Distraction Process Research Articles

Optic nerve elongation during fronto-facial surgery for Crouzon syndrome: 3D quantification and clinical implications.

Fronto-facial monobloc advancement with internal distraction (FFMBA) is a key procedure in the management of syndromic craniosynostoses. FFMBA involves circumferential dissection and linear enlargement of the orbit, potentially leading to mechanical stress on the optic nerve (ON). Several reports of transient vision loss during the distraction process led us to investigate ON shape modifications during facial advancement, with the aim to potentially refine current clinical guidelines on postoperative management and the distraction schedule. Twenty-six patients with Crouzon syndrome were included in this study. ONs were segmented on pre- and postoperative CT scans. Distraction amplitudes, linear and curved lengths, and cross-section diameters of the ON were assessed along the main axis of the nerve. A two-level hierarchical multivariate linear model was used to screen for factors associated with ON morphology. The mean age at FFMBA was 4.4 ± 3.8 years. Two patients presented with transient impaired vision during distraction. The final mean fronto-orbital and temporo-zygomatic distraction amplitudes were 18 ± 4 mm and 18 ± 6 mm, respectively. At the end of distraction, ONs were elongated (+1.8 mm for curved lengths, p = 0.013), and their mean cross-section was reduced (-1.9 mm2, p < 0.001) in the proximal intraorbital portion (first 15 mm). In the 2 patients with visual symptoms, functional impairment was associated with ON area reduction (OR 0.487, p < 0.001) and increased temporo-zygomatic distraction amplitude (OR 2.240, p < 0.001). ON was elongated during FFMBA, with proximal diameter reduction. Transient visual impairment with normal fundus examination during distraction seemed to have a morphological basis, based on 2 cases. These results suggest the importance of vision monitoring associated with fundus examination during distraction, and advocate for early extubation after FFMBA to allow clinical follow-up.

Histomorphologic, Biomechanical, and Functional Analysis in Mandibular Osteogenesis Induced by External Distraction

The induced bone generation procedure (osteogenic distraction [OD]) is frequently used in cases of jaw deformities in patients with, hemifacial microsomia, mandibular hypoplasia, and so on. This study was undertaken to provide criteria to perform this procedure. The authors evaluated the effects of various parameters using OD to determine the optimal variables. Sixty distractors were placed in 30 canine subjects who then underwent OD after appropriate osteotomy. The procedures were performed during varying latency periods, distraction periods, distraction rate distance, and the consolidation period. Bone biopsies and radiographic studies were performed at 0, 7, 14, 21, 45, and 55 days after the distraction process. The observed changes and the most efficient mandibular OD parameters are reported.

Pharyngeal Airway Changes Following Mandibular Distraction Osteogenesis as Evaluated with Laryngoscopy.

Mandibular distraction osteogenesis (MDO) may improve airway grade in patients with Robin Sequence (RS), but little is known about the response of the oropharyngeal airway to the distraction process in cases of tongue base obstruction (TBAO). This study used drug-induced sleep endoscopy (DISE) to evaluate the impact of MDO on the oropharynx. RS patients with severe obstructive sleep apnea (OSA) were prospectively enrolled, and underwent DISE prior to MDO, and at the time of distractor removal. Laryngoscopy views, glossoptosis degree, polysomnography (PSG) results, oxygen saturations and airway measurements were compared pre- and post-MDO. Twenty patients met inclusion criteria. At the time of distractor placement, a grade II laryngoscopic view was most frequently observed (63%), and one patient (5%) had a grade I view. Median obstructive apnea hypopnea index (OAHI) improved after MDO (49.1 [30.2-74.0] to 9.1, [3.9-18.0], p ≤ .001). Median oxygen saturation nadir also improved (preoperative 69% [60-76] to 85% [82-91], p ≤ .001). At distractor removal, mean laryngoscopic view improved (p ≤ .002) with no views that were grade 3 or higher. Median intraoperative oropharyngeal width improved, (3.1 mm [2.8-4.4] to 6.0 mm [4.4-6.8], p ≤ .021), as did median cephalometric anteroposterior oropharyngeal width (3.5 mm [2.7-4.1] to 6.3 mm [5.6-8.2], p ≤ .002). Following MDO, RS patients with TBAO have an approximate doubling of oropharyngeal width and an improvement in laryngoscopic grade. These findings likely contribute to improved oxygenation, OAHI and ease of intubation.

