Hyperbaric oxygen therapy in inflammatory diseases

Öz

Hyperbaric Oxygen Therapy is a treatment method based on the principle of inhaling 100% oxygen under increa-sed atmospheric pressure in a closed sealed cabin called a pressure chamber, through a mask, hood or intubation tube. Hyperbaric Oxygen Therapy cabins can be monoplace or multiplace chambers where more than one patient can be treated at the same time. The therapeutic oxygen pressure must be applied at a pressure above the ambient pressure. Treatment times average 90 minutes per session, or longer depending on the medical condition of the case. Hyperbaric Oxygen Therapy, which has been actively used in medical practice since 1955, works mainly through two physiological mechanisms. These are the direct physical effects of high pressure and the physiologi-cal effects caused by the increase in partial oxygen pressure. Through these basic mechanisms of action, it redu-ces the volume of pathologically formed gas bubbles in the circulatory system and tissues, increases tissue oxy-genation, accelerates wound healing, reduces the risk of bacterial infection in non-healing wounds, stimulates angiogenesis and regulates the immune response. Thanks to these effects, hyperbaric oxygen therapy is indicated in many medical conditions such as decompression sickness, carbon monoxide poisoning, air and gas embolism, gas gangrene, crush injury, compartment syndrome, retinal artery occlusion, non-healing wounds such as diabetic foot, necrotizing infections of soft tissue, sudden hearing loss and chronic osteomyelitis. In addition, recent experimental and clinical trials are investigating its efficacy in inflammatory and systemic diseases, malignancies, COVID-19 infection, erectile dysfunction, aging, ischemic heart and brain diseases. The aim of this review is to review the mechanisms of action of Hyperbaric Oxygen Therapy, its effects on inflammation and its efficacy on inflammatory diseases, which have been the subject of many new studies in recent years.

Anahtar Kelimeler

• Hyperbaric Oxygen Therapy
• Inflammation
• Immunomodulation
• Cytokines
• Sepsis
• Muscular Atrophy

Yangısal hastalıklarda hiperbarik oksijen tedavisi

Öz

Hiperbarik Oksijen Tedavisi, basınç odası adı verilen kapalı bir sızdırmaz kabin içerisinde, artırılmış atmosferik basınç altında, %100 oranında oksijenin, hastalara maske, başlık ya da entübasyon tüpü vasıtasıyla solutulması prensibine dayanan bir tedavi yöntemidir. Hiperbarik Oksijen Tedavisi’nin uygulandığı kabinler, tek kişilik olabildiği gibi, aynı anda birden fazla hastanın tedavi edilebildiği çok kişilik basınç odaları da bulunmaktadır. Tedavi edici oksijen basıncının, çevre basıncının üzerinde bir basınçta uygulanması gerekmektedir. Tedavi süreleri de, her seans için ortalama 90 dakika veya vakanın tıbbi durumuna göre daha uzundur. 1955 yılından beri tıp pratiğinde aktif olarak kullanılmakta olan Hiperbarik Oksijen Tedavisi, temelde iki fizyolojik mekanizma ile etki göstermektedir. Bunlar, yüksek basıncın doğrudan fiziksel etkisi ve parsiyel oksijen basıncının yükselmesi ile oluşan fizyolojik etkilerdir. Bu temel etki mekanizmaları aracılığıyla, dolaşım sisteminde ve dokularda patolojik olarak oluşan gaz kabarcıklarının hacmini azaltır, doku oksijenasyonunu artırır, yara iyileşmesini hızlandırır, iyileşmeyen yaralarda bakteriyel enfeksiyon riskini azaltır, anjiogenezi uyarır ve immün yanıtı düzenler. Hiperbarik oksijen tedavisi bu etkileri sayesinde, dekompresyon hastalığı, karbon monoksit zehirlenmesi, hava ve gaz embolisi, gazlı gangren, crush yaralanması, kompartman sendromu, retinal arter oklüzyonu, diabetik ayak gibi iyileşmeyen yaralar, yumuşak dokunun nekrotizan enfeksiyonları, ani işitme kaybı ve kronik osteomiyelit gibi birçok tıbbi durumda endikedir. Bunlara ek olarak, son yıllarda yapılan deneysel ve klinik çalışmalarda, yangısal ve sistemik hastalıklar, maligniteler, COVID-19 enfeksiyonu, erektil disfonksiyon, yaşlanma, iskemik kalp ve beyin hastalıkları gibi durumlarda da etkinliği araştırılmaktadır. Bu derlemenin amacı, Hiperbarik Oksijen Tedavisi’nin etki mekanizmalarını, yangı üzerine etkilerini ve son yıllarda yapılan birçok yeni çalışmaya konu olan yangısal hastalıklar üzerindeki etkinliğini gözden geçirmektir.

