Scientific papers 2025
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01 - Cellular Mechanisms of Oxygen Transport Hemoglobin
Dynamics
- Published by Uva Clinical Anaesthesia and Intensive Care
Authors:
Indunil Karunarathna, Sanjeewa Dius, R Ranwala, Sau
Bandara, Sanjaya Godage, PN Rodrigo, Asoka
Jayawardana, U Vidanagama, Cam Fernando, Upul
Ekanayake, T Hapuarachchi, Prasanna Gunasena, P
Aluthge, Nihal Perera , Senaka Gunathilake, Kapila De
Alvis , Kapila Gunawardana, Samadi Rajapaksha, A
Warnakulasooriya , P Athulgama
Student performance is key for solving learning issues and
measuring outcomes. This paper suggests a machine
learning method to predict student performance in online
learning by analyzing eleven behavioral indicators. Results
highlight the link between students' learning initiative and
duration, significantly impacting performance prediction.
02 - Machine learning approach to student performance prediction
of online learning.
- Published by PLOS One
Author: Jing Wang, Yun Yu
Student performance is important for solving learning
problems and measuring outcomes. This paper presents a
machine learning method to predict student performance
in online learning. Eleven behavioral indicators are
analyzed, filtering out weakly correlated ones. The logistic
regression model shows better prediction ability,
highlighting the link between student initiative, learning
duration, and performance.
03 - Therapeutic delivery of oxygen using artificial oxygen carriers
demonstrates the possibility of treating a wide range
of diseases
- Published by the Journal of Nanobiotechnology - BMC.
Authors: Nijaya Mohanto, Himangsu Monda, Young-
Joon Park, and Jun-Pil Jee
Artificial oxygen carriers may replace red blood cells in
cases of significant blood loss from accidents, surgeries,
trauma, and more. They show promise for treating various
diseases. There is a need for stable, non-toxic carriers amid
challenges. This paper reviews different types of artificial
carriers, their effects, and ongoing research.
08 - An Overview of Rebreather Trimix Diving Practices in France
and Self-reported Accidentology.
- Published by the Universite de Bretagne Occidentale
Authors: E. Gouin, F. Guerrero, J-É. Blatteau
This study assessed practices and accidents in trimix
rebreather diving. An anonymous survey was shared with
certified trimix divers in France, gathering data on
demographics, planning, and abnormal symptoms during
dives. Results showed a predominantly male population
with high certification levels. Many divers experienced gas
toxicity symptoms and decompression incidents. The study
highlights the need for better data and continued
research on decompression and its physiological effects.
Author: Andy Adler, Tarek el Harake, Martina Mosing,
Andreas Fahlman
Electrical impedance tomography (EIT) can provide
valuable information on ventilation in humans and land
mammals, particularly in sea mammals and human divers.
However, in-water use is challenging due to the
conductive nature of sea water. This study demonstrates
that EIT can produce reasonable images with an outer
insulating layer and custom belts, demonstrating its
feasibility with appropriate techniques.
Authors:
Linda M. Reynard, Jennifer N. Leichliter, Daniela E.
Winkler, Marcus Clauss, and Thomas Tütken
This study investigates the isotopic variation in diet
components and diet type across different taxa in rats,
guinea pigs, and quail. The diet to tissue offsets for d2H
and d18O of tissue-bound organic matter in muscle and
dentine collagen were found to vary by diet type. The
study also found large variation in Dd2H and Dd18O by
tissue type and moderate differences by species. This
isotopic variability is crucial for studies such as migratory
research, diet reconstructions, and climate inferences,
especially in species with varying dietary habits.
11 - Divergent thinking in groups during cold-water immersion is
impaired by cold stress not the cold shock response
- Published by Frontiers
Authors:
Max Kailler Smith, Rebecca Weller, Tony Duong, Rebecca
McClintock, Matthew Peterson, Nathaniel Barr,
Douglas M. Jones, and Timothy L. Dunn
Examining the impact of cold shock response on higher-
level thinking in active duty service members during a 13-
minute cold-water immersion revealed no relationship
between the magnitude of cold shock response and DAT
performance. However, those with lower skin
temperatures performed worse on the Divergent
Association Task. This study suggests that the ability to
engage in divergent thinking is relatively preserved during
the critical ~10-minute window, although skin cooling
may bias attention toward cold stress, affecting task
performance.
16 - The Impact of Recreational Diving to a Depth of 40 m on
Selected Intracellular DAMPs
- Published by the International Journal of Molecular Sciences - MDPI
Authors:
Anna Nowakowska, Małgorzata Marchelek-My´sliwiec,
Marta Skórka-Majewicz, Wojciech ˙Zwierełło, Konrad
Grzeszczak, and Izabela Gutowska
Recreational diving, a popular activity under extreme
environmental conditions, can induce increased levels of
reactive oxygen and nitrogen species in the body,
potentially modulating damage-associated molecular
patterns (DAMPs), their receptors, and antioxidant
response. Diving also influenced the expression of genes
encoding key enzymes associated with glutathione
synthesis and reduced plasma glutathione levels.
