Addition Of Hyperbaric Oxygen Therapy Research Articles

Economic analysis of hyperbaric oxygen therapy for the treatment of ischaemic diabetic foot ulcers.

The aim was to determine the cost-effectiveness and cost-utility of additional hyperbaric oxygen therapy (HBOT) compared to standard care (SC) for ischaemic diabetic foot ulcers (DFUs) regarding limb salvage and health status. An economic analysis was conducted, comprising cost-effectiveness and cost-utility analyses, with a 12-month time horizon, using data from the DAMO₂CLES multicentre randomised clinical trial. Cost-effectiveness was defined as cost per limb saved and cost-utility as cost per quality-adjusted life year (QALY). The difference in cost effectiveness between HBOT+SC and SC alone was determined via an incremental cost-effectiveness ratio (ICER). One-hundred and twenty patients were included, with 60 allocated to HBOT+SC and 60 to SC. No significant cost difference was found in the intention-to-treat analysis: €3,791 (bias corrected and accelerated [BCA] 95% CI, €3,556 - €-11,138). Cost per limb saved showed an ICER of €37,912 (BCA 95% CI €-112,188 - €1,063,561) for HBOT+SC vs. SC. There was no significant difference in mean QALYs: 0.54 for HBOT+SC vs. 0.56 for SC alone (-0.02; BCA 95% CI -0.11-0.08). This resulted in a cost-utility of minus €227,035 (BCA 95% CI €-361,569,550 - €-52,588) per QALY. Subgroup analysis for Wagner stages III/IV showed an ICER of €19,005 (BCA 95%CI, -€18,487 - €264,334) while HBOT did not show any benefit for Wagner stage II. HBOT as an adjunct to SC showed no significant differences in costs and effectiveness for patients with DFUs regarding limb salvage and health status. However, for patients with Wagner stage III/IV ischaemic DFUs there was a trend towards better effectiveness and cost-effectiveness.

Evaluating Hyperbaric Oxygen Therapy to Improve Single-Stage Dermal Substitute and Skin Grafting: A Comparative Study

Abstract Background Dermal substitutes offer a valuable tool in soft-tissue reconstruction, reducing the need for donor site tissue and its associated complications. However, conventional approaches often require multiple surgeries. This study aimed to compare the effectiveness of a single-stage procedure combining dermal substitute and skin grafting with hyperbaric oxygen (HBO) therapy to the standard multistage protocol. Materials and Methods A comparative study was conducted from January 2022 to December 2023. The medical records of 24 patients who underwent soft-tissue reconstruction were reviewed. Patients were categorized into two groups based on whether they received HBO therapy (HBO group) or followed the standard multistage protocol (control group). Outcomes were compared between the groups. Results The study included 18 males and 6 females with an average age of 43 years (range: 5–91 years). Underlying medical conditions included diabetes mellitus (n = 11) and peripheral vascular disease (n = 2). Wounds were due to various causes, including necrotizing fasciitis (n = 2), trauma (n = 10), diabetic ulcers (n = 6), postburn hypertrophic scars/contractures (n = 3), chronic ulcers (n = 1), and sternal wound dehiscence (n = 1). All the patients achieved successful wound closure with dermal substitute application, eliminating the need for additional surgery. Notably, the group receiving HBO therapy experienced a shorter overall hospital stay compared with the standard multistage group. Conclusion This study demonstrates the effectiveness of dermal substitutes in soft-tissue reconstruction. Furthermore, the addition of HBO therapy in a single-stage procedure appears beneficial for successful outcomes, potentially reducing hospital stay compared with the traditional multistage approach.

Transcutaneous oxygen tension-guided hyperbaric oxygen therapy for preventing skin necrosis after hyaluronic acid filler injections.

Hyaluronic acid (HA) fillers, popular for facial cosmetic enhancements, pose risks of vascular complications like skin necrosis due to arterial blockage, necessitating effective treatments such as hyperbaric oxygen therapy (HBOT). This study presents a series of cases where measurements of transcutaneous oxygen pressure (TcPO2) informed the application of HBOT for skin necrosis induced by HA. In cases 1 and 3, following the injection of HA, potential skin necrosis was observed. In addition to standard treatment, TcPO2 revealed values below 40mmHg, indicating tissue hypoxia. Treatment with HBOT increased TcPO2 levels to above 200mmHg, suggesting that HBOT could correct the hypoxia. Monitoring TcPO2 levels also aided in determining the optimal time to discontinue HBOT. In cases 2 and 4, patients received standard treatment, resulting in TcPO2 levels above 40mmHg, indicating adequate tissue oxygenation, and no additional HBOT was administered. All four patients mentioned above showed good clinical recovery. This study investigates the application of TcPO2 measurement technology in aiding decisions on whether to utilize HBOT in the treatment of complications arising from HA fillers, as well as in optimizing HBOT protocols.

