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Tsushima R, Mori K, Imaki S. Secondary deterioration in a patient with cerebral and coronary arterial gas embolism after brief symptom resolution: a case report. Diving Hyperb Med 2024; 54:61-64. [PMID: 38507911 DOI: 10.28920/dhm54.1.61-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 03/22/2024]
Abstract
Introduction Hyperbaric oxygen treatment (HBOT) is recommended for arterial gas embolism (AGE) with severe symptoms. However, once symptoms subside, there may be a dilemma to treat or not. Case presentation A 71-year-old man was noted to have a mass shadow in his left lung, and a transbronchial biopsy was performed with sedation. Flumazenil was intravenously administered at the end of the procedure. However, the patient remained comatose and developed bradycardia, hypotension, and ST-segment elevation in lead II. Although the ST changes spontaneously resolved, the patient had prolonged disorientation. Whole- body computed tomography revealed several black rounded lucencies in the left ventricle and brain, confirming AGE. The patient received oxygen and remained supine. His neurological symptoms gradually improved but worsened again, necessitating HBOT. HBOT was performed seven times, after which neurological symptoms resolved almost completely. Conclusions AGE can secondarily deteriorate after symptoms have subsided. We recommend that HBOT be performed promptly once severe symptoms appear, even if they resolve spontaneously.
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Affiliation(s)
- Ryota Tsushima
- Yokohama Municipal Citizen's Hospital 1-1, Mitsuzawanishi-chou, Kanagawa-ku, Yokohama-city, Kanagawa-ken 221-0855, Japan
- Corresponding author: Dr Ryota Tsushima, Yokohama Municipal Citizen's Hospital 1-1, Mitsuzawanishi-chou, Kanagawa-ku, Yokohama-city, Kanagawa-ken 221-0855, Japan,
| | - Kosuke Mori
- Yokohama Minami Kyosai Hospital 1-21-1, Mutsurahigashi, Kanazawa-ku, Yokohama- city, Kanagawa-ken 236-0037, Japan
| | - Shohei Imaki
- Yokohama Municipal Citizen's Hospital 1-1, Mitsuzawanishi-chou, Kanagawa-ku, Yokohama-city, Kanagawa-ken 221-0855, Japan
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Wackett J, Devaney B, Chau R, Ho J, King N, Grewal J, Armstrong J, Mitra B. Reported outcome measures in necrotising soft tissue infections: a systematic review. Diving Hyperb Med 2024; 54:47-56. [PMID: 38507909 DOI: 10.28920/dhm54.1.47-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/01/2024] [Indexed: 03/22/2024]
Abstract
Introduction There are inconsistencies in outcome reporting for patients with necrotising soft tissue infections (NSTI). The aim of this study was to evaluate reported outcome measures in NSTI literature that could inform a core outcome set (COS) such as could be used in a study of hyperbaric oxygen in this indication. Methods A systematic review of all NSTI literature identified from Cochrane, Ovid MEDLINE and Scopus databases as well as grey literature sources OpenGrey and the New York Academy of Medicine databases which met inclusion criteria and were published between 2010 and 2020 was performed. Studies were included if they reported on > 5 cases and presented clinical endpoints, patient related outcomes, or resource utilisation in NSTI patients. Studies did not have to include intervention. Two independent researchers then extracted reported outcome measures. Similar outcomes were grouped and classified into domains to produce a structured inventory. An attempt was made to identify trends in outcome measures over time and by study design. Results Three hundred and seventy-five studies were identified and included a total of 311 outcome measures. Forty eight percent (150/311) of outcome measures were reported by two or more studies. The four most frequently reported outcome measures were mortality without time specified, length of hospital stay, amputation performed, and number of debridements, reported in 298 (79.5%), 260 (69.3%), 156 (41.6%) and 151 (40.3%) studies respectively. Mortality outcomes were reported in 23 different ways. Randomised controlled trials (RCTs) were more likely to report 28-day mortality or 90-day mortality. The second most frequent amputation related outcome was level of amputation, reported in 7.5% (28/375) of studies. The most commonly reported patient-centred outcome was the SF-36 which was reported in 1.6% (6/375) of all studies and in 2/10 RCTs. Conclusions There was wide variance in outcome measures in NSTI studies, further highlighting the need for a COS.
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Affiliation(s)
| | - Bridget Devaney
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
- Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Corresponding author: Dr Bridget Devaney, Head of Hyperbaric Medicine, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia,
| | | | | | | | - Jasleen Grewal
- Department of Medicine, Alfred Health, Melbourne, Australia
| | | | - Biswadev Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
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Eker A, Celik S, Ozer EE, Basmacı I, Sefik E, Bozkurt IH, Gunlusoy B, Degirmenci T. Comparison of the effect of hyperbaric oxygen therapy and tadalafil daily use on erectile function: a prospective, double controlled study. Int Urol Nephrol 2024; 56:867-876. [PMID: 37910381 DOI: 10.1007/s11255-023-03852-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Erectile dysfunction (ED) is a worldwide health problem. Oral phosphodiesterase type 5 inhibitors (PDE5I) are used in its first-line treatment. This study aimed to compare the effects of hyperbaric oxygen (HBO) treatment with PDE5I treatment and determine the patient-dependent factors affecting the efficacy of the HBO treatment and duration of action of HBO treatment. METHODS Adult male patients who presented to the HBO unit for HBO treatment with non-urological indications and had ED based on the International Index for Erectile Function (IIEF-5) constituted the target population of this study. Participants were given HBO treatment (Group 1), no treatment (Group 2), or daily oral tadalafil 5 mg treatment (Group 3). The treatment duration was 1 month. Patients were assessed by IIEF-5 both initially and after the completion of 1 month. RESULTS There were significant increases in the mean IIEF-5 scores of the patients in Group 1 and Group 3 (p < 0.001, p < 0.001). However, there was no significant improvement in Group 2 (p = 0.496). Also, the post-treatment IIEF-5 scores of Group 1 and Group 3 were significantly higher than Group 2 (p < 0.001). There was no significant difference between the IIEF-5 scores and ∆IIEF-5 values of Group 1 and Group 3 (p = 0.166, p = 0.093). Evaluation regarding comorbidities revealed that patients with the peripheral vascular disease did not improve with HBO treatment (p = 0.285). CONCLUSION HBO can improve erectile functions, and it can be a reasonable alternative for patients who cannot use PDE5Is due to comorbidities or treatment side effects.
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Affiliation(s)
- Anıl Eker
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Serdar Celik
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Elif Ebru Ozer
- Department of Hyperbaric Medicine, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ismail Basmacı
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ertuğrul Sefik
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Halil Bozkurt
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Izquierdo-Alventosa R, Inglés M, Cortés-Amador S, Muñoz-Gómez E, Mollà-Casanova S, Gimeno-Mallench L, Chrivella-Garrido J, Serra-Añó P. Effects of a low-pressure hyperbaric oxygen therapy on psychological constructs related to pain and quality of life in women with fibromyalgia: A randomized clinical trial. Med Clin (Barc) 2024:S0025-7753(24)00033-2. [PMID: 38383268 DOI: 10.1016/j.medcli.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Self-reported psychological variables related to pain have been posited as the major contributors to the quality of life of fibromyalgia (FM) women and should be considered when implementing therapeutic strategies among this population. The aim of this study was to explore the effect of low-pressure hyperbaric oxygen therapy (HBOT) on psychological constructs related to pain (i.e., pain catastrophism, pain acceptance, pain inflexibility, mental defeat) and quality of life in women with FM. METHODS This was a randomized controlled trial. Thirty-three women with FM were randomly allocated to a low-pressure hyperbaric oxygen therapy group (HBOTG) (n=17), who received an 8-week intervention (5 sessions per week), and a control group (CG) (n=16). All women were assessed at baseline (T0) and upon completion of the study (T1) for self-perceived pain intensity, pain catastrophism, pain acceptance, pain inflexibility, mental defeat and quality of life. RESULTS At T1, the HBOTG improved across all variables related to pain (i.e. self-perceived pain intensity, pain catastrophism, pain acceptance, pain flexibility, mental defeat) (p<0.05) and quality of life (p<0.05). In contrast, the CG showed no improvements in any variable. Furthermore, significant differences between the groups were found in quality of life (p<0.05) after the intervention. CONCLUSIONS HBOT is effective at improving the psychological constructs related to pain (i.e. pain catastrophism, pain acceptance, pain flexibility, mental defeat) and quality of life among women with FM. Clinical Trial Link Clinical Trials gov identifier (NCT03801109).
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Affiliation(s)
- Ruth Izquierdo-Alventosa
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain; Freshage Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, CIBERFES-ISCIII, INCLIVA, Valencia, Spain.
| | - Sara Cortés-Amador
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Lucia Gimeno-Mallench
- Department of Biomedical Sciences, Faculty of Health Sciences, Cardenal Herrera CEU University, Valencia, Spain
| | | | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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Şahin Y, Sayın E, Aslan Y, Bayri Y. Comparative analysis of linezolid, vancomycin, and hyperbaric oxygen therapies in a rat model of ventriculoperitoneal shunt infection. Childs Nerv Syst 2024:10.1007/s00381-024-06305-y. [PMID: 38316673 DOI: 10.1007/s00381-024-06305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Staphylococcus epidermidis is the most common causative microorganism of ventriculoperitoneal shunt infections. This study aimed to compare linezolid and vancomycin treatments and to examine the effect of these antibiotics alone and combined with hyperbaric oxygen therapy on the amount of bacterial colonies in the experimental S. epidermidis shunt infection model. METHODS A shunt catheter was placed in the cisterna magna of 49 adult male Wistar albino rats. The rats were randomly divided into seven groups, as follows: sterile control, infected control, vancomycin, linezolid, hyperbaric oxygen, vancomycin + hyperbaric oxygen, linezolid + hyperbaric oxygen. In all groups except the sterile control group, 0.2 ml 107 CFU/mL S. epidermidis was inoculated to the cisterna magna. Parenteral vancomycin was administered 40 mg/kg/day to the vancomycin groups, and 50 mg/kg/day of enteral linezolid to the linezolid groups. Hyperbaric oxygen groups were given 100% oxygen at a pressure of 2.4 ATA for 50 min a day. One day after the last treatment, colony quantities in the shunt catheters and CSF were analyzed. RESULTS The number of CSF colonies in the linezolid group was significantly lower than in the vancomycin group (p < 0.05). The number of CSF colonies in the linezolid + HBO group was significantly lower than in the vancomycin + HBO group (p < 0.05). CONCLUSIONS Linezolid treatment was found to be more effective than vancomycin in ventriculoperitoneal shunt infection caused by S. epidermidis. There was no statistical difference among other treatment groups. Hyperbaric oxygen therapy is shown to contribute to the sterilization of cultures.
