2020年 · 第100卷第43期

Glioma refers to the tumor originating from glial cells, which is the most common primary intracranial tumor. At present, the treatment methods mainly rely on surgery and postoperative adjuvant radiotherapy and chemotherapy, but most patients are insensitive to traditional treatment and have poor prognosis^[1,2]。 Immunotherapy and targeted therapy as new therapeutic methods may be beneficial to delay tumor recurrence and improve the therapeutic effect of tumor. As a result of the first edition of the Chinese Expert Consensus on Immune and Targeted Therapy for CNS Gliomas^[3]It has caused great repercussions in China, and in the past two years or so, there have been new and substantial progress in stage II/III targeted therapy, immunotherapy and related combination therapy forms in the field of glioblastoma (GBM) treatment^[4]This time, the leader relies on the Glioma Professional Committee of Chinese Medical Doctors Association and the Neurotumor Branch of Shanghai Anti-Cancer Association to organize relevant domestic experts. After repeated discussions and revisions, according toTable 1The evidence of different levels of evidence-based medicine shown in is updated to form the second edition of the "Chinese Expert Consensus on Immunology and Targeted Therapy of Central Nervous System Glioma" (hereinafter referred to as the "Second Edition Consensus"), and the application scope of different treatment strategies is evaluated and recommended. For specific recommendation level standards, seeTable 2For the reference and application of the majority of clinical medical workers, it is hoped that it can contribute to the standardization of this treatment method, so as to promote the comprehensive diagnosis and treatment of glioma in China, and ultimately benefit the majority of patients and their families.

cerebral small vessel disease (CSVD) is a common and devastating subclinical disease that has important implications for both stroke and dementia. Variability in blood pressure may increase the risk of stroke and dementia, but whether blood pressure variability is related to CSVD is inconclusive. The study was a systematic review and meta-analysis of prospective cohort studies that examined the relationship between blood pressure variability and the presence or progression of CSVD markers, including white matter hyperintensity, lacunar, and microbleeding on magnetic resonance imaging. The study searched three major databases, Medline, Embase, and Web of Science. Ten studies were screened to meet the comprehensive qualitative criteria and seven studies could be included in the meta-analysis. These studies included a total of 2 796 patients aged (74 ± 4) years with a mean follow-up of 4.0 years. By statistical analysis, systolic blood pressure variability was associated with an increased probability of the presence or progression of white matter hyperintensity by approximately 1 standard deviation [odds ratio 1.26 (95%CI：1.06~1.50）]。 While systolic blood pressure variability was associated with the presence of lacunae [odds ratio 0.93 (95%CI: 0.74 to 1.16)] and the presence of microhemorrhage [odds ratio 1.13 (95%CI: 0.89-1.44)] were not statistically significant. The results demonstrate that large blood pressure variability is associated with higher white matter hyperintensity (WMH) burden, which may provide important support for exploring the early triggers of stroke and dementia. The causal relationship between the two needs to be explored in future longitudinal research. If it is observed that the causal relationship holds, it suggests that CSVD and thus stroke and dementia can be largely prevented by maintaining a stable blood pressure.

cerebral small vessel disease (CSVD) is characterized by altered pial and parenchymal microcirculation. CSVD leads to decreased blood flow to the brain and impaired blood-brain barrier function, which are the main reasons for age-related declines in brain health. The resulting effects on organ function are diverse and can lead to cognitive and non-cognitive deficits. Its underlying phenotype and mechanism are multifactorial, and there is currently no special treatment. Cerebral blood flow is a biomarker of brain health and a predictor of future cognitive function; Microvascular aging is the greatest risk factor for cerebrovascular disease and its subsequent effects. Although aging is known to affect the structure, mechanics, and function of small blood vessels in the brain, the exact consequences and relative importance of each alteration are unclear. Targeted trials and therapeutic strategies are needed to directly determine the effects of specific vascular cells on end organ effects and function, in addition to the importance of less studied cell types such as perivascular macrophages. For CSVD, exploring the details of the endothelial transcriptome and communicome in disease and aging models, discussing the research of hematopoietic cells, non-coding RNA, and the interaction of various microbial communities (such as the oral cavity, gastrointestinal tract, skin, lung, placenta, vagina, and uterus) with the brain, all need further development. In addition to the leptomeninges and cerebral parenchymal vessels, more knowledge of the biology of other microcirculations (e.g., meninges, choroid plexus) is needed. Vascular aging does not typically occur in isolation and therefore needs to be studied in conjunction with associated models of major chronic risk factors for CSVD, including hypertension and diabetes.