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Zaman T, Canarslan Demir K, Gunduz SH, Gulap Y, Basak AM, Yilmaz KB. Hyperbaric Oxygen Therapy as an Effective Adjunctive Treatment in the Reconstruction of Tissue Defects With Graft in Diabetic Foot Patients: A Retrospective Cohort Study. Int Wound J 2025; 22:e70686. [PMID: 40400128 PMCID: PMC12095177 DOI: 10.1111/iwj.70686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Revised: 04/08/2025] [Accepted: 04/30/2025] [Indexed: 05/23/2025] Open
Abstract
Diabetic foot patients frequently experience delayed wound healing due to compromised vascularity and oxygenation, which increases the risk of graft failure. Hyperbaric oxygen therapy (HBOT) has demonstrated potential in enhancing graft survival and accelerating wound healing in these patients. This study aimed to assess the efficacy of HBOT in improving graft success and wound healing rates in diabetic foot patients undergoing foot graft reconstruction. Forty-five diabetic patients with tissue defects requiring graft procedures were included. Among these, 28 patients received HBOT (2.4 ATA for 120 min daily), and 17 served as controls. Wound healing was assessed based on milestones of wound closure (25%, 50%, 75% and complete healing). The control group consisted of patients with adequate graft nutrition who did not require HBOT or were unable to undergo HBOT for other reasons. Statistical analyses were performed to compare healing times and graft retention rates between the two groups. Patients in the HBOT group exhibited significantly faster healing, with a median time to 50% healing of 18 days compared to 30.5 days in the control group (p < 0.05). A moderate negative correlation was observed between graft retention rates and time to complete healing (p < 0.05), indicating that higher graft retention was associated with shorter healing times. Despite higher HbA1c levels in the HBOT group, favourable healing outcomes were achieved. No adverse effects were reported in the HBOT group. HBOT significantly enhances graft survival and accelerates wound healing in diabetic foot patients, even in cases with poor glycaemic control. HBOT emerges as a valuable adjunctive treatment for patients with compromised vascular beds and hypoxic tissues. Future randomised controlled trials are needed to validate these results.
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Affiliation(s)
- Taylan Zaman
- Department of Underwater and Hyperbaric MedicineUniversity of Health Sciences, Gulhane Training and Research HospitalAnkaraTurkey
| | - Kübra Canarslan Demir
- Department of Underwater and Hyperbaric MedicineUniversity of Health Sciences, Gulhane Training and Research HospitalAnkaraTurkey
| | - Sukru Hakan Gunduz
- Department of Aerospace MedicineUniversity of Health Sciences, Defense Health Sciences InstituteAnkaraTurkey
| | - Yasin Gulap
- Department of General SurgeryUniversity of Health Sciences, Gulhane Training and Research HospitalAnkaraTurkey
| | - Ali Murat Basak
- Department of Orthopedics and TraumatologyUniversity of Health Sciences, Gulhane Training and Research HospitalAnkaraTurkey
| | - Kerim Bora Yilmaz
- Department of General SurgeryUniversity of Health Sciences, Gulhane Training and Research HospitalAnkaraTurkey
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Jackson JB, Bakaes Y, Jacques B, Gauthier C, Mills WL, Nguyen K, Gonzalez T, Cone DL. Adjunctive Hyperbaric Oxygen Therapy for Patients with Chronic Refractory Osteomyelitis: A Report of Treatment Outcomes and Risk Factors for Treatment Failure. Adv Skin Wound Care 2025; 38:40-45. [PMID: 39836555 DOI: 10.1097/asw.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
OBJECTIVE To evaluate the effect of hyperbaric oxygen (HBO) therapy on the outcomes of patients with chronic refractory osteomyelitis (CRO) when combined with modern antibiotics with modern delivery methods and/or surgical treatments. METHODS The authors conducted a retrospective review on 58 patients with CRO from a single institution who underwent HBO therapy along with standard treatment between January 2009 and December 2019. To investigate associations with binary outcomes of interest, they estimated logistic regression models. All models were adjusted for sex, smoking status, and pertinent comorbidities. Exponentiated logistic regression model coefficients were interpreted as odds ratios for each outcome of interest. Multivariable logistic regression was used to control for potential confounding variables. RESULTS When controlling for multiple confounding factors, patients who completed HBO treatment had 7.76 times the odds of having improvement of their CRO compared with patients who started HBO treatment but did not complete it (P = .015). Further, patients who completed HBO treatment had 7.7 times the odds of experiencing CRO improvement when controlling for CRO stage (P = .006). However, completion of HBO did not statistically significantly impact the resolution of CRO or the odds of further surgery or amputation. Patients with diabetes, peripheral vascular disease, and congestive heart failure had increased odds of having an amputation (Ps = .026, .037, and .024, respectively). CONCLUSIONS Patients who completed HBO treatment had increased odds of experiencing improvement of their CRO compared with patients who started HBO treatment but did not complete it. Patients with CRO who had diabetes and congestive heart failure had increased odds of undergoing an amputation.
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Affiliation(s)
- J Benjamin Jackson
- At the University of South Carolina, Columbia, South Carolina, USA, J. Benjamin Jackson III, MD, MBA, is Professor of Orthopaedic Surgery and Director of Orthopaedic Research, Department of Orthopaedics; and Yianni Bakaes, BS, and Ben Jacques, BS, are Medical Students, School of Medicine. Chase Gauthier, MD, is Research Fellow, Prisma Health Department of Orthopedics, Columbia, South Carolina. Also at the University of South Carolina, William L. Mills Jr, MD, and Kenny Nguyen, MD, are Medical Residents, School of Medicine; Tyler Gonzalez, MD, MBA, is Assistant Professor of Orthopaedic Surgery, Department of Orthopaedics; and David L. Cone, MD, is Clinical Associate Professor of Family and Preventative Medicine, School of Medicine. The authors have disclosed no financial relationships related to this article. Submitted September 6, 2023; accepted in revised form January 16, 2024
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Schindler C, Mikosiński J, Mikosiński P, Kärkkäinen HR, Sanio M, Kurkipuro J, Mierau I, Smith W, Vartiainen A, Décory L, Weber D, Wirth T, Yrjänheikki J, Schellong S, Samaranayake H. Multi-target gene therapy AUP1602-C to improve healing and quality of life for diabetic foot ulcer patients: a phase I, open-label, dose-finding study. Ther Adv Endocrinol Metab 2024; 15:20420188241294134. [PMID: 39838970 PMCID: PMC11748067 DOI: 10.1177/20420188241294134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 10/09/2024] [Indexed: 01/23/2025] Open
Abstract
Background Diabetic foot ulcer (DFU) is a common and highly morbid complication of diabetes with high unmet medical needs. AUP1602-C, a topical four-in-one gene therapy medicinal product (GTMP), consisting of a Lactococcus cremoris strain that produces fibroblast growth factor-2, interleukin-4, and colony-stimulating factor-1, is a promising novel treatment for DFU. Objectives The aim of this first-in-human study was to investigate whether AUP1602-C is safe and effective in improving wound healing and quality of life (QoL) in patients with non-healing DFU (nhDFU), and to determine the recommended phase II dose. Design Phase I, single-arm, open-label, uncontrolled, dose escalation study. Methods The study consisted of four cohorts of patients receiving AUP1602-C as a single dose of 2.5 × 105 colony-forming units (CFU)/cm2 ulcer size or as repeated doses between 2.5 × 106 and 2.5 × 108 CFU/cm2 administered 3 times per week for 6 weeks. Within each cohort, a 3 + 3 scheme for monitoring safety, tolerability, and efficacy was applied. Results In total, 16 patients aged 53-80 years were included, 3 each in the safety and low dose, 4 in the medium dose, and 6 in the high-dose cohort. AUP1602-C demonstrated a favorable safety profile with almost 100% dosing compliance. The most frequently reported side effect related to treatment was skin maceration. No serious adverse reactions, systemic toxicity, deaths, or side effects suggestive of immunogenicity, hypersensitivity, allergic reaction, or dose-limiting toxicities related to treatment were reported. No biodistribution events were observed and shedding-related events were rare and did neither show accumulation nor dose dependency. The recommended phase II dose of 2.5 × 108 CFU/cm2 demonstrated complete healing in 83% of patients without recurrence of ulcers during follow-up. Conclusion AUP1602-C was safe and well tolerated and demonstrated dose-dependent efficacy in patients with nhDFU. Data supports further clinical development of AUP1602-C. Trial registration The study was registered in ClinicalTrials.gov (NCT04281992) and ClinicalTrialsRegister.eu (2018-003415-22).
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Affiliation(s)
- Christoph Schindler
- Center for Clinical Trials and Center for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany
| | | | | | | | - Mirka Sanio
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Jere Kurkipuro
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Igor Mierau
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Wesley Smith
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Aki Vartiainen
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Laurent Décory
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Dirk Weber
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Thomas Wirth
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
| | - Juha Yrjänheikki
- Aurealis Therapeutics, Zug, Switzerland
- Aurealis Therapeutics, Kuopio, Finland
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Davis M, Hom D. Current and Future Developments in Wound Healing. Facial Plast Surg 2023; 39:477-488. [PMID: 37308128 PMCID: PMC11121504 DOI: 10.1055/s-0043-1769936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Poor wound healing on the face and neck can lead to significant morbidity and dissatisfaction in facial plastic surgery. With current advances in wound healing management and commercially available biologic and tissue-engineered products, there are several options available to optimize acute wound healing and treat delayed or chronic wounds. This article summarizes some of the key principals and recent developments in wound healing research in addition to potential future advancements in the field of soft tissue wound healing.
