HBOT and Stroke_TBI,

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David A Steenblock, D.O.

For a consultation, call us at 1-800-300-1063

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Hyperbaric Oxygen Research

for Stroke and TBI

Dr. David A. Steenblock

Personalized Regenerative Medicine

Mission Viejo, CA 92691

1-800-300-1063

Definition

Hyperbaric oxygen is Supercharged Oxygen! Hyperbaric (hyper high; baric pressure)oxygen can be defined as inhaling 100% inside a chamber that is pressured to greater than thepressure at sea level or 1 ATA (atmospheres absolute). Dr. Steenblock uses 100% oxygen bymask with pressurized air (21%) rather than 100% pressureized oxygen for greater safety. Healso uses pressures of about 1.5 ATA to 2.0 ATA that are recommended by experts in the fieldsuch as Dr. K.K. Jain, as being safe as well as effective for brain injured patients. Using higherpressures can result in increased oxidative stress that is counterproductive to tissue repair andhealing

Jain, K.K. Textbook of Hyperbaric Medicine, 5th

Edition, Hogrefe Publishing, Cambridge,

MA, 2009.

Oxygen is Life!

A continuous, sufficient oxygen supply is essential for cell function. The brain is about 2% ofthe bodys mass and utilizes 20% of the bodys oxygen. Oxygen delivery to the brain is highly

dependent on the flow of blood. A lack of oxygen to the brain cells, that lasts for a couple ofminutes, can lead to brain damage. A lack of oxygen beyond five or six minutes, can lead to thepersons death. The neurons are the most vulnerable to hypoxia (a lack of oxygen) and ischemia

(a lack of blood flow). The second most vulnerable brain cells to a lack of oxygen are theoligodendrocytes that produce myelin for the nerves. Multiple sclerosis is considered to be adisorder of the myelin. The third most vulnerable cells are the astrocytes (white matter) thatsupport the neurons. Next are the microglia that play a protective role in the brain as immunecells. However, when they become activated, as with hypoxia, ischemia, or inflammation, theycan also be destructive to the brain cells.

Shen J, Liu KJ, Liu S, Miyake M. Chapter 3: Cerebral Tissue Oxygenation: Transportation,

Metabolism, Measurement, and Significance in the Ischemic Brain. In Zhang, John (Ed),

Hyperbaric Oxygen for Neurological Disorders, Best Publishing Company, Flagstaff, AZ, 2008;

pp 6784.

Back to the Future!

David A. Steenblock, D.O. Inc

Personalized Regenerative Medicine


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According to Dr. Jain, the history of increased pressure for healing dates back to Alexander theGreat in 320 BC when he was lowered into the Bosphorus Straits in a glass barrel to give him asecret weapon in battles. (The Textbook of Hyperbaric Medicine).

There have been various attempts through the centuries to use oxygen under pressure forincreased healing and well-being. More recently, in 1960, Dr. Ita Boerema at the University of

Amsterdam, Netherlands was able to keep pigs alive in a hyperbaric chamber after thehemoglobin had been removed from their bodies. As his fame grew, Dr. Boerema was given thelatitude to construct a surgical room inside a hyperbaric chamber where he proceeded to treat3,300 patients (including infants, the elderly and the comatose) with conditions that includedrespiratory distress, gas and drug poisoning, shock, and gas gangrene. 1 The hyperbaric chamberalso extended the possibilities for cardiovascular surgery. After hyperbaric oxygen wasintroduced to the surgical procedures, the mortality rate for surgery dropped from 66% to 23%.The world then began to take notice. 2

1) Boerema I. Use of hyperbaric oxygen. American Heart Journal. 1965; 69:289-292.

2)Leopardi LN, Metcalfe MS, Forde A, Maddern GJ. Ite Boerema surgeon and engineerwith a double-Dutch legacy to medical technology. Surgery 2004; 135(1): 99-103.

In 2009, a paper on HBOT from the Department of Neurosurgery, University Hospital ofMnster in Germany was published on the benefits of HBOT to help support brain oxygen levelsin damaged tissue. http://www.ncbi.nlm.nih.gov/pubmed/19277461

Where in the world is HBOT now?

According to Dr. Jains Textbook of Hyperbaric Medicine, 2nd Edition, published in 1996, about

40% of the worlds hyperbaric chambers were found in the USSR, 12% were found in bothSouth Korea and the Peoples Republic of China, and 11% were found in Europe, Japan and theU.S. Dr. Jains recent 5

th edition (2009) shows 37% of the worlds hyperbaric chambers in

China, 26% in Russia, 10% in both Europe and Japan, 8% in South Korea and 7% are found inthe U.S. Four of these 7% of the worlds chambers are located at Dr. Steenblocks clinic.

1) Jain, K.K. Textbook of Hyperbaric Medicine, 2nd

Edition, Hogrefe Publishing, Kirkland,

WA, 1996.

2) Jain, K.K. Textbook of Hyperbaric Medicine, 5th

Edition, Hogrefe Publishing, Cambridge,

MA, 2009.

Stroke statistics

Stroke is the leading cause of long-term disability and now the second leading cause of death inthe U.S. 1 The direct and indirect costs of stroke exceed $56 billion a year. 2

1) Veltkamp R, Schwab S, Sun L. Chapter 6: HBO for Stroke: Basic Science Studies. In Zhang,

John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing Company, Flagstaff,

AZ, 2008; pp 135-154.

2) Singhal AB, Lo EH. Chapter 5: Oxygen Therapy for Ischemic Stroke: Clinical Aspects. In

Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing Company,

Flagstaff, AZ, 2008; pp 115-134

Stroke is a brain attack
http://www.ncbi.nlm.nih.gov/pubmed/19277461http://www.ncbi.nlm.nih.gov/pubmed/19277461http://www.ncbi.nlm.nih.gov/pubmed/19277461


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A heart attack is also called a cardiac infarction. Likewise, stroke involves an infarct zone ofdead tissue as well as the tissue that surrounds the infarct zone, called the ischemic penumbra.

(The image in brain tomography is that of light, representing the penumbra, that surrounds adarkened central area, the infarct zone of dead tissue, similar to the penumbra image of the sun

being eclipsed by the moon). In the hours, days, and weeks following a stroke, the neurons inthis area usually suffer a delayed death from partial oxygen and increased inflammation and

oxidative stress. A recent scenario is that neurons in this penumbra area that have enoughoxygen to survive but not enough to function, may be idling or asleep formonths and evenyears after a stroke. The salvaging of this surrounding area is associated with improved clinicaloutcome. Hyperbaric oxygens supercharged oxygen is able to revitalize these idling neuronsthat have been deficient in oxygen but not enough to die yet.Neubauer R.A, Gottlieb SF, Kagan RL. Enhancing idling neurons. (Letter). Lancet, March 3.

1990, pg. 542.

What are the benefits of HBOT for stroke?

Matchett and associates provide a summary of the benefits of hyperbaric oxygen treatment inanimal models of cerebral ischemia (stroke), many of which have evaluated energy metabolismin the ischemic penumbra region. Most of these studies conclude that hyperbaric oxygenimproves neurological outcome. In fact, these positive outcomes are described as a rather robustbeneficial effect.

Matchett GA, Martin RD, Zhang JH. Hyperbaric oxygen therapy and cerebral ischemia:

neuroprotective mechanisms. Neurological Research 2009; 31: 114-121.

http://www.ncbi.nlm.nih.gov/pubmed/19298750

Hyperbaric oxygen provides the following neuroprotective benefits:

1.Sustains cell viability in acute hypoxic tissue, especially in the ischemic penumbraarea that surrounds the infarct core. (Matchett)One of Neubauers early studies on idling neurons:http://www.ncbi.nlm.nih.gov/pubmed/1617842

2. Increases oxygen (pO2) from 34 mmHg (air-about 21% oxygen) to 90 mmHg (100%oxygen). HBO also increases the diffusion distance for oxygen1 so the oxygen can reachthe cell from farther distances away. HBO increases oxygen in the plasma tenfold.2 Thisis important in areas where there is blood vessel damage that limit tissue access to the redblood cells.

1) Ostrowski RP, Zhang JH. Chapter 4: Mechanisms of HBO for Neurological

Disorders. In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best

Publishing Company, Flagstaff, AZ, 2008; pp 85-114.