However, the study found that key inflammation-related
molecules (NF-rB, NOS2, TLR4, RAGE) did not change
significantly.
17 - Measuring the research productivity on environmental
toxicology: A scientometric study
- Published by The Scientific Temper
Authors: Shanmuganathi Ayyankalai, Srinivasaragavan
Subburaj, Prasanna Kumari Nataraj
This paper analyzes the growth and development of
Environmental Toxicology literature, revealing 6,663
publications in 2022, with 183279 Citations. The most
productive countries are the USA, China, Germany,
Canada, and England. Highly cited journals include
Environmental Toxicology and Chemistry, Integrated
Environmental Assessment and Management,
Environmental Health Perspectives, and Toxicological
Sciences.
18 - The Impact of Recreational Diving to a Depth of 40 m on
Selected Intracellular DAMPs
- Published by Molecular Science - MDPI
Authors:
Anna Nowakowska, Małgorzata Marchelek-Mysliwiec,
Marta Skórka-Majewicz, Wojciech ˙Zwierełło, Konrad
Grzeszczak, and Izabela Gutowska
Recreational diving can affect the body due to extreme
conditions, such as high oxygen and pressure, which
increase reactive oxygen and nitrogen species. A study
involving 21 divers at a depth of 40 meters analyzed
various intracellular damage markers before and after
diving. There was a significant decrease in molecules
released by cells in response to stress, injury, or
inflammation, one hour later, indicating an adaptive
response to oxidative stress.
Authors: Sandra Arhesa, Amung Ma’mun, Boyke
Mulyana, Nina Sutresna, Silvia Agustin
This study explores the freediving abilities of the Bajo
people in Wakatobi, Indonesia. Using a qualitative case
study approach, data was collected from 20 informants.
Thematic analysis revealed key aspects of Bajo diving,
including factors influencing performance, specific
techniques, dive duration and depth, training methods,
and traditional equipment. The study highlights the
profound interaction between the marine environment
and socio-cultural practices, distinguishing traditional
methods from modern practices. The study concludes
that this diving culture needs preservation and health
education.
22 - Case study on the diving ability of the Bajo tribe in Indonesia
- Published by Retos Publications
Author:
Ahmet Sedat Dünda, Mucahit Oruç, Osman Celbis, Emine
Türkmen samdancı, Ayse Nur Akatlı, Hasan Okumus,
Çasatay Taskapan, Onural Özhan, Hakan Parlakpınars
The study aimed to determine the cause of deaths
associated with electric shock, particularly those formed
with water conduction. It involved 42 rats and examined
serum NT-ProBNP, H-FABP levels, histopathological
changes, and antibody status in various tissues. The results
showed a significant difference between groups in serum
H-FABP values and immunohistochemical staining. This
study is the first in literature to use an experimental model
of electric shock with water conduction.
23 - An experimental rat model of electric shock injury with isolated
electric shock and water conduction: the histopathological
changes on the skin and internal organs and the effect on
biochemical Parameters.
- Published by the International Journal of Legal Medicine - Springer
25 - An EPHA2-centered gene regulatory network associates with
hyperbaric oxygen treatment response in perianal fistulizing
Crohn’s disease patients
- Published by Digestive Desease Week - DDW
Authors:
I.C.N Fung, L.G.M. Mulders, R. Weiss, I.A.M van Thiel, K.J.
Beek , I. Admiraal, C. Verseijden, J. Verhoeff, M. Zwart, M.L.
Ridderikhof, J. Tielbeek, J. Stoker, R.A. van Hulst, C.J.
Buskens, M.E. Wildenberg, K.B. Gecse , A.Y.F. Li Yim, W.J.
de Jonge, G.R. D’Haens
Perianal fistulizing Crohn's disease (PFCD) is a severe
Crohn's disease complication with low long-term
remission rates. Hyperbaric oxygen therapy (HBOT) has
been used as an adjunct therapy to reduce disease
activity and improve surgical closure.
Authors: Lubna A. Alolaiwi, Fawziah A. Alzahrani, and
Sulaiman A. AlShammari
This study investigates the prevalence of orofacial pain
among divers, focusing on military, occupational, and
recreational divers. A systematic literature search
revealed that barodontalgia had the highest prevalence
rate among the four types of orofacial pain, ranging
from 10.8% to 56.1%. Periodontal issues had the lowest
rate, ranging from 2.8 to 6.6%. Military divers were most
affected by all types of pain. The study emphasizes the
need for tailored preventive strategies, including dental
care, ergonomic interventions, oral hygiene education,
equipment fitting, and clenching management.
32 - Extremely deep bounce dives: planning and physiological
challenges based on the experiences of a sample of French-
speaking technical Divers
- Published by EUBS (Author-provided)
Authors: Emmanuel Gouin, Emmanuel Dugrenot,
Bernard Gardette
This study explores the limits of extreme-depth diving and
strategies developed to overcome them. Eight
experienced rebreather divers were interviewed about
their preparation, planning, and execution of such dives.
