To compare the risk of chronic obstructive pulmonary disease (COPD) between patients newly diagnosed with RA and individuals without RA. This large-scale study aims to provide novel insights into the association between RA and COPD by evaluating the impact of clinical factors and medications on COPD risk, using robust propensity-score matching.

This retrospective comparative cohort study utilized data from the TriNetX Research Network, collected on October 9, 2023. Patients newly diagnosed with RA from 2010 to 2021 were compared to non-RA individuals matched on demographics and medical history. Propensity-score matching balanced baseline covariates. The primary outcome was the 5-year risk of newly onset COPD (ICD-10: J41-J44), analyzed using Kaplan-Meier and Cox's proportional hazards models.

The study included 136,820 pairs of RA and non-RA patients. The 5-year cumulative probability of COPD was 7.36% in the RA cohort versus 5.97% in the non-RA cohort, with a hazard ratio of 1.228 (95% CI = 1.186-1.272). Subgroup analyses showed higher COPD risk in RA patients across different demographics and clinical factors. Males, older patients, higher rheumatoid factor, and higher erythrocyte sedimentation rate increased COPD risk, while DMARDs and systemic NSAIDs reduced it.

RA patients have a significantly higher risk of developing COPD compared to non-RA individuals. These findings underscore the importance of targeted COPD prevention and management in RA patients.

The COVID-19 pandemic underscored the need for efficient real-time evidence generation to inform public health interventions and policies. To address this gap, a formalized research partnership between the California Department of Public Health (CDPH) and the University of California (UC) was created. The aim of this case study is to describe the achievements and lessons learned from the California Collaborative for Public Health Research (CPR3). This state-wide infrastructure (1) streamlines data sharing and use between UC researchers and public health agencies; (2) sets priority research agendas that reflect the needs of the state's diverse communities; and (3) fosters research collaboration and evidence translation. This partnership may serve as a guide for how academic and public health entities can jointly prioritize, conduct, and act upon policy-relevant research for current and emerging threats.

Pregnant and lactating refugee women rank among the groups least likely to vaccinate against COVID-19. This qualitative study explores their reasons for COVID-19 vaccine hesitancy.

Between June 2023 and January 2024, cultural health navigators (CHNs) employed by one hospital system conducted in- depth interviews with COVID-19 vaccine-hesitant pregnant and lactating refugee women from five language groups (Arabic, Burmese, Kinyarwanda, Somali, and Swahili). The team also conducted in-depth interviews and a focus group with the five CHNs to further understand community-level factors influencing refugee women's vaccine hesitancy. All qualitative data were analyzed using inductive thematic analysis.

Participants expressed fear of long-term health effects, especially of becoming infertile or of their babies dying, as the primary reasons for not vaccinating. Others reported their perceptions that COVID-19 is no longer a significant health concern. CHNs described the role of social media in spreading misinformation about the vaccine, leading to vaccine hesitancy. Some unanticipated themes that emerged included the role of men in vaccine decision-making and the fear of disrespecting their healthcare provider by declining the vaccine.

Study results indicated the need to continue to combat misinformation about the COVID-19 vaccine amongst pregnant and lactating refugee women and the need to take a community-based approach to increase vaccine trust. For example, community health workers or CHNs can provide patient education to increase vaccine trust. Trusted civil organizations could disseminate messages targeting vaccine misinformation spread on social media platforms. Additionally, digital storytelling in refugees' native languages can be a helpful dissemination tool to increase vaccine education and combat misinformation and vaccine hesitancy.

Earlier studies have indicated a positive correlation systemic immune-inflammatory index (SII) and systemic inflammatory response index (SIRI) levels and the development of coronary heart disease (CHD). However, the correlation between SII, SIRI levels and the incidence of CHD in patients with asthma has not been described. The purpose of the study was to research the potential correlation between the levels of SII, SIRI and the incidence of CHD in patients with asthma.

We conducted a retrospective cross-sectional analysis in which data of individuals from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. This study included 39,156 adults. Weighted multivariable regression analysis and subgroup analyses were used to assess the independent and combined associations between CHD prevalence and SII, SIRI levels of asthmatic population.

