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Undersea Hyperb Med 2022 Second Quarter;49(2):563-568

Duke University, Department of Anesthesiology, Division of Hyperbaric Medicine and Environmental Physiology, Durham, North Carolina U.S.

Introduction: This case report describes an initially overlooked Type II decompression sickness (DCS) occurrence that was confused with a cerebral vascular accident in a patient with chronic atrial fibrillation (AF). The purpose of this case report is to reinforce the maxim that DCS needs to be suspected anytime a scuba diver experiences signs or symptoms compatible with DCS after completing a scuba dive.

Methods: A 71-year-old scuba diver with a history of AF and who was taking warfarin made four dives, all with maximum depths less than 60 fsw (20 msw) over a 10-hour interval. Read More

Undersea Hyperb Med 2022 Second Quarter;49(2):207-226

Department of Physiology, Biosciences Institute, University of São Paulo.

Inert gas bubbles in tissues and in blood have been historically considered as the only triggering factors for DCS, but now many other factors are considered to affect the final outcome of a decompression profile for a certain individual. In this sense, inflammation seems to play a relevant role, not only due to the physical damage of tissues by the bubbles, but as a potentiator of the process as a whole. The present study aims to put forward a mathematical model of bubble formation associated with an inflammatory process related to decompression. Read More

Int J Environ Res Public Health 2022 Apr 29;19(9). Epub 2022 Apr 29.

Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium.

Despite evolution in decompression algorithms, decompression illness is still an issue nowadays. Reducing vascular gas emboli (VGE) production or preserving endothelial function by other means such as diving preconditioning is of great interest. Several methods have been tried, either mechanical, cardiovascular, desaturation aimed or biochemical, with encouraging results. Read More

Biom J 2022 May 6. Epub 2022 May 6.

ISBA, UCLouvain, Louvain la Neuve, Belgium.

The receiver-operating characteristic (ROC) curve is the most popular graphical method for evaluating the classification accuracy of a diagnostic marker. In time-to-event studies, the subject's event status is time-dependent, and hence, time-dependent extensions of ROC curve have been proposed. However, in practice, the calculation of this curve is not straightforward due to the presence of censoring that may be of different types. Read More

Sci Rep 2022 Apr 21;12(1):6592. Epub 2022 Apr 21.

Veterinary Histology and Pathology, Atlantic Center for Cetacean Research, University Institute of Animal Health and Food Safety (IUSA), Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Canary Islands, Spain.

Decompression sickness (DCS) is a clinical syndrome caused by the formation of systemic intravascular and extravascular gas bubbles. The presence of these bubbles in blood vessels is known as gas embolism. DCS has been described in humans and animals such as sea turtles and cetaceans. Read More

Clin Case Rep 2022 Apr 14;10(4):e05706. Epub 2022 Apr 14.

Chester medical school University of Chester Chester UK.

The diagnosis of decompression sickness (DCS) is mostly based on clinical suspicion, and there is currently no available modality to fully confirm the diagnosis. However, the use of echocardiography in suspected DCS cases has become more common. In this case, transthoracic echocardiography (TTE) was used to detect microbubbles in the right cardiac chambers and monitor the patient after hyperbaric oxygen therapy (HBOT), suggesting the possible applicability of TTE in diagnosing and monitoring DCS patients. Read More

J Orthop Case Rep 2021 Jun;11(6):102-105

Department of Orthopaedics, Instituto de Seguridad del Trabajo, Viña del Mar, Chile.

Introduction: Dysbaric osteonecrosis (DON) is a specific type of atraumatic osteonecrosis that has been shown to occur mainly in deep-sea divers and workers exposed to increased air pressure environments. The pathophysiology is not entirely understood but is thought to be due to subclinical decompression sickness resulting in arterial gas emboli. This leads to vascular occlusion and subsequent bone death. Read More

Toxicol Appl Pharmacol 2022 Jun 13;444:116023. Epub 2022 Apr 13.

Departments of Anesthesiology and Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27710, USA. Electronic address:

Carbon tetrafluoride (CF) is an inert gas with higher molecular weight and lower water solubility than commonly used hyperbaric breathing gases. These inert gas properties decrease time required to decompress and avoid decompression sickness after deep dives. To assess CF toxicity, Sprague-Dawley rats were exposed to 8 atm absolute (ATA) air (10 males, 10 females) or 8 ATA 79% CF/21% O (25 males, 25 females). Read More

J Exp Biol 2022 05 12;225(9). Epub 2022 May 12.

Aarhus Institute of Advanced Studies, Aarhus University, DK-8000 Aarhus, Denmark.

Closely related species are expected to diverge in foraging strategy, reflecting the evolutionary drive to optimize foraging performance. The most speciose cetacean genus, Mesoplodon, comprises beaked whales with little diversity in external morphology or diet, and overlapping distributions. Moreover, the few studied species of beaked whales (Ziphiidae) show very similar foraging styles with slow, energy-conserving movement during long, deep foraging dives. Read More

Curr Sports Med Rep 2022 Apr;21(4):109-111

University of Miami Miller School of Medicine, University of Miami Hospitals and Clinics, Miami, FL.

