Effect of hyperbaric exposure on cognitive performance: an investigation conducting numerical Stroop tasks during a simulated 440 m sea water saturation diving.

BACKGROUND: Saturation diving (SD) is useful and safe in deep diving for long durations. Japan Maritime Self-Defense Force (JMSDF) Undersea Medical Center (UMC) maintained safely deep 45 ATA SDHowever, cognitive performance was reportedly impaired by hyperbaric exposure in over 31 atmosphere absolute (ATA) SD. This study investigated the effects of hyperbaric exposure during 45 ATA deep SD on expert divers' cognitive function using Stroop tasks, a useful method to examine cognitive function, especially in narrow spaces such as SD chambers. METHODS: Two numerical Stroop tasks were utilized to create two magnitude comparisons of a pair of single-digit numerical and physical tasks. Both numerical Stroop tasks were examined twice, at 1 and 45 ATAs, during a simulated 440 m of sea water depth for SD. Participants were 18 male expert JMSDF SD divers (age 36.58 ± 4.89 years). RESULTS: In the numerical task, reaction time (RT) was significantly delayed at 45 ATA compared with 1 ATA in the incongruent condition. In the physical task, RT at 45 ATA was significantly delayed under all the conditions (congruent, incongruent, and neutral). The correct rates (CR) in both numerical Stroop tasks significantly decreased at 45 ATA compared with 1 ATA in the incongruent condition. CONCLUSIONS: Our findings suggest that divers' cognition is impaired during 45 ATA deep SD. These results emphasize the importance of monitoring cognition in deep sea SD and highlight the need to educate and train for SD. Further examination combining Stroop tasks with other analyses such as event-related potential (ERP) is expected.

Chromosome-level genome provides insights into evolution and diving adaptability in the vulnerable common pochard (Aythya ferina).

The common pochard (Aythya ferina) is a freshwater diving duck found in the Palearctic region that has been classified as vulnerable by the IUCN due to continuous and rapid population declines across their distribution. To gain a better understanding of its genetic mechanism of adaptive evolution, we successfully sequenced and assembled the first high-quality chromosome-level genome of A. ferina using Illumina, Nanopore and Hi-C sequencing technologies. A total assembly length of 1,130.78 Mbp was obtained, with over 98.81% (1,117.37Mbp) of sequence anchored to 35 pseudo-chromosomes. We predicted 17,232 protein-coding genes, 95.9% of which were functionally annotated. We identified 339 expanded and 937 contracted gene families in the genome of A. ferina, and detected 95 genes that have been positively selected. The significantly enriched Gene Ontology and enriched pathways were related to energy metabolism, immune, nervous, and sensory systems, suggests that these factors likely played an important role in its evolution. Importantly, we recovered signatures of positive selection on genes related to vasoconstriction that may be associated with thermoregulatory adaptations of A. ferina for underwater diving. Overall, the high-quality genome assembly and annotation in this study provides valuable genomic resources for ecological and evolutionary studies, as well as toward the conservation of A. ferina.

Reinforcement learning-based framework for whale rendezvous via autonomous sensing robots.

Rendezvous with sperm whales for biological observations is made challenging by their prolonged dive patterns. Here, we propose an algorithmic framework that codevelops multiagent reinforcement learning-based routing (autonomy module) and synthetic aperture radar-based very high frequency (VHF) signal-based bearing estimation (sensing module) for maximizing rendezvous opportunities of autonomous robots with sperm whales. The sensing module is compatible with low-energy VHF tags commonly used for tracking wildlife. The autonomy module leverages in situ noisy bearing measurements of whale vocalizations, VHF tags, and whale dive behaviors to enable time-critical rendezvous of a robot team with multiple whales in simulation. We conducted experiments at sea in the native habitat of sperm whales using an "engineered whale"-a speedboat equipped with a VHF-emitting tag, emulating five distinct whale tracks, with different whale motions. The sensing module shows a median bearing error of 10.55° to the tag. Using bearing measurements to the engineered whale from an acoustic sensor and our sensing module, our autonomy module gives an aggregate rendezvous success rate of 81.31% for a 500-meter rendezvous distance using three robots in postprocessing. A second class of fielded experiments that used acoustic-only bearing measurements to three untagged sperm whales showed an aggregate rendezvous success rate of 68.68% for a 1000-meter rendezvous distance using two robots in postprocessing. We further validated these algorithms with several ablation studies using a sperm whale visual encounter dataset collected by marine biologists.

