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Cellprene® biomaterial is reported as an angiogenic resorbable elastomeric blend, but it has poor miscibility between polymers. Poly(isoprene) present in Cellprene® is the main component of Natural Rubber Latex, which is extracted from Hevea brasilienses trees. The epoxidation reaction of Natural Rubber not only reduces the number of double bonds but also increases the hydrophilicity of rubber. The mixing of epoxidized Poly(isoprene) with Poly (Lactic-co-Glycolic acid) is an alternative route for the preparation of miscible and biocompatible blends that can be used in Tissue Engineering. The blends developed in this work were obtained by the solvent casting method. The physico-chemical and mechanical properties of the membranes were evaluated and compared with Cellprene® showing a higher miscibility of the blend that were previously epoxidized demonstrated by the approach of the involved Tg value. Biological essays showed non-cytotoxic results with a cell viability greater than 95%. The in vitro interaction of HMV-II cells with the epoxidized blend showed specific epithelial and morphological markers after 24 h of culture. The results indicate the high viability of the epoxidized mixture for application in Tissue Engineering. [ABSTRACT FROM AUTHOR]

Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be potentially fatal, even in the absence of underlying cardiac disease. Anecdotal cases of reversible myocardial dysfunction have been described in this setting, but little is known of its pathogenesis. The purpose of the present study was to determine the clinical outcomes and the determinants associated with this condition. The data from 54 consecutive divers admitted for acute immersion pulmonary edema during a 5.5-year period were retrospectively studied. A diagnosis of myocardial dysfunction was established by the presence of elevated cardiac troponin T levels, coupled with electrocardiographic changes and/or wall motion abnormalities on the echocardiogram. The demographic, clinical, biologic, and diving characteristics were tested as potential predictors of this disorder. All the patients had complete resolution of symptoms within 72 hours, but 3 required intensive ventilation or hemodynamic support at admission. Reversible myocardial dysfunction was observed in 28% and was associated more with age >50 years (odds ratio [OR] 5.5, 95% confidence interval [CI] 1.5 to 21, p=0.013), hypertension (OR 8.2, 95% CI 2.1 to 32, p=0.002), diabetes (OR 22.1, 95% CI 1.1 to 458; p=0.002), and release of natriuretic peptides (OR 9.1, 95% CI 2.4 to 35, p=0.001). Follow-up investigations at 1 month were obtained for 49 patients and revealed a significant number of patients with occult hypertension. In conclusion, reversible myocardial dysfunction is not uncommon in divers with immersion pulmonary edema. The short-term overall prognosis is not adversely altered, but severe heart failure with a fatal outcome is unpredictable. Close monitoring of older divers with latent cardiovascular risk factors is warranted. [ABSTRACT FROM AUTHOR]

Background. To measure International Normalized Ratio (INR) in hemodialysis patients with tunneled dialysis catheters (TDCs), blood sampling is frequently obtained via the catheter at the start of the session. INR measurements via finger-prick point of care testing (POCT) and via blood sampling taken from the dialysis circuit are evaluated as alternatives. Methods. In 14 hemodialysis patients with TDCs, treated with vitamin K antagonists (VKA), INR measurements via POCT were compared with plasma INR samples taken via the catheter at the start of dialysis and via the dialysis circuit after 30 and 60 minutes during 3 nonconsecutive dialysis sessions. Results. Blood samples taken at the start of dialysis at the catheter site were frequently contaminated with heparin originating from the locking solution (unfractionated heparin concentration (UFH) >1.0 IU/ml in 13.2%). POCT INR at the start of dialysis was not different from plasma INR after 30 and 60 minutes (Wilcoxon test p = 0.113 , n = 37, and p = 0.631 , n = 36, respectively). Moreover, there was no difference between POCT INR at the start of dialysis and POCT INR after 30 and 60 minutes (Wilcoxon test p = 0.797 and p = 0.801, respectively; n = 36). Passing and Bablok regression equation was used, y = 0.460 + 0.733x; n = 105. Treatment decisions based on these 2 methods showed a very good overall agreement (kappa = 0.810; 95% CI: 0.732–0.889; n = 105). Conclusions. Measuring plasma INR via the TDC at the start of dialysis should be abandoned. Measuring POCT INR via a finger prick at the start or even after 30 to 60 minutes is an alternative. The most elegant alternative is to take plasma INR samples via the dialysis circuit 30 minutes or later after the start of the dialysis. [ABSTRACT FROM AUTHOR]

