Human physiology under high pressure: I. Effects of Nitrogen, Carbon Dioxide, and Cold

The best of leaders at the worst of times: medical scientist and war premier

Professor Juan Negrín López was Prime Minister of the democratically elected left-wing government of Spain for the latter two-and-a-half years of the three-year Civil War which ravaged the country between 1936 and 1939. The side loyal to the government lost, partly because of the generous aid received by their opponents from Germany and Italy, partly because of the Anglo-French agreement, observed by most countries but ignored by Germany and Italy, to outlaw arms supplies to either side, partly because of internal dissent, and partly because of the greater military capability of the enemy. Negrín led the country with tenacity and wisdom, but is remembered with ambivalence in Spain, and hardly at all elsewhere, although he spent the years of his post-war exile in the UK and France. This paper draws attention to a member of the medical profession who achieved both academic and political distinction, but whose career ended in a disaster which he was powerless to prevent. Among his admirable qualities, he should be remembered for his courage. Like most wars, the Spanish Civil War had its share of psychopaths and villains - but also its share of heroes, and Juan Negrín belongs among their number.

Hydrogen gas: from clinical medicine to an emerging ergogenic molecule for sports athletes 1

H₂ has been clinically demonstrated to provide antioxidant and anti-inflammatory effects, which makes it an attractive agent in exercise medicine. Although exercise provides a multiplicity of benefits including decreased risk of disease, it can also have detrimental effects. For example, chronic high-intensity exercise in elite athletes, or sporadic bouts of exercise (i.e., noxious exercise) in untrained individuals, result in similar pathological factors such as inflammation, oxidation, and cellular damage that arise from and result in disease. Paradoxically, exercise-induced pro-inflammatory cytokines and reactive oxygen species largely mediate the benefits of exercise. Ingestion of conventional antioxidants and anti-inflammatories often impairs exercise-induced training adaptations. Disease and noxious forms of exercise promote redox dysregulation and chronic inflammation, changes that are mitigated by H₂ administration. Beneficial exercise and H₂ administration promote cytoprotective hormesis, mitochondrial biogenesis, ATP production, increased NAD⁺/NADH ratio, cytoprotective phase II enzymes, heat-shock proteins, sirtuins, etc. We review the biomedical effects of exercise and those of H₂, and we propose that hydrogen may act as an exercise mimetic and redox adaptogen, potentiate the benefits from beneficial exercise, and reduce the harm from noxious exercise. However, more research is warranted to elucidate the potential ergogenic and therapeutic effects of H₂ in exercise medicine.

Selective Effects of an Anaesthetic Drug on Cognitive Behaviour

The prediction has been tested that under the influence of an anaesthetic drug, nitrous oxide, cognitive performances undergo differential impairment, the extent of which is positively correlated with the “complexity” of the task, Ten kinds of performance were investigated, ranging from speed of finger tapping to reasoning by analogy. The relative complexity of each task was determined, in accordance with conventional criteria, from its respective qualitative category or “level”—relational, associative, and motor—and within each category from qualitative analysis of the component processes involved in its execution. A simple group difference design was used, involving two groups of 50 subjects each, matched for age and sex.

Significant deterioration as a consequence of drug administration occurred in the performance of all tasks. On the whole, the more complex a task the more did it tend to be impaired. Motor performances were, however, impaired to a greater extent than had been predicted. The possible significance of these findings is discussed.

Assessment of the interaction of hyperbaric N2, CO2, and O2 on psychomotor performance in divers

Diving narcosis results from the complex interaction of gases, activities, and environmental conditions. We hypothesized that these interactions could be separated into their component parts. Where previous studies have tested single cognitive tasks sequentially, we varied inspired partial pressures of CO₂, N₂, and O₂ in immersed, exercising subjects while assessing multitasking performance with the Multi-Attribute Task Battery II (MATB-II) flight simulator. Cognitive performance was tested under 20 conditions of gas partial pressure and exercise in 42 male subjects meeting U.S. Navy age and fitness profiles. Inspired nitrogen (N₂) and oxygen (O₂) partial pressures were 0, 4.5, and 5.6 ATA and 0.21, 1.0, and 1.22 ATA, respectively, at rest and during 100-W immersed exercise with and without 0.075-ATA CO₂ Linear regression modeled the association of gas partial pressure with task performance while controlling for exercise, hypercapnic ventilatory response, dive training, video game frequency, and age. Subjects served as their own controls. Impairment of memory, attention, and planning, but not motor tasks, was associated with N₂ partial pressures >4.5 ATA. Sea level O₂ at 0.925 ATA partially rescued motor and memory reaction time impaired by 0.075-ATA CO₂; however, at hyperbaric pressures an unexpectedly strong interaction between CO₂, N₂, and exercise caused incapacitating narcosis with amnesia, which was augmented by O₂ Perception of narcosis was not correlated with actual scores. The relative contributions of factors associated with diving narcosis will be useful to predict the effects of gas mixtures and exercise conditions on the cognitive performance of divers. The O₂ effects are consistent with O₂ narcosis or enhanced O₂ toxicity.