Breath-hold capacities and circadian dive rhythmicity shape optimal foraging strategies in a polar marine mammal, the Weddell seal (Leptonychotes weddellii).

Air-breathing vertebrates must balance their response to diel shifts in prey accessibility with physiological thresholds and the need to surface after each dive. Weddell seal (Leptonychotes weddellii) dive behaviors were tracked across the year under rapidly-changing light regimes in the Ross Sea, Antarctica ( ~ 75-77°S). This provides a 'natural experiment' with free-living seals experiencing 24-hrs of light (Polar Day), light/dark cycling, and continuous darkness (Polar Night). The Weddell seal's temporal niche switches from nocturnal diving in the summer to diurnality for the remainder of the year. Rhythmicity in dive efforts (depth, duration, post-dive surface recuperation, bottom time, and exceeding physiologic thresholds) is stronger and more closely circadian during times of the year with light/dark cycling compared with Polar Day or Night. With light/dark cycling, animals also make the most extreme dives (those that far exceed the calculated aerobic dive limit, cADL) significantly earlier than solar noon. Offsetting the longest dives that require longer surface recuperation times from mid-day allows animals to maximize total dive time under high-light conditions conducive for visual hunting. We identify an optimal foraging strategy to exploit a diel preyscape in a highly-seasonal environment, while balancing tradeoffs imposed by physiological thresholds in a diving mammal.

The investigation of diving accidents and fatalities.

Diving accidents result from a variety of causes including human error, inadequate health and fitness, environmental hazards and equipment problems. They usually involve a cascade of events resulting in the diver being injured or deceased. The accuracy and usefulness of a diving accident investigation relies on well-targeted interviews, good field investigation, evidence collection and preservation, and appropriate equipment assessment. In the event of a fatality, a thorough and targeted autopsy is indicated. Investigators should have the appropriate knowledge, training, skills and support systems to perform the required tasks. Relevant investigations include the victim's medical and diving history, the dive circumstances and likely accident scenario, management of the accident including rescue and first aid, equipment inspection and testing and a thorough postmortem examination conducted by a forensic pathologist with an awareness of the special requirements of a diving autopsy and the knowledge to correctly interpret the findings. A chain of events analysis can determine the likely accident scenario, identify shortcomings and inform countermeasures.

The deeper the rounder: body shape variation in lice parasitizing diving hosts.

Seal lice, unique among insects, show remarkable adaptability to the extreme conditions of the deep sea. Evolving with their seal and sea lion hosts, they have managed to tolerate hypoxia, high salinity, low temperature, and elevated hydrostatic pressure. Given the diving capabilities of their mammalian hosts, which can reach depths of hundreds to thousands of meters, our study examines the morphological variation among closely related seal lice species infesting hosts with different maximum diving depths. In particular, our research reveals a significant morphological difference between lice associated with regular and deep-diving hosts, where lice from deep-diving hosts tend to be rounder. This could be an adaptation to withstand the high hydrostatic pressures found in the deep ocean. The rounded shape optimizes the louse's ability to withstand external pressure by redistributing it over a larger ventral/dorsal plane. This in turn minimizes the internal energy required to support body deformations, thereby increasing the louse's resilience in the deep sea environment.

Decompression sickness in surface decompression breathing air instead of oxygen.

We report an unusual decompression sickness (DCS) incident in a commercial diving project. Eleven divers completed 91 dives to 23.5-36.2 m with bottom times ranging 23-67 min. The divers were breathing compressed air while immersed. Decompression was planned as surface decompression in a deck decompression chamber breathing oxygen typically for 15-30 min. Due to a technical error the divers breathed air rather than oxygen during the surface decompression procedure. Two divers suffered DCS. Both were recompressed on site with the same error resulting in them breathing compressed air rather than oxygen. One of them experienced a severe relapse with cardiovascular decompensation following recompression treatment. While DCS was expected due to the erroneous decompression procedures, it is noteworthy that only two incidents occurred during 91 dives with surface decompression breathing air instead of oxygen. Accounting for this error, the median omitted decompression time was 17 min (range 0-26 min) according to the Bühlmann ZHL-16C algorithm. These observations suggest that moderate omission of decompression time has a relatively small effect on DCS incidence rate. The other nine divers were interviewed in the weeks following completion of the project. None of them reported symptoms at the time, but five divers reported having experienced minor symptoms compatible with mild DCS during the project which was not reported until later.

