Comprehensive Physiology Wiley Online Library

Saturation Diving; Physiology and Pathophysiology

Full Article on Wiley Online Library



Abstract

In saturation diving, divers stay under pressure until most of their tissues are saturated with breathing gas. Divers spend a long time in isolation exposed to increased partial pressure of oxygen, potentially toxic gases, bacteria, and bubble formation during decompression combined with shift work and long periods of relative inactivity. Hyperoxia may lead to the production of reactive oxygen species (ROS) that interact with cell structures, causing damage to proteins, lipids, and nucleic acid. Vascular gas‐bubble formation and hyperoxia may lead to dysfunction of the endothelium. The antioxidant status of the diver is an important mechanism in the protection against injury and is influenced both by diet and genetic factors.

The factors mentioned above may lead to production of heat shock proteins (HSP) that also may have a negative effect on endothelial function. On the other hand, there is a great deal of evidence that HSPs may also have a “conditioning” effect, thus protecting against injury.

As people age, their ability to produce antioxidants decreases. We do not currently know the capacity for antioxidant defense, but it is reasonable to assume that it has a limit. Many studies have linked ROS to disease states such as cancer, insulin resistance, diabetes mellitus, cardiovascular diseases, and atherosclerosis as well as to old age. However, ROS are also involved in a number of protective mechanisms, for instance immune defense, antibacterial action, vascular tone, and signal transduction. Low‐grade oxidative stress can increase antioxidant production.

While under pressure, divers change depth frequently. After such changes and at the end of the dive, divers must follow procedures to decompress safely. Decompression sickness (DCS) used to be one of the major causes of injury in saturation diving. Improved decompression procedures have significantly reduced the number of reported incidents; however, data indicate considerable underreporting of injuries. Furthermore, divers who are required to return to the surface quickly are under higher risk of serious injury as no adequate decompression procedures for such situations are available.

Decompression also leads to the production of endothelial microparticles that may reduce endothelial function. As good endothelial function is a documented indicator of health that can be influenced by regular exercise, regular physical exercise is recommended for saturation divers.

Nowadays, saturation diving is a reasonably safe and well controlled method for working under water. Until now, no long‐term impact on health due to diving has been documented. However, we still have limited knowledge about the pathophysiologic mechanisms involved. In particular we know little about the effect of long exposure to hyperoxia and microparticles on the endothelium. © 2014 American Physiological Society. Compr Physiol 4:1229‐1272, 2014.

Comprehensive Physiology offers downloadable PowerPoint presentations of figures for non-profit, educational use, provided the content is not modified and full credit is given to the author and publication.

Download a PowerPoint presentation of all images


Figure 1. Figure 1. An underwater work site. To the left is the diving bell used by the diver to “commute” to the work place.
Figure 2. Figure 2. Dust levels during a hyperbaric welding trial shift showing mass concentration of PM2.5 and concentration of particles with a mean diameter of 10‐240 nm. The mean diameter of particles observed was 25‐30 nm (120).
Figure 3. Figure 3. Particle aerodynamic diameter observed during hyperbaric welding operations. Local extraction ventilation was used only during welding, and the peak concentrations shown represent periods of high speed grinding when local extraction was not used (120).
Figure 4. Figure 4. Drilling mud burn showing a dermatitis affecting the ankle and forefoot.
Figure 5. Figure 5. Temperature of thermal comfort in hyperbaric helium, adapted from (364).
Figure 6. Figure 6. The synthesis of NO and NO from diet (256).
Figure 7. Figure 7. Left shows bubble formation, right shows dive profiles, upper panel shows a U.S. Navy profile, and the bottom shows short periods of recompression (282).
Figure 8. Figure 8. Bubbles appear as high‐intensity signals in carotid artery (brain circulation) 4‐23 h after decompression is complete. The intensity is a measure of the size and shows that after 23 h there still are small gas bubbles in blood vessels supplying the brain (54).
Figure 9. Figure 9. Mass stranding of whales. From Der Spiegel 21, 2013.
Figure 10. Figure 10. Imbalance or dysregulation of defense against oxidative stress (124).
Figure 11. Figure 11. Modifiable risk factors that can be influenced by the diver (383).
Figure 12. Figure 12. The principle of systems epidemiology (189).


Figure 1. An underwater work site. To the left is the diving bell used by the diver to “commute” to the work place.


Figure 2. Dust levels during a hyperbaric welding trial shift showing mass concentration of PM2.5 and concentration of particles with a mean diameter of 10‐240 nm. The mean diameter of particles observed was 25‐30 nm (120).


Figure 3. Particle aerodynamic diameter observed during hyperbaric welding operations. Local extraction ventilation was used only during welding, and the peak concentrations shown represent periods of high speed grinding when local extraction was not used (120).


Figure 4. Drilling mud burn showing a dermatitis affecting the ankle and forefoot.


Figure 5. Temperature of thermal comfort in hyperbaric helium, adapted from (364).


Figure 6. The synthesis of NO and NO from diet (256).


Figure 7. Left shows bubble formation, right shows dive profiles, upper panel shows a U.S. Navy profile, and the bottom shows short periods of recompression (282).


Figure 8. Bubbles appear as high‐intensity signals in carotid artery (brain circulation) 4‐23 h after decompression is complete. The intensity is a measure of the size and shows that after 23 h there still are small gas bubbles in blood vessels supplying the brain (54).


Figure 9. Mass stranding of whales. From Der Spiegel 21, 2013.


Figure 10. Imbalance or dysregulation of defense against oxidative stress (124).


Figure 11. Modifiable risk factors that can be influenced by the diver (383).