Anahtar Kelimeler

• Hiperbarik Oksijen Tedavisi
• İnflamasyon
• İmmünomodülasyon
• Sitokinler
• Sepsis
• Kas Atrofisi

Kaynakça

1. 1. Savage S. New medical therapy: hyperba-rics. Tenn Med. 2010;103(3):39-40.
2. 2. Bert P. La pression barométrique: recherches de physiologie expérimentale. G. Masson, 1878.
3. 3. Çimsit M. Basınç odaları. Çimsit M (Editör) Hiperbarik Tıp Teori ve Uygulama. Eflatun Ya-yınevi, 1. Baskı, Ankara, 2009: 13-22
4. 4. Sharkey S. Current indications for hyperbaric oxygen therapy. J Aust Def Health Serv. 2000;1:64-72.
5. 5. Kirby JP, Snyder J, Schuerer DJE, Peters JS, Bochicchio GV. Essentials of Hyperbaric Oxy-gen Therapy: 2019 Review. Mo Med. 2019;116(3):176-179.
6. 6. Ortega MA, Fraile-Martinez O, García-Montero C, et al. A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities. Medicina (Kaunas). 2021;57(9):864. Published 2021 Aug 24. doi:10.3390/medicina57090864
7. 7. Widmaier EP, Raff H ve Strang KT. Vander İn-san Fizyolojisi: Vücut Fonksiyon Mekanizma-ları, Çev Ed: Özgünen T. Güneş Tıp Kitabevleri, 2014.
8. 8. Sison-Martinez J, Hendriksen S, Cooper JS. Hyperbaric Treatment Of Clostridial Myositis And Myonecrosis. In: StatPearls. Treasure Is-land (FL): StatPearls Publishing; September 26, 2022.

9. 9. Hammarlund C. The Physiologic Effects of Hy-perbaric Oxygenation, Hyperbaric Medicine Practice, 2 th edition. Ed: Kindwall EP and Whelan HT. Best Publishing Company, Flags-taff, AZ, USA. 37-68, 2002.
10. 10. Pittman RN. Regulation of Tissue Oxygenation. San Rafael (CA): Morgan & Claypool Life Sci-ences; 2011.
11. 11. Jones MW, Brett K, Han N, Wyatt HA. Hyper-baric Physics. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 26, 2022.
12. 12. Leach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy. BMJ. 1998;317(7166):1140-1143. doi:10.1136/bmj.317.7166.1140
13. 13. Brugniaux JV, Coombs GB, Barak OF, Dujic Z, Sekhon MS, Ainslie PN. Highs and lows of hy-peroxia: physiological, performance, and clini-cal aspects. Am J Physiol Regul Integr Comp Physiol. 2018;315(1):R1-R27. doi:10.1152/ajpregu.00165.2017
14. 14. Camporesi EM, Bosco G. Mechanisms of action of hyperbaric oxygen therapy. Undersea Hyperb Med. 2014;41(3):247-252.