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Affiliation(s)
- Yener Şahin
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Elvan Sayın
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yavuz Aslan
- Department of Diving and Hyperbaric Medicine, TR Health Ministry Health Sciences University Istanbul Sultan Abdülhamit Han Training and Research Hospital, Istanbul, Turkey
| | - Yaşar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey.
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Vinkel J, Rib L, Buil A, Hedetoft M, Hyldegaard O. Key pathways and genes that are altered during treatment with hyperbaric oxygen in patients with sepsis due to necrotizing soft tissue infection (HBOmic study). Eur J Med Res 2023; 28:507. [PMID: 37946314 PMCID: PMC10636866 DOI: 10.1186/s40001-023-01466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND For decades, the basic treatment strategies of necrotizing soft tissue infections (NSTI) have remained unchanged, primarily relying on aggressive surgical removal of infected tissue, broad-spectrum antibiotics, and supportive intensive care. One treatment strategy that has been proposed as an adjunctive measure to improve patient outcomes is hyperbaric oxygen (HBO2) treatment. HBO2 treatment has been linked to several immune modulatory effects; however, investigating these effects is complicated due to the disease's acute life-threatening nature, metabolic and cell homeostasis dependent variability in treatment effects, and heterogeneity with respect to both patient characteristics and involved pathogens. To embrace this complexity, we aimed to explore the underlying biological mechanisms of HBO2 treatment in patients with NSTI on the gene expression level. METHODS We conducted an observational cohort study on prospective collected data, including 85 patients admitted to the intensive care unit (ICU) for NSTI. All patients were treated with one or two HBO2 treatments and had one blood sample taken before and after the intervention. Total RNAs from blood samples were extracted and mRNA purified with rRNA depletion, followed by whole-transcriptome RNA sequencing with a targeted sequencing depth of 20 million reads. A model for differentially expressed genes (DEGs) was fitted, and the functional aspects of the obtained set of genes was predicted with GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of genes and Genomes) enrichment analyses. All analyses were corrected for multiple testing with FDR. RESULTS After sequential steps of quality control, a final of 160 biological replicates were included in the present study. We found 394 protein coding genes that were significantly DEGs between the two conditions with FDR < 0.01, of which 205 were upregulated and 189 were downregulated. The enrichment analysis of these DEGs revealed 20 GO terms in biological processes and 12 KEGG pathways that were significantly overrepresented in the upregulated DEGs, of which the term; "adaptive immune response" (GO:0002250) (FDR = 9.88E-13) and "T cell receptor signaling pathway" (hsa04660) (FDR = 1.20E-07) were the most significant. Among the downregulated DEGs two biological processes were significantly enriched, of which the GO term "apoptotic process" (GO:0006915) was the most significant (FDR = 0.001), followed by "Positive regulation of T helper 1 cell cytokine production" (GO:2000556), and "NF-kappa B signaling pathway" (hsa04064) was the only KEGG pathway that was significantly overrepresented (FDR = 0.001). CONCLUSIONS When one or two sessions of HBO2 treatment were administered to patients with a dysregulated immune response and systemic inflammation due to NSTI, the important genes that were regulated during the intervention were involved in activation of T helper cells and downregulation of the disease-induced highly inflammatory pathway NF-κB, which was associated with a decrease in the mRNA level of pro-inflammatory factors. TRIAL REGISTRATION Biological material was collected during the INFECT study, registered at ClinicalTrials.gov (NCT01790698).
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Affiliation(s)
- Julie Vinkel
- Department of Anesthesiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Leonor Rib
- Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
| | - Alfonso Buil
- Institute for Biological Psychiatry, Mental Health Centre Sct. Hans, Roskilde, Denmark
| | - Morten Hedetoft
- Department of Anesthesiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
- Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Ole Hyldegaard
- Department of Anesthesiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Marjot J, Mackenzie J, Jepson N, Reeves E, Bennett M. Investigation into the effect of hyperbaric hyperoxia on serum cardiac Troponin T levels as a biomarker of cardiac injury. Diving Hyperb Med 2023; 53:281-284. [PMID: 37718303 PMCID: PMC10735667 DOI: 10.28920/dhm53.3.281-284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023]
Abstract
Introduction There is clinical equipoise as to whether hyperoxia is injurious to the myocardium, both in the setting of acute ischaemic insults and on the stable myocardium. This study examined the effect of extreme hyperoxia - in the form of hyperbaric oxygen treatment - on the myocardium through measurement of high-sensitivity cardiac troponin. Methods Forty-eight individuals were enrolled to undergo a series of 30 exposures to hyperbaric oxygen for treatment of non-cardiac pathologies. High-sensitivity troponin T was measured before and after each session. Results There was no clinically significant difference in troponin measurements following acute or recurrent sequential exposures to extreme hyperoxia, despite the studied patient population having a high rate of previous ischaemic heart disease or cardiovascular risk factors. Conclusions This study demonstrates that profound hyperoxaemia does not induce any measurable cardiac injury at a biochemical level. Neither is there a reduction in cardiac troponin to suggest a cardioprotective effect of hyperbaric hyperoxia. This provides some reassurance as to the cardiac safety of the routine use of hyperbaric oxygen treatment in management of non-cardiac pathology.
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Affiliation(s)
- Jack Marjot
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
- Corresponding author: Dr Jack Marjot, Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia, ORCiD ID: 0009-0002-0212-1343.
| | - John Mackenzie
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
| | - Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney
| | - Ewan Reeves
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
| | - Michael Bennett
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
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Laupland BR, Laupland K, Thistlethwaite K, Webb R. Contemporary practices of blood glucose management in diabetic patients: a survey of hyperbaric medicine units in Australia and New Zealand. Diving Hyperb Med 2023; 53:230-236. [PMID: 37718297 PMCID: PMC10735644 DOI: 10.28920/dhm53.3.230-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023]
Abstract
Introduction Blood glucose levels may be influenced by hyperbaric oxygen treatment (HBOT). Patients with diabetes mellitus commonly receive HBOT but there is a lack of standardised blood glucose management guidelines. We documented relevant contemporary practices applied for patients with diabetes treated in hyperbaric medicine units. Methods A survey was administered in 2022 to the directors of all 13 accredited hyperbaric units in Australia and New Zealand to identify policies and practices related to management of patients with diabetes receiving HBOT. Results Twelve of the 13 units routinely managed patients with diabetes. Three-quarters (9/12) used < 4 mmol·l-1 as their definition of hypoglycaemia, whereas the other three used < 5, < 3.6, and < 3 mmol·l-1. Units reported 26% (range 13-66%) of their patients have a diagnosis of diabetes of which 93% are type 2. Ten (83%) units reported specific written protocols for managing blood glucose. Protocols were more likely to be followed by nursing (73%) than medical staff (45%). Ten (83%) units routinely tested blood glucose levels on all patients with diabetes. Preferred pre-treatment values for treatments in both multiplace and monoplace chambers ranged from ≥ 4 to ≥ 8 mmol·l-1. Seven (58%) units reported continuation of routine testing throughout a treatment course with five (42%) units having criteria-based rules for discontinuing testing for stable patients over multiple treatments. Two-thirds of units were satisfied with their current policy. Conclusions This survey highlights the burden of diabetes on patients treated with HBOT and identifies considerable variability in practices which may benefit from further study to optimise management of these patients.
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Affiliation(s)
- Brenda R Laupland
- Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Corresponding author: Dr Brenda Laupland, Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029 Australia, ORCiD ID: 0009-0005-4883-1932,
| | - Kevin Laupland
- Queensland University of Technology (QUT), Brisbane, Australia
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Robert Webb
- Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Clinical Informatics, Digital Metro North, Metro North Health, Brisbane, Australia
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Casanova-Maldonado I, Arancibia D, Lois P, Peña-Villalobos I, Palma V. Hyperbaric oxygen treatment increases intestinal stem cell proliferation through the mTORC1/S6K1 signaling pathway in Mus musculus. Biol Res 2023; 56:41. [PMID: 37438828 DOI: 10.1186/s40659-023-00444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023] Open
Abstract
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.
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Affiliation(s)
- Ignacio Casanova-Maldonado
- Laboratory of Stem Cells and Developmental Biology, Faculty of Sciences, Universidad de Chile, Las Encinas 3370, Milenio Building Floor 3, 7800024, Santiago de Chile, Nunoa, Chile.
| | - David Arancibia
- Laboratory of Stem Cells and Developmental Biology, Faculty of Sciences, Universidad de Chile, Las Encinas 3370, Milenio Building Floor 3, 7800024, Santiago de Chile, Nunoa, Chile
| | - Pablo Lois
- Laboratory of Stem Cells and Developmental Biology, Faculty of Sciences, Universidad de Chile, Las Encinas 3370, Milenio Building Floor 3, 7800024, Santiago de Chile, Nunoa, Chile
- Education Department, Faculty of Humanities, Universidad Mayor, Santiago de Chile, Providencia, Chile
| | - Isaac Peña-Villalobos
- Laboratory of Stem Cells and Developmental Biology, Faculty of Sciences, Universidad de Chile, Las Encinas 3370, Milenio Building Floor 3, 7800024, Santiago de Chile, Nunoa, Chile.
| | - Verónica Palma
- Laboratory of Stem Cells and Developmental Biology, Faculty of Sciences, Universidad de Chile, Las Encinas 3370, Milenio Building Floor 3, 7800024, Santiago de Chile, Nunoa, Chile.
