Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that affects approximately 0.5% to 1% of the population in the United States and Northern Europe. Interstitial lung disease (ILD) is the most common and severe pulmonary manifestation of RA, collectively referred to as RA-associated ILD (RA-ILD). RA-ILD contributes significantly to morbidity and mortality and often presents with a variable clinical course. Although corticosteroids and disease-modifying antirheumatic drugs (DMARDs) remain the cornerstone of RA management, their role in RA-ILD is less clearly defined. In contrast, antifibrotic therapies such as pirfenidone and nintedanib, initially developed for idiopathic pulmonary fibrosis, are now being explored for their potential in treating fibrosing variants of RA-ILD. Despite increasing clinical use, no systematic review has comprehensively compared the safety and efficacy of antifibrotic versus anti-inflammatory therapies in chronic RA-ILD.

This study aims to compare the impact of antifibrotic and anti-inflammatory therapies on lung function, radiologic progression, clinical outcomes, and safety in patients with chronic RA-ILD.

This study will follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and is registered with PROSPERO (CRD42024583847). A comprehensive search of PubMed, Embase, and the Cochrane Library will be conducted for studies published between January 1991 and August 2024. Eligible studies will include adult patients (aged ≥18 years) with a diagnosis of RA and confirmed ILD based on radiological or histopathological findings who have been treated with either antifibrotic or anti-inflammatory therapies. The PECOS (Population, Exposure, Comparator, Outcome, Study Design) framework will be used to define inclusion criteria. The primary outcomes assessed in this review will include the following pulmonary function parameters: forced vital capacity, forced expiratory volume in 1 second, and diffusing capacity of the lungs for carbon monoxide. Anti-inflammatory therapies will be stratified into corticosteroids, conventional synthetic DMARDs, and biologic DMARDs to account for heterogeneity. The Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tools will be used for quality assessment, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology will be used to evaluate the certainty of evidence.

The literature search and screening commenced in August 2024, and data extraction is underway. The final results are expected by December 2025.

This systematic review and meta-analysis will provide a comprehensive comparison of antifibrotic and anti-inflammatory therapies in the treatment of chronic RA-ILD. The findings will help inform clinical decision-making, support evidence-based treatment selection, and identify gaps in current research. By addressing both efficacy and safety, this review aims to guide future studies and improve patient outcomes for this complex and debilitating condition.

PROSPERO CRD42024583847; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024583847.

DERR1-10.2196/73219.

The COVID-19 pandemic disrupted traditional hospice care, prompting the use of telehospice to deliver end-of-life services remotely while maintaining quality and continuity of care.

This integrative review examines the feasibility, effectiveness and challenges of telehospice during the COVID-19 pandemic, with a focus on patient outcomes and caregiver experiences.

An integrative review approach was used to analyse 12 peer-reviewed studies published between January 2020 and June 2023.

Telehospice enhanced access to care in rural and underserved areas, enabled timely symptom management and strengthened interdisciplinary collaboration. Families reported improved communication, emotional support and involvement in decision-making. However, challenges to telehospice care such as limited internet access, digital literacy gaps and difficulties replicating the intimacy of in-person care were frequently noted.

Telehospice is a feasible and acceptable model for end-of-life care. Ongoing investment in infrastructure, training and equitable access is essential for long-term integration.

Frontline construction workers are generally faced with risk factors such as alcoholism, smoking, and being far away from home, which pose a great threat to their mental health. However, this issue has not yet attracted significant attention form the global community. For this reason, we examined depression, anxiety, and stress levels among construction workers in China and identified their key risk factors, such as education, occupational tenure, geographical mobility, physical well-being, COVID-19 status, insomnia, and alcohol dependency.

We conducted an online survey using validated scales, including the Depression, Anxiety, and Stress Scale, Insomnia Severity Index Scale, Alcohol Dependence Scale, Family-work Conflict Scale, Leadership Support Scale, Workplace Exclusion Scale, and Proactive Personality Scale.

We analysed 912 valid responses (790 males, 122 females; mean age = 36.35 years (standard deviation = 10.11). Depression, anxiety, and stress levels were significantly influenced by age, education, work-related injuries, COVID-19 status, insomnia, alcohol dependence, workplace exclusion, and work-family conflict among construction workers (all P-values < 0.05). The regression analysis showed that work-family conflict, workplace exclusion, alcohol dependence, and insomnia were positively associated with depression (P < 0.001), while proactive personality and leadership support were negatively associated with depression (all P-values <0.05). Similarly, physical health, workplace exclusion, alcohol dependence, and insomnia were positively associated with anxiety (all P-values <0.001). Additionally, having a proactive personality negatively influenced depression (P < 0.001). Anxiety positively predicted physical health issues (P < 0.001), workplace exclusion (P < 0.001), alcohol dependence (P < 0.001), and insomnia (P < 0.001), whereas leadership support reduced anxiety levels (P = 0.01).

Mental health risks among construction workers are linked to work and personal factors, including insomnia, alcohol dependence, workplace exclusion, and work-family conflict. Employers should implement targeted interventions to improve the work environment, leadership support, and social support systems to enhance the workers' mental well-being.

