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Ajan A, Roberg K, Fredriksson I, Abtahi J. Reproducibility of Laser Doppler Flowmetry in gingival microcirculation. A study on six different protocols. Microvasc Res 2024; 153:104666. [PMID: 38301938 DOI: 10.1016/j.mvr.2024.104666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Laser Doppler Flowmetry (LDF) is a non-invasive technique for the assessment of tissue blood flow, but increased reproducibility would facilitate longitudinal studies. The aim of the study was to assess the interday reproducibility of Laser Doppler Flowmetry (LDF) at rest, at elevated local temperatures, and with the use of the vasodilator Methyl Nicotinate (MN) in six interconnected protocols for the measurement of the blood supply to the microvascular bed of the gingiva. METHODS Ten healthy volunteers were included. Interweek LDF measurements with custom-made acrylic splints were performed. Six protocols were applied in separate regions of interest (ROI): 1; basal LDF, 2; LDF with thermoprobe 42 °C, 3; LDF with thermoprobe 45 °C, 4; LDF with thermoprobe 42 °C and MN, 5; LDF with thermoprobe 45 °C and MN and 6; LDF with MN. RESULTS Intra-individual reproducibility was assessed by the within-subject coefficient of variation (wCV) and the intraclass correlation coefficient (ICC). Basal LDF measurements demonstrated high reproducibility with wCV 11.1 in 2 min and 10.3 in 5 min. ICC was 0.9 and 0.92. wCV after heat and MN was 4.9-10.3 and ICC 0.82-0.93. The topically applied MN yielded increased blood flow. CONCLUSION This is the first study evaluating the reproducibility of basal LDF compared to single or multiple vasodilatory stimuli in gingiva. Multiple collector fibers probe and stabilizing acrylic splints are recommended. Vasodilatory stimulation showed a tendency toward higher reproducibility. Furthermore, MN yields vasodilation in gingiva.
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Affiliation(s)
- Aida Ajan
- Department of Oral and Maxillofacial Surgery, Linköping University Hospital, Linköping, Sweden; Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden.
| | - Karin Roberg
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden; Department of Otorhinolaryngology in Linköping, Region Östergötland, Linköping, Sweden.
| | - Ingemar Fredriksson
- Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden.
| | - Jahan Abtahi
- Department of Oral and Maxillofacial Surgery, Linköping University Hospital, Linköping, Sweden; Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden.
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Lin ZC, Bennett MH, Hawkins GC, Azzopardi CP, Feldmeier J, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2023; 8:CD005005. [PMID: 37585677 PMCID: PMC10426260 DOI: 10.1002/14651858.cd005005.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND This is the third update of the original Cochrane Review published in July 2005 and updated previously in 2012 and 2016. Cancer is a significant global health issue. Radiotherapy is a treatment modality for many malignancies, and about 50% of people having radiotherapy will be long-term survivors. Some will experience late radiation tissue injury (LRTI), developing months or years following radiotherapy. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based on the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of complications following surgery and radiotherapy. OBJECTIVES To evaluate the benefits and harms of hyperbaric oxygen therapy (HBOT) for treating or preventing late radiation tissue injury (LRTI) compared to regimens that excluded HBOT. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 24 January 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. survival from time of randomisation to death from any cause; 2. complete or substantial resolution of clinical problem; 3. site-specific outcomes; and 4. ADVERSE EVENTS Our secondary outcomes were 5. resolution of pain; 6. improvement in quality of life, function, or both; and 7. site-specific outcomes. We used GRADE to assess certainty of evidence. MAIN RESULTS Eighteen studies contributed to this review (1071 participants) with publications ranging from 1985 to 2022. We added four new studies to this updated review and evidence for the treatment of radiation proctitis, radiation cystitis, and the prevention and treatment of osteoradionecrosis (ORN). HBOT may not prevent death at one year (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.47 to 1.83; I2 = 0%; 3 RCTs, 166 participants; low-certainty evidence). There is some evidence that HBOT may result in complete resolution or provide significant improvement of LRTI (RR 1.39, 95% CI 1.02 to 1.89; I2 = 64%; 5 RCTs, 468 participants; low-certainty evidence) and HBOT may result in a large reduction in wound dehiscence following head and neck soft tissue surgery (RR 0.24, 95% CI 