Information about the residual activity of herbicides sprayed in the control of cotton stalks and its potential to affect the development and productivity of corn sown in the following crop are limited. The objective of this work was to identify the carryover effect promoted by the single and sequential application of herbicides used in the control of cotton stalks and to estimate the plant-back for corn sowing. Two trials were carried out simultaneously in a greenhouse, one for a single application and one for a sequential application of herbicides treatments. It was used a 15 x 5 factorial scheme, in a randomized block design with four replicates. The first factor was composed of herbicide treatments and the second factor of five sowing seasons after the application (0, 30, 60, 90 and 120 days). The experimental plots were composed of plastic pots with a capacity of 3 dm3 filled with loamy soil (470 g kg-1 clay), dried and sieved. The herbicides sprayed were 2,4-D, glyphosate, saflufenacil, [imazapic + imazapyr], dicamba, fluroxypyr, and sulfentrazone. The sequential application of most treatments provided an increase in the residual activity of the evaluated herbicides. The 2,4-D (1,340 g ha-1), 2,4-D + glyphosate (1,340 + 720 g ha-1) and 2,4-D + glyphosate + saflufenacil (1,340 + 720 + 105 g ha-1) presented the shortest safety intervals and were those that presented the lowest risk of affecting the corn sown in succession, even in sequential applications. However, the treatments that consisted of association with herbicides with higher residual activity in the soil such as dicamba, fluroxypyr, sulfentrazone and [imazapic + imazapyr], presented higher carryover potential for corn crop, being observed a safety interval greater than 94 days after sequential application of 2,4-D + glyphosate + sulfentrazone. [ABSTRACT FROM AUTHOR]

Psychiatric care is a fruitful setting for exploring the rise of surveillance medicine, which shapes gray zones of uncertainty between health and illness. Predicting psychosis has become a priority in the international mental health field, but French psychiatrists appear reluctant to refer their young patients for standardized assessments or disclose their risks to them. This research addressed French psychiatrists' attitudes towards risk disclosure about psychosis to adolescents presenting symptoms that might reflect either typical teenager unease or the first signs of psychosis onset. A mixed-method design included 12 in-depth qualitative interviews followed by an online survey with responses from 487 psychiatrists. French psychiatrists' reluctance to engage in risk disclosure emerges from a professional norm: a belief in the self-fulfilling prophecy. They — especially those with a background in social science and psychology — believe in the optimistic self-fulfilling prophecy. They fear the consequences of pessimistic predictions, struggle to maintain functional optimism, favor long-term inconspicuous medical watchfulness, and systematically understand favorable outcomes as a consequence of medical care, independent of the accuracy of risk detection. • French psychiatrists are reluctant to use predictive approaches about psychosis risks. • Their professional norms are based on belief in the self-fulfilling prophecy. • They avoid disclosure of risks and engage in emotional work to maintain optimism. • They understand favorable outcomes to result from psychiatric treatment. • This belief is influenced by their theoretical background. [ABSTRACT FROM AUTHOR]

Background: Over the last twenty years, predicting psychosis has become a priority of both research and policies. Those approaches include the use of the At Risk Mental State category (ARMS) and of standardized predictive tools. In comparison to most developed countries, early interventions programs are only little developed in France. However, cases of young patients presenting unclear symptoms that might be a beginning psychosis or might as well reflect some adolescent unease are commonplace in psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding psychosis risk management. Do they anticipate mental disorders? Method: The Grounded Theory is an agreed-upon qualitative method in social science field that links subjective experiences (individual narratives) to social processes (professional norms and mental health policies). 12 French youth psychiatrists were interviewed about psychosis early management and their daily prognosis practices with teenagers. Results: If all participants were aware of early intervention programs, most of them did not make use of standardized scales. Psychiatrists’ reluctance toward a psychosis risk standardized assessment was shaped by three difficulties: first the gap between theoretical knowledge and practice; second their impossibility to make reliable prognoses; and third, the many uncertainties surrounding medical judgment, adolescence and the nature of psychosis. Nevertheless, they provided their young patients with multiple months follow up without disclosing any risk category. Conclusion: Anticipating a psychosis onset remains a highly uncertain task for psychiatrists. In France, psychiatrists’ inconspicuous risk management might be supported by the universal costs coverage that is not conditional on a diagnosis disclosure. [ABSTRACT FROM AUTHOR]

