tire slip follow a given reference based on the friction coefficient for the different tested road conditions, resulting in a small reference error and good transient response.

Efficacy of Conservative Therapy in Overhead Athletes with Glenohumeral Internal Rotation Deficit: A Systematic Review and Meta-Analysis.

BACKGROUND: To evaluate the effectiveness of conservative therapy in range of movement (ROM), strength, pain, subacromial space and physical function, in overhead athletes with glenohumeral internal rotation deficit (GIRD). METHODS: A systematic review and meta-analysis was designed, and the protocol was registered in PROSPERO (CRD42021281559). The databases searched were: PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Web of Science and SCOPUS. Randomized controlled trials (RCTs) involving conservative therapy applied in overhead athletes with GIRD were included. Two independent assessors evaluated the quality of the studies with the PEDro scale, and with the Cochrane Risk-of-Bias tool. The overall quality of the evidence was assessed using GRADE. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software. Estimates were presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). RESULTS: A total of eleven studies involving 514 overhead athletes were included in the systematic review; of these 8 were included in the meta-analysis. The methodological quality of the included RCTs ranged from high to low. Conservative therapy showed significant improvements in internal rotation, adduction, physical function and subacromial space. CONCLUSIONS: Conservative therapy based on stretch, passive joint and muscular mobilizations can be useful to improve the internal rotation and adduction ROM, subacromial space, and physical function of the shoulder in overhead athletes with glenohumeral internal rotation deficit.

Clinical relevance of massage therapy and abdominal hypopressive gymnastics on chronic nonspecific low back pain: a randomized controlled trial.

PURPOSE: To determine the clinical relevance of the effects that Massage-Therapy (MT) and Abdominal-Hypopressive-Gymnastics (AHG) and the combination of both procedures have on the disability, pain intensity, quality of life, and lumbar mobility of patients with chronic nonspecific low back pain (CNSLBP). METHODS: A randomized controlled-trial with parallel-groups, concealed allocation, assessor blinding, and intention-to-treat analysis was carried out. The sample included 60 adults with CNSLBP. The participants received MT (n = 20), AHG (n = 20), or MT + AHG (n = 20). Each group received 8 interventions. RESULTS: The ODI change scores were significantly higher (p < 0.05) in the MT + AHG group than in the other two groups. Significant differences were found in the results of NRS, Schober's test, and SF-12 PCS (p < 0.05) in each group. There were significant differences (p < 0.05) between the values of SF-12 MCS in AHG and MT + AHG groups. CONCLUSIONS: Massage Therapy and Abdominal Hypopressive Gymnastics reduce pain levels, increase the mobility of the lumbar spine, and improve disability and quality of life (PCS) in patients with CNSLBP in the short term. Likewise, AHG and MT + AHG improve quality of life (MCS). The combination of both therapies provides more benefits in terms of lumbar disability in patients with CNSLBP in the short term. This improvement is clinically relevant. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02721914).IMPLICATIONS FOR REHABILITATIONMassage Therapy (MT) and Abdominal Hypopressive Gymnastics (AHG), reduce pain, improve mobility and quality of life, and reduce disability in the short term.These results are clinically relevant.The combination of manual and active therapy (MT + AHG) seems to be more effective and produces clinically relevant changes.

Implantes cocleares: prioridad para niños con pérdida sensorial dual en Cuba / Cochlear implants: priority for children with dual sensory loss in Cuba

RESUMEN Fundamento: desde el año 2005 se crea el Programa Cubano de Implantes Cocleares para niños sordos y sordociegos, con prioridad para niños con pérdida sensorial dual. Objetivo: describir el comportamiento de la pérdida sensorial dual en niños del Programa Cubano de Implantes Cocleares. Métodos: se realizó un estudio observacional, descriptivo, retrospectivo de niños con pérdida sensorial dual que recibieron implante coclear entre febrero de 2005 y marzo de 2013 en Cuba. De las historias clínicas y la base de datos del programa fue obtenida la información que permitió elaborar el informe. Con antelación, se ilustran los primeros resultados sobre neuroplasticidad obtenidos con potencial evocado somatosensorial de nervio mediano realizado con parte del protocolo de estudio de investigación preimplante coclear en el Programa Cubano de Implantes Cocleares. Resultados: con el programa se han beneficiado 27 niños con pérdida sensorial dual con implantes cocleares, con cobertura a todas las provincias del país. Seis niños presentaron una enfermedad asociada, predominaron los factores pre/peri-natales y el síndrome de Usher como principales agentes causales de la sordoceguera. La pérdida auditiva fue prelocutiva en 24 niños, confirmada y caracterizada mediante electroaudiometría. Los estudios de imágenes de oídos no mostraron malformaciones. La implantación fue unilateral, sobre todo el oído derecho, sin complicaciones quirúrgicas en ninguno de los niños. Mientras que el estudio de neuroplasticidad evidencia reorganización cortical somestésica en niños con pérdida sensorial dual. Conclusiones: el Programa Cubano de Implantes Cocleares ha logrado un trabajo sostenido en la evaluación e implantación de niños con pérdida sensorial dual, distinguiéndose la investigación sobre neuroplasticidad, la cual ha dado evidencias de representación cortical somestésico preimplante coclear en estos niños. Ello será útil para evaluar la reorganización cortical post-implante coclear y correlacionarlo con el aprovechamiento del uso del implante coclear.

