Microcirculatory and clinical effects of serial percutaneous application of carbon dioxide in primary and secondary Raynaud’s phenomenon

Elastic Banding Compression as a Novel Treatment to Maintain Hemodynamics in a Patient With Klippel-Trenaunay Syndrome

Klippel-Trenaunay syndrome (KTS) is also associated with venous thrombosis originating from varicose veins in the lower extremities, pulmonary embolism, and pulmonary hypertension. This study describes the anesthetic management of laparoscopic cholecystectomy in a 54-year-old male KTS patient with orthostatic hypotension due to massive varicose veins in the lower extremities and pulmonary thromboembolism. Compressing the varicosities with an elastic bandage can maintain stable circulatory dynamics even under general anesthesia management to prevent position and insufflation-induced changes that can occur spontaneously.

Efficacy of the continuous use of a lotion with carbon dioxide on male subjects with mild acne

OBJECTIVE

Acne vulgaris is caused by dyslipidemia, dyskeratosis and/or abnormal bacterial growth. The obstruction of skin pores due to hyperkeratosis of the infundibulum contributes to the formation of comedones. Thus, normalizing keratinization of epidermal cells in skin pores might be useful to improve acne. Recently, it has been found that the transcutaneous application of carbon dioxide (CO₂ ) regulates imbalances of the desquamatory process. In this study, we evaluated the efficacy of a skin lotion containing CO₂ on mild acne.

METHODS

Twenty-four healthy Japanese males (20-29 years old) with mild acne attended this evaluation. The subjects were divided into 2 groups, one group used a skin lotion containing CO₂ and the other group used a skin lotion without CO₂ . Following facial washing, each subject topically applied the skin lotion with or without CO₂ twice a day for 4 weeks. Prior to the start of the evaluation (week 0) and following 2 and 4 weeks of treatment, acne symptoms were assessed by a dermatologist and by instrumental measurements.

RESULTS

Topical application of the skin lotion with CO₂ for 4 weeks significantly improved acne symptoms, which was recognized by the subjects. However, treatment with the skin lotion without CO₂ did not improve acne symptoms. This improvement of acne symptoms by CO₂ was not accompanied by changes in sebum levels, skin surface pH, skin capacitance, or porphyrin levels.

CONCLUSION

The transcutaneous application of a lotion with CO₂ improves acne symptoms by normalizing keratinization without affecting skin surface conditions.

Local Application of Transcutaneous Carbon Dioxide Paste Decreases Inflammation and Accelerates Wound Healing

INTRODUCTION

 Delayed wound healing after surgery lowers the long-term quality of a patient's life and leads to discomfort and pain. However, treatments for wound healing are often difficult and have not yet been fully established. In this study, we investigated the effect of a special paste that can be administered transdermally and holds a non-gaseous carbon dioxide (CO₂) source in its carrier, which can be applied to the head and neck region for wound healing in a rat skin defect model.

METHODS

Forty-eight Sprague Dawley rats were randomized into control and CO₂ groups. We punched a 6.2-mm wound on the back of each rat. The control rats were left untreated, whereas rats in the CO₂ group were treated with the CO₂ paste every day after surgery. We evaluated wound healing 3, 7, 14, and 21 days after wounding by analyzing the diameter of the wound, gene expression of inflammatory markers vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-β, hypoxia-inducible factor (HIF)-1α, interleukin (IL)-1β, and IL-6 using quantitative real-time polymerase chain reaction, hematoxylin and eosin, and immunohistochemical staining patterns.

RESULTS

Rats in the CO₂ group showed accelerated wound healing compared to those in the control group. Furthermore, VEGF and TGF-β were overexpressed, whereas HIF-1α, IL-1β, and IL-6 were downregulated in the rats treated with CO₂. Immunohistochemical analysis also revealed similar patterns of expression.

CONCLUSION

Taken together, the CO₂ paste promoted wound healing by regulating the hypoxic environment, reducing inflammation, and accelerating angiogenesis.

Clinical efficacy of artificially carbonated water bathing on superficial bacterial folliculitis in dogs

BACKGROUND

Bathing with artificially carbonated water is reported to be a valuable therapeutic option for various human skin disorders.

