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Peña Pascucci I, Pernas Mozas S, Garrido Sánchez L. Osteolytic Lesions in a Sub-Adult Loggerhead Sea Turtle ( Caretta caretta): A Case Report. Animals (Basel) 2024; 14:1317. [PMID: 38731321 PMCID: PMC11083253 DOI: 10.3390/ani14091317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/19/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Osteolytic lesions in loggerhead sea turtles (Caretta caretta) during rehabilitation are attributed to multiple causes, including gas embolism, hypothermia, and osteomyelitis due to bacterial or fungal infection. This study reports the appearance of osteolytic lesions in a sub-adult loggerhead sea turtle with involvement of the right fore and hind flippers, visible swelling of the elbow and knee joints, and accompanied by lameness after 45 days of rehabilitation. Radiographs and computed tomography revealed multiple lytic bone lesions. This was the fourth rehabilitation admission of the turtle after being accidentally captured by trawler ships (bycatch) in 2019, 2020, 2022, and 2023. Potential causes were dysbaric osteonecrosis due to a past decompression sickness event and hypothermia with osteomyelitis from bacterial infection. Blood cultures and antibiotic susceptibility testing led to the isolation of Ewingella americana responsive to enrofloxacin. This study investigates extensive fore and hind flipper involvement in a sub-adult loggerhead turtle, aiming to determine causes and risk factors. The pathogenesis and significance of these lesions is discussed.
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Affiliation(s)
- Ignacio Peña Pascucci
- Fundación para la Conservación y Recuperación de Animales Marinos (CRAM), El Prat de Llobregat, 08820 Barcelona, Spain; (S.P.M.); (L.G.S.)
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2
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Alvarado R, Scheven UM, Meiners JC. Real-time imaging of decompression gas bubble growth in the spinal cord of live rats. Magn Reson Med 2024. [PMID: 38651172 DOI: 10.1002/mrm.30128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/19/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To observe the growth and resolution of decompression gas bubbles in the spinal cord of live rats in real time using MRI. METHODS We constructed an MRI-compatible pressure chamber system to visualize gas bubble dynamics in deep tissues in real time. The system pressurizes and depressurizes rodents inside an MRI scanner and monitors their respiratory rate, heart rate, and body temperature while providing gaseous anesthesia under pressure during the experiments. RESULTS We observed the formation of decompression gas bubbles in the spinal cord of rats after compression to 7.1 bar absolute and rapid decompression inside the MRI scanner while maintaining continuous gaseous anesthesia and vital monitoring. CONCLUSION We have shown the direct observation of decompression gas bubble formation in real time by MRI in live, anesthetized rats.
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Affiliation(s)
- Roman Alvarado
- Department of Physics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biophysics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ulrich M Scheven
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Jens-Christian Meiners
- Department of Physics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biophysics, University of Michigan, Ann Arbor, Michigan, USA
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Ashworth ET, Ogawa R, Nguyen J, Afif C, Sá RC, Butts Pauly K, Vera DR, Lindholm P. A novel method for tracking nitrogen kinetics in vivo under hyperbaric conditions using radioactive nitrogen-13 gas and positron emission tomography. J Appl Physiol (1985) 2024; 136:949-953. [PMID: 38420678 DOI: 10.1152/japplphysiol.00859.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/08/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Decompression sickness (DCS) is caused by gaseous nitrogen dissolved in tissues forming bubbles during decompression. To date, no method exists to identify nitrogen within tissues, but with advances in positron-emission tomography (PET) technology, it may be possible to track gaseous radionuclides into tissues. We aimed to develop a method to track nitrogen movement in vivo and under hyperbaric pressure that could then be used to further our understanding of DCS using nitrogen-13 (13N2). A single anesthetized female Sprague-Dawley rat was exposed to 625 kPa, composed of air, isoflurane, and 13N2 for 10 min. The PET scanner recorded 13N2 during the hyperbaric exposure with energy windows of 250-750 keV. The PET showed an increase in 13N2 concentration in the lung, heart, and abdominal regions, which all reached a plateau after ∼4 min. This showed that it is possible to gain noninvasive in vivo measurements of nitrogen kinetics through the body while at hyperbaric pressures. Tissue samples showed radioactivity above background levels in the blood, brain, liver, femur, and thigh muscle when assessed using a γ counter. The method can be used to evaluate an array of challenges to our understanding of decompression physiology by quantifying nitrogen load through γ counts of 13N2, and signal intensity of the PET. Further development of the method will improve the specificity of the measured outcomes, and enable it to be used with larger mammals, including humans.NEW & NOTEWORTHY This article describes a method for the in vivo quantification and tracking of nitrogen through the mammalian body whilst exposed to hyperbaric pressure. The method has the potential to further our understanding of decompression sickness, and quantitatively evaluate the effectiveness of both the treatment and prevention of decompression sickness.
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Affiliation(s)
- Edward T Ashworth
- Department of Emergency Medicine, University of California San Diego, La Jolla, California, United States
| | - Ryotaro Ogawa
- Department of Radiology, University of California San Diego, La Jolla, California, United States
| | - Juliana Nguyen
- Department of Emergency Medicine, University of California San Diego, La Jolla, California, United States
| | - Chloe Afif
- Department of Emergency Medicine, University of California San Diego, La Jolla, California, United States
| | - Rui C Sá
- Department of Medicine, University of California San Diego, La Jolla, California, United States
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Stanford, California, United States
| | - David R Vera
- Department of Radiology, University of California San Diego, La Jolla, California, United States
| | - Peter Lindholm
- Department of Emergency Medicine, University of California San Diego, La Jolla, California, United States
- Department of Radiology, University of California San Diego, La Jolla, California, United States
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Ito S, Maki Y, Higuchi K. Chronic Subdural Hematoma in a Middle-Aged Amateur Scuba Diver: A Case Report. Cureus 2024; 16:e56049. [PMID: 38606242 PMCID: PMC11008981 DOI: 10.7759/cureus.56049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Scuba diving has become a common and popular activity, and adverse events can occur following this activity. Among those events, intracranial hemorrhage is very rare, and only intracerebral hemorrhage and subarachnoid hemorrhage are reported. However, the occurrence of chronic subdural hematoma (CSDH), possibly as an adverse event following scuba diving, has not been described. A 49-year-old man with no significant medical history visited our hospital complaining of memory disturbance and aphasia. He had experienced a minor head trauma five months before and had gone scuba diving six times between the traumatic episode and the visit to our hospital. A brain computed tomography scan revealed a left CSDH. The patient underwent burr-hole surgery to remove the CSDH, and his symptoms resolved. We report the first case of CSDH possibly related to scuba diving. No recurrence of CSDH was observed at 28 months postoperatively.
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Affiliation(s)
- Sayaka Ito
- Neurosurgery, Kohka Public Hospital, Koka, JPN
| | - Yoshinori Maki
- Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
- Rehabilitation, Hikari Hospital, Otsu, JPN
| | - Kazushi Higuchi
- Neurosurgery, Japanese Red Cross Nagahama Hospital, Nagahama, JPN
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Lampropoulou DI, Papageorgiou D, Pliakou E. Diving Medicine: An Exciting Journey Through Time and Future Prospects. Cureus 2024; 16:e56947. [PMID: 38665707 PMCID: PMC11044526 DOI: 10.7759/cureus.56947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Humans, led by their eternal wish to explore the unknown, have always wanted to perfect their diving skills and conquer the sea world. The adverse conditions experienced by divers brought about medical problems and a new field of medicine. Diving medicine serves the identification, treatment, and precautions against illnesses that are related to diving activities. While the development of diving equipment is advancing, divers have had the chance to reach greater depths for a longer time. Along with this success, a novel medical condition under the term 'decompression illness' (DCI) was introduced. Although the history of hyperbaric medicine is very long, progress in the field of mechanics has offered great contributions to the management of the disease. The first attempt at DCI guidelines was made by the US Navy in 1944-1945 and resulted in the creation of hyperbaric treatment tables. These tools received international recognition, offering a major advance. Hyperbaric-Diving Medicine holds an important place in modern medical science nowadays with indications for various diseases. At the same time, there is great scientific interest and a lot of research in the use of hyperbaric oxygen for several medical disorders, demonstrating great potential.
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Marsh PL, Moore EE, Moore HB, Bunch CM, Aboukhaled M, Condon SM, Al-Fadhl MD, Thomas SJ, Larson JR, Bower CW, Miller CB, Pearson ML, Twilling CL, Reser DW, Kim GS, Troyer BM, Yeager D, Thomas SG, Srikureja DP, Patel SS, Añón SL, Thomas AV, Miller JB, Van Ryn DE, Pamulapati SV, Zimmerman D, Wells B, Martin PL, Seder CW, Aversa JG, Greene RB, March RJ, Kwaan HC, Fulkerson DH, Vande Lune SA, Mollnes TE, Nielsen EW, Storm BS, Walsh MM. Corrigendum: Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies. Front Immunol 2024; 15:1378003. [PMID: 38380313 PMCID: PMC10877275 DOI: 10.3389/fimmu.2024.1378003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2023.1230049.].
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Affiliation(s)
- Phillip L. Marsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO, United States
| | - Hunter B. Moore
- University of Colorado Health Transplant Surgery - Anschutz Medical Campus, Aurora, CO, United States
| | - Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Michael Aboukhaled
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Shaun M. Condon
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | | | - Samuel J. Thomas
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - John R. Larson
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Charles W. Bower
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Craig B. Miller
- Department of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United States
| | - Michelle L. Pearson
- Department of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United States
| | | | - David W. Reser
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - George S. Kim
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Brittany M. Troyer
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Doyle Yeager
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Scott G. Thomas
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Daniel P. Srikureja
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Shivani S. Patel
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Sofía L. Añón
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine, South Bend, IN, United States
| | - Joseph B. Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - David E. Van Ryn
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
- Department of Emergency Medicine, Beacon Health System, Elkhart, IN, United States
| | - Saagar V. Pamulapati
- Department of Internal Medicine, Mercy Health Internal Medicine Residency Program, Rockford, IL, United States
| | - Devin Zimmerman
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Byars Wells
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Peter L. Martin
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Christopher W. Seder
- Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States
| | - John G. Aversa
- Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States
| | - Ryan B. Greene
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Robert J. March
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniel H. Fulkerson
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Stefani A. Vande Lune
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, United States
| | - Tom E. Mollnes
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Erik W. Nielsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Benjamin S. Storm
- Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Mark M. Walsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Indiana University School of Medicine, South Bend, IN, United States
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Isaacson G. The Laryngologist Who Saved the Brooklyn Bridge. Laryngoscope 2024. [PMID: 38284795 DOI: 10.1002/lary.31306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To understand the role of a single laryngologist, Andrew Heermance Smith, in elucidating the mechanisms of Caisson Disease and controlling it effects on bridge workers. DATA SOURCES Scientific and lay publications, letters and records of the Roebling family, obituaries and internet sources. REVIEW METHODS Historical review. RESULTS AH Smith combined physiological observations and experiments in the Brooklyn Bridge caissons with a review of the existing engineering and medical literature to describe the Caisson Disease and to devise strategies to ameliorate its effects. CONCLUSION Despite an incorrect conclusion about the pathophysiology of decompression sickness, Smith's stringent standards and timely interventions allow completion of the masonry towers of the Brooklyn Bridge. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery, and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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Devos P, Guedeney P, Montalescot G. Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges. J Clin Med 2023; 13:54. [PMID: 38202061 PMCID: PMC10780039 DOI: 10.3390/jcm13010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Patent foramen ovale (PFO) concerns nearly a quarter of the general population and incidence may reach up to 50% in patients with cryptogenic stroke. Recent randomized clinical trials confirmed that percutaneous closure of PFO-related stroke reduces the risk of embolic event recurrence. PFO also comes into play in other pathogenic conditions, such as migraine, decompression sickness or platypnea-orthodeoxia syndrome, where the heterogeneity of patients is high and evidence for closure is less well-documented. In this review, we describe the current indications for PFO percutaneous closure and the remaining challenges, and try to provide future directions regarding the technique and its indications.
