Search Results (1,455)

Constant light (LL) exposure is an established environmental risk factor for metabolic diseases, in which the whitening of brown adipose tissue (BAT) plays a critical role. This study aimed to elucidate the molecular mechanisms through which cordycepin counteracts LL-induced BAT whitening and improves metabolic function. We established an LL-exposed mouse model and employed an integrative approach combining pharmacological, metabolic, molecular, and computational (docking) assays to define cordycepin’s effects and targets. Cordycepin treatment significantly improved cold tolerance and attenuated BAT whitening in LL mice. Mechanistically, cordycepin directly bound to and enhanced the activity of the NAD⁺-dependent deacetylase SIRT1. This activation mitigated LL-induced impairments in mitochondrial biogenesis, dynamics, and autophagy. Furthermore, SIRT1 activation rebalanced fatty acid metabolism by downregulating CD36 and upregulating CPT1, thereby restoring the coupling of fatty acid uptake to oxidation. All beneficial effects of cordycepin were abolished by the selective SIRT1 inhibitor EX-527. In summary, our work provides strong evidence that cordycepin directly interacts with SIRT1 and enhances its deacetylase activity, thereby restoring mitochondrial function and fatty acid oxidative homeostasis in BAT to counteract constant LL-induced metabolic dysfunction. These findings position cordycepin as a promising natural compound targeting the SIRT1 pathway for metabolic disorders. Full article

Background: Diabetic peripheral neuropathy (DPN) affects up to 50% of diabetes patients and is driven by hyperglycemia-induced oxidative stress, mitochondrial dysfunction, polyol pathway activation, advanced glycation end-product formation, and inflammation. Current management is largely symptomatic, prompting interest in metabolic/nutritional therapies. This review critically evaluates the mechanistic rationale and clinical evidence for alpha-lipoic acid (ALA) and benfotiamine as adjunctive treatments for DPN. Methods: A structured narrative review of PubMed/MEDLINE was conducted using predefined keywords for DPN, oxidative stress, metabolic therapy, and thiamine derivatives. Randomized controlled trials, clinical studies, systematic reviews, and relevant experimental studies were included. Evidence was synthesized qualitatively with emphasis on mechanistic plausibility, clinical efficacy, intervention duration, and methodological rigor. Results: ALA consistently improves short-term symptoms across multiple randomized trials. The long-term NATHAN 1 trial reported a marginal, borderline significant effect on the primary composite endpoint (NIS-LL, p = 0.05) without significant improvements in nerve conduction studies; therefore, evidence for functional stabilization is very limited and inconclusive. ALA’s effects are attributed to antioxidant activity, mitochondrial protection, and improved microvascular function. Benfotiamine has a strong biochemical rationale (transketolase activation, diversion of glycolytic intermediates from damaging pathways), but clinical evidence remains limited to short-duration, symptom-based studies, with no large-scale, long-term trials published. Conclusions: Both agents target key pathways in DPN pathogenesis. ALA is the most established adjunctive metabolic therapy for symptomatic DPN, although no study has demonstrated structural nerve regeneration or a definitive disease-modifying effect. Benfotiamine is biologically plausible but requires further validation in long-term randomized trials with structural and biomarker-based endpoints. Outside of documented thiamine deficiency, its routine use cannot be recommended based on current evidence. Full article

