Mild hyperbaric oxygen: mechanisms and effects

The role of hyperbaric oxygen in idiopathic sudden sensorineural hearing loss

Idiopathic sudden sensorineural hearing loss is an unexplained sudden loss of sensorineural hearing, with no specific pathogenesis, and is difficult to treat. The most common therapeutic strategy for idiopathic sudden sensorineural hearing loss is the use of steroids combined with neurotrophic drugs, as other treatments have shown limited efficacy. However, in recent years, hyperbaric oxygen therapy has emerged as a promising treatment option. Studies have shown that hyperbaric oxygen therapy, in combination with conventional treatments, can effectively alleviate inner ear edema, improve blood circulation, and suppress inflammation. Therefore, hyperbaric oxygen therapy plays an important role in the treatment of idiopathic sudden sensorineural hearing loss. In this review, we aim to assess existing studies and summarize the clinical effects and mechanisms of hyperbaric oxygen therapy in idiopathic sudden sensorineural hearing loss, providing a basis for further research on the clinical treatment of this disorder.

Case report: Dementia sensitivity to altitude changes and effective treatment with hyperbaric air and glutathione precursors

A 78-year-old man with dementia experienced waxing and waning of symptoms with changes in altitude as he traveled from his home in the Rocky Mountains to lower elevations and back. To replicate the improvement in his symptoms with travel to lower elevations (higher pressure), the patient was treated with a near-identical repressurization in a hyperbaric chamber using compressed air. With four 1-h treatments at 1.3 Atmospheres Absolute (ATA) and concurrent administration of low-dose oral glutathione amino acid precursors, he recovered speech and showed improvement in activities of daily living. Regional broadcast media had documented his novel recovery. Nosocomial COVID-19 and withdrawal of hyperbaric air therapy led to patient demise 7 months after initiation of treatment. It is theorized that hyperbaric air therapy stimulated mitochondrial biochemical and physical changes, which led to clinical improvement.

Acute and chronic central nervous system oxidative stress/toxicity during hyperbaric oxygen treatment of subacute and chronic neurological conditions

Introduction

Oxygen toxicity has been defined as acute central nervous system (CNS), acute pulmonary, and chronic pulmonary oxygen toxicity. This study identifies acute and chronic CNS oxygen toxicity under 2.0 atmospheres absolute (ATA) pressure of oxygen. Methods: The authors' medical records from September 29, 1989 to January 20, 2023 and correspondence to the authors (9/1994 to 1/20.2023) from patients with signs and/or symptoms historically identified as acute CNS oxygen toxicity and those with neurological deterioration receiving hyperbaric oxygen for neurological conditions were reviewed. Acute cases were those occurring with ≤5 HBOTs and chronic cases >5 HBOTs. Chronic cases were separated into those at 1.5 ATA, > 1.5 ATA, or < 1.5 ATA oxygen. Cumulative dose of oxygen in atmosphere-hours (AHs) was calculated at symptom onset.

Results

Seven acute cases, average 4.0 ± 2.7 AHs, and 52 chronic cases were identified: 31 at 1.5 ATA (average 116 ± 106 AHs), 12 at >1.5 ATA (103 ± 74 AHs), and 9 at <1.5 ATA (114 ± 116 AHs). Second episodes occurred at 81 ± 55, 67 ± 49, and 22 ± 17 AHs, and three or more episodes at 25 ± 18, 83 ± 7.5, and 5.4 ± 6.0 AHs, respectively. Most cases were reversible. There was no difference between adults and children (p = 0.72). Acute intervention in cases (<3 months) was more sensitive than delayed intervention (21.1 ± 8.8 vs. 123 ± 102 AHs, p = 0.035). Outside sources reported one acute and two chronic exposure deaths and one patient institutionalized due to chronic oxygen toxicity. A withdrawal syndrome was also identified.

Conclusion

Hyperbaric oxygen therapy-generated acute and chronic cases of CNS oxygen toxicity in chronic neurological conditions were identified at <2.0 ATA. Chronic CNS oxygen toxicity is idiosyncratic, unpredictable, and occurred at an average threshold of 103-116 AHs with wide variability. There was no difference between adults and children, but subacute cases were more sensitive than chronic intervention cases. When identified early it was reversible and an important aid in proper dosing of HBOT. If ignored permanent morbidity and mortality resulted with continued HBOT.

Oxygen Saturation or Tissue Oxygen Determinations on Skin Whose Viability is at Risk

The triad of ischaemia, neuropathy, and infection are among the principal causes of lower extremity wounds that are commonly prevalent in patients with diabetic foot (DF) a condition in which peripheral arterial disease commonly co-exists. The prevalence of this condition is increasing globally and with it, the mounting costs of its management. One aspect of management is saving limbs and or digits, a crucial part of this process is assessing tissue viability of skin which is a focus of this review: there are other aspects which are well described in the literature. Amputations are offered to limit the damage resulting from acute/chronic ischaemia. Holstein measured skin perfusion pressure using a radioisotope clearance technique to describe critically ischaemic skin; he found 30 mm Hg as the threshold above which healing may reliably be expected. Recent advances in vascular surgery and related technology have informed evidence-based advice to revascularize and save limbs; in practice, this may leave a wound in the distal skin unhealed; managing these raises questions of tissue viability. Much effort has been made to manage, prevent and to better understand these lower extremity wounds using measurements of tissue oxygen, oxygen saturation and skin imaging. The measurement techniques and their relevant merits are examined in this article. Advances in wound management systems and protocols can also facilitate the repair processes, and those which can have a particular impact on restoring or maintaining tissue perfusion are also discussed in the article.