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Affiliation(s)
- Morgan Davis
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, California
| | - David Hom
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, California
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Leite CBG, Tavares LP, Leite MS, Demange MK. Revisiting the role of hyperbaric oxygen therapy in knee injuries: Potential benefits and mechanisms. J Cell Physiol 2023; 238:498-512. [PMID: 36649313 DOI: 10.1002/jcp.30947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
Knee injury negatively impacts routine activities and quality of life of millions of people every year. Disruption of tendons, ligaments, and articular cartilage are major causes of knee lesions, leading to social and economic losses. Besides the attempts for an optimal recovery of knee function after surgery, the joint healing process is not always adequate given the nature of intra-articular environment. Based on that, different therapeutic methods attempt to improve healing capacity. Hyperbaric oxygen therapy (HBOT) is an innovative biophysical approach that can be used as an adjuvant treatment post-knee surgery, to potentially prevent chronic disorders that commonly follows knee injuries. Given the well-recognized role of HBOT in improving wound healing, further research is necessary to clarify the benefits of HBOT in damaged musculoskeletal tissues, especially knee disorders. Here, we review important mechanisms of action for HBOT-induced healing including the induction of angiogenesis, modulation of inflammation and extracellular matrix components, and activation of parenchyma cells-key events to restore knee function after injury. This review discusses the basic science of the healing process in knee injuries, the role of oxygen during cicatrization, and shed light on the promising actions of HBOT in treating knee disorders, such as tendon, ligament, and cartilage injuries.
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Affiliation(s)
- Chilan B G Leite
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Luciana P Tavares
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Magno S Leite
- Laboratório de Poluição Atmosférica Experimental LIM05, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Marco K Demange
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Mantri Y, Mishra A, Anderson CA, Jokerst JV. Photoacoustic imaging to monitor outcomes during hyperbaric oxygen therapy: validation in a small cohort and case study in a bilateral chronic ischemic wound. BIOMEDICAL OPTICS EXPRESS 2022; 13:5683-5694. [PMID: 36733747 PMCID: PMC9872873 DOI: 10.1364/boe.472568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 06/18/2023]
Abstract
Hyperbaric oxygen therapy (HBO2) is a common therapeutic modality that drives oxygen into hypoxic tissue to promote healing. Here, ten patients undergoing HBO2 underwent PA oximetry of the left radial artery and forearm pre- and post-HBO2; this cohort validated the use of PA imaging in HBO2. There was a significant increase in radial artery oxygenation after HBO2 (p = 0.002) in the validation cohort. We also include a case study: a non-diabetic male in his 50s (HB 010) presenting with bilateral ischemic and gangrenous wounds. HB 010 showed higher perfusion and oxygen saturation on the right foot than the left after HBO2 which correlated with independent surgical observations. Imaging assisted with limb salvage treatment. Hence, this work shows that PA imaging can measure changes in arterial oxygen saturation due to HBO2; it can also produce 3D maps of tissue oxygenation and evaluate response to therapy during HBO2.
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Affiliation(s)
- Yash Mantri
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Aditya Mishra
- Materials Science Program, University of California San Diego, La Jolla, CA, USA
| | - Caesar A. Anderson
- Department of Emergency Medicine, Hyperbaric and Wound Healing Center, University of California San Diego, Encinitas, CA, USA
| | - Jesse V. Jokerst
- Materials Science Program, University of California San Diego, La Jolla, CA, USA
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
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7
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Fischer HG, Gey A, Fischer M, Plontke SK. [Hyperbaric oxygen therapy : Selected indications in the discipline of otorhinolaryngology]. HNO 2022; 70:848-860. [PMID: 36173420 DOI: 10.1007/s00106-022-01227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
Hyperbaric oxygenation (HBO) represents the controlled exposure to positive pressure with simultaneous inhalation of pure oxygen. It is considered to be an effective treatment option for diseases with restricted blood flow as oxygen not only binds chemically to hemoglobin but also physically dissolves in blood plasma. With the help of a hyperbaric chamber the ambient pressure of a patient can be modified and the physiological characteristics in positive pressure can be medically used. The indications relevant to otorhinolaryngology are necrotizing otitis externa and skull base osteomyelitis, other forms of osteomyelitis, gangrene, wound healing disorders and sudden loss of hearing. When choosing a treatment, not only the availability and costs of HBO treatment play a role but also the patient's tolerance of overpressure. The risks of treatment, e.g., due to oxygen toxicity or barotrauma of the middle ear or the paranasal sinuses, must be weighed up against the potential benefits.
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Affiliation(s)
- Hans-Georg Fischer
- Praxis für Hals-Nasen-Ohrenheilkunde, Schlehenweg 30, 04329, Leipzig, Deutschland. .,Abteilung für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Deutschland. .,Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Alexandra Gey
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Martin Fischer
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg, Leipzig, Deutschland
| | - Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Reiterer M, Eakin A, Johnson RS, Branco CM. Hyperoxia Reprogrammes Microvascular Endothelial Cell Response to Hypoxia in an Organ-Specific Manner. Cells 2022; 11:cells11162469. [PMID: 36010546 PMCID: PMC9406746 DOI: 10.3390/cells11162469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Organ function relies on microvascular networks to maintain homeostatic equilibrium, which varies widely in different organs and during different physiological challenges. The endothelium role in this critical process can only be evaluated in physiologically relevant contexts. Comparing the responses to oxygen flux in primary murine microvascular EC (MVEC) obtained from brain and lung tissue reveals that supra-physiological oxygen tensions can compromise MVEC viability. Brain MVEC lose mitochondrial activity and undergo significant alterations in electron transport chain (ETC) composition when cultured under standard, non-physiological atmospheric oxygen levels. While glycolytic capacity of both lung and brain MVEC are unchanged by environmental oxygen, the ability to trigger a metabolic shift when oxygen levels drop is greatly compromised following exposure to hyperoxia. This is particularly striking in MVEC from the brain. This work demonstrates that the unique metabolism and function of organ-specific MVEC (1) can be reprogrammed by external oxygen, (2) that this reprogramming can compromise MVEC survival and, importantly, (3) that ex vivo modelling of endothelial function is significantly affected by culture conditions. It further demonstrates that physiological, metabolic and functional studies performed in non-physiological environments do not represent cell function in situ, and this has serious implications in the interpretation of cell-based pre-clinical models.
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Affiliation(s)
- Moritz Reiterer
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Amanda Eakin
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK
| | - Randall S. Johnson
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Cristina M. Branco
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK
- Correspondence:
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Özyurt A. Does hyperbaric oxygen therapy pressure reduce mechanical stability of implants? JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:59. [PMID: 35838809 PMCID: PMC9287222 DOI: 10.1007/s10856-022-06680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Hyperbaric oxygen therapy (HBOT) has beneficial effects for patients complaining of poor bone healing such as related to diabetes mellitus. However, it is known that changing pressure conditions might cause dental barotrauma in the oral cavity. The aim of this study was to evaluate implant mechanical stability under HBOT pressure. Thirty-five implants were placed in bone blocks divided into five groups as control, 1, 3, 5, 7 HBOT cycles. In one cycle, 2.4 bar 100% oxygen pressure was performed. Implants' stabilities were measured with resonance frequency analysis (RFA) and removal torque (RT) meter device. Data were analyzed using Shapiro Wilk, ANOVA, and Tukey HSD tests for RFA and RT values considering p < 0.05 as the statistical significance level. RFA and RT values were compared by Pearson correlation coefficiency. RFA values of 5 and 7 HBOT cycles were significantly lower than 1, 3 HBOT and control group (p < 0.001). There was no statistical difference between 5 and 7 HBOT cycles RFA values. HBOT pressure simulation slightly but statistically decreased the stability for the implants exposed to 5 and 7 HBOT cycles. Graphical abstract.
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Affiliation(s)
- Anıl Özyurt
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dokuz Eylül University, İzmir, 35340, Turkey.
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Mantri Y, Dorobek TR, Tsujimoto J, Penny WF, Garimella PS, Jokerst JV. Monitoring peripheral hemodynamic response to changes in blood pressure via photoacoustic imaging. PHOTOACOUSTICS 2022; 26:100345. [PMID: 35295617 PMCID: PMC8918860 DOI: 10.1016/j.pacs.2022.100345] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 05/18/2023]
Abstract
Chronic wounds and amputations are common in chronic kidney disease patients needing hemodialysis (HD). HD is often complicated by drops in blood pressure (BP) called intra-dialytic hypotension. Whether intra-dialytic hypotension is associated with detectable changes in foot perfusion, a risk factor for wound formation and impaired healing remains unknown. Photoacoustic (PA) imaging is ideally suited to study perfusion changes. We scanned the feet of 20 HD and 11 healthy subjects. HD patients were scanned before and after a dialysis session whereas healthy subjects were scanned twice at rest and once after a 10 min exercise period while BP was elevated. Healthy (r = 0.70, p < 0.0001) and HD subjects (r = 0.43, p < 0.01) showed a significant correlation between PA intensity and systolic BP. Furthermore, HD cohort showed a significantly reduced PA response to changes in BP compared to the healthy controls (p < 0.0001), showing that PA can monitor hemodynamic changes due to changes in BP.
