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Galuret S, Vallée N, Tronchot A, Thomazeau H, Jannin P, Huaulmé A. Gaze behavior is related to objective technical skills assessment during virtual reality simulator-based surgical training: a proof of concept. Int J Comput Assist Radiol Surg 2023; 18:1697-1705. [PMID: 37286642 DOI: 10.1007/s11548-023-02961-8] [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] [Received: 01/20/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Simulation-based training allows surgical skills to be learned safely. Most virtual reality-based surgical simulators address technical skills without considering non-technical skills, such as gaze use. In this study, we investigated surgeons' visual behavior during virtual reality-based surgical training where visual guidance is provided. Our hypothesis was that the gaze distribution in the environment is correlated with the simulator's technical skills assessment. METHODS We recorded 25 surgical training sessions on an arthroscopic simulator. Trainees were equipped with a head-mounted eye-tracking device. A U-net was trained on two sessions to segment three simulator-specific areas of interest (AoI) and the background, to quantify gaze distribution. We tested whether the percentage of gazes in those areas was correlated with the simulator's scores. RESULTS The neural network was able to segment all AoI with a mean Intersection over Union superior to 94% for each area. The gaze percentage in the AoI differed among trainees. Despite several sources of data loss, we found significant correlations between gaze position and the simulator scores. For instance, trainees obtained better procedural scores when their gaze focused on the virtual assistance (Spearman correlation test, N = 7, r = 0.800, p = 0.031). CONCLUSION Our findings suggest that visual behavior should be quantified for assessing surgical expertise in simulation-based training environments, especially when visual guidance is provided. Ultimately visual behavior could be used to quantitatively assess surgeons' learning curve and expertise while training on VR simulators, in a way that complements existing metrics.
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Affiliation(s)
- Soline Galuret
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
| | - Nicolas Vallée
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
- Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France
| | - Alexandre Tronchot
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
- Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France
| | - Hervé Thomazeau
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
- Orthopedics and Trauma Department, Rennes University Hospital, 35000, Rennes, France
| | - Pierre Jannin
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France.
| | - Arnaud Huaulmé
- LTSI - UMR 1099, Univ. Rennes, Inserm, 35000, Rennes, France
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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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Maximen J, Rossetti A, Vallée N, DE Geyer A, Dreano T, Ropars M. Fractures of the fifth metacarpal neck treated by syndactyly: functional and quality of life outcomes of a series of 39 patients. Acta Orthop Belg 2023; 89:225-231. [PMID: 37924538 DOI: 10.52628/89.2.11778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The management of the fractures of the fifth metacarpal neck is still debated between surgical, orthopedic, and functional treatments. The main objective of our study was to report the functional results at two, six, and twelve weeks of patients treated with syndactyly for fifteen days for a fracture of the neck of the fifth metacarpal and to determine if these results were compatible with a short-term medical follow-up and if they allowed for a quick return to work. Thirty-nine patients were retrospectively included. Functional results and their variations were analyzed at two, six, and twelve weeks using self-questionnaires filled out during consultation (VAS scores, QuickDASH, EuroQol-5D-5L, and EuroQol- 5D-VAS). The duration of work leave was extracted from medical records. Two weeks after the trauma, patients mostly had a very moderate impact of their fracture on their daily life with an average VAS of 4.2±1, QuickDASH of 42.2±20.9, and EuroQol-5D-VAS of 78±11. QuickDASH and EuroQol-5D-VAS scores showed significant improvement between two and twelve weeks of follow-up, decreasing from 42.2±20.9 to 2.1±6 and from 78±11 to 96±6, respectively (p<0.0001). The dimensions of common activities, pain, and autonomy had the most patients in the "moderate impairment" subgroup at two weeks. Only the dimension of common activities still had 21% of patients moderately impacted. Twenty-five patients returned to work at an average of 21.8±1.5 days. Syndactyly treatment offers good functional results at two weeks that are confirmed during follow-up, compatible with reduced medical follow-up and early return to work.
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Morin J, Vallée N, Dufresne PL, Rives S, Lehot H, Daubresse L, Roffi R, Druelle A, Cungi PJ, Blatteau JE. Symptomatic or asymptomatic SAR-CoV-2 positive divers should be medically evaluated before returning to scuba diving. Front Physiol 2022; 13:1022370. [DOI: 10.3389/fphys.2022.1022370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: In order to allow the resumption of diving activities after a COVID-19 infection, French military divers are required to undergo a medical fitness to dive (FTD) assessment. We present here the results of this medical evaluation performed 1 month after the infection.Methods: We retrospectively analyzed between April 2020 and February 2021 200 records of divers suspected of COVID-19 contamination. Data collected included physical examination, ECG, blood biochemistry, chest CT scan and spirometry.Results: 145 PCR-positive subjects were included, representing 8.5% of the total population of French military divers. Two divers were hospitalized, one for pericarditis and the other for non-hypoxemic pneumonia. For the other 143 divers, physical examination, electrocardiogram and blood biology showed no abnormalities. However 5 divers (3.4%) had persistent subjective symptoms including fatigability, exertional dyspnea, dysesthesias and anosmia. 41 subjects (29%) had significant decreases in forced expiratory flows at 25–75% and 50% on spirometry (n = 20) or bilateral ground-glass opacities on chest CT scan (n = 24). Only 3 subjects were affected on both spirometry and chest CT. 45% of these abnormalities were found in subjects who were initially asymptomatic or had non-respiratory symptoms. In case of abnormalities, normalization was obtained within 3 months. The median time to return to diving was 45 days (IQR 30, 64).Conclusion: Our study confirms the need for standardized follow-up in all divers after COVID-19 infection and for maintaining a rest period before resuming diving activities.
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Andre S, Lehot H, Morin J, Louge P, de Maistre S, Roffi R, Druelle A, Gempp E, Vallée N, Vergne M, Blatteau JE. Influence of prehospital management on the outcome of spinal cord decompression sickness in scuba divers. Emerg Med J 2022; 39:emermed-2021-211227. [PMID: 35135892 DOI: 10.1136/emermed-2021-211227] [Citation(s) in RCA: 1] [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: 01/26/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Decompression sickness (DCS) with spinal cord involvement has an unfortunately high rate of long-term sequelae. The objective of this study was to determine the association of prehospital variables on the outcome of spinal cord DCS, especially the influence of the initial clinical presentation and the time to recompression. METHODS This was a retrospective study using prospectively collected data which included divers with spinal cord DCS seen at a single hyperbaric centre study from 2010 to 2018. Information regarding dive, latency of onset of symptoms, time to recompression and prehospital management, that is, use of oxygen, treatment and means of evacuation, were analysed as predictor variables. The initial clinical severity was estimated by the score of the French society of diving and hyperbaric medicine (MEDSUBHYP). The primary end point was the presence or absence of sequelae at discharge assessed by the modified score of the Japanese Orthopedic Association. RESULTS 195 divers (48±12 years, 42 women) were included. 34% had neurological sequelae at discharge. In multivariate analysis, a MEDSUBHYP score ≥6 and a time to recompression >194 min were significantly associated with incomplete neurological recovery (OR 9.5 (95% CI 4.6 to 19.8), p<0.0001 and OR 2.1 (95% CI 1.03 to 4.5), p=0.04, respectively). Time to recompression only appeared to be significant for patients with high initial clinical severity. As time to recompression increased, the level of sequelae also increased (p=0.014). CONCLUSION Determining the initial clinical severity is critical in identifying patients who need to be evacuated for recompression as quickly as possible.
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Affiliation(s)
- Sophie Andre
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
- SAMU 83 Var France, Toulon, France
| | - Henri Lehot
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
| | - Jean Morin
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
| | - Pierre Louge
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
- Hyperbaric Medicine, HUG, Geneve, Switzerland
| | | | - Romain Roffi
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
| | - Arnaud Druelle
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
| | - Emmanuel Gempp
- Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
| | | | - Muriel Vergne
- SAMU de coordination médicale maritime, SAMU 83 Var France, Toulon, France
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Boussuges A, Rives S, Finance J, Chaumet G, Vallée N, Risso JJ, Brégeon F. Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position. Front Med (Lausanne) 2021; 8:742703. [PMID: 34778304 PMCID: PMC8579005 DOI: 10.3389/fmed.2021.742703] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/16/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Diagnosing diaphragm dysfunction in the absence of complete paralysis remains difficult. The aim of the present study was to assess the normal values of the thickness and the inspiratory thickening of both hemidiaphragms as measured by ultrasonography in healthy volunteers while in a seated position. Methods: Healthy volunteers with a normal pulmonary function test were recruited. The diaphragmatic thickness was measured on both sides at the zone of apposition of the diaphragm to the rib cage during quiet breathing at end-expiration, end-inspiration, and after maximal inspiration. The thickening ratio, the thickening fraction, and the thickness at end-inspiration divided by the thickness at deep breathing were determined. The mean values and the lower and upper limits of normal were determined for men and women. Results: 200 healthy volunteers (100 men and 100 women) were included in the study. The statistical analysis revealed that women had a thinner hemidiaphragm than men on both sides and at the various breathing times studied. The lower limit of normality of the diaphragm thickness measured at end-expiration was estimated to be 1.3 mm in men and 1.1 mm in women, on both sides. The thickening fraction did not differ significantly between men and women. In men, it ranged from 60 to 260% on the left side and from 57 to 200% on the right side. In women, it ranged from 58 to 264% on the left side and from 60 to 229% on the right side. The lower limits of normality of the thickening fraction were determined to be 40 and 39% in men and 39 and 48% in women for the right and left hemidiaphragms, respectively. The upper limit for normal of the mean of both sides of the ratio thickness at end-inspiration divided by the thickness at deep breathing was determined to be 0.78 in women and 0.79 in men. Conclusion: The normal values of thickness and the indexes of diaphragmatic function should help clinicians with detecting diaphragm atrophy and dysfunction.