Management of Crush Injury’s Complications Using Hyperbaric Oxygen Therapy: Case Series

Abstract: Crush injury occurs due to an external trauma mechanism that directly affects the skin, muscle, and bone tissue. Crush injuries can involve several parts of the body at the same time. When accompanied by handling, wound healing in crush injury can be long-term, so that it can affect the function of the patient. Various complications that can occur ranging from secondary infection, necrosis, recurrent bleeding, to compartment syndrome. We reported serial cases of crush injury with various clinical presentations and complications, varying in the age range of 16-65 years. All four patients were given multiple managements, such as open reduction external fixation and extensive debridement. There were complications such as secondary infection and delay in the wound healing process in patients who did not on time for follow-up. The four patients received additional treatment in the form of wound dressings hyperbaric oxygen therapy (HBOT) with 5-10 90-minute sessions under 2.4 ATA pressure for 10 consecutive days. Follow-up was carried out again within a period of one month to compare the wound condition before and after HBOT. The clinical condition was getting better, marked by the formation of granulation tissue. The state of hyperoxia in HBOT accelerated the inflammatory process and angiogenesis during the wound healing process characterized by the eradication of bacteria in the wound tissue and accelerated neovascularization formation. In conclusion, adequate therapy, wound dressing, and patient compliance affect patient outcome. Moreover, the addition of hyperbaric oxygen therapy has shown to accelerate the wound healing process and restore the patient's limb function. Keywords: crush injury; hyperbaric oxygen therapy; oxygen; wound healing

HYPERBARIC OXYGEN THERAPY (HBOT) AS THE TREATMENT OF PROLONGED HYPOXEMIA DUE TO COVID-19

Background - hyperbaric oxygen therapy (HBOT) is a clinical method of treatment with oxygen while under increased atmospheric pressure. It has been proven as an independent therapeutic factor for a number of diseases, and in the case of COVID-19, its potential as an adjuvant therapy is still being studied. Case report – in the case of a 61-year-old man with severe pneumonia resulting from infection with COVID-19 and persisting hypoxemia and dyspnea after the acute phase. Prescribed continuous oxygenation in home conditions due to deteriorating general condition and quality of life. Undertaken additional hyperbaric oxygen therapy resulting in significant improvement after the 20th session. Conclusion - the connection between HBOT and improved paraclinical and imaging indicators, in this case, suggests conclusions of a therapeutic effect of HBOT in hypoxemia as a post-COVID symptom.

COVID-19-Induced Acute Respiratory Distress Syndrome Treated with Hyperbaric Oxygen: Interim Safety Report from a Randomized Clinical Trial (COVID-19-HBO).

A few prospective trials and case series have suggested that hyperbaric oxygen therapy (HBOT) may be efficacious for the treatment of severe COVID-19, but safety is a concern for critically ill patients. We present an interim analysis of the safety of HBOT via a randomized controlled trial (COVID-19-HBO). A randomized controlled, open-label, clinical trial was conducted in compliance with good clinical practice to explore the safety and efficacy of HBOT for severe COVID-19 in critically ill patients with moderate acute respiratory distress syndrome (ARDS). Between 3 June 2020, and 17 May 2021, 31 patients with severe COVID-19 and moderate-to-severe ARDS, a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) < 26.7 kPa (200 mmHg), and at least two defined risk factors for intensive care unit (ICU) admission and/or mortality were enrolled in the trial and randomized 1:1 to best practice, or HBOT in addition to best practice. The subjects allocated to HBOT received a maximum of five treatments at 2.4 atmospheres absolute (ATA) for 80 min over seven days. The subjects were followed up for 30 days. The safety endpoints were analyzed. Adverse events (AEs) were common. Hypoxia was the most common adverse event reported. There was no statistically significant difference between the groups. Numerically, serious adverse events (SAEs) and barotrauma were more frequent in the control group, and the differences between groups were in favor of the HBOT in PaO2/FiO2 (PFI) and the national early warning score (NEWS); statistically, however, the differences were not significant at day 7, and no difference was observed for the total oxygen burden and cumulative pulmonary oxygen toxicity dose (CPTD). HBOT appears to be safe as an intervention for critically ill patients with moderate-to-severe ARDS induced by COVID-19. NCT04327505 (31 March 2020) and EudraCT 2020-001349-37 (24 April 2020).

