Massive Subcutaneous Emphysema after Hydrogen Peroxide Irrigation of a Penetrating Facial Injury

We present the case of a child impaled in the face by a meat thermometer who subsequently suffered a significant complication due to the administration of hydrogen peroxide to the wound. The soft tissues of the face rapidly expanded and blanched, the child experienced mental status changes, and imaging revealed massive subcutaneous emphysema, pneumomediastinum, and pneumo-orbit. Herein we review the literature on this rare complication and provide photodocumentation in the hopes that other practitioners, patients, and parents avoid administering hydrogen peroxide into or near any penetrating injury. Laryngoscope, 134:2954-2957, 2024.

Bleaching efficacy of in-office dental bleaching with different application protocols: a single-blind randomized controlled trial

OBJECTIVE

This randomized controlled trial aimed to evaluate the equivalence in the color change, adverse effects, self-perception (AS) and the impact on oral condition (IO) of participants submitted to different application protocols of in-office dental bleaching.

MATERIALS AND METHODS

165 participants were bleached with a 35% hydrogen peroxide gel (Total Blanc Office One-Step, DFL), according to the following protocols: (1) 2 applications of 20-min each (2 × 20 min); (2) 1 × 40-min and; (3) 1 × 30-min. The color change was evaluated with the Vita Easyshade spectrophotometer, Vita Classical and Vita Bleachedguide scales. The intensity and risk of tooth sensitivity (TS) and gingival irritation (GI) were recorded using a 0-10 visual analogue scale (VAS). AS and IO was assessed before and after the bleaching procedure using the Orofacial Aesthetic Scale and Oral Health Impact Profile-14, respectively.

RESULTS

Equivalent color change were observed (p < 0.001), with no significant difference between groups. The group 2 × 20 min presented the highest risk of TS (76%, 95% CI 63 to 85), compared to the 1 × 30 min (p < 0.04). The intensity of TS and GI and the risk of GI was similar between groups (p > 0.31). Irrespectively of the group (p = 0.32), significant improvements were observed for all items of AS and IO after bleaching (p < 0.02).

CONCLUSIONS

The 1 × 30 min protocol produced equivalent color change to the other bleaching protocols with reduced risk of TS and shorter application time.

CLINICAL RELEVANCE

A more simplified application regimen of a single application of 30 min yields effective bleaching and patient satisfaction while minimizing undesirable side effects and improving patient satisfaction.

The value of sequential application of hydrogen peroxide, povidone-iodine and physiological saline in reducing postoperative infections after total knee arthroplasty: A prospective, randomized, controlled study

BACKGROUND

Currently, in the field of total joint arthroplasty (TJA), there are no studies that have demonstrated the value of the sequential application of hydrogen peroxide, povidone-iodine, and physiological saline during the surgical procedure in decreasing postoperative infections in total knee arthroplasty (TKA), and in decreasing the incidence of periprosthetic joint infections (PJI) in particular. This study aimed to assess the efficacy of the sequential application of hydrogen peroxide, povidone-iodine, and physiological saline in reducing postoperative infections in TKA.

METHODS

The study prospectively included 4743 patients, with Group A (2371, 49.9%) receiving sequential intraoperative application of hydrogen peroxide, povidone-iodine, and physiological saline irrigation of the incision, and Group B (2372, 50.1%) receiving intraoperative application of physiological saline irrigation of the incision only, to collect the patients' baseline data and clinical characteristics, and to statistically assess the incidence of superficial infections and the PJI during the follow up period to evaluate the clinical value of the study.

RESULTS

The baseline levels of patients in Groups A and B were comparable. There were 132 (2.8%) lost visits during the study period. The incidence of superficial infections within 30 days after surgery was 0.22% in Group A and 1.17% in Group B, the difference between the two groups was statistically significant (P = 0.007). The incidence of PJI was 0.17% in Group A and 1.26% in Group B, the difference between the two groups was statistically significant (P = 0.0121).

CONCLUSION

Sequential application of hydrogen peroxide, povidone-iodine, and physiological saline to irrigate incision in TKA can significantly reduce the incidence of postoperative superficial infections and PJI. The scientific and rational application of this therapy intraoperatively greatly reduces the incidence of PJI and postoperative superficial infections, which is of great benefit to the patient's prognosis.

Application Tip and Concentration of a Self-mixing Bleach: Hydrogen Peroxide Inside the Pulp Chamber, Color Change, and Amount of Bleaching Gel Used

PURPOSE

The objective of this study was to evaluate if the application method (tip with brush or tip without brush) and hydrogen peroxide (HP) concentration (6% or 35% self-mixing) of in-office bleaching gel influences the penetration of HP into the pulp chamber, color change, and the amount of bleaching gel used.

METHODS

Forty healthy premolars were randomly divided into the following five groups (n=8): no treatment; HP6% using a tip with a brush, HP6% using a tip without a brush, HP35% using a tip with a brush, and HP35% using a tip without a brush. After treatments, the HP concentration (μg/mL) within the pulp chamber was determined using UV-Vis spectrophotometry. The color change (ΔEab, ΔE00, and ΔWID) was evaluated using a digital spectrophotometer. The amount of gel used (g) in each group was measured using a precision analytical balance. Data from each test were submitted to parametric tests (α=0.05).

RESULTS

The tip with a brush resulted in a lower amount of HP inside the pulp chamber and less gel used when compared with the tip without a brush, regardless of HP concentration (p<0.05). However, regarding the tip used, although no significant difference was observed when HP35% was used (p>0.05), a higher whitening effect was observed when the 6% HP was applied without a brush as opposed to with a tip brush (p<0.05).

CONCLUSIONS

The use of a tip with a brush, regardless of the in-office bleaching gel concentration (6% or 35% self-mixing), presented a lower penetration and lower volume of spent gel when compared to a tip without brush. However, the whitening effect depended on the concentration of HP used.

Cell survival after DNA damage in the comet assay

The comet assay is widely used in basic research, genotoxicity testing, and human biomonitoring. However, interpretation of the comet assay data might benefit from a better understanding of the future fate of a cell with DNA damage. DNA damage is in principle repairable, or if extensive, can lead to cell death. Here, we have correlated the maximally induced DNA damage with three test substances in TK6 cells with the survival of the cells. For this, we selected hydrogen peroxide (H₂O₂) as an oxidizing agent, methyl methanesulfonate (MMS) as an alkylating agent and etoposide as a topoisomerase II inhibitor. We measured cell viability, cell proliferation, apoptosis, and micronucleus frequency on the following day, in the same cell culture, which had been analyzed in the comet assay. After treatment, a concentration dependent increase in DNA damage and in the percentage of non-vital and apoptotic cells was found for each substance. Values greater than 20-30% DNA in tail caused the death of more than 50% of the cells, with etoposide causing slightly more cell death than H₂O₂ or MMS. Despite that, cells seemed to repair of at least some DNA damage within few hours after substance removal. Overall, the reduction of DNA damage over time is due to both DNA repair and death of heavily damaged cells. We recommend that in experiments with induction of DNA damage of more than 20% DNA in tail, survival data for the cells are provided.

Assessing Patients' Satisfaction With Hydrogen Peroxide Topical Solution, 40% for Treatment of Raised Seborrheic Keratoses

OBJECTIVES

Assess participants&rsquo; satisfaction following treatment with a proprietary hydrogen peroxide topical solution 40%, w/w (HP40) for raised seborrheic keratoses (SKs).

METHODS

In this Phase 4, open-label study, eligible participants aged 30&ndash;75 years had clinically typical raised SKs including 2 target SKs (Physician&rsquo;s Lesion Assessment&trade; [PLA] grade of &ge;2 [0 = clear; 1 = near clear; 2 = thin (&le;1 mm); 3 = thick (&gt;1 mm)]; 5&ndash;15 mm diameter) on the face and 1 target SK on the neck or d&eacute;colletage. SKs received HP40 treatment on day 1. All SKs with PLA grade &ge;1 were retreated on days 15 and 29. Endpoints included patients&rsquo; satisfaction with their skin&rsquo;s appearance at day 113, relationships between patients&rsquo; satisfaction and lesion PLA grade (evaluated by chi-square test), and patients&rsquo; satisfaction with their treatment experience.

