{"id":20852,"date":"2022-04-14T16:10:43","date_gmt":"2022-04-14T20:10:43","guid":{"rendered":"https:\/\/world.dan.org\/?post_type=dan_alert_diver&p=20852"},"modified":"2023-05-30T17:46:08","modified_gmt":"2023-05-30T21:46:08","slug":"what-does-it-mean","status":"publish","type":"dan_alert_diver","link":"https:\/\/world.dan.org\/fr\/alert-diver\/article\/what-does-it-mean\/","title":{"rendered":"Qu'est-ce que cela signifie ?"},"content":{"rendered":"

Stephen Thom \u00e9tudie le r\u00f4le des microparticules dans la SCD et d'autres pathologies.<\/span><\/h2>\n\n\n\n

<\/p>\n\n\n\n

PROFESSEUR DE M\u00c9DECINE D'URGENCE<\/span><\/strong> et chercheur \u00e0 la facult\u00e9 de m\u00e9decine de l'universit\u00e9 du Maryland, Stephen Thom est titulaire d'un dipl\u00f4me de m\u00e9decine et d'un doctorat de l'universit\u00e9 de Rochester. Il a auparavant dirig\u00e9 divers programmes cliniques, notamment en m\u00e9decine hyperbare et en m\u00e9decine d'urgence, ainsi qu'un laboratoire de recherche \u00e0 l'universit\u00e9 de Pennsylvanie.<\/p>\n\n\n\n

Quel est votre parcours acad\u00e9mique ?<\/span><\/strong><\/p>\n\n\n\n

My medical specialty is emergency medicine. My doctorate in microbiology was specifically in microbial physiology, where my focus was high-pressure gas physiology. I studied the effects of high hydrostatic pressure and various gases \u2014 oxygen and the entire array of noble gases \u2014 on various microorganisms. That was probably my start in studying things related to dive medicine.<\/p>\n\n\n\n

\u00c9tiez-vous int\u00e9ress\u00e9 par la plong\u00e9e avant de vous engager dans cette voie de recherche ? \u00cates-vous plongeur ?<\/span><\/strong><\/p>\n\n\n\n

Yes, this goes back to my junior year in college. The only certification available in upstate New York at the time was through the YMCA, so that\u2019s where I got certified. I really enjoy diving, but it\u2019s been quite a few years since my last dive. These days I don\u2019t get many chances to dive, but I still go when I have the opportunity for cushy diving with great visibility and something to see underwater.<\/p>\n\n\n

\n
\"Dr.
Le Dr Thom examine l'activation des cellules au microscope.<\/figcaption><\/figure>\n<\/div>\n\n\n

Comment avez-vous commenc\u00e9 \u00e0 faire de la recherche sur la plong\u00e9e ?<\/span><\/strong><\/p>\n\n\n\n

En tant qu'\u00e9tudiant de premier cycle, j'ai suivi pendant un certain temps un double programme de biologie et de g\u00e9ologie. J'ai choisi la g\u00e9ologie parce qu'elle me permettait de suivre des cours d'oc\u00e9anographie, et c'est ce qui m'int\u00e9ressait vraiment. J'\u00e9tais d\u00e9termin\u00e9e \u00e0 devenir biologiste marin, ce qui \u00e9tait tr\u00e8s populaire \u00e0 l'\u00e9poque. Un membre de la facult\u00e9 de microbiologie de l'\u00e9cole de m\u00e9decine menait des recherches sous haute pression. J'ai approch\u00e9 Robert Marquis, le chef de ce groupe, qui a reconnu mon int\u00e9r\u00eat et a accept\u00e9 un \u00e9tudiant inconnu comme volontaire dans son laboratoire. De fil en aiguille, Marquis est devenu mon directeur de th\u00e8se, et les recherches que j'ai men\u00e9es avec lui sont devenues mon principal centre d'int\u00e9r\u00eat.<\/p>\n\n\n\n

When I was a senior in college, I was undecided if I should stick with my research interest or pursue medicine. Marquis looked at me and said, \u201cWell, Steve, we have a combined M.D. and Ph.D. program here.\u201d Naive undergrad that I was, I gave him a puzzled look and asked, \u201cSo I don\u2019t even have to choose?\u201d<\/p>\n\n\n\n

