BackgroundThe use of acellular dermal matrix (ADM) for post-mastectomy reconstruction is considered by many surgeons to be an accepted component of surgical technique. Early clinical experience is described for SimpliDerm® - a novel human ADM , and AlloDerm® Ready-To-Use (RTU) - an established ADM .MethodsRecords were retrospectively reviewed from four sites between 2016 and 2021 of patients who underwent immediate, two-stage reconstruction with either SimpliDerm (n=38) or AlloDerm RTU (n=69) after mastectomy and were followed out to exchange to permanent implant(s), tissue expander(s) explant, or death.Results2. Significantly more patients in the SimpliDerm group were of Hispanic or Latino ethnicity . Reconstructions were predominantly prepectoral (82.3%). A total of 35 adverse events (AEs) occurred in 27 (25.2%) patients, with no difference in AE type, classification, or rates between ADM groups. No AEs were considered related to either ADM. The observed AE profiles and rates are similar to those published for other ADMs in immediate breast reconstruction.Immediate breast reconstruction with tissue expanders and ADM was performed on 107 patients (181 breasts). Overall mean patient age was 51.4 ± 12.4 years, and mean BMI was 28.0 ± 5.8 kg/mConclusionsThere continues to be a need for additional clinically equivalent ADMs to provide physicians with more availability and options for their practice. This retrospective, multisite study describes comparable clinical outcomes with SimpliDerm and AlloDerm RTU through a median of 133.5 days (~four months) following immediate two-stage breast reconstruction. Acellular dermal matrices (ADMs) are used in approximately 60% of all breast reconstructions performed every year in the United States (US) . In addiADMs are manufactured from decellularized biologic xenograft or allograft material. In addition to their basic clinical characteristics and species/tissue source , ADMs may be differentiated based on their processing methods during manufacturing. The different manufacturing processes required to remove immunogenic components and sterilize the matrix give rise to a variety of ADMs with differing physical and biological characteristics. Different processing methods may affect product handling, remodeling, and integration into native tissues, which could influence clinical performance and overall cost .Enhanced preservation of extracellular matrix (ECM) structure has been shown in clinical and pre-clinical studies to support the integration of ADM into native tissues by promoting constructive tissue remodeling processes such as neovascularization and inflammation , 14. SimA recent publication reports early (30-day) outcomes of a retrospective series using two ADMs (SimpliDerm and AlloDerm RTU) in immediate, two-stage breast reconstructions . HoweverEach participating site received approval from a review board  to perform a retrospective chart review of SimpliDerm and AlloDerm RTU used in consecutive patients undergoing immediate, two-stage breast reconstruction post-mastectomy between August 2016 and July 2021. Patients were excluded if they underwent delayed breast reconstruction, cosmetic or aesthetic breast augmentation or revision, or revision of a prior breast reconstruction.All treating surgeons were experienced with using both hADMs in ADM-based breast reconstruction, and their general surgical technique and postoperative protocol was similar between surgeons and hADM products. Both SimpliDerm and AlloDerm RTU were prepared based on the appropriate manufacturer’s instructions and used to cover the tissue expander Figure . The choStandard patient-specific and procedural data were extracted from the medical records along with peri- and postoperative outcomes and complications. Complications related to surgical procedure or disease were reported during the perioperative period and recorded as requiring or not requiring explantation and/or surgical intervention. Adverse events were recorded as any untoward medical occurrence in a study subject that occurred at any time during follow-up and may or may not have been related to the study intervention. Serious adverse events were those considered to be life-threatening, resulting in death, requiring hospitalization, resulting in significant disability, or requiring intervention to prevent these outcomes. Major complications were defined as those requiring hospitalization and/or surgical intervention, and minor complications as those requiring outpatient clinic treatment only .Statistical analysisContinuous variables were assessed for normality. Independent samples t-tests were used to compare mean differences between cohorts. Medians were compared using Mann Whitney U test. Pearson chi-squares were reported for comparisons with expected cell counts of five or greater, and Fisher’s exact tests were reported if a cell count was less than five. Statistical significance was set to P<.05. SPSS version 26  was used for statistical analysis.Records from four centers in the US totaling 107 patients (181 breasts) who underwent immediate, two-stage, tissue-expander-based breast reconstruction with the use of SimpliDerm  or AlloDerm RTU , followed by exchange to permanent implant(s), tissue expander(s) explant, or death were reviewed during the study period.Patient demographicsPatient demographics are listed in Table Relating to ADM types, there were no statistically significant differences between groups for patient age, race, BMI, smoking status, medical history, or pretreatment medications Table . RegardiProcedural detailsMastectomy indication was predominantly for the treatment of malignancy (87.3%) Table . The plaThe bilateral reconstruction rate did not differ by ADM type  Table . Use of Follow-up and complicationsFollow-up details and reported complications are listed in Table Median follow-up time was similar between groups , trending toward longer follow-up time in the AlloDerm RTU group . There were no differences between groups in the proportion of patients who reached their exchange procedure  or in the number of days from reconstruction to exchange. The proportion of patients with complications requiring surgical intervention or resulting in explantation also did not differ between groups - a total of six patients in each group had a complication that resulted in explantation . Final expander fill volumes and permanent implant volumes for patients who underwent an exchange procedure (N=162 breasts) also were comparable between groups  were reported in 27 (25.2%) patients  were similar to the number of patients in previously published analyses (10.6% - 33.3%) which described significant associations with postoperative complications , 23, 26.Ethnicity and outcomes of breast reconstructionIn general, ethnicity is under-reported in ADM-based breast reconstruction publications, and the relationship of ethnicity to access to care and clinical outcomes can be complex. Many studies have reported lower rates of breast reconstruction and higher rates of adverse events following reconstruction in Hispanic and Latino patients compared to non-Hispanic whites -30. The LimitationsThis study was limited by its retrospective and non-randomized design, the number of patients, mixed plane of expander/implant placement, and length of follow-up. The non-randomized design makes it difficult to understand if patient selection played a role in the over-representation of individuals with specific characteristics, such as pretreatment chemotherapy or Hispanic or Latino ethnicity, or how these characteristics may have affected outcomes. Also, since our ethnicity data were gathered retrospectively from existing patient charts, the accuracy of this data is unknown. The modest sample size may have prevented the identification of statistical significance in outcomes that showed numerical trends. Additional studies are warranted to determine clinical outcomes between sub- and pre-pectoral placement in patients receiving these ADMs, as this was not possible with our small cohort. Studies reporting long-term clinical outcomes will further our understanding of these ADMs and their long-term complication profiles. These limitations, while frequent in recently published studies due to intrinsic challenges related to studying ADMs in post-mastectomy breast reconstruction, nevertheless limit the interpretability of study findings. The longer-term (post-exchange procedure) consequences of post-mastectomy breast reconstruction remain an additional clinical concern and need to be addressed in future investigations.Implant-based breast reconstruction will continue to be performed in conjunction with ADM, as more studies continue to demonstrate the safety and clinical and aesthetic benefits in this setting. Our findings support that SimpliDerm is a clinically equivalent ADM to AlloDerm RTU that is safe and effective for two-stage breast reconstructions through over four months of follow-up.


