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Žarak M, Perović A, Njire Bratičević M, Šupraha Goreta S, Dumić J. Adaptive response triggered by the repeated SCUBA diving is reflected in cardiovascular, muscular, and immune biomarkers. Physiol Rep 2021; 9:e14691. [PMID: 33463896 PMCID: PMC7814492 DOI: 10.14814/phy2.14691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 02/02/2023] Open
Abstract
It has been shown that one recreational SCUBA (rSCUBA) diving session is sufficient to cause changes in plasma level of cardiovascular (CV) and muscular biomarkers. To explore whether repetitive rSCUBA diving triggers an adaptive response of the CV, muscular, and immune system, we measured the cardiac damage (NT-proBNP, hs-TnI, and CK-MB), muscle damage (myoglobin (Mb), galectin-3, CK, and LDH), vascular endothelial activation (ET-1 and VEGF), and inflammatory (leukocyte count (Lkc), CRP, and IL-6) biomarkers. A longitudinal intervention study included divers (N = 14) who conducted one dive per week over 5 weeks at the depth of 20-30 m for 30 min after a non-dive period of 5 months. The blood samples were collected before and after the first, third, and fifth dives and specific biomarkers were measured in plasma or serum by the standard laboratory methods. The concentrations of the majority of measured biomarkers increased after every single dive; the exception was ET-1 concentration that decreased. The cumulative effect of five dives has been reflected in diminishing changes in hs-TnI, Mb, galectin-3, ET-1, VEGF, and IL-6 levels, and more pronounced increases in NT-proBNP and hs-CRP levels. The median values of all measured biomarkers in all time points, except Mb, remained within the corresponding reference range. Repeatedly performed rSCUBA diving activates an adaptive response of the CV, muscular, and immune system that is reflected in changes in the specific biomarker concentration.
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Affiliation(s)
- Marko Žarak
- Clinical Department of Laboratory DiagnosticsDubrava University HospitalZagrebCroatia
| | - Antonija Perović
- Department of Laboratory DiagnosticsDubrovnik General HospitalDubrovnikCroatia
| | | | - Sandra Šupraha Goreta
- Faculty of Pharmacy and BiochemistryDepartment of Biochemistry and Molecular BiologyUniversity of ZagrebZagrebCroatia
| | - Jerka Dumić
- Faculty of Pharmacy and BiochemistryDepartment of Biochemistry and Molecular BiologyUniversity of ZagrebZagrebCroatia
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Kozakiewicz M, Slomko J, Buszko K, Sinkiewicz W, Klawe JJ, Tafil-Klawe M, Newton JL, Zalewski P. Acute Biochemical, Cardiovascular, and Autonomic Response to Hyperbaric (4 atm) Exposure in Healthy Subjects. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:5913176. [PMID: 29977313 PMCID: PMC5994282 DOI: 10.1155/2018/5913176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore the effect of a hyperbaric environment alone on the cardiovascular system by ensuring elimination of factors that may mask the effect on hyperbaria. The research was performed in a hyperbaric chamber to eliminate the effect of physical activity and the temperature of the aquatic environment. Biochemical analysis and examination with the Task Force Monitor device were performed before and immediately after exposure. TFM was used for noninvasive examination of the cardiovascular system and the functional evaluation of the autonomic nervous system. Natriuretic peptides were measured as biochemical markers which were involved in the regulation of haemodynamic circulation vasoconstriction (urotensin II). L-arginine acted as a precursor of the level of the nitric oxide whereas angiotensin II and angiotensin (1-7) were involved in cardiac remodeling. The study group is comprised of 18 volunteers who were professional divers of similar age and experience. The results shown in our biochemical studies do not exceed reference ranges but a statistically significant increase indicates the hyperbaric environment is not without impact upon the human body. A decrease in HR, an increase in mBP, dBP, and TPR, and increase in parasympathetic heart nerves activity suggest an increase in heart afterload with a decrease in heart activity within almost one hour after hyperbaric exposure. Results confirm that exposure to a hyperbaric environment has significant impact on the cardiovascular system. This is confirmed both by changes in peptides associated with poorer cardiovascular outcomes, where a significant increase in the studied parameters was observed, and by noninvasive examination.