ABSTRACT Background : since 2005 the Cuban Cochlear Implant Program for deaf and deaf-blind children has been created, with priority for children with dual sensory loss. Objective: is to describe the work of the Cuban Cochlear Implant Program with children with dual sensory loss. Methods : a descriptive, retrospective study of children with dual sensory loss who received a cochlear implant between February 2005 and March 2013 in Cuba. The information to conform this descriptive report was obtained from the clinical histories and the database of the program; it also illustrates the first results on neuroplasticity obtained with the somatosensory evoked potential of the median nerve carried out with part of the pre-cochlear implant research study protocol in the Cuban Cochlear Implant Program. Results : the program has benefited 27 children with dual sensory loss with cochlear implants, covering all provinces of the country. Six children presented an associated pathology, with pre/peri-natal factors and Usher Syndrome as the main causal agents of deaf-blindness. Hearing loss was pre-lingual in 24 children, confirmed and characterized by electro-audiometry. No malformations were found in the ear images. The implantation was unilateral, mostly the right ear, without surgical complications in all the children. While the neuroplasticity study shows somesthetic cortical reorganization in children with dual sensory loss. Conclusions : the Cuban Cochlear Implant Program has achieved sustained work in the evaluation and implantation of children with dual sensory loss, a distinctive aspect being the research on neuroplasticity, which has provided evidence of somesthetic cortical representation pre-cochlear implantation in these children. This will be useful to assess cortical reorganization post- cochlear implant and correlate it with the use of the cochlear implant.

Calidad de vida en niños del Programa Cubano de Implantes Cocleares / Quality of life in children of the Cuban Cochlear Implant Program

RESUMEN Fundamento: los estudios publicados sobre los resultados del Programa Cubano de Implantes Cocleares hacen referencia a evaluaciones audiológicas y quirúrgicas, lo que carece de la dimensión que aportaría conocer, el impacto del programa en la calidad de vida de los niños implantados y familia. Objetivo: determinar el impacto del Programa Cubano de Implantes Cocleares en la calidad de vida de los niños implantados y su familia. Métodos: se realizó un estudio descriptivo, prospectivo, longitudinal (pre- y post-implante coclear) a partir de la aplicación del cuestionario de calidad de vida del proyecto internacional pediátrico Cochlear paediatric implanted recipient observational study y la prueba de categorías del rendimiento auditivo, mediante un análisis de varianza de medidas repetidas. Resultados: el estudio evidencia que los implantes cocleares impactan en la familia y la calidad de vida de los niños, con mejora significativa tan temprano como seis meses post-implante coclear y mayores beneficios al año de implantados, respaldado por los hallazgos en la prueba de categorías del rendimiento auditivo, mientras que las expectativas de los padres se ajustan según avanza la rehabilitación post-implante coclear. Conclusiones: los implantes cocleares impactan en la calidad de vida del niño y su familia en la medida que avanza el programa de rehabilitación post-implante, al ajustarse a las expectativas de los padres o tutores, los cuales reportan cambios positivos en el desarrollo de las actividades diarias del niño, efecto sostenido en el tiempo.