Figure 12. The principle of systems epidemiology (189).
References
 1.Aarli JA, Vaernes RJ, Brubakk AO, Nyland H, Skeidsvoll H and Toenjum S. Central nervous dysfunction associated with deep‐sea diving. Acta Neurol Scand 71: 2‐10, 1985.
 2.Abu‐Soud HM, Rousseau DL and Stuehr DJ. Nitric oxide binding to the heme of neuronal nitric‐oxide synthase links its activity to changes in oxygen tension. J Biol Chem 271: 1996.
 3.Abu‐Soud HM, Wang J, Rousseau DL, Fukuto JM, Ignarro LJ and Stuehr DJ. Neuronal nitric oxide synthase self‐inactivates by forming a ferrous‐nitrosyl complex during aerobic catalysis. J Biol Chem 270: 1995.
 4.Aguilera F, Mendez J, Pasaro E and Laffon B. Review on the effects of exposure to spilled oils on human health. J Appl Toxicol 30: 291‐301, 2010.
 5.Aharon A, Tamari T and Brenner B. Monocyte‐derived microparticles and exosomes induce procoagulant and apoptotic effects on endothelial cells. Thromb Haemost 100: 878‐885, 2008.
 6.Ahlen C, Iversen OJ, Risberg J, Volden G and Aarset H. Diver's hand: a skin disorder common in occupational saturation diving. Occup Environ Med 55: 141‐143, 1998.
 7.Ahlen C, Mandal LH, and Iversen OJ. Identification of infectious Pseudomonas aeroginosa strains in an occupational saturation diving environment. Occup Environ Med 55(7): 480‐484, 1998.
 8.Aitken RJ, Buckingham D, Richardson D, Gardiner JC and Irvine DS. Impact of a deep saturation dive on semen quality. Int J Androl 23: 2000.
 9.Alfadda AA and Sallam RM. Reactive oxygen species in health and disease. J Biomed Biotechnol 2012: 936486, 2012.
 10.Allen BW, Demchenko IT and Piantadosi CA. Two faces of nitric oxide: implications for cellular mechanisms of oxygen toxicity. J Appl Physiol 106: 2009.
 11.Almqvist H, Arborelius J, Barr PO, Jansson B and Kaijser L. Oxygen toxicity in nitrogen mixtures. Acta Physiol Scand 75: 64‐68, 1969.
 12.Altenburger R, Scholz S, Schmitt‐Jansen M, Busch W and Escher BI. Mixture toxicity revisited from a toxicogenomic perspective. Environ Sci Technol 46: 2508‐2522, 2012.
 13.Altman P and Dittmer D. Biological Handbooks: Respiration and Circulation. Bethesda, MD: FASEB, 1971.
 14.Anderson B, Jr. and Farmer JC, Jr. Hyperoxic myopia. Trans Am Ophthalmol Soc 76: 116‐124, 1978.
 15.Antonini JM, Santamaria AB, Jenkins NT, Albini E and Lucchini R. Fate of manganese associated with the inhalation of welding fumes: potential neurological effects. Neurotoxicology 27: 304‐310, 2006.
 16.Arieli R, Ertracht O, Oster I, Vitenstein A and Adir Y. Effects of nitrogen and helium on CNS oxygen toxicity in the rat. J Appl Physiol 98: 144‐150, 2005.
 17.Aronsen RB and Swanson DW. Video survey pf coral reefs: uni‐ and multivariate applications. Proc Eighth Int Coral Reefs Symp 2: 1441‐1446, 1997.
 18.Baden J, Green C, Halsey M, Monk S and Wardley‐Smit B. Preliminary evidence for hyperbaric induced infertility in male mice. Undersea Biomed Res 8: 64‐65, 1981.
 19.Baehr EK, Revelle W and Eastman CI. Individual differences in the phase and amplitude of the human circadian temperature rhythm: with an emphasis on morningness‐eveningness. J Sleep Res 9: 117‐127, 2000.
 20.Baker EL, Jr., Smith TJ and Landrigan PJ. The neurotoxicity of industrial solvents: a review of the literature. Am J Ind Med 8: 207‐217, 1985.
 21.Bartelson N, Criborn O and Muren A. Oxygen convulsions in mice. Influence of nitrogen admixture. Athens, Greece: European Undersea Biomedical Soc., 1980.
 22.Bean JW and Johnson PC. Adrenocortical response to single and repeated exposure to oxygen at high pressure. Am J Physiol 179: 410‐414, 1954.
 23.Bean J. Effects of oxygen at high pressure. Psysiol Rev 25: 1‐147, 1945.
 24.Beckman JS and Koppenol WH. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly. Am J Physiol 271: 61424‐61437, 1996.
 25.Beehler CC, Newton NL, Culver JF and Tredici TJ. Retinal detachment in adult dogs resulting from oxygen toxicity. Arch Ophthalmol 71: 665‐670, 1964.
 26.Behnke AR. Respiratory resistance, oil‐water splubility and mental effects of compared with helium and nitrogen. Am J Physiol 126: 409‐415, 1939.
 27.Behnke AR. Decompression sickness following exposure to high pressures. In: Fulton JF, editor. Decompression Sickness. Philadelphia: Saunders, 1951, p. 53‐89.
 28.Behnke AR, Forbes H and Motley E. Circulatory and visual effects of oxygen at 3 atmosphers pressure. Am J Physiol 114: 436‐442, 1935.
 29.Bennett PB. Hyperbaric oxygen and the significance of increased cerebral oxygen and carbon dioxide tensions. Int Anesthesiol Clin 4: 41‐62, 1966.
 30.Bennett PB. Performance impairment in deep diving due to nitrogen, helium, neon, and oxygen. Baltimore: Williams and Wilkins, 1967.
 31.Bennett PB and Rostain JC. The high pressure nervous syndrome. In: Brubakk AO and Neuman TS, editors. Physiology and Medicine of Diving. Toronto: Saunders, 2003, p. 323‐357.
 32.Berghage TE. Decompression sickness during saturation dives. Undersea Biomed Res 3: 387‐398, 1976.
 33.Berghage TE, Goehring GS and Donelson C. Pressure reduction limits for rats subjected to various time/pressure exposures. Undersea Biomedical Research 5: 323‐334, 1978.
 34.Bert P. Barometric Pressure. Columbus, OH: College Book Company, 1943.
 35.Bitterman N, Bitterman H, Kinarty A, Melamed Y and Lahat N. Effect of a single exposure to hyperbaric oxygen on blood mononuclear cells in human subjects. Undersea and Hyperbaric Med 20: 197‐204, 1993.
 36.Bitterman N, Lahat N, Rosenwald T, Kinarty A, Melamed Y and Bitterman H. Effect of hyperbaric oxygen on tissue distribution of mononuclear cell subsets in the rat. J Appl Physiol 77: 2355‐2359, 1994.
 37.Bitterman N, Laor A and Melamed Y. CNS oxygen toxicity in oxygen‐inert gas mixtures. Undersea Biomed Res 14: 477‐483, 1987.
 38.Blatteau JE, Brubakk AO, Gempp E, Castagna O, Risso JJ and Vallee N. Sidenafil pre‐treatment promotes decompression sickness in rats. PLoS One 8: e60639, 2013.
 39.Boveris A. Mitochondrial production of superoxide radical and hydrogen peroxide. Adv Exp Med Biol 78: 67‐82, 1977.
 40.Boycott AE, Damant CC and Haldane JS. The prevention of compressed‐air illness. J Hyg, London 8: 342‐443, 1908.
 41.Bradley ME and Vorosmarti J. Hematological changes resulting from hyperbaric oxygenation in divers and non‐divers. Aerosp Med 39: 493‐497, 1968.
 42.Brauer RW. Hydrostatic pressure effects on the central nervous system: perspectives and outlook. Phil Trans R Soc Lond 304: 17‐30, 1984.
 43.Brauer RW and Beaver RW. Synergism of hyperoxia and high helium pressures in the causation of convulsions. J Appl Physiol 53: 192‐202, 1982.
 44.Brenner BM, Ballermann BJ, Gunning ME and Zeidel ML. Diverse biological actions of atrial natriuretic peptide. Physiol Rev 70: 665‐699, 1990.
 45.Bridges WZ. Electroretinographic manifestations of hyperbaric oxygen. Arch Ophthalmol 75: 812‐817, 1966.
 46.Bridges WZ. Electroretinographic changes during hyperoxia. Washington DC: Natl. Acad. Sci. Natl. Res. Council, 1966.
 47.Broman M, Kallskog O, Nygren K and Wolgast M. The role of antidiuretic hormone in cold‐induced diuresis in the anaesthetized rat. Acta Physiol Scand 162: 475‐480, 1998.
 48.Brownlee I, Fairclough A and Paxman AJ. The potential health effects of seaweed extracts. In: Haupage, editor. Seeweed: Ecology, Nutrient Composition and Medical Uses. New York: 2012, p. 119‐136.
 49.Brubakk AO. God reise hjem ‐ sikker dekompresjon av dykkere. Kunnskapstatus og fremtidsperspektiver 2012. Stavanger, Norway: Petroliumstilsynet, 2013, p. 1‐41.
 50.Brubakk AO, Bolstad G, and Jacobsen G. Helseeffekter av lufdykking. Yrkes og sportsdykkere. STF23 A93053. Trondheim, Norway: SINTEF Unimed, 1993, p. 1‐27.
 51.Brubakk AO, Duplancic D, Valic Z, Palada I, Obad A, Bakovic D, Wisloff U and Dujic Z. A single air dive reduces arterial endothelial function in man. J Physiol 566: 901‐906, 2005.
 52.Brubakk AO and Eftedal O. Evaluation of reverse dive profiles. In: Lang MA and Lehner CE, editors. Reverse Dive Profiles. Washington: Smithsonian Institution, 2000, p. 111‐121.
 53.Brubakk AO, Holmes S, and Eftedal O. Decompression from Saturation, Aurora Dives April/May 1993. STF23‐F93041. Trondheim, Norway: SINTEF, 1993.
 54.Brubakk AO, Peterson R, Grip A, Holand B, Onarheim J, Segadal K, Kunkle TD and Tønjum S. Gas bubbles in the circulation of divers after ascending excursions from 300 to 250 msw. J Appl Physiol 60: 45‐51, 1986.
 55.Bryan NS, Alexander DD, Coughlin JR, Milkowski AL and Boffetta P. Ingested nitrate and nitrite and stomach cancer risk: an updated review. Food Chem Toxicol 50: 3646‐3665, 2012.
 56.Buhlmann AA. [Computation of low‐risk compression. Computation model and results of experimental decompression research]. Schweiz Med Wochenschr 118: 185‐197, 1988.
 57.Burns JD. Concentration‐dependent attenuation of hyperbaric oxygen toxicity. Aerospace Med 43: 989‐992, 1972.
 58.Butler BD, Robinson R, Little T, Chelly JE and Doursout MF. Cardiopulmonary changes with moderate decompression in rats. Undersea Hyperb Med 23: 83‐89, 1996.
 59.Butler FK. Central nervous system oxygen toxicity in closed circuit scuba divers III. U.S. Navy Experimental Diving Unit Report No 5‐86 1986.
 60.Butler FK and Thalmann ED. Central nervous system oxygen toxicity in closed‐circuit scuba divers. Bethesda, MD: Undersea Medical Society, 1984.
 61.Butler FK, Jr. and Thalmann ED. Central nervous system oxygen toxicity in closed circuit scuba divers II. Undersea Biomed Res 13: 193‐223, 1986.
 62.Cabigas BP, Su J, Hutchins W, Shi Y, Schaefer RB, Recinos RF, Nilakantan V, Kindwall E, Niezgoda JA and Baker JE. Hyperoxic and hyperbaric‐induced cardioprotection: role of nitric oxide synthase 3. Cardiovasc Res 72: 143‐151, 2006.
 63.Caldwell PRB, Lee WL, Schildkraut HS and Archibald ER. Changes in lung volume, diffusion capacity, and blood gases in men breathing oxygen. J Appl Physiol 21: 1477‐1483, 1966.
 64.Camporesi RM and Bosco E. Vemtilation, gas exchange and exercuse under pressure. In: Brubakk AO and Neuman TS, editors. Physiology and Medicine of Diving. Toronto: Saunders, 2003, p. 77‐116.
 65.Caulfield JB, Shelton RW and Burke JF. Cytotoxic effects of oxygen on striated muscle. Arch Pathol 94: 127‐132, 1972.
 66.Chance B, Sies H and Boveris A. Oxygen toxicity. Physiol Rev 59: 527‐589, 1979.
 67.Chavko M, Braisted JC, Outsa NJ and Harabin AL. Role of cerebral blood flow in seizures from hyperbaric oxygen exposure. Brain Res 791: 75‐82, 1998.
 68.Cheung CY, Green DJ, Litt GJ and Laugharn JA, Jr. High‐pressure‐mediated dissociation of immune complexes demonstrated in model systems. Clin Chem 44: 299‐303, 1998.
 69.Chinnery PF, Elliott HR, Syed A and Rothwell PM. Mitochondrial DNA haplogroups and risk of transient ischaemic attack and ischaemic stroke: a genetic association study. Lancet Neurol 9: 498‐503, 2010.
