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Composed of c-Jun and c-Fos, AP-1 is activated by ROS and synergizes with NF-B to enhance pro-inflammatory factor transcription, while participating in the regulation of airway epithelial cell squamous metaplasia (27)

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After reviewing literature and conducting a two-round Delphi survey with 42 experts, a consensus emerged that emphasizes prioritizing clinical symptoms in diagnosis, with serum B12 as a screening marker supported by methylmalonic acid or homocysteine levels for additional confirmation

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