Received Hyperbaric Oxygen Therapy Research Articles

Effect of hyperbaric oxygen treatment on patients with heatstroke complicated by multiple organ dysfunction:A retrospective study

BackgroundThe benefits of hyperbaric oxygen (HBO) in treating animals with heat stroke (HS) have been established. This study aims to retrospectively analyze the effect of HBO on multiple organ dysfunction following HS in humans. MethodsRetrospective data were collected from patients with HS admitted to our hospital in the past 7 years. Patients were categorized into groups based on whether they received HBO therapy. The study compared various factors, including sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) scores, mortality rates, neurological function scores, serum myocardial enzyme levels, liver, kidney, and coagulation function indicators, blood routine results, electrolyte levels, and modified Barthel index (MBI) score for standard daily living ability before treatment and after 2 and 4 weeks of treatment. ResultsThe mortality rates in the HBO and control group were 0% and 8.49%, respectively. Upon admission, the HBO group had higher SOFA and APACHE-Ⅱ scores and lower neurological, coagulation, and liver functions than those of the control group. HBO treatment significantly improved SOFA, APACHE-Ⅱ, and neurological scores while relieving levels of alanine aminotransferase, aspartate aminotransferase, creatinine, and myocardial enzymes. Additionally, it mitigating lymphocyte and platelet count decline caused by HS. The MBI score was significantly enhanced after treatment in the HBO group. ConclusionsClinical practice advocates administering HBO therapy to patients with severe illness, organ damage, and nerve impairment. Compared with conventional treatment, combined HBO therapy demonstrated superior efficacy in alleviating multiple organ dysfunction and improving daily living ability in patients with HS.

A Pilot Study to Determine the Safety and Efficacy of Repeated Hyperbaric Oxygen Therapy in Multiple Myeloma Patients Undergoing High-Dose Therapy and Autologous Stem/Progenitor Cell Transplantation

Background Serum erythropoietin (EPO) negatively impacts hematopoietic stem cell homing and engraftment. Hyperbaric oxygen (HBO) therapy can reduce serum EPO in healthy volunteers and when given prior to stem cell infusion may improve engraftment after hematopoietic stem cell transplant (HSCT). We previously performed a phase II trial randomizing patients with multiple myeloma undergoing high dose melphalan and autologous HSCT 1:1 between a single HBO treatment and no HBO. HBO was given as 100% oxygen, 2.5 ATA for a total of 90 min, in a single treatment on Day 0 prior to the transplant. A total of 99 patients were enrolled with 52 randomized to HBO. HBO significantly reduced EPO levels for the first 24 hours after auto transplant, but EPO levels quickly rebounded by 48 hours after transplant. We hypothesized multiple HBO treatments will keep EPO levels low during the duration of stem cell homing (i.e: the first 72 hours after HSCT) and may improve neutrophil and NK cell recovery. Methods We performed a pilot study to evaluate the safety and tolerability of multiple HBO treatments during autologous HSCT. Patients with multiple myeloma undergoing autologous HSCT were eligible. Patients received HBO therapy, consisting of hyperbaric oxygen at 2.5 ATA for a total of 90 minutes breathing 100% oxygen on days 0 (prior to HSCT), 1, and 2 of transplant. The primary objective of this pilot study was to determine the safety of repeated HBO therapy in the setting, as defined by treatment limiting toxicity (TLT) including occurrence of seizure disorder, pneumothorax, death, or any irreversible grade Ill or any grade IV toxicity within 24 hours of HBO therapy. Secondary objectives were to determine the effects of multiple HBO therapy on neutrophil count recovery and the effect of multiple HBO on serum EPO. Results 10 patients have been enrolled that are evaluable for the primary objective. All patients had multiple myeloma and 4 were female. 9/10 patients successfully completed all 3 HBO treatments and 1/10 completed HBO on days 1 and 2 only because of ear pain on day 0. No patients experienced treatment limiting toxicity. The median times to neutrophil and platelet engraftment was 12 days (range 11-14) and 16 days (range 14-28), respectively. The median length of hospitalization was 13 days (range 12-16). Febrile neutropenia occurred in 3/10 patients with just one incidence of documented infection. This was significantly less than the rate of febrile neutropenia in patients receiving a single treatment of HBO or no HBO (81% and 47%, respectively, p<0.05). 3 patients required red blood cell transfusion and 5 platelet transfusion. Conclusions Multiple HBO treatment were well tolerated without treatment limiting toxicity during autologous HSCT for multiple myeloma.

