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Clinical effect of hyperbaric oxygen at different pressures on sepsis-associated encephalopathy in children and its effect on cerebral oxygen metabolism

Juan LI ; Weixiao YAN

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):316-319,323. doi:10.3760/cma.j.cn311847-20191218-00401

Objective:To investigate the clinical effect of hyperbaric oxygen (HBO) at different treatment on sepsis-associated encephalopathy(SAE) in children and its effect on cerebral oxygen metabolism.Methods:A total of 180 children with SAE, treated in Qinghai Women and Children′s Hospital from March 2015 to March 2018, were selected as the research objects and divided into the 0.24 MPa HBO group (high pressure group, n=90) and 0.15 MPa HBO group (low pressure group, n=90) by random number table method. The scores of the Acute Physiology And Chronic Health Evaluation scoring system (APACHEⅡ), Pediatric Cerebral Performance Category scale (PCPC), and Pediatric Evaluation of Disability Inventory (PEDI) before and after treatment were compared between the two groups. The markers of brain injury [neuron-specific enolase (NSE), S100B protein polypeptide (S100B)], inflammatory factor levels [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6)] of the two groups after treatment were detected; and the jugular venous oxygen saturation (SjvO 2), carotid-venous blood oxygen content difference (AVDO 2), cerebral oxygen uptake rate (CEO 2), and cerebral tissue oxygen partial pressure (PbtO 2)]differences of the two groups before and after the treatment were calculated. Results:After 4 courses of treatment, the scores of APACHE Ⅱ and PCPC in the high pressure group were significantly lower than those of the low pressure group ( P<0.05). In the PEDI scale, the daily activities, mobility, and communication abilities of patients in the high pressure group after treatment were all significantly lower than those in the low pressure group ( P<0.05). The levels of NSE, S100B, TNF-α, CRP, and Il-6 of the high pressure group after treatment were significantly lower than those of the low pressure group after treatment ( P<0.05). After treatment, the scores of SjvO 2 and CEO 2 in the high-pressure group were significantly higher than those in the low-pressure group, while AVDO2 was significantly lower than that in the low-pressure group ( P<0.05). However, there was no statistically significant difference in PbtO 2 level between the two groups before and after the treatment ( P>0.05). Conclusion:HBO on SAE in children can significantly reduce the levels of brain injury markers and inflammatory factors, correct brain oxygen metabolism disorder, facilitate the recovery of brain injury, and improve the quality of life of patients.

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Observation on the curative effect of hyperbaric oxygen assisted treatment on 55 cases of fetal growth restriction

Yan LU ; Rong MA ; Yixuan WANG ; Yaoyue ZHANG ; Qiong LAN ; Junning JING

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):327-330. doi:10.3760/cma.j.cn311847-20200227-00068

Objective:To analyze the effect of hyperbaric oxygen (HBO) assisted treatment on fetal growth restriction (FGR).Methods:A total of 110 pregnant women with FGR admitted in Gansu Provincial Maternity and Child-care Hospital from June 2018 to June 2019 were selected as research objects. They were randomly divided into observation group and control group in a ratio of 1∶1, with 55 cases in each group. The control group was treated with low molecular heparin combined with aspirin, and the observation group was treated with HBO on the basis of the treatment of the control group for 6 weeks. The fetal growth was examined by color Doppler ultrasound. The clinical effect and fetal hemodynamic parameters before and after treatment were compared. The maternal and infant outcomes such as complications of pregnancy and neonatal conditions were statistically analyzed. The coagulation functions of pregnant women before and after treatment were also analyzed.Results:The effective rate of the observation group (83.64%) was significantly higher than that of the control group (63.64%) with statistical difference ( χ2=5.666, P=0.017). After treatment, the high systolic blood flow/late diastolic blood flow (S/D), resistance index (RI), and pulse index (PI) of the two groups were all remarkably decreased ( P<0.01), and those of the observation group were lower than those of the control group ( P<0.05) before and after treatment. There was no statistical difference in the comparisons of neonatal complications and pregnancy complications after treatment between the two groups ( P>0.05). The coagulation function index of both two groups after treatment were all improved than those before treatment with statistically significant difference ( P<0.05), but there was no statistically significant difference between the coagulation function index of the observation group and that of the control group after treatment( P>0.05). Conclusion:HBO combined with aspirin and low molecular heparin in the treatment of FGR can significantly improve the fetal hemodynamic parameters, and therefore improve the clinical efficacy.