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Affiliation(s)
- Yash Mantri
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Tyler R. Dorobek
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Jason Tsujimoto
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - William F. Penny
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Pranav S. Garimella
- Department of Nephrology – Hypertension, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jesse V. Jokerst
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Materials Science Program, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
- Correspondence to: University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Biofilm Survival Strategies in Chronic Wounds. Microorganisms 2022; 10:microorganisms10040775. [PMID: 35456825 PMCID: PMC9025119 DOI: 10.3390/microorganisms10040775] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023] Open
Abstract
Bacterial biofilms residing in chronic wounds are thought to have numerous survival strategies, making them extremely difficult to eradicate and resulting in long-term infections. However, much of our knowledge regarding biofilm persistence stems from in vitro models and experiments performed in vivo in animal models. While the knowledge obtained from such experiments is highly valuable, its direct translation to the human clinical setting should be undertaken with caution. In this review, we highlight knowledge obtained from human clinical samples in different aspects of biofilm survival strategies. These strategies have been divided into segments of the following attributes: altered transcriptomic profiles, spatial distribution, the production of extracellular polymeric substances, an altered microenvironment, inter-and intra-species interactions, and heterogeneity in the bacterial population. While all these attributes are speculated to contribute to the enhanced persistence of biofilms in chronic wounds, only some of them have been demonstrated to exist in human wounds. Some of the attributes have been observed in other clinical diseases while others have only been observed in vitro. Here, we have strived to clarify the limitations of the current knowledge in regard to this specific topic, without ignoring important in vitro and in vivo observations.
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Kurkipuro J, Mierau I, Wirth T, Samaranayake H, Smith W, Kärkkäinen HR, Tikkanen M, Yrjänheikki J. Four in one-Combination therapy using live Lactococcus lactis expressing three therapeutic proteins for the treatment of chronic non-healing wounds. PLoS One 2022; 17:e0264775. [PMID: 35226700 PMCID: PMC8884502 DOI: 10.1371/journal.pone.0264775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/17/2022] [Indexed: 01/03/2023] Open
Abstract
Diabetes mellitus is one of the major concerns for health care systems, affecting 382 million people worldwide. Among the different complications of diabetes, lower limbs chronic ulceration is a common, severe and costly cause of morbidity. Diabetic foot ulcers are a leading cause of hospitalization in diabetic patients and its rate exceed the ones of congestive heart failure, depression or renal disease. Diabetic non-healing ulcers account for more than 60% of all non-traumatic lower limb amputations and the five-year mortality after amputation is higher than 50%, being equal to several types of advanced cancer. The primary management goals for an existing diabetic foot ulcer are to achieve primary healing as expeditiously as possible and to achieve a reduction of the amputation rate in the patients. Unfortunately, approximately a quarter of patients do not partially or fully respond to the standard of care. Advanced therapies for chronic wounds are existing, however, recent guidelines including the latest reviews and meta-analyses of the scientific and clinical evidence available from current treatment strategies and new therapeutic agents revealed that there is a lack of clinical data and persistent gap of evidence for many of the advanced therapeutic approaches. In addition, no pharmacological wound healing product has gained authority approval for more than 10 years in both US and EU, constituting a highly unmet medical need. In this publication we present data from a live biopharmaceutical product AUP1602-C designed as a single pharmaceutical entity based on the non-pathogenic, food-grade lactic acid bacterium Lactococcus lactis subsp. cremoris that has been genetically engineered to produce human fibroblast growth factor 2,interleukin4 and colony stimulating factor 1. Designed to address different aspects of wound healing (i.e. fibroblast proliferation, angiogenesis and immune cell activation) and currently in phase I clinical study, we show how the combination of the individual components on the wound micro-environment initiates and improves the wound healing in chronic wounds.
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Hyperbaric oxygen adjuvant therapy in severe mangled extremities. Injury 2021; 52:3511-3515. [PMID: 34256945 DOI: 10.1016/j.injury.2021.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 06/15/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mangled Extremity Severity Score (MESS) was first described more than 30 years ago by attempting to predict the need for empiric amputation. In severe traumatic crush and blast injuries, achieving satisfactory limb salvage may be difficult. Notably, a MESS of 7 or higher is consistently predictive of amputation. Additionally, Hyperbaric Oxygen Therapy (HBOT) has been described for many purposes, and related studies have reported HBOT showed benefits in wound healing properties. OBJECTIVE The study aimed to evaluate the results of a prospective series of a new modality of adjuvant HBOT for severe mangled extremities. METHOD A total of 18 patients were evaluated for clinical and radiographic review. Current standard treatments followed by adjuvant HBOT were administered, and the mean follow-up period was 22 months. Time to wound closure, the number of surgeries and adjuvant HBOT treatment were analyzed for patient clinical evaluation. Complications and limb amputation rates were also recorded. RESULT Most clinical findings on follow-up were good to excellent after adjunctive HBOT. Minimal soft tissue infection was recorded, and limb salvage was successful in most cases. Only 1 patient (5.56 %) needed limb amputation because of a dying limb with chronic refractory osteomyelitis. CONCLUSION HBOT is an excellent adjunctive option in severely mangled extremities. Nevertheless, the main treatments are eliminating infection and managing surgery, and are promising in the recovery of severe extremity injuries. Although the MESS was evaluated at 7 or higher, limb salvage procedures followed by HBOT should be considered.
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Xu Z, Liang B, Tian J, Wu J. Anti-inflammation biomaterial platforms for chronic wound healing. Biomater Sci 2021; 9:4388-4409. [PMID: 34013915 DOI: 10.1039/d1bm00637a] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nowadays, there has been an increase in the number of people with chronic wounds, which has resulted in serious health problems worldwide. The rate-limiting stage of chronic wound healing has been found to be the inflammation stage, and strategies for shortening the prolonged inflammatory response have proven to be effective for increasing the healing rate. Recently, various anti-inflammatory strategies (such as anti-inflammatory drugs, antioxidant, NO regulation, antibacterial, immune regulation and angiogenesis) have attracted attention as potential therapeutic pathways. Moreover, various biomaterial platforms based on anti-inflammation therapy strategies have also emerged in the spotlight as potential therapies to accelerate the repair of chronic wounds. In this review, we systematically investigated the advances of various biomaterial platforms based on anti-inflammation strategies for chronic wound healing, to provide valuable guidance for future breakthroughs in chronic wound treatment.
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Affiliation(s)
- Zejun Xu
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, P. R. China.
| | - Biao Liang
- Center of Digestive Endoscopy, Guangdong Second Provincial general Hospital, No. 466, Xingang Middle Road, Guangzhou 510317, Haizhu District, China.
| | - Junzhang Tian
- Center of Digestive Endoscopy, Guangdong Second Provincial general Hospital, No. 466, Xingang Middle Road, Guangzhou 510317, Haizhu District, China.
| | - Jun Wu
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, P. R. China.
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Yunir E, Tahapary DL, Tarigan TJE, Harbuwono DS, Oktavianda YD, Kristanti M, Iswati E, Sarumpaet A, Soewondo P. Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia. J Diabetes Metab Disord 2021; 20:805-813. [PMID: 34178865 PMCID: PMC8212257 DOI: 10.1007/s40200-021-00827-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Diabetic foot ulcer (DFU) is a common chronic complication of type 2 diabetes mellitus (T2DM) in Indonesia, with a prevalence of 7.3%. However, the characteristics of these patients remain unclear. We investigated the characteristics of patients with DFU without peripheral arterial disease (PAD) and analyzed non-vascular factors related to severity of DFU in a tertiary care national referral hospital in Indonesia. METHODS This was a cross-sectional study including 123 hemodynamically stable DFU patients without PAD recruited from Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia from 2010-2015. RESULTS DFU patients were predominantly over 50 years old (75.6%) and diagnosed with T2DM for 5 years with poor glycemic control (82.7%) and peripheral neuropathy (91.3%). Most patients had anemia (86.7%), leukocytosis (84.6%), and were undernourished, as characterized by a low lipid profile (90.8%) and hypoalbuminemia (83.7%). Most had extensive size of ulcer at the initial visit, with a median size of 16.23 (2.92-60.16) cm2. Ulcers were mostly located of the forefoot (62.5%) and were caused by mechanical trauma (46.2%). Bivariate analysis revealed that significant factors for the development of DFU were related to DFU size, including duration of T2DM (p = 0.04), leukocyte levels (p = < 0.01), and thrombocyte levels (p = < 0.01). Multivariate analysis showed leucocyte (p = 0.03) and thrombocyte (p = 0.023) had significantly correlated with DFU severity. CONCLUSION Leucocyte and thrombocyte may be the greatest contributing non-vascular factors for severity of DFU in Indonesia.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dicky L. Tahapary
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tri Juli Edi Tarigan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dante Saksono Harbuwono
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yoga Dwi Oktavianda
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Melly Kristanti
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Eni Iswati
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Angela Sarumpaet
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Pradana Soewondo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Vinkel J, Holm NFR, Jakobsen JC, Hyldegaard O. Effects of adding adjunctive hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers: a protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2020; 10:e031708. [PMID: 32601110 PMCID: PMC7328748 DOI: 10.1136/bmjopen-2019-031708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Diabetic foot ulcer represents a major health problem globally. Preliminary studies have indicated that systemic treatment of diabetic foot ulcer patients with hyperbaric oxygen therapy have beneficial effects on wound healing, risk of amputation, glycaemic control, atherosclerosis, inflammatory markers and other clinical and laboratory parameters. This protocol for a systematic review aims at identifying the beneficial and harmful effects of adding hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers. METHODS AND ANALYSIS This protocol was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of hyperbaric oxygen therapy in the treatment of diabetic foot ulcer versus any control group with any intervention defined as standard wound care or similar, together with sham interventions. Our primary outcome will be: all-cause mortality, serious adverse events and quality of life. Our secondary outcomes will be: healing of index wound, major amputation and wound infection. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5 and Trial Sequential Analysis. For both our primary and secondary outcomes, we will create a 'Summary of Findings' table and use GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment to assess the quality of the evidence. ETHICS AND DISSEMINATION We use publicly accessible documents as evidence, there is no participant involvement at an individual level and an institutional ethics approval is not required. The results of the review will be sought published in a peer-reviewed journals, also in the event of insignificant results or null results, and thereby it will be disseminated to clinicians and public available. PROSPERO REGISTRATION NUMBER CRD42019139256.