Cardiopulmonary adaptations of a diving marine mammal, the bottlenose dolphin: Physiology during anesthesia.

Diving marine mammals are a diverse group of semi- to completely aquatic species. Some species are targets of conservation and rehabilitation efforts; other populations are permanently housed under human care and may contribute to clinical and biomedical investigations. Veterinary medical care for species under human care, at times, may necessitate the use of general anesthesia for diagnostic and surgical indications. However, the unique physiologic and anatomic adaptations of one representative diving marine mammal, the bottlenose dolphin, present several challenges in providing ventilatory and cardiovascular support to maintain adequate organ perfusion under general anesthesia. The goal of this review is to highlight the unique cardiopulmonary adaptations of the completely aquatic bottlenose dolphin (Tursiops truncatus), and to identify knowledge gaps in our understanding of how those adaptations influence their physiology and pose potential challenges for sedation and anesthesia of these mammals.

Medical examination of divers after COVID-19 infection: a prospective, observational study using published (original and revised) guidelines for evaluation.

Introduction: The COVID-19 pandemic raised significant concerns about fitness to dive due to potential damage to the pulmonary and cardiovascular systems. Our group previously published guidelines (original and revised) for assessment of these divers. Here, we report a prospective, observational study to evaluate the utility of these guidelines. Methods: Recreational, commercial, and scientific divers with a history of COVID-19 were consented and enrolled. Subjects were evaluated according to the aforementioned guidelines and followed for any additional complications or diving related injuries. Results: One-hundred and twelve divers (56 male, 56 female, ages 19-68) were enrolled: 59 commercial, 30 scientific, 20 recreational, two unknown (not documented), one military. Cases were categorised according to two previous guidelines ('original' n = 23 and 'revised' n = 89): category 0 (n = 6), category 0.5 (n = 64), category 1 (n = 38), category 2 (n = 2), category 3 (n = 1), uncategorisable due to persistent symptoms (n = 1). One hundred divers (89.3%) were cleared to return to diving, four (3.6%) were unable to return to diving, four (3.6%) were able to return to diving with restrictions, and four (3.6%) did not complete testing. Regarding diving related complications, one diver had an episode of immersion pulmonary oedema one year later and one diver presented with decompression sickness and tested positive for COVID-19. Conclusions: Most divers who presented for evaluation were able to return to diving safely. Abnormalities were detected in a small percentage of divers that precluded them from being cleared to dive. Guidelines were easily implemented by a variety of clinicians.

Arterial dissection in scuba divers: a potential adverse manifestation of the physiological effects of immersion.

Introduction: Aortic dissections and dissections of cervical, cerebral, and coronary arteries have been previously reported in scuba divers. These incidents may be the consequence of a variety of physiological effects. We review the reported cases of arterial dissection in scuba divers and discuss potential contributing factors related to immersion and diving. Methods: Medline, CINAHL Plus, and SPORTDiscus were searched for published reports of arterial dissection and the Australasian Diving Safety Foundation fatality database was searched for additional cases from Australia. Identified cases were recorded and scrutinised for possible contributing factors. Results: Nineteen cases of arterial dissection, both fatal and non-fatal, were identified. These included cervical or intracranial artery dissection (n = 14), aortic dissection (n = 4), and coronary artery dissection (n = 1). There were 14 male and five female victims; mean age 44 years (SD 14, range 18-65). Contributing factors may include a combination of vasoconstriction and blood redistribution, untreated hypertension, increased pulse pressure, abnormal neck movement or positioning, constrictive and burdensome equipment, exercise, increased gas density and circuit resistance with concomitant elevated work of breathing, atheroma, and possibly the mammalian dive response. Conclusions: Dissecting aneurysms of the aorta or cervical, cerebral, and coronary arteries should be considered as a potential complication of scuba diving. The development of aneurysms associated with scuba diving is likely multifactorial in pathogenesis. Detailed reporting is important in the evaluation of cases. The potential role of the mammalian dive response as a contributing factor requires further evaluation.

