Publications

Selected scientific publications on diving medicine and physiology.

2019 Oct 1
Diving physiopathology: the end of certainties? Food for thought
Balestra C, Germonpre P, Rocco M, Biancofiore G & Kot J.

Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy and functional aspects of patent foramen ovale (PFO) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (VGE) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms.

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2019 Jul 24
An EMD-Based Algorithm for Emboli Detection in Echo Doppler Audio Signals
Pierleoni P, Palma L, Belli A, Pieri M, Maurizi L, Pellegrini M & Marroni A.

Divers’ health state after underwater activity can be assessed after the immersion using precordial echo Doppler examination. An audio analysis of the acquired signals is performed by specialist doctors to detect circulating gas bubbles in the vascular system and to evaluate the decompression sickness risk. Since on-site medical assistance cannot always be guaranteed, we propose a system for automatic emboli detection using a custom portable device connected to the echo Doppler instrument. The empirical mode decomposition method is used to develop a real-time algorithm able to automatically detect embolic events and, consequently, assess the decompression sickness risk according to the Spencer’s scale. The proposed algorithm has been tested according to an experimental protocol approved by the Divers Alert Network. It involved 30 volunteer divers and produced 37 echo Doppler files useful for the algorithm’s performances evaluation. The results obtained by the proposed emboli detection algorithm (83% sensitivity and 76% specificity) make the system particularly suitable for real-time evaluation of the decompression sickness risk level. Furthermore, the system could also be used in continuous monitoring of hospitalized patients with embolic risks such as post surgery ones.

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2019 Jul 11
Static Metabolic Bubbles as Precursors of Vascular Gas Emboli During Divers' Decompression: A Hypothesis Explaining Bubbling Variability
Imbert JP, Egi SM, Germonpre P & Balestra C

Introduction: The risk for decompression sickness (DCS) after hyperbaric exposures (such as SCUBA diving) has been linked to the presence and quantity of vascular gas emboli (VGE) after surfacing from the dive. These VGE can be semi-quantified by ultrasound Doppler and quantified via precordial echocardiography. However, for an identical dive, VGE monitoring of divers shows variations related to individual susceptibility, and, for a same diver, dive-to-dive variations which may be influenced by pre-dive pre-conditioning. These variations are not explained by currently used algorithms. In this paper, we present a new hypothesis: individual metabolic processes, through the oxygen window (OW) or Inherent Unsaturation of tissues, modulate the presence and volume of static metabolic bubbles (SMB) that in turn act as precursors of circulating VGE after a dive.

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2019 May 1
Clustering of recreational divers by their health conditions in a database of a citizen science project
Ozyigit T, Yavuz C, Egi SM, Pieri M, Balestra C & Marroni A.

Divers Alert Network Europe has created a database with a large amount of dive-related data that has been collected since 1993 within the scope of the Diving Safety Laboratory citizen science project. The main objectives of this study are the grouping divers by their health information and revealing significant differences in diving parameters using data mining techniques. Due to the methodology of the project, data cleaning was performed before applying clustering methods in order to eliminate potential mistakes resulting from inaccuracies and missing information. Despite the fact that 63% of the data were lost during the cleaning phase, the remaining 1,169 "clean" diver data enabled meaningful clustering using the "two-step" method. Experienced male divers without any health problems are in Cluster 1.

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2019 Feb 21
Altered Venous Blood Nitric Oxide Levels at Depth and Related Bubble Formation During Scuba Diving
Cialoni D., Brizzolari A., Samaja M., Pieri M. and Marroni A.

Introduction: Nitric oxide (NO) plays an important role in the physiology and pathophysiology of diving, and the related endothelial dysfunction and oxidative stress roles have been extensively investigated. However, most available data have been obtained before and after the dive, whilst, as far as we know, no data is available about what happens during the water immersion phase of dive. The scope of this study is to investigate the Nitrate and Nitrite (NOX) concentration and the total plasma antioxidant capacity (TAC) before, during and after a single SCUBA dive in healthy scuba diving volunteers, as well as to look for evidence of a possible relationship with venous gas bubble formation. Materials and Methods: Plasma, obtained from blood of 15 expert SCUBA divers, 13 male and 2 female, was investigated for differences in NOX and TAC values in different dive times. Differences in NOX and TAC values in subjects previously known as "bubble resistant" (non-bubblers - NB) and "bubble prone" (Bubblers - B) were investigated.

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