Patients with rare disease are a vulnerable group in healthcare who urgently need more attention from the government and society. Despite their overall number, they face challenges such as limited diagnosis and treatment options, poor access to medications, and heavy financial burdens. Providing better protection for this group is not only essential for public well-being, but also an important indicator of societal progress. This paper analyzes the current status and challenges of rare disease protection in China, with a focus on building diagnostic and treatment networks, optimizing the multitiered social security system, and improving pharmaceutical access mechanisms. It highlights issues such as incomplete health insurance coverage, unequal resource allocation, and insufficient incentives for drug development. To address these challenges, we suggest strengthening policies, improving the multitiered social security system, encouraging social support, and promoting medical and pharmaceutical innovation to provide comprehensive care for rare disease patients.

Objective To explore the safety and feasibility of posterior quadratus lumborum block(PQLB)in patients undergoing laparoscopic myomectomy.Methods A retrospective analysis was conducted on clinical data of 62 gynecological patients who underwent laparoscopic myomectomy from July 2021 to July 2024.The patients were divided into two groups based on the preoperative blocking method:the PQLB group and the transversus abdominis plane block(TAP)group,with 31 patients in each group.In the PQLB group,bilateral PQLB was performed under ultrasound guidance with 20 ml of 0.35％ropivacaine on each side.In the TAP group,bilateral transversus abdominis plane blocks were performed under ultrasound guidance with 20 ml of 0.4％or 0.5％ropivacaine on each side.The mean arterial pressure and heart rate were recorded before anesthesia(T0),at the time of the block(T1),at skin incision(T2),and during the recovery period(T3).The local anesthetic toxicity,nerve injury,intraoperative opioid consumption,postoperative remedial analgesic usage and dosage,as well as the incidence of nausea and vomiting,were monitored.Results The operations were successfully completed in all the 62 patients.No significant differences were observed between the two groups in mean arterial pressure(F=0.323,P=0.572)and heart rate(F=0.195,P=0.660)at 4 different time points.There were no significant differences in the dosage of anesthetic analgesics during surgery(Z=-0.458,P=0.647)and length of hospital stay(Z=-1.652,P=0.099)between the two groups.The postoperative remedial analgesic usage rate in the PQLB group was significantly lower than that in the TAP group(32.3％vs.74.2％,x2=10.949,P=0.000).Within 48 h after operation,the use of non-steroidal anti-inflammatory drugs(NSAIDs)dosage in the PQLB group was significantly lower than that in the TAP group[0(0,0)mg vs.400(0,1600)mg,Z=-4.849,P=0.000],and no significant difference was observed between the two groups in the use of opioid(tramadol)dosage(Z=-0.045,P=0.964).There was no significant difference in the incidence of postoperative nausea and vomiting(P＞0.05).The scores of numeric rating scale for abdomial wall pain and visceral pain in the PQLB group at 12 and 24 h after surgery did not exceed 3 points.No local anesthetic toxicity or nerve injury was observed.Conclusion PQLB provides effective analgesia for patients undergoing laparoscopic myomectomy,offering better control of visceral pain,helping reduce intraoperative opioid consumption,and lowering the risk of postoperative adverse reactions.

Objective To explore current status and potential subtypes of elderly stroke patients' medication literacy among,and to analyze related influencing factors of different subtypes.Methods A total of 285 elderly stroke patients admitted in the First Affiliated Hospital of Zhengzhou University from November 2023 to June 2024 were selected as subjects.General Information questionnaire,medication literacy scale for elderly patients with chronic diseases,and perceived social support scale were conducted.Latent profile analysis(LPA)of elderly stroke patients' medication literacy was conducted,and Logistic regression analysis was used to explore influencing factors of different profiles.Results Score of medication literacy scale for elderly stroke patients was(48.26±12.51)points.Medication literacy among elderly stroke patients can be divided into 3 profiles,namely proactive-high literacy type(51.9％),balanced-medium literacy type(34.0％),and dependent-low literacy type(14.1％).Logistic regression analysis showed that recent medication types,current place of residence,educational level,diabetes,and social support were the influencing factors of elderly stroke patients' medication literacy(P＜0.05).Conclusion The level of medication literacy among elderly stroke patients is medium,which is characterized by 3 categories.Medical staffs targeted intervention should be adopted according to different category characteristics,so as to accurately meet their nursing needs,finally improve the level of elderly stroke patients' medication literacy.

