Volume 98 ·  Issue 45 ·  2018

In 2018, the Neurocritical Care Collaboration Group of the Neurology Branch of the Chinese Medical Association and the Neurocritical Care Professional Committee of the Neurologist Branch of the Chinese Medical Doctor Association launched the "Chinese Expert Consensus on Monitoring and Treatment of Intracranial Hypertension"^[1]。 The purpose of the launch is to keep pace with the times and change the unchanging intracranial pressure monitoring and treatment mode; Optimizing the imperfect intracranial pressure monitoring and treatment plan; Make more neurologists, emergency physicians and critical care physicians have clear goals, appropriate measures and perfect.

Today, sepsis is still one of the most important fatal diseases in critically ill patients. Every year, there are about 31 million confirmed cases worldwide, and its in-hospital mortality rate is as high as 30%. The definition of sepsis has been updated three times. In 2016, the American Society of Critical Care Medicine and the European Society of Critical Care proposed the latest definition of sepsis, that is, life-threatening multiple organ dysfunction caused by the host response to infection-induced dysfunction. Accordingly, the diagnosis of sepsis must have three elements: first, there is infection; Second, the host response to infection is dysregulated; Third, abnormal responses lead to multiple organ dysfunction. It can be seen that the pathogenesis of sepsis includes the imbalance of body response including immune dysfunction: from extensive activation to excessive inflammation, and finally into a systemic suppression state, that is, from "controllable" to "out of control" and finally to "failure" evolution process. Correspondingly, the prevention and treatment of sepsis involves many measures: actively treating the primary disease, effectively controlling infection, protecting and maintaining important organ functions, immune regulation, etc. Although anti-infective treatment, intensive care and organ protection measures have significantly reduced the in-hospital mortality of sepsis patients, the improvement of their long-term prognosis is still a difficult problem; Immunomodulation may be an effective way to benefit sepsis patients in the long term. autophagy is an inherent metabolic and adaptive regulatory mechanism of eukaryotic cells, and its effects in the immune system have been the focus of recent attention. Many observations have shown that autophagy in sepsis has protective effects on the immune, respiratory, circulatory, digestive and coagulation systems of the body, and is one of the important targets of immunomodulation strategies, which is expected to open up a new way for the prevention and treatment of sepsis.

Alzheimer's disease (AD), commonly known as Alzheimer's disease, is a neurodegenerative disease that seriously endangers the physical and mental health of the elderly. With the progress of population aging in China, the incidence of this disease is increasing year by year. According to statistics, the prevalence of AD among the elderly over 65 years old in China is 3.21%^[1]It has become one of the main diseases that seriously endanger the health of the elderly and affect the sustainable development of society. Therefore, it is very urgent and important to explore the pathogenesis of this disease and seek possible prevention and treatment means and measures.

Increased intracranial pressure (ICP) can cause serious adverse consequences, and is common in brain diseases such as craniocerebral trauma, intracranial infection, cerebrovascular disease and brain tumor. The neurocritical care unit (NCU) treated most patients with acute severe brain injury, refractory intracranial hypertension (ICP>20 mmHg, 1 mmHg =0.133 kPa), and the proportion of standard treatment failed accounted for about 20%^[1]The mortality rate is as high as 80% ~100%^[2]。 Therefore, accurately monitoring the changes of intracranial pressure, reasonably confirming the intervention boundary value of intracranial pressure, and effectively controlling intracranial pressure become the key to reduce the mortality rate and improve the prognosis of neurological function. To this end, the Neurocritical Care Collaboration Group of Neurology Branch of Chinese Medical Association and the Neurocritical Care Professional Committee of Neurologist Branch of Chinese Medical Doctors Association launched the Chinese Expert Consensus on Monitoring and Treatment of Intracranial Pressure Increase.

knee osteoarthritis (KOA) is a chronic degenerative bone and joint disease. The prevalence of symptomatic KOA among middle-aged and elderly people in China is 8.1%^[1]And there is a rising trend. The disease seriously affects the quality of life of patients and has a certain disability rate, which causes a huge burden on society and economy. Traditional Chinese and Western medicine have their own advantages in the diagnosis and treatment of KOA. In order to clarify the role of integrated Chinese and Western medicine in the diagnosis and treatment of KOA and improve the diagnosis and treatment level of integrated Chinese and Western medicine, the Professional Committee of Orthopaedics and Traumatology of Chinese Society of Integrated Chinese and Western Medicine organized experts to formulate this guide after many discussions according to the latest progress in the diagnosis and treatment of KOA in recent years, with reference to domestic and foreign guidelines and the latest evidence-based medical evidence, combined with clinical experience. This guide is for academic guidance only, and should be implemented in conjunction with the specific circumstances of patients and medical treatment. Refer to the relevant product instructions before taking various preventive and therapeutic measures.