Orthopedic mechanism analysis of growing rod distraction for early-onset scoliosis based on 3D morphological parameters.

Traditional growing rod (TGR) provides a corrective moment for deformed segments to straighten the spine, whose clinical efficacy has proven positive and growth-friendly. However, an insufficient understanding of orthopedic mechanisms can affect the development of clinical strategies. This research attempts to analyze the spine that has undergone four distraction operations: exploring the spinal orthopedic mechanism, including alignment, growth, and morphology. In this study, the spinal morphology curves were illustrated in three human planes to exhibit the changes in spinal alignment. The spinal growth characteristics were measured to discuss the unsynchronized and diminishing growth rate. The spinal deformations were evaluated to indicate asymmetric growth. As a result, the spinal alignment changes indicated the orthopedic process improved, but the re-unbalance occurred after multiple distractions. Then, unsynchronized growth existed in the superior and inferior segments, and the growth rate over every distraction diminished. Finally, asymmetric growth was indicated as the axial/circumferential growth ratio getting greater and the cuneate level approaching normal. Accordingly, a TGR is growth-friendly, but combining the osteotomy fusion of lumbar segments for severe early-onset scoliosis may be an excellent choice to solve the insufficient corrective stimulation. Regarding the distraction process, reshaping before the final fusion can fix the balance loss, and a prolonged distraction frequency fits the law of diminishing return. In conclusion, studying orthopedic mechanisms based on morphological measurement can guide clinical strategy optimization.

GUIDED GROWTH FOR PAEDIATRIC FIXED KNEE FLEXION DEFORMITIES: DO THE PLATES NEED TO BE THAT CLOSE TO THE PATELLA?

This study was performed at Assiut University, Assiut, Egypt.Anterior distal femoral hemiepiphysiodesis (ADFH) using intra-articular plates for the correction of paediatric fixed knee flexion deformities (FKFD) has two main documented complications: postoperative knee pain and implant loosening. This study describes a biomechanical analysis and a preliminary report of a novel extra-articular technique for ADFH.Sixteen femoral sawbones were osteotomized at the level of the distal femoral physis and fixed by rail frames to allow linear distraction simulating longitudinal growth. Each sawbone was tested twice: first using the conventional technique with medial and lateral parapatellar eight plates (group A) and then with the plates inserted in the proposed novel location at the most anterior part of the medial and lateral surfaces of the femoral condyles with screws in the coronal plane (group B). Gradual distraction was performed, and the resulting angular correction was measured. Strain gauges were attached to the plates, and the amount of strain (and equivalent stress) over the plates was recorded. This technique was then applied to 9 paediatric FKFDs of different aetiologies. The preoperative FKFD and the amount of subsequent angular correction were measured.The amount of angular correction was higher in group B at 5, 10-, and 15-mm of distraction (p&lt;0.001). The maximum and overall stresses measured throughout the distraction process were higher in group A (p&lt;0.001). The mean FKFD improved from 24 ± 9° preoperatively to 9 ± 7° after 10 ± 3° months (p&lt;0.001). The correction rate was 1.81 ± 0.65° per month.During ADFH, the fixation of the eight plates in the coronal plane at the anterior part of the femoral condyles may produce greater correction and lower stresses over the implants as compared to the conventional technique. Preliminary results from our initial series seem to support the effectiveness of this technique with respect to the degree of angular correction achieved.

