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Hypermobility syndrome usually causes pain in limbs from extension type injuries. The authors report on a 16-yr-old female adolescent with incapacitating chest pain secondary to extreme hypermobility of the chest. This pain led the patient to see multiple specialists without improvement or diagnosis. Physical examination results revealed a very hypermobile patient who was able to internally rotate her shoulders inward until her elbows touched. This unusual hyperextension maneuver was achieved by holding the shoulders in anteversion with her hands on her hips (see figures in the article). Currently, there is no literature reporting hypermobility as a cause for chronic chest pain. Pain medication including opioids did not reduce the patient's chronic chest pain. Specific physical therapy to strengthen core and chest wall muscles in addition to working on proper breathing techniques with the diaphragm decreased pain and resulted in a resolution of this condition. We report that hypermobility can cause significant chest pain and may require creative physical therapy to strengthen the specific musculature. [ABSTRACT FROM AUTHOR]

Pectin is a co-product from juicing and the physico-chemical quality is important to functionality of pectin in food and pharmaceutical applications. Juice and peel from Huanglongbing (HLB) control and infected Valencia oranges were analyzed. Infected fruit had smaller diameter, lower L* and b* values and highly variable a* values. Juice from infected fruit had higher pectinmethylesterase (PME) activity of 1.5 Units/mL, which retained higher activity during 15 days of storage at 4 °C, and juice had higher cloud loss. Also, the juice obtained from infected fruit had lower °Brix (8.5–8.9), higher titratable acidity (0.71–0.88%), and lower pH (3.45–3.75). Molecular weights of 154–157 kDa and degrees of esterification of 65–67% were similar. Pectin yield from dried peel was reduced by 6% in infected fruit to 4.18 g/100 g. Total neutral sugars in pectin from control fruit were higher, 84.1 μg/mg, compared to infected fruit, 60.7 μg/mg. Glucose, galactose, and arabinose, were higher in control fruit, 25.0, 40.8, and 9.7 μg/mg, compared to 14.5, 27.4, and 8.3 μg/mg in infected fruit. Viscosity was 0.015 Pa s, in 1% pectin from control or infected fruit (p > 0.05). Juice quality, including cloud stability, was negatively impacted by HLB, however pectin functionality was minimally impacted. • Huanglongbing negatively impacts citrus juice ◦Bx, pH, titratable acidity, color. • Juice from infected fruit has higher pectinmethylesterase activity and cloud loss. • Lower yield of pectin from peel was obtained from infected fruit. • Pectin is similar in control or infected fruit. [ABSTRACT FROM AUTHOR]