OBJECTIVE

To evaluate the clinical efficacy of artificially carbonated water bathing on superficial bacterial folliculitis (SBF) caused by Staphylococcus pseudintermedius (SP) in dogs.

ANIMALS

Nineteen dogs with SBF from whom SP was isolated from skin lesions were enrolled.

METHODS AND MATERIALS

Dogs with SBF were allocated randomly to either the artificially carbonated water bathing group or the control group bathed with tap water. The dogs were bathed with the designated water type on day (D)0, D7 and D14. Clinical scores and skin surface pH were evaluated on D0 and D21. Colony forming unit (cfu) assays were performed in vitro to investigate whether the artificially carbonated water affected growth of clinical SP isolates.

RESULTS

The mean rate of improvement in the clinical scores was significantly higher in the carbonated water group than in the control group. Dogs bathed with carbonated water exhibited significant decreases in their skin surface pH after bathing; dogs bathed with tap water did not. No dogs experienced significant adverse events. The cfus of SP incubated in vitro with artificially carbonated water did not significantly differ from those incubated with tap water.

CONCLUSION

Bathing with artificially carbonated water might be an effective and safe adjunctive therapy for canine SP-induced SBF.

Carbon dioxide hydrate as a recovery tool after fatigue of the plantar flexors

This study investigated the effects of cooling the triceps surae with carbon dioxide hydrate (CDH), which is a gas hydrate, a crystalline structure belonging to the clathrates, on the recovery from muscle fatigue. Thirty-six healthy young men were equally and randomly assigned to an ICE group, a CDH group, or a non-cooling (NON) group. All participants performed 80 maximal voluntary isometric contractions (MVCs) of the plantar flexors as a fatiguing task. MVC torque and voluntary activation were determined before, immediately after, and 20 min after the fatiguing task. Evoked torque was similarly assessed except for immediately after the task. In the ICE and CDH groups, the triceps surae was cooled for 5 min using ice and CDH, starting 5 min after the fatiguing task, respectively. The MVC torque and voluntary activation were higher in order of before >20 min after >immediately after the fatiguing task regardless of group, and those time-course changes did not differ between the groups. A decrease in the evoked torque from before to 20 min after the fatiguing task was observed in the ICE and NON groups but not in the CDH group. These results suggest that cooling muscle with CDH can facilitate recovery from peripheral muscle fatigue. This may be due to an increase in blood flow caused by carbon dioxide contained within the CDH, and indicates the potential of CDH as a recovery tool after fatiguing exercise.

The effect of transcutaneous application of gaseous CO2 on diabetic chronic wound healing-A double-blind randomized clinical trial

Chronic wounds in diabetics are difficult to treat, therefore, adjuvant therapies have been investigated. Bathing in CO₂ -rich water (spa therapy) has been known in Europe for decades for its positive effect on peripheral vascular disorders. Recently, much effort has been invested in developing optimal application methods of CO₂ . Uses include subcutaneous injections of CO₂ , bathing in CO₂ -enriched water, and transcutaneous application of CO₂ . To verify the effect of transcutaneous application of gaseous CO₂ on the healing of chronic diabetic wounds, a randomized double-blind clinical research was designed. The research included 30 and 27 wounds in the study and control groups, respectively. In addition to standard treatment, patients in the study group received 20 therapies with medical-grade CO₂ gas and the control group received the same treatment with air. Results showed significantly faster healing in the study group: 20 of the 30 wounds in the study group were healed compared with none in the control group. Mean wound surface and volume in the study group was reduced significantly (surface: 96%, P = .001, volume: 99%, P = .003) compared with a small reduction in the control group (surface: 25%, P = .383, volume: 27%, P = .178). Considering our results, transcutaneous application of gaseous CO₂ is an effective adjuvant therapy in diabetic chronic wound treatment.

