Brief summaryNearly 50% patients of novel coronavirus (SARS-CoV-2)-infected pneumonia could not reach obvious clinical and radiological remission within 10 days after hospitalization. These refractory COVID-19 patients showed an obvious difference with the general patients in clinical characteristics. AbstractBackground: Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China.This study aimed to clarify the characteristics of patients with refractory COVID-19. Methods:In this retrospective single-center study, we included 155 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from January 1 st to February 5 th . The cases were divided into general and refractory COVID-19 groups according to the clinical efficacy after hospitalization, and the difference between groups were compared. Results:Compared with general COVID-19 patients (45.2%), refractory patients had an older age, male sex, more underlying comorbidities, lower incidence of fever, higher levels of maximum temperature among fever cases, higher incidence of breath shortness and anorexia, severer disease assessment on admission, high levels of neutrophil, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and C-reactive protein, lower levels of platelets and albumin, and higher incidence of bilateral pneumonia and pleural effusion (P<0.05). Refractory COVID-19 patients were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatment including corticosteroid, antiviral drugs and immune enhancer (P<0.05). After adjustment, those with refractory COVID-19 were also more likely to have a male sex and manifestations of anorexia and fever on admission, and receive oxygen, expectorant and adjunctive agents (P<0.05) when considering the factors of disease severity on admission, mechanical ventilation, and ICU transfer.Conclusion: Nearly 50% COVID-19 patients could not reach obvious clinical and radiological remission within 10 days after hospitalization. The patients with male sex, anorexia and no fever on admission predicted poor efficacy.

BACKGROUND The liver is frequently subject to insult because of viral infection, alcohol abuse, or toxic chemical exposure. Extensive research has been conducted to identify blood markers that can better discern liver damage, but little progress has been achieved in clinical practice. Recently, circulating microRNAs (miRNAs) have been reported as potential biomarkers for the noninvasive diagnosis of cancer. In this study, we investigated whether plasma miRNAs have diagnostic utility in identifying liver disease. METHODS The study was divided into 2 phases: marker selection by real-time quantitative PCR analysis of a small set of plasma samples, and marker validation with a large set of plasma samples from 83 patients with chronic hepatitis B viral infections, 15 patients with skeletal muscle disease, and 40 healthy controls. Two mouse model systems, d-galactosamine- and alcohol-induced liver injury, were also developed to evaluate whether differences in miRNA concentration were associated with various liver diseases. RESULTS Among the miRNA candidates identified, miR-122 presented a disease severity–dependent change in plasma concentration in the patients and animal models. Compared with an increase in aminotransferase activity in the blood, the change in miR-122 concentration appeared earlier. Furthermore, this change was more specific for liver injury than for other organ damage and was more reliable, because the change was correlated with liver histologic stage. CONCLUSIONS Our findings suggest that circulating miR-122 has potential as a novel, predictive, and reliable blood marker for viral-, alcohol-, and chemical-induced liver injury.

2 6 Sweden 2 7 2 8 Abstract = 186 words, Main text = 1722 words, Figures =2. Abstract 3 0 Objectives: Comorbidities have significant indications for the disease outcome of COVID-19, 3 1 however which underlying diseases that contribute the most to aggravate the conditions of 3 2 COVID-19 patients is still largely unknown. SARS-CoV-2 viral clearance is a golden standard 3 3 for defining the recovery of COVID-19 infections. To dissect the underlying diseases that 3 4 could impact on viral clearance, we enrolled 106 COVID-19 patients who were hospitalized in 3 5 Methodology: We comprehensively analyzed demographic, clinical and laboratory data, as 3 8 well as patient treatment records. Survival analyses with Kaplan-Meier and Cox regression 3 9 modelling were employed to identify factors influencing the viral clearance negatively. 4 0 Results: We found that increasing age, male gender, and angiotensin-converting enzyme 2 4 1 (ACE2) associated factors (including hypertension, diabetes, and cardiovascular diseases) 4 2 adversely affected the viral clearance. Furthermore, analysis by a random forest survival 4 3 model pointed out hypertension, cortisone treatment, gender, and age as the four most 4 4 important variables. 4 5 Conclusions: We conclude that patients at old age, males, and/or having diseases 4 6 associated with high expression of ACE2 will have worse prognosis during a COVID-19 4 7 infections. 4 8 4 9

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