Addressing the current clinical problems of conventional antidepressants， such as delayed onset of action and prominent adverse reactions， this paper explores the theoretical basis， mechanism of action， and application prospects of nasal administration as a novel rapid antidepressant strategy. By clarifying the conceptual connotation of rapid antidepressants， elucidating their clinical demands and application advantages， and explaining the physiological basis of nasal-to-brain delivery， it is proposed that the olfactory and trigeminal nerve pathways can bypass the blood-brain barrier to achieve rapid targeted delivery of drugs to brain tissue. On this basis， combined with the theory of opening orifices with aromatic medicinals in traditional Chinese medicine （TCM） as well as related research in modern aromatherapy， the ancient and modern clinical evidence of nasal administration in regulating emotions was systematically reviewed. Furthermore， this article discusses the application advantages of nasal administration in special populations such as the elderly， children， and pregnant women， and analyzes the practical bottlenecks such as mucosal clearance， limited formulation volume， and safety evaluation. Nasal administration is expected to become an important supplementary means for rapid antidepressants， and the integrated model of "TCM aromatic medicinals plus nanopreparations plus nasal administration" can provide new ideas for research on the integration of TCM and western medicine in treating depression.

AIM:To investigate the appropriate dose of intravenous dexmedetomidine(Dex)for se-dation in minimally invasive breast surgery under regional block.METHODS:A total of 120 patients with multiple breast masses were selected and di-vided into Dex 0.5 μg/kg group(group D1),Dex 0.75 μg/kg group(group D2),Dex 1.0 μg/kg group(group D3)and normal saline group(group C)ac-cording to the random number table method.After intravenous injection of test drugs,minimally inva-sive rotary cutting under retromammary space an-esthesia was performed.The optimal sedation rate during operation,the optimal sedation rate after operation,Ramsay sedation scores were recorded before anesthesia,at the end of intravenous admin-istration,at the retromammary space anesthesia,at the beginning of surgery,5 min after surgery,at the end of surgery,30 min after administration,and 60 min after administration,visual analogue scale(VAS),vital signs(SBP,DBP,HR,SpO2),the inci-dence of moderate and above pain(VAS＞3)and ad-verse reactions were observed.The optimal seda-tion was defined as intraoperative Ramsay score 2-4 points and postoperative Ramsay score 2-3 points.RESULTS:Dex had a dose-dependent seda-tive and analgesic effect.The optimal sedation rate during operation in group D2 and D3 was significant-ly higher than that in group C and D1,and the opti-mal sedation rate after operation in group D2 was the highest.The rate of VAS score greater than 3 points in group D2 and group D3 was significantly lower than that in group C and group D1,and there was no statistical difference between group D2 and group D3.The incidence of dizziness in group D2and group D3 was higher than that in group C and group D1.There was no significant difference in the inci-dence of hypotension,hypertension,severe brady-cardia,hypoxemia and nausea among the groups.CONCLUSION:Preoperative single intravenous ap-plication of 0.75 μg/kg dexmedetomidine has a def-inite sedative and analgesic effect,and the optimal sedation rate during and after operation is high.It is an appropriate dose for sedation assisted by min-imally invasive breast surgery under regional block.

This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

Objective To explore the correlation between serum hypoxia-inducible factor-1α(HIF-1α)levels and cerebral microbleeds(CMBs)and cognitive impairment and to assess the predictive value of HIF-1α for CSVD-related cognitive impairment.Methods A total of 104 patients with CSVD who attended the Department of Neurology,First Affiliated Hospital of Xinxiang Medical University from June 2022 to November 2023 were enrolled.All enrolled patients were subjected to basic statistics,cranial nuclear magnetic resonance examination,cognitive function assessment,and serum HIF-1α test,and the number and location of CMBs were counted.Based on the above data the enrolled patients were grouped.The correlation between HIF-1α and cognitive function and CMBs was studied the influencing factors of CMBs and cognitive impairment were analyzed,and the predictive value of HIF-1α on the occurrence of cognitive impairment was evaluated.Results There were statistically significant differences in HIF-1α levels and cognitive function among different CMBs groups.Serum HIF-1α levels were significantly negatively correlated with overall cognitive function,visuospatial and executive function,attention,and delayed recall,and serum HIF-1α was positively correlated with the number of CMBs.HIF-1α may be a risk factor for CMBs and cognitive impairment associated with CSVD,and serum HIF-1α has potential in predict the cognitive impairment caused by CSVD.Conclusion Serum levels of HIF-1α were associated with the number of CMB and CSVD-related cognitive impairment,and serum levels of HIF-1α may have a predictive value for CSVD-related cognitive impairment.