2) Singhal AB, Lo EH. Chapter 5: Oxygen Therapy for Ischemic Stroke: Clinical

Aspects. In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best

Publishing Company, Flagstaff, AZ, 2008; pp 115-134

3. Improves tissue metabolism

The mitochondria in cells are the energy factories. They produce the energy needed forthe cell to function. An increase in oxygen delivery to ischemic areas improves local
http://www.ncbi.nlm.nih.gov/pubmed/19298750http://www.ncbi.nlm.nih.gov/pubmed/19298750http://www.ncbi.nlm.nih.gov/pubmed/1617842http://www.ncbi.nlm.nih.gov/pubmed/1617842http://www.ncbi.nlm.nih.gov/pubmed/1617842http://www.ncbi.nlm.nih.gov/pubmed/19298750


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tissue metabolism. Anerobic metabolism, utilized when oxygen is deficient, producesabout 2 moles of ATP (cell energy from the mitochondria). Aerobic metabolism, thatrequires oxygen, results in over ten times the anerobic amount of energy. Preservation ofATP and other high energy phosphate compounds help to maintain mitochondrial functionas well as cell survival and function. (Matchett; Ostrowski)

4. Reduces excitotoxic effects.Hyperbaric oxygen reduces the need for glucose, pyruvate, and lactate. Sufficientoxygen reduces the glutamate stimulation of the cell and its excitotoxic effects. Toomuch glutamate leads to sodium and calcium entry into the cell and a greater need forATP production to remove these minerals. An imbalance of charges between the insideand outside of the cell in sodium-potassium and calcium-phosphorus can lead todepolarization and eventual cell death. (Matchett)A supportive article by Yang and associates:http://www.ncbi.nlm.nih.gov/pubmed/19851780

5. Reduces risk of infection.Oxygen is required for the leukocyte killing of microorganisms. Hyperbaric oxygen isreported to double (or more) leukocyte bacteriocidal activity and control bacterial andfungal infections. (Ostrowski)Supportive free article by Bitterman:http://www.ncbi.nlm.nih.gov/pubmed/19291278

6. Reduces oxidative stress.At 1.5 ATA, HBO inhibits hydroxyl radical in the brain, a reactive oxygen species (ROS)that causes oxidative stress and tissue damage. At 2 ATA, HBO upregulates manganese-superoxide dismutase (SOD) and decreases NADPH oxidation (that increases ROS). Inaddition, thioredoxins, antioxidants that are increased by oxygen, have been found toprevent programmed cell death. (Ostrowski)Free article:http://www.ncbi.nlm.nih.gov/pubmed/16556878

7. Reduces inflammation.Hyperbaric oxygen reduces pro-inflammatory cyclooxygenase-2 mRNA (COX-2). COX-2 stimulates pro-inflammatory prostanoids, prostaglandins, prostacyclins and throm-boxane. Hyperbaric oxygen also reduces inflammatory mediators such as TumorNecrosis Factor-alpha, Interleukin 1 and Interleukin 6. (Matchett)

Supportive article by Vlodavsky and associates:http://www.ncbi.nlm.nih.gov/pubmed/16409552

8. Decreases size of the cerebral infarctionThe secondary factors that result in cell death in the penumbra and thereby increase thesize of the infarction include inflammation, degradation of the extracellular matrix (thatstabilizes the brain cells), oxidative damage, sodium influx, edema (swelling), glutamateexcitotoxicity, depolarization and programmed cell death (apoptosis). The size of theinfarction has been associated with the amount of blood-brain barrier breakdown, whichis associated with an increase in extracellular matrix degeneration and edema.Extracellular matrix degradation is also a factor in promoting hemorrhage and neuraldeath by apoptosis. Hyperbaric oxygen helps to repair the extracellular matrix and theblood-brain barrier. (Veltkamp)
http://www.ncbi.nlm.nih.gov/pubmed/19851780http://www.ncbi.nlm.nih.gov/pubmed/19851780http://www.ncbi.nlm.nih.gov/pubmed/19291278http://www.ncbi.nlm.nih.gov/pubmed/19291278http://www.ncbi.nlm.nih.gov/pubmed/19291278http://www.ncbi.nlm.nih.gov/pubmed/16556878http://www.ncbi.nlm.nih.gov/pubmed/16556878http://www.ncbi.nlm.nih.gov/pubmed/16556878http://www.ncbi.nlm.nih.gov/pubmed/16409552http://www.ncbi.nlm.nih.gov/pubmed/16409552http://www.ncbi.nlm.nih.gov/pubmed/16409552http://www.ncbi.nlm.nih.gov/pubmed/16556878http://www.ncbi.nlm.nih.gov/pubmed/19291278http://www.ncbi.nlm.nih.gov/pubmed/19851780


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One of his other articles:http://www.ncbi.nlm.nih.gov/pubmed/15777761

9. Reduces edema (swelling)By improving oxygen delivery to the cells energy factories, the mitochondria, ATP isable to help sustain ionic pump function in the cells to counteract sodium influx andeventual cell death.

1In addition, by protecting the integrity of the blood brain barrier

and reducing inflammation, HBO reduces swelling.

2

(Ostrowski; Matchett)A supportive free article by Qin and associates:http://www.ncbi.nlm.nih.gov/pubmed/17322079

10.Reduces intracranial pressure.HBO reduces cerebral blood volume and edema, resulting in reduced ICP. (Ostrowski)A supportive free article from Ren and associates:http://www.ncbi.nlm.nih.gov/pubmed/11780460

11.Reduces breakdown of the blood-brain barrierThe blood-brain barrier (BBB) is formed by endothelial cells (that build the blood

vessels), the extracellular matrix and astrocytes (white matter). Edema and secondaryhemorrhages result from BBB damage.

Hyperbaric oxygen reduces MMP-9 (matrix

metalloproteinase-9) that degrades the extracellular matrix. (Matchett; Ostrowski)A supportive Veltkamp free article:http://www.ncbi.nlm.nih.gov/pubmed/16020761

12. Reduced programmed cell death (apoptosis).Apoptosis is initiated by both mitochondrial dysfunction (resulting in reduced ATP andincreased oxidative damage) and degradation of the extracellular matrix. Hyperbaricoxygen can inhibit these processes. HBOT inhibits hypoxia-inducible factor-1alpha(HIF-1a), improves the Bcl-2/Bax ratio in favor of anti-apoptosis and reduces cytochromeC release from the mitochondria. There is also evidence that HBOT reduces PARPcleavage, reduces cleaved caspase 3 and reduces DNA fragmentation which contribute tocell death. (Matchett)Supportive article by Yin and associates:http://www.ncbi.nlm.nih.gov/pubmed/12843789

13. Promotes the development of new blood vesselsShort term use reduces vascular endothelial growth factor (VEGF) and helps preserve theblood brain barrier. However, the daily use of HBOT stimulates VEGF and thedevelopment of new capillaries in the brain that will eventually provide a consistentsupply of oxygen to the cells. Oxygen is also necessary for fibroblast differentiation toproduce collagen, which supports capillary formation. (Ostrowski)Supportive free article by Sheikh and associates:http://www.ncbi.nlm.nih.gov/pubmed/11074883

14. Promotes peripheral nerve regenerationHyperbaric oxygen stimulates the regeneration of the peripheral nerves after injury.(Matchett)Supportive article by Bradshaw and associates:http://www.ncbi.nlm.nih.gov/pubmed/8840479
http://www.ncbi.nlm.nih.gov/pubmed/15777761http://www.ncbi.nlm.nih.gov/pubmed/15777761http://www.ncbi.nlm.nih.gov/pubmed/15777761http://www.ncbi.nlm.nih.gov/pubmed/17322079http://www.ncbi.nlm.nih.gov/pubmed/17322079http://www.ncbi.nlm.nih.gov/pubmed/11780460http://www.ncbi.nlm.nih.gov/pubmed/11780460http://www.ncbi.nlm.nih.gov/pubmed/16020761http://www.ncbi.nlm.nih.gov/pubmed/16020761http://www.ncbi.nlm.nih.gov/pubmed/16020761http://www.ncbi.nlm.nih.gov/pubmed/12843789http://www.ncbi.nlm.nih.gov/pubmed/12843789http://www.ncbi.nlm.nih.gov/pubmed/12843789http://www.ncbi.nlm.nih.gov/pubmed/11074883http://www.ncbi.nlm.nih.gov/pubmed/11074883http://www.ncbi.nlm.nih.gov/pubmed/8840479http://www.ncbi.nlm.nih.gov/pubmed/8840479http://www.ncbi.nlm.nih.gov/pubmed/8840479http://www.ncbi.nlm.nih.gov/pubmed/11074883http://www.ncbi.nlm.nih.gov/pubmed/12843789http://www.ncbi.nlm.nih.gov/pubmed/16020761http://www.ncbi.nlm.nih.gov/pubmed/11780460http://www.ncbi.nlm.nih.gov/pubmed/17322079http://www.ncbi.nlm.nih.gov/pubmed/15777761


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15. Promotes white matter growth in the CNS.

Hyperbaric oxygen can stimulate the growth of oligodendrocytes and myelin basicprotein (white matter) in the brain.

Yang YJ, Wang XL, Yu XH, Wang X, Xie M, Liu CT. Hyperbaric oxygen induces

endogenous neural stem cells to proliferate and differentiate in hypoxic-ischemic brain

damage in neonatal rats. Undersea Hyperbaric Medicine 2008, 35(2): 113-29.http://www.ncbi.nlm.nih.gov/pubmed/18500076

Hyperbaric oxygen therapy stimulates the production of glial cell derived neurotrophicfactor in a rat model of spinal cord injury.