ABSTRACT Background: the studies published on the results of the Cuban Cochlear Implants Program refer to audiological and surgical evaluations, lacking the dimension that knowing about the impact of cochlear implants on the quality of life of children and their family. Objective: to determine the impact in the Cuban Cochlear Implants Program on the quality of life of children and their family. Methods: it was carried out a descriptive, prospective, longitudinal study (pre- and post-cochlear implant) from the application of a quality of life questionnaire of the international pediatric project cochlear pediatric implanted recipient observational study and the categories auditory performance test, being applied an analysis of variance of repeated measures. Results: the study shows that cochlear implants impact on the quality of life of children and family, and improves significantly as early as six months post-cochlear implant, with greater benefits one year after implantation, supported by the findings of the categories auditory performance test. While parental expectations are adjusted as post-cochlear implant rehabilitation progresses. Conclusions: cochlear implants impact on the quality of life of the child and family with the post-implant rehabilitation program progresses, adjusting the expectations of the parents or child's guardian, who report positive changes in the development of their daily activities, a sustained effect in the time.

Visual Binocular Disorders and Their Relationship with Baropodometric Parameters: A Cross-Association Study.

The aim of this study was to establish a relationship between nonstrabismic binocular dysfunction and baropodometric parameters. A total of 106 participants underwent binocular vision assessment by evaluating horizontal heterophoria, horizontal and vertical fusional vergence ranges, and vergence facility. Posturography was measured using the FreeMED baropodometric platform. Among the variables that the software calculates are foot surface, foot load, and foot pressure. Our results showed that in the participants with positive fusional vergence (PFV) (near) blur and recovery values outside the norm, there are statistically significant differences between the total foot area (p < 0.05), forefoot area (p < 0.05), forefoot load (p < 0.05), and rearfoot load (p < 0.05), in all of the cases of left foot vs. right foot. In the group of subjects who did not meet Sheard's criterion (distance), that is, those with unstable binocular vision, there was a statistically significant difference (p < 0.01) between maximum left and right foot pressure. In conclusion, our results establish a relationship between nonstrabismic binocular dysfunctions and some baropodometric parameters.

Effects of Massage Therapy on the Development of Babies Born with Down Syndrome.

OBJECTIVE: To determine the short-term effects of infant massage on the development of Down syndrome babies. MATERIALS AND METHODS: The study compared two groups (intervention and control), each with 16 babies with Down syndrome between 4 and 8 months old. The variables developmental age and developmental quotient were measured at two distinct time points, at pretest and after 5 weeks, using the Brunet-Lézine Early Childhood Psychomotor Development revised scale. This scale measures the variables of age and development quotient in a partial way (motor, visual-motor coordination, language, and social development) and in a global way. The experimental group received infant massage, applied by the parents, during these 5 weeks, every day for at least 10 minutes. The massage protocol was based on the methodology created by Vimala McClure. The control group received it after 5 weeks. RESULTS: All developmental variables were improved in the experimental group but not in the control group. There were significant differences in developmental age between the two groups, and this outcome was better in the experimental group (p < 0.001). The 2-by-2 mixed-model analysis of variance indicates a statistically significant group-by-time interaction for all development quotients, both partial and global (p < 0.001), which was significantly higher in the experimental group than in the control group. CONCLUSION: Infant massage therapy improves the development of babies with Down syndrome in the short term.

Soluble melanins of the Randia echinocarpa fruit - Structural characteristics and toxicity.

The water-soluble melanins (SM) of Randia echinocarpa fruit possess interesting biological activities and have been scarcely characterized. In this study, SM were obtained at boiling (SMBT) and room (SMRT) temperatures and characterized by UV-Vis, IR, thermogravimetric analysis, and GC-MS of the hydrolysis products of the SM; besides, the solid-state 13 C NMR, elemental analysis, and acute and sub-acute toxicity of the SMBT were determined. SMBT and SMRT contain organic acids and carbohydrates and their spectroscopic signals and thermograms were similar, but the SMBT yield was higher. The SMBT were characterized by their elemental composition (C 48.260 ± 0.011%, N 3.693 ± 0.009% and H 6.093 ± 0.076%) consistent with the presence of aromatic rings and eumelanins, degradation temperature at 300°C, 13 C NMR signals supporting melanin-bonding with carbohydrates and organic acids, and innocuity in Balb/C mice (acute assay, LD50  > 5 g/kg b.w.; sub-acute assay, no lethality at 500 mg/kg b.w. for 30 days). PRACTICAL APPLICATIONS: The consumption of melanins has been associated with health benefits because of their biological activities (e.g., antioxidant, immunostimulatory, UV- and radiation-protective). Randia echinocarpa is employed in Mexican traditional medicine against chronic degenerative diseases (e.g., cancer and diabetes) and ailments of organs (e.g., kidney and lung) and systems (e.g., circulatory and gastrointestinal). The R. echinocarpa fruit contains water-soluble melanins (SM) that inhibit carbohydrate-digestive enzymes and show high antioxidant activity; thus, SM could be useful for the prevention and treatment of diabetes. This study showed that the SM structure contains melanin-bonding organic acids and carbohydrates, which could be associated with the SM solubility and higher yield, and that SMBT were innocuous in the acute and sub-acute assays in mice. Thus, the R. echinocarpa SMBT could be used as safe potential ingredients to develop functional products.