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Affiliation(s)
- Mariusz Kozakiewicz
- Department of Food Chemistry, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Dębowa 3, 85-626 Bydgoszcz, Poland
| | - Joanna Slomko
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Katarzyna Buszko
- Department of Theoretical Foundations of Bio-Medical Sciences and Medical Informatics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Jagiellonska 13, 85-067 Bydgoszcz, Poland
| | - Wladyslaw Sinkiewicz
- 2nd Department of Cardiology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Malgorzata Tafil-Klawe
- Department of Human Physiology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Julia L. Newton
- Institute for Ageing and Health, The Medical School, Newcastle University, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
| | - Pawel Zalewski
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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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: 12] [Impact Index Per Article: 1.5] [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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Louge P, Coulange M, Beneton F, Gempp E, Le Pennetier O, Algoud M, Dubourg L, Naibo P, Marlinge M, Michelet P, Vairo D, Kipson N, Kerbaul F, Jammes Y, Jones IM, Steinberg JG, Ruf J, Guieu R, Boussuges A, Fenouillet E. Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness. Medicine (Baltimore) 2016; 95:e4060. [PMID: 27368044 PMCID: PMC4937958 DOI: 10.1097/md.0000000000004060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder.Thirty-one patients (19 IPE, 12 DCS) treated at the Hyperbaric Medicine Department (Ste-Anne hospital, Toulon, France; July 2013-June 2014) were recruited into the study. Ten healthy divers were recruited as controls. We tested: (i) copeptin, a surrogate marker for antidiuretic hormone and a stress marker; (ii) ischemia-modified albumin, an ischemia/hypoxia marker; (iii) brain-natriuretic peptide (BNP), a marker of heart failure, and (iv) ultrasensitive-cardiac troponin-I (cTnI), a marker of myocardial ischemia.We found that copeptin and cardiac biomarkers were higher in IPE versus DCS and controls: (i) copeptin: 68% of IPE patients had a high level versus 25% of DCS patients (P < 0.05) (mean ± standard-deviation: IPE: 53 ± 61 pmol/L; DCS: 15 ± 17; controls: 6 ± 3; IPE versus DCS or controls: P < 0.05); (ii) ischemia-modified albumin: 68% of IPE patients had a high level versus 16% of DCS patients (P < 0.05) (IPE: 123 ± 25 arbitrary-units; DCS: 84 ± 25; controls: 94 ± 7; IPE versus DCS or controls: P < 0.05); (iii) BNP: 53% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 383 ± 394 ng/L; DCS: 37 ± 28; controls: 19 ± 15; IPE versus DCS or controls: P < 0.01); (iv) cTnI: 63% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 0.66 ± 1.50 μg/L; DCS: 0.0061 ± 0.0040; controls: 0.0090 ± 0.01; IPE versus DCS or controls: P < 0.01). The combined "BNP-cTnI" levels provided most discrimination: all IPE patients, but none of the DCS patients, had elevated levels of either/both of these markers.We propose that antidiuretic hormone acts together with a myocardial ischemic process to promote IPE. Thus, monitoring of antidiuretic hormone and cardiac biomarkers can help to make a quick and reliable diagnosis of IPE.