Abstract: With more than 9 million recreational certified self-contained underwater breathing apparatus divers in the United States, clinicians should be aware of the unique diving-related injuries. One of the most common diving-related injuries is type 1 decompression sickness, or "the bends." The bends commonly manifest as localized joint pain, most often occurring within 24 h of surfacing and resolving over the following 1 to 2 d. Read More

N Engl J Med 2022 03;386(13):1254-1264

From the School of Medicine, University of Auckland, and the Department of Anaesthesia, Auckland City Hospital - both in Auckland, New Zealand (S.J.M.); Prince of Wales Clinical School, University of New South Wales, and Wales Anaesthesia, Prince of Wales Hospital - both in Sydney (M.H.B.); and the Departments of Anesthesiology and Medicine, Duke University Medical Center, and the Center for Hyperbaric Medicine and Environmental Physiology, Duke University - both in Durham, North Carolina (R.E.M.).

Am J Case Rep 2022 Mar 29;23:e935473. Epub 2022 Mar 29.

Department of Internal Medicine, Naples Community Hospital, Naples, FL, USA.

BACKGROUND Deep sea diving can cause decompression illness which comprises both decompression sickness and arterial gas embolism. Decompression sickness is a clinical diagnosis with symptoms including dizziness, joint pain, rash, and myalgias and is due to nitrogen bubbles that form in tissues during ascent. These gas bubbles can be clinically silent even in the absence of decompression sickness and can rarely predispose a patient to venous thrombus, for which the role of hyperbaric oxygen (HBO) is undefined. Read More

Diving Hyperb Med 2022 Mar;52(1):22-26

DDRC Healthcare, Plymouth, UK.

Introduction: Otological disorders, including Eustachian tube dysfunction (ETD), are commonly observed in divers. Data were gathered to observe the prevalence of ear disorders, and awareness of ear health recommendations for recreational divers in the United Kingdom.

Methods: An anonymous online survey included: diver/diving demographics, the validated Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) (a mean score of ≥ 2. Read More

Diving Hyperb Med 2022 Mar;52(1):7-15

Department of Emergency Medicine, School of Medicine, University of California, San Diego, California, USA.

Introduction: In dissolved gas decompression algorithms, the ceiling is the depth at which the dissolved gas pressure in at least one tissue equals the maximum tolerated value defined by the algorithm. Staged decompression prescribes stationary stops in three-metre intervals so as to never exceed this maximum tolerated value. This keeps the diver deeper than the ceiling until the ceiling itself decreases to coincide with the next, three-metre shallower stage. Read More

Fa Yi Xue Za Zhi 2021 Oct;37(5):683-686

Department of Forensic Medicine, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.

Investigation of the cause of death during diving is one of the contents of forensic pathology. In this article, relevant foreign literature is reviewed to summarize the techniques and methods used in the identification of diving deaths, such as accident reconstruction, diving monitoring data, postmortem CT examination and gas analysis (location and quantity) in the body of the corpse, in order to provide a reference for forensic identification of such cases. Read More

Math Biosci 2022 03 12;345:108793. Epub 2022 Feb 12.

Department of Chemistry, University of Guelph, Guelph, Ontario, N1G 2W1, Canada. Electronic address:

An approximation that had been widely used for more than 70 years to estimate the concentration of a dissolved volatile solute at the external surface of a gas bubble was found to be inaccurate for small bubbles. The approximation was to assume that a Henry's law-based partition equilibrium determines the solute's concentration at the bubble's external surface. An alternative model is developed here, wherein solute exchange across the bubble surface, and solute diffusion in the medium next to the bubble, collectively determine the solute's concentration near the bubble's external surface. Read More

J Neurotrauma 2022 May;39(9-10):715-723

Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.

Hyperbaric oxygen (HBO) therapy is frequently used to treat peripheral wounds or decompression sickness. Evidence suggests that HBO therapy can provide neuroprotection and has an anti-inflammatory impact after neurological injury, including spinal cord injury (SCI). Our primary purpose was to conduct a genome-wide screening of mRNA expression changes in the injured spinal cord after HBO therapy. Read More

Eur J Appl Physiol 2022 Apr 10;122(4):993-1005. Epub 2022 Feb 10.

Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.

Purpose: It is speculated that diving might be harmful to the nervous system. The aim of this study was to determine if established markers of neuronal injury were increased in the blood after diving.

Methods: Thirty-two divers performed two identical dives, 48 h apart, in a water-filled hyperbaric chamber pressurized to an equivalent of 42 m of sea water for 10 min. Read More

Emerg Med J 2022 Feb 7. Epub 2022 Feb 7.

Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France

Background: Decompression sickness (DCS) with spinal cord involvement has an unfortunately high rate of long-term sequelae. The objective of this study was to determine the association of prehospital variables on the outcome of spinal cord DCS, especially the influence of the initial clinical presentation and the time to recompression.

Methods: This was a retrospective study using prospectively collected data which included divers with spinal cord DCS seen at a single hyperbaric centre study from 2010 to 2018. Read More

J Neurol Sci 2022 Mar 2;434:120181. Epub 2022 Feb 2.