 70.Chironi GN, Boulanger CM, Simon A, Dignat‐George F, Freyssinet JM and Tedgui A. Endothelial microparticles in diseases. Cell Tissue Res 335: 143‐151, 2009.
 71.Cho K. Chronic “jet lag” produces temporal lobe atrophy and spatial cognitive defects. Nature Neuroscience 4: 567‐568, 2001.
 72.Cho K, Ennaceur A, Cole JC and Suh CK. Chronic jet lag produces cognitive deficits. J Neurosci 20: RC66, 2000.
 73.Clark JM. Pulmonary limits of oxygen tolerance in man. Experimental Lung Res 14: 1988.
 74.Clark JM and Lambertsen CJ. Alveolar‐arterial O2 differences in man at 0.2, 1.0, 2.0, and 3.5 ata inspired PO2. J Appl Physiol 30: 897‐910, 753‐763, 1971.
 75.Clark JM and Lambertsen CJ. Pulmonary oxygen toxicity: a review. Pharmacol Rev 23: 37‐133, 1971.
 76.Clark JM and Lambertsen CJ. Rate of development of pulmonary O2 toxicity in man during O2 breathing at 2.0 Ata. J Appl Physiol 30: 339‐352, 1971.
 77.Clark JM and Thom SR. Oxygen under pressure. In: Brubakk AO and Neuman TS, editors. Physiology and Medicine of Diving. Philadelphia: Saunders, 358‐418, 2003.
 78.Clark J, Gelfand R, Flores N, Lambertsen C and Pisarello J. Pulmonary Tolerance in Man to Continuous Oxygen Exposure at 3.0, 2.5, 2.0, and 1.5 ATA in Predictive Studies V. Bethesda, MD: Undersea and Hyperbaic Medical Society, 1987.
 79.Claybaugh JR, Freund BJ, Luther G, Muller K and Bennett PB. Renal and hormonal responses to exercise in man at 46 and 37 atmospheres absolute pressure. Aviat Space Environ Med 68: 295‐304, 1997.
 80.Claybaugh JR, Lin YC, Schafstall HG and Bennett PB. Cardiovascular and endocrine responses to 90 degree tilt during a 35‐day saturation dive to 46 and 37 ATA. Aviat Space Environ Med 78: 2007.
 81.Cleeter MW, Cooper JM, Darley‐Usmar VM, Moncada S and Schapira AH. Reversible inhibition of cytochrome c oxidase, the terminal enzyme of the mitochondrial respiratory chain, by nitric oxide: implications for neurodegenerative diseases. FEBS Lett 345: 50‐54, 1994.
 82.Clifton EH, Mahnken CVW, Van Derwalker JC and Walker RA. Tektite I, man‐in‐the‐sea project: marine science program. Science 168: 659‐663, 1970.
 83.Coburn M, Maze M and Franks NP. The neuroprotective effects of xenon and helium in an in vitro model of traumatic brain injury. Crit Care Med 36: 588‐595, 2008.
 84.Coggon D, Inskip H, Winter P and Pannett B. Lobar pneumonia: an occupational disease in welders. Lancet 344: 41‐43, 1994.
 85.Colvin AP. Human Factors in Decompression Sickness in Compressed Air Workers in the United Kingdom 1986‐2000. A Case‐Controlled Study and Analysis Using the HSE Department Database. London: Health and Safety Excecutive, 2003, p. 171.
 86.Conway JM, Thorp JW, Stein TP, Seale JL and Rumpler WV. Decreased protein synthesis during dry saturation diving. Undersea Hyperb Med 22: 219‐227, 1995.
 87.Cooper CB. Underwater habitats at 300 fsw: a thing of the past and still viable? In: Lang MA and Smith NE, editors. Procedings of the Advanced Scientific Diving Workshop. Washington DC: Smithsonian Institution, 2006, p. 153‐156.
 88.Cornfield DN, Reeve HL, Tolarova S, Weir EK and Archer S. Oxygen causes fetal pulmonary vasodilation through activation of a calcium‐dependent potassium channel. Proc Natl Acad Sci USA 93: 8089‐8094, 1996.
 89.Costigan MG. Hydrogen sulfide: UK occupational exposure limits. Occup Environ Med 60: 308‐312, 2003.
 90.Cotes JE, Davey IS, Reed JW and Rooks M. Respiratory effects of a single saturation dive to 300 m. Brit J of Industrial Medicine 44: 76‐82, 1987.
 91.Cousteau JY. World Without Sun. New York: Harper and Row, 1965.
 92.Cox RA, McIver NK, King JD and Calder IM. Hyperthermia in hyperbaric activities. Lancet 2: 1303‐1304, 1980.
 93.Crapo JD. Morphologic changes in pulmonary oxygen toxicity. Annu Rev Physiol 48: 721‐731, 1986.
 94.Crosbie A and Simpson M. Report from Workshop on VOCs in Diving Chambers. OTO 1999, 096. HSE, 2000.
 95.Crosbie WA, Reed JW and Clarke MC. Functional characteristics of the large lungs found in commercial divers. J Appl Physiol 46: 639‐645, 1979.
 96.Daniels S. Does diving distroy the brain? In: Lang MA and Brubakk AO, editors. The Future of Diving: 100 years of Haldane and Beyond. Washington DC: Smithsonian Institution Scholarly Press, 2009, p. 137‐143.
 97.Daniels S and Grossman Y. Biological effects of pressure. In: Brubakk AO and Neuman TS, editors. Physiology and Medicine of Diving. Toronto: Saunders, 2003, p. 255‐299.
 98.David HN, Haelewyn B, Degoulet M, Colomb DG, Jr., Risso JJ and Abraini JH. Ex vivo and in vivo neuroprotection induced by argon when given after an excitotoxic or ischemic insult. PLoS One 7: 2012.
 99.David HN, Haelewyn B, Risso JJ and Abraini JH. Modulation by the noble gas argon of the catalytic and thrombolytic efficiency of tissue plasminogen activator. Naunyn Schmiedebergs Arch Pharmacol 386: 91‐95, 2013.
 100.David HN, Haelewyn B, Rouillon C, Lecoq M, Chazalviel L, Apiou G, Risso JJ, Lemaire M and Abraini JH. Neuroprotective effects of xenon: a therapeutic window of opportunity in rats subjected to transient cerebral ischemia. FASEB J 22: 1275‐1286, 2008.
 101.Davis WB, Rennard, SI, B. Hennan, PB, Crystal, RG Pulmonary oxygen toxicity. Early reversible changes in human alveolar structure induced by hyperoxemia. New Engl J Med 309: 878‐883, 1983.
 102.Demchenko IT, Atochin DN, Boso AE, Astern J, Huang PL and Piantadosi CA. Oxygen seizure latency and peroxynitrite formation in mice lacking neuronal or endothelial nitric oxide synthases. Neurosci Lett 344: 53‐56, 2003.
 103.Demchenko IT, Bennett P and Piantadosi C. The role of nitric oxide in hyperbaric neurotoxicity. In: High Pressure Biology and Medicine. Rochester, NY: University of Rochester Press, 1998.
 104.Demchenko IT, Boso A, Bennett P, Whorton A and Piantadosi C. Hyperbaric oxygen reduces cerebral blood flow by inactivating nitric oxide. Nitric Oxide: Biol Chem 4: 597‐608, 2000.
 105.Demchenko IT, Boso AE, Whorton AR and Piantadosi CA. Nitric oxide production is enhanced in rat brain before oxygen‐induced convulsions. Brain Res 917: 253‐261, 2001.
 106.Demchenko IT, Welty‐Wolf KE, Allen BW and Piantadosi CA. Similar but not the same: normobaric and hyperbaric pulmonary oxygen toxicity, the role of nitric oxide. Am J Physiol Lung Cell Mol Physiol 293: 6229‐6238, 2007.
 107.Demchenko IT, Zhilyaev SY, Moskvin AN, Piantadosi CA and Allen BW. Autonomic activation links CNS oxygen toxicity to acute cardiogenic pulmonary injury. Am J Physiol Lung Cell Mol Physiol 300: L102‐L111, 2011.
 108.Denicola A, Freeman BA, Trujillo M and Radi R. Peroxynitrite reaction with carbon dioxide/bicarbonate: kinetics and influence on peroxynitrite‐mediated oxidations. Arch Biochem Biophys 333: 49‐58, 1996.
 109.Dickens F. The toxic effects of oxygen on brain metabolism and on tissue enzymes; brain metabolism. Biochem J 40: 145‐171, 1946.
 110.Dimitrov S, Lange T, Tieken S, Fehm HL and Born J. Sleep associated regulation of T helper 1/T helper 2 cytokine balance in humans. Brain Behav Immun 18: 341‐348, 2004.
 111.Dise CA, Clark JM, Lambersten CJ and Goodman DB. Hyperbaric hyperoxia reversibly inhibits erythrocyte phospholipid fatty acid turnover. J Appl Physiol 62: 533‐538, 1987.
 112.Divers Alert Network (DAN). Annual Report Diving Alert Network. Durham, NC: Divers Alert Network, 1999.
 113.Diving Medical Advisory Committee. Accelerated emergency decompression (AED) from saturation. DMAC 31. London: DMAC, 2013.
 114.Djurhuus R, Segadal K and Svardal AM. Glutathione in blood cells decreases without DNA breaks after a simulated saturation dive to 250 msw. Aviat Space Environ Med 77: 597‐604, 2006.
 115.Doeuvre L, Plawinski L, Toti F and Angles‐Cano E. Cell‐derived microparticles: a new challenge in neuroscience. J Neurochem 110: 457‐468, 2009.
 116.Domachevsky L, Pick CG, Arieli Y, Krinsky N, Abramovich A and Eynan M. Do hyperbaric oxygen‐induced seizures cause brain damage? Epilepsy Res 100: 37‐41, 2012.
 117.Domoto H, Nakabayashi K, Hashimoto A, Suzuki S and Kitamura T. Decrease in platelet count during saturation diving. Aviat Space Environ Med 72: 380‐384, 2001.
 118.Donald K. Oxygen and the diver. Hanley Swan, UK: The SPA Ltd, 1992.
 119.Donald, KW. Oxygen poisoning in man. Br Med J 17: 667‐673, 1947.
 120.Donaldson K, Brown D, Clouter A, Duffin R, MacNee W, Renwick L, Tran L and Stone V. The pulmonary toxicology of ultrafine particles. J Aerosol Med 15: 213‐220, 2002.
 121.Doolette DJ and Mitchell SJ. Biophysical basis for inner ear decompression sickness. J Appl Physiol 94: 2145‐2150, 2003.
 122.Doran GR, Chaudry L, Brubakk AO and Garrard MP. Hyperbaric liver dysfunction in saturation divers. Undersea Biomed Res 12(2): 151‐164, 1985.
 123.Dore CJ, Halsey MJ, Monk S and Wardley‐Smith B. Assessment of recovery from hyperbaric‐induced subfertility in male mice. J Appl Physiol 55: 151‐164, 1983.
 124.Droge W. Free radicals in the physiological control of cell function. Physiol Rev 82: 47‐95, 2002.
 125.DSYS. Report from diver database DSYS 2005. Stavanger, Petrolium Safety Authority (Ptil), 2006.
 126.Dujic Z, Duplancic D, Marinovic‐Terzic I, Bakovic D, Ivancev V, Valic Z, Eterovic D, Petri NM, Wisloff U and Brubakk AO. Aerobic exercise before diving reduces venous gas bubble formation in humans. J Physiol 555: 637‐642, 2004.
 127.Dujic Z, Obad A, Palada I, Valic Z and Brubakk AO. A single open sea air dive increases pulmonary artery pressure and reduces right ventricular function in professional divers. Eur J Appl Physiol 97: 478‐485, 2006.
 128.Dujic Z, Palada I, Valic Z, Duplancic D, Obad A, Wisloff U and Brubakk AO. Exogenous nitric oxide and bubble formation in divers. Med Sci Sports Exerc 38: 1432‐1435, 2006.
 129.Dundas CR. Alphaxalone/alphadolone in diving‐chamber anaesthesia. Lancet 1: 378, 1979.
 130.Dutka AJ. Long term effects on the central nervous system. In: Brubakk AO and Neuman TS, editors. Physiology and Medicine of Diving. Toronto: 2003, p. 680‐699.
 131.Eatock BC and Nishi RY. Dopler ultrasonic detection of intravascular bubbles during decompression from the 1985 Can/UK saturation dives to 100 and 360 msw. 86‐R‐10. Downwiew, Ontario: DCIM, 1986.
 132.Eckenhoff RG and Vann RD. Air and nitrox saturation decompression: a report of 4 schedules and 77 subjects. Undersea Biomed Res 12: 41‐52, 1985.
 133.Eckenhoff RG, Olstad CS and Carrod G. Human dose‐response relationship for decompression and endogenous bubble formation. J Appl Physiol 69: 914‐918, 1990.
 134.Edstrom JE and Rockert H. The effect of oxygen at high pressure on the histology of the central nervous system and sympathetic and endocrine cells. Acta Physiol Scand 55: 255‐263, 1962.
 135.Eftedal I, Jorgensen A, Rosbjorgen R, Flatberg A and Brubakk AO. Early genetic responses in rat vascular tissue after simulated diving. Physiol Genomics 44: 1201‐1207, 2012.
 136.Eftedal I, Ljubkovic M, Flatberg A, Jorgensen A, Brubakk AO and Dujic Z. Acute and potentially persistent effects of scuba diving on the blood transcriptome of experienced divers. Physiol Genomics 45: 965‐97, 2013.