Foster children avoidance-related interactive behaviors with caregivers

BackgroundA lot of the research concerning foster children – often children who have suffered maltreatment in the family home - has focused on internalized and externalized symptoms. Few studies, however, have looked at the interactions between such children and caregivers. PurposeThe purpose of this study is to explore the Emotion Regulation Strategies (ERS) of children in foster care and to highlight those most commonly employed in family or placement contexts. The parents' and foster carers' ERS are also analyzed in order to understand the co-regulatory processes at work. MethodAn in-depth analysis of observation sequences was performed. Three data collection times, spaced across a period of 6 months (t1, t2 and t3), were included in the observation protocol. Each observation, recorded using a video camera, comprised 45 min of free time and 15 min of structured tasks. Transcription and coding of ERS were performed for each sequence using a microanalytical method. Both children's and adults' ERS were coded. ResultsChildren tended to be readily distracted when interacting with adults, and more particularly so with their parents. While they tended to display relatively normative processes with a foster carer, they turned to pathological avoidance mechanisms with their parents such as physical venting or self-stimulation. Interactions during structured tasks showed a significant reduction in distraction processes. ConclusionThis study highlights the prevalence of distraction behavior in foster children during their interactions with caregivers, and offers an insight into how structured interactions provide a framework that mitigates children's avoidance behaviors and so enhances adult-child collaboration.

Dose–response effect of L-theanine on psychomotor speed, sustained attention, and inhibitory control: a double-blind, placebo-controlled, crossover study

ABSTRACT Background: L-theanine is a non-protein-forming amino acid found in tea. Previous research shows high doses (100–400 mg) of L-theanine enhances attention, mainly by reducing mind wandering and distracter processing. We hypothesized that these indirect mechanisms could significantly improve the performance of low-level attentional tasks, whereas the relative contribution could be less in complex attentional tasks that require active, higher-order processing of target stimuli. Methods: To test this hypothesis, we conducted a double-blind, placebo-controlled, counterbalanced, four-way crossover study in 32 healthy young adults, where we compared the effects of three doses of L-theanine (100, 200 and 400 mg) with a placebo (distilled water), administered before and 50 min after dosing, on three attentional tasks from the Cambridge Neuropsychological Test Automated Battery [viz. Reaction Time (RTI)–visuomotor speed, Rapid Visual Information Processing (RVP)–sustained attention, and Stop Signal Task (SST)–inhibitory control]. Results were analyzed in dose × time repeated measures ANOVA models, with subsequent pairwise comparisons. Results: Active doses significantly improved reaction times in the RTI (100–200 mg) and RVP (200–400 mg) tasks from baseline (p < 0.05), but once controlled for the change-from-baseline caused by placebo, only the RTI simple reaction times showed significant improvements, following 100 mg (Δ = 16.3 ms, p = 0.009) and 200 mg (Δ = 16.9 ms, p = 0.009) of L-theanine. Conclusions: Consistent with our hypothesis, these findings suggest that L-theanine significantly improves attention in simple visuomotor tasks, but not in more complex sustained attention tasks, or executive control tasks that require top-down inhibition of pre-active responses.

Periosteum-inspired in situ CaP generated nanocomposite hydrogels with strong bone adhesion and superior stretchability for accelerated distraction osteogenesis

