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Study on temporal changes in energy and material metabolism in burned mice
Su Sen, Liu Xiaoyan, Zhang Ting, Zhou Zhihao, Fan Shijun, Xia Lin, Peng Xi
, Available online  , doi: 10.3760/cma.j.cn501225-20250807-00349
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Abstract:
  Objective  To investigate the temporal dynamics of energy metabolism and material metabolism in burned mice.  Methods  This study was an experimental study. Sixteen male C57BL/6N mice aged 8-10 weeks were randomly assigned using a random number table to sham injury group (n=8) treated with sham injury and burn group (n=8) treated with scald injury. From days 1 to 14 post-burn, the daily water intake, food intake, activity levels, energy expenditure, and resting energy expenditure (REE) of mice were dynamically monitored using a small animal metabolic monitoring system. Daily body weight changes and respiratory entropy from days 1 to 14 post-burn, cumulative water intake, food intake, and activity levels from days 1 to 14 post-burn, respiratory entropy from days 1 to 7 post-burn, energy expenditure on days 1, 3, 7, 10, and 14 post-burn, and nighttime carbohydrate and fat oxidation rates on days 1, 3, 7, 10, and 14 post-burn were calculated. Forty-eight male C57BL/6N mice aged 8-10 weeks were randomly assigned using a random number table: 8 mice received sham injury, and the remaining 40 mice underwent scald injury. Cardiac blood samples were collected from burn mice at 1, 3, 7, 10, and 14 days post-burn and from sham mice at 1 day post-burn. Plasma was obtained by centrifugation. Liquid chromatography-mass spectrometry was employed to identify plasma metabolites (hereinafter referred to as metabolites) and determine their temporal dynamics. Metabolites from sham mice at 1 day post-burn were compared with those from burn-injured mice at the same time point, and metabolites from burn-injured mice at 1, 3, 7, 10, and 14 days post-burn were analyzed. Additionally, the correlation between the selected metabolites and REE was analyzed, and the relevant metabolites underwent Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis.  Results  Compared with those in sham group, the daily and cumulative water intake and food intake of mice in burn group from days 1 to 14 post-burn showed no statistically significant differences overall (P>0.05); the body weight changes of mice in burn group were significantly reduced from days 2 to 14 post-burn (P<0.05); cumulative daytime and nighttime activity levels of mice in burn group were significantly reduced from days 1 to 14 post-burn (P<0.05); daily activity levels of mice in burn group lost normal circadian rhythms from days 1 to 14 post-burn; energy expenditure of mice in burn group was significantly reduced on day 1 post-burn (P<0.05) and significantly increased on days 7, 10, and 14 post-burn (P<0.05); the REE of mice in burn group was significantly increased from days 4 to 14 post-burn (P<0.05); respiratory entropy of mice in burn group was significantly reduced during nighttime from days 1 to 7 post-burn (P<0.05), while no significant difference was observed during daytime (P>0.05); carbohydrate oxidation rates of mice in burn group were significantly reduced at night on days 1 and 3 post-burn (P<0.05); fat oxidation rates of mice in burn group were significantly increased at night on days 1, 3, and 7 post-burn (P<0.05). A total of 450 metabolites were identified in plasma samples from mice. Among these, 253 metabolites exhibited specific temporal patterns and could be clustered into five distinct patterns. Eighty-five metabolites of burn-injured mice exhibited statistically significant changes following injury (P<0.05). Forty metabolites showed significant association with REE, with the top metabolites including linoleic acid, oleic acid, glucose, etc. KEGG pathway enrichment analysis revealed significant associations between REE and pathways including fatty acid synthesis and degradation, amino acid (e.g., isoleucine, tryptophan) synthesis and metabolism, and glycolysis/gluconeogenesis (P<0.05).  Conclusions  Both burn injury and time significantly influence energy metabolism patterns and material metabolism characteristics in mice. The hypermetabolic state persisted up to 14 days post-burn, with multiple fatty acid, amino acid, and glucose metabolic pathways associated with this elevated metabolism.