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The research on external circulation environmental control system for saturation diving living chamber

Bin CHEN ; Wenhai KE ; Keshun YIN ; Sheng ZHANG

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):257-261,274. doi:10.3760/cma.j.cn311847-20200226-00067

In this article, for the 6-man 500 m saturation diving chamber, the calculation thinking of circulating air volume, and refrigerating and heating production were introduced; the design and selection requirements of refrigeration unit, circulating fan, magnetic coupling transmission device, and heat exchanger module were also introduced; and the research findings of refrigerating and heating control technology of this system were put forward. The article can provide a reference for developing environmental control system for living chambers of deep saturation diving.

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Therapeutic effect of hyperbaric oxygen therapy on patients with esophageal cancer and its impact on quality of life

Qi SUN ; Xingyuan LI ; Wenzhi HUANG ; Lijuan LU

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):305-308. doi:10.3760/cma.j.cn311847-20191205-00356

Objective:To investigate the efficacy of hyperbaric oxygen (HBO) therapy in the treatment of esophageal cancer and its impact on patients′ quality of life.Methods:A total of 98 patients with esophageal cancer admitted to the PLA Navy Anqing Hospital from February 2014 to February 2016 were enrolled and randomly divided into control group and observation group, with 49 patients in each group. The control group was treated with chemotherapy. The observation group was treated with HBO on the basis of the treatment of control group. The short-term efficacy and adverse reactions of the two groups were compared. The quality of life was assessed by the Quality of Life Questionnaire-Core 30 (QLQ-C30) of cancer patients. After 3 years of follow-up, the long-term efficacies of the two groups were compared.Results:The near-term total effective rate of the observation group (44.9%) was obviously higher than that of the control group (36.7%), with statistically significant difference ( χ2=4.037, P<0.05). After treatment, the total scores of physical function and quality of life of the patients in the observation group were significantly higher than those in the control group, with statistically significant difference ( P<0.05). After 4 courses of treatment, the incidence of adverse reaction of the observation group was significantly lower than that of the control group ( P<0.05). During the 3-year-long follow-up, the 1-year survival rate of the observation group was significantly higher than that of the control group (79.6% vs. 59.2%, χ2=5.027, P<0.05). The 2-year and 3-year survival rates of the observation group were higher than those of the control group, but there was no significant difference ( P>0.05). Conclusion:HBO-assisted chemotherapy has a good clinical effect on the patients with esophageal cancer and can improve the quality of life, which is of perceivable clinical significance for the treatment of esophageal cancer.

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Curative effect and influence on blood supply of hyperbaric oxygen assisting minimally invasive plate osteosynthesis in treating the middle and distal tibia fracture

Zhendong ZHOU ; Baotie DONG ; Liangjian FEI ; Xuguang NIU ; Zilong LI ; Hong LI

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):291-294,299. doi:10.3760/cma.j.cn311847-20190806-00199