Tai PA, Chang CK, Niu KC, Lin MT, Chiu WT, Lin CM. Attenuating experimentalspinal cord injury by hyperbaric oxygen: stimulating production of vasculendothelial andglia cell line-derived neurotrophic growth factors and interleukin-10. J Neurotrauma.2010, 27(6): 1121-7. http://www.ncbi.nlm.nih.gov/pubmed/20334467

16. Promotes bone marrow stem cell mobilization.In humans, HBOT was shown at 2ATA to stimulate stem cell mobilization from the bonemarrow. With animal studies, hyperbaric oxygen increased nitric oxide, which wasshown to promote the mobilization.Thom SR, Bhopale VM, Velazquez OC, Goldstein LJ, Thom LH, Buerk DG. Stem cell

mobilization by hyperbaric oxygen. Am J Physiol Heart Circ Physiol 2006; 290(4):

H1378-86. http://www.ncbi.nlm.nih.gov/pubmed/16299259

17. Promotes axonal growth.

Nogo-A is increased after cerebral ischemia which reduces axonal regrowth. HBOT isassociated with reduced levels of Nogo-A, which may be a factor in how HBOTpromotes nerve regeneration. (Matchett)

Supportive article by Zhou and associates:http://www.ncbi.nlm.nih.gov/pubmed/12951059

18. Promotes new neurons

(lab study) Newborn rat neural stem cells were given HBOT of different pressures andexposure times. The highest percentage of neurons differentiated from the neural stemcells were found for the one hour of HBOT at 2 ATA.http://www.ncbi.nlm.nih.gov/pubmed/20497646Note: This is the protocol generally used by Dr. Steenblocks clinic.

19. The sooner the better for Stroke and TBI.

According to animal research, beginning hyperbaric oxygen within 6 hours of stroke onsetwas most effective and treatment after 24 hours also showed benefit in acute cerebralischemia. In cerebral hemorrhage studies, hyperbaric oxygen should to be initiatedimmediately after the hemorrhage onset to produce benefits. (Matchett)

20.. Oxidative Stress can result from higher pressures.The major concern about hyperbaric oxygen is the potential damage from oxidative stress.However, this generally occurs with hyperbaric pressures at 2.5 ATA and higher. HBOT
http://www.ncbi.nlm.nih.gov/pubmed/18500076http://www.ncbi.nlm.nih.gov/pubmed/18500076http://www.ncbi.nlm.nih.gov/pubmed/20334467http://www.ncbi.nlm.nih.gov/pubmed/20334467http://www.ncbi.nlm.nih.gov/pubmed/16299259http://www.ncbi.nlm.nih.gov/pubmed/16299259http://www.ncbi.nlm.nih.gov/pubmed/12951059http://www.ncbi.nlm.nih.gov/pubmed/12951059http://www.ncbi.nlm.nih.gov/pubmed/20497646http://www.ncbi.nlm.nih.gov/pubmed/20497646http://www.ncbi.nlm.nih.gov/pubmed/20497646http://www.ncbi.nlm.nih.gov/pubmed/12951059http://www.ncbi.nlm.nih.gov/pubmed/16299259http://www.ncbi.nlm.nih.gov/pubmed/20334467http://www.ncbi.nlm.nih.gov/pubmed/18500076


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at 1.5 ATA is reported to inhibit hydroxyl radical in the brain.. The Guidelines forhyperbaric oxygen recommend pressures no greater than 3 ATA. HBO at lower pressures(2 ATA and below for one hour on a daily basis) does not increase lipid peroxidation.After reviewing the literature, Dr. Jain recommends 1.5 to 2ATA for neurological patientswho are more susceptible to seizures. (Textbook of Hyperbaric Medicine)

Hyperbaric Oxygen Therapy for StrokeUpdate Feb, 2011

Stroke after cardiac surgery

HBOT is recommended for patients who have a stroke after open cardiac surgery.http://www.ncbi.nlm.nih.gov/pubmed/20191794

Stroke and secondary damage

Experimental and clinical studies have reported positive effects of HBOT in ischemic stroke.Survival rates have increased and neurological outcome has improved with hyperbarixoxygenation. http://www.ncbi.nlm.nih.gov/pubmed/19485935

Integrative medicine program for stroke

Long term HBOT is safe and holds great promise for ischemic stroke.http://www.ncbi.nlm.nih.gov/pubmed/19364191

Delayed hyperbaric oxygenation compared to normobaric hyperoxia

(rat study) HBOT was more effective in transient experimental ischemia even when accountingfor delayed treatment onset of HBOT. http://www.ncbi.nlm.nih.gov/pubmed/17850964

Neural protection by inhibiting HIF-1a

(rat study) HBOT provides neuroprotection in cerebral ischemia in part due to its inhibition ofhypoxia-inducible factor-1a (that can increase inflammation) and the elevation of Bcl-2 thatreduces cell death. http://www.ncbi.nlm.nih.gov/pubmed/17462608

Time window in stroke for thrombolytic drugs

HBOT can extend the time window in acute ischemic stroke for tPA treatment.http://www.ncbi.nlm.nih.gov/pubmed/17439702

Acupuncture combined with HBOT

72 patients with cerebral infarction were divided into two groups and either treated with acombination of acupuncture and HBOT (experimental group) or routine medicine and HBOT(control group). While balance was improved in both groups, the acupuncture and HBOTcombination showed greater improvement in motor function and balance.
http://www.ncbi.nlm.nih.gov/pubmed/20191794http://www.ncbi.nlm.nih.gov/pubmed/20191794http://www.ncbi.nlm.nih.gov/pubmed/19485935http://www.ncbi.nlm.nih.gov/pubmed/19485935http://www.ncbi.nlm.nih.gov/pubmed/19364191http://www.ncbi.nlm.nih.gov/pubmed/19364191http://www.ncbi.nlm.nih.gov/pubmed/17850964http://www.ncbi.nlm.nih.gov/pubmed/17850964http://www.ncbi.nlm.nih.gov/pubmed/17462608http://www.ncbi.nlm.nih.gov/pubmed/17462608http://www.ncbi.nlm.nih.gov/pubmed/17439702http://www.ncbi.nlm.nih.gov/pubmed/17439702http://www.ncbi.nlm.nih.gov/pubmed/17439702http://www.ncbi.nlm.nih.gov/pubmed/17462608http://www.ncbi.nlm.nih.gov/pubmed/17850964http://www.ncbi.nlm.nih.gov/pubmed/19364191http://www.ncbi.nlm.nih.gov/pubmed/19485935http://www.ncbi.nlm.nih.gov/pubmed/20191794


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HBOT combined with edaravone in embolic stroke

6 of 19 patients receiving HBOT and a free radical scavenger for 7 days had favorable outcomesat a 90 day follow-up compared to 1 out of 19 in the control group who received conventional

treatment. Free article:http://www.ncbi.nlm.nih.gov/pubmed/16936457Hyperbaric oxygen in neurological patientsThe results of HBOT are promising and warrant further investigation.http://www.ncbi.nlm.nih.gov/pubmed/16510383

Improvement in motor and cognitive impairmentEighteen patients with cerebrovascular disease and lacunar infarcts received HBOT for 45minues for 10 days and 8 patients received hyperbaric air (after the study, the control group wasalso given the HBOT). Neurological improvement persisted in the majority of patients for up tosix months. Repetition of the protocol in patients with returning symptoms resulted inimprovement. http://www.ncbi.nlm.nih.gov/pubmed/16457083

A therapeutic window of 3-6 hours

HBOT within 3-6 hours of cerebral ischemia onset or repeated administration if delayed cansalvage injured neuronal tissues or promote functional recovery.http://www.ncbi.nlm.nih.gov/pubmed/15869872

Here things liven up a bit

The Hyperbaric Oxygen Therapy in Acute Ischemic Stroke Trial Pilot Study

Rusyniak and associates did a study with a flawed protocol and concluded that HBOT has nobenefit and can actually be harmful.Free article:http://www.ncbi.nlm.nih.gov/pubmed/12574578

Criticism: Thirty-three subjects within 24 hours of stroke onset were divided intotwo groups. One group received 100% oxygen at 1.14 ATA for 60 minutes (thesham group) and the other group received 100% oxygen at 2.5 ATA for 60

minutes. The patients were then evaluated three months later on a battery ofstroke tests. The test scores were better for the sham group. The authorsconcluded that HBO offers no benefit and may even be harmful in stroke. Thisstudy provided heparin and standard medical practice. The study also omittedhemorrhagic stroke patients. However, Rusyniak has been heavily criticized forusing 2.5 ATA for acute stroke patients, especially since Jain has beenrecommending 1.5 ATA as safe for acute stroke patients for over twelve years.The 1.5 ATA level avoids complications resulting from increased lipidperoxidation and seizures. The 1.14 ATA was, in fact, closer to Jainsrecommended pressures.