Clinical efficacy of free transplantation of the lower abdominal conjoined perforator flaps in repairing the extensive soft tissue defects in extremities
Zhong Shuo, Liu Linfeng, Wang Yunpeng, Li Ranyue
, Available online  , doi: 10.3760/cma.j.cn501225-20250127-00043
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Abstract:
  Objective  To investigate the clinical efficacy of free transplantation the lower abdominal conjoined perforator flaps in repairing the extensive soft tissue defects in extremities.  Methods  This study was a retrospective observational study. From May 2021 to March 2024, 9 patients with extensive soft tissue defects in extremities meeting the inclusion criteria were admitted to the following two hospitals, including 6 cases in Shandong Provincial Hospital Affiliated to Shandong First Medical University and 3 cases in Shandong Public Health Clinical Center. There were 6 male patients and 3 female patients, aged 34 to 66 years. After the wound infection was controlled, the areas of soft tissue defects in the upper extremities ranged from 30 cm×10 cm to 45 cm×18 cm, and those in the lower extremities ranged from 32 cm×12 cm to 40 cm×9 cm. The lower abdominal conjoined perforator flaps were adopted for repairing the wounds in 8 patients. In one patient, a combined repair of flap and skin grafting was adopted due to the extensive wound area. The flap harvest areas were 30 cm×10 cm to 45 cm×13 cm for repairing the wounds in the upper extremities, and those were 32 cm×12 cm to 40 cm×9 cm for repairing the wounds in the lower extremities. Most wounds in the abdominal donor sites could be directly sutured in stage Ⅰ. If there was high local tension, the wounds were repaired by transplanting the "dog-ear" soft tissue or replanting the avulsed skin, or temporarily covered with negative pressure materials and closed in stage Ⅱ after tension relief. The carried blood vessels of the flaps and anastomosis methods were recorded. Postoperatively, the flap survival (including the occurrence of vascular crisis) and the wound healing in the donor sites were observed. During follow-up, the appearance, texture, and sensory recovery of the flaps, as well as the occurrence of scars and complications in the donor sites were observed. At the last follow-up, the 5-grade Likert scale was used to investigate the satisfaction of patients with the treatment effects in the recipient and donor sites.  Results  The flaps carried bilateral superficial branch of superficial circumflex iliac artery (SCIA-SB) and superficial inferior epigastric artery (SIEA) in 4 patients, the flaps carried unilateral SCIA-SB and bilateral SIEA in two patients, and the flaps carried bilateral SCIA-SB and unilateral SIEA in three patients. In one patient, due to a vascular defect of approximately 3 cm at the anastomosis site, an ipsilateral dorsal pedal vein was used for bridging anastomosis; the blood vessels in the donor and recipient sites were directly anastomosed in the remaining patients. Postoperatively, the flaps survived smoothly, without vascular crisis. Postoperatively, the wounds in the donor sites healed well in 7 patients, the wound in the donor site healed after stage Ⅱ skin grafting due to high tension in one patient, and one patient had dehiscence of the abdominal suture, which healed after dressing changes. Except for one patient lost to follow-up, the remaining 8 patients were followed up for 12 to 24 months. The flaps had a soft texture without swelling or ulceration, and protective sensation was recovered in all patients. Only MILD scars remained in the abdominal donor site, without complications such as abdominal hernia. At the last follow-up, the satisfaction scores of patients with the treatment effects in the recipient and donor sites were 4-5 (with the mean score of 4.6) and 4-5(with the mean score of 4.2), respectively.  Conclusions  The lower abdominal conjoined perforator flaps can be applied in repairing the extensive soft tissue defects in extremities. After the operation, the wounds in the donor sites can mostly be directly sutured. Only mild scars are left after wound healing, which has little impact on the appearance and function in the donor sites.
