By analyzing the current application of multi-modal data in the diagnosis of gastric "inflammation-cancer" transformation， this study explored the feasibility and strategies for constructing a disease-syndrome integrated diagnosis and treatment system. Based on traditional Chinese medicine （TCM） phenomics， we proposed utilizing multi-modal data from literature research， cross-sectional studies， and cohort follow-ups， combined with artificial intelligence technology， to establish a multi-dimensional diagnostic and treatment index system. This approach aims to uncover the complex pathogenesis and transformation patterns of gastric "inflammation-cancer" progression. Additionally， by dynamically collecting TCM four-diagnostic information and modern medical diagnostic information through a long-term follow-up system， we developed three major modules including information extraction， multi-modal phenotypic modeling， and information output， to make it enable real-world clinical data-driven long-term follow-up and treatment of chronic atrophic gastritis. This system can provide technical support for clinical diagnosis， treatment evaluation， and research， while also offering insights and methods for intelligent TCM diagnosis.

BACKGROUND:Muscle aging is closely related to various epigenetic changes,and exercise has a certain regulatory effect on these epigenetic changes.However,the specific mechanism is not fully understood. OBJECTIVE:To review the epigenetic mechanisms of skeletal muscle and how exercise can improve skeletal muscle aging and promote adaptive changes in muscle through these epigenetic mechanisms,aiming to provide a more comprehensive understanding of skeletal muscle aging and disease mechanisms. METHODS:During the period from June 1st to August 1st,2023,literature searches were conducted for relevant literature published from database inception to August 2023 in databases including Web of Science,PubMed,CNKI,WanFang,and VIP.The search terms used included"skeletal muscle,""muscle,""aging,""older adult,""aging,""exercise,""physical exercise,""epigenetic,"and"epigenetics"in Chinese as well as"skeletal muscle,muscle,aging,older adult,senescence,age,exercise,sports,physical activity,epigenetic,epigenetics"in English.Boolean logic operators were used to connect the search terms for retrieval,and corresponding strategies were developed.According to the predetermined inclusion and exclusion criteria,70 eligible articles were selected. RESULTS AND CONCLUSION:Epigenetics refers to the phenomenon where gene expression and function are regulated without changes in gene sequence,and epigenetic changes in skeletal muscle are an important field.The epigenetic mechanisms of skeletal muscle play an important role in muscle aging,mainly involving DNA methylation,histone modification,regulation of non-coding RNAs,chromatin remodeling,changes in mitochondrial function and expression changes of aging-related genes.Exercise significantly regulates the epigenetics of skeletal muscle,including promoting DNA methylation,muscle histone modification,regulating miRNA expression,and regulating lncRNA expression,regulating muscle factors(such as interleukin-6),regulating mitochondrial function(such as peroxisome proliferators-activated receptors γ co-activator 1α).Future studies are recommended for long-term,cross-diverse population-based exercise interventions;the application of multi-omics techniques such as proteomics and metabolomics;strengthening the understanding of epigenetic changes at the single-cell level;cross-species comparative studies as well as human clinical trials for the translation of animal model findings to humans;strategies for combining exercise and pharmacological interventions to assess their synergistic effects;and epigenetic studies of crosstalk interactions between skeletal muscle and different organs.

