Risk Factors and Dynamic Nomogram Development for Surgical Site Infection Following Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis: A Retrospective Cohort Study.

Background: As the worldwide population ages, the population receiving open wedge high tibial osteotomy (OWHTO) is growing, and surgical site infection (SSI) is a rare but fatal surgical complication. This study aimed to identify risk factors independently associated with SSI following OWHTO and develop a predictive nomogram. Methods: Clinical data of patients who received OWHTO and followed up for more than 12 months in our hospital were retrospectively reviewed. Multivariable logistic regression was performed to determine independent risk factors for SSI and to construct predictive nomograms. The study further illustrated the predictive performance of the model by using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results: A total of 1294 eligible patients were included in the study. Multivariate analysis revealed tobacco consumption (OR=3.44, p=0.010), osteotomy size ≥12 mm (OR=3.3, p=0.015), the use of allogeneic bone or artificial bone graft substitutes (allogeneic bone vs none, OR=4.08, p=0.037; artificial bone vs none, OR=5.16, p=0.047), Kellgren-Lawrence (K-L) grade IV (OR=2.5, p=0.046), systemic immune-inflammation index (SII) >423.62 (OR=6.2, p<0.001), high-sensitivity C-reactive protein (HCRP) >2.6 mg/L (OR=2.42, p=0.044), and a higher level of fasting blood glucose (FBG) (OR=1.32, p=0.022) were the independent predictors of SSI. The cutoff score of the model was 148, with a sensitivity of 76.0% and specificity of 81.0%. The concordance index (C-index) and Brier score of the nomogram were 0.856 and 0.017, and the corrected values after 1000 bootstrapping validations were 0.820 and 0.018, respectively. Furthermore, the ROC curve, calibration curve, and DCA exhibited excellent predictive accuracy and clinical applicability of the model. Conclusion: This study developed a dynamic nomogram based on seven predictors, which allowed surgeons to individualize risk stratification of patients and intervene promptly to reduce SSI rates.

Molecular Identification and Pathogenicity of Diaporthe eres and D. hongkongensis (Diaporthales, Ascomycota) Associated with Cherry Trunk Diseases in China.

This study aimed to identify fungal species associated with trunk diseases of sweet cherries (Prunus avium) in several commercial cherry orchards in Beijing, Guizhou and Shandong provinces, China. In total, eighteen fungal strains that fitted well into the species concept of Diaporthe were isolated. Based on both morphological and multi-locus phylogenetic analyses of internal transcribed spacer region (ITS), beta-tubulin (tub-2), calmodulin (Cal) and translation elongation factor 1-α (tef1-α) sequencing data, fourteen isolates were identified as Diaporthe eres, while four isolates were classified as D. hongkongensis. Here, we report D. hongkongensis causing sweet cherry branch dieback disease and, further, we confirmed the host association of D. eres with sweet cherries in China. A pathogenicity assay revealed the ability of both D. eres and D. hongkongensis to cause shoot necrosis and stem lesions on Prunus avium cv. 'Brooks' (mean lesion lengths of 1.86 cm and 1.56 cm, respectively). The optimal temperature for the growth of both Diaporthe species was tested. The optimal growth temperature for D. hongkongensis was 30 °C, and the 25-28 °C temperatures were the most favorable for the growth of D. eres strains. This research advances the understanding of fungal trunk diseases in fruit crops, particularly gummosis and branch dieback disease in Chinese cherry orchards, and will aid growers in making decisions about cultural practices and disease management.

Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis.

PURPOSE: Proximal tibia osteotomy with absorbable spacer combined with fibular osteotomy (TPOASI) is an emerging surgical technique for treating knee osteoarthritis (KOA); however, the efficacy of this procedure remains unknown. We hypothesize that TPOASI can achieve similar clinical outcomes to opening-wedge high tibial osteotomy (OW-HTO). The objective of this study is to compare the clinical results between these two procedures. METHODS: Patients who underwent TPOASI or OW-HTO from July 2016 to September 2020 were included. The following outcome parameters were determined before and after the surgery: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale of pain, the Intermittent and Persistent Osteoarthritis Pain Scale, femorotibial angle, and post-operative complications. RESULTS: In total, 209 cases were analyzed (102 in TPOASI group; 107 in OW-HTO group) with 3.1 years average follow-up. Both procedures achieved significant improvement in KOOS (62.0 to 24.4 in the TPOASI and 62.8 to 26.2 in the OW-HTO group, p < 0.001) and WOMAC score (68.9 to 24.1 in the TPOASI versus 69.9 to 26.1 in the OW-HTO group, p < 0.001). There were no significant differences in complications or femorotibial angle between the two groups but the only significant difference in the outcome parameters was the WOMAC stiffness score (19.6 in the TPOASI versus 26.5 in the OW-HTO group). CONCLUSION: TPOASI achieves comparable results to OW-HTO in terms of clinical scores, radiographic results, and complications, but has the advantage of avoiding internal fixation removal.