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1.
HNO ; 2024 Jul 01.
Artigo em Alemão | MEDLINE | ID: mdl-38951143

RESUMO

Scuba diving and other modes of device-supported diving are popular activities that can be especially demanding and hazardous for people with preexisting physical conditions. Due to the high ambient pressure, the temperature differences, and potential unpredictable events, which have manifold effects on the organism, diving carries a high risk of life-threatening disease. A special risk is present if the body does not readily equalize air pressure changes. Therefore, prior to diving, all divers should undergo detailed education regarding the physical principles of the sport as well as specific physical examination. Consultation of an otolaryngologist is of exceptional relevance because many otorhinolaryngologic diseases can lead to (usually temporary) unfitness to dive. The role of the modern otorhinolaryngologist trained in diving medicine is to correctly advise the patient and restore fitness for diving via conservative or invasive methods.

2.
Int Marit Health ; 75(2): 89-102, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38949219

RESUMO

BACKGROUND: Saturation diving is a standard method of intervention for commercial diving during offshore operations. Current saturation procedures achieve a high level of safety with regards to decompression sickness but still put the divers under multiple stressors: 1) Environmental stress (long confinement, heat/cold, dense gases, high oxygen levels), 2) Work stress (muscular fatigue, psychological pressure, breathing equipment, etc.), 3) venous gas emboli associated with decompression, 4) Inflammation related to oxidative stress and microparticles. We present the results of a saturation divers monitoring campaign performed in the North Sea Danish sector, on the Tyra field, during 2022. The study was supported by TotalEnergies, the field operator, and performed by Boskalis Subsea Services, the diving contractor, onboard the diving support vessel Boka Atlantis. The objective was twofold: document the level of diving stress during saturation operations in the Danish sector, and compare the performances of two saturation procedures, the Boskalis and the NORSOK procedures. MATERIALS AND METHODS: Fourteen divers volunteered for the study. The monitoring package include weight and temperature measurements, psychomotor tests (objective evaluation) and questionnaires (subjective evaluation), Doppler bubble detection and bioimpedance. The results were presented in a radar diagram that provides a general view of the situation. RESULTS: The data were analysed along 3 dimensions: work and environmental, desaturation bubbles, oxidative stress and inflammation. The results showed little or no variations from the reference values. No bubbles were detected after excursion dives and the final decompression, except for two divers with a grade 1 after arriving at surface. No statistical difference could be found between the Boskalis and the NORSOK saturation procedures. CONCLUSIONS: At a depth of 40-50 msw corresponding to the Danish sector, the two saturation procedures monitored induce no or little stress to the divers. The divers know how to manage their diet, equilibrate their hydration and pace their effort. Data available on divers' post saturation period show a recovery over the 24-48 hours following the end of the decompression. Further research should focus on diving deeper than 100 msw where a greater stress can be anticipated.


Assuntos
Doença da Descompressão , Mergulho , Humanos , Mergulho/efeitos adversos , Mergulho/fisiologia , Mar do Norte , Adulto , Masculino , Saturação de Oxigênio/fisiologia , Pessoa de Meia-Idade , Estresse Fisiológico , Dinamarca , Monitorização Fisiológica/métodos
3.
J Wildl Dis ; 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39005143

RESUMO

Scaup, including both Lesser and Greater (Aythya affinis and Aythya marila, respectively), are a grouping of populous and widespread North American diving ducks. Few influenza type A viruses (IAV) have been reported from these species despite a high prevalence of antibodies to IAV being reported. Existing virologic and serologic data indicate that IAV infection routinely occurs in scaup, yet it is unknown which IAV subtypes are linked to these infections. In this study, we aimed to gain a more complete picture of IAV natural history in Lesser and Greater Scaup from two coastal flyways in North America in 2015-18 (302 samples from California in the Pacific Flyway and 471 samples from Maryland in the Atlantic Flyway). Low prevalence of active IAV infection was detected by real-time reverse-transcription PCR in Lesser Scaup sampled in Maryland and California (2.8% and 8.1%, respectively). A single IAV (H1N1) was isolated in embryonated chicken eggs from a bird sampled in California. Similarly low levels were observed in Greater Scaup in California (3.3%). Antibodies to the nucleoprotein as detected with a commercial blocking ELISA were observed in all species and flyway combinations. Antibody seroprevalence estimates were higher in adult Lesser Scaup than in juveniles at both the ≤0.5 (P<0.001, z=-3.582) and ≤0.7 serum-sample-to-negative-control absorbance thresholds (P=0.003, z=-2.996). Neutralizing antibodies to H1-H12, H14, and H15 were detected using a microtiter virus neutralization assay, with the highest prevalence of antibodies against H1 (38%), H6 (36%), and H11 (35%). The high prevalence of antibodies to IAV and evidence of previous exposure to numerous subtypes are consistent with a high level of population immunity and a low prevalence of infection. These results must be interpreted in the context of season (winter sampling), as results may vary with the annual influx of naïve juvenile birds.

