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Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infected wounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier's gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis. With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon.
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Hyperbaric oxygen and wound healing
William A. Zamboni, MD, FACS
, Leslie K. Browder, MD
John Martinez, MD
Division of Plastic Surgery, University of Nevada School of Medicine, 2040 W. Charleston Blvd., Suite 301,
Las Vegas, NV 89102, USA
Department of Surgery, University of Nevada School of Medicine, 2040 W. Charleston Blvd., Suite 301,
Las Vegas, NV 89102, USA
Nonhealing wounds are a major health problem
worldwide. Managing difficult wounds often involves
prolonged hospitalizations, numerous surgical inter-
ventions, and medical wound management, all of
which frequently lead to exuberant costs, morbidity,
and even mortality. A thorough understanding of basic
wound healing, diagnosis, and principles of hyper-
baric oxygen ( HBO) as an adjuvant therapy can
facilitate healing a problem wound.
Wound healing
Phases of wound healing
A wound heals by primary or secondary intention.
A laceration or incision, which is reapproximated, is
an example of wound healing by primary intention.
Most chronic wounds heal by secondary intention via
formation of granulation tissue, contraction, and
central migration of the peripheral epithelium.
The three phases of wound healing are inflam-
mation, repair, and maturation, all of which super-
impose to effectively repair a wound. The inflammation
phase involves vascular and cellular responses. Arte-
rioles constrict, and then dilate. Fibrin congregates,
platelets aggregate, and the coagulation cascade is
initiated. Neutrophils and macrophages invade the
wound, removing tissue debris and bacteria. Macro-
phages attract the fibroblast to the injured site,
stimulating fibroblast proliferation and angiogenesis.
Resolution of the inflammation phase initiates the
repair phase, in which collagen synthesis from fibro-
blast proliferation occurs. During maturation, colla-
genase is present, promoting breakdown and repair of
existing collagen cross-links, and thus contributing to
the wound strength.
Impaired wound healing
Problem wounds are those that fail to heal in
response to standard medical and surgical therapy.
These wounds are frequently found in patients who
have multiple local and systemic factors inhibiting
tissue healing. Advanced ag e, nutritional deficits,
vascular insu fficiency, diabetes, infection, tobacco
use, hypoxia, and immunosupp ressi on are among
some of the important risk factors that interfere with
wound healing. Among these, hypoxia and infection
adversely affect wound healing most frequently. The
consequence of many of these risk factors results in
low oxygen tensions, which adversely effect neutro-
phil, macrophage, and fibroblast functions.
The role of oxygen
The neutrophil, macrophage, and fibroblast
require oxygen to function during inflammation and
repair phases. Both, oxygen-dependent and oxygen-
independent systems are required in order for neu-
trophils and macrophages to kill microorganisms.
0094-1298/03/$ see front matter D 2003, Elsevier Science (USA). All rights reserved.
PII: S 0094-1298(02)00068-8
* Corresponding author.
E-mail address:
(W.A. Zamboni).
Clin Plastic Surg 30 (2003) 67 75
Oxygen radicals derived from molecular oxygen are
important in bacterial killing. Leukocytes contain an
enzyme—NADPH-linked oxygenase—that is acti-
vated, resulting in oxidants. After activation, an
oxidative burst allows molecular oxygen to be
reduced to superoxide radicals, thus killing bacteria
by oxidizing cell membranes. The superoxide radi-
cals are reduced to oxygen and peroxide by super-
oxide dismutase. Myeloperoxidase combines with
peroxide and chloride or iodide to form hypochlorite
or hypoiodite. Intracellulary, excess peroxide is
reduced to oxygen by a catalase. If iron is present,
the reaction occurs extracellulary, producing OH
harmful oxygen radical. This oxygen radical kills
bacteria effectively, but also harms surrounding cells.
If cells are hypoxic, the oxygen-dependent pathway is
severely incapacitated, leading to increasing rates of
infection [1].
Collagen synthesis from fibroblasts also requires
oxygen. Fibroblasts follow the macrophages into the
wound environment. Nonhelical procollagen is cre-
ated by protein synthesis involving proline, lysine,
and glycine. Oxygen is an important cofactor re-
quired during hydroxylation of proline and lysine
during formation of procollagen. Next, propeptides
are cleaved off of procollagen to form tropocollagen
via lysyl oxidase. Glycosaminoglyc ans provide a
matrix for cross-linking and aggregation of collagen
molecules to form collagen mature fibers. Mature
collagen synthesis requires prolyl-hydroxylase and
lysyl-hydroxylase, which are enzymes dependent on
oxygen for function. Energy metabolism of the cell
is first priority, occurring through oxidative phos-
phorylation, which then allows enzymes to use
molecular oxygen. If the tissue is hypoxic, procolla-
gen hydroxylation suffers and mature collagen can-
not be formed [2].