Hyperbaric oxygen therapy augments ciprofloxacin effect against Pseudomonas aeruginosa biofilm infected chronic wounds in a mouse model

IntroductionChronic wounds have a compromised microcirculation which leads to restricted gas exchange. The majority of these hypoxic wounds is infested with microorganisms congregating in biofilms which further hinders the antibiotic function. We speculate whether this process can be counteracted by hyperbaric oxygen therapy (HBOT). MethodologyTwenty-eight BALB/c mice with third-degree burns were included in the analyses. Pseudomonas aeruginosa embedded in seaweed alginate beads was injected under the eschar to mimic a biofilm infected wound. Challenged mice were randomized to receive either 4 days with 1 x ciprofloxacin combined with 2 × 90 min HBOT at 2.8 standard atmosphere daily, 1 x ciprofloxacin as monotherapy or saline as placebo. The mice were clinically scored, and wound sizes were estimated by planimetry daily. Euthanasia was performed on day 8. Wounds were surgically removed in toto, homogenized and plated for quantitative bacteriology. Homogenate supernatants were used for cytokine analysis. ResultsP. aeruginosa was present in all wounds at euthanasia. A significant lower bacterial load was seen in the HBOT group compared to either the monotherapy ciprofloxacin group (p = 0.0008), or the placebo group (p < 0.0001). IL-1β level was significantly lower in the HBOT group compared to the placebo group (p = 0.0007). Both treatment groups had higher osteopontin levels than the placebo group (p = 0.002 and p = 0.004). The same pattern was seen in the S100A9 analysis (p = 0.01 and p = 0.008), whereas no differences were detected between the S100A8, the VEGF or the MMP8 levels in the three groups. ConclusionThese findings show that HBOT improves the bactericidal activity of ciprofloxacin against P. aeruginosa wound biofilm in vivo. HBOT in addition to ciprofloxacin also modulates the host response to a less inflammatory phenotype.

Addition of hyperbaric oxygen therapy versus usual care alone for inflammatory bowel disease: A systematic review and meta-analysis

ObjectiveInflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disease that includes ulcerative colitis (UC) and Crohn's disease (CD). Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized environment. Existing literature suggests that HBOT may be an effective therapy for IBD, but a quantitative analysis is lacking. This study aims to estimate the adjunctive role of HBOT in treating IBD and lowering its recurrence rate. DesignSystematic review and meta-analysis. MethodsThe Cochrane Library, EMBASE, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases were systematically searched by two reviewers independently. Meta-analyses were performed using Review Manager (RevMan, version 5.3). A random-effects model was applied due to the heterogeneity between studies. ResultsTwenty-nine out of the initially identified 606 articles were covered in this review, with a total of 2151 patients (2071 for UC and 80 for CD). No randomized data of HBOT for CD were included. Among UC patients, usual care plus HBOT were more likely to achieve a clinical response than usual care alone (risk ratio [RR], 1.24; 95% confidence interval (CI), 1.17 to 1.31; P < 0.001). Subgroup analysis showed that the number of HBOT sessions had no statistically significant effect on overall efficacy (P > 0.05). The pooled data showed a lower recurrence rate in the usual care plus HBOT group (RR, 0.35; 95% CI, 0.24 to 0.53; P < 0.001). The standardized mean difference in the serum tumor necrosis factor level between HBOT and non-HBOT groups was -2.13 (95% CI, -3.09 to -1.18; P < 0.001). No severe adverse events of HBOT were observed. ConclusionsHBOT might be an effective and safe adjunctive treatment for IBD. Further studies are required to investigate the optimal protocol of HBOT in IBD treatment.

