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Ning K, Guan ZB, Lu HT, Zhang N, Sun XJ, Liu WW. Lung macrophages are involved in lung injury secondary to repetitive diving. J Zhejiang Univ Sci B 2021; 21:646-656. [PMID: 32748580 DOI: 10.1631/jzus.b1900687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to establish an animal model of decompression-induced lung injury (DILI) secondary to repetitive diving in mice and explore the role of macrophages in DILI and the protective effects of high-concentration hydrogen (HCH) on DILI. Mice were divided into three groups: control group, DILI group, and HCH group. Mice were exposed to hyperbaric air at 600 kPa for 60 min once daily for consecutive 3 d and then experienced decompression. In HCH group, mice were administered with HCH (66.7% hydrogen and 33.3% oxygen) for 60 min after each hyperbaric exposure. Pulmonary function tests were done 6 h after decompression; the blood was harvested for cell counting; the lung tissues were harvested for the detection of inflammatory cytokines, hematoxylin and eosin (HE) staining, and immunohistochemistry; western blotting and polymerase chain reaction (PCR) were done for the detection of markers for M1 and M2 macrophages. Our results showed that bubbles formed after decompression and repeated hyperbaric exposures significantly reduced the total lung volume and functional residual volume. Moreover, repetitive diving dramatically increased proinflammatory factors and increased the markers of both M1 and M2 macrophages. HCH inhalation improved lung function to a certain extent, and significantly reduced the pro-inflammatory factors. These effects were related to the reduction of M1 macrophages as well as the increase in M2 macrophages. This study indicates that repetitive diving damages lung function and activates lung macrophages, resulting in lung inflammation. HCH inhalation after each diving may be a promising strategy for the prevention of DILI.
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Affiliation(s)
- Ke Ning
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, the Naval Military Medical University, Shanghai 200433, China
| | - Zhen-Biao Guan
- Department of Respiratory Diseases, Hongkou Branch of Changhai Hospital, the Naval Military Medical University, Shanghai 200081, China
| | - Hong-Tao Lu
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, the Naval Military Medical University, Shanghai 200433, China
| | - Ning Zhang
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, the Naval Military Medical University, Shanghai 200433, China
| | - Xue-Jun Sun
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, the Naval Military Medical University, Shanghai 200433, China
| | - Wen-Wu Liu
- Department of Diving Medicine, Faculty of Naval Medicine, the Naval Military Medical University, Shanghai 200433, China
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[What is the Best Therapeutic Strategy for Decompression Illness? First Aid Oxygen Inhalation and Hyperbaric Oxygen Therapy]. J UOEH 2021; 43:243-254. [PMID: 34092769 DOI: 10.7888/juoeh.43.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.
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Yu X, Xu J, Liu W, Zhang Z, He C, Xu W. Protective effects of pulmonary surfactant on decompression sickness in rats. J Appl Physiol (1985) 2020; 130:400-407. [PMID: 33270509 DOI: 10.1152/japplphysiol.00807.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Decompression sickness (DCS) is a systemic pathophysiological process featured by bubble load. Lung dysfunction plays a harmful effect on off-gassing, which contributes to bubble load and subsequent DCS occurrence. This study aimed to investigate the effects of pulmonary surfactant on DCS as it possesses multiple advantages on the lung. Rats were divided into three groups: the normal (n = 10), the surfactant (n = 36), and the saline (n = 36) group. Animals in surfactant or saline group were administered aerosol surfactant or saline 12 h before a stimulated diving, respectively. Signs of DCS were recorded and bubble load was detected. The contents of phospholipid and surfactant protein A (SPA), protein, IL-1 and IL-6 in bronchoalveolar lavage fluid (BALF), and lung wet/dry (W/D) ratio were determined. Serum levels of IL-6, ICAM-1, E-selectin, GSH, and GSSG were detected. In surfactant-treated rats, the morbidity and mortality of DCS markedly decreased (P < 0.01 and P < 0.05, respectively). Survival time prolonged and the latency to DCS dramatically delayed (P < 0.01). More importantly, bubble load markedly decreased (P < 0.01). The increases of protein, IL-1 and IL-6 in BALF, and lung W/D ratio were alleviated. Restoration of total phospholipid and SPA in BALF and ICAM-1 and E-selectin in serum was observed. The inflammation and oxidation were attenuated (P < 0.01). In conclusion, prediving administrating exogenous surfactant by aerosolization is an efficient, simple, and safe method for DCS prevention in rats.NEW & NOTEWORTHY This is the first study exploring the effects of aerosol surfactant on DCS prevention and it was proven to be an efficient and simple method. The role of surfactant in facilitating off-gassing was thought to be the critical mechanism in bubble degrading and subsequent DCS prevention.