Parkrun has grown to be one of the most popular. The present study identifies the motives of residents in the Western Cape Province to join parkrun and how their involvement influences future physical activity levels. Participants (N = 1787) completed a survey consisting of demographic history, parkrun participation history, motivations for participation, and physical activity-related behaviour changes associated with parkrun participation. The majority of participants were female (n = 952) and over 50 years of age . Along with health-related benefits, the provision of a safe and organised event was reported as a key motive to participate. The social connectedness developed by parkrun encouraged continued participation and promoted uptake of more physical activity. Close to half the participants reported increases in physical activity levels after joining parkrun, which demonstrates the benefit obtained from participation in structured mass participation events. With the large diversity in socioeconomic status in South Africa related to physical activity levels, parkrun provides a protected and engaging environment that provides opportunity for increased physical activity and potentially reducing the burden on the healthcare system.Mass participation events are promoted in South Africa as a positive public health initiative.  South Africa is a low- to middle-income country (LMIC) with diverse cultures and people of different socioeconomic strata . Physicaparkrun. Parkrun is a weekly free mass participation event held in parks and other free open areas [Mass participation physical activity events have been used to increase positive health behaviour among participants . These aen areas . In Soutparkrun to be associated with positive improvements in both physical and mental health and well-being [parkrun was important in engaging physically inactive participants; low socioeconomic communities were more likely to participate, and non-active runners used the events as an easy access starting point. Each event also creates a sense of belonging and social connectedness, which is a strong motivation for continued participation [parkrun as a mass participation physical fitness event.Research has identified participation in ll-being ,12,13. Scipation . A sensecipation . When apcipation . Thus, aparkrun seeks to address as a mass participation event to encourage physical activity [parkrun, and to ascertain the physical activity-related behavioural changes among registered parkrun participants in the Western Cape Province of South Africa.However, the majority of this research has been conducted in Australia and the UK ,17, and activity . The aimparkrun Global and parkrun South Africa, all registered members of the 37 parkrun South Africa sites in the Western Cape were contacted via email with details about the study, a plain language statement and a link to complete the online survey. Face-to-face collection was also conducted to include participants at three sites  who may not have had access to data or electronic resources required to complete the online questionnaire. Participants at these sites were recruited through short announcements made by parkrun organisers before the start of each event. After each race, interested participants completed informed consent and the survey in hard copy. Participants who completed the online questionnaire were not included in the face-to-face survey to prevent duplication of results and vice versa. To be eligible in either format, participants had to be over 18 years of age, registered with one of the regions of Parkrun sites, and to have completed a minimum of two parkrun events in the preceding six months.Following formal permission from parkrun study in Australia [parkrun participation history, motivations for participation, and physical activity-related behaviour changes associated with parkrun participation. Minor adaptations were made to improve the contextual relevance of the questionnaire to South African parkrun, and included information on Discovery Health Vitality points. Discovery Health is South Africa’s biggest private medical aid covering healthcare costs. It rewards members who are registered in their Vitality Programme with points when they engage in health-/fitness-related activities, e.g., gym attendance, health screening, participating in parkrun, total daily step count, etc. For each parkrun event completed, members get 300 points. Once accrued, points can be redeemed for discounts on services and purchases. In an effort to improve response rates, the survey was compressed into the smallest functional size, and took on average four minutes to complete.A survey, adapted from a previous ustralia , was useparkrun. The online version of the survey was completed over a two-week period in August 2019. Face-to-face data collection, using a paper-based survey that was identical to the online version, was completed at eight parkrun events over a five-week period in August and September of the same year. The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the University of Cape Town, Faculty of Health Sciences Human Research Ethics Committee (HREC REF 119/2019 and HREC REF 142/2019). A certificate of approval was also granted by the parkrun research board.Initially the survey was forwarded to experts in physical activity and wellness in public health for assessment of the content and construct validity related to the adaption of the original survey to a South African audience. Three experts gave feedback on the clarity and relevance of the questions and recommended the inclusion of socialisation as a motivation for participation and including comments for participants regarding motivation and physical activity before and after joining parkrun. Independent variables used for this analysis include gender, education level, and gym membership. For all statistical analyses, a p-value less than 0.05 was accepted as statistically significant.All face-to-face data collected were manually coded and saved for analysis. Informed consent was not provided by 627 participants and they were excluded, along with 169 who did not meet the inclusion criteria and 222 who had incomplete data. Statistical analyses were performed using TIBCO Software’s STATISTICA application version 13.5.0.17 and Graphpad Prism software version 8.3.0. The Shapiro–Wilk test was used to assess for normality among continuous variables of age, height, weight, and body mass index (BMI). All data were found to be not normally distributed. Categorical data were analysed based on frequency and grouped in relation to gender, educational level, level of physical activity, and motivation for participation. Associations between categorical variables were assessed using the Chi-square test of association. The Kruskal–Wallis H test was used to determine differences between at least three independent groups on total activity times (dependent variable). The Wilcoxon signed rank test and the Mann–Whitney U test were used to compare physical activity levels before and after joining A final sample consisted of complete data for 1787 participants. The majority of participants were female, aged 50 years or over, and had a BMI in the overweight category. Most participants were married, had completed higher education, were employed, reported to be in very good personal health, and were regular exercisers see .parkrun were compared, using Chi-square, according to sex. Women favoured a safe environment, stress relief, and cost as their main motivations, whereas men recognized competition with others as a key motivator  or increased their weekly physical activity levels (n = 429) after joining parkrun. All participants who reported increasing their physical activity levels after joining parkrun were grouped according to demographic characteristics  took up new activities  and over the age of 50, which is comparable with parkrun participation globally [parkrun in Australia and the UK [The aim of this study was to identify the motives for participant in globally ,17. Partd the UK . This isd the UK , which md the UK . Educatid the UK  and may parkrun. There are considerable health and fitness benefits, including positive changes in weight, increases in cardiorespiratory fitness, and improvements in mental health [parkrun and initiate new physical activity practices, which is common within exercise motivation literature [Multiple motives exist for initiating participation in l health ,24. Evenl health . An additerature .parkrun as a safe environment for exercise participation. Over 79% of households in South Africa feel unsafe in their neighbourhoods [Parkrun is a community event manned by community members and volunteers to ensure safety for participants. Women in particular identified this as a motive for participation. This is a consistent barrier to participation globally [Parkrun addresses these issues and provides a safe space for exercise for all groups. It is not just a safer physical environment that is provided, but also a family-orientated nature [parkrun is on fun, enjoyment, and personal development, which can break down recognised barriers to women’s participation in physical activity [Many people chose ourhoods . Parkrunglobally . Parkrund nature . The focactivity . Furtheractivity .parkrun is of great importance to continued participation. Parkrun creates a community and provides a sense of belonging. Over half the respondents in the present study reported socialisation to be influential to their participation. Similar findings have been attributed to parkrun globally [Parkrun also promotes a system that encourages participants to volunteer in the organisation and running of each event. This approach supports more social interaction, with group identification and participation known to have a reciprocal relationship [parkrun participants are able to gain a sense of autonomy. Competence is also developed and supported by the recognition of achieving personal goals and reaching milestones of 50/100/150/etc. runs [The socialisation that is provided by globally . Parkruntionship . Consisttionship . Applyintc. runs .parkrun. Only a small percentage, much lower than the national average [parkrun, with