Carbon dioxide ameliorates reduced desquamation in dry scaly skin via protease activation

OBJECTIVE

Scaling, a phenomenon showing an abnormal detachment of the stratum corneum (SC) owing to desquamation dysfunction, is commonly observed in various skin diseases or xerotic skin due to ageing and low humidity. Therefore, it is considered that ameliorating the disturbed desquamatory process of the SC leads to improvement in scaling. Carbon dioxide (CO₂ ) is known to be good for some skin diseases; however, the effect of CO₂ on scaling and its mechanism are not sufficiently clear. We aimed to elucidate the effect of transepidermal application of CO₂ on scaling and its mechanism of action.

METHODS

Twenty healthy men with mild scaling on the cheeks were recruited for a double-blind, placebo-controlled, split-face study. They applied the formulation containing CO₂ twice daily for 1 week. After the study, the SC was collected by tape stripping to analyse desquamatory protease activities and degradation of extracellular corneodesmosomes. Furthermore, the contribution of pH to proteolysis of the corneodesmosome by CO₂ was evaluated using three-dimensional (3D) cultured epidermal models.

RESULTS

The spectroscopic absorbance of tape strips, used as scaling indicators, was decreased, concomitantly with the amelioration of incomplete degradation of desmoglein-1, one of the main corneodesmosomal proteins, and activation of trypsin-like protease in the SC by transepidermal application of CO₂ . Experiments using 3D cultured epidermis showed that pH in the epidermal tissue was lowered by CO₂ , whereas a pH change was not observed with the application of the formulation containing hydrochloric acid, which was added to equalize the pH to that of the CO₂ formulation.

CONCLUSION

The transcutaneous application of CO₂ ameliorates reduced desquamatory process in xerotic skin, with concomitant mild acidification of the SC, thereby leading to improvement in scaling. Thus, CO₂ may have an advantage of efficiently and safely counteracting scaling of various skin disorders.

The effects of a single carbon dioxide and hot water hand bath on acral perfusion in systemic sclerosis: A randomized, clinical study

Secondary Raynaud's phenomenon is the most common manifestation of systemic sclerosis, affecting more than 99% of systemic sclerosis patients, and a major cause of morbidity. Frequent and prolonged secondary Raynaud's phenomenon attacks not only cause severe discomfort and pain but also ischemic acral tissue damage. In addition to vasoactive drugs, carbon dioxide (CO2) hand bath and hot water bath are potential non-pharmacological treatment options which can be self-administered by affected patients at any time. In order to compare the efficacy of these two physical measures, this randomized, clinical study evaluated the effects of a single CO2 hand bath in patients with systemic sclerosis and secondary Raynaud's phenomenon and a healthy control group versus a single hot water hand bath on acral perfusion in systemic sclerosis by Doppler ultrasonography. None of the patients had currently digital ulcers, a vasoactive medication or a concomitant vascular disease. CO2 immersion induced an acute hemodynamic response, whereas hot water immersion had no significant effect on acral perfusion in systemic sclerosis.

Topical cutaneous application of CO2 accelerates bone healing in a rat femoral defect model

BACKGROUND

Bone defects may occur because of severe trauma, nonunion, infection, or tumor resection. However, treatments for bone defects are often difficult and have not been fully established yet. We previously designed an efficient system of topical cutaneous application of carbon dioxide (CO₂) using a novel hydrogel, which facilitates CO₂ absorption through the skin into the deep area within a limb. In this study, the effect of topical cutaneous application of CO₂ on bone healing was investigated using a rat femoral defect model.

METHODS

In this basic research study, an in vivo bone defect model, fixed with an external fixator, was created using a rat femur. The affected limb was shaved, and CO₂ was applied for 20 min/day, 5 days/week. In the control animals, CO₂ gas was replaced with air. Radiographic, histological, biomechanical, and genetic assessments were performed to evaluate bone healing.

RESULTS

Radiographically, bone healing rate was significantly higher in the CO₂ group than in the control group at 4 weeks (18.2% vs. 72.7%). The degree of bone healing scored using the histopathological Allen grading system was significantly higher in the CO₂ group than in the control group at 2 weeks (1.389 ± 0.334 vs. 1.944 ± 0.375). The ultimate stress, extrinsic stiffness, and failure energy were significantly greater in the CO₂ group than in the control group at 4 weeks (3.2 ± 0.8% vs. 38.1 ± 4.8%, 0.6 ± 0.3% vs. 41.5 ± 12.2%, 2.6 ± 0.8% vs. 24.7 ± 5.9%, respectively.). The volumetric bone mineral density of the callus in micro-computed tomography analysis was significantly higher in the CO₂ group than in the control group at 4 weeks (180.9 ± 43.0 mg/cm³ vs. 247.9 ± 49.9 mg/cm³). Gene expression of vascular endothelial growth factor in the CO₂ group was significantly greater than that in the control group at 3 weeks (0.617 ± 0.240 vs. 2.213 ± 0.387).

