Background Studies have shown that benzo(a)pyrene (BaP) exhibits neurotoxicity and can induce cognitive dysfunction. Olfactory dysfunction is an early marker of mild cognitive impairment; however, the mechanism by which BaP exposure causes this impairment is still unclear. Objective To investigate the effects of BaP exposure on olfactory function in mice. Methods Thirty 5-month-old male C57BL/6 mice were randomly assigned to five groups (n=6 per group): blank control, solvent control (olive oil), and low, medium and high doses (0.72, 1.44, and 2.89 mg·kg⁻¹, respectively). Following one week of acclimatization, BaP was administered intranasally every other day. Behavioral changes were assessed using the buried food test and Morris water maze (MWM). Olfactory bulb tissues were subsequently harvested for analysis. Hematoxylin-eosin (HE) staining was used to evaluate pathological changes, while immunofluorescence and quantitative polymerase chain reaction (qPCR) were employed to examine the expression and distribution of protein and mRNA expressions and distributions of olfactory marker protein (OMP), membrane-spanning 4-pass A1 (MS4A1), trace amine-associated receptor1 (TAAR1). Results The buried food test revealed that BaP exposure significantly prolonged the time taken to find food in a dose-dependent manner (F=56.753, P< 0.01). MWM results showed significant main effects for both time (F=128.5, P<0.01) and dose (F=3.889, P<0.05), with a significant interaction effect between them (F=2.128, P<0.05). HE staining showed that in the 2.89 mg·kg⁻¹ group, although granule remained abundant, mitral cell layer neurons exhibited structural atrophy and deep staining. Immunofluorescence demonstrated a decreased distribution of OMP, MS4A1, and TAAR1 in the olfactory nerve layer and glomerular layers in the 2.89 mg·kg⁻¹ group compared with the blank control group (F=11.590, P<0.01; F=12.807, P<0.01; F=7.436, P<0.01). Furthermore, mRNA expression levels of OMP, MS4A1, and TAAR1 in the 2.89 mg·kg⁻¹ group were also significantly downregulated compared to the control group (F=6.720, P<0.01; F=16.931, P<0.01; F=48.060, P<0.01). Conclusion BaP exposure leads to olfactory dysfunction in mice by inducing pathological damage to mitral cells and reducing the expression of key olfactory receptors and markers in the olfactory bulb.

Background Studies have shown that benzo(a)pyrene (BaP) exhibits neurotoxicity and can induce cognitive dysfunction. Olfactory dysfunction is an early marker of mild cognitive impairment; however, the mechanism by which BaP exposure causes this impairment is still unclear. Objective To investigate the effects of BaP exposure on olfactory function in mice. Methods Thirty 5-month-old male C57BL/6 mice were randomly assigned to five groups (n=6 per group): blank control, solvent control (olive oil), and low, medium and high doses (0.72, 1.44, and 2.89 mg·kg⁻¹, respectively). Following one week of acclimatization, BaP was administered intranasally every other day. Behavioral changes were assessed using the buried food test and Morris water maze (MWM). Olfactory bulb tissues were subsequently harvested for analysis. Hematoxylin-eosin (HE) staining was used to evaluate pathological changes, while immunofluorescence and quantitative polymerase chain reaction (qPCR) were employed to examine the expression and distribution of protein and mRNA expressions and distributions of olfactory marker protein (OMP), membrane-spanning 4-pass A1 (MS4A1), trace amine-associated receptor1 (TAAR1). Results The buried food test revealed that BaP exposure significantly prolonged the time taken to find food in a dose-dependent manner (F=56.753, P< 0.01). MWM results showed significant main effects for both time (F=128.5, P<0.01) and dose (F=3.889, P<0.05), with a significant interaction effect between them (F=2.128, P<0.05). HE staining showed that in the 2.89 mg·kg⁻¹ group, although granule remained abundant, mitral cell layer neurons exhibited structural atrophy and deep staining. Immunofluorescence demonstrated a decreased distribution of OMP, MS4A1, and TAAR1 in the olfactory nerve layer and glomerular layers in the 2.89 mg·kg⁻¹ group compared with the blank control group (F=11.590, P<0.01; F=12.807, P<0.01; F=7.436, P<0.01). Furthermore, mRNA expression levels of OMP, MS4A1, and TAAR1 in the 2.89 mg·kg⁻¹ group were also significantly downregulated compared to the control group (F=6.720, P<0.01; F=16.931, P<0.01; F=48.060, P<0.01). Conclusion BaP exposure leads to olfactory dysfunction in mice by inducing pathological damage to mitral cells and reducing the expression of key olfactory receptors and markers in the olfactory bulb.