Totally, 2,321 adults were included in our analysis, with 116 participants experiencing CHD and the remaining 2,205 participants being free of CHD. SII levels did not significantly correlate with any of the participants' baseline characteristics, nor did SIRI levels (r < 0.1). Higher levels of SII were related to increased incidence of CHD, with an OR of 1.462 (95% CI, 1.031-1.893) (p < 0.001). Similarly, SIRI levels had similar results, with OR of 1.268 (95% CI, 1.095-1.441) (p < 0.05). Positive correlations between SII, SIRI levels and the incidence of CHD were observed (p < 0.05). Curve fitting further illustrated a positive correlation between SII, SIRI and the incidence of CHD in participants with asthma. Threshold effect analysis showed that higher levels of SII and SIRI were associated with a higher incidence of CHD, especially when SII and SIRI levels exceeded the thresholds of 411.238 and 1.812. Stratified analyses confirmed that the associations between higher SII and SIRI and increased CHD incidence in most subgroups remained consistent.

The incidence of CHD in asthmatic individuals was positively correlated with elevated SII and SIRI levels among US adults. SII and SIRI serve as recently emerged inflammatory markers for assessing CHD prevalence in the asthmatic population. However, in order to confirm these findings, more rigorous large-scale prospective studies are needed.

Promoting the absorption of COVID-19 pneumonia is critical for reducing pulmonary sequelae and improving prognosis. This study aimed to evaluate the efficacy and safety of nebulized unfractionated heparin, acetylcysteine, budesonide, and ipratropium bromide (HABIT) in hospitalized patients with COVID-19 pneumonia.

This single-center, open-label, randomized, parallel-group trial was conducted at a tertiary hospital in China. Participants were randomized 1:1 to receive either standard of care (SOC) or SOC plus nebulized HABIT. The HABIT protocol included daily quadruple nebulization for seven days, comprising 6000 units heparin sodium, 2 mg budesonide, 0.3 g acetylcysteine, and 0.5 mg ipratropium bromide. The primary outcome was the change in lung lesions assessed by chest CT scans on admission (Day 0) and post-treatment (Day 8).

A total of 74 patients were randomized to the HABIT group (n = 37) or the control group (n = 37). Four patients per group were excluded during follow-up, leaving 66 patients for final analysis. Baseline CT scores were comparable between groups (10.55 ± 3.11 vs. 10.76 ± 2.85, p = 0.774). Post-treatment, the HABIT group showed significantly lower mean CT scores (6.6 ± 2.98 vs. 8.69 ± 2.53, p = 0.003) and greater lesion absorption (37.5% vs. 20%, p < 0.001) compared to controls. The HABIT group also exhibited a non-significant improvement in PaO₂/FiO₂ (75.27 vs. 51.23, p = 0.113). Safety analysis showed no significant differences in activated partial thromboplastin time or serious adverse events.

The adjunctive HABIT regimen demonstrates favorable efficacy and safety in treating COVID-19 pneumonia.

The clinical trial was registered with the Chinese Clinical Trial Registry (ChiCTR; www.chictr.org.cn ; ID: ChiCTR2300073871) on July 24, 2023. Ethical approval was valid from May 2023 to May 2025.

Allergic rhinitis is a prevalent immune disorder with a significant impact on quality of life and socioeconomic burden. Korean Medicine treatments such as herbal medicine and acupuncture are widely utilized for allergic rhinitis due to clinical effectiveness and patient preferences. In particular, herbal decoctions, a key component of Korean Medicine treatment for allergic rhinitis, offer personalized treatment but pose challenges for randomized controlled trials due to the difficulty of placebo development. This study aims to establish a registry utilizing real-world data (RWD) on Korean Medicine treatment for allergic rhinitis, focusing on the effectiveness, safety, and cost-effectiveness of herbal decoctions in clinical practice.

