Pursuit and escape drive fine-scale movement variation during migration in a temperate alpine ungulate.

Climate change reduces snowpack, advances snowmelt phenology, drives summer warming, alters growing season precipitation regimes, and consequently modifies vegetation phenology in mountain systems. Elevational migrants track spatial variation in seasonal plant growth by moving between ranges at different elevations during spring, so climate-driven vegetation change may disrupt historic benefits of migration. Elevational migrants can furthermore cope with short-term environmental variability by undertaking brief vertical movements to refugia when sudden adverse conditions arise. We uncover drivers of fine-scale vertical movement variation during upland migration in an endangered alpine specialist, Sierra Nevada bighorn sheep (Ovis canadensis sierrae) using a 20-year study of GPS collar data collected from 311 unique individuals. We used integrated step-selection analysis to determine factors that promote vertical movements and drive selection of destinations following vertical movements. Our results reveal that relatively high temperatures consistently drive uphill movements, while precipitation likely drives downhill movements. Furthermore, bighorn select destinations at their peak annual biomass and maximal time since snowmelt. These results indicate that although Sierra Nevada bighorn sheep seek out foraging opportunities related to landscape phenology, they compensate for short-term environmental stressors by undertaking brief up- and downslope vertical movements. Migrants may therefore be impacted by future warming and increased storm frequency or intensity, with shifts in annual migration timing, and fine-scale vertical movement responses to environmental variability.

Mapping and Omics Integration: Towards Precise Rice Disease Resistance Breeding.

Rice (Oryza sativa), as a staple crop feeding a significant portion of the global population, particularly in Asian countries, faces constant threats from various diseases jeopardizing global food security. A precise understanding of disease resistance mechanisms is crucial for developing resilient rice varieties. Traditional genetic mapping methods, such as QTL mapping, provide valuable insights into the genetic basis of diseases. However, the complex nature of rice diseases demands a holistic approach to gain an accurate knowledge of it. Omics technologies, including genomics, transcriptomics, proteomics, and metabolomics, enable a comprehensive analysis of biological molecules, uncovering intricate molecular interactions within the rice plant. The integration of various mapping techniques using multi-omics data has revolutionized our understanding of rice disease resistance. By overlaying genetic maps with high-throughput omics datasets, researchers can pinpoint specific genes, proteins, or metabolites associated with disease resistance. This integration enhances the precision of disease-related biomarkers with a better understanding of their functional roles in disease resistance. The improvement of rice breeding for disease resistance through this integration represents a significant stride in agricultural science because a better understanding of the molecular intricacies and interactions underlying disease resistance architecture leads to a more precise and efficient development of resilient and productive rice varieties. In this review, we explore how the integration of mapping and omics data can result in a transformative impact on rice breeding for enhancing disease resistance.

A Rare Case of Synovial Chondromatosis of Knee with both Intra-articular and Extra-articular Involvement: A Case Report.

Introduction: Synovial chondromatosis (SC) is a relatively rare benign disorder characterized by developing many nodules composed of cartilage within the synovial cavities of joints. It impacts several joints, with the knee joint being the most often affected. Extra-articular involvement, such as bursae or tendon sheaths, is rare. Furthermore, the coexistence of intra- and extra-articular SC is an infrequent condition. Hence, we present a rare case of SC with intra- and extra-articular involvement. Case Presentation: The patient, a 38-year-old woman, reported experiencing progressive right knee discomfort for 2 months. In addition, a growing mass was observed on the medial aspect of the right knee that was noticeable for the past 2 months. MRI examination revealed the presence of both intra-articular and extra-articular lesions. A two-step surgical procedure, including arthroscopy synovectomy involving the debridement of the lesions and removal of the extra-articular mass through an open incision, was performed. Histopathological analysis confirmed SC. At the 1-year follow-up, the patient reported complete relief of discomfort in the right knee. Conclusion: The coexistence of extra-articular and intra-articular SC is an exceedingly rare condition. Surgical removal of the loose bodies and a synovectomy performed as thoroughly as possible constitute the mainstay of treatment in managing SC.

Development of High-Performance Coconut Oil-Based Rigid Polyurethane-Urea Foam: A Novel Sequential Amidation and Prepolymerization Process.

