Marine nationale

Sleepiness and fatigue can reach particularly high levels during long-haul overnight flights. Under these conditions, voluntary or even involuntary sleep periods may occur, increasing the risk of accidents. The aim of this study was to assess the performance of an in-flight automatic detection system of low-vigilance states using a single electroencephalogram channel. Fourteen healthy pilots voluntarily wore a miniaturized brain electrical activity recording device during long-haul flights ( 10 ±2.0 h, Atlantic 2 and Falcon 50 M, French naval aviation). No subject was disturbed by the equipment. Seven pilots experienced at least a period of voluntary ( 26.8 ±8.0 min, n = 4) or involuntary sleep (N1 sleep stage, 26.6 ±18.7 s, n = 7) during the flight. Automatic classification (wake/sleep) by the algorithm was made for 10-s epochs (O1-M2 or C3-M2 channel), based on comparison of means to detect changes in α, β, and θ relative power, or ratio [( α+θ)/β], or fuzzy logic fusion (α, β). Pertinence and prognostic of the algorithm were determined using epoch-by-epoch comparison with visual-scoring (two blinded readers, AASM rules). The best concordance between automatic detection and visual-scoring was observed within the O1-M2 channel, using the ratio [( α+θ )/β] ( 98.3 ±4.1% of good detection, K = 0.94 ±0.07, with a 0.04 ±0.04 false positive rate and a 0.87 ±0.10 true positive rate). Our results confirm the efficiency of a miniaturized single electroencephalographic channel recording device, associated with an automatic detection algorithm, in order to detect low-vigilance states during real flights.

We demonstrate tunable radiofrequency emission from a meter-long linear plasma column produced in air at atmospheric pressure. A short-lived plasma column is initially produced by femtosecond filamentation and subsequently converted into a long-lived discharge column by application of an external high voltage field. Radiofrequency excitation is fed to the plasma by induction and detected remotely as electromagnetic radiation by a classical antenna.

', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France. In just few weeks, the FMMS developed ad hoc medical capabilities to support national health authorities. It additionally developed adaptive, collective en route care via aeromedical and naval units and deployed a military intensive care field hospital. A COVID-19 crisis cell coordinated the French Armed Forces health management. The French Military Centre for Epidemiology and Public Health provided all information needed to guide the decision-making process. Medical centres of the French Armed Forces organised the primary care for military patients, with the widespread use of telemedicine. The Paris Fire Brigade and the Marseille Navy Fire Battalion emergency departments ensured prehospital management of patients with COVID-19. The eight French military training hospitals cooperated with civilian regional health agencies. The French military medical supply chain supported all military medical treatment facilities in France as well as overseas, coping with a growing shortage of medical equipment. The French Armed Forces Biomedical Research Institute performed diagnostics, engaged in multiple research projects, updated the review of the scientific literature on COVID-19 daily and provided expert recommendations on biosafety. Finally, even students of the French military medical academy volunteered to participate in the fight against the COVID-19 pandemic. In conclusion, in an unprecedented medical crisis, the FMMS engaged multiple innovative and adaptive actions, which are still ongoing, in the fight against COVID-19. The collaboration between military and civilian healthcare systems reinforced the shared objective to achieve the goal of 'saving the greatest number'.

Previous studies have highlighted that bubble-induced platelet aggregation is a predictor index of decompression sickness (DCS) severity in animals and bubble formation after a single air dive in humans. The present study attempted to investigate plasmatic indexes of the coagulation system and platelet activation in our rat model of DCS. Male Sprague-Dawley rats were assigned to one experimental group with a hyperbaric exposure and one control group maintained at atmospheric pressure. Rats were compressed to 1,000 kPa (90 m saltwater) for 45 min while breathing air. The onset of death time and DCS symptoms were recorded during a 30-min observed period after rats had surfaced. Plasmatic indexes were platelet factor 4 (PF4) for platelet activation, soluble glycoprotein V (sGPV) for thrombin generation, and thrombin-antithrombin complexes for the coagulation system. Blood samples for a platelet count and markers were taken 3 wk before the experimental protocol and within the 30 min after rats had surfaced. We confirmed a correlation between the percent fall in platelet count and DCS severity. Plasmatic levels of sGPV and PF4 were significantly increased after the hyperbaric exposure, with no change in the control group. The present study confirms platelet consumption as a potential index for evaluating decompression stress and DCS severity. The results point to the participation of thrombin generation in the coagulation cascade and platelet activation in bubble-induced platelet aggregation. In our animal model of DCS, the results cannot prejudge the mechanisms of platelet activation between bubble-induced vessel wall injury and bubble-blood component interactions.