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Turgut B, Canarslan Demir K, Sarıyerli Dursun GB, Zaman T. Hemiplegia resulting from acute carbon monoxide poisoning. Diving Hyperb Med 2023; 53:155-157. [PMID: 37365135 PMCID: PMC10584395 DOI: 10.28920/dhm53.2.155-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 06/28/2023]
Abstract
Carbon monoxide (CO) poisoning can cause neurological complications such as movement disorders and cognitive impairment through hypoxic brain damage. Although peripheral neuropathy of the lower extremities is a known complication of CO poisoning, hemiplegia is very rare. In our case, a patient who developed left hemiplegia due to acute CO poisoning received early hyperbaric oxygen treatment (HBOT). The patient had left hemiplegia and anisocoria at the beginning of HBOT. Her Glasgow coma score was 8. A total of five sessions of HBOT at 243.2 kPa for 120 minutes were provided. At the end of the 5th session, the patient's hemiplegia and anisocoria were completely resolved. Her Glasgow coma score was 15. After nine months of follow-up, she continues to live independently with no sequelae, including delayed neurological sequelae. Clinicians should be aware that CO poisoning can (rarely) present with hemiplegia.
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Affiliation(s)
- Burak Turgut
- Department of Underwater and Hyperbaric Medicine, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
- Corresponding author: Dr Burak Turgut, SBÜ-Gülhane Eğitim ve Araştırma Hastanesi, Sualtı Hekimliği ve Hiperbarik Tıp Kliniği, Etlik/Ankara, Turkey,
| | - Kübra Canarslan Demir
- Department of Underwater and Hyperbaric Medicine, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - G B Sarıyerli Dursun
- Department of Underwater and Hyperbaric Medicine, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Taylan Zaman
- Department of Underwater and Hyperbaric Medicine, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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Talbot Z, Lee A, Boet S. Hyperbaric medicine in Canadian undergraduate medical school curriculum. Diving Hyperb Med 2023; 53:138-141. [PMID: 37365131 PMCID: PMC10584399 DOI: 10.28920/dhm53.2.138-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/18/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Hyperbaric oxygen treatment (HBOT) has fourteen approved indications in the management of acute and chronic diseases in various medical specialties. However, lack of physician knowledge and exposure to hyperbaric medicine may hinder the ability of patients to access this treatment option for approved indications. We aimed to determine the prevalence and nature of HBOT-related learning objectives in Canadian undergraduate medical education programs. METHODS Pre-clerkship and clerkship learning objectives from responding Canadian medical schools' curricula were reviewed. These were acquired through the school websites or by emailing the faculties. Descriptive statistics were used to summarise the number of hyperbaric medicine objectives taught in Canadian medical schools, and within each institution. RESULTS Learning objectives from seven of the 17 Canadian medical schools were received and reviewed. From the curriculum of the responding schools, only one objective was found to be related to hyperbaric medicine. Hyperbaric medicine was absent from the other six schools' objectives. CONCLUSIONS Based on the responding Canadian medical schools, hyperbaric medicine objectives were mostly absent from undergraduate medical curricula. These findings illustrate a possible gap in HBOT education and the need for discussion regarding the design and implementation of HBOT educational initiatives in medical training.
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Affiliation(s)
- Zoé Talbot
- Faculty of Medicine, University of Ottawa, ON, Canada
| | - Alex Lee
- Faculty of Medicine, University of Ottawa, ON, Canada
| | - Sylvain Boet
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada
- Corresponding author: Dr Sylvain Boet, Department of Anesthesiology and Pain Medicine and Department of Innovation in Medical Education, The Ottawa Hospital, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, K1H 8L6, Ontario, Canada,
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Peng X, Gao B, Wang X, Qin X, Peng M, Zeng X. Hyperbaric oxygen and treadmill exercise partially prevented bone loss and bone microarchitecture deterioration in ovariectomized rats. Diving Hyperb Med 2023; 53:111-119. [PMID: 37365128 PMCID: PMC10584393 DOI: 10.28920/dhm53.2.111-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Previous studies have demonstrated the beneficial effects of treadmill exercise (EX) on osteoporosis, and of hyperbaric oxygen (HBO) on osteoblast and osteoclast formation in vitro. We investigated the effects of HBO and the combination of HBO and EX on osteoporosis in ovariectomized rats. METHODS Forty 3-month-old female Sprague-Dawley rats were randomly divided into 5 groups (n = 8): a sham control group (Control); an ovariectomy group; an ovariectomy with treadmill exercise treatment group; an ovariectomy with HBO treatment group; and an ovariectomy with HBO treatment combined with treadmill exercise group. The HBO exposures were 203 kPa, 85-90% O₂, 90 min and the exercise regimen was 20 m·min⁻¹, 40 min·day¹, 5° slope. Both treatments were administered once daily, five days a week for 12 weeks until the rats were sacrificed. RESULTS All three treatments (HBO, exercise, and both combined) significantly promoted the expression of the osteoblast-related gene and oxidative metabolism-related gene (PGC-1α). They also exerted significant inhibitory effects on the osteoclast-related mRNA expression (RANKL) and bone resorption marker CTX-I. Additionally, exercise and the combination exercise-HBO treatment increased serum superoxide dysmutase (SOD) and sclerostin expression. No significant between-group difference was observed. CONCLUSIONS Hyperbaric oxygen, exercise, and the combination ameliorated bone microarchitecture deterioration and ovariectomy-induced bone loss in rats, and these inhibitory effects may be associated with the increased SOD and up-regulated PGC-1α.
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Affiliation(s)
- Xiaoling Peng
- Department of Hyperbaric Oxygen, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China
| | - Binli Gao
- Department of Hyperbaric Oxygen, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China
| | - Xiangxiu Wang
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaohong Qin
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mei Peng
- Department of Hyperbaric Oxygen, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China
| | - Xianrong Zeng
- Department of Hyperbaric Oxygen, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People's Republic of China
- Corresponding author: Professor Xianrong Zeng, 32# W. Sec 2, 1st Ring Rd, Chengdu City, Sichuan Province, People's Republic of China,
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Abstract
INTRODUCTION End-tidal carbon dioxide (ETCO2) monitoring is essential for monitoring intubated critical care patients, yet its use in hyperbaric environments can be problematic. We postulated that the EMMA mainstream capnometer may function accurately under hyperbaric conditions. METHODS Stage 1. The EMMA mainstream capnometer was tested at 101 kPa against a reference side-stream capnometer, Philips IntelliVue M3015B microstream, using 10 customised reference gases of various carbon dioxide (CO₂) concentrations (2.47%-8.09%, or 18.5-60.7 mmHg at 101 kPa) in either air or oxygen. Stage 2. The functionality and accuracy of the EMMA capnometer was tested under hyperbaric conditions, 121-281 kPa, using the same test gases. RESULTS At 101 kPa, the EMMA capnometer measured CO₂ at levels lower than expected (mean of differences = -2.5 mmHg (95% CI -2.1 to -2.9, P < 0.001)). The Philips capnometer measured CO₂ more closely to expected CO₂ (mean of differences = -1.1 mmHg (95% CI -0.69 to -1.4, P < 0.001). Both devices demonstrated a significant linear relationship with expected CO₂. The EMMA capnometer functioned up to the maximum test pressure (281 kPa). The device over-read CO₂ measurements at pressures > 141 kPa. Although variance increased at pressures in the therapeutic range for hyperbaric treatments, a significant linear relationship between expected and EMMA measured CO₂ was demonstrated. The EMMA capnometer tolerated pressures to 281 kPa, but its display was limited to CO₂ < 99 mmHg. CONCLUSIONS This study validated EMMA capnometer function to 281 kPa in the hyperbaric environment. The device over-read CO₂ measurements at pressures >141 kPa, however there was a linear relationship between expected and measured CO₂. The EMMA capnometer may be clinically useful for monitoring expired CO₂ in patients undergoing hyperbaric oxygen treatment.
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Affiliation(s)
- Alicia Tucker
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
- Corresponding author: Dr Alicia Tucker, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, 26 Campbell St, Hobart 7000, Tasmania, Australia,
| | - David Smart
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Sokolowski SA, Räisänen-Sokolowski AK, Tuominen LJ, Lundell RV. Delayed treatment for decompression illness: factors associated with long treatment delays and treatment outcome. Diving Hyperb Med 2022; 52:271-276. [PMID: 36525684 PMCID: PMC10026386 DOI: 10.28920/dhm52.4.271-276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Effectiveness of delayed hyperbaric oxygen treatment (HBOT) for decompression illness (DCI) and factors affecting treatment delays have not been studied in large groups of patients. METHODS This retrospective study included 546 DCI patients treated in Finland in the years 1999-2018 and investigated factors associated with recompression delay and outcome. Treatment outcome was defined as fully recovered or presence of residual symptoms on completion of HBOT. The symptoms, use of first aid oxygen, number of recompression treatments needed and characteristics of the study cohort were also addressed. RESULTS Delayed HBOT (> 48 h) remained effective with final outcomes similar to those treated within 48 h. Cardio-pulmonary symptoms were associated with a shorter treatment delay (median 15 h vs 28 h without cardiopulmonary symptoms, P < 0.001), whereas mild sensory symptoms were associated with a longer delay (48 vs 24 h, P < 0.001). A shorter delay was also associated with only one required HBOT treatment (median 24 h vs 34 h for those requiring multiple recompressions) ( P = 0.002). Tinnitus and hearing impairment were associated with a higher proportion of incomplete recoveries (78 and 73% respectively, P < 0.001), whereas a smaller proportion of cases with tingling/itching (15%, P = 0.03), nausea (27%, P = 0.03), motor weakness (33%, P = 0.05) and visual disturbances (36%, P = 0.04) exhibited residual symptoms. Patients with severe symptoms had a significantly shorter delay than those with mild symptoms (median 24 h vs 36 h respectively, P < 0.001), and a lower incidence of complete recovery. CONCLUSIONS Delayed HBOT remains an effective and useful intervention. A shorter delay to recompression is associated with fewer recompressions required to achieve recovery or recovery plateau.
