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Querido AL, Ebbelaar CF, Wingelaar TT. Diving with psychotropic medication: review of the literature and clinical considerations. Diving Hyperb Med 2023; 53:259-267. [PMID: 37718301 PMCID: PMC10735636 DOI: 10.28920/dhm53.3.259-267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/20/2023] [Indexed: 09/19/2023]
Abstract
This review discusses the safety concerns associated with diving while using psychotropic medication and the limited literature available on the topic. Despite the risks, some divers continue to dive while taking these medications, and their reasons for doing so are unclear. The exact mechanisms of action of these drugs in hyperbaric environments are poorly understood. While current standards and advice for fitness-to-dive assessments are based on limited evidence and expert opinion, developing evidence-based strategies could improve patient care and optimise diving safety. This review appraises relevant literature in diving medicine and provides clinical perspectives for diving physicians conducting fitness-to-dive assessments on patients using psychotropic medication.
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Affiliation(s)
- Abraham L Querido
- Praktijk Querido, Hilversum, the Netherlands
- Dutch Society of Diving and Hyperbaric Medicine, Bilthoven, the Netherlands
| | - Chiel F Ebbelaar
- PharmC, consultancy for clinical psychopharmacology, Utrecht, the Netherlands
- Leiden University Medical Center, Department of Dermatology, Leiden, the Netherlands
- University Medical Center Utrecht, Department of Pathology, Division of Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs T Wingelaar
- Dutch Society of Diving and Hyperbaric Medicine, Bilthoven, the Netherlands
- Royal Netherlands Navy, Diving Medical Center, Den Helder, the Netherlands
- Corresponding author: Dr Thijs T Wingelaar, Rijkszee en Marinehaven, 1780 CA Den Helder, the Netherlands,
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Kjellberg A, Douglas J, Hassler A, Al-Ezerjawi S, Boström E, Abdel-Halim L, Liwenborg L, Hetting E, Jonasdottir Njåstad AD, Kowalski J, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. COVID-19-Induced Acute Respiratory Distress Syndrome Treated with Hyperbaric Oxygen: Interim Safety Report from a Randomized Clinical Trial (COVID-19-HBO). J Clin Med 2023; 12:4850. [PMID: 37510965 PMCID: PMC10381696 DOI: 10.3390/jcm12144850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND A few prospective trials and case series have suggested that hyperbaric oxygen therapy (HBOT) may be efficacious for the treatment of severe COVID-19, but safety is a concern for critically ill patients. We present an interim analysis of the safety of HBOT via a randomized controlled trial (COVID-19-HBO). METHODS A randomized controlled, open-label, clinical trial was conducted in compliance with good clinical practice to explore the safety and efficacy of HBOT for severe COVID-19 in critically ill patients with moderate acute respiratory distress syndrome (ARDS). Between 3 June 2020, and 17 May 2021, 31 patients with severe COVID-19 and moderate-to-severe ARDS, a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) < 26.7 kPa (200 mmHg), and at least two defined risk factors for intensive care unit (ICU) admission and/or mortality were enrolled in the trial and randomized 1:1 to best practice, or HBOT in addition to best practice. The subjects allocated to HBOT received a maximum of five treatments at 2.4 atmospheres absolute (ATA) for 80 min over seven days. The subjects were followed up for 30 days. The safety endpoints were analyzed. RESULTS Adverse events (AEs) were common. Hypoxia was the most common adverse event reported. There was no statistically significant difference between the groups. Numerically, serious adverse events (SAEs) and barotrauma were more frequent in the control group, and the differences between groups were in favor of the HBOT in PaO2/FiO2 (PFI) and the national early warning score (NEWS); statistically, however, the differences were not significant at day 7, and no difference was observed for the total oxygen burden and cumulative pulmonary oxygen toxicity dose (CPTD). CONCLUSION HBOT appears to be safe as an intervention for critically ill patients with moderate-to-severe ARDS induced by COVID-19. CLINICAL TRIAL REGISTRATION NCT04327505 (31 March 2020) and EudraCT 2020-001349-37 (24 April 2020).
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Affiliation(s)
- Anders Kjellberg
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Johan Douglas
- Department of Anaesthesia and Intensive Care, Blekingesjukhuset, 371 85 Karlskrona, Sweden
| | - Adrian Hassler
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Sarah Al-Ezerjawi
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emil Boström
- Acute and Reparative Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lina Abdel-Halim
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lovisa Liwenborg
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Eric Hetting
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | | | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Academic Specialist Center, Center for Diabetes, 113 65 Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynaecology and Reproduction, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Emergency Medicine, Division of Hyperbaric Medicine, University of California San Diego, La Jolla, CA 92093, USA
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Analysis of Volatile Organic Compounds in Exhaled Breath Following a COMEX-30 Treatment Table. Metabolites 2023; 13:metabo13030316. [PMID: 36984755 PMCID: PMC10056109 DOI: 10.3390/metabo13030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
The COMEX-30 hyperbaric treatment table is used to manage decompression sickness in divers but may result in pulmonary oxygen toxicity (POT). Volatile organic compounds (VOCs) in exhaled breath are early markers of hyperoxic stress that may be linked to POT. The present study assessed whether VOCs following COMEX-30 treatment are early markers of hyperoxic stress and/or POT in ten healthy, nonsmoking volunteers. Because more oxygen is inhaled during COMEX-30 treatment than with other treatment tables, this study hypothesized that VOCs exhaled following COMEX-30 treatment are indicators of POT. Breath samples were collected before and 0.5, 2, and 4 h after COMEX-30 treatment. All subjects were followed-up for signs of POT or other symptoms. Nine compounds were identified, with four (nonanal, decanal, ethyl acetate, and tridecane) increasing 33–500% in intensity from before to after COMEX-30 treatment. Seven subjects reported pulmonary symptoms, five reported out-of-proportion tiredness and transient ear fullness, and four had signs of mild dehydration. All VOCs identified following COMEX-30 treatment have been associated with inflammatory responses or pulmonary diseases, such as asthma or lung cancer. Because most subjects reported transient pulmonary symptoms reflecting early-stage POT, the identified VOCs are likely markers of POT, not just hyperbaric hyperoxic exposure.