RESULTS

Forty-one patients (mean [range] age, 62.4 [46&ndash;73] years) completed the study. 95% of patients were at least moderately satisfied with their skin&rsquo;s appearance and 90.2% of target lesions were clear. A statistically significant association was observed between the number of target lesions achieving clearance and patients&rsquo; satisfaction with skin appearance level (&chi;2=22.03; P=0.001). 93% of patients were at least moderately satisfied with their HP40 treatment experience. Eight patients experienced treatment-emergent adverse events (TEAEs), most of which were mild or moderate; 4 experienced TEAEs considered treatment-related.

CONCLUSIONS

Most patients with SKs on the face, neck, and d&eacute;colletage were satisfied or very satisfied with both their skin&rsquo;s appearance and their treatment experience following HP40 treatment. These results support the use of HP40 for raised SKs. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.4974.

Scalable in-hospital decontamination of N95 filtering face-piece respirator with a peracetic acid room disinfection system

BACKGROUND

Critical shortages of personal protective equipment, especially N95 respirators, during the coronavirus disease 2019 (COVID-19) pandemic continues to be a source of concern. Novel methods of N95 filtering face-piece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep healthcare workers (HCWs) safe.

METHODS

A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency. PAA and hydrogen peroxide off-gassing from treated masks were also assessed.

RESULTS

The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2,447 cubic-foot (69.6 cubic-meter) room with an aerosol deployment time of 16 minutes and a dwell time of 32 minutes. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle, respectively.

CONCLUSION

The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID-19 pandemic.

Scalable in-hospital decontamination of N95 filtering face-piece respirator with a peracetic acid room disinfection system

BACKGROUND

Critical shortages of personal protective equipment, especially N95 respirators, during the coronavirus disease 2019 (COVID-19) pandemic continues to be a source of concern. Novel methods of N95 filtering face-piece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep healthcare workers (HCWs) safe.

METHODS

A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency. PAA and hydrogen peroxide off-gassing from treated masks were also assessed.

RESULTS

The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2,447 cubic-foot (69.6 cubic-meter) room with an aerosol deployment time of 16 minutes and a dwell time of 32 minutes. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle, respectively.

CONCLUSION

The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID-19 pandemic.

Sesamin and sesamol attenuate H2O2-induced oxidative stress on human neuronal cells via the SIRT1-SIRT3-FOXO3a signaling pathway

Background: An imbalance of free radicals and antioxidant defense systems in physiological processes can result in protein/DNA damage, inflammation, and cellular apoptosis leading to neurodegenerative disorders such as Alzheimer's disease (AD), Parkinson's disease (PD), and Huntington's disease (HD). Sesamin and sesamol, compounds derived from sesame seeds and oil, have been reported to exert various pharmacological effects, especially antioxidant activity. However, their molecular mechanisms against the oxidative stress induced by exogenous hydrogen peroxide (H₂O₂) remain to be elucidated. Aim: In this study, neuroprotective effects of sesamin and sesamol on H₂O₂-induced human neuroblastoma (SH-SY5Y) cell death and possible signaling pathways in the cells were explored. Methods: MTT assay and flow cytometry were conducted to determine cell viability and apoptotic profiles of neuronal cells treated with sesamin and sesamol. Carboxy-DCFDA assay was used to measure reactive oxygen species (ROS). Moreover, Western blot analysis was performed to investigate protein profiles associated with neuroprotection. Results: Pretreatment of the cells with 1 µM of sesamin and sesamol remarkably reduced the SH-SY5Y cell death induced by 400 µM H₂O₂ as well as the intracellular ROS production. Moreover, the molecular mechanisms underlying neuroprotection of the compounds were associated with activating SIRT1-SIRT3-FOXO3a expression, inhibiting BAX (proapoptotic protein), and upregulating BCL-2 (anti-apoptotic protein). Conclusion: The findings suggest that sesamin and sesamol are compounds that potentially protect neuronal cells against oxidative stress similar to that of the resveratrol, the reference compound. These antioxidants are thus of interest for further investigation in in vivo models of neuroprotection.

Evaluation of hydrogen peroxide-assisted endoscopic ultrasonography-guided necrosectomy in walled-off pancreatic necrosis: A single-center experience

Hydrogen peroxide is a liquid that functions in mechanical removal of the necrotic tissue via the elimination of tissue debris.In this study, we aimed to evaluate the effectiveness of the use of hydrogen peroxide in necrosectomy treatment of walled-off pancreatic necrosis.Records of 24 patients who were diagnosed with pancreatic necrosis or walled-off pancreatic necrosis and underwent endoscopic necrosectomy (EN) were retrospectively assessed. Patients were divided into 2 groups; hydrogen peroxide used for treatment or not used, and these 2 groups were compared.A total of 24 patients underwent endoscopic intervention for walled-off pancreatic necrosis. Procedural success was comparable between the 2 groups. During the post-procedural follow-up, the duration of the hospital stay, recurrence, and complication rates were found to be similar in both groups. The mean number of the endoscopic interventions was significantly lower in the hydrogen peroxide group (4.2 ± 1.4 vs 6.1 ± 4.2; P = .01).The use of hydrogen peroxide for EN in walled-off pancreatic necrosis patients seems to have similar efficiency and safety. However, it can be said that the use of hydrogen peroxide could reduce the number of endoscopic procedures.

The effect of chronic dosing and p53 status on the genotoxicity of pro-oxidant chemicals in vitro

In this study, we have studied the cytotoxicity and genotoxic potency of 3 pro-oxidants; H2O2, menadione and KBrO3 in different dosing scenarios, namely acute (1-day dosing) and chronic (5-days). For this purpose, relative population doubling (RPD%) and mononucleated micronucleus (MN) test were used. TK6 cells and NH32 were employed in in vitro experiments. In the study, the total acute dose was divided into 5 days for each prooxidant chemicals by dose fractionation (1/5th per day) method. Acute dosing was compared to chronic dosing. The oxidative stress caused by the exposure of cells with pro-oxidant chemicals to the cells was determined by an optimized 2',7'-dichlorofluorescein diacetate (DCFHDA) test method. The antioxidant levels of the cell lines were altered with buthionine sulfoxide (BSO) and N-acetyl cysteine (NAC), and the effect of antioxidant capacity on the MN formation in the cells was observed with this method. In the case of H2O2 and menadione, fractional dosing has been observed to result in lower toxicity and lower genotoxicity. But in the case of KBrO3, unlike the other 2 pro-oxidants, higher MN induction was observed with fractionated doses. DCFHDA test clearly demonstrated ROS induction with H2O2 and menadione but not with KBrO3. Unexpectedly, DCFHDA test demonstrated that KBrO3 did not cause an increase ROS levels in both acute and chronic dosing, suggesting an alternative ROS induction mechanism. It was also observed that, treatment with BSO and NAC, caused increasing and decreasing of MN fold change respectively, allowing further ROS specific mechanisms to be explored. Hence, dose fractionation expectedly caused less MN, cytotoxicity and ROS formation with H2O2 and menadione exposure, but not with KBrO3. This implies a unique mechanism of action for KBrO3 induced genotoxicity. Chronic dosing in vitro may be a valuable approach allowing better understanding of how chemicals damage DNA and pose human hazards.