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Affiliation(s)
| | - Anne K Räisänen-Sokolowski
- Department of Pathology, Helsinki University, Helsinki, Finland
- HUSLAB, Pathology, Helsinki University Hospital, Helsinki, Finland
| | - Laura J Tuominen
- Department of Pathology, Helsinki University, Helsinki, Finland
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Richard V Lundell
- Department of Pathology, Helsinki University, Helsinki, Finland
- Diving Medical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
- Corresponding author: Dr Richard V Lundell, Diving Medical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland,
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Chevasutho P, Premmaneesakul H, Sujiratana A. Descriptive study of decompression illness in a hyperbaric medicine centre in Bangkok, Thailand from 2015 to 2021. Diving Hyperb Med 2022; 52:277-280. [PMID: 36525685 PMCID: PMC10017199 DOI: 10.28920/dhm52.4.277-280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study aimed to determine the characteristics of decompression illness patients and their treatment outcomes, at the Center of Hyperbaric Medicine, Somdech Phra Pinklao Hospital, one of the largest centres in Thailand. METHODS Past medical records of patients with decompression illness from 2015 to 2021 were retrieved and analysed. RESULTS Ninety-eight records of diving-related illness from 97 divers were reviewed. Most of the divers were male (n = 50), Thai (n = 86), and were certified at least open water or equivalent (n = 88). On-site first aid oxygen inhalation was provided to 17 divers. Decompression sickness (DCS) cases were characterised according to organ systems involved. The most prominent organ system involved was neurological (57%), followed by mixed organs (28%), musculoskeletal (13%), and pulmonary (2%). There were three cases of arterial gas embolism (AGE). Median presentation delay was three days. Ninety patients were treated with US Navy Treatment Table 6. At the end of their hyperbaric oxygen treatment, most divers (65%) recovered completely. CONCLUSIONS Despite oxygen first aid being given infrequently and long delays before definitive treatment, treatment outcome was satisfactory. Basic knowledge and awareness of diving-related illnesses should be promoted among divers and related personnel in Thailand along with further studies.
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Affiliation(s)
- Pitchaya Chevasutho
- Occupational Medicine Center, Chonburi Hospital, Chonburi, Thailand
- Corresponding author: Dr Pitchaya Chevasutho, Occupational Medicine Center, Chonburi Hospital, 69 Moo 2, Sukhumvit Rd, Chonburi, Thailand 20000,
| | - Hansa Premmaneesakul
- Maritime Medicine Division, Somdech Phra Pinklao Hospital, Naval Medical Department, Bangkok, Thailand
| | - Atipong Sujiratana
- Maritime Medicine Division, Somdech Phra Pinklao Hospital, Naval Medical Department, Bangkok, Thailand
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16
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Cousin N, Goutay J, Girardie P, Favory R, Drumez E, Mathieu D, Poissy J, Parmentier E, Duburcq T. Effects of high oxygen tension on healthy volunteer microcirculation. Diving Hyperb Med 2022; 52:260-270. [PMID: 36525683 PMCID: PMC10017198 DOI: 10.28920/dhm52.4.260-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Previous studies have highlighted hyperoxia-induced microcirculation modifications, but few have focused on hyperbaric oxygen (HBO) effects. Our primary objective was to explore hyperbaric hyperoxia effects on the microcirculation of healthy volunteers and investigate whether these modifications are adaptative or not. METHODS This single centre, open-label study included 15 healthy volunteers. Measurements were performed under five conditions: T0) baseline value (normobaric normoxia); T1) hyperbaric normoxia; T2) hyperbaric hyperoxia; T3) normobaric hyperoxia; T4) return to normobaric normoxia. Microcirculatory data were gathered via laser Doppler, near-infrared spectroscopy and transcutaneous oximetry (PtcO₂). Vascular-occlusion tests were performed at each step. We used transthoracic echocardiography and standard monitoring for haemodynamic investigation. RESULTS Maximal alterations were observed under hyperbaric hyperoxia which led, in comparison with baseline, to arterial hypertension (mean arterial pressure 105 (SD 12) mmHg vs 95 (11), P < 0.001) and bradycardia (55 (7) beats·min⁻¹ vs 66 (8), P < 0.001) while cardiac output remained unchanged. Hyperbaric hyperoxia also led to microcirculatory vasoconstriction (rest flow 63 (74) vs 143 (73) perfusion units, P < 0.05) in response to increased PtcO₂ (104.0 (45.9) kPa vs 6.3 (2.4), P < 0.0001); and a decrease in laser Doppler parameters indicating vascular reserve (peak flow 125 (89) vs 233 (79) perfusion units, P < 0.05). Microvascular reactivity was preserved in every condition. CONCLUSIONS Hyperoxia significantly modifies healthy volunteer microcirculation especially during HBO exposure. The rise in PtcO₂ promotes an adaptative vasoconstrictive response to protect cellular integrity. Microvascular reactivity remains unaltered and vascular reserve is mobilised in proportion to the extent of the ischaemic stimulus.
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Affiliation(s)
- Nicolas Cousin
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Julien Goutay
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Patrick Girardie
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Raphaël Favory
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Elodie Drumez
- Unité de méthodologie - biostatistique et data management, CHU Lille, Lille, France
| | - Daniel Mathieu
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Julien Poissy
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Erika Parmentier
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Thibault Duburcq
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
- Corresponding author: Dr Thibault Duburcq, Centre Hospitalier Universitaire de Lille, Hôpital Roger Salengro - Centre de réanimation, Avenue du Professeur Emile Laine , 59037 LILLE Cedex, France,
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Tuominen LJ, Sokolowski S, Lundell RV, Räisänen-Sokolowski AK. Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment. Diving Hyperb Med 2022; 52:78-84. [PMID: 35732278 PMCID: PMC9527095 DOI: 10.28920/dhm52.2.74-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Technical diving is increasing in popularity in Finland, and therefore the number of decompression illness (DCI) cases is also increasing among technical divers. Although hyperbaric oxygen treatment (HBOT) remains the standard of care, there are anecdotal reports of technical divers treating mild DCI symptoms themselves and not seeking a medical evaluation and possible recompression therapy. This study aimed to make an epidemiologic inventory of technical diving-related DCI symptoms, to establish the incidence of self-treatment and to determine the apparent effectiveness of different treatment methods. METHODS A one-year prospective survey with online questionnaires was conducted. Fifty-five experienced and highly trained Finnish technical divers answered the survey and reported their diving activity, DCI symptoms, symptom treatment, and treatment outcome. RESULTS Of the reported 2,983 dives, 27 resulted in symptoms of DCI, which yielded an incidence of 91 per 10,000 dives in this study. All of the reported DCI symptoms were mild, and only one diver received HBOT. The most common self-treatments were oral hydration and rest. First aid oxygen (FAO2) was used in 21% of cases. Eventually, none of the divers had residual symptoms. CONCLUSIONS The incidence of self-treated DCI cases was 27 times higher than that of HBO-treated DCI cases. There is a need to improve divers' awareness of the importance of FAO2 and other recommended first aid procedures and to encourage divers to seek medical attention in case of suspected DCI.
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Affiliation(s)
- Laura J Tuominen
- Helsinki University, Helsinki, Finland
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
- Corresponding author: Dr Laura Tuominen, Helsinki University, Yliopistonkatu 4, 00100 Helsinki, Finland,
| | | | - Richard V Lundell
- Helsinki University, Helsinki, Finland
- Diving Medical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Anne K Räisänen-Sokolowski
- Helsinki University, Helsinki, Finland
- Diving Medical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
- Department of Pathology, HUSLAB, Helsinki University Hospital, and Helsinki University, Helsinki, Finland
- DAN Europe Foundation, Finnish Division, Roseto, Italy
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Altun BD, Sümen SG, Dumlu A. A diving physician's experience of dental barotrauma during hyperbaric chamber exposure: case report. Diving Hyperb Med 2022; 52:63-65. [PMID: 35313376 DOI: 10.28920/dhm52.1.63-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/17/2022] [Indexed: 11/05/2022]
Abstract
Previous cases of dental barotrauma have been reported in pilots and divers. We report a case of dental barotrauma and barodontalgia in a diving physician accompanying patients during hyperbaric oxygen treatment, and due to pressure changes in the hyperbaric chamber. The physician developed sharp pain localised to the right maxillary molars but radiating to the face, ear and head during decompression from 243 kPa (2.4 atmospheres absolute). The pain intensified following completion of decompression and was consistent with irreversible pulpitis. Clinical examination and panoramic radiography suggested fracture of a heavily restored tooth due to barotrauma. This was managed by tooth extraction. The physician subsequently discontinued accompanying the patients during their hyperbaric oxygen treatment sessions. Dentists and maxillofacial surgery specialists suggest waiting for a minimum of four weeks or until the tooth socket and/or oral tissue has healed sufficiently to minimise the risk of infection or further trauma before exposure to further pressure change. Although seemingly rare, and despite the comparatively slow pressure changes, dental barotrauma can occur in hyperbaric chamber occupants.