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Affiliation(s)
- Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRAE, Marseille, France.,Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRAE, Marseille, France
| | - Julie Finance
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | | | - Nicolas Vallée
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | - Jean-Jacques Risso
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | - Fabienne Brégeon
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Maximen J, Vallée N, Ropars M, Kim W. Chronic pain of the elbow due to angioleiomyoma: a case report. JSES Int 2021; 5:561-563. [PMID: 34136871 PMCID: PMC8178644 DOI: 10.1016/j.jseint.2021.01.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Julien Maximen
- Orthopedic Surgery Resident, Department of Orthopedic surgery, Pontchaillou University Hospital, Rennes, France
- Corresponding author: Julien Maximen, MD, Department of Orthopedic surgery, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.
| | - Nicolas Vallée
- Orthopedic Surgery Resident, Department of Orthopedic surgery, Pontchaillou University Hospital, Rennes, France
| | - Mickael Ropars
- Department of Orthopedic surgery, Pontchaillou University Hospital, Rennes, France
| | - Warren Kim
- Centre de la MAIN de Bretagne, Institut locomoteur de l’ouest, Saint-Grégoire, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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de Maistre S, Gaillard S, Martin JC, Richard S, Boussuges A, Rives S, Desruelle AV, Blatteau JE, Tardivel C, Risso JJ, Vallée N. Cecal metabolome fingerprint in a rat model of decompression sickness with neurological disorders. Sci Rep 2020; 10:15996. [PMID: 32994526 PMCID: PMC7524739 DOI: 10.1038/s41598-020-73033-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/11/2020] [Indexed: 01/19/2023] Open
Abstract
Massive bubble formation after diving can lead to decompression sickness (DCS), which can result in neurological disorders. We demonstrated that hydrogen production from intestinal fermentation could exacerbate DCS in rats fed with a standard diet. The aim of this study is to identify a fecal metabolomic signature that may result from the effects of a provocative hyperbaric exposure. The fecal metabolome was studied in two groups of rats previously fed with maize or soy in order to account for diet effects. 64 animals, weighing 379.0_20.2 g on the day of the dive, were exposed to the hyperbaric protocol. The rats were separated into two groups: 32 fed with maize (Div MAIZE) and 32 fed with soy (Div SOY). Gut fermentation before the dive was estimated by measuring exhaled hydrogen. Following hyperbaric exposure, we assessed for signs of DCS. Blood was analyzed to assay inflammatory cytokines. Conventional and ChemRICH approaches helped the metabolomic interpretation of the cecal content. The effect of the diet is very marked at the metabolomic level, a little less in the blood tests, without this appearing strictly in the clinic status. Nevertheless, 37 of the 184 metabolites analyzed are linked to clinical status. 35 over-expressed compounds let suggest less intestinal absorption, possibly accompanied by an alteration of the gut microbial community, in DCS. The decrease in another metabolite suggests hepatic impairment. This spectral difference of the ceca metabolomes deserves to be studied in order to check if it corresponds to functional microbial particularities.
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Affiliation(s)
- Sébastien de Maistre
- Service de médecine Hyperbare Expertise plongée, Hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800, Toulon Cedex 9, France
| | | | - Jean-Charles Martin
- UMR INRA 12060/INSERM1263/AMU C2VN, Plateforme Métabolomique, Faculté de Médecine la Timone, 13385, Marseille Cedex, France
| | | | - Alain Boussuges
- Institut de Recherche Biomédicale des Armées-Equipe de Recherche Subaquatique Opérationnelle, 83800, Toulon Cedex 9, France
| | - Sarah Rives
- Institut de Recherche Biomédicale des Armées-Equipe de Recherche Subaquatique Opérationnelle, 83800, Toulon Cedex 9, France
| | - Anne-Virginie Desruelle
- Institut de Recherche Biomédicale des Armées-Equipe de Recherche Subaquatique Opérationnelle, 83800, Toulon Cedex 9, France
| | - Jean-Eric Blatteau
- Service de médecine Hyperbare Expertise plongée, Hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800, Toulon Cedex 9, France
| | - Catherine Tardivel
- UMR INRA 12060/INSERM1263/AMU C2VN, Plateforme Métabolomique, Faculté de Médecine la Timone, 13385, Marseille Cedex, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées-Equipe de Recherche Subaquatique Opérationnelle, 83800, Toulon Cedex 9, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées-Equipe de Recherche Subaquatique Opérationnelle, 83800, Toulon Cedex 9, France.
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Boussuges A, Rives S, Marlinge M, Chaumet G, Vallée N, Guieu R, Gavarry O. Hyperoxia During Exercise: Impact on Adenosine Plasma Levels and Hemodynamic Data. Front Physiol 2020; 11:97. [PMID: 32116800 PMCID: PMC7026462 DOI: 10.3389/fphys.2020.00097] [Citation(s) in RCA: 5] [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: 09/26/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Adenosine is an ATP derivative that is strongly implicated in the cardiovascular adaptive response to exercise. In this study, we hypothesized that during exercise the hyperemia, commonly observed during exercise in air, was counteracted by the downregulation of the adenosinergic pathway during hyperoxic exposure. Methods Ten healthy volunteers performed two randomized sessions including gas exposure (Medical air or Oxygen) at rest and during exercise performed at 40% of maximal intensity, according to the individual fitness of the volunteers. Investigations included the measurement of adenosine plasma level (APL) and the recording of hemodynamic data [i.e., cardiac output (CO) and systemic vascular resistances (SVR) using pulsed Doppler and echocardiography]. Results Hyperoxia significantly decreased APL (from 0.58 ± 0.06 to 0.21 ± 0.05 μmol L–1, p < 0.001) heart rate and CO and increased SVR in healthy volunteers at rest. During exercise, an increase in APL was recorded in the two sessions when compared with measurements at rest (+0.4 ± 0.4 vs. +0.3 ± 0.2 μmol L–1 for medical air and oxygen exposures, respectively). APL was lower during the exercise performed under hyperoxia when compared with medical air exposure (0.5 ± 0.06 vs. 1.03 ± 0.2 μmol L–1, respectively p < 0.001). This result could contribute to the hemodynamic differences between the two conditions, such as the increase in SVR and the decrease in both heart rate and CO when exercises were performed during oxygen exposure as compared to medical air. Conclusion Hyperoxia decreased APLs in healthy volunteers at rest but did not eliminate the increase in APL and the decrease in SVR during low intensity exercise.
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Affiliation(s)
- Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix-Marseille Université, INSERM, INRA, Marseille, France
| | - Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), Aix-Marseille Université, INSERM, INRA, Marseille, France
| | - Marion Marlinge
- Center for Cardiovascular and Nutrition Research (C2VN), Aix-Marseille Université, INSERM, INRA, Marseille, France
| | | | - Nicolas Vallée
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | - Régis Guieu
- Center for Cardiovascular and Nutrition Research (C2VN), Aix-Marseille Université, INSERM, INRA, Marseille, France
| | - Olivier Gavarry
- Laboratoire Impact de l'Activité Physique sur la Santé, UFR STAPS, Université de Toulon, La Garde, France
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Desruelle AV, Louge P, Richard S, Blatteau JE, Gaillard S, De Maistre S, David H, Risso JJ, Vallée N. Demonstration by Infra-Red Imaging of a Temperature Control Defect in a Decompression Sickness Model Testing Minocycline. Front Physiol 2019; 10:933. [PMID: 31396102 PMCID: PMC6668502 DOI: 10.3389/fphys.2019.00933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/16/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022] Open
Abstract
The prevention, prognosis and resolution of decompression sickness (DCS) are not satisfactory. The etiology of DCS has highlighted thrombotic and inflammatory phenomena that could cause severe neurological disorders or even death. Given the immunomodulatory effects described for minocycline, an antibiotic in widespread use, we have decided to explore its effects in an experimental model for decompression sickness. 40 control mice (Ctrl) and 40 mice treated orally with 90 mg/kg of minocycline (MINO) were subjected to a protocol in a hyperbaric chamber, compressed with air. The purpose was to mimic a scuba dive to a depth of 90 msw and its pathogenic decompression phase. Clinical examinations and blood counts were conducted after the return to the surface. For the first time they were completed by a simple infrared (IR) imaging technique in order to assess feasibility and its clinical advantage in differentiating the sick mice (DCS) from the healthy mice (NoDCS). In this tudy, exposure to the hyperbaric protocol provoked a reduction in the number of circulating leukocytes. DCS in mice, manifesting itself by paralysis or convulsion for example, is also associated with a fall in platelets count. Cold areas ( < 25°C) were detected by IR in the hind paws and tail with significant differences (p < 0.05) between DCS and NoDCS. Severe hypothermia was also shown in the DCS mice. The ROC analysis of the thermograms has made it possible to determine that an average tail temperature below 27.5°C allows us to consider the animals to be suffering from DCS (OR = 8; AUC = 0.754, p = 0.0018). Minocycline modulates blood analysis and it seems to limit the mobilization of monocytes and granulocytes after the provocative dive. While a higher proportion of mice treated with minocycline experienced DCS symptoms, there is no significant difference. The infrared imaging has made it possible to show severe hypothermia. It suggests an modification of thermregulation in DCS animals. Surveillance by infrared camera is fast and it can aid the prognosis in the case of decompression sickness in mice.