Unmanned aerial vehicle (UAV) imagery offers a promising alternative to manual and vehicle-based inspection for highway pavement distress detection, but the high-angle perspective reduces the relative size and feature richness of small distresses and amplifies aliasing during downsampling, limiting the accuracy of existing detectors. To address these problems, this paper proposes an improved YOLOv8 algorithm with four coordinated modifications: (i) a Feature-Focusing Diffusion Pyramid Network (FFDPN) that replaces the conventional PAN to strengthen multi-scale feature fusion and preserve fine-grained details; (ii) an Information Interaction Detection Head (IIDH) that replaces the decoupled dual-branch head, sharing interaction features between the classification and regression branches via deformable convolution (DCNv2) to reduce parameters while improving task synergy; (iii) an Edge Information Extraction Module (EIEM) placed at the front of the backbone, which uses Sobel-based gradient response plus max-pooling to inject low-level edge priors; and (iv) a WaveletPool downsampling operator that decomposes features into LL/LH/HL/HH sub-bands to suppress aliasing of small-scale distresses. Experiments on 3408 UAV images of four distress categories (transverse, longitudinal, and alligator cracks and potholes) show that the improved model reaches 93.7% Precision, 89.6% Recall, and 96.0% mAP@0.50—a 12.2 percentage-point gain over YOLOv8n—while using only 2.41 × 10⁶ parameters and outperforming Faster R-CNN, DETR, YOLOv7-tiny, YOLOv9, YOLOv10n, YOLOv11n, and YOLO-World on the same benchmark. The model eliminates the duplicate and missed detections observed in baselines, at a moderate cost in FPS (30.3 vs. 57.1 for YOLOv8n). Full article

The stability and health of the ecological environment are the premise of urbanization development, and promoting their coordinated advancement constitutes the goal of sustainable social development. This research employs panel data from 30 Chinese provinces and provincial-level municipalities over the period 2011–2023 to construct a comprehensive evaluation index system for urbanization and ecological environment (U-EE). The coupling coordination degree (CCD) model is used to evaluate the coordinated development level of U-EE. Combining the Dagum–Gini index and decomposition (DGID), the spatial autocorrelation model (SAM) and trend surface analysis (TSA), the evolution characteristics and changing trends of the U-EE coordination degree (D-UEE) in both time and space are explored. It is found that, first of all, the CCD model results show that D-UEE is not high overall, yet exhibits a consistent year-on-year upward trend. Secondly, the DGID results show that the intra-group differences among the four regions—namely, the eastern, central, western and northeastern regions—are decreasing year by year, among which the eastern region has the largest difference and the northeastern region has the smallest difference. In terms of inter-group differences, the east–west disparity is the largest, whereas the central–northeast difference is the smallest. Thirdly, the global Moran’s index (GMI) results show that D-UEE presents significant spatial aggregation distribution characteristics and there is a positive correlation phenomenon. Fourthly, from the perspective of the local Moran’s index (LMI), most of the regions are concentrated in the first and third quadrants, corresponding to HH and LL types, exhibiting significant positive spatial autocorrelation and clustering patterns characterized by spatial homogeneity. Fifthly, the results of TSA show that the spatial distribution of D-UEE is high in the eastern and low in the western regions, and high in the southern and low in the northern regions. Through analysis of the results, it is evident that the intra-regional gap in the country is narrowing, but the east–west gap is still the most important reason for spatial differentiation. There are still some incoordination issues between the U-EE systems, but they are continuously improving and moving in a positive direction. Full article

To address the technical challenges associated with complex connection configurations and excessively long lap zones in the industrialized and prefabricated construction of reinforcements, this study proposes a novel parallel-lap splice that incorporates a third overlapping reinforcement. This innovative design offers several advantages, including neat ends, ease of construction, and enhanced economic efficiency. An experimental investigation was conducted to evaluate the effects of this new splice on the flexural behavior of reinforced concrete (RC) beams, with lap length (l_l) as the key variable (l_l = 64d, 40d, and 25d). A total of nine simply supported RC beams (three groups of three specimens each), all incorporating parallel-lap splices, were tested under four-point bending. The key mechanical properties were analyzed, including the mechanical characteristics, failure modes, flexural capacity, bending stiffness, and maximum flexural crack width. The experimental and analytical results reveal that RC beams with the new parallel-lap splice exhibit a distinctive “one primary + two secondary” crack pattern, characterized by a dominant flexural crack at midspan and secondary cracks at the ends of the lap zone. At the ultimate limit state, specimens with l_l = 64d experienced concrete crushing at the top surface of the midspan while those with l_l = 40d and l_l = 25d did not. Additionally, the l_l = 64d and l_l = 40d beams showed slight strength hardening, whereas the l_l = 25d beams exhibited rapid strength degradation. In terms of load-bearing capacity, both the l_l = 64d and l_l = 40d beams met the requirements specified in current design codes, while the l_l = 25d specimens showed a reduction in capacity exceeding 20%. Under serviceability limit states, midspan deflections and maximum crack widths for the l_l = 64d, l_l = 40d, and l_l = 25d specimens were found to fully comply with, marginally satisfy, and fail to meet the requirements of the design code, respectively. Based on these findings, as well as regression analysis of the relationship between peak load and lap length, it is recommended that a reasonable lap length for the proposed parallel-lap splice be taken as 60d, with a lap length correction factor of 1.5. Full article

