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世界核心医学期刊文摘(神经病学分册) 2006年第11期 57-58页

作者： kulstad j.j Green P.S Cook D.G S. Craft 郭俊 VAPSHCS S-182-GRECC 1660 S. Columbian Way Seattle WA 98108 United States Dr.

BACKGROUND: Hyperinsulinemia and insulin resistance are risk factors for memory impairment and Alzheimer disease (AD). Insulin regulates levels of the amyloid β-peptide (Aβ)in vitro in neuronal cultures and in vivo in the CSF of normal older adults. OBjECTIVE: To determine whether insulin affected plasma Aβlevels and whether such effects differed for patients with AD compared with normal older adults. METHODS: Fifty-nine patients with AD and 50 healthy older adults each received infusions of saline and of insulin (1.0 mU·kg·min)with accompanying dextrose to maintain euglycemia. A subset of participants (19 AD, 12 normal) received two additional conditions, in which insulin was infused at a lower (0.33 mU·kg·min) and higher (1.67 mU·kg·min) rate. Plasma insulin and Aβ.were measured after 120 minutes of infusion. RESULTS: Adults with AD had higher plasma insulin vs normal adults at the two higher infusion rates, despite receiving comparable amounts of insulin. For normal adults, insulin reduced plasma Aβlevels at the middle (1.0 mU·kg·min) dose, with attenuated effects at lower and higher doses. In contrast, for patients with AD, insulin raised plasma Aβ.levels at the two higher doses (1.0 and 1.67 mU·kg·min). CONCLUSIONS: These results suggest that patients with Alzheimer disease (AD) have reduced insulin clearance and insulin-provoked plasma amyloid β-peptide (Aβ) elevation. Abnormal regulation of peripheral Aβby insulin may contribute to AD risk.

关键词：胰岛素 AD 多肽 β-淀粉样蛋白阿尔茨海默病患者血浆

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Induction of therapeutic hypothermia via the esophagus:a proof of concept study

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World journal of Emergency Medicine 2012年第2期3卷 118-122页

作者： Erik B.kulstad D.Mark Courtney Donald Waller Department of Emergency Medicine Advocate Christ Medical Center Department of Emergency Medicine Feinberg School of MedicineNorthwestern University PreLabs LLCOak ParkILUSA

BACKGROUND:Induction of hypothermia(a 4℃decrease from baseline)improves outcomes in adult cardiac arrest and neonatal hypoxic ischemic encephalopathy,and may benefit other conditions as *** used to implement or prevent hypothermia typically require skin contact with blankets or pads or intravascular access with catheter *** study was to evaluate the potential to induce mild therapeutic hypothermia via an esophageal route in a porcine ***:Single-animal proof-of-concept study of a prototype esophageal device in a 70 kg Yorkshire *** measured the rate of temperature change after placement of a prototype device to induce hypothermia via the esophagus,and compared this rate to known temperature changes that occur under similar laboratory conditions without a hypothermic ***:Swine temperature decreased from a starting temperature of 37.8℃to 33.8℃(achieving the goal of a 4℃decrease)in 175 minutes,resulting in a cooling rate of 1.37℃/*** of the esophagus showed normal tissue without evidence of ***:A prototype of an esophageal cooling device induced hypothermia effectively in a large single-swine model.

关键词： Mild therapeutic hypothermia Esophagus Swine Cardiac arrest

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An attending physician float shift for the improvement of physician productivity in a crowded emergency department

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World journal of Emergency Medicine 2013年第1期4卷 10-14页

作者： Muhammad Umer Nasim Chintan Mistry Robert Harwood Erik kulstad Laura Tommaso Department of Emergency Medicine Advocate Christ Medical CenterOak LawnILUSA Advocate Lutheran General Hospital Park RidgeIllinois 60068USA

BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the *** address this problem,we added a "float shift" to our winter schedule solely to care for *** sought to quantify the effect of this float shift,hypothesizing greater physician ***:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift *** calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of *** then compared the mean number of patients seen per shift in February with ***:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,*** number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float ***:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.

关键词： Crowding Physician staffing Boarding patients Float shift

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