The effectiveness of hyperbaric oxygen therapy on the final outcome of patients with sudden sensorineural hearing loss

PurposeTo evaluate the therapeutic effect of the combination of systemic steroids (SS) and hyperbaric oxygen therapy (HBOT) in patients with idiopathic sudden sensorineural hearing loss (SSNHL). Materials and methodsFifty patients with idiopathic sudden sensorineural hearing loss were allocated into 2 groups: the control group received Dexamethasone IV (SS) and the therapy group received Dexamethasone IV combined with 15 sessions of hyperbaric oxygen therapy (SS + HBOT) as initial treatment. Hearing assessment was performed at the admission to hospital and 3 months after the onset of treatment. Siegel's criteria were used to evaluate the hearing outcomes. Prognostic factors were identified by linear regression analyses. ResultsHearing improvement rate was 64 % in the therapy group and 56 % in the control group, difference which was not statistically significant (p = 0.369). Furthermore, when patients of each group were categorized into 5 subgroups by disease severity (mild, moderate, moderate to severe, severe, profound), differences in treatment outcome between the subgroups of the same severity were not significant. A descending type audiogram curve was proven an unfavorable prognostic factor in both groups, as it led to a significantly lower hearing gain (30 dB) compared to other curve shapes (b = −29.10, 95 % CI = −56.39, −1.82). ConclusionsThe addition of hyperbaric oxygen therapy to systemic steroids caused no significant hearing improvement, despite a mild tendency toward a greater improvement rate within the combination group. More prospective randomized trials with larger series of patients could shed even more light on the effectiveness of combination therapy (SS + HBOT) in patients affected by SSNHL.

Addition of Hyperbaric Oxygen Therapy vs Standard Therapy in SSNHL

The background of sudden sensorineural hearing loss is that occurs suddenly, with unknown causes, and the number of cases increases with age. The modality of therapy that is often used today is empiric therapy. The purpose of this literature review is to determine the impact of adding hyperbaric oxygen therapy compared to standard therapy in cases of sudden sensorineural hearing loss. Methods The article search was carried out in various valid online data centers, namely PubMed, Science Direct, Cochrane Library, and Google Scholar. Looking for articles that discuss the addition of hyperbaric oxygen therapy in sudden sensorineural hearing loss. The results search yielded 1 observational study and 2 systematic studies. The addition of hyperbaric oxygen therapy provides a better clinical outcome. Conclusion: Hyperbaric oxygen therapy has a better effect than standard therapy only in cases of sudden sensorineural hearing loss.

Comparison of Therapeutic Results with/without Additional Hyperbaric Oxygen Therapy in Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Prospective Study

Objective: To assess the efficacy of the combination of hyperbaric oxygen (HBO) and pharmacological treatment in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and define patients amenable for HBO therapy. Methods: Prospective, randomized, trial involving 136 cases with unilateral ISSNHL that were randomly divided into 2 groups: the pharmacological treatment (P) group and HBO + pharmacological treatment (HBO+P) group, which received additional HBO for 14 days besides the pharmacological treatments. Pure tone audiometry gain larger than 15 dBHL was defined as success, and the success rate of each group was calculated. Results: The overall success rate of the HBO+P group and the P group is 60.6% (40/66) and 42.9% (30/70), respectively (p < 0.05). Furthermore, patients with mild-moderate baseline hearing loss, aged ≤50 years, receiving treatment in ≤14 days, or without accompanied dizziness/vertigo in the HBO+P group had higher success rate than the P group (p < 0.05). Conclusions: HBO combined with pharmacological treatments leads to better hearing recovery than pharmacological treatments alone.

The effect of various treatment modalities in idiopathic sudden sensorineural hearing loss: A retrospective evaluation

Objective: In this study, we retrospectively evaluated the effects of treatment modalities on healing in patients diagnosed with idiopathic sudden sensorineural hearing loss.&#x0D; Material and Method: In this study, we retrospectively reviewed the records of 65 patients diagnosed with idiopathic sudden sensorineural hearing loss and treated as inpatients. The treatment modalities applied to the patients were determined randomly. &#x0D; Results: The effect of intra-tympanic steroid and / or hyperbaric oxygen therapy in addition to intravenous steroid on 500, 1000, 2000 and 4000 Hz frequencies and improvement in bone conduction was not statistically significant.&#x0D; Conclusion: Although intra-tympanic steroid or hyperbaric oxygen therapy in addition to intravenous steroid therapy, which is the standard treatment of idiopathic sudden sensorineural hearing loss, does not increase the rate of improvement and speed, it may help to reduce the undesirable effects of the steroid dose.