4.
Undersea Hyperb Med ; 51(2): 185-187, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38985154

RESUMO

A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor's helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted.


Assuntos
Dissecção Aórtica , Dor no Peito , Doença da Descompressão , Mergulho , Humanos , Mergulho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dissecção Aórtica/etiologia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/complicações , Dissecção Aórtica/cirurgia , Dor no Peito/etiologia , Doença da Descompressão/etiologia , Doença da Descompressão/terapia , Doença da Descompressão/complicações , Doença da Descompressão/diagnóstico por imagem , Doença da Descompressão/diagnóstico , Doença Aguda , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial
5.
Undersea Hyperb Med ; 51(2): 189-196, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38985155

RESUMO

Hypoxia, centralization of blood in pulmonary vessels, and increased cardiac output during physical exertion are the pathogenetic pathways of acute pulmonary edema observed during exposure to extraordinary environments. This study aimed to evaluate the effects of breath-hold diving at altitude, which exposes simultaneously to several of the stimuli mentioned above. To this aim, 11 healthy male experienced divers (age 18-52y) were evaluated (by Doppler echocardiography, lung echography to evaluate ultrasound lung B-lines (BL), hemoglobin saturation, arterial blood pressure, fractional NO (Nitrous Oxide) exhalation in basal condition (altitude 300m asl), at altitude (2507m asl) and after breath-hold diving at altitude. A significant increase in E/e' ratio (a Doppler-echocardiographic index of left atrial pressure) was observed at altitude, with no further change after the diving session. The number of BL significantly increased after diving at altitude as compared to basal conditions. Finally, fractional exhaled nitrous oxide was significantly reduced by altitude; no further change was observed after diving. Our results suggest that exposure to hypoxia may increase left ventricular filling pressure and, in turn, pulmonary capillary pressure. Breath-hold diving at altitude may contribute to interstitial edema (as evaluated by BL score), possibly because of physical efforts made during a diving session. The reduction of exhaled nitrous oxide at altitude confirms previous reports of nitrous oxide reduction after repeated exposure to hypoxic stimuli. This finding should be further investigated since reduced nitrous oxide production in hypoxic conditions has been reported in subjects prone to high-altitude pulmonary edema.


Assuntos
Altitude , Suspensão da Respiração , Mergulho , Ecocardiografia Doppler , Hipóxia , Pulmão , Humanos , Masculino , Mergulho/fisiologia , Mergulho/efeitos adversos , Adulto , Adulto Jovem , Hipóxia/fisiopatologia , Pessoa de Meia-Idade , Adolescente , Pulmão/fisiopatologia , Pulmão/diagnóstico por imagem , Pulmão/irrigação sanguínea , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Edema Pulmonar/diagnóstico por imagem , Pressão Arterial/fisiologia , Saturação de Oxigênio/fisiologia , Óxido Nítrico/metabolismo , Pressão Sanguínea/fisiologia , Hemoglobinas/análise
6.
Artigo em Inglês | MEDLINE | ID: mdl-38970686