Background: Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papillomavirus (HPV). In recent years, research on anal CA has primarily focused on treatment rather than underlying mechanisms. The mechanism of HPV persistence and recurrence in CA require further exploration. It needs multiple researches in mechanisms to focalize treatment targets. Objective: To investigate the relationship between intestinal mucosal immunity and the relapse of anal CA and persistent infection. Methods: Levels of interferon gamma (IFN-γ) and secretory immunoglobulin A (sIgA) were measured using enzyme-linked immunosorbnent assay in anal mucosal cells obtained from patients treated at Tianjin Union Medical Center from September 2022 to December 2024. All the participants signed Informed Consent and the whole plan was approved by Institutional Review Board in Tianjin Union Medical Center (No. B155). Results: The levels of IFN-γ and sIgA significantly decreased after infection, and persistent infection exhibited even lower levels. These two factors increased following treatment, reaching peak concentrations at 4 weeks before decreasing again. Conclusion These findings demonstrate a significant association between persistent anal CA infection and dysregulation of intestinal mucosal immunity.

Objective This study aims to explore the layout and optimization of management disciplines in"Double First-Class"Traditional Chinese Medicine(TCM)universities,providing talent support and management guidance for the devel-opment of TCM.Methods Based on an overview of the development of management disciplines in TCM universities,six"Doub-le First-Class"TCM universities were selected as research subjects.Data were collected and compared using web retrieval and lit-erature research methods.Results Management disciplines in TCM universities still face challenges,such as weak foundational infrastructure and difficulties in interdisciplinary integration,insufficient faculty and suboptimal curriculum systems,and a single teaching model with a disconnect between theory and practice.Conclusion This paper proposes targeted suggestions and strate-gies for optimizing the layout of management disciplines in TCM universities,including strengthening support for management dis-ciplines and deepening TCM management characteristics,optimizing curriculum design and enhancing faculty resources,and in-novating teaching models to promote the deep integration of theory and practice.

Objective To evaluate the application of carbapenem antibiotics in conjunction with hemofil-tration for patients with septic shock and to analyze the impact on serum levels of lncRNA XIST and miRNA-130a.Methods A prospective study was conducted on 80 patients with septic shock treated at our hospital from August 2022 to January 2024.These patients were randomly divided into a control group and an experimental group,each comprising 40 cases.The control group received carbapenem antibiotics,while the experimental group received carbapenem antibiotics in combination with hemofiltration.The clinical outcomes of both groups were evaluated,and comparisons were made regarding their hemodynamic indices[including cardiac output(CO),central venous pressure(CVP),and mean arterial pressure(MAP)],immune function indices[including interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-alpha(TNF-α)],oxygen metabolism indices[including blood oxygen saturation(SaO2),blood lactate(LAC),and oxygenation index(PaO2/FiO2)],as well as serum levels of lncRNA XIST and miRNA-130a expression.Results Following treatment,the levels of CO,CVP,MAP,SaO2,PaO2/FiO2,and miRNA-130a were significantly increased,whereas the levels of IL-6,CRP,TNF-α,LAC,and lncRNA XIST were significantly decreased compared to pre-treatment levels(all P<0.05).In comparison with the control group,the experimental group exhibited significantly higher levels of CO,CVP,MAP,and miRNA-130a,as well as significantly lower levels of IL-6,CRP,TNF-α,and lncRNA XIST(all P<0.05).The overall effective rate in the experimental group was significantly higher than that in the control group(χ2=4.501,P<0.05),while no significant difference was observed in the incidence of adverse reactions between the two groups(χ2=0.180,P>0.05).Conclusion Carbapenem antibiotics and hemofiltration therapy can alleviate the symptoms of septic shock patients by downregulating lncRNA XIST expression,upregulating miRNA-130a expression,modulating inflammatory factors,enhancing oxygen metabolism indices,and maintaining hemodynamic stability.