OBJECTIVE: To investigate whether prehydration 90 min before a dive could decrease bubble formation, and to evaluate the consequent adjustments in plasma volume (PV), water balance and plasma surface tension (ST). METHODS: Eight military divers participated in a crossover trial of pre-dive hydration using saline-glucose beverage (protocol 1) and a control dive with no prehydration (protocol 2). Drink volume was 1300 ml (osmolality 324 mOsm/l) and drinking time was 50-60 min. The diving protocol consisted of an open sea field air dive at 30 msw depth for 30 min followed by a 9 min stop at 3 msw. Haemodynamic parameters, body weight measurements, urine volume and blood samples were taken before/after fluid intake and after the dive. Decompression bubbles were examined by a precordial pulsed Doppler. RESULTS: Bubble activity was significantly lower for protocol 1 than for protocol 2. PV increased after fluid ingestion by 3.5% and returned toward baseline after diving for protocol 1, whereas it decreased by 2.2% after diving for protocol 2. Differences in post-dive PV between the two conditions were highly significant. Body weight loss before/after diving and post-dive urine volume after diving were significant in both protocols, but the relative decline in weight remained lower for protocol 1 than for protocol 2, with reduction of negative water balance due to higher fluid retention. There were no differences in ST after fluid intake and after diving for the two protocols. CONCLUSION: Pre-dive oral hydration decreases circulatory bubbles, thus offering a relatively easy means of reducing decompression sickness risk. The prehydration condition allowed attenuation of dehydration and prevention of hypovolaemia induced by the diving session. Hydration and diving did not change plasma surface tension in this study.

BACKGROUND: Immersion pulmonary edema is potentially a catastrophic condition; however, the pathophysiological mechanisms are ill-defined. This study assessed the individual and combined effects of exertion and negative pressure breathing on the cardiovascular system during the development of pulmonary edema in SCUBA divers. METHODS: Sixteen male professional SCUBA divers performed four SCUBA dives in a freshwater pool at 1 m depth while breathing air at either a positive or negative pressure both at rest or with exercise. Echocardiography and lung ultrasound were used to assess the cardiovascular changes and lung comet score (a measure of interstitial pulmonary edema). RESULTS: The ultrasound lung comet score was 0 following both the dives at rest regardless of breathing pressure. Following exercise, the mean comet score rose to 4.2 with positive pressure breathing and increased to 15.1 with negative pressure breathing. The development of interstitial pulmonary edema was significantly related to inferior vena cava diameter, right atrial area, tricuspid annular plane systolic excursion, right ventricular fractional area change, and pulmonary artery pressure. Exercise combined with negative pressure breathing induced the greatest changes in these cardiovascular indices and lung comet score. CONCLUSIONS: A diver using negative pressure breathing while exercising is at greatest risk of developing interstitial pulmonary edema. The development of immersion pulmonary edema is closely related to hemodynamic changes in the right but not the left ventricle. Our findings have important implications for divers and understanding the mechanisms of pulmonary edema in other clinical settings.

COGEMA-La Hague nuclear reprocessing plant in the Cotentin Peninsula (northwest France) releases in the atmosphere about 19 TBq.yr -1 of radiocarbon. Three experiments in a terrestrial environment with sampling of a bio-indicator like furze were performed in 1997, 1998, and 1999, and additional air samples in the chimney plume were measured. Results presented here establish the 14 C distribution in the La Hague environment and suggest that a part of the 14 C content in the vegetation near the coast results from a 14 CO 2 degassing of seawater supplied with the liquid waste from the nuclear plant.

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting.

