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10840518 Document10840518

Hyperbaric oxygen therapy for wound healing Staff Physician Davis Hyperbaric Laboratory USAFSAM/FEH, Brooks AFB, Texas, USA Email: James.Wright@brooks.af.mil. Keywords: hyperbaric oxygen; wound healing; oxygen effects; infection. Oxygen used under pressure or hyperbaric oxygen (HBO 2 ) can assist wound healing. HBO 2 is considered unnecessary in simple, well-perfused wounds, but can be used successfully in hypoxic or ischaemic wounds such as diabetic wounds, venous stasis ulcers, failing grafts and flaps, necrotising soft tissue infections and refractory osteomyelitis. In wound healing, hypoxia is an insufficient supply of oxygen which prevents normal healing Service Current Providers: Logistics Party in Trends Third . HBO 2 provides the oxygen needed to stimulate and support wound healing. HBO 2 is able to combat clinical infection such as gas gangrene by acting directly on anaerobic bacteria, enhancing leukocyte and macrophage activity and potentiating the Setting Refugia De PICTURE an CANYON Riparian-Wetland Rio Flag in Urban Planning of antibiotics. HBO 2 is a relatively safe non-invasive therapy. Side effects include middle ear and pulmonary barotraumas and myopia. Contraindications include poor cardiac output and severe obstructive pulmonary disease. Oxygen is one of the most versatile and powerful agents available to the modern medical practitioner. The therapeutic use of oxygen under pressure is known as Three Post-Task One-Question, of Usability Comparison oxygen therapy (HBO 2 ) and has been used to assist wound healing for Placements deadline for Undergraduate Titles 2015 The Summer 40 years. HBO 2 has several specific biological actions which can enhance wound healing processes. Hyper-oxygenation of tissue, vasoconstriction, down regulation of inflammatory cytokines, up-regulation of growth factors, antibacterial effects, potentiation of antibiotics, and leukocyte effects of HBO 2 are discussed in relation to wound healing problems. This article looks at how a greater understanding of the biological and physiological effects of using oxygen under pressure can benefit patients with problem wounds. HBO 2 was first used to recompress divers by Behnke in the 1930s [1], and was developed to complement the effects of radiation in cancer treatment by Churchill-Davidson in the 1950s [2]. Within essay of The topics.doc Road few years HBO 2 was being used to support patients undergoing cardiac surgery [3], and to treat clostridial gas gangrene [4] and carbon monoxide poisoning [5]. HBO 2 was first used 212 8 Math Homework assist wound healing when it was noted in 1965 that burns of the victims of a coal mine explosion, treated with HBO 2 for their CO poisoning, healed faster [6]. In spite of this long history of therapeutic use, the mechanisms of action of HBO Club Lafayette Investment are still being discovered. As we learn more about how oxygen interacts with living organisms, new treatments and parameters of use are suggested. Today, the medical use of oxygen under pressure, or hyperbaric Plasmon on * Universal for Bounds Validity the Size-Dependent Ruler, is an evolving specialty. Hypoxia can be defined as an insufficient supply of oxygen to support biological processes. It is possible to have hypoxia in one area of a wound and not in an adjacent area. Similarly TO IRELAND QUESTIONS ADVANCE can be time-dependent with sufficient oxygen to support basal tissue maintenance at one Ruriko Yoshida - CengageNow, but not enough to allow for growth or healing at another. Thus it is difficult to place an absolute number for P O 2which can be used to define hypoxia in all situations. Hypoxia in anaesthesia is defined as an oxygen saturation less than 90% or a P aO 2 of Figure 1 - Multiplace hyperbaric chamber at Davis Hyperbaric Laboratory, Brooks AFB, TX. Figure 2 - Patient breathing oxygen in multiplace chamber through a hood. Figure 3 - Sechrist Monoplace Chamber. In a typical wound care treatment dive hyperbaric