Objective:To explore the developmental trajectory and influencing factors of self-management behavior among stroke patients.Methods:A total of 478 ischemic stroke patients admitted to the department of neurology of a grade-Ⅲ hospital in Henan Province from July 2023 to June 2024 were selected as the investigation objects. Baseline data of patients were collected using the general situation questionnaire, stroke knowledge questionnaire, stroke health belief scale, stroke self-management behavior scale and self-rating depression scale. The self-management behavior level of patients was assessed at discharge, 1 month, 3 months and 6 months after discharge. Mplus 7.0 software was used to conduct trajectory analysis of stroke patients' self-management behaviors, and multiple Logistic regression analysis was used to analyze the influencing factors associated with the development trajectory types of different stroke self-management behaviors.Results:The self-management behavior scores of stroke patients at discharge, 1 month, 3 months and 6 months after discharge were 206.59(167.59, 230.57), 169.59(129.73, 196.73), 149.82(120.89, 171.48), and 147.14(123.02, 181.64), respectively. Four trajectory categories were described. Category 1 was low-level pattern of initial decrease followed by stabilization, accounting for 16.95%(81/478)( P<0.001, intercept=2.701). Category 2 was low-level pattern of initial decrease followed by increase, accounting for 12.97%(62/478)( P<0.001, intercept =2.696). Category 3 was medium-level pattern of initial decrease followed by stabilization, accounting for 57.11%(273/478)( P<0.001, intercept =3.829). Category 4 was high-level pattern of initial decrease followed by increase, accounting for 12.97%(62/478)( P<0.001, intercept=4.366). The self-management behavior of stroke patients with low level of stroke knowledge, low level of health belief, aged 60 to 70 years old, residence in rural areas and middle school and below education level were more likely to belong to the low level group(all P<0.05). Patients with low depression in the low level group were more likely to be classified as low-level pattern of initial decrease followed by increase( P<0.05). Conclusion:The trajectory category of self-management behavior could be predicted by stroke knowledge level, health belief level, age, place of residence, educational background and depression. Their self-management behavior level may be improved through targeted interventions according to the characteristics of different trajectory categories.

Objective:To explore the dual mediating effects of health belief and depression among health knowledge, social support, and health behaviors based on the capacity, opportunity, motivation-behavior (COM-B) model, and analyze the influencing factors of health behaviors in patients with ischemic stroke.Methods:This multi-center cluster sampling research recruited ischemic stroke patients ( n=1 696) who were hospitalized in neurology departments of five tertiary hospitals in Henan Province from October 2023 to October 2024. A cross-sectional investigation was conducted using the general information questionnaire, social support rating scale (SSRS), stroke prevention knowledge questionnaire(SPKQ), short form health belief model scale(SF-HBMS), health promoting lifestyle profile-Ⅱ (HPLP-Ⅱ), and patient health questionnaire-9(PHQ-9) to ultimately reveal the pathways and effect sizes among variables. Partial correlation analysis and multiple linear stepwise regression analysis were conducted to examine the relationships among social support, health knowledge, health belief, health behaviors, and depression in stroke patients by SPSS 26.0 software. Structural equation modeling was constructed using AMOS 28.0 software, and the mediating effect was tested using the Bootstrap method. Results:The scores of social support, health knowledge, health belief, and health behaviors among ischemic stroke patients were (37.46±9.94), (26.56±6.84), (75.62±12.62) and (130.79±26.27), respectively. The score of depression was 5.00 (2.00, 8.00). Health behaviors were positively correlated with health knowledge, social support, and health belief( r=0.333, 0.246, 0.267, all P<0.05), while negatively correlated with depression ( r=-0.146, P<0.05). Multiple linear stepwise regression analysis showed that health knowledge, social support, health belief, and depression were all influencing factors of health behaviors in ischemic stroke patients (all P<0.05). Health belief (effect value=0.068, 95% CI=0.048-0.093) and depression (effect value=0.009, 95% CI=0.003-0.018) both played partial mediating roles between health knowledge and health behaviors, accounting for 17.3%(0.077/0.446) of the total effect. Meanwhile, health belief (effect value=0.045, 95% CI=0.029-0.063) and depression (effect value=0.016, 95% CI=0.008-0.027) both played partial mediating roles between social support and health behaviors, accounting for 26.5%(0.061/0.230) of the total effect. Conclusion:Health knowledge and social support can not only directly influence health behaviors but also indirectly affect them through health belief and depression in patients with ischemic stroke.

