***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract The possibility of obtaining increased survival of split skin grafts by the use of hyperbaric oxygen was investigated in a controlled clinical trial . This showed that a significant improvement can be obtained . In this series an increase in survival of 29 % of the surface area of the grafts was achieved . A high proportion of complete " takes " occurred ; 64 % of the treated cases as opposed to 17 % of the controls . The results suggest that the method is valuable when extensive raw areas have to be covered , or when good cosmetic results are important BACKGROUND Hyperbaric oxygen therapy is a recognised modality of treatment with applications in plastic surgery . This modality of treatment works by providing higher oxygen delivery to tissues . The benefits of this modality of treatment in free flap surgery were studied . METHOD A r and omised prospect i ve study was done . Ten patients undergoing free tissue transfer by microvascular technique were studied . These patients were r and omised into two groups . In Group 1 the patients were subjected to hyperbaric oxygen therapy postoperatively for seven days . Group 2 served as the control group . Patients in this group were not subjected to hyperbaric oxygen therapy . Patients were evaluated up to 14 days postoperatively . The flaps were evaluated for any flap loss , presence of venous congestion in the flap , flap oedema , and completeness of healing at the flap site . RESULTS No significant difference was found in terms of flap survival , time to resolution of venous congestion , resolution of oedema , and period of postoperative recovery . CONCLUSION Routine use of hyperbaric oxygen therapy does not result in better survival of free flaps Blinding embodies a rich history spanning over two centuries . Most research ers worldwide underst and blinding terminology , but confusion lurks beyond a general comprehension . Terms such as single blind , double blind , and triple blind mean different things to different people . Moreover , many medical research ers confuse blinding with allocation concealment . Such confusion indicates misunderst and ings of both . The term blinding refers to keeping trial participants , investigators ( usually health-care providers ) , or assessors ( those collecting outcome data ) unaware of the assigned intervention , so that they will not be influenced by that knowledge . Blinding usually reduces differential assessment of outcomes ( information bias ) , but can also improve compliance and retention of trial participants while reducing biased supplemental care or treatment ( sometimes called co-intervention ) . Many investigators and readers naïvely consider a r and omised trial as high quality simply because it is double blind , as if double-blinding is the sine qua non of a r and omised controlled trial . Although double blinding ( blinding investigators , participants , and outcome assessors ) indicates a strong design , trials that are not double blinded should not automatically be deemed inferior . Rather than solely relying on terminology like double blinding , research ers should explicitly state who was blinded , and how . We recommend placing greater credence in results when investigators at least blind outcome assessment s , except with objective outcomes , such as death , which leave little room for bias . If investigators properly report their blinding efforts , readers can judge them . Unfortunately , many articles do not contain proper reporting . If an article cl aims blinding without any accompanying clarification , readers should remain sceptical about its effect on bias reduction OBJECTIVE Many reports showed that level of soluble interleukin 2 receptor ( sIL-2R ) in sera was obviously increased in burn patients , while plasma fibronectin ( Fn ) was markedly decreased , and they had close relation with the occurrence and development of burn infection . The purpose of this study was to verify the significance of hyperbaric oxygen therapy ( HBOT ) in the prevention and treatment of burn infections by observing its effect on the levels of serum sIL-2R and Fn in severe burn patients . METHODS Forty two burn patients ( with more than 30 % body surface area or three degree more than 10 % ) were selected and divided into two groups at r and om : HBOT group(25 cases ) and non-HBOT group(17 cases ) ; forty healthy blood donors were selected as normal control . The venous blood sample s were drawn from 42 patients at 1/3 , 1 , 2 , 3 , 5 , 7 , 10 , 14 , 17 , 21 , 28 and 35 days postburn , the levels of serum sIL-2R and Fn were measured by ELISA and rocket electrophoresis