0.06 to 0.94; I2 = 70%; 2 RCTs, 264 participants; low-certainty evidence). In addition, pain scores in ORN improve slightly after HBOT at 12 months (mean difference (MD) -10.72, 95% CI -18.97 to -2.47; I2 = 40%; 2 RCTs, 157 participants; moderate-certainty evidence). Regarding adverse events, HBOT results in a higher risk of a reduction in visual acuity (RR 4.03, 95% CI 1.65 to 9.84; 5 RCTs, 438 participants; high-certainty evidence). There was a risk of ear barotrauma in people receiving HBOT when no sham pressurisation was used for the control group (RR 9.08, 95% CI 2.21 to 37.26; I2 = 0%; 4 RCTs, 357 participants; high-certainty evidence), but no such increase when a sham pressurisation was employed (RR 1.07, 95% CI 0.52 to 2.21; I2 = 74%; 2 RCTs, 158 participants; high-certainty evidence). AUTHORS' CONCLUSIONS These small studies suggest that for people with LRTI affecting tissues of the head, neck, bladder and rectum, HBOT may be associated with improved outcomes (low- to moderate-certainty evidence). HBOT may also result in a reduced risk of wound dehiscence and a modest reduction in pain following head and neck irradiation. However, HBOT is unlikely to influence the risk of death in the short term. HBOT also carries a risk of adverse events, including an increased risk of a reduction in visual acuity (usually temporary) and of ear barotrauma on compression. Hence, the application of HBOT to selected participants may be justified. The small number of studies and participants, and the methodological and reporting inadequacies of some of the primary studies included in this review demand a cautious interpretation. More information is required on the subset of disease severity and tissue type affected that is most likely to benefit from this therapy, the time for which we can expect any benefits to persist and the most appropriate oxygen dose. Further research is required to establish the optimum participant selection and timing of any therapy. An economic evaluation should also be undertaken.
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Affiliation(s)
- Zhiliang Caleb Lin
- Hyperbaric Service, Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
| | - Michael H Bennett
- Department of Anaesthesia, Prince of Wales Clinical School, University of NSW, Sydney, Australia
- Academic Head, Wales Anaesthesia and Department of Diving and Hyperbaric Medicine, Prince of Wales Clinical School, Sydney, Australia
| | - Glen C Hawkins
- UNSW Medicine, Prince of Wales Clinical School, Sydney, Australia
| | | | - John Feldmeier
- Department of Radiation Oncology, Medical College of Ohio, Toledo, Ohio, USA
| | - Robert Smee
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Christopher Milross
- Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, Camperdown, Australia
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3
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Eldisoky RH, Younes SA, Omar SS, Gharib HS, Tamara TA. Hyperbaric oxygen therapy efficacy on mandibular defect regeneration in rats with diabetes mellitus: an animal study. BMC Oral Health 2023; 23:101. [PMID: 36793042 PMCID: PMC9930221 DOI: 10.1186/s12903-023-02801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND This study aimed to investigate the influence of hyperbaric oxygen therapy on mandibular critical-sized defect regeneration in rats with experimentally induced type I diabetes mellitus. Restoration of large osseous defects in an impaired osteogenic condition such as diabetes mellitus is a challenging task in clinical practice. Therefore, investigating adjunctive therapies to accelerate the regeneration of such defects is crucial. MATERIALS AND METHODS Sixteen albino rats were divided into two groups (n = 8/group). To induce diabetes mellitus, a single streptozotocin dosage was injected. Critical-sized defects were created in the right posterior mandibles and filled with beta-tricalcium phosphate graft. The study group was subjected to 90-min sessions of hyperbaric oxygen at 2.4 ATA, for 5 consecutive days per week. Euthanasia was carried out after 3 weeks of therapy. Bone regeneration was examined histologically and histomorphometrically. Angiogenesis was assessed by immunohistochemistry against vascular endothelial progenitor cell marker (CD34) and the microvessel density was calculated. RESULTS Exposure of diabetic animals to hyperbaric oxygen resulted in superior bone regeneration and increased endothelial cell proliferation, which were revealed histologically and immunohistochemically, respectively. These results were confirmed by histomorphometric analysis which disclosed a higher percentage of new bone surface area and microvessel density in the study group. CONCLUSIONS Hyperbaric oxygen has a beneficial effect on bone regenerative capacity, qualitatively and quantitively, as well as the ability to stimulate angiogenesis.