BackgroundDistraction osteogenesis (DO) is an efficacious but lengthy procedure to reconstruct segmental bone defects under the principle of tension-stress, during which the periosteum-mediated mechanical stimulation plays a pivotal role. Inspired by the dynamic process of DO and the mechanical stimulation of periosteum, a new design of bionic periosteum was developed to simulate the mechanical transduction of natural periosteum for the application in DO procedure.MethodsIn this study, an injectable organic-inorganic hybrid hydrogel was developed based on a novel combination of the PEGylated poly (glycerol sebacate) (PEGS) polymer network and in situ formed CaP nanoparticles (ICPNs). Rat bone marrow mesenchymal stem cells (rBMSCs) and human umbilical vein endothelial cells (HUVECs) were cultured and tested in vitro to evaluate biocompatibility, cell adhesion, proliferation, and pro-osteogenic and pro-angiogenic activity. In vivo experiments were conducted in the rat tibial model of distraction osteogenesis.ResultsThe developed nanocomposite hydrogels exhibited excellent injectability, robust bone adhesion, superior stretchability, and enhanced osteogenic activity. The results of in vitro and in vivo studies showed that PEGS/ICPN hydrogels could promote new bone formation and mineralization during the dynamic distraction process through the synergistic effects of angiogenesis and osteogenesis.ConclusionsThis periosteum-inspired nanocomposite hydrogel represents a mechanobiology approach for effectively restoring large bone defects through the dynamic DO process.

Changes in venous drainage after posterior cranial vault distraction and foramen magnum decompression in syndromic craniosynostosis.

The authors' objective was to measure the effect of posterior cranial vault distraction (PCVD) plus foramen magnum decompression (FMD) on dural sinus volume and venous flow in patients with syndromic craniosynostosis. The volumes of the sagittal, straight, transverse, and sigmoid sinuses of 5 consecutive patients with syndromic craniosynostosis who underwent PCVD+FMD were calculated in cubic centimeters with T2-weighted volumetric MRI sequences before surgery, immediately after surgery, and after the end of the distraction process. Tridimensional reconstructions of phase-contrast magnetic resonance angiography (PC-MRA) images were obtained with multiplanar reconstruction (MPR). The average total volume of all dural sinuses increased immediately after surgery (from 10.06 cm3 to 12.64 cm3) and continued to increase throughout the 30-day distraction period (from 12.64 cm3 to 14.71 cm3) (p = 0.04), except that the right sigmoid sinus remained stable after the initial increase. The most important increases were observed for the left transverse sinus (+113.2%), right transverse sinus (+104.3%), left sigmoid sinus (+91.3%), and sagittal sinus (+41.8%). Less important modifications were evident for the right sigmoid sinus (+33.7%) and straight sinus (+23.4%). Significant improvements in venous flow were noted on the tridimensional reconstructions of the PC-MRA images. Venous obstruction grading score improved in 4 patients (average [range] 2.4 [ 2-5]) (p = 0.023) and remained stable in 1 patient. All patients had chronic tonsillar herniation (CTH) (mean [range] 16.6 [8-26] mm), and 3 had syringomyelia. CTH showed improvement on the last follow-up MRI evaluation in 4 patients (mean [range] 10.5 [0-25] mm) and worsened from 15 mm to 19 mm in 1 patient. Syringomyelia improved in 2 patients and remained unchanged in 1. This study has provided the first radiological evidence of the impact of craniofacial surgery on dural sinus anatomy and venous drainage. The venous anomalies described in patients with syndromic craniosynostosis are not static, and PCVD+FMD triggers a dynamic process that can lead to significant modifications of intracranial venous drainage. The traction exerted by the distracted bone flap onto the occipitoparietal dura mater adherent to the inner calvaria may account for the enlargement of the dural sinus throughout the distraction period. The impact of these modifications on venous pressure, intracranial pressure, CTH, and hydrocephalus remains to be determined.

Two-Axis Continuous Distractor for Mandibular Reconstruction.

