[Prospective study on the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children].

Objective: To explore the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children. Methods: A prospective non-randomized controlled study was conducted. From January 2022 to April 2023, 40 children with severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. According to the willingness of the children or their families, the children were assigned to conventional rehabilitation group and combined rehabilitation group. During the study, 8 children dropped out of the study, 17 children were finally included in the conventional rehabilitation group with 6 males and 11 females, aged (8.5±2.4) years, and 15 children were included in the combined rehabilitation group with 5 males and 10 females, aged (9.6±2.5) years. The children in the 2 groups received conventional burn rehabilitation treatment in the hospital, including active and passive activity training, scar massage, and pressure therapy. The children in combined rehabilitation group received resistance training with elastic band of 3 to 5 times per week after discharge, and the children in conventional rehabilitation group received daily activity ability training after discharge. Before home rehabilitation training (1 week before discharge) and 12 weeks after home rehabilitation training, the grip strength was measured using a handheld grip dynamometer, the muscle strengths of the upper and lower limbs were measured using a portable dynamometer for muscle strength, lean body mass was measured by bioelectrical impedance measuring instrument, and the 6-min walking distance was measured. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, or Fisher's exact probability test. Results: After 12 weeks of home rehabilitation training, the grip strengths of children in combined rehabilitation group and conventional rehabilitation group were (15±4) and (11±4) kg, respectively, which were significantly higher than (10±4) and (9±4) kg before home rehabilitation training (with t values of -9.99 and -11.89, respectively, P values all <0.05); the grip strength of children in combined rehabilitation group was significantly higher than that in conventional rehabilitation group (t=3.24, P<0.05). After 12 weeks of home rehabilitation training, the muscle strengths of upper and lower limbs of children in combined rehabilitation group (with t values of -11.39 and -3.40, respectively, P<0.05) and the muscle strengths of upper and lower limbs of children in conventional rehabilitation group (with t values of -7.59 and -6.69, respectively, P<0.05) were significantly higher than those before home rehabilitation training, and the muscle strengths of upper and lower limbs of children in combined rehabilitation group were significantly higher than those in conventional rehabilitation group (with t values of 3.80 and 7.87, respectively, P<0.05). After 12 weeks of home rehabilitation training, the lean body mass of children in combined rehabilitation group was significantly higher than that before home rehabilitation training (t=0.21, P<0.05). After 12 weeks of home rehabilitation training, the 6-min walking distances of children in conventional rehabilitation group and combined rehabilitation group were significantly longer than those before home rehabilitation training (with t values of -5.33 and -3.40, respectively, P<0.05), and the 6-min walking distance of children in combined rehabilitation group was significantly longer than that in conventional rehabilitation group (t=3.81, P<0.05). Conclusions: Conventional burn rehabilitation treatment in hospital and home resistance training with elastic band for 12 weeks after discharge can significantly improve the muscle function and walking ability of severely burned children.

[Effects of miniature free groin perforator flaps in repairing small wounds on hands].

Objective: To investigate the effects of miniature free groin perforator flaps in repairing small wounds on hands. Methods: The retrospective observational study was conducted. Fifteen patients with 16 small wounds on hands were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital from July 2020 to October 2022, including 12 males and 3 females, aged 19 to 56 years. The size of skin and soft tissue defect was 2.0 cm×1.5 cm to 6.0 cm×3.0 cm after debridement. According to size and shape of the wounds, 13 single-lobe perforator flaps and 2 bilobed perforator flaps were designed in the groin region, with the flap size of 4.5 cm×2.5 cm to 7.5 cm×3.5 cm. According to the condition of the recipient area, the arteries and veins at the pedicle of the flap were anastomosed to the arteries and veins of the recipient area respectively. The wounds in the donor area of the flap was closed by layered and tension-reducing suture. The thickness of the flap was measured during operation. The survival of the flap was observed, and the complications in the donor and recipient areas were recorded after operation. The appearance and texture of the flap were observed during follow-up. At the last follow-up, the sensory recovery of the affected hand was evaluated, the function of the affected hand was evaluated according to the trial standard of the upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association, the scar in the donor and recipient areas were observed, and the satisfaction of patients for the curative effects was inquired. Results: The thickness of the flap was ranged from 0.3 to 1.0 cm, with an average thickness of 0.6 cm. After operation, 11 single-lobe flaps and 2 bilobed flaps survived well; in the left 2 single-lobe flaps, one flap had venous crisis but returned to normal after removing stitches to reduce tension and bloodletting of flaps, while the other one flap had a little necrosis on tip but healed after dressing change. No complications occurred in donor and recipient areas. During follow-up of 8 to 35 months after operation, the flaps had good elasticity and soft texture; 8 flaps were slightly bloated and were trimmed 3 to 8 months after operation, while the appearances of the other flaps were good. At the last follow-up, all flaps recovered protective feeling; the function of the affected hand was evaluated as excellent in 10 cases, good in 4 cases, and fair in 1 case; only linear scar remained in the donor and recipient areas; the patients were satisfied with the appearance and function recovery of the affected hand. Conclusions: The miniature free groin perforator flaps in repairing small wounds on hands have the advantages of high survival rate of flaps, hidden flap donor area, little damage, few complications, good repair effect, etc., showing clinical application value. It is recommended for repairing non-functional wounds on hands.

[Research advances on the application of rehabilitation exercise training in pediatric burn rehabilitation].

The sequelae of pediatric burn seriously affect the physical function and quality of life of children with burns. Rehabilitation exercise training mainly based on aerobic and resistance exercise can effectively alleviate the negative effects. This article reviews the effects of rehabilitation exercise training on cardiopulmonary function, muscle function, and quality of life of children with burns, and introduces the latest rehabilitation exercise training prescription for children with burns based on type, mode, intensity, frequency, and time of exercise, so as to improve the level of rehabilitation treatment for children with burns.

[Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns].

