An Analysis of 14 Cases of the Temporal Bone Langerhans Cell Histiocytosis in Children / 听力学及言语疾病杂志

Objective To study the clinical characteristics of the Langerhans cell histiocytosis (LCH ) of the temporal bone in children .Methods A total of 14 children with LCH of the temporal bone at Wuhan Children's Hospital were retrospectively reviewed from June 2011 to December 2016 .The clinical data ,imaging findings ,diag-nosis ,treatment and prognosis were studied .The correlation between clinical classifications and prognosis was also analyzed .Among the 14 patients ,5 were girls and 9 were boys .Eight cases were the single system group (3 cases as the single temporal bone ,5 case as the multifocality ) ,and 6 case as the multisystem group .Results The most common clinical characteristics of LCH were temporal tumors ,otorrhea ,otalgia ,hearing loss and the granulation of external auditory canals .The followed-up was for 1～5 years .Four cases were regressive ,l case kept stable ,while 2 cases showed progressive .The prognosis in the multisystem group was significantly worse than the single system group(P<0 .05) .Conclusion The most of temporal bone LCH involves the single system ,while temporal tumor and otorrhea are common as the first signs of temporal bone LCH .The imaging examination remains as the major di-agnosis method .The differential diagnosis focuses on the common ear infection and otic neoplasms .The diagnosis is based on histological and immunophenotypic examination of the lesion tissue .The prognosis of the single system group is much better than the multisystem group .

Effects of Perioperative Application of ELP Enteric Soft Capsules on Therapeutic Efficacy and Prognosis in Children after Grommet Insertion of Chronic Secretory Otitis Media / 中国药房

OBJECTIVE:To investigate the effects of perioperative application of Eucalyptol,limonene and pinene(ELP)en-teric soft capsules on therapeutic efficacy and prognosis in children after grommet insertion of chronic secretory otitis media. METH-ODS:92 cases(145 ears)of chronic secretory otitis media were divided into 2 groups by random number table method,including 46 cases in observation group(68 ears)and 46 cases in control group(77 ears). Both groups received grommet insertion under gen-eral anesthesia by otomicroscope. Control group was not given any drugs;observation group was given ELP enteric soft capsules 1.2 g,bid,from 3 d before operation to 5 d after operation. Subjective therapeutic efficacy and pure tone audiometry of 2 groups were observed 3 days,5 days,2 weeks,1 month and 3 months after surgery as well as acoustic impedance monitoring in children with tube withdrawal from ear 1 month and 3 months after surgery. RESULTS:The total effective rates of observation group 3 days,5 days,2 weeks,1 month and 3 months after surgery were 72.06%,82.35%,85.29%,89.70%and 95.59%;those of con-trol group were 59.74%,66.23%,80.52%,87.01% and 92.21%,with statistical significance(P<0.05). The pure tone audiome-try score of observation group 3 days,5 days,2 weeks,1 month and 3 months after surgery were significantly lower than those of control group,with statistical significance(P<0.05). Therapeutic effective rates of acoustic impedance monitoring in children with tube withdrawal from ear 1 month and 3 months after surgery were 77.78% and 90.48% in observation group,which were signifi-cantly higher than 61.54% and 81.48% in control group,with statistical significance(P<0.05). CONCLUSIONS:The periopera-tive application of ELP enteric soft capsules can significantly improve function recovery and hearing level in children after grommet insertion of chronic secretory otitis media.

Pathogenic Bacteria Distribution and Antimicrobial Susceptibility of Children with Acute Otitis Media / 听力学及言语疾病杂志