The LENS four-element diagnostic method and WDSR scoring and grading system applicable to the discipline of wound repair
Zhao Ran, Wang Yibing
, Available online  , doi: 10.3760/cma.j.cn501225-20250809-00353
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With the acceleration of population aging, various acute and chronic wounds in the elderly have become an important burden on global public health. The establishment and development of the wound repair discipline have become an urgent need of the times. Currently, the diagnosis of various wound diseases is descriptive and heterogeneous, which objectively limits academic exchanges and the development of the discipline. This article proposed the LENS four-element diagnostic method that is universally applicable to focal wounds, including location, etiology, nature, and severity. It is expected to comprehensively and accurately reflect the condition of the wounds and provide valuable information for wound treatment, disease grading, and prognosis evaluation. This article proposed the WDSR scoring and grading system, which selects four indicators for scoring, including wound width, depth, sinus, and recurrence. The system grades the wounds according to the total score (grades Ⅰ-Ⅳ), which can quantitatively assess the severity of the local wounds. It is advocated that the wound repair discipline with conditions pilots the LENS four-element diagnostic method and the WDSR scoring and grading system to promote the standardized development of the wound repair discipline.
Construction of an assessment system for hand burn wound and scar topography map based on the Delphi method
Bian Ruihao, Huang Shixin, Li Jingbo, Zheng Jiaxuan, Zhu Jiayuan, Xu Yingbin, Wu Jun, Tang Bing, Chen Shaozhen
, Available online  , doi: 10.3760/cma.j.cn501225-20250830-00375
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  Objective  To construct a topographic map assessment system for hand burn wounds and scars.  Methods  A combination of literature analysis and survey research was adopted in this study. Based on hand anatomy and function, and focusing on the assessment of hand wounds and scars after burns, a topographic map assessment system for hand burn wounds and scars was initially developed. A pre-consultation was conducted in the form of on-site presentations. Following revisions according to the suggestions of experts, a round of formal Delphi consultation was carried out with 16 experts in burns, rehabilitation, and relevant fields from December 2024 to March 2025. Among the consultation experts, 6 were male and 10 were female, aged (43±9) years, with working experience ranged from 9 to 39 years, and seven (43.75%) experts held the title of associate senior or higher. The effective recovery rate of the consultation questionnaires and the mean expert authority coefficient of all items were calculated. The mean experts' importance score, the mean coefficient of variation, and the mean full-score ratio, as well as the Kendall's coefficient of concordance and the coefficient of variation of all the third-level items were calculated. Based on the consultation results, the items for the topographic map assessment system for hand burn wounds and scars were ultimately determined.  Results  The effective recovery rate of the consultation questionnaires was 100% (16/16), and the mean expert authority coefficient of all items was 0.84. For all the third-level items, the mean experts' importance score was 4.76, the mean coefficient of variation was 0.10, and the mean full-score ratio was 80.32%. For all the third-level items, the Kendall's coefficient of concordance of experts' importance scores was 0.18, with statistically significance (χ2=15.83, P<0.05), and the mean coefficient of variation was <0.25. After the formal inquiry, no items were deleted or added, and finally a topographic map assessment system for hand burn wounds and scars was formed. The evaluation system consists of a combination of hand burn wounds and scars topographic map and an evaluation table for wounds, scars, and deformities, and range of motion, including 6 first-level items, 16 second-level items, and 44 third-level items.  Conclusions  A comprehensive and highly usable topographic map assessment system for hand burn wounds and scars was constructed, which enables precise assessment of the severity of wounds, scars, and deformities and range of motion of hand burns.