12According to Jain, the design of the study invalidates

any conclusions.5 A 1.5 ATA group should have been included and the 2.5 ATAchanged to perhaps 2 ATA for the wellbeing of the patients.
http://www.ncbi.nlm.nih.gov/pubmed/17378195http://www.ncbi.nlm.nih.gov/pubmed/17378195http://www.ncbi.nlm.nih.gov/pubmed/16936457http://www.ncbi.nlm.nih.gov/pubmed/16936457http://www.ncbi.nlm.nih.gov/pubmed/16936457http://www.ncbi.nlm.nih.gov/pubmed/16510383http://www.ncbi.nlm.nih.gov/pubmed/16510383http://www.ncbi.nlm.nih.gov/pubmed/16457083http://www.ncbi.nlm.nih.gov/pubmed/16457083http://www.ncbi.nlm.nih.gov/pubmed/15869872http://www.ncbi.nlm.nih.gov/pubmed/15869872http://www.ncbi.nlm.nih.gov/pubmed/12574578http://www.ncbi.nlm.nih.gov/pubmed/12574578http://www.ncbi.nlm.nih.gov/pubmed/12574578http://www.ncbi.nlm.nih.gov/pubmed/12574578http://www.ncbi.nlm.nih.gov/pubmed/15869872http://www.ncbi.nlm.nih.gov/pubmed/16457083http://www.ncbi.nlm.nih.gov/pubmed/16510383http://www.ncbi.nlm.nih.gov/pubmed/16936457http://www.ncbi.nlm.nih.gov/pubmed/17378195


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Free article - Response by Dr. Hart -http://www.ncbi.nlm.nih.gov/pubmed/12933967Free article - Response by Dr. Jain -http://www.ncbi.nlm.nih.gov/pubmed/12933966Free article - Response from Dr. Zhang -http://www.ncbi.nlm.nih.gov/pubmed/12933965

Neuroprotection from reducing elevated dopamine levels

(rat study) Dopamine levels in the striatum significantly increased at 30 minutes after cerebralischemia and continued to increase to peak levels at 60 minutes. Dopamine metabolites canincrease free radical damage so elevated levels of dopamine can indirectly produce more braindamage. There was no increase in dopamine with HBOT treatment.http://www.ncbi.nlm.nih.gov/pubmed/12070618

Lims HBOT case study with haemorrhagic strokeA case study is presented of a patient with haemorrhagic stroke who was treated successfullywith HBOT. http://www.ncbi.nlm.nih.gov/pubmed/11513061

Dosage for Acute Stroke

According to Rogatsky, the rate of effect produced by an HBO treatment is dependent on theoxygen pressure, the duration of the treatment (time) and the number of treatments (N). Thisdosage, as an equation is DHBOT = pO2 x Ts x Nt. Rogatsky proceeded to calculate variousstudies in terms of 2 ATA, treatment time (1 hour) and number of treatments. Rogatsky usedthree studies, including Neubauers study of 2 ATA for one hour for an average of 16 sessions as

a parameter for 100% efficacy for acute stroke treatment within 4 hours of symptom onset.19The authors conclude that any discussions of efficacy or non-efficacy of HBO should alsoinclude these parameters that relate HBO dosage to efficacy. In addition, according to thedosage to efficacy analysis, the benefit increased progressively as more treatments were given.

Rogatsky GG, Shifrin EG, Mayevsky SA. Optimal dosing as a necessary condition for the

efficacy of hyperbaric oxygen therapy in acute ischemic stroke: A critical review. Neurol Res

2003; 25: 95-98.


Dr. Steenblocks Treatment Suggestions for Chronic Stroke Patients

In 1996, Dr. Steenblocks research group evaluated 50 chronic stroke patients who underwent

HBOT (1.5 to 2 ATA), biofeedback and physical therapy in addition to standard medical care.The average number of treatments was 55 and the results showed that about 97% of the patientsshowed improvement in one or more of their lost or diminished functions. The study, ImprovedTherapy for Rehabilitation of Stroke was presented in a Poster Session at the National Stroke

Associations Ninth Annual Stroke Rehabilitation Conference in Boston, Massachusetts, October

16-17, 1997. According to Dr. Steenblock, about thirty to forty treatments are required for there-growth of the capillary beds. Additional treatments are then needed to strengthen the stabilityof the capillaries. As more HBO treatments are done, more capillaries are strong enough topenetrate deeper and deeper into the infarct zone. This re-growth results in more tissue repair


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and/or replacement and better clinical outcome. For most chronic stroke patients, Dr. Steenblocksuggests a program of 60 HBO treatments and then if the patient is still making progress, another20 treatments may be suggested.

Nighoghossians HBOT double-blind pilot study.

The Nighoghossian clinical trial divided 34 subjects with middle cerebral artery stroke into eitherHBO or hyperbaric air within 24 hours of symptom onset. The treatments were administereddaily for ten days at 1.5 ATA for 40 minute sessions. While the HBO group performedsignificantly better at one year on the Orgogozo and Trouillos tests (but not on the Rankinscores), no difference was seen at six months or one year and pre- compared to post-treatmentscores on any scale. The authors concluded that HBO was safe in these patients and that therewas an outcome trend favoring HBO therapy.Free article:http://www.ncbi.nlm.nih.gov/pubmed/7631339

Criticisms about this design include a small sample size and the inclusion of TBI subjectswhere immediate HBOT treatment is imperative to outcome.1) Ostrowski RP, Zhang JH. Chapter 4: Mechanisms of HBO for Neurological Disorders.

In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing

Company, Flagstaff, AZ, 2008; pp 85-114.

2) Singhal AB, Lo EH. Chapter 5: Oxygen Therapy for Ischemic Stroke: Clinical Aspects.

In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing

Company, Flagstaff, AZ, 2008; pp 115-134

Andersons pilot study of HBOT for acute stroke.

Also criticized for the study design.Free article: http://www.ncbi.nlm.nih.gov/pubmed/1926256

Comment by Dr. Jain:

Andersons study in 1991 was randomized, using 39 acute stroke patients. One group wasgiven pressured air at 1.5 ATA and another group was given 100% oxygen at 1.5 ATA.Both groups underwent 1 hour of treatment every 8 hours for 15 sessions. The results ofthe two groups for post-treatment were compared four months after the treatments. Thegroup given pressured air also showed reduced infarct volumes, which reduced thesignificance of the pressurized oxygen effects. The randomization process was also apoint of criticism. The control group (pressured air) also had less severe neurologicaldeficits and smaller infarcts. According to Jain, the results of this study neither prove ordisprove the usefulness of HBO in acute stroke and can be disregarded.

(Jain, Textbook of

Hyperbaric Medicine, 2009)

Brain Imaging to identify hypometabolic areas in the brain

Neubauer concludes that HBOT in conjunction with physical and rehabilitative therapy may helpreactivate idling neurons to remain permanently active.
http://www.ncbi.nlm.nih.gov/pubmed/7631339http://www.ncbi.nlm.nih.gov/pubmed/7631339http://www.ncbi.nlm.nih.gov/pubmed/7631339http://www.ncbi.nlm.nih.gov/pubmed/1926256http://www.ncbi.nlm.nih.gov/pubmed/1926256http://www.ncbi.nlm.nih.gov/pubmed/1926256http://www.ncbi.nlm.nih.gov/pubmed/7631339


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Kaasiks HBOT study of stroke patients

HBOT significantly reduced metabolic acidosis in the cerebral venous blood compared to thecontrol group.


Neubauers study of generalized small-vessel stenosis in the brain

A case study is presented of a person suffering from mental confusion, memory loss, irrationalspeech and occasional violence. HBOT resolved the symptoms and intermittent treatmentmaintained the improvements for four years. When the patient had a stroke, HBOT againimproved his symptoms of disorientation and confusion.http://www.ncbi.nlm.nih.gov/pubmed/6888786

Lebedevs article on HBOT and ischemic strokeRegression of the neurological defects was most evident in patients exposed to HBO. HBOprevents the development of recurrent cerebral circulatory disorders in the acute stage ofischemic stroke and reduces the incidence of some complications in this period (pneumonia,pulmonary edema, thromboembolism.http://www.ncbi.nlm.nih.gov/pubmed/6613431

Neubauers Lancet Letter reviewing HBOT benefits

"Hyperbaric oxygen (HBO) efficiently increases the diffusional driving force for oxygen,thereby increasing tissue oxygen availability. This overcomes ischemia/hypoxia and so reducescerebral edema, restores integrity to the blood/brain barrier and cell membranes, neutralizes toxicamines, promotes phagocytosis, scavenges free radicals, stimulates angiogenesis, and reactivatesidling neurons."

Neubauer, R. et al. "Stroke Treatment." (letter). THE LANCET, June 29, l991; 1601.

Neubauers Case Study of Chronic Stroke (15 years post-stroke onset)

In 1990, Neubauer and associates published a letter in the Lancet about treating a patient 15years after her stroke with 60 HBO treatments. The results included reduced spasticity,improved movement, improved speech and the cessation of drooling. There was also a sharpincrease in SPECT tracer uptake in areas previously showing hypometabolism.

Neubauer, R. et al. "Enhancing idling neurons." letter. THE LANCET, March 3, l990; 542.

