BACKGROUND & AIMS: :Structural and system theories propose that disruptions in family subsystem functioning increase risk for youth maladjustment. While there is growing evidence to support this proposition, studies that specifically focus on the larger family system remain relatively rare. Furthermore, the pathways that connect problems in family subsystem alliances to externalizing or internalizing problems in youth are as yet largely unexplored. This study examined youth emotional reactivity (anger and sadness) to family conflict as an indirect pathway of the association between family boundary disturbances and youth adjustment in a sample of two-parent families (N = 270). Observational coding was used to group families into Balanced, Dyadic, or Disengaged family alliance structures and to assess youth emotional reactivity, and parent-report was used to assess youth psychopathology. Structural equation modeling indicated both anger and sadness served as indirect pathways through which family boundary disturbances are linked with youth adjustment. In addition, gender was tested as a moderator and important gender differences were found. Specifically, boys were directly impacted by dyadic disturbances while girls were directly impacted by family disengagement. The findings help target goals for intervention and indicate that worthwhile objectives may include realigning family subsystem boundaries, changing family communication patterns, and improving affective coping skills for youth.

背景与目标： : 结构和系统理论提出，家庭子系统功能的中断会增加青年适应不良的风险。尽管越来越多的证据支持这一主张，但专门针对较大家庭系统的研究仍然相对罕见。此外，将家庭子系统联盟中的问题与青年问题的外部化或内部化联系起来的途径尚未探索。这项研究考察了青年对家庭冲突的情感反应性 (愤怒和悲伤)，这是家庭边界干扰与青年适应之间关联的间接途径。在两个父母家庭的样本中 (N = 270)。使用观察性编码将家庭分为平衡，二元或脱离的家庭联盟结构，并评估年轻人的情绪反应性，并使用父母报告评估年轻人的心理病理学。结构方程模型表明，愤怒和悲伤都是家庭边界干扰与青年适应联系的间接途径。此外，作为主持人对性别进行了测试，并发现了重要的性别差异。具体来说，男孩直接受到二元干扰的影响，而女孩直接受到家庭脱离的影响。研究结果有助于针对干预目标，并表明有价值的目标可能包括调整家庭子系统边界，改变家庭沟通方式以及提高青年的情感应对能力。

BACKGROUND & AIMS: :This study extends research examining the implications of parent-youth informant discrepancies on youth victimization. Latent class analysis (LCA) identified dyads distinguished by patterns of parent and youth report of victimization. Analyses examined how latent classes were related to adjustment (i.e., anxiety/depression, aggression, and delinquency) concurrently and at follow-up assessment (~2.5 years) in a socioeconomically and ethnically diverse sample. Participants were 485 youths (58.1% male; M age = 12.83 years, SD = 1.60) and their primary caregivers from the Project on Human Development in Chicago Neighborhoods. This study compared three classes of youths: (a) Parent > Youth (24.0%), (b) Youth > Parent (21.5%), and (c) Relative Agreement (54.5%). Findings did not support the hypothesis that groups reflecting parental underreporting of youth victimization experiences would show poor adjustment relative to all other classes longitudinally. Surprisingly, youths who self-reported lower levels of victimization than parents reported were at risk for maladjustment over time. This type of discrepant dyad may deserve more careful attention than previously considered in the literature.

背景与目标： : 本研究扩展了研究父母-青年线人差异对青年受害的影响的研究。潜在阶级分析 (LCA) 确定了以父母和青年受害报告的模式为特征的二元组。在社会经济和种族不同的样本中，分析研究了潜在类别与调整 (即焦虑/抑郁，攻击和犯罪) 同时以及随访评估 (〜2.5年) 之间的关系。参与者是来自芝加哥社区人类发展项目的485名青年 (58.1% 名男性; M年龄 = 12.83岁，SD = 1.60岁) 及其主要照顾者。这项研究比较了三类年轻人 :( a) 父母> 青年 (24.0%)，(b) 青年> 父母 (21.5%) 和 (c) 相对同意 (54.5%)。研究结果不支持以下假设: 反映父母对青少年受害经历的报告不足的群体相对于所有其他类别的纵向调整不佳。令人惊讶的是，自我报告的受害程度低于父母报告的年轻人随着时间的推移有适应不良的风险。这种类型的不一致的二元组可能比以前在文献中考虑的要更仔细地注意。