Low-light (LL) stress is a major abiotic limiting factor in protected cherry tomato production, adversely affecting vegetative growth, inducing oxidative damage, and disrupting fruit sugar metabolism. To clarify the regulatory role of exogenous abscisic acid (ABA) in mitigating LL stress, we examined the effects of varying ABA concentrations on plant growth, antioxidant capacity, and fruit sugar metabolism in cherry tomatoes under low-light conditions. A two-factor randomized complete block design, with two light regimes—normal light (NL, 100% natural sunlight) and low light (LL, 25% natural sunlight)—and three ABA concentrations (CK: 0 mg·L⁻¹, T1: 10 mg·L⁻¹, T2: 20 mg·L⁻¹). Fruits were sampled at three typical ripening stages (green mature, breaker, and red ripe) to evaluate vegetative and reproductive physiological responses. The results showed that exogenous ABA application effectively suppressed LL-induced excessive stem elongation and alleviated LL-caused reductions in stem diameter and biomass accumulation. ABA treatment significantly increased peroxidase (POD) activity and reduced malondialdehyde (MDA) and hydrogen peroxide (H₂O₂) accumulation, thereby relieving LL-triggered oxidative damage. In addition, ABA regulated key sugar-metabolizing enzymes (soluble acid invertase (SAI), sucrose synthase (SS), sucrose phosphate synthase (SPS), and amylase (Amy)) and the transcript levels of related functional genes (HXK1, SPS, SS, AI), thereby mediating stage-dependent fruit sugar metabolism under LL stress. In conclusion, exogenous ABA effectively modulates vegetative growth, antioxidant homeostasis, and stage-specific fruit sugar metabolism, ultimately alleviating low-light stress damage in cherry tomato. Among the tested treatments, 20 mg·L⁻¹ ABA exhibited the most pronounced mitigation effects, which can be recommended as an optimal foliar application concentration for cherry tomato cultivation in low-light protected facilities. Full article

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a major cause of morbidity and mortality worldwide, particularly due to the emergence of drug-resistant strains. Membrane-active antimicrobial peptides (AMPs) represent attractive therapeutic candidates because they target bacterial envelope integrity and disrupt essential cellular processes. We evaluated two rationally designed LL-37-derived peptides: a truncated C-terminally amidated analog (LL37-1) and a modified variant incorporating N-terminal acetylation and a single D-amino acid substitution (D-LL37). Dose–response analysis demonstrated that D-LL37 exhibited greater antimycobacterial potency, with lower inhibitory concentrations of 90% (IC₉₀) and 50% (IC₅₀) values (18.40 ± 0.39 μM and 10.11 ± 0.60 μM, respectively) compared with LL37-1 (25.44 ± 0.36 μM and 15.45 ± 1.40 μM). Fluorescence-based permeability assays revealed partial membrane disruption (36% and 44% at IC₉₀ for LL37-1 and D-LL37, respectively), which was supported by ultrastructural alterations observed by scanning electron microscopy, including bacillary shortening, rough surface formation, cell clusters, and the presence of cellular debris, all of which are consistent with membrane damage. RT-qPCR analysis demonstrated significant upregulation of the P-type ATPase genes ctpF, ctpA, and ctpH following D-LL37 exposure. Collectively, these findings indicate that optimized LL-37-derived peptides exert antitubercular activity associated with envelope perturbation and coordinated activation of ion transport-related stress responses. Full article

