Inner ear decompression sickness (IEDCS) is an uncommon diving-related injury affecting the vestibulocochlear system, with symptoms typically including vertigo, tinnitus, and hearing loss, either in isolation or combination. Classically associated with deep, mixed-gas diving, more recent case series have shown that IEDCS is indeed possible after seemingly innocuous recreational dives, and there has been one previous report of IEDCS following routine hyperbaric chamber operations. The presence of right-to-left shunt (RLS), dehydration, and increases in intrathoracic pressure have been identified as risk factors for IEDCS, and previous studies have shown a predominance of vestibular rather than cochlear symptoms, with a preference for lateralization to the right side. Most importantly, rapid identification and initiation of recompression treatment are critical to preventing long-term or permanent inner ear deficits. This case of a U.S. Navy (USN) diver with previously unidentified RLS reemphasizes the potential for IEDCS following uncomplicated diving and recompression chamber operations - only the second reported instance of the latter.

A widely accepted belief is that Nathaniel Henshaw was the first practitioner of hyperbaric medicine. He is said to have constructed the first hyperbaric chamber where he treated several disorders and provided opportunities to prevent disease and optimize well-being. While there is little doubt Henshaw was the first to conceptualize this unique medical technology, careful analysis of his treatise has convinced this writer that his was nothing more than a proposal. Henshaw\'s air chamber was never built. He would have failed to appreciate how its structural integrity could be maintained in the presence of enormous forces generated by envisioned changes in its internal pressure and, likewise, how its door could effectively seal the chamber during hypo-and hyperbaric use. Henshaw would have also failed to appreciate the limitations of his two proposed measuring devices and the toxic nature of one. Neither of these would have provided any quantitative information. The impracticality of his proposed method of compressing and decompressing the chamber is readily apparent. So, too, the likely toxic accumulation of carbon dioxide within the unventilated chamber during lengthy laborious periods required to operate it. Henshaw recommended pressures up to three times atmospheric pressure and durations for acute conditions until their resolution. Such exposures would likely result in fatal decompression sickness upon eventual chamber ascent, a condition of which nothing was known at the time. It would be another 170 years before a functional air chamber would finally become a reality. Henshaw\'s legacy, then, is limited to the concept of hyperbaric medicine rather than being its first practitioner.

BACKGROUND: The fluctuation in concentrations of airborne allergens frequently presents a challenge to assessing the efficacy of allergen immunotherapy (AIT) in \'field\' studies. Allergen exposure chambers (AECs) are specialized medical installations developed to expose individuals to allergens at defined and consistent concentrations under a controlled environment. The aim of the study was to validate the provocation test with timothy grass pollen as well as to assess its safety in the AEC in patients with allergic rhinitis.
METHODS: In the ALLEC® AEC, varying concentrations of timothy grass pollen were dispersed. Allergic symptoms were measured by total nasal symptom score (TNSS), acoustic rhinometry, peak nasal inspiratory flow (PNIF) and nasal discharge volume. Lung function, assessed through peak expiratory flow rate (PEFR) and forced expiratory volume in the first second (FEV1), was used to evaluate safety.
RESULTS: The consistency of the test was proved by the stability of environmental conditions, including temperature, humidity and CO2 levels, as well as constant concentrations of grass pollen at predetermined levels ranging from 1000 to 10,000 particles per cubic meter (p/m3). Allergic individuals developed symptoms at concentrations of 3000 p/m3 and above, across all measured endpoints. Lung function was not affected throughout all the challenges. The reproducibility of symptoms was confirmed throughout the tests. The concentration of 8000 p/m3 together with a challenge duration of 120 min was found to be optimal.
CONCLUSIONS: The study demonstrates that the ALLEC® grass pollen exposure chamber provides a reliable and safe method for inducing repeatable symptoms in patients with allergic rhinitis. This approach can be effectively applied for allergy diagnostics and clinical endpoint determination during AIT.

UNASSIGNED: Although decompression illness is rare for nondivers, it can happen in an environment involving rapid decompression. Recompression is the recommended treatment. We herein report a decompression illness case with cutis marmorata and osteonecrosis in both legs during pneumatic caisson work.
UNASSIGNED: A 59-year-old compressed air worker suffered sudden dyspnea during pneumatic caisson work. He had rash on his trunk and limbs. He was diagnosed with decompression illness, and hyperbaric oxygen therapy was performed twice. He had no neurological dysfunction nor sequalae on discharge, but magnetic resonance imaging follow-up revealed osteonecrosis in both legs.
UNASSIGNED: A detailed medical history should be taken when treating patients with dyspnea at work. Cutis marmorata often precedes more severe symptoms. Early introduction of hyperbaric oxygen therapy is desirable.

