Oxidative stress is fundamental to hyperbaric oxygen therapy

The goal of this review is to outline advances addressing the role that reactive species of oxygen and nitrogen play in therapeutic mechanisms of hyperbaric oxygen. The review will be organized around major categories of problems or processes where controlled clinical trials have demonstrated clinical efficacy for hyperbaric oxygen therapy. Reactive species are now recognized to play a major role in cell signal transduction cascades, and the discussion will focus on how hyperbaric oxygen acts through these pathways to mediate wound healing and ameliorate postischemic and inflammatory injuries.     

Oxygen Therapy Use in Older Adults with Chronic Obstructive Pulmonary Disease

Rationale

Oxygen therapy improves survival and function in severely hypoxemic chronic obstructive pulmonary disease (COPD) patients based on two landmark studies conducted over 40 years ago. We hypothesize that oxygen users in the current era may be very different. We examined trends and subject characteristics associated with oxygen therapy use from 2001–2010 in the United States.

Methods

We examined Medicare beneficiaries with COPD who received oxygen from 2001 to 2010. COPD subjects were identified by: 1) ≥2 outpatient visits >30 days apart within one year with an encounter diagnosis of COPD; or 2) an acute care hospitalization with COPD as the primary or secondary discharge diagnosis. Oxygen therapy and sustained oxygen therapy were defined as ≥1 and ≥11 claims for oxygen, respectively, in the durable medical equipment file in a calendar year. Primary outcome measures were factors associated with oxygen therapy and sustained oxygen therapy over the study period.

Results

Oxygen therapy increased from 33.7% in 2001 to 40.5% in 2010 (p-value of trend <0.001). Sustained oxygen therapy use increased from 19.5% in 2001, peaked in 2008 to 26.9% and declined to 18.5% in 2010. The majority of subjects receiving oxygen therapy and sustained oxygen therapy were female. Besides gender, factors associated with any oxygen use or sustained oxygen therapy were non-Hispanic white race, low socioeconomic status and ≥2 comorbidities.

Conclusions

Any oxygen use among fee-for service Medicare beneficiaries with COPD is high. Current users of oxygen are older females with multiple comorbidities. Decline in sustained oxygen therapy use after 2008 may be related to reimbursement policy change.     

心肺脑复苏后如何进行早期氧疗

心肺脑复苏（Cardiopulmonary—cerebralResuscitation,CPCR）是抢救心跳骤停（CardiacArrest）患者的重要手段,而早期氧疗（AcuteOxygenTherapy）是提高心肺脑复苏成功率的重要辅助措施。以往人们一直认为CPCR后应尽早给予患者高浓度氧疗;然而,近年认为早期氧疗不当非但达不到挽救心跳骤停患者生命、降低致残率之目的,反而会降低复苏成功率。基础研究和临床研究提示,与暴露于正常空气或低浓度氧气组相比,大脑缺氧后早期暴露于高浓度氧气中的动物或患者,脑组织损伤更加严重。其可能机制主要有高浓度氧含量引起的氧化应激和乳酸堆积造成的脑组织损伤。此外,复苏后高浓度氧疗还可造成心肌损伤,其主要机制有大量活性氧簇（ReactiveOxygenSpecies,ROS）造成心脏的继发性损伤、Ca2＋通道激活,引起血管收缩加重心肌缺血、K＋ATP通道关闭,造成心肌受损、血管紧张素Ⅱ释放增多和缩血管物质20-HETE生成增多,加重心肌缺血等。因此,在对复苏后病人进行氧疗过程中,目前主张限制复苏后早期氧疗。     

The use of clostridial spores for cancer treatment

Hypoxic/necrotic regions, absent in normal tissues, can be exploited to target tumours in cancer therapy using nonpathogenic strains of the bacterial genus Clostridium. Following administration of Clostridium spores to tumour-bearing organisms, these spores can only germinate within the hypoxic/necrotic regions of solid tumours, proving their exquisite selectivity. Low oxygen tension is a common feature of solid tumours, which may arise from the unique physiological environment, generated to a large extent by the abnormal tumour vasculature, and provides as such a niche for anaerobic bacteria. Some clostridia tested clearly showed innate oncolytic activity, but they could not completely eradicate the tumour. Recombinant clostridia producing prodrug-converting enzymes or cytokines resulted in the production of such proteins solely within the tumour, and where applicable, could convert the prodrug in a toxic compound. Moreover, in some cases, tumour eradication or tumour control could be observed. This review brings an overview of the relative successes and failures of the Clostridium-directed tumour therapy with both wild-type strains and strains producing proteins useful in antitumour therapy.     