BACKGROUND & AIMS: :Although the psychiatric consultant in the general hospital setting is frequently called on to distinguish major depression from adjustment disorder, no studies to date have examined whether the two diagnoses are in fact distinguishable. Analysis of computerized data base records from 944 cases seen by psychiatric consultants from 1981-1987 revealed 59 cases of major depression and 130 cases of adjustment disorder with depressed mood. Patients with major depression were more likely to be older (p less than 0.001), widowed (p less than 0.001), and living alone (p less than 0.005). Patients with adjustment disorder with depressed mood received higher ratings on Axis IV (p less than 0.01), and lower severity of illness ratings (p less than 0.001) were seen later in the hospital stay (p less than 0.05), and they were more likely to be rated by the consultant as improved by the time the case was terminated (p less than 0.001). The results suggest that the two disorders may be distinguished in the consultation population and that adjustment disorder with depressed mood may have descriptive validity in the medical inpatient setting.

背景与目标： : 尽管经常要求综合医院的精神病顾问将重度抑郁症与适应障碍区分开，但迄今为止尚无研究检查这两种诊断是否实际上是可区分的。1981-1987年的精神病顾问对944例病例的计算机数据库记录进行分析，发现59例重度抑郁症和130例情绪低落的适应障碍。重度抑郁症患者更可能年龄较大 (p小于0.001)，丧偶 (p小于0.001) 和独居 (p小于0.005)。情绪低落的适应障碍患者在IV轴上的评分较高 (p小于0.01)，而在住院时间较晚 (p小于0.05) 的疾病评分较低 (p小于0.001)，而且他们更有可能被顾问评为在案件终止时有所改善 (p小于0.001)。结果表明，在咨询人群中可以区分这两种疾病，并且情绪低落的调节障碍在医疗住院患者中可能具有描述性有效性。

BACKGROUND & AIMS: BACKGROUND:Social adjustment is impaired in depressed patients. The difficulty to adjust to social circumstances has been hypothesized to be one of the causes of depression, as well as a consequence of the disorder. Genetic variation in the serotonin transporter gene has been previously associated with social adjustment levels in patients with mood disorders. METHODS:We investigated whether variations on the HTR1A (rs6295) and HTR2A (rs7997012) genes were associated with levels of social adjustment using the Social Adjustment Scale in two samples of depressed patients (total n=156). RESULTS:Patients carrying the GG genotype of the HTR2A-rs7997012 showed better social adjustment in areas of work and family unit bonding. LIMITATIONS:These findings did not survive correction for multiple testing and should be interpreted with caution. CONCLUSION:Our finding is in line with previous observations that have associated the G allele of the HTR2A-rs7997012 with higher rate of antidepressant response. The HTR2A-rs7997012 is worthy of further investigation in studies examining factors that are related to depression course and outcome.

