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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 8 | Issue 3
Page Nos. 73-128

Online since Tuesday, September 25, 2018

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RESEARCH ARTICLES  

Inhalation of high concentration hydrogen gas improves short-term outcomes in a rat model of asphyxia induced-cardiac arrest p. 73
Lei Huang, Richard L Applegate, Patricia M Applegate, Warren Boling, John H Zhang
DOI:10.4103/2045-9912.241063  PMID:30319760
Cardiogenic global brain hypoxia-ischemia is a devastating medical problem that is associated with unfavorable neurologic outcomes. Low dose hydrogen gas (up to 2.9%) has been shown to be neuroprotective in a variety of brain diseases. In the present study, we investigated the protective effect of water by electrolysis-derived high concentration hydrogen gas (60%) in a rat model of asphyxia induced-cardiac arrest and global brain hypoxia-ischemia. High concentration hydrogen gas was either administered starting 1 hour prior to cardiac arrest for 1 hour and starting 1 hour post-resuscitation for 1 hour (pre- & post-treatment) or starting 1 hour post-resuscitation for 2 hours (post-treatment). In animals subjected to 9 minutes of asphyxia, both therapeutic regimens tended to reduce the incidence of seizures and neurological deficits within 3 days post-resuscitation. In rats subjected to 11 minutes of asphyxia, significantly worse neurological deficits were observed compared to 9 minutes asphyxia, and pre- & post-treatment had a tendency to improve the success rate of resuscitation and to reduce the seizure incidence within 3 days post-resuscitation. Findings of this preclinical study suggest that water electrolysis-derived 60% hydrogen gas may improve short-term outcomes in cardiogenic global brain hypoxia-ischemia.
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Hydrogen-rich water ameliorates rat placental stress induced by water restriction p. 79
Yun-Zhi Shi, Song Jin, Han Qin, Heng-Bo Jiang, Guo-Hua Song, Shu-Cun Qin
DOI:10.4103/2045-9912.241064  PMID:30319761
Dehydration is one of the intrauterine abnormalities that could lead to fetal growth retardation and to increase the risk of a variety of adult diseases later in life. This study were to determine the impact of hydrogen-rich water (HRW) supplementation on placental angiotensin II type 1 receptor and placental oxidative stress induced by water restriction. Pregnant Wistar rat were randomly assigned to one of the three groups (n =12 per group). In control group, pure water and food were supplied ad libitum. Water restriction group and HRW group were respectively given pure water and HRW with free access to food, excepting only one hour was available for drinking from day 7 to day 17 of pregnancy. The placental damages and biomarkers of stress were detected by histopathology, immunohistochemistry and western blot, as well as serological test were performed. We demonstrated that maternal water restriction resulted in reduced urine volume and increased serum osmotic pressure, along with decreased fetus weight and crown-rump length. Although placental weight and the number of fetuses had no significant difference among groups, the placental efficiency significantly increased after the oral administration of HRW to the mothers. Meanwhile, the serological derivatives of reactive oxygen metabolites decreased, a significant improvement of placental microstructure with more developed junctional zone and denser labyrinth was manifested, the upregulated expression of angiotensin II type 1 receptor, nuclear factoκB, malondialdehyde, 8-hydroxydeoxyguanosine, p38, c-Jun N-terminal kinase and down-regulation of superoxide dismutase were revealed in the placenta. Collectively, HRW administration is able to effectively attenuate placental stress induced by water restriction.
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Efficacy of dexmedetomidine versus remifentanil to blunt the hemodynamic response to laryngoscopy and orotracheal intubation: a randomized clinical trial p. 85
Hesameddin Modir, Bijan Yazdi, Esmail Moshiri, Abolfazl Mohammadbeigi, Samira Afshari
