MANTZOROS, CHRISTOS S., ANTONIOS D. LIOLIOS, NICHOLAS A. TRITOS, VIRGINIA G. KAKLAMANI, DIMITRIOS E. DOULGERAKIS, IOANNIS GRIVEAS, ALAN C. MOSES, JEFFREY S. FLIER. Circulating insulinconcentrations, smoking, and alcohol intake are important independent predictors of leptin in young healthy men. Obes Res. 1998;6:179-186. Objective: Leptin, an adipocyte-secreted hormone, has been shown to signal the status of energy stores to the brain, regulate energy homeostasis, and mediate the neuroendocrine response to food deprivation. Obesity is associated with increased leptin levels, and several hormones, including insulin and glucocorticoids, have been associated with leptin levels and expression in rodents. Although obesity has been strongly associated with increased leptin in humans, a significant percentage of leptin's variability remains unexplained. The role of endogenous hormones, demographic factors, or certain life-style factors in explaining the residual variability of leptin levels has not yet been clarified. We performed this cross-sectional study to document the relative importance of obesity, lifestyle factor, and endogenous hormones in determining serum leptin levels. Research Methods and Procedures:We measured serum concentrations of insulin, cortisol, testosterone, growth hormone, and dehydroepiandrosterone sulfate; ascertained anthropometric, demographic, and lifestyle characteristics; and studied these variables in relationship to serum leptin concentrations in a sample of young healthy men.Results: Obesity and alcohol intake were independently and positively associated with circulating leptin concentrations. Additionally, cigarette smoking was negatively and independently associated with leptin concentrations. Finally, serum insulin concentration was an independent hormonal determinant of circulating leptin concentrations, whereas serum testosterone was negatively associated with leptin only by bivariate analysis.Discussion: We conclude that, in addition to obesity, cigarette smoking, alcohol intake, and serum insulin levels are associated with leptin levels in a population of healthy young men.

In this case report we describe a case of propofol infusion syndrome in an adult after a short-term infusion of large-dose propofol during a neurosurgical procedure. Large-dose propofol (9 mg.kg(-1).h(-1)) was given for only 3 h during surgery and was followed by a small-dose infusion (2.3 mg.kg(-1).h(-1)) for 20 h postoperatively. The patient had also received large doses of methylprednisolone. He developed a marked lactic acidosis with mild biological signs of renal impairment and rhabdomyolysis but no cardiocirculatory failure. There were no other evident causes of lactic acidosis as documented by laboratory data. We believe this is the first report of reversible lactic acidosis associated with a short duration of large-dose propofol anesthesia.

In all, >135 Web-based education resources exist, including video Web resources for critical care education in a variety of e-learning formats, such as tutorials, self-directed learning modules, interactive case studies, webcasts, podcasts, and video-enhanced programs. As identified by critical care educators and practitioners, e-learning is actively being integrated into critical care medicine and nursing training programs for continuing medical education and competency training purposes. Knowledge of available Web-based educational resources may enhance critical care practitioners' ongoing learning and clinical competence, although this has not been objectively measured to date.