The application of Distraction Osteogenesis (DO) techniques in the reconstruction of skeletal deficiencies is a relatively new topic in the fields of oral and maxillofacial surgeries. In many reconstruction applications, using DO is the preferred technique, as opposed to conventional reconstruction techniques, as there are more advantages and fewer side effects when it is used. The first generation of DO devices is made up of manual distractors that can apply an intermittent distraction force to the bone segment during the distraction process. Manual DO techniques have shown the functionality of the DO technique. Further research has recently been performed on the development of automatic devices for generating a controlled continuous force. However, the existing automatic techniques have limitations, and are yet to be used in reconstruction applications in humans. There is still a gap between the developed techniques and an ideal distractor to be used in mandibular reconstruction surgeries. In this research, a two-axis continuous distractor is proposed for use in mandibular reconstruction applications. The proposed distractor can generate two continuous distraction forces that can be applied to two independent distraction vectors. The proposed device can perform the standard distraction process using the predetermined distraction factors. The control system has a high positioning accuracy and resolution in controlling the position of the intra-oral end effectors while applying two continuous forces for moving the bone segment. The proposed two-axis continuous distractor meets the current requirements, and can be used as an ideal continuous DO device for different mandibular reconstruction applications.

Towards collision detection in foot and ankle deformity correction using parallel external fixator: A novel analytical approach

Gradual correction using external fixator has been advocated as a minimally invasive solution for limb deformity and is widely used in the clinic. This treatment manner requires a long-term distraction process, which is guided by a preplanned correction path. However, bone cross-section (BCS) collision and soft tissue (ST)-distraction rod (DR) collision may occur on the path and then affect the continuity of the process. Thus, collision detection should be carried out before performing distraction. Existing detection solutions do not simultaneously consider these two types of collisions, and primarily target long-bone deformity. To solve these issues, taking more complex foot and ankle deformity as the research object, a novel analytical detection approach is proposed in this paper. By modelling the contours of BCS, ST, and DRs as convex envelope planes/bodies using different spatial line styles, the spatial posture relations of their boundaries can be reproduced on the correction path, and collision detection can be transformed into the mathematical problem of calculating point-plane and point-line distances. Subsequently, two algorithms are proposed for BCS and ST-DR collision detections, and adjustment strategies are provided to resolve algorithm anomalies. Clinical case simulation proves the effectiveness and applicability of the approach. Since the detection is used for pre-distraction prediction rather than real-time monitoring, the correction path with potential collision risk can be re-planned before distraction, and finally, guarantees the safety of gradual correction.

Kinematic and biomechanical responses of the spine to distraction surgery in children with early onset scoliosis: A 3-D finite element analysis.

Periodical and consecutive distraction is an effective treatment for severe early onset scoliosis (EOS), which enables the spinal coronal and sagittal plane deformity correction. However, the rate of rod fractures and postoperative complications was still high mainly related to the distraction process. Previous studies have primarily investigated the maximum safe distraction force without a rod broken, neglecting the spinal re-imbalance and distraction energy consumption, which is equally vital to evaluate the operative value. This study aimed to reveal the kinematic and biomechanical responses occurring after spinal distraction surgery, which were affected by traditional bilateral fixation. The spinal models (C6-S1) before four distractions were reconstructed based on CT images and the growing rods were applied with the upward displacement load of 0–25 mm at an interval of 5 mm. Relationships between the distraction distance, the distraction force and the thoracic and lumbar Cobb angle were revealed, and the spinal displacement and rotation in three-dimensional directions were measured. The spinal overall imbalance would also happen during the distraction process even under the safe force, which was characterized by unexpected cervical lordosis and lateral displacement. Additionally, the law of diminishing return has been confirmed by comparing the distraction energy consumption in different distraction distances, which suggests that more attention paid to the spinal kinematic and biomechanical changes is better than to the distraction force. Notably, the selection of fixed segments significantly impacts the distraction force at the same distraction distance. Accordingly, some results could provide a better understanding of spinal distraction surgery.

Effects of mental fatigue on risk preference and feedback processing in risk decision-making

Mental fatigue is a common phenomenon in modern people, especially after a long period of mental work. Individuals frequently have to make critical decisions when in a mentally fatigued state. As an important and complex cognitive function, risk decision-making might be influenced by mental fatigue, which is consequent with increased distraction and poor information processing. However, how mental fatigue shapes individuals’ decision-making remains relatively unclear. The purpose of this study was to examine the effect of mental fatigue on risk decision-making performance and risk-preference in a simple gambling task, using both behavioral methods and event-related potential techniques. Forty young adults were divided into a mental fatigue group and a no-fatigue group and participated in the experiments. Results showed that individuals with mental fatigue tended to be more risk-averse than those without fatigue when facing risk options. The P300 amplitudes were smaller and FRN amplitudes were larger in the mental fatigue group than in the no-fatigue group. These findings provide insight into a relationship between mental fatigue and risk decision-making, from the perspective of the neurological mechanism.