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Affiliation(s)
- Julie Vinkel
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
| | - Niels Frederich Rose Holm
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
- Department of Cardiology, Holbaek Sygehus, Holbaek, Sjaelland, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Holbæk Hospital, Holbaek, Denmark
| | - Ole Hyldegaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
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Rogers RK, Montero-Baker M, Biswas M, Morrison J, Braun J. Assessment of foot perfusion: Overview of modalities, review of evidence, and identification of evidence gaps. Vasc Med 2020; 25:235-245. [PMID: 32362209 DOI: 10.1177/1358863x20909433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patients with critical limb ischemia have nonhealing wounds and/or ischemic rest pain and are at high risk for amputation and mortality. Accurate evaluation of foot perfusion should help avoid unnecessary amputation, guide revascularization strategies, and offer efficient surveillance for patency. Our aim is to review current modalities of assessing foot perfusion in the context of the practical clinical management of patients with critical limb ischemia.
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Affiliation(s)
- R Kevin Rogers
- Section of Vascular Medicine, Division of Cardiology, University of Colorado, Aurora, CO, USA
| | - Miguel Montero-Baker
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Minakshi Biswas
- Section of Vascular Medicine, Division of Cardiology, University of Colorado, Aurora, CO, USA
| | - Justin Morrison
- Section of Vascular Medicine, Division of Cardiology, University of Colorado, Aurora, CO, USA
| | - Jonathan Braun
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
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Tejada S, Batle JM, Ferrer MD, Busquets-Cortés C, Monserrat-Mesquida M, Nabavi SM, Del Mar Bibiloni M, Pons A, Sureda A. Therapeutic Effects of Hyperbaric Oxygen in the Process of Wound Healing. Curr Pharm Des 2020; 25:1682-1693. [PMID: 31269879 DOI: 10.2174/1381612825666190703162648] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/20/2019] [Indexed: 12/20/2022]
Abstract
Chronic and non-healing wounds, especially diabetic foot ulcers and radiation injuries, imply remarkable morbidity with a significant effect on the quality of life and a high sanitary cost. The management of these wounds requires complex actions such as surgical debris, antibiotic treatment, dressings and even revascularization. These wounds are characterized by poor oxygen supply resulting in inadequate oxygenation of the affected tissue. The adjuvant treatment with hyperbaric oxygen therapy (HBOT) may increase tissue oxygenation favoring the healing of wounds which do not respond to the usual clinical care. The increase in the partial pressure of oxygen contributes to cover the energy demands necessary for the healing process and reduces the incidence of infections. Moreover, the increase in oxygen leads to the production of reactive species with hormetic activity, acting on signaling pathways that modulate the synthesis of inflammation mediators, antioxidants and growth factors which can contribute to the healing process. Studies performed with cell cultures and in animal models seem to demonstrate the beneficial effects of HBOT. However, clinical trials do not show such conclusive results; thus, additional randomized placebo-controlled studies are necessary to determine the real efficacy of HBOT and the mechanism of action for various types of wounds.
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Affiliation(s)
- Silvia Tejada
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
| | - Juan M Batle
- MEDISUB Recerca (Institut de Recerca Hiperbarica), Cami d´Aucanada 52, E-07410 Pto. de Alcudia, Balearic Islands, Spain
| | - Miguel D Ferrer
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
| | - Carla Busquets-Cortés
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
| | - Margalida Monserrat-Mesquida
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
| | - Seyed M Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, 14359-16471 Tehran, Iran
| | - Maria Del Mar Bibiloni
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
| | - Antoni Pons
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
| | - Antoni Sureda
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands & CIBEROBN (Physiopathology of Obesity and Nutrition), E-07122, Palma de Mallorca, Balearic Islands, Spain
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Aasen DM, Wiedel C, Maroni P, Cohen ME, Meng X, Meguid RA. Association of Hospital Altitude and Postoperative Infectious Complications After Major Operations. High Alt Med Biol 2019; 20:421-426. [DOI: 10.1089/ham.2019.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Davis M. Aasen
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Cole Wiedel
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Maroni
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Robert A. Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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20
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Longobardi P, Hoxha K, Bennett MH. Is there a role for hyperbaric oxygen therapy in the treatment of refractory wounds of rare etiology? Diving Hyperb Med 2019; 49:216-224. [PMID: 31523797 PMCID: PMC6884104 DOI: 10.28920/dhm49.3.216-224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/01/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Delayed wound healing indicates wounds that have failed to respond to more than 4-6 weeks of comprehensive wound care. Wounds with delayed healing are a major source of morbidity and a major cost to hospital and community healthcare providers. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to wounds and has been applied to a variety of wound types. This article reviews the place of HBOT in the treatment of non-healing vasculitic, calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV), pyoderma gangrenosum (PG) ulcers. METHODS We searched electronic databases for research and review studies focused on HBOT for the treatment of delayed healing ulcers with rare etiologies. We excluded HBOT for ulcers reviewed elsewhere. RESULTS We included a total of three case series and four case reports including 63 participants. Most were related to severe, non-healing ulcers in patients with vasculitis, CUA, LV, and PG. There was some evidence that HBOT may improve the healing rate of wounds by increasing nitric oxide (NO) levels and the number of endothelial progenitor cells in the wounds. HBOT may also improve pain in these ulcers. CONCLUSION We recommend the establishment of comprehensive and detailed wound care registries to rapidly collect prospective data on the use of HBOT for these problem wounds. There is a strong case for appropriately powered, multi-centre randomized trials to establish the true efficacy and cost-effectiveness of HBOT especially for vasculitis ulcers that have not improved following immunosuppressive therapy.
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Affiliation(s)
- Pasquale Longobardi
- Corresponding author: Dr Pasquale Longobardi, Chief Medical Director, Centro Iperbarico, via Augusto Torre 3, 48124 Ravenna, Italy,
- Centro Iperbarico (Hyperbaric Medicine and Wound Care Centre), Ravenna, Italy
| | - Klarida Hoxha
- Centro Iperbarico (Hyperbaric Medicine and Wound Care Centre), Ravenna, Italy
| | - Michael H Bennett
- Department of Anaesthesia, University of New South Wales, Sydney, Australia
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Marston WA, Lantis JC, Wu SC, Nouvong A, Lee TD, McCoy ND, Slade HB, Tseng SC. An open-label trial of cryopreserved human umbilical cord in the treatment of complex diabetic foot ulcers complicated by osteomyelitis. Wound Repair Regen 2019; 27:680-686. [PMID: 31376297 PMCID: PMC6900178 DOI: 10.1111/wrr.12754] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
Clinical trials of potential new therapies for diabetic foot ulcers rarely enroll patients whose wounds extend to muscle, fascia, or bone with clinical and radiographic evidence of underlying osteomyelitis. An open‐label, multicenter trial of cryopreserved human umbilical cord (TTAX01) was undertaken in 32 subjects presenting with such complex wounds with a mean duration of 6.1 ± 9.0 (range: 0.2–47.1) months and wound area at screening of 3.8 ± 2.9 (range: 1.0–9.6) cm2. Aggressive surgical debridement at baseline resulted in 17 minor amputations and an increase in mean wound area to 7.4 ± 5.8 (range: 1.1–28.6) cm2. All subjects were placed on systemic antibiotics for at least 6 weeks in conjunction with baseline application of TTAX01. Repeat applications were made at no less than 4‐week intervals over the 16‐week trial. Initial closure occurred in 18 of 32 (56%) wounds, with 16 (50%) of these having confirmed closure in 16 weeks with a median of one‐product application. Cases with biopsy confirmed osteomyelitis (n = 20) showed initial closure in 12 (60%) wounds and confirmed closure in 10 (50%) wounds. Four of the five ulcers presenting as recurrences experienced confirmed closure. Mean overall time to healing was 12.8 ± 4.3 weeks. Mean wound area reduction from baseline was 91% for all wounds. Of the 16 wounds without confirmed closure during the 16‐week treatment period, five (31.3%) achieved 99–100% wound area reduction by their final visit. The product was well tolerated. Two minor amputations occurred during the study period due to recurrent or persistent osteomyelitis; however, there were no major amputations.