O nabo (Raphanus raphanistrum) é uma planta daninha que interfere na produtividade final do trigo. O uso repetido de herbicidas inibidores da enzima ALS favoreceram a seleção de biótipos resistentes, tornando necessário o uso de herbicidas alternativos. O objetivo do trabalho foi avaliar o controle de nabo e seletividade ao trigo sob diferentes doses de saflufenacil e bentazona, e outros herbicidas de uso comum nesta cultura. O estudo foi realizado em casa de vegetação em delineamento inteiramente casualizado com quatro repetições. Os tratamentos de saflufenacil (0; 8,5; 17; 35 e 70 g ha-1), bentazona (0; 180; 360; 720 e 1440 g ha-1), metsulfurom metílico (3,6 g ha-1) e 2,4-D (670 g e.a. ha-1), além da testemunha capinada. As variáveis analisadas foram controle de nabo e fitotoxicidade ao trigo aos 8 e 14 DAA. Os resultados evidenciaram que o controle de nabo foi superior a 90% aos 14 DAA para doses superiores a 17 e 360 g ha-1 de saflufenacil e bentazona, respectivamente. Ao comparar com os tratamentos adicionais, observouse que ambos os herbicidas podem substituir o metsulfurom-metilico e o 2,4-D para controle de nabo. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have shown vascular dysfunction of main conductance arteries and microvessels after diving. We aim to evaluate the impact of bubble formation on vascular function and haemostasis. To achieve this, we used a vibration preconditioning to influence bubble levels without changing any other parameters linked to the dive.Methods: Twentty-six divers were randomly assigned to one of three groups: (1) the "vibrations-dive" group (VD; n = 9) was exposed to a whole-body vibration session 30 min prior the dive; (2) the "diving" group (D; n = 9) served as a control for the effect of the diving protocol; (3) The "vibration" protocol (V; n = 8) allowed us to assess the effect of vibrations without diving. Macro- and microvascular function was assessed for each subject before and after the dive, subsequently. Bubble grades were monitored with Doppler according to the Spencer grading system. Blood was taken before and after the protocol to assess any change of platelets or endothelial function.Results: Bubble formation was lower in the VD than the diving group. The other measured parameters remained unchanged after the "vibration" protocol alone. Diving alone induced macrovascular dysfunction, and increased PMP and thrombin generation. Those parameters were no longer changed in the VD group. Conversely, a microvascular dysfunction persists despite a significant decrease of circulating bubbles.Conclusions: Finally, the results of this study suggest that macro- but not microvascular impairment results at least partly from bubbles, possibly related to platelet activation and generation of pro-coagulant microparticles. [ABSTRACT FROM AUTHOR]

We report a case of an ethanol and massive gamma-butyrolactone (GBL) intoxication, the precursor of the recreational drug gamma-hydroxybutyric acid (GHB), resulting in life-threatening metabolic acidosis (pH 6.5) with a highly increased anion- and osmolal gap. Rapid analysis using gas chromatography revealed a GHB plasma concentration of 4400 mg/L, far above the upper limit concentration of 1000 mg/L found in adult fatalities attributed to GBL. Full recovery was established following supportive treatment including haemodialysis. This is the first report of a combined ethanol/GBL intoxication as a cause of high serum anion- and osmolal-gap metabolic acidosis. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). Methods: Two hundred and seventy nine injured recreational divers (42 ± 12 years; 53 women) presenting symptoms of spinal cord DCS were retrospectively included from seven hyperbaric centers in France and Belgium. Diving information, symptom latency after surfacing, time interval between symptom onset and hyperbaric treatment were studied. The initial severity of spinal cord DCS was rated with the Boussuges severity score, and the presence of sequelae was evaluated at 1 month. Initial recompression treatment at 2.8 ATA with 100% oxygen breathing or deeper recompression up to 4 or 6 ATA with nitrogen or helium-oxygen breathing mixture were also recorded. Results: Twenty six percent of DCS had incomplete resolution after 1 month. Multivariate analysis revealed several independent factors associated with a bad recovery: age ≥42 [OR 1.04 (1-1.07)], depth ≥39 m [OR 1.04 (1-1.07)], bladder dysfunction [OR 3.8 (1.3-11.15)], persistence or worsening of clinical symptoms before recompression [OR 2.07 (1.23-3.48)], and a Boussuges severity score >7 [OR 1.16 (1.03-1.31)]. However, the time to recompression and the choice of initial hyperbaric procedure did not significantly influence recovery after statistical adjustment. Conclusions: Clinical symptoms of spinal cord DCS and their initial course before admission to the hyperbaric center should be considered as major prognostic factors in recovery. A new severity score is proposed to optimize the initial clinical evaluation for spinal cord DCS. [ABSTRACT FROM AUTHOR]