Emphasizing nutritional therapy in burn rehabilitation
Peng Xi, Su Sen
, Available online  , doi: 10.3760/cma.j.cn501225-20251105-00459
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Although burn injury is an acute trauma, its clinical course exhibits characteristics of a chronic disease. Rehabilitation of burn patients often lasts several years, and nutritional therapy is crucial to their recovery. Previous burn nutrition research has primarily focused on the acute phase, with insufficient attention given to nutritional interventions during rehabilitation. Patients in the burn rehabilitation phase remain in hypermetabolism, accompanied by chronic inflammation, insulin resistance, fat browning, muscle wasting, bone loss, and metabolic disorders, which severely impair functional recovery and quality of life. Therefore, we systematically review the pathophysiological and metabolic alterations that occur during burn rehabilitation and propose evidence-based nutritional strategies. These include principles for estimating energy requirements, optimizing macronutrient composition, and ensuring adequate micronutrient intake. The paper advocates an integrated "hospital-community-home" care model that combines nutritional assessment, education, targeted interventions, pharmacotherapy, and exercise rehabilitation into a therapeutic system. This approach aims to accelerate patient recovery and facilitate successful reintegration into society.
Practical guideline on the prevention and management of diabetic foot in China (Ⅱ)
, Available online  , doi: 10.3760/cma.j.cn501225-20251029-00448
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Diabetic foot is one of the common and serious complications among the patients with diabetes mellitus. The major causes of amputation and/or death in the patients are foot deformities, ulcers, ischemia, and possible concurrent infections. To further standardize diabetic foot prevention and treatment in China, improve its diagnostic and therapeutic consistency, and promote the development of a specialized tiered care system, Chinese Burn Association, Yangtze River Delta Integrated Diabetic Foot Alliance, and Editorial Committee of Chinese Journal of Burns and Wounds organized a multidisciplinary expert team. The team determined clinical issues related to the diagnosis, treatment, and prevention of diabetic foot and evaluated the quality grades of relevant evidence using the grading of recommendations assessment, development and evaluation system, and eventually developed the Practical guideline on the prevention and management of diabetic foot in China. There were 46 recommendations formed in the guideline, covering comprehensive medical assessment, internal medical treatments such as control of blood glucose, blood pressure, and blood lipid, antithrombotic and anti-infection therapy, perioperative risk assessment and management, surgical treatments such as debridement, vascular reconstruction, and tissue repair surgeries, as well as foot disease prevention, multidisciplinary cooperation, and the construction of a tiered care system, aiming to provide guidance for the clinical practice of diabetic foot in China.
Digital technology empowers burn rehabilitation: new paradigms and future prospects
Yu Jia'ao, Zhang Xiuhang
, Available online  , doi: 10.3760/cma.j.cn501225-20250918-00398
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Burn rehabilitation has long transcended the physical repair of "breaking before rebuilding" at the superficial skin layer, evolving into a complex project concerning the systemic reconstruction of life quality. Its multi-dimensional nature demands breakthroughs not only in the scope of physiological recovery but also in the technical challenges related to limb function reconstruction. This necessitates integrated interventions that encompass acute care, functional rehabilitation training, and social reintegration, a process that typically lasts from several months to several years. Globally, the vast majority of the millions of newly burned patients each year embark on this long-term rehabilitation process. Nevertheless, the current clinical rehabilitation model has notable limitations. With the profound integration of digital technologies and medical field, burn rehabilitation has entered a new stage of "digital transformation", evolving from localized technological exploration to a comprehensive, multi-dimensional integrated model. This paper systematically examines the theoretical underpinnings of digital transformation in burn rehabilitation, analyzes the limitations of traditional models in assessment, treatment, and doctor-patient collaboration, and delineates the evolutionary trajectory of digitalization from data digitization and single-technology utilization to integrated transformation. It explores the key applications and empirical impacts of digital technologies in rehabilitation assessment, treatment, and patient management, identifies challenges such as technical cost barriers, data security ethics, and regional development disparities, and proposes technical development directions towards intelligent, integrated, and cost-effective solutions, along with multi-dimensional collaborative strategies. These findings offer theoretical support and practical guidance for digital transformation in this field, propelling burn rehabilitation from traditional passive models to proactive and precise paradigms.