背景与目标：

BACKGROUND & AIMS: PURPOSE:We sought to identify perioperative factors associated with long-term adjustment to an incontinent ostomy. METHODOLOGY:The Ostomy Adjustment Scale (OAS), a demographic form, and a $5 gift certificate were mailed to 200 ostomates. Associations between items from the Survey of Perioperative Factors of Ostomy Adjustment, demographic forms, and total OAS scores were assessed using bivariate and multiple linear regression analysis. RESULTS:The survey response rate was 74%. About half (70/146, 49%) of the respondents were women, 99% (144/145) were Caucasian, and 74% (109/146) were married. Their mean age was 65+/-14 years. Fifty-six percent (79/141) of the respondents had an ileostomy, 28% (39/141) had a colostomy, and 15% (21/141) had a urostomy. The mean OAS score for all the respondents was 159.5+/-26.2, indicating a good overall adjustment to an incontinent ostomy. In bivariate analyses, the factor associated with a lower OAS score indicating poorer adjustment was distress related to affording and obtaining ostomy supplies. The more helpful the ostomates found the preoperative education provided by a wound, ostomy, and continence specialist nurse, the better was their adjustment as indicated by a higher OAS score. Having ongoing/recurrent illness and having an ostomy created by a specialty surgeon were also associated with better adjustment. When multiple factors were considered in a stepwise regression analysis, adjustment was lowered by distress about obtaining ostomy supplies. Adjustment was improved when preoperative education provided by a wound, ostomy, and continence specialist nurse was considered helpful for the ongoing/ recurrent illness. CONCLUSION:Many ostomates have a good long-term adjustment to ostomy surgery and value education provided by a wound, ostomy, and continence nurse. Perioperative patient education and addressing patient distress over obtaining supplies are areas that can benefit from wound, ostomy, and continence nurse intervention.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The Premorbid Adjustment Scale (PAS) has been the most widely used scale to quantify premorbid status in schizophrenia, coming to be regarded as the gold standard of retrospective assessment instruments. AIMS:To examine the psychometric properties of the Spanish version of the PAS (PAS-S). METHOD:Retrospective study of 140 individuals experiencing a first episode of psychosis (n=77) and individuals who have schizophrenia (n=63), both adult and adolescent patients. Data were collected through a socio-demographic questionnaire and a battery of instruments which includes the following scales: PAS-S, PANSS, LSP, GAF and DAS-sv. The Cronbach's alpha was performed to assess the internal consistency of PAS-S. Pearson's correlations were performed to assess the convergent and discriminant validity. RESULTS:The Cronbach's alpha of the PAS-S scale was 0.85. The correlation between social PAS-S and total PAS-S was 0.85 (p<0.001); while for academic PAS-S and total PAS-S it was 0.53 (p<0.001). Significant correlations were observed between all the scores of each age period evaluated across the PAS-S scale, with a significance value less than 0.001. There was a relationship between negative symptoms and social PAS-S (0.20, p<0.05) and total PAS-S (0.22, p<0.05), but not with academic PAS-S. However, there was a correlation between academic PAS-S and general subscale of the PANSS (0.19, p<0.05). Social PAS-S was related to disability measures (DAS-sv); and academic PAS-S showed discriminant validity with most of the variables of social functioning. PAS-S did not show association with the total LSP scale (discriminant validity). CONCLUSION:The Spanish version of the Premorbid Adjustment Scale showed appropriate psychometric properties in patients experiencing a first episode of psychosis and who have a chronic evolution of the illness. Moreover, each domain of the PAS-S (social and academic premorbid functioning) showed a differential relationship to other characteristics such as psychotic symptoms, disability or social functioning after onset of illness.

背景与目标：

BACKGROUND & AIMS: :The association between plant water stress and synthesis of red, anthocyanin pigments in leaves has led some plant biologists to propose an osmotic function of leaf reddening. According to this hypothesis, anthocyanins function as a solute in osmotic adjustment (OA), contributing to depression of osmotic potential (Ψ(π)) and maintenance of turgor pressure during drought-stressed conditions. Here we calculate the percent contribution of anthocyanin to leaf Ψ(π) during OA in two angiosperm evergreen species, Galax urceolata and Gaultheria procumbens. Both species exhibit dramatic leaf reddening under high light during winter, concomitant with declines in leaf water potential and accumulation of solutes. Data previously published by the authors on osmotic potential at full turgor (Ψ(π,100)) of G. urceolata and G. procumbens leaves before and after leaf reddening were used to estimate OA. In vivo molar concentrations of anthocyanin, glucose, fructose, and sucrose measured from the same individuals were converted to pressure equivalents using the Ideal Gas Law, and percent contribution to OA was estimated. Estimated mean OA during winter was -0.7MPa for G. urceolata and -0.8MPa for G. procumbens. In vivo concentrations of anthocyanin (3-10mM) were estimated to account for ∼2% of OA during winter, and comprised <0.7% of Ψ(π,100) in both species. Glucose, fructose, and sucrose combined accounted for roughly 50 and 80% of OA for G. urceolata and G. procumbens, respectively, and comprised ∼20% of Ψ(π,100). We observed that a co-occurring, acyanic species (Vinca minor) achieved similar OA without synthesizing anthocyanin. We conclude that anthocyanins represent a measurable, albeit meager, component of OA in red-leafed evergreen species during winter. However, due to their low concentrations, metabolic costliness relative to other osmolytes, and striking red color (unnecessary for an osmotic function), it is unlikely that they are synthesized solely for an osmoprotectant role.