DOI:10.4103/2045-9912.241065  PMID:30319762
The study aims to compare the efficacy of dexmedetomidine (DEX) vs. remifentanil (REM) to blunt the hemodynamic response to laryngoscopy and orotracheal intubation. Enrolled in a double-blind clinical trial, 124 patients undergoing elective surgery under general anesthesia at Amirkabir Hospital (Arak, Iran), were assigned into four groups equally (31 patients in each group), DEX, REM, DEX-REM, and normal saline (NS), who received intravenous DEX (1 µg/kg), REM (1 µg/kg), their equal mixture (each 0.5 µg/kg, 1 minute before tracheal intubation), and NS, respectively. Then, blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured on arrival to the operating room, 1 minute before laryngoscopy and tracheal intubation, immediately after intubation, and afterwards every 5 to 15 minutes, and finally the data were analyzed using SPSS 18.0. The groups were same regarding to age, sex and baseline hemodynamic variables including mean of BP (P = 0.157), HR (P = 0.105) and SaO2 (P = 0.366). Tukey post-hoc test showed that there DEX, REM, and a DEX + REM groups was same regarding to MBP and HR, but these hemodynamic responses were higher in NS group than other groups at all time after laryngoscopy and intubation (P < 0.05). Moreover, repeated measure test showed a decreasing trend in MBP and HR in three intervention groups at all time after intubation (P > 0.05). A DEX/REM mixture had the lowest BP and three intervention groups had lower HR than the NS group. A mixture of the drugs used seems to lead to not only a prevented increase in HR and BP during laryngoscopy but also a decreased BP and HR. This study was registered in Iranian Registry Clinical Center with the registration No. IRCT2016092722254N1.
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Removal of toluene vapors from the polluted air with modified natural zeolite and titanium dioxide nanoparticles p. 91
Hasan Irvani, Mojtaba Nakhaei Pour, Ali Vahidi, Somayeh Arezoomandan, Hosein Shojaee-Farah Abady
DOI:10.4103/2045-9912.241074  PMID:30319763
Toluene is a colorless and flammab1le liquid with the same solubilizing capacity as benzene that is in many cases used as an alternative to benzene, because of the uncertainty of being carcinogens. Workers can be exposed to toluene by breathing the chemical. To avoid inhalation and dermal effects caused by exposure to toluene, solutions such as adsorption, thermal oxidation, membrane separation and photocatalytic processes are applied. In this study, removal of toluene vapors with modified natural zeolite and titanium dioxide nanoparticles was discussed. The natural zeolite was modified using chemical and thermal methods. The samples characterized by Brunauer-Emmet-Teller, Barrett-Joyner-Halenda, X-ray diffraction and scanning electron microscopy tests. After stabilization of TiO2 nanoparticles, the removal efficiency for the toluene vapors at a concentration of 50, 150 and 300 ppm were evaluated using a dynamic system. The results showed that the zeolite has a very porous surface and after modifying the context its specific surface area increased 2.54 times. The results of the adsorption capacity calculation and photocatalytic process showed that modified zeolite samples-TiO2 bed has greater efficiency in the adsorption capacity and better photocatalytic activity than a Ze-TiO2 bed. Ze-TiO2 bed was able to remove 26% of toluene vapors at the concentration of 50 ppm and inlet flow rate of 1 L/m, which was 1.26 times more than a bed Ze-TiO2. According to the results of this study, while modifying the natural zeolite increased desirable properties such as specific surface area and Si/Al ratio, but in comparison with similar studies with synthetic bed such as zeolite Y and ZSM-5, could not achieve desired results in a photocatalytic activity for its application in industry. However, because of its abundance in the world and Iran and therefore low cost of preparation and also due to its unique characteristics, it is recommended that more studies to be done about modifying and its application in photocatalytic processes.
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REVIEWS Top