Objective To explore the relationship between serum chitosinase 3-like protein 1(CHI3L1)and Syndecan-1(SDC1)levels and bone metabolism in elderly patients with type 2 diabetes mellitus and their predictive efficacy on osteoporosis.Methods A total of 412 elderly patients with type 2 diabetes admitted to this hospital from May 2019 to May 2023 were included in this study,and were divided into normal bone mass group(n=151),reduced bone mass group(n=138)and osteoporosis group(n=123)according to the iffer-ences in bone mineral density.Serum CHI3L1 and SDC1 levels were detected by enzyme-linked immunosor-bent assay,and serum levels of type 1 collagen cross-linked carboxyl terminal peptide(CTX),25-hydroxyvita-min D[25-(OH)D],osteocalcin(OC),and type 1 procollagen N-terminal propeptide(P1NP)were deter-mined by automatic chemiluminescence immunoassay.Pearson correlation analysis was used to investigate the relationship between serum CHI3L1,SDC1 and bone metabolism in elderly patients with type 2 diabetes.Re-ceiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum CHI3L1 and SDC1 on osteoporosis in elderly patients with type 2 diabetes.Multivariate Logistic regression analysis was used to investigate the influencing factors of osteoporosis in elderly patients with type 2 diabetes.Results There were significant differences in diabetes course,fasting blood glucose,HbA1c and HDL-C a-mong normal bone mass group,decreased bone mass group and osteoporosis group(P＜0.05).The levels of serum CHI3L1,25-(OH)D,P1NP and osteocalcin in osteoporosis group were lower than those in osteopenia group,and those in osteopenia group were lower than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum SDC1 and CTX levels in osteoporosis group were higher than those in osteopenia group,and those in osteopenia group were higher than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum CHI3L1 was positively correlated with 25-(OH)D,P1NP and OC(P＜0.05),and negatively correlated with CTX(P＜0.05).Serum SDC1 was negatively correlated with 25-(OH)D,P1NP,OC(P＜0.05),and positively correlated with CTX(P＜0.05).The area under the curve(AUC)of serum CHI3L1,SDC1 and their combination predicted osteoporosis in elderly pa-tients with type 2 diabetes were 0.851,0.772 and 0.904,respectively.Multivariate Logistic regression analysis showed that long duration of diabetes,increased HbA1c,high expression of OC,CHI3L1＞4.16 ng/mL,SDC1≥50.94 ng/mL were all influential factors for osteoporosis in elderly patients with type 2 diabetes(P＜0.05).Conclusion Low expression of CHI3L1 and high expression of SDC1 in serum are associated with ab-normal bone metabolism in elderly patients with type 2 diabetes.These two indexes are expected to be used as biological markers to predict osteoporosis in elderly patients with type 2 diabetes.

Objective To investigate the clinical efficacy of pan-immune inflammatory value(PIV)in pre-dicting the prognosis of elderly patients with severe pneumonia(SP).Methods A total of 160 elderly patients with SP admitted to this hospital from January to June 2023 were selected as the study group,and 100 elderly patients with common pneumonia in the hospital in the same period were selected as the control group.Ac-cording to the prognosis at discharge,the patients were divided into good prognosis group(128 cases)and poor prognosis group(32 cases).Neutrophil count,platelet count,monocyte count and lymphocyte count were detected by automatic blood cell analyzer,and PIV was finally calculated.Receiver operating characteristic(ROC)curve was used to analyze the prognostic value of PIV in elderly patients with SP.Multivariate Logis-tic regression was used to analyze the prognostic factors in elderly patients with SP.Results The counts of neutrophil,monocyte and PIV in control group were lower than those in study group,and the counts of lym-phocytes,platelet in control group were higher than those in study group,the difference was statistically sig-nificant(P＜0.05).Neutrophil,monocyte count and PIV in the good prognosis group were significantly lower than those in the poor prognosis group,and platelet count and lymphocyte count in the good prognosis group were higher than those in the poor prognosis group,with statistical significance(P＜0.05).ROC curve analy-sis showed that the area under the curve of PIV in predicting poor prognosis in elderly SP patients was 0.941,which was larger than that of neutrophil,monocyte,platelet count and lymphocyte count(P＜0.001).The proportion of mechanical ventilation,C rection protein(CRP)and procalcitonin(PCT)levels in poor progno-sis group were higher than those in good prognosis group(P＜0.05).Multivariate Logistic regression analysis showed that mechanical ventilation,CRP,PCT and PIV were independent risk factors for the prognosis of eld-erly SP patients(P＜0.05).Conclusion PIV is an independent risk factor for predicting the prognosis of eld-erly patients with SP.PIV is an important prognostic factor for elderly patients with SP.

