12 results on '"Burklow TR"'
Search Results
2. Leptin Attenuates Cardiac Hypertrophy in Patients With Generalized Lipodystrophy.
- Author
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Nguyen ML, Sachdev V, Burklow TR, Li W, Startzell M, Auh S, and Brown RJ
- Subjects
- Adolescent, Adult, Blood Pressure, Cardiomegaly etiology, Echocardiography, Female, Glycated Hemoglobin analysis, Humans, Hypertrophy, Left Ventricular pathology, Hypertrophy, Left Ventricular physiopathology, Insulin Resistance, Leptin therapeutic use, Lipodystrophy pathology, Lipodystrophy, Congenital Generalized complications, Lipodystrophy, Congenital Generalized diet therapy, Male, Middle Aged, National Institutes of Health (U.S.), Prospective Studies, Triglycerides blood, United States, Ventricular Septum pathology, Ventricular Septum physiopathology, Young Adult, Cardiomegaly prevention & control, Hypertrophy, Left Ventricular prevention & control, Leptin analogs & derivatives, Lipodystrophy complications, Lipodystrophy drug therapy
- Abstract
Context: Lipodystrophy syndromes are rare disorders of deficient adipose tissue, low leptin, and severe metabolic disease, affecting all adipose depots (generalized lipodystrophy, GLD) or only some (partial lipodystrophy, PLD). Left ventricular (LV) hypertrophy is common (especially in GLD); mechanisms may include hyperglycemia, dyslipidemia, or hyperinsulinemia., Objective: Determine effects of recombinant leptin (metreleptin) on cardiac structure and function in lipodystrophy., Methods: Open-label treatment study of 38 subjects (18 GLD, 20 PLD) at the National Institutes of Health before and after 1 (N = 27), and 3 to 5 years (N = 23) of metreleptin. Outcomes were echocardiograms, blood pressure (BP), triglycerides, A1c, and homeostasis model assessment of insulin resistance., Results: In GLD, metreleptin lowered triglycerides (median [interquartile range] 740 [403-1239], 138 [88-196], 211 [136-558] mg/dL at baseline, 1 year, 3-5 years, P < .0001), A1c (9.5 ± 3.0, 6.5 ± 1.6, 6.5 ± 1.9%, P < .001), and HOMA-IR (34.1 [15.2-43.5], 8.7 [2.4-16.0], 8.9 [2.1-16.4], P < .001). Only HOMA-IR improved in PLD (P < .01). Systolic BP decreased in GLD but not PLD. Metreleptin improved cardiac parameters in patients with GLD, including reduced posterior wall thickness (9.8 ± 1.7, 9.1 ± 1.3, 8.3 ± 1.7 mm, P < .01), and LV mass (140.7 ± 45.9, 128.7 ± 37.9, 110.9 ± 29.1 g, P < .01), and increased septal e' velocity (8.6 ± 1.7, 10.0 ± 2.1, 10.7 ± 2.4 cm/s, P < .01). Changes remained significant after adjustment for BP. In GLD, multivariate models suggested that reduced posterior wall thickness and LV mass index correlated with reduced triglycerides and increased septal e' velocity correlated with reduced A1c. No changes in echocardiographic parameters were seen in PLD., Conclusion: Metreleptin attenuated cardiac hypertrophy and improved septal e' velocity in GLD, which may be mediated by reduced lipotoxicity and glucose toxicity. The applicability of these findings to leptin-sufficient populations remains to be determined., (Published by Oxford University Press on behalf of the Endocrine Society 2021.)
- Published
- 2021
- Full Text
- View/download PDF
3. Rare Cause of Dyspnea in a 34-Year-Old Patient.
- Author
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Gannon MP, Kureshi F, Burklow TR, Benton C, Sirajuddin A, and Arai AE
- Subjects
- Adult, Humans, Hypertension, Pulmonary physiopathology, Male, Aorta abnormalities, Cardiac Catheterization, Dyspnea etiology, Hypertension, Pulmonary etiology, Pulmonary Artery abnormalities
- Published
- 2019
- Full Text
- View/download PDF
4. Clinical impact of a novel ambulatory rhythm monitor in children.
- Author
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May JW, Carter EL, Hitt JR, and Burklow TR
- Subjects
- Adolescent, Arrhythmias, Cardiac physiopathology, Child, Child, Preschool, Cross-Sectional Studies, Equipment Design, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Reproducibility of Results, Retrospective Studies, Time Factors, Arrhythmias, Cardiac diagnosis, Electrocardiography, Ambulatory instrumentation, Monitoring, Ambulatory methods
- Abstract
Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor's impact in clinical practice. Patients aged 0-18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.