Objective To analyze pathogenic bacteria distribution and antimicrobial susceptibility in children with acute otitis media(AOM ) .Methods Otorrhea samples from 146 episodes of AOM were cultured .The antimi‐crobial susceptibility of the main pathogenic bacteria was determined .The results were analyzed by SPSS19 .0 .Re‐sults 1) The strains of bacteria were isolated from 109 children with the positive rate of 74 .66% .Streptococcus pneumoniae (SP ) was the major bacteria(64 episodes ,58 .72% ) ,followed by staphlococcus aureus(SA) (19 epi‐sodes ,17 .43% ) .2) Sp was all sensitive to vancomycin ,levofloxacin ,moderate to penicillin ,amoxicillin ,cefo‐taxime ,and highly resistent to erythromycin and clindamycin .Staphlococcus aureus were all sensitive to vancomy‐cin ,tetracycline ,and Amy card ,and moderate to amoxicillin clavulanic acid potassium ,cefoxitin ,and oxacillin ,all resistent to penicillin and ampicillin .3) The strains of SP in age≤1year ,>1 -3years ,and >3 years respectively were 31(50 .82% ) ,25(56 .82% ) ,8 (19 .51% ) .There were significant differences between them(χ2 =14 .073 ,P=0 .001) .4)The strains of SP in 2012 ,2013 ,2014 respectively were 16(30 .19% ) ,22(48 .89% ) ,26(54 .17% ) ,There were significant differences between them(χ2 =6 .557 ,P=0 .038) .The antimicrobial susceptibility of SP had no sig‐nificant differences among 2012 ,2013 ,2014 ,but a yearly resistance decreasing trend was seen .Conclusion SP was the main bacterial contributor for AOM in Wuhan children .SP detection rate increases every year ,mainly in chil‐dren less than 3 years old .T he antimicrobial susceptibility is stable .

Efficacy of sublingual immunotherapy with Dermatophagoides farina drops in monosensitized and polysensitized patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the efficacy of sublingual immunotherapy (SLIT) with standardized Dermatophagoides farina drops in monosensitized and polysensitized patients with allergic rhinitis.@*METHOD@#The clinical data of 162 patients treated with standardized Dermatophagoides farina drops were analyzed retrospectively. These patients were divided into the monoallergen sensitized group and polyallergen sensitized group according to the results of skin prick tests. The total nasal symptoms score (TNSS), the total medication score (TMS) and adverse effects (AEs) were evaluated before treatment, 2 year after SLIT treatment and 3 year after drug discontinuance. Result:After SLIT treatment for 2 years and drug discontinuance for 3 years, the TNSS (3. 14[2. 47; 3. 65], 3. 45 [2. 76; 3. 92], respectively) and TMS (0. 42[0. 36; 0. 57],0. 35[0. 26; 0. 44], respectively) in the monoallergen sensitized group were lower than that before the treatment (TNSS: 9. 00 [8. 00; 10. 00], TMS: 2. 16 [1. 88; 2. 37]), which have showed a statistically significant difference(P0. 05).@*CONCLUSION@#SLIT with standardized Dermatophagoides farina drops has a long-term efficacy in monosensitized and polysensitized patients with allergic rhinitis. Moreover, a longer SLIT treatment (>2 years) may be necessary to consolidate its efficacy.

The observation and analysis the function and morphology of the eustachian tube in secretory otitis media and chronic rhinosinusitis in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe and analyze the function and morphology of pharyngeal ostium of the eustachian tubes in secretory otitis media and chronic rhinosinusitis in children under direct vision,in order to provide an objective basis for clinical treatments.@*METHOD@#Fifty cases of secretory otitis media,50 cases of chronic rhinosinusitis and a control group of 50 cases with hoarseness were examined under video laryngoscope to observe the pharyngeal ostium morphological changes of the eustachian tubes, and their functional statuses were tested by using acoustic impedance instrument. All the data were analyzed by statistical methods.@*RESULT@#(1) In the secretory otitis group, the abnomal rate of the pharyngeal ostium of the eustachian tubes was 94% while the chronic rhinosinusitis group was 80%,and between them there was no significant differences (P > 0.05). But both of them had significant differences with the control group (P < 0.05). (2) In the secretory otitis group, the rate of the eustachian tube dysfunction was 70% while the chronic rhinosinusitis group was 26%, and between them there was significant differences (P < 0.05), and both of them have significant differences when compared with the control group (P < 0.05).@*CONCLUSION@#There are some abnormal points exist in the function and the morphology of the eustachian tube in secretory otitis media and chronic rhinosinusitis in children. Eustachian tube dysfunction played a dominant role in the pathogenesis of secretory otitis media in children rather than the morphological change did compared to the chronic rhinosinusitis in children.