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Affiliation(s)
- Rodina H. Eldisoky
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Salwa A. Younes
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Samia S. Omar
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hagar S. Gharib
- grid.7155.60000 0001 2260 6941Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Tarek A. Tamara
- grid.489816.a0000000404522383Naval Hyperbaric Medical Institute, Military Medical Academy, Alexandria, Egypt
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4
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Kim LN, Rubenstein RN, Chu JJ, Allen RJ, Mehrara BJ, Nelson JA. Noninvasive Systemic Modalities for Prevention of Head and Neck Radiation-Associated Soft Tissue Injury: A Narrative Review. J Reconstr Microsurg 2022; 38:621-629. [PMID: 35213927 PMCID: PMC9402815 DOI: 10.1055/s-0042-1742731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radiation-associated soft tissue injury is a potentially devastating complication for head and neck cancer patients. The damage can range from minor sequelae such as xerostomia, which requires frequent daily maintenance, to destructive degenerative processes such as osteoradionecrosis, which can contribute to flap failure and delay or reverse oral rehabilitation. Despite the need for effective radioprotectants, the literature remains sparse, primarily focused on interventions beyond the surgeon's control, such as maintenance of good oral hygiene or modulation of radiation dose. METHODS This narrative review aggregates and explores noninvasive, systemic treatment modalities for prevention or amelioration of radiation-associated soft tissue injury. RESULTS We highlighted nine modalities with the most clinical potential, which include amifostine, melatonin, palifermin, hyperbaric oxygen therapy, photobiomodulation, pentoxifylline-tocopherol-clodronate, pravastatin, transforming growth factor-β modulators, and deferoxamine, and reviewed the benefits and limitations of each modality. Unfortunately, none of these modalities are supported by strong evidence for prophylaxis against radiation-associated soft tissue injury. CONCLUSION While we cannot endorse any of these nine modalities for immediate clinical use, they may prove fruitful areas for further investigation.
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Affiliation(s)
- Leslie N. Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robyn N. Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J. Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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5
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Helmers R, Milstein DMJ, Straat NF, Navran A, Teguh DN, van Hulst RA, Smeele LE, de Lange J. The impact of hyperbaric oxygen therapy on late irradiation injury in oral microcirculation. Head Neck 2022; 44:1646-1654. [PMID: 35488468 PMCID: PMC9321996 DOI: 10.1002/hed.27073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Late side effects of radiotherapy in patients with head and neck cancer (HNCPs) result in decreased tissue vascularity, a compromised healing capacity and spontaneous breakdown of tissue. The aim of this study was to examine the in vivo effect of hyperbaric oxygen therapy (HBOT) on the microcirculation in irradiated oral tissue. METHODS Using a handheld microscope, the effect of HBOT on oral mucosal microcirculation parameters was measured in 34 previously irradiated HNCPs prior to HBOT and at 4 weeks and 6 months posttreatment. RESULTS A significant increase in mean buccal vessel density and decrease in buccal vessel diameter was found 6 months after HBOT compared to baseline, 22 ± 11 versus 25 ± 7 cpll/mm2 (p < 0.05) and 20 ± 4 versus 16 ± 5 μm (p < 0.05), respectively. CONCLUSION Our results indicate that oral microcirculation histopathology associated with irradiation is able to respond to HBOT by redirecting oral microcirculation parameters towards values consistent with healthy tissue.
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Affiliation(s)
- Renée Helmers
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nina F Straat
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - David N Teguh
- Department of Surgery/Hyperbaric Medicine, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert A van Hulst
- Department of Surgery/Hyperbaric Medicine, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre (UMC), AMC, University of Amsterdam, Amsterdam, the Netherlands
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6
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Kouadio AA, Fabienne J, Soueidan A, Volteau C, Koffi NJ, Djérédou KB, Le Bars P. Effects of wearing removable dentures and aging on palatal mucosa blood flow by laser doppler. J Indian Prosthodont Soc 2022; 22:161-168. [PMID: 36511027 PMCID: PMC9132508 DOI: 10.4103/jips.jips_292_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim The purpose of this work is to analyze the effects of removable dental prostheses and aging on blood microcirculation in the palatal mucosa. Settings and Design Blood flow was measured in two groups using the Laser Doppler Flowmeter at three specific anatomical sites: Retro incisive papilla, medial raphe, and Schroeder area. Materials and Methods Group 1 included young, healthy dentulous individuals (mean age: 23 ± 3 years), and Group 2 contained elderly edentulous individuals (mean age: 62 ± 11.69 years). For Group 1, measurements were taken in a single session; for Group 2, the measurements were taken in two sessions: The first just before the prosthetic load (E1) and again 1 week after new dentures were provider (E2). Statistical Analysis Used Statistical analyses were performed using SAS software, Version 9.4 of the SAS System for Windows, Copyright © 2017 SAS Institute Inc. (Cary, NC, USA). A P < 0.05 was classified as statistically significant. Results Measurements of blood flow of the palatal mucosa showed that the healthy young dentulous participants had significantly lower perfusion unit values than the elderly edentulous participants at all three anatomical sites (P < 0.05). For Group 2, the comparisons between the measurements taken before (E1) and after (E2) new dentures were provided showed no significant differences. Conclusion Our results indicate that the process of aging significantly modifies the blood flow of the palatal mucosa while wearing removable dental prostheses does not modify the blood flow of the palatal mucosa in a 1week period. These results are not influenced by systemic pathology (e.g., diabetes, cardiovascular diseases) or smoking.
