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Brandel MG, Plonsker JH, Rennert RC, Produturi G, Saripella M, Wali AR, McCann C, Ravindra VM, Santiago-Dieppa DR, Pannell JS, Steinberg JA, Khalessi AA, Levy ML. Treatment of pediatric intracranial aneurysms: institutional case series and systematic literature review. Childs Nerv Syst 2024:10.1007/s00381-024-06384-x. [PMID: 38635071 DOI: 10.1007/s00381-024-06384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Pediatric intracranial aneurysms (IAs) are rare and have distinct clinical profiles compared to adult IAs. They differ in location, size, morphology, presentation, and treatment strategies. We present our experience with pediatric IAs over an 18-year period using surgical and endovascular treatments and review the literature to identify commonalities in epidemiology, treatment, and outcomes. METHODS We identified all patients < 20 years old who underwent treatment for IAs at our institution between 2005 and 2020. Medical records and imaging were examined for demographic, clinical, and operative data. A systematic review was performed to identify studies reporting primary outcomes of surgical and endovascular treatment of pediatric IAs. Demographic information, aneurysm characteristics, treatment strategies, and outcomes were collected. RESULTS Thirty-three patients underwent treatment for 37 aneurysms over 18 years. The mean age was 11.4 years, ranging from one month to 19 years. There were 21 males (63.6%) and 12 females (36.4%), yielding a male: female ratio of 1.75:1. Twenty-six (70.3%) aneurysms arose from the anterior circulation and 11 (29.7%) arose from the posterior circulation. Aneurysmal rupture occurred in 19 (57.5%) patients, of which 8 (24.2%) were categorized as Hunt-Hess grades IV or V. Aneurysm recurrence or rerupture occurred in five (15.2%) patients, and 5 patients (15.2%) died due to sequelae of their aneurysms. Twenty-one patients (63.6%) had a good outcome (modified Rankin Scale score 0-2) on last follow up. The systematic literature review yielded 48 studies which included 1,482 total aneurysms (611 with endovascular treatment; 656 treated surgically; 215 treated conservatively). Mean aneurysm recurrence rates in the literature were 12.7% and 3.9% for endovascular and surgical treatment, respectively. CONCLUSIONS Our study provides data on the natural history and longitudinal outcomes for children treated for IAs at a single institution, in addition to our treatment strategies for various aneurysmal morphologies. Despite the high proportion of patients presenting with rupture, good functional outcomes can be achieved for most patients.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - Jillian H Plonsker
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of Utah, 175 North Medical Drive East, Salt Lake City, CA, USA
| | - Gautam Produturi
- School of Medicine, University of California, San Diego, CA, USA
| | - Megana Saripella
- School of Medicine, University of California, San Diego, CA, USA
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - Carson McCann
- School of Medicine, University of California, San Diego, CA, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - David R Santiago-Dieppa
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - Jeffrey A Steinberg
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, USA.
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Götz MG, Godwin K, Price R, Dorn R, Merrill-Steskal G, Klemmer W, Hansen H, Produturi G, Rocha M, Palmer M, Molacek L, Strater Z, Groll M. Macrocyclic Oxindole Peptide Epoxyketones-A Comparative Study of Macrocyclic Inhibitors of the 20S Proteasome. ACS Med Chem Lett 2024; 15:533-539. [PMID: 38628795 PMCID: PMC11017298 DOI: 10.1021/acsmedchemlett.4c00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/22/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Peptide macrocycles have recently gained attention as protease inhibitors due to their metabolic stability and specificity. However, the development of peptide macrocycles with improved binding potency has so far been challenging. Here we present macrocyclic peptides derived from the clinically applied proteasome inhibitor carfilzomib with an oxindole group that mimics the natural product TMC-95A. Fluorescence kinetic activity assays reveal a high potency of the oxindole group (IC50 = 0.19 μM) compared with agents lacking this motif. X-ray structures of the ligands with the β5-subunit of the yeast 20S proteasome illustrate that the installed macrocycle forces strong hydrogen bonding of the oxindole group with β5-Gly23NH. Thus, the binding of our designed oxindole epoxyketones is entropically and enthalpically favored in contrast to more flexible proteasome inhibitors such as carfilzomib.