Intratumoral Hydrogen Peroxide With Radiation Therapy in Locally Advanced Breast Cancer: Results From a Phase 1 Clinical Trial

PURPOSE

Hydrogen peroxide (H2O2) plays a vital role in normal cellular processes but at supraphysiological concentrations causes oxidative stress and cytotoxicity, a property that is potentially exploitable for the treatment of cancer in combination with radiation therapy (RT). We report the first phase 1 trial testing the safety and tolerability of intratumoral H2O2 + external beam RT as a novel combination in patients with breast cancer and exploratory plasma marker analyses investigating possible mechanisms of action.

METHODS AND MATERIALS

Twelve patients with breast tumors ≥3 cm (surgically or medically inoperable) received intratumoral H2O2 with either 36 Gy in 6 twice-weekly fractions (n = 6) or 49.5 Gy in 18 daily fractions (n = 6) to the whole breast ± locoregional lymph nodes in a single-center, nonrandomized study. H2O2 was mixed in 1% sodium hyaluronate gel (final H2O2 concentration 0.5%) before administration to slow drug release and minimize local discomfort. The mixture was injected intratumorally under ultrasound guidance twice weekly 1 hour before RT. The primary endpoint was patient-reported maximum intratumoral pain intensity before and 24 hours postinjection. Secondary endpoints included grade ≥3 skin toxicity and tumor response by ultrasound. Blood samples were collected before, during, and at the end of treatment for cell-death and immune marker analysis.

RESULTS

Compliance with H2O2 and RT was 100%. Five of 12 patients reported moderate pain after injection (grade 2 Common Terminology Criteria for Adverse Events v4.02) with median duration 60 minutes (interquartile range, 20-120 minutes). Skin toxicity was comparable to RT alone, with maintained partial/complete tumor response relative to baseline in 11 of 12 patients at last follow-up (median 12 months). Blood marker analysis highlighted significant associations of TRAIL, IL-1β, IL-4, and MIP-1α with tumor response.

CONCLUSIONS

Intratumoral H2O2 with RT is well tolerated with no additional toxicity compared with RT alone. If efficacy is confirmed in a randomized phase 2 trial, the approach has potential as a cost-effective radiation response enhancer in multiple cancer types in which locoregional control after RT alone remains poor.

The rule of hydrogen peroxide long term rinse during a particular alveolar bone healing after ONJ injuries in a patient with periodontal disease: a 4-year radiological follow up report of a mental nerve emergence migration

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) is a pathology initially described in the early 2000s that has become increasingly common in clinical dentistry and maxillofacial practice due to the frequent use of bisphosphonates medical drugs (BPs) to treat various diseases such as osteoporosis, Paget's syndrome, osteomyelitis and in bone metastases secondary to tumors. Supragingival irrigation applied as monotherapy and in combination with root planning or BFs related bone necrosectomy revealed that supragingival irrigation with a variety of agents reduced the gingival microbial load and gingival inflammation. In this 4-year follow-up study we analyze the use of hydrogen peroxide (H2O2) as an antimicrobial agent for maintenance periodontal health, improving the longevity of teeth and oral cavity healing process.

Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review

BACKGROUND

Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic.

AIM

The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs.

METHODS

A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included.

FINDINGS AND CONCLUSION

A single cycle of vaporized hydrogen peroxide (H₂O₂) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H₂O₂ may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H₂O₂ does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.

Hydrogen Peroxide Topical Solution, 45% for Common Warts: Phase 2 Efficacy and Safety Trial Results

BACKGROUND

No FDA-approved prescription therapies are available for common warts.

OBJECTIVE

We evaluated a proprietary hydrogen peroxide topical solution, 45% (w/w) (HP45) for treatment of common warts.

METHODS

In the phase 2 randomized, double-blind, vehicle-controlled WART-203 trial (NCT03278028), eligible patients aged &ge;8 years had 1&ndash;6 warts (1 target wart) on the trunk or extremities with a Physician&rsquo;s Wart Assessment&trade; (PWA) grade &ge;2 (range, 0 [clear] to 3 [wart 3&ndash;8 mm in diameter or length]). Patients self-administered HP45 or vehicle twice weekly for 8 weeks and were evaluated through 12 weeks posttreatment (week 20). Efficacy assessments included mean change in target wart PWA grade from baseline at week 8 (primary endpoint) and proportions of patients with target wart clearance. Safety assessments included treatment-emergent adverse events (TEAEs) and local skin reactions (LSRs).

RESULTS

A total of 157 patients completed 8 weeks of treatment (HP45, n=79; vehicle, n=78); 151 patients completed the 20-week posttreatment evaluation (HP45, n=75; vehicle, n=76). A significantly greater reduction in mean target wart PWA grade from baseline at week 8 was achieved with HP45 (&minus;0.87) vs vehicle (&minus;0.17; P&lt;0.0001) and maintained at week 20 (&minus;1.00 vs &minus;0.39; P=0.0004). The proportion of patients with target wart clearance at week 8 was significantly greater with HP45 (25.3%) vs vehicle (2.6%; P&lt;0.0001) and remained significantly greater at week 20 (37.3% vs 11.8%; P=0.0002). Forty-seven patients reported 76 TEAEs; most were mild or moderate in severity. Most LSRs were mild and resolved by week 20. In pediatric patients (HP45, n=13; vehicle, n=6), greater reductions in mean target wart PWA grade from baseline were observed with HP45 vs vehicle at weeks 8 (&minus;1.0 vs 0) and 20 (&minus;1.2 vs &minus;0.5).

CONCLUSION

These findings support the efficacy and safety of HP45 for the treatment of common warts in patients &ge;8 years of age. J Drugs Dermatol. 2020;19(10):969-976. doi:10.36849/JDD.2020.5054.

Disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria using hydrogen peroxide plasma: Impact on the reutilization of disposable devices

INTRODUCTION

One of the serious consequences of the SARS-CoV-2 pandemic is the shortage of protective equipment for health personnel. N95 masks are considered one of the essential protective equipment in the management of patients with COVID-19. The shortage of N95 masks implies potential health risks for health personnel and significant economic losses for the health institution. The objective of this work was to investigate the disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria by using hydrogen peroxide plasma.

MATERIAL AND METHODS

We examined the disinfection capacity of hydrogen peroxide plasma against the SARS-CoV-2 and 2 members of the ESKAPE bacteria (Acinetobacter baumannii and Staphylococcus aureus) through a study of artificial contamination in situ of N95 masks. Amplification of specific genes by real-time reverse transcription polymerase chain reaction of SARS-CoV-2 and microbiological culture of ESKAPE bacteria was performed before and after the disinfection process.

RESULTS

SARS-CoV-2 was not detected in all assays using 5 different concentrations of the virus, and A baumannii and S aureus were not cultivable with inoculums of 102 to 106 CFU after disinfection tests of N95 masks with hydrogen peroxide plasma.

CONCLUSION

Disinfection of N95 masks by using the hydrogen peroxide plasma technology can be an alternative for their reuse in a shortage situation. Implications for the use of disinfection technologies of N95 masks and the safety of health personnel are discussed.

Role of hydrogen peroxide injection for penetrating abdominal injury in creating CT Tractogram

Penetrating abdominal trauma is responsible for approximately 35% of patients admitted to urban trauma centers, and up to 12% of those admitted in suburban or rural centers in the United States. Current protocol relies heavily on CT imaging as the diagnostic tool in evaluating for peritoneal violation in hemodynamically stable patients, however it is associated with false negative rates. In addition, visualization of the fascia of the rectus abdominis, the transversalis fascia, and the peritoneum cannot be reliably identified with CT. Studies have probed into the use of injecting IV contrast dyes prior to imaging to establish a CT tractography. We present a case of a 31-year-old male presenting to the emergency department for evaluation of stab wounds following an altercation. On exam, a 1 cm penetrating wound to the LUQ of his abdomen was noted. A CT scan of the abdomen and pelvis was performed with 91 mL of Omnipaque-350 intravenous contrast. Prior to imaging, 30 mL of hydrogen peroxide was injected directly into the opening site of the stab wound to amplify the wound tract. The result was a well-visualized intact peritoneum. We propose hydrogen peroxide as an alternative method to liquid contrast in reestablishing the stab wound tract. This method creates a negative contrast level to augment the ability of CT imaging to determine peritoneal penetration. Key Words: Penetrating Abdominal Injury, CT Tractography, Abdominal Trauma, Hydrogen Peroxide, Trauma Management.