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Affiliation(s)
- William A Marston
- Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - John C Lantis
- Department of Surgery, Mt Sinai West and St Luke's Hospitals, New York, New York
| | - Stephanie C Wu
- Department of Podiatric Surgery & Applied Biomechanics, Rosalind Franklin University, North Chicago, Illinois
| | | | - Tommy D Lee
- Research & Development, TissueTech, Inc., Miami, Florida
| | | | - Herbert B Slade
- Research & Development, TissueTech, Inc., Miami, Florida.,Department of Pediatrics, University of North Texas Health Sciences Center, Fort Worth, Texas
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Goggins CA, Khachemoune A. The use of hyperbaric oxygen therapy in the treatment of necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2019. [DOI: 10.15570/actaapa.2019.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Digit Tip Injuries: Current Treatment and Future Regenerative Paradigms. Stem Cells Int 2019; 2019:9619080. [PMID: 30805012 PMCID: PMC6360566 DOI: 10.1155/2019/9619080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/07/2018] [Accepted: 12/27/2018] [Indexed: 11/18/2022] Open
Abstract
Over the past several decades there has been a profound increase in the understanding of tissue regeneration, driven largely by the observance of the tremendous regenerative capacity in lower order life forms, such as hydra and urodeles. However, it is known that humans and other mammals retain the ability to regenerate the distal phalanges of the digits after amputation. Despite the increased knowledge base on model organisms regarding regenerative paradigms, there is a lack of application of regenerative medicine techniques in clinical practice in regard to digit tip injury. Here, we review the current understanding of digit tip regeneration and discuss gaps that remain in translating regenerative medicine into clinical treatment of digit amputation.
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Hyperbaric Oxygen Therapy and Utilization in Infectious Disease. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Savvidou OD, Kaspiris A, Bolia IK, Chloros GD, Goumenos SD, Papagelopoulos PJ, Tsiodras S. Effectiveness of Hyperbaric Oxygen Therapy for the Management of Chronic Osteomyelitis: A Systematic Review of the Literature. Orthopedics 2018; 41:193-199. [PMID: 30035798 DOI: 10.3928/01477447-20180628-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hyperbaric oxygen has been used as an adjunctive measure in the treatment of chronic osteomyelitis. The aim of this systematic literature review was to analyze the outcome and the complications of hyperbaric oxygen for chronic osteomyelitis. Forty-five of 96 studies reporting the use of hyper-baric oxygen for 460 patients with chronic osteomyelitis met the inclusion criteria and were analyzed qualitatively. All patients previously received antibiotics and surgical debridement. Mixed bacterial flora was detected in most of the studies. Staphylococcus aureus was the isolated pathogen in 12 (60%) of the 20 cohort and in 4 (20%) of the 20 case studies. Adjuvant hyperbaric oxygen was effective in 16 (80%) of the 20 cohort and 19 (95%) of the 20 case studies. Overall, 308 (73.5%) of 419 patients with complete data had a successful outcome and no reported relapse. Available evidence supports a potentially beneficial role of adjunctive hyperbaric oxygen, especially in refractory cases of chronic osteomyelitis. [Orthopedics. 2018; 41(4):193-199.].
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Adjunctive Hyperbaric Oxygen Therapy for Healing of Chronic Diabetic Foot Ulcers. J Wound Ostomy Continence Nurs 2017; 44:536-545. [DOI: 10.1097/won.0000000000000374] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Everts PA, Warbout M, de Veth D, Cirkel M, Spruijt NE, Buth J. Use of epidermal skin grafts in chronic wounds: a case series. Int Wound J 2017; 14:1213-1218. [PMID: 29076239 DOI: 10.1111/iwj.12787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic wounds. Wound bed preparation consisted of surgical necrotectomy or sharp debridement, hyperbaric oxygen therapy, negative pressure wound therapy, compression therapy, platelet-rich plasma therapy and/or heparan sulphate agents. Epidermal grafts were harvested from the patient's thigh and applied to the wound. Wound and donor site healing was monitored. A total of 78 patients (average age = 64·1 ± 15·6 years) were included in the study. Common comorbidities included hypertension (47·4%), venous insufficiency (37·2%) and obesity (28·2%). Average wound duration was 13·2 months (range: 0·3-180 months). The most common wound types were dehiscence (29·5%), radiation ulcer (24·4%) and venous ulcer (17·9%). Total time from epidermal grafting to wound closure was 10·0 ± 7·3 weeks. Of the 78 wounds, 66 (84·6%) reached full wound closure (49 < 3 months, 16 > 3 months, 1 without time data). Of 78 wounds, 10 (12·8%) underwent partial wound healing, while 2 wounds (2/78; 2·6%) remained unhealed. These results suggest that wound surface reduction can be achieved by proactive early application of biological therapies and epidermal skin grafts, which may help decrease time to wound healing.
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Affiliation(s)
| | | | | | | | | | - Jaap Buth
- Da Vinci Clinic, Geldrop, The Netherlands
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André-Lévigne D, Modarressi A, Pepper MS, Pittet-Cuénod B. Reactive Oxygen Species and NOX Enzymes Are Emerging as Key Players in Cutaneous Wound Repair. Int J Mol Sci 2017; 18:ijms18102149. [PMID: 29036938 PMCID: PMC5666831 DOI: 10.3390/ijms18102149] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 02/07/2023] Open
Abstract
Our understanding of the role of oxygen in cell physiology has evolved from its long-recognized importance as an essential factor in oxidative metabolism to its recognition as an important player in cell signaling. With regard to the latter, oxygen is needed for the generation of reactive oxygen species (ROS), which regulate a number of different cellular functions including differentiation, proliferation, apoptosis, migration, and contraction. Data specifically concerning the role of ROS-dependent signaling in cutaneous wound repair are very limited, especially regarding wound contraction. In this review we provide an overview of the current literature on the role of molecular and reactive oxygen in the physiology of wound repair as well as in the pathophysiology and therapy of chronic wounds, especially under ischemic and hyperglycemic conditions.
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Affiliation(s)
- Dominik André-Lévigne
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland.
| | - Ali Modarressi
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland.
| | - Michael S Pepper
- Department of Human Genetics and Development, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland.
- SAMRC Extramural Unit for Stem Cell Research and Therapy, and Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa.
| | - Brigitte Pittet-Cuénod
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland.
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Abstract
GENERAL PURPOSE To provide information about hyperbaric oxygen therapy (HBOT), its mechanisms, indications and safe applications based on clinical evidence. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Recall the physiology of wound healing and the mechanisms of action of HBOT.2. Identify current applications of HBOT based on clinical evidence as well as its risks and contraindications. ABSTRACT Treating chronic wounds and infections are challenging medical problems worldwide. Hyperbaric oxygen therapy (HBOT), the administration of 100% oxygen at pressures greater than 1.4 atmosphere absolute in a series of treatments, can be used as an adjunctive therapy in many wound care settings because it improves oxygenation and neovascularization and decreases inflammation in chronic wounds. A growing number of studies support the benefits of HBOT for enhancing wound healing and decreasing the likelihood of negative events such as amputation. However, many practitioners are unfamiliar with HBOT. This article provides a general introduction to HBOT, reviews the physiology and mechanisms of behind HBOT, discusses all the indications for HBOT, and explores in-depth the clinical evidence for HBOT in the treatment of arterial insufficiencies, diabetic ulcers, delayed radiation injury, and chronic refractory osteomyelitis.
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Avishai E, Yeghiazaryan K, Golubnitschaja O. Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalised medicine. EPMA J 2017; 8:23-33. [PMID: 28620441 PMCID: PMC5471802 DOI: 10.1007/s13167-017-0081-y] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 12/14/2022]
Abstract
Whereas the physiologic wound healing (WH) successfully proceeds through the clearly defined sequence of the individual phases of wound healing, chronic non-healing wounds/ulcers fail to complete the individual stages and the entire healing process. There are many risk factors both modifiable (such as stress, smoking, inappropriate alcohol consumption, malnutrition, obesity, diabetes, cardio-vascular disease, etc.) and non-modifiable (such as genetic diseases and ageing) strongly contributing to the impaired WH. Current statistics demonstrate that both categories are increasingly presented in the populations, which causes dramatic socio-economic burden to the healthcare sector and society at large. Consequently, innovative concepts by predictive, preventive and personalised medicine are crucial to be implemented in the area. Individual risk factors, causality, functional interrelationships, molecular signature, predictive diagnosis, and primary and secondary prevention are thoroughly analysed followed by the expert recommendations in this paper.
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Affiliation(s)
- Eden Avishai
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kristina Yeghiazaryan
- Radiological Clinic, Medical Faculty, Friedrich-Wilhels-University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Olga Golubnitschaja
- Radiological Clinic, Medical Faculty, Friedrich-Wilhels-University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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Dunnill C, Patton T, Brennan J, Barrett J, Dryden M, Cooke J, Leaper D, Georgopoulos NT. Reactive oxygen species (ROS) and wound healing: the functional role of ROS and emerging ROS-modulating technologies for augmentation of the healing process. Int Wound J 2017; 14:89-96. [PMID: 26688157 PMCID: PMC7950185 DOI: 10.1111/iwj.12557] [Citation(s) in RCA: 756] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/15/2022] Open
Abstract
Reactive oxygen species (ROS) play a pivotal role in the orchestration of the normal wound-healing response. They act as secondary messengers to many immunocytes and non-lymphoid cells, which are involved in the repair process, and appear to be important in coordinating the recruitment of lymphoid cells to the wound site and effective tissue repair. ROS also possess the ability to regulate the formation of blood vessels (angiogenesis) at the wound site and the optimal perfusion of blood into the wound-healing area. ROS act in the host's defence through phagocytes that induce an ROS burst onto the pathogens present in wounds, leading to their destruction, and during this period, excess ROS leakage into the surrounding environment has further bacteriostatic effects. In light of these important roles of ROS in wound healing and the continued quest for therapeutic strategies to treat wounds in general and chronic wounds, such as diabetic foot ulcers, venous and arterial leg ulcers and pressure ulcers in particular, the manipulation of ROS represents a promising avenue for improving wound-healing responses when they are stalled. This article presents a review of the evidence supporting the critical role of ROS in wound healing and infection control at the wound site, and some of the new emerging concepts associated with ROS modulation and its potential in improving wound healing are discussed.
