ObjectiveTo introduce the indications and operative procedure of anatomic reconstruction of the distal radioulnar ligaments in patients with chronic instability of the distal radioulnar joint(DRUJ),and report its preliminary clinical results.Methods From October 2008 to June 2009,6 patients with instability of the DRUJ underwent anatomical reconstruction using a free palmaris longus tendon graft,including 4 males and 2 females with an average age of 22 years.A 5 cm dorsal incision was made between the fifth and sixth extensor compartments.An L-shaped flap was created in the DRUJ capsule.This flap is then elevated proximally to expose the articular surface of the DRUJ and the proximal triangular fibular cartilage complex(TFCC).A tunnel was made through the radius.The other tunnel was made between the ulnar neck and the fovea of the ulnar head.A whole-length palmaris longus tendon graft was taken.The volar opening of the radius tunnel was exposed through a longitudinal incision radial to the flexor carpi ulnaris tendon.One end of the graft was pulled to the palmar side easily through the tunnel.A hemostat was penetrated through the volar capsule to the volar side proximal to the remaining TFCC.The end of the graft was grasped with the hemostat and pulled back along this tract.Both graft limbs were passed through the ulnar tunnel to exit at the ulnar neck.One limb of the tendon was passed around the ulnar neck and deep to the ECU sheath.With the forearm in neutral rotation,the limbs were pulled taut,tied together,and secured with sutures.Immobilize the extremity in a long-arm plaster splint with the forearm in neutral position for 4 weeks,and changed to a short arm cast for an additional four weeks.ResultsThe average follow-up period for all 6 patients was 14 months(range,9-24).No infection and sensory nerve branch disturbance occurred.The pain symptom was reduced and the grip force was improved significantly.A functional evaluation was performed using the modified Mayo wrist scoring system.All patients had better wrist scores postoperatively in the short (mean,95) term compared to preoperatively(mean,69).Five patients satisfied with the final result.Conclusion Anatomic reconstruction of the distal radioulnar ligaments is indicated for chronic DRUJ instability without osteoarthritis,it is a reliable method with a very good short term follow up result.Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints and kinematics.

Objective:To investigate the effect of autologous cartilage and artificial material implants on the occurrence of postoperative complications during rhinoplasty.Methods:This study included 447 patients who underwent cosmetic rhinoplasty at Hanmei Cosmetic Hospital in Dongguan. The age of enrolled patients was 18-52 years, and the mean age was 26.8±6.9 years. They were divided into an autologous cartilage group (334 patients in total) and an artificial material group (113 patients in total) according to the implant material used; the differences in postoperative complications were compared between the two groups and the influencing factors related to the occurrence of complications were analyzed.Results:The follow-up time of all patients was 3-24 months, and the mean time was 19.4 months. 51 (11.4%) of the 447 patients developed postoperative complications during the follow-up period, and the rate of functional failure in the artificial material group (16.8%) was significantly higher than that in the autologous cartilage group (9.6%) (χ 2=4.17, P=0.037). In the autologous cartilage group, the most frequent complications were irregular nasal contour, a total of 10 cases (3.0%), and infection, 8 cases (2.4%); while the most frequent complications in the artificial material group were infection, 6 cases (5.3%) and prosthesis exposure, 3 cases (2.7%). At 2-year follow-up, 32 cases of the postoperative complication rate occurred (16.8%) in the autologous cartilage group, which was significantly higher than that of 19 cases (9.6%) in the artificial material group, and the difference between the two groups was statistically significant (log-rank χ 2=4.37, P=0.039). The results of the multifactorial COX risk factor analysis showed that history of smoking ( HR=1.78, 1.21-2.29, P=0.004), previous history of rhinoplasty ( HR=2.89, 2.08-3.97, P<0.001) and use of artificial materials ( HR=1.34, 1.17-2.08, P=0.013) and external incision (protective factor, HR= 0.92, 0.78-0.98, P=0.037) were independent risk factors for the development of functional complications. Conclusions:Neither the use of autografts nor artificial implants in rhinoplasty prevents the occurrence of complications, and the types of complications occurring in both differ, with artificial grafts having a higher rate of postoperative complications.

Lactic acid bacteria and cellulose degrading bacteria play an important role in fermentation process of silage, because they can prevent the rancidity and increase the nutritive value of silage. But the propagation of lactic acid bacteria will inhibit the activity of cellulose degrading bacteria in the silage fermentation system. This problem can be solved by releasing lactic acid bacteria and cellulose degrading bacteria in different time. Therefore, we immobilized lactic acid bacteria as a microbial agent for sustained release. Firstly, the optimal balling concentration of the composite immobilized carrier and composite immobilized carrier were obtained by immobilization of blank balls and corncob adsorbed Lactobacillus plantarum S1 respectively. The best immobilization condition of L. plantarum S1 was obtained by comparing the immobilized rate and balling effect of two kinds of balls, which were embedded by sodium alginate (SA), CMC-Na and embedded-crosslinked by SA, CMC-Na, polyvinyl alcohol (PVA). The results showed that the best balling concentration was achieved by using 6% PVA+0.4% SA+0.3% CMC-Na for embedding-crosslinking and 1.2% SA+0.5% CMC-Na for direct embedding respectively. In addition, comparing with the mechanical strength and embedding rate of five kinds of immobilization process, the best immobilized process was obtained by adding of the mixture of immobilized carriers (1.2%SA+ 0.5%CMC-Na) and corncob adsorbed L. plantarum S1 slowly into 4% CaCl₂ for 24 hours. The corncob adsorption and SA embedding methodology can effectively increase the embedding efficiency of Lactobacillus plantarum S1.