Image-guided percutaneous biopsy is a common method for sampling small samples of pulmonary lesions, and it is of great value in the diagnosis of pulmonary diseases. At present, clinical imaging guidance methods include conventional computed-tomography (CT) guidance, CT fluoroscopy guidance, C-arm CT guidance, ultrasound guidance, fluoroscopy guidance, conventional magnetic resonance imaging (MRI) guidance, magnetic resonance fluoroscopy guidance, etc. Each of the above guidance methods has its own advantages and disadvantages, among which conventional CT guidance is the most widely used^{[1,2,3,4,5,6,7,8,9,10,11]}。 In recent years, high-field magnetic resonance imaging has been gradually applied to the imaging diagnosis of lung lesions and guided percutaneous biopsy. This technique has the advantages of good soft tissue resolution, vascular emptying effect, multi-parameter and multi-sequence imaging, functional imaging, arbitrary plane imaging, allowing flexible needle insertion path design and no ionizing radiation, but also has the disadvantages of low spatial resolution and long imaging time^{[12,13,14,15,16,17,18,19,20,21]}。 High Field Intensity MRI Guided Puncture Biopsy of Pulmonary Lesions with High Diagnostic Accuracy and Low Probability of Complications^[21,22]This technique, as a guiding means without ionizing radiation and with good soft tissue resolution, can play an important role in percutaneous puncture biopsy of lung lesions.

To investigate the impact of beta-blockers on long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for stable coronary artery disease (SCAD) with adequate left ventricular ejection function (LVEF).

A total of 3 946 consecutive SCAD patiens who underwent PCI with adequate LVEF between January and December 2013 in Fuwai Hospital were prospectively included in this study. According to beta-blocker use at discharge, patients were divided into no-beta-blocker group (n=309) and beta-blocker group (n=3 637). Major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, revascularization, stroke and stent thrombosis at 2 years were compared between the two groups. Multivariate Cox regression analysis and Propensity-score matched analysis were used to identify independent risk factors of poor prognosis.

Compared with those in the beta-blocker group, patients of no-beta-blocker group were more likely to have lower body mass index, less complex comorbidities, slower heart rate either on admission or at discharge. There was no significant association of beta-blocker use with 2-year mortality (0.8% versus 1.3%, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.23 to 1.86, P=0.421), myocardial infarction ( HR 0.66, 95% CI 0.24 to 2.64, P=0.718) or MACCE (HR 0.70, 95% CI 0.65 to 1.32, P=0.674). Results were similar in propensity score-matched analysis.

In this large, prospective, single-center study, patients with beta-blocker prescription appear to have more risk factors. No beta-blockers at discharge is not an independent risk factor of poor prognosis at up to 2 years among stable patients who underwent PCI with adequate LVEF.

To investigate a diffusion weighted imaging (DWI)-based morphological classification for acute isolated pontine infarcts (AIPI) and to assess differences in clinical characteristics, risk factors and functional outcomes among the different morphologies.

All participants from SMART cohort with DWI-proven AIPI were included and categorized into 3 groups: basilar artery branch disease (BABD) group, small artery disease (SAD) group and large-artery-occlusive disease (LAOD) group, according to lesion extent of the transverse axial plane and basilar artery atherosclerosis severity. The clinical characteristics, vascular risk factors and 6-month′s functional outcome was analyzed among 3 groups.

Of the 1 129 patients enrolled, 175 had AIPI. BABD was the most frequent subtype of AIPI (46.3%), followed by SAD (36.0%) and LAOD (17.7%). Neurological impairment on admission was more severe in the LAOD and BABD group than SAD group (P<0.001). In terms of risk factors, the percentage of hypertension was significant different among three groups (P<0.05). The average National Institute of Health stroke scale was 3.49 for SAD group, 5.93 for LAOD group, 5.97 for BABD group, and the differences were significant (P<0.001). The Poor outcome (mRS>2) was found in only 13.7% of patients at 6-month post-stroke and there was no difference among 3 groups.