Neurochemistry of Pressure-Induced Nitrogen and Metabolically Inert Gas Narcosis in the Central Nervous System

Gases that are not metabolized by the organism are thus chemically inactive under normal conditions. Such gases include the "noble gases" of the Periodic Table as well as hydrogen and nitrogen. At increasing pressure, nitrogen induces narcosis at 4 absolute atmospheres (ATAs) and more in humans and at 11 ATA and more in rats. Electrophysiological and neuropharmacological studies suggest that the striatum is a target of nitrogen narcosis. Glutamate and dopamine release from the striatum in rats are decreased by exposure to nitrogen at a pressure of 31 ATA (75% of the anesthetic threshold). Striatal dopamine levels decrease during exposure to compressed argon, an inert gas more narcotic than nitrogen, or to nitrous oxide, an anesthetic gas. Inversely, striatal dopamine levels increase during exposure to compressed helium, an inert gas with a very low narcotic potency. Exposure to nitrogen at high pressure does not change N-methyl-d-aspartate (NMDA) glutamate receptor activities in Substantia Nigra compacta and striatum but enhances gama amino butyric acidA (GABAA) receptor activities in Substantia Nigra compacta. The decrease in striatal dopamine levels in response to hyperbaric nitrogen exposure is suppressed by recurrent exposure to nitrogen narcosis, and dopamine levels increase after four or five exposures. This change, the lack of improvement of motor disturbances, the desensitization of GABAA receptors on dopamine cells during recurrent exposures and the long-lasting decrease of glutamate coupled with the higher sensitivity of NMDA receptors, suggest a nitrogen toxicity induced by repetitive exposures to narcosis. These differential changes in different neurotransmitter receptors would support the binding protein theory. © 2016 American Physiological Society. Compr Physiol 6:1579-1590, 2016.

Influence of extreme hypercapnia on respiratory motor nerve activity in cats

Sedative drugs have been found to depress the respiratory activity of upper airway muscles more than that of the diaphragm. To determine whether CO2 at narcotic levels has a similar action, we recorded phrenic and hypoglossal nerve activities in decerebrate, vagotomized, paralyzed cats. T5 or T6 external intercostal nerve activity was also recorded in some animals. End-tidal CO2 concentration was raised progressively to over 30% or until depression of nerve activity was apparent. Respiratory frequency was reduced by severe hypercapnia in most cats. Hypoglossal nerve activity was consistently decreased more than that of the phrenic nerve. In most cases intercostal nerve activity was also more susceptible than phrenic nerve activity to hypercapnic depression. The results indicate that CO2 at narcotic levels interferes both with the central pattern generator for breathing movements and with the expression of the pattern in specific motor nerves.

Anxiety, perceptual and motor skills in an underwater environment

This research has analyzed the perceptual and motor skills in an underwater environment at 30 m of 24 subjects differing in diving experience. The State-Trait Anxiety Inventory, Form X-1, was administered to evaluate possible changes in anxiety associated with hyperbaric conditions during the perceptual and motor task. Analysis indicates that in comparison with experienced divers, less experienced divers showed a performance decrement. No changes in anxiety were observed.

EFFICIENCY AT SORTING CARDS IN COMPRESSED AIR

At a site where compressed air was being used in the construction of a tunnel, 34 men sorted cards twice, once at normal atmospheric pressure and once at 3½, 2½, or 2 atmospheres absolute pressure. An additional six men sorted cards twice at normal atmospheric pressure. When the task was carried out for the first time, all the groups of men performing at raised pressure were found to yield a reliably greater proportion of very slow responses than the group of men performing at normal pressure. There was reliably more variability in timing at 3½ and 2½ atmospheres absolute than at normal pressure. At 3½ atmospheres absolute the average performance was also reliably slower. When the task was carried out for the second time, exposure to 3½ atmospheres absolute pressure had no reliable effect. Thus compressed air affected performance only while the task was being learnt; it had little effect after practice. No reliable differences were found related to age, to length of experience in compressed air, or to the duration of the exposure to compressed air, which was never less than 10 minutes at 3½ atmospheres absolute pressure.

Submarine escape breathing air

Recent research has even further emphasized the physiological dangers to which man is exposed when breathing gases at increased tensions. If he breathes air his activity under water is greatly limited by the problems of supply and compressed air illness. The latter is due to the formation of bubbles of nitrogen in the body on return to normal atmosphere. If he breathes oxygen, then he is in grave danger of oxygen poisoning, with convulsions, even at relatively shallow depths (Donald, 1947). During the recent war, mixtures of nitrogen and oxygen were employed for important work where the diver wished to go to considerable depths while carrying his own gases. These mixtures were varied in composition and rate of supply so that oxygen poisoning was avoided, and immediate rapid surfacing was possible, without compressed air illness occurring. However, this ingenious compromise is limited in its application, for as greater depths are reached, the oxygen has to be greatly reduced to avoid convulsions. The resultant rise in the proportion of nitrogen being breathed causes bubble formation in any but the shortest exposures. It is to be doubted whether the maintenance and meticulous supervision required, when using mixtures, will allow the use of these in the more normal conditions of peace-time. It has become increasingly apparent that the prolonged underwater survival of men requires pressure-withstanding devices in which he can exist at normal physiological tensions, i.e. atmospheric pressure. The rigid diving suit and submersible chambers, such as the bathysphere, are in their infancy; but the submarine, where the same conditions apply, is now a highly successful and developed method of underwater existence and locomotion. The further evolution of these devices, and of the submarine, depends mainly on engineering advances and not upon attempting to extend the comparatively rigid limits imposed by human physiology. The maintenance of a healthy atmosphere within a submarine is again a chemical and engineering problem which is capable of solution and constant improvement.