The utilization of coconut diethanolamide (p-CDEA) as a substitute polyol for petroleum-based polyol in fully biobased rigid polyurethane-urea foam (RPUAF) faces challenges due to its short chain and limited cross-linking capability. This leads to compromised cell wall resistance during foam expansion, resulting in significant ruptured cells and adverse effects on mechanical and thermal properties. To address this, a novel sequential amidation-prepolymerization route was employed on coconut oil, yielding a hydroxyl-terminated poly(urethane-urea) prepolymer polyol (COPUAP). Compared to p-CDEA, COPUAP exhibited a decreased hydroxyl value (496.3-473.2 mg KOH/g), an increase in amine value (13.464-24.561 mg KOH/g), and an increase in viscosity (472.4-755.8 mPa·s), indicating enhanced functionality of 34.3 mgKOH/g and chain lengthening. Further, COPUAP was utilized as the sole B-side polyol in the production of RPUAF (PU-COPUAP). The improved functionality of COPUAP and its improved cross-linking capability during foaming have significantly improved cell morphology, resulting in a remarkable 4.7-fold increase in compressive strength (132-628 kPa), a 3.5-fold increase in flexural strength (232-828 kPa), and improved insulation properties with a notable decrease in thermal conductivity (48.02-34.52 mW/m·K) compared to PU-CDEA in the literature. Additionally, PU-COPUAP exhibited a 16.5% increase in the water contact angle (114.93° to 133.87°), attributing to the formation of hydrophobic biuret segments and a tightly packed, highly cross-linked structure inhibiting water penetration. This innovative approach sets a new benchmark for fully biobased rigid foam production, delivering high load-bearing capacity, exceptional insulation, and significantly improved hydrophobicity.

Erector spinae plane block (ESPB) for intractable, non-surgical abdominal pain: a scoping review.

Abdominal pain is one of the most common presenting chief complaints in the emergency department (ED). Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of non-surgical abdominal pain has not yet been characterized. Our scoping review aims to review the current literature on the safety and efficacy of ESPB in the management of patients experiencing intractable, non-surgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for non-surgical abdominal pain. Reviewers screened 30 titles and abstracts that met the predefined inclusion and exclusion criteria. Following initial screening, 24 articles underwent full-text review. Two reviewers also screened references included in each study. A total of 14 journal articles were reviewed, including 12 case-based studies, one systematic review, and one narrative review of ESPB in the treatment of non-surgical abdominal pain. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and each case reported no complications. This scoping review provides support for ESPB in the management of intractable, non-surgical abdominal pain. ESPB demonstrates efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Block Time: A Multispecialty Systematic Review of Efficacy and Safety of Ultrasound-guided Upper Extremity Nerve Blocks.

INTRODUCTION: Ultrasound-guided peripheral nerve blockade is a common pain management strategy to decrease perioperative pain and opioid/general anesthetic use. In this article our goal was to systematically review publications supporting upper extremity nerve blocks distal to the brachial plexus. We assessed the efficacy and safety of median, ulnar, radial, suprascapular, and axillary nerve blocks by reviewing previous studies. METHODS: We searched MEDLINE and Embase databases to capture studies investigating these nerve blocks across all specialties. We screened titles and abstracts according to agreed-upon inclusion/exclusion criteria. We then conducted a hand search of references to identify studies not found in the initial search strategy. RESULTS: We included 20 studies with 1,273 enrolled patients in qualitative analysis. Both anesthesiology (12, 60%) and emergency medicine (5, 25%) specialties have evidence of safe and effective use of radial, ulnar, median, suprascapular, and axillary blocks for numerous clinical applications. Recently, multiple randomized controlled trials show suprascapular nerve blocks may result in lower pain scores in patients with shoulder dislocations and rotator cuff injuries, as well as in patients undergoing anesthesia for shoulder surgery. CONCLUSION: Distal upper extremity nerve blocks under ultrasound guidance may be safe, practical strategies for both acute and chronic pain in perioperative, emergent, and outpatient settings. These blocks provide accessible, opioid-sparing pain management, and their use across multiple specialties may be expanded with increased procedural education of trainees.

Using a Linear Probe Ultrasound for the Detection of First-Trimester Pregnancies in the Emergency Department.