Effects of Hyperbaric Oxygen Preconditioning on Doxorubicin Cardiorespiratory Toxicity.

Cardiorespiratory dysfunction resulting from doxorubicin (DOX) chemotherapy treatment is a debilitating condition affecting cancer patient outcomes and quality of life. DOX treatment promotes cardiac and respiratory muscle pathology due to enhanced reactive oxygen species (ROS) production, mitochondrial dysfunction and impaired muscle contractility. In contrast, hyperbaric oxygen (HBO) therapy is considered a controlled oxidative stress that can evoke a substantial and sustained increase in muscle antioxidant expression. This HBO-induced increase in antioxidant capacity has the potential to improve cardiac and respiratory (i.e., diaphragm) muscle redox balance, preserving mitochondrial function and preventing muscle dysfunction. Therefore, we determined whether HBO therapy prior to DOX treatment is sufficient to enhance muscle antioxidant expression and preserve muscle redox balance and cardiorespiratory muscle function. To test this, adult female Sprague Dawley rats received HBO therapy (2 or 3 atmospheres absolute (ATA), 100% O2, 1 h/day) for 5 consecutive days prior to acute DOX treatment (20 mg/kg i.p.). Our data demonstrate that 3 ATA HBO elicits a greater antioxidant response compared to 2 ATA HBO. However, these effects did not correspond with beneficial adaptations to cardiac systolic and diastolic function or diaphragm muscle force production in DOX treated rats. These findings suggest that modulating muscle antioxidant expression with HBO therapy is not sufficient to prevent DOX-induced cardiorespiratory dysfunction.

Idiopathic Sudden Sensorineural Hearing Loss: Is Hyperbaric Oxygen Treatment the Sooner and Longer, the Better?

(1) Background: We aimed to evaluate hearing benefits from hyperbaric oxygen (HBO) therapy in patients with Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). (2) Methods: We performed a retrospective analysis of chart reviews on patients with ISSHL between Jan 2016 and Dec 2021. All patients were referred to receive HBO therapy by the department of Ear, Nose and Throat (ENT). Hearing gain was assessed based on pure-tone audiometry (PTA). Data were analyzed for 102 patients after 1 to 5 therapy sessions, and for 46 patients after 6 to 10 therapy sessions. (3) Results: After 1–5 HBO sessions, patients (N = 102) showed an improvement in 45 (44.1%) of the patients (p < 0.000). Also, improvements were found with patients showing different grades of ISSHL: 11 (26.8%) with slight-moderate, 11 (40.7%) with severe, and 23 (67.6%) with profound ISSHL. Significant treatment effects were found at different affected frequencies, especially the low frequency range. After 6–10 HBO sessions, patients (N = 46) showed similar treatment effects as after 1–5 HBO sessions, but no additional improvement. Moreover, patients who received HBO treatment within 12 days showed improvement effects 6.484 times greater (p < 0.000) compared with those who received treatment after 13 days. (4) Conclusions: The improvement of HBO therapy on ISSHL was significant after 1–5 sessions, with larger improvements for those suffering more serious symptoms. Further adding more HBO treatment sessions to 6–10, no further improvement was found. Patients starting HBO therapy within 12 days of ISSHL showed 6.484 times greater improvements compared with those starting HBO therapy later.

The role of hyperbaric oxygen to platelet aggregation in noninsulin-dependent diabetes mellitus (NIDDM)

Hyperglycemia in diabetes mellitus (DM) could cause rheological disorder, such as platelet aggregation and blood hyperviscosity. Hyperbaric oxygen (HBO) could decrease collagen as platelet aggregation agonist. This study aimed to explore the effect of HBO treatment to platelet aggregation parameters (latency time(LT), aggregation speed, aggregation index, and aggregation percentage) with the collagen aggregator in the noninsulin dependent diabetes mellitus (NIDDM). The number of subjects in this study were 16 for each group normoxia normobaric (NONB) and HBO. NIDDM patients from DM polyclinic in Rumah Sakit AngkatanLaut (RSAL) Dr Ramelan Surabaya which was fulfilled inclusion criteria would receive HBO Therapy. Control Group/NONB were treated with NONB condition (20% O2 1 ATA) for 90min and treatment group/HBO were treated with hyperoxia hyperbaric condition (100% O2 2.4 ATA) for 3×30min with interval of 2×5min for inhaling fresh air. Subject has been blood taken for platelet aggregation test before and after HBO Therapy. The length of treatment was 5days for both condition (NONB and HBO). The data from both groups, NONB and HBO were tested first by normality test, homogenity test, correlation test, analysis of covariance, and paired t-test. Based on paired t-test, the decrease on platelet aggregation speed, aggregation index, and aggregation percentage after HBO treatment was showed significant difference on the LT and aggregation index while in aggregation speed and aggregation percentage was not significant. NONB group after 5days was showed a significant difference on the aggregation speed and aggregation index while in LT and aggregation percentage was not significant. The utilization of HBO 2.4 ATA 100% O2 3×30min, once a day, for 5days could decrease the platelet aggregation parameters (LT, aggregation speed, aggregation index, and aggregation percentage) in patients with NIDDM.