I never looked back \u2014 I still do both kinds of work. I get to switch from basic science in the lab one day to being an attending physician in the emergency department the next, and I\u2019m delighted with how things have worked out.<\/p>\n\n\n\n

Quel a \u00e9t\u00e9 le principal enseignement de votre th\u00e8se de doctorat ?<\/span><\/strong><\/p>\n\n\n\n

Based on biochemical observations, my work demonstrated that so-called inert gases such as helium, argon, and others are not actually biologically inert. We sort of already knew that in terms of the theory on narcotic mechanism, meaning insertion of these gases into membranes and proteins. My work showed that these gases also generate oxidative stress, and we\u2019re still using that principle in some of our research.<\/p>\n\n\n\n

It is clearer now than back then, but we still have questions. The major question is simple: So what? What does that really mean \u2014 in terms of diving mammals, animals of all kinds, and humans? I do not have an answer yet; we\u2019re still working on it.<\/p>\n\n\n\n

Parlez-nous de votre travail actuel.<\/span><\/strong><\/p>\n\n\n\n

L'universit\u00e9 du Maryland m'a recrut\u00e9 comme professeur de m\u00e9decine d'urgence et pour diriger un laboratoire de recherche. L'universit\u00e9 m'a promis que j'aurais tr\u00e8s peu de travail administratif et un engagement clinique modeste, ce qui m'a sembl\u00e9 formidable apr\u00e8s avoir cumul\u00e9 plusieurs emplois en m\u00e9decine d'urgence et en recherche pendant des ann\u00e9es. J'ai maintenant un laboratoire avec une \u00e9quipe de trois personnes : un assistant de recherche qui est un technicien de laboratoire, un associ\u00e9 de recherche qui est \u00e9galement un jeune professeur, et un chercheur postdoctoral.<\/p>\n\n\n\n

Nous b\u00e9n\u00e9ficions actuellement d'une subvention des National Institutes of Health pour \u00e9tudier les cellules souches vasculog\u00e9niques, c'est-\u00e0-dire les cellules qui fabriquent de nouveaux vaisseaux sanguins. Il s'agit l\u00e0 d'un objectif clinique, principalement pour la recherche sur les plaies diab\u00e9tiques. En ce qui concerne la plong\u00e9e, nous b\u00e9n\u00e9ficions de plusieurs subventions de l'Office of Naval Research, dont l'une porte sur les r\u00e9actions du syst\u00e8me nerveux central \u00e0 la haute pression. Nous \u00e9tudions le syst\u00e8me glymphatique.<\/p>\n\n\n\n

Qu'est-ce que le syst\u00e8me glymphatique ?<\/span><\/strong><\/p>\n\n\n\n

Until a few years ago, it was dogma that the brain does not have a lymphatic system like the rest of the body. That idea didn\u2019t exactly make sense, but it\u2019s what the data said. It\u2019s now clear and demonstrable that this notion was wrong. There is indeed a circulatory system for fluid other than blood in the brain that supplies brain tissue with nutrients and removes waste products. That system is now called the glymphatic system \u2014 a lymphatic system dependent on glial cells. We are looking at the glymphatic function in a model and how it responds to gases under high pressure, just as would occur while diving.<\/p>\n\n\n\n

Vous avez d\u00e9j\u00e0 beaucoup travaill\u00e9 sur les microparticules et vous avez contribu\u00e9 \u00e0 r\u00e9volutionner notre compr\u00e9hension du lien entre l'inflammation et la maladie de d\u00e9compression (DCS). Pouvez-vous nous en dire plus \u00e0 ce sujet ?<\/span><\/strong><\/p>\n\n\n\n

Les microparticules sont des v\u00e9sicules de taille microm\u00e9trique d\u00e9tach\u00e9es de la surface des cellules. Elles contiennent des constituants membranaires et cytoplasmiques provenant de leurs cellules m\u00e8res. Cependant, elles ne sont pas seulement des d\u00e9bris de la paroi cellulaire ou vasculaire, mais elles fonctionnent \u00e9galement comme des mol\u00e9cules de signalisation et de transport. Les hautes pressions des gaz inertes tels que l'h\u00e9lium, l'azote et l'argon peuvent d\u00e9clencher la production de microparticules inflammatoires.<\/p>\n\n\n\n