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Affiliation(s)
- Pierre Louge
- Department of Hyperbaric Medicine, Sainte-Anne Hospital, Toulon
| | - Mathieu Coulange
- Department of Hyperbaric Medicine, Sainte-Marguerite Hospital, Marseille
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Frederic Beneton
- Department of Hyperbaric Medicine, Sainte-Marguerite Hospital, Marseille
| | - Emmanuel Gempp
- Department of Hyperbaric Medicine, Sainte-Anne Hospital, Toulon
| | - Olivier Le Pennetier
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Maxime Algoud
- Laboratory of Biochemistry, Timone University Hospital, Marseille
| | - Lorene Dubourg
- Laboratory of Biochemistry, Timone University Hospital, Marseille
| | - Pierre Naibo
- Laboratory of Biochemistry, Timone University Hospital, Marseille
| | - Marion Marlinge
- Laboratory of Biochemistry, Timone University Hospital, Marseille
| | - Pierre Michelet
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Donato Vairo
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Nathalie Kipson
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - François Kerbaul
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Yves Jammes
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Ian M. Jones
- School of Biological Sciences, University of Reading, United Kingdom
| | | | - Jean Ruf
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Régis Guieu
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
- Laboratory of Biochemistry, Timone University Hospital, Marseille
- Correspondence: Régis Guieu, Faculty of Medicine, Bd Dramard, (e-mail: )
| | - Alain Boussuges
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
| | - Emmanuel Fenouillet
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the Army
- Institut des Sciences Biologiques, CNRS, France
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Perovic A, Unic A, Dumic J. Recreational scuba diving: negative or positive effects of oxidative and cardiovascular stress? Biochem Med (Zagreb) 2014; 24:235-47. [PMID: 24969917 PMCID: PMC4083575 DOI: 10.11613/bm.2014.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/16/2014] [Indexed: 12/22/2022] Open
Abstract
Environmental conditions and increased physical activity during scuba diving are followed by increased production of free radicals and disturbed redox balance. Redox balance disorder is associated with damage of cellular components, changes of cellular signaling pathways and alterations of gene expression. Oxidative stress leads to increased expression of sirtuins (SIRTs), molecules which play an important role in the antioxidant defense, due to their sensitivity to the changes in the redox status and their ability to regulate redox homeostasis. These facts make SIRTs interesting to be considered as molecules affected by scuba diving and in that sense, as potential biomarkers of oxidative status or possible drug targets in reduction of reactive oxygen species (ROS) accumulation. In addition, SIRTs effects through currently known targets make them intriguing molecules which can act positively on health in general and whose expression can be induced by scuba diving.A demanding physical activity, as well as other circumstances present in scuba diving, has the greatest load on the cardiovascular function (CV). The mechanisms of CV response during scuba diving are still unclear, but diving-induced oxidative stress and the increase in SIRTs expression could be an important factor in CV adaptation. This review summarizes current knowledge on scuba diving-induced oxidative and CV stress and describes the important roles of SIRTs in the (patho)physiological processes caused by the redox balance disorder.
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Affiliation(s)
- Antonija Perovic
- Department of Biochemical and Hematological Laboratory Diagnostics, Dubrovnik General Hospital, Dubrovnik, Croatia
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Ayme K, Gavarry O, Rossi P, Desruelle AV, Regnard J, Boussuges A. Effect of head-out water immersion on vascular function in healthy subjects. Appl Physiol Nutr Metab 2013; 39:425-31. [PMID: 24669983 DOI: 10.1139/apnm-2013-0153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Immersion in thermoneutral water increases cardiac output and peripheral blood flow and reduces systemic vascular resistance. This study examined the effects of head-out water immersion on vascular function. Twelve healthy middle-aged males were immersed during 60 min in the seated position, with water at the level of xiphoid. Local and central vascular tone regulating systems were studied during that time. Brachial artery diameter and blood flow were recorded using ultrasonography and Doppler. Endothelial function was assessed with flow-mediated dilation. Results were compared with the same investigations performed under reference conditions in ambient air. During water immersion, brachial artery diameter increased (3.7 ± 0.2 mm in ambient air vs. 4 ± 0.2 mm in water immersion; p < 0.05). Endothelium-mediated dilation was significantly lower in water immersion than in ambient air (10% vs. 15%; p = 0.01). Nevertheless, the difference disappeared when the percentage vasodilatation of the brachial artery was normalized to the shear stimulus. Smooth muscle-mediated dilation was similar in the 2 conditions. Spectral analysis of systolic blood pressure variability indicated a decrease in sympathetic vascular activity. Plasma levels of nitric oxide metabolites remained unchanged, whereas levels of natriuretic peptides were significantly elevated. An increase in brachial blood flow, a decrease in sympathetic activity, a warming of the skin, and an increase in natriuretic peptides might be involved in the increase in reference diameter observed during water immersion. Endothelial cell reactivity and smooth muscle function did not appear to be altered.
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Affiliation(s)
- Karine Ayme
- a UMR-MD2, Dysoxie Suractivité, Institut de Recherche Biomédicale des Armées et Université d'Aix-Marseille, Marseille, France
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