Linear probe point-of-care ultrasound (LPUS) presents a less invasive alternative for identifying intrauterine pregnancies (IUPs) compared to usual practice (transabdominal (TAUS) or transvaginal (TVUS) ultrasound). TAUS and TVUS can be invasive or produce lower-resolution images than LPUS. The purpose of this study is to determine whether a linear probe alone can identify first-trimester IUPs. A convenience sample of 21 patients were enrolled at the University of California Irvine ED during a 7-month period. The inclusion criteria were English- or Spanish-speaking women (≥18 years) in their first trimester of pregnancy (≤12 weeks pregnant) with a body mass index (BMI) of <35. The exclusion criteria were psychiatric, incarcerated, or cognitively impaired patients. An ED physician performed LPUS and ordered a confirmatory ultrasound. The 21 patients enrolled had a mean age of 28.6 ± 6.60 years, BMI of 26.6 ± 5.03, and gestational age of 7.4 ± 2.69 weeks. Considering the 95% confidence interval, we are 97.5% confident that the sensitivity and specificity of LPUS to identify IUPs does not exceed 67.1% and 93.2%, respectively. Our pilot data did not demonstrate that LPUS can independently visualize IUPs in first-trimester patients.

Ultrasound-guided Percutaneous Lavage as Treatment for Pellegrini-Stieda Syndrome with Suspected Same Patho-mechanism as Rotator Cuff Syndrome: A Case Report.

Introduction: Pellegrini-Stieda syndrome is described as pain and restriction at the range of motioncaused by calcification in the medial collateral ligament (MCL) around the knee with the recognized radiographic findings of the lesion in the affected site. The pathomechanism of Pellegrini-Stieda is suspected to be similar as calcification of the rotator cuff that is thought to be reactive calcification followed by resorption and tendon remodeling involving four phases (pre-calcific, formative, resorptive, and healing) without any trauma history. Since the calcium deposit in the rotator cuff has been well managed by percutaneous lavage, in this case report, we assumed that the pathomechanism of Pellegrini-Stieda Syndrome is similar to calcification of the rotator cuff, thus can be treated with the same principle using ultrasound-guided percutaneous lavage (UGPL). Objective: The aim of the study was to discuss UGPL as management for Pellegrini-Stieda with suspected similar pathomechanism to rotator cuff calcification. Case Report: A 52-year-old woman came to the outpatient clinic with a week of severe pain in her right knee. The patient had difficulty walking due to stiffness and pain that is aggravated by moving her knee. Radiographic examination confirmed calcified lesions located within the MCL on the right knee. In consideration of the acute pain, we opted to perform UGPL procedure. Follow-ups were done 1 week and 1 month after the procedure. The patient reported no pain when walking and bending her knee during the follow-up examination and there was no complication noted. Overall, she was very satisfied with the result. We also interviewed her for the lower extremity functional scale Score which the patient gave 64 points and 72 points out of 80 for week 1 and 1 month, respectively, indicating favorable results. Conclusion: Based on our case, UGPL can be an option for treating Pellegrini-Stieda Syndrome because it produces the same result as UGPL on rotator cuff calcification. Surgery should be the last resort if this procedure fails. Future high-quality randomized controlled trials were required to determine the reliability of this method.

"Two Is Better Than One": The Multifactorial Nature of Phage-Antibiotic Combinatorial Treatments Against ESKAPE-Induced Infections.

Phage-antibiotic synergy (PAS) has been extensively explored over the past decade, with the aim of developing more effective treatments against multidrug-resistant organisms. However, it remains unclear how to effectively combine these two approaches. To address this uncertainty, we assessed four main aspects of PAS interactions in this review, seeking to identify commonalities of combining treatments within and between bacterial species. We examined all literature on PAS efficacy toward ESKAPE pathogens and present an analysis of the data in papers focusing on: (1) order of treatment, (2) dose of both phage and antibiotics, (3) mechanism of action, and (4) viability of transfer from in vivo or animal model trials to clinical applications. Our analysis indicates that there is little consistency within phage-antibiotic therapy regimens, suggesting that highly individualized treatment regimens should be used. We propose a set of experimental studies to address these research gaps. We end our review with suggestions on how to improve studies on phage-antibiotic combination therapy to advance this field.