背景与目标： : 植物水分胁迫与叶片中红色，花色苷色素的合成之间的联系已导致一些植物生物学家提出了叶片变红的渗透功能。根据该假设，花青素在渗透调节 (OA) 中起溶质作用，有助于在干旱胁迫条件下降低渗透势 (Ψ(π)) 和维持膨大压力。在这里，我们计算了两种被子植物常绿物种Galax urceolata和procumberns在OA期间花青素对叶 Ψ(π) 的贡献百分比。两种物种在冬季在高光下均表现出明显的叶片变红，同时叶片水势下降和溶质积累。作者先前发表的关于叶片变红之前和之后的大叶和平卧叶片全膨大 (Ψ(π，100)) 渗透势的数据用于估计OA。使用理想气体法将从同一个体测得的体内花青素，葡萄糖，果糖和蔗糖的摩尔浓度转换为压力当量，并估算了对OA的贡献百分比。冬季，G. urceolata的估计平均OA为-0.7MPa，G.Procumens的估计平均OA为-0.8MPa。据估计，花青素的体内浓度 (3-10mm) 占冬季OA的约2%，并且在两种物种中均 <Ψ(π，100) 的0.7%。葡萄糖、果糖和蔗糖的组合分别占牛膝和牛膝G的OA的大约50和80%，并且包括20% 的 Ψ(π，100)。我们观察到，共生的acyanic物种 (Vinca minor) 在没有合成花青素的情况下获得了相似的OA。我们得出的结论是，花青素代表冬季红叶常绿物种中OA的可测量成分，尽管微不足道。但是，由于它们的低浓度，相对于其他渗透物的代谢成本以及醒目的红色 (对于渗透功能而言是不必要的)，因此不太可能仅出于渗透保护剂的作用而合成它们。

BACKGROUND & AIMS: :In a prospective, randomized clinical trial, we compared the accuracy of warfarin dosage-adjustments predictions using a computer program to the skill of an experienced anticoagulation nurse-specialist. The computer program predicts the steady state warfarin dose by applying Bayesian forecasting techniques to a mathematical model of the dynamic pharmacologic response to warfarin. Fifty patients who were receiving chronic warfarin therapy and who required a dosage adjustment because their prothrombin time was greater than or equal to 2 s away from their target prothrombin time were enrolled. The baseline characteristics of each group were similar, including the mean of the absolute value of the differences between initial prothrombin times and corresponding target prothrombin times. After a new a new warfarin dose was predicted, the prothrombin time was measured at least 7 days after dosage adjustment. Overall, the results in each group were comparable. There was no significant difference between groups and the mean of the absolute value of the differences between final prothrombin times and target prothrombin times, nor was there a difference in the proportion of patients who had a final prothrombin time within 2 s of the target prothrombin time. We conclude that the accuracy of warfarin dosage adjustments made using computer modeling is comparable to the skill of an anticoagulation nurse-specialist.

背景与目标： : 在一项前瞻性，随机临床试验中，我们将使用计算机程序对华法林剂量调整预测的准确性与经验丰富的抗凝护士专家的技能进行了比较。计算机程序通过将贝叶斯预测技术应用于华法林动态药理反应的数学模型来预测稳态华法林剂量。纳入了50名接受慢性华法林治疗且因凝血酶原时间距离目标凝血酶原时间大于或等于2 s而需要调整剂量的患者。各组的基线特征相似，包括初始凝血酶原时间和相应目标凝血酶原时间之间差异的绝对值的平均值。预测新的华法林剂量后，在剂量调整后至少7天测量凝血酶原时间。总体而言，每组的结果具有可比性。两组间和最终凝血酶原时间与目标凝血酶原时间的差异绝对值的平均值无显著差异，在目标凝血酶原时间2 s内有最终凝血酶原时间的患者比例也无差异。我们得出的结论是，使用计算机建模进行华法林剂量调整的准确性与抗凝护士专家的技能相当。

BACKGROUND & AIMS: :The pyrazolo[3,4-d]pyrimidine-4,6-diamine nucleosides 2b-d stabilize the dA-dT base pair significantly when the dA-residue is replaced. Oligonucleotide duplexes incorporating 2b-d show a 4-6 degrees C Tm increase per modification. The 7-bromo compound 2b harmonizes the stability of the dA-dT vs. the dG-dC pair. According to this the stability of such duplexes depends no longer on the base pair composition of a DNA molecule.