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Affiliation(s)
- Anne-Virginie Desruelle
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Pierre Louge
- Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des Armées, Toulon, France
| | | | - Jean-Eric Blatteau
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France.,Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des Armées, Toulon, France
| | | | - Sébastien De Maistre
- Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des Armées, Toulon, France
| | - Hélène David
- Apricot Inhalotherapeutics, Saint-Laurent-de-l'Île-d'Orléans, QC, Canada
| | - Jean-Jacques Risso
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Nicolas Vallée
- Unité Environnements Extrêmes, Département Environnement Opérationnel, Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Toulon, France
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Boussuges A, Chaumet G, Vallée N, Risso JJ, Pontier JM. High Bubble Grade After Diving: The Role of the Blood Pressure Regimen. Front Physiol 2019; 10:749. [PMID: 31281261 PMCID: PMC6595181 DOI: 10.3389/fphys.2019.00749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/08/2019] [Accepted: 05/31/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction: Previous studies have suggested that the circulatory system was involved in the production of circulatory bubbles after diving. This study was designed to research the cardio-vascular function characteristics related to the production of high bubble grades after diving. Methods: Thirty trained divers were investigated both at baseline and after a 30-msw SCUBA dive. At baseline, the investigations included blood pressure measurement, echocardiography, and assessment of aerobic fitness using VO2 peak measurement. Blood samples were taken at rest, to measure the plasma concentration of NOx and endothelin-1. After diving, circulating bubbles were detected in the pulmonary artery by pulsed Doppler at 20-min intervals during the 90 min after surfacing. The global bubble quantity production was estimated by the KISS index. Results: Divers with a high bubble grade (KISS > 7.5) had systolic blood pressure, pulse pressure, weight, and height significantly higher than divers with a low bubble grade. By contrast, total arterial compliance, plasma NOx level, and percentage of predicted value of peak oxygen uptake were significantly lower in divers with a high bubble grade. Cardiac dimensions, left ventricular function, and plasma endothelin-1 concentration were not significantly different between groups. The multivariate analysis identified blood pressure as the main contributor of the quantity of bubble production. The model including pulse pressure, plasma NOx level, and percentage of predicted value of peak oxygen uptake has an explanatory power of 49.22%. Conclusion: The viscoelastic properties of the arterial tree appeared to be an important contributor to the circulating bubble production after a dive.
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Affiliation(s)
- Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, Marseille, France
| | | | - Nicolas Vallée
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | - Jean Jacques Risso
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | - Jean Michel Pontier
- Cephismer, Centre d'expertise plongée pour la Marine Nationale, Toulon, France
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13
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Blatteau JE, Gaillard S, De Maistre S, Richard S, Louges P, Gempp E, Druelles A, Lehot H, Morin J, Castagna O, Abraini JH, Risso JJ, Vallée N. Reduction in the Level of Plasma Mitochondrial DNA in Human Diving, Followed by an Increase in the Event of an Accident. Front Physiol 2018; 9:1695. [PMID: 30555340 PMCID: PMC6282000 DOI: 10.3389/fphys.2018.01695] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023] Open
Abstract
Circulating mitochondrial DNA (mtDNA) is receiving increasing attention as a danger-associated molecular pattern in conditions such as autoimmunity or trauma. In the context of decompression sickness (DCS), the course of which is sometimes erratic, we hypothesize that mtDNA plays a not insignificant role particularly in neurological type accidents. This study is based on the comparison of circulating mtDNA levels in humans presenting with various types of diving accidents, and punctured upon their admission at the hyperbaric facility. One hundred and fourteen volunteers took part in the study. According to the clinical criteria there were 12 Cerebro DCS, 57 Medullary DCS, 15 Vestibular DCS, 8 Ctrl+ (accident-free divers), and 22 Ctrl- (non-divers). This work demonstrates that accident-free divers have less mtDNA than non-divers, which leads to the assumption that hyperbaric exposure degrades the mtDNA. mtDNA levels are on average greater in divers with DCS compared with accident-free divers. On another hand, the amount of double strand DNA (dsDNA) is neither significantly different between controls, nor between the different DCS types. Initially the increase in circulating oligonucleotides was attributed to the destruction of cells by bubble abrasion following necrotic phenomena. If there really is a significant difference between the Medullary DCS and the Ctrl-, this difference is not significant between these same DCS and the Ctrl+. This refutes the idea of massive degassing and suggests the need for new research in order to verify that oxidative stress could be a key element without necessarily being sufficient for the occurrence of a neurological type of accident.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | | | - Sébastien De Maistre
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Simone Richard
- Mediterranean Institute of Oceanography, Université de Toulon, Toulon, France
| | - Pierre Louges
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Emmanuel Gempp
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Arnaud Druelles
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Henri Lehot
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Jean Morin
- Hôpital d’Instruction des Armées – Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Olivier Castagna
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Jacques H. Abraini
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
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14
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Lambrechts K, de Maistre S, Abraini JH, Blatteau JE, Risso JJ, Vallée N. Tirofiban, a Glycoprotein IIb/IIIa Antagonist, Has a Protective Effect on Decompression Sickness in Rats: Is the Crosstalk Between Platelet and Leukocytes Essential? Front Physiol 2018; 9:906. [PMID: 30050468 PMCID: PMC6050390 DOI: 10.3389/fphys.2018.00906] [Citation(s) in RCA: 5] [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: 04/27/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
In its severest forms, decompression sickness (DCS) may extend systemically and/or induce severe neurological deficits, including paralysis or even death. It seems that the sterile and ischemic inflammatory phenomena are consecutive to the reaction of the bubbles with the organism and that the blood platelet activation plays a determinant role in the development of DCS. According to the hypotheses commonly put forward, the bubbles could either activate the platelets by direct contact or be the cause of abrasion of the vascular epithelium, which would expose the basal plate glycogen and then prompt the platelets to activate. The purpose of this study is to confirm anti-platelet drugs specific to GPIIb/IIIa integrin could prevent DCS, using a rat model. There is a significant difference concerning the incidence of the drug on the clinical status of the rats (p = 0.016), with a better clinical outcome for rats treated with tirofiban (TIR) compared with the control rats (p = 0.027), even if the three anti-GPIIb/IIIa agents used have limited respiratory distress. TIR limited the decrease in platelet counts following the hyperbaric exposure. TIR help to prevent from DCS. TIR is specific to GPIIb/IIIa whereas eptifibatide and abciximab could inhibit αVβ3 and αMβ2 involved in communication with the immune system. While inhibiting GPIIb/IIIa could highlight a platelet-dependent inflammatory pathway that improves DCS outcomes, we wonder whether inhibiting the αVβ3 and αMβ2 communications is not a wrong approach for limiting mortality in DCS.