Salarin C inhibits the maintenance of chronic myeloid leukemia progenitor cells

We previously showed that incubation of chronic myeloid leukemia (CML) cells in very low oxygen selects a cell subset where the oncogenetic BCR/Abl protein is suppressed and which is thereby refractory to tyrosine kinase inhibitors used for CML therapy. In this study, salarin C, an anticancer macrolide extracted from the Fascaplysinopsis sponge, was tested as for its activity on CML cells, especially after their incubation in atmosphere at 0.1% oxygen. Salarin C induced mitotic cycle arrest, apoptosis and DNA damage. Salarin C also concentration-dependently inhibited the maintenance of stem cell potential in cultures in low oxygen of either CML cell lines or primary cells. Surprisingly, the drug also concentration-dependently enforced the maintenance of BCR/Abl signaling in low oxygen, an effect which was paralleled by the rescue of sensitivity of stem cell potential to IM. These results suggest a potential use of salarin C for the suppression of CML cells refractory to tyrosine kinase inhibitors     

Reversal of sexual impotence in male patients with chronic obstructive pulmonary disease and hypoxemia with long term oxygen therapy

Erectile impotence is commonly encountered in male patients with respiratory failure and hypoxia. In this study, 42% of the patients experienced reversal of sexual impotence during long term oxygen therapy (LTOT). We examine the association between sexual impotence, gonadal axis hormones, hypoxia, and oxygen therapy. Nineteen sexually impotent male patients eligible for LTOT (pO₂ < 7.3 kPa during stable disease) and with sexual impotence received oxygen therapy for 1 month (n = 12) or 24 h (n = 7). pO₂, LH, FSH, testosterone, and SHBG (sex hormone binding globulin) were monitored. Five of 12 patients receiving oxygen for 1 month regained sexual potency. The responders showed a significant increase in arterial pO₂ and serum testosterone, and a decline in SHBG compared to non-responders. None of the patients receiving oxygen for 24 h experienced reversal of sexual impotence, despite a significant increase in pO₂. In these patients, serum testosterone did not increase significantly. Reversal of sexual impotence may be achieved in some patients with respiratory failure. The oxygen therapy must, however be administered for an adequate length of time.     

综述与专论: 高压氧疗法治疗脑缺血的相关机制

脑缺血是指大脑各部分血液供应不足导致脑组织缺血缺氧，进而导致密集缺血区脑组织出现不可逆的损伤坏死，其高致残率、高死亡率会对患者及其家庭造成严重的伤害。在脑缺血发生后，及时采取一定的治疗措施控制梗死灶的大小，并挽救半暗带中的细胞是脑缺血预后的关键。高压氧疗法是针对脑缺血的一种潜在治疗方法，在近年来得到了越来越广泛的关注和研究，本文旨在综述近年来国内外关于高压氧疗法治疗脑缺血的相关机制及研究进展，为脑缺血患者的治疗和预后提供新思路。     

Oxygenation inhibits the physiological tissue-protecting mechanism and thereby exacerbates acute inflammatory lung injury

Acute respiratory distress syndrome (ARDS) usually requires symptomatic supportive therapy by intubation and mechanical ventilation with the supplemental use of high oxygen concentrations. Although oxygen therapy represents a life-saving measure, the recent discovery of a critical tissue-protecting mechanism predicts that administration of oxygen to ARDS patients with uncontrolled pulmonary inflammation also may have dangerous side effects. Oxygenation may weaken the local tissue hypoxia-driven and adenosine A_2A receptor (A_2AR)-mediated anti-inflammatory mechanism and thereby further exacerbate lung injury. Here we report experiments with wild-type and adenosine A_2AR-deficient mice that confirm the predicted effects of oxygen. These results also suggest the possibility of iatrogenic exacerbation of acute lung injury upon oxygen administration due to the oxygenation-associated elimination of A_2AR-mediated lung tissue-protecting pathway. We show that this potential complication of clinically widely used oxygenation procedures could be completely prevented by intratracheal injection of a selective A_2AR agonist to compensate for the oxygenation-related loss of the lung tissue-protecting endogenous adenosine. The identification of a major iatrogenic complication of oxygen therapy in conditions of acute lung inflammation attracts attention to the need for clinical and epidemiological studies of ARDS patients who require oxygen therapy. It is proposed that oxygen therapy in patients with ARDS and other causes of lung inflammation should be combined with anti-inflammatory measures, e.g., with inhalative application of A_2AR agonists. The reported observations may also answer the long-standing question as to why the lungs are the most susceptible to inflammatory injury and why lung failure usually precedes multiple organ failure.     