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Sánchez Chapul L, Pérez de la Cruz G, Ramos Chávez LA, Valencia León JF, Torres Beltrán J, Estrada Camarena E, Carillo Mora P, Ramírez Ortega D, Baños Vázquez JU, Martínez Nava G, Luna Angulo A, Martínez Canseco C, Wences Chirino TY, Ríos Martínez J, Pérez de la Cruz V. Characterization of Redox Environment and Tryptophan Catabolism through Kynurenine Pathway in Military Divers’ and Swimmers’ Serum Samples. Antioxidants (Basel) 2022; 11:antiox11071223. [PMID: 35883715 PMCID: PMC9312203 DOI: 10.3390/antiox11071223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Endurance and resistance exercises, alone or in combination, induce metabolic changes that affect tryptophan (Trp) catabolism. The kynurenine pathway (KP) is the main route of Trp degradation, and it is modulated by the inflammatory and redox environments. Previous studies have shown that KP metabolites work as myokines that mediate the positive systemic effects related to exercise. However, it is poorly understood how different exercise modalities and intensities impact the KP. The aim of this study was to characterize the effect of two different exercise modalities, military diving and swimming, on the KP and the redox environment. A total of 34 healthy men from the Mexican Navy were included in the study, 20 divers and 14 swimmers, who started and stayed in military training consistently during the six months of the study; 12 Mexican men without fitness training were used as the control group. Physical fitness was determined at the beginning and after 6 months of training; criteria included body composition; serum levels of Trp, kynurenine (KYN), kynurenic acid (KYNA) and 3-hydroxykynurenine (3-HK); the glutathione ratio (GSH/GSSG); and malondialdehyde (MDA).. Results showed a significant loss of body fat in both the diver and swimmer groups. Compared with the control group, divers showed a decrease in Trp and 3-HK levels, but no changes were observed in the KYN/Trp, KYNA/Trp or 3-HK/Trp ratios, while swimmers showed a decrease in KYN levels and an increase in the KYNA and 3-HK levels. Additionally, divers showed a decrease in the GSH/GSSG ratio and an increase in MDA levels, in contrast to the swimmers, who showed a decrease in MDA levels and an increase in GSH/GSSG levels. Our findings suggest a differential shift in the KP and redox environment induced by diving and swimming. Swimming promotes an antioxidant environment and a peripheral overactivation of the KP.
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Affiliation(s)
- Laura Sánchez Chapul
- Laboratorio de Enfermedades Neuromusculares, División de Neurociencias Clínicas, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico; (A.L.A.); (T.Y.W.C.)
- Dirección General Adjunta de Sanidad Naval, Secretaría de Marina Armada de México, Mexico City 04830, Mexico;
- Correspondence: (L.S.C.); (V.P.d.l.C.); Tel.: +52-55-5999-1000 (ext. 19204) (L.S.C.); +52-55-5606-3822 (ext. 2006) (V.P.d.l.C.)
| | - Gonzalo Pérez de la Cruz
- Department of Mathematics, Faculty of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico;
| | - Lucio Antonio Ramos Chávez
- Departamento de Neuromorfología Funcional, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría “Ramón de la Fuente”, Mexico City 14370, Mexico;
| | - Jesús F. Valencia León
- Dirección General Adjunta de Sanidad Naval, Secretaría de Marina Armada de México, Mexico City 04830, Mexico;
| | - Joel Torres Beltrán
- Subdirección de Medicina del Deporte, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Erika Estrada Camarena
- Laboratorio de Neuropsicofarmacología, Dirección de Investigación, Instituto Nacional de Psiquiatría “Ramón de la Fuente”, Mexico City 14370, Mexico;
| | - Paul Carillo Mora
- División de Neurociencias Clínicas, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Daniela Ramírez Ortega
- Neuroimmunology Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City 14269, Mexico;
| | - José U. Baños Vázquez
- Escuela de Búsqueda y Rescate y Buceo, Secretaría de Marina Armada de México, Mexico City 04830, Mexico;
| | - Gabriela Martínez Nava
- Laboratorio de Gerociencias, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Alexandra Luna Angulo
- Laboratorio de Enfermedades Neuromusculares, División de Neurociencias Clínicas, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico; (A.L.A.); (T.Y.W.C.)
| | - Carlos Martínez Canseco
- Servicio de Bioquímica, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico;
| | - Tiffany Y. Wences Chirino
- Laboratorio de Enfermedades Neuromusculares, División de Neurociencias Clínicas, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City 14389, Mexico; (A.L.A.); (T.Y.W.C.)
| | - Juan Ríos Martínez
- Instituto de Investigación en Ciencias de la Salud de la Secretaria de Marina, Mexico City 04849, Mexico;
| | - Verónica Pérez de la Cruz
- Neurobiochemistry and Behavior Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City 14269, Mexico
- Correspondence: (L.S.C.); (V.P.d.l.C.); Tel.: +52-55-5999-1000 (ext. 19204) (L.S.C.); +52-55-5606-3822 (ext. 2006) (V.P.d.l.C.)
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Elbaradei A, Wang Z, Malmstadt N. Oxidation of Membrane Lipids Alters the Activity of the Human Serotonin 1A Receptor. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2022; 38:6798-6807. [PMID: 35608952 DOI: 10.1021/acs.langmuir.1c03238] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lipid oxidation has significant effects on lipid bilayer properties; these effects can be expected to extend to interactions between the lipid bilayer and integral membrane proteins. Given that G protein-coupled receptor (GPCR) activity is known to depend on the properties of the surrounding lipid bilayer, these proteins represent an intriguing class of molecules in which the impact of lipid oxidation on protein behavior is studied. Here, we study the effects of lipid oxidation on the human serotonin 1A receptor (5-HT1AR). Giant unilamellar vesicles (GUVs) containing integral 5-HT1AR were fabricated by the hydrogel swelling method; these GUVs contained polyunsaturated 1-palmitoyl-2-linoleoyl-sn-glycero-3-phosphocholine (PLinPC) and its oxidation product 1-palmitoyl-2-(9'-oxo-nonanoyl)-sn-glycero-3-phosphocholine (PoxnoPC) at various ratios. 5-HT1AR-integrated GUVs were also fabricated from lipid mixtures that had been oxidized by extended exposure to the atmosphere. Both types of vesicles were used to evaluate 5-HT1AR activity using an assay to quantify GDP-GTP exchange by the coupled G protein α subunit. Results indicated that 5-HT1AR activity increases significantly in bilayers containing oxidized lipids. This work is an important step in understanding how hyperbaric oxidation can change plasma membrane properties and lead to physiological dysfunction.