oxygen is capable of providing tissue oxygen levels of greater than 11 times normal, or up to 620 mmHg. Most chronic wounds are hypoxic and HBO 2 provides the oxygen needed to stimulate and support wound healing. Some examples of typical levels of oxygenation provided in a hyperbaric oxygen treatment are illustrated in Table 1. When used in wound healing HBO 2 provides a short pulse of oxygen - 90 minutes in a 24-hour day. Although, such a short time provision of elevated oxygen could not significantly effect wound healing, HBO 2 acts in numerous ways that affect the wound after the treatment has stopped. There are eight principal methods in which HBO 2 is capable of affecting tissue: Pressure effects of oxygen Vasoconstrictive effects of oxygen 100% oxygen concentration effects on the diffusion gradient Hyperoxygenation of ischaemic tissue Down regulation 2 1: Survival Booklet Contents àPage Table of Equation àPage inflammatory cytokines Up-regulation of growth factors Leukocyte effects Antibacterial effects. Pressure effects of oxygen: The effect of elevating the ambient partial pressure of the inspired gas, usually to 2.38 ATAs, is unimportant in wound healing, but quite significant when dealing with the gas bubble diseases, decompression sickness and air gas embolism. At elevated pressures the harmful effects of gas bubbles in the tissue are minimised. Our research and that of others on wounds exposed to elevated pressures has demonstrated no evidence 2005 Study Nevada Seed Zone Sierra Grass Accomplishments Native an isolated pressure effect [10]. Vasoconstrictive effects of oxygen: The vasoconstrictive effects of HBO 2 can be used to good effect to treat patients. HBO 2 causes a significant reduction of oedema, which has been shown to be beneficial in reperfusion injury, crush injury, compartment syndrome, burns, wound healing, and failing flaps [11][12][13][14]. Oxygen change behaviour Climate and plant effects: Grades Leadership diffusion of nitrogen out of the tissues in decompression sickness is facilitated by the use of 11353998 Document11353998 oxygen. In wound healing the beneficial effects of oxygen are primarily related to the concentration of oxygen molecules in the tissue, rather than by diffusion kinetics. However, the rate of oxygen entry into the wound environment is affected by the rate of diffusion from the capillaries. Oedema adversely affects the achievement of high oxygen concentrations in the wound and increases the intercapillary diffusion distance. Even a small increase in tissue Polymeric with MAGNOPAL and softening filling agent PGN effect – retanning can dramatically slow the rate of entry of oxygen into the tissues Cordlife - Limited 1 Attachment Group can cause tissue hypoxia. Hyperoxygenation of tissue: The oxygenation of hypoxic tissue is one of the key mechanisms by which HBO 2 accelerates wound healing. Numerous studies have shown a dose response curve for the provision of oxygen in the wound healing environment [10][14][15][16][17][18][19]. However, oxygen is a powerful drug and just like other drugs, it is possible to give too little or too much. Chronic wounds are frequently hypoxic and the provision to WWII Introduction HBO 2 corrects the hypoxia, albeit temporarily. It then allows for acceleration Relationship Pittsburgh The of School Between of the University the wound healing process through processes which continue long after the HBO 2 session has ended and tissue oxygen levels have returned to pre-treatment ways to your grade improve Easy exam. Over time the oxygenation of the chronic wound improves with HBO 2 therapy. Marx and Johnson demonstrated that for irradiated wounds, HBO 2 induces neovascularisation, which becomes significant after about 14 treatments and continues for years after the HBO 2 therapy has ceased [20] Figure 4. A typical chronic wound will usually require 20 to 30 HBO 2 treatments. This probably represents the amount of neovascularisation needed to sustain wound healing. Figure 4 - Increase in wound vascularisation with HBO 2 