Objective: To analyze the risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns. Methods: A retrospective case series study was conducted. From January 2018 to August 2022, 361 patients with extensive burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 231 males and 130 females, aged 50 (36, 58) years, with total burn area of 45% (35%, 60%) total body surface area. According to the highest level of creatine kinase isoenzyme-MB (CK-MB) within 72 h post injury, the patients were divided into early myocardial injury group (CK-MB≥75 U/L, 182 patients) and non-early myocardial injury group (CK-MB<75 U/L, 179 patients). The following data of patients in the 2 groups were collected and analyzed, including gender, age, total burn area, admission time post injury, combination with shock on admission, combination with inhalation injury on admission; the main blood test indexes such as myocardial enzyme spectrum, blood routine, liver and kidney function, and electrolytes within 72 h post injury; and treatment outcomes and fatality rate. Data were statistically analyzed with chi-square test, independent sample t test, or Mann-Whitney U test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for early myocardial injury and for death in patients with extensive burns. Results: There were statistically significant differences in gender, combination with shock on admission, total burn area, and admission time post injury of patients between the two groups (with χ2 values of 6.40 and 6.10, Z values of 5.41 and 3.03, respectively, P<0.05). There were no statistically significant differences in age, combination with inhalation injury on admission of patients between the two groups (P>0.05). The CK-MB, creatine kinase, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, white blood cell count, neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), aspartate aminotransferase, potassium, and hemoglobin within 72 h post injury were significantly higher than those in non-early myocardial injury group (with Z values of 15.40, 6.26, 7.59, 7.02, 2.64, 4.53, 4.07, 6.32, and 4.12, t=2.34, respectively, P<0.05), while the level of calcium was significantly lower than that in non-early myocardial injury group (Z=2.72, P<0.05). There were no statistically significant differences in other blood test indexes of patients between the two groups (P>0.05). The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns (with odds ratios of 1.03, 1.07, 1.04, and 1.02, 95% confidence intervals of 1.02-1.05, 1.00-1.11, 1.02-1.07, and 1.00-1.03, respectively, P<0.05). The fatality rate of patients in early myocardial injury group was 8.8% (16/182), which was significantly higher than 2.8% (5/179) in non-early myocardial injury group (χ2 =5.93, P<0.05). Early myocardial injury, age, combination with shock on admission, and combination with inhalation injury on admission were the independent risk factors for death in patients with extensive burns (with odds ratios of 3.60, 1.04, 6.53, and 3.14, 95% confidence intervals of 1.17-11.05, 1.01-1.07, 1.39-30.68, and 1.15-8.56, respectively, P<0.05). Conclusions: The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns. Patients with extensive burns with early myocardial injury have a higher fatality rate, and early myocardial injury is an independent risk factor for the patients' death.

[Influence of muscle energy technology combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint].

Objective: To investigate the influence of muscle energy technology (MET) combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint. Methods: A retrospective controlled clinical trial was conducted. From January 2020 to January 2022, 53 patients with elbow joint flexion dysfunction after deep burns who met the inclusion criteria were treated in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 32 males and 21 females, aged (37±12) years. According to the treatment method used, the patients were divided into conventional treatment alone group (15 cases), conventional treatment+joint mobilization surgery group (18 cases), and conventional treatment+joint mobilization surgery+MET group (20 cases). Before treatment and 2 months after treatment, the patient's elbow joint range of motion was measured using a protractor, the Mayo elbow joint function score was used to evaluate elbow joint function, a portable muscle strength tester was used to measure elbow extensor muscle strength, and visual analogue scale was used to evaluate pain degree. Data were statistically analyzed with one-way analysis of variance, least significant difference test, paired sample t test, Kruskal-Wallis H test, Wilcoxon signed rank-sum test, chi-square test, Fisher's exact probability test, and Bonferroni correction. Results: After two months of treatment, the elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery group and conventional treatment+joint mobilization surgery+MET group ((103±12)° and 60 (50, 66), (131±14)° and 73 (65, 80)) were significantly larger and higher than those in conventional treatment alone group ((77±15)° and 45 (35, 50), P values all <0.05), respectively. The elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery+MET group were significantly larger and higher than those in conventional treatment+joint mobilization surgery group (P values all <0.05), respectively. After two months of treatment, the elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery+MET group were respectively significantly larger and lower than those in conventional treatment alone group and conventional treatment+joint mobilization surgery group (P values all <0.05). The elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery group were similar to those in conventional treatment alone group (P>0.05). The elbow joint range of motion and elbow extensor muscle strength (with t values of 9.37, 25.54, 28.71, 6.70, 7.20, and 7.01, respectively, P<0.05), elbow joint function scores and pain scores (with Z values of 3.15, 3.63, 3.93, 3.30, 3.52, and 3.84, respectively, P<0.05) of patients in conventional treatment alone group, conventional treatment+joint mobilization surgery group, and conventional treatment+joint mobilization surgery+MET group after two months of treatment were significantly improved compared with those before treatment. Conclusions: The combination of MET and Maitland joint mobilization surgery can effectively improve elbow joint range of motion, elbow joint function, elbow extensor muscle strength, and pain of patients with deep elbow joint burns, therefore it is worthy of promotion.

[Pan-cancer analysis of ubiquitin-specific protease 7 and its expression changes in the carcinogenesis of scar ulcer].