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Affiliation(s)
- Christopher Dunnill
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUK
- Department of Biological Sciences, School of Applied SciencesUniversity of HuddersfieldHuddersfieldUK
| | | | | | | | - Matthew Dryden
- Department of MicrobiologyHampshire Hospitals NHS Foundation TrustWinchesterUK
- Rare and Imported Pathogens Laboratory (RIPL)Public Health EnglandPorton DownUK
| | - Jonathan Cooke
- Centre for Infection Prevention and Management, Division of MedicineImperial CollegeLondonUK
- Manchester Pharmacy SchoolFaculty of Medical and Human Sciences, University of ManchesterManchesterUK
| | - David Leaper
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUK
| | - Nikolaos T Georgopoulos
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUK
- Department of Biological Sciences, School of Applied SciencesUniversity of HuddersfieldHuddersfieldUK
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Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections - a single center's experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:198-202. [PMID: 27785131 PMCID: PMC5071585 DOI: 10.5114/kitp.2016.62604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Deep sternal wound infection (DSWI) is one of the most serious complications after cardiac surgery procedures, observed in 5% of patients. Current standard medical therapy for DSWI includes antibiotics, surgical debridement, resuturing or negative pressure wound therapy (NPWT). Unfortunately, in some cases these methods are insufficient, and additional therapeutic options are needed. AIM To assess the effects and usefulness of additional hyperbaric oxygen therapy (HBO2) in patients with DSWI after cardiac surgery procedures. MATERIAL AND METHODS A retrospective analysis of 10 patients after cardiac surgery who developed DSWI in the period 2010-2012 was performed. After 3 months of ineffective conventional therapy including targeted antibiotic, surgical sternal debridement and NPWT, patients were qualified for additional HBO2 therapy. A total of 20 sessions of HBO2 therapy were performed, each 92 minutes long. RESULTS After 4 weeks of HBO2 treatment, 7 patients presented complete wound healing with fibrous scar formation. One patient was qualified for the another cycle of HBO2 therapy with 20 additional sessions, and complete wound healing was observed. In 2 cases, after 5 and 19 sessions, HBO2 was interrupted because of improper qualifications. CONCLUSIONS The HBO2 as an additional therapy in DSWI was successful in 80% of cases, and no complications were observed. However, due to the small number of published studies with a small number of patients, randomized, clinical trials are needed to assess the clinical results of HBO2 in DSWI after cardiac surgery procedures.
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André-Lévigne D, Modarressi A, Pignel R, Bochaton-Piallat ML, Pittet-Cuénod B. Hyperbaric oxygen therapy promotes wound repair in ischemic and hyperglycemic conditions, increasing tissue perfusion and collagen deposition. Wound Repair Regen 2016; 24:954-965. [PMID: 27684570 DOI: 10.1111/wrr.12480] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/03/2016] [Indexed: 01/21/2023]
Abstract
The treatment of chronic wounds remains inconsistent and empirical. Hyperbaric oxygen therapy (HBOT) is a promising method to improve wound repair but there is still a lack of understanding of its mechanisms of action and its indications are not yet clearly defined. We studied the effects of HBOT in four different wound conditions by inflicting bilateral wounds on the dorsal aspect of the feet of nonischemic or ischemic limbs in normoglycemic or hyperglycemic rats. To create an ischemic condition, arterial resection was performed unilaterally. Forty-four animals received HBOT five times a week until complete wound closure. Wound repair was compared with 44 rats receiving standard dressing only. HBOT increased blood flow and accelerated wound closure in ischemic and hyperglycemic wounds, most significantly when the two conditions were combined. Wound contraction and reepithelialization were similarly stimulated by HBOT. The acceleration of wound contraction was not associated with increased myofibroblasts expression, nor fibroblast recruitment or higher cell count in the granulation tissue. Of note, we observed a significant increase in collagen deposition in early time points in ischemic wounds receiving HBOT. This data emphasizes that an early application of HBOT might be crucial to its efficacy. We concluded that wounds where ischemia and hyperglycemia are combined, as it is often the case in diabetic patients, have the best chance to benefit from HBOT.
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Affiliation(s)
- Dominik André-Lévigne
- Division of Plastic, Reconstructive & Aesthetic Surgery, Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Ali Modarressi
- Division of Plastic, Reconstructive & Aesthetic Surgery, Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Rodrigue Pignel
- Division of Hyperbaric Medicine, Department of Health and Community Medicine, University Hospitals of Geneva, Geneva, Switzerland'
| | | | - Brigitte Pittet-Cuénod
- Division of Plastic, Reconstructive & Aesthetic Surgery, Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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Xiong T, Chen H, Luo R, Mu D, Cochrane Developmental, Psychosocial and Learning Problems Group. Hyperbaric oxygen therapy for people with autism spectrum disorder (ASD). Cochrane Database Syst Rev 2016; 10:CD010922. [PMID: 27737490 PMCID: PMC6464144 DOI: 10.1002/14651858.cd010922.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The rising prevalence of autism spectrum disorder (ASD) has increased the need for evidence-based treatments to lessen the impact of symptoms. Presently, no therapies are available to effectively treat individuals with all of the symptoms of this disorder. It has been suggested that hyperbaric oxygen therapy may alleviate the biochemical dysfunction and clinical symptoms of ASD. OBJECTIVES To determine whether treatment with hyperbaric oxygen:1. improves core symptoms of ASD, including social communication problems and stereotypical and repetitive behaviors;2. improves noncore symptoms of ASD, such as challenging behaviors;3. improves comorbid states, such as depression and anxiety; and4. causes adverse effects. SEARCH METHODS On 10 December 2015, we searched CENTRAL, Ovid MEDLINE, Embase, and 15 other databases, four of which were Chinese language databases. We also searched multiple trial and research registers. SELECTION CRITERIA We selected randomized controlled trials (RCTs) and quasi-RCTs of any dose, duration, and frequency for hyperbaric oxygen therapy compared with no treatment or sham treatment for children and adults with ASD. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration, in that three review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence by using the GRADE approach. MAIN RESULTS We included one trial with a total of 60 children with a diagnosis of ASD who randomly received hyperbaric oxygen therapy or a sham treatment. Using GRADE criteria, we rated the quality of the evidence as low because of the small sample size and wide confidence intervals (CIs). Other problems included selection bias and short duration or follow-up.Overall, study authors reported no improvement in social interaction and communication, behavioral problems, communication and linguistic abilities, or cognitive function. With regard to the safety of hyperbaric oxygen therapy (adverse events), they reported minor-grade ear barotrauma events. Investigators found significant differences between groups in total number of side effect events (Peto odds ratio (OR) 3.87, 95% CI 1.53 to 9.82) and in the number of children who experienced side effects (Peto OR 4.40, 95% CI 1.33 to 14.48). AUTHORS' CONCLUSIONS To date, there is no evidence that hyperbaric oxygen therapy improves core symptoms and associated symptoms of ASD. It is important to note that adverse effects (minor-grade ear barotrauma events) can occur. Given the absence of evidence of effectiveness and the limited biological plausibility and possible adverse effects, the need for future RCTs of hyperbaric oxygen therapy must be carefully considered.
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Affiliation(s)
- Tao Xiong
- West China Second University Hospital, Sichuan UniversityDepartment of PediatricsNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
- Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan UniversityChengduSichuanChina
| | - Hongju Chen
- West China Second University Hospital, Sichuan UniversityDepartment of PediatricsNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
- Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan UniversityChengduSichuanChina
| | - Rong Luo
- West China Second University Hospital, Sichuan UniversityDepartment of PediatricsNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
- Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan UniversityChengduSichuanChina
| | - Dezhi Mu
- West China Second University Hospital, Sichuan UniversityDepartment of PediatricsNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
- Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan UniversityChengduSichuanChina
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Marchesi A, Parodi PC, Brioschi M, Riccio M, Perrotta RE, Colombo M, Calori GM, Vaienti L. Soft-tissue defects of the Achilles tendon region: Management and reconstructive ladder. Review of the literature. Injury 2016; 47 Suppl 4:S147-S153. [PMID: 27492062 DOI: 10.1016/j.injury.2016.07.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Defects of the Achilles tendon region represent a challenge for reconstructive surgeons. Several options are available but there is still no reconstructive ladder for this specific and tricky area. An up-to-date reconstructive ladder according to local and general conditions is proposed based on our multicentre experience and an extensive review of the English literature on PubMed. MATERIALS AND METHODS An extensive review of the English literature was performed on PubMed using the following key-words: "Achilles region", "heel", "soft-tissue reconstruction", "flaps", "grafts" and "dermal substitutes". RESULTS A total of 69 complete papers were selected, covering the last thirty years' literature. Although most of the studies were based on limited case-series, local and general conditions were always reported. A comprehensive reconstructive ladder of all the available reconstructive techniques for the Achilles region has been created based on our personal multicentre experience and the results of the literature review. CONCLUSIONS The reconstructive ladder is a concept that is still a mainstay in plastic surgery and guides decisions in the repair strategy for soft tissue defects. The optimal solution, according to the experience of the surgeon and the wishes of the patient, is the one that implies less sacrifice of the donor site. Perforator flaps should be the first-line option for small-to-moderate defects; the distally-based sural flap is the most reported for moderate-to-large defects of the Achilles region, and free flaps should be reserved mainly for complex and wide reconstructions.
