Sarcopenia, a hallmark of cancer cachexia, is linked to an unfavorable prognosis in several malignancies. This study investigated the role of sarcopenia as an independent prognostic factor in lung cancer patients with malignant pleural effusion (MPE) and explored the potential underlying mechanisms using metabolomics. Clinical data from 393 lung cancer patients with MPE at Wuhan Union Hospital from January 2016 to September 2021 were analyzed retrospectively. Univariate and multivariate analyses were used to evaluate the prognostic significance of skeletal muscle and adipose tissue measurements obtained from computed tomography scans of the fourth thoracic vertebra (T4) and third lumbar vertebra. Additionally, metabolomic profiling of pleural fluid from 84 patients was performed, and the effects of candidate metabolites were validated in vitro and in vivo. The T4 skeletal muscle area (T4-SMA) served as an independent prognostic indicator for overall survival in lung cancer patients with MPE. Based on their T4-SMA, patients were categorized into sarcopenia and non-sarcopenia groups using sex-specific cutoff values. Metabolomic analysis identified 61 differential metabolites between sarcopenic and non-sarcopenic patients, with significant sex-based differences. Pathway analysis suggested disruptions in amino acid and unsaturated fatty acid metabolism. Furthermore, arachidonic acid was found to induce muscle atrophy by activating multiple signaling pathways associated with inflammation and sarcopenia. These findings indicate that sarcopenia is an independent prognostic factor in lung cancer with MPE. Alterations in fatty acid and amino acid metabolism, as well as inflammation, may contribute to the potential mechanisms underlying sarcopenia.

AIMS:To explore the association of obesity with the progression and outcome of coronavirus disease 2019 (COVID-19) at the acute period and 5-month follow-up from the perspectives of computed tomography (CT) imaging with artificial intelligence (AI)-based quantitative evaluation, which may help to predict the risk of obese COVID-19 patients progressing to severe and critical disease.MATERIALS AND METHODS:This retrospective cohort enrolled 213 hospitalized COVID-19 patients. Patients were classified into three groups according to their body mass index (BMI): normal weight (from 18.5 to <24 kg/m2 ), overweight (from 24 to <28 kg/m2 ) and obesity (≥28 kg/m2 ).RESULTS:Compared with normal-weight patients, patients with higher BMI were associated with more lung involvements in lung CT examination (lung lesions volume [cm3 ], normal weight vs. overweight vs. obesity; 175.5[34.0-414.9] vs. 261.7[73.3-576.2] vs. 395.8[101.6-1135.6]; p = 0.002), and were more inclined to deterioration at the acute period. At the 5-month follow-up, the lung residual lesion was more serious (residual total lung lesions volume [cm3 ], normal weight vs. overweight vs. obesity; 4.8[0.0-27.4] vs. 10.7[0.0-55.5] vs. 30.1[9.5-91.1]; p = 0.015), and the absorption rates were lower for higher BMI patients (absorption rates of total lung lesions volume [%], normal weight vs. overweight vs. obesity; 99.6[94.0-100.0] vs. 98.9[85.2-100.0] vs. 88.5[66.5-95.2]; p = 0.013). The clinical-plus-AI parameter model was superior to the clinical-only parameter model in the prediction of disease deterioration (areas under the ROC curve, 0.884 vs. 0.794, p < 0.05).CONCLUSIONS:Obesity was associated with severe pneumonia lesions on CT and adverse clinical outcomes. The AI-based model with combinational use of clinical and CT parameters had incremental prognostic value over the clinical parameters alone.

Infection with SARS-CoV-2, the cause of coronavirus infectious disease–19 (COVID-19), has caused a pandemic with >850,000 cases worldwide and increasing. Several studies report outcomes of COVID-19 in predominately well persons. There are also some data on COVID-19 in persons with predominately solid cancer but controversy whether these persons have the same outcomes. We conducted a cohort study at two centres in Wuhan, China, of 128 hospitalised subjects with haematological cancers, 13 (10%) of whom developed COVID-19. We also studied 226 health care providers, 16 of whom developed COVID-19 and 11 of whom were hospitalised. Co-variates were compared with the 115 subjects with haematological cancers without COVID-19 and with 11 hospitalised health care providers with COVID-19. There were no significant differences in baseline co-variates between subjects with haematological cancers developing or not developing COVID-19. Case rates for COVID-19 in hospitalised subjects with haematological cancers was 10% (95% Confidence Interval [CI], 6, 17%) compared with 7% (4, 12%; P = 0.322) in health care providers. However, the 13 subjects with haematological cancers had more severe COVID-19 and more deaths compared with hospitalised health care providers with COVID-19. Case fatality rates were 62% (32, 85%) and 0 (0, 32%; P = 0.002). Hospitalised persons with haematological cancers have a similar case rate of COVID-19 compared with normal health care providers but have more severe disease and a higher case fatality rate. Because we were unable to identify specific risk factors for COVID-19 in hospitalised persons with haematological cancers, we suggest increased surveillance and possible protective isolation.