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Affiliation(s)
- Kate Lambrechts
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France.,Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS - Human Motricity, Education, Sport and Health Laboratory), Université du Sud Toulon Var, La Garde, France
| | - Sébastien de Maistre
- Hôpital d'Instruction des Armées - Service de Médecine Hyperbare et Expertise Plongée (Military Teaching Hospital - Hyperbaric Medicine and Diving Expertise Department), Toulon, France
| | - Jacques H Abraini
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France.,Département d'Anesthésiologie, Université Laval, Laval, QC, Canada.,Faculté de Médecine, Université de Caen Normandie (UNICAEN), Caen, France
| | - Jean-Eric Blatteau
- Hôpital d'Instruction des Armées - Service de Médecine Hyperbare et Expertise Plongée (Military Teaching Hospital - Hyperbaric Medicine and Diving Expertise Department), Toulon, France
| | - Jean-Jacques Risso
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France
| | - Nicolas Vallée
- Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées - Equipe Résidente de Recherche Subaquatique Opérationnelle (Armed Forces Biomedical Research Institute - Resident Operational Subaquatic Research Team), Toulon, France
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15
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Chazalviel L, David HN, Haelewyn B, Blatteau JE, Vallée N, Risso JJ, Besnard S, Abraini JH. The underestimated effect of normobaric hyperoxia on cerebral blood flow and its relationship to neuroprotection. Brain 2018; 139:e62. [PMID: 27412390 DOI: 10.1093/brain/aww178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laurent Chazalviel
- Normandie Université, UNICAEN, CNRS, UMR 6301 ISTCT, Equipe Cervoxy, Caen, France
| | - Hélène N David
- Université Laval, Département d'Anesthésiologie, Québec, Canada.,Monatomics Technology, 24 rue Erlanger, 75016 Paris, France
| | - Benoit Haelewyn
- Normandie Université, UNICAEN, Centre Universitaire de Ressources Biologiques, Caen, France
| | - Jean-Eric Blatteau
- Hôpital d'Instruction des Armées (HIA) Sainte-Anne, Service de Médecine Hyperbare et Expertise Plongée (SMHEP), Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France
| | | | - Jacques H Abraini
- Université Laval, Département d'Anesthésiologie, Québec, Canada.,Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France.,Normandie Université, UNICAEN, Faculté de Médecine, Caen, France
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16
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David HN, Haelewyn B, Blatteau JÉ, Risso JJ, Vallée N, Abraini JH. Xenon-helium gas mixture at equimolar concentration of 37.5% protects against oxygen and glucose deprivation-induced injury and inhibits tissue plasminogen activator. Med Gas Res 2017; 7:181-185. [PMID: 29152211 PMCID: PMC5674656 DOI: 10.4103/2045-9912.215747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/25/2023] Open
Abstract
Xenon (Xe) is considered to be the golden standard neuroprotective gas. However, Xe has a higher molecular weight and lower thermal conductivity and specific heat than those of nitrogen, the main diluent of oxygen in air. These physical characteristics could impair or at least reduce the intrinsic neuroprotective action of Xe by increasing the patient's respiratory workload and body temperature. In contrast, helium (He) is a cost-efficient gas with a lower molecular weight and higher thermal conductivity and specific heat than those of nitrogen, but is far less potent than Xe. In this study, we hypothesized that mixing Xe and He could allow obtaining a neuroprotective gas mixture with advantageously reduced molecular weight and increased thermal conductivity. We found that Xe and He at the equimolar concentration of 37.5% reduced oxygen-glucose deprivation-induced increase in lactate dehydrogenase in brain slices, an ex vivo model of acute ischemic stroke. These results together with the effects of Xe-He on the thrombolytic efficiency of tissue plasminogen activator are discussed.
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Affiliation(s)
| | | | - Jean-Éric Blatteau
- Hôpital d'Instruction des Armées (HIA) Sainte-Anne, Service de Médecine Hyperbare et Expertise Plongée (SMHEP), Toulon, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, Toulon, France
| | - Jacques H Abraini
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, Toulon, France.,Université Laval, Faculté de Médecine, Département d'Anesthesiologie, Québec, QC, Canada.,Université de Caen-Normandie, Caen, France
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17
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Abraini JH, David HN, Blatteau JÉ, Risso JJ, Vallée N. A method for calculating the gas volume proportions and inhalation temperature of inert gas mixtures allowing reaching normothermic or hypothermic target body temperature in the awake rat. Med Gas Res 2017; 7:175-180. [PMID: 29152210 PMCID: PMC5674655 DOI: 10.4103/2045-9912.215746] [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: 11/04/2022] Open
Abstract
The noble gases xenon (Xe) and helium (He) are known to possess neuroprotective properties. Xe is considered the golden standard neuroprotective gas. However, Xe has a higher molecular weight and lower thermal conductivity and specific heat than those of nitrogen, the main diluent of oxygen (O2) in air, conditions that could impair or at least reduce the intrinsic neuroprotective properties of Xe by increasing the critical care patient's respiratory workload and body temperature. In contrast, He has a lower molecular weight and higher thermal conductivity and specific heat than those of nitrogen, but is unfortunately far less potent than Xe at providing neuroprotection. Therefore, combining Xe with He could allow obtaining, depending on the gas inhalation temperature and composition, gas mixtures with neutral or hypothermic properties, the latter being advantageous in term of neuroprotection. However, calculating the thermal properties of a mixture, whatever the substances - gases, metals, rubbers, etc. - is not trivial. To answer this question, we provide a graphical method to assess the volume proportions of Xe, He and O2 that a gas mixture should contain, and the inhalation temperature to which it should be administered to allow a clinician to maintain the patient at a target body temperature.
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Affiliation(s)
- Jacques H Abraini
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, Toulon, France.,Université Laval, Faculté de Médecine, Département d'Anesthesiologie, Québec, QC, Canada
| | - Hélène N David
- Université Laval, Faculté de Médecine, Département d'Anesthesiologie, Québec, QC, Canada
| | - Jean-Éric Blatteau
- Hôpital d'Instruction des Armées Sainte-Anne, Service de Médecine Hyperbare et Expertise Plongée, Toulon, France
| | - Jean Jacques Risso
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, Toulon, France
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18
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Cosnard C, De Maistre S, Abraini JH, Chazalviel L, Blatteau JE, Risso JJ, Vallée N. Thirty-five Day Fluoxetine Treatment Limits Sensory-Motor Deficit and Biochemical Disorders in a Rat Model of Decompression Sickness. Front Physiol 2017; 8:604. [PMID: 28928667 PMCID: PMC5591790 DOI: 10.3389/fphys.2017.00604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/05/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022] Open
Abstract
According to the OECD statistical base for 2014, anti-depressants will, on average, be distributed at a rate of 62 daily doses per 1,000 inhabitants for the 25 countries surveyed (Health at a glance: Europe 2014; OECD Health Statistics; World Health Organization and OECD Health Statistics, 2014). Divers must be concerned. On another hand, divers are potentially exposed to decompression sickness including coagulation inflammation and ischemia, which can result in neurological lesions or even death. The purpose of this study is to assess whether chronic treatment with anti-depressants may represent a contraindication to the practice of an at-risk activity, such as, scuba diving, or even presents a benefit by attenuating the severity of the symptoms. We study for the first time the effect of a 35-day fluoxetine treatment (20 mg/kg) on the occurrence of decompression sickness in laboratory rats (n = 79). Following exposure to the hazardous protocol, there is a significant correlation between the type of treatment and the clinical status of the rats in favor of a better clinical prognosis for the rats treated with fluoxetine with a significantly higher number of No DCS status and a lower number of Severe DCS status in the Flux, compared to Controls. The treatment modifies the rat performances both significantly and favorably during the physical and behavioral tests, just like their biological and biochemical constants. After decompression, rats under treatment display lower sensory-motor deficit and lowers biochemical disorders. From a biological point of view, we conclude fluoxetine should not be seen as a contraindication for diving on the basis of anticipated increased physiological risk.
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Affiliation(s)
- Caroline Cosnard
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées, Hopital d'instruction des Armées Sainte-AnneToulon, France
| | - Sébastien De Maistre
- Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des ArméesToulon, France
| | - Jacques H Abraini
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées, Hopital d'instruction des Armées Sainte-AnneToulon, France.,Département d'Anesthésiologie, Université LavalLaval, QC, Canada.,Faculté de Médecine, Université de Caen Normandie (UNICAEN)Caen, France
| | | | - Jean-Eric Blatteau
- Service de Médecine Hyperbare et Expertise Plongée, Hôpital d'Instruction des ArméesToulon, France
| | - Jean-Jacques Risso
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées, Hopital d'instruction des Armées Sainte-AnneToulon, France
| | - Nicolas Vallée
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Institut de Recherche Biomédicale des Armées, Hopital d'instruction des Armées Sainte-AnneToulon, France.,Université de ToulonLa Garde, France
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19
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Chazalviel L, Blatteau JE, Vallée N, Risso JJ, Besnard S, Abraini JH. Effects of normobaric versus hyperbaric oxygen on cell injury induced by oxygen and glucose deprivation in acute brain slices. Med Gas Res 2016; 6:169-173. [PMID: 27867486 PMCID: PMC5110143 DOI: 10.4103/2045-9912.191364] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Normobaric oxygen (NBO) and hyperbaric oxygen (HBO) are emerging as a possible co-treatment of acute ischemic stroke. Both have been shown to reduce infarct volume, to improve neurologic outcome, to promote endogenous tissue plasminogen activator-induced thrombolysis and cerebral blood flow, and to improve tissue oxygenation through oxygen diffusion in the ischemic areas, thereby questioning the interest of HBO compared to NBO. In the present study, in order to investigate and compare the oxygen diffusion effects of NBO and HBO on acute ischemic stroke independently of their effects at the vascular level, we used acute brain slices exposed to oxygen and glucose deprivation, an ex vivo model of brain ischemia that allows investigating the acute effects of NBO (partial pressure of oxygen (pO2) = 1 atmospheres absolute (ATA) = 0.1 MPa) and HBO (pO2 = 2.5 ATA = 0.25 MPa) through tissue oxygenation on ischemia-induced cell injury as measured by the release of lactate dehydrogenase. We found that HBO, but not NBO, reduced oxygen and glucose deprivation-induced cell injury, indicating that passive tissue oxygenation (i.e. without vascular support) of the brain parenchyma requires oxygen partial pressure higher than 1 ATA.