Dual response mimetic enzyme of novel Co4S3/Co3O4 composite nanotube for antibacterial application

Novel Co₄S₃/Co₃O₄ composite nanotubes were first time successfully synthesized through the control of Na₂S treatment of Co(CO₃)_0.35Cl_0.20(OH)_1.10 precursor and testified to having both oxidase-like and peroxidase-like catalytic activities. Through nanoscale Kirkendall effect, acicular precursor was vulcanized to form Co₄S₃/Co₃O₄ nanotubes (NTs). Co₄S₃/Co₃O₄ NTs exhibit great properties such as smaller K_m and higher V_max than natural horseradish peroxidase, favorable selectivity and ideal stability. Co₄S₃/Co₃O₄ NTs with promising biocompatibility can realize spectral sterilization towards Escherichia coli and Staphylococcus sciuri in the presence of low level H₂O₂. It turned to be that superoxide anion radical catalyzed by Co₄S₃/Co₃O₄ NTs not only oxidizes 3, 3', 5, 5'-tetramethylbenzidine in the catalytic process but also eliminates gram-bacteria during sterilization. The successful synthesis of biofunctional Co₄S₃/Co₃O₄ NTs can serve as significant applications of new energy and environmental catalysis.

Effects of phosphate and hydrogen peroxide on the performance of a biological activated carbon filter for enhanced biofiltration

Biofilm formation on biofilters can influence their hydraulic performance, thereby leading to head loss and an increase in energy use and costs for water utilities. The effects of a range of factors, including hydrogen peroxide and phosphate, on the performance of biological activated carbon (BAC) and biofilm formation were investigated using laboratory-scale columns. Head loss, total carbohydrates, and proteins were reduced in the nutrient-enhanced, oxidant-enhanced, and nutrient + oxidant-enhanced BAC filters. However, there were no changes in the removal of dissolved organic matter, trihalomethane formation potential, or selected trace organic contaminants. The biofilm formation on polyvinyl chloride and stainless steel coupons using the laboratory biofilm reactor system was lower when the effluent from a nutrient-enhanced column was used, which indicated that there was less biofilm formation in the distribution systems. This may have been because the effluent from the nutrient-enhanced column was more biologically stable. Therefore, enhanced biofiltration could be used not only to reduce head loss in biofilters, but also to delay biofilm formation in distribution systems.

The Formation, Persistence, and Resistance to Disinfectant of the Erysipelothrix piscisicarius Biofilm

Erysipelothrix piscisicarius is an emergent pathogen in fish aquaculture, particularly in the ornamental fish trade. Very little is known on the biology of this pathogen; however, the recurrence of infection and disease outbreaks after removing the fish from a system and disinfecting the tank suggest its environmental persistence. Moreover, biofilm lifestyle in E. piscisicarius has been suspected but not previously shown. The purpose of this study was to investigate the formation of biofilms on an abiotic surface in Erysipelothrix spp. We used hydroxyapatite-coated plastic pegs to demonstrate the attachment, growth, and persistence of E. piscisicarius on abiotic surfaces in both fresh and marine environments and to investigate the susceptibility of this pathogen to different disinfectants that are used in the aquaculture industry. E. piscisicarius formed biofilms that persisted significantly longer than planktonic cells did in both freshwater and saltwater over a period of 120 h (P = 0.004). The biofilms were also more resistant to disinfectants than the planktonic cells were. Hydrogen peroxide was the most effective disinfectant against E. piscisicarius, and it eradicated the biofilms and planktonic cells at the recommended concentrations. In contrast, Virkon and bleach were able to eradicate only the planktonic cells. This information should be taken into consideration when developing biosecurity protocols in aquaculture systems, aquariums, and private collections.

Photosynthesis is sensitive to nitric oxide and respiration sensitive to hydrogen peroxide: Studies with pea mesophyll protoplasts

Reports on the effect of nitric oxide (NO) or reactive oxygen species (ROS) on photosynthesis and respiration in leaf tissues are intriguing; therefore, the effects of exogenous addition of sodium nitroprusside (SNP, releases NO) or H2O2 on the photosynthetic O2 evolution and respiratory O2 uptake by mesophyll protoplasts in pea (Pisum sativum) were evaluated in the present study. Low concentrations of SNP or H2O2 were used to minimize nonspecific effects. The effects of NO or H2O2 on respiration and photosynthesis were different. The presence of NO decreased the rate of photosynthesis but caused a marginal stimulation of dark respiration. Conversely, externally administered H2O2 drastically decreased the rate of respiration but only slightly decreased photosynthesis. The PS I activity was more sensitive to NO than PS II. On the other hand, 100 μM H2O2 had no effect on the photochemical reactions of either PS I or PS II. The sensitivity of photosynthesis to antimycin A or SHAM (reflecting the interplay between chloroplasts and mitochondria) was not affected by NO. By contrast, H2O2 markedly decreased the sensitivity of photosynthesis to antimycin A and SHAM. It can be concluded that chloroplasts are the primary targets of NO, while mitochondria are the primary targets of ROS in plant cells. We propose that H2O2 can be an important signal to modulate the crosstalk between chloroplasts and mitochondria.

Hydrogen Peroxide Topical Solution, 40% (w/w) for the Treatment of Seborrheic Keratoses: A Review

HP40 (Eskata™) is a stabilized, topical solution of 40% hydrogen peroxide (H2O2) packaged in an applicator pen that is US FDA-approved to treat seborrheic keratoses (SKs). By harnessing the oxidative capabilities of H2O2 , 1-2 treatments with HP40 produced a higher rate of clearance of four SKs per patient compared to vehicle in two phase 3 trials. The clearance rate was higher for the face than the trunk and extremities. Similarly, the risks of pigmentary changes and scarring from HP40 were lower for the face than other locations. Further, based on an ex vivo study, HP40 may be less cytotoxic to melanocytes than cryotherapy, but clinical trials comparing these therapies are needed. Limitations of HP40 are its low efficacy and requirement of multiple treatments, which can result in elevated costs. The application can also be time-consuming, though extenders or even staff members can apply it. Therefore, HP40 may be better reserved for the treatment of facial SKs.

Redox-regulation of ion homeostasis in growing lily pollen tubes

The pollen tube is characterized by cytoplasm compartmentalization typical for cells with polar growth. This concept includes "ion zoning", i.e. gradient distribution of ionic currents across the plasma membrane and free inorganic ions in the cytoplasm. One of the putative mechanisms for maintaining "ion zoning" is indicated by the sensitivity of the ion transport systems to reactive oxygen species (ROS). Here we test the possibility of redox regulation of ionic gradients and membrane potential (MP) gradient in growing pollen tubes using quantitative fluorescence microscopy. ROS quencher MnTMPP and exogenic H₂O₂ cause different alterations of intracellular Ca²⁺ gradient, pH gradient and MP gradient during short-term exposure. MnTMPP significantly shifts the gradients of Ca²⁺ and MP at low concentrations while high concentration cause growth alterations (ballooned tips) and cytoplasm acidification. H₂O₂ at 0,5 and 1 mM affects ion homeostasis as well (MP, Ca²⁺, pH) but doesn't decrease viability or alter shape of the tubes. Here we present original quantitative data on the interconnection between ROS and ion transport during tip growth.