Clinical efficacy of free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection in repairing wounds formed after lower limb salvage surgery
Shao Zhuoheng, Li Lei, Li Changsong, Yu Xinshui, Liu Jie, Fu Qiang, Ju Jihui
, Available online  , doi: 10.3760/cma.j.cn501225-20250225-00085
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Abstract:
  Objective  To investigate the clinical efficacy of free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection in repairing wounds formed after lower limb salvage surgery.  Methods  This study was a retrospective observational study. From January 2020 to June 2024, 66 patients with wounds formed after lower limb salvage surgery were admitted to the Department of Orthopaedics Trauma of Suzhou Ruihua Orthopedic Hospital, including 46 males and 20 females, aged 19-76 years. The microbiological culture results of wound secretion specimens from 8 patients were positive before flap transplantation. The wounds were all located on unilateral lower leg, with a wound area of 9 cm×6 cm to 40 cm×30 cm after debridement, which were repaired with free anterolateral thigh flaps measuring from 10 cm×8 cm to 35 cm×11 cm. Large wounds were repaired with additional split-thickness skin grafting or double anterolateral thigh flap transplantation. According to the anatomical location form low to high, the three non-major recipient arteries adjacent to the wound, namely the medial sural artery, the descending genicular artery, and the descending branch of the lateral circumflex femoral artery, were graded in a stepwise manner, and the lowest-grade uninjured artery was selected as the blood supply artery for the free flap covering the wound. Wounds in flap donor area were closed directly or covered with full-thickness skin grafts from the abdomen. Data recorded included the type of the lowest-grade usable non-major artery in the recipient area confirmed by preoperative digital subtraction angiography (DSA) examination, intraoperatively used type of non-major artery in the recipient area, the ratio of the calibers of the non-major artery in the recipient area to the flap vessel, type of vascular anastomosis, flap pedicle length, wound repair method, and arterial and venous connection method for double anterolateral thigh flaps, as well as flap survival and vascular crisis occurrrence, wound healing in recipient and donor areas, and occurrrence of specific donor-site complications after surgery before discharge. The flap's color, texture, and wound infection control were followed up. The outcome of the flap transplantation was evaluated using a comprehensive assessment scale at the final follow-up.  Results  Preoperative DSA examination identified the lowest-grade usable non-major recipient artery as the medial sural artery in 35 cases, the descending genicular artery in 24 cases, and the descending branch of the lateral circumflex femoral artery in 7 cases, which were consistent with the non-major artery in the recipient area used intraoperatively. The caliber ratio of recipient artery-to-flap vessel that were anastomosed intraoperatively was 0.5-1.0 for the medial sural artery, 0.5-0.8 for the descending genicular artery, and 0.5-0.7 for the descending branch of the lateral circumflex femoral artery. End-to-end direct anastomosis was performed in 20 cases, and end-to-end "fish-mouth" anastomosis was performed in 46 cases. The flap pedicle length was 8-18 cm. Wounds were repaired with flap transplantation alone in 57 cases and transplantation of flap combined with skin graft in 9 cases. For double anterolateral thigh flaps, the main arterial and venous trunk of the primary flap was connected to the main arterial and venous trunk of the secondary flap in 2 cases, and the arterial and venous branches of the primary flap was connected to the main arterial and venous trunk of the secondary flap in 1 case. Postoperatively, 67 flaps survived successfully, while vascular crisis occurred in 2 flaps, which survived after surgical exploration and re-anastomosis. Preoperatively non-infected wounds in 55 cases and infected wounds in 4 cases healed successfully postoperatively, while preoperatively non-infected wounds in 3 cases developed postoperative infection leading to delayed healing, and preoperatively infected wounds in 4 cases healed with delay. All donor site wounds healed well without specific complications like infection or muscle necrosis. Follow up for 6-24 months showed that all 69 flaps exhibited good color and texture with no wound infection. At the final follow-up, the outcome of the flap transplantation was evaluated as excellent in 39 cases, good in 21 cases, and fair in 6 cases.  Conclusions  The free anterolateral thigh flap supplied by non-major artery in the recipient area based on gradient selection demonstrates abundant blood supply, which can be used to repair wounds formed after lower limb salvage surgery in one time, without increasing the risk of further damage to the distal limb blood vessels, and can effectively control infections. This technique merits clinical promotion.