Objective: To explore the biological role and clinical significance of ubiquitin-specific protease 7 (USP7) in the carcinogenesis of scar ulcer. Methods: A retrospective observational study combined with bioinformatics analysis was used. The RNA expression profile data of USP7 in tumor and/or its corresponding paracancular normal tissue were obtained from The Cancer Genome Atlas (TCGA) database and the Gene Expression Omnibus database, and the RNA sequencing data were transformed by log2. The variations of USP7 gene were analyzed by cBioPortal database. The USP7 mRNA expression in tumor and adjacent normal tissue in TCGA database were obtained by using the "Gene_DE" module in TIMER 2.0 database. The survival rates of patients with high and low USP7 expression in cutaneous melanoma (SKCM), cervical squamous cell carcinoma (CESC), lung squamous cell carcinoma (LUSC), and head and neck squamous cell carcinoma (HNSC) were analyzed using the Gene Expression Profile Interactive Analysis 2 (GEPIA2) database, and the Kaplan-Meier survival curves were drawn. Sangerbox database was used to analyze the correlation of USP7 expression in pan-cancer with microsatellite instability (MSI) or tumor mutation burden (TMB) pan-cancer. Through the "correlation analysis" module in the GEPIA2 database, the correlation of USP7 expression in pan-cancer with the expression levels of five DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2, and EPCAM) and three essential DNA methyltransferases (DNMT)--DNMT1, DNMT3A, and DNMT3B were evaluated. The USP7 expression in CESC, HNSC, LUSC, and SKCM and its correlation with infiltration of immune cells (B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages, and dendritic cells) were analyzed by the "Immune-Gene" module in TIMER 2.0 database. The "Similar Genes Detection" module of GEPIA2 database was used to obtain the top 100 protein sets with similar expression patterns to USP7. Intersection analysis was performed between the aforementioned protein sets and the top 50 protein sets that were directly physically bound to USP7 obtained by using the STRING database. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analysis were performed for the two protein sets mentioned above using the DAVID database. The samples of normal skin, hypertrophic scar, scar ulcer, and scar carcinoma with corresponding clinicopathologic features were collected from the Department of Pathology of Tongren Hospital of Wuhan University & Wuhan Third Hospital from October 2018 to October 2022, and the USP7 expression in tissue was detected by immunohistochemical method, with the number of samples of 6. Data were statistically analyzed with Log-rank test, one-way analysis of variance, and Bonferroni test. Results: In pan-cancer, the main gene variations of USP7 were mutation and amplification, and the top 3 tumors with the highest variation frequency (>6%) were bladder urothelial carcinoma, SKCM, and endometrial carcinoma. The main mutation of USP7 gene in pan-cancer was missense mutation. In SKCM with the highest mutation frequency, the main type of mutation was missense mutation in USP7_ICP0_bdg domain. USP7 mRNA expression in breast invasive carcinoma, bile duct carcinoma, colon carcinoma, esophageal carcinoma, HNSC, renal chromophobe cell carcinoma, hepatocellular carcinoma, lung adenocarcinoma, LUSC, prostate carcinoma, and gastric carcinoma was significantly higher than that in corresponding paracancer normal tissue (P<0.05). USP7 mRNA expression in glioblastoma multiforme, renal clear cell carcinoma, renal papillary cell carcinoma, and thyroid carcinoma was significantly lower than that in corresponding paracancular normal tissue (P<0.05). In addition, USP7 mRNA expression in SKCM metastases was much higher than that in primary tumor tissue (P<0.05). Survival curves showed no significant difference in survival rate between patients with high USP7 expression and patients with low USP7 expression in CESC, HNSC, LUSC, and SKCM (Log-rank P>0.05, with hazard ratios of 1.00, 0.99, 1.00, and 1.30, respectively). USP7 expression in colon cancer, colorectal cancer, thymic cancer, and thyroid cancer was negatively correlated with TMB (with Pearson correlation coefficients of -0.26, -0.19, -0.19, and 0.11, respectively, P<0.05). USP7 expression in glioma, CESC, lung adenocarcinoma, mixed renal carcinoma, and LUSC was positively correlated with MSI expression (with Pearson correlation coefficients of 0.22, 0.14, 0.15, 0.08, and 0.14, respectively, P<0.05), and USP7 expression in colon cancer, colorectal cancer, invasive breast cancer, prostate cancer, HNSC, thyroid cancer, and diffuse large B-cell lymphoma were significantly negatively correlated with MSI expression (with Pearson correlation coefficients of -0.31, -0.27, -0.13, -0.19, -0.16, -0.18, and -0.53, respectively, P<0.05). The expression of USP7 in CESC was positively correlated with that of both MSH2 and MSH6 (with Spearman correlation coefficients of 0.51 and 0.44, respectively, P<0.05), and the expression of USP7 in HNSC was positively correlated with the expression of EPCAM, MLH1, MSH2, MSH6, and PMS2 (with Spearman correlation coefficients of 0.39, 0.14, 0.49, 0.54, and 0.41, respectively, P<0.05), and the expression of USP7 in LUSC was positively correlated with the expression of EPCAM, MSH2, MSH6, and PMS2 (with Spearman correlation coefficients of 0.20, 0.36, 0.40, and 0.34, respectively, P<0.05), and the expression of USP7 in SKCM was positively correlated with the expression of EPCAM, MLH1, MSH2, MSH6, and PMS2 (with Spearman correlation coefficients of 0.11, 0.33, 0.42, 0.55, and 0.34, respectively, P<0.05). The expression of USP7 in CESC, HNSC, LUSC, and SKCM was significantly positively correlated with the expression of DNMT1, DNMT3A, and DNMT3B (with Spearman correlation coefficients of 0.42, 0.34, 0.22, 0.45, 0.52, 0.22, 0.36, 0.36, 0.22, 0.38, 0.46, and 0.21, respectively, P<0.05). The expression of USP7 in CESC, HNSC, LUSC, and SKCM was positively correlated with CD4+ T cell infiltration (with Partial correlation coefficients of 0.14, 0.22, 0.13, and 0.16, respectively, P<0.05). Being similar to the pattern of USP7 expression and ranked among top 100 protein sets, the top 5 proteins were C16orf72, BCLAF1, UBN, GSPT1, ERI2 (with Spearman correlation coefficients of 0.83, 0.74, 0.73, and 0.72, respectively, all P values<0.05). The top 50 protein sets that directly physically bind to USP7 overlapped with the aforementioned protein set by only one protein, thyroid hormone receptor interaction factor 12. KEGG enrichment analysis showed that USP7 related genes were involved in cell cycle, spliceosome, cell senescence, and p53 signal pathway. GO enrichment analysis showed that USP7 related genes were involved in transcriptional regulation, protein ubiquitination, DNA repair, and cytoplasmic pattern recognition receptor signal pathways. Analysis of clinical samples showed that USP7 expression was significantly higher in hypertrophic scars (0.35±0.05), scar ulcers (0.43±0.04), and scar cancers (0.61±0.03) than in normal skin (0.18±0.04), P<0.05. Conclusions: USP7 may be a clinical biomarker for the progression of cicatricial ulcer cancer.

[Treatment methods of upper limbs with destructive electric burns and its clinical efficacy].