Objective:To evaluate the curative effect of hyperbaric oxygen assisting minimally invasive plate osteosynthesis in treating the middle and distal tibia fracture and its influence on the blood supply.Methods:One hundred cases of patients with tibial fractures from January 2016 to December 2018 admitted to the First Department of Ortho Pedics Forth People′s Hospital of Shenyang were selected and randomly divided into control group ( n=50) and observation group ( n=50). The control group was treated with minimally invasive steel plate osteoplasty, and the observation group was treated with hyperbaric oxygen therapy on the basis of the treatment of the control group for 4 consecutive weeks. The pain intensity scores measured by Visual Analog Scale (VAS), skin blood supply at the fracture site, fracture healing and scabbing, bone density, knee/ankle function were compared between the two groups 1 week, 1 month, and 6 months after surgery. Results:One week after surgery, the differences of VAS, fracture healing scores, and bone density between the groups all showed no statistical significance ( P>0.05). One month after surgery, the VAS score, the score of fracture healing and scabbing, and the bone density of the observation group were significantly better than those of the control group ( P<0.05). In the observation group, the incidence of poor blood supply to the skin at the fracture site was 14.0%, which was significantly lower than that of the control group (32.0%) ( P<0.05). The recovery rate of the function of knee and ankle joints was 58.0%, which was higher than that in the control group (38.0%) ( P<0.05). Six months after surgery, the VAS score of the observation group was significantly decreased, and the bone density in the observation group was significantly increased, compared with those of the control group. All differences were statistically significant ( P<0.05). The blood supply to the skin, the fracture healing and scabbing, and the functional recovery of knee and ankle joints of the observation groups were better than those of the control group, but there were no statistical differences( P>0.05). Conclusion:Hyperbaric oxygen assisting minimally invasive plate osteosynthesis in treating the middle and distal tibia fracture could increase the partial pressure of blood oxygen, accelerate the revascularization at the fracture site, reduce local tissue edema and necrosis, promote bone healing, and reduce postoperative pain, which could be used as an auxiliary treatment for the middle and distal tibial fracture.

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Effect of hyperbaric oxygen on proliferation of endogenous neural stem cells in rats with focal cerebral ischemia

Yongjun MAI ; Xiang LI ; Liangzuo ZHENG ; Hong YANG ; Xiaomou WEI ; Lianbi XUE

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):286-290. doi:10.3760/cma.j.cn311847-20190918-00229