Emerging mechanisms and novel applications of hydrogen gas therapy p. 98
Nathanael Matei, Richard Camara, John H Zhang
DOI:10.4103/2045-9912.239959  PMID:30319764
Clinical and pre-clinical studies have reported a broad range of applications for hydrogen gas therapy. Classically, conventional antioxidant therapy is limited because it neutralizes both the detrimental and protective effects of reactive oxygen species. As a weak reducing agent, hydrogen gas avoids this paradox by reacting with strong oxidants while leaving other beneficial oxidants reactive. This review gathers a promising list of hydrogen gas applications that merit further mechanistic investigation and additional therapeutic trials. Reports support the ability of hydrogen gas to downregulate the expression of pro-inflammatory cytokines and pro-apoptotic factors. Mechanistically, hydrogen gas has been shown to downregulate miR-9 and miR-21, while upregulating miR-199 to reduce inflammatory injury. In angiogenic pathways, hydrogen’s inhibition of cyclic guanosine monophosphate-degrading phosphodiesterase led to higher levels of cyclic guanosine monophosphate, activation of protein kinase, and angiogenesis; next, as hydrogen gas increased the levels of intracellular calcium, stimulated vascular endothelial growth factor increased nitric oxide production. In conjunction, hydrogen gas opened adenosine triphosphate-sensitive potassium channel channels, which activate downstream mitogen-activated protein kinase pathways. Growing molecular mechanisms have discovered a plethora of downstream targets for hydrogen gas therapy that include autophagy (via the adenosine 5’-monophosphate-activated protein kinase/mammalian target of rapamycin pathway), histone modification, mitochondrial unfolded protein response, acute oxidative stress after exercise, and oxidative stress secondary to aging. In conclusion, evolving research has discovered novel molecular connections that will continue to widen applications for hydrogen therapy.
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Clinical utility of ozone therapy for musculoskeletal disorders p. 103
Omar Seyam, Noel L Smith, Inefta Reid, Jason Gandhi, Wendy Jiang, Sardar Ali Khan
DOI:10.4103/2045-9912.241075  PMID:30319765
Oxygen-ozone (O3) therapy serves as an alternative medical technique that increases the oxygen in the body along with the introduction of O3. O3 therapy has finally reached a level where the biological mechanisms of action have been understood, showing that they are in the domain of physiology, biochemistry, and pharmacology. Few clinical applications have been reviewed here as well as exemplifying that O3 therapy is particularly useful in musculoskeletal disorders. In the therapeutic range, O3 can be used as a more effective and safe substitute of standard medications. O3 therapy has been used for many years for its ability to inactivate various viruses, cancer, and acquired immune deficiency syndrome but is now making strides in the treatment of musculoskeletal disorders such as rheumatoid arthritis, lumbar facet joint syndrome, subacromial bursitis, carpal tunnel syndrome, osteoarthritis, hip bursitis, shoulder adhesive capsulitis, herniated disc, and temporomandibular joint disorder.
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Ozone therapy for diabetic foot p. 111
Robert Kushmakov, Jason Gandhi, Omar Seyam, Wendy Jiang, Gunjan Joshi, Noel L Smith, Sardar Ali Khan
DOI:10.4103/2045-9912.241076  PMID:30319766
Diabetic foot ulcers (DFU) are a burden to the diabetic community. With increasing medical bills, to unsuccessful treatment, those suffering from DFUs can use alternative therapeutics. First seen in the mid-1800s, ozone (O3) is thought to be unstable, due to inherent molecular nature. With the help of pharmaceutical science, various O3 treatments have flourished in the medical community to help those suffering from DFUs. Promising results are seen through numerous studies. Usually, a mixture of both O2 and O3 is seen in pressurized machines as administered to the foot ulcer. Foot ulcers, specifically DFUs, need to be assessed, cleaned, and treated as fast as possible for the fastest results. Results such as amputation can be seen if the foot is not attended to as soon as possible. With fast growing clinical trials in O3 therapy and quick administration of the O3, O3 therapy may be on the rise to be at the forefront of treating DFUs. Compelling evidence is seen in clinical trials, but more must be done to fully understand the role of O3 in DFUs.
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Potential application value of xenon in stroke treatment p. 116
Chong-Shun Zhao, Hao Li, Zhong Wang, Gang Chen
DOI:10.4103/2045-9912.241077  PMID:30319767
Stroke is an acute disease with extremely high mortality and disability, including ischemic stroke and hemorrhagic stroke. Currently only limited drugs and treatments have been shown to have neuroprotective effects in stroke. As a medical gas, xenon has been proven to have neuroprotective effect in considerable amount of previous study. Its unique properties are different from other neuroprotective agents, making it is promising to play a special therapeutic role in stroke, either alone or in combination with other treatments. In this article, we aim to review the role of xenon in the treatment of stroke, and summarize the mechanism of using xenon to produce therapeutic effects after stroke according to the existing research. Moreover, we intend to explore and demonstrate the feasibility and safety of xenon for clinical treatment of stroke. Despite the disadvantages of difficulty in obtaining and being expensive, as long as the use of reasonable methods, xenon can play an important role in the treatment of stroke.
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CASE REPORT Top