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Affiliation(s)
- Xuhua Yu
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Jiajun Xu
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Wenwu Liu
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Ze Zhang
- The 17th detachment of the frigate, Jiangmen, China
| | - Chunyang He
- Department of Hyperbaric Oxygen, General Hospital in Western Theater of Operations, Chengdu, China
| | - Weigang Xu
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
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Romary E, Marmin J, Castagna O. Bases physiopathogéniques de l’œdème pulmonaire d’immersion. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2019-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’œdème pulmonaire d’immersion (OPI) est souvent décrit en plongée en scaphandre autonome mais peut aussi s’observer en nage de surface ou en apnée sousmarine. Cette pathologie, directement liée aux contraintes environnementales de l’immersion, est favorisée par un terrain cardiovasculaire. Elle peut également toucher des cœurs sains à travers un exercice physique associé à un effort ventilatoire important. L’OPI a pour origine une augmentation du gradient de pression transmurale au niveau des capillaires pulmonaires par une élévation de la pression capillaire (précharge et postcharge) et une diminution de la pression alvéolaire. Au travers d’un cas clinique, nous précisons les mécanismes physiopathologiques encore méconnus de ce déséquilibre pressionnel et nous décrivons les principes de prise en charge préhospitalière et hospitalière de l’OPI avec un rappel des diagnostics différentiels à évoquer devant une symptomatologie respiratoire au décours d’une plongée. Nous insistons sur une sensibilisation et un dépistage cardiologique d’un terrain à risque, en particulier d’une hypertension artérielle, chez tout plongeur de plus de 50 ans.
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Han CH, Zhang PX, Liu WW. Macrophage polarization is related to the pathogenesis of decompression induced lung injury. Med Gas Res 2017; 7:220-223. [PMID: 29152216 PMCID: PMC5674661 DOI: 10.4103/2045-9912.215753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Studies have shown that blood bubbles may be detectable and there is ultrasonic evidence of acute interstitial lung edema even after diving without protocol violation. Macrophages play a central role in the inflammation, and macrophage polarization is closely related to the pathogenesis some lung diseases. Available findings indicate that decompression may induce the production of pro-inflammatory cytokines, chemokines, and adhesion molecules in the blood and tissues, which are associated with the macrophage polarization, and hyperbaric treatment may exert therapeutic effects on decompression related diseases via regulating these factors. Thus, we hypothesize that the polarization of circulating and/or resident macrophages is involved in the pathogenesis of decompression induced lung injury.
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Affiliation(s)
- Cui-Hong Han
- Department of Pathology, the First Hospital of Jining City, Jining City, Shandong Province, China
| | - Pei-Xi Zhang
- Department of Cardiothoracic Surgery, the First Hospital of Jining City, Jining City, Shandong Province, China
| | - Wen-Wu Liu
- Department of Diving and Hyperbaric Medicine, Secondary Military Medical University, Shanghai, China
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Boussuges A, Ayme K, Chaumet G, Albier E, Borgnetta M, Gavarry O. Observational study of potential risk factors of immersion pulmonary edema in healthy divers: exercise intensity is the main contributor. SPORTS MEDICINE-OPEN 2017; 3:35. [PMID: 28975560 PMCID: PMC5626674 DOI: 10.1186/s40798-017-0104-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/26/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The risk factors of pulmonary edema induced by diving in healthy subjects are not well known. The aim of the present study was to assess the parameters contributing to the increase in extravascular lung water after diving. METHODS This study was carried out in a professional diving institute. All divers participating in the teaching program from June 2012 to June 2014 were included in the study. Extravascular lung water was assessed using the detection of ultrasound lung comets (ULC) by chest ultrasonography. Clinical parameters and dive profiles were recorded using a questionnaire and a dive computer. RESULTS One-hundred six divers were investigated after 263 dives. They used an open-circuit umbilical supplying compressed gas diving apparatus in 202 cases and a self-contained underwater breathing apparatus in 61 cases. A generalized linear mixed model analysis was performed which demonstrated that the dive induced a significant increase in ULC score (incidence rate ratio: 3.16). It also identified that the predictive variable of increased extravascular lung water after the dive was the exercise intensity at depth (z = 3.99, p < 0.0001). The other parameters studied such as the water temperature, dive profile, hyperoxic exposure, or anthropometric data were not associated with the increase in extravascular lung water after the dive. CONCLUSIONS In this study, the exercise intensity was the main contributor to the increase in extravascular lung water in healthy divers. To improve the prevention of immersion pulmonary edema, the exercise intensity experienced during the dive should thus be adapted to the aerobic fitness level of the divers.