The problem wound environment is hypoxic,
acidotic, and contains high levels of lactate. This
environment forms a concentration gradient, largely
responsible for the inward movement of wound
healing cells [3]. Hypoxia is the result of the initial
vascular damage, coagulation, and vasoconstriction.
Furthermore, leukocytes increase oxygen consump-
tion, causing a lower oxygen tension in the wound
[2]. Acidosis results from an increase in oxygen
Fig. 1. Monoplace hyperbaric oxygen chamber. (Courtesy of Sunrise Hospital and Medical Center, Las Vegas, NV.)
W.A. Zamboni et al. / Clin Plastic Surg 30 (2003) 67–7568
demand in the face of a decreased oxygen supply. In
wounds, lactate accumulates due to hypoxia. Lactate
accumulation is also caused by leukocytes, fibro-
blasts, and endothelial cells. These cells have few
mitochondria and therefore rely on glycolysis, even
in the presence of oxygen, resulting in high levels of
lactate. Furthermore, lactate stimu lates collagen
secretion and angiogenesis.
Angiogenesis occurs rapidly in wounds across a
gradient of low lactate and high oxygen tension to
areas of high lactate and low oxygen levels [3].
Although profound hypoxia inhibits all wound-
healing processes, moderate low oxygen tensions
initiates angiogenic growth factor production in
vitro and upregulates vascular endothelial growth
factor [2]. Recent data supports lactate as the agent
responsible for initiating these growth factors [3],
but the intricate details of this pathway remain to
be elucidated.
Wound diagnosis
To determine the etiology of a nonhealing wound,
an accurate diagnosis must be made. As with any
medical problem, the evaluation begins with an
adequate history and physical examination. Informa-
tion regarding t he duration, wound environment
(dressings, t opical treatments), surgery (debride-
ments, grafts), and presence of comorbidities (dia-
betes, vascular disease, malnutrition, and so forth) are
important components. Examination of the wound
will provide information such as wound size, loca-
tion, depth, and infection. Peripheral vascular disease
can be diagnosed by the presence of skin changes and
diminished pulses. Venous stasis can also be deter-
mined. Examination of the granulation tissue will
also provide clues as to the etiology of the wound.
If the granulation tissue is beefy red in appearance,
the wound environment is healthy. If the granulation
tissue is pale, friable, or nonexistent, the wound is
likely hypoxic.
The foundation of treating a problem wound is the
identification and correction of the underlying etio-
logic and risk factors that may hinder the healing
process. An angiogram should be obtained, if indi-
cated, to determine the presence of vascular abnormal-
ities amenable to surgical intervention. Furthermore,
noninvasive evaluation, consisting of evaluation of
tissue oxygenation and perfusion of the wound, is
essential. Arteriole Doppler studies, consisting of both
segmental and toe pressures, should be obtained to
evaluate perfusion. Transcutaneous oximetry (TcPO
is used to assess oxygenation of the wound. If both of
these values are normal, a wound should heal sponta-
neously. If they are abnormal, adjunctive therapy may
be needed to aid in healing the wound.
HBO as a therapy
The management o f probl em wound s should
always include correction of perfusion and oxygena-
tion deficiencie s, debrid ement, inf ection con trol,
aggressive wound care, and s urgical closure. In
problem wounds, adjunctive care may also be neces-
sary. When a deficiency in oxygenation of the
wound is found, in the face of nonreconstructable
vascular disease, HBO as an adjunctive therapy
should be considered.
HBO is defined as a treatment in which 100%
oxygen is delivered to a patient at greater than two
times the normal atmospheric pressure at sea level.
The goal is to increase oxygen delivery to tissues by
increasing the partial pressure of oxygen in plasma.
This is based on Henry’s law, which states that the
Fig. 2. Multiplace hyperbaric oxygen chamber (inside).
(Courtesy of Kindred Hospital, Las Vegas, NV.)
W.A. Zamboni et al. / Clin Plastic Surg 30 (2003) 67–75 69
concentration of a gas dissolved in fluid is directly
proportional to the pressure exerted on the gas. In
other words, HBO therapy results in ‘hyperoxic
plasm a, because arteriole PO
levels can reach
greater than 2000 mm Hg and tissue PO
can reach levels greater than 600 mm Hg.
HBO therapy is accomplished via a monoplace or
multiplace chamber. A monoplace chamber is a
hollow sphere designed to deliver HBO to one patient
without the use of an oxygen mask (Fig. 1). Respira-
tor-dependant patients can be supported on ventila-
tors that are specially designed for the monoplace
chamber. Pertinent vital signs and transcutaneous
oxygen levels can be monitored while the patient is
in the monoplace chamber. Multiplace chambers can
accommodate more than one person (Figs. 2, 3).