Ozone therapy as a primary and sole treatment for acute bacterial infection: case report Highly accessed article p. 121
Robert Jay Rowen
DOI:10.4103/2045-9912.241078  PMID:30319768
The world is facing a crisis of antibiotic resistance, which impacts every treating physician on the planet. Thousands of patients die yearly in the USA from infections that have failed to respond to anti-infectives. Alarms have been ringing about bacterial infection fatality resurgence, the end of the antibiotic era, a calamity in progress. Ozone therapy has been used in medicine since World War I. However, it is not patentable and has suffered from lack of private source funding for research sufficient to have it accepted by the mainstream. Basic science, both in vivo and in vitro, research has found it to have several effects including modulating the immune system, enhancing circulation, destroying microorganisms including bacteria and viruses, and enhancing oxygen delivery and consumption by the body. This report presents background basic ozone science and a case report of acute bacterial infection – tick bite cellulitis, which immediately responded to ozone therapy as the sole treatment, and which fully resolved within 24-48 hours. Ozone therapy could be considered as an adjunctive or alternative therapy for bacterial infection.
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SHORT COMMUNICATION Top

Nitrous oxide in waste anesthetic gases with different fresh gas flow: a case-based pilot observation and a practical thought on scavenging p. 125
Habib Md Reazaul Karim, Manish Keshwani
DOI:10.4103/2045-9912.241066  PMID:30319769
Use of nitrous oxide (N2O) as an anaesthetic gas has been on contradicting views for various reasons; operating room (OR) pollution and occupational exposure is one of those controversies. The present pilot experiment was planned to analyze the anaesthesia gas waste at the machine end of scavenging outlet and calculate the probable portion of N2O in the OR air, which is likely to help us in informed decision making. Anaesthesia gas waste was sampled at the machine end of scavenging outlet and was connected directly and analyzed using a gas analyzer attached to Mindray A7 anaesthesia workstation. An assembly of L connector, sampling line, corrugated tube and endotracheal tube were used to perform the procedure. The measurements were taken at 600, 1200 and 1800 mL/minutes of fresh gas flow (FGF). A total of 15 paired readings from five general anaesthesia cases were taken. The N2O percentage in the anaesthesia waste gases with a FGF of 600, 1200 and 1800 mL was 3.4 ± 0.54, 8.2 ± 0.83 and 14.0 ± 0.70, respectively. On calculation, the likely concentration of N2O in OR with FGF of 600 mL/min is 0.576 ppm, which will lead to the time weighted average 4.6 ppm exposure per day in modular OR. Reducing FGF to 600 mL/min reduces the N2O concentration in OR by 75% as compared to the FGF of 1800 mL/min. The time weighted average exposure to N2O is far below the permissible limit in modular OR.
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LETTER TO THE EDITOR Top

The role of argon in dentistry p. 128
Thorakkal Shamim
DOI:10.4103/2045-9912.241079  PMID:30319770
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