women most likely to incorporate more regular exercise and increased physical activity into their lifestyle. A similar finding has been reported in both Australia [parkrun, almost three quarters now integrated regular exercise into their daily life. This increased physical activity has the potential to reduce incidence of NCDs [parkrun, appears to be an important strategy to encourage less physically inactive lifestyles.The large majority (83.4%) of participants were physically active  prior to joining  average , classif average . The lowustralia  and the ustralia . Further of NCDs . In LMICparkrun participants in the country due to the diversity of South African socioeconomic demographics. A logical first step would be to replicate this study in a greater proportion of the South African population to ascertain a more complete overview and minimize any selection bias. Furthermore, only active and registered parkrun participants were recruited and the results may not be applicable to non-parkrunners and those who had previously participated in parkrun and since withdrawn. The current study used a cross-sectional design and therefore, it is not possible to determine a cause-and-effect relationship in describing the various variables in the study. Although there were instances where people reported losing weight after parkrun, this could be as a result of other factors and not due to parkrun alone. A longitudinal prospective study is advised to evaluate health-related behaviour changes and motivations of parkrun participants.The Western Cape Province is one of the most economically active provinces of South Africa, contributing over 13% to the national gross domestic product and providing 23.6% of the country’s employment in 2018 . As suchparkrun for physical and mental health benefits. The provision of a safe environment for physical activity by parkrun is an important factor, particularly in LMICs, and encourages greater participation from women and older people. The added dimension of social connectedness from an organised, regular mass participation event appears to increase self-determined behaviours and encourage persistence and continued physical activity. This may contribute to better health and reduce the load on the national health system. Almost half of all respondents reported increased physical activity since joining the parkrun community, demonstrating an opportunity for mass participation events to become an efficient method for improving the health and well-being of the general population.In general, residents in the Western Cape Province of South Africa reported in this study that they participated in


Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features.st 2020 and August 6th, 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. “traditional” vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset.We searched PubMed and EMBASE covering the period between January 1Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18–27%) of subjects after the first dose of vaccine and in 29% (95% CI 23–35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10–12% of cases. No differences were detected across different vaccines or by mRNA-based vs. “traditional” ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown.Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40–60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid.The online version contains supplementary material available at 10.1186/s10194-022-01400-4. In late 2019, SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), the etiologic agent of Coronavirus Disease 2019 (COVID-19) spread rapidly into the human population causing a global pandemic, with a relevant impact on mortality but also on a multi-organ morbidity  and COVIAccording to recent data published by the U.S Centre for Disease Control, referred to 13 jurisdictions and to the period April 4 – July 17 2021, 92% of infections, 92% of hospitalizations and 91% of deaths were observed among not fully vaccinated (i.e. one dose of two-doses products) or unvaccinated people compared to fully vaccinated (i.e. two doses or one dose of one-shot products) . Data puThe first vaccines against COVID-19 were introduced in some countries in the second half of 2020 . Since tHeadache is one of the most frequently reported adverse events (AEs) after vaccination, with some differences in term of incidence related to different vaccine type and dose. In some recent meta-analyses , 14, datWe will probably have to deal with COVID-19 prevention treatments for the next years, and the definition and incidence of possible side effects is crucial. In addition to being a common post-vaccination AEs, headache constitutes the cardinal symptom of primary headache disorders, which are among the most prevalent and disabling conditions , and oneWe conducted a literature review with meta-analysis and reported results according to the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) .Search terms had to combine information three main terms, i.e. COVID-19/SARS-CoV-2 AND Vaccination AND headache/adverse events. For each of three main terms, PubMed and EMBASE were searched using either free text and MeSH and EMTREE terms. The PubMed search was synthetically organized in this way: [COVID-19 (MeSH) OR COVID (free search in ti/abs)] AND [COVID-19 Vaccines (MeSH) OR Vaccin* (free search in ti/abs)] AND [headache (MeSH) OR headache (free search in ti/abs) OR trial OR side effect (free search in ti/abs)]. Similarly, the EMBASE search was synthetically organized in this way: [Coronarvirus OR SARS-CoV2 (emtree) OR COVID (free search in ti/abs)] AND [SARS-CoV2 Vaccine (emtree) OR Vaccin* (free search in ti/abs)] AND [headache (emtree) OR headache (free search in ti/abs) OR trial OR side effect (free search in ti/abs)].st 2020 and August 6th, 2021, looking for record in English and with an abstract. The full search strings are reported in the PubMed and EMBASE were searched covering the period between January 1Retrieved references were exported as.csv files and imported to Rayyan QRCI  for duplRetrieved references were equally and randomly assigned to the authors who screened titles and abstracts for eligibility. Nine authors  performed the double check about titles and abstracts eligibility of 20% randomly selected references.To be eligible and be evaluated in full texts, records had to be referred to primary research and to report, in titles and abstracts, information on headache incidence following vaccination against SARS-CoV-2. Authors were instructed to select records if they: a) referred to vaccine for SARS-CoV-2, or similar terms; b) were primary research articles; c) mentioned safety profile/adverse events; d) mentioned headache post-vaccination. Conversely, authors were instructed to exclude records if they: a) were published before 2020; b) did not have an abstract; c) were not in English; d) were letters, editorials, conference material, book chapters, case reports, literature reviews or meta-analyses; e) were clearly out of topic ; f) referred to pediatric populations (aged below 12) exclusively.In this phase, the agreement among the judgements of the raters (inter-rater reliability) was estimated with Krippendorff's alpha coefficient (α) ranging from 0  to 1 . In case of disagreement, the record was retained for full-text evaluation. In case α was below 0.70, a second 20% set of reference was submitted to double check.Eligible references were equally and randomly assigned to the authors who screened full texts for inclusion. For full texts evaluation, studies were excluded if: a) were not available in full text; b) were not in English or published before 2020; c) did not refer primary research on COVID vaccine trials ; d) were not based on adult humans ; e) did not report data on safety issues and adverse events derived from a systematic evaluation, i.e. we excluded studies in which a case report form (CRF), either self-reported or based on structured interview with a health professional, was not used.Five authors  performed a double check on 50% of the full texts with regard to their eligibility and Krippendorff's α was calculated: the choice for such a high rate is due to the large set of co-authors.Data extraction was performed through an ad hoc electronic spreadsheet of Microsoft Excel for Windows. Included studies were equally and randomly assigned to the authors who extracted information on the sample considering the whole sample, the sub-sample receiving placebo (where applicable), the sub-sample receiving each vaccine (for studies reporting information on more than one vaccine type), as well as for all subjects receiving any kind of vaccine.Extracted information included basic information, such as total number of participants, number of females, and average age, as well as the core information, i.e. the number of subjects who developed headache after vaccine or placebo inoculation. Additional information was: the number of subject developing migraine-like headache; the number of subject developing TTH-like headache; the number of subject with history of any headache; the number of subject with any chronic medical condition; the rank position of headache among reported AEs; the average days between injection and headache onset. With the exclusion of the last variables (which had to be reported directly), if the information was not directly available , it had to be calculated. Finally, authors were asked to refer whether the trial was in Phase II, III or IV, and whether the sample was entirely composed of subjects with specific health conditions .A final control measure was made on extracted data: five authors  double checked 100% of extracted data. Such a choice was again made in consideration of the large amount of authors selecting full-texts and extracting data.We descriptively summarized data reported to provide an overview of the included studies and samples in the studies, using medians and interquartile ranges (IQR) for raw data. The measure of interest was the proportion of subjects who developed headache among those who received vaccination of any kind, or placebo.2-test, and significant heterogeneity was defined when P-value was below 0.10. Inconsistency was