INTRODUCTION: It has been suggested that repeated compression-decompression cycles reduce diver susceptibility to decompression sickness (DCS). This study examined whether intensive scuba dive training would reduce bubble formation and modulate endothelial function as shown by skin circulation. METHODS: There were 22 military divers who were studied before and after a 90-d program of physical training and open-sea air diving (mean 67 dives total). Skin blood flow in the forearm was measured at rest (baseline), during post-occlusive hyperemia (endothelium-dependent vasodilatation), and with local heating to 42 degrees C (maximal vasodilatation). Subjects were also examined by pulsed Doppler for venous bubbles 30, 60, and 90 min after surfacing from a hyperbaric exposure to 400 kPa (30 msw) for 30 min in a dry chamber. RESULTS: None of the divers experienced DCS during the training period. There was no change in weight, body mass index, maximal oxygen uptake, or endothelial function. Bubble grades by the Kisman Integrated Severity Score were significantly decreased immediately after the diving training period (3.6 +/- 9.2 vs. 16.4 +/- 14.3) and increased 3 mo after this period (10.3 +/- 13.9 vs. 3.6 +/- 9.2). DISCUSSION: The results highlight that repeated scuba dives and regular physical exercise activity reduce bubble formation and probably have a protective effect against DCS risk. Although this phenomenon has been observed for decades, the mechanism remains complex and the results cannot elucidate the effects of physical exercise and NO production. Bubble formation could activate the stress response which could be the basis for diving acclimatization.

We previously showed microvascular alteration of both endothelium-dependent and -independent reactivity after a single SCUBA dive. We aimed to study mechanisms involved in this postdive vascular dysfunction. Ten divers each completed three protocols: (1) a SCUBA dive at 400 kPa for 30 min; (2) a 41-min duration of seawater surface head immersed finning exercise to determine the effect of immersion and moderate physical activity; and (3) a simulated 41-min dive breathing 100% oxygen (hyperbaric oxygen [HBO]) at 170 kPa in order to analyze the effect of diving-induced hyperoxia. Bubble grades were monitored with Doppler. Cutaneous microvascular function was assessed by laser Doppler. Endothelium-dependent (acetylcholine, ACh) and -independent (sodium nitroprusside, SNP) reactivity was tested by iontophoresis. Endothelial cell activation was quantified by plasma Von Willebrand factor and nitric oxide (NO). Inactivation of NO by oxidative stress was assessed by plasma nitrotyrosine. Platelet factor 4 (PF4) was assessed in order to determine platelet aggregation. Blood was also analyzed for measurement of platelet count. Cutaneous vascular conductance (CVC) response to ACh delivery was not significantly decreased by the SCUBA protocol (23 ± 9% before vs. 17 ± 7% after; P = 0.122), whereas CVC response to SNP stimulation decreased significantly (23 ± 6% before vs. 10 ± 1% after; P = 0.039). The HBO and immersion protocols did not affect either endothelial-dependent or -independent function. The immersion protocol induced a significant increase in NO (0.07 ± 0.01 vs. 0.12 ± 0.02 μg/mL; P = 0.035). This study highlighted change in microvascular endothelial-independent but not -dependent function in highly trained divers after a single air dive. The results suggest that the effects of decompression on microvascular function may be modified by diving acclimatization.

INTRODUCTION: Ultrasonic detection of venous gas emboli (VGE) in the precordial (PRE) region is commonly used in evaluation of decompression stress. While subclavian (SC) VGE detection can also be used to augment and improve the evaluation, no study has rigorously compared VGE grades from both sites as decompression stress indicators. METHODS: This retrospective study examined 1,016 man-dives breathing air extracted from the Defence Research and Development Canada dataset. Data for each man-dive included dive parameters (depth, bottom time, total ascent time), PRE and SC VGE grades (Kisman-Masurel) and post-dive decompression sickness (DCS) status. Correlation between SC and PRE grades was analyzed and the association of the probability of DCS (pDCS) with dive parameters and high bubble grades (HBG III- to IV) was modelled by logistic regression for SC and PRE separately for DCS risk ratio comparisons. RESULTS: PRE and SC VGE grades were substantially correlated (R = 0.66) and were not statistically different (p = 0.61). For both sites, pDCS increased with increasing VGE grade. When adjusted for dive parameters, the DCS risk was significantly associated with HBG for both PRE (p = 0.03) and SC (p < 0.001) but the DCS risk ratio for SC HBG (RR = 6.0, 95% CI [2.7-12.3]) was significantly higher than for PRE HBG (RR = 2.6, 95% CI [1.1-6.0]). CONCLUSIONS: The association of bubble grades with DCS occurrence is stronger for SC than PRE when exposure severity is taken into account. The usefulness of SC VGE in decompression stress evaluation has been underestimated in the past.