CONCLUSIONS

Topical cutaneous application of CO₂ accelerated bone healing in a rat femoral defect model. CO₂ application can be a novel and useful therapy for accelerating bone healing in bone defects; further research on its efficacy in humans is warranted.

Transcutaneous Carbon Dioxide Treatment Is Capable of Reducing Peripheral Vascular Resistance in Hypertensive Patients

AIM

We aimed to investigate the effects of a single carbon dioxide (CO₂) treatment on arterial stiffness by monitoring the changes of aortic pulse-wave velocity (PWV) and aortic augmentation index (AIXao), which are indicators of arterial stiffness.

PATIENTS AND METHODS

PWV and AIXao were measured by an invasively validated oscillometric device. The measurements of stiffness parameters were performed before the CO₂ treatment, and at 1, 4 and 8 h after the first treatment.

RESULTS

Thirty-one patients were included. No significant changes were found in PWV. AIXao decreased significantly 1 h and 4 h after CO₂ treatment compared to baseline values (p=0.034 and p<0.001). AIXao increased 8 h after the CO₂ treatment, but remained significantly lower than baseline AIXao values (p=0.016).

CONCLUSION

CO₂ treatment is capable of reducing peripheral vascular resistance. We hypothesize that CO₂ is not only a temporal vasodilator but is also capable of activating vasodilation pathways.

Facial application of high-concentration carbon dioxide prevents epidermal impairment associated with environmental changes

Purpose

The transdermal application of carbon dioxide (CO₂) gas dissolved in a solution and bathing in carbonated springs have been known to improve circulatory disorders. We aimed to elucidate and profile the effects of CO₂ application on local skin function.

Patients and methods

A liquid formulation that included high-concentration CO₂ or a control formulation was applied to the face of healthy men for 8 weeks. Quantitative analysis was performed during the dry winter months.

Results

At the site where the control formulation was applied, transepidermal water loss (TEWL) increased while the moisturizing function (conductance) of facial skin decreased during the study period. However, at the CO₂-treated site, increases in TEWL and decreases in conductance were significantly suppressed. In addition, the deterioration in scaliness and wrinkles parameters were suppressed by ≥40% at the CO₂-treated site. There were no significant differences in skin surface pH or color properties between the control and test sites.

Conclusion

This study suggests that the continuous application of a high-concentration CO₂ formulation can affect skin physiology and has the potential to suppress reductions in the barrier and moisturizing functions of the stratum corneum accompanied by desquamation, which occurs during the winter.

Transcutaneous Carbon Dioxide Treatment Affects Heart Rate Variability - A Pilot Study

BACKGROUND

The aim of this study was to investigate the effects of carbon-dioxide treatment on heart rate variability (HRV) parameters: mean RR interval (RRI), standard deviation of RR intervals (SDNN), root mean square of successive RR differences (RMSSD); and Porta and Guzik indices, as measures of heart rate asymmetry.

MATERIALS AND METHODS

Twenty patients were enrolled (mean±SD, age=59±7.8 years). Measurements were performed before CO₂ treatment, at the beginning of treatment, at 15 min of treatment, immediately after and 1 h after the treatment.

RESULTS

Significant increase in SDNN was found 1 h after the treatment when compared to that before it (p=0.011). There were no significant changes in other parameters.

CONCLUSION

CO₂ treatment can influence the autonomic nervous system identified by SDNN changes. However, larger studies are required to confirm these results.