RESUMO

This paper reviews the utility of zebrafish (Danio rerio) as a model system for exploring neurobehavioral phenomena in preclinical research, focusing on physiological processes, disorders, and neurotoxicity biomarkers. A comprehensive review of the current literature was conducted to summarize the various behavioral characteristics of zebrafish. The study examined the etiological agents used to induce neurotoxicity and the biomarkers involved, including Aß42, tau, MMP-13, MAO, NF-Кß, and GFAP. Additionally, the different zebrafish study models and their responses to neurobehavioral analysis were discussed. The review identified several key biomarkers of neurotoxicity in zebrafish, each impacting different aspects of neurogenesis, inflammation, and neurodegeneration. Aß42 was found to alter neuronal growth and stem cell function. Tau's interaction with tubulin affected microtubule stability and led to tauopathies under pathological conditions. MMP-13 was linked to oxidative assault and sensory neuron degeneration. MAO plays a role in neurotransmitter metabolism and neurotoxicity conversion. NF-Ðšß was involved in pro-inflammatory pathways, and GFAP was indicative of neuroinflammation and astroglial activation. Zebrafish provide a valuable model for neurobehavioral research, adhering to the "3Rs" philosophy. Their neurotoxicity biomarkers offer insights into the mechanisms of neurogenesis, inflammation, and neurodegeneration. This model system aids in evaluating physiological and pathological conditions, enhancing our understanding of neurobehavioral phenomena and potential therapeutic interventions.

7.
Ann N Y Acad Sci ; 1537(1): 74-81, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38963660

RESUMO

This study explores the impact of feathers on the hydrodynamic drag experienced by diving birds, which is critical to their foraging efficiency and survival. Employing a novel experimental approach, we analyzed the kinematics of both feathered and nonfeathered projectiles during their transition from air to water using high-speed imaging and an onboard accelerometer. The drag coefficients were determined through two methods: a direct calculation from the acceleration data and a theoretical approach fitted to the observed velocity profiles. Our results indicate that feathers significantly increase the drag force during water entry, with feathered projectiles exhibiting approximately double the drag coefficient of their smooth counterparts. These findings provide new insights into the role of avian feather morphology in diving mechanics and have potential implications for the design of bioinspired aquatic vehicles in engineering. The study also discusses the biological implications of increased drag due to feathers and suggests that factors such as body shape might play a more critical role in the diving capabilities of birds than previously understood.


Assuntos
Aves , Mergulho , Plumas , Hidrodinâmica , Plumas/fisiologia , Plumas/anatomia & histologia , Animais , Mergulho/fisiologia , Aves/fisiologia , Fenômenos Biomecânicos
9.
Artigo em Inglês | MEDLINE | ID: mdl-39058431

RESUMO

Endothelial function declines with aging and independently predicts future cardiovascular disease (CVD) events. Diving also impairs endothelial function in humans. Yet, dolphins, being long-lived mammals adapted to diving, undergo repetitive cycles of tissue hypoxia-reoxygenation and disturbed shear stress without manifesting any apparent detrimental effects, as CVD is essentially nonexistent in these animals. Thus, dolphins may be a unique model of healthy arterial aging and may provide insights into strategies for clinical medicine. Emerging evidence shows that the circulating milieu (bioactive factors in the blood) is at least partially responsible for transducing reductions in age-related endothelial function. To assess if dolphins have preserved endothelial function with aging due to a protected circulating milieu, we tested if the serum (pool of the circulating milieu) of bottlenose dolphins (Tursiops truncatus) induces the same arterial aging phenotype as the serum of age-equivalent humans. We incubated conduit arteries from young and old mice with dolphin and human serum and measured endothelial function ex vivo via endothelium-dependent dilation to acetylcholine. While young arteries incubated with serum from mid-life/older adult human serum had lower endothelial function, those incubated with dolphin serum consistently maintained high endothelial function regardless the age of the donor. Thus, studying the arterial health of dolphins could lead to potential novel therapeutic strategies to improve age-related endothelial dysfunction in humans.

