Selected scientific publications on diving medicine and physiology.

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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2020 Jul 3
Association between Heart Rate Variability and decompression - induced physiological stress
Sergio Rhein Schirato, Ingrid El-Dash, Vivian El-Dash, Bruna Bizzarro, Massimo Pieri, Alessandro Marroni, Danilo Cialoni, José Guilherme Chaui-Berlinck

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.

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2017 May 21
Beneficial effect of enriched air nitrox on bubble formation during scuba diving. An open-water study
Brebeck AK., Deussen A., Range U., Balestra C., Cleveland S., Schipke JD.

Bubble formation during scuba diving might induce decompression sickness. This prospective randomised and double-blind study included 108 advanced recreational divers (38 females). Fifty-four pairs of divers, 1 breathing air and the other breathing nitrox28 undertook a standardised dive (24 ± 1 msw; 62 ± 5min) in the Red Sea. Venous gas bubbles were counted (Doppler) 30-<45 min (early) and 45-60 min (late) post-dive at jugular, subclavian and femoral sites. Only 7% (air) vs. 11% (air28®) (n.s.) were bubble-free after a dive. Independent of sampling time and breathing gas, there were more bubbles in the jugular than in the femoral vein. More bubbles were counted in the air-group than in the air28-group (pooled vein: early: 1845 vs. 948; P = 0.047, late: 1817 vs. 953; P = 0.088). The number of bubbles was sex-dependent. Lastly, 29% of female air divers but only 14% of male divers were bubble-free (P = 0.058). Air28® helps to reduce venous gas emboli in recreational divers. The bubble number depended on the breathing gas, sampling site and sex. Thus, both exact reporting the dive and in particular standardising sampling characteristics seem mandatory to compare results from different studies to further investigate the hitherto incoherent relation between inert gas bubbles and DCS.

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2009 May 1
Bubble Detection on Left Atrium Related With Patent Foramen Ovale
Parlak I.B., Egi S.M., Ademoglu A., Germonpre P., Esen O.B., Aydin S., Tekin S., Balestra C., Marroni A., Ieee

Several illnesses such as paradoxical embolism, decompression sickness, migraine and cerebral ischemia are characterized by bubbles which might cross the septum wall between left and right atrium. In this study, we aimed to detect bubbles on echocardiographic frames which are segmented automatically using Snakes method. In recent studies, analyzes are done on fixed ROIs and PFO grading as well. We conclude that our approach would give more accurate results for bubble detection and counting by taking account into entire left atrium (LA) areas.

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2016 Jan 1
CADDY Project, Year 2: The First Validation Trials
Mišković N., Pascoal A., Bibuli M., Caccia M., Neasham J. A., Birk A., Egi M., Grammer K., Marroni A., Vasilijević A., Vukić Z.

"CADDY - Cognitive Autonomous Diving Buddy" is an FP7 project that that is devoted to developing a cognitive underwater robotic system that will help divers during their activities in this hazardous environment. The envisioned resulting system will play a threefold role similar to those that a human buddy diver should have: buddy "observer", buddy "slave", and buddy "guide". During the second year of the project, validation trials were organized in Croatia with the purpose of testing all developed algorithms that will enable the three roles of the CADDY system. The trials were structured in five experiments. This paper is devoted to providing a concise overview of the conducted experiments and major results.

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