According to the morphological classification, BABD is the most frequent subtype of AIPI. The differences of the clinical characteristics and risk factors among three groups indicate that differences observed in morphology might have distinct pathophysiologic mechanisms. AIPI can be reliably classified based on morphology using clinical magnetic resonance images.

To explore the effects of menopausal factor on fine anatomy of bladder, urethra and vagina in women undergoing vaginal delivery.

Gynecological patients in Nanfang hospital from January 2013 to October 2016 were collected, and then the patients whose MRI images quality meet the require of reconstruction, with the history of vaginal delivery experience, without any cesarean section experience, and the first labor time was ≤30 years old were enrolled. The patients who had pelvic floor dysfunction when done MRI examinations were excluded. Finally, 238 cases were randomly selected out, and 238 models of data were reconstructed and measured by Mimics and UG software. The independent t test was used to do the comparison between menopausal group and those not yet menopause.

First, we built 238 3D models totally. Second, the parameters related with bladder and urethra: the angle of bladder and urethra, β angle, urethra pubic angle, α angle, retropubic space, the length between bladder neck and edge of pubic midpoint, and urethral striated muscle thickness of menopausal group were bigger than those of pre-menopausal group. While for the urethra tilt angle, the former group was smaller than that of the latter group. But there was no significant statistical differences between two groups. Third, the parameters related with vagina: the proximal urethral vaginal gap of the post-menopause group was smaller than that of pre-menopausal group, while for the middle and distal urethral vaginal gap, the former group was bigger than that of the latter group. The length and width of vaginal anterior wall of the post-menopausal group were smaller than those of pre-menopausal group. Beside the middle urethral vaginal gap, all the difference between two groups had no statistical meaning. The 2D shape of axial vaginal, H type occupation of the former group was obviously lower than that of the latter group.

Menopause has an effect on fine anatomy of pelvic organ. Especially on the shape of vagina, the middle urethral vaginal gap become much wider after menopause, the occupation of shallow concave type become much higher post-menopausal. It means the lateral and backward support function of the urethra and vagina is relatively weakened after menopausal, and the shape of vagina become smaller.

To compare the clinical effects of modified double-lumen drainage tube and traditional silicone tube in external drainage of chronic subdural hematoma.

Selected 49 patients suffering from chronic subdural hematoma hospitalized in the Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College between July 2016 and June 2018 who underwent external drainage, and divided them randomly into experimental groups (using modified brain protection double lumen drainage tube in 23 cases) and control group (using traditional silicone drainage tube in 26 cases). Comparison of postoperative hematoma residual volume, the tube indwelling time, the numbers of drainage tube contact with brain tissue and arachnoid membrane, the numbers of infections, the numbers of postoperative epilepsy cases, and changes in Modified Rankin Scale scores between the two groups.

At the time of extubation, the residual amount of hematoma in the experimental group was (13±7) ml, and that in the control group was (17±8) ml. There was no significantly statistical difference in the residual amount of hematoma between the experimental group and the control group (P>0.05). The tube indwelling time of the experimental group was (2.0±0.9) days, and that of the control group was (2.7±0.8) days. The difference between the experimental group and the control group in the drainage tube indwelling time was statistically significant (P<0.05). No cases of drainage tube contact with brain tissue and/or arachnoid membrane appeared in the experimental group, and 7 cases of drainage tube contact with brain tissue or arachnoid membrane appeared in the control group. No infection occurred in both groups. No cases of epilepsy occurred in preoperative, and there were 0 cases of epilepsy in the experimental group and 1 case in the control group in postoperative. There were significantly statistical differences in each of the two groups in the modified Rankin scale before and after surgery (P<0.001), there was no significant difference in postoperative Modified Rankin Scale scores between the two groups.

The modified brain protection double-lumen drainage tube has good drainage effect in the external drainage of chronic subdural hematoma, and the short tube retention time, causing fewer complications. It is a safe and effective tool for treating chronic subdural hematoma, and it is worthy of clinical promotion.

To investigate the efficacy of CT-guidance interstitial Iodine-125 seed brachytherapy as a salvage therapy for recurrent head and neck carcinoma.

