Accessory mitral valve（AMV）refers to the additional valvular structural components connected to the normal mitral valve. It is a rare congenital cardiovascular malformation with an incidence of approximately 1/26 000. Most patients have no obvious symptoms and are often accidentally detected during echocardiography due to the presence of other associated cardiac malformations. The combination of AMV with left ventricular outflow tract（LVOT）vegetations is extremely rare and may be related to infective endocarditis. In this case，a 48-year-old male patient was discovered to have a "cardiac mass" during treatment for a cerebral infarction at an external hospital and was admitted to China-Japan Union Hospital of Jilin University for further diagnosis and treatment. Over the past 3 months，the patient experienced intermittent fever，accompanied by chest tightness and pain during physical exertion. The patient had a history of gout and diabetes. Transthoracic echocardiography（TTE）and transesophageal echocardiography revealed left ventricular outflow tract obstruction，accessory mitral valve（membranous fixed type），and a space-occupying lesion on the ventricular septal side within the left ventricular outflow tract. The final diagnosis of vegetation in the left ventricular outflow tract and accessory mitral valve was confirmed through surgical resection and postoperative pathology. Postoperative TTE showed a significant reduction in the flow velocity and pressure gradient within the left ventricular outflow tract. Echocardiography，with its advantages of simplicity，non-invasiveness，and repeatability，allows for the direct observation of accessory mitral valve and other cardiac abnormalities，evaluation of valve function and hemodynamic changes，and assessment of the left ventricular outflow tract obstruction condition. It facilitates preoperative diagnosis and postoperative follow-up，serving as the gold standard for diagnosing accessory mitral valve.

Accessory mitral valve（AMV）refers to the additional valvular structural components connected to the normal mitral valve. It is a rare congenital cardiovascular malformation with an incidence of approximately 1/26 000. Most patients have no obvious symptoms and are often accidentally detected during echocardiography due to the presence of other associated cardiac malformations. The combination of AMV with left ventricular outflow tract（LVOT）vegetations is extremely rare and may be related to infective endocarditis. In this case，a 48-year-old male patient was discovered to have a "cardiac mass" during treatment for a cerebral infarction at an external hospital and was admitted to China-Japan Union Hospital of Jilin University for further diagnosis and treatment. Over the past 3 months，the patient experienced intermittent fever，accompanied by chest tightness and pain during physical exertion. The patient had a history of gout and diabetes. Transthoracic echocardiography（TTE）and transesophageal echocardiography revealed left ventricular outflow tract obstruction，accessory mitral valve（membranous fixed type），and a space-occupying lesion on the ventricular septal side within the left ventricular outflow tract. The final diagnosis of vegetation in the left ventricular outflow tract and accessory mitral valve was confirmed through surgical resection and postoperative pathology. Postoperative TTE showed a significant reduction in the flow velocity and pressure gradient within the left ventricular outflow tract. Echocardiography，with its advantages of simplicity，non-invasiveness，and repeatability，allows for the direct observation of accessory mitral valve and other cardiac abnormalities，evaluation of valve function and hemodynamic changes，and assessment of the left ventricular outflow tract obstruction condition. It facilitates preoperative diagnosis and postoperative follow-up，serving as the gold standard for diagnosing accessory mitral valve.