Objective:To explore the influencing factors of self-management of first-treatment pulmonary tuberculosis patients based on the random forest model, and to provide a theoretical basis for clinical staff to improve the self-management of pulmonary tuberculosis patients by providing efficient, high-quality, and individualized interventions.Methods:A cross-sectional study was used to select pulmonary tuberculosis patients who were hospitalized in the Department of Respiratory Medicine of the Fourth People′s Hospital of the Ningxia Hui Autonomous Region and who met the inclusion and exclusion criteria from December 2023 to February 2024 by using the convenience sampling method as the study subjects. General information questionnaire, Chronic Disease Patients′ Self-health Management Ability Assessment Scale, Perceived Social Support Scale, Hospital Anxiety and Depression Scale, and a tuberculosis prevention and treatment knowledge questionnaire were used to conduct the survey, and Spearman′s correlation was used to analyze the correlation between variables, and multivariate linear regression and a random forest model were used to analyze the influencing factors of self-management.Results:A total of 204 first-treatment pulmonary tuberculosis patients, 111 males and 93 females, 64 patients aged 18-44 years, 59 patients aged 45-59 years, and 81 patients ≥60 years were finally investigated. The total self-management score of tuberculosis patients was 162.00 (148.00, 176.75), and the total self-management score was positively correlated with the total perceived social support score, family support, friend support, and other support, respectively ( r values were 0.307-0.400, all P<0.01), negatively correlated with the anxiety and depression scores, respectively ( r=-0.195, -0.313, both P<0.01), and positively correlated with the total score of knowledge of tuberculosis control ( r=0.257, P<0.01); the results of multiple linear stepwise regression analysis showed that literacy, family support, other support, anxiety, and knowledge of tuberculosis control were the influencing factors of self-management ability ( t values were -2.89-2.98, all P<0.05), which explained a total of 23.1% of the total variance; and the random forest model ranked the importance of the influencing factors in the order of high to low were other support, family support, knowledge of tuberculosis control, literacy, and anxiety. Conclusions:The self-management of first-treatment pulmonary tuberculosis patients is at an intermediate level, In order to improve the self-management ability of first-treatment pulmonary tuberculosis patients, clinical personnel should establish a "patient-centered" self-management education concept, pay attention to the construction of their social support system, provide adequate, continuous, individualized knowledge education and information support, promote their psychological health, and reduce their negative emotions.