Application of slightly acidic electrolyzed water and ultraviolet light for Salmonella enteritidis decontamination of cell suspensions and surfaces of artificially inoculated plastic poultry transport coops and other facility surfaces

The efficiency of combination treatment of slightly acidic electrolyzed water (SAEW) and ultraviolet light (UV) for inactivation of Salmonella enteritidis (S. enteritidis) on the surface of plastic poultry coops and other facility surfaces was evaluated in the presence of organic matter. The bactericidal activities of SAEW, UV + SAEW, and composite phenol (CP) for inactivating S. enteritidis were also compared. Moreover, a model of UV + SAEW treatment of plastic transport coops with different times and available chlorine concentrations (ACC) was developed using multiple linear regression analysis. There are differences between SAEW and CP inactivation of S. enteritidis on coops, stainless steel, and glass surfaces (P < 0.05), and there are no differences between SAEW and CP on tire surfaces (P > 0.05). Disinfection of some rough material surfaces with SAEW treatment alone under feces interference on poultry farms may need a longer treatment time and/or a higher ACC than smooth surfaces. The combined treatment of UV and SAEW showed higher inactivation efficiency of S. enteritidis compared to CP and SAEW treatment alone (P < 0.05) in pure cultures or on the facility surfaces. A complete 100% inactivation of S. enteritidis on plastic poultry coop surfaces was obtained by using UV + SAEW with an ACC of 90 mg/L for more than 70 s. The established model had a good fit that was quantified by the determination coefficient R² (0.93) and a lack of fit test (P > 0.05). The bactericidal efficiency of UV + SAEW increased with greater ACC and increasing time. The findings of this study indicate that the combination treatment of UV and SAEW may be a promising disinfection method and could be used instead of SAEW alone, especially on rough materials in the presence of organic matter on poultry farms.

In vitro bleaching effect of hydrogen peroxide with different time of exposition and concentration on shear bond strength of orthodontic brackets to human enamel: A meta-analysis of in vitro studies

INTRODUCTION

Controversy exists regarding the effect of bleaching on shear bond strength (SBS) of orthodontic brackets to enamel. This study aims to do a review and meta-analysis on the effect of bleaching with hydrogen peroxide on SBS according to the interval between bleaching and bonding to human enamel and the concentration of Hydrogen Peroxide.

METHODS

An electronic search of the literature was performed in Scopus, PubMed and Cochrane databases including CENTRAL and Cochrane library for relevant in vitro studies on the effect of bleaching with hydrogen peroxide on shear bond strength of human enamel, published until June 2018. Modified Cochrane Risk of Bias tool was used to assess the quality of the individual studies. AMSTAR tool was used for assessing the quality of the study.

RESULTS

Nineteen studies were included in the qualitative analysis. Regardless of the interval between bleaching and bonding, reduction in SBS was not statistically significant when the hydrogen peroxide of less than 35% is used. Bleaching with 35% hydrogen reduces SBS when the bonding is conducted immediately (P<0.0001) or the time interval was shorter than one day (P<0.0005). On the other hand, use of high dose hydrogen peroxide resulted in a statistically significant reduction in SBS irrespective of the time interval between the procedures (P<0.05 for all categories of time interval).

CONCLUSION

Bleaching with hydrogen peroxide decreases the SBS of brackets in patients undergoing orthodontic treatment especially if the time interval between bleaching and bonding procedures is short and a high concentration of hydrogen peroxide is used.

Enhancing Outcomes in Seborrheic Keratosis: Using a Novel Treatment Solution

Seborrheic keratosis (SK) is an extremely common benign cutaneous lesion that often appears on individuals older than the age of 50. SK lesions can appear in numerous clinical variations, but typically, SKs present with a well-demarcated, “stuck-on” appearance having a waxy or keratotic surface. Even though SK lesions are usually benign, many individuals elect for SK treatment or removal due to cosmetic concerns. One study regarding SK appearance reported that 61% of women tried to conceal the appearance of the SKs by using certain hairstyles, make-up, and clothes. Conventional treatment for SK lesions ranges from cryosurgery to curettage. Although these removal methods are effective for SK treatment, each method contains a potential for side effects such as pigmentation changes, scarring, and discomfort before and after the procedure. Due to many of these concerns, patients prefer topical treatments for SKs, which has led to a new emerging topical containing hydrogen peroxide topical solution 40% (HP40; Eskata™). Here, we report the methods and results from an HP40 treatment for two individuals, each over 70 years old. Application of the topical solution was performed on each target SK, up to four times, with a 20-second application and 1 minute between applications. The two participants reported moderate success of HP40 in the removal of their SKs with minimal adverse effects. J Drugs Dermatol. 2019;18(7 Suppl):s178-182.

Clinical Experience With 40% Hydrogen Peroxide Topical Solution for the Treatment of Seborrheic Keratosis

Despite reassurances about the benign nature of seborrheic keratoses (SKs), patients often request treatment due to cosmetic concerns or for symptomatic relief when SKs become irritated or pruritic. Treatment options include cryotherapy, surgical techniques, and topical therapies. In this study, we present two patients with SKs located on their face and neck who received in-office treatment with 40% Hydrogen Peroxide Topical Solution (Eskata™, HP40), a new FDA-approved topical therapy that has demonstrated efficacy in phase 3 trials. Compared to non-topical, more invasive techniques, HP40 may lead to less pigmentary changes, and may be more efficacious for SKs on the face and neck. Both patients received two treatment courses of HP40, which resulted in positive therapeutic outcomes, including the absence of scarring and pigmentary changes. In addition to the case presentations, we will discuss considerations for appropriate administration of HP40 to maximize clinical outcomes. J Drugs Dermatol. 2019;18(7 Suppl):s173-177.

Eskata (40% Hydrogen Peroxide Solution) for the Treatment of Seborrheic Keratoses

“Barnacles”, “liverspots”, “age spots": Seborrheic keratoses (SKs) have many different names, sizes, and clinical presentations in our patients. The only commonality among SKs is that patients despise them. While patients are initially concerned about their malignant potential, once they are reassured, most patients quickly transition from relief to request: “Can you get rid of them?” An observational study conducted across multiple dermatology practices found that SKs have a significant impact on quality of life, causing patients to adopt strategies to cover them and seek treatment for asymptomatic lesions.1 Given their benign potential, the only reason to remove an asymptomatic raised SK is cosmetic. When doing a cosmetic procedure, the acceptable risk is often lower given that the benefit for treatment is aesthetic. Ideally, a cosmetic intervention would have a wealth of evidence-based data and a favorable side effect profile. Eskata 40% hydrogen peroxide topical solution, the only FDA-approved drug for the treatment of raised SKs, strikes the perfect balance between efficacy and side effect profile.

Effect of gel replacement during in-office dental bleaching: a case report

In-office dental bleaching allows the dentist to have greater control of the procedure and prevents patients from ingesting chemicals. To obtain optimum results, in-office bleaching usually requires a longer period of application as well as changes of the bleaching agent applied to the tooth surfaces at each appointment. The objective of this case report was to assess, by means of a split-mouth design in a single patient, the final tooth color and tooth sensitivity resulting from 2 different bleaching protocols: 1 application of 35% hydrogen peroxide for 45 minutes and 3 applications of 35% hydrogen peroxide for 15 minutes each. Neither the patient nor 5 individuals who were blinded to the techniques noted a difference in the final esthetic results of the 2 protocols immediately after the procedure. In addition, the patient reported that no tooth sensitivity was associated with either protocol. The results of dental bleaching on both sides were maintained after 15 days. The results shown in the present case report suggest that there may be no need to renew the gel during in-office dental bleaching.