Nous \u00e9tudions comment cet effet d\u00e9clencheur fonctionne au niveau biochimique dans le mod\u00e8le. Nous avons commenc\u00e9 \u00e0 pr\u00e9lever des \u00e9chantillons de sang chez l'homme pour voir si nous pouvions prouver l'existence des m\u00eames m\u00e9canismes. Dans l'id\u00e9al, ces personnes ont \u00e9t\u00e9 soumises \u00e0 des pressions \u00e9lev\u00e9es dans des caissons hyperbares, mais nous souhaitons \u00e9galement \u00e9tudier les plongeurs en eau libre et les personnes souffrant de DCS. Nous esp\u00e9rons obtenir davantage d'informations sur l'activation des globules blancs et les r\u00e9ponses immunitaires gr\u00e2ce \u00e0 des \u00e9chantillons pr\u00e9lev\u00e9s dans le monde entier.<\/p>\n\n\n\n

We have published several papers on microparticles and recently have been hopeful that we can advance our understanding with a new project. We\u2019re moderately smarter now than we were a few years ago in terms of what I call the bad actors. Many microparticles are part of normal human health, and only a subset seems to cause injuries.<\/p>\n\n\n\n

DCS is one pathological scenario. Our view is that high-pressure exposure is physiological stress, which is important to distinguish as profoundly different from damage. I\u2019m not saying that you are hurting yourself simply by diving. Divers put their bodies in a stressful environment, and the microparticles are a response. For all we know, some of them may be good for you and will not normally hurt you, but as with most things in the extreme, they can injure you if they get to that point.<\/p>\n\n\n\n

Qu'est-ce qui est apparu en premier : la bulle ou la microparticule ?<\/span><\/strong><\/p>\n\n\n\n

I accept that many people don\u2019t like the notion that microparticles may be a central element of DCS and that we have not definitively proven that to be the case. All our work, though, supports that they play a role. We keep trying new angles, considering that maybe we\u2019re wrong and it doesn\u2019t play a part, but we always end up understanding that the theory still holds. This research, which my group has put together over a decade, has me thinking more and more that we have an answer.<\/p>\n\n\n\n

Many in this field are married to gas bubbles\u2019 role in decompression, which does not concern me. One element of the gas bubble hypothesis for DCS fundamentally comes down to the bubbles\u2019 nucleation site. From mathematical models going back to the 1960s, the conclusion is that the nucleation site has a half-micron radius \u2014 that is, perhaps coincidentally, the size range of a microparticle.<\/p>\n\n\n\n

Il y a quelques ann\u00e9es, nous avons \u00e9galement montr\u00e9 qu'un sous-ensemble de microparticules form\u00e9es en r\u00e9ponse \u00e0 une pression \u00e9lev\u00e9e poss\u00e8de une phase gazeuse qui pourrait hypoth\u00e9tiquement \u00eatre un site de nucl\u00e9ation de bulles. La question est donc de savoir si les bulles de gaz sont un \u00e9piph\u00e9nom\u00e8ne de la formation des microparticules.<\/p>\n\n\n\n

Comment voyez-vous l'\u00e9volution de votre recherche dans les dix prochaines ann\u00e9es ?<\/span><\/strong><\/p>\n\n\n\n

I think the microparticle story is not restricted to dive physiology. In 2009 or 2010, when I wrote my first grant on microparticles, you could read the world\u2019s literature on microparticles in an afternoon. Now it would take months to read the tens of thousands of papers about the many disorders that involve microparticles. Like with DCS, there are questions about whether microparticles represent the cart or the horse, and this seems to depend upon the particular disorder and many other variables.<\/p>\n\n\n\n

We are doing some work looking at microparticles in diabetic studies, but the other big disorder \u2014 at least in my eyes \u2014 is carbon monoxide poisoning, which is very common. It is a major problem worldwide and is another area where a role for microparticles evolved very slowly. The more we look, the more we find that microparticles seem to be driving carbon monoxide injuries systemically and, most important, in the brain. And now we find that glymphatic dysfunction in our carbon monoxide model is alarmingly prevalent. That is what our next grant, should we receive it, will cover.<\/p>\n\n\n\n