This study was conducted in Northwest Ethiopia in 2025 to estimate genetic parameters for dairy cattle hybrids under a group-based mass selection scheme. The objective was to investigate lactation milk yield (MY), lactation length (LL), and key fitness traits across varying breed compositions, aligned with suitable agro-ecological zones and milkshed systems. The findings may then serve as a framework to develop economically efficient and sustainable dairy genotypes tailored to the region. Data were collected from 355 dairy households using semi-structured questionnaires and monthly monitoring of MY. A mass selection scheme was applied to evaluate the productive and reproductive performance of Holstein-Friesian (HF) and Jersey hybrids across varying levels of exotic breed compositions. To identify superior genotypes, a total merit index (TMI) was developed, utilizing economic weights of +0.20 for production traits and −0.12 for reproductive traits. General liner model (GLM) analyses were performed to evaluate the performance of different breeds and exotic breed composition. Realized genetic parameters including genetic correlations (rg) as an indicator of pleiotropy, genetic gain (GG) per trait, and aggregate genetic response (AGG) were estimated for each group using specialized procedures in R software. Breed type (stratified by exotic breed composition), agro-ecology zone, and milkshed system were defined as the main and sub-fixed effects. The genetic contribution to the performance of hybrids indicated that the Holstein-Friesian (HF) hybrid baseline scheme achieved significantly higher efficiency, with an aggregate genetic gain) (AGG) of 155.50, compared with 136.03 for the Jersey hybrid schemes. Specifically, the >75% HF hybrid group exhibited the highest predicted AGG (183.00), a result primarily underpinned by significant gains in MY (182.53 L) and extended LL (0.28 months). This indicated that higher exotic breed composition in HF crosses maximizes the genetic gain when selection is weighted toward productivity. Conversely, the 62.5% Jersey hybrid exhibited the lowest AGG (110.38) and GG for MY (109.86 L), indicating that intermediate Jersey breed compositions may be suboptimal under the studied conditions. Analysis of interaction effects revealed environment-specific superiorities: in the Bahir Dar midland milkshed, the >75% HF hybrids achieved the highest genetic gains in MY (182.53 L) and a superior AGG (181.34). In contrast, within the Gondar midland milkshed, >75% Jersey hybrids reached the highest overall AGG (177.11), with a corresponding GG for MY of 178.75 L per lactation. The observed variance in MY (δ² = 362.44) indicated significant potential for genetic improvement through group-based selection. Pleiotropy was identified between MY and LL (r_g = 0.14), whereas an antagonistic trade-off was observed between maturity and conception efficiency (r_g = −0.34). The consistent upward trend in the performance of hybrids as breed composition increased from 50% to >75% across both main and sub-effects suggests that these genotypes are suited to the environment. In conclusion, single- and multiple-trait predictions based solely on breed and breed comparisons were suboptimal; instead, selection strategies incorporating genotype-by-environment (G × E) interactions offered the most effective alternative for regional dairy selection alternatives. Full article