藻红蛋白光敏剂研究进展

光动力学治疗法作为一种新的肿瘤治疗方法,近年来发展十分迅速。从红藻中提取的藻红蛋白可以作为光动力学治疗法的一种新的光敏剂。本概述了我国红藻藻红蛋白资源概况、光疗法和光敏剂作用机理及其研究发展历史与现状,重点阐述了藻红蛋白光敏剂的应用现状、前景和发展趋势,并认为藻红蛋白是光动力学治疗法中一种非常有前景的光敏剂。藻红蛋白在490nm有吸收光谱,而发射光谱位于560nm;藻红蛋白能特异性地聚集在肿瘤细胞周围,吸收周围环境光能并传递给氧分子,使氧分子转化为具有强氧化性的多线态氧,从而可以大量杀死肿瘤细胞。     

Dosimetry in photodynamic therapy: oxygen and the critical importance of capillary density.

Recently published results of tumor response to various photoradiation protocols in photodynamic therapy appear to contradict accepted definitions of photodynamic dose. In this report, the failure of standard dosimetry models to predict therapeutic outcome is interpreted on the basis of PDT-induced oxygen consumption in tumors with relatively low capillary densities. Calculated estimates of oxygen consumption in photodynamic therapy are combined with the Krogh cylinder model of oxygen diffusion. It is shown that, for tissue volumes in which the intercapillary spacing is less than a specific critical distance, oxygen may be considered constant and unaffected by the therapy. Under these conditions, the 1O2 delivered to a given volume of tissue is spatially uniform and proportional to the number of photons absorbed by the sensitizer. When the intercapillary spacing exceeds the critical distance, the dose of 1O2 varies with radial distance from the capillary wall. In this situation, dose may no longer be considered simply in terms of the product of the photon fluence and the sensitizer absorption coefficient. Since fractionation will increase the 1O2 dose only to cells relatively remote from the capillary wall, the analysis further suggests that fractionating the radiation dose should result in an improved therapeutic ratio for photodynamic therapy.     

Acute and chronic effects of hyperbaric oxygen therapy on blood circulation of human muscle and tendon in vivo

ABSTRACT: Kubo, K and Ikebukuro, T. Acute and chronic effects of hyperbaric oxygen therapy on blood circulation of human muscle and tendon in vivo. J Strength Cond Res 26(10): 2765-2770, 2012-This study aimed to investigate the acute and chronic effects of hyperbaric oxygen therapy on blood circulation of human muscle and tendon in vivo. Using near-infrared spectroscopy and red laser lights, we determined acute changes in blood volume (THb) and oxygen saturation (StO2) of the medial gastrocnemius muscle and Achilles tendon during 60 minutes of hyperbaric oxygen therapy (1.3 atm absolute and 50% O2, experiment 1). In addition, we determined the chronic effects of hyperbaric oxygen therapy (60 minutes, 2 times per week, 6 weeks) on THb and StO2 of muscle and tendon (experiment 2). In experiment 1, THb of the muscle increased gradually from resting level, but StO2 did not change. On the other hand, THb and StO2 of the tendon increased during hyperbaric oxygen therapy. In experiment 2, the pattern of changes in the measured variables during 60 minutes of therapy was similar for both the muscle and tendon between the first and last therapies. During resting, THb and StO2 of the tendon were significantly lower after 6 weeks of therapy, although those of the muscle were not. In conclusion, oxygen saturation of the tendon increased during hyperbaric oxygen therapy, whereas that of the muscle did not. This result would be related to the difference in the treated effects between muscle and tendon. However, oxygen saturation of the tendon, but not the muscle, during resting decreased after 6 weeks of therapy.     

AN INVESTIGATION INTO THE CAUSE OF THE SPONTANEOUS AGGREGATION OF FLAGELLATES AND INTO THE REACTIONS OF FLAGELLATES TO DISSOLVED OXYGEN : PART II.