No abstract: http://www.ncbi.nlm.nih.gov/pubmed/1968553

Neubauers review of 122 thrombotic stroke patients

Neubauer recommends that stroke patients be treated at 1.5 to 2 ATA.Free article:http://www.ncbi.nlm.nih.gov/pubmed/7394869

Jains HBOT study on chronic stroke and spasticity

In 1989, Jain and associates published a study on HBO and its contributions to rehabilitativemedicine in 21 chronic stroke patients and a year later, 25 patients. The sessions were limited todaily treatments for six weeks. All of the patients showed neurological improvement after the
http://www.ncbi.nlm.nih.gov/pubmed/1617842http://www.ncbi.nlm.nih.gov/pubmed/1617842http://www.ncbi.nlm.nih.gov/pubmed/3232453http://www.ncbi.nlm.nih.gov/pubmed/3232453http://www.ncbi.nlm.nih.gov/pubmed/6888786http://www.ncbi.nlm.nih.gov/pubmed/6888786http://www.ncbi.nlm.nih.gov/pubmed/6613431http://www.ncbi.nlm.nih.gov/pubmed/6613431http://www.ncbi.nlm.nih.gov/pubmed/1968553http://www.ncbi.nlm.nih.gov/pubmed/1968553http://www.ncbi.nlm.nih.gov/pubmed/7394869http://www.ncbi.nlm.nih.gov/pubmed/7394869http://www.ncbi.nlm.nih.gov/pubmed/7394869http://www.ncbi.nlm.nih.gov/pubmed/7394869http://www.ncbi.nlm.nih.gov/pubmed/1968553http://www.ncbi.nlm.nih.gov/pubmed/6613431http://www.ncbi.nlm.nih.gov/pubmed/6888786http://www.ncbi.nlm.nih.gov/pubmed/3232453http://www.ncbi.nlm.nih.gov/pubmed/1617842


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treatment program. The degree of improvement varied according to the extent and duration ofthe neurological deficit. The best results were achieved in those patients with a short diseasehistory and less spasticity and/or neurological deficit. The authors recommend that HBO therapybe used as an adjunct in stroke management and whenever possible and have physical therapyexercise carried out in the hyperbaric chamber. The authors also conclude that HBO isconsidered an invaluable adjunct in stroke rehabilitation in patients with spastic hemiplegia.

2,3,4,5

Jain, K.K. Effect of hyperbaric Oxygenation on Spasticity in Stroke Patients. Journal ofHyperbaric Medicine, 1989; 4(2): 55-61.

Marronis study on HBOT for chronic stroke patients

In 1987, Marroni and associates enlisted 80 stabilized stroke patients with stroke onset from twoto 172 months earlier. Thirty HBO sessions were given. Those undergoing hyperbaric oxygenplus physical therapy showed the best results. The HBO alone and combined with physicaltherapy produced improvements in neuromotor performance, especially at 2 ATA. The resultswere still present at the third month after treatment.

Marroni, A. et al. "Hyperbaric Oxygen Therapy at 1.5 or 2.0 ATA as an Adjunct to the Rehab-

ilitation of Stabilized Stroke Patients. A Controlled Study." Proceedings of the 9th

International

Congress on Hyperbaric Medicine, March 1-4, l987; Sydney, Australia, pp. 161-167.

Isakovs article on ischemic stroke and respiratory disorders

HBOT had a normalizing effect on respiratory function in breathing disorders.http://www.ncbi.nlm.nih.gov/pubmed/463432

Holbachs study of chronic stroke

This was one of the first studies in chronic stroke. Forty patients with stroke associated withcarotid artery occlusion participated.Free Article: http://www.ncbi.nlm.nih.gov/pubmed/1273908

Sarnos study on the mental and verbal improvements of stroke patients after HBOT.

Free Article: http://www.ncbi.nlm.nih.gov/pubmed/5008300

Harts case study of stroke treated successfully with HBOT.

Dr. Hart was working at Long Beach Memorial Hospital with the Navy. They were involved inhelping divers who suffered from the bends recover with hyperbaric oxygen. One officer

suffered a stroke and Dr. Hart tried hyperbaric oxygen to see if it would help. It did. A series oftreatments were needed but the officer eventually returned to active duty.

The abstract: The treatment of a patient for three and one-half months, following occlusion ofthe right middle cerebral artery with the associated neurological sequelae, with hyperbaricoxygen combined with methyldopa and hydrochlorthazide is presented. Treatment scheduledwas two and one-half atmospheres absolute. The treatment was interrupted after 15 treatments torule out spontaneous remission for a period of 30 days, and no further improvement occurreduntil treatments were reinstituted. The dramatic return to a near normal state during treatmentappears to indicate that he did benefit from therapy.

Hart, G.B. et al. "The Treatment of Cerebral Ischemia with Hyperbaric Oxygen (OHP)." Stroke,l971; 2: 247-250. No online abstract: http://www.ncbi.nlm.nih.gov/pubmed/5165167
http://www.ncbi.nlm.nih.gov/pubmed/463432http://www.ncbi.nlm.nih.gov/pubmed/463432http://www.ncbi.nlm.nih.gov/pubmed/1273908http://www.ncbi.nlm.nih.gov/pubmed/1273908http://www.ncbi.nlm.nih.gov/pubmed/5008300http://www.ncbi.nlm.nih.gov/pubmed/5008300http://www.ncbi.nlm.nih.gov/pubmed/5165167http://www.ncbi.nlm.nih.gov/pubmed/5165167http://www.ncbi.nlm.nih.gov/pubmed/5165167http://www.ncbi.nlm.nih.gov/pubmed/5008300http://www.ncbi.nlm.nih.gov/pubmed/1273908http://www.ncbi.nlm.nih.gov/pubmed/463432


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Hyperbaric Oxygen Therapy for Traumatic Brain InjuryUpdate Feb, 2011

HBOT neuroprotective effects in TBI

(rat study) Three and six hours after the TBI, rats receiving the HBOT showed a significantreduction in brain damage. The improvements subsided by 12 hours. In contrast, multiple HBOtreatments (3-5 sessions) even when started 48 hours after the TBI, significantly reducedneurology deficit scores and neuronal loss in the hippocampus. Despite improvements in

behavior and reduced brain injury, the overall benefits were weaker than improvements at 6hours after the TBI. The results suggest that HBOT can alleviate brain damage after a TBI and asingle HBO treatment has a time limitation of 12 hours and that multiple HBO treatments canextend the post-TBI delivery time window. The results clearly suggest the validity of HBOT fortreating traumatic brain injuries. http://www.ncbi.nlm.nih.gov/pubmed/20568957

TBI treatment using a modified monoplace chamberTwenty-seven patients with severe TBI were safely treated, monitored and managed in amonoplace chamber. The compression used was pressurized air at 1.5 ATA. A total of 75hyperbaric treatments were given. The patients also received 100% oxygen via mechanicalventilation. The chambers were adapted to safely treat these critically ill patients. The patients

were monitored for cardiovascular, ventilatory, intracranial pressure, brain tissue oxygen levels,brain temperature and cerebral microdialysis parameters.http://www.ncbi.nlm.nih.gov/pubmed/20369651

Case report of treating mild TBI with hyperbaric oxygen

Six months after being injured in a roadside improvised explosive devise (IED) blast in Irqa, twoUS Air Force airmen were treated with HBOT. They received 100% oxygen for one hour at 1.5ATA. The treatment resulted in rapid improvements of their headaches, sleep disturbances andother symptoms. These improvements were maintained for three months, with most measuresreturning to pre-injury levels. These results were most likely due to the HBOT.http://www.ncbi.nlm.nih.gov/pubmed/20112530

Severe TBI treated with HBOT or Normobaric hyperoxia

Sixty-nine patients with severe TBIs (mean Glasgow Coma Scale Score 5.8) were randomizedinto three groups, a control group, hyperbaric oxygen group and normobaric hyperoxia group.Hyperbaric oxygen therapy was more robust in its increasing brain tissue oxygen levels. Therewere also some improvements in the normobaric group as well. No signs of pulmonary orcerebral oxygen toxicity were observed. http://www.ncbi.nlm.nih.gov/pubmed/19852540

Case Study of blast-induced chronic TBI
http://www.ncbi.nlm.nih.gov/pubmed/20568957http://www.ncbi.nlm.nih.gov/pubmed/20568957http://www.ncbi.nlm.nih.gov/pubmed/20369651http://www.ncbi.nlm.nih.gov/pubmed/20369651http://www.ncbi.nlm.nih.gov/pubmed/20112530http://www.ncbi.nlm.nih.gov/pubmed/20112530http://www.ncbi.nlm.nih.gov/pubmed/19852540http://www.ncbi.nlm.nih.gov/pubmed/19852540http://www.ncbi.nlm.nih.gov/pubmed/19852540http://www.ncbi.nlm.nih.gov/pubmed/20112530http://www.ncbi.nlm.nih.gov/pubmed/20369651http://www.ncbi.nlm.nih.gov/pubmed/20568957


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A 25 year old military veteran experienced an explosion in combat and lost consciousness.Three years later, he still suffered from post concussion syndrome and post traumatic stressdisorder. The subject underwent 39 hyperbaric sessions of 1.5 ATA. There was permanentmarked improvement in his symptoms and the SPECT brain blood flow. He has since beenemployed for eight consecutive months.Free Article: http://www.ncbi.nlm.nih.gov/pubmed/19829822

HBOT with Subacute TBI

Twenty-two stable TBI patients wee treated with HBOT and 22 patients were the control group.The GCS of the HBOT group improved from 11.1 to 13.5 and the control group improved from10.4 to 11.5. Those patients with GOS = 4 before HBOT maintained significant improvementsix months after HBOT. http://www.ncbi.nlm.nih.gov/pubmed/18642650