Hyperbaric Oxygen Therapy in the Treatment of Ischaemic Lower Extremity Ulcers in Patients with Diabetes: Results of the Damocles Multicentre Randomised Clinical Trial

Introduction - Conflicting evidence exists on the effects of hyperbaric oxygen therapy (HBOT) in the treatment of chronic ischaemic leg ulcers. The aim of this multicentre trial was to investigate whether HBOT, as an adjunct to revascularisation and standard wound care, can improve wound healing and reduce major amputation rates in patients with diabetes and ischaemic lower extremity ulcers. Methods - The DAMOCLES study was designed as a multicentre, randomised, parallel-group, superiority trial. In total, 120 patients were randomised to standard care without (SC) or with HBOT (SC+HBOT). Eligible diabetic patients had a Wagner grade 2-4 ulcer present for at least 4 weeks and concomitant limb ischaemia with or without revascularisation options. Primary outcomes were limb salvage and complete wound healing after 12 months of follow-up, as well as time to wound healing. Other endpoints were amputation-free survival (AFS) and mortality. Results - Both groups contained 60 patients. Limb salvage was achieved in 47 patients (78%) in the SC group vs. 53 (88%) patients in the SC+HBOT group (risk difference [RD] 0.10, 95% CI -0.04 to 0.23). After 12 months, 28 index wounds were healed in the SC group vs. 30 in the SC+HBOT group (RD 0.03, 95% CI -0.14 to 0.21). AFS was achieved in 41 patients in the SC group and 49 patients in the SC+HBOT group (RD 0.13, 95% CI -0.02 to 0.28). In the SC+HBOT group 21 patients (35%) were unable to complete the HBOT-protocol as initially planned. Those who did had significantly less major amputations and higher AFS (RD 0.26, 95% CI 0.10 to 0.38). Conclusion - Additional HBOT did not significantly improve complete wound healing and limb salvage in patients with diabetes and lower limb ischaemia. However, a trend was seen towards a better amputation-free survival among HBOT-treated patients. The potential efficacy of HBOT may not be realised because a considerable number of patients is unable to complete a full HBOT-regimen.

The Differences of Effectivness HBO 2,4 ATA Between 7 and 10 Days In Bone Remodelling of Tension Area of Orthodontic Tooth Movement

Mechanical force of orthodontics, would inhibit periodontal ligament vascularization and blood flow, causing biochemical and cellular changes, such as cell deformation, inflammation, and circulatory disturbances. Each of these conditions afecting cell diferentiation, cell repair, and cell migration, is driven by numerous molecular and inflammatory mediators. Fibroblasts, osteoblasts, osteocytes, osteoclasts, odontoblasts, cementoblasts, chondrocytes and immune cells are the major cell types involved in the remodeling process on orthodontic tooth movement. Hyperbaric oxygen therapy is one of many solutions which stimulates the growth of new blood vessels and result in a substantial increase in tissue oxygenation. It plays a role in bone remodeling process.Purpose: To determine the differences of Hyperbaric Oxygen (HBO)2.4 ATA 7 and 10 days in osteoblast and osteocytes number during bone remodelling in Orthodontic tooth movement. Materials and Methods: The experiment using a post test only control group design. 32 male guinea pigs were randomly divided into 4 groups. K1 was control group without any treatment, K2 was a group which was given a mechanical orthodontic pressure, K3 was the group treated mechanical orthodontic with the addition of hyperbaric oxygen therapy. The maxillary incisors were moved distally by elastic separator. After HBO on day 7, all groups were sacrificed then analyzed osteoblast and osteocytes number by One-way ANOVA and LSD statistical test. Results: The study showed significant differences in osteoblast and osteocytes number during bone remodelling in orthodontic tooth movement between groups.Conclusion: HBO therapy 2.4 ATA for 7 days effective to induce bone remodelling during orthodontic tooth movement.