The KOrean medicine REgistry for Allergic rhinitis in Real-world settings (KOREA-R) aims to enroll 400 patients with allergic rhinitis receiving Korean Medicine treatment at two Korean Medicine hospitals from February 2025 to June 2028. Patients will be examined in three visits at 2-week intervals, followed by two additional online follow-ups at 6 and 12 months after week 4. RWD on symptom severity, quality of life, treatment administration and compliance, adverse events, and laboratory blood tests will be collected. Participation is voluntary, with no restrictions on treatment types or dosages. Statistical analyses, including propensity score matching and difference-in-difference, will be used to evaluate the effectiveness, safety, and cost-effectiveness of Korean Medicine treatment, particularly herbal decoctions. Data management ensures confidentiality and quality through a validated electronic data capture system and regular monitoring.

The findings of KOREA-R will provide insights into the effectiveness and safety of Korean Medicine treatment for allergic rhinitis, with a focus on herbal decoctions tailored to individual patient symptoms and pattern identifications. Additionally, by systematically collecting RWD for multidimensional analysis, KOREA-R will offer valuable information on the cost-utility and cost-effectiveness of herbal decoctions for both patients and healthcare policymakers.

Clinical Research Information Service, KCT0010133 (Registration date: January 13, 2025).

We aimed to evaluate whether cytomegalovirus (CMV) reactivation affects the length of stay (LOS) and mortality of critically ill patients with coronavirus disease 2019 (COVID-19) following standard steroid and anti-cytokine treatments.

Retrospective data analysis of an observational cohort study.

We included all inpatients aged ≥ 20 years with severe acute respiratory syndrome coronavirus 2 infection in Northern Taiwan between May and July 2021. Blood, sputum, or endotracheal aspirate samples were collected weekly from critically ill patients with COVID-19 who did not respond to steroid treatment and sent for CMV reverse transcriptase-polymerase chain reaction testing. We investigated whether there were differences in comorbidities and prognoses between patients who tested positive for CMV and those who tested negative.

Of the 167 inpatients with COVID-19, 43.3% (13/30) were critically ill, refractory to steroid treatment, and had CMV reactivation. Most (69.2%, 9/13) patients with CMV DNAemia had concurrent CMV positivity in the tracheal aspirate. Compared with CMV-negative patients, CMV-positive patients had a longer LOS but not higher 14- and 28-day mortality rates.

A high proportion of critically ill patients with COVID-19 who were refractory to steroid treatment developed CMV DNAemia. In critically ill patients with COVID-19, CMV reactivation can prolong hospitalization.

Although disease-modifying therapies (DMTs) may suppress coronavirus disease 2019 (COVID-19) vaccine responses in people with multiple sclerosis (pwMS), limited data are available on the cumulative effect of additional boosters. Maturation of Spike immunoglobulin G (IgG) to target a greater diversity of SARS-CoV-2 variants, especially past the BA.1 variant, has not been reported. In addition, the prediction of variant-specific protection, given that Spike antibody testing is not performed routinely, remains a challenge. We, therefore, evaluated whether additional vaccine doses improved the breadth of cross-variant recognition to target emerging SARS-CoV-2 variants. Machine learning-based models were designed to predict variant-specific protection status.

In a prospective observational cohort (n = 442), Spike IgG titers and live virus neutralization against D614, BA.1, BA.2, BA.5, XBB.1.1, XBB.1.5, and EG.5.1 variants were determined in 1,011 serum samples (0-12 months after 2-4 doses). Predictive protection models were developed by K-fold cross-validation on training and test data sets (random split 70:30).

After primary vaccination, pwMS on immunosuppressive disease-modifying therapy (IMM-DMT) had 10-fold and 7.2-fold lower D614 Spike IgG titers than pwMS on low-efficacy (LE)-DMT and cladribine (p < 0.01). After 4 doses, pwMS on IMM-DMT had significantly lower Spike IgG titers, compared with pwMS on low-efficacy disease-modifying therapy, for D614 (p < 0.05), as well as BA.1, BA.2, BA.5, XBB.1, XBB.1.5, and EG.5.1(p < 0.01). The breadth of Spike IgG to recognize variants other than the cognate antigen increased after 4 doses of all DMTs. Although pwMS on IMM-DMT displayed reduced cross-variant recognition, a fourth dose resulted in a 2-4-fold increase in protection against newer variants and a reduction in two-thirds of pwMS without protective Spike IgG (p < 0.0001). Tixagevimab and cilgavimab did not induce additional cross-variant protection. Variant-specific predictive models of vaccine protection were influenced by treatment, time since primary vaccination, and age, with high sensitivity (99.4%, 95% CI 96.8-99.99) and specificity (72.0%, 95% CI 50.6-87.9) for XBB.1.5/EG.5.1 variants.