Methylphenidate and the risk of acute central nervous system oxygen toxicity: a rodent model and observational data in human divers.

Introduction: The effects of methylphenidate, a stimulant often prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD), on the development of central nervous system oxygen toxicity (COT) have not been experimentally evaluated. Methods: The records of all pure-oxygen-rebreather divers evaluated at our institution from 1975-2022 were assessed. Cases of COT were defined as a new onset of tinnitus, tunnel vision, myoclonus, headache, nausea, loss of consciousness, or seizures resolving within 15 minutes from breathing normobaric air, and matched 4:1 with similar controls. Any medications issued to the diver in the preceding three months, including methylphenidate, were recorded. In the animal arm of this study, male mice were exposed to increasing doses of methylphenidate orally, with subsequent exposure to hyperbaric O2 until clinically evident seizures were recorded. Results: Seventy-five cases of COT were identified in divers, occurring at a median of 80 (range 2-240) minutes after dive initiation at a median depth of 5 m (2-13). Hypercarbia was documented in 11 (14.7%) cases. Prescription of methylphenidate in the preceding three months was not associated with increased risk (OR 0.72, 95% CI 0.16-3.32) of COT. In mice, increasing methylphenidate exposure dose was associated with significantly longer mean COT latency time being 877 s (95% CI 711-1,043) with doses of 0 mg·kg⁻¹; 1,312 s (95% CI 850-1,773) when given 0.75 mg·kg⁻¹; and 1,500 s (95% CI 988-2,012) with 5 mg·kg⁻¹ (F = 4.635, P = 0.014). Conclusions: Observational human data did not demonstrate an association between methylphenidate and an increased risk of COT. Methylphenidate exposure in mice prolongs COT latency and may have protective effects against COT.

Large lungs in divers: a risk for pulmonary barotrauma?

This retrospective study analysed a series of investigations on lung function in military divers and the importance of computed tomography (CT) scans concerning fitness to dive. We examined the incidence of blebs and bullae in a population of military divers with large lungs prompted by six cases of pulmonary barotrauma. All of these divers' medicals were normal apart from having large lungs (FVC > 120% predicted). A subsequent survey of the database of all divers and submariners of the Royal Netherlands Navy (RNLN) found another 72 divers/submariners with large lungs who were then evaluated by a CT scan. This resulted in the identification of three further individuals with blebs and/or bullae, who were then declared unfit to dive. In total, the incidence of these lung abnormalities in this cohort was 11.5%. We discuss the possible consequences for fitness to dive with regard to the current literature on the subject, and also consider the most recent standards of reference values for pulmonary function indices. Based on our results and additional insights from other studies, we advise using the Global Lung Initiative reference values for pulmonary function, while performing high resolution CT scans only in divers with clinical indications.

Retrospective analysis of challenging cases for medical examiners of diving.

Introduction: Assessing a diver's fitness to dive enhances diving safety, with medical examiners of diving (MED) being entrusted with this responsibility. However, the effectiveness of MED training in preparing physicians for this task remains underexplored. In the Netherlands, where any physician can pursue MED qualification, challenging cases can be presented to a board of experts. Methods: This retrospective analysis included all cases presented to a board of experts in the period 2013-2023. Aside from baseline information, cases were coded using the International Classification of Diseases 11th Revision (ICD-11). Additionally, the type of advice given by the board was also recorded. Results: A total of 291 cases could be included, 62.5% were male divers with a median age of 47 years old (interquartile range 29-55). Circulatory (20.9%), respiratory (16.2%), neurologic (14.4%), psychiatric (9.6%) and endocrine (6.5%) disease comprised more than two-thirds of all presented cases. Problems for the MED included multimorbidity, knowledge of guidelines and interpretation of diagnostic data. Conclusions: These results could be used to improve MED courses or serve as a topic for continuing medical education for MEDs, however, further research into generalisability is required.

Role of tympanocentesis in the prevention of middle ear barotrauma induced by fast buoyant ascent escape from 200 m underwater.