Microfluidic assemblies designed for assessment of drug effects on deformability of human erythrocytes

Extreme deformability of human erythrocytes is a prerequisite for their ability to squeeze through narrow capillaries of the blood microcirculation system. Various drugs can modify this deformability and consequently provoke circulation problems. We demonstrate that microfluidic assemblies are very convenient platforms for in vitro study of the associated processes. Two types of microfluidic channels were designed to quantitatively investigate modifications of erythrocyte deformability induced by hydrogen peroxide, ethanol and pentoxifylline based on transit velocity measurements. With a high sensitivity our microfluidic assemblies show that hydrogen peroxide decreases erythrocyte deformability in a dose-dependent manner. Then, results on ethanol resolve a biphasic nature of this reactant on the deformability of single erythrocyte cells. Results on pentoxifylline provide evidence that, similar to ethanol, also this medical drug has a double-sided effect on the erythrocyte deformability, i.e. increasing the deformability at low concentrations, while decreasing it at higher ones. Taken together, our microfluidic designs propose a potent measurement method for the erythrocyte deformability, as well as providing a perspective to evaluate effects of drugs on it.

Endoscopic Ultrasound-Guided Fine-Needle Injection of Hydrogen Peroxide into the Pancreas: Feasibility and Tolerability Study Using a Survival Porcine Model

Hydrogen peroxide (H₂O₂) has been reported to be an effective radiation sensitizer for various cancers. A combination therapy comprising fine-needle injection (FNI) of H₂O₂ under endoscopic ultrasound (EUS) guidance and chemoradiation might improve treatment outcomes of pancreatic cancer; however, there have been no reports thus far. The aims of this study were to evaluate the feasibility and safety of EUS-FNI of H₂O₂ into the pancreas using a porcine survival model. EUS-FNI was performed in the pancreas of six pigs, which were randomly divided into three groups based on the solution injected: group 1, 2 mL of sodium hyaluronate (control); group 2, 0.5 mL of H₂O₂; group 3, 2 mL of H₂O₂. To evaluate any adverse events, blood tests and computed tomography (CT) were performed before and after FNI, as well as days 3 and 7 subsequently. The pigs were necropsied on day 7. Histologic evaluation was performed according to the criteria for experimental acute pancreatitis. EUS-FNI was successful in all pigs. CT immediately after FNI revealed gas formation in the FNI area in groups 2 and 3. No adverse events were revealed by blood tests and CT. Histologic evaluations revealed pancreatitis scores of 5 and 5 in group 1, 7 and 7 in group 2 and 14 and 15 in group 3. EUS-FNI of H₂O₂ into the pancreas is feasible; however, it could cause pancreatitis. FNI of H₂O₂ into only the pancreatic tumor might be ideal in minimizing possible adverse events.

Oxyresveratrol protects human lens epithelial cells against hydrogen peroxide-induced oxidative stress and apoptosis by activation of Akt/HO-1 pathway

Oxidative stress induced by hydrogen peroxide (H₂O₂) triggers human lens epithelial cell (HLEC) apoptosis and initiates cataract formation. Oxyresveratrol (Oxy) was reported to possess antioxidant and free radical scavenging activities. Herein, we investigated the effects of Oxy on H₂O₂-induced oxidative stress and apoptosis in HLECs and the associated mechanisms. Cell viability was detected by MTT assay. The oxidative damage was assessed by measuring the activities of superoxide dismutases-1 (SOD-1), catalase (CAT), glutathione reductase (GSH), and malondialdehyde (MDA). Apoptosis was analyzed by flow cytometry analysis. The changed expressions of heme oxygenase-1 (HO-1) and protein kinase B (Akt) pathways were evaluated by qRT-PCR and western blot. We found that exposure to H₂O₂ dose-dependently reduced cell viability, and induced oxidative stress and apoptosis in HLECs, which were reversed by pretreatment with Oxy. Oxy increased p-Akt and HO-1 expressions in H₂O₂-stimulated HLECs. Akt and HO-1 expressions form a regulatory axis and Oxy activated the Akt/HO-1 pathway in H₂O₂-stimulated HLECs. Inhibition of the Akt/HO-1 pathway by LY294002 or ZnPP attenuated the effects of Oxy on oxidative stress and apoptosis in H₂O₂-stimulated HLECs. In conclusion, Oxy protected H₂O₂-induced oxidative stress and apoptosis through activating the Akt/HO-1 pathway, suggesting the protective effect of Oxy against H₂O₂-induced cataract.

Non-Enzymatic Synthesis of Bioactive Isoprostanoids in the Diatom Phaeodactylum following Oxidative Stress

The ecological success of diatoms requires a remarkable ability to survive many types of stress, including variations in temperature, light, salinity, and nutrient availability. On exposure to these stresses, diatoms exhibit common responses, including growth arrest, impairment of photosynthesis, production of reactive oxygen species, and accumulation of triacylglycerol (TAG). We studied the production of cyclopentane oxylipins derived from fatty acids in the diatom Phaeodactylum tricornutum in response to oxidative stress. P. tricornutum lacks the enzymatic pathway for producing cyclopentane-oxylipins, such as jasmonate, prostaglandins, or thromboxanes. In cells subjected to increasing doses of hydrogen peroxide (H₂O₂), we detected nonenzymatic production of isoprostanoids, including six phytoprostanes, three F_2t-isoprostanes, two F_3t-isoprostanes, and three F_4t-neuroprostanes, by radical peroxidation of α-linolenic, arachidonic, eicosapentaenoic, and docosahexanoic acids, respectively. H₂O₂ also triggered photosynthesis impairment and TAG accumulation. F_1t-phytoprostanes constitute the major class detected (300 pmol per 1 million cells; intracellular concentration, ∼4 µm). Only two glycerolipids, phosphatidylcholine and diacylglycerylhydroxymethyl-trimethyl-alanine, could provide all substrates for these isoprostanoids. Treatment of P. tricornutum with nine synthetic isoprostanoids produced an effect in the micromolar range, marked by the accumulation of TAG and reduced growth, without affecting photosynthesis. Therefore, the emission of H₂O₂ and free radicals upon exposure to stresses can lead to glycerolipid peroxidation and nonenzymatic synthesis of isoprostanoids, inhibiting growth and contributing to the induction of TAG accumulation via unknown processes. This characterization of nonenzymatic oxylipins in P. tricornutum opens a field of research on the study of processes controlled by isoprostanoid signaling in various physiological and environmental contexts in diatoms.

Clinical Evaluation of 10% Hydrogen Peroxide on Tooth Sensitivity and Effectiveness in at Home Dental Bleaching

AIM

The purpose of this study was to evaluate the dental effect and sensitivity of at-home dental bleaching with 10% hydrogen peroxide (H₂O₂).

MATERIALS AND METHODS

Twenty volunteers with A2 or darker central incisors were selected for this study. Was used 10% H₂O₂ for thirty minutes twice a day, for two weeks. Shade evaluation was assessed visually by the value-oriented shade guide Vita Classical shade guide, Vita Bleachedguide 3D-MASTER and by the Easyshade spectrophotometer at baseline, during bleaching (first and second weeks), and post-bleaching (one month). The perceptions of sensitivity were recorded by the patients through the numerical rating scale (0 to 4) and 0 to 10 visual analog scales daily. Data from the shade guide units was subjected to a one way repeated measures (RM) analysis of variance (ANOVA) test (a = 5%). The overall AE, absolute risk and intensity of tooth sensitivity were calculated as well as the 95% confidence interval.

RESULTS

The absolute risk of tooth sensitivity was 65% and the intensity was mild. Data from ASGU and AE after 1 month of bleaching for H₂O₂ 10% showed significant whitening, 4 units for Vita Classical, 5 units for Vita Bleachedguide and 9.7 units for spectrophotometer.

CONCLUSION

At-home bleaching using 10% hydrogen peroxide is effective in 14 days of bleaching. The most common adverse events were mild tooth sensitivity, and no subjects discontinued use early because of a treatment-related adverse event.

CLINICAL SIGNIFICANCE

At-home dental bleaching with 10% hydrogen peroxide gel reduces the time of use of the tray, maintaining the effectiveness with low intensity of dental sensitivity. Brazilian clinical trials registry (REBEC) RBR-45xmzj.

