A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

Objective Robotic guidance provides indirect visualization of key anatomic landmarks to facilitate minimally invasive surgery (MIS) and is emerging as a reliable and accurate technique for posterior spine instrumentation. We sought to describe eight years of experience with robotic guidance at a high-volume, multi-surgeon center. We hypothesize that robotic guidance will lead to (1) low rates of complication, readmissions, and revision surgery, (2) reduced fluoroscopic radiation exposure, (3) and accurate thoracolumbar instrumentation. Methods A retrospective review of complications, revision surgery, and readmission rates in patients undergoing thoracolumbar fusion surgery utilizing three robotic generations. Secondary analysis was conducted comparing the three robotic generations for complications, revision surgery, accuracy, and readmission rates along with intraoperative fluoroscopic duration. Results A total of 628 patients (3,874 robotic-guided screws) ages 12–81 years-old (43.9% male) were included in the study. At one year, the cumulative complication incidence was 15.5% with a 10.3% incidence of surgical complications (3.7% wound, 1.2% robot-related, and 5.4% non-robot-related complications). At one year, the revision surgery incidence was 9.4%. There was no statistical difference between complications, readmission, or revision surgery after initial admission among the three robotic generations. The average intraoperative fluoroscopic duration was 53.8 seconds (11.9 seconds per screw and 17.6 seconds per instrumented level). Conclusion Robotic guidance in thoracolumbar instrumented fusions was associated with low complication, revision surgery, and readmission rates. Our results suggest robotic guidance can provide accurate guidance with minimal adverse events in thoracolumbar instrumentation

Galectin-3 alters the lateral mobility and clustering of beta 1-integrin receptors

Glycoprotein receptors are influenced by myriad intermolecular interactions at the cell surface. Specific glycan structures may interact with endogenous lectins that enforce or disrupt receptor-receptor interactions. Glycoproteins bound by multivalent lectins may form extended oligomers or lattices, altering the lateral mobility of the receptor and influencing its function through endocytosis or changes in activation. In this study, we have examined the interaction of Galectin-3 (Gal-3), a human lectin, with adhesion receptors. We measured the effect of recombinant Gal-3 added exogenously on the lateral mobility of the alpha 5 beta 1 integrin on HeLa cells. Using single-particle tracking (SPT) we detected increased lateral mobility of the integrin in the presence of Gal-3, while its truncated C-terminal domain (Gal-3C) showed only minor reductions in lateral mobility. Treatment of cells with Gal-3 increased beta 1-integrin mediated migration with no apparent changes in viability. In contrast, Gal-3C decreased both cell migration and viability. Fluorescence microscopy allowed us to confirm that exogenous Gal-3 resulted in reorganization of the integrin into larger clusters. We used a proteomics analysis to confirm that cells expressed endogenous Gal-3, and found that addition of competitive oligosaccharide ligands for the lectin altered the lateral mobility of the integrin. Together, our results are consistent with a Gal-3-integrin lattice model of binding and confirm that the lateral mobility of integrins is natively regulated, in part, by galectins

Modulation of immune responses by targeting CD169/Siglec-1 with the glycan ligand

A fundamental role in the plant-bacterium interaction for Gram-negative phytopathogenic bacteria is played by membrane constituents, such as proteins, lipopoly- or lipooligosaccharides (LPS, LOS) and Capsule Polysaccharides (CPS). In the frame of the understanding the molecular basis of plant bacterium interaction, the Gram-negative bacterium Agrobacterium vitis was selected in this study. It is a phytopathogenic member of the Rhizobiaceae family and it induces the crown gall disease selectively on grapevines (Vitis vinifera). A. vitis wild type strain F2/5, and its mutant in the quorum sensing gene ΔaviR, were studied. The wild type produces biosurfactants; it is considered a model to study surface motility, and it causes necrosis on grapevine roots and HR (Hypersensitive Response) on tobacco. Conversely, the mutant does not show any surface motility and does not produce any surfactant material; additionally, it induces neither necrosis on grape, nor HR on tobacco. Therefore, the two strains were analyzed to shed some light on the QS regulation of LOS structure and the consequent variation, if any, on HR response. LOS from both strains were isolated and characterized: the two LOS structures maintained several common features and differed for few others. With regards to the common patterns, firstly: the Lipid A region was not phosphorylated at C4 of the non reducing glucosamine but glycosylated by an uronic acid (GalA) unit, secondly: a third Kdo and the rare Dha (3-deoxy-lyxo-2-heptulosaric acid) moiety was present. Importantly, the third Kdo and the Dha residues were substituted by rhamnose in a not stoichiometric fashion, giving four different oligosaccharide species. The proportions among these four species, is the key difference between the LOSs from both the two bacteria. LOS from both strains and Lipid A from wild type A. vitis are now examined for their HR potential in tobacco leaves and grapevine roots