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Clinical Director, State University of New York Downstate Medical Center College of Medicine

The observational studies varied with respect to when meat intake was examined, how outcomes were assessed, and adjustment for key confounders. It should be noted that this conclusion does not apply to overweight or obesity outcomes, for which insufficient evidence was available. The second conclusion graded as "Moderate" was that consuming complementary foods with different dietary fats or fatty acid composition does not influence growth, size, or body composition. The studies varied with regard to the types of fats and outcomes examined, and outcomes after age 24 months were not examined. Again, evidence was insufficient to determine a relationship with overweight or obesity. Second, juice intake is positively Scientific Report of the 2020 Dietary Guidelines Advisory Committee 21 Part D. Only a few observational studies were available, and most did not specify the type or percentage of fruit in the juice. Limited evidence suggested that type or amount of cereal given does not favorably or unfavorably influence growth, size, body composition, and/or prevalence/incidence of overweight or obesity, but a grade was not assigned because of inconsistency in the types of cereal and outcomes examined. Similarly, evidence was insufficient as to whether different dietary patterns are related to growth, size, body composition, and/or prevalence of malnutrition, overweight, or obesity. The studies were difficult to compare due to variation in dietary patterns, health outcomes, and adjustment for confounding factors. The authors also found no relationship between total fat or polyunsaturated fatty acid intake in the first years of life and these outcomes. For that reason, the conclusion statement from this review was graded as "Limited. The Committee examined associations between seafood consumption and neurocognitive development, but no studies were located for the birth to age 24 months population. Plasma or serum zinc was the most common biomarker of zinc status used in the studies reviewed. This biomarker has several limitations24 so the findings of studies using this zinc status outcome should be considered with caution. It showed lower zinc status in infants randomly assigned to receive infant cereal not fortified with zinc. The studies reviewed varied in Scientific Report of the 2020 Dietary Guidelines Advisory Committee 23 Part D. Iron is particularly important for normal neurological development and immune function. For this reason, both iron and zinc are considered "problem nutrients" for breastfed infants at ages 6 to 12 months, and complementary foods rich in these nutrients are needed to fill the gap. As mentioned previously, polyunsaturated fatty acids are key nutrients for brain development. It was difficult to compare the studies because the patterns examined differed with regard to the combinations of foods and food groups included. These studies assessed bone health outcomes at age 4 or 6 years and did not account for how dietary patterns may have shifted during the follow-up period. Chapter 5: Foods and Beverages Consumed During Infancy and Toddlerhood Food Allergies and Atopic Allergic Diseases Table D5. Strong evidence indicated that introducing peanut in the first year of life (after age 4 months) reduces the risk of food allergy to peanuts. Conclusion statements and grades from a systematic review examining the relationship between the types and amounts of complementary foods consumed and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis Peanut, tree nuts, seeds Strong evidence suggests that introducing peanut in the first year of life (after 4 months of age) may reduce risk of food allergy to peanuts [Grade: Strong].

It is the largest part of the hindbrain and lies posterior to the fourth ventricle, the pons, and the medulla oblongata. The cerebellum is divided into three main lobes: the anterior lobe, the middle lobe, and the flocculonodular lobe. The anterior lobe may be seen on the superior surface of the cerebellum and is separated from the middle lobe by a wide V-shaped fissure called the primary fissure. The middle lobe (sometimes called the posterior lobe), which is the largest part of the cerebellum, is situated between the primary and uvulonodular fissures. A deep horizontal fissure that is found along the margin of the cerebellum separates the superior from the inferior surfaces; it is of no morphologic or functional significance. Molecular Layer the molecular layer contains two types of neurons: the outer stellate cell and the inner basket cell. These neurons are scattered among dendritic arborizations and numerous thin axons that run parallel to the long axis of the folia. In a plane transverse to the folium, the dendrites of these cells are seen to pass into the molecular layer, where they undergo profuse branching. The primary and secondary branches are smooth, and subsequent branches are covered by short, thick dendritic spines. It has been shown that the spines form synaptic contacts with the parallel fibers derived from the granule cell axons. At the base of the Purkinje cell, the axon arises and passes through the granular layer to enter the white matter. On entering the white matter, the axon acquires a myelin sheath, and it terminates by synapsing with cells of one of the intracerebellar nuclei. Collateral branches of the Purkinje axon make synaptic contacts with the dendrites of basket and stellate cells of the granular layer in the same area or in distant folia. A few of the Purkinje cell axons pass directly to end in the vestibular nuclei of the