To identify predictive factors for different exercise-induced desaturation (EID) severities and evaluate health-related quality of life six months later in chronic obstructive pulmonary disease (COPD) patients.

This retrospective study consecutively analyzed 116 COPD outpatients (male: 82.8% [96/116]; age: 63.48 ± 7.48 years; disease severity distribution: GOLD 1/2/3/4 = 55.8%/34.6%/7.7%/1.9%). Patients were categorized into three groups based on oxygen desaturation (SpO₂) during the six-minute walk test (6MWT): non-EID (n = 52), mild-EID (n = 42), and severe-EID (n = 22). EID was classified as follows: Mild EID: SpO₂ decrease ≥4% with nadir SpO₂ ≥90%. Severe EID: SpO₂ decrease ≥4% with nadir SpO₂ ≤90%. Non EID: SpO₂ decrease <4% with nadir SpO₂ ≥90%. A six-month follow-up was conducted via telephone to record adverse events and assess quality of life using the Chinese version of the EQ-5D questionnaire, which includes five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, along with the EQ-VAS scale.

Significant differences were observed across the three groups in peripheral blood oxygen saturation (SpO₂, %), peak expiratory flow (PEF, L/s), PEF (%), forced expiratory volume in the first second (FEV1, L), FEV1 (%), 6MWT distance (6MWD, m), Borg dyspnea, and Borg fatigue scores. The optimal cutoff values for predicting EID severity was 54.45% for FEV1% (AUC=0.716), 450.5 m for 6MWD (AUC = 0.761), and 94.5% for resting SpO₂ (AUC = 0.737). Multivariate logistic regression analysis identified low FEV1%, reduced 6MWD, and low resting SpO₂ as risk factors for severe EID (FEV1%: p = 0.002; 6MWD: p = 0.008; SpO₂: p = 0.018. Severe EID patients had significantly lower EQ-5D index and EQ-VAS scores (EQ-5D index: p = 0.002; EQ-VAS: P = 0.005), particularly in mobility and usual activities dimensions (mobility: p = 0.001; usual activities: p = 0.038).

Low FEV1%, reduced 6MWD, and low resting SpO₂ are key risk factors for severe EID, provide practical thresholds for clinical management of EID in COPD patients.

Chronic obstructive pulmonary disease (COPD) is a complex lung condition primarily affecting the airways and alveoli, characterized by persistent progressive airflow limitation. COPD ranks as the third leading cause of death worldwide, with its incidence and mortality rates escalating annually due to an aging population. This study aimed to explore the association between low-density lipoprotein cholesterol (LDL-C) and COPD, as well as the impact of statin drugs on the progression of COPD.

Employing an integrated approach that encompasses observational studies, genetic epidemiology, and molecular biology, this research investigated the link between LDL-C and COPD using clinical survey data, genome-wide association study (GWAS) data, and transcriptomic data. Additionally, it assessed the potential role of statin drugs in the treatment of COPD.

The study discovered that LDL-C serves as a protective factor for COPD, and statin drugs may promote the progression of COPD by reducing LDL-C levels. This finding provides a new perspective on the metabolic disruptions in COPD and offers significant guidance for future therapeutic strategies.

This research confirms the inverse correlation between LDL-C and COPD and reveals that statin drugs might influence the progression of COPD by affecting LDL-C levels. These findings underscore the importance of considering metabolic factors in COPD management and suggest new directions for therapeutic strategies.

Frailty is a complex clinical syndrome characterized by reduced physiological resilience and heightened susceptibility to external stressors, culminating in increased risks of functional decline, hospitalization, and mortality. In individuals with chronic obstructive pulmonary disease (COPD), frailty exacerbates disease burden and is closely linked to adverse outcomes, including increased exacerbation frequency, diminished quality of life, and poor prognosis. This review synthesizes current evidence on the interplay between frailty and COPD, emphasizing clinical implications, diagnostic frameworks, emerging biomarkers, and tailored management strategies. A systematic literature search was conducted across PubMed, Scopus, and Embase databases, employing key terms such as "frailty", "chronic obstructive pulmonary disease", "COPD", "frailty assessment", "biomarkers", and "frailty management in COPD". Inclusion criteria targeted English-language studies reporting original data with a direct focus on frailty in the context of COPD. By synthesizing multidimensional assessment strategies and potential therapeutic modalities, this review supports the development of precision-based interventions to reduce frailty and improve outcomes in patients with COPD.

The lactate dehydrogenase-to-albumin ratio (LAR) has emerged as a prognostic marker for critically ill patients, yet its relationship with mortality in chronic obstructive pulmonary disease (COPD) remains poorly understood. Our purpose is to assess the predictive value of LAR in COPD patients.

In this retrospective cohort study, data were extracted from the MIMIC IV database. COPD patients were divided into two groups based on 28-day all-cause mortality. To investigate the relationship between LAR and short-term mortality, multivariate Cox regression, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis were performed.