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Affiliation(s)
- Busra Dilara Altun
- Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey.,Corresponding author: Dr Busra Dilara Altun, Marmara Üniversitesi Başıbüyük Sağlık Yerleşkesi, Diş Hekimliği Fakültesi, Başıbüyük Yolu 9/3 34854 Başıbüyük, Maltepe, İstanbul, Turkey,
| | - Selin Gamze Sümen
- Underwater and Hyperbaric Medicine at the University of Health Sciences, Hamidiye Medical Faculty, Istanbul, Turkey
| | - Asim Dumlu
- Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey
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Velure GK, Müller B, Hauken MA. Symptom burden and health-related quality of life six months after hyperbaric oxygen therapy in cancer survivors with pelvic radiation injuries. Support Care Cancer 2022; 30:5703-5711. [PMID: 35320424 PMCID: PMC9135809 DOI: 10.1007/s00520-022-06994-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Late radiation tissue injuries (LRTIs) after treatment for pelvic cancer may impair health related quality of life (HRQoL). Hyperbaric oxygen therapy is an adjuvant therapy for LRTIs, but limited studied. The aim of this study was to explore the development and association between symptoms of LRTI and HRQoL following hyperbaric oxygen treatment. METHODS A pretest-posttest design was used to evaluate the changes in pelvic LRTIs and HRQoL from baseline (T1), immediately after treatment (T2) and at six-month follow-up (T3). EPIC and EORTC-QLQ-C30 were used to assess LRTIs and HRQoL. Changes were analysed with t-tests, and associations with Pearson's correlation and multiple regression analyses. RESULTS Ninety-five participants (mean age 65 years, 52.6% men) were included. Scores for urinary and bowel symptoms, overall HRQoL, all function scales and the symptoms scales sleep, diarrhoea, pain and fatigue were significantly improved six months after treatment (P-range = 0.00-0.04). Changes were present already at T2 and maintained or further improved to T3. Only a weak significant correlation between changes in symptoms and overall HRQoL was found (Pearson r-range 0.20-0.27). CONCLUSION The results indicate improvement of pelvic LRTIs and HRQoL following hyperbaric oxygen therapy, corresponding to minimal or moderate important changes. Cancer survivors with pelvic LRTIs and impaired HRQoL may benefit from undergoing hyperbaric oxygen therapy. Especially the reduced symptom-severity and improved social- and role function can influence daily living positively. TRIAL REGISTRATION ClinicalTrials.gov: NCT03570229. Released 2. May 2018.
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Affiliation(s)
- Grete K Velure
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Møllendalsbakken 9, N - 5009, Bergen, Norway. .,Hyperbaric Medicine Unit, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Bernd Müller
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Møllendalsbakken 9, N - 5009, Bergen, Norway.,Hyperbaric Medicine Unit, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - May Aa Hauken
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Møllendalsbakken 9, N - 5009, Bergen, Norway
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Kaku M, Izumino J, Yamamoto T, Yashima Y, Shimoe S, Tanimoto K. Functional regulation of osteoblastic MC3T3E-1 cells by hyperbaric oxygen treatment. Arch Oral Biol 2022; 138:105410. [PMID: 35305478 DOI: 10.1016/j.archoralbio.2022.105410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of the present study was to examine the influence of hyperbaric oxygen (HBO) on the function of osteoblastic MC3T3-E1 cells. DESIGN Murine MC3T3-E1 cells were exposed to HBO treatment (at 2.5 absolute atmospheric pressure with 100% oxygen, 90 min per day) for 28 days. Alkaline phosphatase (ALP) staining, activity, and calcium (Ca) content were measured. Gene expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hypoxia-inducible factor-1α (HIF-1α), type 1 collagen (COL1), and osteocalcin (OCN) was assessed using real-time quantitative polymerase chain reaction after a single HBO exposure for 1.5, 6, and 12 h. Furthermore, adenosine triphosphate (ATP) levels were measured using a luminescent cell viability assay. RESULTS ALP activity and Ca content were higher in the HBO group compared to those in the control group. Gene expression of bFGF, COL1, and OCN was upregulated in the HBO group; however, that of VEGF and HIF-1α significantly decreased in the HBO group in comparison with that in the control group. ATP levels were significantly higher in the HBO group compared to those in the control group. CONCLUSIONS These findings suggest that HBO accelerates bone formation by increasing the ATP levels of osteoblasts, and bFGF can act as a substitute for VEGF in vascularization by HBO application.
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Affiliation(s)
- Masato Kaku
- Department of Anatomy and Functional Restorations, Division of Oral Health Sciences, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
| | - Jin Izumino
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Taeko Yamamoto
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yuka Yashima
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Saiji Shimoe
- Department of Anatomy and Functional Restorations, Division of Oral Health Sciences, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Spiliopoulos S, Festas G, Paraskevopoulos I, Mariappan M, Brountzos E. Overcoming ischemia in the diabetic foot: Minimally invasive treatment options. World J Diabetes 2021; 12:2011-2026. [PMID: 35047116 PMCID: PMC8696640 DOI: 10.4239/wjd.v12.i12.2011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
As the global burden of diabetes is rapidly increasing, the incidence of diabetic foot ulcers is continuously increasing as the mean age of the world population increases and the obesity epidemic advances. A significant percentage of diabetic foot ulcers are caused by mixed micro and macro-vascular dysfunction leading to impaired perfusion of foot tissue. Left untreated, chronic limb-threatening ischemia has a poor prognosis and is correlated with limb loss and increased mortality; prompt treatment is required. In this review, the diagnostic challenges in diabetic foot disease are discussed and available data on minimally invasive treatment options such as endovascular revascularization, stem cells, and gene therapy are examined.
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Affiliation(s)
- Stavros Spiliopoulos
- Second Department of Radiology, Interventional Radiology Unit, Attikon University Hospital, Athens 12461, Greece
| | - Georgios Festas
- Second Department of Radiology, Interventional Radiology Unit, Attikon University Hospital, Athens 12461, Greece
| | - Ioannis Paraskevopoulos
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Martin Mariappan
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Elias Brountzos
- Second Department of Radiology, School of Medicine; National and Kapodistrian University of Athens, Athens 12461, Greece
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22
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Forner LE, Dieleman FJ, Shaw RJ, Kanatas A, Butterworth CJ, Kjeller G, Alsner J, Overgaard J, Hillerup S, Hyldegaard O, Arnell P, von Buchwald C, Kaanders JHAM, Smeele LE, Specht L, Johansen J, Witjes MJH, Merkx MAW, Jansen EC. Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. Radiother Oncol 2021; 166:137-44. [PMID: 34843843 DOI: 10.1016/j.radonc.2021.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials. METHODS AND MATERIALS Patients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Primary outcome was healing of ORN one year after surgery evaluated by a clinically adjusted version of the Common Toxicity Criteria of Adverse Events (CTCAE) v 3.0. Secondary outcomes included xerostomia, unstimulated and stimulated whole salivation rates, trismus, dysphagia, pain, Activities of Daily Living (ADL) and quality of life according to EORTC. Data were combined from two separate trials. Ninety-seven were enrolled and 65 were eligible for the intent-to-treat analysis. The 33% drop-out was equally distributed between groups. RESULTS In group 1, 70% (21/30) healed compared to 51% (18/35) in group 2. HBO was associated with an increased chance of healing independent of baseline ORN grade or smoking status as well as improved xerostomia, unstimulated whole salivary flow rate, and dysphagia. Due to insufficient recruitment, none of the endpoints reached a statistically significant difference between groups. ADL data could only be obtained from 50 patients. CONCLUSION Hyperbaric oxygen did not significantly improve the healing outcome of osteoradionecrosis after surgical removal of necrotic bone as compared to standard care (70% vs. 51%). This effect is not statistically significant due to the fact that the study was underpowered and is therefore prone to type II error.
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23
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Bapteste L, Kamar Z, Mazaud A, Balança B. Air embolism during lumbar surgery in the prone position. Diving Hyperb Med 2021; 51:303-305. [PMID: 34547783 DOI: 10.28920/dhm51.3.303-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/05/2021] [Indexed: 11/05/2022]
Abstract
Only a few clinical cases of cerebral arterial gas embolism during spinal surgery are published. It seems important not to overlook this diagnosis in order to initiate rapid appropriate treatment. This was a suspected case of paradoxical gas embolism revealed postoperatively by neurological deficits and whose recovery was noted during hyperbaric oxygen treatment. Unfortunately, no complementary examination showed gas embolism and only the context, the clinical picture and the case evolution evoke this diagnosis. The diagnostic difficulty in the immediate postoperative period is highlighted.
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Affiliation(s)
- Lionel Bapteste
- Anesthésie Réanimation Hospices Civils de Lyon, France.,Dr Lionel Bapteste, Anesthésie Réanimation Hospices Civils de Lyon, France,
| | - Zeinab Kamar
- Anesthésie Réanimation Hospices Civils de Lyon, France
| | - Anthony Mazaud
- Centre de médecine hyperbare Hospices Civils de Lyon, France
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24
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Abstract
INTRODUCTION Oxygen toxicity seizures (OTS) are a well-recognised complication of hyperbaric oxygen treatment (HBOT). As such, seizure-like activity during HBOT is usually presumed to be a result of central nervous system oxygen toxicity (CNS-OT). Four cases are reported here where causes other than CNS-OT were determined as being the likely cause of the seizure; causes we have labelled 'OTS mimics'. Through review of the current literature, and our hyperbaric medicine unit's experience to date, we aimed to highlight the relevance of these OTS mimics, as the potential for significant morbidity and mortality exists with incorrect diagnoses. METHODS A retrospective review of the medical records of all patients treated at the Fiona Stanley Hospital and Fremantle Hospital hyperbaric medicine units who had a seizure during HBOT between November 1989 and June 2020. These events were reviewed to determine whether causes for seizures other than oxygen toxicity were evident. RESULTS Four OTS mimics were identified: posterior reversible encephalopathy syndrome, pethidine toxicity, previous subarachnoid haemorrhage with resultant epilepsy, and severe hypoglycaemia. CONCLUSIONS This case series highlights the need for caution when diagnosing an apparent OTS. Multiple conditions may mimic the signs and symptoms of oxygen toxicity. This creates scope for misdiagnosis, with potential for consequent morbidity and mortality. A pragmatic approach is necessary to any patient exhibiting seizure-like activity during HBOT, with suspicion for other underlying pathologies.