Efficacy of free lateral arm tissue flap in repairing complex finger wounds
Yang Xi, Liu Wuhua, Duan Jiazhang, Fang Xiang, Xu Yongqing, Shi Yan, Zhang Xing, He Xiaoqing
, Available online  , doi: 10.3760/cma.j.cn501225-20240927-00359
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  Objective  To explore the efficacy of free lateral arm flap in repairing complex finger wounds.  Methods  This study was a retrospective observational study. From January 2020 to December 2023, 8 patients with complex finger wounds who met the inclusion criteria were admitted to the 920th Hospital of Joint Logistic Support Force of PLA, including 5 males and 3 females, aged 24 to 56 years. There were 4 cases with multi-finger skin defects; there were 4 cases with single-finger skin combined with bone defects, 3 of whom were complicated with extensor tendon defects. The size of skin defects was 2.5 cm×2.0 cm to 8.0 cm×3.5 cm, and the size of bone defects was 1.5 cm×1.0 cm×1.0 cm to 2.0 cm×1.5 cm×1.0 cm. Five cases were repaired by free lateral arm tissue flap transplantation in the same period of emergency debridement; the remaining 3 patients underwent extended debridement in stage Ⅰ and free lateral arm tissue flap transplantation for repair in stage Ⅱ. Four patients each underwent resection of lobulated flaps and chimeric osteocutaneous flaps, including 4 cases carrying the posterior arm cutaneous nerve and three cases had their extensor tendons being reconstructed with the triceps brachii aponeurosis. The size of skin flaps was 3.0 cm×2.5 cm to 9.0 cm×4.0 cm, and the size of bone flap was consistent with the size of the bone defect. The donor site wounds of skin flaps and bone flaps were closed with interrupted sutures. Postoperatively, the survival status of the tissue flaps was observed, and the pedicle division status of the lobulated flaps was recorded. At the final follow-up, the following parameters were assessed and documented: the appearance and texture of flaps, the sensory recovery of the affected finger transplanted with the posterior arm cutaneous nerve using the British Medical Research Council sensory function assessment criteria, the dorsiflexion of the affected finger transplanted with the triceps brachii aponeurosis, the survival of the bone flaps confirmed via X-ray examination, the scar formation at the donor sites of skin flaps, and the function of the affected fingers evaluated based on the trial standard for functional evaluation of the upper limb of the Hand Surgery Society of the Chinese Medical Association.  Results  Postoperatively, the tissue flaps survived well. The pedicles of the lobulated flaps were successfully divided under local anesthesia 4 weeks after surgery. The follow-up duration ranged from 10 to 24 months, with an average of 13.5 months. At the final follow-up, the color and texture of the flaps were good, the sensation of the affected fingers transplanted with posterior arm cutaneous nerve recovered to S2-S3 level, the affected fingers transplanted with triceps brachii aponeurosis all achieved limited improvement in dorsiflexion, X-ray examination showed that the bone flaps survived; linear scars formed at the donor sites of skin flaps after wound healing, and the function of the affected fingers was evaluated as excellent in 5 cases and good in 3 cases.  Conclusions  The lateral arm tissue is rich in perforators and has few anatomical variations, which can be prepared into lobulated flaps and chimeric osteocutaneous flaps for the repair of complex finger wounds. The surgical operation is relatively simple, and the appearance and function of the donor and recipient sites are relatively good after surgery.