Objective:To observe the effects of hyperbaric oxygen (HBO) at different courses of treatment on the proliferation of endogenous neural stem cells(NSCs) in cerebral ventricular subventricular zone (SVZ) and hippocampal dentate gyrus (DG) in rats with focal cerebral ischemia at different periods.Methods:The model of focal cerebral ischemia-reperfusion was performed by middle cerebral artery occlusion (MCAO). A total of 105 rats were divided by lottery into pseudo-surgery group(SS), ischemia-reperfusion group (IR group), HBO at 1 st day after ischemia-reperfusion group (IR1d+ HBO group), HBO at 7 th day after ischemia-reperfusion group (IR7d+ HBO group), HBO at 14 th day after ischemia-reperfusion group (IR14d+ HBO group), and HBO at 28 th day after ischemia-reperfusion group (IR28d+ HBO). The SVZ and DG-derived NSCs were detected by immunofluorescence BrdU/Nestin double labeling at the 2 nd, 4 th, 6 th, and 8 th week after modeling. Results:At the 2 nd week after modeling, the number of DG BrdU/Nestin positive cells was 21.20±2.58 in the SS group, 56.40±4.51 in the IR group, 82.80±7.19 in the IR1d+ HBO group, and 70.00±5.09 in the IR7d+ HBO group. At the 4 th week, it was 21.00±2.92 in the SS group, 37.20±3.27 in the IR group, 70.60±5.12 in the IR1d+ HBO group, 57.20±3.56 in the IR7d+ HBO group, 45.80±4.32 in the IR14d+ HBO group. At the 6 th week, it was 20.20±1.92 in the SS group, 26.40±2.74 in the IR group, 48.00±3.16 in the IR1d+ HBO group, 40.60±3.36 in the IR7d+ HBO group, 31.60±2.41 in the IR14d+ HBO group, 26.60±2.30 in the IR28d+ HBO group. The number of DG BrdU/Nestin positive cells was statistically significant among all subgroups during the same period ( P<0.01) except for that at the 8 th week. The pairwise comparison showed the numbers of DG BrdU/Nestin positive cells in the IR group at all time points were all higher than those in the SS group at the same time point ( P<0.05). Except for that at the 8 th week, all the numbers of DG BrdU/Nestin positive cells in the IR1d+ HBO group, the IR7d+ HBO group, and the IR14d+ HBO group at each time point were higher than those in the IR group ( P<0.05). In all the subgroups, the number of DG BrdU/Nestin positive cells reached the highest point at the 2 nd week/the initial measurement point ( P<0.05). At the 2 nd week after modeling, the number of SVZ BrdU/Nestin positive cells was 25.20±2.86 in the SS group, 66.40±2.96 in the IR group, 90.40±6.50 in the IR1d+ HBO group, 75.00±4.58 in the IR7d+ HBO group. At the 4 th week, it was 24.20±1.48 in the SS group, 49.80±4.32 in the IR group, 72.40±4.92 in the IR1d+ HBO group, 57.80±6.46 in the IR7d+ HBO group, 43.80±3.56 in the IR14d+ HBO group. At the 6 th week, it was 24.40±2.41 in the SS group, 28.80±2.77 in the IR group, 51.00±4.30 in the IR1d+ HBO group, 42.00±3.39 in the IR7d+ HBO group, 34.80±2.58 in the IR14d+ HBO group, 31.30±3.41 in the IR28d+ HBO group. The number of SVZ BrdU/Nestin positive cells was statistically significant among all subgroups during the same period ( P<0.05). The pairwise comparison showed the numbers of SVZ BrdU/Nestin positive cells in the IR group at all time points were all higher than those in the SS group at the same time point ( P<0.05) except for the 8 th week. The numbers of SVZ BrdU/Nestin positive cells in the IR1d+ HBO group at each time point were higher than that in the IR group( P<0.05). The numbers of SVZ BrdU/Nestin positive cells in the IR7d+ HBO group, the IR14d+ HBO group, and the IR28d+ HBO group at the 2 nd, 4 th, and 6 th week were higher than those in the IR group at the same time point ( P<0.05). In all the subgroups, the number of SVZ BrdU/Nestin positive cells reached the highest point at the 2 nd week/the initial measurement point ( P<0.05). Conclusion:The earlier HBO treatment on cerebral infarction starts, the better promotion of the proliferation of SVZ and DG-derived NSCs achieves. HBO treatment has almost no effect on the proliferation of endogenous NSCs at late cerebral infarction.

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Analysis of the preventive effect of pegylated recombinant human granulocyte stimulating factor on granulocytopenia in metastatic hormone-sensitive prostate cancer after chemotherapy

Hong CHANG ; Jie FANG ; Huili XU ; Jinzhuan ZHANG ; Haibing DONG

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):312-315. doi:10.3760/cma.j.cn311847-20200117-00032

Objective:To analyze the preventing effect of pegylated recombinant human granulocyte stimulating factor (PEG-rhG-CSF) on granulocytopenia after chemotherapy for prostate cancer, and to evaluate its safety and effectiveness.Methods:A total of 61 patients aged 53-82 with metastatic hormone-sensitive prostate cancer (mHSPC), who received docetaxel (75 mg/m 2, 21 days constitute one chemotherapy course) alone or docetaxel (75 mg/m 2 on d1) combined with cisplatin (30 mg/m 2, from d1 to d3) and carboplatin (400 mg/m 2, from d1 to d3) during a 21-day chemotherapy course from February 2019 to December 2019, were included. These patients also received endocrine therapy over the same period, including surgical and medical castration, and castration combined with antiandrogen medications, lasting 6 cycles in total. Patients were divided into two groups, the control group (30 cases) and the observation group (31 cases). The control group received no leukogenic drugs, and was given human granulocyte stimulating factor (rhG-CSF) treatment only after the occurrence of granulocytopenia until the WBC count in peripheral blood was above 10×10 9/L. The observation group was given PEG-rhG-CSF within 48 hours after chemotherapy. Results:Among the 61 patients, one patient died, two stopped receiving chemotherapy due to liver dysfunction, one was lost to follow-up. A total of 57 valid cases were included in per protocol set (PPS) in the end, of which 30 cases were from the observation group and 27 cases from the control group. The incidence of neutropenia in the observation group was 33.3%, of which the incidence of grade 3 neutropenia was 10.0%, the incidence of agranulocytosis was 0, and the drug doses reduction of chemotherapy was 0, which were lower than the 77.8%, 33.3%, 18.5%, and 18.5%, respectively, in the control group, with statistically significant differences ( P<0.05). The differences in adverse reactions in both groups, included aching bones, muscle pain, lack of strength, and soreness at the injection sites, were of no statistical significance ( P>0.05). Conclusion:The curative effect of PEG-rhG-CSF is definite on the patients with mHSPC who received chemotherapy either with docetaxel alone or docetaxel combined with cisplatin and carboplatin. It can reduce the incidence of granulocytopenia, agranulocytosis, and chemotherapy drug dose reduction caused by myelosuppression. It, therefore, can ensure the patients receive chemotherapy with standard dosage, and thus improve the cure rate.

