Background: Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD.Methods: We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events.Results: We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7 ± 14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%).Conclusion: Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.

COVID-19 is the disease caused by SARS-CoV-2 that portends both a relatively high mortality rate as well as high rate of intensive care admission amongst all age groups; however effective therapy remains poorly characterized. Post-transplant patients are especially high risk and underrepresented in the literature. In these patients, cytokine release may play a significant role in the development of acute respiratory distress syndrome, raising the hypothesis that interleukin-6 inhibitors such as tocilizumab may be of benefit. Here, we describe two high-risk post-transplant patients who were treated with single-dose tocilizumab after intubation for moderate acute respiratory distress syndrome secondary to confirmed COVID-19 infection. Both patients recovered rapidly and were successfully extubated and discharged from the hospital without need for supplemental oxygen shortly thereafter, and their clinical improvement correlated with response in interleukin-6 levels. Tocilizumab appears to hold promise for critically ill COVID-19 patients who require mechanical ventilation when given shortly after intubation.

Caffeine is widely consumed daily as a stimulant, ergogenic aid or performance enhancer. In addition to the traditional forms of caffeine consumption (e.g., coffee, tea and caffeinated soft drinks), alternative sources are becoming increasingly popular such as caffeinated tablets/capsules and gum. Caffeinated chewing gum offers rapid caffeine absorption and is commercially available. Although the acute cardiovascular effects of caffeine consumption from traditional sources are well documented, the effects of caffeinated chewing gum are unknown. Therefore, this double‐blinded, randomized, placebo‐controlled, crossover study sought to investigate the acute effects of caffeinated chewing gum on central arterial stiffness and aortic blood pressure, independent predictors of cardiovascular disease. Sixteen young (21±1 yrs, means±SE), male, light caffeine users, free of clinical disease, who did not use tobacco products, or medications participated in this study. Central arterial stiffness (carotid to femoral pulse wave velocity; cfPWV) and aortic blood pressures (systolic and diastolic blood pressure; aoSBP and aoDBP, and pulse pressure; aoPP) were assessed using SphygmoCor XCEL (AtCor Medical) on two visits, separated by at least one week. During each visit, vascular measures were obtained before, and 1‐ and 2‐hrs following consumption of caffeinated or placebo chewing gum. We found that cfPWV increased at 2‐hrs following consumption of caffeinated chewing gum (6.3±0.1 vs. 6.5±0.1 m·s−1; pre vs. 2‐hrs; P=0.017), but did not change after placebo (P>0.05). AoMAP and aoDBP increased by 6±2 and 6±1 mmHg, respectively, at 1‐hr following caffeinated chewing gum (P≤0.008) and remained elevated at 2‐hrs, but did not change in response to placebo (P>0.05). AoSBP, aoPP and heart rate did not significantly change in response to caffeinated or placebo chewing gum (P>0.05). In conclusion, caffeinated chewing gum acutely increases central arterial stiffness and aortic blood pressure in young healthy men. Future investigations should confirm these findings in women and examine whether the response is exaggerated in individuals who are hypertensive or have other risk factors for cardiovascular disease. Support or Funding Information This work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.

Coffee is widely consumed and several studies have examined the acute effects of coffee consumption on blood pressure. However, little attention has focused on the acute effects of coffee on central arterial stiffness, wave reflection, and aortic blood pressure, independent predictors of cardiovascular disease. The objective of this investigation was to conduct a randomized, placebo‐controlled study of the acute effects of coffee on central arterial stiffness and hemodynamics. Sixteen young males (21±2 yrs; means±SE) who were light caffeine users consumed 16 oz. of cold coffee, containing 160 mg caffeine, or placebo (cold water) on two visits separated by at least a week. Central arterial stiffness (carotid to femoral pulse wave velocity; cfPWV), aortic wave reflection (augmentation index normalized at heart rate 75; AIx75) and aortic blood pressures (systolic, diastolic and mean blood pressure; aoSBP, aoDBP, aoMAP and pulse pressure; aoPP) were assessed using SphygmoCor XCEL (AtCor Medical) before and 1hr and 2hr after beverage consumption. In response to coffee, cfPWV increased at 1hr and remained elevated at 2hr (6.29±0.16 vs. 6.48±0.17 vs. 6.53±0.15 m/sec; P=0.03 for base vs. 1hr and P=0.004 for base vs. 2hr), but did not change in response to placebo (6.48±0.13 vs. 6.41±0.16 vs. 6.37±0.19 m/sec; P>0.5 for base vs. 1hr vs. 2hr and P=0.01 for condition × time). AIx75 decreased at 1hr and remained decreased at 2hr following coffee (5.5±2.9 vs. −2.4±3.1 vs. −1.7±3.3 %; P=0.0002 for base vs. 1hr and P=0.008 for base vs. 2hr) and placebo (3.9±2.8 vs. ‐ 3.7±2.5 vs. −6.7±2.6 %; P<0.0001 for base vs. 1hr and for base vs. 2hr), but to a different degree (P=0.015 for condition × time). AoSBP and aoPP were not affected by coffee or placebo (P>0.05). However, aoDBP and aoMAP increased in response to coffee by 7±2 and 5±1 mmHg, respectively, at 1hr and remained elevated at 2hr (aoDBP: 67±1 vs. 74±1 vs. 72±2 mmHg; P=0.002 for base vs. 1hr and P=0.03 for base vs. 2hr, aoMAP: 80±1 vs. 85±1 vs. 84±2 mmHg; P=0.003 for base vs. 1hr and P=0.04 for base vs. 2hr), but did not change following placebo (P>0.9 and P≥0.001 for condition × time). In conclusion, consumption of coffee containing 160 mg caffeine leads to acute changes in central arterial stiffness and hemodynamics in healthy young men. Future investigations should confirm these findings in women and examine whether responses are exaggerated in individuals who are hypertensive or have other cardiovascular disease risk factors. Support or Funding Information This work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.