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Volatile Organic Compounds Frequently Identified after Hyperbaric Hyperoxic Exposure: The VAPOR Library. Metabolites 2022; 12:metabo12050470. [PMID: 35629974 PMCID: PMC9142890 DOI: 10.3390/metabo12050470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 01/31/2023] Open
Abstract
Diving or hyperbaric oxygen therapy with increased partial pressures of oxygen (pO2) can have adverse effects such as central nervous system oxygen toxicity or pulmonary oxygen toxicity (POT). Prevention of POT has been a topic of interest for several decades. One of the most promising techniques to determine early signs of POT is the analysis of volatile organic compounds (VOCs) in exhaled breath. We reanalyzed the data of five studies to compose a library of potential exhaled markers for the early detection of POT. GC-MS data from five hyperbaric hyperoxic studies were collected. Wilcoxon signed-rank tests were used to compare baseline- and postexposure measurements; all ion fragments that significantly varied were compared by similarity using the National Institute of Standards and Technology (NIST) library. All identified molecules were cross-referenced with open-source databases and other scientific publications on VOCs to exclude compounds that occurred as a result of contamination, and to identify the compounds most likely to occur due to hyperbaric hyperoxic exposure. After identification and removal of contaminants, 29 compounds were included in the library. This library of hyperbaric hyperoxic-related VOCs can help to advance the development of an early noninvasive marker of POT. It enables validation by others who use more targeted MS-related techniques, instead of full-scale GC-MS, for their exhaled VOC research.
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de Jong FJM, Wingelaar TT, Brinkman P, van Ooij PJAM, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Pulmonary Oxygen Toxicity Through Exhaled Breath Markers After Hyperbaric Oxygen Treatment Table 6. Front Physiol 2022; 13:899568. [PMID: 35620607 PMCID: PMC9127798 DOI: 10.3389/fphys.2022.899568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: The hyperbaric oxygen treatment table 6 (TT6) is widely used to manage dysbaric illnesses in divers and iatrogenic gas emboli in patients after surgery and other interventional procedures. These treatment tables can have adverse effects, such as pulmonary oxygen toxicity (POT). It is caused by reactive oxygen species’ damaging effect in lung tissue and is often experienced after multiple days of therapy. The subclinical pulmonary effects have not been determined. The primary aim of this study was to measure volatile organic compounds (VOCs) in breath, indicative of subclinical POT after a TT6. Since the exposure would be limited, the secondary aim of this study was to determine whether these VOCs decreased to baseline levels within a few hours.Methods: Fourteen healthy, non-smoking volunteers from the Royal Netherlands Navy underwent a TT6 at the Amsterdam University Medical Center—location AMC. Breath samples for GC-MS analysis were collected before the TT6 and 30 min, 2 and 4 h after finishing. The concentrations of ions before and after exposure were compared by Wilcoxon signed-rank tests. The VOCs were identified by comparing the chromatograms with the NIST library. Compound intensities over time were tested using Friedman tests, with Wilcoxon signed-rank tests and Bonferroni corrections used for post hoc analyses.Results: Univariate analyses identified 11 compounds. Five compounds, isoprene, decane, nonane, nonanal and dodecane, showed significant changes after the Friedman test. Isoprene demonstrated a significant increase at 30 min after exposure and a subsequent decrease at 2 h. Other compounds remained constant, but declined significantly 4 h after exposure.Discussion and Conclusion: The identified VOCs consisted mainly of (methyl) alkanes, which may be generated by peroxidation of cell membranes. Other compounds may be linked to inflammatory processes, oxidative stress responses or cellular metabolism. The hypothesis, that exhaled VOCs would increase after hyperbaric exposure as an indicator of subclinical POT, was not fulfilled, except for isoprene. Hence, no evident signs of POT or subclinical pulmonary damage were detected after a TT6. Further studies on individuals recently exposed to pulmonary irritants, such as divers and individuals exposed to other hyperbaric treatment regimens, are needed.
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Affiliation(s)
- Feiko J. M. de Jong
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- *Correspondence: Feiko J. M. de Jong,
| | - Thijs T. Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Pieter-Jan A. M. van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | | | - Marcus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
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Hyperbaric Exposure of Scuba Divers Affects the Urinary Excretion of Nucleic Acid Oxidation Products and Hypoxanthine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053005. [PMID: 35270697 PMCID: PMC8910156 DOI: 10.3390/ijerph19053005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 12/10/2022]
Abstract
In recent studies, oxidative stress after scuba diving has been explored by measuring urinary biomarkers in volunteers under controlled conditions. Dive depth and duration, water temperature, and workload are all variables that can elicit metabolic responses. A controlled diving experiment was performed in an indoor pool at 20, 30, and 40 m depths at a water temperature of 32 °C, on three different days. Samples of urine from five male scuba divers were taken before diving and at four time points after diving, and then tested for their concentration of five different oxidative stress biomarkers by means of liquid chromatography tandem mass spectrometry and by 1H nuclear magnetic resonance metabolomics analysis. The results showed no variation in the five biomarkers after diving, but a decreasing trend was observed over the three days, with no differences among the three depths. The lack of effect on oxidative stress biomarkers has been attributed to the comfortable water temperature and to the absence of exercise in the divers during the experiment. Instead, an increase in hypoxanthine excretion, which can be considered a biomarker sensitive to hyperbaric exposure, was found after diving. Finally, the results suggest a physiological mechanism of metabolic adaptation to a new condition.