Necrotizing fasciitis: A review of three clinical encounters

Background: Necrotizing fasciitis is a potentially lethal soft tissue infection characterized by rampant necrosis and destruction of subcutaneous tissues. Current estimates of necrotizing soft tissue infections in the United States are 4.3 infections per 100,000 of the population. Although the incidence of necrotizing soft tissue infections has decreased in the last decade, the toxic and lethal nature of the disease process lends utmost importance to accurate diagnosis and immediate management. The purpose of this review article is to report three cases of necrotizing fasciitis and provide literature review in regards to hallmark characteristics, predisposing risk factors and treatment optimization.Case: The first case depicts a newly diagnosed 43-year-old male HIV patient with necrotizing fasciitis infection characterized by Klebsiella, Serratia and anaerobic bacteria cultures. The second case describes the course of a 71-year-old male diagnosed with necrotizing fasciitis in the setting of a complicated anal fistula characterized by B. fragilis, S. anginosus and Prevotella species. The third and final case describes the course of a 44-year-old female diagnosed with necrotizing fasciitis in the setting of Ludwig’s Angina characterized by Klebsiella and Dubliensis species. Treatment was initiated with extensive wound debridement, multiple washouts and broad antibiotic regimens in all three cases. Additional hyperbaric oxygen therapy was administered in the third case.Conclusions: These case reports illustrate the range of severity and settings in which necrotizing fasciitis can occur. Significant morbidity and mortality rates are associated with a delay in treatment initiation. Given this, it is of utmost importance to develop and maintain a high clinical acumen for necrotizing soft tissue infections.

Addition of Hyperbaric Oxygen Therapy vs Medical Therapy Alone for Idiopathic Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss (SSNHL) causes substantial disease burden for both individuals and socioeconomic aspects. The benefit of hyperbaric oxygen therapy (HBOT) in addition to standard medical therapy (MT) for idiopathic SSNHL has been unclear. To perform a systematic review and meta-analysis to compare HBOT + MT with MT alone as a treatment for patients with SSNHL. PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched up to February 2018. Randomized clinical trials and nonrandomized studies comparing HBOT + MT with MT alone for SSNHL treatment. Two investigators independently screened the eligible studies, established data, and assessed quality and risk of bias. A systematic review and meta-analysis using random-effects models was conducted. The primary outcome was complete hearing recovery, and secondary outcomes were any hearing recovery and absolute hearing gain. Three randomized clinical trials and 16 nonrandomized studies comparing outcomes after HBOT + MT vs MT alone in 2401 patients with SSNHL (mean age, 45.4 years; 55.3% female) were included. Pooled odds ratios (ORs) for complete hearing recovery and any hearing recovery were significantly higher in the HBOT + MT group than in the MT alone group (complete hearing recovery OR, 1.61; 95% CI, 1.05-2.44 and any hearing recovery OR, 1.43; 95% CI, 1.20-1.67). Absolute hearing gain was also significantly greater in the HBOT + MT group than in the MT alone group. The benefit of HBOT was greater in groups with severe to profound hearing loss at baseline, HBOT as a salvage treatment, and a total HBOT duration of at least 1200 minutes. The addition of HBOT to standard MT is a reasonable treatment option for SSNHL, particularly for those patients with severe to profound hearing loss at baseline and those who undergo HBOT as a salvage treatment with a prolonged duration. Optimal criteria for patient selection and a standardized regimen for HBOT should be applied in routine practice, with future trials to investigate maximal treatment benefit.

Hyperbaric Oxygen Therapy in the Treatment of Ischemic Lower- Extremity Ulcers in Patients With Diabetes: Results of the DAMO2CLES Multicenter Randomized Clinical Trial.

Conflicting evidence exists on the effects of hyperbaric oxygen therapy (HBOT) in the treatment of chronic ischemic leg ulcers. The aim of this trial was to investigate whether additional HBOT would benefit patients with diabetes and ischemic leg ulcers. Patients with diabetes with an ischemic wound (n = 120) were randomized to standard care (SC) without or with HBOT (SC+HBOT). Primary outcomes were limb salvage and wound healing after 12 months, as well as time to wound healing. Other end points were amputation-free survival (AFS) and mortality. Both groups contained 60 patients. Limb salvage was achieved in 47 patients in the SC group vs. 53 patients in the SC+HBOT group (risk difference [RD] 10% [95% CI -4 to 23]). After 12 months, 28 index wounds were healed in the SC group vs. 30 in the SC+HBOT group (RD 3% [95% CI -14 to 21]). AFS was achieved in 41 patients in the SC group and 49 patients in the SC+HBOT group (RD 13% [95% CI -2 to 28]). In the SC+HBOT group, 21 patients (35%) were unable to complete the HBOT protocol as planned. Those who did had significantly fewer major amputations and higher AFS (RD for AFS 26% [95% CI 10-38]). Additional HBOT did not significantly improve complete wound healing or limb salvage in patients with diabetes and lower-limb ischemia.