quantified using the I2 statistic [2 below 40% indicates no or not relevant heterogeneity; I2 comprised between 30 and 60% indicates moderate heterogeneity: I2 comprised between 50 and 90% indicates substantial heterogeneity; I2 higher than 75% indicates considerable heterogeneity [The 95% Confidence Intervals (95%CI) were based on Wilson’s procedure . Due to tatistic : I2 beloogeneity . MS exceSub-analyses included: analysis of headache development by single vaccines, for those vaccine type in which there were at least three studies; comparison between vaccine recipients (taken as a whole) and placebo recipients; comparison between first and second doses in terms of headache onset ; comparison between newly-developed mRNA-based vaccines and traditional vaccines (inactivated and vector-based vaccines) recipients.Finally, to address the impact of age and sex on headache development, a meta-regression analysis was performed. Mean participants’ age and percentage of females in each single study were entered as moderators for the effect of vaccination or placebo on headache development. Meta-regression can be performed only if at least 6 effect size estimates with corresponding data for moderators are available: thus, it was run only for a portion of compounds and placebo .Once duplicate were removed, a total of 9338 records were selected for abstract check. Of them, 298 records were retained (double check agreement 98.1%) for full-text evaluation, which resulted in 84 papers included in the review (double check agreement 98.0%) –110  of subjects developed headache after the first dose of vaccine and 29% (95% CI 23–35%) after the second, and that these rates were two-fold higher compared to those receiving placebo (10–12%). Headache was generally reported as the third most common AE, the first usually being pain at injection site. No significant differences could be observed between vaccines based on the new mRNA technology and “traditional”  ones, together with a minor impact of age, which enables presuming that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction.After almost two years since the beginning of the COVID-19 pandemic, the SARS-CoV-2 is still causing a large number of deaths worldwide, and vaccination campaign is the most promising and safe way to reduce its spreading: this in fact means to reduce the impact of COVID-19 on the health of citizens , by reduFirst, included studies report largely heterogeneous results on onset of post-vaccination headache, with no information about pre-existing headache disorders, which might act as risk factors for post-vaccination headache development. Moreover, no information on headache features, time to onset, duration and response to acute treatment could be derived by included studies. So, our literature review cannot provide direct evidence on pre-existing headache and features of post-vaccination headache, which is fundamental to determine if headache occurring after vaccination against SARS-CoV-2 can be considered as one of the usual headaches (for those with previous history of headache), or a totally new headache.The main reason for such a poor description of headache features lies in the selection criteria we applied, i.e. that we selected studies focused on vaccine efficacy, in which headache was addressed within solicited AEs, i.e. using structured CRFs. In most cases, such AEs were collected within 7 days from injection: this clearly leaves poor data to present the features of such headache, and thus such data do not enable to distinguish reversible, common and non-severe cases from those that should be considered as red flags for life threatening conditions, like cerebral venous thrombosis (CVT). Some reports specifically address headache as a premonitory symptom of CVT in non-replicant adenovirus vector based COVID-19 vaccine recipients , 118. SuHowever, in most cases, headache occurring after vaccination from SARS-CoV-2 is reversible, with onset few hours after vaccine receipt and a few hours to few days’ duration. Two manuscripts showed differences between first and second dose: our results show headache is more common after the second dose, but one study by Perrotta and colleagues showed the opposite (29.2% after the first and 22.1% after the second) . The sevFinally, with regard to the features of headache occurring after SARS-CoV-2 vaccines, some inputs were available in four different studies , 121, anWith regard to treatment for post-vaccination headache, available literature provides little information. The aforementioned studies , 121 shoThe possible mechanism of post-vaccination headache is currently unknown and, in order to make some hypotheses, a step back to the mechanisms that have been hypothesized for SARS-CoV-2 to spread and impact on human body is needed. Several possible routes for SARS-CoV-2 virus spread in the human body are currently postulated: use of the bloodstream with subsequent neuronal dissemination, infection of endothelial cells within the blood–brain barrier (BBB) or blood-cerebrospinal fluid barrier, use of transsynaptic pathways after infection of the endings nerves (forward or retrograde transport) mainly in the olfactory bulb, crossing the BBB as a result of leukocyte infection (Trojan horse mechanism) or through the use of the glymphatic system , 123. HoSARS-CoV-2 has been shown to be a neurotropic virus that has the ability to infect and replicate in cultures of neuronal cells and brains . It seemCOVID-19 related headache is frequently accompanied by osmophobia, phonophobia, and photophobia, which are less frequently reported in post-vaccination headache. In addition, other clinical features may present with some differences: post-vaccination headache is in fact mostly bilateral, less intensity and shorter duration than COVID-19 related headache . Post-vaProbably the only common denominator for all of the analysed vaccine types is SARS-CoV-2 spike protein (SP). SP binds with ACE2 and leads to diverse biological, and potentially pain-related reactions . PresentThere exists an alternative to above described rationale. It attributes this symptom to disorder of homoeostasis. Vaccines are designed to induce humoral and cellular immunity. These reactions include diverse mechanisms, some of which possibly may provoke headache. Adaptive immune reaction takes days or weeks to develop, and hence would not provoke headache occurring hours after vaccination. However, innate immunity has been proven to begin within hours after vaccine administration , 138. ThThe attribution of headache to immune reaction is a compelling idea. It could be hypothesised that in this situation a more robust immune reaction could translate to more headache cases, but also more effective immunogenicity. Alas the studies from our meta-analysis did not try to find an association between post-vaccination headache and vaccine effectiveness. A post-hoc analysis could solve this conundrum. Finally, it should be mentioned that both of above-described mechanisms (SP and innate immune reaction) could explain many similarities between headache characteristics after COVID-19 vaccination , 121 andWhen discussing the possible mechanism of post-vaccination headache, one might wonder if, in the case of viral vector COVID-19 vaccines, the headache is not a consequence of systemic infection. Then the headache could be identified using ICHD-3 code 9.9.2.1 – Acute headache attributed to systemic viral infection. However, in such a case, one would expect a higher incidence of headaches from this type of vaccination, which was not observed in this meta-analysis. That is naturally a completely theoretical situation, since adenoviruses in vector-based vaccines are unable to replicate. Hence their spread is limited to the muscle where they were administered via injection.It should also be remembered that in very rare cases the headache following vaccination may be a consequence of a complication of the COVID-19 vaccination. Cases of cerebral venous thrombosis or ischemic stroke in unusual locations associated with vaccine-induced immune thrombotic thrombocytopenia (VITT) have been reported following ChAdOx1-S and Ad26.COV2S vaccine , 142. ThSome limitations have to be taken into consideration. First, we were unable to locate eight studies. Second, there was a considerable heterogeneity across studies and two very large studies account for approximately 85% of the studies’ sample . Third, there is a mixture of phase-II/III and phase-IV studies, and therefore comparison against placebo is not always reported. Fourth, we were unable to report information on headache type and duration, and on presence of headache before vaccination, as this kind of information was not reported among selected studies: the information reported in this manuscript referred to headache features and higher likelihood to develop it among patients with history of headache was in fact derived from descriptive studies which did not meet our inclusion criteria. Finally, we have no information at all whether being on a migraine-specific prophylaxis might have a positive effect on post-vaccine headache development.In conclusion, headache is the third most common AE associated to vaccination against SARS-CoV-2, and it occurred in 22% (95% CI: 18–27%) after the first and in 29% (95% CI: 23–35%) after the second dose over a 7-day period, and such rates are higher compared to those receiving placebo (10–12%) as well as compared to population studies showing 6–17% likelihood to have headache on the previous day. The features of such headache, in approximately one-third of the cases, resemble that of migraine with pulsating quality, phono and photophobia, whereas aggravation with activity is more common . Its onset is generally within the first 24 h and the majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid.Our meta-analysis showed no significant difference in the frequency of headaches observed with different vaccine types, which differ essentially in composition. Given the various mechanisms possibly implicated in the onset of post-vaccination headache, it seems most likely to be related to the systemic inflammatory response with a still unclear mechanism.Additional file 1.