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Vallée N, Rives S, Desruelle AV, Marzetti S, Barchasz V, Risso JJ, Gies V. High Oxygen Consumption in SARS-COV2: Could the Development of Low-Cost Oxygen Rebreather Be Considered? Front Physiol 2021; 11:607913. [PMID: 33584333 PMCID: PMC7873898 DOI: 10.3389/fphys.2020.607913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nicolas Vallée
- Institut de Recherche Biomédicale des Armées_Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Sarah Rives
- 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
| | | | | | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées_Equipe de Recherche Subaquatique Opérationnelle, Toulon, France
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Zhang Y, You B, Chen Y, Yang J, Xie C, Huang G, Li R, Hu P. Effect of Transcriptional Regulatory Factor FoxO3a on Central Nervous System Oxygen Toxicity. Front Physiol 2021; 11:596326. [PMID: 33391015 PMCID: PMC7775677 DOI: 10.3389/fphys.2020.596326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022] Open
Abstract
Central nervous system (CNS) oxygen toxicity (CNS-OT) is a toxic reaction that appears after the inhalation of gas at an excessive oxygen partial pressure during underwater operation or hyperbaric oxygen (HBO) treatment. The mechanism of CNS-OT has not been clearly characterized. Though it has been attributed to the excessive oxidative stress induced by HBO, evidences against this hypothesis have been reported. Here we find that Forkhead box protein O3 (FoxO3a) is important for CNS-OT protection. FoxO3a knock-out (KO) mice had a shorter latency to develop convulsions and greater number of seizures within a certain period of time. The acute lung injury (ALI) induced by CNS-OT was also more severe in FoxO3a KO mice. Further analysis reveals a significant decrease in the activity of catalase (CAT), an antioxidant enzyme and a significant increase in the content of malondialdehyde (MDA), an oxidative product, in brain tissues of FoxO3a KO mice. Short-time HBO exposure could increase FoxO3a expression level and trigger its nuclear translocation. The level of nuclear localized FoxO3a peaked at 8 h after exposure. Our results demonstrate that the activity of FoxO3a is highly sensitive to HBO exposure and FoxO3a plays important roles in protecting CNS-OT. Further mechanic analysis reveals that FoxO3a protects CNS-OT via activating antioxidative signaling pathway.
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Affiliation(s)
- Yanan Zhang
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Navy Medical University, Shanghai, China
| | - Benming You
- Department of Pharmacy, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yuliang Chen
- Department of Nautical and Aviation Medicine Center, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junlin Yang
- Xinhua Hospital, Shangahai Jiao Tong University, Shanghai, China
| | - Chengwei Xie
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Navy Medical University, Shanghai, China
| | - Guoyang Huang
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Navy Medical University, Shanghai, China
| | - Runping Li
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Navy Medical University, Shanghai, China
| | - Ping Hu
- State Key Laboratory of Cell Biology, Center of Excellence in Molecular and Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.,Xinhua Hospital, Shangahai Jiao Tong University, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
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Cerebrospinal fluid oxygen optimisation for rescue of metabolically challenged in vitro cortical brain tissue. IBRO Rep 2020; 9:302-309. [PMID: 33235940 PMCID: PMC7670121 DOI: 10.1016/j.ibror.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Hypoxic-ischaemic brain injury is a major cause of morbidity and mortality internationally. Using an in vitro isolated cortex model, this study investigated the optimal cerebrospinal fluid oxygenation parameters for rescuing metabolically challenged cortical tissue. In particular, we asked whether maximizing oxygen content with oxygen nanobubbles could support improved tissue recovery. Mouse cortical slices were metabolically starved, followed by recovery in artificial cerebrospinal fluid (aCSF) containing different levels of dissolved oxygen ranging from mean(SD) 2(0.5) to 39(1.0) mg/L; with and without oxygen nanobubbles. Tissue recovery was assessed by quantifying and comparing the amplitude, length, high frequency content and event frequency of seizure-like events generated in no-magnesium aCSF at the beginning and end of the protocol. In general, there was improved recovery with increasing oxygen content up to 25-34 mg/L. The outcome of slices recovered in nanobubbled aCSF was no different to conventionally oxygenated slices with similar dissolved oxygen content. Dissolved oxygen content above 34 mg/L afforded no additional benefit. In conclusion, aCSF dissolved oxygen content of approximately 30 mg/L is optimal for cortical tissue recovery from metabolic starvation, which is easily achievable using conventional oxygenation methods. Oxygen in the form of nanobubbles does not appear to be readily available for tissue oxidative processes in this model.
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Kjellberg A, De Maio A, Lindholm P. Can hyperbaric oxygen safely serve as an anti-inflammatory treatment for COVID-19? Med Hypotheses 2020; 144:110224. [PMID: 33254531 PMCID: PMC7456590 DOI: 10.1016/j.mehy.2020.110224] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION SARS-CoV-2 affects part of the innate immune response and activates an inflammatory cascade stimulating the release of cytokines and chemokines, particularly within the lung. Indeed, the inflammatory response during COVID-19 is likely the cause for the development of acute respiratory distress syndrome (ARDS). Patients with mild symptoms also show significant changes on pulmonary CT-scan suggestive of severe inflammatory involvement. HYPOTHESIS The overall hypothesis is that HBO2 is safe and reduces the inflammatory response in COVID-19 pneumonitis by attenuation of the innate immune system, increase hypoxia tolerance and thereby prevent organ failure and reduce mortality. EVALUATION OF THE HYPOTHESIS HBO2 is used in clinical practice to treat inflammatory conditions but has not been scientifically evaluated for COVID-19. Experimental and empirical data suggests that HBO2 may reduce inflammatory response in COVID-19. However, there are concerns regarding pulmonary safety in patients with pre-existing viral pneumonitis. EMPIRICAL DATA Anecdotes from "compassionate use" and two published case reports show promising results. CONSEQUENCES OF THE HYPOTHESIS AND DISCUSSION Small prospective clinical trials are on the way and we are conducting a randomized clinical trial.