Effects of hyperbaric oxygen therapy on vascular endothelial growth factor protein and mRNA in crush injury patients: A randomized controlled trial study

IntroductionLimb injury is a major health concern that imposes a direct danger to both life and limb viability. At Kandou Hospital Manado, hyperbaric oxygen (HBO) therapy has been performed as an adjunctive treatment for crush injury although no study has yet directly compared outcomes of HBO versus conventional therapy. Documentation of the association between HBO therapy and the healing process of crush injury is necessary to reduce the gaps in the literature and to establish an evidence-based clinical use of HBO therapy. MethodsIn this study, we assessed the changes in the vascular endothelial growth factor (VEGF) serum levels and VEGF mRNA expression as biomarkers of wound healing using ELISA and qRT-PC at four different measurement times: at baseline, after receiving initial treatment (debridement and limb-salvage surgeries), 2 h after the first session HBOT, and after a full 10 HBOT sessions. A randomized controlled trial (RCT) was used to enroll patients subjected to crush injury who were admitted to the Surgical Emergency Department (ER) of Kandou Hospital Manado, Indonesia. ResultsVEGF serum levels increased significantly in patients suffering from crush injury who received HBO therapy versus the control group. The increased VEGF serum is expected to result in an acceleration time of wound healing and a reduction in amputation rate. ConclusionThere was a significant difference between crush injury patients who received conservative therapy versus those receiving HBO therapies; thus, there was an increased likelihood of an accelerated wound healing and a reduction in the risk of amputation.

The effects of systemic ozone application and hyperbaric oxygen therapy on knee osteoarthritis: an experimental study in rats.

To evaluate the effects of systemic medical ozone (O3) application and hyperbaric oxygen (HBO) therapy on surgically induced knee osteoarthritis (OA) in a rat model. We performed anterior cruciate ligament transection (ACLT) in order to create experimental OA in the right knees of 27 male rats. The left knee joints of all rats were sham-operated without ACLT as the negative control group. The rats were randomly assigned into three groups: (1) control group, which received no treatment; (2) O3 group, which received intraperitoneal 30 μg medical O3; (3) HBO group, which received HBO therapy for 60 minutes twice a day. We sacrificed the rats on the tenth week after the operation. We evaluated the degree of OA using Mankin scores. As a result of histopathological examination, the mean Mankin scores in the right knees with ACLT were 8.17 ± 2.12 in the control group, 6.22 ± 1.56 in the HBO group, and 4.72 ± 1.30 in the O3 group. The differences between the O3 group and the HBO group and the O3 group and the control group were found to be statistically significant (p 0.001, p 0.039, respectively). There was no difference between the HBO group and the control group (p 0.086). The results of the present study show that systemic medical O3 application was more effective than HBO therapy and may reduce development of cartilage damage and prevent OA formation.

Hyperbaric oxygen (HBO) therapy as an effective approach to the treatment of patients with severe idiopathic sudden sensorineural hearing loss

Background: The potential etiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is cochlear ischemia, therefore, hyperbaric oxygen (HBO) therapy is a promising treatment, particularly in patients with severe hearing loss (≥70 dB).Aims/objectives: To evaluate the efficacy of HBO therapy.Material and methods: The medical records of patients diagnosed with ISSNHL were retrospectively reviewed (≥70 dB). Patients received HBO therapy 14 times in addition to systemic and intratympanic steroid therapy (HBO group), or systemic and intratympanic steroid therapy only (control group).Results: Data from a total of 82 patients (83 ears) were included in the analysis; 37 (38 ears) in the HBO group and 45 (45 ears) in the control group. After 2 weeks’ treatment, hearing was significantly improved in the HBO group versus controls (weighted four-frequency average 28.1 ± 26.9 dB versus 14.8 ± 13.5 dB, respectively; p < .05), particularly in the low frequency groups (0.5 kHz, 1 kHz, 2 kHz; p < .05).Conclusion and significance: These data demonstrate that HBO therapy is an effective initial treatment option for patients with ISSNHL suffering from severe hearing loss.