Despite not eliciting adequate antibody response in pwMS on IMM-DMT, COVID-19 boosters improve the breadth of the humoral response against SARS-CoV-2 emerging variants. Vaccine protection can be predicted by statistical modeling.

The escalating morbidity and mortality of chronic obstructive pulmonary disease (COPD) necessitates improved diagnostic approaches for comorbid infections. COPD patients exhibit heightened susceptibility to opportunistic pathogens like Nocardia species due to compromised airway defenses and frequent glucocorticoid/immuno-suppressant use. Despite its clinical significance, Nocardia infection remains diagnostically challenging due to nonspecific presentations and imaging features.

To develop and validate a diagnostic model integrating clinical characteristics and risk factors for COPD complicated by Nocardia infection.

A retrospective analysis was conducted on clinical data from 586 patients diagnosed with COPD and Nocardia infection, including clinical symptoms, laboratory tests, imaging findings, and treatment outcomes. Patients were screened according to inclusion and exclusion criteria and divided into two groups: COPD with Nocardia infection group (infection group) and COPD-only group (control group).

This retrospective study analyzed 586 COPD patients (2019-2024), stratified into Nocardia-infected (n = 289) and noninfected (n = 297) cohorts. Demographic, laboratory, pulmonary function, and imaging data were collected. Multivariate logistic regression identified independent predictors, which informed a nomogram model. Model performance was assessed via concordance index (C-index), calibration curves, and ROC analysis.

Independent risk factors included hemoptysis (OR = 1.99, 95% CI: 0.76-5.26), lymphocyte count (OR = 6.81, 95% CI: 4.06-11.42), hemoglobin (OR = 1.01, 95% CI: 0.99-1.03), and pulmonary function parameters (FEV₁/FVC ratio OR = 12.47, 95% CI: 1.25-124.16). The model demonstrated excellent discrimination (C-index: 0.895 infected, 0.829 noninfected) and calibration (mean absolute error: 0.127-0.170). ROC analysis revealed AUCs of 0.896 (95% CI: 0.90-0.97) and 0.830 (95% CI: 0.77-0.89) for infected and noninfected groups, respectively.

This validated nomogram provides a clinically actionable tool for early Nocardia detection in COPD patients, addressing a critical diagnostic gap. External validation is warranted to confirm generalizability.

Chronic obstructive pulmonary disease (COPD), which exhibits high morbidity and mortality rates, is a respiratory illness associated with persistent airflow obstruction. This study aimed to examine effects of beach chair position on respiratory mechanics in individuals with COPD hospitalized in intensive care unit (ICU) to assess its effectiveness compared to supine position.

Forty-six participants with COPD, admitted to the ICU and receiving either invasive or non-invasive mechanical ventilation were included in this prospective study. The subjects were initially placed in the supine position. After a few hours, the patients were positioned to spend at least 16 h a day in the beach chair position. Mechanical ventilator data were recorded every hour in each position. The primary outcome of this study included comparison of compliance, elastance, and peak airway resistance, time constant, airway resistance, pH, pCO2 and pO2 data in supine and beach chair positions.

In compared with supine positioning, beach chair positioning resulted in significant enhancement in compliance (35.98 ± 17.51 mL/cmH₂O vs. 44.69 ± 28.74 mL/cmH₂O, p- value = 0.009) and elastance (29.59 ± 11.87 cmH₂O/L vs. 39.86 ± 41.55 cmH₂O/L, p-value = 0.009) whereas peak airway pressure, time constant, airway resistance, pH, pCO₂ and pO₂ did not significantly differ between supine and beach chair position.

Beach chair positioning improves lung compliance and elastance in individuals with COPD in ICU when compared to supine positioning. This study suggests that the beach chair position may offer significant respiratory benefits in terms of respiratory mechanics for COPD patients.