背景与目标： : 吡唑并 [3,4-d] 嘧啶-4，6-二胺核苷2b-d在取代dA残基时显著稳定dA-dT碱基对。掺入2b-d的寡核苷酸双链体显示每次修饰4-6 ℃ Tm增加。7-溴化合物2b协调了dA-dT对dG-dC对的稳定性。根据此稳定性这种双链体不再取决于DNA分子的碱基对组成。

BACKGROUND & AIMS: OBJECTIVE:We sought to assess how the inclusion of claims from complementary and alternative medicine (CAM) providers affects measures of morbidity burden and expectations of health care resource use for insured patients. METHODS:Claims data from Washington State were used to create 2 versions of a case-mix index. One version included claims from all provider types; the second version omitted claims from CAM providers who are covered under commercial insurance. Expected resource use was also calculated. The distribution of expected and actual resource use was then compared for the 2 indices. RESULTS:Inclusion of claims from CAM providers shifted 19,650 (32%) CAM users into higher morbidity categories. When morbidity categories were defined using claims from all providers, CAM users in the highest morbidity category had average (+/-SD) annual expenditures of $6661 (+/-$13,863). This was less than those in the highest morbidity category when CAM provider claims were not included in the index ($8562 +/- $16,354), and was also lower than the highest morbidity patients who did not use any CAM services ($8419 +/- $18,885). CONCLUSIONS:Inclusion of services from CAM providers under third-party payment increases risk scores for their patients but expectations of costs for this group are lower than expected had costs been estimated based only on services from traditional providers. Risk adjustment indices may need recalibration when adding services from provider groups not included in the development of the index.

背景与目标：

BACKGROUND & AIMS: The ideal skin-flap reconstruction provides functional preservation and a good cosmetic outcome in both the reconstructed site and the donor site. Although various flaps are used for reconstruction of the vulvar and buttock region, there are disadvantages associated with each. In 1996, Yii and Niranjan reported the gluteal-fold flap for vulvar reconstruction. As presently used, this flap is bulky, particularly in obese patients or when used for hemilateral reconstruction. Thinning the flap has been considered impossible because of the obscurity of the blood supply. In the study presented here, the pedicle vessels of this flap were studied in eight cadavers; the authors found that the flap is nourished by a direct cutaneous system of the internal pudendal artery and vein. Accordingly, adjustment of the flap volume was believed to be possible, with the exception of the adipose tissue containing the pedicle vessels. The authors have since used 14 thinned flaps for seven vulvar, one vaginal, and two buttock defects in 10 patients. All flaps survived completely. Good functional and cosmetic results were achieved with hemilateral or bilateral flaps in vulvar or buttock reconstruction. In the buttock in particular, the usefulness of this flap for anal and pelvic-floor reconstruction was demonstrated. The scar at the donor site, concealed in the gluteal fold, was acceptable. The gluteal-fold flap is very useful for various vulvar and buttock reconstructions because it can be adjusted to the required volume.

背景与目标： 理想的皮瓣重建可在重建部位和供体部位提供功能性保存和良好的美容效果。尽管使用各种皮瓣重建外阴和臀部区域，但每种皮瓣都存在缺点。1996年，Yii和Niranjan报告了臀肌皮瓣用于外阴重建。如目前使用的，该皮瓣体积庞大，尤其是在肥胖患者中或用于半侧重建时。由于血液供应的模糊，使皮瓣变薄被认为是不可能的。在这里介绍的研究中，在八具尸体中研究了该皮瓣的蒂血管; 作者发现皮瓣是由阴部内动脉和静脉的直接皮肤系统滋养的。因此，除了含有蒂血管的脂肪组织外，皮瓣体积的调整被认为是可能的。此后，作者在10例患者中使用了14个变薄的皮瓣治疗7个外阴，1个阴道和2个臀部缺损。所有襟翼完全存活。在外阴或臀部重建中，半侧或双侧皮瓣可获得良好的功能和美容效果。特别是在臀部，证明了该皮瓣对肛门和骨盆底重建的有用性。隐藏在臀褶中的供体部位的疤痕是可以接受的。臀折皮瓣对于各种外阴和臀部重建非常有用，因为它可以调节到所需的体积。