 137.Eftedal O. Ultrasonic detection of decompression induced vascular microbubbles (Dissertation). NTNU, 2007.
 138.El‐Zein M, Malo JL, Infante‐Rivard C and Gautrin D. Incidence of probable occupational asthma and changes in airway calibre and responsiveness in apprentice welders. Eur Respir J 22: 513‐518, 2003.
 139.El‐Zein M, Malo JL, Infante‐Rivard C and Gautrin D. Prevalence and association of welding related systemic and respiratory symptoms in welders. Occup Environ Med 60: 655‐661, 2003.
 140.Elayan IM, Axley MJ, Prasad PV, Ahlers ST and Auker CR. Effect of hyperbaric oxygen treatment on nitric oxide and oxygen free radicals in rat brain. J Neurophysiol 83: 2022‐2029, 2000.
 141.Elliott C, Reed J, Cotes J, Robinson N and King J. Narrowing of small lung airways in commercial divers. Br J Ind Med 47: 197‐202, 1990.
 142.Enander AE. Working performance in the cold. In: Reinertse RE, Brubakk AO and Påsche A, editors. Working and Survival in the Cold. Trondheim: Tapir Publisher, 1995, p. 69‐87.
 143.End E. Rapid decompresssion following inhalation of helium‐oxygen mixtures under pressure. Am J Physiol 120: 712‐718, 1937.
 144.Epstein M. Cardiovascular and renal effects of head‐out water immersion in man: application of the model in the assessment of volume homeostasis. Circ Res 39: 619‐628, 1976.
 145.Erusalimsky JD. Vascular endothelial senescence: from mechanisms to pathophysiology. J Appl Physiol 106: 326‐332, 2009.
 146.Fahlman A and Dromsky DM. Dehydration effects on the risk of severe decompression sickness in a swine model. Aviat Space Environ Med 77: 102‐106, 2006.
 147.Fallin MD and Kao WH. Is “X”‐WAS the future for all of epidemiology? Epidemiology 22: 457‐459, 2011.
 148.Fang Z, Ionescu P, Chortkoff BS, Kandel L, Sonner J, Laster MJ and Eger EI. Anesthetic potencies of n‐alkanols: results of additivity and solubility studies suggest a mechanism of action similar to that for conventional inhaled anesthetics. Anesth Analg 84: 1042‐1048, 1997.
 149.Fang Z, Sonner J, Laster MJ, Ionescu P, Kandel L, Koblin DD, Eger EI and Halsey MJ. Anesthetic and convulsant properties of aromatic compounds and cycloalkanes: implications for mechanisms of narcosis. Anesth Analg 83: 1097‐1104, 1996.
 150.Fernandez A, Arbelo M and Martin V. Whales: no mass strandings since sonar ban. Nature 497: 317, 2013.
 151.Fisher AB. Intracellular Production of Oxygen‐Derived Free Radicals. Halliwell B, editor. Bethesda, MD: FASEB, 1987.
 152.Fisher A, Bassett D and Forman H. Oxygen Toxicity of the Lung: Biochemical Aspects. Bethesda, MD: American Physiological Society, 1979.
 153.Fisher A and Forman H. Oxygen utilization and toxicity in the lungs. Washington DC: American Physiological Society, 1983.
 154.Flook V. Development of the ANALOX hyper‐gas diving bell monitor. HSE Research Report 030. Health and Safety Executive, 2003.
 155.Flynn ET, Vorosmarti J, Jr., and Modell HI. Temperature requirements for the maintanance of thermal balance in hight prssure helium oxygen environments. Navy Experimental Diving Unit 1974, p. 21‐73.
 156.Ford ES. Risks for all‐cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 28: 1769‐1778, 2005.
 157.Ford ES and Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidemiol 41: 1338‐1353, 2012.
 158.Ford ES, Kohl HW, III, Mokdad AH and Ajani UA. Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults. Obes Res 13: 608‐614, 2005.
 159.Forman H and Fisher A. Antioxidant defenses. New York: Springer, 1981.
 160.Foteinos G, Afzal AR, Mandal K, Jahangiri M and Xu Q. Anti‐heat shock protein 60 autoantibodies induce atherosclerosis in apolipoprotein E‐deficient mice via endothelial damage. Circulation 112: 1206‐1213, 2005.
 161.Fox DP, Robertson FW, Brown T, Whitehead AR and Douglas JD. Chromosome aberrations in divers. Undersea Biomed Res 11: 193‐204, 1984.
 162.Francis TJR and Gorman DF. Pathogenesis of the decompression disorders. In: Elliot DH and Bennett PB, editors. The Physiology and Medicine of Diving. London: WB Saunders, 1993, p. 454‐480.
 163.Frank L, Iqbal J, Hass M and Massaro D. New “rest period” protocol for inducing tolerance to high O2 exposure in adult rats. Am J Physiol 257: L226‐L231, 1989.
 164.Franks NP, Dickinson R, de Sousa SL, Hall AC and Lieb WR. How does xenon produce anaesthesia? Nature 396: 324, 1998.
 165.Fraser L, Monk S, Wardley‐Smith B, Cohen S and Halsey M. A comparison of fertility in vitro and in vivo after exposure of male mice to high environmental pressure. Gamete Res 13: 143‐149, 1986.
 166.Freeman BA and Crapo JD. Biology of disease: free radicals and tissue injury. Lab Invest 47: 412‐426, 1982.
 167.Freeman BA and Crapo JD. Hyperoxia increases oxygen radical production in rat lungs and lung mitochondria. J Biol Chem 256: 10986‐10992, 1981.
 168.Fridovich I. Superoxide anion radical (O2.), superoxide dismutases, and related matters. J Biol Chem 272: 18515‐18517, 1997.
 169.Fridovich I and Freeman B. Antioxidant defenses in the lung. Annu Rev Physiol 48: 693‐702, 1986.
 170.Fuentes A, McPherson B, and Hickson L. Auditory dysfunction associated with solvent exposure. BMC Public Health 13. 2013, p. 35.
 171.Garcia‐Cardena G, Fan R, Shah V, Sorrentino R, Cirino G, Papapetropoulos A and Sessa WC. Dynamic activation of endothelial nitric oxide synthase by Hsp90. Nature 392: 821‐824, 1998.
 172.Gardette B. Correlation between decompression sickness and circulating bubbles in 232 divers. Undersea Biomed Res 6: 99‐107, 1979.
 173.Gempp E, Blatteau JE, Pontier JM, Balestra C and Louge P. Preventive effect of pre‐dive hydration on bubble formation in divers. Br J Sports Med 43: 224‐228, 2009.
 174.Gernhardt MJ and Lambertsen CJ. Commercial diving. In: Brubakk AO and Neuman TS, editors. Physiology and medicine of diving. Toronto: Saunders, 2003, p. 29‐44.
 175.Gernhardt M. Development and evaluation of a decompression stress index based on tissue bubble dynamics (Dissertation). University of Pennsylvania, 1991.
 176.Gersh I. Syndrome of oxygen poisoning in cats. War Med (Chic 1941) 8: 221‐228, 1945.
 177.Goldstein JR and Mengel CE. Hemolysis in mice exposed to varying levels of hyperoxia. Aerosp Med 40: 12‐13, 1969.
 178.Gow A, Duran D, Thom SR and Ischiropoulos H. Carbon dioxide enhancement of peroxynitrite‐mediated protein tyrosine nitration. Arch Biochem Biophys 333: 42‐48, 1996.
 179.Graeme KA and Pollack CV, Jr. Heavy metal toxicity, part II: lead and metal fume fever. J Emerg Med 16: 171‐177, 1998.
 180.Grandjean AC and Grandjean NR. Dehydration and cognitive performance. J Am Coll Nutr 26: 549S‐554S, 2007.
 181.Griffith DE, Holden WE, Morris JF, Min LK and Krishnamurthy GT. Effects of common therapeutic concentrations of oxygen on lung clearance of 99mTc DTPA and bronchoalveolar lavage albumin concentration. Am Rev Respir Dis 134: 233‐237, 1986.
 182.Gronning M, Risberg J, Skeidsvoll H, Moen G, Aanderud L, Troland K, Sundal E and Thorsen E. Electroencephalography and magnetic resonance imaging in neurological decompression sickness. Undersea Hyperb Med 32: 397‐402, 2005.
 183.Groth M and Lyngenbo O. Respiratory symptoms in Danish welders. Scand J Soc Med 17: 271‐276, 1989.
 184.Gruss M, Bushell TJ, Bright DP, Lieb WR, Mathie A and Franks NP. Two‐pore‐domain K+ channels are a novel target for the anesthetic gases xenon, nitrous oxide, and cyclopropane. Mol Pharmacol 65: 443‐452, 2004.
 185.Gutvik CR, Dunford RG, Dujic Z and Brubakk AO. Parameter estimation of the Copernicus decompression model with venous gas emboli in human divers. Med Biol Eng Comput 48: 625‐636, 2010.
 186.Hammami MM, Bouchama A, Shail E, Aboul‐Enein HY and Al‐Sedairy S. Lymphocyte subsets and adhesion molecules expression in heatstroke and heat stress. J Appl Physiol 84: 1615‐1621, 1998.
 187.Harabin AL, Braisted JC and Flynn ET. Response of antioxidant enzymes to intermittent and continuous hyperbaric oxygen. J Appl Physiol 69: 328‐335, 1990.
 188.Harabin AL, Homer LD, Weathersby PK and Flynn ET. An analysis of decrements in vital capacity as an index of pulmonary oxygen toxicity. J Appl Physiol 63: 1130‐1135, 1987.
 189.Haring R and Wallaschofski H. Diving through the “‐omics”: the case for deep phenotyping and systems epidemiology. OMICS 16: 231‐234, 2012.
 190.Harrington JM. Shift work and health—a critical review of the literature on working hours. Ann Acad Med Singapore 23: 699‐705, 1994.
 191.Havnes MB, Ahlen C, Brubakk AO and Iversen OJ. Concentration of circulating autiantbodies against HSO60 is lowered through diving when xonpared to non‐diving rats. Microb Ecol Health Dis 23: 1‐5, 2012.
 192.Hawley D, Halsey MJ and Wardley‐Smith B. Hyperbaric‐induced subfertility in mice: lack of effect of decompression. J Appl Physiol Respir Environ Exercise Physiol 60: 1710‐1712, 1986.
 193.Hayes PA and Bramham E. Physiological and engineering aspects of diver thermal protection and rewarming. Association of Diving Contractors Internatiuonal Symposium. New Orleans: Association of Diving Contractors, 1981.
 194.Hayward MG and Keatinge WR. Progressive symptomless hypothermia in water: possible cause of diving accidents. Br Med J 1: 1182, 1979.
 195.Health and Safety Executive. Occupational Exposure Limits for Hyperbaric Conditions. Hazard assesment document EH715/2. Health and Safety Executive, 2000.
 196.Heinen A, Huhn R, Smeele KM, Zuurbier CJ, Schlack W, Preckel B, Weber NC and Hollmann MW. Helium‐induced preconditioning in young and old rat heart: impact of mitochondrial Ca(2+) ‐sensitive potassium channel activation. Anesthesiology 109: 830‐836, 2008.
 197.Heitzer T, Just H and Munzel T. Antioxidant vitamin C improves endothelial dysfunction in chronic smokers. Circulation 94: 6‐9, 1996.
 198.Heitzer T, Schlinzig T, Krohn K, Meinertz T and Munzel T. Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease. Circulation 104: 2673‐2678, 2001.
 199.Hennig J, Kieferdorf P, Moritz C, Huwe S and Netter P. Changes in cortisol secretion during shiftwork: implications for tolerance to shiftwork? Ergonomics 41: 610‐621, 1998.
 200.Henry JA. Composition and toxicity of petroleum products and their additives. Hum Exp Toxicol 17: 111‐123, 1998.
 201.Heremans K. The Behaviour of Proteins Under Pressure. Dorecht, Netherlands: Kluwer Academic Publishers, 1993.
 202.Hertig BA, Riedsak ML and Belding HS. Time course of sweating in warm baths. Adv Biol Skin 3: 213‐229, 1962.
 203.Hess RT and Menzel DB. Effect of dietary antioxidant level and oxygen exposure on the fine structure of the proximal convoluted tubules. Aerosp Med 42: 646‐649, 1971.
 204.Hills B. A thermodynamic and kinetic approach to decompression sickness (Dissertation). University of Adelaide, 1966.
 205.Hills BA. Neurologic oxygen toxicity: effects of switch of inert gas and change of pressure. Aerospace Med 43: 716‐723, 1972.