Hyperoxia: Effective Mechanism of Hyperbaric Treatment at Mild-Pressure

HBOT increases the proportion of dissolved oxygen in the blood, generating hyperoxia. This increased oxygen diffuses into the mitochondria, which consume the majority of inhaled oxygen and constitute the epicenter of HBOT effects. In this way, the oxygen entering the mitochondria can reverse tissue hypoxia, activating the electron transport chain to generate energy. Furthermore, intermittent HBOT is sensed by the cell as relative hypoxia, inducing cellular responses such as the activation of the HIF-1α pathway, which in turn, activates numerous cellular processes, including angiogenesis and inflammation, among others. These effects are harnessed for the treatment of various pathologies. This review summarizes the evidence indicating that the use of medium-pressure HBOT generates hyperoxia and activates cellular pathways capable of producing the mentioned effects. The possibility of using medium-pressure HBOT as a direct or adjunctive treatment in different pathologies may yield benefits, potentially leading to transformative therapeutic advancements in the future.

Hyperbaric oxygen therapy: a possible choice for patients with resistant thin endometrium during frozen embryo transfer treatments

BACKGROUND

Thin endometrium is considered suboptimal for embryo implantation, leading to compromised pregnancy rates without effective therapies. While some studies have reported promoted endometrial growth after a period of hyperbaric oxygen therapy (HBOT) in patients with intrauterine adhesion, there have been no reports in patients with resistant thin endometrium. The purpose of this study was to investigate the impact of HBOT on endometrium growth and pregnancy outcomes in patients with resistant thin endometrium during frozen embryo transfer (FET) treatments.

METHODS

This prospective pre-post cohort study was conducted at a university-affiliated assisted reproductive medical center between October 2021 and December 2022. Patients who had experienced at least one canceled transfer cycle due to a thin endometrium(< 7 mm) on the endometrium transformation day, despite the use of standard therapies as well as adjuvant therapies, were enrolled in the study. Patients were assigned voluntarily to either the HBOT group or the concurrent control group. The HBOT group received daily HBOT for at least 10 days during the proliferative phase, in addition to the routine endometrium preparation methods and the concurrent control group underwent cycles without HBOT. Propensity score matching (PSM) was used to ensure comparability between the groups. Both self-control and case-control comparisons were conducted. The primary outcome measured was endometrial thickness (ET) on the day of endometrium transformation. Secondary outcomes included intrauterine pregnancy rate (IPR), embryo implantation rate (IR), miscarriage rate, and others.

RESULTS

Patients in the HBOT group demonstrated a significantly thicker endometrial thickness on the day of endometrium transformation after undergoing therapy (5.76 ± 1.66 vs. 6.57 ± 1.23, P = 0.002). This improvement was accompanied by a decreased rate of cycle cancellations. Baseline parameters and endometrial thickness were comparable between the HBOT group and the concurrent control group during the cycle. The IPR was similar in patients who received cleavage-stage embryos (0.0% vs. 6.7%, P = 1.00), but significantly higher in patients in the HBOT group who received blastocysts (53.8% vs. 18.2%, P = 0.017).

CONCLUSIONS

A period of HBOT prior to endometrium transformation contributes to increased endometrial thickness and facilitates blastocyst implantation in patients with resistant thin endometrium during FET treatments.

TRIAL REGISTRATION

The trial was registered on the Chinese Clinical Trial Registry (registration no. ChiCTR2300072831, retrospectively registered).

Effects of hyperbaric oxygen therapy on human psychomotor performance: A review

Psychomotor performance is the coordination of a sensory or ideational (cognitive) process and a motor activity. All sensorimotor processes involved in planning and execution of voluntary movements need oxygen supply and seem to be significantly disrupted in states of hypoxia. Hyperbaric oxygen therapy has become a widely used treatment in routine medicine and sport medicine due to its beneficial effects on different aspects of human physiology and performance. This paper presents state-of-the-art data on the effects of hyperbaric oxygen therapy on different aspects of human psychomotor function. The therapy's influence on musculoskeletal properties and motor abilities as well as the effects of hyperbaric oxygenation on cognitive, myocardial and pulmonary functions are presented. In this review the molecular and physiological processes related to human psychomotor performance in response to hyperbaric oxygen are discussed to contribute to this fast-growing field of research in integrative medicine. Please cite this article as: Olex-Zarychta D. Effects of hyperbaric oxygen therapy on human psychomotor performance: A review. J Integr Med. 2023; 21(5): 430-440.

Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy

Background

Wound healing remains among the most concerning complications in aesthetic surgery. The use of hyperbaric oxygen therapy (HBOT) is an accepted method of supporting wound healing.

Objectives

The aim of this study is to assess the role of HBOT in postoperative healing and complication rates following facelift surgery.

Methods

This case-control study comprised facelift patients who received HBOT and those who did not between 2019 and 2022. Data were extracted from the patients' medical records, with the primary outcomes being the presence of complications, wound-healing duration, and patient satisfaction.

Results

The authors recruited 20 female patients who underwent facelift for this study, with 9 patients in the HBOT group and 11 patients in the control group. The average number of HBOT sessions received was 7.22, and each session lasted an average of 78 ± 5 min. The duration of wound healing in the HBOT group ranged from 7 to 30 days (mean of 13.3 days), whereas the control group ranged from 6 to 90 days (mean of 36.9 days). This indicates a statistically significant shorter time to wound healing in the HBOT group compared to the control group (P < .001).

Conclusions

Future prospective randomized controlled trials with larger sample sizes and blinding are needed to further evaluate the potential benefits of HBOT in the postoperative period. Nonetheless, our findings suggest that HBOT may be a promising adjunctive therapy for patients undergoing facelift surgery.

Level of Evidence 3

Hyperbaric oxygen treatment increases intestinal stem cell proliferation through the mTORC1/S6K1 signaling pathway in Mus musculus

BACKGROUND

Hyperbaric oxygen treatment (HBOT) has been reported to modulate the proliferation of neural and mesenchymal stem cell populations, but the molecular mechanisms underlying these effects are not completely understood. In this study, we aimed to assess HBOT somatic stem cell modulation by evaluating the role of the mTOR complex 1 (mTORC1), a key regulator of cell metabolism whose activity is modified depending on oxygen levels, as a potential mediator of HBOT in murine intestinal stem cells (ISCs).

RESULTS

We discovered that acute HBOT synchronously increases the proliferation of ISCs without affecting the animal's oxidative metabolism through activation of the mTORC1/S6K1 axis. mTORC1 inhibition by rapamycin administration for 20 days also increases ISCs proliferation, generating a paradoxical response in mice intestines, and has been proposed to mimic a partial starvation state. Interestingly, the combination of HBOT and rapamycin does not have a synergic effect, possibly due to their differential impact on the mTORC1/S6K1 axis.

CONCLUSIONS

HBOT can induce an increase in ISCs proliferation along with other cell populations within the crypt through mTORC1/S6K1 modulation without altering the oxidative metabolism of the animal's small intestine. These results shed light on the molecular mechanisms underlying HBOT therapeutic action, laying the groundwork for future studies.

A Novel Strategy to Enhance Antioxidant Content in Saccharomyces Cerevisiae Based on Oxygen Pressure

Antioxidant foods represent a potent lever to improve diets while creating value. Yet, their cultivation is often tied to a specific area and climate, limiting availability and increasing market cost. Therefore, microorganism-based antioxidant production emerges as a promising technology to solve these problems. In this view, a novel process was investigated for antioxidant accumulation in yeast culture. S. cerevisiae cells were exposed to various hyperbaric air conditions from 1 to 9 bar (A). Yeast cultures exhibited an increased reactive oxygen species content, which induced oxidative defense expression. After a few hours, reactive oxygen species levels decreased while antioxidant contents remained high, leading to a net increase in antioxidant power. At 6 bar (A), yeast achieved the highest net antioxidant power (phenolics content +48.3 ± 18.6 %, reducing power +120 ± 11.4 %) with an acceptable growth rate (0.27 h^-1). Regarding time evolution, a 2 h exposure seems to be the optimum: cells have the lowest reactive oxygen species level while their antioxidant power is increased. From a biotechnological perspective, this finding highlights air pressure as an antioxidant-manipulating stress strategy. Moreover, the proposed process led to a patent that could potentially reduce energy and chemical consumption in such antioxidant accumulation processes.

Mild Hyperbaric Oxygen Exposure Enhances Peripheral Circulatory Natural Killer Cells in Healthy Young Women

Mild hyperbaric oxygen (HBO) enhances oxygen absorption in blood, relieving fatigue without causing oxidative stress. The benefits of mild HBO have been recognized in the treatment of lifestyle-related diseases and hypertension, but no research has been conducted on its effects on immunity. The aim of the present study is to investigate the effect of mild HBO on natural killer (NK) cells and cytokines in healthy young women. This crossover randomized control trial was conducted with 16 healthy young women. Participants were randomly exposed to normobaric oxygen (NBO; 1.0 atmospheres absolute (ATA), 20.8% oxygen) and mild HBO conditions (1.4 ATA, 35-40% oxygen, injected 18L oxygen per minute) in a hyperbaric oxygen chamber for 70 min. Heart rate, parasympathetic activity, NK cell count, interleukin (IL)-6, IL-12p70 and derivatives of reactive oxygen metabolites (d-ROMs) were measured before and after both exposures. In the NBO condition, parasympathetic activity remained unchanged, whereas after mild HBO exposure, parasympathetic activity was significantly increased. NK cells remained unchanged after NBO exposure, while NK cells were increased after exposure to mild HBO. Exposure to mild HBO did not increase d-ROM values, IL-6 and IL-12p70 protein levels. These findings suggest that exposure to mild HBO can be a useful protocol to increase NK cells by regulating parasympathetic activity via increasing oxygen delivery.