Objective: To investigate the treatment methods of upper limbs with destructive electric burns and its clinical efficacy. Methods: A retrospective observational study was conducted. From July 2014 to December 2020, 20 male patients with destructive electric burns in upper limbs who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, aged from 21 to 57 years, of whom 7 patients underwent emergency surgery, and a total of 20 affected limbs were treated with limb salvage. The necrotic bone was resected in 5 affected limbs, the residual hand and wrist at the distal end of left affected limb was replanted to the residual end of the right forearm in one patient in a cross heterotopic way, and short reduction and replantation after osteotomy were performed for two affected limbs with distal ulnar and radial necrosis. After thorough debridement, the area of wound proposed to be repaired by tissue flap was from 12 cm×7 cm to 58 cm×13 cm. According to the size and distribution of wound, the wounds of 2 affected limbs were repaired by transplantation of pedicled latissimus dorsi myocutaneous flap and free groin flap with vascular anastomosis. The wounds of the remaining 17 affected limbs were repaired with the transplantation of free latissimus dorsi myocutaneous flap, anterolateral thigh flaps, and paraumbilical perforator flap, with 10 affected limbs with larger wounds being jointly transplanted with the groin flap or the paraumbilical perforator flap on the other side. The total grafted tissue flap area was 20 cm×8 cm to 52 cm×20 cm. During tissue flap transplantation, according to the length of blood vessel defect in the affected limb, the distal artery of the affected limb was bridged with the distal part of flap vascular pedicle, undamaged vein on the affected side, superficial vein of abdominal wall, and great saphenous vein, etc., in 14 affected limbs, and the great saphenous vein was grafted in 3 of them with impeded distal return for recanalization of distal limb veins. The wound in the donor area was repaired by direct suture or grafting with split-thickness scalp. After the wound was basically healed, the functional rehabilitation training was started gradually, and the functional reconstruction and scar rectification surgery were started 3 months after tissue flap transplantation. The survival of tissue flaps/skin grafts, wound healing, limb salvage, and follow-up status after surgery were recorded. At the last follow-up, the function of the successfully salvaged limb was evaluated and scored by the disabilities of the arm, shoulder and hand (DASH) scoring scale. Results: After surgery, the grafted tissue flap in the affected limb and the skin grafts transplanted on the wound at flap donor site survived, and wounds at the recipient and donor sites healed well. Two affected limbs had distal necrosis within 10 days after tissue flap transplantation, and the middle and upper forearms were amputated. The remaining 18 affected limbs were successfully salvaged (including shortened replantation and cross heterotopic replantation). During 6-48 months of follow-up, 5 affected limbs that were successfully salvaged developed aseptic dissolution of residual tendon and bone tissue 3 to 18 months after tissue flap transplantation, which gradually healed after surgical debridement combined with vacuum sealing drainage treatment. At the last follow-up, the stump of two affected limbs healed well after amputation; 18 affected limbs that were successfully salvaged all survived well, of which 8 affected limbs had good recovery of finger flexion and extension function and thumb opponensplasty and could complete daily activities independently, 9 affected limbs regained partial mobility and could complete daily activities such as dressing and eating with the assistance of the opposite upper limb or auxiliary devices, and one affected limb had no function. At the last follow-up, the functional scores of DASH scoring scale of the 18 affected limbs that were successfully salvaged ranged from 30.0 to 100. Conclusions: Timely surgical debridement, proper treatment of the injured bone tissue, effective vascular bridging for reconstruction of the distal artery of the affected limb, and the use of blood-rich tissue flap to repair the wound, combined with early rehabilitation and functional restoration treatment, are beneficial to salvage the upper limb with destructive electric burns and improve the function of the affected limb.

[A case with giant ulcer caused by skin diffuse large B-cell lymphoma in the axilla].

In May 16th, 2019, a male patient (aged 51 years) with a rare giant ulcer caused by skin diffuse large B-cell lymphoma in the axilla was admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, and the ulcer wound was confirmed by biopsy and immunohistochemical analysis after extensive excision. Ultimately, a good prognosis was obtained by transplantation of flap and skin graft in combination with radiotherapy and chemotherapy.

[Analysis of the development trend of burn discipline from the literature published in Chinese Journal of Burns in 22 years].

Objective: To analyze the literature published in Chinese Journal of Burns (now Chinese Journal of Burns and Wounds) in the last 22 years, and to explore the development trend of burn discipline. Methods: The relevant clinical and research literature published in Chinese Journal of Burns from January 1, 2000 to December 31, 2021 were retrieved through China National Knowledge Infrastructure database. Bibliometrics was used to classify and analyze the literature by research types, involved research fields, and reported causes of injury, and compare them every 3 years according to the year of publication (with literature published in 2021 being included in the last time period). Keywords of all the literature were retrieved, which were corrected and conversed later. CiteSpace 6.1.R2 software was used to visually cluster the included keywords, count high-frequency and high-centrality keywords, and divide the high-frequency keywords by time as before for segment comparison. Results: A total of 4 485 relevant papers were included, with an average of about 204 papers each year. The research types analysis of literature showed that clinical diagnosis and treatment literature had the highest proportion, reaching 65.3% (2 929/4 485), followed by cell experiment and animal experiment literature, accounting for 18.1% (812/4 485) and 13.2% (591/4 485), respectively. The proportion of various research types of the literature in each time period was basically stable. The analysis of the research fields involved in the literature showed that the literature in the field of systemic treatment of burns accounted for the highest proportion, reaching 60.2% (2 699/4 485), followed by the literature in the fields of acute wounds and plastic surgery, accounting for 20.2% (908/4 485) and 7.3% (326/4 485), respectively. The proportion of the literature in the field of systemic treatment of burns decreased from 84.0% (430/512) in 2000-2002 to 40.3% (373/926) in 2018-2021, with a decreasing proportion of 43.7%. While compared with that in 2000-2002, the proportions of literature in the fields of acute wounds, plastic surgery, chronic wounds, and burn rehabilitation were on the rise, with the proportions in 2018-2021 increased by 11.7%, 9.1%, 10.7%, and 5.5%, respectively. In the first 6 time periods, the number of literature in the field of discipline management was few and remained in single digits, but it increased to 49 in 2018-2021. Among the 1 099 literature in the field of systemic treatment of burns with a clear cause of injury, the literature on thermal burns was the most, accounting for 58.5% (643/1 099), followed by the literature on electrical burns and chemical burns, accounting for 19.8% (218/1 099) and 12.6% (138/1 099), respectively. The comparison by time period showed that the proportion of literature reporting thermal burns showed a significant downward trend, while the proportion of literature reporting other causes of injury did not change significantly. A total of 6 822 keywords from 2 236 literature were included for analysis. Visual cluster analysis showed that relevant studies focused on burns, surgical flaps, scars, and wound healing. The top 3 keywords in frequency were burns, wound healing, and surgical flaps, and the top 3 keywords in centrality were burns, scars, and skin transplantation. The comparison by time period showed that the only keyword with a stable frequency in the top 10 ranks was burns; with the passage of time, some keywords such as endotoxin/endotoxins and fibroblasts gradually dropped out of the top 10 ranks, while keywords such as wounds and injuries, surgical flaps, and negative-pressure wound therapy gradually entered the top 10 ranks. Conclusions: Among the literature published in Chinese Journal of Burns during the last 22 years, the literature on systemic treatment of burns and thermal burns has gradually decreased, while the literature on chronic wounds and burn rehabilitation has increased. Surgical flaps, wound healing, and scar prevention and treatment are the current research hot spots in burn discipline.