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Affiliation(s)
- Kevin Foley
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia
| | - Neil Banham
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia.,Corresponding author: Dr Neil Banham, Department of Hyperbaric Medicine, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150, Australia,
| | | | - Ian Gawthrope
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia
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25
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Bonnington S, Banham N, Foley K, Gawthrope I. Oxygen toxicity seizures during United States Navy Treatment Table 6: An acceptable risk in monoplace chambers? Diving Hyperb Med 2021; 51:167-172. [PMID: 34157732 DOI: 10.28920/dhm51.2.167-172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hyperbaric oxygen treatment (HBOT) may be complicated by oxygen toxicity seizures, which typically occur with hyperbaric partial pressures of oxygen exceeding 203 kPa (2 atmospheres absolute). All other hyperbaric units in Australia exclusively use a multiplace chamber when treating with United States Navy Treatment Table 6 (USN TT6) due to this perceived risk. The purpose of this study was to determine the safety of a monoplace chamber when treating decompression illness (DCI) with USN TT6. METHODS A retrospective review of the medical records of all patients treated at Fiona Stanley Hospital Hyperbaric Medicine Unit with USN TT6 between November 2014 and June 2020 was undertaken. These data were combined with previous results from studies performed at our hyperbaric unit at Fremantle Hospital from 1989 to 2014, creating a data set covering a 30-year period. RESULTS One thousand treatments with USN TT6 were performed between 1989 and 2020; 331 in a monoplace chamber and 669 in a multiplace chamber. Four seizures occurred: a rate of 0.59% (1/167) in a multiplace chamber; and none in a monoplace chamber, indicating no statistically significant difference between seizures in a monoplace versus multiplace chamber (P = 0.31). CONCLUSIONS The rate of oxygen toxicity seizures in a monoplace chamber is not significantly higher than for treatment in the multiplace chamber. We conclude that using the monoplace chamber for USN TT6 in selected patients poses an acceptably low seizure risk.
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Affiliation(s)
- Samantha Bonnington
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Western Australia
| | - Neil Banham
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Western Australia.,Corresponding author: Dr Neil Banham, Department of Hyperbaric Medicine, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150, Australia,
| | - Kevin Foley
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Western Australia
| | - Ian Gawthrope
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Western Australia
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26
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Ashton C, Banham N, Needham M. Acute spontaneous spinal cord infarction: Utilisation of hyperbaric oxygen treatment, cerebrospinal fluid drainage and pentoxifylline. Diving Hyperb Med 2020; 50:325-331. [PMID: 33325011 DOI: 10.28920/dhm50.4.325-331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/09/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Spinal cord infarction (SCI) is a potentially devastating disorder presenting with an acute anterior spinal artery syndrome, accounting for an estimated 1% of stroke presentations. Aetiologies include aortic surgical complications, systemic hypotension, fibrocartilaginous embolism and vascular malformations. Diagnosis is clinical combined with restriction on diffusion-weighted magnetic resonance imaging (MRI). There are no treatment guidelines for non-perioperative cases although there is limited literature regarding potential therapies, including hyperbaric oxygen treatment (HBOT) and cerebrospinal fluid (CSF) drainage. We describe 13 cases of acute SCI, five receiving HBOT, and three also receiving pentoxifylline and drainage of lumbar CSF. METHODS Data for all patients with MRI-proven SCI at Fiona Stanley Hospital from 2014-2019 were reviewed. RESULTS Thirteen patients, median age 57 years (31-74), 54% female, were identified. Aetiologies: two fibrocartilaginous emboli; seven likely atherosclerotic; two thromboembolic; two cryptogenic. All presented with flaccid paraplegia except one with Brown-Sequard syndrome. Levels ranged from C4 to T11. Five patients received HBOT within a median time of 40 hours from symptom onset, with an average 15 treatments (10-20). Three of these received triple therapy (HBOT, pentoxifylline, CSF drainage) and had median Medical Research Council manual muscle testing power of 5, median modified Rankin Score (mRS) of 1 and American Spinal Injury Association (ASIA) score of D on discharge, compared with 2 power, mRS 3.5 and ASIA B in those who did not. CONCLUSIONS SCI can be severely disabling. Triple therapy with pentoxifylline, CSF drainage and HBOT may reduce disability and further prospective trials are required.
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Affiliation(s)
- Catherine Ashton
- Neurology Department, Fiona Stanley Hospital, Murdoch, Australia.,Corresponding author: Dr Catherine Ashton, Neurology Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia,
| | - Neil Banham
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Merrilee Needham
- Neurology Department, Fiona Stanley Hospital, Murdoch, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Australia.,University of Notre Dame, Fremantle, Australia
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27
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Baines CR, Cooper PD, O'Rourke GA, Miller C. Evaluation of the Abbot FreeStyle Optium Neo H blood glucose meter in the hyperbaric oxygen environment. Diving Hyperb Med 2020; 50:144-151. [PMID: 32557416 DOI: 10.28920/dhm50.2.144-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/06/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This study investigated the effects of hyperbaric oxygen treatment (HBOT) on the accuracy and reliability of point-of-care fingertip capillary blood glucose values in euglycaemic non-diabetic participants compared against venous serum blood glucose samples processed in an accredited pathology laboratory. METHOD Ten non-diabetic hyperbaric staff members (age 35-55 years) underwent a standard 243 kPa HBOT exposure for 95 minutes. Blood glucose levels were measured via (i) finger-prick capillary test using the FreeStyle Optium™ Neo H glucometer and (ii) venous serum test using the Cobas 6000 laboratory analyser. Samples were taken at (T1) 0 minutes (pre-HBOT), (T2) 25 minutes, and (T3) 55 minutes into HBOT. RESULTS All participants were euglycaemic at T1 (BGL 3.8-5.4 mmol·L⁻¹). The highest venous serum value was 5.90 mmol·L⁻¹ at T3 and the highest capillary value was 6.30 mmol·L⁻¹ at T1. Post hoc tests showed a statistically significant difference between the mean capillary result pre-dive (T1) and readings at T2 (P = 0.001) and T3 (P < 0.001) while differences between T2 and T3 capillary results were not statistically significant, illustrating the effect of HBOT on capillary beds. Differences in venous values across the time points were not significant. CONCLUSION Venous serum glucose samples processed in an accredited laboratory may be more consistently accurate, but capillary point-of-care testing avoids delays in sample processing and provides glucose data that are of clinical relevance. The FreeStyle Optium™ Neo H glucometer is safe to use and provides a reliable measurement of blood glucose in the HBOT environment.
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Affiliation(s)
- Carol R Baines
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Corresponding author: Carol R Baines, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Liverpool Street, Hobart, Tasmania, Australia 7000,
| | - P David Cooper
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Geraldine A O'Rourke
- Office of the Chief Nurse and Midwife, Health Professional Policy and Advisory Services, Department of Health, Tasmania, Australia
| | - Charne Miller
- Alfred Health Clinical School, La Trobe University, Prahran, Victoria, Australia
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28
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Banham ND, Saw J, Hankey GJ, Ghia D. Cerebral arterial gas embolism proven by computed tomography following transthoracic echocardiography using bubble contrast. Diving Hyperb Med 2020; 50:300-302. [PMID: 32957135 DOI: 10.28920/dhm50.3.300-302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/21/2020] [Indexed: 11/05/2022]
Abstract
A 75 year-old male developed features of an acute stroke following bubble contrast echocardiography, which was shown on emergent computed tomography scanning to be a result of cerebral arterial gas embolism (CAGE) to the left middle cerebral artery. Ischaemic stroke symptoms have previously been reported as a rare complication of bubble contrast echocardiography. Radiologically proven CAGE from bubble contrast echocardiography had not been reported at the time this case occurred. Immediate provision of 100% oxygen and administration of hyperbaric oxygen are recommended treatments for CAGE and were associated with a substantial recovery for this patient.
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Affiliation(s)
- Neil Dg Banham
- Hyperbaric Medicine Unit, Fiona Stanley Hospital, Perth, Western Australia.,Corresponding author: Neil DG Banham, Director, Hyperbaric Medicine Unit, Fiona Stanley Hospital, Perth, Western Australia,
| | - Jacqui Saw
- Department of Neurology, Fiona Stanley Hospital, Perth, Western Australia
| | - Graeme J Hankey
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia.,Medical School, University of Western Australia, Perth, Western Australia
| | - Darshan Ghia
- Department of Neurology, Fiona Stanley Hospital, Perth, Western Australia.,Medical School, University of Western Australia, Perth, Western Australia
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29
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Mao JZ, Laird PS, Imperato NS, Knepley KD, Khan A, Agyei JO, O'Connor TE, Pollina J, Mullin JP. Utilization, Utility, and Variability in Usage of Adjunctive Hyperbaric Oxygen Therapy in Spinal Management: A Review of the Literature. World Neurosurg 2020; 145:492-499.e2. [PMID: 32889196 DOI: 10.1016/j.wneu.2020.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
The objective of this review was to understand the clinical utilization, utility, and variability in the usage of adjunctive hyperbaric oxygen therapy (HBOT). Surgical site infection is associated with high morbidity and mortality, increased health care expenditure, and decreased quality of life. With the increasing prevalence of adult spinal deformity and spinal fusion surgery, it is imperative to understand the potential benefits of adjunctive treatments. HBOT is a safe and common procedure indicated to treat various medical conditions. We conducted a literature search across 3 databases for English articles published between December 1, 2019 and December 1, 2000. Thirteen studies were included. HBOT may lessen the duration of antimicrobial therapy and mitigate instrument removal and revision surgery. The current usage indications for HBOT are supported by level III evidence for chronic osteomyelitis and level IV evidence for osteoradionecrosis. However, the same level of evidence exists to support the beneficial use of adjunctive HBOT for noncomplicated spinal infections within 2 months after surgery. When cultured, the most common organisms were Staphylococcus aureus and other low-virulence organisms. The most common treatment protocol consists of 90-minute sessions of 100% Fio2 at 2-3 atmosphere absolute with a mean of 35.3 ± 11.6 sessions for 5.2 ± 1.4 weeks. Adjunctive HBOT should be considered in select high-risk patients. Further improvements in diagnosis and categorization of spinal infections are necessary and will indelibly aid the decision making for the initiation of HBOT.