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Affiliation(s)
- Perrine Devos
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
- Institut de Cardiologie, Centre Hospitalier Universitaire, Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France
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9
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Liu J, Qing L, He Y, Zhu Q, Xu W, Wu J. The involvement of transient receptor potential channels in mast cell activation by microbubbles. J Cell Mol Med 2023; 27:3628-3636. [PMID: 37680043 PMCID: PMC10660621 DOI: 10.1111/jcmm.17947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
This study was to explore the activation of mast cells by microbubbles, with the focus on transient receptor potential (TRP) channels mediated degranulation and calcium influx. Bone marrow-derived mast cells (BMMCs) were primarily obtained from femurs in mice and induced differentiation for 4 weeks. After the purity identification, BMMCs were contacted by homogeneous microbubbles with the diameter of 1 mm for 1 h. β-hexosaminidase and histamine levels in supernatants were assessed by enzyme-linked immunosorbent assay (ELISA) and the CD63 expression was tested by flow cytometry. The intracellular calcium binding with Fluo-4 AM dyes in BMMCs was observed under the fluorescence microscope and the mean fluorescence intensity was quantitatively measured by flow cytometry. β-hexosaminidase release, histamine concentration, CD63 expression and calcium influx were significantly increased in BMMCs group upon microbubble stimulation compared to the control groups. After preconditioning with the available inhibitors and microbubble contact, only transient receptor potential vanilloid 1 (TRPV1) and TRPV4 inhibitors robustly suppressed the microbubble-induced degranulation. Likewise, the elevated fluorescence intensity of cytosolic calcium level was also significantly weaken. The results demonstrated microbubble stimulus effectively promoted BMMCs degranulation, which could be substantially restrained by inhibitors targeted for blocking TRPV1 or TRPV4 channel. The alternation of intracellular calcium level in BMMCs was consistent with the changes of degranulation capacity. It's suggested that the activation of BMMCs by microbubbles may involve specific TRP calcium dependent channels.
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Affiliation(s)
- Jia Liu
- Department of Dermatology, Changhai HospitalSecond Military Medical University (The First Affiliated Hospital of Naval Medical University)ShanghaiChina
| | - Long Qing
- Department of Naval Diving Medicine, Naval Medical CenterNaval Medical UniversityShanghaiChina
| | - Yufei He
- Department of Dermatology, Changhai HospitalSecond Military Medical University (The First Affiliated Hospital of Naval Medical University)ShanghaiChina
| | - Qihui Zhu
- Department of Dermatology, Changhai HospitalSecond Military Medical University (The First Affiliated Hospital of Naval Medical University)ShanghaiChina
| | - Weigang Xu
- Department of Diving and Hyperbaric Medical Research, Naval Medical CenterNaval Medical UniversityShanghaiChina
| | - Jianhua Wu
- Department of Dermatology, Changhai HospitalSecond Military Medical University (The First Affiliated Hospital of Naval Medical University)ShanghaiChina
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10
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Marsh PL, Moore EE, Moore HB, Bunch CM, Aboukhaled M, Condon SM, Al-Fadhl MD, Thomas SJ, Larson JR, Bower CW, Miller CB, Pearson ML, Twilling CL, Reser DW, Kim GS, Troyer BM, Yeager D, Thomas SG, Srikureja DP, Patel SS, Añón SL, Thomas AV, Miller JB, Van Ryn DE, Pamulapati SV, Zimmerman D, Wells B, Martin PL, Seder CW, Aversa JG, Greene RB, March RJ, Kwaan HC, Fulkerson DH, Vande Lune SA, Mollnes TE, Nielsen EW, Storm BS, Walsh MM. Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies. Front Immunol 2023; 14:1230049. [PMID: 37795086 PMCID: PMC10546929 DOI: 10.3389/fimmu.2023.1230049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/12/2023] [Indexed: 10/06/2023] Open
Abstract
Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.
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Affiliation(s)
- Phillip L. Marsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO, United States
| | - Hunter B. Moore
- University of Colorado Health Transplant Surgery - Anschutz Medical Campus, Aurora, CO, United States
| | - Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Michael Aboukhaled
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Shaun M. Condon
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | | | - Samuel J. Thomas
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - John R. Larson
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Charles W. Bower
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Craig B. Miller
- Department of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United States
| | - Michelle L. Pearson
- Department of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United States
| | | | - David W. Reser
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - George S. Kim
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Brittany M. Troyer
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Doyle Yeager
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Scott G. Thomas
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Daniel P. Srikureja
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Shivani S. Patel
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Sofía L. Añón
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine, South Bend, IN, United States
| | - Joseph B. Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - David E. Van Ryn
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
- Department of Emergency Medicine, Beacon Health System, Elkhart, IN, United States
| | - Saagar V. Pamulapati
- Department of Internal Medicine, Mercy Health Internal Medicine Residency Program, Rockford, IL, United States
| | - Devin Zimmerman
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Byars Wells
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Peter L. Martin
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Christopher W. Seder
- Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States
| | - John G. Aversa
- Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States
| | - Ryan B. Greene
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Robert J. March
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniel H. Fulkerson
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Stefani A. Vande Lune
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, United States
| | - Tom E. Mollnes
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Erik W. Nielsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Benjamin S. Storm
- Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Mark M. Walsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Indiana University School of Medicine, South Bend, IN, United States
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11
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Simonnet B, Roffi R, Lehot H, Morin J, Druelle A, Daubresse L, Louge P, de Maistre S, Gempp E, Vallee N, Blatteau JE. Therapeutic management of severe spinal cord decompression sickness in a hyperbaric center. Front Med (Lausanne) 2023; 10:1172646. [PMID: 37746073 PMCID: PMC10514493 DOI: 10.3389/fmed.2023.1172646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Spinal cord decompression sickness (scDCS) unfortunately has a high rate of long-term sequelae. The purpose of this study was to determine the best therapeutic management in a hyperbaric center and, in particular, the influence of hyperbaric treatment performed according to tables at 4 atm (Comex 30) or 2.8 atm abs (USNT5 or T6 equivalent). Methods This was a retrospective study that included scDCS with objective sensory or motor deficit affecting the limbs and/or sphincter impairment seen at a single hyperbaric center from 2010 to 2020. Information on dive, time to recompression, and in-hospital management (hyperbaric and medical treatments such as lidocaine) were analyzed as predictor variables, as well as initial clinical severity and clinical deterioration in the first 24 h after initial recompression. The primary endpoint was the presence or absence of sequelae at discharge as assessed by the modified Japanese Orthopaedic Association score. Results 102 divers (52 ± 16 years, 20 female) were included. In multivariate analysis, high initial clinical severity, deterioration in the first 24 h, and recompression tables at 4 atm versus 2.8 atm abs for both initial and additional recompression were associated with incomplete neurological recovery. Analysis of covariance comparing the effect of initial tables at 2.8 versus 4 atm abs as a function of initial clinical severity showed a significantly lower level of sequelae with tables at 2.8 atm. In studying correlations between exposure times to maximum or cumulative O2 dose and the degree of sequelae, the optimal initial treatment appears to be a balance between administration of a high partial pressure of O2 (2.8 atm) and a limited exposure duration that does not result in pulmonary oxygen toxicity. Further analysis suggests that additional tables in the first 24-48 h at 2.8 atm abs with a Heliox mixture may be beneficial, while the use of lidocaine does not appear to be relevant. Conclusion Our study shows that the risk of sequelae is related not only to initial severity but also to clinical deterioration in the first 24 h, suggesting the activation of biological cascades that can be mitigated by well-adapted initial and complementary hyperbaric treatment.
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Affiliation(s)
- Benjamin Simonnet
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Romain Roffi
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Henri Lehot
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Jean Morin
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Arnaud Druelle
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Lucille Daubresse
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Pierre Louge
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Sébastien de Maistre
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Emmanuel Gempp
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
| | - Nicolas Vallee
- Military Institute of Biomedical Research (IRBA), Subaquatic Operational Research Team (ERRSO), Toulon, France
| | - Jean-Eric Blatteau
- Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France
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12
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Boyle R, Gunga HC. Editorial: Insights in Environmental, Aviation and Space Physiology: 2022. Front Physiol 2023; 14:1278192. [PMID: 37731539 PMCID: PMC10507385 DOI: 10.3389/fphys.2023.1278192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
| | - Hanns-Christian Gunga
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
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13
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Vallée N, Dugrenot E, Desruelle AV, Richard S, Coupé S, Ramdani C, Guieu R, Risso JJ, Gaillard S, Guerrero F. Highlighting of the interactions of MYD88 and NFKB1 SNPs in rats resistant to decompression sickness: toward an autoimmune response. Front Physiol 2023; 14:1253856. [PMID: 37664439 PMCID: PMC10470123 DOI: 10.3389/fphys.2023.1253856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Decompression sickness (DCS) with neurological disorders includes an inappropriate inflammatory response which degenerates slowly, even after the disappearance of the bubbles. There is high inter-individual variability in terms of the occurrence of DCS that could have been mastered by the selection and then the breeding of DCS-resistant rats. We hypothesized the selection of single-nucleotide polymorphisms (SNPs) linked to autoimmunity operated upon a generation of a DCS-resistant strain of rats. We used the candidate gene approach and targeted SNPs linked to the signaling cascade that directly regulates inflammation of innate immunity transiting by the Toll-like receptors. Twenty candidate SNPs were investigated in 36 standard rats and 33 DCS-resistant rats. For the first time, we identify a diplotype (i.e., with matched haplotypes)-when coinherited-that strengthens protection against DCS, which is not strictly homozygous and suggests that a certain tolerance may be considered. We deduced an ideal haplotype of six variants from it (MyD88_50-T, _49-A, _97-C coupled to NFKB_85-T, _69-T, _45-T) linked to the resistant phenotype. Four among the six identified variants are located in pre- and/or post-transcriptional areas regulating MyD88 or NFKB1 expression. Because of missense mutations, the other two variants induce a structural change in the NFKB1 protein complex including one damage alteration according to the Missense3D algorithm. In addition to the MyD88/NFKB1 haplotype providing rats with a strong resistance to DCS, this also highlights the importance that the immune response, here linked to the genetic heritage, can have in the development of DCS and offer a new perspective for therapeutic strategies.
