Objective:To examine the influence of handgrip strength(HGS)on the intrinsic capacity(IC)and explore the correlation between HGS and intrinsic capacity subdomains in elderly patients of varying genders.Methods:A cross-sectional study was conducted on 201 inpatients admitted to the Geriatric Department of Zhejiang Hospital from May 2020 to November 2021.The study collected data on the patients' general situation and intrinsic capacity assessment, which included physical function, nutritional status, visual and hearing status, cognitive function, and depressive mood.The patients were grouped based on the number of impaired subdomains of intrinsic capacity.Multivariate ordered Logistic regression analysis was performed to identify the factors influencing the impaired subdomains of intrinsic capacity.The patients were further divided into normal and decreased grip strength groups based on HGS thresholds of less than 26 kg for males and less than 18 kg for females.Binary Logistic regression analysis was then used to investigate the relationship between HGS and the different subdomains of intrinsic capacity among males and females.Results:Among the 201 inpatients, 68 were impaired in 0 to 1 subdomain(33.8%), 103 in 2 to 3 subdomains(51.2%), and 30 in more than 3 subdomains(14.9%).After adjusting for confounding factors using multivariate ordered Logistic regression analysis, the HGS of the 2 to 3 and more than 3 subdomain groups were found to be lower than the 0 to 1 subdomain group( OR=0.957, 95% CI: 0.924-0.993, P=0.019).Among the patients, 117(58.2%)had normal HGS, while 84(41.8%)had decreased HGS.In the binary Logistic regression analysis of older adults, adjusted for confounders, the results indicated that older men with decreased HGS had higher odds of experiencing cognition problems( OR=3.919, 95% CI: 1.301-11.804, P=0.015).Similarly, older women with decreased HGS had higher odds of having locomotion( OR=10.623, 95% CI: 2.374-47.536, P=0.002), vitality( OR=7.386, 95% CI: 1.875-29.095, P=0.004), and cognition( OR=4.835, 95% CI: 1.218-19.196, P=0.025)problems. Conclusions:The key population for intrinsic capacity screening should be elderly patients with decreased HGS.It is important to note that there are differences in the subdomains of impaired intrinsic capacity among elderly individuals with decreased HGS of different genders.As a result, it is crucial to prioritize the development of intervention programs to improve intrinsic capacity based on the specific needs of elderly individuals of different genders.

Objective:To investigate the awareness of sarcopenia and knowledge about its prevention and control in elderly patients with cardiovascular disease and analyze potential influencing factors for the awareness rate of sarcopenia, in order to provide a theoretical foundation for further developing a precise health education program for elderly patients with cardiovascular disease and sarcopenia.Methods:In this multicenter cross-sectional study, the representative sampling method was used via a questionnaire to collect demographic data, awareness of sarcopenia, and knowledge about its prevention and control from 576 elderly patients aged 60 years and over receiving treatment between March and August 2022 at 12 hospitals including Zhejiang Hospital.Meanwhile, possible influencing factors on the awareness rate of sarcopenia in elderly cardiovascular disease patients were analyzed.Results:The overall awareness rate of sarcopenia in elderly patients with cardiovascular disease was 43.2%(249/576).The awareness rates for sarcopenia-related declines in grip strength and walking speed were 39.9%(230/576)and 39.8%(229/576), respectively.The rates of awareness that sarcopenia is more likely to occur in very elderly people was 37.8%(218/576)and the rate of awareness for its more likely occurrence in elderly people with chronic diseases was 29.3%(169/576).The rates of awareness that resistance exercise and protein supplementation could prevent or improve sarcopenia were 33.9%(195/576)and 37.0%(213/576), respectively.Multivariate Logistic regression analysis found that being female and being 70-89 years old were independent risk factors affecting the awareness of sarcopenia and related knowledge about its prevention and control, while high school education and above and living alone were independent protective factors.Conclusions:The awareness rate of sarcopenia and knowledge about its prevention and control in elderly patients with cardiovascular disease is low and is significantly correlated to the female gender, advanced age, high educational achievement, living alone and other factors.Therefore, when education about sarcopenia is conducted, a precise health education program for sarcopenia should be established to improve the awareness rate of sarcopenia in elderly patients with cardiovascular disease, thus minimizing or delaying the occurrence and development of sarcopenia as much as possible.