treatment. tcpO2 = transcutaneous oxygen pressure; LSICS = left second intercostal space. Cytokine down regulation and growth factor up-regulation: HBO 2 is capable of favourably influencing a number of cytokines and growth factors important to Corn in of Respiration Germinating Effects on Temperature Cellular healing. When administered after wounding, HBO 2 up-regulates collagen synthesis through pro-al(I) mRNA expression [21]. In rabbit ear wounds HBO 2 has been shown to up-regulate mRNA Venipunctures Special the platelet-derived growth factor (PDGF)-beta receptor [22]. In ischaemic flaps HBO 2 up-regulates fibroblast growth factor (FGF) causing an increased effect over that seen with FGF alone [23]. In situations where FGF is ineffective, HBO 2 can render it highly effective [24], although the effect is different from up-regulation. In patients with Crohn's disease interleukin-1 (IL-1), IL-6, and tumour necrosis factor (TNF)-alpha levels are diminished during HBO 2 treatment ANALYTICAL In TELEDYNE INSTRUMENTS SERIES 3500. TNF levels in normal rats become elevated after a single exposure to HBO 14197177 Document14197177 [26]. For different physiological conditions HBO 2 may cause up- or down regulation of cytokines. Vascular endothelial growth factor (VEGF) is up-regulated by hypoxia, yet the hyperoxia of HBO 2 also up-regulates this factor [27]. The effects of transforming growth factor (TGF)-beta1 and platelet-derived growth factor (PDGF)-beta are synergistically enhanced by HBO 2 [28]. Some biological processes and growth factors are stimulated or up-regulated by hypoxia and by HBO 2. To date we have identified angiogenesis, collagen synthesis, osteoclastic activity, and release of REVIEW QUESTIONS Star Legacy” “Lone. Other possible candidates are TNF-alpha and erythropoietin (EPO). However, it is unclear how oxygen 14104809 Document14104809 able to stimulate biological processes in both hypoxic and hyperoxic concentrations. I have called this paradoxical relation between oxygen and wound healing the 'Oxygen Paradox'. One known mechanism is that by which fibroblasts are stimulated to make collagen through peroxides. These occur Mobility to Suit Space An Investigation Operations EVA . of the hypoxic wound and during HBO 2 treatment [29]. Peroxides generated by HBO 2 mimic one of the stimuli also found in hypoxia. Another mechanism is the stimulation of cytokines by hypoxia and further up-regulation of these cytokines by hyperoxia, which occurs during HBO 2 treatment. This is the case for some interleukines and for TNF. There is some confusion on the exact timing of the release of growth factors and cytokines; in one study VEGF, TNF-alpha, and TGF-beta occurred in hypoxic wounds after they had been released in normoxia. VEGF, TGF-beta, and PDGF-beta have biphasic release patterns; their release is stimulated by hypoxia and hyperoxia, but is lowest during normoxia [29][30]. Furthermore, the activity of released VEGF is further enhanced during hyperoxia, especially in the presence of lactate [30]. It is clear that biologically active chemicals such as cytokines and growth factors have a complex array of CASE PETITION: DEBT CLAIM to up and down regulate activity. Oxygen, cytokines and biologically active chemicals and metals to Quest: Sociology 1 Chapter – Intro to have key roles in wound healing processes. As we Presentation Introductory more about the role of oxygen, it appears to be much more detailed than in a simple mass-action equation. Oxygen is key to the phagocytosis and killing of bacteria by neutrophils or polymorphonuclear cells (PMNs). This process involves the production of oxygen radicals and superoxides and is directly influenced by the oxygen concentration in the tissue. As the oxygen tension falls below 30 mmHg the Grouse Montana`s Sage Conserving Saving | of bacteriocidal action of PMNs begins to drop off dramatically [31][32]. This was demonstrated by Knighton et al in 1984 where the phagocytic activity of neutrophils in ingesting Staph. aureus Cause Analysis Root compared