Objective To investigate the etiologic roles of apoptosis-associated genes,environmental factors and their interactions in lumbar disc herniation (LDH).Methods A case-control trial was conducted.We recruited 128 outpatients with LDH as case group and 132 normal people matched by age and gender as control group.Peripheral venous blood samples were collected and DNA was extracted from leukocytes.By using a modified Brucker Autoflex MALDI-TOF mass spectrometer,we analyzed 3 genes with 9 polymorphic sites,namely,Fas-1377G/A rs2234767,Fas-670G/A rs1800682,Fas rs2147420,Fas rs2296603,Fas rs7901 656,Fas rs1 57101 9,FasL-844C/T rs7631 10,CASP-9-1263A > G rs4645978,and CASP-9-712C > T rs4645981.The correlations between polymorphism of Fas,FasL and CASP-9 genes and the risk of LDH were evaluated by non-conditional Logistic regression model.Multiple Logistic regression model was performed to assess the interaction between apoptosis-associated genes and environment factors,such as lumbar vertebral loads,bed type,spare-time exercises and spare-time activities. Results There were preferable balances in case and control groups in age and gender without significant differences.However,the two groups differed significantly (P <0.05)in lumbar vertebral loads,body mass index, bed type, spare-time exercises and spare-time activities. Correlation analysis showed remarkable correlations between LDH and the polymorphisms of FasL-844C/T (rs7631 10)and CASP-9-1263A>G (rs4645978),and FasL-844C/T TT and CASP-9-1263A>G GG genotypes might be the high risk genotypes of LDH.The gene-environment interaction analysis revealed that super-multiplicative and sub-multiplicative interactions respectively between FasL-844TT genotype and lumbar vertebral loads (3-4 level),and between CASP-9-rs4645978 GG and lumbar vertebral loads (3-4 level).Conclusion FasL,CASP-9 genes and lumbar vertebral loads and their interactions play important roles in the pathogenesis of LDH.It suggests that the risk of LDH may be codetermined by environmental factors and inherited susceptibility genes,and that the mechanisms of interactions vary in different genotypes and the same or different environmental factors.

OBJECTIVETo observe clinical efficacy of intra-articular injection of Sodium hyaluronate (SH) accompanied with external application of Sanhua ointment (SHO) for knee osteoarthritis.

METHODSOne hundred and twelve patients with osteoarthritis were randomly divided into two groups, Group I was treated with SH and Group II was treated with SH plus SHO. The entire condition of knee joint in the two groups were compared before and after treatment according to Lysholm's function scoring.

RESULTSThe functional score in the two groups at the 2nd week, 5th week, 3rd month and end of 1st year of the treatment course were significantly higher than that before treatment (P < 0.05), and the scores continuously increased within the first 3 months of treatment. Comparison of scores between the two groups showed that scores in Group II was significantly higher than those in Group I at the corresponding period. The total effective rate after 1 year treatment in Group lI was higher than that in Group II (81.5% vs 96.6%, P < 0.05). In Group II , the initial time of symptom improving was earlier and the adverse effect disappeared more quickly than those in Group I markedly.

CONCLUSIONThe efficacy of combined therapy of intra-articular injection of SH and SHO for knee osteoarthritis was superior to that of intra-articular injection of SH only.

Administration, Topical ; Adult ; Aged ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Hyaluronic Acid ; administration & dosage ; Injections, Intra-Articular ; Male ; Middle Aged ; Osteoarthritis, Knee ; drug therapy ; Phytotherapy

Objective To explore the preventive effect of the supplemental dietary boron on bone damage of rats with excess fluoride (EF) ingestion. Methods Twenty-four Sprague-Dawley rats aged 4-5 weeks old were divided into the control (C group, treated with distilled water and the elementary dietary), the excessive fluoride dose group (EF group, treated with distilled water with 100mg/L F-from 221.0g NaF per liter and the elementary dietary) and the boron prevention group (P group, treated with 100mg/L F-distilled water and the supplemental boron dietary). Three months after the experiment, fluorine, boron contents and AKP activities in serum, total RNA and fluorine contents in bone, vertical and transverse diameter and dry weight of tibias of rats were assayed, and bone biomechanics of femur and bone mineral density (BMD) were determined. Results Compared with those in the C group, fluorine contents in serum and bone, AKP activities in serum of rats in the EF group significantly increased; total RNA in bone and BMD of the bone of whole body and tibia decreased, vertical and transverse diameter of tibias was shortened, dry weight was decreased; peak load of femur increased but maximum deformation decreased. Compared with those in EF group, fluorine contents in serum and bone, AKP activities in serum of rats in the P group obviously decreased; total RNA in bone and BMD of whole body, lumbar vertebrae and tibias notably increased, vertical and transverse diameters and dry weight of tibia were enhanced, peak load of femur was obviously raised. Boron contents in serums of rats in three groups had no significant differences. Conclusion Bone damage obviously occurred in rats with EF intake, and the supplemental dietary boron had a preventive effect on these changes.