The effect of intermittent hyperbaric oxygen on short term recovery from grade II medial collateral ligament injuries

Objective: To examine the hypothesis that intermittent exposure to hyperbaric oxygen (HBO) will increase the rate of recovery from a grade II medial collateral complex injury. Design: A double blinded controlled study of a treatment group and control group of patients who experience an initial clinical assessment, a magnetic resonance imaging scan of the knee (MRI), two weeks of either HBO or sham treatment, a second MRI post-treatment and six weekly follow up visits after the injury. Setting: Allan McGavin Sports Medicine Clinic, University of British Columbia, Vancouver, B.C., Canada. Patients: Nineteen patients entered; 14 completed the clinical assessment portion, 9 of the fourteen completed pre and post treatment MRIs. Interventions: Treatment group: ten HBO treatments consisted of 2 atmospheres absolute (ATA) for one hour with 100% oxygen (02) in ten out of fourteen days in the first two weeks of recovery. Control group: ten HBO treatments consisted of 1.2 ATA with air for one hour in ten out of fourteen days in the first two weeks of recovery Main Outcome Measures: MRI pre-post treatment volumetric analysis; weekly assessments and comparisons of the injured and uninjured knee of: 1) a subjective questionnaire, 2) pain, 3) thigh girth, 4) knee girth, 5) range of motion, 6) maximum flexion, 7) one legged jump test. During the last three weeks a comparison of times straight running to a figure of eight course was made. Results: Significant findings were found during the treatment period (the first two weeks) specifically. A more rapid decrease in the volume of edema in patients treatment with HBO as measured by MRI was observed. Patients treated with HBO also experienced less muscle wasting, greater range of motion and maximum flexion improvements. Comparisons of the running tests suggest a greater mobility during the 4th, 5th and 6th week of recovery. Analysis of variables measured throughout all the trials did not show any significance. Length of the study may have contributed to their insignificance. Conclusions: Early intervention with HBO after a sports injury may be beneficial in increasing the rate of recovery. Possible mechanisms are discussed.Education, Faculty ofKinesiology, School ofGraduat

Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury

BACKGROUND: Soft tissue injuries (including muscle damage after unaccustomed exercise) are common and are often associated with athletic activity. Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than one atmosphere. OBJECTIVES: To assess the benefits and harms of HBOT for treating soft tissue injury, including delayed onset muscle soreness (DOMS). SEARCH METHODS: We searched The Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to February 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE (1950 to February 2010), EMBASE (1980 to 2010 Week 07), CINAHL (1982 to October 2008), an additional database developed in our hyperbaric facility and reference lists of articles. Relevant journals were handsearched and researchers in the field contacted. SELECTION CRITERIA: Randomised trials comparing the effect on closed soft tissue injury (including DOMS) of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy). DATA COLLECTION AND ANALYSIS: Four authors independently evaluated study quality and extracted data. Most of the data presented in the review were extracted from graphs in the trial reports. MAIN RESULTS: Nine small trials involving 219 participants were included. Two trials compared HBOT versus sham therapy on acute closed soft tissue injuries (ankle sprain and medial collateral knee ligament injury respectively). The other seven trials examined the effect of HBOT on DOMS following eccentric exercise in unconditioned volunteers. All 32 participants of the ankle sprain trial returned to their normal activities. There were no significant differences between the two groups in time to recovery, functional outcomes, pain, or swelling. There was no difference between the two groups in knee function scores in the second acute injury trial; however, intention‐to‐treat analysis was not possible for this trial. Pooling of data from the seven DOMS trials showed significantly and consistently higher pain at 48 and 72 hours in the HBOT group (mean difference in pain score at 48 hours [0 to 10 worst pain] 0.88, 95% CI 0.09 to 1.67, P = 0.03) in trials where HBOT was started immediately. There were no differences between the two groups in longer‐term pain scores or in any measures of swelling or muscle strength. No trial reported complications of HBOT but careful selection of participants was evident in most trials. AUTHORS' CONCLUSIONS: There was insufficient evidence from comparisons tested within randomised controlled trials to establish the effects of HBOT on ankle sprain or acute knee ligament injury, or on experimentally induced DOMS. There was some evidence that HBOT may increase interim pain in DOMS. Any future use of HBOT for these injuries would need to have been preceded by carefully conducted randomised controlled trials which have demonstrated effectiveness

Long-Term Results of Provox ActiValve, Solving the Problem of Frequent Candida- and "Underpressure"-Related Voice Prosthesis Replacements

Objectives: To assess the long-term results of the Provox ActiValve, a prosthesis for voice rehabilitation after total laryngectomy that was designed to lessen the need for frequent replacements caused by Candida and "underpressure." Patients and Methods: Retrospective assessment of device lifetime, indications for replacement, voice quality, and maintenance issues, measured by a structured trial specific questionnaire, in a cohort of 42 laryngectomized patients, experiencing a short Provox2 device lifetime (median, 21 days). Results: The median device lifetime of Provox ActiValve, replaced for leakage through the device and those still in situ at the date of data collection (N = 32), was 337 days (mean 376 days): a statistically significant 16-fold increase compared to the Provox2 prosthesis (P <.001). In 10 patients, replacement was fistula-related (median after 86 days): esophageal pouch (N = 4), fistula granulation (N = 3), extrusion of the device (N = 2), and periprosthetic leakage (N = 1). Eighty-six percent of the patients used a special lubricant to diminish "stickiness" of the valve. Provox ActiValve was preferred by 90% of the patients who completed the trial-specific questionnaire. Conclusions: For patients requiring frequent device-related replacements, Provox ActiValve, also long-term, provides a true solution and thereby is a valuable addition to prosthetic voice rehabilitatio

Biofilm formation on the Provox ActiValve: Composition and ingrowth analyzed by Illumina paired-end RNA sequencing, fluorescence in situ hybridization, and confocal laser scanning microscopy

Background: The most frequent cause of voice prosthesis failure is microbial biofilm formation on the silicone valve, leading to destruction of the material and transprosthetic leakage. The Provox ActiValve valve is made of fluoroplastic, which should be insusceptible to destruction. Aim: determining if fluoroplastic is insusceptible to destruction by Candida-species. Methods: 33 dysfunctional Provox ActiValves (collected: 2011-2013). Biofilm-analysis: Illumina paired-end sequencing (IPES); assessment of biofilm-material interaction with fluorescence in situ hybridization (FISH) and confocal laser scanning microscopy (CLSM). Results: IPES (n=10): Candida albicans and Candida tropicalis are dominant populations on fluoroplastic and silicone. Microbial diversity is significantly lower on fluoroplastic. L. gasseri is the prevalent bacterial strain on most voice prostheses. FISH and CLSM (n=23): in none of the cases ingrowth of Candida-species in fluoroplastic is present. Conclusions: Fluoroplastic material of Provox ActiValve appears insusceptible to destruction by Candida-species, which could help improve durability of voice prostheses. This article is protected by copyright. All rights reserved