Large herbivore diversity slows sea ice-associated decline in arctic tundra diversity.

Biodiversity is declining globally in response to multiple human stressors, including climate forcing. Nonetheless, local diversity trends are inconsistent in some taxa, obscuring contributions of local processes to global patterns. Arctic tundra diversity, including plants, fungi, and lichens, declined during a 15-year experiment that combined warming with exclusion of large herbivores known to influence tundra vegetation composition. Tundra diversity declined regardless of experimental treatment, as background growing season temperatures rose with sea ice loss. However, diversity declined slower with large herbivores than without them. This difference was associated with an increase in effective diversity of large herbivores as formerly abundant caribou declined and muskoxen increased. Efforts that promote herbivore diversity, such as rewilding, may help mitigate impacts of warming on tundra diversity.

Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients

Abstract Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid =4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection (p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients.

Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid = 4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection ( p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis. Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robot-assisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA. Methods: We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models. Results: A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, -0.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups. Conclusions: Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Genetic Characterization of the Partial Disease Resistance of Rice to Bacterial Panicle Blight and Sheath Blight by Combined QTL Linkage and QTL-seq Analyses.

Bacterial panicle blight (BPB) and sheath blight (SB) are major diseases of rice and few cultivars have shown a high level of resistance to these diseases. A recombinant inbred line (RIL) population developed from the U.S. cultivars Jupiter (moderately resistant) and Trenasse (susceptible) was investigated to identify loci associated with the partial disease resistance to BPB and SB. Disease phenotypes in BPB and SB, as well as the days-to-heading (DTH) trait, were evaluated in the field. DTH was correlated to BPB and SB diseases, while BPB was positively correlated to SB in the field trials with this RIL population. Genotyping was performed using Kompetitive Allele Specific PCR (KASP) assays and whole-genome sequence (WGS) analyses. Quantitative trait locus (QTL) mapping and bulk segregant analysis using a set of WGS data (QTL-seq) detected a major QTL on the upper arm of chromosome 3 for BPB, SB, and DTH traits within the 1.0-1.9 Mb position. Additional QTLs associated with BPB and SB were also identified from other chromosomes by the QTL-seq analysis. The QTLs identified in this study contain at least nine candidate genes that are predicted to have biological functions in defense or flowering. These findings provide an insight into the complex nature of the quantitative resistance to BPB and SB, which may also be closely linked to the flowering trait.

Utilization of point-of-care ultrasound among graduates of a 4-year longitudinal medical school ultrasound curriculum.

OBJECTIVE: In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, Irvine alumni. METHODS: We surveyed University of California, Irvine alumni from the class of 2011 and beyond. Survey questions included POCUS reliance, frequency of use, and comfort with image acquisition and interpretation compared with peers. The primary outcomes were self-reported comfort and reliance on POCUS. RESULTS: We received 93 responses from 624 surveyed alumni (response rate, 14.9%), of which 87 were analyzed. Although 46 respondents (52.9%) reported more reliance on POCUS, three (3.4%) relied on it less than their peers. At the same time, 72 (82.7%) and 67 (77.0%) felt more comfortable than their colleagues in obtaining and interpreting POCUS, respectively. No respondents felt less comfortable obtaining or interpreting POCUS than their peers. The frequency of POCUS use correlated directly with the frequency with which POCUS changed the responder's case management (rho, 0.860; P<0.001). POCUS reliance also correlated with respondents' comfort level in obtaining (rho, 0.321; P<0.001) and interpreting (rho, 0.378; P<0.001) POCUS results. CONCLUSION: University of California, Irvine graduates had higher reliance on POCUS than peers in their respective specialties. Their POCUS findings frequently changed their case management.

Projected bioclimatic distributions in Nearctic Bovidae signal the potential for reduced overlap with protected areas.

