2016年 · 第96卷第35期

cryptogenic stroke (CS) refers to ischemic stroke (IS) whose etiology cannot be determined with complete examination methods. Its etiology hypothesis IS based on the theory of remote embolization^[1]。 Atrial fibrillation (AF) is a significant risk factor for embolism and stroke^[2]In the past, it was reported that the detection rate of atrial fibrillation in cryptogenic stroke patients was 4.9% ~9.2%, and with the improvement of equipment, the detection rate can be as high as 25%^[3]。 Therefore, the screening of atrial fibrillation is very critical. A clear etiological diagnosis will not only change the direction of treatment, from antiplatelet therapy to anticoagulation, but also related to the formulation of stroke prevention strategies in this group of people.

A 40-year-old female, unemployed, was admitted to the hospital on August 24, 2015 mainly due to "headache and fever for 3 months". The patient developed headache 3 months before admission (end of May 2015), which was intermittent and could be improved by rest. The self-measured body temperature was lower than 38℃ once, and no diagnosis and treatment were made. Two and a half months ago (June 3), the headache worsened and the body temperature was low fever (37~37.9 ℃). Local head CT showed no abnormalities and no treatment. Two months ago (June 22, 2015), he was hospitalized in a hospital in Hubei Province, and was given lumbar puncture examination and anti-infective and antiviral treatment (details unknown), but his symptoms did not improve. Six days later (June 28, 2015), the body temperature reached 38.5℃, and the next day, he was transferred to an affiliated hospital of a university and diagnosed as "meningitis and otitis media". The head MRI examination was completed, meningitis was considered, and "antibacterial and antiviral" treatment was given for 11 days (piperacillin and sulbactam sodium 5.0 g, twice/d; ganciclovir 0.25 g, once/d). The body temperature dropped to normal, and the headache was slightly relieved. After continuing treatment for 10 days, he had fever and headache again, and changed to ceftazidime 2.0 g, twice/d, teicoplanin 0.4 g, once/d, for 2 days. At this time, the body temperature reached 39 ℃, and the headache was not relieved. One month ago (July 20, 2015), I was transferred to a hospital in Hubei Province. My body temperature fluctuated from 37.5 to 38℃. I was diagnosed with "tuberculous meningitis". I was given meropenem 0.5 g, once/8 h, three times/d for 7 days, levofloxacin 0.2 g, twice/d for 25 days, isoniazid injection 0.5 g, once/d for 22 days, oral pyrazinamide 0.5 g, three times/d, rifampicin 0.45 g, once/d, dexamethasone 10 mg, once/d for 7 days, reduced to 5 mg, once/d for 6 days, my body temperature gradually dropped to normal, and my headache was relieved. After stopping dexamethasone, the patient intermittently developed low fever, up to 37.9℃, accompanied by afternoon sweating, and headache was more obvious than before. Reexamination head MRI + enhancement: left fissure meningeal enhancement, and the lesion was enlarged compared with the previous Mingqian. For further diagnosis and treatment, I came to Xuanwu Hospital of Capital Medical University. Since the onset of the disease, I ate normally and lost about 5 kg of weight. Past history: 39 years of history of otitis media in the left ear. Family history: father is deceased and has suffered from tuberculosis.

Early diagnosis of ovarian epithelial cell carcinoma is difficult, and it is difficult to distinguish benign and malignant by other methods except pathological diagnosis. 70% of ovarian epithelial cell carcinoma have reached the advanced stage when diagnosed. The prognosis of ovarian epithelial cell carcinoma is extremely poor, and effective treatments include cytoreductive surgery, paclitaxel and platinum-based chemotherapy. Approximately 80% of patients with ovarian epithelial cell carcinoma relapse after the initial treatment described above^[1]。 Therefore, there is an urgent need for a new marker to detect ovarian epithelial cell carcinoma early, so as to better understand its molecular biological characteristics and give more suitable and effective treatment. Although CA125 is currently widely used as a serological marker to evaluate the therapeutic effect of ovarian epithelial cell carcinoma and as a disease follow-up method after first-line treatment, it has limitations in guiding personalized treatment and cannot provide effective information for second-line treatment. Tumor circulating cells are active tumor cells released from the primary tumor, which can lead to tumor recurrence in situ or distant metastasis through the circulatory system. These cells have tumor-specific genotypes and phenotypes that can grow in new microenvironments. Many previous studies have shown that tumor circulating cells have prognostic significance in many solid tumors, such as breast cancer, colon cancer, stomach cancer, lung cancer, and prostate cancer. Detection of tumor circulating cells in the peripheral blood of patients with ovarian epithelial cell carcinoma has proven feasible^[2]However, the positive rate and median of tumor circulating cells in ovarian epithelial cell carcinoma are lower than those in other malignancies, such as metastatic breast cancer. Because distant metastasis of ovarian epithelial cell carcinoma only occurs in 1/3 of patients, and most of them occur in the advanced stage of the disease, the low detection rate may be due to the fact that most patients do not have enough tumor cells in their blood at the time point of detection to evaluate their clinical relevance.

Resveratrol (RSV) is a polyphenol phytoestrogen, mainly derived from grape, red wine, peanut and other plants. Its main biological effects include anti-inflammatory, anti-cancer, anti-aging and improving bone repair^[1,2,3,4]Etc. Mesenchymal stem cells (MSCs) exist widely in various tissues of the whole body, and have strong proliferative ability and multidirectional differentiation potential. Because of their wide source, low immunogenicity and strong osteogenic ability, MSCs are now regarded as ideal seed cells for bone injury repair and bone tissue engineering.