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Affiliation(s)
- Laurent Chazalviel
- Normandie Université, UNICAEN, CNRS, UMR 6301 ISTCT, Equipe Cervoxy, Caen, France
| | - Jean-Eric Blatteau
- Hôpital d'Instruction des Armées (HIA) Sainte-Anne, Service de Médecine Hyperbare et Expertise Plongée (SMHEP), Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France
| | | | - Jacques H Abraini
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France; Normandie Université, UNICAEN, Faculté de Médecine, France; Université Laval, Département d'Anesthésiologie, Québec, Canada
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Gempp E, Louge P, de Maistre S, Morvan JB, Vallée N, Blatteau JE. Initial Severity Scoring and Residual Deficit in Scuba Divers with Inner Ear Decompression Sickness. Aerosp Med Hum Perform 2016; 87:735-9. [PMID: 27634609 DOI: 10.3357/amhp.4535.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inner ear decompression sickness (IEDCS) in scuba diving results in residual vestibulocochlear deficits with a potential impact on health-related quality of life. The aim of this study was to determine the predictive factors for poor clinical recovery and to try to establish a prognostic score on initial physical examination. METHODS The medical records of injured divers with IEDCS treated in our facility between 2009 and 2014 were retrospectively analyzed. The clinical severity of the deficit was evaluated on admission using a numerical scoring system taking into account the intensity of vestibular symptoms and the presence of cochlear signs. The clinical outcome was assessed at 3 mo by telephone interview. After multivariate analysis of potential risk factors for sequelae, the discriminating value of the score and these prognostic reliability indices were calculated. RESULTS Among the 99 patients included in the study, 24% still had residual symptoms. Statistical analysis revealed that only a high clinical score [OR = 1.39 (95% CI 1.13-1.71)] and a delay in hyperbaric recompression >6 h [OR = 1.001 (95% CI 1-1.003)] were independently associated with incomplete recovery. The advantage of the score lay in its highly specific nature (92%) rather than its sensitivity (48%) for a threshold of 10. CONCLUSION Results suggest that the severity of IEDCS can be easily determined by a clinical score during the acute phase. Recompression treatment should not be delayed. Gempp E, Louge P, de Maistre S, Morvan J-B, Vallée N, Blatteau J-E. Initial severity scoring and residual deficit in scuba divers with inner ear decompression sickness. Aerosp Med Hum Perform. 2016; 87(8):735-739.
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Affiliation(s)
- Emmanuel Gempp
- Department of Diving and Hyperbaric Medicine and the Department of Otorhinolaryngology, Head and Neck Surgery, Sainte Anne’s Military Hospital, Toulon, France
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Chazalviel L, Haelewyn B, Degoulet M, Blatteau JE, Vallée N, Risso JJ, Besnard S, Abraini JH. Hyperbaric oxygen increases tissue-plasminogen activator-induced thrombolysis in vitro, and reduces ischemic brain damage and edema in rats subjected to thromboembolic brain ischemia. Med Gas Res 2016; 6:64-69. [PMID: 27867469 PMCID: PMC5110134 DOI: 10.4103/2045-9912.184713] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 12/21/2022] Open
Abstract
Recent data have shown that normobaric oxygen (NBO) increases the catalytic and thrombolytic efficiency of recombinant tissue plasminogen activator (rtPA) in vitro, and is as efficient as rtPA at restoring cerebral blood flow in rats subjected to thromboembolic brain ischemia. Therefore, in the present study, we studied the effects of hyperbaric oxygen (HBO) (i) on rtPA-induced thrombolysis in vitro and (ii) in rats subjected to thromboembolic middle cerebral artery occlusion-induced brain ischemia. HBO increases rtPA-induced thrombolysis in vitro to a greater extent than NBO; in addition, HBO treatment of 5-minute duration, but not of 25-minute duration, reduces brain damage and edema in vivo. In line with the facilitating effect of NBO on cerebral blood flow, our findings suggest that 5-minute HBO could have provided neuroprotection by promoting thrombolysis. The lack of effect of HBO exposure of longer duration is discussed.
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Affiliation(s)
- Laurent Chazalviel
- Université de Caen Normandie - CNRS, UMR 6301 ISTCT, Equipe Cervoxy, Caen, France
| | | | | | - Jean-Eric Blatteau
- Hôpital d'Instruction des Armées (HIA) Sainte-Anne, Service de Médecine Hyperbare et Expertise Plongée (SMHEP), Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France
| | | | - Jacques H Abraini
- Université de Caen Normandie, Faculté de Médecine, France; Institut de Recherche Biomédicale des Armées (IRBA), Equipe Résidente de Recherche Subaquatique Opérationnelle (ERRSO), Toulon, France; Université Laval, Département d'Anesthésiologie, Québec, Canada
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Vallée N, Lambrechts K, De Maistre S, Royal P, Mazella J, Borsotto M, Heurteaux C, Abraini J, Risso JJ, Blatteau JE. Fluoxetine Protection in Decompression Sickness in Mice is Enhanced by Blocking TREK-1 Potassium Channel with the "spadin" Antidepressant. Front Physiol 2016; 7:42. [PMID: 26909044 PMCID: PMC4755105 DOI: 10.3389/fphys.2016.00042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/27/2015] [Accepted: 01/29/2016] [Indexed: 01/17/2023] Open
Abstract
In mice, disseminated coagulation, inflammation, and ischemia induce neurological damage that can lead to death. These symptoms result from circulating bubbles generated by a pathogenic decompression. Acute fluoxetine treatment or the presence of the TREK-1 potassium channel increases the survival rate when mice are subjected to an experimental dive/decompression protocol. This is a paradox because fluoxetine is a blocker of TREK-1 channels. First, we studied the effects of an acute dose of fluoxetine (50 mg/kg) in wild-type (WT) and TREK-1 deficient mice (knockout homozygous KO and heterozygous HET). Then, we combined the same fluoxetine treatment with a 5-day treatment protocol with spadin, in order to specifically block TREK-1 activity (KO-like mice). KO and KO-like mice were regarded as antidepressed models. In total, 167 mice (45 WTcont 46 WTflux 30 HETflux and 46 KOflux) constituting the flux-pool and 113 supplementary mice (27 KO-like 24 WTflux2 24 KO-likeflux 21 WTcont2 17 WTno dive) constituting the spad-pool were included in this study. Only 7% of KO-TREK-1 treated with fluoxetine (KOflux) and 4% of mice treated with both spadin and fluoxetine (KO-likeflux) died from decompression sickness (DCS) symptoms. These values are much lower than those of WT control (62%) or KO-like mice (41%). After the decompression protocol, mice showed significant consumption of their circulating platelets and leukocytes. Spadin antidepressed mice were more likely to exhibit DCS. Nevertheless, mice which had both blocked TREK-1 channels and fluoxetine treatment were better protected against DCS. We conclude that the protective effect of such an acute dose of fluoxetine is enhanced when TREK-1 is inhibited. We confirmed that antidepressed models may have worse DCS outcomes, but concomitant fluoxetine treatment not only decreased DCS severity but increased the survival rate.