Because compressed air is used for pressurization,
patients must wear tight-sealing oxygen masks, or
hoods, that deliver 100% oxygen. Chambers must
also have vacuum reducers to conduct exhaled carbon
dioxide out of the tank. The advantages of a multi-
place chamber are in treating more than one patient at
a time and direct care for patients, including defi-
brillation, suctioning, and chest tube insertion. In
contrast, if patients are in a monoplace chamber, they
must be decompressed before direct patient care can
Fig. 3. Multiplace hyperbaric oxygen chamber (outside). (Courtesy of Kindred Hospital, Las Vegas, NV.)
Fig. 4. TcPO
W.A. Zamboni et al. / Clin Plastic Surg 30 (2003) 67–7570
be administered. In addition, there are less claustro-
phobic events in multiplace chambers when com-
pared with monoplace chanbers.
An increase in tissue oxygen tension by HBO
therapy enhances wound healing by a number of
mechanisms. It increases neutrophil bactericidal
capaci ty, kills some anaerobic bacteria, inhibits
toxin formation in some anaerobes, encourages
fibroblast activity, and promotes angiogenesis [4].
Classically, oxygen delivery depends on the
amount of oxygen carried by hemoglobin, rather
than on arterial oxygen content. In wounds, how-
Fig. 5. TcPO
evaluation form.
W.A. Zamboni et al. / Clin Plastic Surg 30 (2003) 67–75 71
ever, this is not true. Intercapillary distances are
large and oxygen consumption is relatively low in
wounds. Furthermore, microvasculature damage
and peripheral vasoconstriction increase diffusion
distances. Partial pressure is the driving force of
diffusion. A higher PO
level is needed to force
oxygen into injured and healing tissues [5,6].
Therefore, HBO creates a steep tissue oxygenation
gradient, providing an even more powerful stimu-
lus than lactate or moderate hypoxia, to initiate
and propel wound healing [5,6].
Supporting data
The effects of HBO on wound healing have been
shown in several clinical trials. Conditions such as
osteomyelitis, necrotizing infections, ischemia reper-
fusion, and thermal injuries have been studied with
promising results [7 9]. Perhaps the most inform-
ative studies have been in diabetic lower extremity
wounds. Overall, several studies have shown
decreased wound size [1012], decreased rates of
amputation [10, 1316], and increased numbers of
healed wounds [15, 17, 18] among patients receiving
HBO therapy as an adjunctive treatment.
Baroni et al [10] conducted a nonrandomized
study of 18 hospitalized diabetics and 10 diabetic
control patients. They reported that a significant
number of subjects who received HBO went on to
heal their wound when compared with subjects who
had not received HBO. In a continuation of this study
[16], a significant decrease in amputations was found
among patients who underwent HBO, when com-
pared with the control group. The same researchers
published a third study [17] that involved 151 dia-
betic patients with wounds of the lower extremity
(there was no control group in this study). One
hundred and thirty of the patients completely healed
their wounds with adjunctive HBO. Furthermore, the
authors of a prospective randomized trial [14] invol-
ving 35 subjects who received HBO and 33 patients
who were controls reported a significan tly lower
incidence of major amputations among Wagner grade
IV ulcers. Wattel et al [18] conducted a noncontrolled
study consisting of 59 diabetic patients with wounds.
Fifty-two patients who received HBO went on to heal
their wounds. Doctor et al [13] showed a significant
decrease in amputation rate in 30 patients who were
Fig. 6. Initial evaluation of a 58-year-old insulin-dependent
diabetic patient with a limb-threatening foot wound. The
patient had a normal perfusion pressure and a low
transcutaneous oxygen measurement.
Fig. 7. Wound after surgical debridement.
W.A. Zamboni et al. / Clin Plastic Surg 30 (2003) 67–7572
subjected to HBO when compared with the control
group during a prospective randomized study. Ham-
merlund et al [11] found a significant reduction in
wound size among nondiabetic patients who received
HBO in a prospective randomized study. Zamboni
et al [12] followed nonhealing diabetic ulcers in a
prospective nonrandomized study, and found a sig-
nificant reduction in wound size for HBO patients
when compared with non-HBO patients. Kalani et al
[15] followed chronic diabetic foot wounds for 3 years
in a prospective randomized study. When compared
with conventionally treated wounds, HBO patients
had an accelerated rate of healing, reduced rate of
amputation, and an increased rate of completely
healed wounds on a long-term basis.
Many factors play an important role in wound
healing. Diabetic control, circulatory problems, pres-
ence of infection, and wound size or depth may
adversely affect wound healing. Many of these
studies fail ed to compare these variables during
analysis of their data. Nonetheless, the results are
promising and should serve as a stimulus for the
development of double-blinded prospective random-
ized studies in the future.