Background: 2019 novel coronavirus disease (COVID-19) has caused a pandemic, but data about hospital-associated infection in haematological units are yet to know. We aimed to describe epidemical and clinical features and outcome of COVID-19 diagnosed in hospitalised patients with haematological disorders (HD) and in affected healthcare personnel (HCP). Methods: In this retrospective study, we enrolled all the hospitalised patients and HCP, from January 23 to February 14, at three haematology centres (two in Wuhan, the capital of Hubei and centre of the outbreak; one in Xiangyang, another city in Hubei). Hospitalised patients and affected HCP diagnosed with COVID-19 were eligible without additional restriction, with medical records reviewed and data collected. Findings: There were 31 cases with COVID-19 diagnosed in Wuhan cohorts, with no cases in Xiangyang cohort. Of the 136 hospitalised HD patients and 224 HCP in Wuhan, 15 (11%, HD cases) and 16 (7·1%, HCP, i.e. non-HD cases) were diagnosed, respectively, and 13 (86·7%) of the 15 HD cases were patients with haematological malignancies. There was a cluster infection related to the intensive care unit. Compared to non-HD cases, HD cases showed significantly more fever, cough, and dyspnoea, higher procalcitonin and c-reactive protein levels, and lower lymphocyte, platelet, and haemoglobin levels ( P < ·001). All the severe or critical cases and non-survivors with COVID-19 were HD cases. Rapid progression with a higher incidence (60% vs 0%) of acute respiratory depression syndrome was detected in non-survivors, with a median survival of 12 (range, 6-29) days from symptom onset of COVID-19, as of February 29. Interpretation: In haematological units, hospitalised HD patients and HCP are both at high risk of COVID-19 under an outbreak in Wuhan, partially attributing to hospital-associated transmission. The HD patients with COVID-19 are characterised by significant respiratory, inflammatory and haematological damages and abysmal prognosis.Funding Statement: The National Natural Science Foundation of China (81974009 and 81974221).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the institutional review boards of the relevant centres and the Ethics Commission of Wuhan Central Hospital (2020-007). The requirement for informed patient consent was waived by the ethics committee for this retrospective study.

Background: The severe acute respiratory coronavirus 2 (SARS-CoV-2) has caused a pandemic, but data about hospital-associated infection are scarce. We aimed to describe epidemical and clinical features and outcome of SARS-CoV-2 pneumonia (COVID-19) diagnosed in haematological units, including patients with haematological disorders (HD) and health professionals. Methods: In this retrospective study, we enrolled all the hospitalized patients and medical staff, from January 23 to February 14, at three haematology centres (two in Wuhan, the capital of Hubei and centre of the outbreak; one in Xiangyang, another city in Hubei). Hospitalized patients and medical staff diagnosed with COVID-19 were eligible without additional restriction, with medical records reviewed and data collected. Findings: There were 31 cases with COVID-19 diagnosed in Wuhan cohorts, with no cases in Xiangyang cohort. Of the 136 hospitalized HD patients and 224 medical staff in Wuhan, 15 (11%, HD cases) and 16 (7·1%, non-HD cases) were diagnosed, respectively, and 13 (86·7%) of the 15 HD cases were patients with haematological malignancies. There was a cluster infection related to intensive care unit. Compared to non-HD cases, HD cases showed significantly more fever, cough, and dyspnoea, higher procalcitonin and c-reactive protein levels, and lower lymphocyte, platelet, and haemoglobin levels ( P < ·001). All the severe or critical cases and non-survivors with COVID-19 were HD cases. Rapid progression with a higher incidence (60% vs 0%) of acute respiratory depression syndrome was detected in non-survivors, with a median survival of 12 (range, 6-29) days from symptom onset of COVID-19, as of February 29. Interpretation: In haematological units, hospitalized HD patients and medical staff are both at high risk of COVID-19 under an outbreak in Wuhan, partially attributing to hospital-associated transmission. The HD patients are characterized by great respiratory, inflammatory and haematological damages and extremely poor prognosis. Funding: None. Declaration of Interest: We declare no competing interests. Ethical Approval: This study was approved by the Medical Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (20200062).

Previous studies reported the association between interleukin-6 (IL-6) -174G/C gene polymorphism and the risk of diabetic nephropathy in type 2 diabetes mellitus (T2DN). However, the results remain controversial. In the present study, we conducted a meta-analysis to further examine this relationship between IL-6-174G/C gene polymorphism and T2DN. Three databases (PubMed, SinoMed and ISI Web of Science) were used to search clinical case-control studies about IL-6-174G/C polymorphism and T2DN published until Apr. 14, 2018. Fixed- or random-effects models were used to calculate the effect sizes of odds ratio (OR) and 95% confidence intervals (95% CI). Moreover, subgroup analysis was performed in terms of the excretion rate of albuminuria. All the statistical analyses were conducted using Stata 12.0. A total of 11 case-control studies were included in this study, involving 1203 cases of T2DN and 1571 cases of T2DM without DN. Meta-analysis showed that there was an association between IL-6-174G/C polymorphism and increased risk of T2DN under the allelic and recessive genetic models (G vs. C: OR=1.10, 95%CI 1.03–1.18, P=0.006; GG vs. CC+GC: OR=1.11, 95%CI 1.02–1.21 P=0.016). In the subgroup analysis by albuminuria, a significant association of IL-6-174G/C polymorphism with risk of T2DN was noted in the microalbuminuria group under the recessive model (OR=1.54, 95% CI 1.02–2.32, _P=0.038). In conclusion, this meta-analysis suggests that IL-6-174G/C gene polymorphism is associated with the risk of T2DN.