Objective:To construct a functional exercise intervention programme for breast cancer surgery patients and investigate the application effect, in order to provide a reference for improving patients′ postoperative functional exercise adherence based on the Patient Health Engagement (PHE) model.Methods:Using a randomised controlled trial method, 122 breast cancer surgery patients admitted to the First People′s Hospital of Tai′an were selected by convenience sampling from December 2023 to April 2024, and were divided into 61 cases each in the control group and the intervention group using the random number table method. The control group received routine intervention, while the intervention group received functional exercise intervention based on the PHE model on the basis of the control group, and the patients were observed on postoperative days 7, 30, and 60 days for the functional exercise adherence, health literacy, shoulder joint mobility and edema of the affected limb.Results:Each of the 2 groups eventually completed the study with 58 female cases with 3 cases fell off. The patients in the control group aged (54.84 ± 9.47) years. The patients in the intervention group aged (55.66 ± 7.29) years. After the intervention, the postoperative adherence scores of patients in the control group were (50.48 ± 4.87), (45.45 ± 4.44), and (41.93 ± 4.34) at 7, 30, and 60 days after surgery, respectively, which were lower than those of the intervention group (55.84 ± 3.98), (50.62 ± 3.87), (45.91 ± 4.09), the difference between two groups was significant ( t=-6.49, -6.69, -5.09, all P<0.05). There were statistically significant differences in adherence scores between groups, time and interactions ( F=40.48, 1 096.00, 7.14, all P<0.05). As for the healthy belief, the control group scored (80.22 ± 8.28), (82.84 ± 11.56), (86.79 ± 11.42), and (88.05 ± 11.06) before intervention, at 7, 30, and 60 days after surgery, and the difference in time was statistically significant when compared with the scores of the intervention group at the same time, which were (80.26 ± 9.08), (84.55 ± 9.52), (87.66 ± 7.97), and (89.31 ± 7.09) ( F=31.60, P<0.05). Shoulder mobility scores in the control group were (5.02 ± 1.16), (7.16 ± 1.23), (8.91 ± 1.08) at 7, 30, and 60 days after surgery, respectively, which were lower than those in the intervention group (6.02 ± 1.03), (7.69 ± 1.14), and (10.10 ± 1.05), the difference between two groups was significant ( t=-4.90, -2.43, -6.00, all P<0.05), and the differences in shoulder mobility scores among groups, time, and interaction were all statistically significant ( F=34.19, 558.40, 3.98, all P<0.05). At 60 days after surgery, a total of 2 cases (3.45%) of patients in the control group developed moderate or severe affected limb lymphedema and 0 cases in the intervention group, and the difference was statistically significant in comparison ( χ2=6.03, P<0.05). Conclusions:The functional exercise intervention based on the PHE model can effectively improve the functional exercise compliance and healthy belief of patients undergoing breast cancer surgery, reduce postoperative limb edema, improve shoulder joint motion, and promote postoperative recovery.

Objective To analyze the factors influencing iodine nutritional status in pregnant women dur-ing pregnancy,based on thyroid function and thyroid autoantibody levels,and to explore the association between iodine nutritional abnormalities and pregnancy outcomes.Methods A total of 838 pregnant women who underwent routine prenatal checkups at Qinghai Provincial People's Hospital between January 2021 and June 2023 were pro-spectively enrolled in this study.All participants were followed until delivery.Seven cases were lost to follow-up,resulting in a final sample size of 831 participants.Among them,276 were in the first trimester,384 in the second trimester,and 171 in the third trimester.Data on urinary iodine concentration(UIC),urinary creatinine(UCr),thyroid function indicators,and thyroid autoantibodies were collected.Based on their iodine nutritional status,the participants were categorized into either the iodine-sufficient group or the iodine-abnormal group(including iodine-deficient,iodine-hyper-sufficient,and iodine-excessive subgroups).This study analyzed the iodine nutritional sta-tus of pregnant women during different gestational periods,compared thyroid function indices,prevalence of thy-roid diseases,and the positivity rates of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),and thyroid-stimulating hormone receptor antibody(TRAb)among different iodine status groups.Additionally,ad-verse pregnancy outcomes were compared across groups.Multivariate logistic regression analysis was conducted to identify risk factors associated with iodine abnormalities during pregnancy,and a predictive model was developed to assess its potential predictive value.Results Among the 831 pregnant women included in the study,373 cases(44.89％)exhibited iodine sufficiency,while 458 cases(55.11％)presented with iodine abnormalities,including 282 cases of iodine deficiency,144 cases of iodine hypersufficiency,and 32 cases of iodine excess.No statistically significant differences were observed in the iodine nutritional status across different trimesters(P>0.05).The se-rum level of thyroid-stimulating hormone(TSH)was significantly higher in the iodine abnormal group compared to the iodine sufficient group(P<0.05).Additionally,the iodine abnormal group demonstrated higher positivity rates of TPOAb alone,TGAb,and TRAb,as well as increased incidence of thyroid dysfunction and total adverse pregnancy outcomes compared to the iodine sufficient group(all P<0.05).These adverse indicators were also sig-nificantly elevated in the iodine-deficient,iodine super-sufficient,and iodine overdose subgroups compared to the iodine sufficient group(P<0.05).Elevated serum TSH levels and the presence of TPOAb,TGAb,and TRAb were identified as risk factors for iodine abnormalities during pregnancy(P<0.05).The predictive model con-structed for identifying iodine abnormalities in pregnant women demonstrated an area under the curve(AUC)of 0.876,with a sensitivity of 72.27％and a specificity of 89.01％.Conclusions The prevalence of iodine nutritional abnormalities among pregnant women during pregnancy was high,with most cases presenting iodine deficiency.These abnormalities were associated with thyroid function,thyroid autoimmunity,and pregnancy outcomes,but showed no significant correlation with gestational age.Furthermore,the prediction model developed based on iden-tified risk factors demonstrated effective performance in predicting iodine nutritional abnormalities during preg-nancy.