The value of combination of the mortality in emergency department sepsis score and blood lactate level in the risk stratification of severe sepsis in the emergency department / 中华危重病急救医学

Objective To evaluate the combination of the mortality in emergency department sepsis (MEDS) score with blood lactate level in the risk stratification of patients with severe sepsis in the emergency department (ED).Methods 665 adult patients with severe sepsis admitted from May 2011 to December 2012 in ED were found to be eligible for the study.MEDS score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,and arterial blood lactate was determined,and the outcomes in 28 days were recorded.Logistic regression analysis was used to evaluate the relationship between each predictive factor score and prognosis.Each predictive factor was compared with the areas under the receiver operating characteristics (ROC) curve (AUC).Results The mortality in 28 days was 34.6％ in 665 patients.The mortality in group of MEDS score 12-27 was significantly higher than that group of MEDS score＜12 [51.0％ (156/306) vs.20.6％ (74/155),x2=28.414,P=0.000].In the meantime,APACHE Ⅱ score and blood lactate level were also significantly higher in group of MEDS score 12-27 than those in group with MEDS score＜12 [APACHE Ⅱ score:26.4 ± 10.6 vs.21.7 ± 8.1,t=-3.555,P=0.002; lactate (mmol/L):4.9 (2.3,9.9)vs.3.9 (1.5,8.9),Z=-2.352,P=0.023].Kaplan-Meier survival analysis showed significantdifference in the two groups (the Log Rank test 36.71,P ＜0.01).The levels of 3 predictive factors were predominantly higher in non-survivors than survivors [MEDS score:14.1 ± 6.7 vs.8.2 ± 4.5,t=-6.929,P=0.000; APACHE Ⅱ score:28.1 ±7.1 vs.22.2± 11.3,t=-6.472,P=0.000; lactate (mmol/L):5.4 (2.9,11.0) vs.3.8 (1.2,9.1),t=-6.472,P=0.004].The AUCs were 0.813,0.706 and 0.727 for MEDS score,APACHE Ⅱ score and blood lactate respectively.The predictive ability for 28-day mortality of MEDS score was better than blood lactate (P=0.008) and APACHE Ⅱ score (P=0.005).The AUC of MEDS score combined with lactate was 0.865,and 28-day mortality prediction was better than MEDS score (AUC 0.865 vs.0.813,P＜0.001).The sensitivity (83.1％),specificity (93.2％),positive prediction value (PPV,62.4％),and negative prediction value (NPV,92.1％) for MEDS score combined with lactate were highest among all predictors.Conclusion MEDS score combined with lactate is a good risk stratification tool for emergency patients with severe sepsis,and its prognostic capability is better than either MEDS score,APACHE Ⅱ score or blood lactate.

Analysis of early clinical risk factors of severe acute organic fluorine inhalation poisoning / 中国中西医结合急救杂志