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Affiliation(s)
- A Boussuges
- UMR MD2, Dysoxie-Suractivité, Aix-Marseille Université et Institut de Recherche Biomédicale des Armées (IRBA), Faculté de Médecine Nord, Marseille, France.
| | - K Ayme
- UMR MD2, Dysoxie-Suractivité, Aix-Marseille Université et Institut de Recherche Biomédicale des Armées (IRBA), Faculté de Médecine Nord, Marseille, France
| | | | - E Albier
- Institut National de Plongée Professionnelle, Port de la Pointe Rouge, Marseille, France
| | - M Borgnetta
- Institut National de Plongée Professionnelle, Port de la Pointe Rouge, Marseille, France
| | - O Gavarry
- Laboratoire HandiBio EA 4322, Université de Toulon, La Garde, France
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Yu X, Xu J, Huang G, Zhang K, Qing L, Liu W, Xu W. Bubble-Induced Endothelial Microparticles Promote Endothelial Dysfunction. PLoS One 2017; 12:e0168881. [PMID: 28114372 PMCID: PMC5256891 DOI: 10.1371/journal.pone.0168881] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/07/2016] [Indexed: 12/26/2022] Open
Abstract
Decompression sickness is a systemic pathophysiological process caused by bubbles and endothelial microparticles (EMPs) are established markers reflecting competency of endothelial function and vascular biology. Here, we investigated the effects of bubble-induced EMPs on endothelial cells in vitro and vivo. Rat pulmonary microvascular endothelial cells (PMVECs) were isolated and stimulated by bubbles and bubble-induced EMPs were collected and incubated with normal PMVECs in vitro. Cell viability and apoptosis were detected using Cell Counting Kit-8 assay and Annexin V FITC/PI double staining, respectively. Cell permeability and pro-inflammatory cytokines were determined by electric cell substrate impedance sensing and enzyme-linked immunosorbent assay, respectively. Intracellular nitric oxide and reactive oxygen species production were analyzed microscopically. In vivo study, bubble-induced EMPs were intravenously injected to the rats and soluble thrombomodulin, intercellular adhesion molecule 1, and vascullar adhesion molecule 1 were involved in evaluating endothelial dysfunction. In our study, bubble stimulus resulted in a significant increase of EMPs release by 3 fold. Bubble-induced EMPs significantly decreased cell viability and increased cell apoptosis. Moreover, bubble-induced EMPs induced abnormal increase of cell permeability and over-expression of pro-inflammatory cytokines. Intracellular ROS production increased while NO production decreased. These negative effects caused by bubble-induced EMPs were remarkably suppressed when EMPs pretreated with surfactant FSN-100. Finally, intravenous injection of bubble-induced EMPs caused elevations of soluble thrombomodulin and pro-inflammatory cytokines in the circulation. Altogether, our results demonstrated that bubble-induced EMPs can mediate endothelial dysfunction in vitro and vivo, which can be attenuated by EMPs abatement strategy. These data expanded our horizon of the detrimental effects of bubble-induced EMPs, which may be of great concern in DCS.
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Affiliation(s)
- Xuhua Yu
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
| | - Jiajun Xu
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
| | - Guoyang Huang
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
| | - Kun Zhang
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
| | - Long Qing
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
| | - Wenwu Liu
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
| | - Weigang Xu
- Department of Diving and Hyperbaric Medicine, Faculty of Naval Medicine, the Second Military Medical University, Shanghai, China
- * E-mail:
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Kondo Y, Fukami M, Kukita I. Extracorporeal membrane oxygenation therapy for pulmonary decompression illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:438. [PMID: 25042680 PMCID: PMC4075348 DOI: 10.1186/cc13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gibbs CR, Blake DF, Smart DR, Banham NDG. Pulmonary decompression illness. Emerg Med Australas 2013; 25:91. [DOI: 10.1111/1742-6723.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Clinton R Gibbs
- Emergency Department; The Townsville Hospital; Townsville; Queensland; Australia
| | - Denise F Blake
- Emergency Department; The Townsville Hospital; Townsville; Queensland; Australia
| | - David R Smart
- Department of Diving and Hyperbaric Medicine; Royal Hobart Hospital; Hobart; Tasmania; Australia
| | - Neil DG Banham
- Department of Diving and Hyperbaric Medicine; Fremantle Hospital; Fremantle; Western Australia; Australia
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