Objective:To investigate the effect of robot-assisted total knee arthroplasty (TKA) on the incidence of postoperative deep vein thrombosis (DVT) in the lower limbs.Methods:A total of 405 patients who underwent primary unilateral TKA in the Department of Orthopaedics, Peking University Third Hospital from June 2022 to June 2024 were retrospectively analyzed, consisting of 89 males and 316 females, with a mean age of 67.84±5.60 years. Patients were divided into the conventional group ( n=215) and the robot-assisted group ( n=190) according to the surgical approach. Postoperative DVT incidence, operative time, postoperative hemoglobin and hematocrit levels, perioperative blood loss, and transfusion rate were compared between the two groups to evaluate the impact of robot-assisted TKA on thrombotic events and related clinical indicators. Results:There were no significant differences in age, sex, height, weight, body mass index, or preoperative laboratory results including hemoglobin and hematocrit levels between the two groups ( P>0.05). The postoperative DVT incidence was 26.8% (51/190) in the robot-assisted group and 34.9% (75/215) in the conventional group, with no significant difference ( P>0.05). Univariate logistic regression analysis showed that sex ( P=0.013) and age ( P=0.024) were significantly associated with DVT occurrence. Multivariate logistic regression further revealed that female patients had a significantly higher incidence of DVT than males ( OR=0.438, P=0.005), and older patients had a significantly increased risk of DVT ( OR=1.046, P=0.025); body mass index remained not significantly associated with DVT ( P=0.092). The operative time in the robot-assisted group was 88.62±18.58 min, which was significantly longer than that in the conventional group 79.23±17.68 min ( t=-5.207, P<0.001). Perioperative total blood loss was 1 079.85±344.18 ml in the robot-assisted group and 1 141.47±363.70 ml in the conventional group, with no significant difference ( t=1.745, P=0.082). The transfusion rate was 5.3% in the robot-assisted group and 5.1% in the conventional group, respectively, with no significant differences (χ 2=0.004, P=0.947). Conclusion:Compared with conventional TKA, robot-assisted TKA results in longer operative time but does not increase perioperative blood loss or the risk of postoperative DVT.

Objective:To investigate the effect of robot-assisted total knee arthroplasty (TKA) on the incidence of postoperative deep vein thrombosis (DVT) in the lower limbs.Methods:A total of 405 patients who underwent primary unilateral TKA in the Department of Orthopaedics, Peking University Third Hospital from June 2022 to June 2024 were retrospectively analyzed, consisting of 89 males and 316 females, with a mean age of 67.84±5.60 years. Patients were divided into the conventional group ( n=215) and the robot-assisted group ( n=190) according to the surgical approach. Postoperative DVT incidence, operative time, postoperative hemoglobin and hematocrit levels, perioperative blood loss, and transfusion rate were compared between the two groups to evaluate the impact of robot-assisted TKA on thrombotic events and related clinical indicators. Results:There were no significant differences in age, sex, height, weight, body mass index, or preoperative laboratory results including hemoglobin and hematocrit levels between the two groups ( P>0.05). The postoperative DVT incidence was 26.8% (51/190) in the robot-assisted group and 34.9% (75/215) in the conventional group, with no significant difference ( P>0.05). Univariate logistic regression analysis showed that sex ( P=0.013) and age ( P=0.024) were significantly associated with DVT occurrence. Multivariate logistic regression further revealed that female patients had a significantly higher incidence of DVT than males ( OR=0.438, P=0.005), and older patients had a significantly increased risk of DVT ( OR=1.046, P=0.025); body mass index remained not significantly associated with DVT ( P=0.092). The operative time in the robot-assisted group was 88.62±18.58 min, which was significantly longer than that in the conventional group 79.23±17.68 min ( t=-5.207, P<0.001). Perioperative total blood loss was 1 079.85±344.18 ml in the robot-assisted group and 1 141.47±363.70 ml in the conventional group, with no significant difference ( t=1.745, P=0.082). The transfusion rate was 5.3% in the robot-assisted group and 5.1% in the conventional group, respectively, with no significant differences (χ 2=0.004, P=0.947). Conclusion:Compared with conventional TKA, robot-assisted TKA results in longer operative time but does not increase perioperative blood loss or the risk of postoperative DVT.