The results showed that gas density, oxygen exposure,
and ascent rate exceeded current recommendations.
High pressure nervous syndrome was not a major limiting
factor, but decompression posed greater challenges.
Decompression procedures must be adapted for these
demanding mixed-gas dives, and a dry underwater
habitat could improve decompression tolerance. The role
of hydrogen as a breathing gas remains uncertain.
33 - Diving practices in technical divers’ community and behaviour
towards self-reported unusual symptoms
- Published by Diving and Hyperbaric Medicine (Author-provided)
Authors: Emmanuel Gouin, David PM Monnot, Thierry
Michot, François Guerrero, Jean-Éric Blatteau
The use of gas mixtures containing helium for deep
recreational diving is becoming more common, but its
risks remain poorly documented. A study analyzed 558
questionnaires from certified trimix divers, revealing that
42.2% reported medical risk factors related to diving.
Rebreather use was prevalent, and decompression was
primarily managed using compartmental models. Dive
planning varied among individuals, and gas density at
depth often exceeded current recommendations.
Decompression sickness or breathing symptoms were
common, but no treatment was initiated. The study
suggests continued research into decompression and
physiological effects, as well as awareness and education
efforts in diving first aid.
34 - Mechanisms of Drowning in Children: Influence of Cold Shock
Response on Repolarization Patterns and Arrhythmia Burden in
Healthy Children.
- Published by Research Square
Authors: Sophie Peter
The study examines the effects of cold shock response in
healthy children during immersion into cold water.
Participants were immersed in warm water and then cold
water, measuring their heart rate, heart rate, and
respiratory rate. Results showed lower heart rate variability
parameters in cold water, shorter Tp-Te intervals, and
inadequate QT interval adaptation. No arrhythmias were
detected in healthy children, but the cold shock response
could induce repolarization abnormalities in individuals
with pre-existing conditions. This study provides the first
data on drowning mechanisms in children.
04 - Snorkelling and Breath-Hold Diving Fatalities in Australia—A
Review of 317 Deaths
- Published by MDPI
Authors: John M. Lippmann
This article investigates snorkelling and breath-hold diving
fatalities in Australia from 2000 to 2021, analyzing the
causes and potential countermeasures. The study drew
on data from the Australasian Diving Safety Foundation
and the National Coronial Information System, finding
that the median age of victims was 48, with many
suffering from health issues such as ischaemic heart
disease (IHD) and left ventricular hypertrophy (LVH).
Overweight individuals and those with cardiac
arrhythmias were particularly at risk. The study highlights
the need for targeted health screenings, skill practice in
controlled environments, and improved supervision to
prevent such incidents.
05 - Effects of Hook Maneuver on Oxygen Saturation Recovery After
−40 m Apnea Dive—A Randomized Crossover Trial
- Published by MDPI
Authors: Francisco DeAsís-Fernandez, Alvaro Reina-
Varona, Evangelos Papotsidakis, Juan Lafuente,
and Jose Fierro-Marrero
This study investigates the effectiveness of a specialized
breathing technique known as hook breathing (HB) for
reducing syncope risk and enhancing oxygen saturation
recovery in trained breath-hold divers (BHDs) following a
deep apnea dive. Comparing HB with usual breathing
(UB), the research indicates that HB leads to a more rapid
recovery of oxygen saturation after a dive to -40 meters,
with significant differences noted 30 to 45 seconds after
surfacing.
06 - Impact of SCUBA diving on French military divers’ lung function:
a retrospective cohort
- Published by Chest Pulmonary
Authors: Justin Ulm, Jean-Eric Blatteau, Luc Aigle, Roman
Glogowski, Olivier Castagna, Arnaud Druelle
This article investigates the long-term impacts of SCUBA
diving on pulmonary function, specifically within the
military diving population. A longitudinal study conducted
over 20 years involved 331 male divers with a significant
number of spirometric measurements. The findings
indicate that SCUBA diving is associated with improved
spirometric values, such as forced expiratory volume
(FEV1) and forced vital capacity (FVC), suggesting
beneficial effects on lung health. The study also discusses
how factors such as body mass index (BMI) and smoking
history can influence pulmonary function.
07 - Recent updates on cold adaptation in population and laboratory
studies, including cross-adaptation with nonthermal factors
- Published by the Journal of Physiological Anthropology - BMC
Authors: Hitoshi Wakabayashi, Hiroyuki Sakaue & Takayuki
Nishimura
This article reviews and updates our understanding of
human cold adaptation, focusing on the
thermoregulatory responses to cold, particularly the role
of brown adipose tissue (BAT) in thermogenesis. It
examines the mechanisms underlying cold-induced
vasoconstriction and vasodilation, evaluates cold
acclimatization processes, highlights the significance of
the cold shock response, and discusses the interaction
between exercise and cold exposure on
thermoregulation. It suggests that individuals with less
BAT may rely on shivering, while those in colder regions
exhibit varied responses to cold exposure, underscoring
the complexity of cold adaptation mechanisms.