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Affiliation(s)
- Anders Kjellberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Antonio De Maio
- Division of Trauma, Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; Department of Neurosciences, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, University of California San Diego, La Jolla, CA 92093, USA
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13
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Wingelaar TT, Brinkman P, Hoencamp R, van Ooij PJA, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Assessment of pulmonary oxygen toxicity in special operations forces divers under operational circumstances using exhaled breath analysis. Diving Hyperb Med 2020; 50:2-7. [PMID: 32187611 DOI: 10.28920/dhm50.1.2-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/12/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Netherlands Maritime Special Operations Forces use closed circuit oxygen rebreathers (O₂-CCR), which can cause pulmonary oxygen toxicity (POT). Recent studies demonstrated that volatile organic compounds (VOCs) can be used to detect POT in laboratory conditions. It is unclear if similar VOCs can be identified outside the laboratory. This study hypothesised that similar VOCs can be identified after O₂-CCR diving in operational settings. METHODS Scenario one: 4 h O₂-CCR dive to 3 metres' seawater (msw) with rested divers. Scenario two: 3 h O₂-CCR dive to 3 msw following a 5 day physically straining operational scenario. Exhaled breath samples were collected 30 min before and 30 min and 2 h after diving under field conditions and analysed using gas chromatography-mass spectrometry (GC-MS) to reconstruct VOCs, whose levels were tested longitudinally using a Kruskal-Wallis test. RESULTS Eleven divers were included: four in scenario one and seven in scenario two. The 2 h post-dive sample could not be obtained in scenario two; therefore, 26 samples were collected. GC-MS analysis identified three relevant VOCs: cyclohexane, 2,4-dimethylhexane and 3-methylnonane. The intensities of 2,4-dimethylhexane and 3-methylnonane were significantly (P = 0.048 and P = 0.016, respectively) increased post-dive relative to baseline (range: 212-461%) in both scenarios. Cyclohexane was increased not significantly (P = 0.178) post-dive (range: 87-433%). CONCLUSIONS VOCs similar to those associated with POT in laboratory conditions were identified after operational O₂-CCR dives using GC-MS. Post-dive intensities were higher than in previous studies, and it remains to be determined if this is attributable to different dive profiles, diving equipment or other environmental factors.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands.,Corresponding author: Dr Thijs T Wingelaar, Royal Netherlands Navy Diving Medical Centre, Rijkszee en marinehaven, 1780 CA, Den Helder, the Netherlands,
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands.,Defence Healthcare Organisation, Ministry of Defence, Utrecht, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Pieter-Jan Am van Ooij
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Pulmonology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | | | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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14
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Fukuda S, Niimi Y, Andersen CR, Manyeza ER, Rojas JD, Prough DS, Enkhbaatar P. Blood carboxyhemoglobin elimination curve, half-lifetime, and arterial-venous differences in acute phase of carbon monoxide poisoning in ovine smoke inhalation injury model. Biochem Biophys Res Commun 2020; 526:141-146. [PMID: 32199614 DOI: 10.1016/j.bbrc.2020.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
Smoke inhalation injury (SII) affects more than 50,000 people annually causing carbon monoxide (CO) poisoning. Although the increased blood level of carboxyhemoglobin (CO-Hb) is frequently used to confirm the diagnosis of SII, knowledge of its elimination in the acute phase is still limited. The aim of this study is to determine CO-Hb elimination rates and their differences in arterial (aCO-Hb) and mixed-venous (vCO-Hb) blood following severe SII in a clinically relevant ovine model. Forty-three chronically instrumented female sheep were subjected to SII (12 breaths, 4 sets) through tracheostomy tube under anesthesia and analgesia. After the SII, sheep were awakened and placed on a mechanical ventilator (FiO2 = 1.0, tidal volume 12 mL/kg, and PEEP = 5cmH2O) and monitored. Arterial and mixed-venous blood samples were withdrawn simultaneously for blood gas analysis at various time points to determine CO-HB half-lifetime and an elimination curve. The mean of highest aCO-Hb level during SII was 70.8 ± 13.9%. The aCO-Hb elimination curve showed an approximated exponential decay during the first 60 min. Per mixed linear regression model analysis, aCO-Hb significantly (p < 0.001) declined (4.3%/minute) with a decay constant lambda of 0.044. With this lambda, mean lifetime and half-lifetime of aCO-Hb were 22.7 and 15.7 min, respectively. The aCO-Hb was significantly lower compared to vCO-Hb at all-time points (0-180 min). To our knowledge, this is the first report describing CO-Hb elimination curve in the acute phase after severe SII in the clinically relevant ovine model. Our data shows that CO-Hb is decreasing in linear manner with supportive mechanical ventilation (0-60 min). The results may help to understand CO-Hb elimination curve in the acute phase and improvement of pre-hospital and initial clinical care in patients with CO poisoning.
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Affiliation(s)
- Satoshi Fukuda
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Yosuke Niimi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Clark R Andersen
- Department of Preventive Medicine & Community Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Ennert R Manyeza
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jose D Rojas
- Department of Respiratory Care, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Donald S Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
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15
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Zenske A, Kähler W, Koch A, Oellrich K, Pepper C, Muth T, Schipke JD. Does oxygen-enriched air better than normal air improve sympathovagal balance in recreational divers?An open-water study. Res Sports Med 2019; 28:397-412. [PMID: 31762338 DOI: 10.1080/15438627.2019.1694930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Effects of the hyperbaric environment on the autonomic nervous system (ANS) in recreational divers are not firmly settled. Aim of this exploratory study was to (1) assess ANS changes during scuba diving via recordings of electrocardiograms (ECG) and to (2) study whether nitrox40 better improves sympathovagal balance over air. 13 experienced divers (~40yrs) performed two open-water dives each breathing either air or nitrox40 (25m/39min). 3-channel ECGs were recorded using a custom-made underwater Holter-monitor. The underwater Holter system proved to be safe. Air consumption exceeded nitrox40 consumption by 12% (n = 13; p < 0.05). Both air and nitrox40 dives reduced HR (10 vs 13%; p < 0.05). The overall HRV (pNN50: 82 vs 126%; p < 0.05) and its vagal proportion (RMSSD: 33 vs 50%; p < 0.05) increased during the dive. Moreover, low (LF: 61 vs 47%) and high (HF: 71 vs 140%) frequency power were increased (all p < 0.05), decreasing the ratio of LF to HF (22 vs 34%). : Conventional open-water dives distinctly affect the ANS in experienced recreational divers, with sympathetic activation less pronounced than vagal activation thereby improving the sympathovagal balance. Nitrox40 delivered two positive results: nitrox40 consumption was lower than air consumption, and nitrox40 better improved the sympathovagal balance over air.