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Affiliation(s)
- Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
| | - Kate Lambrechts
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique OpérationnelleToulon, France; UFR STAPS, Laboratoire Motricité Humaine Education Sport Santé, Université du Sud Toulon VarLa Garde, France
| | - Sébastien De Maistre
- Hôpital d'Instruction des Armées, Service de Médecine Hyperbare et Expertise Plongée Toulon, France
| | - Perrine Royal
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
| | - Jean Mazella
- Centre National de la Recherche Scientifique and Université de Nice Sophia Antipolis, Institut de Pharmacologie Moléculaire et Cellulaire, UMR 7275 Valbonne, France
| | - Marc Borsotto
- Centre National de la Recherche Scientifique and Université de Nice Sophia Antipolis, Institut de Pharmacologie Moléculaire et Cellulaire, UMR 7275 Valbonne, France
| | - Catherine Heurteaux
- Centre National de la Recherche Scientifique and Université de Nice Sophia Antipolis, Institut de Pharmacologie Moléculaire et Cellulaire, UMR 7275 Valbonne, France
| | - Jacques Abraini
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique OpérationnelleToulon, France; Département d'Anesthésiologie, Université LavalQuébec, QC, Canada; Faculté de Médecine, Université de Caen NormandieCaen, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
| | - Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
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Abraini J, David H, Vallée N, Risso JJ. Theoretical considerations on the ultimate depth that could be reached by saturation human divers. Med Gas Res 2016; 6:119-121. [PMID: 27867478 PMCID: PMC5110125 DOI: 10.4103/2045-9912.184722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Blatteau JE, de Maistre S, Lambrechts K, Abraini J, Risso JJ, Vallée N. Fluoxetine stimulates anti-inflammatory IL-10 cytokine production and attenuates sensory deficits in a rat model of decompression sickness. J Appl Physiol (1985) 2015; 119:1393-9. [PMID: 26494447 DOI: 10.1152/japplphysiol.00602.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 07/17/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022] Open
Abstract
Despite "gold standard" hyperbaric oxygen treatment, 30% of patients suffering from neurological decompression sickness still exhibit incomplete recovery, including sensory impairments. Fluoxetine, a well-known antidepressant, is recognized as having anti-inflammatory effects in the setting of cerebral ischemia. In this study, we focused on the assessment of sensory neurological deficits and measurement of circulating cytokines after decompression in rats treated or not with fluoxetine. Seventy-eight rats were divided into a clinical (n = 38) and a cytokine (n = 40) group. In both groups, the rats were treated with fluoxetine (30 mg/kg po, 6 h beforehand) or with a saccharine solution. All of the rats were exposed to 90 m seawater for 45 min before staged decompression. In the clinical group, paw withdrawal force after mechanical stimulation and paw withdrawal latency after thermal stimulation were evaluated before and 1 and 48 h after surfacing. At 48 h, a dynamic weight-bearing device was used to assess postural stability, depending on the time spent on three or four paws. For cytokine analysis, blood samples were collected from the vena cava 1 h after surfacing. Paw withdrawal force and latency were increased after surfacing in the controls, but not in the fluoxetine group. Dynamic weight-bearing assessment highlighted a better stability on three paws for the fluoxetine group. IL-10 levels were significantly decreased after decompression in the controls, but maintained at baseline level with fluoxetine. This study suggests that fluoxetine has a beneficial effect on sensory neurological recovery. We hypothesize that the observed effect is mediated through maintained anti-inflammatory cytokine IL-10 production.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France;
| | - Sébastien de Maistre
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Kate Lambrechts
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France; Laboratoire Motricité Humaine, Éducation, Sport, Santé (LAMHESS), Université de Toulon UFR STAPS, La Garde, France
| | - Jacques Abraini
- Département d'Anesthésiologie, Université Laval, Québec, Canada; and Normandie-Université, Université de Caen-Basse Normandie, Caen, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
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Blatteau JE, David HN, Vallée N, Meckler C, Demaistre S, Lambrechts K, Risso JJ, Abraini JH. Xenon Blocks Neuronal Injury Associated with Decompression. Sci Rep 2015; 5:15093. [PMID: 26469983 PMCID: PMC4606806 DOI: 10.1038/srep15093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
Despite state-of-the-art hyperbaric oxygen (HBO) treatment, about 30% of patients suffering neurologic decompression sickness (DCS) exhibit incomplete recovery. Since the mechanisms of neurologic DCS involve ischemic processes which result in excitotoxicity, it is likely that HBO in combination with an anti-excitotoxic treatment would improve the outcome in patients being treated for DCS. Therefore, in the present study, we investigated the effect of the noble gas xenon in an ex vivo model of neurologic DCS. Xenon has been shown to provide neuroprotection in multiple models of acute ischemic insults. Fast decompression compared to slow decompression induced an increase in lactate dehydrogenase (LDH), a well-known marker of sub-lethal cell injury. Post-decompression administration of xenon blocked the increase in LDH release induced by fast decompression. These data suggest that xenon could be an efficient additional treatment to HBO for the treatment of neurologic DCS.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Hélène N David
- Centre de recherche Hôtel-Dieu de Lévis, CSSS Alphonse-Desjardins, Lévis, QC, Canada.,Université Laval, Département d'Anesthésiologie, Québec, QC, Canada
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Cedric Meckler
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Sebastien Demaistre
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Kate Lambrechts
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France.,Laboratoire motricité humaine, éducation, sport, santé (LAMHESS), Université de Toulon UFR STAPS, BP 20132, 83957 La Garde, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Jacques H Abraini
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France.,Université Laval, Département d'Anesthésiologie, Québec, QC, Canada.,Normandie-Université, Université de Caen - Basse Normandie, Caen, France
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David HN, Dhilly M, Poisnel G, Degoulet M, Meckler C, Vallée N, Blatteau JÉ, Risso JJ, Lemaire M, Debruyne D, Abraini JH. Argon prevents the development of locomotor sensitization to amphetamine and amphetamine-induced changes in mu opioid receptor in the nucleus accumbens. Med Gas Res 2014; 4:21. [PMID: 25606340 PMCID: PMC4299783 DOI: 10.1186/s13618-014-0021-z] [Citation(s) in RCA: 3] [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: 10/08/2014] [Accepted: 12/14/2014] [Indexed: 01/20/2023] Open
Abstract
Systemic administration of γ-amino-butyric acid type A (GABA-A) and benzodiazepine receptor agonists has been reported to block the development of locomotor sensitization to amphetamine. Here, we investigated whether the non-anesthetic noble gas argon, shown to possess agonistic properties at these receptors, may block the acquisition of amphetamine-induced locomotor sensitization and mu opioid receptor activation in the nucleus accumbens. Rats were pretreated with saline solution or amphetamine (1 mg/kg) from day 1 to day 3 and then exposed, immediately after injection of amphetamine, to medicinal air or argon at 75 vol% (with the remainder being oxygen). After a 3-day period of withdrawal, rats were challenged with amphetamine on day 7. Rats pretreated with amphetamine and argon had lower locomotor activity (U = 5, P < 0.005) and mu opioid receptor activity in the nucleus accumbens (U = 0, P < 0.001) than rats pretreated with amphetamine and air. In contrast, argon had effect on locomotor and mu receptor activity neither in rats pretreated with saline and challenged with amphetamine (acute amphetamine) nor in rats pretreated and challenged with saline solution (controls). These results indicate that argon inhibits the development of both locomotor sensitization and mu opioid receptor activation induced by repeated administration of amphetamine.
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Affiliation(s)
- Hélène N David
- Centre de recherche Hôtel-Dieu de Lévis, CSSS Alphonse-Desjardins, Lévis, QC Canada ; Département d'Anesthésiologie, Université Laval, Québec, QC Canada
| | - Martine Dhilly
- ISTCT UMR 6301, CEA DSV/I2BM, LDM-TEP group, GIP Cyceron, Caen, France ; ISTCT UMR 6301, CNRS, Caen, France ; ISTCT UMR 6301, Université de Caen Basse-Normandie, Normandie-Université, Caen, France
| | - Géraldine Poisnel
- ISTCT UMR 6301, CEA DSV/I2BM, LDM-TEP group, GIP Cyceron, Caen, France ; ISTCT UMR 6301, CNRS, Caen, France ; ISTCT UMR 6301, Université de Caen Basse-Normandie, Normandie-Université, Caen, France
| | - Mickael Degoulet
- Université de Caen - Basse Normandie, Normandie-Université, Caen, France
| | - Cédric Meckler
- Institut de Recherche Biomédicale des Armées, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Toulon, France
| | | | | | - Marc Lemaire
- Air Liquide, Centre de Recherche Claude-Delorme, Jouy-en-Josas, France
| | - Danièle Debruyne
- ISTCT UMR 6301, CEA DSV/I2BM, LDM-TEP group, GIP Cyceron, Caen, France ; ISTCT UMR 6301, CNRS, Caen, France ; ISTCT UMR 6301, Université de Caen Basse-Normandie, Normandie-Université, Caen, France
| | - Jacques H Abraini
- Département d'Anesthésiologie, Université Laval, Québec, QC Canada ; Université de Caen - Basse Normandie, Normandie-Université, Caen, France ; Institut de Recherche Biomédicale des Armées, Toulon, France
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Blatteau JE, David HN, Vallée N, Meckler C, Demaistre S, Risso JJ, Abraini JH. Cost-efficient method and device for the study of stationary tissular gas bubble formation in the mechanisms of decompression sickness. J Neurosci Methods 2014; 236:40-3. [PMID: 25064190 DOI: 10.1016/j.jneumeth.2014.07.010] [Citation(s) in RCA: 3] [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] [Received: 05/30/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Current in vivo methods cannot distinguish between the roles of vascular and stationary tissular gas bubbles in the mechanisms of decompression sickness (DCS). NEW METHOD To answer this question, we designed a normobaric-hyperbaric chamber for studying specifically the contribution of stationary tissular gas bubbles in the mechanisms of DCS in individually-superfused tissue samples. For validating our method, we investigated in rat brain slices exposed to 0.4MPa air absolute pressure whether fast decompression rate - the most important cause of cerebral DCS - may induce an increase of lactate dehydrogenase (LDH), a marker of cell injury, compared to slow decompression rate. RESULTS We provide a technical description of our pressure chamber and show that fast decompression rate of 0.3MPamin(-1) induced a rapid and sustained increase of LDH release compared to slow compression rate of 0.01MPamin(-1) (P<0.0001). COMPARISON WITH EXISTING METHODS There is no current method for studying stationary tissular gas bubbles. CONCLUSIONS This report describes the first method for studying specifically in tissue samples the role of stationary tissular gas bubbles in the mechanisms of DCS. Advantageously, according to this method (i) biological markers other than LDH could be easily studied; (ii) tissue samples could be taken not only from the brain but also from any part of the animal's body known of interest in DCS research, allowing performing tissue compartment research, a major question in the physics and theory of decompression research; and (iii) histological studies could be performed from the tissue samples.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France.
| | - Hélène N David
- Centre de recherche Hôtel-Dieu de Lévis, Centre Hospitalier Affilié Universitaire, CSSS Alphonse-Desjardins, Lévis, G6V 3Z1 QC, Canada; Université Laval, Département d'Anesthésiologie, Québec, QC, Canada.