20 - Metabolomic analysis of fatal hypothermia using ultra-high-
performance liquid chromatography-mass spectrometry
- Published by Frontiers
Authors: Jia-Hao Li, Jia-Li Liu, Jian-Wen Song, Wei-Liang
Deng, Xin-Zhi Cao, Zhong-Wen Wu, Ding-Hao
Chen, Hui Wang, Song Yu, and Qi Wang
The article discusses the challenges of identifying fatal
hypothermia in forensic medicine and highlights the
potential of metabolomics to uncover disease
mechanisms and molecular markers. Through a
comprehensive analysis using ultra-high-performance
liquid chromatography-mass spectrometry (UHPLC-MS)
on various tissues of mice with fatal hypothermia, the
study identifies significant metabolic differences in 67
metabolites across tissues, revealing unique alterations
and potential survival time indicators that could aid in
forensic investigations.
21 - Heliox in the management of respiratory failure in a Morquio A
syndrome patient with trachea narrowing.
- Published by Science Direct - Elsevier
Authors: Minghan Shi, & Birubi Biman
This paper discusses Morquio A Syndrome, a
mucopolysaccharide deposition disease leading to
respiratory complications due to airway narrowing.
Surgical management is risky and often not feasible due
to intubation challenges. As a result, patients may require
long-term BiPAP support, which can cause adverse effects.
The article highlights a case where a patient with 24-hour
BiPAP dependence was successfully treated using Heliox,
allowing for reduced BiPAP usage and improved quality
of life.
Author: John M. Lippmann
The article examines Australian scuba diving fatalities over
a span of 50 years, comparing data between two periods:
1972-1999 and 2000-2021. It highlights a total of 430
deaths, with shifts in demographics, such as a decrease in
male casualties and an increase in median age and
female participation. The study found trends indicating
increased training and improved safety measures, which
led to a reduction in drowning incidents. However, it also
noted a rise in cardiac-related fatalities associated with
older divers, highlighting the need for enhanced health
education and dive planning to further reduce risks.
36 - Peak VO2Q: A new approach for the interpretation of
cardiorespiratory fitness estimates
- Published by Wiley
Author: Ben Knox-Brown, Joshua Barnes, Chris Harding,
Jonathan Fuld, Karl P. Sylvester
The article discusses the challenges of standardizing
interpretative strategies for peak oxygen uptake (peak V
O2), particularly due to the quality of reference equations.
It introduces peak V O2Q, a new approach that assesses
how a measured value deviates from the 1st percentile. A
retrospective analysis was conducted on data from
patients who underwent cardiopulmonary exercise
testing at two hospitals. The study found consistent 1st
percentile values across demographics and established a
strong association between peak V O2Q and all-cause
mortality, suggesting peak V O2Q could serve as a useful
alternative for interpreting cardiorespiratory fitness
without relying on traditional reference equations.
Author: Vasiliki Katsi, Epameinondas Triantafyllou, Christos
Fragoulis, Christos Vazaios, Spyridon
Maragkoudakis, Alexandros Kasiakogias,
Charalampos Vlachopoulos, and Konstantinos P.
Tsioufis
This review discusses the twofold nature of myocardial
fibrosis in athletes: as a potential indicator of serious
arrhythmias or a harmless result of physiological
remodeling. While moderate exercise fosters beneficial
cardiac adaptations, ultra-endurance training can lead to
significant cardiac alterations. Importantly, the presence of
myocardial fibrosis is linked to potential arrhythmic events
and increased risk of sudden cardiac death, stressing the
need for careful risk assessment in athletes.
41 - Advancing Laboratory Diagnostics for Future Pandemics:
Challenges and Innovations
- Published by MDPI
Author: Lechuang Chen and Qing H. Meng
The article discusses the challenges posed by major
epidemics and pandemics such as SARS, H1N1, Ebola,
and COVID-19 to global disease diagnostics and control
systems. It highlights the deficiencies of traditional
diagnostic models and emphasizes the urgent need for
more advanced and integrated diagnostic technologies.
Key innovations in diagnostics, including molecular
techniques like LAMP and NGS, rapid antigen testing,
serological assays, and point-of-care testing, are examined
as crucial components of a multi-layered approach to
effectively respond to future health crises.
37 - Vascular Ultrasonography Performed by Special Operations
Forces Combat Medics
- Published by The special operation medical association’s official Journal
Authors: Benjamin L. Turner, Jan Cornelis van de Voort,
Boke Linso Sjirk Borger van der Burg, Casper M.
Fransen, Pieter-Jan A.M. van Ooij, Rigo
Hoencamp.