This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

Thousands of variant gene sequences of SARS-CoV-2 have been emerged since the COVID-19 epidemic broke out in Dec.2019.Alpha(B.1.1.7),Beta(B.1.351),Gamma(P.1),Delta(B.1.617.2)and Omicron(B.1.1.529)were the most representative variants.With the continuous emergence of new variants,the predomi-nant strain in the global pandemic as of Jan.2025 is the Omicron BA.2.86-derived mutant,JN.1.The effectiveness of drugs against Omicron variants remains a key research focus in the treatment of SARS-CoV-2 infections.The infectiousness and pathogenicity of the variants altered remarkably due to mutations in the genome on S protein of the mutant strains,and these emerging variants are more likely to evade immunity and were more infectious than the previous prevalent variants.During the process of combating with the constantly emerging novel variants,drugs showed various effects on treatment of diseases caused by different variants.New drugs and treatment coun-termeasures are constantly updated with the prevalence of various variants.The current status of research on pres-ent drugs for treatment of SARS-CoV-2 and the therapeutic effects on emerging variants are reviewed in the article so as to provide reference for prevention and treatment of the upcoming evolved variants.

Thousands of variant gene sequences of SARS-CoV-2 have been emerged since the COVID-19 epidemic broke out in Dec.2019.Alpha(B.1.1.7),Beta(B.1.351),Gamma(P.1),Delta(B.1.617.2)and Omicron(B.1.1.529)were the most representative variants.With the continuous emergence of new variants,the predomi-nant strain in the global pandemic as of Jan.2025 is the Omicron BA.2.86-derived mutant,JN.1.The effectiveness of drugs against Omicron variants remains a key research focus in the treatment of SARS-CoV-2 infections.The infectiousness and pathogenicity of the variants altered remarkably due to mutations in the genome on S protein of the mutant strains,and these emerging variants are more likely to evade immunity and were more infectious than the previous prevalent variants.During the process of combating with the constantly emerging novel variants,drugs showed various effects on treatment of diseases caused by different variants.New drugs and treatment coun-termeasures are constantly updated with the prevalence of various variants.The current status of research on pres-ent drugs for treatment of SARS-CoV-2 and the therapeutic effects on emerging variants are reviewed in the article so as to provide reference for prevention and treatment of the upcoming evolved variants.

BACKGROUND:Acupoint embedding and floating needle therapy are two methods for the treatment of knee osteoarthritis,but there are few reports on the combined treatment of the two methods. OBJECTIVE:To investigate the therapeutic effect of acupoint embedding combined with floating needle therapy on different stages of knee osteoarthritis using generalized estimating equations. METHODS:A total of 436 patients with knee osteoarthritis admitted to Dongguan Hospital of Traditional Chinese Medicine from February 2019 to February 2023 were selected as the research subjects.All patients were randomly divided into a control group with floating needle therapy(n=218)and an observation group with acupoint embedding method combined with floating needle therapy(n=218).Staging was performed according to the K-L staging method.In the control group,there were 57 cases in stage Ⅰ,62 in stage Ⅱ,49 in phase Ⅲ,and 50 in stage Ⅳ,while in the observation group,there were 48 cases in stage Ⅰ,66 in stage Ⅱ,63 in phase Ⅲ,and 41 in stage Ⅳ.The levels of indexes and clinical efficacy were compared between groups before and after treatment.Generalized estimating equation model was used to analyze the influencing factors of clinical efficacy and the interaction effect of different time points,different methods and different stages on therapeutic efficacy. RESULTS AND CONCLUSION:There was no significant difference in baseline data between the observation group and the control group,as well as between the patients of different stages(P>0.05).After treatment,the cure rate of stage Ⅰ patients was the highest after treatment,and the total improvement rate in the observation group was significantly higher than that in the control group.There were significant differences in the cure rate among different stages in each group(P<0.05).After treatment,all indicators in the two groups were significantly decreased.In the control group,there were significant differences in various indicators of patients at different stages after 4 weeks of treatment(P<0.05).In the observation group,after 2 weeks of treatment,there were significant differences in various indicators of patients at different stages(P<0.05),and all the indexes in the observation were lower than those in the control group after 4 weeks of treatment(P<0.05)and the therapeutic effect in the observation group was better than that in the control group.Generalized estimating equation model analysis showed that trauma history,interleukin-6 level,treatment method,treatment time and K-L stage all significantly affected the clinical efficacy in patients.In the interaction effect analysis,after 2 weeks of treatment,there was a significant difference in the visual analogue scale score between the two groups in stages Ⅲ and Ⅳ(P<0.05).After 4 weeks of treatment,there was a significant difference in the visual analogue scale score between the two groups in stages Ⅱ,Ⅲ,and Ⅳ(P<0.05).To conclude,acupoint embedding combined with floating needle therapy is superior to floating needle therapy alone in the treatment of different stages of knee osteoarthritis.Trauma history,interleukin-6 level,treatment method,treatment time and K-L stage significantly influence the therapeutic effect.