Norwegian Centre for Maritime and Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway; Neuro Clinic, Haukeland University Hospital, Bergen, Norway.

Introduction: Decompression sickness (DCS) has traditionally been categorized as type I DCS, affecting joints and skin, and type II affecting the nervous system. In the present study, we wanted to examine whether divers with a history of neurological DCS demonstrated a pattern of symptoms and clinical neurological and neurophysiological signs different from divers with other manifestations of DCS or no history of DCS.

Methods: Up to 1990, 365 Norwegian offshore divers worked in the North Sea. Read More

Bratisl Lek Listy 2022 ;123(2):77-82

Introduction: Patent foramen ovale (PFO) is a risk factor of decompression sickness (DCS). However, data on risk stratification of divers with a PFO are sparse. This study sought to evaluate the risk of neurological DCS (DCSneuro), based on the presence and grade of a right-to-left shunt (RLS). Read More

Aerosp Med Hum Perform 2022 Jan;93(1):54-57

This study aimed to evaluate whether a short familiarization session is sufficient for individuals with no prior experience of sonography to both reliably and consistently evaluate the prevalence of venous gas emboli (VGE) from precordial ultrasonic videos. A total of 10 adults with no prior experience of sonography were introduced to the Eftedal-Brubakk 6-grade scale and were shown 6 video sequences, each of a maximum of 10 heartbeats, representing each grading level. Thereafter, they independently evaluated the prevalence of VGE in 70 ultrasonic videos before and after a 14-d interval (test-retest; intra-rater), with these being compared to an experienced sonographer's grading (inter-rater). Read More

Aerosp Med Hum Perform 2022 Jan;93(1):46-49

Hypobaric decompression sickness remains a problem during high-altitude aviation. The prevalence of venous gas emboli (VGE) serves as a marker of decompression stress and has been used as a method in evaluating the safety/risk associated with aviation profiles and/or gas mixtures. However, information is lacking concerning the variability of VGE formation when exposed to the same hypobaric profile on different occasions. Read More

Medicina (Kaunas) 2022 Jan 10;58(1). Epub 2022 Jan 10.

Emergency Department, Ospedale Civile Vigevano, 27029 Vigevano, Italy.

Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Read More

J Physiol 2022 04 17;600(7):1541-1553. Epub 2022 Feb 17.

Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.

The foramen ovale is an essential component of the fetal circulation contributing to oxygenation and carbon dioxide elimination that remains patent under certain circumstances in ∼30% of the healthy adult population, without major negative sequelae in most. Adults with a patent foramen ovale (PFO) have a greater tendency to develop symptoms of acute mountain sickness and high-altitude pulmonary oedema upon ascent to high altitude, and PFO presence is associated with worse cardiopulmonary function in chronic mountain sickness. This increase in altitude illness prevalence may be related to dysregulated cerebral blood flow associated with altered respiratory chemoreflex sensitivity; however, the mechanisms remain to be elucidated. Read More

Clin Nephrol 2022 May;97(5):298-304

Decompression sickness (DCS) occurs when divers are exposed to reduced barometric pressure during their ascent from depth. We report a case of DCS causing severe acute kidney injury (AKI) after an uneventful dive in which all decompression stops were made as instructed by a dive computer. A 26-year-old man presented with abdominal and bilateral flank pain ~ 24 hours after scuba diving to a depth of 23 m. Read More

Zhejiang Da Xue Xue Bao Yi Xue Ban 2021 Oct;50(5):568-574

2. Key Laboratory of the Plateau Medicine, the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou 730050, China.

To investigate the active compounds from on the heart and brain of mice at simulated high altitude.Fifty healthy male adult BALB/c mice were randomly divided into normal control group, hypoxic model group, acetazolamide group, petroleum ether extract of (PESI) group and octacosan group with 10 mice in each group. Acetazolamide group, PESI group and octacosan group were treated with acetazolamide PESI (200 mg/kg) or octacosan by single tail vein injection, respectively. Read More

Proc (Bayl Univ Med Cent) 2022 1;35(1):129-132. Epub 2021 Sep 1.

Tulane University School of Medicine, New Orleans, Louisiana.

With the Industrial Revolution and the invention of compressed air came mysterious symptoms of unknown etiology. Through careful observation and diligent work from physicians in the 19th century, the true nature of caisson disease was identified and described. By studying thousands of casualties, these scientists were able to identify the cause of caisson disease, develop effective treatment plans for laborers, and institute procedures to prevent this malady. Read More

Am J Prev Med 2022 04 16;62(4):e255-e264. Epub 2021 Dec 16.

Center for Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark. Electronic address:

Introduction: Artisanal fisheries generally do not have injury prevention plans and safety or quality management systems on board, thus making them prone to more fatal and nonfatal injuries. The objective of the study is to systematically review and synthesize the literature to identify the risks of injuries (fatal and nonfatal) and health problems in artisanal fisheries in developing countries.

Methods: A systematic literature search was carried out from December 2019 to March 2020. Read More

Diving Hyperb Med 2021 12;51(4):384-385

NUI as, Gravdalsveien 245, 5165 Laksevag, Norway.