Frontofacial Monobloc Advancement With Internal Distraction: Surgical Technique and Osteotomy Guide.

Craniosynostosis are cranial deformities resulting from the early closure of 1 or more sutures. Concomitant facial changes are complex and usually result from the involvement of multiple sutures, which may lead to restriction of cranial growth and brain expansion, ocular compression, and breathing difficulties. Surgical techniques to correct syndromic craniosynostosis have improved over time, considerably reducing the rate of complications of this procedure. To describe in detail (step-by-step) and with pertinent anatomic considerations the technique of monobloc frontofacial advancement using internal distractors. We describe the monobloc frontofacial advancement technique with the use of internal distractors, which we use in patients with primary syndromic craniosynostosis (Apert, Crouzon, and Pfeiffer) who have major facial hypoplasia and secondary respiratory repercussions. To illustrate this technique, the procedure was performed in 2 cranial models: an adult artificial acrylic skull of normal morphology for better evidence of anatomic repairs and a 3-dimensional printed infant skull from a tomography file obtained from a child diagnosed with Apert syndrome. The benefits of osteogenic distraction and better surgical timing for each procedure are presented. We presented the changes and details of osteotomies performed during the procedure, as well as anatomic details and care regarding the pterygomaxillary dysjunction. Monobloc frontofacial distraction is a procedure with widely demonstrated aesthetic and functional results, and this detailed step-by-step description may improve familiarity with the anatomic landmarks of the procedure and provide a better dynamic understanding of the distraction process.

A Quantification of Scalp Thickness before and after Posterior Vault Distraction Osteogenesis.

Previous literature has documented craniometric changes of the bony calvaria, increases in intracranial volume, and resolution of Chiari malformations following posterior vault distraction osteogenesis. No studies have analyzed changes to the soft-tissue envelope after posterior vault distraction osteogenesis. In this study, the authors aimed to provide objective measurements of scalp thickness in patients undergoing posterior vault distraction osteogenesis, utilizing facial soft-tissue thickness as a proxy to control for growth. The authors hypothesized that the soft tissues of the scalp are not made thinner by the distraction process, either in the region of distraction or in neighboring areas. Subjects who underwent posterior vault distraction osteogenesis for a craniosynostosis diagnosis who had high-resolution predistraction and post-distractor removal computed tomographic scans within 100 days of each operation were included. The scans were analyzed on Materialise Mimics version 21 software (Materialise, Ghent, Belgium). Six key craniometric landmarks (glabella, pogonion, zygion, vertex, euryon, and opisthocranium) were identified on the three-dimensional bone masks in the Frankfort horizontal plane. The points were overlaid onto soft-tissue thickness masks and thicknesses were recorded. Percent change in postoperative facial soft-tissue thickness was used to control for growth of the craniofacial soft-tissue envelope during the study interval. The preoperative and postoperative posterior vault distraction osteogenesis cohorts did not differ significantly at the glabella, pogonion, opisthocranium, vertex, and zygion. The corrected median thickness at the euryon was significantly increased in the post-posterior vault distraction osteogenesis cohort [2.67 mm (IQR, 2.49 mm to 4.02 mm) versus 5.26 mm (IQR, 3.83 mm to 7.82 mm), p = 0.002]. This is the first study to quantify changes in soft-tissue thicknesses preoperatively and postoperatively in patients undergoing posterior vault distraction osteogenesis, demonstrating maintenance of scalp thickness. . Therapeutic, IV.