Objective: To investigate the current status of iron metabolism among apheresis donors in Guangzhou and analyze the improvement effects of health education on iron deficiency in frequent apheresis donors. Methods: Using a generalized linear mixed model (GLMM), a 180-day follow-up was conducted on 261 eligible apheresis donors at the Guangzhou Blood Center from January to July 2024. Hemoglobin (Hb), serum ferritin (SF), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), and transferrin saturation (TS) were selected as outcome variables. The effects of gender, age group, and number of donations within 180 days on these outcomes were analyzed and modeled. A general linear model (GLM) with repeated measures was applied to 55 donors who received health education interventions, comparing changes in Hb and iron metabolism-related indicators before and after follow-up and health education. Results: No significant difference in Hb levels was observed between first-time and regular apheresis donors, but SF levels were significantly higher in first-time donors (F=6.195, P<0.05). The GLMM revealed that female donors exhibited more significant reductions in Hb (T=-12.546) and SF (T=-5.829)(P<0.05 for both). Age group showed no interactive effects on Hb or SF changes. While number of donations within 180 days had no interactive effect on Hb, SF levels significantly decreased with increased number of donations (using ≥9 donations as the reference group; P<0.05 for all groups). After health education, Hb levels remained unchanged, but SF increased compared to pre-intervention levels (mean difference: -18.571, P<0.05), though a declining trend persisted compared to baseline (mean difference from baseline to post-intervention: 23.068,P<0.05). Conclusion: Female and number of donations are primary factors contributing to SF reduction in apheresis donors. Health education interventions promote SF recovery. Extending donation intervals and reinforcing iron deficiency-related health education may improve iron status in donors.

AIM:To investigate the appropriate dose of intravenous dexmedetomidine(Dex)for se-dation in minimally invasive breast surgery under regional block.METHODS:A total of 120 patients with multiple breast masses were selected and di-vided into Dex 0.5 μg/kg group(group D1),Dex 0.75 μg/kg group(group D2),Dex 1.0 μg/kg group(group D3)and normal saline group(group C)ac-cording to the random number table method.After intravenous injection of test drugs,minimally inva-sive rotary cutting under retromammary space an-esthesia was performed.The optimal sedation rate during operation,the optimal sedation rate after operation,Ramsay sedation scores were recorded before anesthesia,at the end of intravenous admin-istration,at the retromammary space anesthesia,at the beginning of surgery,5 min after surgery,at the end of surgery,30 min after administration,and 60 min after administration,visual analogue scale(VAS),vital signs(SBP,DBP,HR,SpO2),the inci-dence of moderate and above pain(VAS＞3)and ad-verse reactions were observed.The optimal seda-tion was defined as intraoperative Ramsay score 2-4 points and postoperative Ramsay score 2-3 points.RESULTS:Dex had a dose-dependent seda-tive and analgesic effect.The optimal sedation rate during operation in group D2 and D3 was significant-ly higher than that in group C and D1,and the opti-mal sedation rate after operation in group D2 was the highest.The rate of VAS score greater than 3 points in group D2 and group D3 was significantly lower than that in group C and group D1,and there was no statistical difference between group D2 and group D3.The incidence of dizziness in group D2and group D3 was higher than that in group C and group D1.There was no significant difference in the inci-dence of hypotension,hypertension,severe brady-cardia,hypoxemia and nausea among the groups.CONCLUSION:Preoperative single intravenous ap-plication of 0.75 μg/kg dexmedetomidine has a def-inite sedative and analgesic effect,and the optimal sedation rate during and after operation is high.It is an appropriate dose for sedation assisted by min-imally invasive breast surgery under regional block.