HBOT and spatial learning and memory in chronic TBI

(rat study) Rat models for TBI were divided into three groups an untreated control group,HBOT group and normobaric air group. The HBOT group received 80 sessions at 1.5 ATA for90 minutes each. They were then retested in the Morris Water Task and sacrificed. HBOTproduced increased vascular density in the injured hippocampus that was associated withimproved spatial learning and cognitive function.http://www.ncbi.nlm.nih.gov/pubmed/17869230

Case Study of HBOT for chronic brain injury

A 54 year old man sustained traumatic brain injuries that resulted in permanent neurologicalsymptoms. A year later, he underwent two series of HBOT, one year apart. The series consistedof 20 and then 60 daily one hour sessions at 2 ATA using 100% oxygen. The first series resultedin improvements in sensorimotor functions and enhanced P300l amplitude in the damagedhemisphere. This first session was not long enough to achieve permanent benefits. However,the improvements returned over a year later as a result of the second and longer series.http://www.ncbi.nlm.nih.gov/pubmed/17234213

HBOT and neuropsychiatric disorders from TBI

Three hundred ten patients with neuropsychiatric disorders from TBI were treated twice withHBOT and evaluated by pre- and post-SPECT as well as CT imaging. SPECT was moresensitive in the degree of abnormal cerebral changed detected. After HBOT, 70.3% of theSPECT scans showed no abnormalities and the patients showed clinical improvements. Thehyperbaric treatment also improved regional cerebral blood flow.http://www.ncbi.nlm.nih.gov/pubmed/17199942

Review of HBOT for stroke, brain trauma and neurologic disease

The results of HBOT are promising and warrant further investigation.http://www.ncbi.nlm.nih.gov/pubmed/16510383


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SPECT imaging to assess HBOT in TBI patients

320 patients with TBI were divided into two groups one with HBOT and the other as thecontrol group. The HBOT was superior to medication treatment alone in the recovery of clinicalsymptoms, control of epilepsy and resolution of hydrocephalus. HBOT has specific curativeeffects on patients with postbrain injury neural status and SPECT can be used to monitor theeffects. The results of HBOT are promising and warrant further investigation.


Improved cerebral metabolism in chronic brain injury after HBOT

This study compared 25 older and 25 younger subjects on SPECT scans before, during and afterHBOT treatment for chronic TBI. There was improvement in blood flow from the beginning oftreatment to the end of the study. An age effect was found on only two measures. The youngergroup had higher blood flows but not more improvement. HBOT can be an effective part of thetreatment for chronic TBI patients. http://www.ncbi.nlm.nih.gov/pubmed/12325401

Benefits of HBOT in severe brain injuryFifty-five patients with severe TBI were divided into an HBOT group and a medication controlgroup. They were evaluated with the Glasgow Coma Scale, brain electric activity mapping(BEAM) prognosis and Glasgow Outcome Scale before and after HBOT. In the hyperbaricgroup, GCS, BEAM and GOS were significantly improved after 3 courses of treatment. HBOTeffectively reduced the mortality and morbidity of the patients. The authors conclude that HBOTis an effective method of treating severe TBI patients.http://www.ncbi.nlm.nih.gov/pubmed/11835741

Shorter, more frequent HBOT sessions for TBI

HBOT, using 100% oxygen at 1.5 ATA was given to 37 patients for 60 minutes each day for 7treatments. The HBOT increased cerebral metabolic rate of oxygen (CMRO2) and decreasedventricular cerebrospinal fluid lactate, suggesting that the treatments can improve aerobicmetabolism in severely brain injured patients. Dr. Sukoff suggests that shorter, more frequentexposure to HBOT may optimize treatment.http://www.ncbi.nlm.nih.gov/pubmed/11565887

HBOT in closed head injury

This 1994 article by Neubauer and associates presents a case study of a patients with a closedhead injury that was successfully treated with intensive HBOT and evaluated with SPECTimaging. http://www.ncbi.nlm.nih.gov/pubmed/8091261

Mental disorders from TBI20 patients with severe brain damage were treated with HBOT, resulting in a more rapidrestitution of consciousness and shortened comatose episode. In cases of delirious states HBOT


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resulted in a disappearance of psychotic disturbances after the first session. This study byTishchenko was published in 1976. http://www.ncbi.nlm.nih.gov/pubmed/1266492

Hyperbaric Oxygen Therapy for Other Conditions2010 Articles

Overview

HBOT is suggested as an additional option in conditions that include problem wounds, spinalcord injury and cerebral ischemic injury. http://www.ncbi.nlm.nih.gov/pubmed/20636981

Anastomosis (surgical resection and reconnection of tissue, generally after irradiation)

Colonic anastomosis

(rat study) HBOT reduced interstitial edema and increased hydroxyproline at the anastomoticsite, resulting in greater healing of anastomotic ischemia.http://www.ncbi.nlm.nih.gov/pubmed/21226391

Tracheal anastomosis

(rat study) Animals treated with HBOT showed excellent healing at the anastomosis.http://www.ncbi.nlm.nih.gov/pubmed/21110272

Anti-Aging

Aging is associated with impaired wound healing and reduced blood vessel growth to ischemictissue. Gene expression was analyzed before and after hyperbaric oxygen. There was anupregulation of genes for antioxidant production and an increased resistance to lethal oxidativestress in endothelial cells. HBOT is suggested as a treatment to help promote healthy aging.http://www.ncbi.nlm.nih.gov/pubmed/20536847

Bone/Skeletal Conditions

Cervical spondylotic amyotrophy

Beneficial in cervical spondylotic amyotrophy -http://www.ncbi.nlm.nih.gov/pubmed/21243002

Disc degeneration

(lab study) Inflammatory changes in intervertebral disc degeneration may be due to interleukin1B and p38 MAPK signal pathways. HBOT improved tissue balance and is suggested forslowing the course of disc degeneration. http://www.ncbi.nlm.nih.gov/pubmed/20661932

Femoral head necrosis
http://www.ncbi.nlm.nih.gov/pubmed/1266492http://www.ncbi.nlm.nih.gov/pubmed/1266492http://www.ncbi.nlm.nih.gov/pubmed/20636981http://www.ncbi.nlm.nih.gov/pubmed/20636981http://www.ncbi.nlm.nih.gov/pubmed/21226391http://www.ncbi.nlm.nih.gov/pubmed/21226391http://www.ncbi.nlm.nih.gov/pubmed/21226391http://www.ncbi.nlm.nih.gov/pubmed/21110272http://www.ncbi.nlm.nih.gov/pubmed/21110272http://www.ncbi.nlm.nih.gov/pubmed/20536847http://www.ncbi.nlm.nih.gov/pubmed/20536847http://www.ncbi.nlm.nih.gov/pubmed/21243002http://www.ncbi.nlm.nih.gov/pubmed/21243002http://www.ncbi.nlm.nih.gov/pubmed/21243002http://www.ncbi.nlm.nih.gov/pubmed/20661932http://www.ncbi.nlm.nih.gov/pubmed/20661932http://www.ncbi.nlm.nih.gov/pubmed/20661932http://www.ncbi.nlm.nih.gov/pubmed/21243002http://www.ncbi.nlm.nih.gov/pubmed/20536847http://www.ncbi.nlm.nih.gov/pubmed/21110272http://www.ncbi.nlm.nih.gov/pubmed/21226391http://www.ncbi.nlm.nih.gov/pubmed/20636981http://www.ncbi.nlm.nih.gov/pubmed/1266492


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Nine patients with Ficat stage II femoral head necrosis were treated with 30 sessions of HBOT.There were significant improvements in pain threshold after twenty treatments. Range of motionimprovements were observed between 20 and 30 treatments. In a seven year follow-up, allpatients reported being pain free, none of the patients required hip surgery and 7 of the 9 hipsshowed substantial healing of the osteonecrosis.http://www.ncbi.nlm.nih.gov/pubmed/20637561

Osteonecrosis

Bisphosphonates are used for metabolic or malignant bone diseases but also promoteosteonecrosis of the jaw bone. Moderate osteonecrosis of the upper jaw was treated withplatelet-rich plasma, HBOT and the cessation of bisphosphonates.http://www.ncbi.nlm.nih.gov/pubmed/21119470

Paraspinal compartment syndrome (from acute exertion)A football was weight-lifting and developed myonecrosis. He was successfully treated withforced diuresis and six session of HBOT. http://www.ncbi.nlm.nih.gov/pubmed/21045996

Spinal Cord Injury

There were reduces risk of secondary spinal cord injury by early decompression and highpressure oxygen after operation. http://www.ncbi.nlm.nih.gov/pubmed/21254684

(rat study) The combination of hypothermia and HBOT can be effective in reducing secondarydamage in spinal cord tissue.