Telomere Length: A Cardiovascular Biomarker and a Novel Therapeutic Target

Coronary artery disease (CAD) is a multifactorial disease with a high prevalence, particularly in developing countries. Currently, the investigation of telomeres as a potential tool for the early detection of the atherosclerotic disease seems to be a promising method. Telomeres are repetitive DNA sequences located at the extremities of chromosomes that maintain genetic stability. Telomere length (TL) has been associated with several human disorders and diseases while its attrition rate varies significantly in the population. The rate of TL shortening ranges between 20 and 50 bp and is affected by factors such as the end-replication phenomenon, oxidative stress, and other DNA-damaging agents. In this review, we delve not only into the pathophysiology of TL shortening but also into its association with cardiovascular disease and the progression of atherosclerosis. We also provide current and future treatment options based on TL and telomerase function, trying to highlight the importance of these cutting-edge developments and their clinical relevance.

Hyperbaric Oxygen Treatment Ameliorates the Decline in Oocyte Quality and Improves the Fertility of Aged Female Mice

The age-related decay in oocyte quality contributes to the gradual decline in fertility and the final occurrence of natural sterility. In this study, we aimed to investigate the effects of the hyperbaric oxygen treatment (HBOT) on oocyte quality in aging mouse oocyte. Eight- and forty-week-old female C57BL/6 J mice were treated with HBO for 10 days, and the quality of oocytes was analyzed. The results revealed that HBOT improved the age-related serum AMH levels. While compared with untreated aged mice, HBOT showed reduced follicular apoptosis and improved oocyte maturation, fertilization, and blastocyst formation in aged mice. HBO triggered changes in the microRNA expression in the ovaries of aged mice. In this study, 27 DEGs were identified in the HBOT mouse ovarian tissues, of which 9 were upregulated and 18 were downregulated. Notably, KEGG analysis revealed that these genes involved in different biological processes differed significantly in the ovary. Among these, the PI3K-Akt signaling was the most prominent pathway that controlled the recruitment and growth of primordial follicles. The calcium signaling pathway was found to be involved during the peri-implantation period. These results suggest that HBOT can be applied to improve the quality of oocytes, and it could be a potential clinical application to improve the fertility of aged female.

Taste perception and food preferences in patients with diabetic foot ulcers before and after hyperbaric oxygen therapy

Objective

The aim of the study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on taste perception and food preferences in patients with diabetic foot ulcers.

Methods

The study involved 75 healthy people (Group C) and 23 patients with diabetic foot ulcers before HBOT (Group Db) and after 25–30 HBOT treatments (Group Da) (2.5 ATA, 87 min). The sip and spit method was used to examine the taste perception for 5 basic flavours. Food preferences were studied using photographs of dishes.

Results

The recognition thresholds in Group C were lower than in Group Db for 5 basic flavours. The taste intensity in Group C was higher than in Group Db for: 0.1% and 1.0% monosodium glutamate, 0.02% citric acid, and 0.002% quinine hydrochloride. The hedonic response in Group C was more negative than in Group Db for: 0.18% sodium chloride, 0.3% monosodium glutamate and 0.1% citric acid. The pleasure derived from eating in Group C was lower than in Group Db for sour and salty products. The recognition thresholds in Group Db were higher than in Group Da for umami and sour. The taste intensity in Group Db was lower than in Group Da for: 0.1%, 0.3% and 1.0% monosodium glutamate. The pleasure derived from eating in Group Db was higher than in Group Da for chocolate and crisps.

Conclusions

In people with diabetic foot ulcers, an impaired all 5 basic tastes occurred with different food preferences compared to healthy people. HBOT causes beneficial changes resulting in increased sensitivity to umami and sour taste as well as a decrease in the pleasure derived from eating chocolate and crisps.

Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics

Hyperbaric oxygen therapy (HBOT), a technique through which 100% oxygen is provided at a pressure higher than 1 atm absolute (ATA), has become a well-established treatment modality for multiple conditions. The noninvasive nature, favorable safety profile, and common clinical application of HBOT make it a competitive candidate for several new indications, one of them being aging and age-related diseases. In fact, despite the conventional wisdom that excessive oxygen accelerates aging, appropriate HBOT protocols without exceeding the toxicity threshold have shown great promise in therapies against aging. For one thing, an extensive body of basic research has expanded our mechanistic understanding of HBOT. Interestingly, the therapeutic targets of HBOT overlap considerably with those of aging and age-related diseases. For another, pre-clinical and small-scale clinical investigations have provided validated information on the efficacy of HBOT against aging from various aspects. However, a generally applicable protocol for HBOT to be utilized in therapies against aging needs to be defined as a subsequent step. It is high time to look back and summarize the recent advances concerning biological mechanisms and therapeutic implications of HBOT in promoting healthy aging and shed light on prospective directions. Here we provide the first comprehensive overview of HBOT in the field of aging and geriatric research, which allows the scientific community to be aware of the emerging tendency and move beyond conventional wisdom to scientific findings of translational value.