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Affiliation(s)
- A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, San Donato Milanese, Via Morandi, 30 - 20097, Milan, Italy.
| | - P C Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - M Brioschi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato. Università degli Studi di Milano, San Donato Milanese, Milan, Italy
| | - M Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - R E Perrotta
- Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy
| | - M Colombo
- Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy
| | - G M Calori
- Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy
| | - L Vaienti
- Department of Plastic and Reconstructive Surgery. I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, San Donato Milanese, Milan, Italy
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Caputo WJ, Vaquero C, Monterosa A, Monterosa P, Johnson E, Beggs D, Fahoury GJ. A retrospective study of cryopreserved umbilical cord as an adjunctive therapy to promote the healing of chronic, complex foot ulcers with underlying osteomyelitis. Wound Repair Regen 2016; 24:885-893. [PMID: 27312890 DOI: 10.1111/wrr.12456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/13/2016] [Indexed: 01/29/2023]
Abstract
Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as multiple comorbidities including diabetes, ischemia, and underlying osteomyelitis are difficult to heal and associated with high morbidity and mortality and high rates of amputation. A retrospective review was performed to assess healing of 31 patients presenting with 33 complex foot ulcers with a confirmed histopathological diagnosis of osteomyelitis treated by the same surgeon at a single wound care center by the following treatment regimen: sharp debridement, resection of infected bone when necessary, open cortex, antibiotics, and application of cryopreserved umbilical cord (cUC). The average ulcer size was 15.6 ± 17.7 cm2 (0.4-73.95 cm2 ). Overall, 26 out of the 33 wounds achieved complete closure (78.8%). Five patients were lost to follow-up and one patient expired during the course of treatment, not believed to be treatment related. Of the remaining 27 wounds in patients not lost to follow-up, 26 achieved complete healing with an average time to healing of 16 weeks and an average of 1.24 applications of cUC. The results suggest that cUC used as an adjunctive tissue therapy in conjunction with surgical debridement, resection of infected bone, open cortex, and antibiotic treatment may be an effective overall treatment strategy to promote wound healing of complex foot ulcers associated with osteomyelitis. The preliminary results are encouraging and warrant further randomized control studies to determine whether cUC might help address such an unmet medical need.
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Affiliation(s)
- Wayne J Caputo
- Department of Podiatry, Clara Maass Medical Center, Belleville, New Jersey. .,The Wound Center, Clara Maass Medical Center, Belleville, New Jersey.
| | - Carina Vaquero
- The Wound Center, Clara Maass Medical Center, Belleville, New Jersey
| | - Alexis Monterosa
- The Wound Center, Clara Maass Medical Center, Belleville, New Jersey
| | | | - Edward Johnson
- Infectious Diseases Department, Clara Maass Medical Center, Belleville, New Jersey
| | - Donald Beggs
- Infectious Diseases Department, Clara Maass Medical Center, Belleville, New Jersey
| | - George J Fahoury
- Department of Podiatry, Clara Maass Medical Center, Belleville, New Jersey
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A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. J Vasc Surg 2016; 63:46S-58S.e1-2. [DOI: 10.1016/j.jvs.2015.10.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 12/16/2022]
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Feitosa MR, Féres Filho O, Tamaki CM, Perazzoli C, Bernardes MVAA, Parra RS, Rocha JJRD, Féres O. Adjunctive Hyperbaric Oxygen Therapy promotes successful healing in patients with refractory Crohn's disease. Acta Cir Bras 2016; 31 Suppl 1:19-23. [PMID: 27142900 DOI: 10.1590/s0102-86502016001300005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate de adjunctive effect of Hyperbaric Oxygen Therapy in a group of patients with refractory Crohn's disease. METHODS A total of 29 subjects with refractory Crohn's disease were submitted to daily sessions of Hyperbaric Oxygen Therapy, in a 2800 Sechrist Monoplace Hyperbaric Chamber (Sechrist, USA) pressurized to 2.4 ATA. Each session lasted 2 hours. The endpoint was closure of enterocutaneous fistulas and complete healing of Pyoderma Gangrenosum and perineal Crohn's disease. RESULTS A total of 829 HBOT sessions were performed and no complications were noted. Overall success rate was 76% (22 cases). Pyoderma Gangrenosum and enterocutaneous fistulas had the highest successful healing rates (100% and 91%, respectively). Perineal Crohn's disease healing rate was 65%. CONCLUSION Adjunctive Hyperbaric Oxygen Therapy promoted satisfactory healing in a group of patients with refractory Crohn's disease.
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Affiliation(s)
- Marley Ribeiro Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | | | - Camila Perazzoli
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Kruse CR, Nuutila K, Lee CCY, Kiwanuka E, Singh M, Caterson EJ, Eriksson E, Sørensen JA. The external microenvironment of healing skin wounds. Wound Repair Regen 2015; 23:456-64. [PMID: 25857996 DOI: 10.1111/wrr.12303] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
Abstract
The skin wound microenvironment can be divided into two main components that influence healing: the external wound microenvironment, which is outside the wound surface; and the internal wound microenvironment, underneath the surface, to which the cells within the wound are exposed. Treatment methods that directly alter the features of the external wound microenvironment indirectly affect the internal wound microenvironment due to the exchange between the two compartments. In this review, we focus on the effects of temperature, pressure (positive and negative), hydration, gases (oxygen and carbon dioxide), pH, and anti-microbial treatment on the wound. These factors are well described in the literature and can be modified with treatment methods available in the clinic. Understanding the roles of these factors in wound pathophysiology is of central importance in wound treatment.
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Affiliation(s)
- Carla R Kruse
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | - Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cameron C Y Lee
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Kiwanuka
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mansher Singh
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elof Eriksson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jens A Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
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Millar IL, McGinnes RA, Williamson O, Lind F, Jansson KÅ, Hajek M, Smart D, Fernandes T, Miller R, Myles P, Cameron P. Hyperbaric Oxygen in Lower Limb Trauma (HOLLT); protocol for a randomised controlled trial. BMJ Open 2015; 5:e008381. [PMID: 26068515 PMCID: PMC4466757 DOI: 10.1136/bmjopen-2015-008381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Open fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in many cases, multiple operations and prolonged rehabilitation. Use of hyperbaric oxygen therapy as an adjunct to standard orthopaedic trauma care has the potential to reduce the complications of musculoskeletal injury and thus improve outcomes. Two previous randomised trials have suggested some positive effect, but neither functional measures nor long-term outcomes were reported. METHODS AND ANALYSIS An international, multicentre, randomised, open-label, clinical trial. Patients with trauma with an acute open fracture of the tibia with severe soft tissue injury (Gustilo grade 3) and high risk of injury-related complications were recruited from participating major trauma hospitals with hyperbaric facilities. Patients were enrolled with the expectation of commencing 12 sessions of hyperbaric oxygen therapy within 48 h of injury. The primary outcome measure is the incidence of acute complications of the open fracture wound at 14 days. Other short-term outcome measures include amputation, need for fasciotomy, time until wound closure, breakdown of closed wounds, time until definitive orthopaedic fixation, number of operative procedures, intensive care stay and hospital stay. Long-term follow-up will continue for 2 years postinjury. ETHICS AND DISSEMINATION Ethics approval was given by The Alfred Health Human Ethics Committee (206/04) and the Monash University Human Research Ethics Committee (CF07/4208). Approval was also obtained from the institutional research ethics committee at each participating site. This study will make a significant contribution to the trauma literature and should answer the question of whether hyperbaric oxygen therapy can significantly improve outcomes in severe lower limb trauma. Collective study results will be published in international journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT00264511; Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12607000559415.
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Affiliation(s)
- Ian L Millar
- Hyperbaric Service, Department of Intensive Care & Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosemary A McGinnes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Owen Williamson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Folke Lind
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Karl-Åke Jansson
- Department of Molecular Medicine and Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Michal Hajek
- Ostrava City Hospital, Ostrava, Czech Republic
- University of Ostrava, Ostrava-Zabreh, Czech Republic
| | - David Smart
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Tiago Fernandes
- Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Matosinhos, Portugal
| | - Russell Miller
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Myles
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hadi HA, Smerdon G, W Fox S. Osteoclastic resorptive capacity is suppressed in patients receiving hyperbaric oxygen therapy. Acta Orthop 2015; 86:264-9. [PMID: 25238438 PMCID: PMC4404782 DOI: 10.3109/17453674.2014.964621] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Hypoxia, necrosis, and bone loss are hallmarks of many skeletal diseases. Hyperbaric oxygen therapy (HBO) is often used as an adjunctive therapy in these cases. However the in vivo effect of HBO on osteoclast formation has not been fully established. We therefore carried out a longitudinal study to examine the effect of HBO on osteoclast formation and bone resorptive capacity in patients who were referred to the Plymouth Hyperbaric Medical Centre. METHODS Osteoclast precursors were isolated from peripheral blood prior to and following 10 and 25 daily hyperbaric treatments (100% O2 at 2.4 atmospheres absolute ATA for 90 min) to determine osteoclast formation and resorptive capacity. The expression of key regulators of osteoclast differentiation RANK, Dc-STAMP, and NFATc1 was also assessed by quantitative real-time PCR. RESULTS HBO reduced the ability of precursors to form osteoclasts and reduced bone resorption in a treatment-dependent manner. The initial suppressive effect of HBO was more pronounced on mononuclear osteoclast formation than on multinuclear osteoclast formation, and this was accompanied by reduction in the expression of key regulators of osteoclast formation, RANK and Dc-STAMP. INTERPRETATION This study shows for the first time that in vivo, HBO suppresses the ability of monocytic precursors to form resorptive osteoclasts.