This study evaluated a microteaching program to train
Dutch Special Operations Forces combat medics with
limited ultrasound experience to perform two-dimensional
venous ultrasound of the inferior vena cava and popliteal
vein for self-monitoring of decompression stress. Using
handheld devices with abdominal and linear probes, 25
medics completed vessel imaging on partners after only 2
minutes of instruction. Participants reported no difference
in difficulty between vessels, and expert assessors rated
image quality as high. This shows that brief microteaching
enables rapid, reliable, diagnostic-quality imaging,
supporting feasibility for field-deployable screening.
Authors: Beaubien E, Filozof A, Lindholm P, Saraiva C,
Chimiak J, Tillmans F
Divers Alert Network initiated the 5-year DRACO study
(2020–2022). Of 1,283 divers enrolled, 75.8% (973)
resumed diving, with most infections mild (85.9%).
However, 14.6% reported post-infection issues, primarily
pulmonary complications and fatigue. Among 776 Fitness
to Dive exams, 10.6% failed, often linked to pre-existing
conditions or delayed return to diving. While most divers
with initial failures eventually resumed diving, 40% of
those who returned reported ongoing issues. The study
concludes that cautious, medically evaluated returns to
diving are essential, as COVID-19’s long-term effects
persist.
15 - Predicting Post-Dive Inert Gas Bubble Grades in Non-
Decompression Scuba Diving with Air: Simplified Model for
Enhanced Diver Safety
- Published by the International Journal of Molecular Sciences - MDPI
Authors:
Andreas Fichtner, Björn Hannesen, Felix Stein, Benedikt
Schrofner-Brunner, Thomas Pohl, Thomas Grab,
Thea Koch, and Tobias Fieback
This study validates a previously proposed formula for
predicting post-dive bubble grades based on individual
factors and dive parameters using an independent
dataset. It also investigates the relevance of detailed dive
profile data in predicting echocardiography-derived
bubble grades and explores the potential of machine
learning models to improve predictive accuracy.
39 - Predictors of acute stress disorder following a military maritime
accident
- Published by Frontiers
Author: Sverre Sanden, Jarle Eid, and Sigurd William
Hystad
This study investigated acute stress disorder (ASD)
symptoms in 118 crew members of the Norwegian frigate
HNoMS Helge Ingstad after its collision and sinking in
November 2018. Six months before the accident (T1), pre-
deployment measures included anxiety, depression,
general health, and professional self-efficacy. Three weeks
post-accident (T2), 28% of participants showed clinically
significant ASD symptoms. Higher pre-incident anxiety
and depression scores, as well as female sex, were linked
to increased ASD risk, while perceived control during the
incident reduced ASD symptoms. Other factors showed
no predictive value.
42 - Revised guideline for central nervous system oxygen toxicity
exposure limits when using an inspired PO2 of 1.3 atmospheres
- Published by Diving and Hyperbaric Medicine
Author: Joseph Hoyt, F Gregory Murphy, Neal W Pollock,
Dawn Kernagis, Nicholas Bird, Michael Menduno,
John Bright, Simon J Mitchell
This study concludes that a four-hour exposure to an
inspired PO2 of 1.3 atm during a dive poses a low risk of
CNS oxygen toxicity. A second four-hour exposure while
resting is also low risk. Longer exposures increase
pulmonary toxicity symptoms, but they are reversible. It is
advised to dive again only after symptoms resolve. For
multiple dives in a day, limit the cumulative total to 4
hours of working dive time and 4 hours of rest. The risk of
CNS oxygen toxicity can also be reduced by lowering the
likelihood of CO2 retention through strategies such as
minimizing underwater work where practicable, and
avoiding gas densities greater than 6 g/L, which is the
density of air at 40 m.
43 - Heliox at 4 ATA Reduces Error Rates Compared to Trimix and Air,
but It Does Not Affect Short-Term Memory in Hyperbaric
Conditions
- Published by MDPI
Authors: Rita I. Sharma, Natalia D. Mankowska, Anna B.
Marcinkowska, Pawel J. Winklewski, and Jacek
Kot
Cognitive impairment while diving can be lessened with
specific breathing mixtures. Hyperbaric conditions are not
only found underwater but also in hyperbaric chambers
used for therapy. Divers face cognitive challenges due to
hyperbaric effects, particularly at depths of 4 atmospheres
absolute (ATA). This study assessed healthy volunteers on
their reaction times, memory, and errors in tasks at three
stages: normal pressure, at 4 ATA, and after returning to
normal. Results indicated that using heliox as a breathing
mixture decreased errors in hyperbaric conditions,
suggesting it could improve safety for both divers and
medical staff in these environments.
44 - Evaluating the Impact of Flight Hours on Pulmonary Function in
Military Pilots
- Published by Aerospace medicine and human performance
Author: Mette Konings, alex C. Wiekenkamp, Yara Q.