Systemic scleroderma: An approach from plastic surgery

Introducción. La esclerosis sistémica (ES) es una enfermedad autoinmune del tejido conectivo que se caracteriza clínicamente por un engrosamiento cutáneo, el cual se da debido a la acumulación de tejido conectivo y puede afectar a otros órganos y a las extremidades. La etiología multifactorial de esta enfermedad corresponde a la interacción de alteraciones en el remodelamiento de la matriz extracelular, función inmunitaria y presencia de vasculopatía proliferativa bajo influencia genética y medioambiental.Objetivo. Realizar una revisión sobre el manejo médico y quirúrgico desde el punto de vista de la cirugía plástica de las lesiones en piel y manos y las alteraciones faciales de los pacientes con ES.Materiales y métodos. Se realizó una búsqueda bibliográfica en las bases de datos Medline, LILACS, PubMed, EMBASE y Current contents con las palabras claves esclerodermia sistémica, cirugía plástica, mano y ulceras.Resultados. La ES requiere manejo multidisciplinario; se presentan casos en los que se indica terapia farmacológica y otros en los que el manejo es quirúrgico complementario.Conclusión. Esta patología afecta de manera importante la piel al provocar lesiones que van desde ulceras digitales hasta atrofia facial, las cuales son susceptibles de manejo por el área de cirugía plástica.

Angiotensin-converting Enzyme Inhibition Improves the Effectiveness of Transcutaneous Carbon Dioxide Treatment

AIM

To study the effect of carbon dioxide (CO₂) therapy on the nitric oxide (NO) pathway by monitoring plasma asymmetric dimethylarginine (ADMA) concentrations.

PATIENTS AND METHODS

Forty-seven hypertensive patients who underwent transcutaneous CO₂ therapy were enrolled. Thirty healthy individuals were recruited for the control group. Blood samples were taken one hour before, as well as one hour, 24 hours and 3 weeks after the first CO₂ treatment. Controls did not undergo CO₂ treatment. Plasma ADMA levels were measured by ELISA.

RESULTS

ADMA levels decreased significantly one hour after the first CO2 treatment compared to the baseline concentrations (p=0.003). Significantly greater reduction was found among patients in whom angiotensin converting enzyme inhibitors (ACEIs) were administered (p=0.019).

CONCLUSION

The short- and long-term decrease of ADMA levels suggests that CO₂ is not only a vasodilator, but also has a beneficial effect on the NO pathway. ACE inhibition seems to enhance the effect of CO₂ treatment.

A novel system for transcutaneous application of carbon dioxide causing an "artificial Bohr effect" in the human body

Background

Carbon dioxide (CO₂) therapy refers to the transcutaneous administration of CO₂ for therapeutic purposes. This effect has been explained by an increase in the pressure of O₂ in tissues known as the Bohr effect. However, there have been no reports investigating the oxygen dissociation of haemoglobin (Hb) during transcutaneous application of CO₂in vivo. In this study, we investigate whether the Bohr effect is caused by transcutaneous application of CO2 in human living body.

Methods

We used a novel system for transcutaneous application of CO₂ using pure CO₂ gas, hydrogel, and a plastic adaptor. The validity of the CO₂ hydrogel was confirmed in vitro using a measuring device for transcutaneous CO₂ absorption using rat skin. Next, we measured the pH change in the human triceps surae muscle during transcutaneous application of CO₂ using phosphorus-31 magnetic resonance spectroscopy (³¹P-MRS) in vivo. In addition, oxy- and deoxy-Hb concentrations were measured with near-infrared spectroscopy in the human arm with occulted blood flow to investigate O2 dissociation from Hb caused by transcutaneous application of CO₂.

Results

The rat skin experiment showed that CO₂ hydrogel enhanced CO₂ gas permeation through the rat skin. The intracellular pH of the triceps surae muscle decreased significantly 10 min. after transcutaneous application of CO₂. The NIRS data show the oxy-Hb concentration decreased significantly 4 min. after CO₂ application, and deoxy-Hb concentration increased significantly 2 min. after CO₂ application in the CO₂-applied group compared to the control group. Oxy-Hb concentration significantly decreased while deoxy-Hb concentration significantly increased after transcutaneous CO₂ application.

Conclusions

Our novel transcutaneous CO₂ application facilitated an O₂ dissociation from Hb in the human body, thus providing evidence of the Bohr effect in vivo.