Bronchitis (ischemic)

Beneficial in postoperative ischemic bronchitis after lung cancer treatment in 82% of the cases.http://www.ncbi.nlm.nih.gov/pubmed/21256268

Cancer

(laboratory study) The combination of HBOT and artemisinin is suggested as an anticancerchemotherapy strategy. http://www.ncbi.nlm.nih.gov/pubmed/21115894

Liver Cancer

HBOT after liver resection reduced complications in patients who experienced major bleeding orshowed severe hepatic hypoxia during surgery. Improved immune function and long term

survival were additional benefits.http://www.ncbi.nlm.nih.gov/pubmed/21069381

Nasopharyngeal carcinoma

(lab study) The combination of HBOT and 5-fluorouracil was effective in inhibiting metastasis.http://www.ncbi.nlm.nih.gov/pubmed/20568543

Ovarian cancer


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(mice study) Hypoxia, a common characteristic of solid tumors, compromises the effectivenessof chemotherapy and radiation. Hypoxia also promotes tumor progression and drug resistanceby signal transducer and activator transcription 3 (STAT3). HBOT reduced tumor volume andinhibited STAT3 activation. The combination of HBOT and cisplatin also reduced the tumorvolume but also drastically reduced body weight.http://www.ncbi.nlm.nih.gov/pubmed/20562529

Carbon Monoxide Poisoning

Carbon monoxide poisoning causes neurological damage from programmed cell death(apoptosis) in neurons. HBOT, especially between 3 and 5 hours after the poisoning, has aprotective effect on the neurons. http://www.ncbi.nlm.nih.gov/pubmed/20843278

Cardiovascular Disease

Vascular Degeneration

Matrix metalloproteinase-9 (MMP-9) is an enzyme involved in extracellular matrix degradation.It helps with matrix remodeling but excessive amounts are detrimental to the tissue. MMP-9over-expression is associated with stroke, cell death, non-healing wounds, TBI, aneurysms andblood vessel leakage in atherosclerosis. This is a case report of a patients MMP-9 levelsdramatically increasing after surgery and hyperbaric oxygen significantly reduced the MMP-9expression. http://www.ncbi.nlm.nih.gov/pubmed/20824409

Hypertension

(rat study) Normotensive rats (WKY) and genetic rat models for hypertension (SHR) weresubjected to hyperbaric oxygen. The hypertensive rats showed reduced systolic blood pressureafter three weeks and lower diastolic blood pressure after seven weeks of treatment compared toa normobaric rat group. Both the normotensive and hypertensive rats who received HBOTshowed lower levels of reactive oxygen metabolites than the control group and the hypertensiverats receiving HBOT showed higher antioxidant levels than the control SHR rats. The resultssuggest that HBOT may be effective in reducing genetically-induced hypertension.http://www.ncbi.nlm.nih.gov/pubmed/20504127

Peripheral Artery Disease

Patients with chronic occlusive arteries in the lower legs showed significant improvements inmuscle perfusion with HBOT. http://www.ncbi.nlm.nih.gov/pubmed/20465155

Cerebral ischemia (stroke) and hemorrhage

See first section on Stroke and TBI.

Dementia (Vascular)


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(rat study) Neurogenesis in the piriform cortex of the brain is closely related to cognitivefunction. Hyperbaric oxygen increased the brain blood supply and neurogenesis in this area inrat models of vascular dementia. http://www.ncbi.nlm.nih.gov/pubmed/20715898

Diabetes

Atherosclerosis and glycemic controlTwenty-eight diabetic patients undergoing HBOT for foot ulcers received improvements in theirfasting blood glucose, hemoglobin A1c, insulin resistance (HOMA-IR), C-reactive protein (hs-CRP), uric acid mean platelet volume, complete blood count and lipid profile.Free article: http://www.ncbi.nlm.nih.gov/pubmed/20602302

Hyperlipidemia

(mice study) Six weeks of hyperbaric air (21% oxygen) significantly reduced free fatty acidsand triglycerides in diabetic mice. The results suggest that hyperbaric air treatments can improvelipid metabolism in type 2 diabetes patients.Free article: http://www.ncbi.nlm.nih.gov/pubmed/20847521

Foot Ulcer

Hyperbaric oxygen improves ulcer healing and consequently patient quality of lifehttp://www.ncbi.nlm.nih.gov/pubmed/21219427

HBOT is suggested for foot ulcer cases that are resistant to antibiotics.http://www.ncbi.nlm.nih.gov/pubmed/21135264

Baseline transcutaneous oximetry correlated more with healing from HBOT than toe bloodpressure or ankle-brachial index. http://www.ncbi.nlm.nih.gov/pubmed/20957342

HBOT for infected diabetic feet can improve healing and reduce the amputation rate in diabetic

patients. http://www.ncbi.nlm.nih.gov/pubmed/20483142

Ears/Hearing

Ear and HBOT Side Effects

Middle-ear barotrauma can be a side effect of hyperbaric oxygen. In 130 patients receivingHBOT, barotraumas occurred in 13.6% of the patients.http://www.ncbi.nlm.nih.gov/pubmed/20737927

Acute Noise Damage

(guinea pig study) Guinea pigs were exposed to acute acoustic trauma and suffered damaged to

the outer hair cells in the cochlea. One exposure to HBOT was not improve the brainstemauditory evoked potential but did reduce the number of injured cochlear outer hair cells and theirfunction.http://www.ncbi.nlm.nih.gov/pubmed/20652293

Sudden hearing loss

174 patients with idiopathic sudden sensorineural hearing loss were treated with tapering dosesof hydrocortisone sodium succinate and hyperbaric oxygen. There were significant correlations
http://www.ncbi.nlm.nih.gov/pubmed/20715898http://www.ncbi.nlm.nih.gov/pubmed/20715898http://www.ncbi.nlm.nih.gov/pubmed/20602302http://www.ncbi.nlm.nih.gov/pubmed/20602302http://www.ncbi.nlm.nih.gov/pubmed/20847521http://www.ncbi.nlm.nih.gov/pubmed/20847521http://www.ncbi.nlm.nih.gov/pubmed/21219427http://www.ncbi.nlm.nih.gov/pubmed/21219427http://www.ncbi.nlm.nih.gov/pubmed/21135264http://www.ncbi.nlm.nih.gov/pubmed/21135264http://www.ncbi.nlm.nih.gov/pubmed/20957342http://www.ncbi.nlm.nih.gov/pubmed/20957342http://www.ncbi.nlm.nih.gov/pubmed/20483142http://www.ncbi.nlm.nih.gov/pubmed/20483142http://www.ncbi.nlm.nih.gov/pubmed/20737927http://www.ncbi.nlm.nih.gov/pubmed/20737927http://www.ncbi.nlm.nih.gov/pubmed/20652293http://www.ncbi.nlm.nih.gov/pubmed/20652293http://www.ncbi.nlm.nih.gov/pubmed/20652293http://www.ncbi.nlm.nih.gov/pubmed/20737927http://www.ncbi.nlm.nih.gov/pubmed/20483142http://www.ncbi.nlm.nih.gov/pubmed/20957342http://www.ncbi.nlm.nih.gov/pubmed/21135264http://www.ncbi.nlm.nih.gov/pubmed/21219427http://www.ncbi.nlm.nih.gov/pubmed/20847521http://www.ncbi.nlm.nih.gov/pubmed/20602302http://www.ncbi.nlm.nih.gov/pubmed/20715898


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between hearing improvement rate and age, duration, initial hearing level and vertigo.http://www.ncbi.nlm.nih.gov/pubmed/21042804

HBOT improved idiopathic sudden sensorineural hearing loss in a retrospective review of 97cases. The average hearing gain in all cases after HBOT was 29.5 dB. Significantimprovements were found in cases that received HBOT early after the symptoms appeared, in

cases that had a higher number of HBOT sessions, those who also received steroids, those withlow frequency-ascending and total audiogram configuration and those with profound hearingloss. High frequency-descending audiogram configurations showed significantly lowerimprovement. http://www.ncbi.nlm.nih.gov/pubmed/20628751

Severe Deafness

HBOT combined with drug treatment can be effective in moderate and severe cases of deafness.http://www.ncbi.nlm.nih.gov/pubmed/21174751

Otitis (infection)

Beneficial in fungal malignant external otitis (can result from prolonged antibiotoic treatment)http://www.ncbi.nlm.nih.gov/pubmed/21237200

EmbolismRisks in divers, compressed air workers, aviators, astronauts, patients with cardiac shunts, etc.)Beneficial in arterial gas embolism and decompression sicknesshttp://www.ncbi.nlm.nih.gov/pubmed/21215883

Systemic Gas Embolism from surgery

Anti-thrombotic prevention and hyperbaric oxygen was rapidly administered to a patient whosuffered from sudden hypotension and gas embolism during surgery. A left fronto-parietal bloodclot was subsequently found. This case study suggests anticoagulant therapy should not be usedin the early stages of gas embolism. http://www.ncbi.nlm.nih.gov/pubmed/20462140

EncephalitisWith acute lymphoblastic leukemia

Granulomatous amebic encephalitis is usually fatal. A child with brain abscesses from theAcanthamoeba

Received antimicrobial chemotherapy and HBOT and had complete resolution of symptoms.http://www.ncbi.nlm.nih.gov/pubmed/21084511

Eyes/Vision

Age-related macular degeneration

Fourteen patients with advanced AMD underwent a one hour session of HBOT at either 1.5 or1.75 ATA that resulted in significant improvements in visual acuity and/or visual field and dailyliving vision.http://www.ncbi.nlm.nih.gov/pubmed/20462142


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Radiation-induced macular ischemia