Wingelaar-Jagt, thijs t. Wingelaar
This study examined the impact of military flying on pilots'
lung function, analyzing 9,182 medical assessments from
2012 to 2025. Only 3 pilots were declared unfit due to
abnormal spirometry. Using a Generalized Estimating
Equation model, cumulative flight hours showed a
nonsignificant, clinically irrelevant positive trend with
FEV/FVC ratio. Some may question the relevance of such
a study to diving activities. The answer is that many pilots
breathe through masks in a low-pressure environment,
while divers work in hyperbaric conditions, which is
interesting to put in perspective.
45 - Case Report: Successful treatment of severe type II
decompression sickness characterized by multiple gas emboli
- Published by Frontiers
Authors: Yan Wang, Yujie Wang, Shuping Li, Donghua Ai,
Yubo Chen, and Mei Jing
Decompression sickness (DCS) typically results from
inadequate decompression, though strict adherence to
protocols reduces but does not eliminate risk. Severe
cases, marked by gas emboli in critical systems (e.g.,
pulmonary artery, right ventricle), are rare even when
protocols are followed. A diver developed severe Type II
DCS despite conservative adherence to decompression
tables (19m depth, 120min dive, 45min decompression),
experiencing symptoms like chest tightness, dyspnea, and
joint pain shortly after surfacing. CT scans confirmed gas
emboli in multiple locations. The patient fully recovered
after prompt recompression therapy.
46 - Use of in-water recompression for decompression illness after
deep freediving: a case series
- Published by Diving and Hyperbaric Medicine
Authors: Nicole Lin, Elaine Yu, Anna Lussier, Emmanuel
Gouin, Peter Lindholm
Anecdotal reports indicate rising use of in-water
recompression (IWR) by freedivers with neurological
symptoms suggestive of decompression illness (DCI), often
due to lack of access to hyperbaric oxygen treatment
(HBOT) in remote settings. This study interviewed six
competitive freedivers about 13 DCI cases. Diagnoses
included 3 likely decompression sickness, 6 consistent with
arterial gas embolism, and 4 ambiguous. Six cases
underwent IWR at 5–25 m for 20–90 min, yielding partial
or full symptom resolution; four later received HBOT. One
diver suffered permanent disability.
47 - The impact of the COVID-19 pandemic on diving routines and
diving hygiene
- Published by Biological Diversity and Conservation
Authors: Yavuz Aslan, Ayse Sena Yumbul Kardas
The COVID-19 pandemic significantly reduced diving
activities in Turkey, with recovery to pre-pandemic levels
still pending despite increased virus knowledge and
adopted safety measures. A study surveyed 46 divers
(mostly experienced, middle-aged, and long-term
practitioners) via a 20-question questionnaire distributed
to four diving schools. Findings revealed heightened
hygiene awareness post-pandemic but noted gaps in
safety measure implementation and diminished
motivation to resume diving.
48 - Perceptions of airway protection tools: an international survey
on the use of mouthpiece retaining straps in closed-circuit
rebreather diving.
- Published by Diving and Hyperbaric Medicine
Authors: Emmanuel Gouin, Emmanuel Dugrenot, Rachel
M Lance , Thierry Michot, Laura Marroni, Frauke
Tillmans
Rebreather diving has a high fatality rate, yet is increasing
in popularity. A mouthpiece retaining strap (MRS) has
been shown to prevent fatalities in military divers, but its
use is limited among recreational divers where drowning
is a significant risk. An online survey of 563 certified
rebreather divers revealed that only 37.3% had received
MRS training. Divers who received training rated MRS
importance significantly higher than those without
training. Key barriers to MRS adoption include negative
past experiences, inadequate training, perceived misuse,
and concerns about complications during emergency
procedures.
51 - Validation and clinical use of the Maquet (Getinge) original
series Rotaflow extracorporeal membrane oxygenation device in
hyperbaric conditions: a technical report
- Published by Diving and Hyperbaric Medicine
Authors: Theo Tsouras, Bridget Devaney, Zhiliang Caleb
Lin, Christopher Covelli, Lloyd Roberts, Vinodh
Bhagyalakshmi Nanjayya, Ian Millar
This study describes the first clinical application of ECMO
in a hyperbaric chamber using modified Maquet Rotaflow
1 and Quadrox-i oxygenator components in a PLS circuit.
Rigorous testing and 13 hyperbaric oxygen treatment
sessions for a patient with life-threatening fungal infection
demonstrated stable circuit flow (with up to 10%
variability between displays), consistent performance
during pressurization/decompression, safe device
temperatures, and no bubble formation or structural
issues. Clinically, the patient remained stable with achieved
hyperoxygenation targets, while oxygen inflow up to 8
L/min maintained CO2 clearance.