Lilium longiflorum is a diploid lily species valued for its tolerance to humid–hot environments and pleasant fragrance. However, its poor cold hardiness and low bulb-forming capacity limit its cultivation. To overcome these deficiencies, autotetraploids were previously generated in our laboratory via somatic doubling. In order to expand the reproductive efficiency of the two, this study optimized in vitro regeneration and bulblet enlargement protocols. We analyzed the effects of various plant growth regulators and sucrose concentrations, alongside the expression of genes related to carbohydrate metabolism and hormone signaling. Results revealed divergent regenerative pathways: diploids favored direct organogenesis (optimal medium: MS + 30 g/L sucrose + 0.5 mg/L 6-BA + 0.2 mg/L NAA + 1.0 mg/L glyphosate), whereas tetraploids thrived via a TDZ-induced callus pathway (1/2 MS + 30 g/L sucrose + 1.0 mg/L NAA + 0.2 mg/L TDZ). During bulblet enlargement, diploids were predominantly regulated by IBA and prone to proliferation (optimal enlargement medium: MS + 60 g/L sucrose + 2.0 mg/L IBA), while tetraploids were sucrose-sensitive and prioritized single-bulb hypertrophy (MS + 60 g/L sucrose + 0.5 mg/L IBA + 0.1 mg/L 6-BA + 0.1 mg/L CPPU). qRT-PCR indicated that LlAGPS1, LlGBSSI, LlSWEET15, LlMYC2, and LlSAUR32 were highly expressed in tetraploids during rapid enlargement (24–36 d), suggesting a role in bulb hypertrophy, whereas upregulated LlSUS4 and LlCWIN3 in diploids correlated with proliferation. The study provides a practical technical reference for the industrialized propagation of high-quality L.longiflorum bulbs and provide a theoretical foundation for understanding ploidy-dependent development in Lilium. Full article

Wetland ecosystems have been a central focus of ecological research for an quite some time. Nevertheless, the degradation of wetland riparian zones has markedly accelerated due to anthropogenic activities, climate change, and habitat heterogeneity. The objective of this paper is to investigate the differences in functional traits of riparian plants under changing wetland environments on a karst plateau, as well as to elucidate the adaptive strategies of wetland plants across different habitats. This study examines the Caohai Wetland located on the Guizhou karst plateau, selecting the leaves of four dominant plant species (Phragmites australis, Onopordum acanthium, Galium odoratum, Paspalum distichum) in the Caohai Wetland lakeshore zone and analyzes the influence of soil factors on the variation of plant functional traits within the wetland riparian zone. The results reveal that: (1) significant differences exist in the functional traits of dominant plants in the riparian zones of karst plateau wetlands, with complex interrelationships among these traits; (2) the coefficients of variation for magnesium (Mg) and calcium (Ca) in the soil are notably high (79.53% and 67.21%, respectively), whereas soil oxidation-reduction potential (ORP) exhibits the lowest coefficient of variation (4.36%)—furthermore, the convergent variation in specific leaf area (SLA) and leaf dry matter content (LDMC) directly reflects the strong environmental filtering imposed by this habitat—and (3) redundancy analysis (RDA) indicates that leaf length (LL), specific leaf area (SLA), leaf area (LA), and plant carbon content (PCC) are particularly sensitive to environmental changes, while soil calcium (Ca), total nitrogen (TN), water-dispersible clay (WDR), soil organic matter (SOM), soil moisture content (SPMC), and total potassium (TK) constitute the principal soil factors influencing plant adaptive strategies in karst plateau wetlands. In conclusion, this study demonstrates that adaptation to karst wetland habitats is mediated through trade-offs in the allocation of photosynthetic products and the regulation of carbon (C), nitrogen (N), and phosphorus (P) nutrient balances under calcium-enriched and phosphorus-limited conditions, thereby reflecting the response characteristics of functional traits in karst plateau wetland plants to environmental changes. Full article