[Retrospective analysis of 35 burn patients in different stages of pregnancy].

Objective: To summarize the clinical outcomes of burn patients in different stages of pregnancy and explore a rational therapeutic scheme for burns during pregnancy. Methods: A retrospective observational study was conducted. From June 2010 to June 2020, 21 patients who met the inclusion criteria were admitted to the Department of Burns of Wuhan Third Hospital and 14 patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University. Based on the pregnancy period when patients suffered burns, the 35 patients were divided into early pregnancy group with 18 patients (aged (26±4) years, with 8 (4, 11) weeks of gestation), middle pregnancy group with 10 patients (aged (26±3) years, with 21 (14, 27) weeks of gestation), and late pregnancy group with 7 patients (aged (30±5) years, with 32 (29, 35) weeks of gestation). All the patients received treatment including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements. The burn-related complications during the treatment, maternal outcomes, fetal outcomes, fetal delivery mode, gestational weeks at delivery, and newborn weight of patients in the 3 groups were recorded. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and Fisher's exact probability test. Results: During the treatment, there were 4, 4, and 2 patients who suffered wound infections and 1, 3, and 2 patients who developed shock symptoms, respectively, in early pregnancy group, middle pregnancy group, and late pregnancy group. There were no statistically significant differences in them among the 3 groups (P>0.05). One patient in late pregnancy group developed into multiple organ dysfunction syndrome after debridement. At last, all the pregnant women survived, and no statistically significant difference existed among the 3 groups (P>0.05). In early pregnancy group, middle pregnancy group, and late pregnancy group, the survived fetus cases were 9, 8, and 6, respectively, and the differences between them were not statistically significant (P>0.05). Variables including stillbirth and full-term birth were close in patients in the 3 groups (P>0.05), while the preterm birth and miscarriage in patients in the 3 groups were statistically different (P<0.05 or P<0.01), with the early pregnancy group having the most miscarriage cases and the fewest preterm birth cases. There were no statistically significant differences in fetal delivery mode, gestational weeks at delivery, and newborn weight among the patients with survived fetus in 3 groups (P>0.05). Conclusions: For patients suffering burns during early, middle, and late pregnancy, superior rates of maternal and fetal survival can be achieved after timely and adequate treatments including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements.

[A prospective randomized controlled study on the effects of bicycle ergometer rehabilitation training on quadriceps and walking ability of patients with lower limb dysfunction caused by extensive burns].

Objective: To explore the effects of bicycle ergometer rehabilitation training on quadriceps and walking ability of patients with lower limb dysfunction caused by extensive burns. Methods: A prospective randomized controlled study was conducted. A total of 40 patients with extensive burns who met the inclusion criteria and were admitted to Tongren Hospital of Wuhan University＆Wuhan Third Hospital from December 2017 to December 2020 were selected. According to the random number table, the patients were divided into conventional training group (16 males, 4 females, aged (45±10) years) and combined training group (13 males, 7 females, aged (39±8) years). Patients in conventional training group were given conventional rehabilitation therapy such as joint loosening, lower limb strength training, walking training, and pressure therapy, while patients in combined training group were given additional bicycle ergometer rehabilitation training on the basis of conventional rehabilitation. For patients in the 2 groups before and after a 2-month's treatment, the thickness of quadriceps was measured by ultrasonic diagnostic instrument, the muscle strength of quadriceps was measured by portable muscle strength tester, the walking ability was tested with a 6-min and a 10-meter walk tests, and the patients' satisfaction for treatment effects was assessed using the modified Likert scale. Data were statistically analyzed with independent or paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, or chi-square test. Results: After 2-month's treatment, the quadriceps thickness of patients in combined training group was (3.76±0.39) cm, which was significantly thicker than (3.45±0.35) cm in conventional training group (t=2.67, P<0.05); quadriceps thickness of patients in conventional training group and combined training group after 2-month's treatment was significantly thicker than that before treatment (with t values of 5.99 and 8.62, respectively, P<0.01). After 2-month's treatment, the quadriceps muscle strength of patients in combined training group was significantly greater than that in conventional training group (Z=2.69, P<0.01); quadriceps muscle strength of patients in conventional training group and combined training group after 2-month's treatment was significantly greater than that before treatment (with Z values of 3.92 and 3.92, respectively, P<0.01). After 2-month's treatment, the 6-min walking distance of patients in combined training group was (488±39) m, which was significantly longer than (429±25) m in conventional training group (t=5.66, P<0.01); the 6-min walking distance of patients after 2-month's treatment in conventional training group and combined training group was significantly longer than that before treatment (with t values of 13.16 and 17.92, respectively, P<0.01). After 2-month's treatment, the 10-meter walking time of patients in combined training group was significantly shorter than that in conventional training group (t=3.20, P<0.01); and the 10-meter walking time in conventional training group and combined training group was significantly shorter than that before treatment (with t values of 7.21 and 13.13, respectively, P<0.01). The patients' satisfaction score for treatment effects in combined training group was significantly higher than that in conventional training group (Z=3.14, P<0.01), and the patients' satisfaction scores for treatment effects in conventional training group and combined training group after 2-month's treatment were significantly greater than those before treatment (with Z values of 3.98 and 4.04, respectively, P<0.01). Conclusions: Bicycle ergometer rehabilitation training can be used to improve quadriceps thickness, muscle strength, and walking ability of patients with lower limb dysfunction caused by extensive burns. It can also improve the satisfaction of patients with the treatment outcome, and therefore is worthy of promotion.

[Clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture deformity after extensive burns].