12 - Agreement of precordial and subclavian Doppler ultrasound
venous gas emboli grades in a large diving data set
- Published by Diving and Hyperbaric Medicine
Authors: S Lesley Blogg, Arian Azarang, Virginie
Papadopoulou, Peter Lindholm
This retrospective study compared agreement between
precordial (PC) and subclavian (SC) Doppler grades for
detecting post-decompression bubbles, using the KM
scale on 453 datasets (5,436 recordings). PC observes
bubbles from the whole body but is noisy, while SC yields
clearer signals. Resting grades matched in 62% of cases
(kappa 0.33); movement grades matched in only 38.9%
(kappa 0.29). Unmatched SC grades were higher than PC
at rest (70.3%) but comparable after movement. Results
indicate substantial discrepancies, suggesting
observations from both sites best represent overall bubble
load.
13 - Longitudinal study of changes in pulmonary function among
inside attendants of hyperbaric oxygen therapy
- Published by Diving and Hyperbaric Medicine
Authors: Kübra Canarslan Demir, Ahmet Ugur Avci, Selcen
Yüsra Abayli, Fatma Sena Konyalioglu, Burak
Turgut
This study analyzed spirometry data from 14 HBOT inside
personnel (2012–2023) to assess long-term lung function
effects from repeated hyperbaric exposure. No significant
changes occurred in FVC, FEV1 or PEF. However,
FEF25–75 fell 16% in staff with >150 sessions (p=0.038),
confirmed by post-hoc testing (p=0.015). No dyspnoea or
other symptoms were reported. The isolated FEF25–75
reduction may reflect improper FVC manoeuvre
execution. The authors stress accurate spirometry
technique and call for further research on cumulative
respiratory effects.
14 - The influence of wetsuit thickness (≥ 7 mm) on lung volumes in
scuba divers
- Published by Diving and Hyperbaric Medicine
Authors: Graham Stevens, David R Smart
This study tested whether thick (≥7 mm) wetsuits impair
lung function in Tasmanian divers despite thermal
benefits. Spirometry on 62 active divers showed significant
FVC and FEV1 reductions with wetsuits. Recreational
divers had larger declines (-7% FVC, -5% FEV1) than
occupational divers (-3% both); females declined more
than males, with female recreational divers worst affected
(up to 15% FVC reduction) and showing an inverse
thickness-volume link. Thick wetsuits thus hinder lung
volumes, with minor impact on fit divers but added risk for
less-fit recreational divers with comorbidities.
19 - Risk Factors for Middle Ear Barotrauma in Patients with Carbon
Monoxide Poisoning Undergoing Monoplace Hyperbaric
Oxygen Therapy: A Retrospective Cohort Study
- Published by MDPI
Authors: Jung-Ho Lee, Hyoung-Youn Lee, Kyung-Hoon
Sun, Tag Heo, and Sung-Min Lee
This retrospective cohort study identified risk factors for
middle ear barotrauma (MEB) in patients undergoing
monoplace HBOT for CO poisoning (May 2021–Dec
2023). MEB severity was graded via video otoscopy using
the modified O’Neill scale and occurred mainly at lower
grades. Multivariate analysis showed altered mental status
(OR 3.16) as an independent risk factor, while higher
albumin (>4.3 g/dL, OR 0.26) and magnesium (OR 0.21)
were protective. Findings emphasize careful pre-treatment
evaluation and monitoring to reduce MEB incidence.
Authors: Sandr
Ca²+ acts as a second messenger in nerve terminals,
entering neurons via voltage-gated channels during
depolarization to trigger neurotransmitter release. High
Ca²+ concentrations are transient and localized near open
channels, driving synaptic transmission. Short-term
synaptic plasticity, regulated by Ca²+-binding proteins like
calmodulin and the CaV2.1 channel, modulates synaptic
strength bidirectionally, aiding information encoding
through facilitation and depression.
27 - Core outcome set for research in necrotising soft tissue infection
patients: an international, multidisciplinary, modified Delphi
consensus study
- Published by Diving and Hyperbaric Medicine
Authors: Bridget Devaney, Jonathan PC Wackett, Nicola
Ma, Amanda Nguyen, Vikash Yogaraj, Morten
Hedetoft, Ole Hyldegaard , Aidan Burrell,
Biswadev Mitra
Necrotising soft tissue infections (NSTI) are severe
infections with high morbidity and mortality, but
inconsistent outcome reporting hinders evidence
synthesis. This study aimed to establish core outcome
measures for future NSTI trials to assess interventions like
hyperbaric oxygen therapy. Using a three-round Delphi
consensus method involving clinicians, researchers, and
patients, five key outcome domains achieved consensus:
mortality, surgical interventions, functional outcomes in
survivors, sepsis metrics (including shock and organ
dysfunction), and resource utilization.
28 - Effect of normobaric and hyperbaric hyperoxia treatment on
symptoms and cognitive capacities in Long COVID patients: a
randomised placebo-controlled, prospective, double-blind trial
- Published by Diving and Hyperbaric Medicine
Authors: Leen D’hoore, Peter Germonpré, Bert Rinia,
Leonard Caeyers, Nancy Stevens, Costantino
Balestra
Long COVID syndrome is a significant health concern,
with inadequately investigated treatments. Hyperbaric
oxygen therapy (HBOT) has been proposed, but its
efficacy is questionable due to potential placebo effects
and high costs. A randomized trial involving 101 patients
compared four HBOT modalities. Despite variability in
responses, no significant differences were found in
symptoms, quality of life, or cognitive performance across
groups. The results suggest that HBOT may not have a
significant effect on Long COVID, and further research is
needed before recommending HBOT.