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Affiliation(s)
- Ayepa Alain Kouadio
- Department of Prosthodontics, UIC Odontology, Nantes Dental School, Abidjan, Cote d’Ivoire,Odontostomatology Faculty, Félix Houphouët Boigny University, Abidjan, Cote d’Ivoire
| | - Jordana Fabienne
- Department of Prosthodontics, UIC Odontology, Nantes Dental School, Abidjan, Cote d’Ivoire
| | - Assem Soueidan
- Department of Periodontology, UIC Odontology, CHU, Nantes Cedex, France
| | | | - N’goran Justin Koffi
- Odontostomatology Faculty, Félix Houphouët Boigny University, Abidjan, Cote d’Ivoire
| | | | - Pierre Le Bars
- Department of Prosthodontics, UIC Odontology, Nantes Dental School, Abidjan, Cote d’Ivoire,Address for correspondence: Dr. Pierre Le Bars, Nantes Dental School, 1 Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France. E-mail: pierre.le-bars@univ-nantes
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7
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Batenburg MCT, van den Bongard HJGD, Kleynen CE, Maarse W, Witkamp A, Ernst M, Doeksen A, van Dalen T, Sier M, Schoenmaeckers EJP, Baas IO, Verkooijen HM. Assessing the effect of hyperbaric oxygen therapy in breast cancer patients with late radiation toxicity (HONEY trial): a trial protocol using a trial within a cohort design. Trials 2020; 21:980. [PMID: 33246494 PMCID: PMC7694912 DOI: 10.1186/s13063-020-04869-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background Breast cancer treatment with radiotherapy can induce late radiation toxicity, characterized by pain, fibrosis, edema, impaired arm mobility, and poor cosmetic outcome. Hyperbaric oxygen therapy (HBOT) has been proposed as treatment for late radiation toxicity; however, high-level evidence of effectiveness is lacking. As HBOT is standard treatment and reimbursed by insurers, performing classic randomized controlled trials is difficult. The “Hyperbaric OxygeN therapy on brEast cancer patients with late radiation toxicity” (HONEY) trial aims to evaluate the effectiveness of HBOT on late radiation toxicity in breast cancer patients using the trial within cohorts (TwiCs) design. Methods The HONEY trial will be conducted within the Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaluation (UMBRELLA). Within UMBRELLA, breast cancer patients referred for radiotherapy to the University Medical Centre Utrecht are eligible for inclusion. Patients consent to collection of clinical data and patient-reported outcomes and provide broad consent for randomization into future intervention studies. Patients who meet the HONEY in- and exclusion criteria (participation ≥ 12 months in UMBRELLA, moderate/severe breast or chest wall pain, completed primary breast cancer treatment except hormonal treatment, no prior treatment with HBOT, no contraindications for HBOT, no clinical signs of metastatic or recurrent disease) will be randomized to HBOT or control group on a 2:1 ratio (n = 120). Patients in the control group will not be informed about participation in the trial. Patients in the intervention arm will undergo 30–40 HBOT treatment sessions in a high pressure chamber (2.4 atmospheres absolute) where they inhale 100% oxygen through a mask. Cohort outcome measures (i.e., physical outcomes, quality of life, fatigue, and cosmetic satisfaction) of the HBOT group will be compared to the control group at 3 months follow-up. Discussion This pragmatic trial within the UMBELLA cohort was designed to evaluate the effectiveness of HBOT on late radiation toxicity in breast cancer patients using the TwiCs design. Use of the TwiCs design is expected to address issues encountered in classic randomized controlled trials, such as contamination (i.e., HBOT in the control group) and disappointment bias, and generate information about acceptability of HBOT. Trial registration ClinicalTrials.gov. NCT04193722. Registered on 10 December 2019. Supplementary information The online version contains supplementary material available at 10.1186/s13063-020-04869-z.