Patient evaluation
Proper patient selection for HBO therapy is cru-
cial. The etiology of the problem wound ensures
successful management. A vascular surgery consul-
tation is the first priority, to determine if a recon-
structible lesion exists. If the patient has
nonreconstructable vascular disease, HBO therapy
may be indicated. Tissue oxygenation and perfusion
must be evaluated in each wound. Noninvasive
arteriole Doppler studies, consisting of s egmental
and toe pressures, are used to evaluate perfusion,
whereas TcPO
is used to evaluate oxygenation.
Currently, TcPO
is the best tool available to
evaluate tissue hypoxia, wound-healing potential,
and patient selection for HBO therapy, and to monitor
progress during therapy (Figs. 4, 5) [19]. A trans-
cutaneous oxygen tension greater than 50 mm Hg
indicates that the wound should heal spontaneously.
Values between 30 and 50 mm Hg are marginal, and
values below 30 mm Hg indicate that the wound
will not heal without adjunctive therapy. HBO
therapy will accelerate tissue repair in hypoxic
wounds in which oxygen tension can be elevated
to therapeutic levels [19]. Therefore, if a patient has
been found to have TcPO
levels below 40 mm Hg,
Fig. 8. Wound after 15 hyperbaric treatments.
Fig. 9. Wound after 30 hyperbaric treatments and prior to
successful skin graft.
W.A. Zamboni et al. / Clin Plastic Surg 30 (2003) 67–75 73
and these levels have been shown to increase to
greater than 100 mm Hg while brea thing 100%
oxygen or to greater than 200 mm Hg at 2.5 atmo-
spheres absolute, the patient may be a candidate for
HBO. Repeated TcPO
with the patient breathing
room air for at least 12 hours after an HBO treatment
is documented on a weekly basis. Importantly, there is
often a 2-week period in which there is no improve-
ment in wound appearance, despite HBO. These
patients may eventually respond to HBO, and there-
fore amputation should be delayed. When healthy
granulation tissue is present—which usually occurs
after 15 to 30 treatments—TcPO
should be measured
at room air. If TcPO
levels are above 40 mm Hg,
HBO should be discontinued and proper wound care
should be continued until the wound heals.
The diabetic patient poses a challenge during
evaluation of tissue perfusion and oxygenation.
Diabetic patients may have normal or falsely ele-
vated noninvasive Doppler studies and low TcPO
levels, implying satis factory perfusion a nd inad-
equate oxygenation of the wound. Many factors
unique to diabete s may contribute to dec reased
oxygen delivery to the wound, such as red blood
cell membrane stiffness and glycosylated hemo-
globin. In general, a diabetic patient with normal
noninvasive Doppler and low TcPO
level responds
best to HBO (Figs. 69).
Presently, the use of HBO therapy is necessary in
only 15% to 20% of patients [19]. HBO therapy in
compromised diabetic wounds is usually reserved for
wounds with tendon or bone exposed, as well as
those wounds with impending gangrene that do not
respond to traditional management of debridement,
antibiotics, and general wound care, including vas-
cular reconstruction. HBO therapy increases wound
oxygen tension, enhancing host antibacterial mecha-
nisms and promoting wound healing [19]. Overall,
HBO is reserved for wounds in which hypoxia and
infection are the etiology. Rarely, HBO is indicated
for other wounds such a venous ulceration or decu-
bitus ulcers [7].
HBO treatment protocols
Protocols for administering HBO vary depending
on the wound severity and chamber type. Oxygen
pressure, duration, periodicity, and total number of
sessions may vary from center to center. Typically,
treatments are delivered at 2.0 to 2.4 atmospheres for
90 to 120 minutes once or twice daily in multiplace
chambers [7]. Treatments in monoplace chambers are
typically performed at 2.0 atmospheres [7]. When
serious infections are present, patients are typically
hospitalized, and given both IV antibiotics and hyper-
baric treatments twice daily. HBO is an adjuvant
treatment ; therefore, diabetic control, debridement,
and aggressive wound treatment are given first pri-
ority. When the wound bed has adequate granulation
tissue, appl ication of grafts can shorten morbidity,
hospital stay, and health care costs.
Problem wounds, which fail to respond to tra-
ditional medical and surgical therapy, can be chal-
lenging to the plastic surgeon. Surgical, outpatient,
and inpatient wound care costs can be exorbitant.
Indirect costs, su ch as those rel ated to p atient
productivity, disability, a nd premature death, can
also be significant. The underlying problem in
failure of a wound to heal is usually hypoxia and
infection. HBO treatments in selected patients can
facilitate healing by increasing tissue oxygen ten-
sion, thus providing the wound with a more favor-
able environment for repair. Therefore, HBO therapy
can be an important component to any comprehen-
sive wound care program.