BACKGROUND & AIMS: OBJECTIVE:To describe and make available an interactive, 24-variable homeostasis model assessment (iHOMA2) that extends the HOMA2 model, enabling the modeling of physiology and treatment effects, to present equations of the HOMA2 and iHOMA2 models, and to exemplify iHOMA2 in two widely differing scenarios: changes in insulin sensitivity with thiazolidinediones and changes in renal threshold with sodium glucose transporter 2 (SGLT2) inhibition. RESEARCH DESIGN AND METHODS:iHOMA2 enables a user of the available software to examine and modify the mathematical functions describing the organs and tissues involved in the glucose and hormonal compartments. We exemplify this with SGLT2 inhibition modeling (by changing the renal threshold parameters) using published data of renal effect, showing that the modeled effect is concordant with the effects on fasting glucose from independent data. RESULTS:iHOMA2 modeling of thiazolidinediones effect suggested that changes in insulin sensitivity in the fasting state are predominantly hepatic. SGLT2 inhibition modeled by iHOMA2 resulted in a decrease in mean glucose of 1.1 mmol/L. Observed data showed a decrease in glucose of 0.9 mmol/L. There was no significant difference between the model and the independent data. Manipulation of iHOMA2's renal excretion threshold variable suggested that a decrease of 17% was required to obtain a 0.9 mmol/L decrease in mean glucose. CONCLUSIONS:iHOMA2 is an extended mathematical model for the assessment of insulin resistance and β-cell function. The model can be used to evaluate therapeutic agents and predict effects on fasting glucose and insulin and on β-cell function and insulin sensitivity.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To describe and compare psychological, behavioural and adjustment problems in pre-school patients with acquired brain lesions of different aetiology. METHODS:Three groups of patients with acquired brain lesions (14 patients post-TBI, 18 brain tumour survivors and 23 patients with vascular or infectious brain lesions), ranging in age between 24-47 months, received a psychological evaluation, including the Child Behavior Checklist for Ages 2-3 (CBCL) and the Vineland Adaptive Behavior Scales (VABS). RESULTS:About half of the total sample (47.2%) showed psychological and behavioural problems. Difficulties vary according to the aetiology of the brain lesions. Brain tumour survivors showed more marked internalizing problems, whereas children with vascular or infectious brain lesions scored higher on the CBCL externalizing scales. Children with traumatic brain injury reported intermediate scores on most of the CBCL scales. CONCLUSIONS:Psychological and behavioural difficulties are very common, not only among school-aged children and adolescents, but also among pre-schoolers with acquired brain lesions. The relevance and the impact of these difficulties must necessarily be considered when developing psychological treatment and rehabilitation plans and planning for social re-entry.

背景与目标：

BACKGROUND & AIMS: PURPOSE:The aim of the study is to investigate the infertility-related stress in a Hungarian infertile population and examine the effects of gender roles, child wish motives, subjective well-being, and marital relationship on the experience of infertility according to our self-constructed conceptual framework. METHODS:Validated self-report questionnaires measuring the factors of the conceptual framework were taken in the study carried out in a sample of 53 people attending the fertility unit of a Hungarian clinic. RESULTS:Infertility-related global stress, infertility-related social concerns, and general health problems have more intensive effect on women than on men (all p < 0.05). Women from the infertile group scored higher their femininity (p < 0.001) and lower their general health (p < 0.05) than the reference population. Infertile men believe deeper in meaning of life than women (p < 0.05) or reference population (p < 0.01). Femininity (β = 0.460, p < 0.05), traditional gender role concepts (β = -0.248, p < 0.05), general health (β = -0.474, p < 0.05), and marital relationship (β = -0.251, p < 0.05) play the strongest role to predict stress caused by infertility. CONCLUSIONS:The current study emphasizes the importance of interrelations of gender role attitudes, gender role identification, general health, and satisfaction in couple relationship with infertility-related stress. In further investigations, both social and personal aspects and their effect on experiencing infertility need to be measured in infertile people, particularly in different cultural settings.

背景与目标：

BACKGROUND & AIMS: :Acute papillary muscle rupture results in severe mitral regurgitation and hemodynamic instability, and it carries a poor prognosis with a high mortality rate. We present a case of an 86-year-old woman affected by mitral regurgitation due to an acute posterior papillary muscle rupture. The patient underwent a mitral valve repair with annuloplasty and artificial chordae implantation. The neochorda was sutured to the posterior mitral leaflet and fixed through the left ventricle wall on the epicardium. The neochorda length was determined on the beating heart under echocardiographic view.

背景与目标： : 急性乳头肌破裂会导致严重的二尖瓣反流和血流动力学不稳定，预后差，死亡率高。我们介绍了一例因急性后乳头肌破裂而受到二尖瓣反流影响的86岁女性。患者接受了二尖瓣修复术，并进行了瓣环成形术和人工腱索植入术。将neochorda缝合到二尖瓣后叶，并通过心外膜上的左心室壁固定。在超声心动图下，在跳动的心脏上确定了新的长度。