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Affiliation(s)
- Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | | | - Anne-Virginie Desruelle
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | | | | | - Céline Ramdani
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Régis Guieu
- Université d’Aix-Marseille, Marseille, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
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14
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Loddé B, Giroux-Metges MA, Galinat H, Kerspern H, Pougnet R, Saliou P, Guerrero F, Lafère P. Does Decreased Diffusing Capacity of the Lungs for Carbon Monoxide Constitute a Risk of Decompression Sickness in Occupational Divers? Int J Environ Res Public Health 2023; 20:6516. [PMID: 37569056 PMCID: PMC10418885 DOI: 10.3390/ijerph20156516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
Long-term alterations of pulmonary function (mainly decreased airway conductance and capacity of the lungs to diffuse carbon monoxide (DLCO)) have been described after hyperbaric exposures. However, whether these alterations convey a higher risk for divers' safety has never been investigated before. The purpose of the present pilot study was to assess whether decreased DLCO is associated with modifications of the physiological response to diving. In this case-control observational study, 15 "fit-to-dive" occupational divers were split into two groups according to their DLCO measurements compared to references values, either normal (control) or reduced (DLCO group). After a standardized 20 m/40 min dive in a sea water pool, the peak-flow, vascular gas emboli (VGE) grade, micro-circulatory reactivity, inflammatory biomarkers, thrombotic factors, and plasmatic aldosterone concentration were assessed at different times post-dive. Although VGE were recorded in all divers, no cases of decompression sickness (DCS) occurred. Compared to the control, the latency to VGE peak was increased in the DLCO group (60 vs. 30 min) along with a higher maximal VGE grade (p < 0.0001). P-selectin was higher in the DLCO group, both pre- and post-dive. The plasmatic aldosterone concentration was significantly decreased in the control group (-30.4 ± 24.6%) but not in the DLCO group. Apart from a state of hypocoagulability in all divers, other measured parameters remained unchanged. Our results suggest that divers with decreased DLCO might have a higher risk of DCS. Further studies are required to confirm these preliminary results.
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Affiliation(s)
- Brice Loddé
- ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France
- Occupational Diseases Center, Brest University Hospital, 29609 Brest, France
| | - Marie-Agnès Giroux-Metges
- ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France
- Respiratory Functional Exploration Unit, Brest University Hospital, 29609 Brest, France
| | - Hubert Galinat
- Department of Biological Hematology, Brest University Hospital, 29609 Brest, France
| | - Hèlène Kerspern
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, 29609 Brest, France
| | - Richard Pougnet
- Occupational Diseases Center, Brest University Hospital, 29609 Brest, France
| | - Philippe Saliou
- ISERM, EFS, UMR 1078, GGB, Infection Control Unit, Western Brittany University (UBO), 29238 Brest, France
| | - François Guerrero
- ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France
| | - Pierre Lafère
- ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France
- Environmental, Occupational, Ageing (Integrative) Physiology Laboratory, HE2B, 1160 Brussels, Belgium
- DAN Europe Research Department, 1160 Brussels, Belgium
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15
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Garcia-Parraga D, Crespo-Picazo JL, Sterba-Boatwright B, Marco V, Muñoz-Baquero M, Robinson NJ, Stacy B, Fahlman A. New insights into risk variables associated with gas embolism in loggerhead sea turtles ( Caretta caretta) caught in trawls and gillnets. Conserv Physiol 2023; 11:coad048. [PMID: 37425482 PMCID: PMC10326834 DOI: 10.1093/conphys/coad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Tissue and blood gas embolism (GE) associated with fisheries bycatch are likely a widespread, yet underestimated, cause of sea turtle mortality. Here, we evaluated risk factors associated with tissue and blood GE in loggerhead turtles caught incidentally by trawl and gillnet fisheries on the Valencian coastline of Spain. Of 413 turtles (303 caught by trawl, 110 by gillnet fisheries), 54% (n = 222) exhibited GE. For sea turtles caught in trawls, the probability and severity of GE increased with trawl depth and turtle body mass. In addition, trawl depth and the GE score together explained the probability of mortality (P[mortality]) following recompression therapy. Specifically, a turtle with a GE score of 3 caught in a trawl deployed at 110 m had a P[mortality] of ~50%. For turtles caught in gillnets, no risk variables were significantly correlated with either the P[GE] or GE score. However, gillnet depth or GE score, separately, explained P[mortality], and a turtle caught at 45 m or with a GE score between 3 and 4 had a P[mortality] of 50%. Differences in the fishery characteristics precluded direct comparison of GE risk and mortality between these gear types. Although P[mortality] is expected to be significantly higher in untreated turtles released at sea, our findings can improve estimates of sea turtle mortality associated with trawls and gillnets, and help guide associate conservation efforts.
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Affiliation(s)
- Daniel Garcia-Parraga
- Fundación Oceanogràfic de la Comunitat Valenciana, Gran Vía Marqués del Turia 19, 46005 Valencia, Spain
| | - Jose Luis Crespo-Picazo
- Fundación Oceanogràfic de la Comunitat Valenciana, Gran Vía Marqués del Turia 19, 46005 Valencia, Spain
| | | | - Vicente Marco
- Fundación Oceanogràfic de la Comunitat Valenciana, Gran Vía Marqués del Turia 19, 46005 Valencia, Spain
| | - Marta Muñoz-Baquero
- Fundación Oceanogràfic de la Comunitat Valenciana, Gran Vía Marqués del Turia 19, 46005 Valencia, Spain
| | - Nathan J Robinson
- Fundación Oceanogràfic de la Comunitat Valenciana, Gran Vía Marqués del Turia 19, 46005 Valencia, Spain
- Institut de Ciències del Mar, Spanish National Research Council - Consejo Superior de Investigaciones Científicas, Barcelona 08003, Spain
| | - Brian Stacy
- National Oceanic and Atmospheric Administration, National Marine Fisheries Service, Office of Protected Resources, University of Florida (Duty Station), PO Box 110885, 2187 Mowry Road, Gainesville, FL 32611, USA
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16
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Arya AK, Balestra C, Bhopale VM, Tuominen LJ, Räisänen-Sokolowski A, Dugrenot E, L’Her E, Bhat AR, Thom SR. Elevations of Extracellular Vesicles and Inflammatory Biomarkers in Closed Circuit SCUBA Divers. Int J Mol Sci 2023; 24:5969. [PMID: 36983042 PMCID: PMC10053377 DOI: 10.3390/ijms24065969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Blood-borne extracellular vesicles and inflammatory mediators were evaluated in divers using a closed circuit rebreathing apparatus and custom-mixed gases to diminish some diving risks. "Deep" divers (n = 8) dove once to mean (±SD) 102.5 ± 1.2 m of sea water (msw) for 167.3 ± 11.5 min. "Shallow" divers (n = 6) dove 3 times on day 1, and then repetitively over 7 days to 16.4 ± 3.7 msw, for 49.9 ± 11.9 min. There were statistically significant elevations of microparticles (MPs) in deep divers (day 1) and shallow divers at day 7 that expressed proteins specific to microglia, neutrophils, platelets, and endothelial cells, as well as thrombospondin (TSP)-1 and filamentous (F-) actin. Intra-MP IL-1β increased by 7.5-fold (p < 0.001) after day 1 and 41-fold (p = 0.003) at day 7. Intra-MP nitric oxide synthase-2 (NOS2) increased 17-fold (p < 0.001) after day 1 and 19-fold (p = 0.002) at day 7. Plasma gelsolin (pGSN) levels decreased by 73% (p < 0.001) in deep divers (day 1) and 37% in shallow divers by day 7. Plasma samples containing exosomes and other lipophilic particles increased from 186% to 490% among the divers but contained no IL-1β or NOS2. We conclude that diving triggers inflammatory events, even when controlling for hyperoxia, and many are not proportional to the depth of diving.
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Affiliation(s)
- Awadhesh K. Arya
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Costantino Balestra
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1090 Brussels, Belgium
- DAN Europe Research Division, DAN Europe Foundation, 64026 Roseto degli Abruzzi, Italy
| | - Veena M. Bhopale
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Laura J. Tuominen
- DAN Europe Research Division, DAN Europe Foundation, 64026 Roseto degli Abruzzi, Italy
| | | | - Emmanuel Dugrenot
- Divers Alert Network, Durham, NC 27707, USA
- Laboratoire ORPHY, EA 4324, Université de Bretagne Occidentale UFR Science, 29238 Brest, France
| | - Erwan L’Her
- LaTIM INSERM UMR 1101, Université de Bretagne Occidentale UFR Science, 29238 Brest, France
| | - Abid R. Bhat
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Stephen R. Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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17
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Kongkamol C, Kongkamol P, Phanlamai C, Sathirapanya P, Sathirapanya C. Role of health locus of control in preventing occupational decompression sickness among deep-sea fisherman divers. Health Psychol Behav Med 2023; 11:2156345. [PMID: 36860422 PMCID: PMC9969968 DOI: 10.1080/21642850.2022.2156345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous fisherman divers frequently experience decompression sickness (DCS). This study aimed to evaluate the associations between the level of knowledge of safe diving, beliefs in the health locus of control (HLC), and regular diving practices with DCS among the indigenous fisherman divers on Lipe island. The correlations among the level of beliefs in HLC, knowledge of safe diving and regular diving practices were evaluated also. Method We enrolled the fisherman divers on Lipe island and collected their demographics, health indices, levels of knowledge of safe diving, beliefs in external and internal HLC (EHLC and IHLC), and regular diving practices to evaluate the associations with the occurrence of DCS by logistic regression analysis. Pearson's correlation was used to test the correlations among the level of beliefs in IHLC and EHLC, knowledge of safe diving, and regular diving practices. Results Fifty-eight male fisherman divers whose mean age was 40.39 (±10.61) (range 21-57) years were enrolled. Twenty-six (44.8%) participants had experienced DCS. Body mass index (BMI), alcohol consumption, diving depth, duration of time in the sea/dive, level of beliefs in HLC and regular diving practices were significantly associated with DCS (p < 0.05). Level of belief in IHLC had a significantly strong reverse correlation with that in EHLC and a moderate correlation with level of knowledge of safe diving and regular diving practices. By contrast, level of belief in EHLC had a significantly moderate reverse correlation with level of knowledge of safe diving and regular diving practices (p < 0.001). Conclusions Encouraging the fisherman divers' belief in IHLC could be beneficial for their occupational safety.
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Affiliation(s)
- Chanon Kongkamol
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Piyada Kongkamol
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chutima Phanlamai
- Health Promotion Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Pornchai Sathirapanya
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chutarat Sathirapanya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Health Impact Assessment Research Center, Prince of Songkla University, Hat Yai, Songkhla, Thailand, Chutarat Sathirapanya Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand; Health Impact Assessment Research Center, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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18
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Asya M, Axel B. Commentary: Comparison of newer hand-held ultrasound devices for post-dive venous gas emboli quantification to standard echocardiography. Front Physiol 2023; 13:1074436. [PMID: 36685195 PMCID: PMC9849592 DOI: 10.3389/fphys.2022.1074436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
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Jüttner B, Wölfel C, Camponovo C, Schöppenthau H, Meyne J, Wohlrab C, Werr H, Klein T, Schmeißer G, Theiß K, Wolf P, Müller O, Janisch T, Naser J, Blödt S, Muche-Borowski C. S2k guideline for diving accidents. Ger Med Sci 2023; 21:Doc01. [PMID: 37033772 PMCID: PMC10073983 DOI: 10.3205/000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 04/11/2023]
Abstract
For the purposes of this guideline, a diving accident is defined as an event that is either potentially life-threatening or hazardous to health as a result of a reduction in ambient pressure while diving or in other hyperbaric atmospheres with and without diving equipment. This national consensus-based guideline (development grade S2k) presents the current state of knowledge and recommendations on the diagnosis and treatment of diving accident victims. The treatment of a breath-hold diver as well as children and adolescents does not differ in principle. In this regard only unusual tiredness and itching without visible skin changes are mild symptoms. The key action statements: on-site 100% oxygen first aid treatment, immobilization/no unnecessary movement, fluid administration and telephone consultation with a diving medicine specialist are recommended. Hyperbaric oxygen therapy (HBOT) remains unchanged as the established treatment in severe cases, as there are no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa.