ObjectiveTo investigate the early clinical risk factors of severe acute inhaled organic fluorine poisoning.Methods The clinical data of patients with acute poisoning of organic fluorine inhalation admitted since 2004 in Northern Jiangsu People's Hospital were retrospectively analyzed. According toDiagnostic Criteria of Occupational Acute Fluorohydrocarbon Poisoning(GBZ66-2002), all the patients were divided into three groups: mild, moderate and severe poisoning groups, the severe cases were included in the intensive group, and the others were grouped in the non-intensive group. The contents in the survey were as follows: gender, age, vital signs on admission (body temperature, pulse rate, respiratory rate, systolic blood pressure), arterial blood gas analysis record〔arterial oxygen saturation(SaO2), oxygenation index(PaO2/FiO2), lactic acid(Lac) and arterial partial pressure of carbon dioxide(PaCO2), pH value(pH)〕. Before treatment, the white blood cell(WBC) count, platelet(PLT) count, levels of alanine transaminase(ALT), creatinine(Cr), blood glucose, electrolytes(potassium, sodium, chloride, calcium), creatine kinase isoenzyme(CK-MB), etc. were examined and recorded. All the patients were immediately arranged for bedside chest X-ray examination, and the chest X-ray lung injury scores were recorded. By univariate and multivariate logistic regression analyses, the receiver operating characteristic curve(ROC curve) was drawn to evaluate the diagnostic value of the clinical risk factors.Results Sixty-two cases consisting with the standard criteria of enrollment were collected in the study, 36 cases being in intensive group and 26 cases in non-intensive group. The univariate analysis showed that the differences in pulse rate, respiratory rate, PaO2/FiO2, WBC, SaO2, Lac, pH, and lung injury score were statistically significant(P<0.05 orP<0.01). Logistic multiple regression analysis showed that PaO2/FiO2, WBC, Lac and chest X-ray lung injury score were the four indexes for predicting the independent risk factors of severe acute inhaled organic fluorine poisoning. The area under ROC curve(AUC) of PaO2/FiO2 was the highest(0.884), 95% confidence interval(95%CI) was 0.784 - 0.984, the critical value was 96.5 mmHg(1 mmHg=0.133 kPa), with the sensitivity of 75.6%, specificity of 95.2%, positive predictive value(PPV) of 92.3% and the negative predictive value(NPV) of 71.4%, in sequence, the rest were WBC(AUC 0.846, 95%CI 0.728 - 0.965, the criticalvalue 12.15×109/L), Lac(AUC 0.800, 95%CI 0.662 - 0.938, the critical value 4.2 mmol/L), chest X-ray lung injury score(AUC 0.795, 95%CI 0.652 - 0.938, the critical value 2.50), the sensitivity of the above three items was 90.2%, 83.6%, 88.5%, specificity was 90.2%, 83.6%, 88.5%, the PPV was 86.7%, 82.4%, 85.8% and NPV was 72.0%, 73.9%, 69.2% respectively.ConclusionThe blood WBC count, Lac, PaO2/FiO2 and chest X-ray lung injury score can be used as the early clinical risk factors of severe acute inhaled organic fluorine poisoning.

The clinical characteristics and treatment progress of otitis media in children / 临床耳鼻咽喉头颈外科杂志

Otitis media is a common problem in children, which may cause hearing loss and complications sometimes. This topic will review the definition, causes, types, clinical characteristics and treatments of each type of ear infections in children, by reading recently literatures. It is important to make an accurate diagnosis and choose a appropriate treatment of otitis media in children to avoid antibiotics abusing. Sometime some cases need operations, which are effective, especially in chronic suppurative otitis media and cholesteatoma, and we need further studying focuse on when do the operations and how to shoose them.

The clinical analysis of tympanoplasty in treating children's chronic otitis media / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effectiveness of tympanoplasty for treatment of chronic otitis media and cholesteatoma in children.@*METHOD@#Twenty-three cases with chronic otitis media and cholesteatoma treated by tympanoplasty were retrospectively studied, among which 15 cases had complete clinical data. The condition of surgical cavities, the duration of getting dry ears, the hearing improvements, the growth of new ear drums and whether the recurrence of cholesteatomas occurred or not were observed.@*RESULTS@#In all patients, the chief complains were ear discharging and hearing loss. The tympanum membranes(pars flaccid or pars tensa) became retracted or perforated and CT scan showed mastoid processes were poor developed in some cases with lesions mainly located at attic, middle tympanum cavity and/or petrous parts. The duration of getting dry ear was (6.0 +/- 1.5) weeks after surgery. The effective rate was 80%. The hearing of 12 cases has been improved, that of 2 cases has no changed, that of 1 case has been descended, and 1 case exhibited recurrent cholesteatoma after surgery.@*CONCLUSION@#This study demonstrated that children's chronic otitis media and cholesteatoma have their own clinic features of wide erosiveness and strong aggressiveness, and tympanoplasty has been proved to treat this disease effectively, also been proved to improve these patients' hearing cognitions and eventually improve their life qualities.

CT and MRI study in severe sensorineural hearing loss in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the value of CT and MRI in diagnosing the children with sensorineural hearing loss.@*METHOD@#Ninety-six cases suspected as severe sensorineural hearing loss were examined by CT/MRI system and 3D reconstruction.@*RESULT@#Of 96 cases, 15 cases were found malformation these malformation included Michel, cochlear hypoplasia, commun cavity, Mondini, inner canal straitness, cochlear nerve undeveloped and vestibular aqueduct enlargements.@*CONCLUSION@#There are 15.63% inner ear malformation occurred in sensorineural hearing loss children. CT and MRI of inner ear have a great clinical value in diagnosing children sensorineural hearing loss by learning the anatomy.