Eight-week healing of grafted calvarial bone defects with hyperbaric oxygen therapy in rats

PurposeThe purpose of this study was to evaluate the synergistic effect of adjunctive hyperbaric oxygen (HBO) therapy on new bone formation and angiogenesis after 8 weeks of healing.MethodsSprague-Dawley rats (n=28) were split into 2 groups according to the application of adjunctive HBO therapy: a group that received HBO therapy (HBO group [n=14]) and another group that did not receive HBO therapy (NHBO group [n=14]). Each group was divided into 2 subgroups according to the type of bone graft material: a biphasic calcium phosphate (BCP) subgroup and an Escherichia coli-derived recombinant human bone morphogenetic protein-2-/epigallocatechin-3-gallate-coated BCP (mBCP) subgroup. Two identical circular defects with a 6-mm diameter were made in the right and left parietal bones of each rat. One defect was grafted with bone graft material (BCP or mBCP). The other defect was not grafted. The HBO group received 2 weeks of adjunctive HBO therapy (1 hour, 5 times a week). The rats were euthanized 8 weeks after surgery. The specimens were prepared for histologic analysis.ResultsNew bone (%) was higher in the NHBO-mBCP group than in the NHBO-BCP and control groups (P<0.05). Blood vessel count (%) and vascular endothelial growth factor staining (%) were higher in the HBO-mBCP group than in the NHBO-mBCP group (P<0.05).ConclusionsHBO therapy did not have a positive influence on bone formation irrespective of the type of bone graft material applied after 8 weeks of healing. HBO therapy had a positive effect on angiogenic activity.

Improvement of satisfaction in burn patients receiving adjuvant hyperbaric oxygen therapy

Background: Hyperbaric oxygen (HBO) therapy is an adjuvant treatment in patients with burns. However, evidence regarding the effectiveness of the HBO therapy for the improvement of patient's satisfaction has seldom been discussed; thus, we share our experience in this topic. Aim and Objectives: This study aimed to evaluate the improvement of burn patients' satisfaction after adjuvant HBO therapy. Materials and Methods: This was a retrospective case–control study involving 35 burn patients admitted to our hospital without a history of chronic pain and burn treatments from 2012 to 2015. Group I consisted of 18 burn patients who received HBO therapy to manage burns. The HBO therapy was administered in the hyperbaric chamber and received 60 min of 100% oxygen at a therapeutic pressure at 50 feet for 20 sessions. Group II consisted of 17 burn patients without a history of HBO therapy. Age, gender, total body surface area (TBSA), scar progression, improvement of visual analogue scale score, satisfaction improvement, and infection rate were documented and analyzed. Results: The mean age of Group I (37.0 ± 9.2) was significantly lower than that of Group II (49.4 ± 17.4) (P = 0.015). The mean improvement pain score in Group I (4.7 ± 1.1) was significantly higher than that of Group II (3.6 ± 0.9) (P = 0.004). The mean satisfaction improvement of Group I (3.4 ± 0.5) was significantly higher than that of Group II (2.9 ± 0.6) (P = 0.009). No significant difference was observed between gender, TBSA, debridement times, skin graft times, skin graft surface, infection rate, length of hospital stay, and progression of scar score in both groups, but there was a positive correlation between HBO therapy and the progression of scar score, so does the infection rate. There is no significant interaction between the two factors (HBO and age) on the improvement of pain score and improvement of satisfaction. Conclusion: Evaluation of the results obtained in the study suggests that the HBO therapy has a significant improvement in the pain relieve and satisfaction improvement after control of age factor in patients with thermal burns.