Brassica juncea is a crucial cultivated mustard species and principal oilseed crop of India and Madhya Pradesh, grown for diverse vegetables, condiments, and oilseeds. Somaclonal variation was explored as a probable source of additional variability for the manipulation of fatty acids, especially low erucic acid contents that may be valuable for this commercially important plant species. The plantlets regenerated from tissue cultures (R0), their R1 generation and respective parental lines were compared for morpho-physiological traits and fatty acid profile for the probable existence of somaclonal variations. The first putative somaclone derived from genotype CS54 contained 5.48% and 5.52% erucic acid in R0 and R1 regenerants, respectively, compared to the mother plant (41.36%). In comparison, the second somaclone acquired from PM30 exhibited a complete absence of erucic acid corresponding to its mother plant (1.07%). These putative somaclones present a source of variation for exploitation in the development of future mustard crops with low erucic acid content. Brassica juncea L.) displays an immense polymorphism and is the basis of diverse types of vegetables, condiments, and oilseeds. It is an important oilseed crop globally, nutritionally affluent in fat, carbohydrate, vitamins, minerals, and water. As a result, its oil is expansively exercised in the medicinal, cosmetic and leather industries. It is an oilseed in high demand proving an increasing trend by fulfilling demand and supply with desired qualitative traits. The occurrence of erucic acid (C22:1) in elevated concentration (35–50%) is a significant drawback to mustard oil [Indian mustard  in further exploitation in conventional and/or molecular breeding programs. In vitro selection employing pathotoxins as a selection mediator for ca napus . Anuradhca napus  evaluated Chopra . Ahmad [d Chopra  attempten et al. . Roy andn et al.  identifin et al.  cultureda et al.  for engia et al.  to manips narrow , especias narrow , soybeans narrow ,23,24,25s narrow ,27,28, os narrow , and Witomnifera  with varIn the current investigation, an effort has been made to investigate the existence of somaclonal variation for low erucic acid content that can further be utilized as a source of added variability for the improvement of Indian mustard. To accomplish this, two genotypes viz., CS54 and PM30, were selected for the present research based on erucic acid content, whether higher or low, with two explants viz., immature cotyledons and seeds, to establish callus and subsequently to raise cell suspension cultures followed by an efficient and reproducible plantlet regeneration. However, the selection of genotypes with low erucic acid content with higher yield is hampered by various aspects, including plant species, genotypes, explant sources, nutritional requirements, and environmental behavior. Thus, the procedure and conditions for callus induction and shoot differentiation followed by plantlet regeneration were optimized for generating somaclones via callus and cell suspension cultures.The potential and limitations of the tissue culture technique for creating new genotype(s) with desired characteristics of agricultural importance have been documented in a considerable number of crop plants, including Brassica. Attempts to select lines with low and high erucic acid content are based on the assumption that depending on the cultivation protocol, the level and content of specific metabolites in tissue culture can be influenced to some extent. Certain metabolic pathways of a particular plant species lead to the synthesis of a specific metabolite . Their production also operates in cells and cell lines selected based on particular metabolite yield, and these lines were derived from the regenerant.In contrast, regenerants derived from these lines may have altered levels of certain metabolites of interest. –1 2,4 dichlorophenoxyacitic acid performed superior among all the combinations tested  medium amended with 3.0 mg Ls tested A–E from m et al.  and Nasrm et al.  were in m et al.  in soybe−1 2,4-D in combination with 0.5 mg L−1 6-Benzylaminopurine(BAP) facilitated higher growth rates  regeneration medium for shoot organogenesis  was induced on modified MS media supplemented with a higher intensity of cytokinin viz., kinetin or zeatin, in combination with lower indole-3-acetic acid (IAA). Cytokinin BAP alone or in combination with auxins IAA or α-naphthalene acetic acid (NAA) did not support plantlet regeneration [1 generation was obtained from the growing Ro generation.The response to callus induction applying 2,4-D was more pronounced in terms of type, nature, and color of callus proliferated. However, plant regeneration has not been obtained on a medium amended with 2,4-D alone from cultured immature seeds in optimum frequencies. Therefore, consecutively to augment shoot regeneration efficiency, callus cultures were subsequently inoculated on MS media fortified with BAP. Well growing callus cell lines of genotypes CS54 and PM30 were subjected to MS.5B  per plant, number(s) of seed per siliqua and plant, seed yield per plant, and biological yield when compared to mother plants. However, the number(s) of primary branches and days to 50% flowering were not significantly varied. The number(s) of secondary branches per plant increased in both putative somaclones significantly compared to the mother plant at a 5% probability level of significance. No statistically significant difference was recorded between the performance of R0 and R1 plants for different morphological parameters investigated except number(s) of silique per plant for somaclone derived from cell lines of genotype CS54 where R1 regenerants showed more number(s) of silique per plant as compared to R0 regenerants. Perhaps this happened due to the mutations of genes and induction of somaclonal variation and the activation of recessive genes that reduced expression of most morpho-physiological traits, as stated earlier by D’Amato [1 generation. Some of the plants showed significantly higher yield and/or other improved characteristics than the control. In addition, a dwarf plant type was also identified. Several plants were selected from this generation and carried forward to R2 generation, and most of these lines bred true in the R2 generation.The data of different morpho-physiological traits are presented in  D’Amato . They di D’Amato  also eva0 and R1 generations of putative somaclones regenerated from cell lines of genotypes CS54, it was interesting to note that plantlets regenerated in vitro, the erucic acid content recorded was 5.48% and 5.52%, respectively, in R0 and R1 regenerants as compared to mother plants (41.36%) of genotype CS54 . The percent value ranged between 2.88% and 10.90%. The highest content (10.90%) was recorded for Ethyl 9,12,15-octadecatrienoate, 9,12,15-Octadecatrienoic acid, methyl ester, -, and n-Propy1 9,12,15-octadecatrienoate at RT 10.4 on given conditions, whereas the lowest value (2.88%) was recorded for Ethyl 9, 12, 15-octadecatrienoate, 9, 12, 15-Octadecatrienoic acid, methyl ester, -, and n-Propyl 9,12,15-octadecatrienoate at 11.4 RT . These fype CS54 . However0 and R1 generations regenerated from callus and cell suspension cultures of genotype PM30 despite its presence (1.07%) in the mother plant. Although palmitic and oleic acid ratios considerably increased in R0 and R1 generations of putative somaclones compared to mother plants. Conforming findings have also been reported by Jagannath et al. [7 generation by Priyamedha et al. [B. junceia and B. napus had a fatty acid profile different from parental values, mainly for oleic and erucic acids. The low oleic acid (13%) in B. juncea increased to 23–26% in hybrids, and high erucic acid in B. juncea (41%) declined to 21–23% among hybrids. Linoleic and linolenic acids showed slight variation from parental values. The fatty acid profile of F1 hybrids shifted towards that of canola quality. The F2 seeds had zero erucic acid and high oleic acid, similar to or exceeding the canola parent. Successful