Assumptions about factors such as climate in shaping species' realized and potential distributions underlie much of conservation planning and wildlife management. Climate and climatic change lead to shifts in species distributions through both direct and indirect ecological pressures. Distributional shifts may be particularly important if range overlap is altered between interacting species, or between species and protected areas. The cattle family (Bovidae) represents a culturally, economically, and ecologically important taxon that occupies many of the world's rangelands. In contemporary North America, five wild bovid species inhabit deserts, prairies, mountains, and tundra from Mexico to Greenland. Here, we aim to understand how future climate change will modify environmental characteristics associated with North American bovid species relative to the distribution of extant protected areas. We fit species distribution models for each species to climate, topography, and land cover data using observations from a citizen science dataset. We then projected modeled distributions to the end of the 21st century for each bovid species under two scenarios of anticipated climate change. Modeling results suggest that suitable habitat will shift inconsistently across species and that such shifts will lead to species-specific variation in overlap between potential habitat and existing protected areas. Furthermore, projected overlap with protected areas was sensitive to the warming scenario under consideration, with diminished realized protected area under greater warming. Conservation priorities and designation of new protected areas should account for ecological consequences of climate change.

Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis.

Background: Proximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade. Methods: This retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD). Result: A total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R2 = 0.29. Conclusion: A significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.

Engineering of Yarrowia lipolytica for the production of plant triterpenoids: Asiatic, madecassic, and arjunolic acids.

Several plant triterpenoids have valuable pharmaceutical properties, but their production and usage is limited since extraction from plants can burden natural resources, and result in low yields and purity. Here, we engineered oleaginous yeast Yarrowia lipolytica to produce three valuable plant triterpenoids (asiatic, madecassic, and arjunolic acids) by fermentation. First, we established the recombinant production of precursors, ursolic and oleanolic acids, by expressing plant enzymes in free or fused versions in a Y. lipolytica strain previously optimized for squalene production. Engineered strains produced up to 11.6 mg/g DCW ursolic acid or 10.2 mg/g DCW oleanolic acid. The biosynthetic pathway from ursolic acid was extended by expressing the Centella asiatica cytochrome P450 monoxygenases CaCYP716C11p, CaCYP714E19p, and CaCYP716E41p, resulting in the production of trace amounts of asiatic acid and 0.12 mg/g DCW madecassic acid. Expressing the same C. asiatica cytochromes P450 in oleanolic acid-producing strain resulted in the production of oleanane triterpenoids. Expression of CaCYP716C11p in the oleanolic acid-producing strain yielded 8.9 mg/g DCW maslinic acid. Further expression of a codon-optimized CaCYP714E19p resulted in 4.4 mg/g DCW arjunolic acid. Lastly, arjunolic acid production was increased to 9.1 mg/g DCW by swapping the N-terminal domain of CaCYP714E19p with the N-terminal domain from a Kalopanax septemlobus cytochrome P450. In summary, we have demonstrated the production of asiatic, madecassic, and arjunolic acids in a microbial cell factory. The strains and fermentation processes need to be further improved before the production of these molecules by fermentation can be industrialized.

Tibial reference point in total knee arthroplasty in patient with proximal tibia vara: A case report.

INTRODUCTION: Center of the intercondylar eminence at the proximal tibia had been widely used as a reference point for tibial bone cut in the Total Knee Arthroplasty (TKA) procedure. However, in the presence of preexisting tibia vara, the center of intercondylar eminence as tibial bone cut reference point often leads to varus malalignment after TKA procedure. CASE REPORT: 75 years old male patient complained of worsening pain on the left knee. The patient has had a history of knee osteoarthritis for the past seven years. The radiograph on the right knee revealed osteoarthritis grade 3 and left knee osteoarthritis grade 4, both with tibia vara. We planned to perform total knee arthroplasty surgery on his left knee with a preoperative planning tibial reference point of 10 mm lateral to the center. Six months after the knee replacement, there was minimal pain on activity, and full ROM was achieved on his left knee. On the radiographic X-ray evaluation, the alignment between the tibial implant surface and mechanical axis is 0.43 degrees valgus. CLINICAL DISCUSSION: In a varus knee malignment, the mechanical axis passes through one-third of the medial side of the knee, which makes the medial side of the implant wear off faster, resulting in the collapse of the medial tibia, thus decreasing implant survival and increasing the need for revision for TKA. CONCLUSION: In patients with preexisting tibia vara, tibial bone cut reference point planning before TKA procedure is important to provide longevity of implant survival and better quality of life.