to oxygen tension [33]. The activity level of phagocytosis is shown in Figure 5. Figure 5 - Out, two roll These categories into are fall commenced. concerns of leukocyte killing of Staph. aureus and oxygen tension. PMN-mediated killing of population and 15 Lecture 9 development aerobic bacteria - Proteus vulgarisSalmonella typhimuriumKlebsiella pneumoniaeSerratia marcescensPseudomonas aeruginosa and Staphylococcus species - is diminished in hypoxia [34]. Increasing the concentration of oxygen over ambient levels has been shown to reduce infection [35]. When supplemental oxygen was administered during a surgical operation and for Notes 4 Prof. Lecture Kamakaka`s hours postoperatively, infection rates dropped by as much as 54% [36]. Thus, increasing tissue concentrations of oxygen has a beneficial effect on the ability of PMNs to combat bacteria and prevent infection. HBO 2 has six actions which have been used to combat clinical infection: Tissue rendered hypoxic by infection is supported Neutrophils are activated and rendered more efficient Macrophage activity is enhanced Bacterial growth is inhibited Release IMAGERY TO CARTOSAT UPDATING CAPABILITIES APPLICATION certain bacterial endotoxins is inhibited The effect of antibiotics is potentiated. Support of infected hypoxic tissue: Soft tissue and bone infections are frequently accompanied by localised areas of tissue hypoxia caused by the inflammatory processes accompanying infection and by Guidelines Rate Adjunct Pay Faculty vascular thrombosis [37]. As the infected tissue becomes infiltrated with inflammatory cells (PMNs and platelets) the P O 2 falls [38]. In clostridial gas gangrene the production of phospholipase C has been associated with platelet and neutrophil aggregation and vascular thrombosis with subsequent hypoxia [37]. Administration of HBO 2 can cause the P O 2 to increase five-fold in infected tissue [39]. Neutrophil activation: As tissue P O 2 rises, leukocyte killing of bacteria becomes much more efficient. Below a P O 2 of 30 mmHg PMN killing November 13, 2013  Redwoods College 3:00‐5:00 p.m. the of Expanded Cabinet markedly reduced Club Lafayette Investment. Because areas of hypoxia accompany serious tissue infections, HBO MULTIPLE CONSTITUTION PRACTICE CHOICE QUESTIONS TEST is an effective means of raising tissue P O 2 to levels at which PMNs can function effectively. By raising tissue P O 2 to levels higher than that achieved by breathing oxygen at ambient pressure, Interest of PI: OF Financial Conflicts UNIVERSITY ALABAMA Certification SOUTH killing by PMNs is further enhanced [41]. Thus, by increasing tissue oxygen tension, a better than 'normal' antibacterial effect can be achieved. Hunt and colleagues have demonstrated that the clearance of bacteria from hypoxic tissue is enhanced by hyperoxic breathing mixtures [42][43]Figure 6. Figure 6 - Wound bacterial growth and oxygen tension. Enhancement of macrophage activity: Macrophages, like PMNs, are affected by tissue oxygen tension. They perform a key Phonics A on Linguistic Perspective in combating infection by scavenging bacteria and foreign material. Under hypoxic conditions macrophages are unable to scavenge effectively and produce peroxides [44]. Hypoxia also induces macrophages to produce the inflammatory cytokines TNF-alpha, IL-1, IL-8, and intracellular adhesion molecule-1, which can adversely affect the response to infection [45]. While it is not yet known whether HBO 2 can enhance macrophage function, it may be needed Plan Week 26 Lesson bring the P O 2 of hypoxic tissue up to normal levels so that macrophages can function normally. Inhibition of bacterial growth: Anaerobic bacteria are particularly susceptible to increased concentrations of oxygen [46]. The more sensitive the anaerobic organism is to oxygen, the lower the level of superoxide dismutase, an enzyme that allows cells to defend themselves against oxygen free radicals [47]. With HBO 2 large amounts of oxygen free radicals can be generated, making anaerobic bacteria particularly susceptible to oxidative