Nous comparons nos mod\u00e8les avec l'empoisonnement au monoxyde de carbone et le DCS. Les m\u00eames \u00e9v\u00e9nements se produisent, montrant des m\u00e9canismes similaires avec les m\u00eames syst\u00e8mes de messagers secondaires et les m\u00eames voies inflammatoires. Il existe des communications entre le cerveau et le sang et entre le sang et le cerveau. Ces connexions semblent \u00e9galement \u00eatre un facteur dans un autre de mes centres d'int\u00e9r\u00eat en m\u00e9decine d'urgence : les l\u00e9sions c\u00e9r\u00e9brales traumatiques.<\/p>\n\n\n\n

The other project comes from the significant questions I posed earlier: What does all this mean, and how does it help the dive community? With all the new knowledge, can we do something besides treating somebody with DCS in a chamber? Hyperbaric treatment may not always be available. We are looking at pharmaceuticals that can reverse or at least suppress the insult related to microparticles and the inflammatory responses. Many agents \u2014 none of them available in your local pharmacy \u2014 work in the model. One of these agents, which we have already shown to work in the model, is now approved for investigation in humans with several kinds of infections but not yet for dive injuries.<\/p>\n\n\n\n

Those who don\u2019t agree with me when I say that DCS is an inflammatory disease will probably be upset about this line of research. If you can accept that statement, however, there are a lot of potentially useful pharmaceutical agents that are worth investigating as a prophylactic or even therapeutic measure. There\u2019s still a lot to be done.<\/p>\n\n\n\n

Que faites-vous pendant votre temps libre ?<\/span><\/strong><\/p>\n\n\n\n

J'aime faire du kayak et je cr\u00e9e des vitraux et des lampes pendant mon temps libre, mais il s'agit en fait de passer plus de temps dans le laboratoire.<\/p>\n\n\n\n

Y a-t-il autre chose que vous aimeriez que nos lecteurs sachent ?<\/span><\/strong><\/p>\n\n\n\n

It has always been incredibly helpful to connect and collaborate with other scientists and groups. If anyone has the means to safely draw blood from divers \u2014 any kind of diving: recreational, provocative technical, scientific, or anything else \u2014 before and after a dive, we are always looking for subjects to add to our studies. Safely collecting blood in this context means having an ethical protocol that an institutional review board has approved. I would be delighted to collaborate with anyone interested.<\/p>","protected":false},"excerpt":{"rendered":"

A PROFESSOR OF EMERGENCY MEDICINE and researcher at the University of Maryland School of Medicine, Stephen Thom holds medical and doctorate degrees from the University of Rochester. He previously led various clinical programs, including hyperbaric and emergency medicine, and a research lab at the University of Pennsylvania. What is your academic background? My medical specialty [\u2026]<\/p>\n","protected":false},"featured_media":20854,"template":"","dan_alert_diver_categories":[466],"dan_alert_diver_issues":[478],"class_list":["post-20852","dan_alert_diver","type-dan_alert_diver","status-publish","has-post-thumbnail","hentry","dan_alert_diver_categories-researcher-profile","dan_alert_diver_issues-q1-2022"],"acf":[],"yoast_head":"\nWhat Does It Mean? - DAN World<\/title>\n<meta name=\"description\" content=\"Stephen Thom studies the role of microparticles in DCS and other conditions.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/world.dan.org\/fr\/alert-diver\/article\/what-does-it-mean\/\" \/>\n<meta property=\"og:locale\" content=\"fr_CA\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What Does It Mean?\" \/>\n<meta property=\"og:description\" content=\"Stephen Thom studies the role of microparticles in DCS and other conditions.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/world.dan.org\/fr\/alert-diver\/article\/what-does-it-mean\/\" \/>\n<meta property=\"og:site_name\" content=\"DAN World\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-30T21:46:08+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/world.dan.org\/wp-content\/uploads\/2022\/04\/stephen-q1_121.researcher-copy-e1647623998876.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"648\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:description\" content=\"Stephen Thom studies the role of microparticles in DCS and other conditions.\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/world.dan.org\\\/alert-diver\\\/article\\\/what-does-it-mean\\\/\",\"url\":\"https:\\\/\\\/world.dan.org\\\/alert-diver\\\/article\\\/what-does-it-mean\\\/\",\"name\":\"What Does It Mean? 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