Under the background of rapid development of artificial intelligence(AI),this paper systematically proposes AI-based education(AIBE).It empowers the teaching process,learning process,research process,and teaching management with AI,and constructs an AI-based educational paradigm,including AI-based teaching(AIBT),AI-based learning(AIBL),AI-based re-search(AIBR),and AI-based management(AIBM).Taking the AI course of immunology teaching as an example,this paper deeply analyzes the practices and explorations of implementing AIBT,AIBL,AIBR and AIBM based on the AI course,so as to accelerate the promotion of the transformation of the fourth generation of medical education.

Objective:By sequencing and analyzing the biliary flora by 16S rDNA high-throughput sequencing technology,to identify the main flora associated with gallbladder stone formation and the main flora regulated by the Dahuang lingxian(DHLX),pre-liminary investigation the effect of DHLX on the biliary flora.Methods:The 50 male guinea pigs were randomly divided into Normal group,Model group,DHLX group.There were 15 guinea pigs in the normal group and 20 guinea pigs in the DHLX group,and 20 guin-ea pigs in the model group:the guinea pig model of gallstone was replicated with high-fat lithogenic diet,which was simultaneously ad-ministrated by gavage.After continuous intervention for 8 weeks,bile and gallbladder tissue samples were collected,and the gallstone formation rate of guinea pigs in each group was calculated,the pathological morphological changes of gallbladder tissue were detected by HE,T-CHO,TBA,LPS,IL-6,TNF-α were detected by ELISA,and the changes of biliary flora were detected by 16S rDNA;the correlation between biliary flora and bile index was detected by Pearson statistical method.Results:The stone formation rate of guinea pigs in the normal group was 8.3%,the rate of model stone composition was 90.8%,and the stone composition rate of DHLX group was 36.4%,and the HE staining results showed that compared with the normal group,the mucous membrane of the guinea pig in the model group was thickened,the columnar epithelial cells were arranged in a large number of inflammatory cells,and the columnar epi-thelial cells of the gallbladder mucosa in the chinese medicine group were arranged neatly compared with the model group,the thick-ness of the mucosa was reduced compared with the model group,and some inflammatory cells were infiltrated;ELISA results showed that compared with the normal group,the expressions of T-CHO,LPS,IL-6 and TNF-α in the bile of guinea pigs in the model group were significantly increased(P<0.01),while the content of TBA was significantly reduced(P<0.01);compared with the model group,the expression of LPS and IL-6 in the bile of the DHLX group were significantly reduced(P<0.01).The results of 16S rDNA showed that compared with the normal group the Ace index and Chao1 index of the model group were significantly reduced(P<0.01),and the Chao1 index of the DHLX group was significantly higher than that of the model group(P<0.05);biliary flora at the genera level was mainly composed of Burkholderia,Sphingomycetes,Breghamus,Delfortella,Pseudomonas;correlation analysis showed that total cholesterol was negatively correlated with the abundance of Methyloversatilis(P<0.05),and total bile acids were positively corre-lated with the abundance of Burkholderia(P<0.05),and Pseudomonas erythrocytes,Rhizobia,the abundance of Phreatobacter was negatively correlated(P<0.01)and LPS was positively correlated with the abundance of Pseudomonas erythrocytes(P<0.01).Conclu-sion:Biliary microflora disorder exists in the formation of biliary stones,and biliary microflora may participate in the formation of stones by regulating cholesterol,bile acids and LPS.DHLX can regulate the changes in the abundance of the microflora,make the structure of the microflora become normal,reduce the inflammation of the gallbladder,and prevent the formation of gallstones.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.