Effect of hyperbaric oxygen therapy on weight loss and hyperlipidemia in rats

OBJECTIVE

To explore whether hyperbaric oxygen therapy(HBO) can promote weight loss and recovery of hyperlipidemia in rats, and to explore the possible mechanism.

METHODS

180 SD rats were divided into 6 groups with 30 rats in each group. The first 3 groups were intraperitoneally injected with fat emulsion to make hyperlipidemia models, and the last three groups were injected with normal saline. The first three groups received 3 h/d, 6 h/d, 0 h/d HBO therapy respectively, and the last three groups received the same treatment. Body weight, blood lipid and transaminase were measured in all SD rats, and pathological sections of heart, liver and kidney were observed.

RESULTS

Hyperlipidemia group treated with 3 h/d hyperbaric oxygen has the effect of reducing hyperlipidemia compared with other groups and has the effect of heart and kidney protection. Although 6 h/d HBO therapy has a more noticeable effect on lowering hyperlipidemia, it has more apparent liver damage effects. The normal group treated with HBO for 3 h/d or 6 h/d both have the effect of weight loss, and the impact of liver injury is not apparent. However, the 6 h/d HBO therapy group had a more prominent weight loss effect.

CONCLUSION

HBO therapy can promote weight loss and reduce hyperlipidemia. Our experiments have shown that 6 h/d and 3 h/d HBO therapy reduces blood lipids in hyperlipidemia SD rats. However, the former has noticeable liver damage effects on SD rats, and the latter is adequate for protecting the liver in normal or hyperlipidemia SD rats. At the same time, it has been proved that HBO therapy has cardio and kidney protection in hyperlipidemia SD rats.

Chronic wounds: Treatment consensus

The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub-sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID-19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care.

Effects of Pre-, Post- and Intra-Exercise Hyperbaric Oxygen Therapy on Performance and Recovery: A Systematic Review and Meta-Analysis

Background: As a World Anti-doping Agency (WADA)-approved treatment, hyperbaric oxygen (HBO₂) therapy has been used to improve exercise performance in sports practice.

Objective: We aimed to investigate the effect of pre-, post-, and intra-exercise HBO₂ therapy on performance and recovery.

Methods: A literature search was conducted using EMBASE, CENTRAL, PubMed, Web of Science, and SPORTDiscus to obtain literature published until May 2021. A total of 1,712 studies that met the following criteria were identified: (1) enrolled healthy adults who were considered physically active; (2) evaluated HBO₂ therapy; (3) included a control group exposed to normobaric normoxic (NN) conditions; (4) involved physical testing (isokinetic or dynamic strength exercise, maximal incremental treadmill/cycle exercise, etc.); and (5) included at least one exercise performance/recovery index as an outcome measure. The Cochrane risk of bias assessment tool was used to evaluate the included studies, and the heterogeneity of therapy effects was assessed using the I² statistic by Review Manager 5.3.

Results: Ten studies (166 participants) were included in the qualitative analysis, and six studies (69 participants) were included in the quantitative synthesis (meta-analysis). In comparisons between participants who underwent HBO₂ therapy and NN conditions, the effects of pre-exercise HBO₂ therapy on exercise performance were not statistically significant (P > 0.05), and the effects of post-exercise HBO₂ therapy on recovery were not statistically significant either (P > 0.05). Although individual studies showed positive effects of intra-exercise HBO₂ therapy on exercise performance, a meta-analysis could not be performed.

Conclusion: Hyperbaric oxygen therapy before or after exercise had no significant effect on performance and recovery. However, hyperbaric oxygen therapy during exercise could improve muscle endurance performance, which needs to be confirmed by further empirical studies. At present, the practical relevance of these findings should be treated with caution.

Hemodynamic response during hyperbaric treatment on skeletal muscle in a type 2 diabetes rat model

Mild hyperbaric treatment prevents type 2 diabetes progression due to increased oxygen concentration and blood flow in skeletal muscle. However, it remains unknown whether this treatment is effective during all stages of type 2 diabetes. This study aimed to investigate the influences of hyperbaric treatment at 1.3 atmospheres absolute (ATA) on hemodynamic response in various stages of type 2 diabetes. Otsuka Long-Evans Tokushima fatty (OLETF) and Long-Evans Tokushima Otsuka (LETO) rats were used as models of type 2 diabetes and healthy controls, respectively. Glucose levels were significantly higher in OLETF rats than in LETO rats at all ages. Glucose intolerance gradually increased with age in OLETF rats. Insulin levels in OLETF rats were significantly higher at 20-week-old, however, were significantly lower at 60-week-old than in LETO rats. Oxy-Hb, total Hb, and StO₂ in skeletal muscle were increased during hyperbaric treatment in both rats. The hemodynamic changes were significantly higher in OLETF rats than LETO rats, and those changes were also pronounced at 8-week-old compared with other age in OLETF rats. These results suggest that hyperbaric treatment at 1.3 ATA acts on pathophysiological factors and the efficacy could be found only in the early stage of type 2 diabetes.