10.
Eur J Appl Physiol ; 2024 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-39044031

RESUMO

PURPOSE: Apnea duration is dependent on three factors: oxygen storage, oxygen consumption, hypoxia and hypercapnia tolerance. While current literature focuses on maximal apneas to improve apnea duration, apnea trained individuals use timed-repeated submaximal apneas, called "O2 and CO2 tables". These tables claim to accommodate the body to cope with hypoxia and hypercapnia, respectively. The aim of this study was twofold. First, to investigate the determinants of maximal apnea duration in apnea novices. Second, to compare physiologic responses to maximal apneas, O2 and CO2 tables. METHODS: After medical screening, lung function test and hemoglobin mass measurement, twenty-eight apnea novices performed three apnea protocols in random order: maximal apneas, O2 table and CO2 table. During apnea, peripheral oxygen saturation (SpO2), heart rate (HR), muscle (mTOI) and cerebral (cTOI) tissue oxygenation index were measured continuously. End-tidal carbon dioxide (EtCO2) was measured before and after apneas. RESULTS: Larger lung volumes, higher resting cTOI and lower resting EtCO2 levels correlated with longer apnea durations. Maximal apneas induced greater decreases in SpO2 (- 16%) and cTOI (- 13%) than O2 (- 8%; - 8%) and CO2 tables (- 6%; - 6%), whereas changes in EtCO2, HR and mTOI did not differ between protocols. CONCLUSION: These results suggest that, in apnea novices, O2 and CO2 tables did not induce a more profound hypoxia and hypercapnia, but a similar reduction in oxygen consumption than maximal apneas. Therefore, apnea novices should mainly focus on maximal apneas to improve hypoxia and hypercapnia tolerance. The use of specific lung training protocols can help to increase oxygen storage capacity.

11.
J Clin Med ; 13(11)2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38892877

RESUMO

Background: Temporomandibular disease (TMD) is commonly seen, and divers also experience pain in the temporomandibular joint (TMJ) or masticatory muscles. This article aims to provide a tool for diving physicians or medical professionals involved in diving medicine since jaw pain among divers is a pertinent subject and can be challenging to evaluate without some background in dentistry or maxillofacial surgery. Method: A basic algorithm was developed to provide a tool to differentiate jaw pains experienced by divers. Three brief case studies were developed, and five diving physicians were tasked with diagnosing the cases using the algorithm. Additionally, simple exercises and massage techniques that can benefit patients with TMD, particularly immediately after diving, are outlined. Results: All five diving physicians successfully diagnosed the cases using the algorithm. However, three of them were unable to diagnose the first case (disc luxation) without consulting the algorithm. Nevertheless, all physicians acknowledged the utility of the algorithm. Conclusions: Jaw pain in divers can stem from diverse causes, but effective treatment options exist. Our study findings provide valuable insights to assist diving physicians in making accurate diagnoses and guiding appropriate patient management, which may include referrals to specialists such as dentists, maxillofacial surgeons, or orthodontists.

12.
J Sci Med Sport ; 27(6): 368-372, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38849159

RESUMO

The present study aims to investigate the demographics and characteristics of scuba diving fatalities in the Philippines which can help in the identification of local trends and ultimately in the development of appropriate preventive measures. Data on scuba diving-related fatalities in the Philippines from 2008 to 2022 were manually retrieved from online news media sources. Information on age, sex, nationality, certification, purpose, and causative factors, whenever possible were collected and analysed. A total of 39 fatalities were identified having a median age of 43.5 (range 20-80). Majority of victims were males (n = 30), and of foreign ethnicity (n = 26). Asphyxia was identified as the possible disabling injury in almost half of the cases (n = 17). The causes of death based on autopsies were determined only for few cases which included drowning (n = 2), heart attack (n = 1), and traumatic injuries from a dynamite blast (n = 1). Potential vulnerable groups were identified to be the ageing population and foreign tourist divers. In the absence of an existing database, this preliminary report provides the best available evidence at this time concerning scuba diving fatalities in the Philippines.


Assuntos
Mergulho , Humanos , Filipinas/etnologia , Filipinas/epidemiologia , Mergulho/lesões , Mergulho/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Adulto , Feminino , Idoso , Adulto Jovem , Idoso de 80 Anos ou mais , Causas de Morte , Meios de Comunicação de Massa , Afogamento/mortalidade , Asfixia/mortalidade
13.
Diving Hyperb Med ; 54(2): 86-91, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38870949

RESUMO

Introduction: Tasmania is a small island state off the southern edge of Australia where a comparatively high proportion of the 558,000 population partake in recreational or occupational diving. While diving is a relatively safe sport and occupation, Tasmania has a significantly higher diving death rate per head of population than other States in Australia (four times the national diving mortality rate). Methods: Three compressed gas diving deaths occurred in seven months between 2021-2022 prompting a review of the statewide approach for the immediate response of personnel to diving-related deaths. The review engaged first responders including the Police Marine and Rescue Service, hospital-based departments including the Department of Hyperbaric and Diving Medicine, and the mortuary and coroner's office. Results: An aide-mémoire for all craft groups, digitalised checklists for first responders (irrespective of diving knowledge), and a single-paged algorithm to highlight inter-agency communication pathways in the event of a diving death were designed to enhance current practices and collaboration. Conclusions: If used, these aids for managing diving related deaths should ensure that time-critical information is appropriately captured and stored to optimise information provided for the coronial investigation.