A case of Keutel syndrome in child (review the literature) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose is to report a calcification of the cartilaginous of the tracheobronchial case in child, and to recognize the clinical and imaging features on Keutel syndrome.@*METHOD@#A comprehensive analysis of the clinical data and X-ray,CT. Some literatures involving some symptoms of this child were reviewed.@*RESULT@#This patient diagnosed with Keutel syndrome finally.@*CONCLUSION@#When we meet calcification of the cartilaginous of the tracheobronchial patient in clinic, it may be Keutel syndrome.

The analyse of telephone follow-up affecting the compliance of sublingual desensitization treatment to allergic rhinitis patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the compliance of sublingual desensitization used in allergic rhinitis patients by telephone follow up, and to discuss the influencing factor associate with medicine pause.@*METHOD@#One hundred and thirty-two patients of allergic rhinitis were randomly divided into two groups, 53 cases was in the control group, 79 cases was in telephone follow up group for a period of 6 months of observation.@*RESULT@#Sublingual desensitization treatment for 6 months, 28/53 cases of control group were compliance, 25/53 cases were loss, and compliance rate was 52.8%; 17/27 cases of follow-up group A were compliance, 10/27 cases were loss, and compliance rate was 63.0%; 21/28 cases of follow-up group B were compliance, 7/28 cases were loss, and compliance rate was 75.0%; 22/24 of follow-up group C were compliance, 2/24 cases were loss, and compliance rate was 91.7% (P < 0.05). Significant difference was found in the 4th month after treatment (P < 0.01). Long-term treatment and cure were the main impact factors for compliance.@*CONCLUSION@#Timely telephone follow-up education and guidance to patients could improve compliance of patients with sublingual desensitization.

Observation of ultrastructure and ECP expression in nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the ultrastructural feature and ECP expression in nasal polyps, and aim to explore its role in the pathogenesis of CRSwNP.@*METHOD@#5 CRSwNP, 5 CRS and 5 control patients underwent sinus surgery were gathered to detect its ultrastructure and expression of ECP by in situ hybridization and electron microscopy technique.@*RESULT@#Under electron microscopy, the eosinophilic cells in CRSwNP group increased, its membrane was intact but fold, the feature of pseudopodium, degranulation and cavitation were all found. The expression level of ECP mRNA was up-regulated.@*CONCLUSION@#The findings suggest that eosinophilic infiltrate and ECP cytologic inflammation reactions may involve in the pathogenesis of CRSwNP.

Effects of toll-like-receptor-9 expression in chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine the presence of TLR-9 protein in primary epithelial cell cultures of chronic rhinosinusitis with nasal polyps (CRSwNP), and then explore the role of innate immune recognition in the pathogenesis of CRSwNP.@*METHOD@#Primary epithelial cell cultures were established in 10 controls and 10 CRSwNP patients who underwent sinus surgery, and flow cytometry was used to confirm its purity and measure the expression of TLR-9 protein.@*RESULT@#By digestive method 98% of cultured primary nasal mucosa cells were epithelial cells and the expression of TLR-9 protein in CRSwNP group (11%-15%) was lower than that in normal group (49%-60%).@*CONCLUSION@#This finding suggests that impaired innate immune responses via TLR-9 on sinonasal epithelial cells may involve in pathogenesis of CRSwNP.

Expression and clinical significance of platelet activating factor (PAC-1), CD629P and thrombus precursor protein (TpP) in severe sepsis / 中华急诊医学杂志