Mild hyperbaric oxygen for the early improvement of mood disturbance induced by high-intensity exercise

BACKGROUND

Excessive training stress can result in decreased performance and deep fatigue due to hormonal changes. There are few available data on recovery methods for mood disturbance, especially fatigue, after high-intensity training. This study, therefore, aimed to examine the effects of mild hyperbaric oxygen at 1.3 atmospheres absolute with 31% oxygen on mood disturbance induced by high-intensity exercises.

METHODS

Ten healthy adult men participated in and completed 2 trials: the control (CON) trial and the mild hyperbaric oxygen (MHO) trial. In a randomized crossover design, each subject cycled for 60 min at the physical work capacity at 75% of their maximal heart rate and were subsequently exposed to the CON and MHO conditions for 60 min as the recovery period.

RESULTS

During the 20 to 40 min recovery time points, the average change ratio of heart rates was lower in the MHO trial than in CON (p < 0.05). We observed that the fatigue-inertia, tension-anxiety, and total mood disturbance Profile of Mood States (POMS) scores decreased 60 min post-exercise in the MHO trial, but no differences of these score were observed in the CON trial. There were no differences in oxidative stress, derived-reactive oxygen metabolites, and biological antioxidant potential between both trials. These results suggest that impaired mood states induced by high-intensity exercise can be improved early by MHO without any changes in oxidative stress. This improvement may be associated with decreased heart rate secondary to MHO exposure after the high intensity exercise.

CONCLUSIONS

We conclude that MHO can improve mood disturbances, especially in the fatigue-inertia and tension-anxiety domains, after high-intensity exercise. This study suggest that MHO is potentially an effective recovery method for mood states after high-intensity training.

Hyperbaric Oxygen Therapy in Management of Diabetic Foot Ulcers: Indocyanine Green Angiography May Be Used as a Biomarker to Analyze Perfusion and Predict Response to Treatment

SUMMARY

The authors present indocyanine green angiography to assess the effects of hyperbaric oxygen therapy and as a potential biomarker to predict healing of chronic wounds. They hypothesize that favorable initial response to hyperbaric oxygen therapy (improved perfusion) would be an early indicator of eventual response to the treatment (wound healing). Two groups were recruited: patients with chronic wounds and unwounded healthy controls. Inclusion criteria included adults with only one active wound of Wagner grade III diabetic foot ulcer or caused by soft-tissue radionecrosis. Patients with chronic wounds underwent 30 to 40 consecutive hyperbaric oxygen therapy sessions, once per day, 5 days per week; controls underwent two consecutive sessions. Indocyanine green angiography was performed before and after the sessions, and perfusion patterns were analyzed. Healing was determined clinically and defined as full skin epithelialization with no clinical evidence of wound drainage. Fourteen chronic-wound patients and 10 controls were enrolled. Unlike unwounded healthy volunteers, a significant increase in indocyanine green angiography perfusion was found in chronic-wound patients immediately after therapy (p < 0.03). Moreover, the authors found that 100 percent of the wounds that demonstrated improved perfusion from session 1 to session 2 went on to heal within 30 days of hyperbaric oxygen therapy completion, compared with none in the subgroup that did not demonstrate improved perfusion (p < 0.01). This study demonstrates a beneficial impact of hyperbaric oxygen therapy on perfusion in chronic wounds by ameliorating hypoxia and improving angiogenesis, and also proposes a potential role for indocyanine green angiography in early identification of those who would benefit the most from hyperbaric oxygen therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Role of Telomeres Shortening in Atherogenesis: An Overview

It is known that the shortening of the telomeres leads to cell senescence, accompanied by acquiring of pro-inflammatory phenotype. The expression of telomerase can elongate telomeres and resist the onset of senescence. The initiation of atherosclerosis is believed to be associated with local senescence of the endothelial cells of the arteries in places with either low or multidirectional oscillatory wall shear stress. The process of regeneration of the artery surface that has begun does not lead to success for several reasons. Atherosclerotic plaques are formed, which, when developed, lead to fatal consequences, which are the leading causes of death in the modern world. The pronounced age dependence of the manifestations of atherosclerosis pushes scientists to try to link the development of atherosclerosis with telomere length. The study of the role of telomere shortening in atherosclerosis is mainly limited to measuring the telomeres of blood cells, and only in rare cases (surgery or post-mortem examination) are the telomeres of local cells available for measurement. The review discusses the basic issues of cellular aging and the interpretation of telomere measurement data in atherosclerosis, as well as the prospects for the prevention and possible treatment of atherosclerosis.