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Clinical features and diagnosis analysis of the patients after recreational diving

Hang LI ; Haidong WANG ; Xiaojing ZHANG ; Shuyi PAN

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):300-304,308. doi:10.3760/cma.j.cn311847-20190708-00173

Objective:To provide a reference for diving medical doctors on the diagnosis and differentiation of the patients with discomfort symptoms after recreational diving, by analyzing those patients′ clinical data and summarizing the features of clinical symptoms, the first diagnosis and consultation at the clinical visit.Methods:The clinical data of 102 outpatients and inpatients with discomfort after recreational diving admitted in and visited the Department of Hyperbaric Oxygen of the Sixth Medical Center of PLA General Hospital from October 2011 to October 2018 were retrospectively analyzed. The age, gender and other demographical data of the patients, as well as the diving history, the first diagnosis, the first consulted department, the department that made confirmed diagnosis, and the number of departments that the patients were transferred, were analyzed.Results:Among the 102 patients included in the study, the age of 30-44 years old accounted for the highest proportion (49.0%), dizziness and headache were the most common symptoms (34.3%) among all discomfort symptoms, and the clinical symptoms mainly involved head, heart, lung, and digestive system. The symptoms of digestive system and the vegetative nervous system were more commonly seen in women than those in men. The diving depths which was less than 10 meters accounted for 84.3%. The majority of patients experienced multiple dives within 24 hours (42.2%). The patients who had the discomfort symptoms after arriving at surface accounted for 69.6%. The proportion of decompression sickness in the diagnosis only accounted for 16.7%. The emergency department was the most-visited department (51.9%) within all the first consulted departments. The average number of departments in which the patients were transferred between the first consulted department and the department that made confirmed diagnosis was 2.2±1.7. Multiple dives, diving depth, suspected history of improper decompression, and the time of symptoms appearing were all significantly correlated with the diagnosis of decompression sickness ( P<0.05). Age, sex, the frequency of previous exercise, stress or panic during the diving were significantly correlated with the diagnosis of non-decompression sickness ( P<0.05). Conclusion:Regarding the diagnosis of the patients with discomfort symptoms after recreational diving, diagnosis other than decompression sickness should be considered.

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Effect of hyperbaric oxygen combined with agomelatine on elderly patients with depression

Wei ZHANG ; Haiyan LIU

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):275-278. doi:10.3760/cma.j.cn311847-20200223-00063