 206.Hirayanagi K, Nakabayashi K, Okonogi K and Ohiwa H. Autonomic nervous activity and stress hormones induced by hyperbaric saturation diving. Undersea Hyperb Med 30: 2003.
 207.Hjelle JO, Eatock BC, Nordahl SH and Dick AP. Doppler monitoring during 3 dives to 360 msw. In: Marroni A and Oriani G, editors. Proc EUBS 87 Diving and Hyperbaric Medicine. Palermo: European Undersea Biomedical Society, 1987, p. 357‐364.
 208.Hlastala MP, Robertson HT and Ross BK. Gas exchange abnormalities produced by venous gas emboli. Respiration Physiology 36: 1‐17, 1979.
 209.Hofso D, Ulvik RJ, Segadal K, Hope A and Thorsen E. Changes in erythropoietin and haemoglobin concentrations in response to saturation diving. Eur J Appl Physiol 95: 191‐196, 2005.
 210.Hong SK, Claybaugh JR, Frattali V, Johnson R, Kurata F, Matsuda M, McDonough AA, Paganelli CV, Smith RM and Webb P. Hana kai ii: a 17‐day dry saturation dive at 18.6 ATA. III. Body fluid balance. Undersea Biomed Res 4: 247‐265, 1977.
 211.Hooker SK, Fahlman A, Moore MJ, De Soto NA, De Quiros YB, Brubakk AO, Costa DP, Costidis AM, Dennison S, Falke KJ, Fernandez A, Ferrigno M, Fitz‐Clarke JR, Garner MM, Houser DS, Jepson PD, Ketten DR, Kvadsheim PH, Madsen PT, Pollock NW, Rotstein DS, Rowles TK, Simmons SE, Van BW, Weathersby PK, Weise MJ, Williams TM and Tyack PL. Deadly diving? Physiological and behavioural management of decompression stress in diving mammals. Proc Biol Sci 279: 1041‐1050, 2012.
 212.Hope A. Loss of body fluid during operational diving with hot water suit. In: Sippinen SA and Lein MA, editors. Proc XXIst Annual EUBS meeting on Diving and Hyperbaric Medicine. Helsinki: EUBS, 1995, 170.
 213.Hope A, Aanderud L and Aakvaag A. Dehydration and body fluid‐regulating hormones during sweating in warm (38 degrees C) fresh‐ and seawater immersion. J Appl Physiol 91: 1529‐1534, 2001.
 214.Hope A and Brekken R. A subjective evaluation of a drinking system for saturation divers. Diving Hyperb Med 40: 8‐10, 2010.
 215.Hope A, Hjelle J, Aanderud L and Aakvaag A. Time and temperature effects on body fluid loss during dives with the open hot‐water suit. Aviat Space Environ Med 76: 655‐660, 2005.
 216.Howley ET, Cox RH, Welch HG and Adams RP. Effect of hyperoxia on metabolic and catecholamine responses to prolonged exercise. J Appl Physiol 54: 59‐63, 1983.
 217.Hurshman AR and Marletta MA. Nitric oxide complexes of inducible nitric oxide synthase: spectral characterization and effect on catalytic activity. Biochem 34: 5627‐5634, 1995.
 218.Hyldegaard O. and Madsen J. Effect of air, heliox, and oxygen breathing on air bubbles in aqueous tissues in the rat. Undersea Hyperb Med 21 (4): 413‐424, 1994.
 219.Ibfelt E, Bonde JP and Hansen J. Exposure to metal welding fume particles and risk for cardiovascular disease in Denmark: a prospective cohort study. Occup Environ Med 67: 772‐777, 2010.
 220.Ikeda T, Suzuki S, Shimizu K, Okamoto Y. and Ilewellyn ME. M‐mode ultrasonic detection of microbubbles following saturation diving. A case report and proposal for a new grading system. Aviat Space Environ Med 60: 166‐169, 1989.
 221.Ikeda M, Nakabayashi K, Shinkai M, Hara Y, Kizaki T, Oh‐ishi S and Ohno H. Supplementation of antioxidants prevents oxidative stress during a deep saturation dive. Tohoku J Exp Med 203: 353‐357, 2004.
 222.International Marine Contractors Association (IMCA). Safe environment and legislation. Safety Flashes 2013, 2013. http://www.imca‐int.com/safety‐environment‐and‐legislation/safety‐flashes.aspx.
 223.Jacobsen G, Jacobsen JE, Peterson RE, McLellan JH, Brooke ST, Nome T and Brubakk AO. Decompression sickness from saturation diving: a case control study of some diving exposure characteristics. Undersea Hyperb Med 24: 73‐80, 1997.
 224.Jamieson D. Oxygen toxicity and reactive oxygen metabolites in mammals. Free Radic Biol Med 7: 87‐108, 1989.
 225.Jersey SL, Hundemer GL, Stuart RP, West KN, Michaelson RS and Pilmanis AA. Neurological altitude decompression sickness among U‐2 pilots: 2002‐2009. Aviat Space Environ Med 82: 673‐682, 2011.
 226.Kajimura M, Fukuda R, Bateman RM, Yamamoto T and Suematsu M. Interactions of multiple gas‐transducing systems: hallmarks and uncertainties of CO, NO, and H2S gas biology. Antioxid Redox Signal 13: 157‐192, 2010.
 227.Kakitsuba N. Thermal problems in hyperbaric environments. Global Environmental Research 13: 27‐33, 2009.
 228.Kaplan HP. Hematologic effects of increased oxygen tensions. Aerosp Med 38: 676‐685, 1967.
 229.Keatinge WR, Hayward MG and McIver NK. Hypothermia during saturation diving in the North Sea. Br Med J 280: 291, 1980.
 230.Keller H and Bühlmann AA. Deep diving and short decompression by breathing mixed gases. J Appl Physiol 20: 1267‐1270, 1965.
 231.Kety SS and Schmidt CF. The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27: 484‐492, 1948.
 232.Kiemer AK and Vollmar AM. Induction of L‐arginine transport is inhibited by atrial natriuretic peptide: a peptide hormone as a novel regulator of inducible nitric‐oxide synthase substrate availability. Mol Pharmacol 60: 421‐426, 2001.
 233.Kojda G and Hambrecht R. Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy? Cardiovasc Res 67: 187‐197, 2005.
 234.Koppenol WH, Moreno JJ, Pryor WA, Ischiropoulos H and Beckman JS. Peroxynitrite, a cloaked oxidant formed by nitric oxide and superoxide. Chem Res Toxicol 5: 834‐842, 1992.
 235.Korkmaz A, Oter S, Deveci S, Ozgurtas T, Topal T, Sadir S and Bilgic H. Involvement of nitric oxide and hyperbaric oxygen in the pathogenesis of cyclophosphamide induced hemorrhagic cystitis in rats. J Urol 170: 2498‐2502, 2003.
 236.Krog J, Tonnesen EK, Jepsen CF, Parner E, Segadal K, Hope A, Ulvik RJ and Hokland ME. Natural killer cells as biomarkers of hyperbaric stress during a dry heliox saturation dive. Aviat Space Environ Med 81: 467‐474, 2010.
 237.Lambertsen CJ. Effects of hyperoxia on organs and their tissues. Robin E, editor. New York: Marcel Dekker Inc., 1978.
 238.Lambertsen CJ. Effects of oxygen at high pressure. In: Fenn WO and Rahn H, editors. Handbook of Physiology Section 3: Respiration, II. Washington DC: American Physiological Society, 1965.
 239.Lang MA. Diving in extreme environments. In: The Scientific Diving Experience. Doctor Philosophiae Thesis no. 564. Trondheim, Norway: NTNU, 2013, 206 pp.
 240.Lang RE, Ruskoaho H, Toth M, Ganten D, Unger T and Dietz R. Mechanisms controlling release of atrial natriuretic peptide. In: Mulrow PJ, Schrier RW, editors. Atrial Hormones and Other Natriuretic Factors. Bethesda, MD: American Physiological Society, 1987.
 241.Lanphier E. Use of nitrogen‐oxygen mixtures in diving. Washington DC: Natl. Acad. Sci. Natl. Res. Council Publication No. 377, 1955.
 242.Lanphier E and Camporesi E. Respiration and exercise. London: Bailliere Tindall, 1982.
 243.Larkin EC, Adams JD, Williams WT and Duncan DM. Hematologic responses to hypobaric hyperoxia. Am J Physiol 223: 431‐437, 1972.
 244.Leach CS, Alexander WC, Fischer CL, Lambertsen CJ and Johnson PC. Endocrine studies during a 14‐day continuous exposure to 5.2 per cent O2 in N2 at pressure equivalent to 100 FSW (4 ATA). Aerosp Med 44: 855‐859, 1973.
 245.Lecompte S, Szabo de EF, Goumidi L, Maiani G, Moschonis G, Widhalm K, Molnar D, Kafatos A, Spinneker A, Breidenassel C, Dallongeville J, Meirhaeghe A and Borel P. Polymorphisms in the CD36/FAT gene are associated with plasma vitamin E concentrations in humans. Am J Clin Nutr 93: 644‐651, 2011.
 246.Lehnigk B, Jorres RA, Elliott DH, Holthaus J and Magnussen H. Effects of a single saturation dive on lung function and exercise performance. Int Arch Occup Environ Health 69: 201‐208, 1997.
 247.Lillo RS, Flynn ET and Homer LD. Decompression outcome following saturation dives with multiple inert gases in rats. J Appl Physiol 59: 1503‐1514, 1985.
 248.Lin CS, Lin G, Xin ZC and Lue TF. Expression, distribution and regulation of phosphodiesterase 5. Curr Pharm Des 12: 3439‐3457, 2006.
 249.Lin YC, Shiraki K, Takeuchi H and Mohri M. Cardiovascular deconditioning occurs during a 7‐day saturation dive at 31 ATA. Aviat Space Environ Med 66: 656‐660, 1995.
 250.Lind L, Fors N, Hall J, Marttala K and Stenborg A. A comparison of three different methods to evaluate endothelium‐dependent vasodilation in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Arterioscler Thromb Vasc Biol 25: 2368‐2375, 2005.
 251.Little HJ. How has molecular pharmacology contributed to our understanding of the mechanism(s) of general anesthesia? Pharmacol Ther 69: 37‐58, 1996.
 252.Liu J, Laster MJ, Taheri S, Eger EI, Koblin DD and Halsey MJ. Is there a cutoff in anesthetic potency for the normal alkanes? Anesth Analg 77: 12‐18, 1993.
 253.Loetscher PD, Rossaint J, Rossaint R, Weis J, Fries M, Fahlenkamp A, Ryang YM, Grottke O and Coburn M. Argon: neuroprotection in in vitro models of cerebral ischemia and traumatic brain injury. Crit Care 13: R206, 2009.
 254.Lossius P, Anderson PA, Holand B, Høylund AP, and Nikolaysen G. Pioneerdykkere i Nordsjøen. Norway: Norges offentlige Utredninger, 2003, p. 5.
 255.Lucchinetti E, Wacker J, Maurer C, Keel M, Harter L, Zaugg K and Zaugg M. Helium breathing provides modest antiinflammatory, but no endothelial protection against ischemia‐reperfusion injury in humans in vivo. Anesth Analg 109: 101‐108, 2009.
 256.Lundberg JO, Carlstrom M, Larsen FJ and Weitzberg E. Roles of dietary inorganic nitrate in cardiovascular health and disease. Cardiovasc Res 89: 525‐532, 2011.
 257.Lyne AJ. Ocular effects of hyperbaric oxygen. Trans Ophthalmol Soc U K 98: 66‐68, 1978.
 258.Ma D, Lim T, Xu J, Tang H, Wan Y, Zhao H, Hossain M, Maxwell PH and Maze M. Xenon preconditioning protects against renal ischemic‐reperfusion injury via HIF‐1alpha activation. J Am Soc Nephrol 20: 713‐720, 2009.
 259.Macdiarnid JL, Ross JAS, Talor CL, Watt SJ, Adie W, Osman LM, Godden D, and Murray AD. Co‐ordinated investigation into the possible long term effects of diving at work. Examination of the long term health impact of diving. Health and Safety Executive (HSE). HSE Research Report 230, 2004, p. 53‐56.
 260.Marabotti C, Scalzini A, Cialoni D, Passera M, L'Abbate A and Bedini R. Cardiac changes induced by immersion and breath‐hold diving in humans. J Appl Physiol 106: 293‐297, 2009.
 261.Marassio G, Prange T, David HN, Santos JS, Gabison L, Delcroix N, Abraini JH and Colloc'h N. Pressure‐response analysis of anesthetic gases xenon and nitrous oxide on urate oxidase: a crystallographic study. FASEB J 25: 2266‐2275, 2011.
 262.Marinovic J, Ljubkovic M, Obad A, Bakovic D, Breskovic T and Dujic Z. Effects of successive air and trimix dives on human cardiovascular function. Med Sci Sports Exerc 41: 2207‐2212, 2009.
 263.Marletta MA, Yoon PS, Iyengar R, Leaf CD and Wishnok JS. Macrophage oxidation of L‐arginine to nitrite and nitrate: nitric oxide is an intermediate. Biochem 27: 8706‐8712, 1988.