Visual system disorders and musculoskeletal neck complaints: a systematic review and meta-analysis.

Accommodation disorders and nonstrabismic binocular dysfunctions affect patients' binocular system and visual performance. These visual disorders could be associated with musculoskeletal discomfort in the neck and shoulder area. The purpose of this systematic review and meta-analysis was to ascertain the relationship between visual system disorders and the musculoskeletal system of the neck. The review protocol is available in PROSPERO (CRD42018112771). All articles selected examined the relationship between neck conditions (chronic neck pain and whiplash) and the visual system in adult populations. Studies with optometric or physiotherapeutic measurements were included. Bias risk was evaluated with the modified Cochrane Collaboration Tool and Study Quality Assessment Tool. To provide complete quality assessment evidence, the authors applied the GRADEpro Guideline Development Tool. The literature search was conducted in November 2018 and yielded 745 studies among all the databases. Out of these studies, 21 were finally included. Most of the studies presented a moderate methodological quality. Only one high-quality trial was found. Based on a qualitative assessment, our systematic review and meta-analysis revealed that all included studies established a relationship between the visual system and musculoskeletal system of the neck. However, the methods for the measurement of the visual system lacked uniformity.

Nonstrabismic binocular dysfunctions and cervical complaints: The possibility of a cross-dysfunction.

The aim of this study is to establish a relationship between non-strabismic binocular dysfunction and neck pain. One hundred twelve participants underwent binocular vision assessment by evaluating horizontal heterophoria, horizontal and vertical fusional vergence ranges and vergence facility. The subjects were classified into two groups: binocular anomalies and normal binocular function. Neck complaints were measured with the Neck Disability Index, visual analogue scale, cervical range of motion, deep-flexor muscle activation score (AS) and performance index (PI). Our results showed that participants with low AS had significantly altered values of lateral phoria (near) (mean = -6.99 SD ± 6.96 PD) and PFV (near) blur (mean = 9.49 SD ± 5.45 PD) against those who presented normal AS (lateral phoria (near) mean = -3.64 SD ± 6.37 PD; PFV (near) blur mean = 12.84 SD ± 6.20 PD). In addition, participants with NFV (near) recovery outside the norm had a significantly lower right side-bending (mean = 35.63 SD ± 8.35 PD) than those within the standard (mean = 39.64 SD ± 9 PD). The subjects with binocular vision impairment showed a diminished response to the deep cervical musculature, with low AS and PI, as well as a tendency to suffer from cervicalgia of more than three months' evolution and a lower range of motion.

Effects of perinatal undernutrition on social transmission of food preference in adult male Wistar rats.

Nutrition plays a fundamental role in learning and memory, and early experimental undernutrition interferes with brain memory processes. Social transmission of food preference (STFP) is a natural olfactory paired-associate learning test that has not been used to assess the effects of early undernutrition on memory consolidation. Male Wistar rats were randomly divided into two groups: control and early undernourished. The underfed rats received different percentages of a balanced diet during gestation. After birth, pups were underfed by alternating every 12 h between two lactating dams, one with ligated nipples. Weaning occurred on PD 25 followed by an ad lib diet until PD 90. Demonstrator rats were given powdered food mixed with cinnamon, followed by a 30-min interaction with an underfed observer. Thereafter, the observer had two choices of food: cinnamon or cocoa. During the food preference test, control and underfed OBS rats preferred the food containing cinnamon. Through social interaction, the UG OBS rats showed latency for head contacts and oral-nasal investigation was higher in the underfed rats; only head contacts and oral-nasal investigation frequency was lower; with the duration lower, but oral-nasal investigation duration was higher (p < 0.05). In the preference phase, the OBS underfed rat latencies for both stimuli were prolonged, the frequency lower only for cocoa, and the duration lower for cinnamon but higher for cocoa (p < 0.05). Findings suggested that early undernutrition interfered with the attentive social transmission to take a decision during the preference phase, but not with the short-term memory consolidation of social food preference.