Mild hyperbaric oxygen exposure attenuates rarefaction of capillary vessels in streptozotocin-induced diabetic soleus muscle in rats

We examined the effects of mild hyperbaric oxygen (mHBO) exposure on capillary rarefaction in skeletal muscles of rats with diabetes. Streptozotocin (100 mg/kg) was administered to male Wistar rats via the tail vein to prepare a diabetic model. These rats were divided into 2 groups: the group with mHBO exposure (1.25 atmospheres absolute (ATA) with 36% oxygen; 3 h/day) and the group without mHBO exposure. Age-matched rats were used as the control group. Eight weeks later, the soleus of the rats was removed and then analyzed. With the onset of diabetes mellitus, capillary number, diameter, and volume in the soleus of the rats with diabetes decreased compared with those of the rats in the control group. In addition, increased anti-angiogenic thrombospondin-1 (TSP-1) and decreased pro-angiogenic murine double minute 2 (MDM-2) protein expressions were observed in the rats with diabetes. Alternatively, mHBO exposure attenuated the decrease in capillary diameter and volume in skeletal muscles of rats with diabetes, suppressed the overexpression of TSP-1, and restored the MDM-2 expression. These results indicate the exposure of mHBO partially attenuates capillary rarefaction in diabetic soleus muscle.

Hyperbaric Oxygen Therapy: Descriptive Review of the Technology and Current Application in Chronic Wounds

Hyperbaric oxygen therapy (HBOT) serves as "primary" or "adjunctive" therapy in a wide range of pathologies. It is considered the mainstay of management for potentially life-threatening conditions such as carbon monoxide poisoning, decompression illness, and gas embolisms. Moreover, HBOT has been utilized for decades as an adjunctive therapy in a variety of medical disciplines, including chronic wounds, which affect approximately 6.5 million Americans annually. In general, chronic wounds are characterized by hypoxia, impaired angiogenesis, and prolonged inflammation, all of which may theoretically be ameliorated by HBOT. Nonetheless, the cellular, biochemical, and physiological mechanisms by which HBOT achieves beneficial results in chronic wounds are not fully understood, and there remains significant skepticism regarding its efficacy. This review article provides a comprehensive overview of HBOT, and discusses its history, mechanisms of action, and its implications in management of chronic wounds. In particular, we discuss the current evidence regarding the use of HBOT in diabetic foot ulcers, while digging deeply into the roots of controversy surrounding its efficacy. We discuss how the paucity of high-quality research is a tremendous challenge, and offer future direction to address existing obstacles.

The Mechanism of NMDA Receptor Hyperexcitation in High Pressure Helium and Hyperbaric Oxygen

Professional divers exposed to pressures greater than 1.1 MPa may suffer from the high pressure neurological syndrome (HPNS). Divers who use closed-circuit breathing apparatus face the risk of CNS hyperbaric oxygen toxicity (HBOTox). Both syndromes are characterized by reversible CNS hyperexcitability, accompanied by cognitive and motor deficits. Previous studies have demonstrated that the hyperexcitability of HPNS is induced mainly by NMDA receptors (NMDARs). In our recent studies, we demonstrated that the response of NMDARs containing GluN1 + GluN2A subunits was increased by up to 50% at high pressure (HP) He, whereas GluN1 + GluN2B NMDARs response was not affected under similar conditions. Our aim was to compare the responses of both types of NMDARs under HBOTox conditions to those of HP He and to reveal their possible underlying molecular mechanism(s). The two combinations of NMDARs were expressed in Xenopus laevis oocytes, placed in a pressure chamber, voltage-clamped, and their currents were tested at 0.1 (control) -0.54 MPa 100% O₂ or 0.1-5.1 MPa He pressures. We show, for the first time, that NMDARs containing the GluN2A subunit exhibit increased responses in 100% O₂ at a pressure of 0.54 MPa, similar to those observed in 5.1 MPa He. In contrast, the GluN1 + GluN2B response is not sensitive to either condition. We discovered that neither condition produced statistically significant changes in the voltage-dependent Mg²⁺ inhibition of the response. The averaged IC₅₀ remained the same, but a higher [Mg²⁺] _o was required to restore the current to its control value. The application of TPEN, a Zn²⁺ chelator, in control, HP He and HBOTox conditions, revealed that the increase in GluN1 + GluN2A current is associated with the removal of the high-affinity voltage-independent Zn²⁺ inhibition of the receptor. We propose that HPNS and HBOTox may share a common mechanism, namely removal of Zn²⁺ from its specific binding site on the N-terminal domain of the GluN2A subunit, which increases the pore input-conductance and produces larger currents and consequently a hyperexcitation.