Comparison of the efficacy of hyperbaric oxygen therapy in patients with postoperative spinal and extremity wound lnfections

Background: Hyperbaric oxygen (HBO) has been shown to promote the healing of ischemic and infected tissue; therefore, it may be useful for treating non-healing postoperative wound infection. The purpose of this study was to compare the efficacy of HBO therapy in the treatment of postoperative spinal and extremity wound infections. Methods: From 1995 to 2011, 284 patients with postoperative wound infection were enrolled in this study and divided into 2 groups: groups I, 26 patients (spinal wound infection) and group II, 235 patients (upper and lower extremities wound infection). HBO therapy was indicated when infection showed no improvement of clinical symptoms/signs and laboratory testing following appropriate antibiotic therapy for at least 2 weeks. All patients received HBO therapy one cycle (20 times) as an adjunctive treatment, and the following data were collected retrospectively: age, sex, comorbidity (diabetes mellitus, liver cirrhosis, and end-stage renal disease), and type of bacteria (gram-positive, gram-negative, and anaerobic). These clinical results and outcomes after HBO therapy were analyzed Results: Sex and diabetes mellitus incidence were significantly different between the 2 groups; the extremities infection group had more male and fewer diabetic patients. No significant difference between the groups was found in terms of other factors, comorbidity, or type of bacteria. Although the overall clinical outcome after HBO treatment was not significantly different between the groups, the spinal group showed a higher percentage of excellent results after infection with a gram-positive pathogen. Conclusion: Patients with post-operative spinal wound infection under HBO therapy have similar treatment responses to patients with the extremities wound infection. Clinical outcomes are not affected by comorbidities such as diabetes mellitus, liver cirrhosis, or end-stage renal disease. Therefore, HBO therapy is recommended as an adjunctive treatment for postoperative spinal wound infection.

Successful Hyperbaric Oxygen Therapy with Thyrotropin-Releasing Hormone Therapy for Delayed Neuropsychiatric Sequelae after Acute Carbon Monoxide Poisoning: A Case Study

Delayed neuropsychiatric sequelae (DNS) after acute carbon monoxide (CO) poisoning is a complication of CO intoxication. Hyperbaric oxygen (HBO) therapy is one of the only established treatments for CO poisoning, but as there is no specific treatment for DNS, the prognosis of DNS patients is generally poor. A 40-year-old male patient, following attempted suicide by CO poisoning, was referred to our department after having received HBO therapy at another hospital, but treatment had been subsequently discontinued due to patient agitation. The patient was diagnosed with DNS after acute CO poisoning, and we reinitiated HBO therapy. However, due to manifestation of symptoms of severe dementia, treatment was discontinued. After initiating thyrotropin-releasing hormone (TRH) therapy, psychiatric symptoms, such as difficulty in following instructions, improved, enabling the resumption of HBO therapy. Daily activities returned to premorbid levels following treatment. Thus, TRH therapy could be effective for patients with DNS due to acute CO poisoning who experience difficulty with HBO therapy.

Expression of T helper cell-associated inflammatory mediator mRNAs in cells of bronchoalveolar lavage fluid samples and oxygen concentration in arterial blood samples from healthy horses exposed to hyperbaric oxygen.

OBJECTIVE To evaluate the mRNA expression of T helper (Th)1, Th2, and Th17 cell-associated inflammatory mediators in cells of bronchoalveolar lavage fluid samples collected from healthy horses exposed to hyperbaric oxygen (HBO) and to monitor blood oxygen concentration during and following HBO therapy. ANIMALS 8 healthy horses. PROCEDURES In a randomized controlled crossover design study, each horse was exposed (beginning day 1) to 100% oxygen at a maximum of 3 atmospheres absolute (304 kPa) daily for 10 days or ambient air at atmospheric pressure in the HBO chamber for an equivalent amount of time (control). Bronchoalveolar lavage fluid samples were collected on days 0 and 10. After validation of candidate reference genes, relative mRNA expressions of various innate inflammatory, Th1 cell-derived, Th2 cell-derived (including eotaxin-2), Th17 cell-derived, and regulatory cytokines were measured by quantitative PCR assays. For 3 horses, arterial blood samples were collected for blood gas analysis during a separate HBO session. RESULTS The optimal combination of reference genes was glyceraldehyde-3-phosphate dehydrogenase, hypoxanthine ribosyltransferase, and ribosomal protein L32. Compared with day 0 findings, expression of eotaxin-2 mRNA was significantly lower (0.12-fold reduction) and the percentage of neutrophils in bronchoalveolar lavage fluid samples was significantly lower on day 10 when horses received HBO therapy. Values of Pao2 rapidly increased (> 800 mm Hg) but immediately decreased to pretreatment values when HBO sessions ended. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that HBO therapy does not increase mRNA expression of inflammatory cytokines, but reduces eotaxin-2 mRNA transcription. The Pao2 increase was transient with no cumulative effects of HBO.