A total of 122 patients who had been treated for recurrent head and neck carcinoma with CT-guided Iodine-125 seed permanent implantation were conducted a retrospective analysis at Peking University Third Hospital from February 2003 to December 2015. The study included 78 male and 44 female patients. Of the 122 patients, 76 had undergone radical surgery, 106 had received EBRT. Among the patients who underwent EBRT, the total dose delivered to PTV ranged from 30 to 140 Gy (median, 68.4 Gy). The actuarial median number of the implanted Iodine-125 seeds was 38 (range, 5-158). The specific activity of Iodine-125 seeds ranged from 14.8 to 28.9 MBq/seed (median, 22.2 MBq). The evaluation of post plan showed the actuarial D90 ranged from 46 to 282 Gy (median, 121 Gy). The overall local control and survival times were determined by using the Kaplan-Meier method from SPSS 13.0.Univariate analysis was performed on the local control rate and overall survival rate.

Tumor responses rate was 75.4%. The median local control time was 10.0 months (95% CI 9.8-24.2 months), and the 1-, 2-, 3-, and 5-year local control were 41.9%, 21.2%, 3.7%, and 3.7%, respectively. Univariate analysis showed that the local control in D90≥120 Gy group had an increasing tendency, but no statistical difference were found. The effect of local control in the squamous cell carcinoma group was slightly worse than that in the non-squamous cell carcinoma group (P=0.032). Multi-factor analysis showed that the effect of local control in the squamous cell carcinoma group was slightly poor (P=0.03). The median survival time was 14 months (95% CI 14.4-35.8 months), and the 1-, 2-, 3- and 5-year survival rate were 51.5%, 34.2%, 19.4%, and 19.4%, respectively. The three factors, such as the tumor responses, KPS status before the seed implantation, and the D90 after the seed implantation, had a tendency to improve the total survival, but there was still no statistical differences. Multivariate analysis showed no clear influence factors.

Interstitial permanent Iodine-125 seed implantation is an effective salvage re-irradiation modality for recurrent head and neck carcinoma after previous surgery and/or EBRT. CT image-guided method could yield the reliable seeds configuration and accurate dose distribution.

To investigate the diagnostic value of MRI for placenta previa complicated with placenta accreta or not.

A total of 220 placenta previa patients were diagnosed by prenatal ultrasound and MRI in The Second Affiliated Hospital of Wenzhou Medical University from May 2014 to May 2017.The MRI images of 220 placenta previa patients suspicious of placenta previa were interpreted by two radiologists who majored on gynecological radiology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of two radiologists in diagnosis of placenta accreta were calculated respectively. Kappa test were used to verify the consistency between two doctors, as well as their MRI diagnosis and pathological results. The diagnostic value of MRI and pathological were assessed by Chi-square test and receiver operating characteristic (ROC)curve.

The 220 patients were all confirmed with placenta previa by surgical pathology.Out of 220, 71 cases were diagnosed as placenta accreta, and 149 cases were diagnosed without placenta accreta. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value with physician A and physician B were 90.1%/84.5%, 88.6%/89.9%, 89.1%/88.2%, 79.0%/80.0% and 95.0%/92.4%, respectively.The consistency between MRI diagnosis and pathological results was excellent in physician A (κ=0.759), and good in physician B (κ=0.734). However, the sensitivity, specificity and accuracy of diagnosis between two physicians had no significant difference (allP>0.05). The area under the curve (AUC) of ROC in physician A and B were 0.858 and 0.847 (P=0.980).

MRI is feasible for patients with placenta previa, as the sensitivity, specificity and accuracy of MRI are high in assessing whether placenta previa complicated with placenta accreta or not.

To explore histological composition of thrombus and clinical effect in mechanical thrombectomy of acute ischemic stroke.

From March 2017 to August 2017 at the Institutes of Biology and Medical Sciences of Soochow University, hematoxylin and eosin (HE) staining was used to quantitatively analyze the composition of thrombus in 58 cases with acute ischemic stroke. The differences in components of thrombus with different TOAST classifications were compared, meanwhile, clinical data such as surgical process and prognosis were also analyzed.