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Affiliation(s)
- Björn Jüttner
- German Diving and Hyperbaric Medical Society (GTÜM)
- *To whom correspondence should be addressed: Björn Jüttner, Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, E-mail:
| | | | | | - Holger Schöppenthau
- German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)
| | | | - Carmen Wohlrab
- Naval Medical Institute of the German Navy (SchiffMedInstM)
| | - Henning Werr
- Naval Medical Institute of the German Navy (SchiffMedInstM)
| | - Till Klein
- Association of German Hyperbaric Treatment Centers (VDD)
| | - Giso Schmeißer
- German Society for Occupational and Environmental Medicine (DGAUM)
| | | | | | - Oliver Müller
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Thorsten Janisch
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Johannes Naser
- Professional Association of German Anaesthesiologists (BDA)
| | - Susanne Blödt
- Association of the Scientific Medical Societies in Germany (AWMF)
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Lee HJ, Lim DS, Kang YC. Recurrent Decompression Illness Even After the Closure of Patent Foramen Ovale in a Diver. JACC Case Rep 2022; 5:101687. [PMID: 36636504 PMCID: PMC9830462 DOI: 10.1016/j.jaccas.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/26/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
Patent foramen ovale (PFO) is a risk factor for the development of decompression illness (DCI) and a therapeutic target for preventing the recurrence of DCI because nitrogen bubbles generated during diving can be paradoxically embolized through the PFO. Here, we report the case of a diver who experienced recurrent DCI even after a successful PFO closure. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea,Address for correspondence: Dr. Hyun-Jong Lee, Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, 91-121 Sosa 2-Dong, Sosa-Gu, Bucheon 14574, Republic of Korea.
| | - Dal Soo Lim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
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Miller ML, Glandon HL, Tift MS, Pabst DA, Koopman HN. Remarkable consistency of spinal cord microvasculature in highly adapted diving odontocetes. Front Physiol 2022; 13:1011869. [PMID: 36505066 PMCID: PMC9728530 DOI: 10.3389/fphys.2022.1011869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
Odontocetes are breath-hold divers with a suite of physiological, anatomical, and behavioral adaptations that are highly derived and vastly different from those of their terrestrial counterparts. Because of these adaptations for diving, odontocetes were originally thought to be exempt from the harms of nitrogen gas embolism while diving. However, recent studies have shown that these mammals may alter their dive behavior in response to anthropogenic sound, leading to the potential for nitrogen supersaturation and bubble formation which may cause decompression sickness in the central nervous system (CNS). We examined the degree of interface between blood, gases, and neural tissues in the spinal cord by quantifying its microvascular characteristics in five species of odontocetes (Tursiops truncatus, Delphinus delphis, Grampus griseus, Kogia breviceps, and Mesoplodon europaeus) and a model terrestrial species (the pig-Sus scrofa domesticus) for comparison. This approach allowed us to compare microvascular characteristics (microvascular density, branching, and diameter) at several positions (cervical, thoracic, and lumbar) along the spinal cord from odontocetes that are known to be either deep or shallow divers. We found no significant differences (p < 0.05 for all comparisons) in microvessel density (9.30-11.18%), microvessel branching (1.60-2.12 branches/vessel), or microvessel diameter (11.83-16.079 µm) between odontocetes and the pig, or between deep and shallow diving odontocete species. This similarity of spinal cord microvasculature anatomy in several species of odontocetes as compared to the terrestrial mammal is in contrast to the wide array of remarkable physio-anatomical adaptations marine mammals have evolved within their circulatory system to cope with the physiological demands of diving. These results, and other studies on CNS lipids, indicate that the spinal cords of odontocetes do not have specialized features that might serve to protect them from Type II DCS.
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22
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Balestra C, Arya AK, Leveque C, Virgili F, Germonpré P, Lambrechts K, Lafère P, Thom SR. Varying Oxygen Partial Pressure Elicits Blood-Borne Microparticles Expressing Different Cell-Specific Proteins-Toward a Targeted Use of Oxygen? Int J Mol Sci 2022; 23:7888. [PMID: 35887238 DOI: 10.3390/ijms23147888] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 02/06/2023] Open
Abstract
Oxygen is a powerful trigger for cellular reactions, but there are few comparative investigations assessing the effects over a large range of partial pressures. We investigated a metabolic response to single exposures to either normobaric (10%, 15%, 30%, 100%) or hyperbaric (1.4 ATA, 2.5 ATA) oxygen. Forty-eight healthy subjects (32 males/16 females; age: 43.7 ± 13.4 years, height: 172.7 ± 10.07 cm; weight 68.4 ± 15.7 kg) were randomly assigned, and blood samples were taken before and 2 h after each exposure. Microparticles (MPs) expressing proteins specific to different cells were analyzed, including platelets (CD41), neutrophils (CD66b), endothelial cells (CD146), and microglia (TMEM). Phalloidin binding and thrombospondin-1 (TSP), which are related to neutrophil and platelet activation, respectively, were also analyzed. The responses were found to be different and sometimes opposite. Significant elevations were identified for MPs expressing CD41, CD66b, TMEM, and phalloidin binding in all conditions but for 1.4 ATA, which elicited significant decreases. Few changes were found for CD146 and TSP. Regarding OPB, further investigation is needed to fully understand the future applications of such findings.
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Apostolos A, Drakopoulou M, Trantalis G, Synetos Α, Oikonomou G, Karapanayiotides T, Tsioufis C, Toutouzas K. The management of patent foramen ovale in divers: where do we stand? Ther Adv Neurol Disord 2022; 15:17562864221103459. [PMID: 35837370 PMCID: PMC9274415 DOI: 10.1177/17562864221103459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Diving is a fascinating activity, but it does not come without any cost; decompression illness (DCI) is one of the most frequent diseases occurring in divers. Rapid surfacing after diving causes alveolar rupture and bubbles release, which enter in the systemic circulation and could embolize numerous organs and tissues. The presence of patent foramen ovale (PFO) contributes to the passage of venous gas bubbles into the arterial circulation, increasing the risk of complications related to DCI. The diagnosis is established with a detailed medical history, a comprehensive clinical evaluation, and a multimodal imaging approach. Although the percutaneous closure of PFO is ambiguous for divers, as a primary prevention strategy, transcatheter management is considered as beneficial for DCI recurrence prevention. The aim of this study is to introduce the basic principles of DCI, to review the pathophysiological connection between DCI and PFO, to highlight the risk factors and the optimal treatment, and, last but not least, to shed light on the role of closure as primary and secondary prevention.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Αndreas Synetos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Oikonomou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- Professor of Cardiology, First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Avenue, Athens 115 27, Greece
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24
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Kim DJ, Han JW. Latent Class Analysis of Decompression Sickness Symptoms of Women Divers. Healthcare (Basel) 2022; 10:healthcare10071246. [PMID: 35885774 PMCID: PMC9317702 DOI: 10.3390/healthcare10071246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to investigate the types of clinical manifestations of decompression sickness among women divers (haenyeos) in Jeju using latent class analysis and to identify factors related to the condition. A total of 527 haenyeos who received their certification in diving fishery from Jeju and were working from 15 March to 31 May 2021 were included in this study. According to the results of the study, the latent classes were classified into type 1, type 2, and mixed symptoms groups (Akaike information criterion (AIC) = 6587.29, Bayesian information criterion (BIC) = 6698.23, sample size-adjusted BIC (saBIC) = 6615.70). For personal characteristics, age (χ2 = 40.31, p < 0.001) and education level (χ2 = 28.15, p < 0.001) showed a significant difference by latent class type. For work-related characteristics, diving experience (χ2 = 29.99, p < 0.001) and break time (χ2 = 9.32, p = 0.011) showed a significant difference by latent class type. The health-related characteristics, menopausal period (χ2 = 40.10, p < 0.001), body mass index (χ2 = 14.80, p = 0.013), and fatigue level (χ2 = 58.23, p < 0.001), showed a significant difference by latent class type. Rather than approaching the management of work-related diseases simply from the work environment perspective, it is important to increase the availability of health professionals who are capable of continuous health monitoring and management of women divers in their workplace.
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25
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Karimpour K, Brenner RJ, Dong GZ, Cleve J, Martina S, Harris C, Graf GJ, Kistler BJ, Hoang AH, Jackson O, Papadopoulou V, Tillmans F. Comparison of Newer Hand-Held Ultrasound Devices for Post-Dive Venous gas Emboli Quantification to Standard Echocardiography. Front Physiol 2022; 13:907651. [PMID: 35755430 PMCID: PMC9222333 DOI: 10.3389/fphys.2022.907651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
Decompression sickness (DCS) can result from the growth of bubbles in tissues and blood during or after a reduction in ambient pressure, for example in scuba divers, compressed air workers or astronauts. In scuba diving research, post-dive bubbles are detectable in the venous circulation using ultrasound. These venous gas emboli (VGE) are a marker of decompression stress, and larger amounts of VGE are associated with an increased probability of DCS. VGE are often observed for hours post-dive and differences in their evolution over time have been reported between individuals, but also for the same individual, undergoing a same controlled exposure. Thus, there is a need for small, portable devices with long battery lives to obtain more ultrasonic data in the field to better assess this inter- and intra-subject variability. We compared two new handheld ultrasound devices against a standard device that is currently used to monitor post-dive VGE in the field. We conclude that neither device is currently an adequate replacement for research studies where precise VGE grading is necessary.
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Affiliation(s)
- Kamellia Karimpour
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
| | | | | | - Jayne Cleve
- Divers Alert Network, Durham, NC, United States
| | | | | | | | | | - Andrew H Hoang
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
| | | | - Virginie Papadopoulou
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
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26
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Kohshi K, Morimatsu Y, Nishikiori H, Kondo T, Tamaki H, Ishitake T. [The Japanese Law Regulating Underwater and Caisson Work: Current Issues and Future Developments]. J UOEH 2022; 44:359-372. [PMID: 36464310 DOI: 10.7888/juoeh.44.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The Japan "Ordinance on Safety and Health of Work under High Pressure", which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.
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Affiliation(s)
- Kiyotaka Kohshi
- Division of Neurosurgery, Nishinihon Hospital, Higashi-ku, Kumamoto 861-8034, Japan
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
| | - Yoshitaka Morimatsu
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
| | - Hideharu Nishikiori
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
- Diving Engineering Department, Chugoku Diving Company Limited, Iwakuni 740-0032, Japan
| | - Toshihiro Kondo
- Corporate Planning Department, 2nd team, Oriental Shiraishi Corporation, Koto-ku, Tokyo 135-0061, Japan
| | - Hideki Tamaki
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
- Division of Surgery and General Medicine, Tamaki Hospital, Hagi 758-0071, Japan
| | - Tatsuya Ishitake
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
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27
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Ninokawa S, Nordham K. Discovery of caisson disease: a dive into the history of decompression sickness. Proc AMIA Symp 2022; 35:129-132. [PMID: 34970062 DOI: 10.1080/08998280.2021.1967021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
With the Industrial Revolution and the invention of compressed air came mysterious symptoms of unknown etiology. Through careful observation and diligent work from physicians in the 19th century, the true nature of caisson disease was identified and described. By studying thousands of casualties, these scientists were able to identify the cause of caisson disease, develop effective treatment plans for laborers, and institute procedures to prevent this malady. Over the next 100 years, numerous advancements in diving medicine would allow for the creation of the highly accurate dive tables that we have today. Much of our understanding of decompression sickness, however, still stems from the observations and scientific endeavors of the 1800s.