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Affiliation(s)
- M C T Batenburg
- Department of Radiation Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, the Netherlands.
| | - H J G D van den Bongard
- Department of Radiation Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, the Netherlands
| | - C E Kleynen
- Department of Radiation Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, the Netherlands
| | - W Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Ernst
- Department of Surgery, Alexander Monro Ziekenhuis, Bilthoven, the Netherlands
| | - A Doeksen
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - T van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - M Sier
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands.,Department of Surgery, Ziekenhuis Rivierenland, Tiel, the Netherlands
| | | | - I O Baas
- Department of Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H M Verkooijen
- Imaging Division, University Medical Centre Utrecht, Utrecht, the Netherlands
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8
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Results of the First Clinical Study in Humans That Combines Hyperbaric Oxygen Pretreatment with Autologous Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1713-1719. [DOI: 10.1016/j.bbmt.2019.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022]
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9
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Helmers R, Straat NF, Navran A, Nai Chung Tong TAP, Teguh DN, van Hulst RA, de Lange J, Milstein DMJ. Patient-Side Appraisal of Late Radiation-Induced Oral Microvascular Changes. Int J Radiat Oncol Biol Phys 2018; 102:1299-1307. [PMID: 29506885 DOI: 10.1016/j.ijrobp.2018.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/09/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the clinical feasibility of examining and measuring late irradiation changes in the oral microcirculation of head and neck (HN) cancer patients using the novel CytoCam video microscope system. METHODS AND MATERIALS In 30 HN cancer patients and 30 age-matched controls, bilateral video images were recorded noninvasively of the oral microcirculation of the buccal mucosa and mandibular gingiva. Tissue perfusion parameters, such as functional capillary density (FCD), buccal blood vessel diameter, and microcirculatory flow index, were analyzed. RESULTS No difference was observed for mean buccal mucosa FCD in irradiated versus healthy tissue, whereas a lower mean gingival FCD in irradiated versus healthy tissue was observed (34 ± 17 capillaries per millimeter squared [cpll/mm2] vs 68 ± 19 cpll/mm2; P < .001). A significant difference in mean buccal blood vessel diameter of 16 ± 3 μm was measured, compared with 14 ± 1 μm in control buccal mucosa (P < .001). No significant difference in microcirculatory flow index was observed between the 2 groups. CONCLUSIONS Quantifying oral microcirculatory injury associated with late irradiation effects using the CytoCam was feasible in HN cancer patients. Results indicate that marked differences in tissue-specific microcirculatory measurements of angioarchitecture, diminished capillary density, and extensively dilated blood vessel diameters are associated with late irradiation effects in HN cancer patients.
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Affiliation(s)
- Renée Helmers
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - Nina F Straat
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Tim A P Nai Chung Tong
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - David N Teguh
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert A van Hulst
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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10
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Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis. Curr Urol Rep 2018; 19:38. [PMID: 29654564 DOI: 10.1007/s11934-018-0790-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW To critically review and summarize existing literature assessing the effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced urologic injury. RECENT FINDINGS Though 5 of the included 13 studies were published in the last 2-3 years, the only randomized controlled study was performed in 2012. Recent studies have confirmed the safety and efficacy of HBOT as well as identified risk factors for success vs. failure of HBOT for hemorrhagic radiation cystitis (HRC). Of the 602 patients that received HBOT for HRC, 84% had a partial or complete resolution. In the 7 studies that utilized RTOG/EORTC, 75% of patients saw an improvement in hematuria of at least one grade (out of possible 5 total). Of the 499 patients with documented follow-up, 14% experienced recurrence, with a median time to recurrence of 10 months (6 to 16.5 months).
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11
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Sønstevold T, Johannessen AC, Reed RK, Salvesen GS, Stuhr L. Hyperbaric oxygen treatment did not significantly affect radiation injury in the mandibular area of rats. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:112-119. [PMID: 29248424 DOI: 10.1016/j.oooo.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hyperbaric oxygen therapy (HBOT) has been used to enhance microcirculation and thereby oxygen tension in tissues. The present study aimed to investigate the effect of HBOT on radiation injury in the mandibular area of rats. STUDY DESIGN The left mandibles of rats were irradiated by external radiotherapy (15 Gy every other week for a total of 75 Gy). Four HBOT strategies were used: 2 prophylactic groups receiving HBOT either between each radiation treatment or immediately following terminated radiation treatment, and 2 therapeutic groups receiving HBOT after the latent period of 6 weeks after irradiation either every day (standard HBOT protocol) or 3 days a week for 6 weeks. Tissue samples of the irradiated area were taken from skin, the salivary gland, and the mandible. All tissues were stained with hematoxylin and eosin for morphologic examination. Furthermore, skin samples were stained with CD31 for blood vessel analysis. RESULTS There was no change in blood vessel density or morphology between controls and HBOT tissues after radiation. The dentin of 2 of the 5 rats that received HBOT either normalized or was not affected by irradiation. CONCLUSIONS HBOT did not affect radiation injury of the mandibular area in rats within 12 weeks after irradiation.