Effects of hyperbaric oxygen therapy on acetaminophen induced nephrotoxicity and hepatotoxicity: the role of heme oxygenase-1

The aim of this study was to investigate the effects of hyperbaric oxygen (HBO) therapy on acetaminophen (APAP) induced renal and liver injudr and the role of heme oxygenase-1 (HO-1) activation. Wistar-Albino rats were randomly assigned into four groups. Control group received no treatment. APAP (3gr/kg) was administered by gastric lavage in APAP group. Animals in the APAP+HBO and APAP+zinc protoporphyrin (ZnPP)+HBO groups received HBO therapy (90 min at 2.5 atm), starting 1 hour after APAP administration, for 2 consecutive days.HO-1 activity was inhibited by ZnPP. APAP+ZnPP+HBO group received intraperitoneal 50 µmol\kg ZnPP injection 30 minutes after APAP treatment and HBO therapy for 2 days. Serum and tissue samples were taken at 48 hours after APAP treatment. Renal and liver functions were evaluated by serum levels of urea, creatinine and transaminases. Lipid peroxidation and tissue levels of antioxidant enzymes were measure by ELISA. Tissue injury was evaluated by light microscopy.HO-1 level was determined by immunohistochemistry. HO-1 mRNA level was investigated by polymerase chain reaction (PCR). Serum transaminase levels significantly increased after APAP treatment (p

Final Results of the First-in-Human Clinical Study Incorporating Hyperbaric Oxygen into Umbilical Cord Blood Transplantation

Background: Umbilical cord blood (UCB) transplantation is associated with delayed blood count recovery and engraftment. We have demonstrated that pre-treatment with hyperbaric oxygen (HBO) therapy to the recipient mice improved engraftment of intravenously infused human UCB CD34+ in a murine transplant model. Further studies from our laboratory attribute HBO effects on engraftment to HBO-induced low erythropoietin (EPO) state in the host, resulting in early UCB CD34+ cell bone marrow homing and an increase in myeloid to erythroid differentiation. These results lead to the first in-human pilot clinical trial investigating the safety of HBO in the setting of UCB transplantation and secondarily evaluating time to blood count recovery. Herein, we report the final results of this study in comparison to our historic institutional data to determine the impact of HBO on blood count recovery and day +100 survival.Materials/methods: Enrolled patients had hematologic malignancies that required reduced intensity conditioning (RIC) or myeloablative conditioning (MAC) and UCB transplantation. They received HBO therapy on day 0 consisting of exposure to 2.5 atmosphere absolutes for a total of 2 hours, in a single hyperbaric chamber, breathing 100% oxygen. Six hours from the start of HBO, single or double UCB units were intravenously infused and patients were followed daily for toxicity and blood count recovery. Serum EPO levels were measured by enzyme-linked immunosorbent assay (ELISA). Mycophenolate mofetil and cyclosporine were used for GVHD prophylaxis. Charts of 48 patients who received UCB transplantation at our institution for hematologic malignancies between 2008 and 2013 were reviewed for comparison.Results: 15 patients, 9 males (60%) and 6 females (40%), with a median age of 44 years (17-70) were treated. One patient had lymphoma and 14 patients had acute leukemia; 10 in first remission and 4 in second remission. Eight patients received one UCB unit and 7 received two units. Patients received a median total nucleated cell dose of 3.02(1.67-4.51) ×107/Kg recipient body weight (BWT), a median CD34 cell dose of 1.2 (0.7-6.5) ×105/Kg recipient BWT, and 9/15 patients received RIC. 14/15 treated patients completed the planned therapy, while one patient did not finish the last 15 minutes due to nausea. None of the patients experienced an unexpected toxicity. All patients engrafted except for one patient who demonstrated prompt autologous blood count recovery. Full donor chimerism was achieved in 7/8 (88%) of engrafted RIC patients 30 days post-transplant. Eleven of the 15 (67%) patients developed acute graft versus host disease at time of engraftment; 36% developed grade I, 54% had grade II and 9% had grade III. On average, EPO levels 8-hours post HBO were 56 (27-92) % of their pre-HBO values. Median time to neutrophil count recovery, median time to platelet count recovery, day +100 survival (Figure-1), percentage of patients who achieved neutrophil recovery and platelet count recovery in the HBO and historic cohorts are summarized in table-1.Conclusions: HBO therapy prior to UCB cell infusion appears to be safe and well-tolerated in the setting of clinical UCB transplantation. Given the potential benefits of relatively fast recovery and lack of toxicity, HBO should be further evaluated as a strategy to promote engraftment in UCB transplantation.Table 1Summary of transplant outcomes in HBO and historic cohorts.AllMACRICHBO (n=15)Historic (n=48)P valueHBO (n=6)Historic (n=21)P valueHBO (n=9)Historic (n=27)P valueDay 100 survival (n/%)No- (0%)11 (24%)0.051- (0%)10 (48%)0.03- (0%)1 (4%)NSYes15 (100%)34 (76%)6 (100%)11 (52%)9 (100%)23 (96%)Neutrophil recovery (n/%)No- (0%)6 (12%)NS- (0%)4 (19%)NS- (0%)2 (7%)NSYes15 (100%)42 (88%)6 (100%)17 (81%)9 (100%)25 (93%)Platelet recovery (n/%)No- (0%)15 (31%)0.013- (0%)11 (52%)0.023- (0%)4 (15%)NSYes15 (100%)33 (69%)6 (100%)10 (48%)9 (100%)23 (85%)Median time to neutrophil recovery (Range)14 (6-45)20.5 (5-71)NS24.5 (16-45)33 (13-71)NS7 (6-17)14 (5-28)NSMedian time to platelet recovery (Range)37.5 (0-85)38 (0-161)NS54.5 (30-84)50 (29-161)NS32 (0-85)38 (0-112)NS [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Hyperbaric oxygen therapy ameliorates acute brain injury after porcine intracerebral hemorrhage at high altitude.