Introduction: We aimed to study middle ear barotrauma caused by fast compression followed by buoyant ascent escape from 200 m underwater and its effect on the auditory system, and to validate the preventive effect of tympanocentesis on middle ear barotrauma. Methods: Twenty Sprague Dawley rats were divided into two groups: rats in group A underwent a simulated fast buoyant ascent escape from a depth of 200 m, while those in group B underwent tympanocentesis before the procedure described for group A. Ear endoscopy, acoustic conductance, and auditory brainstem response (ABR) tests were conducted before and after the procedure to evaluate the severity of middle ear barotrauma and auditory function in both groups. Additionally, histopathological examination of the middle ear in both groups was conducted to evaluate the severity of middle ear barotrauma by observing submucosal haemorrhage. Results: None of the ears in either group showed any abnormalities before the experiment. In group A, middle ear barotrauma was universally observed after the simulation procedure. The tympanograms of all ears were initially type A and became type B after the procedure. Further, after the simulation, the hearing thresholds at different frequencies (4, 8, 16, 24, and 32 kHz) assessed by ABR significantly increased compared to those before the procedure. In group B, no middle ear barotrauma was observed, and the hearing threshold at each frequency did not change significantly compared with post-puncturing. After dissecting the middle ear, gross pathological observations were consistent with the above results. Microscopically, blood accumulation and submucosal haemorrhage in the middle ear cavity were observed in group A but not in group B. Conclusions: Fast buoyant ascent from 200 m underwater can cause middle ear barotrauma, resulting in hearing loss. Tympanic membrane puncture can effectively prevent middle ear barotrauma caused by the rapid buoyant ascent escape procedure.

Maxillary sinus barotrauma with infraorbital nerve paraesthesia after breath-hold diving.

Barosinusitis, or sinus barotrauma, is a sinonasal injury and/or inflammation that results when the aerated spaces of the nose and sinuses are exposed to an uncompensated change in ambient pressure. We describe a 19-year-old male diver who presented to our clinic on the fourth day following a breath-hold diving session. During descent on a constant weight monofin dive at the South Cyprus World Championship he began to experience symptoms due to the inability to equalise the pressure, particularly in the Eustachian tubes and middle ear cavities. He felt pain and pressure in the upper left half of his face, left upper molars, and under his left eye at 60 metres, and he continued diving down to 74 metres. At presentation to our clinic, he still had ecchymosis under his right eye and pain in his upper right teeth, half of his face, and ear. He also described tingling in the lower left half of his nose and the left half of his upper lip. He received decongestants, B vitamins, and underwent endoscopic sinus drainage which alleviated his symptoms alleviated over time. The diver reported complete resolution of tingling, numbness, and pain after three months. It should not be forgotten that if appropriate treatment is delayed, permanent changes may occur as a result of long-term compression of the nerve, and therefore patients should be monitored closely.

Higher proportion of prematurely born adults in elite breath-hold divers.

Introduction: Preterm birth may significantly impair the functional and anatomical development of the respiratory system and could be a background for various life-long medical sequelae. Prematurity has been recently connected to changes in hypercapnic reactions at adult age. Altered reactions to pCO2 in premature-born subjects may impact breath-hold underwater exercises (freediving) results. Methods: AIDA International provided the list of top-100 rankings freediving athletes for the years 2016- 2021 with their personal best results. Data was collected using a subject questionnaire developed for the study (subject-reporting outcomes). Period of data collection: March 2022 to June 2022. Results: Within the sample of divers (n=146), 17.1% (n=25) were born prematurely. 13.7% (n=20) were moderate to late preterm, and 3.4% (n=6) were very preterm. The proportion of the athletes whose birth was premature was 18.1% for females and 16.2% for males. These figures are higher than the standardized estimated mean of the preterm birth rate of 8.5% calculated based on the geographical distribution of our sample. There was no difference in best personal results in freediving between the preterm and full-term elite freedivers. Conclusions: The proportion of preterm within the elite freedivers is higher than could be estimated for the general population. There is no difference in best personal results between preterm and full-term elite freedivers.

Complications After Covid-19 Infection In Singapore Military Divers: A Retrospective Cohort Study.