Phox homology (PX) domains have been recently identified in a number of different proteins and are involved in various cellular functions such as vacuolar targeting and membrane protein trafficking. It was shown that these modules of about 130 amino acids specifically binding to phosphoinositides and that this interaction is crucial for their cellular function. The yeast genome contains 17 PX domain proteins. One of these, Grd19p, is involved in the localization of the late Golgi membrane proteins DPAP A and Kex2p. Grd19p consists of the PX domain with 30 extra residues at the N-terminal and is homologous to the functionally characterized human sorting nexin protein SNX3. We determined the 2.0 Å crystal structure of Grd19p in the free form and in complex with D-myo-phosphatidylinositol 3-phosphate (diC[sub 4]PtdIns(3)P), representing the first case of both free and ligand-bound conformations of the same PX module. The ligand occupies a well defined positively charged binding pocket at the interface between the β-sheet and α-helical parts of the molecule. The structure of the free and bound protein are globally similar but show some significant differences in a region containing a polyproline peptide and a putative membrane attachment site. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the effects of environmental parameters on the mode of action of linenscin OC2 on the cytopkasmic membrane of the bacteria, Listeria innocua (L. innocua). In-depth look at the effects of linenscin OC2 on the viability of L. innocua in a salt environment; Details on the respiratory activity of linenscin OC2-treated L. innocua cells; Results of the study.

Decompression sickness can occur in divers even when recommended decompression procedures are followed. Furthermore, the physiological state of individuals can significantly affect bubbling variability. These informations highlight the need for personalized input to improve decompression in SCUBA diving. The main objective of this study is to propose a fundamental framework for a new approach to inert gas exchanges. A physiological model of oxygen delivery to organs and tissues has been built and adapted to nitrogen. The validation of the model was made by transferring the N 2 to CO 2 . Under normobaric conditions (air breathing, oxygen breathing, and static apnea) and hyperbaric conditions, the O 2 model replicates the reference physiological Po 2 (Spearman correlation tests P < 0.001). The inert gas models can simulate inert gas partial pressures under normobaric and hyperbaric conditions. However, the lack of reference values prevents direct validation of this new model. Therefore, the N 2 model has been transferred to CO 2 . The resulting CO 2 model has been validated by comparing it with physiological reference values (Spearman correlation tests P < 0.01). The validity of the CO 2 model constructed from the N 2 model demonstrates the plausibility of this physiological model of inert gas exchanges. In the context of personalized decompression procedures, the proposed model is of significant interest as it enables the integration of physiological and morphological parameters (blood and respiratory flows, alveolo-capillary diffusion, respiratory and blood volumes, oxygen consumption rate, fat mass, etc.) into a model of nitrogen saturation/desaturation, in which oxygen and CO 2 partial pressures can also be incorporated. NEW & NOTEWORTHY This is the first model of inert gas transport based on the physiology of respiratory gas. It was built for O 2 delivery and validated against literature data; it was then transposed to N 2 exchanges. The transposition procedure was checked by transposing the N 2 model to CO 2 (and validated against literature data). This model opens the possibility to integrate physiological and morphological inputs in a personalized decompression procedure in SCUBA diving.