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Affiliation(s)
- Jennifer Z Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Patrick S Laird
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas S Imperato
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Kurt D Knepley
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Tim E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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30
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Lalieu RC, Bol Raap RD, Dubois EF, van Hulst RA. Sudden death after oxygen toxicity seizure during hyperbaric oxygen treatment: Case report. Diving Hyperb Med 2020; 50:185-188. [PMID: 32557424 DOI: 10.28920/dhm50.2.185-188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/18/2020] [Indexed: 11/05/2022]
Abstract
Acute cerebral oxygen toxicity (ACOT) is a known side effect of hyperbaric oxygen treatment (HBOT), which can cause generalised seizures. Fortunately, it has a low incidence and is rarely harmful. Nevertheless, we present a case of a 37 year-old patient with morbid obesity who died unexpectedly after an oxygen toxicity seizure in the hyperbaric chamber. Considering possible causes, physiologic changes in obesity and obesity hypoventilation syndrome may increase the risk of ACOT. Obesity, especially in extreme cases, may hinder emergency procedures, both in- and outside of a hyperbaric chamber. Physicians in the hyperbaric field should be aware of the possibility of a fatal outcome after ACOT through the described mechanisms and take appropriate preventative measures. Basic airway management skills are strongly advised for involved physicians, especially when specialised personnel and equipment are not immediately available.
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Affiliation(s)
- Rutger C Lalieu
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.,Amsterdam University Medical Centres, Department of Anaesthesiology, Amsterdam, the Netherlands.,Corresponding author: Rutger C Lalieu, Treubstraat 5A, 2288 EG Rijswijk, the Netherlands,
| | | | | | - Rob A van Hulst
- Amsterdam University Medical Centres, Department of Anaesthesiology, Amsterdam, the Netherlands.,Amsterdam University Medical Centres, Department of Surgery, Hyperbaric Dept., Amsterdam, the Netherlands
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31
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Mitchell SJ. Diving and hyperbaric medicine in the SARS-CoV-2 pandemic. Diving Hyperb Med 2020; 50:90-91. [PMID: 32557408 DOI: 10.28920/dhm50.2.90-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Simon J Mitchell
- Editor - Diving and Hyperbaric Medicine Journal.,Department of Anaesthesiology, University of Auckland.,Corresponding author: Professor Simon J Mitchell, Editor - Diving and Hyperbaric Medicine Journal. Department of Anaesthesiology, University of Auckland. Private Bag 92019, Auckland 1142, New Zealand,
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32
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Rozloznik M, Lochmanova A, Chmelar D, Hajek M, Korytkova K, Cisarikova M. Experimental use of flow cytometry to detect bacteria viability after hyperbaric oxygen exposure: Work in progress report. Diving Hyperb Med 2020; 50:152-156. [PMID: 32557417 DOI: 10.28920/dhm50.2.152-156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/23/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hyperbaric oxygen treatment (HBOT), based on inhaling pure oxygen under elevated ambient pressure, is used as adjuvant intervention to promote healing in infected wounds. Despite extensive clinical evidence of beneficial effects of HBOT in soft tissue infections the mechanism of action remains to be elucidated. The aim of this study was to evaluate the use of flow cytometry as a novel method to assess the viability of pathogenic bacteria after hyperbaric oxygen (HBO) exposure. METHODS Bacterial strains associated with soft tissues infections: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus were exposed to oxygen at 2.8 atmospheres absolute (atm abs) (283.6 kPa) pressure for 45, 90, or 120 min, then stained with propidium iodide and thiazole orange and analysed by flow cytometry. RESULTS Escherichia coli and Staphylococcus aureus showed no change in viability, nor morphology, the viability of Pseudomonas aeruginosa reduced in a dose-dependent manner and Klebsiella pneumoniae also showed dye uptake after HBO. CONCLUSIONS These initial results, indicate diverse sensitivity of bacteria to HBO, and suggest that flow cytometry can be used to monitor viability and morphological changes triggered by HBO exposure in bacteria.
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Affiliation(s)
- Miroslav Rozloznik
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic.,DAN Europe, Slovensko, Slovakia.,DNB consult, s.r.o, Kezmarok, Slovakia.,Corresponding author: Dr Miroslav Rozloznik, Department of Biomedical Sciences, Medical Faculty, University of Ostrava, Syllabova 19, Ostrava, Czech Republic,
| | - Alexandra Lochmanova
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic.,Public Health Institute, Ostrava, Czech Republic
| | - Dittmar Chmelar
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic.,Czech National Anaerobic Bacteria Reference Laboratory, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Michal Hajek
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic.,Centre for Hyperbaric Medicine, City Hospital, Ostrava, Czech Republic
| | - Karin Korytkova
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Monika Cisarikova
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic
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33
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Liu XH, Liang F, Jia XY, Zhao L, Zhou Y, Yang J. Hyperbaric Oxygen Treatment Improves Hearing Level via Attenuating TLR4/NF-κB Mediated Inflammation in Sudden Sensorineural Hearing Loss Patients. Biomed Environ Sci 2020; 33:331-337. [PMID: 32553077 DOI: 10.3967/bes2020.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Hyperbaric oxygen treatment (HBOT) has demonstrated efficacy in improving hearing levels of patients with idiopathic sudden sensorineural hearing loss (ISSHL); however, the underlying mechanisms are not well understood. HBOT alleviates the inflammatory response, which is mediated by Toll-like receptor (TLR) 4 and nuclear factor (NF)-κB. In this study we investigated whether HBOT attenuates inflammation in ISHHL patients via alteration of TLR4 and NF-κB expression. METHODS ISHHL patients ( n = 120) and healthy control subjects ( n = 20) were enrolled in this study. Patients were randomly divided into medicine group treated with medicine only ( n = 60) and HBO group receiving both HBOT and medicine ( n = 60). Audiometric testing was performed pre- and post-treatment. TLR4, NF-кB, and TNF-α expression in peripheral blood of ISSHL patients and healthy control subjects was assessed by ELISA before and after treatment. RESULTS TLR4, NF-κB, and TNF-α levels were upregulated in ISSHL patients relative to healthy control subjects; the levels were decreased following treatment and were lower in the HBO group than that in the medicine group post-treatment ( P < 0.05 and P < 0.01). CONCLUSION HBOT alleviates hearing loss in ISSHL patients by suppressing the inflammatory response induced by TLR4 and NF-κB signaling.
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Affiliation(s)
- Xue Hua Liu
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Fang Liang
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xing Yuan Jia
- Institute of Basic Medicine Sciences, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lin Zhao
- Department of Hyperbaric Oxygen Medicine, Beijing Pinggu Hospital, Beijing 101200, China
| | - Yan Zhou
- Institute of Basic Medicine Sciences, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jing Yang
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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34
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Lundell RV, Arola O, Suvilehto J, Kuokkanen J, Valtonen M, Räisänen-Sokolowski AK. Decompression illness (DCI) in Finland 1999-2018: Special emphasis on technical diving. Diving Hyperb Med 2020; 49:259-265. [PMID: 31828744 DOI: 10.28920/dhm49.4.259-265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/11/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This is the first published study on decompression illness (DCI) and its treatment in Finland. Diving conditions are demanding, as even in the summer the water temperature below 20 meters' sea/fresh water (msw/mfw) is 4-10°C. Technical diving has become more popular over the years, so the emphasis of this study was to describe DCI in technical divers and compare it with non-technical recreational divers. METHODS This study includes by estimation over 95% of all hyperbaric oxygen-treated DCI patients during the years 1999-2018 (n = 571). The cases were divided into technical divers (n = 200) and non-technical divers (n = 371). We focused on the differences between these two groups. Technical diving was defined as the usage of mixed breathing gases, closed circuit rebreather diving or planned decompression diving. RESULTS The mean annual number of treated DCI cases in Finland was 29 (range 16-38). The number of divers treated possibly indicate a shift towards technical diving. Technical dives were deeper and longer and were mainly performed in cold water or an overhead environment. Technical divers were more likely to utilize first aid 100% oxygen (FAO2) and sought medical attention earlier than non-technical divers. Symptom profiles were similar in both groups. Recompression was performed using USN Treatment Table Six in the majority of the cases and resulted in good final outcome. Eighty two percent were asymptomatic on completion of all recompression treatment(s). CONCLUSION This 20-year observational study indicates a shift towards technical diving, and hence a more demanding and challenging style of diving among Finnish divers, with a surprisingly constant number of DCI cases over the years. There is still need for improvement in divers' education in use of FAO2 for DCI symptoms. Fortunately, the outcome after recompression therapy is generally successful.