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Cedric Meckler
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Sebastien Demaistre
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France
| | - Jacques H Abraini
- Institut de Recherche Biomédicale des Armées, Équipe Résidente de Recherche, Subaquatique Opérationnelle, BP 600 Toulon Cedex 9, France; Université Laval, Département d'Anesthésiologie, Québec, QC, Canada; Normandie-Université, Université de Caen - Basse Normandie, Caen, France
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Vallée N, Gaillard S, Peinnequin A, Risso JJ, Blatteau JE. Evidence of cell damages caused by circulating bubbles: high level of free mitochondrial DNA in plasma of rats. J Appl Physiol (1985) 2013; 115:1526-32. [DOI: 10.1152/japplphysiol.00025.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bubble formation can occur in the vascular system after diving, leading to decompression sickness (DCS). DCS signs and symptoms range from minor to death. Too often, patients are admitted to a hyperbaric center with atypical symptoms, as bubbles cannot be detected anymore. In the absence of a relevant biomarker for humans, the therapeutic management remains difficult. As circulating DNA was found in the blood of healthy humans and animals, our study was made to correlate the extracellular mitochondrial DNA (mDNA) concentration with the occurrence of clinical DCS symptoms resulting from initial bubble-induced damages. Therefore, 109 rats were subjected to decompression from a simulated 90-m sea water dive, after which, 78 rats survived (71.6%). Among the survivors, 15.6% exhibited typical DCS symptoms (DCS group), whereas the remaining 56% showed no detectable symptoms (noDCS group). Here, we report that the symptomatic rats displayed both a circulating mDNA level (DNADCS → 2.99 ± 2.62) and a bubble grade (median Spencer score = 3) higher than rats from the noDCS group (DNAnoDCS → 1.49 ± 1.27; Spencer score = 1). These higher levels could be correlated with the platelet and leukocyte consumption induced by the pathogenic decompression. Rats with no detectable bubble had lower circulating mDNA than those with higher bubble scores. We determined that in rats, a level of circulating mDNA >1.91 was highly predictive of DCS with a positive-predictive value of 87.3% and an odds ratio of 4.57. Thus circulating mDNA could become a relevant biomarker to diagnose DCS and should be investigated further to confirm its potential application in humans.
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Affiliation(s)
- Nicolas Vallée
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées, Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon Cedex, France; and
| | - Sandrine Gaillard
- Plateforme Technologique BioTechServices, Université du Sud Toulon Var, La Garde Cedex, France
| | - André Peinnequin
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées, Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon Cedex, France; and
| | - Jean-Jacques Risso
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées, Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon Cedex, France; and
| | - Jean-Eric Blatteau
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées, Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon Cedex, France; and
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Blatteau JE, Hugon J, Castagna O, Meckler C, Vallée N, Jammes Y, Hugon M, Risberg J, Pény C. Submarine rescue decompression procedure from hyperbaric exposures up to 6 bar of absolute pressure in man: effects on bubble formation and pulmonary function. PLoS One 2013; 8:e67681. [PMID: 23844058 PMCID: PMC3699632 DOI: 10.1371/journal.pone.0067681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/20/2013] [Indexed: 11/19/2022] Open
Abstract
Recent advances in submarine rescue systems have allowed a transfer under pressure of crew members being rescued from a disabled submarine. The choice of a safe decompression procedure for pressurised rescuees has been previously discussed, but no schedule has been validated when the internal submarine pressure is significantly increased i.e. exceeding 2.8 bar absolute pressure. This study tested a saturation decompression procedure from hyperbaric exposures up to 6 bar, the maximum operating pressure of the NATO submarine rescue system. The objective was to investigate the incidence of decompression sickness (DCS) and clinical and spirometric indices of pulmonary oxygen toxicity. Two groups were exposed to a Nitrogen-Oxygen atmosphere (pO2 = 0.5 bar) at either 5 bar (N = 14) or 6 bar (N = 12) for 12 h followed by 56 h 40 min resp. 60 h of decompression. When chamber pressure reached 2.5 bar, the subjects breathed oxygen intermittently, otherwise compressed air. Repeated clinical examinations, ultrasound monitoring of venous gas embolism and spirometry were performed during decompression. During exposures to 5 bar, 3 subjects had minor subjective symptoms i.e. sensation of joint discomfort, regressing spontaneously, and after surfacing 2 subjects also experienced joint discomfort disappearing without treatment. Only 3 subjects had detectable intravascular bubbles during decompression (low grades). No bubbles were detected after surfacing. About 40% of subjects felt chest tightness when inspiring deeply during the initial phase of decompression. Precordial burning sensations were reported during oxygen periods. During decompression, vital capacity decreased by about 8% and forced expiratory flow rates decreased significantly. After surfacing, changes in the peripheral airways were still noticed; Lung Diffusion for carbon monoxide was slightly reduced by 1% while vital capacity was normalized. The procedure did not result in serious symptoms of DCS or pulmonary oxygen toxicity and may be considered for use when the internal submarine pressure is significantly increased.
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Affiliation(s)
- Jean-Eric Blatteau
- Equipe Résidante de Recherche Subaquatique Opérationnelle (ERRSO), Institut de Recherche Biomédicale des armées (IRBA), Toulon, France.
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Blatteau JE, Hugon J, Gempp E, Castagna O, Pény C, Vallée N. Oxygen breathing or recompression during decompression from nitrox dives with a rebreather: effects on intravascular bubble burden and ramifications for decompression profiles. Eur J Appl Physiol 2011; 112:2257-65. [PMID: 21997676 DOI: 10.1007/s00421-011-2195-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/23/2011] [Indexed: 11/28/2022]
Abstract
Preventive measures to reduce the risk of decompression sickness can involve several procedures such as oxygen breathing during in-water decompression. Theoretical predictions also suggest that brief periods of recompression during the course of decompression could be a method for controlling bubble formation. The aim of this study was to get clearer information about the effects of different experimental ascent profiles (EAPs) on bubble reduction, using pure oxygen or recompression during decompression for nitrox diving. Four EAPs were evaluated using bubble monitoring in a group of six military divers using Nitrox 40% O(2) breathing with a rebreather. For EAP 1 and 2, 100% O(2) was used for the end stage of decompression, with a 30% reduction of decompression time in EAP 1 and 50% in EAP 2, compared to the French navy standard schedule. For EAP 3 and 4, nitrox 40% O(2) was maintained throughout the decompression stage. EAP 3 is based on an air standard decompression schedule, whereas EAP 4 involved a brief period of recompression at the end of the stop. We found that EAP 1 significantly reduced bubble formation, whereas high bubble grades occurred with other EAPs. No statistical differences were observed in bubbles scores between EAP 3 and 4. One diver developed mild neurological symptoms after EAP 3. These results tend to demonstrate that the "oxygen window" plays a key role in the reduction of bubble production and that breathing pure oxygen during decompression stops is an optimal strategy to prevent decompression sickness for nitrox diving.
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Affiliation(s)
- Jean-Eric Blatteau
- Equipe Résidante de Recherche Subaquatique Opérationnelle (ERRSO), Institut de Recherche Biomédicale des armées (IRBA), BP 20545, 83041 Toulon cedex 9, France.
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Vallée N, Rissoe JJ, Blatteau JE. Effect of an hyperbaric nitrogen narcotic ambience on arginine and citrulline levels, the precursor and co-product of nitric oxide, in rat striatum. Med Gas Res 2011; 1:16. [PMID: 22146244 PMCID: PMC3231870 DOI: 10.1186/2045-9912-1-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/05/2011] [Indexed: 11/21/2022] Open
Abstract
Previous studies performed in the laboratory have shown that nitrogen narcosis induces a decrease in striatal glutamate and dopamine levels. Although we stimulated the N-methyl-D-aspartate (NMDA) receptor, an important glutamate receptor required for motor and locomotor activity managed by the striatum, and demonstrated that the receptor was effective when exposed to nitrogen at 3MPa, it was not possible to return the striatal glutamate level to its base values. We conclude that it was the striatopetal neurons of the glutamatergic pathways that were mainly affected in this hyperbaric syndrome, without understanding the principal reasons. Hence we sought to establish what happens in the vicinity of the plasma membrane, downstream the NMDA-Receptor, and we used the hypothesis that there could be neuronal nitric oxide synthase (nNOS) disturbances. A microdialysis study was performed in rat striatum in order to analyse levels of citrulline, the NO co-product, and arginine, the NO precursor. Those both NO metabolites were detectable with an HPLC coupled to a fluorimetric detector. Exposure to pressurized nitrogen induced a reduction in citrulline (-18.9%) and arginine (-10.4%) levels. Under the control normobaric conditions, the striatal NMDA infusion enhanced the citrulline level (+85.6%), whereas under 3 MPa of nitrogen, the same NMDA infusion did not change the citrulline level which remains equivalent to that of the baseline. The level of arginine increased (+45.7%) under normobaric conditions but a decrease occurred in pressurized nitrogen (-51.6%). Retrodialysis with Saclofen and KCl in the prefrontal cortex under normobaric conditions led to an increase in striatal levels of citrulline (+30.5%) and a decrease in arginine levels (-67.4%). There was no significant difference when nitrogen at 3MPa was added. To conclude, the synthesis of citrulline/NO is reduced in nitrogen narcosis while it seems possible to activate it artificially by infusion. We have suggested that the low glutamate levels recorded in nitrogen narcosis induced these dopamine and NO reductions in the striatum.
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Affiliation(s)
- Nicolas Vallée
- Institut de Recherches Biomédicales des Armées-Antenne Toulon, Equipe Résidente de Recherche Opérationnelle, BP 20548, 83041 Toulon Cedex 9, France.