L-Carnitine Is Involved in Hyperbaric Oxygen-Mediated Therapeutic Effects in High Fat Diet-Induced Lipid Metabolism Dysfunction

Lipid metabolism dysfunction and obesity are serious health issues to human beings. The current study investigated the effects of hyperbaric oxygen (HBO) against high fat diet (HFD)-induced lipid metabolism dysfunction and the roles of L-carnitine. C57/B6 mice were fed with HFD or normal chew diet, with or without HBO treatment. Histopathological methods were used to assess the adipose tissues, serum free fatty acid (FFA) levels were assessed with enzymatic methods, and the endogenous circulation and skeletal muscle L-carnitine levels were assessed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Additionally, western blotting was used to assess the expression levels of PPARα, CPT1b, pHSL/HSL, and UCP1. HFD treatment increased body/adipose tissue weight, serum FFA levels, circulation L-carnitines and decreased skeletal muscle L-carnitine levels, while HBO treatment alleviated such changes. Moreover, HFD treatment increased fatty acid deposition in adipose tissues and decreased the expression of HSL, while HBO treatment alleviated such changes. Additionally, HFD treatment decreased the expression levels of PPARα and increased those of CPT1b in skeletal muscle, while HBO treatment effectively reverted such changes as well. In brown adipose tissues, HFD increased the expression of UCP1 and the phosphorylation of HSL, which was abolished by HBO treatment as well. In summary, HBO treatment may alleviate HFD-induced fatty acid metabolism dysfunction in C57/B6 mice, which seems to be associated with circulation and skeletal muscle L-carnitine levels and PPARα expression.

Cross talk between 26S proteasome and mitochondria in human mesenchymal stem cells' ability to survive under hypoxia stress

Mesenchymal stem cells (MSCs) are regarded as unique cells which play an imperative role in the field of regenerative medicine. They are characterized by the self-renewal capacity, multi-lineage differentiation abilities and immunomodulation properties which render them perfectly ideal cell type for treating a wide range of chronic diseases. Despite these enchanted features, there are many hurdles that need to be circumvented to ensure their long-term survival and viability after transplantation. Recently, hypoxia has been indicated as one of the most baffling stress conditions that can affect the survival rate of MSCs either positively or negatively depending on the level of hypoxia. MSCs can survive well under moderate hypoxia, but die shortly if they were exposed to severe hypoxia without clearly convincing explanation for this enigma. The current study reveals a novel mechanism of 26S proteasome in controlling the ability of BM-MSCs to withstand hypoxic stress by maintaining proper mitochondrial function. The results indicated that 26S proteasome remains functioning once BM- MSCs are exposed to moderate hypoxia (2.5%O2) and preserves their survival and proliferation mediated by intact mitochondrial performance, whereas 26S proteasome becomes inactive when BM-MSCs faces severe hypoxia that lead to poor mitochondrial function and less chance to survive longer. The outcomes of this study demonstrated the importance of 26S proteasome machinery in enhancing the resistance of BM-MSCs to hypoxic stress condition which may help in better planning future studies that target this system. Schematic representation summarizing the findings of the current study. 26S proteasome function preservation in normoxia and moderate hypoxia leads to maintain appropriate proliferation and mitochondrial activity in human BM-MSCs and promote their survival. On the opposite side, severe hypoxia disrupts the 26S proteasome function leading to significant reduction in the proliferation, survival and mitochondrial dynamics in human BM-MSCs causing their death.

Queueing arrival and release mechanism for K+ permeation through a potassium channel

The mechanism underlying ion permeation through potassium channels still remains controversial. K+ ions permeate across a narrow selectivity filter (SF) in a single file. Conventional scenarios assume that K+ ions are tightly bound in the SF, and, thus, they are displaced from their energy well by ion-ion repulsion with an incoming ion. This tight coupling between entering and exiting ions has been called the "knock-on" mechanism. However, this paradigm is contradicted by experimental data measuring the water-ion flux coupling ratio, demonstrating fewer ion occupancies. Here, the results of molecular dynamics simulations of permeation through the KcsA potassium channel revealed an alternative mechanism. In the aligned ions in the SF (an ion queue), the outermost K+ was readily and spontaneously released toward the extracellular space, and the affinity of the relevant ion was ~ 50 mM. Based on this low-affinity regime, a simple queueing mechanism described by loose coupling of entering and exiting ions is proposed.

Effects of exposure to mild hyperbaric oxygen during unloading on muscle properties in rats

This study investigated the effects of exposure to mild hyperbaric oxygen during unloading on the properties of the soleus muscle in rats, because exposure to mild hyperbaric oxygen enhances oxidative metabolism in cells and tissues. Therefore, exposure to mild hyperbaric oxygen should inhibit the unloading-induced degenerative changes in skeletal muscles. One group of 7-week-old male Wistar rats were unloaded by hindlimb suspension for 2 weeks (HU, n = 12). A second group of age-matched rats were exposed to mild hyperbaric oxygen at 1317 hPa with 40% oxygen for 3 h a day during hindlimb suspension (HU + MHO, n = 12). A third group of age-matched rats without hindlimb suspension and exposure to mild hyperbaric oxygen were assigned as the controls (WR, n = 12). Soleus muscle weight (per body weight), succinate dehydrogenase (SDH) activity, and peroxisome proliferator-activated receptor γ coactivator-1α (Pgc-1α) mRNA levels were lower in the HU and HU + MHO groups than in the WR group, and these were higher in the HU + MHO group than in the HU group. The unloading-induced type shift from type I to type IIA fibers was inhibited by exposure to mild hyperbaric oxygen during unloading. It is concluded that the unloading-induced decrease in soleus muscle weight (per body weight) and type shift from type I to type IIA fibers in the soleus muscle were partially inhibited by exposure to mild hyperbaric oxygen during unloading.