Objective: Evidence supports the efficacy of coronary computed tomography angiography (CCTA)-based risk scores in cardiovascular risk stratification of patients with suspected coronary artery disease (CAD). We aimed to compare two CCTAbased risk score algorithms, Leiden and Confirm scores, in patients with diabetes mellitus (DM) and suspected CAD. Materials and Methods: This single-center prospective cohort study consecutively included 1241 DM patients (54.1% male, 60.2 ± 10.4 years) referred for CCTA for suspected CAD in 2015–2017. Leiden and Confirm scores were calculated and stratified as < 5 (reference), 5–20, and > 20 for Leiden and < 14.3 (reference), 14.3–19.5, and > 19.5 for Confirm. Major adverse cardiovascular events (MACE) were defined as the composite outcomes of cardiovascular death, nonfatal myocardial infarction (MI), stroke, and unstable angina requiring hospitalization. The Cox model and Kaplan–Meier method were used to evaluate the effect size of the risk scores on MACE. The area under the curve (AUC) at the median follow-up time was also compared between score algorithms. Results: During a median follow-up of 31 months (interquartile range, 27.6–37.3 months), 131 of MACE were recorded, including 17 cardiovascular deaths, 28 nonfatal MIs, 64 unstable anginas requiring hospitalization, and 22 strokes. An incremental incidence of MACE was observed in both Leiden and Confirm scores, with an increase in the scores (log-rank p < 0.001). In the multivariable analysis, compared with Leiden score < 5, the hazard ratios for Leiden scores of 5–20 and > 20 were 2.37 (95% confidence interval [CI]: 1.53–3.69; p < 0.001) and 4.39 (95% CI: 2.40–8.01; p < 0.001), respectively, while the Confirm score did not demonstrate a statistically significant association with the risk of MACE. The Leiden score showed a greater AUC of 0.840 compared to 0.777 for the Confirm score (p < 0.001). Conclusion CCTA-based risk score algorithms could be used as reliable cardiovascular risk predictors in patients with DM and suspected CAD, among which the Leiden score outperformed the Confirm score in predicting MACE.

Objective:To evaluate the rationality of diving procedures and medical support through monitoring the stress, nutrition, and sleep quality of divers.Methods:The vital signs of divers were recorded by the monitor designed for high pressure condition. The bubble escape during decompression was evaluated by Doppler bubble monitor. The stress levels of divers were evaluated by the Stanford acute stress reaction questionnaire (SASRQ), and the sleep qualities of divers were evaluated by Pittsburgh sleep quality index (PSQI). The post-diving effects were evaluated by the tests of blood routine and blood biochemistry, and MRI examination of large joints (bilateral shoulders, hips, and knees).Results:The vital signs of the four divers were stable throughout the training, and there was no significant difference in the mean values of vital signs in each stage ( P>0.05). During the decompression, all Doppler bubble monitoring results were below level 2. The total scores of SASRQ before and after diving were both lower than 57 points, indicating a moderate and low stress level; the stress levels of divers decreased slightly after surfacing, but the differences were not statistically significant ( t=1.464, P=0.239). Before and after diving, the divers’ sleep quality was good, but it decreased after surfacing, and the differences were statistically significant ( t=-4.899, P=0.016). The results of blood routine test, biochemical test, and MRI of bilateral shoulders and hips of the four divers after diving were normal; the results of knee MRI showed that only one diver had a small amount of joint effusion. Conclusion:The physical and mental health of the divers in this training maintained good, indicating the procedures of and the medical support for the diving were safe and effective.