Objective:To investigate the clinical effect of hyperbaric oxygen (HBO) combined with agomelatine on elderly patients with depression, and its effect on the levels of myeloperoxidase (MPO) and fibroblast growth factor-22 (FGF-22) in serum.Methods:A total of 136 elderly patients with depression treated in the Geriatrics Department of Air Force Special Medical Center and Neurology Department of Jilin People′s Hospital from May 2017 to December 2019 were randomly divided into observation group ( n=68) and control group ( n=68) by random number table method. The control group was treated with agomelatine, and the observation group was treated with HBO on the basis of the treatment of the control group. The clinical effect and adverse reaction after treatment, and anxiety score, depression score, and the changes of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), MPO, and FGF-22 of the two groups were compared before and after treatment. Results:After 3 courses of treatment, the total effective rate (91.2%) in the observation group was significantly higher than that in the control group (77.9%), with statistically significant difference ( χ2=4.561, P<0.05). The anxiety scores measured by Hamilton Anxiety Rating Scale (HAM-A) and the depression scores of both groups were significantly reduced after treatment, and the anxiety score and depression score of the observation group were significantly lower than those of the control group, with statistically significant difference ( P<0.05). The levels of TNF-α, IL-1β, and MPO in both groups were all significantly reduced after treatment, while the FGF-22 level in both groups was significantly increased. The levels of TNF-α, IL-1β, and MPO in the observation group were significantly lower than those in the control group, while the FGF-22 level in the observation group was significantly higher than that in the control group, with statistical differences ( P < 0.05). Conclusion:HBO combined with agomelatine has a good clinical effect on elderly patients with depression by improving the symptoms of anxiety and depression, which is worthy of clinical popularization and application in clinic.

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Correlation between non-HDL-C/HDL-C and subclinical atherosclerosis in officers and seamen of naval special duty

Fang ZHENG ; Dongchu LIAO ; Hai YU ; Yinjin HU ; Yun JIN

Chinese journal of nautical medicine and hyperbaric medicine.2020;27(3):270-274. doi:10.3760/cma.j.cn311847-20191016-00260

Objective:To investigate the correlation and its clinical significance between the ratio of non-high density lipoprotein cholesterol to high density lipoprotein cholesterol (non-HDL-C/HDL-C) and subclinical arteriosclerosis (SA) in officers and seamen of naval special duty.Methods:A total of 118 officers and seamen of naval special duty with SA admitted to Xiamen Special Services Recuperation Center of the Army from June 2015 to June 2018 were selected as SA group. According to the carotid intima-media thickness (C-IMT) and plaque occurrence, they were divided into two subgroups: 60 cases in thickening group and 58 cases in plaque group. And another 60 officers and seamen of naval special duty admitted in the sanatorium in the same period for resting were selected into control group as they were healthy after examination. Routine physical examination recordings were compared among those groups, including general clinical data (cardiovascular health behavioral factors score, C-IMT, and blood glucose) and recordings on lipid [triglyceride (TG), total cholesterol (TC), HDL-C, low density lipoprotein cholesterol (LDL-C), non-HDL-C, non-HDL-C/HDL-C ratio, and atherogenic index of plasma (AIP)]. C-IMT and AIP were analyzed by correlation and multiple linear regression, and carotid plaque occurrence was analyzed by binary logistic regression.Results:①Among the control group, the thickening group, and the plaque group, variance analysis showed that TG, TC, LDL-C, non-HDL-C, AIP, non-HDL-C/HDL-C, C-IMT increased in turn significantly, while HDL-C, exercise score, and healthy diet score decreased in turn significantly ( P<0.05 or P<0.01). ②Correlation analysis showed that there was a positive correlation of non-HDL-C/HDL-C with C-IMT and AIP, respectively ( P<0.01 or P<0.05). ③Regression analysis showed that non-HDL-C/HDL-C entered the regression model with C-IMT and AIP as dependent variables ( P<0.01), and did not enter the regression model with common carotid artery plaque as the dependent variable ( P>0.05). Conclusion:There is obvious abnormal lipid metabolism in officers and seamen of naval special duty with SA. Non-HDL-C/HDL-C is positively correlated with C-IMT and AIP, which is a risk factor of officers and seamen of naval special duty with SA and can be used as a good index for evaluating officers and seamen of naval special duty with SA. Among the officers and seamen of naval special duty, the control of lipid should be focused on.

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