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Affiliation(s)
- Richard V Lundell
- Diving Medical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland.,Helsinki University, Helsinki, Finland.,Corresponding author: Sähkölaitoksentie 4, 00860 Helsinki, Finland,
| | - Olli Arola
- National Hyperbaric Oxygen Therapy Center, Intensive Care Unit, Turku University Hospital, Turku, Finland
| | | | | | - Mika Valtonen
- National Hyperbaric Oxygen Therapy Center, Intensive Care Unit, Turku University Hospital, Turku, Finland
| | - Anne K Räisänen-Sokolowski
- Helsinki University, Helsinki, Finland.,Hyperbaric Center Medioxygen, Helsinki, Finland.,Department of Pathology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
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Golan H, Makogon B, Volkov O, Smolyakov Y, Hadanny A, Efrati S. Imaging-based predictors for hyperbaric oxygen therapy outcome in post-stroke patients. Report 1. Med Hypotheses 2019; 136:109510. [PMID: 31846850 DOI: 10.1016/j.mehy.2019.109510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 01/06/2023]
Abstract
We tested the hypothesis that if SPECT/CT-detected volumes of active and inactive parts of brain tissue present correlation with the results of hyperbaric oxygen therapy (HBOT) of ischemic stroke, SPECT imaging may serve as a selective tool for post-stroke patients to indicate cases that may significantly benefit from HBOT. A retrospective analysis was conducted on 62 consecutive patients administered for HBOT after the ischemic stroke episode. All patients received 60 daily hyperbaric sessions consisting of 90 min of exposure to 100% oxygen at a pressure of 0.2 MPa. The results of the treatment were assessed in correlation with SPECT/CT-detected changes of volumes of the penumbra area around the stroke zone. Patients who significantly benefitted from HBOT (n = 24) by an improvement of their clinical neurologic status and quality of life had the large penumbra zone (363 ± 20.5 ml) that was significantly diminished during HBOT. Patients who did not benefit from HBOT (n = 20) had a relatively small volume of the penumbra zone (148 ± 29.3 ml) and its further diminishing during HBOT was insignificant. The HBOT results were unclear in 18 patients with penumbra volumes between these values. These findings support our hypothesis that the large volume of the penumbra area around the stroke zone can serve as a significant predictor for positive clinical outcome following HBOT in post-stroke patients. The SPECT/CT-based assessment procedure of the volume of the penumbra may serve as an effective selecting tool when HBOT is administered for patients with ischemic stroke.
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Affiliation(s)
- Haim Golan
- Nuclear Medicine Institute, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel.
| | - Boris Makogon
- Radiology Dept, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel
| | - Olga Volkov
- Nuclear Medicine Institute, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel
| | - Yuri Smolyakov
- Department of Medical Physics and Informatics, Chita State Medical Academy, Russia
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel; Neurosurgery Department, Galilee Medical Center, Naharyia, Israel; Galilee Faculty of Medicine, Bar Ilan University, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Israel
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Lundborg M, Helseth E, Josefsen R, Braathen M, Skogen K, Ramm-Pettersen J. Hyperbaric oxygen therapy of air embolus in the cerebral venous sinuses after intracranial surgery: a case report. Acta Neurochir (Wien) 2018; 160:1401-1405. [PMID: 29696503 DOI: 10.1007/s00701-018-3537-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/04/2018] [Indexed: 01/28/2023]
Abstract
A case with cerebral venous air embolism (CVAE) after neurosurgery and treated with hyperbaric oxygen therapy (HBOT) is presented. This is a rare and potentially fatal complication that neurosurgeons should be aware of. A 52-year-old male was diagnosed with an intracerebral hematoma. An emergency evacuation of the hematoma was performed with a craniotomy and the postoperative CT scan showed a complete evacuation of the hematoma, but it also revealed a CVAE. The patient was immediately referred to HBOT and received three sessions within 48 h. The CT scan after the first HBOT showed no CVAE, venous thrombosis, or new hematoma.
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Kot J. Staffing and training issues in critical care hyperbaric medicine. Diving Hyperb Med 2015; 45:47-50. [PMID: 25964039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
The integrated chain of treatment of the most severe clinical cases that require hyperbaric oxygen therapy (HBOT) assumes that intensive care is continued while inside the hyperbaric chamber. Such an approach needs to take into account all the risks associated with transportation of the critically ill patient from the ICU to the chamber and back, changing of ventilator circuits and intravascular lines, using different medical devices in a hyperbaric environment, advanced invasive physiological monitoring as well as medical procedures (infusions, drainage, etc) during long or frequently repeated HBOT sessions. Any medical staff who take care of critically ill patients during HBOT should be certified and trained according to both emergency/intensive care and hyperbaric requirements. For any HBOT session, the number of staff needed for any HBOT session depends on both the type of chamber and the patient's status--stable, demanding or critically ill. For a critically ill patient, the standard procedure is a one-to-one patient-staff ratio inside the chamber; however, the final decision whether this is enough is taken after careful risk assessment based on the patient's condition, clinical indication for HBOT, experience of the personnel involved in that treatment and the available equipment.
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Affiliation(s)
- Jacek Kot
- National Centre for Hyperbaric Medicine Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland, E-mail:
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Yaman O, Yaman B, Aydın F, Var A, Temiz C. Hyperbaric oxygen treatment in the experimental spinal cord injury model. Spine J 2014; 14:2184-94. [PMID: 24530437 DOI: 10.1016/j.spinee.2014.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 01/03/2014] [Accepted: 02/03/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal cord trauma is a major cause of mortality and morbidity. Although no known treatment for spinal cord injury exists, a limited number of effective treatment modalities and procedures are available that improve secondary injury. Hyperbaric oxygen (HBO) treatment has been used to assist in neurologic recovery after cranial injury or ischemic stroke. PURPOSE To report the findings on the effectiveness of HBO treatment on rats with experimental traumatic spinal cord injury. Improvement was evaluated through motor strength assessment and nitrite level assay testing. STUDY DESIGN We randomly distributed 40 rats among 5 groups of 8 rats each: sham incurable trauma, induced trauma, HBO treatment begun at the 1st hour, HBO treatment begun at the 6th hour, and HBO treatment begun at the 24th hour. METHOD The HBO treatment was administered to rats in three of the groups and conducted in two 90-minute sessions, under an absolute atmospheric pressure of 2.4 at 100% oxygen for 5 days. In the motor strength evaluations, all the rats were observed during the inclined plane test and clinical motor examination on the first, third, and fifth days. In addition, the nitrite levels of spinal cord tissues on the sixth day were also studied. RESULTS Results from the inclined plane levels and motor strength test from all the three groups undergoing HBO treatment were higher than those from Group 2. It was also determined that early HBO treatment resulted in higher recovery rates (groups 3 and 4). The highest levels were seen in the group in which the HBO treatments were started in the first hour (Group 3). It was noted that nitrite levels of rats in the group exposed to trauma increased, compared with the sham group, but increased levels also diminished after HBO treatments. Again, the greatest decrease in nitrite levels was evident in the group where the HBO treatment was started the earliest (Group 3). CONCLUSIONS Prompt HBO treatment after trauma significantly contributed to the clinical, histopathologic, and biochemical recovery of the rats.
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Affiliation(s)
- Onur Yaman
- Department of Neurosurgery, Tepecik Education and Training Hospital, 35110 Yenişehir, Konak, Izmir, Turkey.
| | - Banu Yaman
- Department of Pathology, Faculty of Medicine, Aegean University, 35040 Bornova, Izmir, Turkey
| | - Figen Aydın
- Hyperbaric Oxygen Treatment Center, 1587/1 Street No:1/D 35040 Bornova, Izmir, Turkey
| | - Ahmet Var
- Department of Biochemistry, Faculty of Medicine, University of Celal Bayar, Manisa, Turkey
| | - Cüneyt Temiz
- Department of Neurosurgery, Faculty of Medicine, University of Celal Bayar, 45030 Manisa, Turkey
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Liu X, Zhou Y, Wang Z, Yang J, Gao C, Su Q. Effect of VEGF and CX43 on the promotion of neurological recovery by hyperbaric oxygen treatment in spinal cord-injured rats. Spine J 2014; 14:119-27. [PMID: 24183749 DOI: 10.1016/j.spinee.2013.06.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 05/13/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal cord injury (SCI) is a serious health issue that may result in high health care costs, with additional social and psychological burdens. Hyperbaric oxygen (HBO) treatment has been found to be beneficial for neurological recovery; however, the underlying mechanisms are yet to be characterized. PURPOSE The aim of this study was to investigate the mechanisms of HBO treatment in SCI by measuring the expression levels of vascular endothelial growth factor (VEGF) and Connexin43 (CX43) in the injured spinal cord tissue. STUDY DESIGN/SETTING An experiment animal study of rats undergoing SCI and HBO treatment. METHODS The spinal cord injury model was established in rats, which were randomly divided into the following four groups: (1) the sham-operated group (SH), (2) the sham-operated and hyperbaric oxygen treatment group (SH+HBO), (3) the spinal cord injury group (SCI), and (4) the spinal cord injury and hyperbaric oxygen treatment group (SCI+HBO). For groups of SH+HBO and SCI+HBO, the animals received 1 hour of HBO at 2.0 ATA in 100% O2 twice per day for 3 days and then daily for the following days consecutively after surgery. After operation, neurological assessments were performed, the spinal cord tissue samples were harvested for histopathological evaluation, Western blot and real-time polymerase chain reaction analysis. RESULTS The Basso-Bettie-Bresnahan scores were significantly improved in the SCI+HBO group compared with the SCI group on the postoperative 7th and 14th days. The histology scores were significantly decreased by HBO treatment compared with that in the SCI group on the postoperative 3rd, 7th, and 14th days. Western blot analysis and real-time polymerase chain reaction revealed that the expression level of vascular endothelial growth factor (VEGF) in the SCI+HBO group was significantly increased compared with the SCI group. The protein expression level of CX43 and its mRNA level in the SCI+HBO group were significantly decreased on the postoperative 3rd and 7th days, whereas its expression was significantly increased by HBO treatment on the postoperative 14th day compared with the SCI group. CONCLUSIONS HBO treatment improved neurological recovery when applied after SCI. The expression level changes of VEGF and CX43 may contribute to the further understanding on the molecular mechanisms of HBO treatment on SCI.
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Abstract
The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes.
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Affiliation(s)
- Herrick J Siegel
- Orthopaedic Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.
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