Objective:To monitor and analyze the divers’ body load during hyperbaric exposure in deep heliox saturation diving at sea, so as to provide reference for safeguarding the safety and health of divers.Methods:The heart rate and rating of perceived exertion (RPE) of the divers were taken to monitor their body loads and the results were analyzed.Results:The heart rates of the four divers were stable. At 6: 30 (63 m) on the third day of decompression, diver 1 had a very low heart rate of 43 beats/min and diver 3 had a heart rate of 53 beats/min. There was no statistically significant difference in the mean heart rates of divers during saturation exposure and each time point of decompression with those before entering the cabin. The overall RPE results of divers ranged from 6 to 16 points, and the overall trend of development was consistent with the pressure change; the highest load was shown in the stage from 100 m stable pressure to the end of excursion diving, while the loads in other stages were relatively small. The mean value of RPE before entering the cabin was slightly higher than that in the pressurized stage, and it reached the peak in the excursion diving stage and then remained stable in the decompression stage. The RPE results of divers in the second diving bell at the end of excursion diving stage were significantly higher than those before entering the cabin ( t=-4.700, P=0.018). Conclusion:It is of important value to guarantee the operation safety by monitoring the divers’ body loads under high pressure. The combination of monitoring heart rate and RPE results can accurately reflect the body load and is conducive to the safety of diving operation.

Objective:To investigate the sleep and stress state of support personnel during deep saturation diving training so as to provide reference for psychological support for such personnel on diving mission.Methods:The Pittsburgh sleep quality index (PSQI) and Stanford acute stress response questionnaire (SASRQ) were used to evaluate 61 sailors from a warship in their annual task of supporting deep saturation diving training.Results:The total score of PSQI was 12.82±3.55, with 57 people higher than 7 points, accounting for 93.44%. There were significant differences in PSQI scores among different age groups, and that of the group aged 20-29 was the highest ( F=3.573, P=0.035). The scores of daytime functional and PSQI of support personnel at different posts were significantly different, and the scores in the posts directly supporting divers are significantly lower than those in the other two kinds of posts ( F=4.945, P=0.010; F=3.806, P=0.029). The average stress level of the crew was 36.87±14.84, among them, 5 sailors were under severe stress, and 16 sailors had more than 3 positive items. Among all the investigated crew members, there was a positive correlation between the stress test score and sleep quality except for the item of "using sleeping aids" . Conclusion:Attention should be paid to the psychological state of support personnel during the whole process of saturation deep diving in order to keep the training safe and smooth.

Objective:To evaluate the rationality of diving procedures and medical support through monitoring the stress, nutrition, and sleep quality of divers.Methods:The vital signs of divers were recorded by the monitor designed for high pressure condition. The bubble escape during decompression was evaluated by Doppler bubble monitor. The stress levels of divers were evaluated by the Stanford acute stress reaction questionnaire (SASRQ), and the sleep qualities of divers were evaluated by Pittsburgh sleep quality index (PSQI). The post-diving effects were evaluated by the tests of blood routine and blood biochemistry, and MRI examination of large joints (bilateral shoulders, hips, and knees).Results:The vital signs of the four divers were stable throughout the training, and there was no significant difference in the mean values of vital signs in each stage ( P>0.05). During the decompression, all Doppler bubble monitoring results were below level 2. The total scores of SASRQ before and after diving were both lower than 57 points, indicating a moderate and low stress level; the stress levels of divers decreased slightly after surfacing, but the differences were not statistically significant ( t=1.464, P=0.239). Before and after diving, the divers’ sleep quality was good, but it decreased after surfacing, and the differences were statistically significant ( t=-4.899, P=0.016). The results of blood routine test, biochemical test, and MRI of bilateral shoulders and hips of the four divers after diving were normal; the results of knee MRI showed that only one diver had a small amount of joint effusion. Conclusion:The physical and mental health of the divers in this training maintained good, indicating the procedures of and the medical support for the diving were safe and effective.