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... 8.9 Dari 128 kasus yang menggunakan TOHB sebagai modalitas terapi tambahan di RSUP Prof. Dr. R. D. Kandou selama periode tahun 2011-2016 tercatat bahwa penggunaan TOHB terbanyak untuk decompression sickness (46,87%), diikuti thermal burns (22,65%) dan diabetic ulcer (14,84%), crush injury, skin graft dan pre-post amputation masingmasing sebanyak 6 kasus (4,68%), dan gangrene gas (1,56%). 1,8,9 Pada beberapa laporan dan penelitian, pasien dapat diobati dengan 1-3 sesi TOHB setiap hari. Studi menggunakan model hewan juga menemukan TOHB bermanfaat dalam beberapa kondisi untuk penyembuhan tulang. ...
... 7 Dalam kasus ini, pencangkokan tulang alveolar dilakukan pada usia 14 tahun setelah erupsi gigi taring permanen agar mendapatkan hasil yang lebih baik dukungan tulang untuk kaninus dan untuk mendukung gigi seri lateral. 8,10 Pada kasus ini, celah alveolar ditutup menggunakan cangkok tulang iliaka, karena kemudahan aksesnya, dan juga mudah untuk mendapatkan jumlah yang cukup dari tulang cancellous dengan sayatan perkutan. 5,11 Cangkok cancellous mengalami revaskularisasi cepat yang memungkinkan penyatuan lebih cepat dan osteoblas meletakkan tulang baru pada trabekula lama yang kemudian diproliferasi, yang penting untuk hasil jangka panjang. ...
Gnatoschizis is a congenital disorder due to complex causes involving many genetic and environmental factors. The shape and complexity of the cleft varies greatly, which will determine the final outcome of the reconstruction. The management involves a multidisciplinary approach including orthodontics, prosthodontics, as well as speech and psychological therapist. Bone grafting materials such as iliac crest (corticocancellous autogenous), bone morphogenetic proteins and recombinant human proteins have shown good long-term results. An additional method that is considered effective in accelerating bone growth is the administration of hyperbaric oxygen therapy (HBOT) which has been reported to increase the accumulation of minerals needed for osteogenesis, such as calcium, magnesium, and phosphorous. We reported a case of a 14-year-old girl with gnatoschizis who underwent an alveolar bone graft surgery and one day after the operation was immediately followed by administration of (HBOT) to improve the bone healing process. cleft location. Autogenous iliac bone graft was used for closure of the bony defect at the site of the cleft. Follow up at day-14 showed a satisfying result. In conclusion, in this patient continuity of upper dental arch was achieved as well as optimal alar basis, no fistula, stabile upper dental arch for orthodontic treatment, and ideal alveolar morphology that supported the ultimate goal of cleft palate treatment - improvement of quality of life.Keywords: gnatoschizis; alveolar bone graft; hyperbaric oxygen therapy Abstrak: Gnatoschizis merupakan kelainan kongenital dengan penyebab kompleks yang meli-batkan banyak faktor genetik dan lingkungan. Bentuk dan kompleksitas sumbing sangat bervariasi, yang akan menentukan hasil akhir rekonstruksi. Tatalaksananya melibatkan pendekatan multi-disiplin termasuk ortodontik, prostodontik, serta terapi wicara dan psikologis. Bahan pencang-kokan tulang seperti krista iliaka (corticocancellous autogenous), protein morfogenetik tulang dan protein manusia rekombinan telah menunjukkan hasil jangka panjang yang baik. Salah satu metode tambahan yang dianggap efektif mempercepat pertumbuhan tulang ialah pemberian terapi oksigen hiperbarik (TOHB) yang telah dilaporkan meningkatkan akumulasi mineral yang dibutuh-kan untuk osteogenesis, seperti kalsium, magnesium, dan fosfor. Kami melaporkan kasus seorang anak perempuan berusia 14 tahun dengan gnatoschizis yang menjalani operasi cangkok tulang alveolar dan satu hari setelah operasi langsung dilanjutkan pemberian TOHB untuk meningkatkan proses penyembuhan tulang. Cangkok tulang iliaka autogenous digunakan untuk penutupan defek tulang di lokasi sumbing. Follow up pada hari ke 14 di poliklinik dengan pemeriksaan fisik pada defek lokasi sumbing mendapatkan hasil yang memuaskan. Simpulan laporan kasus ialah pada pasien ini diperoleh kontinuitas lengkung rahang atas, basis alar yang optimal, fistula dihilangkan, segmen rahang atas yang stabil untuk perawatan ortodontik, dan morfologi alveolar yang ideal yang menyokong tujuan akhir tatalaksana sumbing yaitu perbaikan kualitas hidup.Kata kunci: gnatoschizis; cangkok tulang alveolar; terapi oksigen hiperbarik
... Oxygen-generating materials have been used in different tissue engineering applications; however, the optimum oxygen release rates required for these applications differ. For example, wound-healing applications require a fast and relatively short oxygen release to prevent tissue necrosis after severe injuries; however, for engineered tissues or organs, a long-term and stable oxygen release is necessary to maintain cell viability and tissue functionality before the vascularization process is complete [13][14][15]. In our release studies of SPO and CPO, we observed that SPO had a burst oxygen release, while CPO had a more stable oxygen release than SPO, which was expected due to the different chemical decomposition kinetics of SPO and CPO [1,3]. ...