In vivo and in vitro assessment of the bleaching effectiveness of a brush-off patch containing 3.0% hydrogen peroxide

OBJECTIVES

To evaluate the efficacy of a brush-off patch containing 3.0% hydrogen peroxide, which is a new over-the-counter (OTC) product for tooth whitening, and determine the optimal protocol for use.

MATERIALS AND METHODS

We performed an in vitro study using hydroxyapatite specimens and a clinical trial involving 140 volunteers. The brush-off patch was applied to the specimens (in vitro) or the maxillary anterior teeth (in vivo; 14 days) for 10 min twice daily (case 10 group) or 30 min once daily (case 30 group). We also included control groups in both experiments. Lightness (L*), redness (a*), and yellowness (b*) values were measured using a colorimeter. In the in vivo study, color changes were measured at baseline and 7 and 14 days after the start of patch application. The overall color change (ΔE) was statistically analyzed.

RESULTS

In the in vitro study, the color change (ΔE*) after the experiment was significantly different between the two case groups and the control group (p < 0.001). In the in vivo study, the case groups showed color changes at both 7 and 14 days after patch application. In particular, the change in the case 30 group was significantly more prominent on day 14 than on day 7 (p < 0.05).

CONCLUSION

Our findings suggest that brush-off patches containing 3.0% hydrogen peroxide are effective OTC products for tooth whitening.

CLINICAL RELEVANCE

For best results, brush-off patches containing 3.0% hydrogen peroxide can be applied once daily for 30 min.

Self-Supplied Tumor Oxygenation through Separated Liposomal Delivery of H2O2 and Catalase for Enhanced Radio-Immunotherapy of Cancer

The recent years have witnessed the blooming of cancer immunotherapy, as well as their combinational use together with other existing cancer treatment techniques including radiotherapy. However, hypoxia is one of several causes of the immunosuppressive tumor microenvironment (TME). Herein, we develop an innovative strategy to relieve tumor hypoxia by delivering exogenous H₂O₂ into tumors and the subsequent catalase-triggered H₂O₂ decomposition. In our experiment, H₂O₂ and catalase are separately loaded within stealthy liposomes. After intravenous (iv) preinjection of CAT@liposome, another dose of H₂O₂@liposome is injected 4 h later. The sustainably released H₂O₂ could be decomposed by CAT@liposome, resulting in a long lasting effect in tumor oxygenation enhancement. As the result, the combination treatment by CAT@liposome plus H₂O₂@liposome offers remarkably enhanced therapeutic effects in cancer radiotherapy as observed in a mouse tumor model as well as a more clinically relevant patient-derived xenograft tumor model. Moreover, the relieved tumor hypoxia would reverse the immunosuppressive TME to favor antitumor immunities, further enhancing the combined radio-immunotherapy with cytotoxic T lymphocyte-associated antigen 4 (CTLA4) blockade. This work presents a simple yet effective strategy to promote tumor oxygenation via sequential delivering catalase and exogenous H₂O₂ into tumors using well-established liposomal carriers, showing great potential for clinical translation in radio-immunotherapy of cancer.

A Comparison of Oral Hygiene Products and Professional Care: A six-week randomized clinical trial

Purpose: To investigate the anti-gingivitis efficacy of a novel oral hygiene routine consisting of a two-step stannous fluoride dentifrice and hydrogen peroxide whitening gel system, an interactive oscillating-rotating electric toothbrush, and expanded polytetrafluoroethylene floss.Methods: A total of 52 participants (n=52;mean age 35.8±11.23 years) were enrolled in the study and randomized 1:1 to the experimental hygiene group or control (dental prophylaxis followed by use of standard sodium fluoride dentifrice and a manual toothbrush). Participants were instructed to brush twice daily; those in the experimental group were instructed to floss once daily. Oral examinations were conducted at Baseline, Week 2, Week 4, and Week 6.Results: Both groups experienced significant declines in the mean number of bleeding sites from Baseline at all time points, evident as early as Week 2. Bleeding sites continued to decline throughout the trial in the experimental group, whereas they showed an increasing trend between Weeks 2 and 6 in the control group. The experimental group had 55% fewer bleeding sites at Week 2, 85% fewer bleeding sites at Week 4, and 98% fewer bleeding sites at Week 6 (p<0.0001 for all) as compared to the control group. At Week 6, 84% of participants in the experimental group had no bleeding, while all participants in the control group had bleeding.Conclusion: The experimental oral hygiene group showed significantly greater reductions in gingival bleeding than the control oral hygiene group, with benefits seen as early as Week 2 and increasing over the six-week study.

Anatomic Site-Specific Treatment Response With 40% Hydrogen Peroxide (w/w) Topical Formulation for Raised Seborrheic Keratoses: Pooled Analysis of Data from Two Phase 3 Studies

OBJECTIVE

Seborrheic keratoses (SKs) may present in any non-glabrous skin, but data are limited on the response to treatment as based on the SK location. We aimed to understand the relationship between SK location and clearance with up to 2 treatments of 40% (w/w) hydrogen peroxide topical solution (HP40).

METHODS

We conducted a sub-analysis of data pooled from two randomized, double-blind, vehicle (VEH)-controlled clinical trials, including 937 patients, each with 4 target SKs (N=3,748 SKs), with at least 1 on the face and 1 on the trunk or extremities. Treatment response was defined as 0 or 1 on a 4-point Physician's Lesion Assessment (PLA) scale (0=clear; 1=near-clear) after up to 2 applications, 3 weeks apart, and was assessed by SK location (face, trunk, and extremity). Local skin reactions were stratified by anatomic location and categorized based on immediate and delayed post-treatment reactions. Sensitivity analysis was conducted using the mean-per-patient (MPP) percent of SKs that are clear or near-clear at day 106.

RESULTS

Treatment response was greater with HP40 versus VEH regardless of anatomic location of the SK. Clear or near-clear SKs with HP40 was observed in 65% of facial SKs (vs 10% VEH), 46% of truncal SKs (vs 5% VEH), and 38% of extremity SKs (vs 9% VEH). Facial SKs were more likely to be clear or near clear after a single treatment (43%), versus SKs on the trunk (31%) or extremities (14%). Most common immediate reactions with HP40 were erythema, stinging, and edema, which resolved to none or mostly mild within a week. Delayed reactions such as dyspigmentation and scarring occurred at low rates and were least reported for the facial SKs.

CONCLUSIONS

SK clearance with HP40 was highest among SKs on the face and lowest among SKs on the extremities. Dyspigmentation rates were lowest among SKs treated on the face. Anatomic location of SK was a predictor of both treatment response and risk of dyspigmentation with HP40 application. ClinicalTrials.gov listings: NCT02667236 and NCT02667275 J Drugs Dermatol. 2018;17(10):1092-1098.

Managing Seborrheic Keratosis: Evolving Strategies and Optimal Therapeutic Outcomes

Seborrheic keratosis (SK) is the most common skin tumor seen by dermatologists in everyday practice. Although the lesions are mostly benign, many patients still elect to have asymptomatic SK removed. The historical standards of treatment are cryosurgery and electrocautery, two surgical options that are effective at lesion removal but have high rates of postoperative adverse events such as treatment-site scarring and pigmentary alterations. The cosmetic outcomes of SK treatment modalities are of keen interest to dermatologists, as the American population becomes increasingly more diverse. In this article, the inclusion of darker Fitzpatrick skin types into clinical studies investigating post-treatment side effects of SK therapy is reviewed. The recent approval of a 40% hydrogen peroxide topical formulation is discussed in light of these issues, and several non-invasive topical treatments that optimize cosmetic outcomes of SK lesion removal are highlighted. Finally, treatment strategies aimed at reducing cost and minimizing the burden of adverse sequelae are provided. J Drugs Dermatol. 2018;17(9):933-940.

