Effect of repetitive SCUBA diving on humoral markers of endothelial and central nervous system integrity
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ORIGINAL ARTICLE
Effect of repetitive SCUBA diving on humoral markers of endothelial and central nervous system integrity Nada Bilopavlovic • Jasna Marinovic • Marko Ljubkovic • Ante Obad • Jaksa Zanchi • Neal W. Pollock • Petar Denoble • Zeljko Dujic
Received: 10 September 2012 / Accepted: 24 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract During SCUBA diving decompression, there is a significant gas bubble production in systemic veins, with rather frequent bubble crossover to arterial side even in asymptomatic divers. The aim of the current study was to investigate potential changes in humoral markers of endothelial and brain damage (endothelin-1, neuron-specific enolase and S-100b) after repetitive SCUBA diving with concomitant assessment of venous gas bubble production and subsequent arterialization. Sixteen male divers performed four open-water no-decompression dives to 18 msw (meters of sea water) lasting 49 min in consecutive days during which they performed moderate-level exercise. Before and after dives 1 and 4 blood was drawn, and bubble production and potential arterialization were echocardiographically evaluated. In addition, a control dive to 5 msw was performed with same duration, water temperature and exercise load. SCUBA diving to 18 msw caused significant bubble production with arterializations in six divers after dive 1 and in four divers after dive 4. Blood levels of endothelin-1 and neuron-specific enolase did not change after diving, but levels of S-100b were significantly elevated after both dives to 18 msw and a Communicated by Dag Linnarsson. N. Bilopavlovic and J. Marinovic contributed equally to this work. N. Bilopavlovic J. Zanchi Split University Hospital, Split, Croatia J. Marinovic (&) M. Ljubkovic A. Obad Z. Dujic Department of Physiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia e-mail: [email protected] N. W. Pollock P. Denoble Divers Alert Network, Durham, NC, USA
control dive. Creatine kinase activity following a control dive was also significantly increased. Although serum S-100b levels were increased after diving, concomitant increase of creatine kinase during control, almost bubblefree, dive suggests the extracranial release of S-100b, most likely from skeletal muscles. Therefore, despite the significant bubble production and sporadic arterialization after open-water dives to 18 msw, the current study found no signs of damage to neurons or the blood–brain barrier. Keywords Endothelin-1 Neuron-specific enolase S-100b Decompression Diving Arterialization
Introduction During SCUBA diving decompression, as partial pressure of inert gas in blood and tissues exceeds ambient pressure, a significant gas bubble production often occurs. The presence of bubbles in the vessels is usually not associated with overt clinical symptoms and majority of dives result in so-called ‘silent’ bubbles. In most cases, the gas bubbles carried by systemic veins become trapped in the lungs which act as a filter that prevents t
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