techniques respectively , meanwhile , the incidences of sepsis of two groups were compared . RESULTS 1 . In non-HBOT group : the levels of serum sIL-2R were remarkably increased , while serum Fn were markedly decreased at all periods postburn ( compared with normal control : P < 0.05 or P < 0.01 ) ; 2 . In HBOT group : the levels of serum sIL-2R were not obviously increased at all periods except 21 days postburn , and Fn were not decreased at all periods except 8 h postburn ( compared with normal control : P > 0.05 ) . Compared with non-HBOT group , however , the levels of serum sIL-2R were profoundly reduced , while Fn was significantly enhanced at all periods postburn(P < 0.05 or P < 0.01 ) , and the incidence of sepsis was obviously lowered ( P < 0.05 ) . CONCLUSION HBOT can significantly reduce the level of serum sIL-2R but enhance Fn in severe burn patients , so it may have a positive effect on the prevention and treatment of burn infections The foot ulcer is one of most common and devastating complications of diabetes and is associated with considerable morbidity and mortality . The major causes of these ulcers are ischemia/hypoxia , neuropathy , and infection , and they often coexist . Despite conventional therapy including revascularization procedures when appropriate , three situations lead frequently to amputation : persistent critical limb ischemia , soft tissue infection , and impaired wound healing from osteomyelitis . In these conditions , hyperbaric oxygen therapy may be used as an adjunctive treatment and is associated with a better outcome . R and omized , prospect i ve , controlled trails have shown the benefit of hyperbaric oxygen therapy in diabetic ulcers of the lower extremity .  Transcutaneous oxygen measurement performed under hyperbaric oxygen therapy has a prognostic significance when used to select patients who are the most likely to benefit from therapy . Hyperbaric oxygen should be added to conventional treatment if the transcutaneous oxygen tension close to the trophic lesion in 2.5 ATA hyperbaric oxygen is over 200 mmHg . Peri-wound transcutaneous oxygen tensions over 400 mmHg in 2.5 ATA hyperbaric oxygen or over 50 mmHg in normobaric pure oxygen predict healing success with adjuncted hyperbaric oxygen therapy with high accuracy OBJECTIVE The European Consensus Document ( ECD ) defines critical ischaemia ( CI ) according to clinical ( Fontaine ) and blood pressure parameters . However , clinical symptoms may be non-specific and CI may exist without severely reduced blood pressures . This study prospect ively investigated the additive value of transcutaneous oxygen tension ( pO2 ) and toe blood pressure measurements to assess the presence of CI . METHODS Forty-nine patients with 65 legs clinical ly classified as Fontaine stages III ( n = 23 ) and IV ( n = 26 ) were studied .  Ankle and toe systolic blood pressure and pO2  were measured to assess the presence of CI ( cut-off values were 50 , 30 and 30 mmHg , respectively ) . The surgeon was blinded for the toe pressure and pO2 results . The treatment received within 1 month after presentation was recorded as being either conservative or invasive ( vascular surgery or PTA ) . RESULTS An ankle pressure of < or = 50 mmHg classified only 17 % of the legs as having CI . By adding toe pressure and pO2 , significantly more legs ( 63 % ; p < 0.0001 ) were classified as CI , of which 68 % received invasive therapy . Forty-nine percent of the legs with an ankle pressure > 50 mmHg were treated invasively , whereas only 32 % of the legs classified as not having CI by means of toe pressure and pO2 underwent invasive therapy . If the need for invasive treatment is used as the " gold st and ard " for the presence of CI , 54 % of the legs would accurately be classified on the basis of the ankle blood pressure . The combination of toe pressure and pO2 would have yielded 71 % and the ECD criteria 72 % and accurately classified legs . The odds ratio for invasive therapy given a pO2 or toe pressure above the cut-off value was 14 . CONCLUSION Ankle blood pressure measurements have limited diagnostic value . Adding toe and /or oxygen pressures enhances the detection of CI requiring invasive therapy The care for chronic and acute wounds is a substantial problem around the world . This has led to a plethora of products to accelerate healing . Unfortunately , the quality of studies evaluating the efficacy of such wound care products is frequently low . R and omized clinical trials are universally acknowledged as the study design of choice for comparing treatment effects , as they eliminate several sources of bias . We propose a framework for the design and