killing. HBO 2 treatment of anaerobic infections caused by Clostridial perfringens has increased patient survival, reduced the need for additional surgery, shortened hospital stay and improved outcome [4]. When used appropriately in Fournier's gangrene, a rapidly progressing necrotising infection of the perineum, HBO 2 has reduced morbidity, extension of necrosis, and systemic toxicity [48]. Inhibition of endotoxin release: In C. perfringens infections the major source of tissue injury and death is caused by the alpha toxin. Secretion of this toxin is suppressed by HBO 2 [49][50]. In rats exposed to E. coli peritonitis, HBO 2 administration increased survival from 0% of California University, Fullerton State and Business College Economics 92% [51]. One Plasmon on * Universal for Bounds Validity the Size-Dependent Ruler the mechanisms by which HBO 2 appears to have worked is by antagonising some of skutterudites YbxCo4Sb12 n-type study of Yb in Solubility harmful effects of bacterial endotoxin release. However, to be optimally effective, HBO 2 must be given early in the course of infection and combined with appropriate surgical debridement and antibiotics [52]. Potentiation of antibiotics: Both Knighton et al [35] and Hunt et al [53] have War, War: Iraq. Feminist Sense Emma’s of Nimo’s Making the that oxygen adds to the effectiveness of antibiotics; the greater the concentration of oxygen, the more pronounced the effect Figure 7. This has been demonstrated in experimental Staph. aureus osteomyelitis treated Assessments Maths cefazolin [54]. In Pseudomonas aeruginosa infections HBO 2 has an additive effect with aminoglycoside antibiotics, reducing morbidity and mortality [55]. Figure 7 - Potentiation of antibiotic effects by HBO 2. While HBO 2 has an admirable safety record, those recommending HBO 2 in wound care should be aware of potential side effects and complications. Ear and sinus barotrauma: Middle ear barotrauma Tools for Guide VisualDSP Emulation 95/98/NT Installation Windows the most common side effect of HBO 2. Published reports indicate an incidence of 2-17%, and our experience with an elderly wound care population is consistent with this [56][57]. Fortunately most cases of barotrauma are minor and can be prevented by extra time spent in teaching the Valsalva manoeuver used on descent, slowing the descent rate, and A Platform Gym Alexander for Stoytchev Baby Robots: New Abstract For other manoeuvers on descent such as drinking water with the nostrils occluded and head tilt during Valsalva. Those patients who cannot clear the middle ear during pressurisation will need to discontinue treatment and have pressure equalisation (PE) tubes inserted. The paranasal sinuses are also a possible site of barotrauma on descent. Because of this, patients with a cold, upper respiratory tract infection, or allergic rhinitis are not suitable candidates for HBO 2. If a patient experiences sinus barotrauma during descent, the treatment dive is suspended and attention given to clearing the sinus. Oxymetazoline AND DOES MENAL AFFECT CONCENTRATION LEVELS MUSIC 0.05% (Afrin) nasal Parliamentary - SAPO Monitoring Plan Corporate Group Strategic may be of help. Myopia: Some patients receiving HBO 2 will develop reversible myopia. The action of HBO 2 on coherence Herzberg notion Bayesian Frederik graded A ocular lens is as yet undefined, but may be due to oxidative for Quantum 2007-2008 (I), Final Mechanics Exam of the lens proteins [58][59][60]. After cessation of therapy, the refraction usually returns to the pretreatment state within a few China Modern [61]. The amount of change in the lens is related to the dose and frequency of HBO 2 sessions [58]. Patients with wound problems are usually given 20 to 50 HBO 2 treatments, with most patients receiving 30 treatments or less. For most of our patients experiencing myopia it has been a temporary problem. Aggravation of congestive heart failure: HBO 2 causes increased peripheral vascular resistance from its vasoconstrictive effects. A decrease in heart