Late-emerging effects of perinatal undernutrition in neuronal limbic structures underlying the maternal response in the rat.

Maternal care in the rat is an ancient behavioral response to specific multisensory inputs widely integrated in a complex forebrain, limbic and brain stem network to meet the basic needs of the young. Early undernutrition interferes with the morphofunctional organization of the brain, including maternal circuitry. The late-emerging effects of pre- and neonatal undernutrition on nest building and pup retrieval by lactating Wistar rats were correlated with dendritic arbor and perikaryon measurements (Golgi-Cox) in layer II pyramidal neurons of the anterior cingulate cortex, layer III pyramidal neurons of the medial prefrontal cortex and multipolar basolateral amygdala neurons examined on lactation days 4 and 12. In the underfed group, pregnant F0 dams received different percentages of a balanced diet. After birth, prenatally underfed (F1) pups continued the undernutrition by remaining with a nipple-ligated mother for 12 h. Weaning occurred at 25 days of age, and pups were subsequently provided an ad libitum diet. At 90 days of age, F1 dams were maternally tested. Early underfed dams showed significant reductions in nest building and prolonged retrieval latencies for grasping pups by inappropriate body areas. The behavioral alterations were concurrent with highly significant reductions in the somatic cross-sectional area and perimeter, spine density and dendritic crossings of cingulate cells and medial prefrontal cortical pyramids, as well as smaller effects on amygdala neurons. The anatomical findings suggest different postsynaptic organizations that may affect the neuronal excitability stages for the integration and encoding of cues triggering the altered maternal response components of early underfed dams.

Is it possible to relate accommodative visual dysfunctions to neck pain?

The aim of this study was to establish whether there is a relationship between conditions of accommodative visual dysfunctions and cervical complaints. Fifty-two participants were included. Variables were accommodative amplitude, positive and negative relative accommodation (NRA), accommodative response, and accommodative facility. Subjects were classified as accommodative insufficiency, accommodative excess, or normal. Neck complaints were measured with the Neck Disability Index, the Visual Analogue Scale, and by cervical range of motion, deep flexor muscle activation score, and performance index. We found the following significant relationships: between NRA and both performance index and left-side bending; accommodative amplitude right-eye with right-side bending and with left-side bending; accommodative amplitude left-eye with right-side bending; and accommodative facility left-eye with both performance index and left-side bending. In accommodative amplitude right-eye, aIl participants showed significant values and greater than those with accommodative excess. In both groups, performance index values were decreased. Greater pain and lower right-rotation were found in participants with accommodative excess than in those with accommodative insufficiency. We conclude that accommodative dysfunctions are related to low performance index, decreased range of motion, as well as greater neck pain.

Effects of pre- and neonatal undernutrition on the kyphotic response and c-Fos activity in the caudal periaqueductal gray of primiparous lactating Wistar rats.

In rodents, the most representative component of maternal behavior that meets the purpose of newborn nutrition is the kyphotic posture. During this posture, the mother maintains a unique environment for the protection, thermal regulation and breast-feeding of the progeny. The aim of this study was to investigate possible deficiencies in the kyphotic posture of adult lactating dams with pre- and neonatal undernutrition evoked by their own pups suckling in a home-cage situation. Wistar dams that had been previously exposed to perinatal undernutrition were mated at 90days of age, and pregnancy was confirmed by vaginal smears. Before testing if the perinatal underfed dam affected behavior, pups were removed (4h), and both the maternal response and the kyphotic posture were video-recorded (1h) and analyzed at 4 and 12days of lactation. Pre- and post-test litter weight gain was obtained. To immunostain the caudal periaqueductal gray, the litter was separated from their dams 24h before suckling stimulation. The results showed that underfed dams significantly reduced the duration of high kyphosis by choosing unconventional postures (prone and partial kyphosis). The body weight of the F1 offspring was significantly reduced, and the underfed F0 dams showed reduced c-Fos immunostaining at the caudal periaqueductal gray. The findings showed that early underfed dams have deficiencies in the mechanisms underlying the kyphosis, possibly because the pups' cues to evoke this posture were suboptimal and/or because the dam expressed deficient nursing. The results suggest that the abnormal kyphotic posture may affect the mother-litter bonds and have long-term effects on neonatal brain functions.

Flavonoids and Phenolic Acids from Oregano: Occurrence, Biological Activity and Health Benefits.