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Affiliation(s)
- Marion G. Götz
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Kacey Godwin
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Rachel Price
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Robert Dorn
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | | | - William Klemmer
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Hunter Hansen
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Gautam Produturi
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Megan Rocha
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Mathias Palmer
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Lea Molacek
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Zack Strater
- Department
of Chemistry, Whitman College, Walla Walla, Washington 99362, United States
| | - Michael Groll
- Technical
University of Munich, TUM School of Natural
Sciences, Department of Bioscience, Center for Protein Assemblies
(CPA), Ernst-Otto-Fischer
Strasse 8, 85748 Garching, Germany
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Tenorio A, Brandel MG, Produturi G, McCann C, Costantini T, Doucet J, Ciacci JD. 625 The Impact of the Mexico-San Diego Border Wall Extension on Spinal Injuries. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Diaz-Aguilar L, Stone LE, Soliman MAR, Padovano A, Ehresman J, Brown NJ, Produturi G, Battista M, Khan A, Pollina J, Amaral R, Abd-El-Barr MM, Moss I, Smith T, Deol GS, Lee BS, McMains MC, Joseph SA, Schwartz D, Pimenta L, Nguyen AD, Taylor WR. Radiographic alignment outcomes after the single-position prone transpsoas approach: a multi-institutional retrospective review of 363 cases. Neurosurg Focus 2023; 54:E3. [PMID: 36587405 DOI: 10.3171/2022.10.focus22603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/19/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this paper was to evaluate the changes in radiographic spinopelvic parameters in a large cohort of patients undergoing the prone transpsoas approach to the lumbar spine. METHODS A multicenter retrospective observational cohort study was performed for all patients who underwent lateral lumber interbody fusion via the single-position prone transpsoas (PTP) approach. Spinopelvic parameters from preoperative and first upright postoperative radiographs were collected, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT). Functional indices (visual analog scale score), and patient-reported outcomes (Oswestry Disability Index) were also recorded from pre- and postoperative appointments. RESULTS Of the 363 patients who successfully underwent the procedure, LL after fusion was 50.0° compared with 45.6° preoperatively (p < 0.001). The pelvic incidence-lumbar lordosis mismatch (PI-LL) was 10.5° preoperatively versus 2.9° postoperatively (p < 0.001). PT did not significantly change (0.2° ± 10.7°, p > 0.05). CONCLUSIONS The PTP approach allows significant gain in lordotic augmentation, which was associated with good functional results at follow-up.
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Affiliation(s)
- Luis Diaz-Aguilar
- 1Department of Neurological Surgery, University of California, San Diego, La Jolla, California
| | - Lauren E Stone
- 1Department of Neurological Surgery, University of California, San Diego, La Jolla, California
| | - Mohamed A R Soliman
- 2Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.,3Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, New York
| | | | - Jeff Ehresman
- 6Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Nolan J Brown
- 7Department of Neurological Surgery, University of Irvine, California
| | - Gautam Produturi
- 1Department of Neurological Surgery, University of California, San Diego, La Jolla, California
| | - Madison Battista
- 6Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Asham Khan
- 4Department of Neurological Surgery, University at Buffalo, New York
| | - John Pollina
- 4Department of Neurological Surgery, University at Buffalo, New York
| | - Rodrigo Amaral
- 8Department of Neurological Surgery, Instituto de Patologia da Coluna, São Paulo Sul, Brazil
| | | | - Isaac Moss
- 10Department of Orthopedic Surgery, University of Connecticut, Farmington, Connecticut
| | | | - Gurvinder S Deol
- 5Department of Orthopaedic Surgery, WakeMed, Raleigh, North Carolina
| | - Bryan S Lee
- 6Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | | | | | - Luiz Pimenta
- 8Department of Neurological Surgery, Instituto de Patologia da Coluna, São Paulo Sul, Brazil
| | - Andrew D Nguyen
- 1Department of Neurological Surgery, University of California, San Diego, La Jolla, California
| | - William R Taylor
- 1Department of Neurological Surgery, University of California, San Diego, La Jolla, California
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Himstead AS, Shahrestani S, Brown NJ, Produturi G, Shlobin NA, Al Jammal O, Choi EH, Ransom SC, Daniel Diaz-Aguilar L, Sahyouni R, Abraham M, Pham MH. Bony fixation in the era of spinal robotics: A systematic review and meta-analysis. J Clin Neurosci 2022; 97:62-74. [DOI: 10.1016/j.jocn.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 01/02/2023]
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