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Affiliation(s)
- André Zenske
- Department of Anaesthesiology, Operative Intensive Medicine, and Pain Medicine, Klinikum St. Elisabeth Straubing , Straubing, Germany
| | - Wataru Kähler
- Maritime Medicine, German Naval Medical Institute , Kronshagen, Germany
| | - Andreas Koch
- Maritime Medicine, German Naval Medical Institute , Kronshagen, Germany
| | - Kerstin Oellrich
- Maritime Medicine, German Naval Medical Institute , Kronshagen, Germany
| | | | - Thomas Muth
- Institute of Occupational, Social and Environmental Medicine , Düsseldorf, Heinrich Heine University, Germany
| | - Jochen D Schipke
- Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum Düsseldorf , Düsseldorf, Germany
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16
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Wingelaar TT, Brinkman P, de Vries R, van Ooij PJA, Hoencamp R, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Detecting Pulmonary Oxygen Toxicity Using eNose Technology and Associations between Electronic Nose and Gas Chromatography-Mass Spectrometry Data. Metabolites 2019; 9:metabo9120286. [PMID: 31766640 PMCID: PMC6950559 DOI: 10.3390/metabo9120286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/04/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Exposure to oxygen under increased atmospheric pressures can induce pulmonary oxygen toxicity (POT). Exhaled breath analysis using gas chromatography–mass spectrometry (GC–MS) has revealed that volatile organic compounds (VOCs) are associated with inflammation and lipoperoxidation after hyperbaric–hyperoxic exposure. Electronic nose (eNose) technology would be more suited for the detection of POT, since it is less time and resource consuming. However, it is unknown whether eNose technology can detect POT and whether eNose sensor data can be associated with VOCs of interest. In this randomized cross-over trial, the exhaled breath from divers who had made two dives of 1 h to 192.5 kPa (a depth of 9 m) with either 100% oxygen or compressed air was analyzed, at several time points, using GC–MS and eNose. We used a partial least square discriminant analysis, eNose discriminated oxygen and air dives at 30 min post dive with an area under the receiver operating characteristics curve of 79.9% (95%CI: 61.1–98.6; p = 0.003). A two-way orthogonal partial least square regression (O2PLS) model analysis revealed an R² of 0.50 between targeted VOCs obtained by GC–MS and eNose sensor data. The contribution of each sensor to the detection of targeted VOCs was also assessed using O2PLS. When all GC–MS fragments were included in the O2PLS model, this resulted in an R² of 0.08. Thus, eNose could detect POT 30 min post dive, and the correlation between targeted VOCs and eNose data could be assessed using O2PLS.
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Affiliation(s)
- Thijs T. Wingelaar
- Diving and Submarine Medical Center, Royal Netherlands Navy, Rijkszee en Marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-889-510-480
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rianne de Vries
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Breathomix, Pascalstraat 13H, 2811 EL Reeuwijk, the Netherlands
| | - Pieter-Jan A.M. van Ooij
- Diving and Submarine Medical Center, Royal Netherlands Navy, Rijkszee en Marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
- Defense Healthcare Organisation, Ministry of Defence, Herculeslaan 1, 3584 AB Utrecht, The Netherlands
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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17
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Berenji Ardestani S, Matchkov VV, Eftedal I, Pedersen M. A Single Simulated Heliox Dive Modifies Endothelial Function in the Vascular Wall of ApoE Knockout Male Rats More Than Females. Front Physiol 2019; 10:1342. [PMID: 31695628 PMCID: PMC6817487 DOI: 10.3389/fphys.2019.01342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction The number of divers is rising every year, including an increasing number of aging persons with impaired endothelial function and concomitant atherosclerosis. While diving is an independent modulator of endothelial function, little is known about how diving affects already impaired endothelium. In this study, we questioned whether diving exposure leads to further damage of an already impaired endothelium. Methods A total of 5 male and 5 female ApoE knockout (KO) rats were exposed to simulated diving to an absolute pressure of 600 kPa in heliox gas (80% helium, 20% oxygen) for 1 h in a dry pressure chamber. 10 ApoE KO rats (5 males, 5 females) and 8 male Sprague-Dawley rats served as controls. Endothelial function was examined in vitro by isometric myography of pulmonary and mesenteric arteries. Lipid peroxidation in blood plasma, heart and lung tissue was used as measures of oxidative stress. Expression and phosphorylation of endothelial NO synthase were quantified by Western blot. Results and Conclusion A single simulated dive was found to induce endothelial dysfunction in the pulmonary arteries of ApoE KO rats, and this was more profound in male than female rats. Endothelial dysfunction in males was associated with changing in production or bioavailability of NO; while in female pulmonary arteries an imbalance in prostanoid signaling was observed. No effect of diving was found on mesenteric arteries from rats of either sex. Our findings suggest that changes in endothelial dysfunction were specific for pulmonary circulation. In future, human translation of these findings may suggest caution for divers who are elderly or have prior reduced endothelial function.