Proportion of conflict, contingency learning, and recency effects in a Stroop task

Recent research on the relation between learning and cognitive control has assumed that conflict modulates learning, either by increasing arousal and hence improving learning in high-conflict situations, or by inducing control, and hence inhibiting the processing of distracters and their eventual association with the imperative responses. We analyse whether the amount of conflict, manipulated through the proportion of congruency in a set of Stroop inducer trials, affects learning of contingencies established on diagnostic trials composed by neutral words associated with colour responses. The results reproduced the list-wide proportion of congruency effect on the inducer trials, and showed evidence of contingency learning on the diagnostic trials, but provided no indication that this learning was modulated by the level of conflict. Specific analyses conducted to control for the impact of episodic effects on the expression of learning indicated that contingency effects were not driven by the incremental processes that could be expected by associative learning, but rather they were due to the impact of the most recent trial involving the same distracter. Accordingly, these effects disappeared when tested selectively on trials that required a non-matching response with respect to the previous occurrence of the distracter. We interpret this result in the context of the debate on how learning and memory interact with the processes of cognitive control.

Sutural fibroblasts exhibit the function of vascular endothelial cells upon mechanical strain

Midfacial hypoplasia is a type of facial dysplasia. The technique of trans-sutural distraction osteogenesis promotes midface growth so as to ameliorate this symptom. In the process of distraction osteogenesis, the fiber matrix in the suture acts as a mechanical sensor. Compared with osteogenesis, the formation of collagen fibers by fibroblasts is significant in the early stage of sutural distraction. However the transformation of fibroblasts during sutural bone formation induced by tensile force is poorly characterized. Here, we used single-cell RNA sequencing to define the cell classification of the zygomatic maxillary suture and the changes of cell clusters in the suture before and after seven-day distraction. We identified twenty-nine cell subsets spanning monocyte/macrophages, neutrophils, red blood cells, B cells and fibroblasts. Compared with the control group, Monocle analysis revealed the emergence of a unique fibroblast subset (Cdh5+, Col4a1+, Fat1−, and Acta2−) (cluster 27) that expressed vascular endothelial cell genes within the distracted zygomatic maxillary suture. We constructed the differentiation trajectories of the fibroblast population (cluster 23, 27) in the suture before and after distraction. In addition, we clarified that a subset of fibroblasts (cluster 27) lost expression of Fat1, an upregulator of the Hippo pathway, and upregulated Cyr61, a downstream gene of the Hippo pathway, during the distraction process. Further enrichment analysis suggests that cells of the new subset (cluster 27) are undergoing conversion of their identity into a vascular endothelial cell-like state in response to mechanical stimulation, associated with upregulation of angiogenesis genes along the single-cell trajectory. Further immunofluorescence staining confirmed this phenomenon. A combined general transcriptome RNA sequencing data analysis demonstrated that the fibroblasts expressed a number of extracellular matrix-related genes under mechanical strain. These data together provide a new view of the role of fibroblasts in tension-induced sutural angiogenesis via interaction with the Hippo pathway.

‘I then had 50 stitches in my arms…such damage to my own body’: An Interpretative Phenomenological Analysis of Izzat trauma and self‐harm experiences among UK women of South Asian heritage

AbstractBackground and aimsSelf‐mutilation (self‐harm) is a phenomenon that is increasingly being seen in patients presenting in mental health services in the United Kingdom. This present study aimed to explore the lived experience of South Asian women raised in the United Kingdom and their perspective of ‘Izzat’, which refers to honour.MethodSemi‐structured interviews were conducted with 12 women of ‘South Asian' heritage. Their accounts were analysed using interpretative phenomenological analysis (IPA).Findings and discussionThe findings suggest that the concept of Izzat and Asian cultural identity permeated the narratives of all the participants. The results position Izzat as central to cultural discord felt by the women and as a base for some of the discontent that led to self‐mutilating. The analysis revealed five over‐arching themes as the most common factors to self‐harm among South Asian women, which include: (1) The struggle to maintain cultural identity, (2) Experience of loss of control and trauma, (3) Focus on self‐mutilation as a distraction process, (4) Psychological angst as metacommunication of pain, and (5) Enactment of perceived deserved punishment. Our conclusions argue for the importance of understanding the complexity of cultural diversity, introjected cultural expectations, and its impact on the development of trauma and implications for clinical practice.Future research and practice should focus on exploring trauma‐informed methodologies and culturally sensitive approaches in working with those impacted by Izzat and the cultural responsibility of maintaining family honour.

