Background: tV O 2 at the onset of constant work rate (CWR) exercise is a variable of aerobic fitness that shortens with physical training and lengthens with cardiopulmonary disease. Determination of tV O 2 with sufficiently high confidence has typically required multiple exercise transitions limiting its clinical application. Objectives: To design a protocol to determine tV O 2 reliably but simply. Methods: On each of three days, five healthy men performed two CWR tests on a cycle ergometer below the metabolic threshold (V O 2 h) for blood lactate accumulation as determined by gas exchange measurements followed by an incremental work rate (IWR) test. tV O 2 was determined (a) from the ontransit (on-tV O 2 ) and off-transit (off-tV O 2 ) of six CWR tests both individually and superimposed, using non-linear regression with a monoexponential model, and (b) by geometric analysis of the IWR tests (ramp-tV O 2 ).

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The standard of care in the treatment of chronic lung disease includes pulmonary rehabilitation (PR). While evidence of the effectiveness of PR in chronic obstructive lung disease (COPD) is robust, that for pulmonary fibrosis and other non-fibrotic restrictive lung diseases is less extensive. However, PR has been shown to improve functional exercise capacity and health-related quality of life in non-COPD patients, primarily those with interstitial lung diseases. This review examines mechanisms of exercise limitation in non-COPD patients and discusses how they might affect both the application of and outcome measures of PR. We also review the assessment of exercise performance, dyspnea, and quality of life as well as special protocols, safety considerations, and special techniques in PR as applied to patients with pulmonary fibrosis or restrictive lung disease. At present, there are no evidence-based guidelines for PR in non-COPD patients whereas PR is firmly recommended in COPD management. More research is needed to strengthen the evidence for the use of PR in non-COPD patients. Meanwhile, the available data, summarized in this review, support the inclusion of PR in the management of all patients with chronic lung disease including pulmonary fibrosis and restrictive lung disease.

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Hyperbaric oxygen (HBO2) therapy is a UHMS-approved treatment for radiation cystitis and has been used for other causes of cystitis such as cyclophosphamide-induced hemorrhagic cystitis and interstitial cystitis, among others. Immunotherapy with Bacillus Calmette-Gu.rin (BCG) is the most effective treatment of non-muscle invasive bladder cancer. BCG acts as a non-specific stimulant of the reticuloendothelial system, causing a local inflammatory response. BCG attaches to bladder tumor cells as well as urothelial cells which then stimulates an immune response involving a multitude of cytokines and local migration of polymorphonuclear cells that leads to death of the cancer cells. The typical protocol of a single six-week course has been shown to provide long-term protection from tumor recurrence and to reduce disease progression. Irritative bladder side effects are common, but serious side effects are uncommon. Two cases of severe BCG-cystitis treated with HBO2 are presented. Two male patients with bladder cancer were treated with intravesicular BCG. Each developed complications of pain, spasms, urinary frequency and nocturia; one developed gross hematuria. Cystoscopy showed friable mucosa. They failed standard medical therapy and were referred for HBO2. They were treated in a multiplace chamber at 2.2-2.4 ATA. One patient received 60 and the other 40 treatments. Both experienced substantial reduction in their symptoms. BCG cystitis may be considered for HBO2 if other standard therapy has failed.