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Affiliation(s)
- Simin Berenji Ardestani
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU: Norwegian University of Science and Technology, Trondheim, Norway
| | | | - 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
| | - Michael Pedersen
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
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18
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Arieli R. Calculated risk of pulmonary and central nervous system oxygen toxicity: a toxicity index derived from the power equation. Diving Hyperb Med 2019; 49:154-160. [PMID: 31523789 DOI: 10.28920/dhm49.3.154-160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/09/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk of oxygen toxicity has become a prominent issue due to the increasingly widespread administration of hyperbaric oxygen (HBO) therapy, as well as the expansion of diving techniques to include oxygen-enriched gas mixtures and technical diving. However, current methods used to calculate the cumulative risk of oxygen toxicity during an HBO exposure i.e., the unit pulmonary toxic dose concept, and the safe boundaries for central nervous system oxygen toxicity (CNS-OT), are based on a simple linear relationship with an inspired partial pressure of oxygen (PO2) and are not supported by recent data. METHODS The power equation: Toxicity Index = t2 × PO2c, where t represents time and c represents the power term, was derived from the chemical reactions producing reactive oxygen species or reactive nitrogen species. RESULTS The toxicity index was shown to have a good predictive capability using PO2 with a power c of 6.8 for CNS-OT and 4.57 for pulmonary oxygen toxicity. The pulmonary oxygen toxicity index (PO2 in atmospheres absolute, time in h) should not exceed 250. The CNS-OT index (PO2 in atmospheres absolute, time in min) should not exceed 26,108 for a 1% risk. CONCLUSION The limited use of this toxicity index in the diving community, after more than a decade since its publication in the literature, establishes the need for a handy, user-friendly implementation of the power equation.
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Affiliation(s)
- Ran Arieli
- Corresponding author: Dr Ran Arieli, 12 Klil-Hakhoresh, Rakefet, D N Misgav 0020175, Israel, .,Divers Alert Network, Durham NC, USA.,Eliachar Research Laboratory, Western Galilee Medical Centre, Nahariya, Israel
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19
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Tillmans F, Sharghi R, Noy T, Kähler W, Klapa S, Sartisohn S, Sebens S, Koch A. Effect of hyperoxia on the immune status of oxygen divers and endurance athletes. Free Radic Res 2019; 53:522-534. [PMID: 31117828 DOI: 10.1080/10715762.2019.1612890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Physical activity, particularly that, exerted by endurance athletes, impacts the immune status of the human body. Prolonged duration and high-intensity endurance training lead to increased production of reactive oxygen species (ROS) and thereby to oxidative stress. Military combat swimmers (O2-divers) are regularly exposed to hyperbaric hyperoxia (HBO) in addition to intensive endurance training intervals. They are, therefore, exposed to extreme levels of oxidative stress. Several studies support that the intensity of oxidative stress essentially determines the effect on immune status. The aim of this study was to comparatively characterise peripheral blood mononuclear cells (PBMCs) of O2-divers (military combat swimmers), endurance athletes (amateur triathletes), and healthy control volunteers with respect to DNA fragmentation, immune status and signs of inflammation. Furthermore, it was investigated how PBMCs from these groups responded acutely to exposure to HBO. We showed that DNA fragmentation was comparable in PBMCs of all three groups under basal conditions directly after HBO exposure. However, significantly higher DNA fragmentation was observed in O2-divers 18 hours after HBO, possibly indicating a slower recovery. O2-divers also exhibited a proinflammatory immune status exemplified by an elevated number of CD4+CD25+ T cells, elevated expression of proinflammatory cytokine IL-12, and diminished expression of anti-inflammatory TGF-β1 compared to controls. Supported by a decreased basal gene expression and prolonged upregulation of anti-oxidative HO-1, these data suggest that higher oxidative stress levels, as present under intermitted hyperbaric hyperoxia, e.g. through oxygen diving, promote a higher inflammatory immune status than oxidative stress through endurance training alone.
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Affiliation(s)
- Frauke Tillmans
- a Naval Institute for Maritime Medicine , Kronshagen , Germany
| | - Roshanak Sharghi
- b Institute for Experimental Cancer Research, Christian-Albrechts-University Kiel , Kiel , Germany
| | - Tatjana Noy
- a Naval Institute for Maritime Medicine , Kronshagen , Germany
| | - Wataru Kähler
- a Naval Institute for Maritime Medicine , Kronshagen , Germany
| | - Sebastian Klapa
- a Naval Institute for Maritime Medicine , Kronshagen , Germany
| | - Simon Sartisohn
- a Naval Institute for Maritime Medicine , Kronshagen , Germany
| | - Susanne Sebens
- b Institute for Experimental Cancer Research, Christian-Albrechts-University Kiel , Kiel , Germany
| | - Andreas Koch
- a Naval Institute for Maritime Medicine , Kronshagen , Germany
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20
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Wingelaar TT, Brinkman P, van Ooij PJAM, Hoencamp R, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Markers of Pulmonary Oxygen Toxicity in Hyperbaric Oxygen Therapy Using Exhaled Breath Analysis. Front Physiol 2019; 10:475. [PMID: 31068838 PMCID: PMC6491850 DOI: 10.3389/fphys.2019.00475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Although hyperbaric oxygen therapy (HBOT) has beneficial effects, some patients experience fatigue and pulmonary complaints after several sessions. The current limits of hyperbaric oxygen exposure to prevent pulmonary oxygen toxicity (POT) are based on pulmonary function tests (PFT), but the limitations of PFT are recognized worldwide. However, no newer modalities to detect POT have been established. Exhaled breath analysis in divers have shown volatile organic compounds (VOCs) of inflammation and methyl alkanes. This study hypothesized that similar VOCs might be detected after HBOT. Methods Ten healthy volunteers of the Royal Netherlands Navy underwent six HBOT sessions (95 min at 253 kPa, including three 5-min “air breaks”), i.e., on five consecutive days followed by another session after 2 days of rest. At 30 min before the dive, and at 30 min, 2 and 4 h post-dive, exhaled breath was collected and followed by PFT. Exhaled breath samples were analyzed using gas chromatography-mass spectrometry (GC-MS). After univariate tests and correlation of retention times, ion fragments could be identified using a reference database. Using these fragments VOCs could be reconstructed, which were clustered using principal component analysis. These clusters were tested longitudinally with ANOVA. Results After GC-MS analysis, eleven relevant VOCs were identified which could be clustered into two principal components (PC). PC1 consisted of VOCs associated with inflammation and showed no significant change over time. The intensities of PC2, consisting of methyl alkanes, showed a significant decrease (p = 0.001) after the first HBOT session to 50.8%, remained decreased during the subsequent days (mean 82%), and decreased even further after 2 days of rest to 58% (compared to baseline). PFT remained virtually unchanged. Discussion Although similar VOCs were found when compared to diving, the decrease of methyl alkanes (PC2) is in contrast to the increase seen in divers. It is unknown why emission of methyl alkanes (which could originate from the phosphatidylcholine membrane in the alveoli) are reduced after HBOT. This suggests that HBOT might not be as damaging to the pulmonary tract as previously assumed. Future research on POT should focus on the identified VOCs (inflammation and methyl alkanes).