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Oxygen-generating materials have been used in several tissue engineering applications; however, their application as in situ oxygen supply within bioprinted constructs has not been deeply studied. In this study, two oxygen-generating materials, sodium percarbonate (SPO) and calcium peroxide (CPO), were studied for their oxygen release kinetics under a 0.1% O2 condition. In addition, a novel cell-culture-insert setup was used to evaluate the effects of SPO and CPO on the viability of skeletal muscle cells under the same hypoxic condition. Results showed that SPO had a burst oxygen release, while CPO had a more stable oxygen release than SPO. Both SPO and CPO reduced cell viability when used alone. The addition of catalase in SPO and CPO increased the oxygen release rate, as well as improving the viability of skeletal muscle cells; however, CPO still showed cytotoxicity with catalase. Additionally, the utilization of 1 mg/mL SPO and 20 U catalase in a hydrogel for bioprinting significantly enhanced the cell viability under the hypoxic condition. Moreover, bioprinted muscle constructs could further differentiate into elongated myotubes when transferring back to the normoxic condition. This work provides an excellent in vitro model to test oxygen-generating materials and further discover their applications in bioprinting, where they represent promising avenues to overcome the challenge of oxygen shortage in bioprinted constructs before their complete vascularization.
... Reference: (Sahni et al., 2003;Bhutani and Vishwanath, 2012). ...
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Geographical location is a basic principle for the formation and development of society and geopolitics as a strategy. It is the basis for establishing a mentality approach in a society striving for cultural prosperity. The continent of Europe, as one of the cradles that formed the last human civilization, is the place that, highly developed socio-economic and military nations, at different times, sought to impose their hegemon over other countries in the form of unification. Their views, theories and approaches have always been "clothed" in some form of Doctrine, justifying the techniques and means used to achieve the ultimate goal - the creation or "unification" of new territorial spaces. In the last two centuries on the territory of the Old Continent - Europe, two World Wars and many regional conflicts have taken place on this basis. Geopolitics has always been a major tool for any country on the continent that has sought to achieve more than its own prosperity by imposing its influence on a particular territory in one way or another. Keywords: Geopolitics, Europe, Doctrine and regions
... Reference: (Sahni et al., 2003;Bhutani and Vishwanath, 2012). ...
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ABSTRACT Morocco's rangelands cover an area of over 500,000 km2, are mainly located in arid areas and play economic, sociocultural and environmental roles. Since the mid-1970s, the high plateaus of eastern Morocco (HPEM), which are the country's second largest pastoral ecosystem, have shown obvious manifestations of climate change (CC), thus threatening their sustainability and that of the rangelands- based small ruminant production, the main source of livelihood for the local population. Despite livestock rearing on rangelands is highly vulnerable to CC and the understanding of pastoralists’ perceptions is critical for designing more efficient and successful adaptation strategies, how the livestock producers perceive CC is still not studied. This paper aims to detect the main long-term changes that have affected climatic conditions in the HPEM and to assess the consistency between the perception of pastoralists with regard to CC and actual climate trends observed from historical meteorological data. The climate data used include the annual rainfall of 6 meteorological stations, namely Bni Mathar (1931-2019), Tendrara (1931-2019), Bouaârfa (1981-2019), Figuig (1935-2019), Taourirt (1923-2019) and Oujda (1914-2019) and the temperature data from the stations of Bni Mathar (1970-2016) and Oujda (1935-2020). To investigate the trends and ruptures in homogeneity within these climatic series, the Mann-Kendall, Pettitt and Buishand tests were performed, while the standardized precipitation index was used to detect years of drought. Data on CC perceptions were examined using frequency analysis. Rainfall data indicated a general drop in annual amounts of precipitation with a significant downward trend for the stations existing in the north part of the study area, namely Bni Mathar (τb = -0.194, p = 0.007), Taourirt (τb = -0.217, p = 0.002) and Oujda (τb = -0.189, p = 0.004). These stations showed, respectively, rupture dates located at 1976, 1976 and 1980, with rainfall losses of 23, 30 and 22%. The mean (τb = 0.553, p < 0.0001; τb = 0.311, p < 0.0001) and minimum (τb = 0.647, p < 0.0001; τb = 0.333, p < 0.0001) temperatures have experienced a significant increasing trend, respectively for the stations of Bni Mathar and Oujda. The minimum temperature showed the greatest rise either 2.7 °C (39%) between the periods before and after the rupture date of 1988 for Bni Mathar, and of 