Background and Objectives: Vascular cell adhesion molecule-1 (VCAM-1) was identified as a cell adhesion molecule that helps to regulate inflammation-associated vascular adhesion and the transendothelial migration of leukocytes, such as macrophages and T cells. VCAM-1 is expressed by the vascular system and can be induced by reactive oxygen species, interleukin 1 beta (IL-1β) or tumor necrosis factor alpha (TNFα), which are produced by many cell types. The newest data suggest that VCAM-1 is associated with the progression of numerous immunological disorders, such as rheumatoid arthritis, asthma, transplant rejection and cancer. The aim of this study was to analyze the increase in VCAM-1 expression and the impact of exposure in a hyperbaric chamber to VCAM-1 levels in human blood serum. Materials and Methods: The study included 92 volunteers. Blood for the tests was taken in the morning, from the basilic vein of fasting individuals, in accordance with the applicable procedure for blood collection for morphological tests. In both groups of volunteers, blood was collected before and after exposure, in heparinized tubes to obtain plasma and hemolysate, and in clot tubes to obtain serum. The level of VCAM-1 was determined using the immunoenzymatic ELISA method. Results: The study showed that the difference between the distribution of VCAM-1 before and after exposure corresponding to diving at a depth of 30 m was at the limit of statistical significance in the divers group and that, in most people, VCAM-1 was higher after exposure. Diving to a greater depth had a much more pronounced impact on changes in VCAM-1 values, as the changes observed in the VCAM-1 level as a result of diving to a depth of 60 m were statistically highly significant (p = 0.0002). The study showed an increase in VCAM-1 in relation to the baseline value, which reached as much as 80%, i.e., VCAM-1 after diving was almost twice as high in some people. There were statistically significant differences between the results obtained after exposure to diving conditions at a depth of 60 m and the values measured for the non-divers group. The leukocyte level increased statistically after exposure to 60 m. In contrast, hemoglobin levels decreased in most divers after exposure to diving at a depth of 30 m (p = 0.0098). Conclusions: Exposure in the hyperbaric chamber had an effect on serum VCAM-1 in the divers group and non-divers group. There is a correlation between the tested morphological parameters and the VCAM-1 level before and after exposure in the divers group and the non-divers group. Exposure may result in activation of the endothelium.

In many physiological systems, real-time endogeneous and exogenous signals in living organisms provide critical information and interpretations of physiological functions; however, these signals or variables of interest are not directly accessible and must be estimated from noisy, measured signals. In this paper, we study an inverse problem of recovering gas exchange signals of animals placed in a flow-through respirometry chamber from measured gas concentrations. For large-scale experiments (e.g., long scans with high sampling rate) that have many uncertainties (e.g., noise in the observations or an unknown impulse response function), this is a computationally challenging inverse problem. We first describe various computational tools that can be used for respirometry reconstruction and uncertainty quantification when the impulse response function is known. Then, we address the more challenging problem where the impulse response function is not known or only partially known. We describe nonlinear optimization methods for reconstruction, where both the unknown model parameters and the unknown signal are reconstructed simultaneously. Numerical experiments show the benefits and potential impacts of these methods in respirometry.

To investigate changes at a molecular level in the mouse corneal endothelium (CE) exposed to chronic cigarette smoke (CS).
Pregnant mice (gestation days 18-20) were placed in a whole-body exposure smoking chamber, and a few days later pups were born. After 3.5 months of CS exposure, a ConfoScan4 scanning microscope was used to examine the corneal endothelial cells (CECs) of CS-exposed and control (Ct) mice. The CE was peeled under a microscope and maintained as four biological replicates (two male and two female) for CS-exposed and Ct mice; each replicate consisted of 16 CEs. The proteome of the CE was investigated through mass spectrometry.
The CE images of CS-exposed and Ct mice revealed a difference in the shape of CECs accompanied by a nearly 10% decrease in CEC density (P < 0.00003) following CS exposure. Proteome profiling identified a total of 524 proteins exhibiting statistically significant changes in CE from CS-exposed mice. Importantly, proteins associated with Descemet\'s membrane (DM), including COL4α1, COL4α2, COL4α3, COL4α4, COL4α5, COL4α6, COL8α1, COL8α2, and FN1, among others, exhibited diminished protein levels in the CE of CS-exposed mice.
Our data confirm that exposure to CS results in reduced CEC density accompanied by diminished levels of multiple collagen and extracellular matrix proteins associated with DM.