interspecific hybridization of B. juncea and B. napus was confirmed by altered FAP and molecular markers [B. juncea showed an increase in oleic and linoleic acid content, while double zero varieties of B. napus showed a proportional increase in oleic acid content and reduced erucic acid content [0 and R1 generations of putative somaclones of both genotypes. It occurred perhaps due to the metabolic pathway of erucic acid synthesis, as immature cotyledons and seeds have taken as explants sources, and plantlets were regenerated from cell lines derived from these explants.Fatty acid profile analysis of somaclones derived from callus cultures of genotype PM30  also revh et al. , who obsh et al.  reporteda et al. . Amongst markers . Low eru content . In the After hardening, seven plants of genotype CS54 and eight of genotype PM30 were subjected to molecular confirmation. A total of twenty-three RAPD markers  were useFAE1) gene that translates the enzyme β-ketoacyl-CoA synthase (KCS) in erucic acid biosynthesis alleyway and catalyzes the first four enzymatic reactions in the synthesis of very-long-chain monounsaturated fatty acids (VLCMFAs) [FAE1 gene primes the forfeiture of occupation in enzymatic action and diminishes the gathering of VLCMFAs in seeds [0 and R1 generations of putative somaclones raised from both the genotypes compared to mother plants, possibly due to mutations.It has been proven that erucic acid content is governed by the fatty acid elongase 1 (VLCMFAs) ,46,47,48in seeds ,49,50. IBrassica juncea. The conventional breeding scheme reports, limited success in procuring low erucic acid content variants. In an earlier attempt, Roy and Saha [2 generation. In the transgenic approach conducted by Sinha et al. [Brassica [The present study is a probable first of its kind, regenerating low-erucic acid-containing variants employing a suspension culture for and Saha  screeneda et al. , the fata et al.  and showa et al.  offered Brassica ,16.Brassica, the in vitro regeneration capabilities have been genotype-specific [B. juncea, Hachey et al. [B. campestris, and by Zhang and Bhalla [B. napus.Further, the environmental and nutritional conditions can be controlled uniformly and precisely under tissue culture conditions, and at a given time large number(s) of somatic cell lines could be screened swiftly to regenerate variants. In genus specific ,51. Levespecific  in B. juy et al.  in B. cad Bhalla  in B. naTwo genotypes were selected based on different morpho-physiological, biochemical, and SSR molecular characterizations of Indian mustard genotypes ,5,6,7. T−1 sugar and 7.5 g L−1 agar, was supplemented to establish callus cultures from immature cotyledons and seeds, in turn, raising embryogenic cell suspension cultures. The culture media was prepared by making the final volume 1 liter, pH was adjusted to 5.8 ± 0.1 with 1N NaOH/HCl, and 7.5 g L−1 agar was added as a gelling agent. However, in liquid media for cell suspension culture, agar was not incorporated. The warm media in liquid state were dispensed into culture bottles (50–70 mL/bottle) and culture tubes (20–20 mL/tube) followed by sterilization at 121 °C and 15 psi pressure for 25–30 min in an automatic autoclave. Pre-sterilized 100 × 17 mm glass Petri dishes were used for the culture. Media combinations and other ingredients were shortlisted during preliminary experiments carried out in our laboratory. Basal media, PGR’s and other supplements were procured from Hi-Media® Laboratories, Mumbai, India.MS  was emplw/v) Carbendazim for 2 min followed by a rinsing with deionized water. The silique was further exposed to 70% ethyl alcohol for 2 min followed by surface sterilization by immersing in 0.1% mercuric chloride (HgCl2) for 1–2 min and finally three times with sterilized distilled water. Immature cotyledon (0.1 cm) and 1 to 2 mm sized immature seeds were excised from siliquae and cultured on pre-sterilized 100 × 17 mm glass Petri dishes containing 25–30 mL/dish media. All the cultures were incubated in racks inside a culture room exposed to a photoperiodic cycle of 16 h, at an intensity of 1600 lux luminance provided with cool white fluorescent light and 8h darkness at 25 ± 2 °C and 70% RH.Silique containing immature seeds were acquired and treated with Tween-20 for 10 min following cleaning with double distilled water followed by treatment with 0.25%  and were disquieted on a horizontal shaker (120 rpm) at 25 ± 2 °C in the absolute dark. After two weeks, cultures were subjected, under a photoperiod regime, each of 12 h light and dark at an intensity of 1200 lux luminance provided by white, fluorescent light. After two weeks, the cultures were sieved aseptically to eliminate large clumps, and 10 mL filtrate was appended with 40 mL of a fresh medium. The leftover filtrate was subcultured to establish new suspension cultures and for regeneration.−1 BAP) for regeneration and on non-selective media MS.5D.5B  or MSN.5B (MS +1.0 mg L−1 NAA + 0.5 mg L−1 BAP) for the continuation of organogenetic calli growth. After one month of incubation on the selection medium, callus portions with green shoot primordia were separated and transferred into shoot regeneration medium MS.5B (MS + 0.5 mg L−1 BAP). Well-developed cultures with regenerated shootlets were divided into pieces after 45 days and subcultured once again on regeneration media in glass jars to obtain multiple shoots and growth. The shootlets were allowed to grow under growth room conditions at 25 ± 2 °C, RH 75% and 1600 lux for 16 h light and 8 h dark cycles. Well-developed normal-looking shootlets of appropriate length (<7.5 cm) were then transferred to the rooting MS medium amended with 0.5 mg L−1 indole-3-butyric acid (IBA), 15.0 g L−1 sucrose, and 7.5 g L−1 agar in line with the suggestion of Tripathi et al. [Callus cultures/somatic embryoids of two genotypes viz., CS54 and PM30, were obtained from callus cultures. They sustained through continuous sub-culturing and were cut into small pieces. Five pieces of callus and 10–20 cell clumps acquired from liquid culture were picked arbitrarily and inoculated in a Petri dish containing selective media MS.5B  and sand (1:1:1) for 30 days, maintaining the light, humidity, and temperature at greenhouse conditions. After 30 days, well-developed regenerants were placed in a net house for 45 days before being transferred to field conditions, where they were grown till maturity and seed set.0 and R1 generations were compared with their respective mother plants for different morpho-physiological parameters viz., plant height, number(s) of primary and secondary branches, days to 50% flowering and maturity, number(s) of siliqua per plant, siliqua length, number(s) of seed per siliqua, seed yield per plant, and biological yield during field evaluation.Regenerants were assumed as putative somaclones, and RThe plantlets regenerated from in vitro cultures subjected to fatty acids analysis to characterize and quantify different fatty acids, including erucic acid content.