Objective:A one-day nutritional survey study was conducted on geriatric inpatients in the Zhejiang region to evaluate their nutritional and health status.The study aimed to assess the nutritional and health status of elderly patients in the hospital, as well as perform a correlation analysis on the factors influencing the nutritional status of geriatric inpatients.The findings aim to provide evidence to support clinical interventions.Methods:This multicenter cross-sectional study involved conducting a one-day nutritional survey among geriatric inpatients in 42 medical units across Zhejiang, China.Questionnaires were utilized to gather demographic information, record 24-hour dietary intake, calculate total calorie and protein intake, screen for nutrition-related geriatric syndromes, and collect laboratory data from inpatients in the geriatrics department of these medical facilities.Analysis of the data was performed using SPSS 25.0 software to compare groups with varying nutritional statuses and identify potential influencing factors on the nutritional status of elderly hospitalized patients.Results:A total of 325 valid surveys(97.9%)were collected from 332 senior inpatients.Among them, 30 individuals(9.2%)were classified in the malnutrition group, 120 individuals(36.9%)were in the group at risk for malnutrition, and 175 individuals(53.8%)were in the group with appropriate nutrition.Approximately 37.8%(123 out of 325)of elderly hospitalized patients met the recommended minimum daily protein intake of 1g/(kg·d).Following adjustment for confounding variables, the results of multifactorial logistic regression analysis revealed that shorter daily sedentary time(2-4h), independent ambulation, assisted ambulation, maintaining regular food intake before hospitalization, and good or fair self-perceived health were protective factors for the nutritional status of elderly hospitalized patients.Conversely, having fewer than 5 teeth was identified as a risk factor.Conclusions:The prehospital living status of elderly hospitalized patients is closely related to their nutritional status.It is important to prioritize nutritional assessment and provide intervention guidance for lifestyle improvements in this population.

Background/Aims: Disrupted bile acid regulation and accumulation in the liver can contribute to progressive liver damage and fibrosis. However, the effects of bile acids on the activation of hepatic stellate cells (HSCs) remain unclear. This study investigated the effects of bile acids on HSC activation during liver fibrosis, and examined the underlying mechanisms. Methods: The immortalized HSCs, LX-2 and JS-1cells were used for the in vitro study. in vitro, the adeno-associated viruses adeno-associated virus-sh-S1PR2 and JTE-013 were used to pharmacologically inhibit the activity of S1PR2 in a murine model of fibrosis induced by a 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet. Histological and biochemical analyses were performed to study the involvement of S1PR2 in the regulation of fibrogenic factors as well as the activation properties of HSCs. Results: S1PR2 was the predominant S1PR expressed in HSCs and was upregulated during taurocholic acid (TCA) stimulation and in cholestatic liver fibrosis mice. TCA-induced HSC proliferation, migration and contraction and extracellular matrix protein secretion were inhibited by JTE-013 and a specific shRNA targeting S1PR2 in LX-2 and JS-1 cells. Meanwhile, treatment with JTE-013 or S1PR2 deficiency significantly attenuated liver histopathological injury, collagen accumulation, and the expression of fibrogenesis-associated genes in mice fed a DDC diet. Furthermore, TCAmediated activation of HSCs through S1PR2 was closely related to the yes-associated protein (YAP) signaling pathway via p38 mitogen-activated protein kinase (p38 MAPK). Conclusions TCA-induced activation of the S1PR2/p38 MAPK/YAP signaling pathways plays a vital role in regulating HSC activation, which might be therapeutically relevant for targeting cholestatic liver fibrosis.