IntroductionIntracerebral hemorrhage (ICH) at high altitude is not well understood to date. This study investigates the effects of high altitude on ICH, and examines the acute neuroprotection of hyperbaric oxygen (HBO) therapy against high-altitude ICH.MethodsMinipigs were placed in a hypobaric chamber for 72 h before the operation. ICH was induced by an infusion of autologous arterial blood (3 ml) into the right basal ganglia. Animals in the high-altitude ICH group received HBO therapy (2.5 ATA for 60 min) 30 min after ICH. Blood gas, blood glucose and brain tissue oxygen partial pressure (PbtO2) were monitored continuously for animals from all groups, as were microdialysis products including glucose, lactate, pyruvate and glutamate in perihematomal tissue from 3 to 12 h post-ICH.ResultsHigh-altitude ICH animals showed significantly lower PbtO2, higher lactate/pyruvate ratio (LPR) and glutamate levels than low-altitude ICH animals. More severe neurological deficits, brain edema and neuronal damage were also observed in high-altitude ICH. After HBO therapy, PbtO2 was significantly increased and LPR and glutamate levels were significantly decreased. Brain edema, neurological deficits and neuronal damage were also ameliorated.ConclusionsThe data suggested a more serious disturbance of tissue oxygenation and cerebral metabolism in the acute stage after ICH at high altitude. Early HBO treatment reduced acute brain injury, perhaps through a mechanism involving the amelioration of the derangement of cerebral oxygenation and metabolism following high-altitude ICH.

Tissue Flap Preconditioning with Adipose Derived Stem Cells and Hyperbaric Oxygen Treatment

INTRODUCTION: Complex wound, soft tissue reconstruction and transplantation are inherently complicated by ischemia and reperfusion. Efforts at minimizing these deleterious effects involve meticulous design and minimizing the ischemic period. Adjunctive measures have included free microvascular transfer, supercharging, caspase inhibitors and free oxygen radical scavengers.1,2 In this study, we hoped to characterize the potential complementary effects of Hyperbaric Oxygen (HBO) Therapy and Stem Cell (ADSC) delivery in flap preconditioning. MATERIALS AND METHODS: In this randomized controlled trial, the study group (n=6) received autologous ADSC injections subcutaneously, whereas the control group (n=6) received saline injections to the area of flap design.3 Subsequently, half of the animal subjects were exposed to four consecutive HBO treatments. Following preconditioning, a pedicled flap was elevated and clinically assessed via study-blinded observer (Figure 1), alongside objective assessments of heat shock protein (HSP) 70 levels and quantification of TUNEL-positive cells.4 RESULTS: Serial clinical examinations monitored the consistency, color, vascularity and temperature of the skin flaps. The presence of venous congestion was significantly greater in the flaps that did not receive HBO therapy (26.7% vs. 0%, p=0.004). Distal flap necrosis was more often noted in the animal subjects who received ADSCs but were not exposed to HBO (46.7% vs. 6.7%, p=0.013) (Figure 2). Preconditioning with HBO has been shown to provide cytoprotective effects, through the upregulation of HSP 70, and a statistically significant rise was detected in the HBO saline group (p=0.042). Similarly, the TUNEL apoptosis assay indicated that the percentage of apoptotic cells was greater in the HBO saline group (p=0.003).Figure 1: Research Design and Protocol.Figure 2: Clinical Appearance of Tissue Flaps.CONCLUSIONS: Preliminary study findings support that HBO preconditioning of flaps improves tissue viability and survival rates.5 The rise in HSP 70 levels in the HBO saline group suggests a potential response to a more stressful environment and possible cytoprotective effects of ADSC. Further investigation with a larger sample size is necessary to elucidate the optimal time for ADSC injection and the true effects of HBO treatment and ADSC combination on tissue flap survival.