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Affiliation(s)
- Scott Ninokawa
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Kristen Nordham
- Tulane University School of Medicine, New Orleans, Louisiana
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28
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Saharan S, Vettukattil J, Bhat A, Amula V, Bansal M, Chowdhury D, Dyamenahalli U, Gupta SK, Das B, Susheel Kumar TK, Muralidaran A, Trivedi K, Swaminathan S, Bansal N, Doshi U, Hoskoppal A, Balaji S. Patent foramen ovale in children: Unique pediatric challenges and lessons learned from adult literature. Ann Pediatr Cardiol 2022; 15:44-52. [PMID: 35847406 PMCID: PMC9280096 DOI: 10.4103/apc.apc_67_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 11/05/2022] Open
Abstract
A patent foramen ovale (PFO) is a frequent incidental finding during echocardiography in otherwise healthy children. In most healthy children with a diagnosis of isolated incidental PFO, no further follow-up or intervention is necessary. In some children, PFO is associated with certain clinical syndromes such as cryptogenic stroke, decompression sickness, migraine, and platypnea-orthodeoxia syndrome. This review discusses PFO anatomy, diagnostic imaging, PFO-associated clinical situations, management options, and the role of PFO in certain congenital heart disease. This review also highlights the current deficiency of pediatric data guiding management of these uncommon but important PFO-associated conditions. Future multicenter randomized controlled studies are necessary to guide the management of these unique and challenging PFO-associated conditions.
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Affiliation(s)
- Sunil Saharan
- Department of Pediatrics, Division of Cardiology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA,Address for correspondence: Dr. Sunil Saharan, Department of Pediatrics, Division of Cardiology, New York University Langone Health, 550 First Avenue, New York, NY 10016, USA. E-mail:
| | - Joseph Vettukattil
- Department of Pediatrics, Division of Cardiology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Aarti Bhat
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Venu Amula
- Department of Pediatrics, Division of Critical Care, Primary Children's Hospital and University of Utah, Salt Lake City, UT, USA
| | - Manish Bansal
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | | | - Umesh Dyamenahalli
- Department of Pediatrics, Division of Pediatric Cardiology, University of Chicago, Chicago, IL, USA
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bibhuti Das
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - T. K. Susheel Kumar
- Department of Surgery, Section of Congenital and Pediatric Cardiac Surgery, New York University Langone Health, New York, NY, USA
| | - Ashok Muralidaran
- Department of Surgery, Section of Congenital and Pediatric Cardiac Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Kalyani Trivedi
- Department of Pediatrics, Heart and Vascular Institute, Arnot Health, Elmira, New York, USA
| | - Sethuraman Swaminathan
- Department of Pediatrics, Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Bansal
- Department of Pediatrics, Division of Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, NY, USA
| | - Unnati Doshi
- Department of Pediatrics, Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arvind Hoskoppal
- Department of Pediatrics, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health and Science University, Portland, OR, USA
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29
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Kurtul S, Güngördü N. Dysbaric osteonecrosis in diving fisherman: a case report. Med Lav 2022; 113:e2022034. [PMID: 36006094 PMCID: PMC9484289 DOI: 10.23749/mdl.v113i4.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dysbaric osteonecrosis (DON) is defined as avascular bone necrosis, usually involving specific parts of the long bones, which is seen in divers or compressed-air workers due to exposure to pressure. We describe a case of DON in an artisanal diving fisherman working underwater for many years. Methods: A 48-year-old male case was admitted to the occupational disease outpatient with left shoulder and arm pain for 1-2 years. Since the age of 20, he has been artisanal diving fishing with a hookah at a depth of 20-25 meters in the sea. In 2011, he received hyperbaric oxygen therapy for widespread pain in the whole body due to decompression sickness (DCS). In the case's left shoulder joint x-ray and magnetic resonance imaging, degenerative changes in the acromioclavicular joint and signal changes consistent with osteonecrosis starting from the subcortical area of the humeral head and extending to the proximal shaft of the humerus were observed. Conclusions: DON is among the most common long-term pathologies in professional divers. In Turkey, as in our case, not applying safe decompression procedures and unsafe diving practices are common among diving fishers. In studies, the frequency of exposure to pressure, duration and depth of dive, insufficient decompression, formation of DCS and increasing age were associated with DON. Today, DON remains an occupational hazard with significant medical and social consequences. Diving fishers should be informed about the sequelae of DCS and trained on the safety measures to be taken.
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Affiliation(s)
- Seher Kurtul
- Department of Occupational Disease, Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Nejdiye Güngördü
- Department of Occupational Disease, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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30
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Germonpré P, Lafère P, Portier W, Germonpré FL, Marroni A, Balestra C. Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The "Carotid Doppler" Study). Front Physiol 2021; 12:763408. [PMID: 34777020 PMCID: PMC8586212 DOI: 10.3389/fphys.2021.763408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Divers with a patent Foramen Ovale (PFO) have an increased risk for decompression sickness (DCS) when diving with compressed breathing gas. The relative risk increase, however, is difficult to establish as the PFO status of divers is usually only determined after a DCS occurrence. Methods: This prospective, single-blinded, observational study was designed to collect DCS data from volunteer divers after screening for right-to-left shunt (RLS) using a Carotid Doppler test. Divers were blinded to the result of the test, but all received a standardized briefing on current scientific knowledge of diving physiology and “low-bubble” diving techniques; they were then allowed to dive without restrictions. After a mean interval of 8 years, a questionnaire was sent collecting data on their dives and cases of DCS (if any occurred). Results: Data was collected on 148 divers totaling 66,859 dives. There was no significant difference in diving data between divers with or without RLS. Divers with RLS had a 3.02 times higher incidence of (confirmed) DCS than divers without RLS (p = 0.04). When all cases of (confirmed or possible DCS) were considered, the Relative Risk was 1.42 (p = 0.46). DCS occurred mainly in divers who did not dive according to “low-bubble” diving techniques, in both groups. Conclusion: This prospective study confirms that DCS is more frequent in divers with RLS (such as a PFO), with a Relative Risk of 1.42 (all DCS) to 3.02 (confirmed DCS). It appears this risk is linked to diving behavior, more specifically diving to the limits of the adopted decompression procedures.
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Affiliation(s)
- Peter Germonpré
- Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium.,Divers Alert Network (DAN) Europe Research Division, Roseto, Italy
| | - Pierre Lafère
- Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium.,Divers Alert Network (DAN) Europe Research Division, Roseto, Italy.,Environmental & Occupational, Ageing (Integrative) Physiology Lab, Haute Ecole Bruxelles-Brabant (HE2B), Auderghem, Belgium
| | - William Portier
- Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium
| | | | - Alessandro Marroni
- Environmental & Occupational, Ageing (Integrative) Physiology Lab, Haute Ecole Bruxelles-Brabant (HE2B), Auderghem, Belgium
| | - Costantino Balestra
- Divers Alert Network (DAN) Europe Research Division, Roseto, Italy.,Environmental & Occupational, Ageing (Integrative) Physiology Lab, Haute Ecole Bruxelles-Brabant (HE2B), Auderghem, Belgium.,Physical Activity Teaching Unit, Motor Sciences Department, Université Libre de Bruxelles (ULB), Brussels, Belgium
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31
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Wu W, Guo BB, Zhang JG, Wang RS, Ruan HB, Liu L. Forensic Identification of Diving Deaths. Fa Yi Xue Za Zhi 2021; 37:683-686. [PMID: 35187921 DOI: 10.12116/j.issn.1004-5619.2020.400501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Investigation of the cause of death during diving is one of the contents of forensic pathology. In this article, relevant foreign literature is reviewed to summarize the techniques and methods used in the identification of diving deaths, such as accident reconstruction, diving monitoring data, postmortem CT examination and gas analysis (location and quantity) in the body of the corpse, in order to provide a reference for forensic identification of such cases.
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Affiliation(s)
- Wei Wu
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Bing-Bing Guo
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Jing-Guo Zhang
- Chaoyang District Sub-bureau, Public Security Bureau of Beijing, Beijing 100025, China
| | - Rong-Shuai Wang
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Hong-Bin Ruan
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Liang Liu
- Department of Forensic Medicine, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
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32
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Xu J, Fang YQ, Bao XC, Yuan HR, Wang N, Wang FF. [Effect of nuclear radiation on rat model of decompression sickness induced by large depth rapid floating escape]. Zhongguo Ying Yong Sheng Li Xue Za Zhi 2021; 37:486-489. [PMID: 34816658 DOI: 10.12047/j.cjap.6086.2021.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To investigate the effects of different doses of nuclei exposure at different time on morbidity, mortality, and damage indicators in a rat model of decompression sickness caused by rapid flotation escape at a large depth. Methods: Eighty male SD rats were randomly divided into blank control group, escape control group and six intervention groups (escape at 4 hours after 4 Gy radiation, escape at 4 hours after 6 Gy radiation, escape at 4 hours after 12 Gy radiation, escape at 8 hours after 4 Gy radiation, escape at 8 hours after 6 Gy radiation, escape at 8 hours after 12 Gy radiation). Rats in intervention groups were exposed to different doses of γ-ray (4,6,12 Gy, respectively), and then were carried out a large depth and rapid buoyancy escape experiment (maximum pressure depth of 150 m). The changes of lung W/D, spleen index and plasma IL-1β levels were analyzed. Results: Compared with the blank control group, decompression sickness incidence and mortality of rats in escape groups after nuclear exposure were increased significantly. In 4 Gy and 6 Gy irradiation groups, higher morbidity and mortality were observed in rats which escaped at 4 h post nuclear exposure when compared with rats in 8 h groups. Consistent with the changes in morbidity and mortality, the wet / dry ratio of lung tissue, the pathological damage of lung tissue, and the decrease of spleen index showed the same trends: the changes were obvious at 4 h after lower doses nuclear radiation (4 Gy and 6 Gy), not at 8 h. However, these indicators all changed markedly at 4 and 8 h after higher doses nuclear radiation (12 Gy). Plasma IL-1β levels were significantly increased in each post-radiation exposure group when compared with the blank control group and the exposed control group. Conclusion: Nuclear radiation-induced lung injury, the damaged immune function and elevated plasma inflammatory factor concentrations increase the risk of decompression sickness after rapid ascent.
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Affiliation(s)
- Ji Xu
- Department of Diving and Hyperbaric Medicine, Naval Characteristic Medical Center, Naval Medical University, Shanghai 200433, China
| | - Yi-Qun Fang
- Department of Diving and Hyperbaric Medicine, Naval Characteristic Medical Center, Naval Medical University, Shanghai 200433, China
| | - Xiao-Chen Bao
- Department of Diving and Hyperbaric Medicine, Naval Characteristic Medical Center, Naval Medical University, Shanghai 200433, China
| | - Heng-Rong Yuan
- Department of Diving and Hyperbaric Medicine, Naval Characteristic Medical Center, Naval Medical University, Shanghai 200433, China
| | - Nan Wang
- Department of Diving and Hyperbaric Medicine, Naval Characteristic Medical Center, Naval Medical University, Shanghai 200433, China
| | - Fang-Fang Wang
- Department of Diving and Hyperbaric Medicine, Naval Characteristic Medical Center, Naval Medical University, Shanghai 200433, China
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Robinson NJ, García-Párraga D, Stacy BA, Costidis AM, Blanco GS, Clyde-Brockway CE, Haas HL, Harms CA, Patel SH, Stacy NI, Fahlman A. A Baseline Model For Estimating the Risk of Gas Embolism in Sea Turtles During Routine Dives. Front Physiol 2021; 12:678555. [PMID: 34539425 PMCID: PMC8440993 DOI: 10.3389/fphys.2021.678555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Sea turtles, like other air-breathing diving vertebrates, commonly experience significant gas embolism (GE) when incidentally caught at depth in fishing gear and brought to the surface. To better understand why sea turtles develop GE, we built a mathematical model to estimate partial pressures of N2 (PN2), O2 (PO2), and CO2 (PCO2) in the major body-compartments of diving loggerheads (Caretta caretta), leatherbacks (Dermochelys coriacea), and green turtles (Chelonia mydas). This model was adapted from a published model for estimating gas dynamics in marine mammals and penguins. To parameterize the sea turtle model, we used values gleaned from previously published literature and 22 necropsies. Next, we applied this model to data collected from free-roaming individuals of the three study species. Finally, we varied body-condition and cardiac output within the model to see how these factors affected the risk of GE. Our model suggests that cardiac output likely plays a significant role in the modulation of GE, especially in the deeper diving leatherback turtles. This baseline model also indicates that even during routine diving behavior, sea turtles are at high risk of GE. This likely means that turtles have additional behavioral, anatomical, and/or physiologic adaptions that serve to reduce the probability of GE but were not incorporated in this model. Identifying these adaptations and incorporating them into future iterations of this model will further reveal the factors driving GE in sea turtles.