Objective: To investigate the clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture after extensive burns. Methods: A retrospective observational study was conducted. From August 2017 to October 2021, 7 patients with severe scar contracture deformity caused by extensive burns were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 5 males and 2 females, aged 26-65 years, with scar area of 20 cm×4 cm-34 cm×14 cm. In the first stage, the rectangular skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 500-600 mL were embedded above the inguinal ligament, and then normal saline was injected after stitch removal for expansion to meet the needs of repair surgery. In the second stage, the scar was removed by surgical excision to correct the deformity and release the adhesion and contracture; after the removal of the expanders, the expanded ilioinguinal free flaps were harvested. When a larger flap was needed, the paraumbilical perforator flap was harvested at the same time, and the flaps were transplanted to the secondary wound after scar resection. The number of embedded expanders, the total amount of injected normal saline, the expansion time, the complications of skin and soft tissue expansion, the number, area, thickness, and anastomotic vascular pedicles of the expanded ilioinguinal flaps being resected, the type of flaps used, the repair method of flap donor sites, and the survival of flaps after operation were observed and recorded. The long-term repair effect and donor site condition were followed up. At the last follow-up, the patients' satisfaction with the curative effect of each surgical site was investigated according to the grade 5 score of Likert scale. Results: A total of 10 expanders were embedded in 7 patients, of which 4 patients had 1 each and 3 patients had 2 each. The total volume of normal saline injected was 800-1 800 (1 342±385) mL, and the expansion time was 4-24 (11±5) months. One patient had the expander exposed due to infection after the expander being inserted, while the other patients had no complications of skin and soft tissue expansion. Totally 10 expanded ilioinguinal flaps with the area of 22 cm×6 cm-36 cm×16 cm ((326±132) cm2) and the thickness of 0.6-1.1 (0.77±0.16) cm were harvested. Among the 10 expanded ilioinguinal flaps, 5 were pedicled with the superficial circumflex iliac artery, 3 with the superficial abdominal artery with relatively large caliber, 1 with the common trunk of the superficial circumflex iliac artery and the superficial abdominal artery, and 1 flap was anastomosed with the superficial circumflex iliac artery and bridged the superficial abdominal artery for intra-arterial supercharge. Unilateral expanded ilioinguinal flap combined with ipsilateral paraumbilical perforator flap were harvested in 4 cases, bilateral expanded ilioinguinal flaps were harvested in 1 case, and unilateral expanded ilioinguinal flap was harvested in 2 cases. Except for 1 case being transplanted with autologous split-thickness scalp to repair the flap donor site after combined resection of bilateral expanded ilioinguinal flaps, the donor sites of the other patients were sutured directly. All the flaps survived after operation without tip necrosis or wound residue. Follow-up for 3-30 (15±10) months showed that the flap was soft and not bloated, the function and appearance of the recipient area were significantly improved compared with those before operation, and the appearance of the donor sites was good. At the last follow-up, the patients' satisfaction with the treatment effect of the surgical site scored 4-5 (4.5±0.4). Conclusions: The expanded ilioinguinal flap can be obtained in a large area. It has the advantages of rich blood supply, less damage to the donor site, concealed location, and being convenient to be resected and transplanted in combination with the paraumbilical perforator flap. It is suitable for the clinical reconstruction and treatment of severe scar contracture deformity after extensive burns.

[A long way for the popularization and improvement of burn rehabilitation].

In more than half a century, burn rehabilitation in China has experienced three periods: initial exploration in the latter half of the 20th century, gradual development in the first decade of the 21st century, and the accelerating popularization in the recent decade. Looking back at the historical development of burn rehabilitation, we can see not only great progresses, but also many problems and deficiencies. In China, many units still do not even provide burn rehabilitation treatment, and many units where rehabilitation is also in practice, are commonly experiencing problems such as lack of enough therapists, insufficient team construction and training, incomplete treatment programs and limited curative effects, unstable multi-disciplinary cooperation mode, and lack of high-level rehabilitation research and technological innovation. Based on this, this paper puts forward some suggestions for further development and improvement, hoping to push the burn rehabilitation in China from popularization towards a comprehensive high level.

[Comparison of the effects of self-made three-dimensional printed assistant tableware and traditional universal cuff assistant tableware in patients with upper limb dysfunction after burn injury].

Objective: To compare the effects of self-made three-dimensional (3D) printed assistant tableware (hereinafter referred to as 3D assistive device) and traditional universal cuff assistant tableware (hereinafter referred to as universal cuff) on the voluntary eating function of patients with upper limb dysfunction after burns. Methods: The prospective self-control study was conducted. From March 2020 to June 2021, 18 patients with upper limb dysfunction after moderate to severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 15 males and 3 females, aged 21-58 (42±11) years. After using the 3D software and 3D printer to customize 3D assistive devices for patients, the patients were instructed to eat with the 3D assistive devices and the universal cuff on alternate days for 14 consecutive days, each for 7 days. During this time, the patients could also be fed by someone else without using the assistive device. The number of times the patients ate regular meals with each assistive device and the proportion of them to the total number of regular meals ate during the 7 days to which they belonged were counted. After the total use of two assistive devices for 14 days (hereinafter referred to as after use of 14 days), the amount and time of transferring liquid using the two assistive devices of patients were measured; the patients' feeding items in the modified Barthel index (MBI) were scored respectively when eating without the assistive device, with the 3D assistive device, or with the universal cuff; the satisfaction degree of feeding when eating without the assistive device, with the 3D assistive device, or with the universal cuff was evaluated using the 5-grade Likert scale. Data were statistically analyzed with paired sample t test, Wilcoxon signed rank sum test, and chi-square test. Results: The number of the patients ate regular meals with the 3D assistive device during the 7 days was (18.1±2.0) times, which was significantly more than (4.0±2.0) times with the universal cuff (t=53.72, P<0.01). The proportion of the number of the patients ate regular meals with the 3D assistive device to the total number of regular meals ate during the 7 days to which it belonged was 72.4% (325/449), which was significantly higher than 16.7% (72/431) with the universal cuff (χ2=257.36, P<0.01). After use of 14 days, the patients' time and amount of transferring liquid using the 3D assistive device were respectively significantly shorter and more than using the universal cuff (with t values of 2.49 and 7.52, respectively, P<0.05 or P<0.01). The patients' MBI feeding scores when eating with the 3D assistive device and with the universal cuff were close (P>0.05), which were both significantly higher than the score when eating without the assistive device (with Z values of 3.90 and 3.86, respectively, P<0.01).The patients' satisfaction scores of feeding when eating with the 3D assistive device and with the universal cuff were close (P>0.05), which were both significantly higher than the score when eating without the assistive device (with Z values of 3.61 and 3.00, respectively, P<0.01). Conclusions: Both the 3D assistive device and the universal cuff can compensate the limb function of patients with upper limb dysfunction after burns and improve their self-feeding ability, but the 3D assistive device has more advantages in improving patients' willingness to eat and the efficiency of food transfer.