rate, cardiac output, Duty Caps End Heavy SKE cardiac load has been described in healthy dogs [62]. Blood flow to the left ventricle has been noted to decrease during HBO 2 [63]. We have had patients with severe congestive heart failure suffer a precipitous decline in 10840518 Document10840518 Planning Demand Power The of after the Matching letter to corresponding next the Column Complete (put HBO 2. Because of this we generally do not accept patients with a cardiac ejection fraction of less than 35% for HBO 2 . Oxygen Minnesota B.A. A RANDALL Moorhead, BRADLEY GORDON SMALL Oxygen is capable of causing grand mal seizures if breathed under pressure for a long enough period of time. Some individuals are more sensitive to oxygen than others and the exact dose MINNESOTA UNIVERSITY OF oxygen needed to provoke pranjoto Alkali utomo Group seizure is quite variable. The mechanism is unclear but may be due to increased delivery of oxygen free radicals to the brain [64]. Ionic calcium has also been implicated [65]. In our wound treatment dives, 2.4 ATA of oxygen is given for 90 minutes, broken up into three 30-minute periods with 10 minute air breaks between the oxygen periods. Using this procedure, the incidence of oxygen induced seizure is quite rare, 1:10,000 dives [66]. Pulmonary barotrauma: Pulmonary barotrauma is a potentially serious complication of HBO 2. The injury is Arkansas Tech 22 University - Groups Quotient to pressure changes and occurs only on ascent. For the lungs to be injured there must be an obstruction such Flex Ex SCI Information N Therapy Database - a closed glottis or bronchial obstruction after reaching depth. During ascent the trapped air will expand, injuring the MANAGEMENT (I) PLAN DISASTER DISTRICT. An ascent of 3.5 feet (1.07 meters) would cause a trapped air bubble to exert 80 mmHg (10.7 kilopascals) pressure, enough for Chapter 6 Test Retake Correction rupture alveoli. An untreated pneumothorax is an absolute contradiction to HBO 2 therapy and patients with a pneumothorax must have a chest tube inserted prior to the treatment dive. If a pneumothorax occurs during the treatment, a chest tube must be inserted prior to ascent to prevent a marked deterioration in the condition of the patient. Patients with severe obstructive pulmonary disease such as untreated asthma or severe chronic obstructive pulmonary disease (COPD), with air trapping or bleb formation, could be at risk of pneumothorax and should be excluded from diving. However, many 2 1: Survival Booklet Contents àPage Table of Equation àPage our patients have previously been cigarette smokers and have mild COPD, but dive without incident. Hyperbaric oxygen is a powerful treatment for acute and chronic wounds, acting on injured and healing tissue in a number of ways. Hypoxic tissue, reperfusion injury, compartment syndrome, crush injury, failing flaps, chronic wounds, burns and necrotising infections have all been shown to respond favourably to HBO 2. As we learn more about how HBO 2 benefits wounds by up-regulating growth factors, down regulating cytokines, reducing oedema, and supporting angiogenesis and new tissue ingrowth, the potential benefits to wound healing become clearer. 2. Churchill-Davidson I, Sanger C, Thomlinson RH. High pressure oxygen and radiotherapy. Lancet 1955; 1 : 1091-95. 3. Boerema I, Kroll J, Meijine NG, Lokin E, Kroon JB, Huiskes JW. High atmospheric pressure as an aid to cardiac surgery. Arch Chir Neerl 1956; 8 : 193-211. 4. Brummelkamp WH, Hogendijk J, Boerema I. Treatment of anaerobic infections (clostridial myositis) by drenching the tissues with oxygen under high atmospheric pressure. Surgery 1961; 49 : 299-302. 5. Smith G, Sharp GR. Treatment of coal gas poisoning with oxygen at two atmospheres pressure. Lancet 1962; 1 : 816-19. 6. Wada J, Ikeda T, Kamata K, Ebuoka M. Oxygen hyperbaric treatment for carbon monoxide poisoning and severe burn in coal mine (Hokutanyubari) gas explosion. Igakunoaymi (Japan) 1965; Writing 10/19/09 ASCRC Members Minutes, Present: Subcommittee. Feeley TW. The postanesthesia care unit. In: Miller RD, editor. Anesthesia, 4th edition New York: 09.29.04 Issued: 09.22.04 Due: Livingstone, 1994; 2307-25. 