Assuntos
Mergulho , Mergulho/estatística & dados numéricos , Humanos , Tasmânia/epidemiologia , Masculino , Lista de Checagem , Doença da Descompressão/mortalidade , Doença da Descompressão/terapia , Adulto , Feminino , Algoritmos , Socorristas/estatística & dados numéricos , Pessoa de Meia-Idade
14.
Diving Hyperb Med ; 54(2): 137-139, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38870957

RESUMO

Blood alcohol concentrations above defined levels are detrimental to cognitive performance. Empirical and published evidence suggest that nitrogen narcosis is analogous to alcohol intoxication with both impairing prefrontal cortex function. Nitrogen narcosis is also known to have been a factor in fatal accidents. To examine the effects of nitrogen narcosis, a recent publication used the Iowa Gambling Task tool, to simulate dynamic real-life risky decision-making behaviour. If the reported outcomes are corroborated in larger rigorously designed studies it is likely to provide further evidence that divers may well experience the negative effects of a 'narcotic agent', even at relatively shallow depths. These deleterious effects may occur regardless of diving experience, aptitude or professional status. In 1872, English law made it an offence to be 'drunk' whilst in charge of horses, carriages, cattle and steam engines. Understanding the danger was easy, establishing who is 'drunk' in the eyes of the court required a legal definition. Driving above a 'legal limit' for alcohol was made illegal in the United Kingdom in 1967. The limit was set at 80 milligrams of alcohol per 100 millilitres of blood. It took just short of one hundred years to get from first introducing a restriction to specific activities, whilst under the influence of alcohol, to having a clear and well-defined enforceable law. The question surely is whether our modern society will tolerate another century before legally defining safe parameters for nitrogen narcosis?


Assuntos
Mergulho , Narcose por Gás Inerte , Humanos , Mergulho/fisiologia , Mergulho/efeitos adversos , Dirigir sob a Influência/legislação & jurisprudência , Reino Unido , Intoxicação Alcoólica/sangue , Concentração Alcoólica no Sangue
15.
Diving Hyperb Med ; 54(2): 105-109, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38870952

RESUMO

Introduction: Routine dipstick urinalysis is part of many dive medical assessment protocols. However, this has a significant chance of producing false-positive or false-negative results in asymptomatic and healthy individuals. Studies evaluating the value of urinalysis in dive medical assessments are limited. Methods: All results from urinalysis as part of dive medical assessments of divers, submarines, and hyperbaric personnel of the Royal Netherlands Navy from 2013 to 2023 were included in this study. Additionally, any information regarding additional testing, referral, or test results concerning the aforementioned was collected. Results: There were 5,899 assessments, resulting in 46 (0.8%) positive dipstick urinalysis results, predominantly microscopic haematuria. Females were significantly overrepresented, and revisions resulted in significantly more positive test results than initial assessments. Lastly, almost half of the cases were deemed fit to dive, while the other half were regarded as temporarily unfit. These cases required additional testing, and a urologist was consulted three times. Conclusions: To our knowledge, this is the most extensive study evaluating urinalysis in dive medical assessments. In our military population, the incidence of positive test results is very low, and there have not been clinically relevant results over a period of 10 years. Therefore, routinely assessing urine in asymptomatic healthy military candidates is not cost-effective or efficacious. The authors advise taking a thorough history for fitness to dive assessments and only analysing urine when a clinical indication is present.