Objective: To explore the effects of a zerotime exercise (ZTEx) intervention on physical activity levels and sedentary behavior among college students, providing evidence for improving physical activity and reducing sedentary habits. Methods: In September 2023, 45 sedentary college students from a university in Fuzhou were recruited and randomly assigned to either the ZTEx group (23 students) or the control group (22 students) according to a random number table method. ZTEx group received two ZTEx focus group meetings for 3 months, while the control group received safety and health education. The International Physical Activity Questionnaire and a threeaxis accelerometer were used to evaluate the sedentary and physical activity levels of college students. At the same time, evaluations related to physical health and psychological questionnaires were completed. Mixed effects analysis of variance and nonparametric tests were used to statistically analyze the physical health, psychological questionnaire, and sedentary and physical activity data of the college students. Results: Postintervention, the ZTEx group showed significant improvements in the duration of lowintensity physical activity [pretest(1 492.78±369.50)min; posttest(1 918.93±354.63)min] and the number of sedentary interruptions [pretest(45.26±13.69)times; posttest(73.78±16.74)times]; grip strength [pretest(28.77±9.23)kg; posttest(31.78±8.00)kg]; sitting up continuously for 30 seconds [pretest(22.52±4.90)times; posttest(26.96±4.87)times]; general selfefficacy [pretest(26.52±4.14)points; posttest(32.96±5.24)points]; body composition summary [pretest(66.44±4.83)points; posttest(72.62±4.88)points]; and psychological composition summary [pretest(61.21±9.88)points; posttest(63.98±9.57)points], while reducing sedentary time [pretest(3 694.28±687.56)min; posttest(2 865.90±493.81)min] in the past 7 days, the differences were statistically significant(P<0.05). The control group exhibited no significant changes(P>0.05). Conclusion ZTEx effectively improve the lowintensity physical activity, increases sedentary breaks, and reduces prolonged sitting among college students, fostering healthier habits and improving physical/mental wellbeing.

Background: s/Aims: Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons’ perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria. Methods: A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at p < 0.05. Results: Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons. Conclusions This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.

Traumatic aneurysms represent less than 1 percent of intracranial aneurysms and middle meningeal artery pseudoaneurysms are even rare. Traumatic aneurysms are usually pseudoaneurysms formed by the rupture of all the layers of the vessel wall. They are associated with high mortality as they can present as epidural, subdural, and rarely intraparenchymal hematoma. However, only nine cases of traumatic pseudoaneurysms of middle meningeal artery are reported that have presented as an acute intracerebral hematoma. We report a case of ruptured pseudo aneurysm of middle meningeal artery presenting with intraparenchymal hematoma in which hematoma evacuation and aneurysm excision was done immediately. The patient recovered well in the post-operative period. In addition, we reviewed all cases of middle meningeal artery pseudoaneurysms reported in the literature either as extradural hematomas, subdural/intraparenchymal hematomas, or subarachnoid hemorrhages. However, identifying the location of the aneurysm intraoperatively may be challenging as the hematoma may obscure the same. Distance from the sphenoid ridge may serve as a good intraoperative guide. Intraoperative localization along with surgical evacuation if done immediately can lead to gratifying results.

Background: s/Aims: Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons’ perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria. Methods: A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at p < 0.05. Results: Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons. Conclusions This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.

Traumatic aneurysms represent less than 1 percent of intracranial aneurysms and middle meningeal artery pseudoaneurysms are even rare. Traumatic aneurysms are usually pseudoaneurysms formed by the rupture of all the layers of the vessel wall. They are associated with high mortality as they can present as epidural, subdural, and rarely intraparenchymal hematoma. However, only nine cases of traumatic pseudoaneurysms of middle meningeal artery are reported that have presented as an acute intracerebral hematoma. We report a case of ruptured pseudo aneurysm of middle meningeal artery presenting with intraparenchymal hematoma in which hematoma evacuation and aneurysm excision was done immediately. The patient recovered well in the post-operative period. In addition, we reviewed all cases of middle meningeal artery pseudoaneurysms reported in the literature either as extradural hematomas, subdural/intraparenchymal hematomas, or subarachnoid hemorrhages. However, identifying the location of the aneurysm intraoperatively may be challenging as the hematoma may obscure the same. Distance from the sphenoid ridge may serve as a good intraoperative guide. Intraoperative localization along with surgical evacuation if done immediately can lead to gratifying results.

Background: s/Aims: Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons’ perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria. Methods: A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at p < 0.05. Results: Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons. Conclusions This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.

