The target restoration space (TRS) is a required tooth space that should be occupied by an esthetically formed and optimally functioned crown, veneer, or other fixed restoration. It can be either internal of or external of a tooth. Since minimal invasive can't be achieved without a minimal TRS, a precise preparation of slightest damage should conform to the transfer guide based on TRS. This paper introduces the concept, design of TRS, explains how it can be applied in tooth preparation, and helps to better understand a precise and minimal invasive tooth preparation technique.
Crowns ; Humans ; Tooth Preparation

Objective To study the relationship between morphological and functional changes of melanocytes and their effect on the graft color. Methods Eighteen black whited guinea pigs were divided into nine groups randomly and biopsied at 1 d, 2 d, 3 d, 7 d, 14 d, 21 d, 28 d, and 90d after skin grafting, respectively. Then skin spliting and Dopa reaction techniques were used to demonstrate melanocytes. And computer assitant imagine analysis system was applied to observe and quantitate the morphological changes of melanocytes at various time points in three postoperative months. Results During three days after grafting, resulting from the surgery wound and shortage of blood and oxygen supply, the processes of the melanocytes broke off, accompanied by reduction of whole dimension of the cells, size as well as number of the processes. The indices above returned to the normal level between second week and third week after grafting. It was an evident characteristic that number of melanocytic processes became shorter and stouter in the end of the experiment. conclusion Functional changes of melanocytes in the skin grafts are in accord with their morphological changes. Compared to those in the sizes of melanocytes, changes in the processes of the cell are more sensitive in reflection of function of melanocytes. The shorter and stouter processes of melanocytes in the end of the experiment are suitable to the smaller epidermal melanin unit and more efficient in transformation of melanin into the keratinocytes.

Objective To summarize the experience of pituitary adenoma resection by single-nostril transsphenoidal approach and analyze the indications,intraoperative and postoperative common problems in order to improve the technique and quality of life.Methods Summarize the clinical data of 611 pituitary adenoma resections by single-nostril transsphenoidal approach from January 2005 to June 2010 retrospectively,reanalyze the choice of operative indications,analyze the bleeding during the operation and sums up the relevant pro cessing suggestions,and summarize the reasons and countermeasures of postoperative visual impairment.Results The tumors were totally removed in 538 cases,sub-resections in 59 cases,sub-totally removed in 14 cases,and no deaths.Eleven cases were poor gasification or concha sphenoid sinus in 11 totally removed patients.The bleeding came from diploe,emissarium,mucosa of sphenoid sinus,diploe,epidural space,dura matter of the sella turcica region,intercavernous sinuses,tumor or the tumor bed.The bleeding was controlled effectively with different approaches.There were 3 patients who underwent visual impairment,and the impairment was improved after treatment.Conclusion Following the correct operation principle,we can improve the rate of total resection; the single-nostril transsphenoidal approach is also suitable for the poor gasification; The prognosis can improve after deal with the intraoperative and postoperative common problems.

Objective To investigate effect of urinary conditions and lower urinary tract symptoms (LUTS) in patients before and after the reconstructive pelvic surgery (RPS) for pelvic organ prolapse (POP) as well as effect of urinary conditions and LUTS by tension-free vaginal tape-obturator (TVT-O).Methods From Jan. 2007 to Dec. 2009, 213 patients with POP underwent RPS, the factors on preoperative, postoperative urinary conditions and qualities of life and postoperative urinary incontinence were studied prospectively. Results Totally 193 patients who was followed up for more than 3 months after surgery attend questionnaires, and 165 preoperative patients of 193 (85.5%) had LUTS, 105 postoperative patients of 193 (54.4%) had LUTS, which reached statistical difference (P ＜0. 01 ). The rate of LUTS before and after operation: urinary frequency ( 57.0% and 25.9% ), urinary urgency ( 51.8% and 28.0% ), urinary leakage due to cough ( 50. 3% and 15.0% ), dropping urinary leakage ( 44. 6% and 14. 5% ), dysuria (34. 7% and 23.3% ), vesicaltenesmus (49.2% and 19. 7% ) and hand assist urination (31.1% and 2.6% ). The incidence of LUTS after surgery is much lower than that of pre-operation ( P ＜0. 05 ). POP patients with stress urinary incontinence ( SUI ) before the operation, surgery without TVT-O simultaneously are the risk factors of unimproved symptom ( OR = 4. 933, 95% CI: 1. 353 - 17. 990, P=0. 016). Conclusions RPS have alleviated LUTS in patients with POP. RPS with TVT-O are more effective than traditional RPS in treatment of the urinary incontinence if the POP patient with SUI or occult SUI.

Objective To study effect of diclofenac sodium on content of prostaglandin E 2 KC/MC ratio and hyperpigmentation of the full-thickness skin autografts. Methods Content of PGE 2 was determined by radioimmune analysis method, and kinetic changes of KC/MC ratio were observed with histological and histochemical methods. Results In the operation control group, increase of KC/MC ratios was accompanied by of PGE 2 content at the early stage of the experiment; and the KMR became smaller than that in normal control group at the end of the experiment. While in the diclofenac soduim group, KMR was reduced due to the less damage of MC at the early stage, with decrease of PGE 2. Accordingly, KMR became larger at the late period of the experiment, and color of the autografts became lighter. Conclusion Application of diclofenac sodium on the grafts just after transplantation may reduce the damage of inflammation to the epidermal melanin units, control their proliferation and decrease the value of KMR, which lightens the color of the grafts.