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Affiliation(s)
- T T Wingelaar
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - P Brinkman
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - P J A M van Ooij
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - R Hoencamp
- Department of Surgery, Alrijne Hospital Leiderdorp, Leiderdorp, Netherlands.,Defense Healthcare Organisation, Ministry of Defence, Utrecht, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
| | | | - M W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - R A van Hulst
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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21
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Xie CW, Wang ZZ, Zhang YN, Chen YL, Li RP, Zhang JD. Effect of Interaction between Adenosine and Nitric Oxide on Central Nervous System Oxygen Toxicity. Neurotox Res 2019; 36:193-203. [PMID: 30927242 DOI: 10.1007/s12640-019-00025-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 11/26/2022]
Abstract
The metabolism of adenosine (ADO) and nitric oxide (NO) in brain tissues is closely associated with the change of oxygen content. They have contrary effects in the onset of hyperbaric oxygen (HBO)-induced central nervous system oxygen toxicity (CNS OT): ADO can suppress the onset, while NO promotes it. We adopted the ADO-augmenting measure and NO-inhibiting measure in this study and found the combined use had a far superior preventive and therapeutic effect in protecting against CNS OT compared with the use of either measure alone. So we hypothesized that there is an interaction between ADO and NO which has an important impact on the onset of CNS OT. On this basis, we administered ADO-augmenting or ADO-inhibiting drugs to rats. After exposure to HBO, the onset of CNS OT was evaluated, followed by the measurement of NO content in brain tissues. In another experiment, rats were administered NO-augmenting or NO-inhibiting drugs. After exposure to HBO, the onset of CNS OT was evaluated, followed by measurement of the activities of ADO metabolism-related enzymes in brain tissues. The results showed that, following ADO augmentation, the content of NO and its metabolite was significantly reduced, and the onset of CNS OT significantly improved. After ADO inhibition, just the opposite was observed. NO promotion resulted in a decrease in the activity of ADO-producing enzyme, an increase in the activity of ADO-decomposing enzyme, and an aggravation in CNS OT. The above results were all reversed after an inhibition in NO content. Studies have shown that exposure to HBO has a significant impact on the content of ADO and NO in brain tissues as well as their biological effects, and ADO and NO might have an intense interaction, which might generate an important effect on the onset of CNS OT. The prophylaxis and treatment effects of CNS OT can be greatly enhanced by augmenting ADO and inhibiting NO.
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Affiliation(s)
- Cheng-Wei Xie
- Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433, China
| | - Zhong-Zhuang Wang
- Department of Pharmacy, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Ya-Nan Zhang
- Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433, China
| | - Yu-Liang Chen
- Nautical and Aviation Medicine Center, Navy General Hospital of PLA, Beijing, 10048, China
| | - Run-Ping Li
- Department of Diving Medicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433, China.
| | - Jun-Dong Zhang
- Tenth People's Hospital of Tongji University, Shanghai, 200072, China.
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Wingelaar TT, van Ooij PJAM, Brinkman P, van Hulst RA. Pulmonary Oxygen Toxicity in Navy Divers: A Crossover Study Using Exhaled Breath Analysis After a One-Hour Air or Oxygen Dive at Nine Meters of Sea Water. Front Physiol 2019; 10:10. [PMID: 30740057 PMCID: PMC6355711 DOI: 10.3389/fphys.2019.00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/08/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: Exposure to hyperbaric hyperoxic conditions can lead to pulmonary oxygen toxicity. Although a decrease in vital capacity has long been the gold standard, newer diagnostic modalities may be more accurate. In pulmonary medicine, much research has focussed on volatile organic compounds (VOCs) associated with inflammation in exhaled breath. In previous small studies after hyperbaric hyperoxic exposure several methyl alkanes were identified. This study aims to identify which VOCs mark the development of pulmonary oxygen toxicity. Methods: In this randomized crossover study, 12 divers of the Royal Netherlands Navy made two dives of one hour to 192.5 kPa (comparable to a depth of 9 msw) either with 100% oxygen or compressed air. At 30 min before the dive, and at 30 min and 1, 2, 3, and 4 h post-dive, exhaled breath was collected and followed by pulmonary function tests (PFT). Exhaled breath samples were analyzed using gas chromatography–mass spectrometry (GC–MS). After univariate tests and correlation of retention times, ion fragments could be identified using a standard reference database [National Institute of Standards and Technology (NIST)]. Using these fragments VOCs could be reconstructed, which were then tested longitudinally with analysis of variance. Results: After GC–MS analysis, seven relevant VOCs (generally methyl alkanes) were identified. Decane and decanal showed a significant increase after an oxygen dive (p = 0.020 and p = 0.013, respectively). The combined intensity of all VOCs showed a significant increase after oxygen diving (p = 0.040), which was at its peak (+35%) 3 h post-dive. Diffusion capacity of nitric oxide and alveolar membrane capacity showed a significant reduction after both dives, whereas no other differences in PFT were significant. Discussion: This study is the largest analysis of exhaled breath after in water oxygen dives to date and the first to longitudinally measure VOCs. The longitudinal setup showed an increase and subsequent decrease of exhaled components. The VOCs identified suggest that exposure to a one-hour dive with a partial pressure of oxygen of 192.5 kPa damages the phosphatidylcholine membrane in the alveoli, while the spirometry and diffusion capacity show little change. This suggests that exhaled breath analysis is a more accurate method to measure pulmonary oxygen toxicity.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Paul Brinkman
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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