The objective of this study was to evaluate the effects of high levels of maternal exposure to ambient air pollution and heavy metals on risks of autism spectrum disorder (ASD) and epilepsy using the National Health Insurance claims data of South Korea. The data of mothers and their newborns from 2016 to 2018 provided by the National Health Insurance Service were used (n = 843,134). Data on exposure to ambient air pollutants (PM2.5, CO, SO₂, NO₂, and O₃) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during pregnancy were matched based on the mother’s National Health Insurance registration area. SO₂ (OR: 2.723, 95% CI: 1.971–3.761) and Pb (OR: 1.063, 95% CI: 1.019–1.11) were more closely associated with the incidence of ASD when infants were exposed to them in the third trimester of pregnancy. Pb (OR: 1.109, 95% CI: 1.043–1.179) in the first trimester of pregnancy and Cd (OR: 2.193, 95% CI: 1.074–4.477) in the third trimester of pregnancy were associated with the incidence of epilepsy. Thus, exposure to SO₂, NO₂, and Pb during pregnancy could affect the development of a neurologic disorder based on the timing of exposure, suggesting a relationship with fetal development. However, further research is needed.

An ischemic cerebral stroke results from the interruption of blood flow to the brain, triggering rapid and complex cascades of excitotoxicity, oxidative stress, and inflammation. Current reperfusion therapies, including intravenous thrombolysis and mechanical thrombectomy, cause further brain injury due to reperfusion-induced cytotoxicity. To date, novel cytoprotective therapies that could address these challenges have yet to be developed, likely due to the limitations of targeting a single pathologic mechanism. To address these unmet clinical needs, we investigated a synthetic verbenone derivative, SP-8356, as a potential multi-target cytoprotective agent for acute ischemic strokes. In transient middle cerebral artery occlusion (MCAO) rats, SP-8356 significantly reduced brain infarct and edema volumes while improving acute neurological deficits in a dose-dependent manner. Furthermore, SP-8356 improved long-term outcomes, particularly by reducing mortality. These potent cytoprotective effects of SP-8356 were achieved by suppressing the excessive production of free radicals and pro-inflammatory cytokines, reducing the infiltration of inflammatory cells, and mitigating increases in blood–brain barrier permeability. Additional research is needed to determine whether co-administration of SP-8356 can extend the therapeutic time window of reperfusion therapies by mitigating ischemia/reperfusion injury.

Background: According to a recent meta-analysis, in patients with a body mass index (BMI) ≥ 30, a high fraction of inhaled oxygen (FiO₂) did not increase postoperative atelectasis. However, a high FiO₂ generally increases the risk of postoperative atelectasis. Therefore, this study aimed to evaluate the effect of FiO₂ on the development of atelectasis in obese patients using the modified lung ultrasound score (LUSS). Methods: Patients were assigned to 4 groups: BMI ≥ 30: group A (n = 21) and group B (n = 20) and normal BMI: group C (n = 22) and group D (n = 21). Groups A and C were administered 100% O₂ during preinduction and emergence and 50% O₂ during anesthesia. Groups B and D received 40% O₂ for anesthesia. The modified LUSS was assessed before and 20 min after arrival to the postanesthesia care unit (PACU). Results: The difference between the modified LUSS preinduction and PACU was significantly higher in group A with a BMI ≥ 30 (P = .006); however, there was an insignificant difference between groups C and D in the normal BMI group (P = .076). Conclusion: High FiO₂ had a greater effect on the development of atelectasis in obese patients than did low FiO₂; however, in normal-weight individuals, FiO₂ did not have a significant effect on postoperative atelectasis.

The preoperative elevation of ammonia may be associated with postoperative neurologic complications. The aim of this study was to evaluate the effect of preoperative ammonia level on the incidence of delirium in patients after liver transplantation (LT). Patients (n = 260) who received LT from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. The patients' demographic data, perioperative managements, and postoperative complications were assessed. Patients were divided into the following 2 groups: those who had a preoperative elevation (Group A, n = 158) and those with a normal range (Group C, n = 102). The cut-off value for a normal serum ammonia level in our hospital was defined as 32 μg/dL. After propensity score matching, there was no difference in the incidence of delirium between the groups (P = .784). Delirium occurred in 8 of 68 (11.76%) patients in Group A and 7 of 68 (10.29%) patients in Group C after LT. In addition, there was no difference in the incidence of delirium between the groups, even patients were categorized based on serum ammonia levels into 3 groups as follows: < 32 μg/dL (28/158 [17.72%]), 32 to 65 μg/dL (28/158 [17.72%]), and >65 μg/dL (28/158 [17.72%]) (P = .134). The preoperative serum ammonia level was not related with the incidence of postoperative delirium. The high elevation group, especially those with greater than 65 μg/dL of preoperative ammonia, was also not related with the incidence of delirium. However, our study is limited by its retrospective design, so future prospective studies are needed.

Patients with peripheral arterial disease (PAD) are at a higher risk of developing postoperative complications. Arachidonate 5-lipoxygenase-activating protein (ALOX5AP) plays an important role in atherosclerosis pathogenesis. In this study, the relationship between PAD and several single nucleotide polymorphisms (SNPs) of ALOX5AP (rs17216473, rs10507391, rs4769874, rs9551963, rs17222814, and rs7222842) was investigated in elderly patients undergoing general surgery. The medical records of 129 patients aged > 55 years who underwent elective general surgery between May 2018 and August 2019 were retrospectively reviewed. The A/A in rs17216473, A/A in rs10507391, G/G in rs4769874, and A/A in rs9551963 were calculated as 0 points and the rest as 1 point to define the genetic risk score. The prevalence of PAD tended to increase with higher genetic risk scores (patients had less ALOX5AP gene polymorphism of A/A in rs17216473, A/A in rs10507391, G/G in rs4769874, or A/A in rs9551963) (p = 0.005). Multivariate logistic regression analysis revealed that the genetic risk score (p = 0.009) and age (p = 0.007) were positively correlated with the prevalence of PAD. Genetic polymorphisms of ALOX5AP and age were associated with the prevalence of PAD in this study.

Postoperative residual pain and dysesthesia in patients with lumbar spinal stenosis (LSS) can reduce patient satisfaction. We investigated the effects of nefopam on dysesthesia, postoperative pain, and satisfaction in patients with LSS who underwent spine surgery. A total of 73 patients were randomly assigned to two groups: the nefopam group (n = 35), receiving a 20 mL normal saline-based solution containing nefopam 20 mg, and the control group (n = 38), which received 20 mL of normal saline 1 h before the end of the operation. Postoperative incisional pain, dysesthesia scores, and overall satisfaction with postoperative pain management were evaluated. The severity of dysesthesia within 12 and 24 h in the nefopam group was significantly lower than that in the control group (2.3 ± 1.9 and 1.7 ± 1.6 vs. 3.3 ± 2.1, and 2.6 ± 1.9, respectively; p = 0.029 and p = 0.048). Satisfaction scores for postoperative pain management were significantly higher in the nefopam group (3.7 ± 0.6 vs. 3.1 ± 1.0, respectively; p = 0.006). The administration of nefopam effectively reduced the severity of dysesthesia within 24 h of surgery in geriatric patients undergoing spine surgery and increased patient satisfaction with postoperative pain management.