Aims: Hyperbaric oxygen therapy (HBOT) is the standard adjuvant treatment for life-threatening or disabling pathologies. Currently, mechanical and electronic variations of implantable cardioverter-defibrillators (ICD) in hyperbaric conditions have not been evaluated. As a result, many patients eligible for HBOT but ICD recipients cannot undergo this therapy, even in emergency situations., Methods and Results: Twenty-two explanted ICD of various brands and models were randomized in two groups: single hyperbaric exposure at an absolute pressure of 4000 hPa and 30 iterative hyperbaric exposures at an absolute pressure of 4000 hPa. Mechanical and electronic parameters of these ICD were blindly assessed before, during, and after hyperbaric exposures. Regardless of the hyperbaric exposure, we could not find any mechanical distortion, inappropriate occurrence of anti-tachycardia therapies, dysfunction of tachyarrhythmia therapeutic programming, or dysfunction of programmed pacing parameters., Conclusion: Dry hyperbaric exposure seems harmless on ICD tested ex vivo. This result may lead to a reconsideration of the absolute contraindication of emergency HBOT to ICD recipients. A real-life study in these patients with an indication to HBOT should be performed to assess their tolerance to the treatment., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Immersion can cause immersion pulmonary edema (IPE) in previously healthy subjects. We performed a case-control study to better identify IPE risk factors., Methods: We prospectively included recreational scuba divers who had presented signs of IPE and control divers who were randomly chosen among diving members of the French Underwater Federation. We sent an anonymous questionnaire to each diver, with questions on individual characteristics, as well as the conditions of the most recent dive (controls) or the dive during which IPE occurred. Univariate logistic regressions were performed for each relevant factor. Then, multivariate logistic regression was performed., Results: Of the 882 questionnaires sent, 480 (54%) were returned from 88 cases (90%) and 392 control divers (50%). Multivariate analysis identified the following independent risk factors associated with IPE: being aged over 50 years ((OR) 3.30, (95%CI) 1.76-6.19); female sex (OR 2.20, 95%CI 1.19-4.08); non-steroidal anti-inflammatory drug (NSAID) intake before diving (OR 24.32, 95%CI 2.86-206.91); depth of dive over 20 m (OR 2.00, 95%CI 1.07-3.74); physical exertion prior to or during the dive (OR 5.51, 95%CI 2.69-11.28); training dive type (OR 5.34, 95%CI 2.62-10.86); and daily medication intake (OR 2.79, 95%CI 1.50-5.21); this latter factor appeared to be associated with hypertension in the univariate analysis., Conclusion: To reduce the risk of experiencing IPE, divers over 50 years of age or with hypertension, especially women, should avoid extensive physical effort, psychological stress, deep dives and NSAID intake before diving., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

Background: The study was aimed at assessing changes in respiratory function after 15 years of profes- sional diving, among scientific divers., Materials and Methods: A retrospective study was performed on divers who underwent an initial visit and a visit 15 years later at the same medical centre, among divers who had a scientific activity (monitoring the coastline, fauna and flora). Pulmonary function tests were performed in the same laboratory with the same operating standards and using a Jaeger MasterBody plethysmograph. Each subject acted as his or her own control. The data were analysed by Student's t-test and Spearman's correlation coefficient., Results: Twenty-six divers were included. Changes over 15 years included: a decrease in the forced expired volume in 1 second/functional vital capacity (FEV1/FVC) ratio (-6 for absolute value, p < 0.01; and -5% for theoretical value, p = 0.02); a decrease in forced expiratory flow (FEF)25% (-1.1 for absolute value, p < 0.01; and -21% for theoretical value, p < 0.01); a decrease in transfer factor for carbon monoxide (TLCO) (-0.7 for absolute value, p = 0.04); and an increase in vital capacity (VC) (+8% for theoretical value, p = 0.03). A significant correlation was found between the consumption of tobacco in packs per year (PY) and the variations in VC (r = 0.89; p < 0.01) and the variations in the theoretical FEV1 (r = 0.76; p = 0.03). There was a significant relationship between the number of dives and the variations in the percentage of the theoretical FEV1/FVC ratio (r = -0.42; p = 0.04). The same relationship was found for the average of dive duration (r = -0.59; p < 0.01) Conclusions: With increasing length of diving activities service, the pulmonary function displays a trend toward both a decrease in TLCO and a decrease in FEF25%.

Background: Occupational divers are prone to many health risks. For instance, they can get infections. We reviewed the infectious diseases in occupational divers., Materials and Methods: This is a literature review which went on up to 31.12.2017. The research was carried out on Medline and Scopus databases, in French and English languages., Results: Fifteen papers report cases of infections in occupational divers. They are mainly skin infections, but also ear-nose-throat and ophthalmological infections., Discussion and Conclusions: According to data collected, infections among occupational divers are quite scarce. These diseases are not specific to the workplace, and are comparable with data on recreational diving. Prevention is mainly based on hygiene and equipment maintenance.