[A case of pseudotumor of lower extremity combined with protracted infectious skin ulcer induced by severe hemophilia A].

On July 11, 2018, a 26 years old male patient with pseudotumor of lower extremity combined with protracted infectious skin ulcer induced by severe hemophilia A was admitted to Tongren Hospital of Wuhan University＆Wuhan Third Hospital. After treatment of supplementary of clotting factors, prothrombin complex, debridement, and vacuum sealing drainage, skin grafting was performed after granulation tissue formation in wounds. After surgery, clotting factor supplement, anti-infection, prevention of hematoma, and so on were performed. The wounds were finally closed with the survival of skin graft, which dramatically improves the patient's quality of life. This case suggests that aggressive and effective surgical treatment can significantly improve the prognosis of patients with severe hemophilia A.

[Changes in the related indicators of bone formation and bone resorption in severely burned rats].

Objective: To observe the changes in the related indicators of bone formation and bone resorption in severely burned rats. Methods: The experimental research method was adopted. Thirty female Sprague-Dawley rats aged 6 to 8 weeks were divided into sham injury group, 12% total body surface area (TBSA) full-thickness burn group, and 24%TBSA full-thickness burn group according to the random number table, with 10 rats in each group. The rats were treated on the back correspondingly, after which, the burned rats were rehydrated by intraperitoneal injection according to the Parkland formula, and the wound was coated with 20 g/L iodophor until wound healing. On post injury day (PID) 28, the tibia tissue of rats in each group was collected. The new bone tissue and the number of osteoclasts were observed after staining with Masson and tartrate-resistant acid phosphatase, respectively. The abdominal aortic blood of rats in each group was harvested for serum preparation. The bone metabolism indexes of serum calcium ion and phosphorus ion concentration were determined by the methyl thymol blue colorimetric method and phosphomolybdic acid method, respectively. The serum levels of bone formation marker of aminoterminal propeptide of type 1 procollagen (P1NP) and bone resorption marker of beta-carboxy-terminated peptide of type Ⅰ collagen (ß-CTX) were determined by enzyme-linked immunosorbent assay. The first lumbar spine tissue of rats in each group was collected, and the mRNA expression levels of osteoprotegerin, receptor activator of nuclear factor-κB ligand (RANKL), tumor necrosis factor receptor-associated factor 6 (TRAF-6), nuclear factor of activated T cell 1 (NFATC1), c-Fos, and c-Src were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction. Data were statistically analyzed with one-way analysis of variance, Bonferroni method, Welch test, Games-Howell test, Kruskal-Wallis test, Mann-Whitney U test, and Bonferroni correction. Results: On PID 28, compared with that in sham injury group, the formation of new bone tissue in the tibia tissue of rats in the two burn groups was decreased, and the larger the burn area, the more obvious the decrease. The numbers of osteoclasts in the tibia tissue of rats in the two burn groups were similar, both significantly more than the number in sham injury group. On PID 28, the serum calcium ion concentration and serum level of ß-CTX of rats in the three groups were similar (P>0.05). The serum phosphorus ion concentration of rats in 24%TBSA full-thickness burn group was significantly higher than that in 12%TBSA full-thickness burn group (P<0.05), and the serum phosphorus ion concentrations in the two burn groups were significantly higher than the concentration in sham injury group (P<0.01). The serum level of P1NP of rats in 24%TBSA full-thickness burn group was significantly lower than that in sham injury group (P<0.01). On PID 28, the mRNA expression levels of osteoprotegerin in the first lumbar spine tissue of rats in sham injury group, 12%TBSA full-thickness burn group, and 24%TBSA full-thickness burn group were 1.01±0.20, 1.71±0.83, and 2.24±0.51, respectively, and that in 24%TBSA full-thickness burn group was significantly higher than that in sham injury group (P<0.01). The mRNA expression level of RANKL in the first lumbar spine tissue of rats in 24%TBSA full-thickness burn group was 1.31±0.17, which was significantly higher than 1.00±0.14 in sham injury group and 0.97±0.10 in 12%TBSA full-thickness burn group (P<0.01). The mRNA expression levels of TRAF-6, NFATC1 (Z=3.141, 3.782), and c-Src in the first lumbar tissue of rats in 12%TBSA full-thickness burn group and 24%TBSA full-thickness burn group and the mRNA expression level of c-Fos in the first lumbar tissue of rats in 12%TBSA full-thickness burn group were significantly higher than those in sham injury group (P<0.05 or P<0.01). The mRNA expression levels of c-Fos and c-Src in the first lumbar spine tissue of rats in 12%TBSA full-thickness burn group were significantly higher than those in 24%TBSA full-thickness burn group (P<0.01). Conclusions: Severe burns can cause a decrease in the generation of new bone tissue, an increase in the number of osteoclasts and the serum phosphorus ion concentration, and a decrease in the serum level of P1NP in rats. The level of osteoprotegerin, RANKL, TRAF-6, NFATC1, c-Fos, and c-Src in bone tissue showed an increasing trend while the level of NFATC1, c-Fos, and c-Src showed a decreasing trend with the increase of burn area.

[Effects and mechanism of estrogen receptor ß agonist on the migration and oxidative stress of human umbilical vein endothelial cell under high glucose condition].