(1) Baseline data: the age of arteriosclerosis was significantly lower than that of cardiogenic (P<0.05). There was statistically significant differences in onset to admission between the two types of stroke of other undetermined etiology (SUE) and Cardioembolism (CE) (P<0.05). (2) Histological composition of thrombus: there were no significant differences in fibrin and red blood cells (RBC) between the two types of SUE and CE thrombus (P>0.05). There were more RBC in LAA thrombus and more fibrin in CE thrombus (P<0.05). (3) Intraoperative data: the time of admission to recanalization of type LAA was longer than that of type CE (P<0.05). (4) Prognosis: there was no significant difference in the good prognosis between the two types of SUE and CE (P>0.05). It is the same between the types of LAA and CE (P>0.05).

LAA thrombus contains more RBC, and cardiogenic thrombus contains more fibrin. Cryptogenic thrombus has the same composition with cardioembolism. The results may help to choose appropriate recanalization technique in different TOAST stroke and have guiding significance for the secondary prevention of SUE stroke.

To investigate whether MRI findings can differentiate renal epithelioid angiomyolipoma (EAML) from renal no-epithelioid (typical) angiomyolipoma.

A total of 44 patients were collected from General Hospital of PLA.These cases were obtained from January 2009 to June 2015.To retrospectively analyze these mainly MRI findings among 12 cases of EAML (age from 27 to 61 years, male 2 cases, female 10 cases, mean age was 46.7 years); 32 cases of renal no-epithelioid AML (age from 34 to 70 years old, male 9 cases, female 23 cases, mean age was 53.4 years old) as case control study. MRI findings included gender, T₂WI, the signal on gross fat, pseudocapsle, necrosis or cystic degeneration, DWI, hemorrhage and the peak in three phases of dynamic enhancement.All data were analyzed statistically using SPSS version 19.0 (IBM, Armonk, NY, USA). χ ² test and a single order chart were used to analyze the enumeration data.

Comparing with renal no-epithelioid angiomyolipoma, minimal fat, necrosis or cystic degeneration and hemorrhage were statistical significance. P values were 0.002, 0.007, 0.025, respectively.Gender, solid components of tumors on T₂WI, the signal of DWI, pesudocapsule and the peak of enhancement had no statistical significance. P values were 0.863, 0.053, 0.479, 0.460, respectively.

Comparing with renal no-epithelioid AML, necrosis or cystic degeneration and hemorrhage with minimal fat are characteristic MRI findings of EAML.

To investigate the effect and mechanisms of picroside Ⅱ on the brain tissue after cerebral ischemia reperfusion(I/R) in rats.

The middle cerebral artery occlusion(MCAO) rat model was established by inserting a monofilament into middle cerebral artery. The experimental rats were treated by injecting picroside Ⅱ intraperitoneally. The modified neurological severity score (mNSS) and body weight were determined before modeling and after reperfusion of 22 h. The cerebral infarct volume was measured by TTC staining and the cerebral water content was measured in rats. At the same time, ROS content and NADPH oxidase activity were detected. The structure of neurons was observed by electron microscope and the mRNA and protein levels of Rac-1 and Nox2 were detected by RT-PCR and Western blotting.

After modeling, the mNSS score was significantly increased (12.6±1.3 vs 0, P<0.001), while the body weight was lost (13.3%±2.5% vs 4.9%±0.8%,P<0.01). The cerebral infarct volume increased obviously (33.5%±3.4% vs 0,P<0.001), brain water content increased significantly (81.5%±0.9% vs 77.7%±0.9%,P<0.05) and the structure of neuron was damaged obviously. The protein and mRNA levels of Rac-1 and Nox2 were significantly increased (P<0.05). After treatment with picroside Ⅱ, mNSS score decreased significantly (7.9±0.8 vs 12.6±1.3,P<0.05) and the body weight increased obviously (9.3%±1.1% vs 13.3%±2.5%,P<0.05). The infarct volume of brain was significantly reduced (18.2%±1.9% vs 33.5%±3.4%,P<0.05), brain water content decreased obviously (79.1%±0.7% vs 81.5±0.9%,P<0.05), the morphological structures of neurons was restored, and the expressions of Rac-1 and Nox2 were significantly decreased (P<0.05).

It is suggested that picroside Ⅱ could exert antioxidation to protect the brain tissue through inhibiting the expression of Rac-1 and Nox2.

To evaluate the clinical effects of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for L_4/5 single-segment lumbar spinal stenosis.