Disinfection of Blood Pressure Cuffs and Electrocardiographic Telemetry Leads With 0.5% Hydrogen Peroxide Wipes

BACKGROUND

Disinfection of frequently touched surfaces in the hospital is critical for providing safe care. Because of their complex intricate surfaces, blood pressure cuffs and electrocardiographic telemetry leads may be harder than other equipment to disinfect.

OBJECTIVE

To determine the effectiveness of 0.5% hydrogen peroxide wipes in cleaning and disinfecting inpatient hospital surfaces, including hook and loop (Velcro) fasteners of blood pressure cuffs and electrocardiographic telemetry leads.

METHODS

A prospective study of an inpatient telemetry unit was designed to measure the persistence of a UV indicator and the presence of bacterial colonization on electrocardiographic telemetry leads and blood pressure cuffs. Call buttons and patient trays were used as control surfaces, because they are often touched but are easy to disinfect via standard practices.

RESULTS

A total of 392 samples were collected between July 11 and August 3, 2016, and cultured for microorganisms. Among the cultures, 247 (63%) had at least 1 colony-forming unit. After adjustments in a multivariable analysis, odds of a contaminated surface (≥ 10 colony-forming units) after final cleaning with 0.5% hydrogen peroxide wipes were 3.70 times greater for patient trays than for blood pressure cuffs (P = .03) and 3.80 times greater for telemetry leads than for blood pressure cuffs (P = .04). The UV indicator persisted longer on blood pressure cuffs and telemetry leads than on patient trays or call buttons (P < .001).

CONCLUSION

Wipes with 0.5% hydrogen peroxide adequately disinfect blood pressure cuffs but not telemetry leads.

Color stability, psychosocial impact, and effect on self-perception of esthetics of tooth whitening using low-concentration (6%) hydrogen peroxide

OBJECTIVE

The aim of this study was to assess the bleaching efficacy and impact on psychosocial and esthetics self-perception of a low-concentration (6%) hydrogen peroxide (H2O2) gel compared with a conventional (37.5%) H2O2 gel when used as an in-office treatment.

METHOD AND MATERIALS

In total, 35 participants received two sessions of three 12-minute applications of treatment with 37.5% H2O2 on one side of the mouth and 6% H2O2 on the other. Color changes were measured objectively using total variation in color (ΔE) and subjectively using Vita Classical scale (ΔSGU). The Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) and Oral Health Impact Profile (OHIP-14) esthetic questionnaires were administered to measure self-perception and the psychosocial impact of the whitening procedure.

RESULTS

Both gels produced significant changes in tooth color at 1 and 3 months post-whitening. The objective efficacy (ΔE) of 37.5% H2O2 (9.06 ± 2.96) was significantly higher than that of 6% H2O2 (5.69 ± 3.06). The results of the subjective assessment were not statistically different. There was a positive impact on esthetic auto perception (OHIP-14, P < .05) and psychosocial impact (PIDAQ, P < .05) at the 3-month time point.

CONCLUSION

Low concentration of H2O2 (6%) achieved effective bleaching (ΔE > 5 units) with good stability at 3 months accompanied by a positive psychosocial impact and enhanced self-perception. However, the traditional 35% concentration was objectively more effective.

Regional Hyperoxygenation: An Important Enhancing Factor of Anticancer Chemotherapy

Tissue hyperoxygenation is an important factor in enhancing the antitumor activity of cytotoxic agents. The authors describe their technique for regional hyperoxygenation by intrarterial infusion of hydrogen peroxide combined with anticancer agents. The method was tried in 34 patients with extensive head and neck tumors. Objective regression was obtained in 19 (55.7 %). Hyperoxygenation probably influences the cellular metabolic and enzymatic processes, thus enhancing the antineoplastic activity of cytotoxic agents. The method described is useful either as a palliative in extensive inoperable tumors, especially those previously irradiated, or as a first chemotherapeutic step in a comprehensive program of treatment in resistant, slow-growing tumors.

[Low-concentration hydrogen peroxide solution for continuous bladder irrigation after transurethral resection of the prostate]

OBJECTIVE

To evaluate the effectiveness and safety of low-concentration hydrogen peroxide solution (HPS) for continuous bladder irrigation after transurethral resection of the prostate (TURP).

METHODS

We retrospectively analyzed the clinical data about 148 cases of benign prostatic hyperplasia (BPH) treated by TURP from January 2013 to January 2016. Seventy-six of the patients received postoperative continuous bladder irrigation with 0.15% HPS (group A) and the other 72 with normal saline (group B). We compared the two groups of patients in their postoperative hemoglobin (Hb) levels, duration of bladder irrigation, frequency of catheter blockage, time of catheterization, and length of hospital stay.

RESULTS

There were no statistically significant differences between the two groups of patients preoperatively in the prostate volume, International Prostate Symptoms Score, maximum urinary flow rate, postvoid residual urine, or levels of serum PSA and Hb (P > 0.05). At 48 hours after operation, a significantly less reduction was observed in the Hb level in group A than in group B (［3.38 ± 2.56］ vs ［7.29 ± 6.58］ g/L, P < 0.01). The patients of group A, in comparison with those of group B, also showed remarkably shorter duration of postoperative bladder irrigation (［32.57 ± 5.99］ vs ［46.10 ± 8.79］ h, P < 0.01), lower rate of catheter blockage (3.3% vs 11.8%, P < 0.01), shorter time of catheterization (［3.74 ± 0.79］ vs ［4.79 ± 0.93］ d, P < 0.01), and fewer days of postoperative hospital stay (［4.22 ± 0.81］ vs ［4.67 ± 0.88］ d, P < 0.01).

CONCLUSIONS

Low-concentration HPS for continuous bladder irrigation after TURP can reduce blood loss, catheter blockage, bladder irrigation duration, catheterization time, and hospital stay, and therefore deserves a wide clinical application.

Intravitreal Injection of Hydrogen Peroxide Induces Acute Retinal Degeneration, Apoptosis, and Oxidative Stress in Mice

PURPOSE

Oxidative stress is a common pathological condition for multiple retinal diseases. Hydrogen peroxide (H₂O₂) has been applied as an oxidative stress inducer for the in vitro studies. Here, we report the in vivo effect of H₂O₂ exposure to the mouse retina and its underlying mechanism.

METHODS

The H₂O₂ or saline solution was intravitreally injected into the eyes of female C57BL/6J mice for two consecutive days. The retinal structure was evaluated by in vivo imaging using spectral domain optical coherence tomography (OCT) and validated by histological assessment as well as retinal marker expression. In addition, retinal stress, cell apoptosis, and antioxidant enzyme expression were also determined.

RESULTS

Retinal and outer nuclear layer thickness thinning was observed at days 7 and 14 by OCT imaging with the treatment of 10 μg H₂O₂, which was confirmed by the histopathological analysis. The expressions of photoreceptor (Rho, Rora, Rorb, and Rcvrn), bipolar cell (Chat and Calb2), and retinal pigment epithelial (Rpe65) markers were reduced in the H₂O₂-treated group, whereas the expression of retinal ganglion cell marker (Tubb3) was increased. TUNEL-positive cells were obviously found in the outer nuclear layer and inner nuclear layer of H₂O₂-treated mice but sparely found in the ganglion cell layer. Coherently, apoptotic gene expressions (Casp3, Casp9, Bax, and Parp8) were significantly increased in the retina with increasing dosages of H₂O₂, while Bcl2 expression was mildly decreased. In addition, the expressions of Gfap and antioxidant enzyme genes (Txn2, Sod2, and Gpx4) were significantly upregulated in the retina after the H₂O₂ treatment, compared to the vehicle control group.

CONCLUSIONS

This study revealed that intravitreal injection of H₂O₂ induces acute retinal damage by increasing oxidative stress and cell apoptosis in the retina. This acute retinal degeneration mouse model could provide a platform for drug screening against oxidative stress and retinal diseases.