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Affiliation(s)
- Hadil Al Hadi
- School of Biomedical and Healthcare Sciences, Plymouth University
| | - Gary Smerdon
- Diving Diseases Research Centre, Plymouth, Devon, UK
| | - Simon W Fox
- School of Biomedical and Healthcare Sciences, Plymouth University
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Blatchley MR, Gerecht S. Acellular implantable and injectable hydrogels for vascular regeneration. Biomed Mater 2015; 10:034001. [DOI: 10.1088/1748-6041/10/3/034001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Obiagwu C, Paul V, Chadha S, Hollander G, Shani J. Acute pulmonary edema secondary to hyperbaric oxygen therapy. Oxf Med Case Reports 2015; 2015:183-4. [PMID: 25988073 PMCID: PMC4370014 DOI: 10.1093/omcr/omv002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/02/2015] [Accepted: 01/07/2015] [Indexed: 11/13/2022] Open
Abstract
Hyperbaric oxygen therapy (HBOT) has been shown to be effective in the treatment of diabetic ulcers, air embolism, carbon monoxide poisoning and gas gangrene with minimal adverse effects. Very few cases of HBOT causing acute pulmonary edema (PE) has been described; with a study on dogs suggesting that a complication of this therapy could be PE. We describe the case of an 80-year-old man with a history of stable systolic heart failure and diabetes mellitus presenting with acute PE following treatment with HBOT for diabetic foot.
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Affiliation(s)
- Chukwudi Obiagwu
- Department of Medicine , Maimonides Medical Center , Brooklyn, NY , USA
| | - Vishesh Paul
- Department of Pulmonary/Critical Care , Maimonides Medical Center , Brooklyn, NY , USA
| | - Sameer Chadha
- Department of Cardiology , Maimonides Medical Center , Brooklyn, NY , USA
| | - Gerald Hollander
- Department of Cardiology , Maimonides Medical Center , Brooklyn, NY , USA
| | - Jacob Shani
- Department of Cardiology , Maimonides Medical Center , Brooklyn, NY , USA
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Stoekenbroek RM, Santema TB, Koelemay MJ, van Hulst RA, Legemate DA, Reekers JA, Ubbink DT. Is additional hyperbaric oxygen therapy cost-effective for treating ischemic diabetic ulcers? Study protocol for the Dutch DAMOCLES multicenter randomized clinical trial? J Diabetes 2015; 7:125-32. [PMID: 24674297 DOI: 10.1111/1753-0407.12155] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The value of hyperbaric oxygen therapy (HBOT) in the treatment of diabetic ulcers is still under debate. Available evidence suggests that HBOT may improve the healing of diabetic ulcers, but it comes from small trials with heterogeneous populations and interventions. The DAMOCLES-trial will assess the (cost-)effectiveness of HBOT for ischemic diabetic ulcers in addition to standard of care. METHODS In a multicenter randomized clinical trial, including 30 hospitals and all 10 HBOT centers in the Netherlands, we plan to enroll 275 patients with Types 1 or 2 diabetes, a Wagner 2, 3 or 4 ulcer of the leg present for at least 4 weeks, and concomitant leg ischemia, defined as an ankle systolic blood pressure of <70 mmHg, a toe systolic blood pressure of <50 mmHg or a forefoot transcutaneous oxygen tension (TcpO2) of <40 mmHg. Eligible patients may be candidates for revascularization. Patients will be randomly assigned to standard care with or without 40 HBOT-sessions. RESULTS Primary outcome measures are freedom from major amputation after 12 months and achievement of, and time to, complete wound healing. Secondary endpoints include freedom from minor amputations, ulcer recurrence, TcpO2 , quality of life, and safety. In addition, we will assess the cost-effectiveness of HBOT for this indication. CONCLUSION The DAMOCLES trial will be the largest trial ever performed in the realm of HBOT for chronic ulcers, and it is unique for addressing patients with ischemic diabetic foot ulcers who may also receive vascular reconstructions. This matches the treatment dilemma in current clinical practice.
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Systemic administration of hemoglobin improves ischemic wound healing. J Surg Res 2014; 194:696-705. [PMID: 25617971 DOI: 10.1016/j.jss.2014.10.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/07/2014] [Accepted: 10/30/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oxygen plays multifaceted roles in wound healing, including effects on cell proliferation, collagen synthesis, angiogenesis, and bacterial killing. Oxygen deficit is a major factor in the pathogenesis of chronic wounds. MATERIALS AND METHODS We present a novel mechanism for oxygen delivery to ischemic wounds by systemic administration of an oxygen carrier substitute derived from bovine hemoglobin (IKOR 2084) in our ischemic rabbit ear wound model. The wound healing indexes, including epithelial gap and neo-granulation tissue area, were histologically analyzed. In situ expression of endothelial cells (CD31+) and proliferative cells (Ki-67+) were examined by immunohistochemistry analysis. The messenger RNA expression of collagen I, III, and vascular endothelial growth factor was measured by quantitative RT-PCR. Sirius Red staining was implemented for detection of collagen deposition, and terminal deoxynucleotidyl transferase dUTP nick end labeling analysis was performed to examine dermal cellular apoptosis. RESULTS Systemic administration of IKOR 2084 significantly improved oxygen tension of ischemic tissue. When compared with saline controls, IKOR 2084 treatment enhanced wound repair as demonstrated by a reduced epithelial gap and increased granulation tissue area. The expression of Ki-67+, CD31+, vascular endothelial growth factor and collagen was also enhanced by IKOR 2084 administration. Moreover, apoptosis analysis in the wounds showed that cell survival in the dermis was increased by systemic IKOR 2084 administration. CONCLUSIONS Our study suggests that systemic delivery of IKOR 2084 ameliorates hypoxic state, subsequently promotes angiogenesis, cellular proliferation, and collagen synthesis, attenuates hypoxia-induced apoptosis, and improved ischemic wound healing.
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Hyperbaric oxygen treatment outcome for different indications from a single center. Ann Vasc Surg 2014; 29:206-14. [PMID: 25308240 DOI: 10.1016/j.avsg.2014.07.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hyperbaric oxygen (HBO) is used as an adjunctive therapy for a variety of indications. However, there is a lack of high-quality research evaluating HBO treatment outcomes for different indications available in the current literature. METHODS We retrospectively reviewed all patients who underwent HBO therapy at a single hyperbaric center from January 2010 to December 2013 using predetermined criteria to analyze successful, improved, or failed treatment outcomes for the following indications: chronic refractory osteomyelitis, diabetic foot ulcer, failed flap or skin graft, osteoradionecrosis, soft tissue radiation necrosis, and multiple coexisting indications. RESULTS Among the included 181 patients treated with adjunctive HBO at our center, 81.8% had either successful or improved treatment outcomes. A successful or improved outcome was observed in 82.6% of patients treated for chronic refractory osteomyelitis (n = 23), 74.1% for diabetic foot ulcer (n = 27), 75.7% for failed flap or skin graft (n = 33), 95.7% for osteoradionecrosis (n = 23), 88.1% for soft tissue radiation necrosis (n = 42), and 72.4% for multiple coexisting indications (n = 29). Among 4 patients treated for other indications, 100% of the cases were either successful or improved. CONCLUSIONS This study has provided a comprehensive outcome survey of using HBO for the previously mentioned indications at our center. It supplements the literature with more evidence to support the consideration of HBO in different indications.
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Fosen KM, Thom SR. Hyperbaric oxygen, vasculogenic stem cells, and wound healing. Antioxid Redox Signal 2014; 21:1634-47. [PMID: 24730726 PMCID: PMC4175035 DOI: 10.1089/ars.2014.5940] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022]
Abstract
SIGNIFICANCE Oxidative stress is recognized as playing a role in stem cell mobilization from peripheral sites and also cell function. RECENT ADVANCES This review focuses on the impact of hyperoxia on vasculogenic stem cells and elements of wound healing. CRITICAL ISSUES Components of the wound-healing process in which oxidative stress has a positive impact on the various cells involved in wound healing are highlighted. A slightly different view of wound-healing physiology is adopted by departing from the often used notion of sequential stages: hemostatic, inflammatory, proliferative, and remodeling and instead organizes the cascade of wound healing as overlapping events or waves pertaining to reactive oxygen species, lactate, and nitric oxide. This was done because hyperoxia has effects of a number of cell signaling events that converge to influence cell recruitment/chemotaxis and gene regulation/protein synthesis responses which mediate wound healing. FUTURE DIRECTIONS Our alternative perspective of the stages of wound healing eases recognition of the multiple sites where oxidative stress has an impact on wound healing. This aids the focus on mechanistic events and the interplay among various cell types and biochemical processes. It also highlights the areas where additional research is needed.
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Affiliation(s)
- Katina M. Fosen
- Department of Emergency Medicine, Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Stephen R. Thom
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland
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