Literature highlights the involvement of disseminated thrombosis in the pathophysiology of decompression sickness (DCS). We examined the effect of several antithrombotic treatments targeting various pathways on DCS outcome: acetyl salicylate, prasugrel, abciximab, and enoxaparin. Rats were randomly assigned to six groups. Groups 1 and 2 were a control nondiving group (C; n = 10) and a control diving group (CD; n = 30). Animals in Groups 3 to 6 were treated before hyperbaric exposure (HBE) with either prasugrel (n = 10), acetyl salicylate (n = 10), enoxaparin (n = 10), or abciximab (n = 10). Blood samples were taken for platelet factor 4 (PF4), thiobarbituric acid reactive substances (TBARS), and von Willebrand factor analysis. Onset of DCS symptoms and death were recorded during a 60-min observation period after HBE. Although we observed fewer outcomes of DCS in all treated groups compared with the CD, statistical significance was reached in abciximab only (20% vs. 73%, respectively, P = 0.007). We also observed significantly higher levels of plasmatic PF4 in abciximab (8.14 ± 1.40 ng/ml; P = 0.004) and enoxaparin groups (8.01 ± 0.80 ng/ml; P = 0.021) compared with the C group (6.45 ± 1.90 ng/ml) but not CD group (8.14 ± 1.40 ng/ml). Plasmatic levels of TBARS were significantly higher in the CD group than the C group (49.04 ± 11.20 μM vs. 34.44 ± 5.70 μM, P = 0.002). This effect was prevented by all treatments. Our results suggest that abciximab pretreatment, a powerful glycoprotein IIb/IIIa receptor antagonist, has a strong protective effect on decompression risk by significantly improving DCS outcome. Besides its powerful inhibitory action on platelet aggregation, we suggest that abciximab could also act through its effects on vascular function, oxidative stress, and/or inflammation.

Bergsma, E.W.J.; Sadio, M.; Sakho, I.; Almar, R.; Garlan, T.; Gosselin, M., and Gauduin, H., 2020. Sand-spit evolution and inlet dynamics derived from space-borne optical imagery: Is the Senegal-river inlet closing? In: Malvárez, G. and Navas, F. (eds.), Global Coastal Issues of 2020. Journal of Coastal Research, Special Issue No. 95, pp. 372-376. Coconut Creek (Florida), ISSN 0749-0208.With the majority of the world' population living in urbanised coastal zones, regional-scale coastal monitoring is a paramount tool to assess the risk exposure of local areas. At St. Louis, Senegal the coast experienced a recent acceleration in coastal erosion. Additionally, the sand-spit South of St. Louis is highly dynamic with one of the largest migration rates worldwide. In this study we showcase the use of satellite imagery to assess the morphological change of the St. Louis inlet position over more than 3 decades. The Senegal river inlet was artificially opened in 2003 Northward of its natural position. The effect of this opening is measured through local shoreline erosion and use of satellite data to predict the next closure of the Senegal-river inlet. Since the artificial breach coastal erosion at the fishmarket of St. Louis was measured, while the sand-spit initially accreted. Southerly sand-spit migration rates that varied from 475 m per year (before an artificial breach in 2003) to 590 m per year after the breach. With these migration rates and assuming limited changes in, for example, river run-off and wave environment, the inlet will close again around 2050 and 2055.