Objective:To explore the influence of psychological factors on temporomandibular disorders(TMD) in school students.Methods:52 school students aged 14-26 years with TMD classified as muscular dysfunction (MD,n =26),temporomandibular displacement(TD,n =14) and MD with TD(MD +TD,n =12),and 53 healthy adolescents as the controls were investigated.All the participants accepted TMD examination and their psychological status were tested by symptom checklist-90 (SCL-90).The patients were divided into acute(case history ≤6 months,n =32) and chronic(case history ＞6 months,n =20) groups.The psychological differences among the related groups were analyzed by SPSS 17.0 statistical software package.Results:The total and the factor scores of the TMD group were higher than those of control(P ＜ 0.05).There was no significant statistically difference between the MD group and the TD group(P ＞ 0.05).MD + TD group got higher SCL-90 total score and factor scores (except depression,phobic anxiety and Psychoticism score) than the other 2 groups (P ＜ 0.05).The acute and chronic group got similar SCL-90 total scores and factor scores (P ＞ 0.05),except somatization score (P ＜ 0.05).There was a positive correlation between the TMD pain level and total score of SCL-90.Conclusion:The psychological status have remarkable influence on the students with TMD.The pain degree of TMD is affected by psychological factors.Therefore,psychological therapy should be applied during the diagnosis and treatment of students with TMD.

plus stented elephant trunk implantation (Bentall+Sun′s surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ②5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery;2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26 ± 10) weeks. (3)Maternal and fetal outcomes:20 patients survived after treatment (83%,20/24) and 4 patients died (17%,4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant;3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4 ± 1.7) years. So far the infants′ development was good.Conclusions Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.

Objective: To explore the therapeutic effects of edaravone, oxiracetam combined with Shuxuetong on cerebral hematoma and improvement of neurological function in patients with cerebral hemorrhage. Methods: A total of 96 patients with cerebral hemorrhage were randomly divided into observation group and control group by the random number table method, with 48 cases in each group.The observation group received intravenous drip of edaravone (4.0g added into 0.9% sodium chloride injection to 250mL, intravenous drip, 1 time/d), oxiracetam(30mg added into 0.9% sodium chloride injection to 100mL solution, 30min intravenous drip, 2 times/d), and Shuxuetong injection(4mL added into 0.9% sodium chloride injection to 250mL, intravenous drip, 1 time/d) on the basis of routine treatment, and the control group was treated with routine treatment for cerebral hemorrhage.The efficacy and safety in the two groups after treatment of 21 days were observed. Results: After treatment, the neurological deficit score and cerebral hematoma volume of the two groups were improved(all P<0.05), but the improvements of the observation group was significantly better than those of the control group[(4.44±3.20)points vs.(10.53±2.86)points, (21.83±3.85)points vs.(26.71±3.49)points, (7.83±5.31)mL vs.(13.74±6.16)mL, t=9.818, 6.506, 5.035, all P<0.01]. The total effective rate of the observation group was higher than that of the control group(87.5% vs.52.1%, χ²=14.740, P<0.05). No drug-related adverse reactions occurred in two groups. Conclusion The application of oxiracetam and edaravone combined with Shuxuetong injection in patients with cerebral hemorrhage can effectively improve the brain edema and nerve defect, it has a positive significance to promote the patients' recovery after cerebral hemorrhage, and it is worthy of clinical application.

Objective To analyze the clinical features of obstructive sleep apnea-hypopnea syndrome(OSAHS)with initial diagnosis of aorta dissection(AD)and therefore to improve its diagnosis.Methods The clinical data of 6 cases of AD with OSAHS were retrospectively analyzed.Results There were six male cases of obesity whose average body mass index(BMI)was 32.72±3.57,with an average age of(43.83±2.14)and the leading symptoms were daytime hypersomnolence,nocturnal wake by suffocation and habitual snoring.ESS was(13.83±2.14),apnea hypopnea index(AHI)was≥62/h[on averaga of(73.35±9.16)/h],the lowest pulse oxygen saturation(LSpO2%)was(58.67±10.95)%,time of oxygen saturation level lower than 90%(min)[T90(min)]was(244.20±144.74)min,the percent of the total time with oxygen saturation level lower than 90%(TS90%)was 54.48±30.18.They had more than two years history of hypertension.Conclusion Severe OSAHS affects the prognosis of AD.Early diagnosis and timely treatment can delay the progress of AD and lower death rate,with an important significance in improving the prognosis of AD.

Emphysematous cystitis is a rare inflammation of the bladder, which can be life-threatening in severe cases. A senior gentleman with emphysematous cystitis was recently admitted to our hospital. He got bilateral renal hydronephrosis and bilateral terminal pneumatosis of the ureter. The comorbidity was prostatic hyperplasia and diabetes. After indwelling catheter , glucose levels control and anti-infection treatment for 3 days, the repeated CT showed the gas inside the bladder the end of ureter decreased significantly. The blood routine, urine routine, renal function was better than before. The patient was instructed to continue anti-infection treatment. The above laboratory examination indicators returned to normal after a week's re-examination.