15. 15. Hadanny A, Efrati S. The Hyperoxic-Hypoxic Paradox. Biomolecules. 2020;10(6):958. Pub-lished 2020 Jun 25. doi:10.3390/biom10060958
16. 16. Dhamodharan U, Karan A, Sireesh D, et al. Tis-sue-specific role of Nrf2 in the treatment of dia-betic foot ulcers during hyperbaric oxygen the-rapy. Free Radic Biol Med. 2019;138:53-62. doi:10.1016/j.freeradbiomed.2019.04.031
17. 17. Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plast Surg. 2012;45(2):316-324. doi:10.4103/0970-0358.101309
18. 18. Sander AL, Henrich D, Muth CM, Marzi I, Bar-ker JH, Frank JM. In vivo effect of hyperbaric oxygen on wound angiogenesis and epitheliali-zation. Wound Repair Regen. 2009;17(2):179-184. doi:10.1111/j.1524-475X.2009.00455.x
19. 19. Peyssonnaux C, Datta V, Cramer T, et al. HIF-1alpha expression regulates the bactericidal ca-pacity of phagocytes. J Clin Invest. 2005;115(7):1806-1815. doi:10.1172/JCI23865
20. 20. Kościuczuk EM, Lisowski P, Jarczak J, et al. Cathelicidins: family of antimicrobial peptides. A review. Mol Biol Rep. 2012;39(12):10957-10970. doi:10.1007/s11033-012-1997-x
21. 21. Sanford NE, Wilkinson JE, Nguyen H, Diaz G, Wolcott R. Efficacy of hyperbaric oxygen the-rapy in bacterial biofilm eradication. J Wound Care. 2018;27(Sup1):S20-S28. doi:10.12968/jowc.2018.27.Sup1.S20
22. 22. Halbach JL, Prieto JM, Wang AW, et al. Early hyperbaric oxygen therapy improves survival in a model of severe sepsis. Am J Physiol Regul Integr Comp Physiol. 2019;317(1):R160-R168. doi:10.1152/ajpregu.00083.2019
23. 23. Kirby JP. Hyperbaric Oxygen Therapy Emer-gencies. Mo Med. 2019;116(3):180-183.
24. 24. Sağlık Bakanlığı. Hiperbarik Oksijen Tedavisi Uygulanan Özel Sağlık Kuruluşları Hakkında Yönetmelik. Resmi Gazete no: 24480, 1/8/2001. Ek 5. Hiperbarik Oksijen Tedavisi Endikasyonları. https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=4809&MevzuatTur=7&MevzuatTertip=5
25. 25. Bitterman H. Bench-to-bedside review: oxygen as a drug. Crit Care. 2009;13(1):205. doi: 10.1186/cc7151. Epub 2009 Feb 24. PMID: 19291278; PMCID: PMC2688103.
26. 26. Memar MY, Yekani M, Alizadeh N, Baghi HB. Hyperbaric oxygen therapy: Antimicrobial mechanisms and clinical application for infec-tions. Biomed Pharmacother. 2019 Jan;109:440-447. doi: 10.1016/j.biopha.2018.10.142. Epub 2018 Nov 3. PMID: 30399579.
27. 27. Brenner I, Shephard RJ, Shek PN. Immune func-tion in hyperbaric environments, diving, and decompression. Undersea Hyperb Med. 1999;26(1):27-39.