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Pontier JM, Vallée N, Ignatescu M, Bourdon L. Pharmacological intervention against bubble-induced platelet aggregation in a rat model of decompression sickness. J Appl Physiol (1985) 2011; 110:724-9. [PMID: 21212250 DOI: 10.1152/japplphysiol.00230.2010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Decompression sickness (DCS) with alterations in coagulation system and formation of platelet thrombi occurs when a subject is subjected to a reduction in environmental pressure. Blood platelet consumption after decompression is clearly linked to bubble formation in humans and offers an index for evaluating DCS severity in animal models. Previous studies highlighted a predominant involvement of platelet activation and thrombin generation in bubble-induced platelet aggregation (BIPA). To study the mechanism of the BIPA in DCS, we examined the effect of acetylsalicylic acid (ASA), heparin (Hep), and clopidogrel (Clo), with anti-thrombotic dose pretreatment in a rat model of DCS. Male Sprague-Dawley rats (n = 208) were randomly assigned to one experimental group treated before the hyperbaric exposure and decompression protocol either with ASA (3×100 mg·kg(-1)·day(-1), n = 30), Clo (50 mg·kg(-1)·day(-1), n = 60), Hep (500 IU/kg, n = 30), or to untreated group (n = 49). Rats were first compressed to 1,000 kPa (90 msw) for 45 min and then decompressed to surface in 38 min. In a control experiment, rats were treated with ASA (n = 13), Clo (n = 13), or Hep (n = 13) and maintained at atmospheric pressure for an equivalent period of time. Onset of DCS symptoms and death were recorded during a 60-min observation period after surfacing. DCS evaluation included pulmonary and neurological signs. Blood samples for platelet count (PC) were taken 30 min before hyperbaric exposure and 30 min after surfacing. Clo reduces the DCS mortality risk (mortality rate: 3/60 with Clo, 15/30 with ASA, 21/30 with Hep, and 35/49 in the untreated group) and DCS severity (neurological DCS incidence: 9/60 with Clo, 6/30 with ASA, 5/30 with Hep, and 12/49 in the untreated group). Clo reduced fall in platelet count and BIPA (-4,5% with Clo, -19.5% with ASA, -19,9% with Hep, and -29,6% in the untreated group). ASA, which inhibits the thromboxane A2 pathway, and Hep, which inhibits thrombin generation, have no protective effect on DCS incidence. Clo, a specific ADP-receptor antagonist, reduces post-decompression platelet consumption. These results point to the predominant involvement of the ADP release in BIPA but cannot differentiate definitively between bubble-induced vessel wall injury and bubble-blood component interactions in DCS.
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Rostain JC, Lavoute C, Risso JJ, Vallée N, Weiss M. A review of recent neurochemical data on inert gas narcosis. Undersea Hyperb Med 2011; 38:49-59. [PMID: 21384763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Nitrogen narcosis occurs in humans at around 0.4 MPa (4 ATA). Hydrogen narcosis occurs between 2.6 and 3.0 MPa. In rats, nitrogen disturbances occur from 1 MPa and a loss of righting reflex around 4 MPa. Neurochemical studies in striatum of rats with nitrogen at 3 MPa (75% of anesthesia threshold) with differential pulse voltammetry have demonstrated a decrease in dopamine (DA) release by neurons originated from the substantia nigra pars compacta (SNc). Such a decrease is found also with compressed argon, which is more narcotic than nitrogen and with the anesthetic gas nitrous oxide. Inversely, compressed helium with its very low narcotic potency induces DA increase. Microdialysis studies in the striatum have indicated that nitrogen also induces a decrease of glutamate concentration. Nitrogen pressure did not modify NMDA glutamate receptor activities in SNc or striatum but enhanced GABAA receptors activities in SNc. Repetitive exposures to nitrogen narcosis suppressed the DA decrease and induced an increase. This fact and the lack of improvement of motor disturbances did not support the hypothesis of a physiological adaptation. The desensitization of the GABAA receptors on DA cells during recurrent exposures and the parallel long-lasting decrease of glutamate coupled to the increase in NMDA receptor sensitivity suggest a nitrogen neurotoxicity or addiction induced by recurrent exposures. The differential changes produced by inert gases indifferent neurotransmitter receptors would support the binding protein theory.
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Affiliation(s)
- J C Rostain
- Université de la Méditerranée et IMNSSA UMR-MD2, Physiologie et Physiopathologie en Condition d'Oxygénation Extrême, Faculté de Médecine Nord, Institut de Neuroscience Jean Roche, 13015 Marseille, France.
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Abstract
Previous studies have highlighted that bubble-induced platelet aggregation is a predictor index of decompression sickness (DCS) severity in animals and bubble formation after a single air dive in humans. The present study attempted to investigate plasmatic indexes of the coagulation system and platelet activation in our rat model of DCS. Male Sprague-Dawley rats were assigned to one experimental group with a hyperbaric exposure and one control group maintained at atmospheric pressure. Rats were compressed to 1,000 kPa (90 m saltwater) for 45 min while breathing air. The onset of death time and DCS symptoms were recorded during a 30-min observed period after rats had surfaced. Plasmatic indexes were platelet factor 4 (PF4) for platelet activation, soluble glycoprotein V (sGPV) for thrombin generation, and thrombin-antithrombin complexes for the coagulation system. Blood samples for a platelet count and markers were taken 3 wk before the experimental protocol and within the 30 min after rats had surfaced. We confirmed a correlation between the percent fall in platelet count and DCS severity. Plasmatic levels of sGPV and PF4 were significantly increased after the hyperbaric exposure, with no change in the control group. The present study confirms platelet consumption as a potential index for evaluating decompression stress and DCS severity. The results point to the participation of thrombin generation in the coagulation cascade and platelet activation in bubble-induced platelet aggregation. In our animal model of DCS, the results cannot prejudge the mechanisms of platelet activation between bubble-induced vessel wall injury and bubble-blood component interactions.
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Affiliation(s)
- Jean-Michel Pontier
- Medicine Department, French Navy Diving School, Toulon Army
- Institut de Recherche Biomédicale des Armées–antenne Toulon and Institut de Medecine Navale du Service de Sante des Armees, and Underwater and Marine Research Department, Toulon Cedex; and
- Laboratoire de Physiologie et de Physiopathologie en Condition d'Oxygénation Extrême, Université de la Méditerranée, Marseille, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées–antenne Toulon and Institut de Medecine Navale du Service de Sante des Armees, and Underwater and Marine Research Department, Toulon Cedex; and
- Laboratoire de Physiologie et de Physiopathologie en Condition d'Oxygénation Extrême, Université de la Méditerranée, Marseille, France
| | - Lionel Bourdon
- Institut de Recherche Biomédicale des Armées–antenne Toulon and Institut de Medecine Navale du Service de Sante des Armees, and Underwater and Marine Research Department, Toulon Cedex; and
- Laboratoire de Physiologie et de Physiopathologie en Condition d'Oxygénation Extrême, Université de la Méditerranée, Marseille, France
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Abstract
The cytological location of ion channel antagonist-binding sites was studied in sunflower protoplasts using the fluorescent probes DM-Bodipy-PAA and DM-Bodipy-DHP. The binding specificity of the probes was established by competition experiments with Bepridil, phenylalkylamine (Verapamil) and dihydropyridine (Nifedipine) which are known as calcium and potassium channel antagonists. Quantitative image analysis of the fluorescence emitted by the protoplasts showed the existence of interactions between PAA- and DHP-binding sites. Moreover, studies on the cytolocalization of the PAA receptors by confocal imaging showed that in freshly isolated protoplasts, DM-Bodipy-PAA binds exclusively at sites located in the cortical region of the cell.
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Affiliation(s)
- N Vallée
- Laboratoire de Biotechnologie et Amélioration des Plantes (BAP), INP-ENSAT/UA INRA, Toulouse, France
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Legros-Maïda S, Soulié A, Benvenuti C, Wargnier A, Vallée N, Berthou C, Guillet J, Sasportes M, Sigaux N. Granzyme B and perforin can be used as predictive markers of acute rejection in heart transplantation. Eur J Immunol 1994; 24:229-33. [PMID: 8020560 DOI: 10.1002/eji.1830240136] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We have investigated perforin and granzyme B expression in graft-infiltrating lymphocytes of patients who underwent heart transplantation. Those proteins are commonly present in the cytoplasmic granules of cytotoxic T lymphocytes and are released upon effector-target cell interaction. From 28 patients 103 endomyocardial biopsies were obtained and examined by histology and immunocytochemical analysis using relevant monoclonal antibodies. We found that "high" biopsy histological grades were associated with perforin and granzyme B expression in graft-infiltrating lymphocytes of patients with acute severe rejection crisis. In contrast, these markers were not detected in patients without rejection or during graft stabilization. Interestingly, in patients with mild rejection and "low" histological grades, two groups could be distinguished with a differential expression of the two intracytoplasmic proteins. The presence of perforin and granzyme B-expressing cells was found to be predictive of rapid progression to severe rejection, so that this situation required additional treatment; in contrast, their absence seemed to correlate with a good graft outcome without additional treatment. Moreover, perforin and granzyme B expression seemed to be down-regulated by immunosuppressive drugs, which coincided with graft stabilization. In conclusion, our data suggest that detection of granzyme B and perforin in graft-infiltrating lymphocytes might be helpful for routinely monitoring heart transplant patients.
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