Objective:To investigate the prevalence of the decline of intrinsic capacity(IC)and to explore the effect of intrinsic capacity decline on falls and hospital readmission during 1 year follow-up.Methods:A total of 311 elderly patients treated in Geriatrics Department of Zhejiang Hospital were enrolled.General information and intrinsic ability data, including cognitive(simple mental state inventory), motor(Tinetti-Balance Scale and 4 m test), vitality(grip strength and mini-nutrition assessment table), perception(self-rated vision or hearing impairment), and psychosocial(Geriatric depression scale), were collected at admission.Falls and hospital readmission within 1 year after discharge were followed up.Multivariate Logistic regression analysis was used to investigate the relationship of baseline intrinsic ability at admission with falls and hospital readmission during 1-year follow-up.Results:Of 311 elderly hospitalized patients, 282(90.7%)had intrinsic capacity decline.During 1 year follow-up, 38 elderly patients(12.2%)had falls and 69 elderly patients(22.2%)were hospital readmitted.After adjusting for confounding factors such as age, gender, education level, comorbidities, multiple medications, fear of falling, and assistive tool use and so on, Logistic regression analysis showed that decreased balance ability was a risk factor for falls within 1 year in elderly patients( OR=3.515, 95% CI: 1.089-11.346, P=0.036), and slow walking speed was a risk factor for one-year hospital readmission( OR=2.426, 95% CI: 1.181-4.983, P=0.016). Conclusions:Decreased motor capacity is closely associated with falls and hospital readmission within 1 year in older patients.Great attention should be paid to the assessment and intervention of motor ability in elderly patients.

Objective:To explore the associations of malnutrition, sarcopenia and disability in older hospitalized patients.Methods:A retrospective study was conducted on 180 patients who were admitted to the department of geriatrics of our hospital from November 2015 to September 2020 and completed 1-year follow-up.Malnutrition and sarcopenia were diagnosed as the Global Leadership Initiative on Malnutrition(GLIM)criteria and the 2019 sarcopenia criteria issued by the Asian Working Group for Sarcopenia(AWGS2019).Disability was defined as a score of less than or equal to 95 on the Barthel Index(BI).At the end of the 1-year follow-up, a decrease of ≥5 points in the total BI score from baseline was defined as aggravation of the disability.Multivariate Logistic regression models were used to analyze the effects of malnutrition and sarcopenia on the occurrence and aggravation of the disability.Results:Among the 180 elderly patients, 27.2%(49/180)met the diagnosis of malnutrition and 39.4%(71/180)of sarcopenia, and 22.2%(40/180)of malnutrition and sarcopenia overlapped.The incidence of disability was 36.7%(66/180)at baseline and the incidence of an aggravation of disability was 31.7%(57/180)at 1-year follow-up.After adjustment for confounding factors, multivariate Logistic regression analysis showed that malnutrition( OR=3.70, 95% CI=1.27-10.80, P=0.017)and sarcopenia( OR=2.93, 95% CI=1.12-7.64, P=0.028)were risk factors for disability in elderly patients, and sarcopenia was a risk factor for aggravation of disability in elderly patients after a 1-year follow-up( OR=3.99, 95% CI=1.47-10.83, P=0.007). Conclusions:Malnutrition and sarcopenia are closely associated with the occurrence and development of disability in older hospitalized patients.

Objective To establish the fingerprint spectrum and assay three active components (hesperidin, salvianolic acid B and chrysophanol) in Shenshuaining granule by HPLC method. Methods The chromatographic separation was achieved on SunFireTM C₁₈ column with acetonitrile-0.1% formic acid aqueous solution as mobile phase. Gradient elution program was applied with flow rate of 1.0 ml/min, detection wavelength at 254 nm and the column temperature at 25 ℃. The fingerprint spectrum was established and three active components in Shenshuaining granule were assayed. Results There were 22 common peaks on the fingerprints after analyzing chromatograms from 10 batches of Shenshuaining granules. Good fingerprint similarities (≥0.9) between different batches and the control chromatogram were found. This method has great repeatability, stability and precision, which meets all the assay requirements. Conclusion A simple and reliable HPLC method was developed, which is suitable for the fingerprint establishment of Shenshuaining granules. It provides a method for the quality control of Shenshuaining granules.

