Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

Aims: This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods: Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results: In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion: The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis

The UK INFINITY study - early experience and complications of a multicenter series of 504 total ankle arthroplasties.

Introduction/Purpose: This is the first report from the UK INFINITY study. This is a multicentre, non-inventor, prospective observational study of 504 INFINITY fixed bearing total ankle arthroplasties. We report our early experience, complications, radiographic and functional outcomes of this prosthesis. Methods: Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months (454 patients), 1 year (328 patients) and 2 years (104 patients). The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.9 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 259 (51.4%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 32 (6.3%) COFAS 3 and 87 (17.3%) COFAS type 4. 38 patients (7.54%) presented with inflammatory arthritis. 101 (20.0%) of implantations utilised patient specific instrumentation (Prophecy). 169 (33.5%) of patients underwent an additional procedure at the time of surgery. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence. Results: There was a significant (p<0.01) improvement across all functional outcome scores at 6 months, which was sustained at one and two years. There was no significant difference with the use of patient specific instrumentation. 167 (33.1%) underwent additional procedures at index surgery. At the latest follow up 3 implants (0.6%) have been revised. One patient at 6 weeks for deep infection, one patient at 6 months for subsidence and one patient at 18 months for loosening. There were an additional 13 reoperations (2.6%) at the latest follow up. Conclusion: The UK INFINITY study is the largest reported multicentre study of a Total Ankle Arthroplasty to date. This study has shown a low early revision rate and high functional outcomes of the INFINITY prosthesis

An Analysis of Reinsurance and Firm Performance: Evidence from the Taiwan Property-Liability Insurance Industry

[[abstract]]This study investigates the relationship between reinsurance and firm performance by sourcing panel data from the 1999 to 2009 period of the property-liability insurance industry in Taiwan. The results of this investigation offer some insight that firm performance and reinsurance are interdependent. We find that insurers with higher return on assets (ROA) tend to purchase less reinsurance and insurers with higher reinsurance dependence tend to have a lower level of firm performance. Therefore, managers have to strike a balance between decreasing insolvency risk and reducing potential profitability. Other empirical results show that ROA, underwriting risks, liquidity ratio, business line concentration, return on investment (ROI) and financial holding dummy have a significant correlation with reinsurance. In addition, firm size, financial leverage, reinsurance, underwriting risks, liquidity ratio and ROI have a significant influence on firm performance. Our results have practical implications for the property-liability insurance industry and competent authorities in Taiwan.[[incitationindex]]SSCI[[booktype]]紙

Use of a conditional Ubr5 mutant allele to investigate the role an N-end rule ubiquitin-protein ligase in Hedgehog signalling and embryonic limb development

Hedgehog (Hh) signalling is a potent regulator of cell fate and function. While much is known about the events within a Hh-stimulated cell, far less is known about the regulation of Hh-ligand production. Drosophila Hyperplastic Discs (Hyd), a ubiquitin-protein ligase, represents one of the few non-transcription factors that independently regulates both hh mRNA expression and pathway activity. Using a murine embryonic stem cell system, we revealed that shRNAi of the mammalian homologue of hyd, Ubr5, effectively prevented retinoic-acid-induced Sonic hedgehog (Shh) expression. We next investigated the UBR5:Hh signalling relationship in vivo by generating and validating a mouse bearing a conditional Ubr5 loss-of-function allele. Conditionally deleting Ubr5 in the early embryonic limb-bud mesenchyme resulted in a transient decrease in Indian hedgehog ligand expression and decreased Hh pathway activity, around E13.5. Although Ubr5-deficient limbs and digits were, on average, shorter than control limbs, the effects were not statistically significant. Hence, while loss of UBR5 perturbed Hedgehog signalling in the developing limb, there were no obvious morphological defects. In summary, we report the first conditional Ubr5 mutant mouse and provide evidence for a role for UBR5 in influencing Hh signalling, but are uncertain to whether the effects on Hedgehog signaling were direct (cell autonomous) or indirect (non-cell-autonomous). Elaboration of the cellular/molecular mechanism(s) involved may help our understanding on diseases and developmental disorders associated with aberrant Hh signalling

Antiarrhythmic effect of carvedilol after acute myocardial infarction - Results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial

ObjectivesWhether beta-blockers reduce atrial arrhythmias and, when added to an angiotensin-converting enzyme (ACE) inhibitor, ventricular arrhythmia is unknown.BackgroundVentricular and atrial arrhythmias are common after acute myocardial infarction (AMI) and are associated with a poor prognosis. Angiotensin-converting enzyme inhibitors reduce the incidence of both types of arrhythmia.MethodsThe antiarrhythmic effect of carvedilol was examined in a placebo-controlled multicenter trial, the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) study, which enrolled 1,959 patients with reduced left ventricular systolic function after AMI, 98% of whom were treated with an ACE inhibitor.ResultsThe incidence of atrial fibrillation/flutter was 53 to 984 (5.4%) in the placebo group and 22 to 975 (2.3%) in the carvedilol group, giving a carvedilol/placebo hazard ratio (HR) of 0.41 (95% confidence interval [CI] 0.25 to 0.68; p = 0.0003). The corresponding rates of ventricular tachycardia/flutter/fibrillation were 38 to 984 (3.9%) and 9 to 975 (0.9%) (HR 0.24, 95% CI 0.11 to 0.49; p < 0.0001).ConclusionsCarvedilol has a powerful antiarrhythmic effect after AMI, even in patients already treated with an ACE inhibitor. Carvedilol suppresses atrial as well as ventricular arrhythmias in these patients