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Affiliation(s)
- Tonje Sønstevold
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Anne Christine Johannessen
- The Gade Laboratory for Pathology, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway; Center for Cancer Biomarkers, University of Bergen, Norway
| | - Rolf K Reed
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway; Center for Cancer Biomarkers, University of Bergen, Norway
| | - Gerd S Salvesen
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Linda Stuhr
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway; Center for Cancer Biomarkers, University of Bergen, Norway.
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Kouadio AA, Jordana F, Koffi NJ, Le Bars P, Soueidan A. The use of laser Doppler flowmetry to evaluate oral soft tissue blood flow in humans: A review. Arch Oral Biol 2017; 86:58-71. [PMID: 29182953 DOI: 10.1016/j.archoralbio.2017.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
Abstract
The objective of this work is to define the conditions for improving the use of laser Doppler flowmetry (LDF) and to determine the limits for the use of this technique. This article systematically reviews the literature on the evaluation of oral soft tissue blood microcirculation by LDF. We analysed the available literature through October 2016 using the database resources Medline/PubMed, the Cochrane Oral Health Group Specialist Trials Register and the ISI Web of Knowledge. Several points emerged from this literature review The use of LDF involves specific constraints; however, the influence of different factors (temperature, tobacco, pressure etc.) must be adequately controlled when using LDF. LDF measurements of soft tissue within the oral cavity vary depending on the anatomical site. In dentistry, LDF can be used to track healing progress in periodontal surgery and to diagnose vascular flow changes in the connective tissue of mucosae covered by a removable prosthesis at an early stage prior to the onset of clinical inflammation signs.
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Affiliation(s)
- Ayepa Alain Kouadio
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France; UFR d'Odonto-stomatologie, Université Félix Houphouët Boigny, 22 BP 612 Abidjan 22, Cote d'Ivoire.
| | - Fabienne Jordana
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
| | - N'goran Justin Koffi
- UFR d'Odonto-stomatologie, Université Félix Houphouët Boigny, 22 BP 612 Abidjan 22, Cote d'Ivoire.
| | - Pierre Le Bars
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
| | - Assem Soueidan
- Department of Periodontology, UIC Odontology, Nantes Dental School 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
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Hollander MHJ, Boonstra O, Timmenga NM, Schortinghuis J. Hyperbaric Oxygen Therapy for Wound Dehiscence After Intraoral Bone Grafting in the Nonirradiated Patient: A Case Series. J Oral Maxillofac Surg 2017; 75:2334-2339. [PMID: 28784587 DOI: 10.1016/j.joms.2017.07.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In maxillofacial surgery, hyperbaric oxygen treatment is used almost exclusively as adjunctive therapy for osteoradionecrosis of the mandible in irradiated patients. It also is used to prevent the occurrence of osteoradionecrosis in the irradiated patient when dental surgery is indicated. Theoretically, hyperbaric oxygen therapy should benefit the nonirradiated patient in maxillofacial surgery (eg, patients with persistent intraoral wound dehiscences after bone grafting). MATERIALS AND METHODS Six nonirradiated patients underwent hyperbaric oxygen therapy because of compromised wound healing after intraoral bone grafting of the maxilla as a preimplant procedure. All patients were treated 7 to 26 times with hyperbaric oxygen therapy at 2.5 ATA. RESULTS All patients healed uneventfully. In retrospect, almost all patients had a history of chronic maxillary sinusitis or trauma to the operated area. CONCLUSION Hyperbaric oxygen therapy seems to be an effective adjunctive therapy in the treatment of nonirradiated patients with compromised intraoral maxillary bone graft healing. Chronic maxillary sinus problems or a history of trauma could predispose to wound dehiscence after bone grafting.
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Affiliation(s)
- Maria H J Hollander
- Medical Doctor, Institute of Hyperbaric Oxygen Therapy, Hoogeveen, The Netherlands.