Studies suggest that COVID-19 infections may have longer-term and more significant complications, even with mild or absent symptoms. This may predispose divers to pulmonary barotrauma, arterial gas embolisms, and reduced exercise tolerance, and impact physical and cognitive performance during diving. Military diving is physically, physiologically, and psychologically taxing on the individual. This study aims to assess the incidence of complications after COVID-19 infections in a cohort of active military divers and the incidence of diving-related injuries such as decompression sickness and barotrauma following recovery from acute COVID-19 infections. A single-center, retrospective cohort study of complications after COVID-19 infections was done in a cohort of the Republic of Singapore Navy (RSN) Naval Diving Unit (NDU) Divers and involved the collection of retrospective data for 329 military divers who were diagnosed with COVID-19 infection from 25 Mar 2020 and 13 Feb 2023. We found no clinical or subclinical complications after COVID-19 infection in our fully vaccinated, low-risk population of NDU divers after asymptomatic or mild COVID-19 infection. There were also no incidences of diving-related injuries related to COVID-19 after recovery from the acute illness. Based on the study results, it is recommended that all military divers with asymptomatic or mild COVID-19 infections return to military diving activities immediately after recovery from acute COVID-19 infection with resolution of symptoms. As existing guidelines recommend, divers with moderate to critical COVID-19 infection should be reviewed by a diving physician and undergo necessary investigations before returning to military diving.

CO2 Breathing Prior to Simulated Diving Increases Decompression Sickness Risk in a Mouse Model: The Microbiota Trail Is Not Forgotten.

Decompression sickness (DCS) with neurological disorders is the leading cause of major diving accidents treated in hyperbaric chambers. Exposure to high levels of CO2 during diving is a safety concern for occupational groups at risk of DCS. However, the effects of prior exposure to CO2 have never been evaluated. The purpose of this study was to evaluate the effect of CO2 breathing prior to a provocative dive on the occurrence of DCS in mice. Fifty mice were exposed to a maximum CO2 concentration of 70 hPa, i.e., 7% at atmospheric pressure, for one hour at atmospheric pressure. Another 50 mice breathing air under similar conditions served as controls. In the AIR group (control), 22 out of 50 mice showed post-dive symptoms compared to 44 out of 50 in the CO2 group (p < 0.001). We found that CO2 breathing is associated with a decrease in body temperature in mice and that CO2 exposure dramatically increases the incidence of DCS (p < 0.001). More unexpectedly, it appears that the lower temperature of the animals even before exposure to the accident-prone protocol leads to an unfavorable prognosis (p = 0.046). This study also suggests that the composition of the microbiota may influence thermogenesis and thus accidentology. Depending on prior exposure, some of the bacterial genera identified in this work could be perceived as beneficial or pathogenic.

Patent Foramen Ovale and Decompression Illness: The Present and Future.

Presence of patent foramen ovale (PFO), particularly if high-grade, increases the risk of decompression illness (DCI) and its severe forms. In unprovoked or recurrent DCI, neurologic, cutaneous, or cardiopulmonary DCI, testing for PFO is indicated with bubble contrast echocardiography or transcranial Doppler using provocative maneuvers. In patients with PFO and history of DCI, evaluation by a cardiologist with expertise in diving medicine is recommended. Consideration should be given to PFO closure if cessation of diving or conservative diving cannot be achieved. Prospective studies evaluating long-term outcomes in patients who continue to dive after PFO closure are required.

Novel rebreathing adaptation extends dive time in a semi-aquatic lizard.

Bubble use evolved in many small invertebrates to enable underwater respiration, but, until recently, there has been no evidence that vertebrate animals use bubbles in a similar manner. Only one group of vertebrates, semi-aquatic Anolis lizards, may be an exception: these lizards dive underwater when threatened and, while underwater, rebreathe a bubble of air over their nostrils. Although it seems that rebreathing should be adaptive, possibly functioning to extend the time that lizards remain in underwater refugia, this has not been empirically tested. Here, I demonstrate that rebreathing serves to extend dive time in a semi-aquatic anole, Anolis aquaticus. I prevented the formation of normal rebreathing bubbles by applying a commercial emollient on the skin surface where bubbles form to assess the impact of bubbles on rebreathing cycles, gular pumps, and dive times. Lizards that were allowed to rebreathe normally remained underwater an average of 32% longer than those with impaired rebreathing, suggesting a functional role of rebreathing in underwater respiration. Unlike rebreathing, gular pumping was unaffected by treatment and may warrant further research regarding its role in supplementing underwater respiration. This study provides evidence that vertebrates can use bubbles to respire underwater and raises questions about adaptive mechanisms and potential bio-inspired applications.