conduct of future r and omized clinical trials that will offer strong scientific evidence for the effectiveness of wound care interventions . While r and omization is a necessary feature of a robust comparative study , it is not sufficient to ensure a study at low risk of bias . R and omized clinical trials should also ensure adequate allocation concealment and blinding of outcome assessors , apply intention-to-treat analysis , and use patient-oriented outcomes . This article proposes strategies for improving the evidence base for wound care decision making Hyperbaric Oxygen ( HBO ) therapy is advocated for the treatment of severe trauma of the limbs in association with surgery because of its effects on peripheral oxygen transport , muscular ischemic necrosis , compartment syndrome , and infection prevention . However , no controlled human trial had been performed until now to specify the role of HBO in the management of crush injuries . Thirty-six patients with crush injuries were assigned in a blinded r and omized fashion , within 24 hours after surgery , to treatment with HBO ( session of 100 % O2 at 2.5 atmosphere absolute ( ata ) for 90 minutes , twice daily , over 6 days ) or placebo ( session of 21 % O2 at 1.1 ata for 90 minutes , twice daily , over 6 days ) . All the patients received the same st and ard therapies ( anticoagulant , antibiotics , wound dressings ) . Transcutaneous oxygen pressure ( PtCO2 ) measurements were done before ( patient breathing normal air ) and during treatment ( HBO or placebo ) at the first , fourth , eighth , and twelfth sessions . The two groups  ( HBO group , n = 18 ; placebo group , n = 18 ) were similar in terms of age ; risk factors ; number , type or location of vascular injuries , neurologic injuries , or fractures ; and type , location , or timing of surgical procedures . Complete healing was obtained for 17 patients in the HBO group vs. 10 patients in the placebo group ( p < 0.01 ) . New surgical procedures ( such as skin flaps and grafts , vascular surgery , or even amputation ) were performed on one patient in the HBO group vs. six patients in the placebo group ( p < 0.05 ) . Analysis of groups of patients matched for age and severity of injury showed that in the subgroup of patients older than 40 with grade III soft-tissue injury , wound healing was obtained for seven patients ( 87.5 % ) in the HBO group vs. three patients ( 30 % ) in the placebo group ( p < 0.05 ) . No significant differences were found in the length of hospital stay and number of wound dressings between groups . For the patients with complete healing , the PtCO2 values of the traumatized limb , measured in normal air , rose significantly between the first and the twelfth sessions ( p < 0.001 ) . No significant change in PtCO2 value was found for the patients whose healing failed . The Bilateral Perfusion Index ( BPI = PtCO2 of the injured limb/PtCO2 of the uninjured limb ) at the first session increased significantly from 1 ata air to 2.5 ata O2 ( p < 0.05 ) . In patients with complete healing , the BPI was constantly greater than 0.9 to 2.5 ata O2 during the following sessions , whereas the BPI in air progressively rose between the first and the twelfth sessions ( p < 0.05 ) , reaching normal values at the end of the treatment . In conclusion , this study shows the effectiveness of HBO in improving wound healing and reducing repetitive surgery . We believe that HBO is a useful adjunct in the management of severe ( grade III ) crush injuries of the limbs in patients more than 40 years old & NA ; A previous nonblinded study has suggested beneficial effects from hyperbaric oxygen treatment of superficial partial‐thickness radiation burns in human volunteers . This protocol was design ed to either confirm or challenge these previous findings in a r and omized , blinded format . Twelve healthy , nonsmoking volunteers ( 7 males , 5 females ) participated . All were screened for contraindications to hyperbaric oxygen therapy ( acute sinusitis , otitis media , pneumonia , pregnancy , active cancer , pneumothorax ) and given a single test hyperbaric exposure . A st and ardized wound model was employed for the painless creation of a volar forearm lesion on volunteers by applying a suction device to form a blister , excising its epidermal roof , and irradiating the exposed dermis with ultraviolet light . Subjects were r and omized into either a hyperbaric oxygen group ( 100 % oxygen at 2.4 ATA , n=6 ) or the sea‐level air‐breathing equivalent control group ( 8.75 % oxygen at 2.4 ATA , n=6 
    Output:
    
There is a lack of high quality , valid research evidence regarding the effects of HBOT on wound healing .