Background: Inside attendants working in hyperbaric chambers are exposed to risks related to the hyperbaric environment, handling and care. The aim of this study is to review the literature focusing on the impact of this activity on health., Materials and Methods: This is a literature review using the Medline database., Results: Eight articles studied decompression illness (DCI). The incidence of DCI ranged from 0 to 37 per 100,000 sessions in hyperbaric chambers (SHC). The incidence of injuries ranged from 0 to 412 per 100,000 SHC. The most prevalent cause of accidental death was fire: 77 deaths (patients and attendants) between 1923 and 1996. Dysbaric osteonecrosis has been reported in one study only., Conclusions: Inside attendants face risks in the chamber, even if serious health effects seems rare compared to the total number of SHC.

This is the first case report about a transgender professional diver. The purpose of this article is to show the professional adaptations to help him to continue occupational dive and to raise the question of the impact on diving risks of hormonal treatment in this case. He was a 39-year-old man when he began his transition. He had worked as a diver for 9 years before his transition. When he changed to look like a woman, there were a few difficulties in continuing his professional activity. The main difficulty was that he looked like a woman while working with men. Modesty was a crucial issue in the enterprise. There were other problems such as the organisation of premises, the physical workload and the interaction between treatments and diving. There is a lack of a law to guide the employer. French legislation does not address the issue of transsexuals for this profession. The medical recommendations do not specify contraindications or adaptations for diving safely. Because of his transition, he lost muscle mass. The occupational physician helped to adjust his activity: decreasing the weight of his diving suit, creating a female-like locker room etc. Finally, the question of the risk of decompression illness arose. Legal hormonal medication seems not to significantly increase the risk of decompression illness, but this diver was taking illicit treatment to speed up the transition. The occupational physician recommended taking the legal hormonal medication.

Introduction: The purpose of the study was to assess the number of accidents among staff employed in the operation of hyperbaric chambers in France., Materials and Methods: A retrospective study using a questionnaire was carried out on occupational accidents in France between 2005 and 2011., Results: 12 (46%) centres participated in the study, representing 73 subjects. The mean age was 43.5 years (SD=9.73). They had worked in hyperbaric chambers for 9.8 years on average (SD=7.7). The average number of hyperbaric sessions was 198.3 per subject (SD=174.25), for a total of 8.072 hyperbaric sessions; 27% of the subjects reported that they had at least one accident during the study period. In all, 30 accidents were reported: 3 blood exposures, 4 accidents related to patient handling, 20 hyperbaric accidents; 3 other accidents. Of the hyperbaric accidents, 2 (10%) involved decompression sicknesses with cutaneous symptoms, 3 (15%) decompression illness (DCI), 14 (70%) ear traumatisms, 1 (5%) dental accident. The incidences were 372 per 100,000 sessions in hyperbaric chambers (SHC) for all accidents, 248 per 100,000 SHC for hyperbaric accidents and 173 per 100,000 SHC for ENT barotraumas., Conclusion: The accidents involving staff operating hyperbaric chambers were mainly ear traumatisms..

Background: The aim of this study was to assess changes in lung function of professional divers., Materials and Methods: This is a review of the literature. Only studies about professional divers were included. All published studies between 01.01.1984 and 07.01.2014 were systematically searched. The search was performed in Medline and Embase databases and in the "Medicina Maritima" journal. The results of pulmonary function tests were extracted from each study., Results: Fifteen articles were found. Four studies showed a significant decrease in forced vital capacity (FVC). Five studies demonstrated a significant decrease in forced expiratory flows (FEF) at 75% and 50% of FVC expired (FEF75% and FEF50%) after 3 years of diving. Seven studies demonstrated a significant decrease in forced expiratory volume in 1 second (FEV1) after 3 years of diving. But only 2 studies did an age-standardisation so that only 1 study demonstrated a significant decrease in FEV1 after age-standardisation. Three articles showed a decrease in transfer factor for carbon monoxide (TLCO) after 5 years. Dives parameters (like depth, number by year) were not always related to variations on the different lung variables., Conclusions: This literature review showed a decrease in TLCO, FEF75% and FEF25-75%. One wonders whether these variations are due to the age or to diving. The results of such a long-term study would be interesting and might help to guide fundamental research.

