The effect of hyperbaric oxygen therapy on the pathophysiology of skin aging: a prospective clinical trial.

INTRODUCTION: Skin biopsies can be used to evaluate physiological effects of aging targeted intervention at the tissue/cellular levels. Recent clinical trials have shown that hyperbaric oxygen therapy (HBOT) can target aging hallmarks, including telomere shortening, senescent cells clearance and angiogenesis. The aim of this study was to evaluate the effects of HBOT on the skin of a normal, non-pathological, aging population. METHODS: The study was performed as a prospective clinical trial. After signing informed consent and undergoing baseline evaluations, the subjects were assigned to a three-month control period followed by three months of HBOT daily sessions. Skin biopsies were taken at baseline, after three months of no intervention (control) and 1-2 weeks following the last HBOT session. Trichrome, Orecin, lipofuscin and CD31 staining were used to evaluate collagen fibers, elastic fibers, senescent cells and blood vessels, respectively. RESULTS: Out of the cohort of 70 participants in the normal aging population study, thirteen male patients (age 68.07±2.5y) gave consent for repeated skin biopsies. Following HBOT, there was a significant increase in collagen density (p<0.001, effect size(es)=1.10), elastic fiber length (p<0.0001, es=2.71) and the number of blood vessels (p=0.02, es=1.00). There was a significant decrease in fiber fragmentation (p=0.012) and in tissue senescent cells (p=0.03, es=0.84) post-HBOT. No changes were noted in elastic fiber density or thickness. CONCLUSIONS: The study indicates, for the first time in humans, that HBOT can significantly modulate the pathophysiology of the skin aging in a healthy aging population. The demonstrated mechanisms include angiogenesis and senescent cell clearance.

Diagnosis of conjoined twins before 16 weeks' gestation: the 4-year experience of one medical center.

BACKGROUND: Descriptions of the rarely occurring condition of conjoined twins are sparse. METHODS: We report a case series of four conjoined twin pregnancies diagnosed up to 16 weeks of gestation. One was in a quadruplet in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) pregnancy of cryopreserved embryos and the others were spontaneous conceptions. Three were thoracopagus and had increased nuchal translucency (NT) or big nuchal cysts and one was omphalopagus. RESULTS: All the three affected twin pregnancies were terminated by cervical dilatation and uterine evacuation. In another case, selective fetal reduction, shortly followed by embryo reduction to singleton was performed. Histological analysis of one case revealed dissimilar gender. No further cytogenetic or molecular studies were conducted by parental request. The pathophysiology of increased NT, subcutaneous edema or nuchal cysts in thoracopagus conjoined twins, the possible embryonic events that may lead to dizygotic conjoined twins and the clinical management of conjoined twins in sets of multiple gestation are discussed. CONCLUSIONS: The current case series illustrates that there are many problems related to this rare, but intriguing, accident of nature that still need to be overcome.