Selected scientific publications on diving medicine and physiology.

2012 Dec 12
Persistence of critical flicker fusion frequency impairment after a 33 mfw SCUBA dive: evidence of prolonged nitrogen narcosis?
Balestra C, Lafère P, Germonpré P.

One of the possible risks incurred while diving is inert gas narcosis (IGN), yet its mechanism of action remains a matter of controversy. Although providing insights in the basic mechanisms of IGN, research has been primarily limited to animal studies. A human study, in real diving conditions, was needed. Twenty volunteers within strict biometrical criteria (male, age 30-40 years, BMI 20-23, non smoker) were selected. They performed a no-decompression dive to a depth of 33 mfw for 20 min and were assessed by the means of critical flicker fusion frequency (CFFF) measurement before the dive, during the dive upon arriving at the bottom, 5 min before the ascent, and 30 min after surfacing. After this late measurement, divers breathed oxygen for 15 min and were assessed a final time. Compared to the pre-dive value the mean value of each measurement was significantly different (p < 0.001). An increase of CFFF to 104 ± 5.1 % upon arriving to the bottom is followed by a decrease to 93.5 ± 4.3 %. This impairment of CFFF persisted 30 min after surfacing, still decreased to 96.3 ± 8.2 % compared to pre-dive CFFF. Post-dive measures made after 15 min of oxygen were not different from control (without nitrogen supersaturation), 124.4 ± 10.8 versus 124.2 ± 3.9 %. This simple study suggests that IGN (at least partially) depends on gas-protein interactions and that the cerebral impairment persists for at least 30 min after surfacing. This could be an important consideration in situations where precise and accurate judgment or actions are essential.

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2013 Jun 6
Oxidative stress in breath-hold divers after repetitive dives
Theunissen S, Sponsiello N, Rozloznik M, Germonpré P, Guerrero F, Cialoni D, Balestra C.

INTRODUCTION: Hyperoxia causes oxidative stress. Breath-hold diving is associated with transient hyperoxia followed by hypoxia and a build-up of carbon dioxide (CO₂), chest-wall compression and significant haemodynamic changes. This study analyses variations in plasma oxidative stress markers after a series of repetitive breath-hold dives. METHODS: Thirteen breath-hold divers were asked to perform repetitive breath-hold dives to 20 metres' depth to a cumulative breath-hold time of approximately 20 minutes over an hour in the open sea. Plasma nitric oxide (NO), peroxinitrites (ONOO⁻) and thiols (R-SH) were measured before and after the dive sequence. RESULTS: Circulating NO significantly increased after successive breath-hold dives (169.1 ± 58.26% of pre-dive values; P = 0.0002). Peroxinitrites doubled after the dives (207.2 ± 78.31% of pre-dive values; P = 0.0012). Thiols were significantly reduced (69.88 ± 19.23% of pre-dive values; P = 0.0002). CONCLUSION: NO may be produced by physical effort during breath-hold diving. Physical exercise, the transient hyperoxia followed by hypoxia and CO₂ accumulation would all contribute to the increased levels of superoxide anions (O₂²⁻). Since interaction of O₂²⁻ with NO forms ONOO⁻, this reaction is favoured and the production of thiol groups is reduced. Oxidative stress is, thus, present in breath-hold diving.

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2013 Dec 3
Dark chocolate reduces endothelial dysfunction after successive breath-hold dives in cool water
Theunissen S, Schumacker J, Guerrero F, Tillmans F, Boutros A, Lambrechts K, Mazur A, Pieri M, Germonpré P, Balestra C.

OBJECTIVE: The aim of this study is to observe the effects of dark chocolate on endothelial function after a series of successive apnea dives in non-thermoneutral water...

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2013 Apr 1
Nitric oxide-related endothelial changes in breath-hold and scuba divers
Theunissen S, Guerrero F, Sponsiello N, Cialoni D, Pieri M, Germonpré P, Obeid G, Tillmans F, Papadopoulou V, Hemelryck W, Marroni A, De Bels D, Balestra C.

OBJECTIVE:Scuba and breath-hold divers are compared to investigate whether endothelial response changes are similar despite different exposure(s) to hyperoxia. DESIGN:14 divers (nine scuba and five breath-holding) performed either one scuba dive (25m/25 minutes) or successive breath-hold dives at a depth of 20 meters, adding up to 25 minutes of immersion time in a diving pool. Flow-mediated dilation (FMD) was measured using echography. Peripheral post-occlusion reactive hyperemia (PORH) was assessed by digital plethysmography and plasmatic nitric oxide (NO) concentration using a nitrate/nitrite colorimetric assay kit. RESULTS:The FMD decreased in both groups. PORH was reduced in scuba divers but increased in breath-hold divers. No difference in circulating NO was observed for the scuba group. Opposingly, an increase in circulating NO was observed for the breath-hold group. CONCLUSION:Some cardiovascular effects can be explained by interaction between NO and superoxide anion during both types of diving ending to less NO availability and reducing FMD. The increased circulating NO in the breath-hold group can be caused by physical exercise. The opposite effects found between FMD and PORH in the breath-hold group can be assimilated to a greater responsiveness to circulating NO in small arteries than in large arteries.

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2013 Oct 10
EPO modulation in a 14-days undersea scuba dive
Revelli L, Vagnoni S, D'Amore A, Di Stasio E, Lombardi CP, Storti G, Proietti R, Balestra C, Ricerca BM

Erythropoiesis is affected during deep saturation dives. The mechanism should be related to a downregulation of serum Erythropoietin (s-EPO) concentration or to a toxic effect of the hyperbaric hyperoxia. We evaluated s-EPO and other haematological parameters in 6 scuba divers before, during and after a 14-days guinness saturation dive (8-10 m). Athletes were breathing air at 1.8-2 ATA, under the control of a team of physicians. Serum parameters were measured before diving (T0) and: 7 days (T1), 14 days (T2) after the beginning of the dive and 2 h (T3) and 24 h (T4) after resurfacing. Hgb, and many other haematological parameters did not change whereas Ht, s-EPO, the ratio between s-EPO predicted and that observed and reticulocytes (absolute, percent) declined progressively from T0 to T3. At T4 a significant rise in s-EPO was observed. Hgb did not vary but erythropoiesis seemed to be affected as s-EPO and reticulocyte counts showed. All these changes were statistically significant. The experiment, conducted in realistic conditions of dive length, oxygen concentration and pressure, allows us to formulate some hypotheses about the role of prolonged hyperbarism on erythropoiesis. The s-EPO rise, 24 h after resurfacing, is clearly documented and related to the "Normobaric Oxygen Paradox". This evidence suggests interesting hypotheses for new clinical applications such as modulation of s-EPO production and Hgb content triggered by appropriate O₂ administration in pre-surgical patients or in some anemic disease.

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