Assuntos
Mergulho , Hematúria , Militares , Urinálise , Humanos , Urinálise/métodos , Feminino , Mergulho/fisiologia , Masculino , Adulto , Hematúria/diagnóstico , Hematúria/urina , Aptidão Física/fisiologia , Medicina Submarina , Pessoa de Meia-Idade , Países Baixos , Adulto Jovem , Reações Falso-Positivas
16.
Diving Hyperb Med ; 54(2): 110-119, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38870953

RESUMO

Introduction: Inhalation of high concentrations of carbon dioxide (CO2) at atmospheric pressure can be toxic with dose-dependent effects on the cardiorespiratory system or the central nervous system. Exposure to both hyperbaric and hypobaric environments can result in decompression sickness (DCS). The effects of CO2 on DCS are not well documented with conflicting results. The objective was to review the literature to clarify the effects of CO2 inhalation on DCS in the context of hypobaric or hyperbaric exposure. Methods: The systematic review included experimental animal and human studies in hyper- and hypobaric conditions evaluating the effects of CO2 on bubble formation, denitrogenation or the occurrence of DCS. The search was based on MEDLINE and PubMed articles with no language or date restrictions and also included articles from the underwater and aviation medicine literature. Results: Out of 43 articles, only 11 articles were retained and classified according to the criteria of hypo- or hyperbaric exposure, taking into account the duration of CO2 inhalation in relation to exposure and distinguishing experimental work from studies conducted in humans. Conclusions: Before or during a stay in hypobaric conditions, exposure to high concentrations of CO2 favors bubble formation and the occurrence of DCS. In hyperbaric conditions, high CO2 concentrations increase the occurrence of DCS when exposure occurs during the bottom phase at maximum pressure, whereas beneficial effects are observed when exposure occurs during decompression. These opposite effects depending on the timing of exposure could be related to 1) the physical properties of CO2, a highly diffusible gas that can influence bubble formation, 2) vasomotor effects (vasodilation), and 3) anti-inflammatory effects (kinase-nuclear factor and heme oxygenase-1 pathways). The use of O2-CO2 breathing mixtures on the surface after diving may be an avenue worth exploring to prevent DCS.


Assuntos
Dióxido de Carbono , Doença da Descompressão , Animais , Humanos , Pressão Atmosférica , Mergulho/efeitos adversos , Mergulho/fisiologia
17.
Clin Neurol Neurosurg ; 243: 108382, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38944020

RESUMO

OBJECTIVE: Tumors located within the Meckel's cave (MC) pose a significant surgical challenge. Although several corridors to access this complex region have been described, the endoscopic transpterygoid approach (ETPA) and the endoscopic transorbital superior eyelid approach (ETOA) have emerged in recent years, as viable alternatives to traditional microsurgical transcranial approaches (MTA). To date, there is a limited literature on surgical series considering endoscopic-assisted approaches to the MC. METHODS: We conducted a retrospective analysis of patients with primary MC tumors treated at our Institution between 2015 and 2022, specifically those managed via the ETPA assisted by intraoperative Endoscopic Diving Technique (EDT). Lesion resection extent was evaluated using pre- and post-intervention radiological images and surgical videos. Moreover, a literature review on ETPA was performed. RESULTS: This series comprises 7 patients affected by 4 trigeminal schwannomas, 1 benign notochordal cell tumor, 1 dermoid cyst and 1 mesenchymal tumor. In 71 % of cases, trigeminal neuralgia was the presenting symptom. Post-operative clinical improvement was observed in all but one case. Notably, 85.7 % of patients achieved total or near-total resection (NTR), with the remaining case undergoing subtotal resection (STR). No significant intraoperative complications occurred, and no recurrences were observed during the mean follow-up period of 41 months. CONCLUSIONS: In selected cases, the ETPA offers a direct and safe path to lesions located into the MC. This approach circumvents complications and constraints associated with ETOA or MTA. Moreover, the use of the EDT reduces manipulation of critical neurovascular structures, enhancing the efficacy of the ETPA.


Assuntos
Neuroendoscopia , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Neuroendoscopia/métodos , Idoso , Neoplasias da Base do Crânio/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Adulto Jovem , Neurilemoma/cirurgia , Neurilemoma/diagnóstico por imagem
18.
Physiol Rep ; 12(11): e16054, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38872580