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Affiliation(s)
- Nathan J. Robinson
- Department of Research, Fundación Oceanogràfic de la Comunidad Valenciana, Valencia, Spain
| | - Daniel García-Párraga
- Department of Research, Fundación Oceanogràfic de la Comunidad Valenciana, Valencia, Spain
| | - Brian A. Stacy
- National Oceanic and Atmospheric Administration, National Marine Fisheries Service, Office of Protected Resources, University of Florida (duty station), Washington, DC, United States
| | | | - Gabriela S. Blanco
- Instituto de Biología de Organismos Marinos (IBIOMAR-CCT CONICET-CENPAT), Puerto Madryn, Argentina
| | | | - Heather L. Haas
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA, United States
| | - Craig A. Harms
- Department of Clinical Sciences and Center for Marine Sciences and Technology, North Carolina State University, Raleigh, NC, United States
| | - Samir H. Patel
- Coonamessett Farm Foundation, East Falmouth, MA, United States
| | - Nicole I. Stacy
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Andreas Fahlman
- Department of Research, Fundación Oceanogràfic de la Comunidad Valenciana, Valencia, Spain
- Global Diving Research, Inc., Ottawa, ON, Canada
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Tseng WS, Tzeng NS, Lin KH, Huang NC, Huang MY, Kang BH. Effect of Long-Term Diving Exposure on Sleep of Male Occupational Divers in Southern Taiwan: A Cross-Sectional Study. Ann Work Expo Health 2021; 65:649-658. [PMID: 33511395 DOI: 10.1093/annweh/wxaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/10/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Divers with a history of decompression sickness may be at high risk for sleep problems. However, limited studies have investigated the relationship between diving exposure and sleep problems of occupational divers. This study investigated the association between diving exposure and sleep quality and quantity among male occupational divers in southern Taiwan. METHODS This descriptive, cross-sectional study included 52 occupational divers and 121 non-divers recruited from southern Taiwan in 2018. Survey data were collected using the Taiwanese version of the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and a self-report questionnaire that included demographic variables, diving exposure/protocols, and factors associated with sleep quality. RESULTS Among all participants examined, occupational divers were significantly more likely to have both poor sleep quality (adjusted odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.48-6.06; P = 0.002) and excessive daytime sleepiness (adjusted OR = 4.49; 95% CI = 2.12-9.52; P < 0.001). The diving exposure time, depth, ascent rate, and decompression table use showed no significant associations between poor and good sleepers in the divers group. However, a history of decompression sickness was associated with poor sleep quality among divers (adjusted OR = 2.20; 95% CI = 1.07-4.54; P = 0.032). CONCLUSIONS Our results showed that occupational divers had poor sleep quality and more excessive sleepiness than non-divers. Decompression sickness likely contributes to poor sleep quality. Prevention and early detection of decompression sickness-related sleep problems should be an occupational health priority.
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Affiliation(s)
- Wei-Shih Tseng
- Department of Diving and Hyperbaric Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Neurology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Kung-Hung Lin
- Department of Diving and Hyperbaric Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Division of Family Medicine, Department of Community Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Nan-Chieh Huang
- Department of Diving and Hyperbaric Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Division of Family Medicine, Department of Community Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Man-Yuan Huang
- Department of Diving and Hyperbaric Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Bor-Hwang Kang
- Department of Diving and Hyperbaric Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Otorhinolaryngology Head & Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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35
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Honěk J, Šrámek M, Honěk T, Tomek A, Šefc L, Januška J, Fiedler J, Horváth M, Novotný Š, Brabec M, Veselka J. Screening and Risk Stratification Strategy Reduced Decompression Sickness Occurrence in Divers With Patent Foramen Ovale. JACC Cardiovasc Imaging 2021:S1936-878X(21)00509-X. [PMID: 34419390 DOI: 10.1016/j.jcmg.2021.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This paper sought to evaluate the occurrence of decompression sickness (DCS) after the application of a patent foramen ovale (PFO) screening and risk stratification strategy. BACKGROUND PFO is associated with an increased risk of DCS. Recently, transcatheter closure was reported to reduce DCS occurrence in divers with a high-grade shunt. However, to date, there are no data regarding the effectiveness of any PFO screening and risk stratification strategy for divers. METHODS A total of 829 consecutive divers (35.4 ± 10.0 years, 81.5% men) were screened for PFO by means of transcranial color-coded sonography in the DIVE-PFO (Decompression Illness Prevention in Divers with a Patent Foramen Ovale) registry. Divers with a high-grade PFO were offered either catheter-based PFO closure (the closure group) or advised conservative diving (high grades). Divers with a low-grade shunt were advised conservative diving (low grades), whereas those with no PFO continued unrestricted diving (controls). A telephone follow-up was performed. To study the effect of the screening and risk stratification strategy, DCS occurrence before enrollment and during the follow-up was compared. RESULTS Follow-up was available for 748 (90%) divers. Seven hundred and 2 divers continued diving and were included in the analysis (mean follow-up 6.5 ± 3.5 years). The DCS incidence decreased significantly in all groups, except the controls. During follow-up, there were no DCS events in the closure group; DCS incidence was similar to the controls in the low-grade group (HR: 3.965; 95% CI: 0.558-28.18; P = 0.169) but remained higher in the high-grade group (HR: 26.170; 95% CI: 5.797-118.16; P < 0.0001). CONCLUSIONS The screening and risk stratification strategy using transcranial color-coded sonography was associated with a decrease in DCS occurrence in divers with PFO. Catheter-based PFO closure was associated with a DCS occurrence similar to the controls; the conservative strategy had a similar effect in the low-grade group, but in the high-grade group the DCS incidence remained higher than in all other groups.
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Han KH, Hyun GS, Jee YS, Park JM. Effect of Water Amount Intake before Scuba Diving on the Risk of Decompression Sickness. Int J Environ Res Public Health 2021; 18:7601. [PMID: 34300051 DOI: 10.3390/ijerph18147601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022]
Abstract
Background and objective: The aim of this study was to investigate the influence of pre-hydration levels on circulating bubble formation for scuba divers and to evaluate the appropriate volume of water intake for reducing the risk of decompression sickness (DCS). Materials and Methods: Twenty scuba divers were classified into four groups according to the volume of water taken in before scuba diving as follows: no-water-intake group (NWIG), 30%-water-intake group (30WIG), 50%-water intake group (50WIG), and 100%-water-intake group (100WIG). We measured the circulating bubbles using movement status by Doppler on the right and left subclavian veins and precordial regions at pre-dive, post-dive, and 30 min after diving to a depth of 30 m for a duration of 25 min at the bottom. Results: Participants belonging to the 30WIG showed the lowest frequency, percentage, and amplitude of bubbles and consequently the lowest bubble grade in the left and right subclavian veins and precordial region at post-time and 30 min after diving. Conclusions: It can be inferred that pre-hydration with 30% of the recommended daily water intake before scuba diving effectively suppressed the formation of bubbles after diving and decreased the risk of DCS.
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Zhang K, Zhang H, Yi H, Huang G, Zhao X, Yu S, Xu W. The protective effects of 1,3-butanediol acetoacetate diester on decompression sickness in rats. J Appl Physiol (1985) 2021; 131:435-441. [PMID: 34166120 DOI: 10.1152/japplphysiol.00035.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Inert gas bubbles are widely accepted as the causative factor of decompression sickness (DCS), resulting in gas embolism and systemic inflammatory responses. The anticonvulsive ketone ester 1,3-butanediol acetoacetate diester (BD-AcAc2) was reported to have the characteristics of increasing blood oxygen partial pressure (ppO2) and anti-inflammation and was thought to have the potential to reduce bubble formation and alleviate the pathological process of DCS. This study aims to investigate the potential protection of BD-AcAc2 against DCS in a rat model. A single dose of BD-AcAc2 was administered orally to adult male rats (5 g/kg body wt), followed by pharmacokinetic analysis or simulated air dives. After decompression, signs of DCS were monitored, and blood was sampled for biochemical measurements. Blood ketosis peaked at 2 h and lasted for more than 4 h. The incidence of DCS was decreased and postponed significantly in rats treated with BD-AcAc2 compared with those treated with saline (P < 0.05). Although BD-AcAc2 failed to reduce bubble load (P > 0.05), it showed an obvious decreasing trend. BD-AcAc2 significantly increased blood ppO2 and ameliorated oxidative and inflammatory responses, represented by increased plasma malondialdehyde (MDA), IL-1, IL-6, and TNF-α and decreased glutathione thiol (P < 0.05) levels, whereas blood pH remained unchanged (P > 0.05). These results suggest that BD-AcAc2 exerted beneficial effects on DCS rats mainly related to increasing ppO2 and anti-inflammatory and antioxidant properties. Together with its capacity for delaying central nervous system (CNS) oxygen toxicity seizures, BD-AcAc2 might be an ideal drug candidate for DCS prevention and treatment.NEW & NOTEWORTHY This is the first study exploring the effects of BD-AcAc2 on DCS prevention, and it was proven to be an efficient and simple method. The role of BD-AcAc2 in increasing ppO2, anti-inflammatory and antioxidant properties was thought to be the critical mechanism in DCS prevention.
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Affiliation(s)
- Kun Zhang
- Department of Diving and Hyperbaric Medicine, Naval Special Medicine Center, Naval Medical University, Shanghai, China
| | - Haidong Zhang
- Department of Organic Chemistry, School of Pharmacy, Naval Medical University, Shanghai, China
| | - Hongjie Yi
- Department of Hyperbaric Oxygen, The First Affiliated Hospital, Naval Medical University, Shanghai, China
| | - Guoyang Huang
- Department of Diving and Hyperbaric Medicine, Naval Special Medicine Center, Naval Medical University, Shanghai, China
| | - Xupeng Zhao
- Department of Diving and Hyperbaric Medicine, Naval Special Medicine Center, Naval Medical University, Shanghai, China
| | - Shichong Yu
- Department of Organic Chemistry, School of Pharmacy, Naval Medical University, Shanghai, China
| | - Weigang Xu
- Department of Diving and Hyperbaric Medicine, Naval Special Medicine Center, Naval Medical University, Shanghai, China
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Ata N, Cevık E. Approach to a Patient with Stroke After Flying. Neurol India 2021; 68:1224-1225. [PMID: 33109883 DOI: 10.4103/0028-3886.299138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Arriving at a definitive diagnosis in case of a patient with neurological symptoms after a low altitude flight is very critical, while at the same time presenting a dilemma in aeromedical decision making. Symptoms of stroke can closely mimic those of neurologic manifestations of decompression sickness. This paper discusses the approach to a case of a 28-year-old male helicopter passenger who developed left-sided numbness of the body after a 1.5 h flight at 13,000 feet altitude and was hospitalized with the diagnosis of transient ischemic attack.