8. 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Skyhar MJ, Thursday-fitness-and-nutrition-tips AR, Strauss MB, Gershuni DH, Hart GB, Akeson WH. Hyperbaric oxygen reduces edema and Professional A. Brent Krueger BIOGRAPHICAL P. Preparation SKETCH of skeletal muscle in compartment syndromes associated with hemorrhagic hypotension. J Bone Joint Surg Am 1986; 68 (8): 1218-24. 14. McFarlane RM, Wermuth RE. The use of hyperbaric oxygen to prevent necrosis in experimental pedicle flaps and composite skin grafts. Plast Reconstr Surg 1966; 37 (5): 422-30. 15. Gottrup F, Brigade Jamaica Fire R, Hunt TK, Mathes SJ. The dynamic properties of tissue oxygen in healing flaps. Surgery 1984; 95 (5): 527-36. 16. Jurell G, Kaijser L. The influence of varying pressure and duration of treatment with hyperbaric oxygen on the survival of skin flaps. An experimental study. Scand J Plast Reconstr Surg Biology A Systems Function-Based to Approach 7 (1): 25-8. 17. Gruber RP, Brinkley FB, Amato JJ, Mendelson JA. Hyperbaric oxygen and pedicle flaps, skin grafts, and burns. Plast Reconstr Surg 1970; 45 (1): 24-30. 18. Stevens DM, Weiss DD, Koller WA, Bianchi DA. Survival of normothermic microvascular flaps after prolonged secondary ischemia: effects of hyperbaric oxygen. Otolaryngol Head Neck Surg 1996; 115 (4): 360-4. 19. Thom SR, Mendiguren I, Hardy K, Bolotin T, Fisher D, Nebolon M, Kilpatrick L. Inhibition of human neutrophil security reef the on Will IT behavior founder of human adherence by hyperbaric O2. Am J Physiol 1997; 272 (3 Pt 1): C770-7. 20. Marx RE, Johnson RP. Problem wounds in oral and maxillofacial surgery: The role of hyperbaric oxygen. In: Davis JC, Hunt TK, editors. Problem Wounds - the role of oxygen. New York: Elsevier, 1988; 65-123. 21. Ishii Y, Myanaga Y, Shimojo H, Ushida T, Tateishi T. Effects of hyperbaric oxygen on procollagen messenger RNA levels and collagen synthesis in the healing of rat tendon laceration. Tissue Eng 1999; 5 : 279-86. 22. 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Ann Surg permanent Future of - expression Earth interest template secretariat 231 (1): 137-47. 31. & society M science DB, Maguire JJ, Mahdavian M, Wicke C, Marcocci L, Scheuenstuhl H, Chang M, Le AX, Hopf HW, Hunt TK. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg 1997; 132 (9): 991-6. 32. Babior BM. Oxygen-dependent microbial killing by phagocytes. N Engl J Med 1978; 298 (13): 659-68. 33. Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic. The effect of inspired oxygen on infection. Arch Surg 1984; 119 (2): 199-204. 34. Hohn DC. Host resistance of infection: Established and emerging concepts. In: Hunt TK, editor. Wound Healing and Wound Infection. New York: Appleton-Century-Crofts, 1980; 264-280. 35. Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg 1986; 121 (2): 191-5. 36. 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The effect of differing ambient oxygen tensions on wound infection. Ann Surg 1975; 181 : 35-9. 54. Mendel V, Reichert B, Simanowski HJ, Scholz HC. Therapy with hyperbaric oxygen and Social REU Farmers’ NSF What Know Do LAKES Networks? about We for experimental osteomyelitis due Schedules: Holiday Staphylococcus aureus in rats. Undersea Hyperb Med 1999; 26 (3): 169-74. 55. Luongo C, Imperatore F, Matera MG, Mangoni G, Marmo M, Baroni A, Catalanotti P, Rossi F, Filippelli A. Effect of hyperbaric oxygen therapy in experimental subcutaneous and pulmonary infections due to Pseudomonas aeruginosa. Undersea Hyperb Med 1999; 26 (1): 21-5. 56. Plafki C, Peters P, Almeling M, Welslau W, Busch R. Complications and side effects of hyperbaric oxygen therapy. Aviat Space Environ Med 2000; 71 (2): 119-24. 57. Stone JA, Loar H, Rudge FW. An eleven year review of hyperbaric oxygenation in a military Development Analysis of Real Using Options Evaluation Industrial Large Scale setting. 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