28. 28. Weber SU, Koch A, Kankeleit J, et al. Hyperba-ric oxygen induces apoptosis via a mitochond-rial mechanism. Apoptosis. 2009;14(1):97-107. doi:10.1007/s10495-008-0280-z
29. 29. Harnanik T, Soeroso J, Suryokusumo MG, Juli-andhy T. Effects of Hyperbaric Oxygen on T helper 17/regulatory T Polarization in Antigen and Collagen-induced Arthritis: Hypoxia-inducible Factor-1α as a Target. Oman Med J. 2020;35(1):e90. Published 2020 Jan 23. doi:10.5001/omj.2020.08
30. 30. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation [pub-lished correction appears in N Engl J Med 1999 Apr 29;340(17):1376]. N Engl J Med. 1999;340(6):448-454. doi:10.1056/NEJM199902113400607
31. 31. Hao Y, Dong X, Zhang M, Liu H, Zhu L, Wang Y. Effects of hyperbaric oxygen therapy on the expression levels of the inflammatory factors interleukin-12p40, macrophage inflammatory protein-1β, platelet-derived growth factor-BB, and interleukin-1 receptor antagonist in kelo-ids. Medicine (Baltimore). 2020;99(16):e19857. doi:10.1097/MD.0000000000019857
32. 32. Bai X, Song Z, Zhou Y, et al. The apoptosis of peripheral blood lymphocytes promoted by hy-perbaric oxygen treatment contributes to atte-nuate the severity of early stage acute pancreati-tis in rats. Apoptosis. 2014;19(1):58-75. doi:10.1007/s10495-013-0911-x
33. 33. Ansar W, Ghosh S. Biology of C Reactive Pro-tein in Health and Disease. Springer; New Del-hi, India: 2016. Inflammation and Inflammatory Diseases, Markers, and Mediators: Role of CRP in Some Inflammatory Diseases; pp. 67–107.
34. 34. Rocco M, Antonelli M, Letizia V, et al. Lipid peroxidation, circulating cytokine and endothe-lin 1 levels in healthy volunteers undergoing hyperbaric oxygenation. Minerva Anestesiol. 2001;67(5):393-400.
35. 35. Wang BW, Lin CM, Wu GJ, Shyu KG. Tumor necrosis factor-α enhances hyperbaric oxygen-induced visfatin expression via JNK pathway in human coronary arterial endothelial cells. J Biomed Sci. 2011;18(1):27. Published 2011 May 4. doi:10.1186/1423-0127-18-27
36. 36. Dulai PS, Gleeson MW, Taylor D, Holubar SD, Buckey JC, Siegel CA. Systematic review: The safety and efficacy of hyperbaric oxygen the-rapy for inflammatory bowel disease. Aliment Pharmacol Ther. 2014;39(11):1266-1275. doi:10.1111/apt.12753
37. 37. Thoreson R, Cullen JJ. Pathophysiology of inf-lammatory bowel disease: an overview. Surg Clin North Am. 2007;87(3):575-585. doi:10.1016/j.suc.2007.03.001
38. 38. Baumgart DC. The diagnosis and treatment of Crohn's disease and ulcerative colitis. Dtsch Arztebl Int. 2009;106(8):123-133. doi:10.3238/arztebl.2009.0123
39. 39. Wu X, Liang TY, Wang Z, Chen G. The role of hyperbaric oxygen therapy in inflammatory bowel disease: a narrative review. Med Gas Res. 2021;11(2):66-71. doi:10.4103/2045-9912.311497
40. 40. Alenazi N, Alsaeed H, Alsulami A, Alanzi T. A Review of Hyperbaric Oxygen Therapy for Inf-lammatory Bowel Disease. Int J Gen Med. 2021;14:7099-7105. Published 2021 Oct 24. doi:10.2147/IJGM.S336678
41. 41. Atzeni F, Masala IF, Cirillo M, Boccassini L, Sorbara S, Alciati A. Hyperbaric oxygen therapy in fibromyalgia and the diseases involving the central nervous system. Clin Exp Rheumatol. 2020;38 Suppl 123(1):94-98.
42. 42. Cazzola M, Sarzi Puttini P, Stisi S, et al. Fib-romyalgia syndrome: definition and diagnostic aspects. Reumatismo. 2008;60 Suppl 1:3-14. doi:10.4081/reumatismo.2008.1s.3
43. 43. Barilaro G, Francesco Masala I, Parracchini R, et al. The Role of Hyperbaric Oxygen Therapy in Orthopedics and Rheumatological Diseases. Isr Med Assoc J. 2017;19(7):429-434.
44. 44. Macfarlane GJ, Kronisch C, Dean LE, et al. EU-LAR revised recommendations for the manage-ment of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. doi:10.1136/annrheumdis-2016-209724
45. 45. Akarsu S, Tekin L, Ay H, et al. The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome [published correc-tion appears in Undersea Hyperb Med. 2013 May-Jun;40(3):312]. Undersea Hyperb Med. 2013;40(2):197-200.