Objective:To monitor and analyze the divers’ body load during hyperbaric exposure in deep heliox saturation diving at sea, so as to provide reference for safeguarding the safety and health of divers.Methods:The heart rate and rating of perceived exertion (RPE) of the divers were taken to monitor their body loads and the results were analyzed.Results:The heart rates of the four divers were stable. At 6: 30 (63 m) on the third day of decompression, diver 1 had a very low heart rate of 43 beats/min and diver 3 had a heart rate of 53 beats/min. There was no statistically significant difference in the mean heart rates of divers during saturation exposure and each time point of decompression with those before entering the cabin. The overall RPE results of divers ranged from 6 to 16 points, and the overall trend of development was consistent with the pressure change; the highest load was shown in the stage from 100 m stable pressure to the end of excursion diving, while the loads in other stages were relatively small. The mean value of RPE before entering the cabin was slightly higher than that in the pressurized stage, and it reached the peak in the excursion diving stage and then remained stable in the decompression stage. The RPE results of divers in the second diving bell at the end of excursion diving stage were significantly higher than those before entering the cabin ( t=-4.700, P=0.018). Conclusion:It is of important value to guarantee the operation safety by monitoring the divers’ body loads under high pressure. The combination of monitoring heart rate and RPE results can accurately reflect the body load and is conducive to the safety of diving operation.

Objective:To investigate the sleep and stress state of support personnel during deep saturation diving training so as to provide reference for psychological support for such personnel on diving mission.Methods:The Pittsburgh sleep quality index (PSQI) and Stanford acute stress response questionnaire (SASRQ) were used to evaluate 61 sailors from a warship in their annual task of supporting deep saturation diving training.Results:The total score of PSQI was 12.82±3.55, with 57 people higher than 7 points, accounting for 93.44%. There were significant differences in PSQI scores among different age groups, and that of the group aged 20-29 was the highest ( F=3.573, P=0.035). The scores of daytime functional and PSQI of support personnel at different posts were significantly different, and the scores in the posts directly supporting divers are significantly lower than those in the other two kinds of posts ( F=4.945, P=0.010; F=3.806, P=0.029). The average stress level of the crew was 36.87±14.84, among them, 5 sailors were under severe stress, and 16 sailors had more than 3 positive items. Among all the investigated crew members, there was a positive correlation between the stress test score and sleep quality except for the item of "using sleeping aids" . Conclusion:Attention should be paid to the psychological state of support personnel during the whole process of saturation deep diving in order to keep the training safe and smooth.

Objective To evaluate the diagnostic value of pathological features of atypical membranous nephropathy (AMN). Methods Ninety - one patients with AMN diagnosed by renal biopsy during 2011 and 2017 were enrolled in this study. On the basis of M - type phospholipase A2 receptor (PLA2R) and thrombospondin type - 1 domain - containing 7A protein (THSD7A) by immunohistochemistry, patients were divided into AMN group (25 cases without PLA2R and THSD7A) and idiopathic membranous nephropathy (IMN) group (66 cases with positive PLA2R or THSD7A). The results of immunofluorescence (IF), light microscopy (LM) and electron microscopy (EM) of these two groups were compared, and the parameters with statistical difference were screened out in order to assess their value in the diagnosis of AMN in fourfold table. Results IF results showed that in AMN group the proportions of IgG deposition on capillary wall and mesangial area as well as positive otherIgG subclasses and complement C1q but negative IgG4 were significantly higher than those in IMN group (respectively, 56.0％ vs 12.1％ , 44.0％ vs 0, both P＜0.05). Their diagnostic specificities for AMN were 87.9％ and 100.0％, respectively. However, the positive rates of IgG accompanied with IgA and/or IgM, predominant IgG4 with other IgG subclasses and complement C1q in two groups were not significantly different (all P＞0.05). LM results showed that the proportions of false double track sign on basement membrane and fuchsinophilic proteins under epithelium, endothelium, basement membrane and mesangial region in AMN group were significantly higher than those in IMN group (respectively, 36.0％ vs 0, 44.0％ vs 1.5％, both P＜0.05). Their diagnostic specificities for AMN were 100.0％ and 98.5％ , respectively. However, the scores of mesangial cell proliferation of these two groups showed no significantly difference (P＞0.05). EM results showed that the rate of endothelial electron dense deposits in AMN group was significantly higher than that in IMN group (36.0％ vs 1.5％, P＜0.05), and its diagnostic specificity for AMN was 98.5％. Conclusions IgG deposition on both capillary wall and mesangial area, positive other IgG subclasses and C1q with negative IgG4, false -double contour sign, multi - site fuchsinophilic deposits and endothelial electron dense deposits may help for the AMN diagnosis in the absence of PLA2R and THSD7A related data.