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 To observe the feasibility and effectiveness of fluoroscopy-guided Fustar adjustable bent sheath clamp biopsy for diagnosing obstructive esophageal diseases.Methods Totally 29 patients with esophageal or esophagogastric junction obstruction who failed to complete endoscopic biopsy were retrospectively analyzed.Real-time fluoroscopy-guided clamp biopsy of lesion areas were performed through 10F Fustar adjustable bent sheath under local anesthesia.The technical success rate,operation time,radiation dose were recorded,and the complications were evaluated.Results Clamp biopsy of lesion areas were successfully performed in all 29 cases,with technical success rate of 100%(29/29),the average operation time of(29.81±10.05)min and the average radiation dose of(127.14±100.36)mGy.No serious complication such as esophageal perforation nor massive bleeding occurred.After biopsy,22 cases(22/29,75.86%)were preliminarily diagnosed as positive,among them 2 cases underwent surgical operation,and the postoperative pathological results were consistent with biopsy.Negative biopsy results were found in 7 cases(7/29,24.14%),among them 2 cases underwent clamp biopsy again 3 months later which showed positive results.Conclusion Fustar adjustable bent sheath clamp biopsy was feasible and effective for diagnosing obstructive esophageal diseases,which could be regarded as the substitution and supplementation of endoscopic clamp biopsy.

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 investigate whether the clinical and pathological injury of kidney in IgA nephropathy (IgAN) patients with hypertension is associated with circadian blood pressure rhythm change, particularly with elevated nocturnal blood pressure (BP). Methods This study was a retrospective cross-sectional study. Clinic and renal histopathological injury data were obtained from 83 IgAN patients with hypertension. First, 24 h ambulatory BP monitoring (ABPM) data were analyzed. Second, all these IgAN patients were divided into two groups, elevated nocturnal BP group and nocturnal normotensive BP group, and the clinical and pathological differences between this two groups were analyzed. Third, logistic regression analysis was used to analyze the influencing factors of renal tubulointerstitial injury in IgAN patients with hypertension. At last, all these IgAN patients were divided into two groups according to the level of estimated glomerular filtration rate (eGFR), group of patients with eGFR≥60 ml·min-1·(1.73 m2)-1 and the other group with eGFR<60 ml·min-1·(1.73 m2)-1, and the 24 h ABPM data were compared. Results (1) The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension was 79.5％. (2) Compared with nocturnal normotensive BP group, patients in elevated nocturnal BP group had significantly higher levels of 24-hour urinary protein quantity and blood uric acid (both P<0.05), and lower eGFR and urine osmotic pressure clinically (both P<0.05). Index of interstitial fibrosis and tubular atrophy was significantly higher in nocturnal normotensive BP group (P<0.05), while the proportion of glomerular ischemia lesion was not significantly different between two groups. (3) Multivariate logistic regression analysis showed that elevated nocturnal BP was an independent risk factor for severe tubulointerstitial injury of IgAN (OR=1.113, 95％CI 1.038-1.192, P=0.002). (4) Compared with the group of eGFR≥60 ml·min-1·(1.73 m2)-1, 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime SBP and DBP, nocturnal SBP and DBP were significantly higher in group of eGFR<60 ml·min-1·(1.73 m2)-1 (all P<0.05). Conclusion The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension is as high as 79.5％. Elevated nocturnal BP is associated with the severity of renal damage, and elevated nocturnal BP is an independent risk factor for severe tubulointerstitial injury in IgAN patients with hypertension. Therefore, 24 h ABPM should be emphasized, and elevated nocturnal BP should be well controlled to slow the progression of IgAN.