brainstem. Embedded in the white matter of each hemisphere are three masses of gray matter forming the intracerebellar nuclei. Granular Layer the granular layer is packed with small cells with densely staining nuclei and scanty cytoplasm. Each cell gives rise to four or five dendrites, which make 231 Cerebral aqueduct Superior colliculus Midbrain Inferior colliculus Superior medullary velum Lingula Central lobule Culmen Primary fissure Declive Folium Pons Horizontal fissure Cavity of fourth ventricle Root of fourth ventricle and choroid plexus Medulla oblongata Nodule Median aperture in roof of fourth ventricle (inferior medullary velum) Central canal Uvula Tonsil Tuber Cerebral peduncle Oculomotor nerve Cerebellar hemisphere Pyramid Cortex of cerebellum Figure 6-1 Sagittal section through the brainstem and the vermis of the cerebellum. Anterior lobe Superior aspect of vermis Culmen Primary fissure Middle lobe (posterior lobe) Declive A Uvula Nodule Flocculus Central lobule Horizontal fissure Middle cerebellar peduncle Tonsil Biventral lobule Inferior semilunar lobule Pyramid B Tuber Figure 6-2 the cerebellum. The axon of each granule cell passes into the molecular layer, where it bifurcates at a T junction, the branches running parallel to the long axis of the cerebellar folium. These fibers, known as parallel fibers, run at right angles to the dendritic processes of the Purkinje cells. Most of the parallel fibers make synaptic contacts with the spinous processes of the dendrites of the Purkinje cells. Their dendrites ramify in the molecular layer, and their axons terminate by splitting up into branches that synapse with the dendrites of the granular cells. The cortex of the vermis influences the movements of the long axis of the body,namely,the neck,the shoulders,the thorax,the abdomen,and the hips. Immediately lateral to the vermis is a so-called intermediate zone of the cerebellar hemisphere. This area has been shown to control the muscles of the distal parts of the limbs, especially the hands and feet. The lateral zone of each cerebellar hemisphere appears to be concerned with the planning of sequential movements of the entire body and is involved with the conscious assessment of movement errors. Intracerebellar Nuclei Four masses of gray matter are embedded in the white matter of the cerebellum on each side of the midline. From lateral to medial, these nuclei are the dentate, the emboliform, the globose, and the fastigial. Molecular layer Purkinje cell Granular layer Figure 6-5 Photomicrograph of a cross section of a cerebellar folium,showing the three layers of the cerebellar cortex. Structure of the Cerebellum 235 Primary fissure the fastigial nucleus lies near the midline in the vermis and close to the roof of the fourth ventricle; it is larger than the globose nucleus.

The next dermatome that occurs inferior to this is that of the 2nd cervical nerve. At the junction of the neck with the thorax, the 4th cervical dermatome is contiguous with the 2nd thoracic dermatome; the anterior rami of the lower cervical and 1st thoracic spinal nerves lose their cutaneous distribution on the neck and trunk during the development of the upper limb. These spinal cord segments lie within the vertebral foramina of the sixth and seventh cervical vertebrae, respectively. Because of the pressure of the tumor on the cervical region of the spinal cord,the nervous pathways passing down to lower segments of the spinal cord were interrupted. This resulted in the motor anterior gray column cells of the segments of the cord below the level of compression receiving diminished information from the higher centers, with a consequent increase in muscle tone. Any disease process that can interrupt the normal functioning of the basic spinal reflex arc on which skeletal muscle tone is dependent will cause loss of muscle tone. Some examples are spinal shock following trauma to the spinal cord; section of or pressure on a spinal nerve, a posterior root, or an anterior root; syringomyelia; and poliomyelitis. Tabes dorsalis,which is a syphilitic infection of the brain and spinal cord, produces degeneration of the central processes of the posterior root ganglion cells and also, usually, the ganglion cells themselves. The lower thoracic and lumbar sacral segments of the cord are involved first, and the interruption of the proprioceptive fibers results in impairment of appreciation of posture and the tendency to fall down if one closes the eyes while standing. In a normal individual, standing and walking are largely automatic, but as you have read in this chapter, these activities are highly complex and require the proper integration of neural mechanisms at all levels of the spinal cord and brain. In order to maintain normal posture, these reflex arcs must receive adequate nervous input from higher levels of the nervous system. Diseases involving the corpus striatum (caudate and lentiform nuclei) or the substantia nigra result in an alteration in the pattern of nervous impulses impinging on the anterior horn cells of the spinal cord, hence the abnormal muscle tone. The tremor of the parkinsonian syndrome is produced by the alternating movements of the agonist and antagonist muscles of a joint. The tremor is most prominent when the limb is at rest, ceases temporarily when voluntary movement is performed, and then starts again when the movement is completed. In Parkinson disease, there is a neuronal degeneration in the substantia nigra, resulting in the loss of inhibitory control of the substantia nigra over the lentiform nucleus, putamen, and caudate nucleus. Destruction of the anterior gray column cells in the lumbar and sacral regions of the spinal cord resulted in paralysis and