- Published
- 2018
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5. Transient prolonged corrected QT interval in Lyme disease.
- Author
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Seslar SP, Berul CI, Burklow TR, Cecchin F, and Alexander ME
- Subjects
- Adolescent, Electrocardiography, Humans, Long QT Syndrome physiopathology, Male, Borrelia burgdorferi, Long QT Syndrome microbiology, Lyme Disease complications
- Abstract
Lyme disease, caused by the spirochete Borrelia burgdorferi, has known cardiovascular effects typically manifesting in varying degrees of atrioventricular block. Three patients presented with QT interval prolongation associated with Lyme disease, a previously unreported manifestation of Lyme carditis. Implications and a proposed clinical management approach are discussed.
- Published
- 2006
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6. The endovascular management of recurrent aortic hypoplasia and coarctation in a 15-year-old male.
- Author
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Rhodes AB, O'Donnell SD, Gillespie DL, Rasmussen TE, Johnson CA, Fox CJ, Burklow TR, and Hagler DJ
- Subjects
- Adolescent, Aorta, Thoracic abnormalities, Aortic Coarctation surgery, Catheterization, Humans, Male, Recurrence, Stents, Aortic Coarctation therapy, Blood Vessel Prosthesis Implantation
- Abstract
A 15-year-old male complained of easy fatigability, leg weakness, and pain on exertion with episodes of syncope while playing baseball. His past medical history was significant for aortic coarctation associated with a congenital bovine hypoplastic aortic arch. A recent arteriogram revealed innominate and left common carotid artery stenosis as well as recurrent coarctation. He had previously undergone three Dacron patch aortoplasties. At the age of 7, he underwent a fourth operation for recurrent coarctation and because of extensive scar tissue in the region of his prior procedures, a left subclavian artery-to-descending aortic bypass was performed. An endovascular repair to deal with the recent recurrence was performed because of prior surgical difficulties. Percutaneous balloon-expandable stents were placed in the aortic coarctation, innominate, and the left common carotid arteries. Postprocedure, ankle brachial indices were >1 and the patient remains asymptomatic after 1 year.
- Published
- 2005
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7. Vesicant agents and children.
- Author
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Yu CE, Burklow TR, and Madsen JM
- Subjects
- Child, Decontamination, Humans, Poisoning therapy, Bioterrorism, Chemical Warfare Agents poisoning, Mustard Gas poisoning
- Published
- 2003
- Full Text
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8. Weapons of mass destruction: the decontamination of children.
- Author
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Rotenberg JS, Burklow TR, and Selanikio JS
- Subjects
- Chemical Warfare Agents poisoning, Child, Humans, Triage, Biological Warfare, Bioterrorism, Chemical Warfare, Decontamination
- Published
- 2003
- Full Text
- View/download PDF
9. Industrial chemicals: terrorist weapons of opportunity.
- Author
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Burklow TR, Yu CE, and Madsen JM
- Subjects
- Chlorine adverse effects, Chlorine poisoning, Environmental Exposure, Humans, Phosgene adverse effects, Phosgene poisoning, Pulmonary Edema chemically induced, Respiratory System drug effects, Bioterrorism, Chemical Industry
- Published
- 2003
- Full Text
- View/download PDF
10. Understanding the newer automated external defibrillator devices: electrophysiology, biphasic waveforms, and technology.