1.1°C (11%) between the periods before and after 1986 for the Oujda station. The frequency of droughts has increased over the past five decades, showing high values ranging from 43% in the south of the HPEM to 57% in the northern part. Indeed, the frequency of dry years has risen considerably between the two periods before and after 1976, with an average increase of 26 to 49% (i.e., 88%). Results indicated that the overwhelming majority of livestock producers have observed decrease in rainfall (100%) as well as an increase in the frequency of droughts (97%), temperature (82%), high winds (81%) and sandstorms (87%) during the last five decades. Therefore, the pastoralists’ perceptions of CC matched well with the trends observed in the historical meteorological data and the findings of previous studies. To deal with the negative consequences of these observed unfavorable trends arising from CC and improve the resilience of pastoralists, public policies and programs should urgently develop and implement effective and appropriate adaptation actions and jointly integrate pastoralists' perceptions and recorded meteorological data in future climate research.
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Forensic Entomology is a new emerging branch of science where insects are used for the criminal investigations such as estimate the time of death (PMI), location of death, nature of death etc. Order Diptera and Coleoptera have insects like flesh flies (Sarcophagidae), green bottle and blue bottle (Calliphoridae) and beetles are attract on dead bodies so with the help of life cycle of these insects we can easily estimate the criminal investigations. Forensic entomology is a very useful tool for determining time since death and place of death. After 72 hrs forensic entomologist can gather clue by collect the maggots, by the length of maggots PMI can be estimate. It is only accurate method available to determine elapsed time since death in short time period. It is vital that the insects are collected property and its accuracy depends on suitable conditions for insects. Keyword: Forensic entomology, sarcophagidae, calliphoridae, PMI, crime detection
Malignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm.
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Description of the Problem: The risk of osteoporosis and fractures is considerably higher in middle-aged postmenopausal women. Osteoporosis creates a significant burden of morbidity and mortality worldwide and has recently become a significant public health problem. In postmenopausal women, the amount of estrogen in the body is significantly reduced. This situation; can lead to significant health problems, such as a decrease in bone mineral density, increase in abdominal fat and fracture risk, and deterioration in psychological status. Aim: The aim of this review is to pay attention to the point that pilates exercises are an effective approach to prevent osteoporosis and improve general health status in postmenopausal women. Theoretical Framework: Adequate intake of calcium, vitamin D and protein, quitting alcohol and smoking, and various exercise approaches can reduce the prevalence of osteoporosis and fracture risk in women. Therefore, developing programs that promote lifestyle changes in postmenopausal women is necessary to reduce the risk of osteoporosis. Pilates is a combination of exercises that focus on lumbopelvic stabilization and the deep muscles of the trunk, creating a complete connection between mind and body. Pilates exercises performed under expert supervision are recommended for all individuals regardless of physical condition, age or gender. Studies have reported that pilates improves various health parameters, such as pain, muscle strength, balance, body composition, lipid profile, blood glucose level, functional status and quality of life in postmenopausal women. Conclusion: Pilates is considered an effective and safe method for postmenopausal women, especially as it improves balance and reduces the fear of falling.
Being the most versatile of all biomolecules, proteins constitute a large portion of the cell. Nature provides a wide number of proteins that exhibit specific function. The effort to design novel proteins, re-engineer existing ones etc. are the emerging field in computational protein biophysics and a lot of work have already been reported in last two decades. However, the researchers have come across several challenges which arise due to astronomically huge conformational and sequence space that are possible even for a small protein. With the advancement of computational methods, computational protein design (CPD) has emerged to be an important field in understanding the biological roles of proteins, it guides to enormously large structural possibilities of proteins and how it can be applied in biotechnology and biomedicine. Based upon knowledge of protein folding pathways, effective energy functions, sequence and conformational sampling algorithms etc., great progress has been made in protein design. Here, an introduction to protein design and different aspects of protein design such as common inputs considered in CPD, efforts in CPD, challenges of CPD will be discussed and conclude with a brief outlook for the future.
