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ABSTRACT Brizzolari A, Mrakic-Sposta S, Vezzoli A, Balestra C, Bonini B, Barassi A, Camporesi E, Bosco G. Oxy- inflammation after repetitive “open circuit” dives in the Baltic Sea. Undersea Hyperb Med. 2025 Third Quarter; 52(3):211-225. Background: SCUBA diving involves exposure to a hyperbaric environment that can induce oxidative stress and inflammation. This study investigates the evolution of oxy-inflammation status in divers who performed repetitive dives in cold water. Methods: In the Baltic Sea, nine expert divers were recruited to perform five dives (T1-T5). Urine and saliva were collected before (A) and after (B) each dive. Reactive Oxygen Species (ROS), total antioxidant capacity (TAC), lipid peroxidation (8-iso-PGF2α), DNA damage (8-OH-dG), inflammatory status (IL-6), nitric oxide metabolites, neopterin, and electrolyte balance changes were investigated. Results: Pre-dive values showed significant increases at the fourth to fifth days in ROS (+45 and +89%) and consequently in lipid peroxidation (+65%) at the fourth day and in DNA damage (+49 and +61%) at the fourth to fifth days, respectively, compared to the first day value. Post-dive significant increases were recorded at the fourth to fifth days in ROS (+83 % and +146%), and at the fifth day in lipid peroxidation (+59%) and DNA damage (+41%) with respect to the post-dive value of ..

ABSTRACT Elkhatib WY, Teixeira MT, Welch BT, LeTourneau WM, Diedrich DA, Toups G. Myocardial Ischemia- Associated Arterial Embolism Management from Pulmonary Cryotherapy. Undersea Hyperb Med. 2025 Third Quarter; 52(3):349-356. A 52-year-old male undergoing pulmonary lesion cryoablation developed transient intraprocedural and postprocedural hypotension, transient ST elevations on telemetry with associated bradyarrhythmia, and computed tomography imaging revealing arterial gas embolism within the left ventricle and aorta. Coordinated multidisciplinary efforts involving interventional radiology, anesthesiology, cardiology, critical care, and hyperbaric medicine were employed to ensure a successful recovery, alongside important management considerations aimed at minimizing adverse outcomes. Keywords: air embolism; bubbles; cardiovascular; cerebral arterial gas embolism (CAGE); electrocardiography; hyperbaric medicine; hyperbaric oxygen therapy; pulmonary function

ABSTRACT Risberg J, Segadal K, Gennser M. A Scoping Review of the Equivalent Air Depth Concept. Undersea Hyperb Med. 2025 Third Quarter; 52(3):239-259. Surface-oriented diving with nitrogen-oxygen breathing gases (nitrox) other than air will commonlybe planned according to the Equivalent Air Depth (EAD) principle. EAD is the depth at which adiver breathing air will inhale the same pN2 as the nitrox-breathing diver. Using conventional air decompression tables based on the EAD depth will allow longer bottom times or shorter decompression times compared to air breathing at the same water depth. This scoping review aimed to investigate the validity of the EAD principle. A literature review identified 13 eligible studies that reported DCS incidence or vascular bubbles following air and nitrox exposures in humans and experimental animals. Four experimental (N=1,597 mandives) and two epidemiological (N=249,109 mandives) studies on humans did not disclose a higher DCS incidence or bubble scores following nitrox dives compared to air dives of similar EAD. Seven experimental animal studies consistently showed that a high pO2 (>2 atm) increased DCS susceptibility in goats and rats. This can likely be explained by the reduction of the “oxygen window” due to the high tissue and venous pO2. There is insufficient data from animal ..

ABSTRACT Avcı AU, Abaylı SY. The Experience of Hyperbaric Oxygen Therapy in Earthquake-Related Crush Injuries: Could Be Beneficial Even with Delay in Initiation. Undersea Hyperb Med. 2025 Third Quarter; 52(3):261-270. Background: Two significant earthquakes struck southeastern Turkey on February 6. The study aimed to evaluate the effect of HBO2 on patients with crush injuries who received therapy at the Akyurt Hyperbaric Oxygen Therapy Center following the earthquakes. Methods: Thirty-three crush injury patients were included in the study. The Gustilo crush injury grading system, the Mangled Extremity Severity Score (MESS), and the five assessment host function scores were used to evaluate patients. Additionally, the duration from the time under the rubble until HBO2 started, as well as the presence of fasciotomy/amputation before or after HBO2, was recorded. Results: The mean duration from rescue to the initiation of HBO2 was 195 hours. Of the patients, 63.6% were severely injured according to the MESS (≥7). The Gustilo crush injury classification distribution was 30.3% IIIC, 42.4% IIIB, and 27.3% IIIA. Before HBO2, 87.9% of the patients had fasciotomies. Fasciotomy lines were closed (without requiring another fasciotomy or additional complications) during or immediately after HBO2 in 72.4% of 29 patients. Following HBO2, 78.8% of the patients did not require amputation, while 21.2% had amputations. All ..