Treatment for bisphosphonate-related osteonecrosis of the jaw.

Data sourcesCochrane Oral Health Group Trials Register, CENTRAL, Medline, Embase, CancerLit, CINAHL, AMED, clinicaltrials.gov and the WHO International Trial Registry Platform. The reviewers searched six grey literature sites and contacted authors, researchers and pharmaceutical companies.Study selectionRandomised controlled trials for the treatment of BRONJ comparing interventions with other treatment or placebo were included in any setting with no age restriction.Data extraction and synthesisIndependently, two reviewers selected studies for inclusion, risk of bias and data extraction. The main outcome was healing. Secondary outcomes were pain improvement and quality of life.ResultsOne RCT with 49 patients met the inclusion criteria comparing the addition of hyperbaric oxygen therapy to standard of care alone. Changes in the lesion size and number were assessed at 3, 6, 12 and 18 months. Pain was assessed weekly while quality of life was assessed at baseline and six months. Improvement, as measured by the decrease in the size or number of lesions, achieved a RR 1.94, CI 95% (1.01 to 3.74) at three months. No other measure of this outcome was statistically significant. Pain changes and quality of life could not be numerically analysed.ConclusionsThe authors concluded that there is insufficient evidence to support a particular regimen for the treatment of BRONJ.

Hyperbaric Oxygen Therapy as Salvage Therapy for Sudden Sensorineural Hearing Loss.

To measure the effect of hyperbaric oxygen (HBO) therapy as salvage therapy after the failure of steroid therapy for sudden sensorineural hearing loss (SSNHL). Ninety-three patients with SSNHL were unsuccessfully treated with systemic steroid therapy. Following steroid therapy, 43 patients received additional HBO therapy while 50 did not. Hearing levels at 0.25, 0.5, 1, 2, 4, and 8 kHz before and after therapy were measured. A significant difference in hearing thresholds after HBO therapy was found at all frequencies in patients with a hearing loss of >61 dB. The group of patients with a hearing threshold of ≤60 dB had a significant improvement only at 250 and 500 Hz, while group of patients without additional therapy control group showed no hearing improvement. Hyperbaric oxygen therapy therapy as salvage therapy for SSNHL showed some benefits in hearing improvement. Better results could be expected in patients with severe hearing loss, while in patients with mild-or-moderate hearing loss, recovery should be expected only at low frequencies.

Histological changes during orthodontic tooth movement due to hyperbaric oxygen therapy

Background: Mechanical force of orthodontics causes changes in periodontal ligament vascularization and blood flow, resulting in biochemical and cellular changes as well as changes in the contour of the alveolar bone and in the thickness of the periodontal ligaments. Hyperbaric oxygen (HBO) therapy is one of many solutions stimulating the growth of new blood vessels and increasing tissue oxygenation. Thus, HBO plays a role in recovery of periodontal ligament and osteoblasts. Purpose: This study aimed to determine the effects of HBO therapy for seven days on periodontal ligament size and osteoblast number in the tension site during bone remodeling in tooth movement. Method: The study was true experimental laboratories with completely randomized control group post test only design. Twenty-four males guinea pigs were randomly divided into three groups. K0 was the control group without any treatment, K1 was the group given a mechanical orthodontic pressure, and K2 was the group treated with the addition of hyperbaric oxygen therapy. The maxillary incisors were moved distally by elastic separator. After HBO therapy on day 7, all of the groups were sacrificed, and then periodontal ligament size and osteoblast number were analyzed by one-way Anova and LSD statistical tests. Result: The results showed significant differences in the size of the periodontal ligament and the number of osteoblasts in the tension site among the groups (p&lt;0.05). Conclusion: HBO therapy at 2.4 ATA for 7 days is effective in recovery of periodontal ligament and increased osteoblast number during bone remodeling in tension area of orthodontic tooth movement.