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Traumatic brain injury (TBI) management in low resources settings is the challenges toward the worldwide healthcare system. The low resources settings increase the difficulties of improving the workflow of TBI. Under the low resources settings, the prehospital rescue, emergency treatment, surgical operation, intensive care management and early rehabilitation exhibit the unique profile different with common settings. Clinical doctors should pay highest attention to the local healthcare resource providing and implement proper strategies to provide efficient treatment on TBI patients. [ABSTRACT FROM AUTHOR]

【Abstract】 Objective: To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury (TBI) mentioned in Cochrane System-atic Reviews published in the Cochrane Database of Sys-tematic Reviews (CDSR). Methods: An exhausted literature search for all pub-lished Cochrane Systematic Reviews discussing therapeu-tic rather than prevention or rehabilitative interventions of TBI was conducted. We retrieved such databases as CDSR and Cochrane Injury Group, excluded the duplications, and eventually obtained 20 results, which stand for critical ap-praisal for as many as 20 different measures for TBI patients. The important data of each systematic review, including total population, intervention, outcome, etc, were collected and presented in a designed table. Besides, we also tried to find out the possible weakness of these clinical trials in-cluded in each review. Results: Analysis of these reviews yielded meanfuling observations: (1) The effectiveness of most ordinary treat-ments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful, and tranexamic acid, nimodipine and progesterone show a promising effect in bleeding trauma, traumatic subarachnoid hemorrhage, TBI or severe TBI. (2) A majority of the systematic reviews in-clude a small number of clinical trials and the modest num-bers of patients, largely due to the uncertainty of the effectiveness. (3) The quality of most trials reported in the systematic reviews is more or less questionable. (4) In addition, lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Sys-tematic Reviews. Conclusions: For clinical physicians, to translate these conclusions into practice with caution is essential. Basic medication and nursing care deserve additional attention as well and can be beneficial. For researchers, high quality trials with perfect design and comprehensive consideration of various factors are urgently required. Key words: Brain injuries; Meta-analysis; Review; Acute management

Summary: Aims: Ferroptosis, a new form of iron‐dependent programmed cell death, has been shown to be involved in a range of diseases. However, the role of ferroptosis in traumatic brain injury (TBI) has yet to be elucidated. We aimed to investigate whether ferroptosis is induced after TBI and whether the inhibition of ferroptosis would protect against traumatic brain injury in a controlled cortical impact injury (CCI) mouse model. Methods: After establishing the TBI model in mice, we determined the biochemical and morphological changes associated with ferroptosis, including iron accumulation with Perl's staining, neuronal cell death with Fluoro‐Jade B (FJB) staining, iron metabolism dysfunction with Western blotting, reactive oxygen species (ROS) accumulation with malondialdehyde (MDA) assays, and shrunken mitochondria with transmission electron microscopy. Furthermore, a specific inhibitor of ferroptosis, ferrostatin‐1(fer‐1), was administrated by cerebral ventricular injection after CCI. We used cresyl violet (CV) staining to assess lesion volume, along with the Morris water maze and beam walk test to evaluate long‐term outcomes. Results: TBI was followed by iron accumulation, dysfunctional iron metabolism, the upregulation of ferroptosis‐related genes, reduced glutathione peroxidase (GPx) activity, and the accumulation of lipid‐reactive oxygen species (ROS). Three days (d) after TBI, transmission electron microscopy (TEM) confirmed that the mitochondria had shrunk a typical characteristic of ferroptosis. Importantly, the administration of Fer‐1 by cerebral ventricular injection significantly reduced iron deposition and neuronal degeneration while attenuating injury lesions and improving long‐term motor and cognitive function. Conclusion: This study demonstrated an effective method with which to treat TBI by targeting ferroptosis. [ABSTRACT FROM AUTHOR]

In 2019, after Delphi consultation and on-site discussion, the international expert team formed an international consensus on the management algorithm of traumatic brain injury (TBI) patients with intracranial pressure (ICP) monitoring. The consensus aims to guide the implementation of reasonable tiered clinical treatment for patients with TBI who only underwent ICP monitoring. In this paper, the consensus involved in the tiered management process of intracranial hypertension monitoring and the judgment process of withdrawing ICP monitoring and sedation holiday were interpreted, in order to introduce the progress in the field of TBI to the readers. [ABSTRACT FROM AUTHOR]