Objective To assess the efficacy and safety of hyperbaric oxygen treatment for patients with post-stroke depression. Methods Randomized controlled trials (RCTs) about hyperbaric oxygen treatment with placebo or open control in patients with post-stroke depression were comprehensively retrieved in PubMed (1966 to 2012.12), EMbase (1974 to 2012.12), EBSCO (1965 to 2012.12), CENTRAL (2012.11), CBM (1978 to 2012.12), CNKI (1980 to 2012.12), and VIP (1989 to 2012.12). References of the included articles were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Twelve trials involving 822 patients were included, all of which were randomized non-placebo controlled trials. The results of meta-analysis of 12 trials (n=822) showed, the improvement of depression symptoms in the HBO group was better than that in the control group (MD=4.82, 95%CI 3.12 to 6.52). However, funnel plot showed that publication bias was large. After removing three trials for sensitive analysis, the results showed that the improvement of depression symptoms in the HBO group was still better than that in the control group (MD=3.91, 95%CI 3.35 to 4.47). Adverse events were reported in 2 trials, including dizziness, palpitation, mild earache, tinnitus, etc. However, no severe adverse events occurred. Conclusion Current evidence indicates that, HBO can effectively reduce the score of HAMD and no serious adverse reactions occurred. It’s necessary to further carry out high quality randomized controlled trials with large sample size due to limited quality and quantity of the included studies, so as to assess its effectiveness and safety.
Objective To evaluate the role of guide sheath (GS) utilization in radial endobronchial ultrasound guided transbronchial lung biopsy (EBUS-TBLB) for diagnosis of peripheral pulmonary lesions (PPLs). Methods The clinical data of patients who underwent EBUS-TBLB in Peking University First Hospital from July 2012 to June 2015 were retrospectively reviewed. The patients were divided into three groups,ie. a GS group, a non-GS group, and a double biopsy group. Results A total of 118 patients with 126 PPLs were collected. The overall diagnostic yield of EBUS-guided bronchoscopy was 60.3%. The diagnostic yield of GS group, non-GS group and double biopsy group was 65.4%(36/55), 61.5%(8/13), 59.6%(31/52), respectively. The diagnostic yield of the non-GS group was significantly lower than other two groups when PPLs≤20 mm (χ2=6.8,P=0.033), whereas no significant difference was observed when PPLs>20 mm (χ2=2.301,P=0.301). Conclusion GS significantly improves diagnostic yield in EBUS-TBLB when PPLs≤20 mm.
ObjectiveTo investigate the feasibility and effectiveness of using a modified latissimus dorsi musculocutaneous flap for the treatment of upper limb injuries with complex tissue defects classified as Gustilo-Anderson type ⅢB and ⅢC. Methods Between January 2021 and January 2024, 19 cases of upper limb injuries with complex tissue defects classified as Gustilo-Anderson type ⅢB and ⅢC were repaired with a modified latissimus dorsi musculocutaneous flap. There were 14 males and 5 females, with an average age of 33 years (range, 8-65 years). Among these cases, 12 involved injuries to the upper arm and elbow, while 7 involved injuries to the forearm. The disease duration ranged from 2 hours to 10 days (mean, 2.6 days). The patients underwent emergency internal fixation or external fixation for fractures, along with repair of neurovascular injuries. Subsequently, based on the type and extent of tissue defect, 11 cases were treated with pedicled flap transplantation, while 8 cases underwent free flap transplantation. The size of the muscular flaps ranged from 16.0 cm×10.0 cm to 24.0 cm×14.5 cm, while the size of skin flaps ranged from 12.0 cm×5.0 cm to 27.0 cm×7.5 cm. All incisions at donor sites were sutured. Results All 19 flaps survived completely, with primary wound healing in 17 cases and secondary healing with skin grafting on the muscular flap in 2 cases. The incisions at donor sites healed by first intention. All patients were followed up 10-41 months (mean, 21 months), and limb salvage was successful in all cases. All fractures healed with a healing time of 8-14 weeks. At last follow-up, according to the functional evaluation criteria for upper limb replantation established by the Hand Surgery Branch of Chinese Medical Association, 15 cases demonstrated excellent functional recovery, while 3 cases showed good functional outcomes, 1 case showed poor recovery. Conclusion The modified latissimus dorsi musculocutaneous flap, through partial separation of the latissimus dorsi muscle and musculocutaneous perforators combined with a staggered arrangement of the muscle and skin components, enables flexible reconstruction of defects at different tissue levels. This technique demonstrates advantages including a high flap survival rate, satisfactory limb salvage outcomes, favorable functional recovery, and relatively low donor site morbidity, making it an effective method for reconstruction of Gustilo-Anderson type ⅢB and ⅢC upper limb injuries with composite tissue defects.