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Affiliation(s)
- Nazim Ata
- Aeromedical Research and Training Center, Eskisehir, Turkey
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Elia A, Eiken O, Ånell R, Grönkvist M, Gennser M. Whole-body vibration preconditioning reduces the formation and delays the manifestation of high-altitude-induced venous gas emboli. Exp Physiol 2021; 106:1743-1751. [PMID: 34142740 DOI: 10.1113/ep089522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is performing a 30-min whole-body vibration (WBV) prior to a continuous 90-min exposure at 24,000 ft sufficient to prevent venous gas emboli (VGE) formation? What is the main finding and its importance? WBV preconditioning significantly reduces the formation and delays the manifestation of high-altitude-induced VGE. This study suggests that WBV is an effective strategy in lowering decompression stress. ABSTRACT Rapid decompression may give rise to formation of venous gas emboli (VGE) and resultantly, increase the risk of sustaining decompression sickness. Preconditioning aims at lowering the prevalence of VGE during decompression. The purpose of this study was to investigate the efficacy of whole-body vibration (WBV) preconditioning on high-altitude-induced VGE. Eight male subjects performed, on separate days in a randomised order, three preconditioning strategies: 40-min seated-rest (control), 30-min seated-rest followed by 150 knee-squats performed over a 10-min period (exercise) and 30-min WBV proceeded by a 10-min seated-rest. Thereafter, subjects were exposed to an altitude of 24,000 ft (7315 m) for 90 min whilst laying in a supine position and breathing 100% oxygen. VGE were assessed ultrasonically both during supine rest (5-min intervals) and after three fast, unloaded knee-bends (15-min intervals) and were scored using a 5-grade scale and evaluated using the Kisman Integrated Severity Score (KISS). There was a significant difference in VGE grade (P < 0.001), time to VGE manifestation (P = 0.014) and KISS score following knee-bends (P = 0.002) across protocols, with a trend in KISS score during supine rest (P = 0.070). WBV resulted in lower VGE grades (median (range), 1 (0-3)) and KISS score (2.69 ± 4.56 a.u.) compared with control (2 (1-3), P = 0.002; 12.86 ± 8.40 a.u., P = 0.011) and exercise (3 (2-4) , P < 0.001; 22.04 ± 13.45 a.u., P = 0.002). VGE were detected earlier during control (15 ± 14 min, P = 0.024) and exercise (17 ± 24 min, P = 0.032) than WBV (54 ± 38 min). Performing a 30-min WBV prior to a 90-min continuous exposure at 24,000 ft both delays the manifestation and reduces the formation of VGE compared with control and exercise preconditioning.
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Affiliation(s)
- Antonis Elia
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ola Eiken
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Rickard Ånell
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Mikael Grönkvist
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Mikael Gennser
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
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Magri K, Eftedal I, Petroni Magri V, Matity L, Azzopardi CP, Muscat S, Pace NP. Acute Effects on the Human Peripheral Blood Transcriptome of Decompression Sickness Secondary to Scuba Diving. Front Physiol 2021; 12:660402. [PMID: 34177613 PMCID: PMC8222921 DOI: 10.3389/fphys.2021.660402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/12/2021] [Indexed: 01/22/2023] Open
Abstract
Decompression sickness (DCS) develops due to inert gas bubble formation in bodily tissues and in the circulation, leading to a wide range of potentially serious clinical manifestations. Its pathophysiology remains incompletely understood. In this study, we aim to explore changes in the human leukocyte transcriptome in divers with DCS compared to closely matched unaffected controls after uneventful diving. Cases (n = 7) were divers developing the typical cutis marmorata rash after diving with a confirmed clinical diagnosis of DCS. Controls (n = 6) were healthy divers who surfaced from a ≥25 msw dive without decompression violation or evidence of DCS. Blood was sampled at two separate time points-within 8 h of dive completion and 40-44 h later. Transcriptome analysis by RNA-Sequencing followed by bioinformatic analysis was carried out to identify differentially expressed genes and relate their function to biological pathways. In DCS cases, we identified enrichment of transcripts involved in acute inflammation, activation of innate immunity and free radical scavenging pathways, with specific upregulation of transcripts related to neutrophil function and degranulation. DCS-induced transcriptomic events were reversed at the second time point following exposure to hyperbaric oxygen. The observed changes are consistent with findings from animal models of DCS and highlight a continuum between the responses elicited by uneventful diving and diving complicated by DCS. This study sheds light on the inflammatory pathophysiology of DCS and the associated immune response. Such data may potentially be valuable in the search for novel treatments targeting this disease.
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Affiliation(s)
- Kurt Magri
- Hyperbaric Unit, Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Ingrid Eftedal
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Vanessa Petroni Magri
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Lyubisa Matity
- Hyperbaric Unit, Department of Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Stephen Muscat
- Hyperbaric Unit, Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Nikolai Paul Pace
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Velázquez-Wallraf A, Fernández A, Caballero MJ, Møllerløkken A, Jepson PD, Andrada M, Bernaldo de Quirós Y. Decompressive Pathology in Cetaceans Based on an Experimental Pathological Model. Front Vet Sci 2021; 8:676499. [PMID: 34169109 PMCID: PMC8218990 DOI: 10.3389/fvets.2021.676499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Decompression sickness (DCS) is a widely known clinical syndrome in human medicine, mainly in divers, related to the formation of intravascular and extravascular gas bubbles. Gas embolism and decompression-like sickness have also been described in wild animals, such as cetaceans. It was hypothesized that adaptations to the marine environment protected them from DCS, but in 2003, decompression-like sickness was described for the first time in beaked whales, challenging this dogma. Since then, several episodes of mass strandings of beaked whales coincidental in time and space with naval maneuvers have been recorded and diagnosed with DCS. The diagnosis of human DCS is based on the presence of clinical symptoms and the detection of gas embolism by ultrasound, but in cetaceans, the diagnosis is limited to forensic investigations. For this reason, it is necessary to resort to experimental animal models to support the pathological diagnosis of DCS in cetaceans. The objective of this study is to validate the pathological results of cetaceans through an experimental rabbit model wherein a complete and detailed histopathological analysis was performed. Gross and histopathological results were very similar in the experimental animal model compared to stranded cetaceans with DCS, with the presence of gas embolism systemically distributed as well as emphysema and hemorrhages as primary lesions in different organs. The experimental data reinforces the pathological findings found in cetaceans with DCS as well as the hypothesis that individuality plays an essential role in DCS, as it has previously been proposed in animal models and human diving medicine.
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Affiliation(s)
- Alicia Velázquez-Wallraf
- Veterinary Histology and Pathology, Atlantic Center for Cetacean Research, University Institute of Animal Health and Food Safety (IUSA), Veterinary School, University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Antonio Fernández
- Veterinary Histology and Pathology, Atlantic Center for Cetacean Research, University Institute of Animal Health and Food Safety (IUSA), Veterinary School, University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Maria José Caballero
- Veterinary Histology and Pathology, Atlantic Center for Cetacean Research, University Institute of Animal Health and Food Safety (IUSA), Veterinary School, University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Andreas Møllerløkken
- Faculty of Engineering, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Paul D Jepson
- Institute of Zoology, Zoological Society of London, London, United Kingdom
| | - Marisa Andrada
- Veterinary Histology and Pathology, Atlantic Center for Cetacean Research, University Institute of Animal Health and Food Safety (IUSA), Veterinary School, University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Yara Bernaldo de Quirós
- Veterinary Histology and Pathology, Atlantic Center for Cetacean Research, University Institute of Animal Health and Food Safety (IUSA), Veterinary School, University of Las Palmas de Gran Canaria, Canary Islands, Spain
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Zhou Q, Meng X, Huang G, Yi H, Zheng J, Zhang K, Xu W. MEK1/2 Inhibition Synergistically Enhances the Preventive Effects of Normobaric Oxygen on Spinal Cord Injury in Decompression Sickness Rats. Front Physiol 2021; 12:674430. [PMID: 34140895 PMCID: PMC8204088 DOI: 10.3389/fphys.2021.674430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
A previous study from our team found that hyperbaric oxygen (HBO) pretreatment attenuated decompression sickness (DCS) spinal cord injury by upregulating heat shock protein 32 (HSP32) via the ROS/p38 MAPK pathway. Meanwhile, a MEK1/2-negative regulatory pathway was also activated to inhibit HSP32 overexpression. The purpose of this study was to determine if normobaric oxygen (NBO) might effectively induce HSP32 while concurrently inhibiting MEK1/2 and to observe any protective effects on spinal cord injury in DCS rats. The expression of HSP32 in spinal cord tissue was measured at 6, 12, 18, and 24 h following NBO and MEK1/2 inhibitor U0126 pretreatment. The peak time of HSP32 was observed at 12 h after simulated air diving. Subsequently, signs of DCS, hindlimb motor function, and spinal cord and serum injury biomarkers were recorded. NBO-U0126 pretreatment significantly decreased the incidence of DCS, improved motor function, and attenuated oxidative stress, inflammatory response, and apoptosis in both the spinal cord and serum. These results suggest that pretreatment with NBO and U0126 combined can effectively alleviate DCS spinal cord injury in rats by upregulating HSP32. This may lead to a more convenient approach for DCS injury control, using non-pressurized NBO instead of HBO.
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Affiliation(s)
- Quan Zhou
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Xiangyang Meng
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Guoyang Huang
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Hongjie Yi
- Department of Hyperbaric Oxygen, The First Affiliated Hospital, Naval Medical University, Shanghai, China
| | - Juan Zheng
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Kun Zhang
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
| | - Weigang Xu
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, Shanghai, China
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Garrido MA, Mark L, Parra M, Nowak D, Radon K. Executive Function among Chilean Shellfish Divers: A Cross-Sectional Study Considering Working and Health Conditions in Artisanal Fishing. Int J Environ Res Public Health 2021; 18:ijerph18115923. [PMID: 34073026 PMCID: PMC8199200 DOI: 10.3390/ijerph18115923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023]
Abstract
Knowledge about professional diving-related risk factors for reduced executive function is limited. We therefore evaluated the association between decompression illness and executive functioning among artisanal divers in southern Chile. The cross-sectional study included 104 male divers and 58 male non-diving fishermen from two fishing communities. Divers self-reported frequency and severity of symptoms of decompression illness. Executive function was evaluated by perseverative responses and perseverative errors in the Wisconsin Card Sorting Test. Age, alcohol consumption, and symptoms of depression were a-priori defined as potential confounders and included in linear regression models. Comparing divers and non-divers, no differences in the executive function were found. Among divers, 75% reported a history of at least mild decompression sickness. Higher frequency and severity of symptoms of decompression illness were associated with reduced executive function. Therefore, intervention strategies for artisanal divers should focus on prevention of decompression illness.
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Affiliation(s)
- Marie Astrid Garrido
- Center for International Health@Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University, 80539 Munich, Germany; (L.M.); (M.P.); (K.R.)
- Correspondence: ; Tel.: +56-9-78783908
| | - Lorenz Mark
- Center for International Health@Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University, 80539 Munich, Germany; (L.M.); (M.P.); (K.R.)
| | - Manuel Parra
- Center for International Health@Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University, 80539 Munich, Germany; (L.M.); (M.P.); (K.R.)
- Faculty of Medicine, University of Atacama, Atacama 1532297, Chile
| | - Dennis Nowak
- Institute for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University, 80539 Munich, Germany;
| | - Katja Radon
- Center for International Health@Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University, 80539 Munich, Germany; (L.M.); (M.P.); (K.R.)
