{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:23:37Z","timestamp":1760149417493,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"IBSAM (Institut Brestois Sant\u00e9 Mati\u00e8re)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Long-term alterations of pulmonary function (mainly decreased airway conductance and capacity of the lungs to diffuse carbon monoxide (DLCO)) have been described after hyperbaric exposures. However, whether these alterations convey a higher risk for divers\u2019 safety has never been investigated before. The purpose of the present pilot study was to assess whether decreased DLCO is associated with modifications of the physiological response to diving. In this case\u2013control observational study, 15 \u201cfit-to-dive\u201d occupational divers were split into two groups according to their DLCO measurements compared to references values, either normal (control) or reduced (DLCO group). After a standardized 20 m\/40 min dive in a sea water pool, the peak-flow, vascular gas emboli (VGE) grade, micro-circulatory reactivity, inflammatory biomarkers, thrombotic factors, and plasmatic aldosterone concentration were assessed at different times post-dive. Although VGE were recorded in all divers, no cases of decompression sickness (DCS) occurred. Compared to the control, the latency to VGE peak was increased in the DLCO group (60 vs. 30 min) along with a higher maximal VGE grade (p &lt; 0.0001). P-selectin was higher in the DLCO group, both pre- and post-dive. The plasmatic aldosterone concentration was significantly decreased in the control group (\u221230.4 \u00b1 24.6%) but not in the DLCO group. Apart from a state of hypocoagulability in all divers, other measured parameters remained unchanged. Our results suggest that divers with decreased DLCO might have a higher risk of DCS. Further studies are required to confirm these preliminary results.<\/jats:p>","DOI":"10.3390\/ijerph20156516","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T11:23:03Z","timestamp":1691061783000},"page":"6516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does Decreased Diffusing Capacity of the Lungs for Carbon Monoxide Constitute a Risk of Decompression Sickness in Occupational Divers?"],"prefix":"10.3390","volume":"20","author":[{"given":"Brice","family":"Lodd\u00e9","sequence":"first","affiliation":[{"name":"ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France"},{"name":"Occupational Diseases Center, Brest University Hospital, 29609 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Agn\u00e8s","family":"Giroux-Metges","sequence":"additional","affiliation":[{"name":"ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France"},{"name":"Respiratory Functional Exploration Unit, Brest University Hospital, 29609 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubert","family":"Galinat","sequence":"additional","affiliation":[{"name":"Department of Biological Hematology, Brest University Hospital, 29609 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e8l\u00e8ne","family":"Kerspern","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, 29609 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Pougnet","sequence":"additional","affiliation":[{"name":"Occupational Diseases Center, Brest University Hospital, 29609 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Saliou","sequence":"additional","affiliation":[{"name":"ISERM, EFS, UMR 1078, GGB, Infection Control Unit, Western Brittany University (UBO), 29238 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Guerrero","sequence":"additional","affiliation":[{"name":"ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Laf\u00e8re","sequence":"additional","affiliation":[{"name":"ORPHY Laboratory, EA 4324, Western Brittany University (UBO), 29238 Brest, France"},{"name":"Environmental, Occupational, Ageing (Integrative) Physiology Laboratory, HE<sub>2<\/sub>B, 1160 Brussels, Belgium"},{"name":"DAN Europe Research Department, 1160 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.28920\/dhm49.2.96-106","article-title":"A survey of scuba diving-related injuries and outcomes among French recreational divers","volume":"49","author":"Monnot","year":"2019","journal-title":"Diving Hyperb. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.23736\/S0375-9393.19.13618-8","article-title":"Diving physiopathology: The end of certainties? Food for thought","volume":"85","author":"Balestra","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_3","first-page":"530","article-title":"Risks factors for recurrent neurological decompression sickness in recreational divers: A case-control study","volume":"52","author":"Gempp","year":"2012","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_4","unstructured":"Brubakk, A.O., and Neuman, T. (1986). Bennett and Elliott\u2019s Physiology and Medicine of Diving, Saunders Ltd.. [5th ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1152\/japplphysiol.00324.2020","article-title":"Physiological characteristics associated with increased resistance to decompression sickness in male and female rats","volume":"129","author":"Lautridou","year":"2020","journal-title":"J. Appl. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"591","DOI":"10.3389\/fphys.2017.00591","article-title":"Nanobubbles Form at Active Hydrophobic Spots on the Luminal Aspect of Blood Vessels: Consequences for Decompression Illness in Diving and Possible Implications for Autoimmune Disease\u2014An Overview","volume":"8","author":"Arieli","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/0034-5687(90)90121-E","article-title":"Respiratory effects of cold-gas breathing in humans under hyperbaric environment","volume":"81","author":"Burnet","year":"1990","journal-title":"Respir. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1055\/s-0033-1345136","article-title":"The underestimated compression effect of neoprene wetsuit on divers hydromineral homeostasis","volume":"34","author":"Castagna","year":"2013","journal-title":"Int. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.cis.2013.02.002","article-title":"A critical review of physiological bubble formation in hyperbaric decompression","volume":"191\u2013192","author":"Papadopoulou","year":"2013","journal-title":"Adv. Colloid Interface Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s00421-006-0203-z","article-title":"A single open sea air dive increases pulmonary artery pressure and reduces right ventricular function in professional divers","volume":"97","author":"Dujic","year":"2006","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_11","first-page":"339","article-title":"Evolution of the ventilatory function of professional divers over 10 years","volume":"40","author":"Pougnet","year":"2013","journal-title":"Undersea Hyperb. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"119","DOI":"10.5603\/IMH.2019.0019","article-title":"Evolution of the respiratory function of professional divers over 15 years","volume":"70","author":"Pougnet","year":"2019","journal-title":"Int. Marit. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"160097","DOI":"10.1183\/16000617.0097-2016","article-title":"Short- and long-term effects of diving on pulmonary function","volume":"26","author":"Tetzlaff","year":"2017","journal-title":"Eur. Respir. Rev."},{"key":"ref_14","first-page":"203","article-title":"Vascular pressures and passage of gas emboli through the pulmonary circulation","volume":"15","author":"Butler","year":"1988","journal-title":"Undersea Biomed. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1152\/japplphysiol.01369.2009","article-title":"High incidence of venous and arterial gas emboli at rest after trimix diving without protocol violations","volume":"109","author":"Ljubkovic","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1183\/09059180.00006214","article-title":"Lung injury related to extreme environments","volume":"23","author":"Adir","year":"2014","journal-title":"Eur. Respir. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/01902148.2016.1207725","article-title":"Dysregulation of the renin-angiotensin system during lung ischemia-reperfusion injury","volume":"42","author":"Kehoe","year":"2016","journal-title":"Exp. Lung Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/978-3-319-68483-3_3","article-title":"The Pulmonary Vascular Barrier: Insights into Structure, Function, and Regulatory Mechanisms","volume":"228","author":"Parthasarathi","year":"2018","journal-title":"Adv. Anat. Embryol. Cell Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1002\/cphy.c140024","article-title":"Endothelial cell regulation of pulmonary vascular tone, inflammation, and coagulation","volume":"5","author":"Goldenberg","year":"2015","journal-title":"Compr. Physiol."},{"key":"ref_20","unstructured":"Modi, P., and Cascella, M. (2021). StatPearls, StatPearls Publishing LLC."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1183\/20734735.012717","article-title":"The Global Lung Function Initiative (GLI) Network: Bringing the world\u2019s respiratory reference values together","volume":"13","author":"Cooper","year":"2017","journal-title":"Breathe"},{"key":"ref_22","first-page":"26","article-title":"Consensus guidelines for the use of ultrasound for diving research","volume":"46","author":"Blogg","year":"2016","journal-title":"Diving Hyperb. Med."},{"key":"ref_23","first-page":"233","article-title":"A deep stop during decompression from 82 fsw (25 m) significantly reduces bubbles and fast tissue gas tensions","volume":"31","author":"Marroni","year":"2004","journal-title":"Undersea Hyperb. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s00421-017-3537-9","article-title":"Venous gas emboli are involved in post-dive macro, but not microvascular dysfunction","volume":"117","author":"Lambrechts","year":"2017","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e00142","DOI":"10.1002\/phy2.142","article-title":"Effect of decompression-induced bubble formation on highly trained divers microvascular function","volume":"1","author":"Lambrechts","year":"2013","journal-title":"Physiol. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1055\/a-1450-8300","article-title":"Added Value of Blood Cells in Thrombin Generation Testing","volume":"121","author":"Wan","year":"2021","journal-title":"Thromb. Haemost."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1152\/jappl.1974.37.2.247","article-title":"Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration","volume":"37","author":"Dill","year":"1974","journal-title":"J. Appl. Physiol."},{"key":"ref_28","first-page":"137","article-title":"Is there a place for thrombin generation assay in routine clinical laboratory?","volume":"73","author":"Lecut","year":"2015","journal-title":"Ann. Biol. Clin."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1152\/japplphysiol.00811.2010","article-title":"Microparticles initiate decompression-induced neutrophil activation and subsequent vascular injuries","volume":"110","author":"Thom","year":"2011","journal-title":"J. Appl. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"906","DOI":"10.3389\/fphys.2018.00906","article-title":"Tirofiban, a Glycoprotein IIb\/IIIa Antagonist, Has a Protective Effect on Decompression Sickness in Rats: Is the Crosstalk Between Platelet and Leukocytes Essential?","volume":"9","author":"Lambrechts","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1152\/japplphysiol.00139.2015","article-title":"Influence of decompression sickness on vasocontraction of isolated rat vessels","volume":"120","author":"Mazur","year":"2016","journal-title":"J. Appl. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"214","DOI":"10.28920\/dhm50.3.214-219","article-title":"Endothelial function may be enhanced in the cutaneous microcirculation after a single air dive","volume":"50","author":"Guerrero","year":"2020","journal-title":"Diving Hyperb. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1152\/japplphysiol.00807.2020","article-title":"Protective effects of pulmonary surfactant on decompression sickness in rats","volume":"130","author":"Yu","year":"2021","journal-title":"J. Appl. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1152\/japplphysiol.00602.2015","article-title":"Fluoxetine stimulates anti-inflammatory IL-10 cytokine production and attenuates sensory deficits in a rat model of decompression sickness","volume":"119","author":"Blatteau","year":"2015","journal-title":"J. Appl. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"140","DOI":"10.28920\/dhm51.2.140-146","article-title":"The impact of different gas mixtures on inflammatory responses in advanced recreational divers","volume":"51","author":"Rocco","year":"2021","journal-title":"Diving Hyperb. Med."},{"key":"ref_36","first-page":"123","article-title":"Can Diving Depth Affect Blood Hemostasis System Responses?","volume":"11","author":"Bolboli","year":"2019","journal-title":"J. Sport Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1016\/j.clinbiochem.2013.05.070","article-title":"Inflammatory biomarkers for predicting cardiovascular disease","volume":"46","author":"Stoner","year":"2013","journal-title":"Clin. Biochem."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.it.2007.02.006","article-title":"Complement and coagulation: Strangers or partners in crime?","volume":"28","author":"Markiewski","year":"2007","journal-title":"Trends Immunol."},{"key":"ref_39","first-page":"191","article-title":"Complement levels before and after dives with a high risk of DCS","volume":"34","author":"Nyquist","year":"2007","journal-title":"Undersea Hyperb. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/1076029614568712","article-title":"Effects of Hyperbaric and Decompression Stress on Blood Coagulation and Fibrinolysis: Comparison of Thromboelastography and Thromboelastometry","volume":"22","author":"Peng","year":"2016","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/00001721-200106000-00007","article-title":"Changes in the extrinsic and intrinsic coagulation pathways in humans after decompression following saturation diving","volume":"12","author":"Radziwon","year":"2001","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1152\/japplphysiol.01305.2011","article-title":"Microparticle production, neutrophil activation, and intravascular bubbles following open-water SCUBA diving","volume":"112","author":"Thom","year":"2012","journal-title":"J. Appl. Physiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1055\/s-0037-1616518","article-title":"Structure and biology of tissue factor pathway inhibitor","volume":"86","author":"Bajaj","year":"2001","journal-title":"Thromb. Haemost."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.thromres.2007.03.027","article-title":"Decreased levels of PAI-1 and alpha 2-antiplasmin contribute to enhanced fibrinolytic activity in divers","volume":"121","author":"Radziwon","year":"2007","journal-title":"Thromb. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.resp.2017.01.002","article-title":"The DL(NO)\/DL(CO) ratio: Physiological significance and clinical implications","volume":"241","author":"Hughes","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1172\/JCI17271","article-title":"Mechano-oxidative coupling by mitochondria induces proinflammatory responses in lung venular capillaries","volume":"111","author":"Ichimura","year":"2003","journal-title":"J. Clin. Investig."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.cis.2014.01.017","article-title":"Circulatory bubble dynamics: From physical to biological aspects","volume":"206","author":"Papadopoulou","year":"2014","journal-title":"Adv. Colloid Interface Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1007\/s00421-018-3854-7","article-title":"Variability in circulating gas emboli after a same scuba diving exposure","volume":"118","author":"Papadopoulou","year":"2018","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_49","first-page":"121","article-title":"Bubble formation and decompression sickness on direct ascent from shallow air saturation diving","volume":"64","author":"Ikeda","year":"1993","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.3357\/ASEM.2352.2008","article-title":"Blood platelet count and bubble formation after a dive to 30 msw for 30 min","volume":"79","author":"Pontier","year":"2008","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s00421-006-0276-8","article-title":"No changes in lung function after a saturation dive to 2.5 MPa with intermittent reduction in Po2 during decompression","volume":"98","author":"Thorsen","year":"2006","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3389\/fphys.2018.00064","article-title":"Angiotensin Converting Enzyme Inhibitor Has a Protective Effect on Decompression Sickness in Rats","volume":"9","author":"Mazur","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.3389\/fpsyg.2017.01587","article-title":"Dive Risk Factors, Gas Bubble Formation, and Decompression Illness in Recreational SCUBA Diving: Analysis of DAN Europe DSL Data Base","volume":"8","author":"Cialoni","year":"2017","journal-title":"Front. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/15\/6516\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:25:11Z","timestamp":1760127911000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/15\/6516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,3]]},"references-count":53,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["ijerph20156516"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20156516","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2023,8,3]]}}}