46. 46. Kiriakidou M, Ching CL. Systemic Lupus Eryt-hematosus. Ann Intern Med. 2020;172(11):ITC81-ITC96. doi:10.7326/AITC202006020
47. 47. Tsokos GC. Systemic lupus erythematosus. N Engl J Med. 2011;365(22):2110-2121. doi:10.1056/NEJMra1100359
48. 48. Yu H, Nagafuchi Y, Fujio K. Clinical and Im-munological Biomarkers for Systemic Lupus Erythematosus. Biomolecules. 2021;11(7):928. Published 2021 Jun 22. doi:10.3390/biom11070928
49. 49. Chen SY, Chen YC, Wang JK, et al. Early hy-perbaric oxygen therapy attenuates disease se-verity in lupus-prone autoimmune (NZB x NZW) F1 mice. Clin Immunol. 2003;108(2):103-110. doi:10.1016/s1521-6616(03)00091-3
50. 50. Compston D. The genetic epidemiology of mul-tiple sclerosis In: Compston D, Ebers GC, Lassmann H, McDonald WI, Matthews WB, Wekerle H, editors. McAlpine's Multiple Scle-rosis, 3rd ed London: Churchill Livingstone, 1998;45–142.
51. 51. Ludwin SK. The pathogenesis of multiple scle-rosis: relating human pathology to experimental studies. J Neuropathol Exp Neurol. 2006;65(4):305-318. doi:10.1097/01.jnen.0000225024.12074.80
52. 52. Frohman EM, Racke MK, Raine CS. Multiple sclerosis--the plaque and its pathogenesis. N Engl J Med. 2006;354(9):942-955. doi:10.1056/NEJMra052130
53. 53. Goodin DS, Frohman EM, Garmany GP Jr, et al. Disease modifying therapies in multiple sclero-sis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines [published correc-tion appears in Neurology 2002 Aug13;59(3):480]. Neurology. 2002;58(2):169-178. doi:10.1212/wnl.58.2.169
54. 54. Bennett M, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. CNS Neurosci Ther. 2010;16(2):115-124. doi:10.1111/j.1755-5949.2009.00129.x
55. 55. Gardner RC, Yaffe K. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Mol Cell Neurosci. 2015;66(Pt B):75-80. doi:10.1016/j.mcn.2015.03.001
56. 56. Kovacs GG. Molecular pathology of neurode-generative diseases: principles and practice. J Clin Pathol. 2019;72(11):725-735. doi:10.1136/jclinpath-2019-205952
57. 57. Dugger BN, Dickson DW. Pathology of Neuro-degenerative Diseases. Cold Spring Harb Pers-pect Biol. 2017;9(7):a028035. Published 2017 Jul 5. doi:10.1101/cshperspect.a028035
58. 58. Shapira R, Solomon B, Efrati S, Frenkel D, As-hery U. Hyperbaric oxygen therapy ameliorates pathophysiology of 3xTg-AD mouse model by attenuating neuroinflammation. Neurobiol Aging. 2018;62:105-119. doi:10.1016/j.neurobiolaging.2017.10.007
59. 59. Kudchodkar B, Jones H, Simecka J, Dory L. Hyperbaric oxygen treatment attenuates the pro-inflammatory and immune responses in apoli-poprotein E knockout mice. Clin Immunol. 2008;128(3):435-441. doi:10.1016/j.clim.2008.05.004
60. 60. Bhatia D, et al. Hypoxia and its emerging thera-peutics in neurodegenerative, inflammatory and renal diseases. Hypoxia Hum Dis. 2017;21:404–43.