Gaussian atmospheric dispersion models are principally validated for release at ground level, or, if the release is very high up, at distances sufficiently removed from the source for the plume to have reached the ground. In order to improve the evaluation of the near field dispersion (< 4 km) for above-ground releases, the Institute for Protection and Nuclear Safety (IPSN) began an in situ study in June 1997 around the La Hague nuclear reprocessing plant using krypton 85 (85Kr, released in the gaseous effluent by a stack of 100 m high) as a plume tracer. The aim of this study is to compare the results for the atmospheric transfer coefficients (ATC) obtained in 85Kr measurement surveys with the results of three Gaussian atmospheric dispersion models (Doury, Pasquill-Briggs and CAIRE) in order to define the distances at which corrections need to be made to the models and thus improve determination of the ATCs. For all the results, it is observed as expected that the models are not applicable for the source near field; however, the study clearly shows that the CAIRE model gives the best results at all distances.

Sénéchal, N., Sottolichio A., Bertrand, F., Goeldner-Giannella, L., Garlan, T., 2013. Analysis of currents and storm surge in a mixed-energy tidal inlet during storm conditions.Coastal morphodynamic processes around tidal inlets in mixed-energy environments are particularly complex due to severe tide and wave conditions. Collecting data in this area is generally very challenging. Here we present the first hydrodynamic data collected in the outer inlet of the Arcachon lagoon, a mixed-energy inlet situated on the southern part of the French Atlantic coast. Data consist in vertical current profiles and sea surface elevations collected on the offshore edge of the ebb delta under various tidal and wave conditions. In particular data were collected during the severe Joachim storm associated to wave heights up to 8 m. Preliminary results indicate that current profiles, intensities and direction are very sensitive to wave conditions. Under energetic conditions, the vertical profile of currents become uniform and the longshore drift is enhanced (up to 1.5 m/s). Nevertheless data show that under severe wave conditions (Hm0 > 6.0m) and despite high incidence of waves, the longshore drift is weaker (l< 1 m/s) than under ‘usual' storm conditions associated to Hm0 = 4 – 5m. More surprisingly, directions of the longshore drift are not always consistent with wave incidence under those severe storm conditions and the cross-shore components are very weak while under less energetic conditions we observe intense offshore currents (up to 0.8 m/s).

INTRODUCTION: An amphibious assault ship was deployed on 22 March in Corsica to carry out medical evacuation of 12 critical patients infected with COVID-19. The ship has on-board hospital capacity and is the first time that an amphibious assault ship is engaged in this particular condition. The aim is to evaluate the feasibility and safety of prolonged medical evacuation of critical patients with COVID-19. METHODS: We included 12 patients with confirmed COVID-19 infection: six ventilated patients with acute respiratory distress syndrome and six non-ventilated patients with hypoxaemia. Transfer on an amphibious assault ship lasted 20 hours. We collected patients' medical records: age, comorbidities, COVID-19 history and diagnosis, ventilation supply and ventilator settings, and blood gas results. We calculated oxygen consumption (OC). RESULTS: All patients had a medical history. The median delay from onset of symptoms to hospitalisation was 8 (7-10) days. The median Sequential Organ Failure Assessment score on admission was 3 (2-5). There was no significant increase in oxygen during ship transport and no major respiratory complication. There was no significant increase in arterial oxygen pressure to fractional inspired oxygen ratio among ventilated patients during ship transport. Among ventilated patients, the median calculated OC was 255 L (222-281) by hours and 5270 L (4908-5616) during all ship transport. Among non-ventilated patients, the median calculated OC was 120 L (120-480) by hours and 2400 L (2400-9600) during all ship transport. CONCLUSION: The present work contributes to assessing the feasibility and safety condition of critical COVID-19 evacuation on an amphibious assault ship during an extended transport. The ship needs to prepare a plan and a specialised intensive team and conduct patient screening for prolonged interhospital transfers.