 264.Martino TA, Oudit GY, Herzenberg AM, Tata N, Koletar MM, Kabir GM, Belsham DD, Backx PH, Ralph MR and Sole MJ. Circadian rhythm disorganization produces profound cardiovascular and renal disease in hamsters. Am J Physiol Regul Integr Comp Physiol 294: R1675‐R1683, 2008.
 265.Matsuo H, Shinomiya N and Suzuki S. Hyperbaric stress during saturation diving induces lymphocyte subset changes and heat shock protein expression. Undersea Hyperb Med 27: 37‐41, 2000.
 266.McCarty LS and Borgert CJ. Review of the toxicity of chemical mixtures: theory, policy, and regulatory practice. Regul Toxicol Pharmacol 45: 119‐143, 2006.
 267.McCord JM and Fridovich I. The biology and pathology of oxygen radicals. Ann Intern Med 89: 139‐142, 1978.
 268.McKenzie DC, O'Hare TJ and Mayo J. The effect of sustained heavy exercise on the development of pulmonary edema in trained male cyclists. Respir Physiol Neurobiol 145: 209‐218, 2005.
 269.McNeilly JD, Heal MR, Beverland IJ, Howe A, Gibson MD, Hibbs LR, MacNee W and Donaldson K. Soluble transition metals cause the pro‐inflammatory effects of welding fumes in vitro. Toxicol Appl Pharmacol 196: 95‐107, 2004.
 270.Mekjavic B, Golden FS, Eglin M and Tipton MJ. Thermal status of saturation divers during operational dives in the North Sea. Undersea Hyperb Med 28: 149‐155, 2001.
 271.Mekjavic B, Tipton CM and Eiken O. Thernal considerations in diving. In: Brubakk AO and Neuman TS, editors. Physiology and medicine of diving. Toronto: Saunders, 2003, p. 115‐152.
 272.Mengel CE and Kann HE, Jr. Effects of in vivo hyperoxia on erythrocytes. 3. In vivo peroxidation of erythrocyte lipid. J Clin Invest 45: 1150‐1158, 1966.
 273.Mengel CE, Kann HE, Jr., Lewis AM and Horton B. Mechanisms of in vivo hemolysis induced by hyperoxia. Aerosp Med 35: 857‐860, 1964.
 274.Meziani F, Delabranche X, Asfar P and Toti F. Bench‐to‐bedside review: circulating microparticles—a new player in sepsis? Crit Care 14: 236, 2010.
 275.Mihaianu TD, Popescu O and Badiu G. A dynamic study of vanilmandelic acid elimination in the urine of divers in a dive at 21 ATA in saturation with a helium‐oxygen respiratory mixture. Rev Roum Physiol 28: 117‐122, 1991.
 276.Miller SL, Swanson DW, and Chiappone M. Multiple spatial scale assessment of coral reef and hardbottom community structures in the Florida Key Natioanal Marine Sanctuary. Proceedings of the Ninth International Coral Reef Synposium, 2000, p. 69‐74.
 277.Mio Y, Shim YH, Richards E, Bosnjak ZJ, Pagel PS and Bienengraeber M. Xenon preconditioning: the role of prosurvival signaling, mitochondrial permeability transition and bioenergetics in rats. Anesth Analg 108: 858‐866, 2009.
 278.Mitchell SJ and Doolette DJ. Selective vulnerability of the inner ear to decompression sickness in divers with right‐to‐left shunt: the role of tissue gas supersaturation. J Appl Physiol 106: 298‐301, 2009.
 279.Miyamoto N, Matsui N, Inoue I, Seo H, Nakabayashi K and Oiwa H. Hyperbaric diuresis is associated with decreased antidiuretic hormone and increased atrial natriuretic polypeptide in humans. Jpn J Physiol 41: 85‐99, 1991.
 280.Moen G, Specht K, Taxt T, Sundal E, Groning M, Thorsen E, Troland K, Irgens A and Gruner R. Cerebral diffusion and perfusion deficits in North Sea divers. Acta Radiol 51: 1050‐1058, 2010.
 281.Mollerlokken A, Berge VJ, Jorgensen A, Wisloff U and Brubakk AO. Effect of a short‐acting NO donor on bubble formation from a saturation dive in pigs. J Appl Physiol 101: 1541‐1545, 2006.
 282.Mollerlokken A, Gutvik C, Berge VJ, Jorgensen A, Loset A and Brubakk AO. Recompression during decompression and effects on bubble formation in the pig. Aviat Space Environ Med 78: 557‐560, 2007.
 283.Montgomery AB, Luce JM and Murray JF. Retrosternal pain is an early indicator of oxygen toxicity. Am Rev Respir Dis 139: 1548‐1550, 1989.
 284.Moon RE and Gorman DF. Treatment of the decompression disorders. In: Brubakk AO and Neuman TS, editors. Bennett and Elliott's Physiology and Medicine of Diving. London: Saunders, 2003, p. 600‐650.
 285.Moon RE, Camporesi E, Xuan T, Holthaus J, Mitchell PR and Watkins WD. ANP and diuresis during compression to 450 and 600 msw [abstract]. Undersea and Hyperbaric Med 14 (Suppl.): 43‐44, 1987.
 286.Morris CJ, Yang JN and Scheer FA. The impact of the circadian timing system on cardiovascular and metabolic function. Prog Brain Res 199: 337‐358, 2012.
 287.Mostefai HA, Meziani F, Mastronardi ML, Agouni A, Heymes C, Sargentini C, Asfar P, Martinez MC and Andriantsitohaina R. Circulating microparticles from patients with septic shock exert protective role in vascular function. Am J Respir Crit Care Med 178: 1148‐1155, 2008.
 288.Mulkey D, Henderson III R, Olson J, Putnam R and Dean J. Oxygen measurements in brain stem slices exposed to normobaric hyperoxia and hyperbaric oxygen. J Appl Physiol 90: 1887‐1899, 2001.
 289.Murray B. Hydration and physical performance. J Am Coll Nutr 26: 542S‐548S, 2007.
 290.Nagashima H, Matsumoto K, Seo Y, Mohri M, Naraki N and Matsuoka S. Sleep patterns during 30‐m nitrox saturation dives and in a confined atmospheric environment. Psychiatry Clin Neurosci 56: 267‐268, 2002.
 291.Neidig A, Yeung AT, Rosay T, Tettmann B, Strempel N, Rueger M, Lesouhaitier O and Overhage J. TypA is involved in virulence, antimicrobial resistance and biofilm formation in Pseudomonas aeruginosa. BMC Microbiol 13: 77, 2013.
 292.Nichols CW and Lambertsen C. Effects of high oxygen pressures on the eye. N Engl J Med 281: 25‐30, 1969.
 293.Nichols CW, Lambertsen CJ, and Clark JM. Transient Unilateral loss of vision associated with oxygen at high pressure. Arch of Ophthalmology 81 (April): 548‐552, 1969.
 294.Nishi RY. Heat excahnge between man and his environment. In: Nakayama T, editor. Thermal Physiology. Tokyo: Rijouaku‐sha, 2000, p. 33‐72.
 295.Nishi RY, Brubakk AO and Eftedal O. Bubble detection. In: Brubakk AO and Neuman TS, editors. Bennet & Elliott's The Physiology and Medicine of Diving. London: Saunders, 2003, p. 501‐529.
 296.Noell WK. Metabolic injuries of the visual cell. Am J Ophthalmol 40: 60‐70, 1955.
 297.Noell WK. Effects of high and low oxygen tension on the visual system. New York: Macmillan, 1962.
 298.Nolan S, Dixon R, Norman K, Hellewell PG and Ridger V. Nitric oxide regulates neutrophil migration through microparticle formation. Am J Pathol 172: 265‐273, 2008.
 299.Nossum V, Hjelde A and Brubakk AO. Small amounts of venous gas embolism cause delayed impairment of endothelial function and increase polymorphonuclear neutrophil infiltration. Eur J Appl Physiol 86: 209‐214, 2002.
 300.Nyden BB. Hydrolab: NOAA's Undersea Research Program at West Indies Laboratory. Proceedings of the Fifth International Coral Reef Symosium, 1985, p. 607‐609.
 301.Obad A, Marinovic J, Ljubkovic M, Breskovic T, Modun D, Boban M and Dujic Z. Successive deep dives impair endothelial function and enhance oxidative stress in man. Clin Physiol Funct Imaging 30: 432‐438, 2010.
 302.Obad A, Palada I, Valic Z, Ivancev V, Bakovic D, Wisloff U, Brubakk AO and Dujic Z. The effects of acute oral antioxidants on diving‐induced alterations in human cardiovascular function. J Physiol 578: 859‐870, 2007.
 303.Oei GT, Weber NC, Hollmann MW and Preckel B. Cellular effects of helium in different organs. Anesthesiology 112: 1503‐1510, 2010.
 304.Olszanski R, Radziwon P, Baj Z, Kaczmarek P, Giedrojc J, Galar M and Kloczko J. Changes in the extrinsic and intrinsic coagulation pathways in humans after decompression following saturation diving. Blood Coagul Fibrinolysis 12: 269‐274, 2001.
 305.Ormerod AD, Dwyer CM and Goodfield MJ. Novel causes of contact dermatitis from offshore oil‐based drilling muds. Contact Dermatitis 39: 262‐263, 1998.
 306.Ormerod AD, Wakeel RA, Mann TA, Main RA and Aldridge RD. Polyamine sensitization in offshore workers handling drilling muds. Contact Dermatitis 21: 326‐329, 1989.
 307.Osaka T, Yoshimatsu H, Kannan H and Yamashita H. Activity of hypothalamic neurons in conscious rats decreased by hyperbaric environment. Brain Res Bull 22: 549‐555, 1989.
 308.Oslund HG and Alexander J. Oxydative rate of sulpide in sea water, a preliminary study. J Geophys Res 68: 3995, 1963.
 309.Oury TD, Ho YS, Piantadosi CA and Crapo JD. Extracellular superoxide dismutase, nitric oxide, and central nervous system O|2 toxicity. Proc Natl Acad Sci USA 89: 9715‐9719, 1992.
 310.Padburry EH, Ronnestad I, Hope A, Knudsen G and Værnes R. Undetected hypothermia: further indications. In: Bove AA, Bacharach AJ and Greenbaum R, editors. Underwater and Hyperbaric Physiology IX. Bethesda, MD: UHMS, 1987, pp. 156, 161.
 311.Paganelli CV and Kurata FK. Diffusion of water vapor in binary and ternary gas mixtures at increased pressures. Respir Physiol 30: 15‐26, 1977.
 312.Pagel PS, Krolikowski JG, Shim YH, Venkatapuram S, Kersten JR, Weihrauch D, Warltier DC and Pratt PF, Jr. Noble gases without anesthetic properties protect myocardium against infarction by activating prosurvival signaling kinases and inhibiting mitochondrial permeability transition in vivo. Anesth Analg 105: 562‐569, 2007.
 313.Palinkas LA. Mental and cognitive performance in the cold. Int J Circumpolar Health 60: 430‐439, 2001.
 314.Palmer KT, Poole J, Ayres JG, Mann J, Burge PS and Coggon D. Exposure to metal fume and infectious pneumonia. Am J Epidemiol 157: 227‐233, 2003.
 315.Palmquist BM. Ophthalmological effects of hyperbaric oxygen therapy in the elderly. Geriatric Med Today 5: 135‐139, 1986.
 316.Pan Y, Zhang H, VanDeripe DR, Cruz‐Flores S and Panneton WM. Heliox and oxygen reduce infarct volume in a rat model of focal ischemia. Exp Neurol 205: 587‐590, 2007.
 317.Park JW, Piknova B, Huang PL, Noguchi CT and Schechter AN. Effect of blood nitrite and nitrate levels on murine platelet function. PLoS One 8: e55699, 2013.
 318.Park YS, Claybaugh JR, Shiraki K and Mohri M. Renal function in hyperbaric environment. Appl Human Sci 17: 1‐8, 1998.
 319.Pasker HG, Peeters M, Genet P, Clement J, Nemery B and Van de Woestijne KP. Short‐term ventilatory effects in workers exposed to fumes containing zinc oxide: comparison of forced oscillation technique with spirometry. Eur Respir J 10: 1523‐1529, 1997.
 320.Pella R. The protective effect of atrial natriuretic peptide (ANP) on cells damaged by oxygen radicals is mediated through elevated CGMP‐levels, reduction of calcium‐inflow and probably G‐proteins. Biochem Biophys Res Commun 174: 549‐555, 1991.
 321.Penzias W. Saturation diving systems descigne considerations. Journal of Hydronautics 2: 137‐144, 1968.
 322.Philp R. A review of blood changes associated with compression‐ decompression: relationship to decompression sickness. Undersea Biomed Res 1: 117‐150, 1974.