It is well known that immersion pulmonary edema can be life-threatening for divers using a self-contained underwater breathing apparatus (scuba). Swimming-induced pulmonary edema in otherwise healthy individuals is not an object of dispute but its real severity is not well known and is probably underestimated. We report two cases of life-threatening acute respiratory distress while swimming and snorkeling, one of which is well documented for swimming-induced pulmonary edema. The interest of these case reports lies in the suddenness of these life-threatening events. Such accidents can mimic a loss of consciousness due to cardiac dysrhythmia and lead to drowning. In the case of swimming-induced pulmonary edema, the prognosis is far better than for a cardiac disorder, but it is also dependent on the efficiency of the supervision. Swimmers, divers, race organizers and supervising physicians should be given knowledge of this pathology and its potentially acute occurrence. Adequate organizational dispositions are mandatory to prevent swimming-induced pulmonary edema-related deaths.

Background: The professional diver's activity implies body cardiovascular stress. Little data on cardiovascular risk factors is available. Some studies report a high prevalence of tobacco consumption. The purpose of this study is to investigate the cardiovascular risk factors of professional divers and calculate the predicted 5-year risk and the predicted 10-year risk of an acute coronary event., Materials and Methods: In one medical centre, data on dives and cardiovascular risk factors were analysed on Epidata(®) software, by Pearson χ(2) test or by Fisher's exact test, by analysis of variance test or by Kruskal-Wallis test, and by Spearman correlation coefficient. Cardiovascular risk scores at 5 and 10 years were calculated using SCORE., Results: A total 200 professional divers were included. Of these, 31% were smokers or had stopped smoking for less than 3 years; 40% had an abnormal body mass index; 50% had raised total cholesterol levels; 11% had an advanced age; 6.5% had high blood pressure; 81% had at least one risk factor; 66% had an alterable risk factor; 25.5% had a 5-year risk greater than that of the general population of the same age; 2.5% had a high cardiovascular risk at 10 years; and 34% were at intermediate risk., Conclusions: The majority of divers had at least one cardiovascular risk factor. Cardiovascular risk scores were lower than that of the general population. However, some of this population is at high risk. One third of the divers had an intermediate risk, which should lead to the consideration of conducting additional biological examinations to better assess their risk.

We report the case of a healthy 21-year-old woman who performed iterative breath-hold dives in relatively cold water, not exceeding depths of 5 meters but with "empty lungs." At the end of a dive, after experiencing an intense involuntary diaphragmatic contraction underwater, she presented hemoptysis followed by chest pain and cough. Chest radiography and computed tomography were performed 24 hours later, confirming the diagnosis of pneumomediastinum. The clinical course was benign: However, chest pain and effort dyspnea lasted for a few weeks. The pathophysiology of this accident may be explained by a combination of mechanisms involved in several clinical entities, namely pulmonary edema of immersion, pulmonary barotrauma and spontaneous pneumomediastinum.

Iatrogenic gas embolism is a rare but serious problem that has been documented in almost all medical specialties including gynecology. We present a 49-year-old woman undergoing operative hysteroscopy and myomectomy, who sustained sudden hypotension and decrease in the end-tidal carbon dioxid levels during the procedure. Systemic gas embolism was confirmed by echocardiographic evidence of bubbles in both right and left cardiac cavities and a rise of troponin. Hyperbaric oxygen was rapidly administered in addition to maintenance of vital functions and anti-thrombotic prevention with calciparin. A right hemiparesis was apparent after recovery from general anesthesia. Brain-computed tomography and magnetic resonnance imaging, performed on Days 3 and 2 respectively, showed a left fronto-parietal hematoma surrounded by edema. Having ruled out risk factors for a primary ischemic or hemorrhagic stroke, we concluded that hemorragic transformation of the ischemic cerebral lesion caused by gas embolism was responsible for the observed intraparenchymal hematoma. As far as we know, this is the first report relating cerebral gas embolism with an intracerebral hemorrhage. It provides an argument against anticoagulant therapy during the early stages of gas embolism care.

Objectives: Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions of occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident., Study Design: Retrospective case study and prospective frequency study., Patients and Methods: Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosed between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress, auscultation and radiologic features., Results: Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease were involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved. Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousness were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptoms resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal., Conclusion: This accident is not a rare event and may have serious consequences. Oldest divers submitted to stress and/or effort are at higher risk.