Quelles sont les valeurs qui caractérisent sur le territoire français les rayonnements ionisants et les radionucléides d'origine naturelle ? Comment distinguer dans le résultat d'une mesure la part qui résulte éventuellement d'une activité humaine ? Afin d'essayer de répondre à ces questions, un questionnaire a été adressé aux différents organismes qui effectuent en France des mesures de radioactivité dans l'environnement. Les informations mentionnées dans cette étude se rapportent exclusivement à des observations faites dans l'environnement à l'extérieur des bâtiments et du périmètre des installations nucléaires de base (INB). En outre, elles ne concernent, sauf cas particuliers signalés, que des mesures de rayonnements ou de radioéléments d'origine naturelle dont les résultats n'ont pas été perturbés par l'action de l'homme. L'enquête montre la difficulté actuelle de dresser en France un bilan exhaustif des connaissances acquises concernant les caractéristiques du bruit de fond radioactif d'origine naturelle dans l'environnement. Aujourd'hui en France, dans le domaine de la radioactivité naturelle, les efforts consentis manquent de coordination et d'orientation vers certaines priorités. À ce titre, les mesures des 238U et 232Th précurseurs des 226Ra et 228Ra, des descendants solides émetteurs alpha du radon (par la mesure des EAP du 222Rn et 220Rn), des émetteurs gamma post émanation (214Pb, 214Bi, 212Pb), du 210Pb, 210Po et du 14C doivent être privilégiées.

La mesure du tritium sous ses différentes formes (gaz (HT), eau (HTO), ou solide (hydrures)), est une étape importante pour l’évaluation des risques sanitaires et environnementaux associés et in fine son estimation dosimétrique. Dans les échantillons du règne végétal ou animal, le tritium est associé à la fraction eau libre et est inclus dans les composés organiques sous forme de tritium organiquement lié (TOL). Dans ce cas, 2 formes existent : (i) la fraction dite échangeable ou labile (TOL-E) liée à des atomes d’oxygène et d’azote ; (ii) la fraction dite non échangeable (TOL-NE) liée aux atomes de carbones. La technique de référence pour l’analyse du tritium est la scintillation liquide permettant de mesurer des concentrations de l’ordre de quelques Bq.L-1. Les normes (AFNOR, ISO) publiées à ce jour ne concernent que l’analyse du tritium dans l’eau. Seule une méthode CETAMA aborde la mesure du TOL dans des milieux biologiques. Cette méthode a été testée depuis 2001 via des circuits d’intercomparaisons sur des échantillons d’herbe prélevés dans l’environnement. Concernant l’analyse du tritium dans les eaux, les principaux points forts sont la fiabilité de cette analyse pour des concentrations de l’ordre de 1 Bq.L-1, la robustesse et la simplicité de mise en œuvre. Les points faibles sont essentiellement liés à des problèmes de bruit de fond, de conservation et de contamination des échantillons. Concernant l’analyse du TOL, l’analyse est fiable pour des valeurs de l’ordre de 50 Bq.kg-1 d’échantillon frais. Les points faibles sont des problèmes de contamination, de reproductibilité, de temps d’analyse (2 à 6 jours) et l’absence de matériaux de référence. La difficulté à ce jour est la séparation entre TOL-E et TOL-NE qui doit être validée expérimentalement.

INTRODUCTION: Many fisherman divers in Vietnam suffer from decompression sickness (DCS) causing joint pain, severe neurological deficit or even death. The objective of this pilot study was to evaluate the effectiveness of a training programme to prevent DCS and also treat DCS using the method of in-water recompression (IWR). METHODS: 63 divers were interviewed and trained over a period of 3 years from 2009. Fifty one per cent of all trained divers were reinterviewed in 2011-2012 to collect mortality and morbidity data as well as information on changes in diving practices. RESULTS: Since 2009, most fisherman divers have changed their practices by reducing bottom time or depth. Mortality was reduced and the incidence of severe neurological DCS decreased by 75%. Twenty four cases of DCS were treated by IWR. Ten cases of joint pain were treated with IWR using air, affording immediate relief in all cases. Out of 10 cases of neurological DCS, 4/4 recovered completely after IWR with oxygen whereas only 2/6 subjects recovered immediately after IWR with air. In addition, 3/4 further cases of DCS treated with IWR using oxygen immediately recovered. CONCLUSIONS: Our results suggest that IWR is effective for severe neurological DCS in remote fishing communities, especially with oxygen.

Background: Numerous studies show that seawater is the ecological niche of many microorganisms. Some microorganisms are pathogenic to humans. The purpose of this paper is to describe the biological agents and pathologies mentioned in the literature. Materials and methods: This is a review of the literature from the Medline database.