A historical analysis of the policy on intractable diseases in Japan and its peculiarity

This article examines the history of the policy concerning a class of diseases called intractable diseases in Japan with a particular focus on the roles of patient support groups in firstly legitimizing the grouping of such diseases and then shaping the nature of the support that the Japanese Ministry of Health and Welfare provided to the patients and their families affected by them. The Ministry started its policy on intractable diseases in 1972, predating the enactment of the 1983 Orphan Drug Act in the United States, which is known to be one of the most important events for the international rare diseases community. This policy decision was triggered by the emergence of subacute myelo-optic neuropathy (SMON) as a social problem in the country in the late 1960s. The Ministry first made its support available to patients with this particular disease and, as a result of a series of actions from patient support groups and their medical and political supporters, the same support was made available to those considered to be in similarly difficult circumstances. The way in which the support was arranged, however, turned out to be structurally divisive, inviting the patient groups to negotiate with the national and local governments separately depending on subject matters, and for about three decades since the start of the policy, they struggled to present their unified voice in the country. The governmental support for intractable diseases was finally revised in the mid-2000s, but as this article demonstrates, that became possible only after the patient groups came to realize the need of presenting a unified voice in their effort to improve the lives of those affected

A historical analysis of the policy on intractable diseases in Japan and its peculiarity

This article examines the history of the policy concerning a class of diseases called intractable diseases in Japan with a particular focus on the roles of patient support groups in firstly legitimizing the grouping of such diseases and then shaping the nature of the support that the Japanese Ministry of Health and Welfare provided to the patients and their families affected by them. The Ministry started its policy on intractable diseases in 1972, predating the enactment of the 1983 Orphan Drug Act in the United States, which is known to be one of the most important events for the international rare diseases community. This policy decision was triggered by the emergence of subacute myelo-optic neuropathy (SMON) as a social problem in the country in the late 1960s. The Ministry first made its support available to patients with this particular disease and, as a result of a series of actions from patient support groups and their medical and political supporters, the same support was made available to those considered to be in similarly difficult circumstances. The way in which the support was arranged, however, turned out to be structurally divisive, inviting the patient groups to negotiate with the national and local governments separately depending on subject matters, and for about three decades since the start of the policy, they struggled to present their unified voice in the country. The governmental support for intractable diseases was finally revised in the mid-2000s, but as this article demonstrates, that became possible only after the patient groups came to realize the need of presenting a unified voice in their effort to improve the lives of those affected

Intertrochanteric fracture classification

A novel three-dimensional fragment-based classification system based on computed tomography findings was established to characterize femoral intertrochanteric fractures. The intertrochanteric bone fragments were defined as follows : neck, posterior portion of the greater trochanter, anterior portion of the greater trochanter, lesser trochanter, and shaft. Each type of fracture was classified as 2-, 3-, 4-, or 5-fragment according to the number of floating bone fragments. Following the description of the fracture type, each floating bone fragment was appended, with the exception of a fragment involving the shaft. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were ≥ 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). Using this fragment-based classification system, intertrochanteric fractures can be evaluated in more detail than is possible using conventional classification systems

Effect of baseplate position on locking screws

Introduction : Superior screw insertion in reverse shoulder arthroplasty (RSA) carries the potential risk of suprascapular injury. The purpose of this study was to evaluate how the baseplate position affects the superior screw position and length in RSA. Methods : Three-dimensional (3D) computer simulation models of RSA were established using computed tomography data of baseplates with superior and inferior screws and 3D scapular models from 10 fresh cadavers. Superior screw position, the distance from the superior screw hole to the suprascapular notch, and the screw lengths were measured and compared among various baseplate positions with two inferior tilts (0 and 10 degrees) and three rotational patterns (11–5, 12–6, and 1–7 o’clock in the right shoulder). Results : For the 1–7 o’clock / inferior tilt 0 degrees baseplate, the superior screw located anterior to the SS notch in all shoulders, the distance to the SS notch was the longest (12.8 mm), and the inferior screw length was the shortest (23.1 mm). Conclusion : Although there is a concern of a short inferior screw length, initial fixation using a baseplate with 1–7 o’clock rotation and an inferior tilt of 0 degrees appears preferable for SS nerve injury prevention during superior screw insertion

Can intraoperative kinematic analysis predict postoperative kinematics following total knee arthroplasty? A preliminary study

The preliminary study analyzed the relationship between intraoperative navigation-based kinematics and postoperative 2-dimensional/3-dimensional (2D/3D) image registration-based kinematics in total knee arthroplasty (TKA). Six knees in 5 patients were analyzed. All TKA procedures were performed using an image-free knee navigation system. Tibial internal rotation was assessed by intraoperative knee kinematics. At 1 year after surgery, tibial internal rotation was evaluated using a 2D/3D image registration technique under loaded and unloaded conditions. The correlation between intraoperative and postoperative data for the tibial internal rotation angle at 10° increments of knee flexion was then assessed. Difference in the knee flexion angle between the intraoperative and postoperative evaluations was adjusted to account for the sagittal cutting angle of the distal femur and proximal tibia. A correlation was found between the intraoperative and postoperative data for loaded knee flexion with this adjustment (Pearson’s r = 0.725, p = 0.012). However, intraoperative kinematics was not significantly correlated with postoperative kinematics in the absence of loading. Larger adequately powered prospective studies are now needed to confirm our preliminary finding that postoperative loaded kinematics can be predicted by intraoperative evaluation