| | - Onno Boonstra
- Medical Director and Physician, Institute of Hyperbaric oxygen Therapy, Hoogeveen, The Netherlands
| | - Nicolaas M Timmenga
- Staff Member, Department of Oral and Maxillofacial Surgery, Wilhelmina Hospital, Assen, The Netherlands
| | - Jurjen Schortinghuis
- Staff Member, Department of Oral and Maxillofacial Surgery, TREANT Scheper Hospital, Emmen, The Netherlands
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Current Status of Targeted Radioprotection and Radiation Injury Mitigation and Treatment Agents: A Critical Review of the Literature. Int J Radiat Oncol Biol Phys 2017; 98:662-682. [PMID: 28581409 DOI: 10.1016/j.ijrobp.2017.02.211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 01/17/2023]
Abstract
As more cancer patients survive their disease, concerns about radiation therapy-induced side effects have increased. The concept of radioprotection and radiation injury mitigation and treatment offers the possibility to enhance the therapeutic ratio of radiation therapy by limiting radiation therapy-induced normal tissue injury without compromising its antitumor effect. Advances in the understanding of the underlying mechanisms of radiation toxicity have stimulated radiation oncologists to target these pathways across different organ systems. These generalized radiation injury mechanisms include production of free radicals such as superoxides, activation of inflammatory pathways, and vascular endothelial dysfunction leading to tissue hypoxia. There is a significant body of literature evaluating the effectiveness of various treatments in preventing, mitigating, or treating radiation-induced normal tissue injury. Whereas some reviews have focused on a specific disease site or agent, this critical review focuses on a mechanistic classification of activity and assesses multiple agents across different disease sites. The classification of agents used herein further offers a useful framework to organize the multitude of treatments that have been studied. Many commonly available treatments have demonstrated benefit in prevention, mitigation, and/or treatment of radiation toxicity and warrant further investigation. These drug-based approaches to radioprotection and radiation injury mitigation and treatment represent an important method of making radiation therapy safer.
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Ceponis P, Keilman C, Guerry C, Freiberger JJ. Hyperbaric oxygen therapy and osteonecrosis. Oral Dis 2016; 23:141-151. [PMID: 27062390 DOI: 10.1111/odi.12489] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/18/2022]
Abstract
Osteonecrosis of the jaw may be caused by radiation, medication, or infection. Optimal therapy requires a multimodal approach that combines surgery with adjuvant treatments. This review focuses on the use of adjunctive hyperbaric oxygen therapy for this condition. In addition to evidence regarding the basic and clinical science behind hyperbaric oxygen therapy, controversies in the field and economic implications are discussed.
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Affiliation(s)
- P Ceponis
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, ON, Canada
| | - C Keilman
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - C Guerry
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - J J Freiberger
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Bennett MH, Feldmeier J, Hampson NB, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2016; 4:CD005005. [PMID: 27123955 PMCID: PMC6457778 DOI: 10.1002/14651858.cd005005.pub4] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of people having radiotherapy will be long-term survivors. Some will experience late radiation tissue injury (LRTI) developing months or years later. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based upon the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of problems following surgery. OBJECTIVES To assess the benefits and harms of HBOT for treating or preventing LRTI. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11), MEDLINE, EMBASE, DORCTIHM and reference lists of articles in December 2015. We also searched for ongoing trials at clinicaltrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing. DATA COLLECTION AND ANALYSIS Three review authors independently evaluated the quality of the relevant trials using the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and extracted the data from the included trials. MAIN RESULTS Fourteen trials contributed to this review (753 participants). There was some moderate quality evidence that HBOT was more likely to achieve mucosal coverage with osteoradionecrosis (ORN) (risk ratio (RR) 1.3; 95% confidence interval (CI) 1.1 to 1.6, P value = 0.003, number needed to treat for an additional beneficial outcome (NNTB) 5; 246 participants, 3 studies). There was also moderate quality evidence of a significantly improved chance of wound breakdown without HBOT following operative treatment for ORN (RR 4.2; 95% CI 1.1 to 16.8, P value = 0.04, NNTB 4; 264 participants, 2 studies). From single studies there was a significantly increased chance of improvement or cure following HBOT for radiation proctitis (RR 1.72; 95% CI 1.0 to 2.9, P value = 0.04, NNTB 5), and following both surgical flaps (RR 8.7; 95% CI 2.7 to 27.5, P value = 0.0002, NNTB 4) and hemimandibulectomy (RR 1.4; 95% CI 1.1 to 1.8, P value = 0.001, NNTB 5). There was also a significantly improved probability of healing irradiated tooth sockets following dental extraction (RR 1.4; 95% CI 1.1 to 1.7, P value = 0.009, NNTB 4).There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no randomised data reported on the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse events. AUTHORS' CONCLUSIONS These small trials suggest that for people with LRTI affecting tissues of the head, neck, anus and rectum, HBOT is associated with improved outcome. HBOT also appears to reduce the chance of ORN following tooth extraction in an irradiated field. There was no such evidence of any important clinical effect on neurological tissues. The application of HBOT to selected participants and tissues may be justified. Further research is required to establish the optimum participant selection and timing of any therapy. An economic evaluation should be undertaken.