atrophy of the muscles of both legs. The twitching of groups of muscle fibers is referred to as muscular fasciculation and is commonly seen in patients with chronic disease affecting the anterior horn cells. Passively move the joints on the right side of the body and then on the left side, and compare the resistance to these movements by the muscles on the two sides of the body. With a unilateral cerebellar lesion, the shoulder on the affected side may be lower than that on the opposite, normal side. These tests will reveal ataxia on the side of the body in which the lesion is situated. It is commonly demonstrated in cerebellar disease and is due to lack of muscle coordination. When the eyes are turned horizontally, laterally there are quick, rhythmic jerks in the direction of gaze. In unilateral cerebellar lesions, the amplitude of nystagmus is greater and its rate is slower when the eyes are rotated toward the side of the lesion than when they are displaced to the opposite side. The following statements concern nerves: (a) A nerve tract is the name given to a nerve fiber in the peripheral and central nervous systems. The following statements concern nerves: (a) the minor dense line of myelin is made up of protein. The following statements concern an oligodendrocyte: (a) A single oligodendrocyte may be associated with one segment of myelin on a single axon. The following statements concern peripheral nerve plexuses: (a) They are formed by a network of connective tissue fibers. The following statements concern nerve conduction: (a) An adequate stimulus decreases the permeability of the axolemma to Na ions at the point of stimulation.

B: Subdural hemorrhage from the cerebral veins at the site of entrance into the venous sinus on the right side. The hematoma is crescent shaped and occupies the space between the meningeal layer of dura and the arachnoid. In an automobile accident, which structures present within the skull limit damage to the cerebral hemispheres and other parts of the brain Which blood vessels are damaged more commonly, the cerebral arteries or the cerebral veins If so, which ones are damaged most commonly, and what is the reason for their increased susceptibility While performing an autopsy on a patient who had died of a meningioma,the pathologist explained to a group of students that these tumors arise from the arachnoid mater. She explained that they occur in those areas in which the arachnoid pierces the dura to form the arachnoid villi that project into the dural venous sinuses. A 10-year-old girl was admitted to hospital for surgical correction of medial strabismus of the right eye. Twentyfour hours after successful completion of the operation, it was noted that her right eyeball was projecting forward excessively (proptosis), and the conjunctiva of the right eye was inflamed. The ophthalmologist was greatly concerned because he did not want the complication of cavernous sinus thrombosis to occur. What is the connection between infection of the eye and cavernous sinus thrombosis On examination, a 41-year-old man was found to have paralysis of the lateral rectus muscle of his left eye; the left pupil was dilated but reacted slowly to light, and there was some anesthesia of the skin over the left side of the forehead. A carotid arteriogram revealed the presence of an aneurysm of the right internal carotid artery situated in the cavernous sinus. Using your knowledge of anatomy, explain the clinical findings on physical examination. On ophthalmoscopic examination,a 45-year-old woman was found to have edema of both optic discs (bilateral papilledema) and congestion of the retinal veins. He noted that the child had perfectly normal use of his arms but that his legs were stiff, and when he walked, he tended to cross his legs and had a scissorlike gait. Using your knowledge of anatomy, explain what happens to the fetal skull bones during delivery. Why is cerebral hemorrhage more likely to occur in a premature baby with a malpresentation She had apparently been hit on the side of the head by a car while crossing the road. On examination,she was found to have a large,doughlike swelling over the right temporalis muscle. A lateral radiograph of the skull showed a fracture line across the groove for the anterior division of the right middle meningeal artery. A 50-year-old woman complaining of a severe headache of 3 days duration visited her physician. She said that the headache had started getting very severe about 1 hour after she had hit her head on the mantelpiece after bending down to poke the fire. Three hours later, it was noticed that she was becoming mentally confused and also that she was developing a rightsided hemiplegia on the side of the body opposite to the head injury. She had exaggeration of the deep reflexes and a positive Babinski response on the right side. Examination of the cerebrospinal fluid with a spinal tap showed a raised pressure and the presence of blood in the fluid. The meninges and the cerebrospinal fluid afford a remarkable degree of protection to the delicate brain. The dural partitions, especially the falx cerebri and the tentorium cerebelli, limit the extent of brain movement within the skull. The thin-walled cerebral veins are liable to be damaged during excessive movements of the brain relative to the skull, especially at the point where the veins join the dural venous sinuses. The small-diameter cranial nerves of long length are particularly prone to damage during head injuries. They are therefore most commonly found along the superior sagittal sinus and the sphenoparietal sinuses. The anterior facial vein, the ophthalmic veins, and the cavernous sinus are in direct communication with one another.