 323.Philp RB, Bennett PB, Andersen JC, Fields GN, McIntyre BA, Francey I and Briner W. Effects of aspirin and dipyridamole on platelet function, hematology, and blood chemistry of saturation divers. Undersea Biomed Res 6: 127‐146, 1979.
 324.Philp RB, Freeman D and Francey I. Hematology and blood chemistry in saturation diving: II. Open‐sea vs. hyperbaric chamber. Undersea Biomed Res 2: 251‐265, 1975.
 325.Poderoso J, Carreras M, Lisdero C, Riobo N, Schopfer F and Boveris A. Nitric oxide inhibits electron transfer and increases superoxide radical production in rat heart mitochondria and submitochondrial patricles. Arch Biochem Biophys 328: 85‐92, 1996.
 326.Poderoso J, Lisdero C, Schopfer F, Riobo N, Carreras M, Cadenas E and Boveris A. The regulation of mitochondrial oxygen uptake by redox reactions involving nitric oxide and ubiquinol. J Biol Chem 274: 37709‐37716, 1999.
 327.Poderoso JJ, Peralta JG, Lisdero CL, Carreras MC, Radisic M, Schopfer F, Cadenas E and Boveris A. Nitric oxide regulates oxygen uptake and hydrogen peroxide release by the isolated beating rat heart. Am J Physiol (Cell Physiol) 274: C112‐C119, 1998.
 328.Pol B and Watelle TJJ. Memoire sur les effets de la compression de l'air appliquee au creusement des puits a huille. Ann D'hygiene Publique et des Medicine Legale 1: 241‐279, 1854.
 329.Polte T, Hemmerle A, Berndt G, Grosser N, Abate A and Schroder H. Atrial natriuretic peptide reduces cyclosporin toxicity in renal cells: role of cGMP and heme oxygenase‐1. Free Radic Biol Med 32: 56‐63, 2002.
 330.Ramlackhansingh AF, Brooks DJ, Greenwood RJ, Bose SK, Turkheimer FE, Kinnunen KM, Gentleman S, Heckemann RA, Gunanayagam K, Gelosa G and Sharp DJ. Inflammation after trauma: microglial activation and traumatic brain injury. Ann Neurol 70: 374‐383, 2011.
 331.Rautou PE, Vion AC, Amabile N, Chironi G, Simon A, Tedgui A and Boulanger CM. Microparticles, vascular function, and atherothrombosis. Circ Res 109: 593‐606, 2011.
 332.Raymond LW, Raymond NS, Frattali VP, Sode J, Leach CS and Spaur WH. Is the weight loss of hyperbaric habitation a disorder of osmoregulation? Aviat Space Environ Med 51: 397‐401, 1980.
 333.Reed JW, Elliott C and Thorsen E. Increased lung compliance in response to a moderate hyperoxic exposure. Undersea Hyperb Med 28: 19‐23, 2001.
 334.Reid KJ, McGee‐Koch LL and Zee PC. Cognition in circadian rhythm sleep disorders. Prog Brain Res 190: 3‐20, 2011.
 335.Reivich M. Regulation of the cerebral circulation. Clin Neurosurg 16: 378‐418, 1969.
 336.Resnick JS, Brown DM and Vernier RL. Oxygen toxicity in fetal organ culture. I. The developing kidney. Lab Invest 28: 437‐445, 1973.
 337.Rice L and Alfey CP. Modulation of red cell mass by neocytolysis in space and on Earth. Pflugers Arch 441 (Suppl 2‐3): 2000.
 338.Rico DM, Svendsen FJ, Huffer C, Smith M, Pierce R, Winters CJ and Vesely DL. Release of atrial natriuretic factor with increasing absolute atmospheres of pressure in a hyperbaric chamber and reversal with oxygen therapy. J Medicine 20: 337‐344, 1989.
 339.Ridgway SH and Howard R. Dolphins and the bends. Science 216: 651, 1982.
 340.Risberg J. Forbedret Overflateorientert Dykking. Bergen, Norway: Norsk Undervannsinstitutt (NUI), 1994, p. 1‐68.
 341.Ronnestad I, Thorsen E, Segadal K and Hope A. Bronchial response to breathing dry gas at 3.7 MPa ambient pressure. Eur J Appl Physiol Occup Physiol 69: 32‐35, 1994.
 342.Rosenberg E, Shibata HR and MacLean LD. Blood gas and neurological responses to inhalation of oxygen at 3 atmospheres. Proc Soc Exp Biol Med 122 (2): 313‐317, 1966.
 343.Ross JAS. Diving or commuting. Div Hyperb Med 39: 107‐108, 2009.
 344.Ross JAS, Macdiarmid JI, Dick FD and Watt SJ. Hearing symptoms and audiometry in professional divers and offshore workers. Occup Med (Lond) 60: 36‐42, 2010.
 345.Ross JAS, Macdiarmid JI, Semple S, Watt SJ, Moir G and Henderson G. Cognitive symptoms and welding fume exposure. Ann Occup Hyg 57: 26‐33, 2013.
 346.Ross JAS, Semple S, Duffin R, Kelly F, Feldmann J, and Raab A. Characterisation of fumes from hyperbaric welding operations. J Phys; Conf Ser. 151012042, 2009.
 347.Rouch I, Wild P, Ansiau D and Marquie JC. Shiftwork experience, age and cognitive performance. Ergonomics 48: 1282‐1293, 2005.
 348.Rump AF, Siekmann U and Kalff G. Effects of hyperbaric and hyperoxic conditions on the disposition of drugs: theoretical considerations and a review of the literature. Gen Pharmacol 32: 127‐133, 1999.
 349.Russell KS, Haynes MP, Caulin‐Glaser T, Rosneck J, Sessa WC and Bender JR. Estrogen stimulates heat shock protein 90 binding to endothelial nitric oxide synthase in human vascular endothelial. J Biol Chem 275: 5026‐5030, 2000.
 350.Ryzhova TI, Ganenko SI, Povazhenko AA and Sukhapovskaia NS. [Effect of hyperbaric factors on the biochemical and hematological indicators in rats (in vivo) and in humans (in vitro)]. Fiziol Zh 37: 76‐82, 1991.
 351.Sagawa BK. Overall Circulatory Regulation. Seegers, 1996.
 352.Sagawa S, Claybaugh JR, Shiraki K, Park YS, Mohri M and Hong SK. Characteristics of increased urine flow during a dry saturation dive at 31 ATA. Undersea Biomed Res 17: 13‐22, 1990.
 353.Salzano J, Bell W, Weglicki W and Saltzman H. Metabolic Respiratory and Hemodynamic Responses to Exercise at Increased Oxygen Pressure. Baltimore: Williams and Wilkins, 1967.
 354.Sartori C, Allemann Y and Scherrer U. Pathogenesis of pulmonary edema: learning from high‐altitude pulmonary edema. Respir Physiol Neurobiol 159: 338‐349, 2007.
 355.Sato T, Takeda Y, Hagioka S, Zhang S and Hirakawa M. Changes in nitric oxide production and cerebral blood flow before development of hyperbaric oxygen‐induced seizures in rats. Brain Res 918: 131‐190, 2001.
 356.Schaffner F and Felig P. Changes in hepatic structure in rats produced by breathing pure oxygen. J Cell Biol 27: 505‐517, 1965.
 357.Schaffner F, Roberts DK, Ginn FL and Ulvedal F. Electron microscopy of monkey liver after exposure of animals to pure oxygen atmosphere. Proc Soc Exp Biol Med 121: 1200‐1203, 1966.
 358.Schmetterer L, Findl O, Strenn K, Graselli U, Kastner J, Eichler HG and Wolzt M. Role of NO in the O2 and CO2 responsiveness of cerebral and ocular circulation in humans. Am J Physiol 273: R2005‐2012, 1997.
 359.Schmidt T. Thermal considerations of survival in emergency hyperbaric situations. 24th Undersea Medical Society Workshop. Bethesda, MD: Undersea Medical Society, 1981.
 360.Schocket SS, Esterson J, Bradford B, Michaelis M and Richards RD. Induction of cataracts in mice by exposure to oxygen. Isr J Med Sci 8: 1596‐1601, 1972.
 361.Schwiebert C, Huhn R, Heinen A, Weber NC, Hollmann MW, Schlack W and Preckel B. Postconditioning by xenon and hypothermia in the rat heart in vivo. Eur J Anaesthesiol 27: 734‐739, 2010.
 362.Sebens KP, Bernardi G, Patterson MR, and Burkepile D. Saturation diving and underwater laboratories: How underwater technology has aided research in coral biology and reed ecology. In: Lang MA, Marinelli RL, Roberts S, and Taylor PR, editors. Research and Discovery: The Revolution of Science through Scuba. Washington DC: Smithsonian Institution, 2013, p. x‐xx. 39 (Contrib. Marine Sci.)
 363.Shearer AJ, Ross JA and Manson HJ. Althesin, ketamine and methohexitone at pressure—duration of action of a single IV dose. Br J Anaesth 53: 455‐461, 1981.
 364.Shepard AN, Dinsmore DA, Miller SL, Cooper CB, and Wicklund RI. Aquarius undersea laboratory: the next generation. In: Lang MA and Baldwin CC, editors. Methods and Techniques of Underwater Research. Washington DC: Smithsonian Institution, 1996 p. 205‐212.
 365.Shibayama M, Yamami N, Sera AM, Nakayama T and Mano Y. [Saturation diving system at high altitude]. Ann Physiol Anthropol 13: 411‐419, 1994.
 366.Shields TG, Duff PM, Lee WB, and Wilcock SE. Decompression sickness from commercial offshore air‐diving operations on the UK continental shelf during 1982 to 1986. OT 0‐89‐029. Aberdeen, UK: Robert Gordon's Institute of Technology, 1989.
 367.Shimamiya T, Terada N, Wakabayashi S and Mohri M. Effects of 30‐m nitrox saturation dive on the immune system in man. Undersea Hyperb Med 33: 63‐68, 2006.
 368.Shimbo D, Grahame‐Clarke C, Miyake Y, Rodriguez C, Sciacca R, Di TM, Boden‐Albala B, Sacco R and Homma S. The association between endothelial dysfunction and cardiovascular outcomes in a population‐based multi‐ethnic cohort. Atherosclerosis 192: 197‐203, 2007.
 369.Shinomiya N, Suzuki S, Hashimoto A and Oiwa H. Effects of deep saturation diving on the lymphocyte subsets of healthy divers. Undersea Hyperb Med 21: 277‐286, 1994.
 370.Shiraki K, Hong SK, Park YS, Sagawa S, Konda N, Claybaugh JR, Takeuchi H, Matsui N and Nakayama H. Seadragon VI: a 7‐day dry saturation dive at 31 ATA. II. Characteristics of diuresis and nocturia. Undersea Biomed Res 14: 387‐400, 1987.
 371.Smith SM, Davis‐Street JE, Fesperman JV, Smith MD, Rice BL and Zwart SR. Nutritional status changes in humans during a 14‐day saturation dive: the NASA Extreme Environment Mission Operations V project. J Nutr 134: 1765‐1771, 2004.
 372.Soegaard LB, Hansen MN, van EC, Brahm J and Jensen FB. Respiratory properties of blood in the harbor porpoise, Phocoena phocoena. J Exp Biol 215: 1938‐1943, 2012.
 373.Spitzer RL, Terman M, Williams JB, Terman JS, Malt UF, Singer F and Lewy AJ. Jet lag: clinical features, validation of a new syndrome‐specific scale, and lack of response to melatonin in a randomized, double‐blind trial. Am J Psychiatry 156: 1392‐1396, 1999.
 374.Spurgeon A. Watching paint dry: organic solvent syndrome in late‐twentieth‐century Britain. Med Hist 50: 167‐188, 2006.
 375.Stadie W, Riggs B and Haugaard N. Oxygen poisoning: III. The effect of high oxygen pressures upon the metabolism of brain. J Biol Chem 160: 191‐208, 1945.
 376.Stadie W, Riggs B and Haugaard N. Oxygen poisoning: IV. The effect of high oxygen pressures upon the metabolism of liver, kidney, lung and muscle tissue. J Biol Chem 160: 1945.
 377.Steele RM, Brage S, Corder K, Wareham NJ and Ekelund U. Physical activity, cardiorespiratory fitness, and the metabolic syndrome in youth. J Appl Physiol 105: 342‐351, 2008.
 378.Sterk W and Schrier LM. Effects of intermittant exposure tohyperoxia in operational diving. Ornhagen H. FAO Report C50021‐Hi, 123‐131. Stockholm, National Research Defense Institute, 1985.
 379.Stevens W, Clark J, Gelfand R and Lambertsen C. Interacting effects of 2 ATA inspired PO2 and exercise on pulmonary ventilation and arterial PCO2. Undersea Biomed Res 17: 164‐165, 1990.
 380.Sun Z. Genetic AVP deficiency abolishes cold‐induced diuresis but does not attenuate cold‐induced hypertension. Am J Physiol Renal Physiol 290: F1472‐F1477, 2006.
 381.Suvorava T and Kojda G. Prevention of transient endothelial dysfunction in acute exercise: a friendly fire? Thromb Haemost 97: 331‐333, 2007.