× 150 mm), and 5 mL methanol was added to each tube, followed by two drops of concentrated H2SO4. Tubes containing oil–methanol–acid blends were kept in a water bath at 65 °C for an hour. Then tubes were cooled to room temperature, followed by the addition of 2.0 mL hexane into each tube. The tubes were vortexed and held till the hexane layer was settled out that contains methyl esters. The hexane layer (1.0–1.5 mL) was removed carefully using a micropipette and subjected to a 2 mL screw-capped tube. A small amount of hydrous sodium sulfate was added to each tube to seize moisture. A total of 1 mL of the hexane layer holding methyl esters was injected into a pre-conditioned gas chromatograph (GC).Five grams of Brassica seeds of both the genotypes were ground with a pestle and mortar to obtain a fine powder. The powder was shifted to a completely dry test tube  fitted with a mega bore column (30 m long and 0.53 mm Ø) assembled with OV-101, methyl silicone polymer, and applying a FID (flame ionization detector). The column temperature (150–270 °C), injector temperature (250 °C), and detector temperature (250 °C) were maintained. GLC was set to 10 °C per minute increment, and at the end, it was kept at 270 °C.Taq DNA polymerase with PCR buffer  added. The cycling parameters were: 45 cycles at 94 °C of 1 min, 1 min at 36 °C, 2 min at 72 °C with a final extension time of 7 min at 72 °C. Amplicons were separated by electrophoresis on 1.4% agarose gel and envisaged under a gel documentation system after staining with ethidium bromide.DNA was extracted from the young leaves of genotypes, viz., CS54 and PM30, and selected putative somaclone plants using the Qiagen DNA extraction kit. Extracted DNA samples were quantified with the help of a nanodrop spectrophotometer and diluted up to 25 ng/µL. For PCR amplification, a total of 23 random decamer primers  were empp < 0.05. The same letters in one treatment represent non-significant differences at p < 0.05.Experiments on in vitro culture, cell suspension culture, and plantlet regeneration were conducted in CRD (completely randomized design) with two replications for each treatment. For each replication, around 200 explants/cell clumps/embryoids were plated per culture media treatment. Fatty acid profiling was also conducted in CRD in two replications. While morpho-physiological data were analyzed in a randomized block design (RBD) with three replications and the data were analyzed as suggested by Snedecor and Cochran . The sigIn conclusion, two putative somaclones with low erucic acid derived from the cell lines of genotypes CS54 and PM30 have been developed during in vitro culturing, providing a reliable source of variability. Future studies must understand the mechanism of variable erucic acid content in somaclones derived from in vitro cultures, especially suspension cultures. It will help decide the selection strategy for developing low-erucic acid varieties of Indian mustard toward breeding and biotechnological prospects. These putative somaclones may be used in molecular breeding programs, considering them as a parent in the crop improvement program.


A number of studies have investigated the effectiveness of dance in older adults in the context of healthy aging. Analysing results across studies is important to understand whether dance in older adults is an effective adjunctive intervention for the healthy aging. To summarize the current research results about the effectiveness of dance in older adults in the context of healthy aging, and to identify key areas for future research. The search was conducted in Web of Science, PubMed and Google Scholar databases, using the following search string and Boolean logic  locating studies published between database inception and September 2018: Dance OR contemporary dance OR ballroom dance OR Latin dance OR standard dance OR hip-hop dance OR tango AND Cardiovascular OR circulation AND Emotion OR well-being OR blood pressure OR disease OR thrombosis OR vascular OR glucose OR blood OR cardiac OR mental OR heart rate. Two reviewers independently extracted studies data. Eight suitable publications were included. The results showed that dance promote improvements in cognitive parameters when compared to other types of exercise or no-exercise. Significant effects were found on some physiological parameters, even after a short intervention period. Dance proved to be able to assist older adults in the context of healthy aging. The improvements in the cognitive, physiological and motor control parameters are very relevant for this population, due to the impact in a better quality of life. During aging process, the pharmacological treatment in certain cases if necessary is indispensable and this fact is indisputable. However, any non-pharmacological procedures, interventions and programmes that does not disrupt correct bodily function regardless of age group but especially for the older adults is of interest, and even enthusiasm, provided it can be effective in the prevention of certain disease or simply improving well-being. This is especially true when positive effects are elicited on the cardiorespiratory fitness, psycho-motor skills , nervousOne prominent example is dancing, which represents one of the best physical activity (PA) especially recommended for older adults ≥60 y)  and bett0 y  and Despite the fact that exercise is recommended by the World Health Organization (WHO) to maintain health and prevent disease  and presPhysical inactivity is widely observed among individuals aged ≥ 60 years , althougIt seemed essential to investigate interventions designed to promote quality of life (QOL) and health for adults over age 60 years, helping them to ameliorate deterioration related with aging , 25 sincDifferent studies showed that PA could improve age-related changes and among different kind of PA dance is increasingly used as an intervention due to it combines many diverse features related to the physical and psychological aspects .Dancing is a social activity that comprises rhythmic, motor coordination, balance and memory, apart from its requirements for PA. These characteristics make dance a potentially powerful intervention for older adults , 28. HowA number of studies have investigated the effectiveness of dance in older adults in the context of healthy aging. Analysing results across studies is important to understand whether dance in older adults is an effective adjunctive treatment for the healthy aging. This review aimed to summarize the current research results on this topic, and to identify key areas for future research.The search for this narrative review was conducted in Web of Science, PubMed and Google Scholar databases, using the following search string and Boolean logic  to locate studies published between database inception and September 2018: Dance OR contemporary dance OR ballroom dance OR Latin dance OR standard dance OR hip-hop dance OR tango AND Cardiovascular OR circulation AND Emotion OR well-being OR blood pressure OR disease OR thrombosis OR vascular OR glucose OR blood OR cardiac OR mental OR heart rate.Coding of papers only allowed for studies that included at least one typology of dance, including but not limited to: contemporary, ballroom, Latin, standard, hip-hop, tango. The articles must refer to some cardiovascular or circulatory component; and must report a physiological or cognitive variable(s), in participants ≥50 years old. Studies of varying designs were acceptable for the purposes of this review however, technical reports, review articles, non-human based studies, or studies that did not report a physiological or cognitive output were not considered further.We conducted multiple searches in each selected databases and additional searches for relevant references and citations linked to the studies obtained during this primary search. The selection process sought to identify studies, of varying design, with no age restriction, that investigated multiple typologies of dance, cardiovascular and circulatory considerations and physiological and cognitive impact, and were published in English between database inception and September 2018. Two reviewers assessed all titles and abstracts and all full-text articles; decisions to accept or reject a paper were agreed between the first and second reviewer, and a third, independent reviewer helped achieve consensus if the first and second could not agree.Eight studies were included, which were in accordance to the eligibility criteria of this research and presented the best quality. The included studies were subdivided into three topics: 1) cognition, 2) physiological aspects, 3) motor control.et al. [Coubard et al.  examinedet al. [Kattenstroth et al.  investiget al. [In the prospective pilot study, Kim et al.  analysedet al. [Serrano-Guzman et al.  tested tet al. [2peak (L/min). Twenty-five older adults were attended the dance classes called Agilando for 1h/week for 24 weeks (intervention group), and 10 were not (control group). In neither of the groups, significant changes in cardio-respiratory performance were observed.Kattenstroth et al.  tested cet al. [2peak) and