A 62 year old patient was treated with radiation for brain glioma and subsequently experienced avisual acuity of 20/400 in his right eye. Focal laser and intravitreal triamcinolione improved thevision to 20/100. HBOT further improved his vision to 20/50 and resulted in improvement inmacular perfusion. Free article: http://www.ncbi.nlm.nih.gov/pubmed/20505835

Retinal artery occlusionFive patients with retinal artery occlusion were treated with HBOT and all patients improved.http://www.ncbi.nlm.nih.gov/pubmed/20568546

GangreneBeneficial in ulcerative pyoderma gangrenosum -http://www.ncbi.nlm.nih.gov/pubmed/21276167

Gastrointestinal toxicityHyperbaric oxygen is a suggested option for cancer treatments that include radiation, surgeryand/or chemotherapy. http://www.ncbi.nlm.nih.gov/pubmed/20709653

Heatstroke

(mice study) Hyperbaric oxygen protected against heatstroke-induced ischemia and neuronaldamage to the hypothalamus and its temperature regulation function.Free article: http://www.ncbi.nlm.nih.gov/pubmed/20625500

Helium vapor-induced frostbite

A case report of a patient is presented who suffered frostbite injury on his hand from exposure tohelium vapor. The treatment program included hyperbaric oxygen. At an 8 month follow up, hedemonstrated a good range of hand movement and healing of the injury.Full article: http://www.ncbi.nlm.nih.gov/pubmed/20514135

Iron Overdose (acute)(rat study) Iron overdose, that causes free radicals and lipid peroxidation, is one of the leadingcauses of injury and death in children. Animals with acute iron toxicity who were given HBOTshowed a significant reduction in death. http://www.ncbi.nlm.nih.gov/pubmed/20374236

Kidney disease

Renal cyst infections

A patient with polycystic kidney disease experienced a severe infection after surgery. A largeabscess had developed. There was no improvement with antibiotics. After 26 HBOT sessions,the inflammation was gone and has not returned.http://www.ncbi.nlm.nih.gov/pubmed/20886361


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Lung Injury (acute)(rat study) Hyperbaric oxygen inhibited inflammation and improved arterial blood gases andlung water transport in rat models of acute lung injury.http://www.ncbi.nlm.nih.gov/pubmed/20663306

Pancreatitis (acute)(rat study) Seven days of HBOT improved immune function, balanced the T lymphocyte profileand significantly reduced the pathology associated with acute pancreatitis.http://www.ncbi.nlm.nih.gov/pubmed/20854730

(rat study) The combination of HBOT and ulinastatin was more effective in treating acutenecrotizing pancreatitis than either treatment by itself. Full article:http://www.ncbi.nlm.nih.gov/pubmed/20646397

Periodontal diseaseTwenty patients with severe generalized chronic periodontitis underwent scaling and rootplanning. Ten patients also underwent five HBOT sessions. The combination treatmentprogram was more effective for up to three months. Five sessions of HBOT has a short-termbenefit in pocket reduction and bacterial elimination in chronic periodontitis.http://www.ncbi.nlm.nih.gov/pubmed/20462143

Post-traumatic stress disorder

HBOT is beneficial in motor vehicle accident with crush injury resulting in pelvic fractures andsevere pain; the patient who had experienced unconsciousness, showed complete cognitive andpsychiatric recovery after seven sessions. Full article:http://www.ncbi.nlm.nih.gov/pubmed/21212826

Systemic lupus erythematosusSkin ulcers

Skin ulcers can be a complication of vasculitis. A patient with digital ulcer that was resistant toconventional therapy showed benefit with HBOT.http://www.ncbi.nlm.nih.gov/pubmed/21040521

Snake bite

Beneficial for preventing infection and enhancing healing http://www.ncbi.nlm.nih.gov/pubmed/21226390

Suggested for venomous snake bite -http://www.ncbi.nlm.nih.gov/pubmed/21226389

Testosterone Levels
http://www.ncbi.nlm.nih.gov/pubmed/20663306http://www.ncbi.nlm.nih.gov/pubmed/20663306http://www.ncbi.nlm.nih.gov/pubmed/20854730http://www.ncbi.nlm.nih.gov/pubmed/20854730http://www.ncbi.nlm.nih.gov/pubmed/20646397http://www.ncbi.nlm.nih.gov/pubmed/20646397http://www.ncbi.nlm.nih.gov/pubmed/20462143http://www.ncbi.nlm.nih.gov/pubmed/20462143http://www.ncbi.nlm.nih.gov/pubmed/21212826http://www.ncbi.nlm.nih.gov/pubmed/21212826http://www.ncbi.nlm.nih.gov/pubmed/21040521http://www.ncbi.nlm.nih.gov/pubmed/21040521http://www.ncbi.nlm.nih.gov/pubmed/21226390http://www.ncbi.nlm.nih.gov/pubmed/21226390http://www.ncbi.nlm.nih.gov/pubmed/21226389http://www.ncbi.nlm.nih.gov/pubmed/21226389http://www.ncbi.nlm.nih.gov/pubmed/21226389http://www.ncbi.nlm.nih.gov/pubmed/21226389http://www.ncbi.nlm.nih.gov/pubmed/21226390http://www.ncbi.nlm.nih.gov/pubmed/21040521http://www.ncbi.nlm.nih.gov/pubmed/21212826http://www.ncbi.nlm.nih.gov/pubmed/20462143http://www.ncbi.nlm.nih.gov/pubmed/20646397http://www.ncbi.nlm.nih.gov/pubmed/20854730http://www.ncbi.nlm.nih.gov/pubmed/20663306


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Testosterone reduces inflammation and improves healing. 14 male patients and 6 healthy malevolunteers underwent HBOT sessions with pre- and post- evaluation of testosterone levels. Bothpatients and controls showed significant increases in blood testosterone after a series ofhyperbaric oxygen sessions. http://www.ncbi.nlm.nih.gov/pubmed/20890859

UrologyBeneficial in necrotizing fasciitis, radiation-induced cystitis and urgency and frequencysyndrome.http://www.ncbi.nlm.nih.gov/pubmed/21234869

Cystitis (non-bacterial)HBOT is beneficial for cystitis http://www.ncbi.nlm.nih.gov/pubmed/21082515

In 62 patients, the combined treatment of anti-inflammatory therapy and 7-10 HBOT sessions,there were improvements in microcirculation and long-term remission from interstitial cystitis.http://www.ncbi.nlm.nih.gov/pubmed/20886727

Erectile dysfunction after surgery for urethral stricture

HBOT shows benefit in recovery of erectile function after posterior urethral reconstruction.http://www.ncbi.nlm.nih.gov/pubmed/21110096

Wound healing

Overview

Oxygen promotes blood vessel growth, collagen, renewal of the epithelial lining, kills bacteriaand reduces infections. http://www.ncbi.nlm.nih.gov/pubmed/20216492

Appears effective in acute, difficult to heal wounds, that include crush wounds and burn wounds.http://www.ncbi.nlm.nih.gov/pubmed/21184071

Wound healing and smoking

Chronic smoking undergoing HBOT show slower wound healing due to chronically injuredendothelial cells (composing the blood vessels) from carbon monoxide, hydrogen cyanide andother smoke toxins rather from transient elevations in nicotine.http://www.ncbi.nlm.nih.gov/pubmed/20462139

For more research on HBOT, go tohttp://www.ncbi.nlm.nih.gov

and type in hyperbaric oxygen therapy
http://www.ncbi.nlm.nih.gov/pubmed/20890859http://www.ncbi.nlm.nih.gov/pubmed/20890859http://www.ncbi.nlm.nih.gov/pubmed/21234869http://www.ncbi.nlm.nih.gov/pubmed/21234869http://www.ncbi.nlm.nih.gov/pubmed/21082515http://www.ncbi.nlm.nih.gov/pubmed/21082515http://www.ncbi.nlm.nih.gov/pubmed/20886727http://www.ncbi.nlm.nih.gov/pubmed/20886727http://www.ncbi.nlm.nih.gov/pubmed/21110096http://www.ncbi.nlm.nih.gov/pubmed/21110096http://www.ncbi.nlm.nih.gov/pubmed/20216492http://www.ncbi.nlm.nih.gov/pubmed/20216492http://www.ncbi.nlm.nih.gov/pubmed/21184071http://www.ncbi.nlm.nih.gov/pubmed/21184071http://www.ncbi.nlm.nih.gov/pubmed/20462139http://www.ncbi.nlm.nih.gov/pubmed/20462139http://www.ncbi.nlm.nih.gov/http://www.ncbi.nlm.nih.gov/http://www.ncbi.nlm.nih.gov/http://www.ncbi.nlm.nih.gov/http://www.ncbi.nlm.nih.gov/pubmed/20462139http://www.ncbi.nlm.nih.gov/pubmed/21184071http://www.ncbi.nlm.nih.gov/pubmed/20216492http://www.ncbi.nlm.nih.gov/pubmed/21110096http://www.ncbi.nlm.nih.gov/pubmed/20886727http://www.ncbi.nlm.nih.gov/pubmed/21082515http://www.ncbi.nlm.nih.gov/pubmed/21234869http://www.ncbi.nlm.nih.gov/pubmed/20890859


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Documents

HBOT and Stroke_TBI,