 382.Suwazono Y, Dochi M, Sakata K, Okubo Y, Oishi M, Tanaka K, Kobayashi E, Kido T and Nogawa K. A longitudinal study on the effect of shift work on weight gain in male Japanese workers. Obesity (Silver Spring) 16: 1887‐1893, 2008.
 383.Suzuki S. Probable lung injury by long‐term exposure to oxygen close to 50 kilopascals. Undersea Hyperb Med 21: 235‐243, 1994.
 384.Suzuki S, Ikeda T and Hashimoto A. Decrease in the single‐breath diffusing capacity after saturation dives. Undersea Biomed Res 18: 103‐109, 1991.
 385.Takaoka A and Taniguchi T. Cytosolic DNA recognition for triggering innate immune responses. Adv Drug Deliv Rev 60: 847‐857, 2008.
 386.Tao HY, Chen HJ, Zhang H, Guo J and Rong FK. Urinary ANP, ADH, and electrolyte excretion during saturation‐excursion diving to pressures equivalent to 250 and 300 m. Undersea Biomed Res 19: 1992.
 387.Thalmann ED. Principles of U.S. Navy recompression treatments for decompression sickness. In: Moon RE and Sheffield P, editors. Treatment of decompression sickness. Bethesda, MD: UHMS, 1996, p. 75‐95.
 388.Thom SR. Inert gas enhancement of superoxide radical production. Arch Biochem Biophys 295: 391‐396, 1992.
 389.Thom SR, Bhopale V, Fisher D, Manevich Y, Huang PL and Buerk DG. Stimulation of nitric oxide synthase in cerebral cortex due to elevated partial pressures of oxygen: an oxidative stress response. J Neurobiol 51: 85‐100, 2002.
 390.Thom SR and Buerk DG. Nitric oxide synthesis in brain is stimulated by oxygen. Adv Exp Med Biol 510: 133‐137, 2003.
 391.Thom SR, Fisher D, Zhang J, Bhopale VM, Ohnishi ST, Kotake Y, Ohnishi T and Buerk DG. Stimulation of perivascular nitric oxide synthesis by oxygen. Am J Physiol Heart Circ Physiol 284: H1230‐H1239, 2003.
 392.Thom SR, Milovanova TN, Bogush M, Bhopale VM, Yang M, Bushmann K, Pollock NW, Ljubkovic M, Denoble P and Dujic Z. Microparticle production, neutrophil activation, and intravascular bubbles following open‐water SCUBA diving. J Appl Physiol 112: 1268‐1278, 2012.
 393.Thom SR, Yang M, Bhopale VM, Huang S and Milovanova TN. Microparticles initiate decompression‐induced neutrophil activation and subsequent vascular injuries. J Appl Physiol 110: 340‐351, 2011.
 394.Thorsen E, Hjelle J, Segadal K and Gulsvik A. Exercise tolerance and pulmonary gas exchange after deep saturation dives. J Appl Physiol 68: 1809‐1814, 1990.
 395.Thorsen E, Segadal K and Kambestad BK. Mechanisms of reduced pulmonary function after a saturation dive. J Eur Respir 7: 4‐10, 1994.
 396.Thorsen E, Segadal K, Kambestad BK and Gulsvik A. Divers' lung function: small airways disease? Brit J of Industrial Medicine 47: 519‐523, 1990.
 397.Thorsen E, Segadal K, Stuhr LE, Troland K, Gronning M, Marstein S and Hope A. No changes in lung function after a saturation dive to 2.5 MPa with intermittent reduction in Po2 during decompression. Eur J Appl Physiol 98: 270‐275, 2006.
 398.Tiktinsky MH and Morin FC, III. Increasing oxygen tension dilates fetal pulmonary circulation via endothelium‐derived relaxing factor. Am J Physiol 265: H376‐H380, H376‐H380, 1993.
 399.Todnem K, Nyland H, Skeidsvoll H, Svihus R, Rinck P, Kambestad BK, Riise T and Aarli JA. Neurological long term consequences of deep diving. Br J Ind Med 48: 258‐266, 1991.
 400.Todnem K, Nyland HK, Kambestad BK and Aarli JA. Influence of occupational diving upon the nervous system. Br J Ind Med 47: 708‐714, 1990.
 401.Torii R, Sagawa S, Wada F, Nagaya K, Endo Y, Yamazaki F, Nakamura T, Claybaugh JR and Shiraki K. Mechanism for changes in vasopressin during acute exposure at 3 atm abs air. Am J Physiol 273: 1997.
 402.Torok Z. Diving; occupation or physiologic experiment? Journal of the Royal Society of Medicine 89: 72‐73, 1989.
 403.Troland, K, Grønning M, Sundal E, and Thorsenj E. Life‐threatening events experienced by retired North Sea divers. Proceedings EUBS 2004. European Undersea & Baromedical Society, 2004.
 404.Tucker KL, Rich S, Rosenberg I, Jacques P, Dallal G, Wilson PW and Selhub J. Plasma vitamin B‐12 concentrations relate to intake source in the Framingham Offspring study. Am J Clin Nutr 71: 514‐522, 2000.
 405.Uppu RM, Squadrito GL and Pryor WA. Acceleration of peroxynitrite oxidations by carbon dioxide. Arch Biochem Biophys 327: 1996.
 406.U.S. Department of Health and Human Services. A toxicological profile for total petrochemical hydrocarbons (TPH). 1999. http://www.atsdr.cdc.gov/toxprofiles/tp.asp?id=424&tid=75#bookmark02.
 407.Vaernes, R, Paashe A, Segadal K, Lindrup A, and Eines L. Working in water for 4 hours at 350 msw on heliox: an analysis of diver performance as a function of HPNS, body temperature, lockout time, and number of lockouts. Abstract UHMS, Annual Scientific meeting 1984. Bethesda, MD: Undersea Hyperbaric Medical Society, 1984.
 408.Valic Z, Palada I and Dujic Z. Short‐acting NO donor and decompression sickness in humans. J Appl Physiol 102: 1541‐1545, 2007.
 409.Van Noort JM. Toll‐like receptors as targets for inflammation, development and repair in the central nervous system. Curr Opin Investig Drugs 8: 60‐65, 2007.
 410.Van Ooij PJ, Van Hulst RA, Houtkooper A and Sterk PJ. Differences in spirometry and diffusing capacity after a 3‐h wet or dry oxygen dive with a PO(2) of 150 kPa. Clin Physiol Funct Imaging 31: 405‐410, 2011.
 411.Van VE, Van TC, Akila R, Nilson LN, Bast‐Pettersen R, Sainio M, Van DF, Van der Laan G, Verberk M and Wekking E. Chronic solvent‐induced encephalopathy: European consensus of neuropsychological characteristics, assessment, and guidelines for diagnostics. Neurotoxicology 33: 710‐726, 2012.
 412.VanDeripe DR. The swelling of mitochondria from nitrogen gas; a possible cause of reperfusion damage. Med Hypotheses 62: 294‐296, 2004.
 413.Vanhatalo A, Fulford J, Bailey SJ, Blackwell JR, Winyard PG and Jones AM. Dietary nitrate reduces muscle metabolic perturbation and improves exercise tolerance in hypoxia. J Physiol 589: 5517‐5528, 2011.
 414.Vann RD. Decompression from saturation dives. 1‐14. 1984. Durham, Third Annual Conadian Ocean Technology Congress. 22‐3‐1984.
 415.Vann RD, Butler FK, Mitchell SJ and Moon RE. Decompression illness. Lancet 377: 153‐164, 2011.
 416.Voultsios A, Kennaway DJ and Dawson D. Salivary melatonin as a circadian phase marker: validation and comparison to plasma melatonin. J Biol Rhythms 12: 457‐466, 1997.
 417.Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, Janszky I, Mrkobrada M, Parraga G and Hackam DG. Shift work and vascular events: systematic review and meta‐analysis. BMJ 345: e4800, 2012.
 418.Vyskocil A, Truchon G, Leroux T, Lemay F, Gendron M, Gagnon F, Majidi NE, Boudjerida A, Lim S, Emond C and Viau C. A weight of evidence approach for the assessment of the ototoxic potential of industrial chemicals. Toxicol Ind Health 28: 796‐819, 2012.
 419.Waage S, Moen BE, Pallesen S, Eriksen HR, Ursin H, Akerstedt T and Bjorvatn B. Shift work disorder among oil rig workers in the North Sea. Sleep 32: 558‐565, 2009.
 420.Wang JG, Williams JC, Davis BK, Jacobson K, Doerschuk CM, Ting JP and Mackman N. Monocytic microparticles activate endothelial cells in an IL‐1beta‐dependent manner. Blood 118: 2366‐2374, 2011.
 421.Warner SA. Diving accidents—North Sea oil and gas industry 1971‐1975. South Pacific Underwater Medicine Society (SPUMS) 7(2): 19‐23, 1977.
 422.Waterhouse J, Reilly T, Atkinson G and Edwards B. Jet lag: trends and coping strategies. Lancet 369: 1117‐1129, 2007.
 423.Wild CP. Complementing the genome with an “exposome”: the outstanding challenge of environmental exposure measurement in molecular epidemiology. Cancer Epidemiol Biomarkers Prev 14: 1847‐1850, 2005.
 424.Willis MS and Patterson C. Proteotoxicity and cardiac dysfunction—Alzheimer's disease of the heart? N Engl J Med 368: 455‐464, 2013.
 425.Wisloff U, Ellingsen O and Kemi OJ. High‐intensity interval training to maximize cardiac benefits of exercise training? Exerc Sport Sci Rev 37: 139‐146, 2009.
 426.Wisloff U, Richardson RS and Brubakk AO. Exercise and nitric oxide prevent bubble formation: a novel approach to the prevention of decompression sickness? J Physiol 555: 825‐829, 2004.
 427.Wisloff U, Richardson RS and Brubakk AO. NOS inhibition increases bubble formation and reduces survival in sedentary but not exercised rats. J Physiol 546: 577‐582, 2003.
 428.Wissler EH. An analysis of factors leading to hyperthermia in hyperbaric environments. Abstract UHMS. Undersea & Hyperbaric Medical Society, 1977.
 429.World Health Organization (WHO). Systematic Review of Health Aspects of Air Pollution in Europe. 2004. http://www.euro.who.int/document/E83080.pdf.
 430.World Health Organization. Exposure to Benzene; A Major Public Health Concern. 2010.
 431.World Health Organization International Agency for Research on Cancer. Painting, Firefighting, and Shiftwork. IRC Monographs on the Evaluation of Carcinogenic Risks to Humans 98: 561‐764, 2010.
 432.Yamaguchi H, Mohri M and Shiraki K. Evaluation of cutaneous insensible water loss during hyperbaric exposure in humans. Aviat Space Environ Med 70: 990‐995, 1999.
 433.Yang M, Milovanova TN, Bogush M, Uzun G, Bhopale VM and Thom SR. Microparticle enlargement and altered surface proteins after air decompression are associated with inflammatory vascular injuries. J Appl Physiol 112: 204‐211, 2012.
 434.Yarbrough I, Welham W, Brinton E and Behnke AR. Symptoms of oxygen poisoning and limits of tolerance at rest and at work. US Naval Experimental Diving Unit Proj X‐337 Sub. No 62: 1947.
 435.Young J. Acute Oxygen Toxicity in Working Man. New York: Academic Press, 1971.
 436.Zal'tsman G, Zinov'eva I and Kumanichkin S. Increased Individual Predisposition of a Subject to the Effect of High Partial Oxygen Pressure. Washington DC: Israel Program for Scientific Translations, NASA TT F‐358, TT 65‐50136, 1965.
 437.Zwart SR, Jessup JM, Ji J and Smith SM. Saturation diving alters folate status and biomarkers of DNA damage and repair. PLoS One 7: e31058, 2012.
 438.Zwart SR, Kala G and Smith SM. Body iron stores and oxidative damage in humans increased during and after a 10‐ to 12‐day undersea dive. J Nutr 139: 90‐95, 2009.

Further Reading

Brubakk AO and Neuman TS (eds). The physiology and medicine of diving 5th edition, Saunders, Edinburgh 2003.

Brubakk AO, Eftedal OS, Wisloff U. Endothelium and diving. In: Endothelial Biomedicine. Aird WC (ed). Cambridge University Press Cambridge 2007, pp. 497-505.


Wisloff U, Haram GM, Brubakk AO. Exercise and the endothelium. In: Endothelial Biomedicine. Aird WC (ed). Cambridge University Press Cambridge 2007, pp. 506-515.


Brubakk AO, Flook V, Vik A. Gas bubbles and the lungs. In: Lundgren CEG, Miller JN (eds) The lung at depth. Marchel Dekker New York 1999, pp 236-294.


Contact Editor

Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite

Alf O. Brubakk, John A.S. Ross, Stephen R. Thom. Saturation Diving; Physiology and Pathophysiology. Compr Physiol 2014, 4: 1229-1272. doi: 10.1002/cphy.c130048