From September 2016 to March 2018, 7 patients with L_4/5 single-segment lumbar spinal stenosis were treated by PE-TLIF in the Department of Orthopedics, Beijing Chaoyang Hospital. There were 1 male and 6 females, with a mean age of (57±13) years(43-77 years). The operation time, intraoperative blood lose, blood transfusion and complications were recorded, and the pain relief effects were evaluated by visual analog scale (VAS) score and Oswestry dability index (ODI). The indexes before and after the operation were compared with t test.

The average of follow-up time was 13.3 months (6-21 months), and the clinical symptoms relieved significantly. The VAS scores of low back pain and leg pain at 3-day postoperatively and at the last follow-up were (2.28±0.48), (1.57±0.53) and (0.42±0.53), (0.14±0.37), respectively; and the VAS scores were significantly improved when compared with those before the operation[(7.42±0.78), (6.14±1.77)](t=19.718, 6.672, 18.520, 7.937, all P<0.05). At the last follow-up, the ODI score was also significantly lower than that before surgery (54%±10% and 15%±9%,t=12.551, P<0.05). During the follow-up period, one patient had transient hyperreflexia after surgery, and the other 6 patients had no significant complications. None nerve root injury or lower extremity paralysis occurred.

PE-TLIF can obtain satisfactory short-term results in the treatment of single-segment lumbar spinal stenosis, with a lower incidence of complications and rapid recovery after surgery.

Initial CD4^＋T cells can differentiate into different helper T cell subsets according to the action of different transcription factors and cytokines. CD4^＋CD25^＋CD127^{dim/ -}Regulatory T cells (Tregs) highly express the transcription factor FoxP3, which inhibits the immune response mainly through the secretion of interleukin (IL) -10 and IL-35; Th17 cells express retinoic acid-associated solitary nuclear receptor γ T (still rare, ROR γ T), which can secrete IL-17 and IL-22 to promote inflammatory response^[1]。 Tregs and Th17 cell imbalance in patients with coronary heart disease^[2], Notch signaling pathway in hepatitis C^[3]immune thrombocytopenia^[4]Asthma, etc.^[5]It can regulate the imbalance of Tregs and Th17 cells in disease, but the study of this regulatory effect in coronary heart disease is rare. Therefore, we observed the effect of Notch signaling pathway on the proportion and function of Tregs and Th17 cells in patients with coronary heart disease, aiming to explore the role of this regulatory process in coronary heart disease.

Total artificial knee arthroplasty (TKA) relieves pain, joint deformities and improves quality of life caused by end-stage knee osteoarthritis (KOA). The surgical technique and perioperative management of TKA have become mature^[1,2]The artificial knee joint prosthesis is also increasingly improved in terms of material science and prosthesis design. In terms of the service life of the prosthesis, 90% to 95% of patients can use it for more than 20 years^[3,4]Thus, it is called one of the most successful procedures in orthopedic orthopedics. However, although the surgical technique of TKA has become more mature and standardized, as well as good perioperative management and postoperative rehabilitation guidance, a considerable number of patients have not achieved postoperative satisfaction^[5]And even reported dissatisfaction rate of 28.3%^[6]。 Among them, some patients failed to achieve the purpose of relieving pain, improving function and improving quality of life after surgery, and some patients had unknown reasons. The study found that this may be related to the psychological state of patients^[7]。 This article mainly summarizes the relationship between psychological state and satisfaction during perioperative period of TKA and the research status of psychological intervention, and discusses the influence of psychological factors on the postoperative effect of TKA, so as to enhance the emphasis of orthopedic surgeons on the psychological state of patients and improve the postoperative satisfaction of patients.

Glioma is the most common and aggressive primary malignant tumor in the central nervous system. It has the characteristics of high recurrence rate, short survival time and poor effect of conventional treatment. The classical theory suggests that the high heterogeneity of glioma cells is highly correlated with the malignant characteristics of the tumor^[1]。 The immune system also plays an important role in different stages of tumor development. It was found that the changes of glucose metabolism in tumor environment are highly correlated with the occurrence and progression of tumor. Global metabolic analysis has confirmed that the metabolic remodeling of tumor cells can promote the progression of glioma, and metabolic changes play an important role in immune regulation^[2]。 Application of metabolic-related node inhibitors can eliminate tumor-mediated immunosuppression and significantly improve the clinical prognosis of patients^[3]。 The correlation between glioma metabolic remodeling and tumor immunosuppression is reviewed as follows.