Objective: To investigate the association between pelvic incidence (PI) and fixation failure following single-level transforaminal lumbar interbody fusion (TLIF) for low-grade spondylolisthesis and to identify risk factors for pedicle screw loosening. Methods: This retrospective study included 80 patients who underwent single-level TLIF and were divided into a high PI group (n = 40) and a normal/low PI group (n = 40). Radiographic parameters including PI, lumbar lordosis (LL), pelvic tilt (PT), sacra l slope (SS), listhesis magnitude, and PI-LL mismatch were evaluated pre- and postoperatively. Screw loosening and fusion status were assessed at 6, 12, and 24 months. Multivariate logistic regression analysis was performed to identify independent risk factors for screw loosening. Results: The high PI group demonstrated significantly higher screw loosening rates than the normal/low PI group at all follow-up time points, with a rate of 57.5% versus 28.2% at 24 months (p = 0.012). Fusion rates were comparable between groups. Multivariate analysis identified high PI and residual listhesis were independent risk factors for screw loosening (Odds ratio 1.05 and 1.35). PI-LL mismatch > 10° showed higher odds but were not statistically significant. Conclusions: High PI is associated with an increased risk of pedicle screw loosening after single-level TLIF. Careful preoperative assessment and postoperative monitoring may help reduce fixation-related complications. Full article

This study introduces a novel unsupervised framework, ICR-LLS, for detecting pathological gait patterns using instantaneous center of rotation (ICR) trajectories of the shank in the sagittal plane. ICR trajectories were computed from two-dimensional kinematic data captured at the lateral femoral epicondyle and lateral malleolus for both shanks, producing four-dimensional multivariate time series for each gait trial. Pairwise trajectory dissimilarities were quantified using circularly aligned Dynamic Time Warping (DTW), preserving temporal and spatial structure. The resulting dissimilarity matrix was embedded into a three-dimensional space using a force-directed network layout, enabling intuitive visualization of inter-subject gait relationships. Density-based clustering (DBSCAN), enhanced with a consensus-based ensemble approach, was employed to automatically identify clusters representing typical (healthy) gait patterns and outliers corresponding to pathological deviations. The framework is evaluated on a public dataset comprising individuals with Parkinson’s disease (PD) and healthy controls, achieving a normalized mutual information (NMI) of 0.449 and a Separation-to-Compactness Ratio (SCR) of 6.754, indicating a meaningful cluster structure. In addition, classification-oriented metrics yield an accuracy of 90%, sensitivity of 70%, and specificity of 96.7%, supporting the method’s effectiveness in distinguishing pathological gait. By combining minimal 2D kinematic inputs with unsupervised learning, ICR-LLS provides an interpretable framework for the exploratory analysis of gait variability, and although further validation is required, the findings suggest that ICR trajectories may serve as a meaningful biomechanical descriptor for characterizing pathological locomotion. Full article

Food waste filtrate (FW) and landfill leachate (LL) are high-strength organic wastewaters with complex compositions that pose significant challenges for conventional biological treatment. Anaerobic co-digestion is considered an effective strategy to improve process stability and methane recovery through substrate complementarity. In this study, an internal circulation (IC) anaerobic reactor was used to evaluate the co-digestion performance of FW and LL at different volumetric mixing ratios (3:7, 5:5, and 7:3). Methane production, COD removal, pH, volatile fatty acids (VFA), alkalinity, extracellular polymeric substances (EPS), enzyme activities, sludge morphology, and sludge structural and spectroscopic characteristics were analyzed to evaluate process performance and explore stability-related responses under different mixing ratios. The results showed that the 5:5 mixing ratio achieved the best overall performance. Under this condition, methane content remained at 78.79–81.60%, the volumetric methane production rate reached 893.38–1080.43 L CH₄/(m³·d), and methane yield was 0.219–0.265 L CH₄/g COD. COD removal efficiency was maintained at 86.93–88.35%. Meanwhile, the reactor operated within a relatively stable window, with pH of 6.98–7.80, VFA of 485.6–521.6 mg/L, alkalinity of 2000–3100 mg CaCO₃/L, and a VFA/TA ratio of 0.167–0.261. Compared with the other ratios, the 5:5 condition was associated with higher EPS levels, more favorable enzyme activity patterns, and a more compact sludge structure. Overall, FW-LL co-digestion exhibited clear ratio dependence, and the 5:5 mixing ratio provided the best balance between methane production, organic matter removal, and process stability. These findings offer quantitative support for substrate-ratio optimization and stable operation of anaerobic treatment systems for high-strength organic wastewaters. Full article