maximum heart rate (HRmax) were assessed during spiroergometric cardiopulmonary exercise testing on a treadmill. Before the dance training the mean results of VO2peak (mL⋅kg-1⋅min-1) and HRmax (bpm) were 24.3 ± 2.9 and 161.8 ± 15.5, and after the intervention 23.9 ± 3.2 and 164.5 ± 17.0, respectively. Neither VO2peak nor HRmax parameter changes were significant.Rossmeissl et al.  assessedet al. [2max (p<0.05) suggesting a significant increase in aerobic capacity post-intervention in comparison to pre-intervention. Authors described physical activity measure as the number of steps taken in each session: there was a significant increase in the number of steps recorded between the first and last training session  = 29.342, p<0.01). The number of steps increased from 761.4 ± 401.82 on the first session to 1679.9 ± 496.98 steps recorded at the tenth session.Sampaio et al.  evaluateet al. [Serrano-Guzman et al.  evaluateet al. [Wu et al.  analysedet al. [2peak), first and second ventilatory thresholds (VT1 and VT2) among ten women from 60 to 75 years old. The results of VO2 (mL⋅kg-1⋅min-1) are: VO2peak (23.3 ± 4.3), VT1 (17.2 ± 3.5) and VT2 (20.9 ± 3.4). Dancing: warm-up , across-the-floor (14.2 ± 2.4 ~62%VO2peak), choreography (14.6 ± 3.2 ~63%VO2peak) and show . Since cardiorespiratory demands of a dance class for older women are at low aerobic intensity, authors concluded that a dance class may be modulated to improve aerobic fitness, at least at initial stages of training.Rodrigues-Krause et al.  assessedet al. [Kattenstroth et al.  performeChoice reaction and visual analysis of processing time were performed using the standardized Reaction Time Analysis (RA) implemented in the Viennese test system , which is based on a model assuming additivity of factors of the perception, cognitive processing and motor response. Posture and balance were analysed using a force platform. The performance of small hand and arm movements was evaluated using a commercial, computer-based test-battery for clinical neuropsychological research. This test assesses the degree of ataxia and the speed of movement by the ability of making rapid repeated aimed movements. Touch threshold was evaluated by probing the fingertips with von Frey filaments . Spatial 2-point discrimination (2pd) thresholds were assessed on the tips of the left (LID) and right (RID) index fingers by using the method of constant stimuli.p-value 0.073). For the domain of tactile performance, subjects in the dance group showed lower touch and 2pd thresholds, made fewer mistakes, and were faster in the haptic object recognition task. Postural performance improved significantly among subjects in the dance group. No differences were ascertained for subjects in the control group.In all tests contributing to reaction times, significant improvements were found for the dance group while no differences were found in the control group. In the domain Hand/Motor performance, subjects in the dance group showed a significant reduction of the number of errors for steadiness and a speeding up for aiming and pin plugging  and gain in performance after the intervention showed that subjects characterized by a low performance at the baseline attained higher individual gains. Significant correlations were found for reaction times , hand/motor performance , the tactile domain , and posture .This review aimed to summarize the current research on the effectiveness of dance in older adults in the context of healthy aging and to identify research gaps that need to be addressed in the future.In total, we found 8 suitable publications that investigated the specific effects of dance in older adults on cognitive, physiological, and motor control parameters related with aging. The small number of included publications on this review, as well as the fact that the oldest publication was published in 2011, indicates that dance for older adults as a potential intervention to enhance healthy aging is a relatively new area of research. However, various outcomes have been investigated as cognitive, physiological, kinaesthetic, motor and non-motor symptoms.It seems to be obvious that not all symptoms of aging can be reduced in the same way with different kinaesthetic, physiotherapeutic and physical activity approaches. However, this review, after analysed results across studies, aimed to indicate that these aging symptoms might be reduced due to participation in dance interventions.Furthermore, the study results showed especially promoting aspects of dance intervention in cognitive parameters what seems to be interesting in context of WHO principles and modern approach there is “no health without mental health” . Since aet al. [Cognition is a general term that refers to the mental abilities, which includes the short- and long-term memory, working memory, verbal fluency, and the ability to feel, to think, to reason, to form complex structures of thought and to respond to external stimuli , 45. Coget al.  outlinedet al. [2peak, lower body muscle power and static balance. Interestingly, we have observed non-significant changes in blood pressure [2peak and HRmax [et al. [In the cardiorespiratory parameters we found different results. Rodrigues-Krause et al.  indicatepressure , VO2peaknd HRmax . Kattens [et al.  found noTo create positive changes in cardiorespiratory system, increasing aerobic capacity, aerobic endurance, maximal oxygen uptake and other physiological parameters, there is needed appropriate adjustment to age and health status bout of appropriate intensity, volume and weekly frequency of exercise. During aging aerobic and anaerobic capacity and power decline -49. Howe2max [It is particularly interesting that significant effects were found on some physiological parameters, as VO2max  and mobi2max , even af2max , 31, 34.max). In addition, muscle mass plays a particularly important role in the elderly since muscle metabolism, and the associated myocyte oxygen, stimulates the cardiovascular system to produce more intense functioning. In the group of older adults, this is one of the main reasons for the decrease in the exercise capacity, especially after exceeding 60 years old and in women in the postmenopausal period.For older adults, it is also possible to observe training adaptation in terms of cardiorespiratory parameters. However, in their case, physiological processes look much different than young people. Among others, in older adults appears a natural decrease in aerobic and anaerobic capacity resulting from the reduction of the body's tolerance to training, lowering the maximum values of the oxygen uptake, which reduces the maximal cardiac output  it provides up-to-date summary of dance studies in relation to cognitive and physical health status in older adults, (2) our inclusion and exclusion criteria did not negate studies with symptomatic samples and this potentially prevented the results bias. Although this review provides some evidence of the beneficial effects of regular dance activities on cognitive functions, physiological markers and multiple physical fitness components (mainly cardiorespiratory fitness), future studies are needed to validate the hypothesis that dancing could simultaneously improve cognition functions, physiological status and physical fitness of elderly populations. Moreover, future research should also move beyond investigating effectiveness and begin to refine the prescription of training to promote the greatest benefits in terms of healthy aging concept.Dance proved to be able to assist older adults in the context of healthy aging. The improvements in the cognitive, physiological and motor control parameters are very relevant for this population, due to the impact in better quality of life.We identified a lack of studies and scientific information in the area of dance and older adults, indicating that this area of research is relatively new. It is suggested that another research conducted in this field, should include different outcomes and should be studied with greater and better scientific accuracy, as clinical trials.