Disruptions of Sustained Spatial Attention Can Be Resistant to the Distractor's Prior Reward Associations.

Attention can be involuntarily biased toward reward-associated distractors (value-driven attentional capture, VDAC). Yet past work has primarily demonstrated this distraction phenomenon during a particular set of circumstances: transient attentional orienting to potentially relevant stimuli occurring in our visual environment. Consequently, it is not well-understood if reward-based attentional capture can occur under other circumstances, such as during sustained visuospatial attention. Using EEG, we investigated whether associating transient distractors with reward value would increase their distractibility and lead to greater decrements in concurrent sustained spatial attention directed elsewhere. Human participants learned to associate three differently colored, laterally presented squares with rewards of varying magnitude (zero, small, and large). These colored squares were then periodically reintroduced as distractors at the same lateral locations during a demanding sustained-attention rapid-serial-visual-presentation (RSVP) task at the midline. Behavioral and neural evidence indicated that participants had successfully learned and maintained the reward associations to the distractors. During the RSVP task, consistent with prior work, we found that the distractors generated dips in the instantaneous amplitude of the steady-state visual evoked potentials (SSVEPs) elicited by the midline RSVP stimuli, indicating that the distractors were indeed transiently disrupting sustained spatial attention. Contrary to our hypotheses, however, the magnitude of this dip did not differ by the magnitude of the distractor’s reward associations. These results indicate that while sustained spatial attention can be impaired by the introduction of distractors at another location, the main distraction process is resistant to the distractors’ reward associations, thus providing evidence of an important boundary condition to value-driven attentional capture.

Mechanics of guided growth of the distal femur for correction of fixed knee flexion deformities: an extra-articular technique.

Anterior distal femoral hemiepiphysiodesis using intra-articular plates for correction of pediatric fixed knee flexion deformities (FKFD) has two documented complications: postoperative knee pain and implant loosening. The aim of this study is to investigate the mechanical properties of a novel extra-articular technique for anterior distal femoral hemiepiphysiodesis in patients with FKFD and to compare them to the conventional technique. Sixteen femoral sawbones were osteotomized at the level of the distal femoral physis and fixed by rail frames to allow linear distraction simulating longitudinal growth. Each sawbone was tested twice: first using the conventional technique with eight plates placed anteriorly just medial and lateral to the femoral sulcus (group A) and then with plates inserted in the proposed novel location at the most anterior part of the medial and lateral surfaces of the femoral condyles with screws in the coronal plane (group B). Gradual linear distraction was performed, and the resulting angular correction was measured. Strain gauges were attached to the plates, and the amount of strain (and equivalent stress) over the plates in response to linear distraction was recorded. The two groups were compared using the Wilcoxon signed-rank test. The amount of angular correction was statistically higher in group B (extra-articular plates) at 5, 10-, and 15-mm of distraction (p < 0.001). As regards stress over the plates, the maximum stress and the area under the curve (sum of all stresses measured throughout the distraction process) were significantly higher when the plates were inserted at the conventional position (group A) (p < 0.001). During anterior distal femoral hemiepiphysiodesis, the fixation of the eight plates in the coronal plane at the anterior part of the femoral condyles may produce a greater amount of correction and a lower degree of stress over the implants as compared to the conventional technique.