A new approach in constructing a univariate absolutely continuous probability model via power transformation is adopted. The proposed distribution appears to subsume several popular univariate continuous probability models that are already existent in the literature. In addition, the hazard rate function of the proposed distribution appears to possess all possible shapes, increasing, decreasing, and upside-down which is not present in all existing extensions and generalizations of the log-logistic (LL) distribution. Various established estimation strategies under the classical approach such as maximum product spacing, weighted least squares estimation, etc., are adopted to exhibit the flexibility of the proposed probability distribution. The emphasis has been made on the estimation procedure and the new probability model is indeed augmenting the existing literature in many aspects which are highlighted in the simulation and also in the real data application section. Full article

Background/Objectives: Adult spinal deformity (ASD) correction is a complex surgery to restore spinal alignment and relieve patients’ symptoms. Modern techniques and technologies allow for aggressive surgical correction in tissue-friendly ways that preserve anatomy and may enable faster recovery. Robotic-assisted posterior spinal stabilization may be used as an adjunct to complex ASD reconstruction to facilitate a minimally invasive approach, reduce perioperative morbidity and physiological insult, and allow for the performance of procedures traditionally reserved for large academic centers to be effectively performed by qualified surgeons in optimized patients at smaller hospitals with fewer resources. The objective of this study is to assess realignment, perioperative complications, and patient-reported outcomes of complex, minimally invasive, robotic-assisted adult spinal deformity correction in a surgical specialty hospital. Methods: Demographic, surgical, and perioperative data were collected from the medical record. The Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for pain scores were collected preoperatively and at regular post-op visits. X-rays were captured preoperatively before hospital discharge and at follow-up visits. Results: Fifty consecutive deformity patients were corrected with a two-stage approach (anterior column reconstruction followed by posterior stabilization with robotic-assisted screw placement on the next day) at a 48-bed (eight operating rooms), surgeon-owned, subspecialty hospital. The average patient age was 70 years, and 64% were female. The average estimated blood loss (EBL) values for the first and second stages were 62 mL and 205 mL, respectively. The average operative time was 172 min during the first stage and 210 min for the second stage. Three interbody spacers (first stage) and 16 screws (second stage) were inserted on average in each procedure. The average length of stay (LOS) in the hospital was 5 days, and the average follow-up period was 10.6 months. No patients required a transfer to another facility with intensive care unit (ICU) capabilities, and none required a revision of hardware placement. There was an average reduction in the lumbar coronal scoliotic curve of 14.5° and an increase in lumbar lordosis of 14.8° at the latest follow-up (p < 0.01). The average mismatch between pelvic incidence and lumbar lordosis (PI-LL) preoperatively was 17.6°, which was reduced to 9.6° at the latest postoperative follow-up (p < 0.01). Mean ODI (%) and NRS scores were significantly improved by 33.8% (46.7 ± 13.3 to 30.9 ± 19.8; p < 0.01) and 55% (6.0 ± 2.2 to 2.7 ± 2.6; p < 0.01), respectively, at last follow-up. Conclusions: This study demonstrates the feasibility of performing complex, robotic-assisted ASD corrective surgery in a surgical specialty hospital, achieving significant correction of sagittal and coronal deformities, relieving patients’ symptoms, and offering efficiency and consistency to pedicle screw placement. This study demonstrates that a minimally invasive approach to complex deformity reconstruction reduces perioperative morbidity with decreased operative times, EBL, and LOS when compared to historic controls. This approach allows for the democratization of deformity care in that procedures typically reserved for large academic centers can be successfully accomplished at smaller institutions in optimized patients by qualified surgeons with appropriate perioperative support staff. Full article