Objective The effects of stachydrine(STA)on the proliferation,apoptosis and radiosensitivity of acute myeloid leukemia(AML)cells by regulating the transcription factor forkhead box protein O3(FOXO3)-forkhead box protein M1(FOXM1)signaling axis.Methods Human AML cells(HL-60)were treated with STA at a concentration of 50～1 600 μmol/L,and the activity of HL-60 cells was detected using the cell counting kit-8(CCK-8)method to screen for the optimal drug concentration;HL-60 cells were separated into Control group,low,medium,and high concentration STA groups(STA-L group,STA-M group,STA-H group),STA+lentivirus transfection control group(STA-H+LV-NC group),and high-concentration STA+FOXO3 overexpression lentiviral group(STA-H+LV-FOXO3 group).5-ethyny1-2'-deoxyuridine(Edu)was applied to detect HL-60 cell proliferation;flow cytometry(FCM)was applied to detect cell apoptosis;cell cloning experiments were applied to detect the radiotherapy sensitivity of cells;Western blot was applied to detect the expression of cell proliferation antigen markers(Ki67),Cyclin D1,Caspase-3,B-cell lymphoma2 assaciated X protein(Bax),FOXO3,and FOXM1 proteins.Results STA concentrations of 100,200 and 400 μmol/L were selected for subsequent experiments.Compared with the control group,the positive rate of Ki67,Cyclin D1,Edu,FOXO3 and FOXM1 expression levels in the STA-L,STA-M,and STA-H groups decreased sequentially(tSTA-L=2.169～5.879,tSTA-M=3.089～11.284,tSTA-H=4.572～11.502),Caspase-3 and Bax expression levels,the apoptosis rate,increased sequentially(tSTA-L=9.171,10.082,20.144;tSTA-M=5.435,7.530,7.450;tSTA-H=4.138,4.159,5.956)and the differences were statistically significant(all P<0.05),respectively.Compared with the STA-H+LV-NC group,the positive rate of Edu and the expression levels of Ki67,Cyclin D1,FOXO3 and FOXM1 were obviously increased in the STA-H+LV-FOXO3 group(t=10.055～16.267),Caspase-3 and Bax expression levels,the apoptosis rate were obviously reduced(t=5.736,5.433,8.933),and the differences were statistically significant(all P<0.05),respectively.The colony formation rate of HL-60 cells in the radiotherapy group and STA+radiotherapy group decreased with the increase of radiotherapy dose,and the differences were statistically significant(F=78.630,137.843,all P<0.05),and the colony formation rate of HL-60 cells in the STA+radiotherapy group was lower than that in the radiotherapy group at the same dose(t=1.480～11.301,all P<0.05).Conclusion Stachydrine inhibits AML cell proliferation,induces apoptosis,and enhances radiotherapy sensitivity by inhibiting the FOXO3-FOXM1 signaling axis.

Objective:To explore the developmental trajectory and influencing factors of self-management behavior among stroke patients.Methods:A total of 478 ischemic stroke patients admitted to the department of neurology of a grade-Ⅲ hospital in Henan Province from July 2023 to June 2024 were selected as the investigation objects. Baseline data of patients were collected using the general situation questionnaire, stroke knowledge questionnaire, stroke health belief scale, stroke self-management behavior scale and self-rating depression scale. The self-management behavior level of patients was assessed at discharge, 1 month, 3 months and 6 months after discharge. Mplus 7.0 software was used to conduct trajectory analysis of stroke patients' self-management behaviors, and multiple Logistic regression analysis was used to analyze the influencing factors associated with the development trajectory types of different stroke self-management behaviors.Results:The self-management behavior scores of stroke patients at discharge, 1 month, 3 months and 6 months after discharge were 206.59(167.59, 230.57), 169.59(129.73, 196.73), 149.82(120.89, 171.48), and 147.14(123.02, 181.64), respectively. Four trajectory categories were described. Category 1 was low-level pattern of initial decrease followed by stabilization, accounting for 16.95%(81/478)( P<0.001, intercept=2.701). Category 2 was low-level pattern of initial decrease followed by increase, accounting for 12.97%(62/478)( P<0.001, intercept =2.696). Category 3 was medium-level pattern of initial decrease followed by stabilization, accounting for 57.11%(273/478)( P<0.001, intercept =3.829). Category 4 was high-level pattern of initial decrease followed by increase, accounting for 12.97%(62/478)( P<0.001, intercept=4.366). The self-management behavior of stroke patients with low level of stroke knowledge, low level of health belief, aged 60 to 70 years old, residence in rural areas and middle school and below education level were more likely to belong to the low level group(all P<0.05). Patients with low depression in the low level group were more likely to be classified as low-level pattern of initial decrease followed by increase( P<0.05). Conclusion:The trajectory category of self-management behavior could be predicted by stroke knowledge level, health belief level, age, place of residence, educational background and depression. Their self-management behavior level may be improved through targeted interventions according to the characteristics of different trajectory categories.