Traumatic aneurysms represent less than 1 percent of intracranial aneurysms and middle meningeal artery pseudoaneurysms are even rare. Traumatic aneurysms are usually pseudoaneurysms formed by the rupture of all the layers of the vessel wall. They are associated with high mortality as they can present as epidural, subdural, and rarely intraparenchymal hematoma. However, only nine cases of traumatic pseudoaneurysms of middle meningeal artery are reported that have presented as an acute intracerebral hematoma. We report a case of ruptured pseudo aneurysm of middle meningeal artery presenting with intraparenchymal hematoma in which hematoma evacuation and aneurysm excision was done immediately. The patient recovered well in the post-operative period. In addition, we reviewed all cases of middle meningeal artery pseudoaneurysms reported in the literature either as extradural hematomas, subdural/intraparenchymal hematomas, or subarachnoid hemorrhages. However, identifying the location of the aneurysm intraoperatively may be challenging as the hematoma may obscure the same. Distance from the sphenoid ridge may serve as a good intraoperative guide. Intraoperative localization along with surgical evacuation if done immediately can lead to gratifying results.

ObjectiveTo describe the epidemiological characteristics and trend of pulmonary tuberculosis among the elderly in Shanghai from 2014 to 2023, to estimate the incidence between 2024‒2025, so as to provide references for optimizing the prevention and control strategies of pulmonary tuberculosis for elderly in Shanghai. MethodsData of pulmonary tuberculosis patients aged ≥60 years in Shanghai registered in the Tuberculosis Registration and Management System of Chinese Center for Disease Control and Prevention from 2014 to 2023 was derived to describe the demographic characteristics of the elderly patients with pulmonary tuberculosis, and to calculate the reported incidence rate and annual percentage change (APC) of pulmonary tuberculosis. The autoregressive integrated moving average (ARIMA) model was constructed using monthly reported incidence data from January 2014 to June 2023, and data from July to December in 2023 were used to validate the model and predict the reported incidence rate of pulmonary tuberculosis among elderly in 2024 and 2025. ResultsA total of 19 208 elderly pulmonary tuberculosis patients were registered and reported in Shanghai from 2014 to 2023, with an average annual reported incidence rate of 35.04/100 000. The reported incidence rate of pulmonary tuberculosis in elderly showed an overall decreasing trend, APC=-3.34% (t=-3.360,P=0.010). While, the proportion of elderly pulmonary tuberculosis patients showed a yearly increasing trend among the total registered and reported cases, APC=5.65% (t=10.820, P<0.001). The difference in the average annual reported incidence rate of pulmonary tuberculosis in elderly was statistically significant in different regions (χ²=31.762, P=0.007), with the central urban areas(33.23/100 000) being lower than that in suburban areas (36.46/100 000), and the annual decreasing rate was faster in central urban area, APC=-4.88% (t=-4.838, P<0.001) and -2.76% (t=-2.811, P=0.023), respectively. The incidence rate was significantly higher in males than that in females (χ²=514.395, P<0.001). Additionally, the difference in reported incidence rate was statistically significant among different age groups(χ²=119.751,P<0.001), among which patients aged ≥80 years had the highest average annual incidence rate (59.69/100 000), and those aged ≤60 years had the lowest average annual incidence rate (28.57/100 000). Compared with the non-residential permanent elderly population (47.68/100 000), the average annual incidence rate of pulmonary tuberculosis among the elderly with household registration in Shanghai was lower (33.82/100 000) (χ²=24.295, P<0.001). The ARIMA (0,0,1) (0,1,1) 12 model was used to predict the incidence rate of pulmonary tuberculosis among the elderly in Shanghai in 2024 and 2025, and which was predicted to be 37.41/100 000 and 35.92/100 000, respectively. ConclusionThe reported incidence rate of pulmonary tuberculosis among the elderly in Shanghai showed an overall yearly downward trend from 2014 to 2023, but its proportion in the total number of reported pulmonary tuberculosis cases increased year by year. Prevention and control efforts should still not be slackened and emphasis should be placed on male, suburban and non-residential permanent elderly populations.