Objective: To investigate the effects and related mechanism of estrogen receptor ß (ERß) agonist on the migration and oxidative stress of human umbilial vein endothelial cells (HUVECs) under high glucose condition. Methods: The experimental research method was adopted. HUVECs were routinely cultured and passaged, and then cells of the logarithmic growth phase were collected for the subsequent experiments. The cells were divided into three groups according to the random number table, including normal control group (cultured with Roswell Park Memorial Institute 1640 cell culture medium (the same cell culture medium below) containing 5.5 mmol/L D-glucose), high glucose alone group (cultured with cell culture medium containing 25.0 mmol/L D-glucose alone), and high glucose+ERß agonist diarylpropionitrile (DPN) group (cultured with cell culture medium containing 25.0 mmol/L D-glucose and 10 µmol/L DPN). Scratch test was conducted to detect the cell migration rate in the 3 groups at 24 h post scratching. Fluorescent probe method was used to detect the reactive oxygen species (ROS, denoted by red fluorescence intensity) of cells in the 3 groups on 5 d post culture. Western blotting was used to detect the protein expression levels of vascular endothelial growth factor (VEGF) and superoxide dismutase 2 (SOD2) of cells in the 3 groups on 5 d post culture. In the above-mentioned experiments, cells were grouped and cultured correspondingly as before, the number of samples in each group was 5. Data were statistically analyzed with one-way analysis of variance and least significant difference t test. Results: At 24 h post scratching, the cell migration rate in high glucose alone group was (36±5)%, which was significantly lower than (76±4)% of normal control group and (65±5)% of high glucose+DPN group (t=14.511, 9.603, P<0.01), and the cell migration rate in high glucose+DPN group was significantly lower than that in normal control group (t=3.943, P<0.01). On 5 d post culture, the level of ROS of cells in high glucose alone group (1.81±0.12) was significantly increased compared with normal control group and high glucose+DPN group (1.00±0.14, 0.91±0.15, t=9.679, 10.549, P<0.01), while the level of ROS of cells in normal control group and high glucose+DPN group were close (t=1.031, P>0.05). On 5 d post culture, the protein expression levels of VEGF and SOD2 of cells in high glucose alone group were significantly lower than the levels of normal control group (t=14.175, 13.787, P<0.01) and high glucose+DPN group (t=6.321, 17.750, P<0.01). The protein expression level of VEGF of cells in high glucose+DPN group was significantly lower than the level of normal control group (t=7.206, P<0.05), while the protein expression level of SOD2 of cells in high glucose+DPN group was significantly higher than the level of normal control group (t=2.890, P<0.05). Conclusions: The activation of ERß can improve the inhibition of HUVECs migration induced by high glucose and alleviate oxidative stress injury induced by high glucose, which may be achieved by promoting the expression of VEGF and SOD2.

[Research advances on the application of platelet concentrate products in wound repair].

Multiple growth factors are required to regulate the wound repair process. Currently, there is still a lack of potent, durable, and inexpensive growth factor product in clinical practice. Meanwhile, platelet concentrate products provide an economical, convenient, and effective choice for the treatment of wounds in clinical practice. Starting from the first generation of platelet concentrate products, platelet-rich plasma, researchers have focused on optimizing the performance of platelet concentrate products for higher stability, more abundant bioactive factors, and more optimal clinical performance. Platelet-rich fibrin and concentrated growth factor emerged since then. Platelet concentrate products have the effect of promoting the speed of wound healing and enhancing the quality. This article aims to summarize the history and classification of platelet concentrate products, compare their properties and clinical applications, elaborate their mechanism of action, and analyze the problems existing in relevant researches while prospecting the future development of this field.

[Research progress on the mechanism of wound skin dys- pigmentation after burns].

Burn wound healing often shows a certain degree of pigmentation disorder. It may not only cause cosmetic and psychological issues affecting patient's normal social activities, but also increase risk of skin cancer or photoaging. Although normal skin pigmentation is fairly well studied, the mechanism that leads to dyspigmentation after burn injury needs to be further explored. Based on summarizing the mechanism of normal skin pigmentation, this paper reviews the latest research progress in postburn dyspigmentation in recent years.

[A prospective randomized controlled study on the effect of balance training on lower limb movement and balance dysfunction in severe burn patients].

Objective: To observe the rehabilitation effect of balance training on motor and balance function of lower extremities of deep burn patients. Methods: A prospective randomized controlled study was conducted. From January 2016 to January 2020, sixty-four patients with lower limb motor and balance dysfunction after deep burn were admitted to Tongren Hospital of Wuhan University＆Wuhan Third Hospital, the burn area was 30% to 70% Total Body Surface Area, and the burn depth of more than one hip, knee and ankle joint of both lower limbs and their periphery were deep second or third degree. According to the method of random number table, the patients were divided into routine training(RT) group and balance training(BT) group. There were 32 cases in each group, 22 males and 10 females in the RT group, aged 40.5 (35.5, 52.8) years old, and 24 males and 8 females in the BT group, aged 37.0 (30.0, 44.0) years old. Patients in group RT were conventionally conducted with knee joint stretch treatment, continuous passive motion treatment, lower limb muscle strength training and pressure therapy; while patients in group BT were conducted with balance training besides RT such as sitting balance, center of gravity transfer, pelvic stability, standing alternately on one leg and standing on balance pad. Patients in the 2 groups were treated for 4 months. Before treatment and after 4 months of treatment,Berg balance score, lower limb function score and balance activity self-confidence score were evaluated . The data were statistically analyzed with t test, Mann-Whitney U test, Wilcoxon signed rank test or χ² test. Results: (1) Before treatment, the difference value of Berg balance score of patients in group RT was (25±9), which was similar to (25±7) in group BT(t=-0.154,P>0.05). After 4 months of treatment, the difference value of Berg balance score of patients in group BT was (43±6), which was higher than (40±6) in group RT (t=2.028,P<0.05). The difference values of Berg balance scores of the patients in group RT and BT after 4 months of treatment were obviously higher than those before treatment(t=-15.189,-26.2,P<0.001). (2) Before treatment, the lower limb function score of patients in group RT was 25.0 (16.5,30.0), which was similar to 23.0(10.3,28.8) in group BT(Z=-1.575,P>0.05). After 4 months of treatment, the lower limb function score of patients in group BT was 55.0(35.0, 60.0) , which was significantly higher than 43.0 (36.0, 53.0) in group RT(Z=-2.744,P<0.01). The lower limb function scale of patients in group RT and BT after 4 months of treatment were obviously higher than those before treatment(Z=-4.943,-4.955,P<0.01). (3) Before treatment, the balance activity self-confidence scores of the two groups were similar(t=-0.966,P>0.05) . After 4 months of treatment , the balance activity self-confidence scores of patients in group ST was significantly higher than that in group RT (t=3.343,P<0.01). The balance activity self-confidence scores of patients in groups RT and BT after 4 months of treatment were obviously higher than those before treatment(t=-19.611,-34.300,P<0.001). Conclusions: The balance training can effectively promote the recovery of lower limb motor and balance function on the basis of conventional rehabilitation treatment for patients with lower limb motor and balance dysfunction after deep burns.