Several herb species classified as oregano have been widely used in folk medicine to alleviate inflammation-related diseases, respiratory and digestive disorders, headaches, rheumatism, diabetes and others. These potential health benefits are partially attributed to the phytochemical compounds in oregano such as flavonoids (FL) and phenolic acids (PA). Flavonoids and phenolic acids are among the most abundant and most studied phytochemicals in oregano species. Epidemiological, in vitro and in vivo experiments have related long-term consumption of dietary FL and PA with a decreased risk of incidence of chronic diseases. The aim of this manuscript is to summarize the latest studies on the identification and distribution of flavonoids and phenolic compounds from oregano species and their potential antioxidant, anti-inflammatory and anti-cancer health benefits.

Maternal alterations induced by exposure to an unfamiliar home cage in early underfed dams.

The expression of different behavioral components in the adult rat depends on a number of early influences, including age, hormones, manipulations of sensory cues, and perinatal undernutrition, all of which impact the development of brain areas underlying adaptive processes, maternal behavior, and the response to novelty. The current study investigates the effects of pre- and neonatal undernutrition on various components of maternal behavior of dams exposed to the challenge of an unfamiliar home cage on days 4, 8, and 12 of lactation. Food restriction was initiated from gestational day (G) G6 to G19 when dams received 50-70% of the normal balanced diet, followed by 100% from G20 to G21. After birth, pups were underfed by alternating every 12h between two lactating dams, one of which, had ligated nipples. Weaning was at 25days of age followed by an ad libitum diet until postpartum day 90, when females were mated, and subsequently tested for maternal behavior in an unfamiliar cage. The results indicated that in early underfed mothers the frequency of handling wood shavings and of, approaching, licking, crouching, and grasping pups for retrieval was significantly reduced. Moreover, self-grooming increased substantially in the underfed dams, but the frequency of rearing was reduced. Additionally, the body weight of pups nursed by early underfed dams was significantly lower than that of control pups. These findings suggest a relation between early food restriction and the deficient maternal care observed when these dams were challenged by exposure to an unfamiliar home cage.

Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international, randomised, double-blind, phase 3 trial.

BACKGROUND: Aromatase inhibitors are a standard of care for hormone receptor-positive locally advanced or metastatic breast cancer. We investigated whether the selective oestrogen receptor degrader fulvestrant could improve progression-free survival compared with anastrozole in postmenopausal patients who had not received previous endocrine therapy. METHODS: In this phase 3, randomised, double-blind trial, we recruited eligible patients with histologically confirmed oestrogen receptor-positive or progesterone receptor-positive, or both, locally advanced or metastatic breast cancer from 113 academic hospitals and community centres in 20 countries. Eligible patients were endocrine therapy-naive, with WHO performance status 0-2, and at least one measurable or non-measurable lesion. Patients were randomly assigned (1:1) to fulvestrant (500 mg intramuscular injection; on days 0, 14, 28, then every 28 days thereafter) or anastrozole (1 mg orally daily) using a computer-generated randomisation scheme. The primary endpoint was progression-free survival, determined by Response Evaluation Criteria in Solid Tumors version 1·1, intervention by surgery or radiotherapy because of disease deterioration, or death from any cause, assessed in the intention-to-treat population. Safety outcomes were assessed in all patients who received at least one dose of randomised treatment (including placebo). This trial is registered with ClinicalTrials.gov, number NCT01602380. FINDINGS: Between Oct 17, 2012, and July 11, 2014, 524 patients were enrolled to this study. Of these, 462 patients were randomised (230 to receive fulvestrant and 232 to receive anastrozole). Progression-free survival was significantly longer in the fulvestrant group than in the anastrozole group (hazard ratio [HR] 0·797, 95% CI 0·637-0·999, p=0·0486). Median progression-free survival was 16·6 months (95% CI 13·83-20·99) in the fulvestrant group versus 13·8 months (11·99-16·59) in the anastrozole group. The most common adverse events were arthralgia (38 [17%] in the fulvestrant group vs 24 [10%] in the anastrozole group) and hot flushes (26 [11%] in the fulvestrant group vs 24 [10%] in the anastrozole group). 16 (7%) of 228 patients in in the fulvestrant group and 11 (5%) of 232 patients in the anastrozole group discontinued because of adverse events. INTERPRETATION: Fulvestrant has superior efficacy and is a preferred treatment option for patients with hormone receptor-positive locally advanced or metastatic breast cancer who have not received previous endocrine therapy compared with a third-generation aromatase inhibitor, a standard of care for first-line treatment of these patients. FUNDING: AstraZeneca.