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Aim: Today, chronic pain is a universal problem in societies in terms of severe deterioration of the psychosocial status and functionality of individuals. The aim of this study is to determine the relationship between the pain beliefs of individuals with chronic diseases and their level of adaptation to the disease. Methods: The research was conducted in descriptive and cross-sectional type. The sample of the study consisted of 71 individuals with chronic diseases between 01.09.2021 and 15.09.2021. An online survey form was prepared to collect the data. Data were collected using the personal information form, the Pain Beliefs Scale, and the Chronic Disease Adaptatıon Assessment Scale. Ethics committee approval was obtained to conduct the study. In the evaluation of the data; means, percentile distributions and Pearson correlation analyzes were used. Results: While the level of assessment of adaptation to the disease of individuals with chronic disease (69.70±7.02) was found to be above the moderate level, it was determined that it was at a moderate level in psychological beliefs (3.11±1.47) and organic beliefs (4.19±0.78). Conclusion: It was determined that there was no significant relationship between the levels of adaptation to the disease and organic and pain beliefs of individuals with chronic disease. It can be recommended that this study be performed with different patient groups. Key words: Belief, chronic. pain, patient
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Description of the problem: Orthorexia Nervosa (ON) is a condition that is also known as 'healthy eating obsession', but has not yet been accepted as a pathology with international diagnostic and treatment criteria. It is important to have information about the diagnosis and treatment strategies of Orthorexia Nervosa in the light of the recently published literature data and to interpret the obtained data correctly. Objective: In this review study, it is aimed to evaluate the current literature on Orthorexia Nervosa. Theoretical framework: It has been reported that individuals with Orthorexia Nervosa generally pay attention to being "healthy and natural" rather than the amount of food, spend more than 3 hours a day for healthy nutrition, and energy and some macro and micronutrient deficiencies can be seen. In addition, it cannot be said that ON only causes medical complications. When they adapt their lives according to the strict dietary rules they set, deterioration in their social relations can also be observed. It has been reported that they may develop prejudices against the eating habits of others and prefer not to eat with them. Loneliness and social isolation are the most common symptoms. However, it should be noted that these diagnostic criteria were created only by certain researchers and have not yet been approved by the American Psychiatric Association. Conclusion: When the current literature is examined, it is seen that the number of studies on Orthorexia Nervosa is quite high. Orthorexia Nervosa has not yet been defined as a separate eating disorder. However, studies show that it shows different symptoms from other eating disorders and that it is a separate eating disorder. More clinical studies are needed to fully and accurately determine the diagnostic criteria and to develop treatment methods, and highsensitivity measurement tools are needed to diagnose Orthorexia Nervosa.
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Background: HBOT has been seen to improve quality oflife, reduce fatigue, improve CD4 counts, and reduce viral loads in HIV positive and AIDS patients. This effect has been seen to be multi factorial; development of reactive oxygen species, improved lipid peroxidation, improvement in microvascular and macrovascular functions, and improved lymphocytic functions could playa role in combating the HN. Patients presenting with chief complaint of fatigue have been seen to report a significant reduction in fatigue following administration ofHBOT.
Hyperbaric oxygen application has now become a useful technique for both diagnostic and therapeutic purposes in CNS, cardiovascular and respiratory diseases, as well as in soft-tissue and orthopaedic pathologies and haematologic disorders. With a specific didactic approach, supported by numerous illustrations and tables, this volume aims to present all aspects of oxygen application under pressure not only to resolve some clinical problems, but also to improve recovery or to modify a negative illness evolution. Both scientists and practitioners will find this work a useful and updated reference book.
Plastic surgery is a broad specialty encompassing a variety of areas including the treatment of traumatic soft tissue injury, burn care, hand surgery, microsurgery and limb replantation, problem wound management, flap reconstruction, cosmetic surgery, and congenital deformity. In recent years an emphasis on less anecdotal and more scientific research has provided a better understanding of the role of hyperbaric oxygen therapy (HBO) for many plastic surgical conditions. Patient selection remains the key to successful outcome. The rationale for HBO treatment of a specific plastic surgery problem should be based on scientific research if possible. If supportive research is not available or applicable to a specific case, then the decision to treat should be based on sound physiological principles. The purpose of this chapter is to familiarize the reader with several of the more common plastic surgery problems and to review the appropriate use of HBO for each condition based on a current knowledge of the literature and the author’s experience.
The use of hyperbaric oxygen therapy as part of the treatment of thermal burns is far from being universally accepted. Although there appears to be substantial experimental animal evidence of the positive effects of hyperbaric oxygen in many aspects of the pathophysiology of the severe burn, the clinical human studies confirming these effects are lacking. Reasons for this are mostly related to practical and logistic difficulties in organising such studies. In view of the current available knowledge, hyperbaric oxygen therapy should only be administered according to strict protocols of utilisation, optimising the possible benefits while avoiding any extra risk