Establishment and validation of a risk prediction model for the occurrence of enteral nutrition intolerance in adult patients with severe burns
Sun Dan, Lyu Guozhong, Cao Ling, Ding Lingtao, Hui Ning, Chang Jiang, Fei Guo, Zhou Qing, Zou Fang, Hua Jianing
, Available online  , doi: 10.3760/cma.j.cn501225-20250820-00360
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Abstract:
  Objective  To establish and validate a risk prediction model for the occurrence of enteral nutrition intolerance (ENI) in adult patients with severe burns.  Methods  This study was a retrospective cohort study. A total of 155 adult patients with severe burns who met the inclusion criteria and hospitalized at the Affiliated Hospital of Jiangnan University between November 2020 and November 2024 were enrolled in modeling group, including 127 males and 28 females, aged 19 to 85 years. An additional 40 adult patients with severe burns who met the inclusion criteria and hospitalized at the Affiliated Hospital of Nantong University between November 2022 and November 2024 were enrolled in validation group, including 30 males and 10 females, aged 25 to 79 years. The gender, age, body mass index, number of underlying diseases, total burn area, modified early warning score, mechanical ventilation, white blood cell count, C-reactive protein level, serum albumin level, and fasting blood glucose level within 24 hours of admission, number of antibiotic types, intestinal probiotics, and sedatives and analgesics used during treatment were compared between the two groups of patients. Based on the occurrence of ENI, patients in modeling group were divided into two categories: those who developed ENI (96 cases) and those who did not (59 cases). The aforementioned data of these two categories of patients were compared to identify independent predictive factors for ENI of patients in modeling group. Accordingly, a risk prediction model for ENI of patients in modeling group was constructed, and both static and web-based dynamic nomograms were developed. The performance of the prediction model was evaluated using receiver operating characteristic (ROC) curves. The modeling group data was repeatedly sampled 1 000 times using Bootstrap method for internal validation, and external validation was conducted in validation group. Calibration curves and clinical decision curve analysis were used to analyze the calibration accuracy and clinical practicality of the prediction model, respectively.  Results  There were statistically significant differences between modeling group and validation group in terms of total burn area, number of antibiotic types used during treatment, mechanical ventilation and serum albumin levels within 24 h of admission of patients (with Z values of -2.35 and -2.68, χ2 values of 4.58 and 4.63, respectively, P<0.05). No statistically significant differences were observed in other variables between the two groups (P>0.05). There were statistically significant differences between patients developed ENI and those who did not in the number of underlying diseases, fasting blood glucose level within 24 h of admission, the number of antibiotic types used during treatment, white blood cell count within 24 h of admission, and the use of intestinal probiotics and that of sedative and analgesic agents (with Z values of 2.04, 4.24, and 3.36, χ2 values of 26.02, 24.13, and 4.49, respectively, P<0.05). Multivariate logistic regression analysis showed that the number of underlying diseases, total burn area, white blood cell count and fasting blood glucose level within 24 h of admission, and the use of intestinal probiotics during treatment were independent predictive factors for ENI of patients in modeling group (with odds ratios of 2.33, 1.03, 0.11, 1.22, and 0.08, 95% confidence intervals of 1.25-4.32, 1.00-1.06, 0.04-0.30, 1.04-1.42, and 0.03-0.24, respectively, P<0.05). Based on the aforementioned independent predictive factors, a risk prediction model for ENI in patient of modeling group was successfully established, and both a static and a web-based dynamic nomogram were developed. The area under the ROC curve of the prediction model was 0.90 (with 95% confidence interval of 0.84-0.95), with a sensitivity of 86.50%, a specificity of 84.70%, a maximum Youden's index of 0.712, and an optimal threshold of 61.4%. In internal and external validation, the areas under the ROC curves of the prediction model were 0.88 and 0.91, respectively (with 95% confidence intervals of 0.82-0.94 and 0.81-0.99, respectively), the calibration curves of the prediction model were all near the reference line, and the threshold probability ranges displayed by the clinical decision curves were 2%-96% and 18%-98%, respectively, with net returns>0.  Conclusions  The independent predictive factors for the occurrence of ENI in adult patients with severe burns include the number of underlying diseases, total burn area, white blood cell count and fasting blood glucose level within 24 h of admission, and the use of intestinal probiotics during treatment. The nomogram prediction model constructed on this basis has a good predictive efficiency for the risk of the occurrence of ENI in adult patients with severe burns.

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