29 - An unblinded training exposure to hypoxia enhances
subsequent hypoxia awareness
- Published by Diving and Hyperbaric Medicine
Authors: August Allocco, Hanna van Waart, Charlotte JW
Connell, Nicole YE Wong, Abhi Charukonda,
Nicholas Gant, Xavier CE Vrijdag, Simon J Mitchell
This study assessed whether prior unblinded hypoxia
exposure improves divers' ability to recognize hypoxia and
self-rescue during a subsequent blinded virtual-reality dive.
Forty participants were split into two groups: one received
symptom information via a leaflet, while the other
experienced hypoxia firsthand. Results showed 90% of the
hypoxia-experienced group self-rescued before SpO2
dropped to 70%, compared to 33% in the information-
only group (P < 0.001). The latter group also had lower
oxygen saturation (73.4% vs 81.4%) and inhaled oxygen
fraction at rescue. Light-headedness and shortness of
breath were the most common symptoms.
30 - Functional outcome and quality of life after iatrogenic cerebral
air embolism treated with hyperbaric oxygen: a prospective
cohort study
- Published by Diving and Hyperbaric Medicine
Authors: Raoul A Fakkert, Lisa van Beers, Nina C Weber,
Benedikt Preckel, Robert A van Hulst, Robert P
Weenink
Iatrogenic cerebral air embolism (CAE) is a rare, potentially
fatal condition from invasive procedures requiring prompt
hyperbaric oxygen therapy (HBOT), yet long-term
functional outcomes and quality of life (QoL) data remain
limited. This prospective study of 22 patients (64% arterial
CAE) treated with HBOT showed median time-to-
treatment of 7 hours. Mortality was 23%; at six months, 8
patients achieved full recovery (GOS 5) and 6 had
moderate disability (GOS 4). Over half of survivors (53%)
reported reduced QoL. Outcomes seemed better in
retrograde venous CAE and worse after
neuroangiographic procedures.
31 - The implications of the diving response in altering carbon dioxide
sensitivity as measured by changes in heart rate, respiration rate
and psychological measures in panic disorder patients
- Published by Frontiers
Authors: Peter Kyriakoulis, and Catherine Lissette Caballero
Breath-hold divers exhibit reduced CO2 sensitivity due to
training, whereas individuals with panic disorder (PD)
often show heightened sensitivity. This study examined
whether cold facial immersion (CFI), a diving response
(DR) technique, could alleviate panic symptoms by
modulating CO2 sensitivity. While CFI did not significantly
reduce physiological markers of CO2 sensitivity (e.g., heart
rate, respiration rate), it did decrease both physiological
and cognitive panic symptoms in individuals with PD.
These findings suggest CFI may have anxiolytic effects in
PD, warranting further research with larger samples.
49 - Case Report: Successful treatment of severe type II
decompression sickness characterized by multiple gas emboli
- Published by Frontiers
Authors: Yan Wang, Yujie Wang, Shuping Li, Donghua Ai,
Yubo Chen, and Mei Jing
Decompression sickness (DCS) is usually caused by
inadequate decompression, though protocols reduce but
cannot eliminate all cases. Severe Type II DCS with
multiple gas emboli after following tables is rare. This case
involved a diver at 19 m depth for 120 min with heavy
lifting who performed conservative decompression (45
min per Chinese tables). Thirty minutes after surfacing, he
developed chest tightness, dyspnea, fatigue, and left leg
pain. CT revealed gas emboli in the pulmonary artery,
right ventricle, and hepatic portal vein. He recovered fully
after recompression therapy. The report highlights DCS
unpredictability with excessive workload, stresses prompt
treatment, and calls for individualized protocols based on
physiological variables.
50 - Exploring Oxygen Therapy as a Supporting Treatment for
Asthma: Current Insights and Perspectives
- Published by MPDI
Authors: Michał Zwolinski, Adrian Hovagimyan, Jakub
Ignatowicz, Marta Stelmasiak, Aneta Lewicka,
Tomasz Szopinski, Łukasz Szymanski, Justyna
Bien-Kalinowska, Bałan J. Barbara, and Sławomir
Lewicki
Asthma affects over 260 million people and remains
challenging despite advances in medications like
corticosteroids and biologics, prompting interest in
adjunctive long-term oxygen therapies. Experimental data
suggest benefits including anti-inflammatory effects,
reduced oxidative stress, and improved pulmonary
function. However, evidence for hyperbaric oxygen
therapy (HBOT) is limited; small studies indicate safety but
inconclusive efficacy, with risks like barotrauma. Large-
scale RCTs are needed to define its role.