ABSTRACT Hsieh CH, Wen YW, Liao CT, Lee SR. Hyperbaric Oxygen Treatment after Surgery and Radiation for Oral Cancers Does not Increase the Likelihood of a Second Primary Development, nor Reduce Disease Specific or Overall Survival. Undersea Hyperb Med. 2025 Third Quarter; 52(3):271-278. Objective: This study aims to analyze whether receiving Hyperbaric oxygen (HBO2) therapy affects oral cancer prognosis using real-world data from the National Health Insurance Research Database (NHIRD) in Taiwan. Method: This study is a retrospective cohort study. Cancer registration files, the NHIRD, and death statistics files from 2011 to 2019 were used for data extraction. We identified 6,297 oral cancer patients, all of whom underwent tumor resection surgery and radiation therapy. Among them, 254 patients received HBO2 therapy for osteoradionecrosis. We then divided them into two groups for comparison based on whether they received HBO2 therapy or not. First, propensity score matching was used to eliminate basic characteristic differences between the groups, and then Kaplan-Meier survival analysis was conducted. To eliminate immortal time bias and obtain hazard ratios, a time-dependent Cox proportional hazards model was used for estimation. Result: After undergoing curative tumor resection combined with adjunctive radiation therapy, oral cancer patients were divided into two groups based on whether they received hyperbaric oxygen therapy. ..

ABSTRACT Nukala N, Rao R, Nemeth D, Badam M. Hyperbaric Oxygenation Therapy as Adjunctive Treatment of Complex Wound Associated with Sterno-clavicular Septic Arthritis. Undersea Hyperb Med. 2025 Third Quarter; 52(3):279-282. Introduction: Sternoclavicular septic arthritis with pyomyositis is a relatively rare condition. While most cases of septic arthritis are caused by gram-positive organisms, such as Staphylococci and Streptococci spp., a small number of patients present with gram-negative organisms as the cause of their condition. Signs and symptoms can be non-specific, and although CT imaging aids in diagnosis, a timely identification relies primarily on a high index of clinical suspicion. Case Description: We present a case of a 44-year-old female patient with a history of poorly controlled diabetes mellitus who presented with a chronic, non-healing wound that developed on a background of non-traumatic sternoclavicular septic arthritis, chronic osteomyelitis of the clavicle and manubrium, and concomitant pectoralis pyomyositis caused by a gram-negative pathogen. The use of HBO2 as an addition to this patient’s treatment regimen hastened the healing process. Conclusion: Given the rarity of this condition, we consider that adding to the body of literature with regards to the diagnosis and treatment of this condition can help clinicians develop a keen eye for it, decreasing the morbidity and mortality associated ..

ABSTRACT Ma Y, Lv W, Hu H, Pan S, Guo D. Risk factors and Outcome Analysis of Delayed Neurological Sequelae in elderly patients with carbon monoxide poisoning. Undersea Hyperb Med. 2025 Third Quarter; 52(3):283-292. Carbon monoxide (CO) poisoning is one of the common causes of poisoning and can result in significant neurological sequelae. However, few studies have focused on the elderly population. We retrospectively reviewed elderly (age≥65 years) with CO poisoning from non-fire accidents and non-suicide at the 6th Medical Center PLA General Hospital in China from 2013 to 2023. A total of 167 patients were enrolled. The annual case number decreased from 2013 to 2023, particularly during the cold months (November to February). The most common source of exposure was coal heating (90%). The most common presenting symptoms were changes in consciousness (90%). Eighty-eight patients (52%) developed delayed neurological sequelae (DNS), of which sixty-nine (78%) converted to long-term neurological sequelae (LNS). The most common imaging manifestations were hypoxic-ischemic damage in the basal ganglia (54%) and demyelination in white matter (46%). After multivariate analysis, initial GCS score and coma time (GCS scores<8) were the independent risk factors for patients with DNS (p<0.001). Interestingly, myocardial injury was more common in non-DNS elderly ..