RESUMO

We aimed to determine the relative contribution of hypercapnia and hypoxia to the bradycardic response to apneas. We hypothesized that apneas with hypercapnia would cause greater bradycardia than normoxia, similar to the response seen with hypoxia, and that apneas with hypercapnic hypoxia would induce greater bradycardia than hypoxia or hypercapnia alone. Twenty-six healthy participants (12 females; 23 ± 2 years; BMI 24 ± 3 kg/m2) underwent three gas challenges: hypercapnia (+5 torr end tidal partial pressure of CO2 [PETCO2]), hypoxia (50 torr end tidal partial pressure of O2 [PETO2]), and hypercapnic hypoxia (combined hypercapnia and hypoxia), with each condition interspersed with normocapnic normoxia. Heart rate and rhythm, blood pressure, PETCO2, PETO2, and oxygen saturation were measured continuously. Hypercapnic hypoxic apneas induced larger bradycardia (-19 ± 16 bpm) than normocapnic normoxic apneas (-11 ± 15 bpm; p = 0.002), but had a comparable response to hypoxic (-19 ± 15 bpm; p = 0.999) and hypercapnic apneas (-14 ± 14 bpm; p = 0.059). Hypercapnic apneas were not different from normocapnic normoxic apneas (p = 0.134). After removal of the normocapnic normoxic heart rate response, the change in heart rate during hypercapnic hypoxia (-11 ± 16 bpm) was similar to the summed change during hypercapnia+hypoxia (-9 ± 10 bpm; p = 0.485). Only hypoxia contributed to this bradycardic response. Under apneic conditions, the cardiac response is driven by hypoxia.


Assuntos
Apneia , Bradicardia , Frequência Cardíaca , Hipercapnia , Hipóxia , Humanos , Hipercapnia/fisiopatologia , Feminino , Masculino , Frequência Cardíaca/fisiologia , Hipóxia/fisiopatologia , Apneia/fisiopatologia , Adulto , Bradicardia/fisiopatologia , Adulto Jovem , Pressão Sanguínea/fisiologia , Dióxido de Carbono/metabolismo
19.
Eur J Appl Physiol ; 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38802707

RESUMO

PURPOSE: Postural control deteriorates following a transition between two environments, highlighting a sensory conflict when returning to natural conditions. Aquatic immersion offers new perspectives for studying postural control adaptation in transitional situations. Our aim is to study immediate and post-task static postural control adaptation on land after a prolonged fin swimming exercise in total immersion. METHODS: Standing static postural control was assessed in 14 professional or recreational SCUBA divers (11 men, 3 women; 33.21 ± 10.70 years), with eyes open and closed, before, immediately after, and in the following 20 min following a fully-immersed 45-min fin swimming exercise. Centre-of-pressure metrics (COP) including average position, amplitude, velocity, length and 95% ellipse were evaluated in medial-lateral (x-axis) and anterior-posterior (y-axis) directions with a force platform. The Romberg ratio was also assessed for each metric. RESULTS: A two-way repeated measures analysis of variance revealed a significant effect of the measurement period on COPx vel (p = 0.01), COPy vel (p < 0.01) and Length (p < 0.01), and of the visual condition on COPy vel (p < 0.01) and Length (p < 0.01). Eyes closed measures were systematically higher than eyes open measures despite there being no significant difference in the Romberg ratio in all periods. Post-immersion, the velocity and total trajectory of the centre of pressure remained systematically lower than baseline values in both visual conditions. CONCLUSION: Post-immersion, COP velocity and length significantly decreased, suggesting a sensory reweighting strategy potentially associated with ankle stiffening.

20.
Transl Anim Sci ; 8: txae076, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38764467

RESUMO

Waterfowl are housed in captivity for research studies that are infeasible in the wild. Accommodating the unique requirements of semi-aquatic species in captivity while meeting experimental design criteria for research questions can be challenging and may have unknown effects on animal health. Thus, testing and standardizing best husbandry and care practices for waterfowl is necessary to facilitate proper husbandry and humane care while ensuring reliable and repeatable research results. To inform husbandry practices for captive-reared and wild-caught lesser scaup (Aythya affinis; hereafter, scaup), we assessed body mass and fat composition across two different aspects of husbandry, source population (captive-reared or wild caught), and housing densities (birds/m2). Our results suggest that housing scaup at low densities (≤0.6 m2/bird, P = 0.049) relative to other species can minimize negative health effects. Captive-reared scaup were heavier (P = 0.027) with greater body fat (P < 0.001) and exhibited fewer signs of stress during handling than wild-caught scaup. In our experience, scaup which are captive-reared from eggs collected in the wild were better for long-term captivity studies as they maintained body mass between and recovered lost body mass following trials. Researchers would benefit from carefully evaluating the tradeoffs of using short- and long-term captive methods on their research question before designing projects, husbandry practices, and housing facilities for waterfowl.

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