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Affiliation(s)
- Michael H Bennett
- Prince of Wales Clinical School, University of NSWDepartment of AnaesthesiaSydneyNSWAustralia
| | - John Feldmeier
- Medical College of OhioDepartment of Radiation OncologyToledoOhioUSA
| | - Neil B Hampson
- Virginia Mason Medical CenterCenter for Hyperbaric Medicine1100 Ninth AvenueSeattleWashington StateUSA98101
| | - Robert Smee
- Prince of Wales HospitalDepartment of Radiation OncologyBarker StreetRandwickNSWAustralia2031
| | - Christopher Milross
- Chris O'Brien LifehouseRadiation Oncology and Medical Services119‐143 Missenden RoadPO Box M33 Missenden RoadCamperdownNSWAustralia2050
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Boersema GSA, Wu Z, Kroese LF, Vennix S, Bastiaansen-Jenniskens YM, van Neck JW, Lam KH, Kleinrensink GJ, Jeekel J, Lange JF. Hyperbaric oxygen therapy improves colorectal anastomotic healing. Int J Colorectal Dis 2016; 31:1031-1038. [PMID: 27041554 PMCID: PMC4834105 DOI: 10.1007/s00384-016-2573-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Hyperbaric oxygen treatment (HBOT) has been found to improve the healing of poorly oxygenated tissues. This study aimed to investigate the influence of HBOT on the healing in ischemic colorectal anastomosis. METHODS Forty Wistar rats were randomly divided into a treatment group that received HBOT for 10 consecutive days (7 days before and 3 days after surgery), or in a control group, which did not receive the therapy. Colectomy with an ischemic anastomosis was performed in all rats. In each group, the rats were followed for 3 or 7 days after surgery to determine the influence of HBOT on anastomotic healing. RESULTS Five rats from each group died during follow-up. No anastomotic dehiscence was seen in the HBOT group, compared to 37.5 % and 28.6 % dehiscence in the control group on postoperative day (POD) 3 and 7, respectively. The HBOT group had a significantly higher bursting pressure (130.9 ± 17.0 mmHg) than the control group (88.4 ± 46.7 mmHg; p = 0.03) on POD 3. On POD 3 and POD 7, the adhesion severity was significantly higher in the control groups than in the HBOT groups (p < 0.005). Kidney function (creatinine level) of the HBOT group was significantly better than of the control group on POD 7 (p = 0.001). Interestingly, a significantly higher number of CD206+ cells (marker for type 2 macrophages) was observed in the HBOT group at the anastomotic area on POD 3. CONCLUSION Hyperbaric oxygen enhanced the healing of ischemic anastomoses in rats and improved the postoperative kidney function.
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Affiliation(s)
- G S A Boersema
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Z Wu
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
| | - L F Kroese
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - S Vennix
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - J W van Neck
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - K H Lam
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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Svalestad J, Hellem S, Thorsen E, Johannessen AC. Effect of hyperbaric oxygen treatment on irradiated oral mucosa: microvessel density. Int J Oral Maxillofac Surg 2015; 44:301-7. [PMID: 25604154 DOI: 10.1016/j.ijom.2014.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/07/2014] [Accepted: 12/19/2014] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on microvascular tissue and cell proliferation in the oral mucosa. Twenty patients, aged 51-78 years, were allocated randomly to a treatment or a control group. All had a history of radiotherapy (50-70 Gy) to the orofacial region 2-6 years previously. Tissue samples were taken from the irradiated buccal oral mucosa before HBOT and at 6 months after treatment. In the control group, tissue samples were taken on two occasions, 6 months apart. The samples were subjected to immunohistochemistry staining: double staining with CD31 and D2-40 for microvessels, or Ki-67 for the analysis of cell proliferation. Blood vessel density and area were significantly increased after HBOT (P=0.002-0.041). D2-40-positive lymphatic vessels were significantly increased in number and area in the sub-epithelial area (P=0.002 and P=0.019, respectively). No significant differences were observed in the control group. There were no significant differences in Ki-67-expressing epithelial cells between the two groups. It is concluded that the density and area of blood and lymphatic vessels in the irradiated mucosa are increased by HBOT 6 months after therapy. Epithelial cell proliferation is not affected by HBOT.
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Affiliation(s)
- J Svalestad
- Department of Clinical Dentistry - Oral and Maxillofacial Surgery, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.
| | - S Hellem
- Department of Clinical Dentistry - Oral and Maxillofacial Surgery, University of Bergen, Bergen, Norway
| | - E Thorsen
- Hyperbaric Medical Unit, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - A C Johannessen
- Department of Clinical Medicine, The Gade Laboratory for Pathology, University of Bergen, Bergen, Norway; Department of Pathology, Haukeland University Hospital, Bergen, Norway
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