Objective To investigate the expression and clinical significance of platelet activating factor [PAC]-1, CD62P and TPP hi severe sepsis. Method Patients with severe sepsis who were admitted into the EICU of Subei People's Hospital from April 2007 to March 2008 were included. Patients with severe sepsis (Group Ⅲ)were treated according to the treatment guidelines for severe sepsis, and were divided, according to their clinical records, into those who survived and those who died within 28 days of admission. Patients admitted during the same period with symptoms of infection but without severe sepsis were included as the General Infected Group (Group Ⅱ). A Control Group (Group Ⅰ) comprised patients who visited the hospital over the same period for physical examination or the healthy volunteers. The group members were all included randomly, and the gender and sex of patients in all three groups were similar. Patients with acute brain infarction, acute coronary syndrome,serious diabetes, hyperlipidemia, malignant tumor, leukemia, primary liver, renal and hematopoietic system dis-eases,long-term bedridden patients, pregnant women, and patients taking hormone treatment or hranunosuppres-sants were excluded from the study. Morning venous blood was collected and ELISA and Flow Cytometry performed on the fwst day of admission for Groups Ⅰ- and Ⅱ, and on the first, third and fifth day after admission for Group Ⅲ, to determine the TpP,PAC-1 and CD62P respectively; and the Marshall score was determined. Data were ana-lyzed by SPSS 12.0 software. For continuous variables, comparisons among groups were analyzed by ANOVA.Levene's and LSD test were applied to assess homogeneity. Bivariate test is applied to Correlation Analysis. P<0.05 was regarded as a statistically significant difference. Results There were a total of 20 patients each in GroupⅠ-and GroupⅡ, and 30 in Group Ⅲ; of these, 19 were classed as survivors and 11 died during the 28-day peri-od. On the first day of admission, there were no significant differences in PAC-1, CD62P or TpP expression between Groups Ⅰ- and Ⅱ(P>0.05); however, Group Ⅲ was significantly different compared with both Group Ⅰ and Group Ⅱ (both:P<0.05). The expression of PAC-1, CD62P and TpP tended to decline in the survivor group,and became normal with the treatment process, while the expression of PAC-1 ,CD62P and TpP in the patients who died remained high, and even increased significantly over time. On the first day, the expression of CD62P and TpP in the patients who survived and in those who died was not significantly different (P>0.05); on the third day,however, a significant difference appeared with values of (2.89±1.48) % vs. (5.04±2.57) % (P<0.01) for CD62P, and (5.24±2.22) mg/L vs. (9.20±1.93) mg/L (P<0.01) for TpP. The expression of PAC-1 was significantly different between the two subgroups on the first day, with values of (3.15±0.42)% vs. (5.30±.48)% (P<0.01). The Marshall score of the two groups showed similar changes. Correlation analysis showed that PAC-1, CD62P and TpP were significantly correlated with the Marshall score. Conclusions Platelet activation and microthrombosis existing in the early stage of severe sepsis work together in the early hypercoagulable state.They both play important roles in disease development and progression. The dynamic detection of CD62P and TpP is beneficial to the diagnosis and prognosis of severe sepsis.PAC-1 appears to hold a risk stratification effect, as pa-tients with high expression of PAC-1 in the early stage show poor prognosis. Therefore, PAC-1 could be used as a marker of severe sepsis and poor prognsis.

Pediatric sulcus vocalis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the clinic features of the sulcus vocalis in children.@*METHOD@#From Jan 1995 to April 2005,56 cases of pediatric sulcus vocalis were found by video-laryngoscopy. All received an operation called sulcus vocalis microdissection and vocal cord plasty with four steps: an incision along the superolateral edge of the sulcus; freeing of the mucosa adhering to the vocal ligament; detachment of the ligamentous fibers; redraping of the mucosa.@*RESULT@#The total effective rate was 96.4% after surgical treatment.@*CONCLUSION@#There are 5% sulcus vocalis among children referred for voice disorders. The sulci are frequently found in association with other laryngeal abnormalities. Sulcus vocalis microdissection and vocal cord plasty might be a rational and effective surgical modality.

Gut Protective Effect of Rhubarb and Glutamine on Intestinal Ischemia Reperfusion Rats / 医学研究杂志

Objective To observe and compare the protective effect of rhubarb and Gln on morphology and permeability of rats intestine after SMA ischemia reperfusion.Methods 40 male rats were divided into rhubarb ,Gln, control and pseudosugery group(n=10)randomly. The intestinal I/R model of rhubarb ,Gln and control group rats was established and TPN was done.Rhubarb ,Gln and normal saline were given orally in rhubarb,Gln and control group respectively. SMA was decoherenced but not blocked in control group. Urine ,intestine,MLN and portal vein blood were collected for L/M,morphology and bacterial translocation study.Results (1)L/M was significant high in control group compared with pseudosugery group(P