The Medial Patellofemoral Complex: Surgical anatomy, dynamic assessment, and considerations for reconstruction in the treatment of patellofemoral instability

Patellar instability is a difficult problem to treat due to its multifactorial nature. While soft tissue reconstruction has become the primary procedure in surgical management of patellar instability, many challenges remain in optimizing the outcomes of these procedures. Our understanding of the anatomy of the MPFL continues to evolve, now including the quadriceps tendon fibers and the term MPFC, to better represent this ligamentous complex that attaches to both the patella and quadriceps tendon. Our ability to assess patellar stability has implications for our diagnostic capabilities as well as our ability to intraoperatively assess the function of the MPFC, and promising dynamic imaging modalities have been described. The role of anatomic risk factors such as trochlear dysplasia, patella alta, and bony malalignment, and their influence on soft tissue reconstruction continue to need assessment to better identify the optimal surgical procedures to treat patellar instability in each patient

An exploration of person-centred approach in end-of-life care policies in England and Japan

Abstract Background Increasing evidence has suggested that a person-centred approach (PCA) is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care (EOLC). This article aims to explore the meaning and implications of person-centredness in EOLC policy discourses. Methods By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how PCA in EOLC is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents released between 2000 and 2019 in these two post-industrial and socio-culturally distinctive countries. Results Our analysis found that the PCA is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the pol icies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs. Conclusions This cross-cultural analysis has revealed the complex nature of discourses around PCA in English and Japanese EOLC policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of PCA is needed in EOLC policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences

‘Nation\u27 Consciousnesses in Medieval Ireland

This paper considers the process of the formation of ‘nation’ consciousnesses in Medieval Ireland. It spans from the seventh century, when multiple historical sources appeared, to the second half of the twelfth century, when the period of English rule began. It can be said that Ireland was ‘peripheralized’ by the English ‘empire’ in the second half of the twelfth century and has remained so ever since. What nation consciousnesses had formed in Ireland until that time? Outside forces have invaded Ireland from both the Scandinavian Peninsula in the ninth century and from England in the second half of the twelfth century. How did the arrival of ‘different ethnic groups’ and ‘different nations’ affect the nation consciousnesses of the native inhabitants of Ireland? This paper examines such problems

イキガイテキ ナ ブンショテイシュツメイレイ ト シュケンシンガイ アメリカ ドイツ ニ オケル リカイ ニ チャクモク シテ

田中茂樹教授松岡博教授退官記念

Mutation of the Apc1 homologue shattered disrupts normal eye development by disrupting G1 cell cycle arrest and progression through mitosis

AbstractThe shattered1 (shtd1) mutation disrupts Drosophila compound eye structure. In this report, we show that the shtd1 eye defects are due to a failure to establish and maintain G1 arrest in the morphogenetic furrow (MF) and a defect in progression through mitosis. The observed cell cycle defects were correlated with an accumulation of cyclin A (CycA) and String (Stg) proteins near the MF. Interestingly, the failure to maintain G1 arrest in the MF led to the specification of R8 photoreceptor cells that undergo mitosis, generating R8 doublets in shtd1 mutant eye discs. We demonstrate that shtd encodes Apc1, the largest subunit of the anaphase-promoting complex/cyclosome (APC/C). Furthermore, we show that reducing the dosage of either CycA or stg suppressed the shtd1 phenotype. While reducing the dosage of CycA is more effective in suppressing the premature S phase entry in the MF, reducing the dosage of stg is more effective in suppressing the progression through mitosis defect. These results indicate the importance of not only G1 arrest in the MF but also appropriate progression through mitosis for normal eye development during photoreceptor differentiation

Policy brief: end of life care policies and laws in England and Japan: from mutual learning to policy transfer

England and Japan are confronted with unprecedented challenges and opportunities in the face of population ageing and changing expectations about death and dying, which place heavy demands on health and social care systems. An in-depth analysis has been undertaken to compare a set of key policy documents and legislation implemented and enacted in both countries. This policy brief summarises key findings from the analysis to report the commonalities and differences of end of life care, decision-making and bereavement support. The policy brief aims to be valuable for academics, policy-makers, practitioners, as well as the general public. It paints a comparative picture of end of life care policies and laws between the two post-industrial and rapidly ageing societies. This comparison enables mutual understanding, aiming to inform and reshape future policy-making and legislation in both countries

Genetic analysis in Japanese patients with osteogenesis imperfecta: Genotype and phenotype spectra in 96 probands

Background Osteogenesis imperfecta (OI) is a rare connective-tissue disorder characterized by bone fragility. Approximately 90% of all OI cases are caused by variants in COL1A1 or COL1A2. Additionally, IFITM5 variants are responsible for the unique OI type 5. We previously analyzed COL1A1/2 variants in 22 Japanese families with OI through denaturing high-performance liquid chromatography screening, but our detection rate was low (41%). Methods To expand the genotype-phenotype correlations, we performed a genetic analysis of COL1A1/2 and IFITM5 in 96 non-consanguineous Japanese OI probands by Sanger sequencing. Results Of these individuals, 54, 41, and 1 had type 1 (mild), type 2-4 (moderate-to-severe), and type 5 phenotypes, respectively. In the mild group, COL1A1 nonsense and splice-site variants were prevalent (n = 30 and 20, respectively), but there were also COL1A1 and COL1A2 triple-helical glycine substitutions (n = 2 and 1, respectively). In the moderate-to-severe group, although COL1A1 and COL1A2 glycine substitutions were common (n = 14 and 18, respectively), other variants were also detected. The single case of type 5 had the characteristic c.-14C>T variant in IFITM5. Conclusion These results increase our previous detection rate for COL1A1/2 variants to 99% and provide insight into the genotype-phenotype correlations in OI

Daughterless homodimer synergizes with Eyeless to induce Atonal expression and retinal neuron differentiation

AbstractClass I Basic Helix-Loop-Helix (bHLH) transcription factors form homodimers or heterodimers with class II bHLH proteins. While bHLH heterodimers are known to have diverse roles, little is known about the role of class I homodimers. In this manuscript, we show that a linked dimer of Daughterless (Da), the only Drosophila class I bHLH protein, activates Atonal (Ato) expression and retinal neuron differentiation synergistically with the retinal determination factor Eyeless (Ey). The HLH protein Extramacrocheate (Emc), which forms heterodimer with Da, antagonizes the synergistic activation from Da but not the Da–Da linked dimer with Ey. We show that Da directly interacts with Ey and promotes Ey binding to the Ey binding site in the Ato 3׳ enhancer. Interestingly, the Ey binding site in the Ato 3׳ enhancer contains an embedded E-box that is also required for the synergistic activation by Ey and Da. Finally we show that mammalian homologs of Ey and Da can functionally replace their Drosophila counterparts to synergistically activate the Ato enhancer, suggesting that the observed function is evolutionary conserved

犬の特発性脳炎における抗トランスグルタミナーゼ自己抗体に関する研究

学位の種別:課程博士University of Tokyo(東京大学