Objective:To investigate the impact of geriatric syndromes on physical performance and fall risk in elderly patients with type 2 diabetes mellitus.Methods:A total of 179 elderly inpatients and outpatients with diabetes mellitus in the geriatric department of Zhejiang Hospital were recruited in this cross-sectional study.According to the number of geriatric syndromes including frailty, cognitive impairment, malnutrition, depression, poly-pharmacy and co-morbidity, patients were classified into Group A(n=40, with ≤1 geriatric syndrome), Group B(n=84, with 2-3 geriatric syndromes)and Group C(n=55, with ≥4 geriatric syndromes). Clinical data and physical performance status, fall risk and one-year fall history were compared between the groups.Effects of each geriatric syndrome on disability in daily life, balance and gait ability, and increased fall risk in elderly patients were further analyzed.Results:Patients with more geriatric syndromes were older, had a higher proportion of using walking aids and a higher prevalence of disability in daily life, balance and gait impairment, and increased fall risk( P<0.05). Furthermore, univariate and multivariate Logistic regression indicated that frailty and malnutrition were risk factors for disability in daily life( OR=3.467 and 3.369, P<0.05)and balance and gait impairment( OR=3.031 and 3.266, P<0.05), and that cognition impairment was a risk factor for increased fall risk( OR=2.559, P<0.05)and balance and gait impairment( OR=3.930, P<0.05). Conclusions:Frailty, malnutrition and cognition impairment can lead to physical performance impairment and increased fall risk in elderly patients with type 2 diabetes mellitus.Clinical intervention should be conducted to improve the quality of life in elderly adults.

Objective:To study the role and possible molecular mechanism of neural precursor cell-expressed developmentally down-regulated gene 4-like ( NEDD4 L) in the replication of hepatitis B virus (HBV). Methods:Small interfering RNA (siRNA) targeting NEDD4 L, plasmid expressing NEDD4 L with hemagglutinin(HA) C-terminal tag (pcDNA3.1- NEDD4 L-HA), plasmid expressing 1.3×HBV genome (pGEM-HBV1.3) and poly (dAT: dAT) were respectively transfected into HepG2 cells using Lipofectamine2000. HepG2.2.15 cells, a cell line that can stably express HBV, were used as control. The mRNA levels of NEDD4 L, interferon (IFN)-α, IFN-β, interferon-stimulated gene 56 ( ISG56), myxovirus resistance protein A ( MxA), oligoadenylate synthetase ( OAS), and the levels of HBV DNA or 3.5 kb HBV RNA were detected by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR). Western blot was used to detect the silence and over-expression of NEDD4 L, and the protein levels of the related signaling molecules. The amount of IFN-β in the cellular supernatant was measured by enzyme linked immunosorbent assay (ELISA). Student t test was used for comparison of continuous data between groups. Results:The levels of NEDD4L mRNA and protein in HepG2.2.15 cells were 10.53±0.47 and 4.17±0.43, respectively, which were both statistically higher than those in HepG2 cells (1.00±0.05, t=3.27, P=0.008 and 1.26±0.25, t=1.68, P=0.030, respectively). In HepG2 cells with knockdown of NEDD4 L, the expression level of HBV DNA in cellular supernatant was 0.32±0.09, which was statistically lower than that in the control (1.00±0.05, t=-0.93, P=0.020), and the expression level of 3.5 kb HBV RNA was 0.49±0.11, which was statistically lower than that in the control (1.00±0.05, t=-0.68, P=0.040), while the mRNA levels of IFN-β and downstream effector molecules ( ISG56, MxA and OAS) were all significantly increased compared with the control ( t=4.66, 9.38, 7.29 and 7.01, respectively, all P<0.01). With poly (dAT: dAT) treatment and vesicular stomatitis virus (VSV) stimulation, the levels of IFN-β in HepG2 cells with knockdown of NEDD4 L were (776.41±115.49) ng/L and (961.21±130.19) ng/L, respectively, which were both statistically higher than those of the control group ((320.15± 56.05) ng/L, t=2.43, P=0.020; (440.17±67.82) ng/L, t=2.85, P=0.030, respectively). With poly (dAT: dAT) treatment and VSV stimulation, the levels of IFN-β in HepG2 cells with overexpression of NEDD4 L were (156.18±26.47) ng/L and (176.67±34.51) ng/L, respectively, which were both statistically lower than those of the control group ((320.38±49.39) ng/L, t=-2.03, P=0.040; (440.59±68.83) ng/L, t=-1.93, P=0.030, respectively). Western blot showed that the replication of HBV reduced the protein level of melanoma differentiation-associated protein 5 (MDA5), a key molecule in upstream of IFN-β, but the down-regulation was not obvious in cells with the knockdown of NEDD4 L. Conclusion:The replication of HBV could promote the up-regulation of NEDD4L protein and subsequently reduce the protein level of MDA5, thereby inhibiting the production of IFN-β, which facilitates HBV to escape the innate immune response.