ABSTRACT Degregori EB, Caye P, Soares ABU, Schiefler OHM, Antunes BN, Reinstein RS, Freitas J, Polanczyk VK, Mangini NP, Amancio GHS, Brun MV, Müller DCM. Impact of hyperbaric oxygen therapy on tolerability, clinical signs, lactatemia and glycemia in patients with pyometra. Undersea Hyperb Med. 2025 Third Quarter; 52(3):293-304. This study evaluated the physical parameters, lactatemia, glycemia, and tolerability in canines with pyometra and sepsis who underwent hyperbaric oxygen therapy (HBO2). Eighteen female dogs were randomly assigned to two groups: the hyperbaric group (HG) (three sequential sessions of HBO2 [O2 with 2 ATA for 45 min] after ovariohysterectomy) and the control group (CG) (ovariohysterectomy). Glycemia and lactatemia were measured at admission (T0), 1 hour after the end of the surgical procedure (T1), 24 hours (T2), 48 hours (T3), and 72 hours (T4) after surgery. Physical assessments were conductedat the same times, except for HG, which was assessed before and after each HBO session. There wasno difference between the groups in relation to the physical parameters evaluated; however, rectal temperature was reduced in the group subjected to HBO2. We observed an increase in lactate at T0 and T2, and a reduction at T3 and T4 in both groups. We did not identify changes in blood glucose ..

ABSTRACT Wang C, Zhang L, Yu Q, Liu Y, Ren Z, Xue L. Characteristic of volume-controlled ventilation with small tide volume in hyperbaric oxygen chamber. Undersea Hyperb Med. 2025 Third Quarter; 52(3):305-312. Purpose: To evaluate the characteristics of tidal volume (VT) delivered by a Shangrila590 ventilator with preset tide volume (VTset) 50-300 mL in volume-controlled ventilation (VCV) during hyperbaric oxygen (HBO2) therapy. Methods: Experiments were conducted in a multi-place HBO2 chamber at 1.0, 2.0, and 2.8 atmospheres absolute (ATA abs) and were divided into three groups accordingly. The ventilator was connected to the test lung in the chamber. The VTset of the ventilator was adjusted before the experiments. At five VTset levels (50, 100, 150, 200, 300 mL), the VT and inspiratory peak pressure (Ppeak) detected by the ventilator and the test lung were recorded for 30 cycles (n=30). The measurements of the test lung were considered to be the true value, and the ventilator and test lung data were compared to evaluate the accuracy of the ventilator. Test lung compliance (CTL) was detected by the ventilator, and breathing circuit compliance (CBC) was calculated by measuring the pressure and volume of the breathing circuit. Ventilation data were compared among three groups to clarify the change during ..

ABSTRACT Eckert KA, Fife CE, Carter MJ. Systematic Review of Hyperbaric Oxygen for Late Radiation Tissue Injury (Bowel, Bladder). Undersea Hyperb Med. 2025 Third Quarter; 52(3):313-325. Background: This systematic review evaluated comparative studies to determine if hyperbaric oxygen therapy (HBO2) is beneficial to late radiation tissue injury (LRTI) of the bowel/bladder. Methods: We included adequately powered, comparative studies evaluating the effect of HBO2 on patients with LRTI (≥3 months duration and/or ≥6 months after radiation therapy) to the bowel/bladder compared to no HBO2 or placebo/sham; complete outcomes data must have corresponded to the tools used to measure change in LRTI symptoms. Medline was searched through May 4, 2023, Embase through May 29, 2023, and Google Scholar through May 5, 2023. The Cochrane risk-of-bias tool and GRADE approach were used with a certainty of outcomes assessment. Results: Three RCTs were included with 273 subjects. Two double-blinded studies evaluated rectal symptoms; one open study evaluated cystitis. One study had a low risk of bias; two had some concerns. All had moderate certainty of outcomes. There is moderate certainty with a weak recommendation for using HBO2 for rectal complications or cystitis, which (in context of GRADE terminology) means the decision to treat depends on a case-by-case basis. Discussion: The highly heterogeneous design of the ..

ABSTRACT Zamora FV, de Farias Santos ACF, Zamora AV, Galvao LKCS, Santos Pimenta N, Salles JPCEA, Carneiro VB, Starling CEF. Hyperbaric Oxygen Treatment for Long-COVID syndrome: A Systematic Review of Current Evidence on Cognitive Decline. Undersea Hyperb Med. 2025 Third Quarter; 52(3):327-335. Introduction: There is no established specific treatment for long-COVID syndrome (LCS), yet hyperbaric oxygen (HBO2) treatment has been studied as a potential option. Therefore, we conducted a systematic review to evaluate the benefits of HBO2 treatment in LCS patients. Methods: We systematically searched PubMed, Embase, and Cochrane databases until April 2024. Risk of bias and GRADE quality assessment were evaluated. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42024530421. Results: Seven studies from seven countries, divided into RCTs and observational studies, included 199 participants. HBO2 treatment protocols included breathing 100% oxygen at 2.0 ATA until 2.5 ATA; the number of sessions varied from ten to 60 depending on the patient's comorbidities and symptoms. Memory, executive function, attention, fatigue, and pain level improved with HBO2 treatment. The intervention had minimal side effects, and none were serious. Conclusion: HBO2 treatment might be a potential option and safe treatment in LCS patients. However, further research should be focused on evaluating its efficacy in a larger number ..