The study included 1048 COPD patients, with 37% experiencing 28-day mortality. LAR was identified as an independent predictor of 28-day mortality (hazard ratio [HR] 1.01, 95% confidence interval [CI]: 1.01-1.01, P < 0.001). ROC analysis showed that LAR had an area under the curve (AUC) of 69.48% (95% CI: 65.67-73.29%), demonstrating superior discriminatory power compared to lactate dehydrogenase (AUC = 66.69%) or albumin (AUC = 36.88%) alone. Additionally, LAR's predictive performance was comparable to that of the Simplified Acute Physiology Score II (SAPSII), which yielded an AUC of 76.8% (95% CI: 73.54-80.06%). COPD patients with high LAR values (>120) had significantly higher 28-day mortality rates (P < 0.001).

Elevated LAR is an independent predictor of 28-day mortality in ICU patients with COPD. LAR proves to be a valuable prognostic tool that may assist in the early identification of high-risk patients with CPPD.

While diet may impact the risk of chronic obstructive pulmonary disease (COPD), the relationship between COPD and dietary inflammatory potential remains largely unexplored. This study aimed to evaluate the association between COPD status and the dietary inflammatory index (DII).

Utilizing NHANES data from 2013 to 2018, the study investigated the relationship between Dietary Inflammatory Index (DII) scores, derived from 24-hour dietary recall interviews, and COPD status. Weighted logistic regression and restricted cubic spline (RCS) analyses were employed to assess this association. Additionally, stratified and interaction analyses were conducted to evaluate the consistency of the relationship and identify potential modifiers.

Individuals diagnosed with COPD demonstrated significantly elevated DII scores in comparison to those without COPD. An increment of one unit in the DII was correlated with an increased risk of developing COPD, as indicated by an odds ratio (OR) of 1.05 (95% CI:1.09, 1.21; P=0.007). Following comprehensive multivariate adjustments, the odds ratio for COPD, when comparing individuals in the highest quartile of DII scores to those in the lowest quartile, was 1.34 (95% CI:1.01, 1.77; P<0.001). A positive linear association was observed between DII and COPD, although the relationship was nonlinear (P=0.618). Moreover, the association between DII and COPD was consistent across various stratified analyses.

The study results imply that consuming a pro-inflammatory diet is connected to a greater chance of developing COPD among US residents. Dietary strategies aimed at reducing inflammation might help in preventing COPD and associated illnesses.

Venous thromboembolism (VTE) is widespread and poses significant risks of illness and death, making it a vital public health issue. Obstructive sleep apnea (OSA), which is the most prevalent sleep disorder, is connected to an increased possibility of cardiovascular diseases and VTE. The length of VTE treatment hinges mainly on the frequency of its recurrence in patients. Our data about VTE and its recurrence in OSA patients are limited. In this review, we aim to investigate the risk of VTE recurrence in OSA patients and evaluate the role of continuous positive airway pressure (CPAP) therapy in mitigating this risk. A literature search gathered information about VTE pathogenesis and its potential recurrence mechanism in OSA. The recurrent episodes of partial or complete obstruction of the upper airway in OSA lead to intermittent lack of oxygen. Hypoxemia acts as a central cornerstone of VTE incidence in OSA patients, leads to activating all the vertices of Virchow's triad, and creates the appropriate condition for the developmental and even recurrence of VTE. Intermittent hypoxia causes an increase in the inflammatory state and coagulation activity, leading to oxidative stress and endothelial dysfunction. Furthermore, it results in heightened viscosity and venous stasis. The results of previous studies on VTE recurrence in OSA patients are conflicting. Even though the use of CPAP leads to diminished proinflammatory cytokines and oxidative stress indicators, there is currently insufficient clinical evidence to support that this therapy can prevent recurrent VTE in patients with OSA. Further investigation is necessary to gain a better comprehension of the probability and frequency of relapse of VTE in OSA patients, as the present research has generated inconclusive outcomes.

The therapeutic options for patients with coronavirus disease (COVID-19) are limited. Mesenchymal stem cells (MSCs) have immunomodulatory and regenerative properties that may inhibit excessive inflammatory responses, promote recovery from COVID-19-induced lung injury, and potentially serve as a therapeutic option.

An evaluation of the safety and efficacy of using human umbilical cord mesenchymal stem cells (hUC-MSCs) in 5 critically ill patients with COVID-19 was conducted in this study. In all patients, hUC-MSCs were administered intravenously three times at a dosage of 3 × 10⁷ cells per time, 2 days between each infusion. Safety was evaluated using adverse events. The efficacy was assessed by coagulation function (serum D dimer), inflammatory index (CRP and IL-6) and immune index (lymphocyte count, neutrophil count, CD4, CD19, and CD16 + 56), as well as chest computed tomography (CT) images. Post-infusion visits focused on oxygen saturation and progression of lung lesions.

Infusions of hUC-MSCs were not associated with any serious adverse events. The CT scans indicate that lung lesions have been adequately controlled after receiving the hUC-MSCs. HUC-MSCs injection improved immune system function and alleviated inflammation.

According to our findings, intravenous infusion of hUC-MSCs has proven to be safe, and it has also proven to show potential therapeutic benefits for patients with severe COVID-19.