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Bhopale VM, Ruhela D, Brett KD, Nugent NZ, Fraser NK, Levinson SL, DiNubile MJ, Thom SR. Plasma gelsolin modulates the production and fate of IL-1β-containing microparticles following high-pressure exposure and decompression. J Appl Physiol (1985) 2021; 130:1604-1613. [PMID: 33764168 DOI: 10.1152/japplphysiol.01062.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Plasma gelsolin (pGSN) levels fall in association with diverse inflammatory conditions. We hypothesized that pGSN would decrease due to the stresses imposed by high pressure and subsequent decompression, and repletion would ameliorate injuries in a murine decompression sickness (DCS) model. Research subjects were found to exhibit a modest decrease in pGSN level while at high pressure and a profound decrease after decompression. Changes occurred concurrent with elevations of circulating microparticles (MPs) carrying interleukin (IL)-1β. Mice exhibited a comparable decrease in pGSN after decompression along with elevations of MPs carrying IL-1β. Infusion of recombinant human (rhu)-pGSN into mice before or after pressure exposure abrogated these changes and prevented capillary leak in brain and skeletal muscle. Human and murine MPs generated under high pressure exhibited surface filamentous actin (F-actin) to which pGSN binds, leading to particle lysis. In addition, human neutrophils exposed to high air pressure exhibit an increase in surface F-actin that is diminished by rhu-pGSN resulting in inhibition of MP production. Administration of rhu-pGSN may have benefit as prophylaxis or treatment for DCS.NEW & NOTEWORTHY Inflammatory microparticles released in response to high pressure and decompression express surface filamentous actin. Infusion of recombinant human plasma gelsolin lyses these particles in decompressed mice and ameliorates particle-associated vascular damage. Human neutrophils also respond to high pressure with an increase in surface filamentous actin and microparticle production, and these events are inhibited by plasma gelsolin. Gelsolin infusion may have benefit as prophylaxis or treatment for decompression sickness.
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Affiliation(s)
- Veena M Bhopale
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Deepa Ruhela
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Stephen R Thom
- University of Maryland School of Medicine, Baltimore, Maryland
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Abstract
Hyperbaric oxygen therapy refers to inhalation of pure oxygen in a closed chamber. Hyperbaric oxygen has a therapeutic effect in numerous pathological conditions, such as decompression sickness, arterial gas embolism, carbon monoxide poisoning and smoke inhalation, osteomylitis, osteoradionecrosis and wound healing. Hyperbaric oxygen therapy is used for treating underlying hypoxia. This review indicates the action of hyperbaric oxygen on biochemical and various physiological changes in cellular level. Narrative review covers the current indications and contraindications of hyperbaric oxygen therapy. The review also focuses on the therapeutic effects of hyperbaric oxygen pretreatment and precondition in different pathological conditions. The complications and side effects of hyperbaric oxygen therapy are discussed.
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Affiliation(s)
- Suman Sen
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Sheuli Sen
- Department of Pediatric Nursing, Sumandeep Nursing College, Sumandeep University, Vadodara, Gujarat, India
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Pougnet R, Pougnet L, Dewitte JD, Loddé B, Lucas D. Temporary and permanent unfitness of occupational divers. Brest Cohort 2002-2019 from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Int Marit Health 2020; 71:71-77. [PMID: 32212151 DOI: 10.5603/imh.2020.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In France, the monitoring of professional divers is regulated. Several learned societies (French Occupational Medicine Society, French Hyperbaric Medicine Society and French Maritime Medicine Society) have issued follow-up recommendations for professional divers, including medical follow-up. Medical decisions could be temporary unfitness for diving, temporary fitness with monitoring, a restriction of fitness, or permanent unfitness. The aim of study was to point out the causes of unfitness in our centre. MATERIALS AND METHODS The divers' files were selected from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Only files with a special medical decision were selected, between 2002 and 2019. RESULTS Three hundred and ninety-six professional divers are followed-up in our centre and 1371 medical decisions were delivered. There were 29 (7.3%) divers with a special medical decision, during 42 (3.1%) medical visit. Twelve (3.0%) had a permanent unfitness. The leading cause of unfitness was pulmonary diseases: emphysema (3), chronic obstructive pulmonary disorder (2), asthma (2). Sixteen (4.0%) divers had temporary unfitness. The leading causes were cardiovascular (4 times) and neurological (6 times). Twelve (3.0%) divers had had at least one decompression sickness. CONCLUSIONS Judgments of permanent unfitness for diving were rare (3.0% of divers), but were because of life-threatening disease. Medical follow-up of occupational divers was justified to decrease the risk of fatal event during occupational dives.
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Affiliation(s)
- Richard Pougnet
- Centre for Professional and Environmental Pathologies (Centre de Ressource en Pathologie Professionnelle et Environnementale CRPPE), Brest University Hospital (CHRU), Brest, France. .,French Society for Maritime Medicine, France. .,Laboratory for Studies and Research in Sociology (LABERS), EA 3149, Faculty of Humanities and Social Science (Faculté de Lettres et Sciences Sociales), Victor Segalen, European University of Brest, Brest, France.
| | - Laurence Pougnet
- French Society for Maritime Medicine, France.,Medical Laboratory, HIA Clermont-Tonnerre, CC41 BCRM Brest, France.,Host-Pathogen Interaction Study Group (Groupe d'Étude des Interactions Hôte-Pathogène GEIHP), EA 3142, European University of Brest, Brest, France
| | - Jean-Dominique Dewitte
- Centre for Professional and Environmental Pathologies (Centre de Ressource en Pathologie Professionnelle et Environnementale CRPPE), Brest University Hospital (CHRU), Brest, France.,French Society for Maritime Medicine, France.,Laboratory for Studies and Research in Sociology (LABERS), EA 3149, Faculty of Humanities and Social Science (Faculté de Lettres et Sciences Sociales), Victor Segalen, European University of Brest, Brest, France
| | - Brice Loddé
- Centre for Professional and Environmental Pathologies (Centre de Ressource en Pathologie Professionnelle et Environnementale CRPPE), Brest University Hospital (CHRU), Brest, France.,French Society for Maritime Medicine, France.,Optimization of Physiological Regulations (ORPHY), EA 4324, Faculty of Science and Technology, European University of Brest, Brest, France
| | - David Lucas
- Centre for Professional and Environmental Pathologies (Centre de Ressource en Pathologie Professionnelle et Environnementale CRPPE), Brest University Hospital (CHRU), Brest, France.,French Society for Maritime Medicine, France.,Optimization of Physiological Regulations (ORPHY), EA 4324, Faculty of Science and Technology, European University of Brest, Brest, France
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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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Schirato SR, El-Dash I, El-Dash V, Bizzarro B, Marroni A, Pieri M, Cialoni D, Chaui-Berlinck JG. Association Between Heart Rate Variability and Decompression-Induced Physiological Stress. Front Physiol 2020; 11:743. [PMID: 32714210 PMCID: PMC7351513 DOI: 10.3389/fphys.2020.00743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/08/2020] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to analyze the correlation between decompression-related physiological stress markers, given by inflammatory processes and immune system activation and changes in Heart Rate Variability, evaluating whether Heart Rate Variability can be used to estimate the physiological stress caused by the exposure to hyperbaric environments and subsequent decompression. A total of 28 volunteers participated in the experimental protocol. Electrocardiograms were performed; blood samples were obtained for the quantification of red cells, hemoglobin, hematocrit, neutrophils, lymphocytes, platelets, aspartate transaminase (AST), alanine aminotransferase (ALT), and for immunophenotyping and microparticles (MP) research through Flow Cytometry, before and after each experimental protocol from each volunteer. Also, myeloperoxidase (MPO) expression and microparticles (MPs) deriving from platelets, neutrophils and endothelial cells were quantified. Negative associations between the standard deviation of normal-to-normal intervals (SDNN) in the time domain, the High Frequency in the frequency domain and the total number of circulating microparticles was observed (p-value = 0.03 and p-value = 0.02, respectively). The pre and post exposure ratio of variation in the number of circulating microparticles was negatively correlated with SDNN (p-value = 0.01). Additionally, a model based on the utilization of Radial Basis Function Neural Networks (RBF-NN) was created and was able to predict the SDNN ratio of variation based on the variation of specific inflammatory markers (RMSE = 0.06).
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Affiliation(s)
- Sergio Rhein Schirato
- Department of Physiology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ingrid El-Dash
- Department of Physiology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Vivian El-Dash
- Department of Physiology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Bruna Bizzarro
- Peter Murányi Experimental Research Center, Albert Einstein Hospital, São Paulo, Brazil
| | | | - Massimo Pieri
- DAN Europe Research Division, Roseto degli Abruzzi, Italy
| | - Danilo Cialoni
- DAN Europe Research Division, Roseto degli Abruzzi, Italy
- Environmental Physiology and Medicine Laboratory, Department of Biomedical Sciences, University of Padova, Padua, Italy
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Uppal H, Jayatunga U. Decompression illness type II with stroke: challenging situation in acute neurorehabilitation. Int Marit Health 2020; 71:105-108. [PMID: 32604454 DOI: 10.5603/imh.2020.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022] Open
Abstract
A professional 55-year-old female experienced diver, who surfaced after the second dive, had a lucid interval before dropping Glasgow Coma Scale (GCS) to 3/15. She was admitted to intensive care unit and commenced on hyperbaric oxygen therapy. Her initial computed tomography of the head was normal but her magnetic resonance imaging of the brain at 48 hours showed extensive bilateral cortical watershed territory infarcts. She developed acute respiratory distress syndrome which resolved within a few days. Her GCS gradually improved from 3/15 to 6/15, was repatriated to United Kingdom after about 2 weeks of the insult and admitted to a tertiary care hospital where she had myoclonic seizures and was started on anti-epileptics. Then she was transferred to the Rehabilitation Medicine Ward of Leicester General Hospital, with GCS 14/15 with poor sitting balance, for her management and rehabilitation. She had weakness of right upper and lower limbs, dysarthria, neuropathic bilateral shoulder pains, pressure ulcer of left heel, bladder and bowel incontinence and cognitive issues. She improved to have significant neurological recovery within next 3 months, became ambulant independently and bladder and bowel continent. Her Barthel index (from 4 to 17), Montreal Cognitive Assessment Test, Adembrook Cognitive Examination and Berg Balance scale (from 33/56 to 44/56) improved significantly. Early diagnosis, treatment and rehabilitation can have a significant impact on the recovery of decompression illness.
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Affiliation(s)
- Harleen Uppal
- Department of Neurorehabilitation, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
| | - Uditha Jayatunga
- Department of Neurorehabilitation, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Mallon Andrews K. Catching Air: Risk and Embodied Ocean Health among Dominican Diver Fishermen. Med Anthropol Q 2020; 35:64-81. [PMID: 32521085 DOI: 10.1111/maq.12592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/25/2022]
Abstract
This article explores the connections between bodily health and environmental health among diver fishermen in the Dominican Republic, and how these relationships are excluded from broader conversations about marine conservation at the national and global levels. As changing ocean environments refigure marine ecosystems, making fish scarce in the shallows, diver fishermen must dive deeper and stay longer in risky conditions, using a compressor to pump an unlimited supply of air to the diver below. As a result, decompression sickness (the bends) has become a pervasive injury and a way that coastal communities experience changing ocean health. The article analyzes injury narratives from divers who "caught air," the local term for the bends, arguing that decompression sickness is a symptom of failing ecologies and strained human relations with the sea, where environments at risk become embodied through parallel risky practices at sea.
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