- Author
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Bridy MA and Burklow TR
- Subjects
- Action Potentials, Arrhythmias, Cardiac physiopathology, Humans, Potassium Channels physiology, Electric Countershock, Heart Conduction System physiopathology, Myocardium cytology
- Published
- 2002
- Full Text
- View/download PDF
11. Neurally mediated cardiac syncope: autonomic modulation after normal saline infusion.
- Author
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Burklow TR, Moak JP, Bailey JJ, and Makhlouf FT
- Subjects
- Adolescent, Blood Pressure, Blood Volume drug effects, Child, Circadian Rhythm, Electrocardiography, Ambulatory, Female, Heart Rate physiology, Humans, Infusions, Intravenous, Male, Reproducibility of Results, Autonomic Nervous System physiopathology, Blood Volume physiology, Sodium Chloride administration & dosage, Syncope physiopathology, Tilt-Table Test
- Abstract
Objectives: This study assessed the heart variability response to orthostatic stress during tilt table testing before and after normal saline administration., Background: The efficacy of sodium chloride and mineralocortoid in the treatment of neurally mediated cardiac syncope is attributed to intravascular volume expansion; however, their modulation of autonomic nervous system activity has not been evaluated., Methods: Heart rate variability analysis was performed on 12 adolescents with a history of syncope or presyncope (mean age 15.2+/-0.7 years) during tilt table testing. Subjects were upright 80 degrees for 30 min or until syncope. After normal saline administration, the patient was returned upright for 30 min. Heart rate variability analysis data were analyzed by an autoregression model (Burg method)., Results: All subjects reproducibly developed syncope during control tilt table testing; median time to syncope was 9.4+/-2.1 min. After normal saline infusion, none of the subjects developed syncope after 30 min upright. In the control tilt, there was an initial increase followed by a progressive decrease in low frequency power until syncope. Repeat tilt after normal saline administration demonstrates that low frequency power increased but the magnitude of initial change was blunted when compared with control. In addition, low frequency power increased during normal saline tilt sequence compared with the control tilt, during which it decreased., Conclusions: Normal saline blunted low frequency power stimulation and prevented paradoxical low frequency power (sympathetic) withdrawal. Increasing intravascular volume with normal saline alters autonomic responses that may trigger neurally mediated syncope reflexes.
- Published
- 1999
- Full Text
- View/download PDF
12. Sex hormones prolong the QT interval and downregulate potassium channel expression in the rabbit heart.
- Author
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Drici MD, Burklow TR, Haridasse V, Glazer RI, and Woosley RL
- Subjects
- Animals, Anti-Arrhythmia Agents pharmacology, Dihydrotestosterone blood, Electrocardiography, Estradiol blood, Female, Heart physiology, Ovariectomy, Potassium Channels genetics, Quinidine pharmacology, RNA, Messenger metabolism, Rabbits, Reaction Time, Sex Characteristics, Dihydrotestosterone pharmacology, Down-Regulation, Estradiol pharmacology, Heart drug effects, Myocardium metabolism, Potassium Channels metabolism
- Abstract
Background: Sex hormones are known to exert direct and indirect effects on cardiovascular function, but their effects on cardiac repolarization have not been elucidated. The repolarization phase of the cardiac action potential or QT interval of the ECG is regulated largely by potassium channels such as the delayed rectifier currents HK2 and IsK., Methods and Results: The effects of ovariectomy (OVX) and estradiol (E2) or dihydrotestosterone (DHT) treatment were evaluated on HK2, HERG, and IsK mRNA levels, QT duration, and quinidine-induced changes in QT interval in isolated rabbit hearts. HK2 and 0.7-kilobase IsK mRNA were downregulated in cardiac ventricular tissue from OVX rabbits treated with either E2 or DHT. The QT interval was prolonged in E2- and DHT-treated animals (OVX + vehicle, 223 +/- 6 ms; OVX + DHT, 236 +/- 10 ms; and OVX + DHT, 245 +/- 6 ms; P < .05)., Conclusions: The association between hormone-induced changes in baseline QT interval and the mRNA level for these channels suggests that sex hormones may play a critical role in regulating cardiac repolarization. However, the changes in baseline QT and potassium channel mRNA after hormone treatment were not concordant with the changes in QT interval after the infusion of quinidine, after which E2-treated animals responded similarly to controls (18.4 +/- 4.6% and 19.3 +/- 4.6% increase in QT interval, respectively) and DHT-treated animals exhibited less QT prolongation (11.4 +/- 3.8% increase; P < .03).
- Published
- 1996
- Full Text
- View/download PDF
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