The aim of this study was to investigate whether VO2 max can be accurately measured in a respiration chamber. Thirty participants aged 23.4 ± 3.9 years with a wide range in VO2 max were included. Participants performed four incremental cycle ergometer tests (VO2 max) with a minimum of 5 days between tests. These tests consisted of one familiarization test with face mask, followed by two VO2 max tests in the respiration chamber and one test with face mask in randomized order. Oxygen consumption and CO2 production were measured continuously using Omnical (Maastricht University, the Netherlands) gas analysis system. The mean VO2 max was 3634 ± 766 ml, which resulted in mean VO2 max per lean body mass of 60.8 ± 8.0 ml/kg. Repeated respiration chamber tests showed a high concordance, and no significant differences were detected between tests (Lin\'s concordance correlation coefficient (Rc) = 0.99; ∆70 ± 302 ml/min; p = .38). There was high concordance between the mean VO2 max from both respiration chamber tests and the mean face mask tests, and no significant difference (Rc = 0.99; ∆41 ± 173 ml/min; p = .22) was observed. The Bland-Altman plots showed no proportional bias between different tests. In conclusion, the respiration chamber has been found to be a valid and reproducible method for measuring VO2 max. New research opportunities are possible in the respiration chamber, such as maximal exercise testing during 24-hour measurements.

Experimental hypoxia has been used for decades to examine the adaptive response to low-oxygen environments. Various models have been studied, including flies, worms, fish, rodents, and humans. Our lab has recently used this technology to examine the effect of environmental hypoxia on mammalian heart regeneration. In this chapter, we describe studies of systemic hypoxia in mice. We found that systemic hypoxia can blunt oxidative DNA damage and induce cardiomyocyte proliferation. While our primary interests are focused on cardiovascular research, these hypoxia protocols are applicable to any other organ system.

The objective of the present study was to investigate factors related to variation in feed efficiency (FE) among cows. Data included 841 cow/period observations from 31 energy metabolism studies assembled across 3 research stations. The cows were categorized into low-, medium-, and high-FE groups according to residual feed intake (RFI), residual energy-corrected milk (RECM), and feed conversion efficiency (FCE). Mixed model regression was conducted to identify differences among the efficiency groups in animal and energy metabolism traits. Partial regression coefficients of both RFI and RECM agreed with published energy requirements more closely than cofficients derived from production experiments. Within RFI groups, efficient (Low-RFI) cows ate less, had a higher digestibility, produced less methane (CH4) and heat, and had a higher efficiency of metabolizable energy (ME) utilization for milk production. High-RECM (most efficient) cows produced 6.0 kg/d more of energy-corrected milk (ECM) than their Low-RECM (least efficient) contemporaries at the same feed intake. They had a higher digestibility, produced less CH4 and heat, and had a higher efficiency of ME utilization for milk production. The contributions of improved digestibility, reduced CH4, and reduced urinary energy losses to increased ME intake at the same feed intake were 84, 12, and 4%, respectively. For both RFI and RECM analysis, increased metabolizability contributed to approximately 35% improved FE, with the remaining 65% attributed to the greater efficiency of utilization of ME. The analysis within RECM groups suggested that the difference in ME utilization was mainly due to the higher maintenance requirement of Low-RECM cows compared with Medium- and High-RECM cows, whereas the difference between Medium- and High-RECM cows resulted mainly from the higher efficiency of ME utilization for milk production in High-RECM cows. The main difference within FCE (ECM/DMI) categories was a greater (8.2 kg/d) ECM yield at the expense of mobilization in High-FCE cows compared with Low-FCE cows. Methane intensity (CH4/ECM) was lower for efficient cows than for inefficient cows. The results indicated that RFI and RECM are different traits. We concluded that there is considerable variation in FE among cows that is not related to dilution of maintenance requirement or nutrient partitioning. Improving FE is a sustainable approach to reduce CH4 production per unit of product, and at the same time improve the economics of milk production.