61. 61. Mensah-Kane P, Sumien N. The potential of hy-perbaric oxygen as a therapy for neurodegenera-tive diseases. Geroscience. 2023;45(2):747-756. doi:10.1007/s11357-022-00707-z
62. 62. Jeong H, Baek SY, Kim SW, et al. Comorbidi-ties of rheumatoid arthritis: Results from the Korean National Health and Nutrition Exami-nation Survey [published correction appears in PLoS One. 2017 May 18;12 (5):e0178309]. PLoS One. 2017;12(4):e0176260. Published 2017 Apr 19. doi:10.1371/journal.pone.0176260
63. 63. Quiñonez-Flores CM, González-Chávez SA, Pacheco-Tena C. Hypoxia and its implications in rheumatoid arthritis. J Biomed Sci. 2016;23(1):62. Published 2016 Aug 22. doi:10.1186/s12929-016-0281-0
64. 64. Harnanik T, Prihartono S, Juliandhy T. Hyper-baric oxygen in animal model of rheumatoid arthritis: Analysis Of HIF-1α, ACPA and IL-17a. Infect Dis Rep. 2020;12(Suppl 1):8766. Published 2020 Jul 6. doi:10.4081/idr.2020.8766
65. 65. Komatsu N, Okamoto K, Sawa S, et al. Pathoge-nic conversion of Foxp3+ T cells into TH17 cells in autoimmune arthritis. Nat Med. 2014;20(1):62-68. doi:10.1038/nm.3432
66. 66. Sit MT, Schmidt TW, Edmonds LD, et al. The Effects of Hyperbaric Oxygen on Rheumatoid Arthritis: A Pilot Study. J Clin Rheumatol. 2021;27(8):e462-e468. doi:10.1097/RHU.0000000000001540
67. 67. Liu SH, Driban JB, Eaton CB, McAlindon TE, Harrold LR, Lapane KL. Objectively Measured Physical Activity and Symptoms Change in Knee Osteoarthritis. Am J Med. 2016;129(5):497-505.e1. doi:10.1016/j.amjmed.2015.12.029
68. 68. Peat G, McCarney R, Croft P. Knee pain and os-teoarthritis in older adults: a review of commu-nity burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91-97. doi:10.1136/ard.60.2.91
69. 69. Hermann W, Lambova S, Muller-Ladner U. Cur-rent Treatment Options for Osteoarthritis. Curr Rheumatol Rev. 2018;14(2):108-116. doi:10.2174/1573397113666170829155149
70. 70. Wilson HD, Toepfer VE, Senapati AK, Wilson JR, Fuchs PN. Hyperbaric oxygen treatment is comparable to acetylsalicylic acid treatment in an animal model of arthritis. J Pain. 2007;8(12):924-930. doi:10.1016/j.jpain.2007.06.005
71. 71. Juskovic A, Nikolic M, Ljujic B, et al. Effects of Combined Allogenic Adipose Stem Cells and Hyperbaric Oxygenation Treatment on Pathoge-nesis of Osteoarthritis in Knee Joint Induced by Monoiodoacetate. Int J Mol Sci. 2022;23(14):7695. Published 2022 Jul 12. doi:10.3390/ijms23147695
72. 72. Rocheteau P, Chatre L, Briand D, et al. Sepsis induces long-term metabolic and mitochondrial muscle stem cell dysfunction amenable by me-senchymal stem cell therapy. Nat Commun. 2015 Dec 15;6:10145. doi: 10.1038/ncomms10145. PMID: 26666572; PMCID: PMC4682118.
73. 73. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemio-logy of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-1310. doi:10.1097/00003246-200107000-00002
74. 74. Cox MC, Booth M, Ghita G, et al. The impact of sarcopenia and acute muscle mass loss on long-term outcomes in critically ill patients with int-ra-abdominal sepsis. J Cachexia Sarcopenia Muscle. 2021;12(5):1203-1213. doi:10.1002/jcsm.12752
75. 75. David S, Brunkhorst FM. Sepsis-3 : Was ist ge-sichert in der Therapie? [Sepsis-3 : What has been confirmed in therapy?]. Internist (Berl). 2017 Dec;58(12):1264-1271. German. doi: 10.1007/s00108-017-0338-5. PMID: 29046941; PMCID: PMC7096026.