Application of hyperbaric oxygen in the treatment of refractory peptic ulcer

Objective To explore the application effect of hyperbaric oxygen （ HBO ） in the treatment of refractory peptic ulcer .Methods Clinical data of 259 patients with refractory peptic ulcer were retrospectively ana-lyzed.According to whether received HBO therapy , these patients were divided into the HBO group （ n=127 ） and control group（n=132）.The total effective rate,Helicobacter pylori（Hp） eradication rate and relapse rate of the two groups were compared .Results The total effective rate ,Hp eradication rate of the HBO group were 93.7%,92.1%, respectively,which were significantly higher than 65.2%,56.1% of the control group （χ2 =31.97,7.32,all P〈0.05）.The relapse rate of the HBO group was 8.4%,which was significantly lower than 33.3%of the control group （χ^2 =12.51,P〈0.05）.Conclusion HBO combined with conventional drug in the treatment of refractory peptic ulcer has significant effect . Key words: Peptic ulcer; Hyperbaric oxygenation

Management of Pathologic Fractures of the Mandible Secondary to Osteoradionecrosis

To review our experience with late Marx stage III osteoradionecrosis (ORN) of the mandible in patients who present with pathologic fracture. Case series with chart review. Tertiary care center. Thirty-seven patients were identified from June 1998 to August 2010 who underwent treatment of Marx grade III osteoradionecrosis with pathologic fracture of the mandible. All patients underwent reconstruction with osteocutaneous free tissue transfer and when possible underwent hyperbaric oxygen therapy Marx protocol. The average time between completion of radiation therapy and presentation of ORN-induced pathologic fracture was 3.2 years. Sixteen patients developed ORN following tooth extraction. Sixteen patients had no previous documented ORN prior to presenting with pathologic fracture. Follow-up after surgery averaged 4.5 years with no recurrence of disease. The overall complication rate was 24% with no total flap loss. Of the patients, 95% returned to prefracture dietary intake. Twenty-six patients underwent a staged protocol, in which after resection and plate reconstruction, they underwent 20 hyperbaric oxygen (HBO) dives. They then underwent free tissue transfer followed by a further 10 HBO dives. There were no flaps lost or nonbony unions. Eleven patients did not receive HBO therapy as part of their surgical treatment plan. Again, there was no total flap loss, but 2 skin paddles were lost and 4 bony nonunions occurred. Pathologic fracture in conjunction with ORN has a relatively high treatment complication rate. Free tissue transfer and HBO are the treatment of choice for this population.

Hyperbaric oxygen for lung infection patients with severe brain injury and tracheotomy

Objective To compare the effectiveness of hyperbaric oxygen (HBO) therapy and normal pressure oxygen inhalation for lung infection in patients with severe brain injury and tracheotomy.Methods Sixty lung infection patients with severe brain injury and tracheotomy were stratified by age and Glasgow coma scale (GCS) score into an HBO group (30) and a conventional therapy group (30).Both groups were given treatments to reduce intracranial hypertension and protect the brain,surgery,antibiotics,and symptomatic and support therapy.In the conventional group the patients received oxygen therapy at normal oxygen pressure by tracheal cannula.In the HBO group,the patients received HBO therapy through self-made oxygen devices by the authors.The body temperature,cough and expectoration,respiratory sounds and white blood cell (WBC) count were compared between the groups.Results There were statistically significant differences in body temperature,cough and expectoration,respiratory sounds and the normalized time for the count and classification of WBC between the groups.Conclusion HBO had good treatment effectiveness for excretion and expectorant in lung infection patients with severe brain injury and tracheotomy. Key words: Hyperbaric oxygenation; Craniocerebral trauma; Tracheotomy; Pulmonary edema; Lung infection