Spontaneous aggregations of flagellates are formed under the cover-glass because the organisms are attracted to and remain in regions where the concentration of dissolved oxygen is less than the saturation concentration under atmospheric partial pressure. These regions of lessened oxygen content arise towards the center of the liquid beneath the cover-glass, owing to the oxygen consumed by the flagellates in respiration not being replaced here by the solution of atmospheric oxygen, as it is along the edges of the liquid. The flagellates, however, are insensitive to the attraction of regions of lessened oxygen concentration when the oxygen concentration throughout the liquid is above a certain value. Therefore, for the aggregations to form, either the initial concentration of dissolved oxygen must be below this limiting value, or an interval of time must first elapse after the making of the preparation until the respiration of the organisms has reduced the oxygen concentration throughout the liquid down to this limiting value. The aggregations will then form because the flagellates have become positively chemotropic to the lower concentration of oxygen at the center of the liquid. Once established, such an aggregation of flagellates does not remain long in the same form. An area free from flagellates appears at the center of the aggregation so that the organisms lie in a circular band surrounding the clear area. The latter increases in size and its bordering band of flagellates in diameter, the band gradually becoming less circular and more square in shape, if the cover-glass is a square one. The clear central area is a region where the oxygen consumption of the flagellates has reduced the oxygen content to such a low value that the organisms are forced to leave the region. They collect in a band where the concentration of dissolved oxygen is an optimum for them. It is the equilibrium position between the oxygen consumed at the center and that diffusing in from the edges of the liquid. As the consumption at the center is more rapid than the replacement from the edge, the flagellate band moves outwards until it becomes stationary at a position where the rates of consumption and replacement of oxygen are equal. Although the flagellates collect in this manner in regions of optimum oxygen concentration, yet greater concentrations of dissolved oxygen have no injurious effect on them. Concentrations of dissolved oxygen lower than the optimum have the effect of inhibiting the movement of the flagellates. They recover their activity, however, immediately they are given access to dissolved oxygen again. Work done in the past on chemotropism of flagellates will have to be revised in the light of the above facts, since the oxygen content of solutions used has never been taken into account.     

Effects of a polypeptide drug on the state of energy metabolism of myocardial cells in hypoxic and ischemic conditions]

Cordialin, the agent extracted from the heart, is known to inhibit hyperoxidation of succinic acid, increasing NADH oxidation speed in suspension of cardiomyocytes in hypoxia. Cordialin presence in oxygenated cells' suspension oxidating succinate, doesn't change oxygen consumption speed. The results received may be a theoretical basis for cordialin utilization in therapy of myocardial diseases, associated with hypoxia and ischemia. Cordialin utilization may be recommended for the treatment of acute myocardial infarction and for prolongation of time-period for thrombolytic therapy, treatment of IMD, angina and other pathological states, in which oxygen transport disturbance to myocardium cells occurs.     

光动力疗法中氧的弥散模型仿真及其意义

组织中的氧是由血管中扩散而来,存在一定的差异。光动力疗法使用的卟啉类光敏剂主要是通过将能量转移到氧分子产生单线态氧来产生毒性物质,因此在光动力治疗中有氧的消耗,使组织中氧分布对光动力作用具有特殊意义。本文对氧在靶组织和正常组织中的分布、光动力效应对组织中氧含量的影响、以及氧含量对光动力效应的反作用等方面进行了综述。     

Hypoxia, reactive oxygen, and cell injury

Hypoxia usually decreases the formation of reactive oxygen species by oxidases and by autoxidation of components of cellular electron transfer pathways and of quinoid compounds such as menadione. In the case of menadione reactive oxygen species are liberated to a significant extent only at non-physiologically high oxygen partial pressures (PO2). At physiological and hypoxic PO2 values electron shuttling of menadione in the mitochondrial respiratory chain predominates. In contrast, lipid peroxidation induced by halogenated alkanes, such as carbon tetrachloride, in liver leads to an increase in the formation of reactive oxygen and thus in cell injury under hypoxic conditions. Reactive oxygen species may also be generated during reoxygenation of a previously hypoxic tissue. Based on experiments with isolated hepatocytes a three-zone-model of liver injury due to hypoxia and reoxygenation is presented; 1) a zone where the cells die by hypoxia; 2) a zone where the cells are destroyed upon reoxygenation, presumably mediated by an increase in the cellular ATP content; and 3) a zone where cell injury occurs upon reoxygenation, mediated by reactive oxygen species possibly liberated by xanthine oxidase.     

Treatment of Sleep Disordered Breathing Liberates Obese Hypoxemic Patients from Oxygen

Background

Obese hypoxemic patients have a high prevalence of sleep disordered breathing (SDB). It is unclear to what extent treatment of SDB can improve daytime hypoxemia.