76. 76. Harrois A, Huet O, Duranteau J. Alterations of mitochondrial function in sepsis and critical illness. Curr Opin Anaesthesiol. 2009;22(2):143-149. doi:10.1097/ACO.0b013e328328d1cc
77. 77. Rello J, Valenzuela-Sánchez F, Ruiz-Rodriguez M, Moyano S. Sepsis: A Review of Advances in Management. Adv Ther. 2017;34(11):2393-2411. doi:10.1007/s12325-017-0622-8
78. 78. Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest. 1992 Jul;102(1):208-15. doi: 10.1378/chest.102.1.208. PMID: 1623755.
79. 79. Buras JA, Holt D, Orlow D, Belikoff B, Pavli-des S, Reenstra WR. Hyperbaric oxygen protects from sepsis mortality via an interleukin-10-dependent mechanism. Crit Care Med. 2006 Oct;34(10):2624-9. doi: 10.1097/01.CCM.0000239438.22758.E0. PMID: 16932233.
80. 80. Edremitlioğlu M, Kiliç D, Oter S, et al. The ef-fect of hyperbaric oxygen treatment on the renal functions in septic rats: relation to oxidative damage. Surg Today. 2005;35(8):653-661. doi:10.1007/s00595-004-3000-5
81. 81. Bærnthsen NF, Hansen MB, Wahl AM, Simon-sen U, Hyldegaard O. Treatment with 24 h-delayed normo- and hyperbaric oxygenation in severe sepsis induced by cecal ligation and puncture in rats. J Inflamm (Lond). 2017;14:27. Published 2017 Nov 25. doi:10.1186/s12950-017-0173-4
82. 82. Oter S, Edremitlioglu M, Korkmaz A, et al. Ef-fects of hyperbaric oxygen treatment on liver functions, oxidative status and histology in septic rats. Intensive Care Med. 2005;31(9):1262-1268. doi:10.1007/s00134-005-2701-6
83. 83. Bajek S, Nikolić M, Soić-Vranić T, Bajek G, Cvijanović O, Starcević-Klasan G. Influence of hyperbaric oxygen treatment on myogenic transcriptional factors of denervated rat muscle. Coll Antropol. 2012 Mar;36(1):167-72. PMID: 22816216.
84. 84. Yamamoto N, Oyaizu T, Yagishita K, Enomoto M, Horie M, Okawa A. Multiple and early hy-perbaric oxygen treatments enhance muscle hea-ling after muscle contusion injury: a pilot study. Undersea Hyperb Med. 2021 Third-Quarter;48(3):227-238. PMID: 34390627.
85. 85. Oyaizu T, Enomoto M, Yamamoto N, Tsuji K, Horie M, Muneta T, Sekiya I, Okawa A, Yagishi-ta K. Hyperbaric oxygen reduces inflammation, oxygenates injured muscle, and regenerates ske-letal muscle via macrophage and satellite cell activation. Sci Rep. 2018 Jan 22;8(1):1288. doi: 10.1038/s41598-018-19670-x. PMID: 29358697; PMCID: PMC5778072.
86. 86. Horie M, Enomoto M, Shimoda M, Okawa A, Miyakawa S, Yagishita K. Enhancement of sa-tellite cell differentiation and functional reco-very in injured skeletal muscle by hyperbaric oxygen treatment. J Appl Physiol (1985). 2014;116(2):149-155. doi:10.1152/japplphysiol.00235.2013
87. 87. Woo J, Min JH, Lee YH, Roh HT. Effects of Hyperbaric Oxygen Therapy on Inflammation, Oxidative/Antioxidant Balance, and Muscle Damage after Acute Exercise in Normobaric, Normoxic and Hypobaric, Hypoxic Environ-ments: A Pilot Study. Int J Environ Res Public Health. 2020;17(20):7377. Published 2020 Oct 10. doi:10.3390/ijerph17207377 .