ABSTRACT Johnson-Arbor K. Hyperbaric oxygen therapy for high performance athletes: a narrative review. Undersea Hyperb Med. 2025 Third Quarter; 52(3):337-347. Elite athletes who sustain severe injuries may experience physiological, psychological, and financial repercussions. Many therapies, including hyperbaric oxygenation (HBO2), have been investigated as potential methods of preventing and treating injuries in elite athlete populations. This narrative review explores several applications of HBO2 therapy relevant to athletes, based on the available human and animal literature. In animal studies, the administration of HBO2 is associated with improved muscle healing after soft tissue injury. Although human studies are inconclusive, some data suggest that short courses of HBO2 may result in reduced pain and faster return to play after soft tissue musculoskeletal injury. For individuals with sequelae of traumatic brain injury, limited data suggest that HBO2 may improve neurobehavioral symptoms. However, studies involving the use of hyperbaric oxygen therapy to treat concussions in athletes are limited. Mild HBO2 has been used to facilitate post-exercise recovery and reduce fatigue and performance decrements. The treatment vessels used to deliver mild HBO2 are typically intended for treating altitude sickness only. They are associated with safety and regulatory concerns when used for other purposes, including athletic recovery. Overall, there is limited evidence to support the ..

ABSTRACT Elkhatib WY, Teixeira MT, Welch BT, LeTourneau WM, Diedrich DA, Toups G. Myocardial Ischemia- Associated Arterial Embolism Management from Pulmonary Cryotherapy. Undersea Hyperb Med. 2025 Third Quarter; 52(3):349-356. A 52-year-old male undergoing pulmonary lesion cryoablation developed transient intraprocedural and postprocedural hypotension, transient ST elevations on telemetry with associated bradyarrhythmia, and computed tomography imaging revealing arterial gas embolism within the left ventricle and aorta. Coordinated multidisciplinary efforts involving interventional radiology, anesthesiology, cardiology, critical care, and hyperbaric medicine were employed to ensure a successful recovery, alongside important management considerations aimed at minimizing adverse outcomes. Keywords: air embolism; bubbles; cardiovascular; cerebral arterial gas embolism (CAGE); electrocardiography; hyperbaric medicine; hyperbaric oxygen therapy; pulmonary function

ABSTRACT Kelly M, Jones ET, Shapshak D. Rapid Progression of Cutaneous Large B-Cell Lymphoma During Hyperbaric Oxygen Therapy: A Case Report. Undersea Hyperb Med. 2025 Third Quarter; 52(3):357- 360. We present a case of a patient with a history of chronic lymphocytic leukemia (CLL) and cutaneous B-cell lymphoma of the right leg. She had previously received radiation treatment to the affected area and subsequently developed radiation fibrosis with two non-healing ulcerations at the previous tumor sites. A biopsy revealed spongiotic and sparse superficial perivascular dermatitis. Due to poor wound healing, adjunctive hyperbaric oxygen (HBO2) therapy was initiated. However, shortly after beginning HBO2 treatments, the wounds worsened. Repeat biopsies were performed, and the new areas were consistent with cutaneous large B-cell lymphoma. Consequently, HBO2 therapy was discontinued, and aggressive chemotherapy/immunotherapy was initiated. We recommend that patients with a history of cutaneous B-cell lymphoma be closely monitored for signs of tumor recurrence or disease worsening if they are to undergo adjunctive hyperbaric oxygen therapy. Keywords: cancer; cutaneous large B-cell lymphoma; hyperbaric oxygen therapy; wounds

ABSTRACT Canarslan-Demir K, Ozgok-Kangal K, Artan E, Turgut B. Does Covid-19 Cause Avascular Necrosis? Undersea Hyperb Med. 2025 Third Quarter; 52(3):361-368. COVID-19 has been associated with an increased risk of avascular necrosis (AVN), which affects various joints, including the hip, vertebrae, knee, and jaw. Understanding AVN’s pathogenesis and risk factors asa consequence of COVID-19 is essential for improving treatment and identifying preventive measures. This retrospective cohort study aims to assess the impact of COVID-19 on the etiology of AVN andraise awareness among clinicians. The study analyzed patients diagnosed with AVN and treated with Hyperbaric Oxygen Therapy at Gülhane Training and Research Hospital from January 2018 to January 2023. Patients were categorized into two groups: those admitted before the pandemic (the control group) and those admitted after (the study group). The results showed a significant increase in AVN cases during the post-pandemic period, with a higher incidence of femoral head involvement and more advanced stages of AVN in patients with a history of COVID-19. The findings suggest that COVID-19 and high-dose steroid use may increase AVN risk, highlighting the need for careful steroid management and monitoring for joint pain in these patients. Further research is recommended to explore the link between COVID-19 ..