Methods

We performed a retrospective cohort study of obese hypoxemic individuals, all of whom underwent polysomnography, arterial blood gas analysis, and subsequent initiation of positive airway pressure (PAP) therapy for SDB. Patients were followed for one year for change in partial pressure of arterial oxygen and the need for supplemental oxygen.

Results

One hundred and seventeen patients were treated with nocturnal PAP and had follow-up available. Adherence to PAP was satisfactory in 60%, and was associated with a significant improvement in daytime hypoxemia and hypercapnea; 56% of these patients were able to discontinue supplemental oxygen. Adherence to PAP therapy and the baseline severity of OSA predicted improvement in hypoxemia, but only adherence to PAP therapy predicted liberation from supplemental oxygen.

Conclusions

The identification and treatment of SDB in obese hypoxemic patients improves daytime hypoxemia. It is important to identify SDB in these patients, since supplemental oxygen can frequently be discontinued following treatment with PAP therapy.     

Synthesis, photophysical and photochemical studies of new water-soluble indium(III) phthalocyanines.

The preparation of water-soluble indium(III)phthalocyanine complexes is described for the first time in this study. Peripherally and non-peripherally 3-hydroxypyridine tetrasubstituted indium(III) phthalocyanines (5a, 6a) and their quaternarized derivatives (5b, 6b) have been synthesized and characterized by elemental analysis, IR, 1H NMR spectroscopy, electronic spectroscopy and mass spectra. The quaternarized compounds (5b, 6b) show excellent solubility in water, which makes them potential photosensitizers for use in photodynamic therapy (PDT) applications. Photochemical and photophysical measurements were conducted on 3-pyridyloxy appended indium(III) phthalocyanines in dimethylsulfoxide (DMSO) for non-ionic (5a, 6a) and in both DMSO and water for quaternarized (5b, 6b) derivatives. General trends are described for quantum yields of photodegradation, fluorescence lifetimes, fluorescence quantum yields, triplet lifetimes and triplet quantum yields as well as singlet oxygen quantum yields of these compounds. The singlet oxygen quantum yields (Phi(Delta)), which give an indication of the potential of the complexes as photosensitizers in applications where singlet oxygen is required (Type II mechanism) are very high (Phi(Delta) > 0.55). Thus, these complexes may be useful as Type II photosensitizers.     

Bioluminescence and its application in the monitoring of antimicrobial photodynamic therapy

Light output from bioluminescent microorganisms is a highly sensitive reporter of their metabolic activity and therefore can be used to monitor in real time the effects of antimicrobials. Antimicrobial photodynamic therapy (aPDT) is receiving considerable attention for its potentialities as a new antimicrobial treatment modality. This therapy combines oxygen, a nontoxic photoactive photosensitizer, and visible light to generate reactive oxygen species (singlet oxygen and free radicals) that efficiently destroy microorganisms. To monitor this photoinactivation process, faster methods are required instead of laborious conventional plating and overnight incubation procedures. The bioluminescence method is a very interesting approach to achieve this goal. This review covers recent developments on the use of microbial bioluminescence in aPDT in the clinical and environmental areas.     

Hemodynamic and biochemical effects of 100% oxygen breathing in humans.

High concentrations of inspired oxygen have been reported to have significant hemodynamic effects that may be related to increased free radical production. If oxygen therapy increases free radical production, it may also modify hemodynamic responses to a nitric oxide donor. Twenty-nine healthy male volunteers were studied using randomized, double-blind, placebo-controlled, crossover designs to determine whether oxygen therapy is associated with hemodynamic and forearm vascular effects. We measured hemodynamic parameters and forearm vascular responses before and 1 h after exposure to 100% oxygen versus medical air. Plasma 8-iso-PGF2alpha and plasma vitamin C were measured to assess the biochemical effects of oxygen administration. Hemodynamic measurements were also made following the acute administration of sublingual nitroglycerin. Oxygen therapy caused no significant change in blood pressure, plasma 8-iso-PGF2alpha, or vitamin C. Oxygen did cause a significant reduction in heart rate and forearm blood flow, and an increase in peripheral vascular resistance. Oxygen caused no change in the hemodynamic response to nitroglycerin. Therefore, in healthy young adults, therapy with 100% oxygen does not affect blood pressure, despite causing an increase in vascular resistance, is not associated with evidence of increased free radical injury, and does not affect the hemodynamic responses to nitroglycerin.