Interactions among tumors, nerves, and immune cells influence cancer progression, but the mechanisms coordinating these compartments remain incompletely understood. Bioelectric signaling has been proposed as an additional coordinating layer, yet direct in vivo evidence for a tumor–nerve–immune electrical axis remains limited. In non-tumor models, RUSH3D-HR enables mesoscale in vivo imaging of dynamic cellular behaviors, including neutrophil swarming and migrasome dynamics, and has revealed reduced splenic neutrophil swarming following electroacupuncture at Zusanli (ST36). These observations provide dynamic cellular readouts and demonstrate an intervention-associated response; however, the platform does not directly measure membrane voltage, ionic currents, or electric fields, and these findings establish neither electrical coupling nor a specific neural circuit. In this mini review, we examine the proposed axis as a focused, falsifiable complement to broader cancer neuroscience. We distinguish direct observations from mechanistic hypotheses, consider established biochemical explanations involving neurotransmitters and inflammatory mediators, and discuss how context-dependent neural effects, supporting glial cells, opioids, and cancer-induced nerve injury may modify tumor–nerve–immune interactions. We then outline a staged experimental roadmap in tumor models, integrating RUSH3D-HR with voltage and ion reporters, extracellular electrophysiological recordings, and compartment-specific perturbations. This framework prioritizes temporal relationships, identification of candidate signal sources and responding compartments, and causal tests that discriminate electrical contributions from biochemical and systemic effects. Establishing reproducible links between electrical measurements, cellular behavior, and tumor outcomes will be essential for evaluating the axis. Until such evidence is obtained, the tumor–nerve–immune electrical axis should be regarded as a hypothesis-generating experimental program rather than a validated physiological circuit.

Human serum albumin (HSA) is a multifunctional carrier protein that helps maintain vascular barrier integrity and intravascular fluid homeostasis and has long been used in the management of critically ill patients, including those with acute brain injury. HSA is thought to exert neuroprotective effects through four complementary mechanisms: oncotic/volume expansion and hemodilution, antioxidant and anti-inflammatory effects, HSA-nitric oxide-mediated antithrombotic activity, and glycocalyx stabilization, although the precise pathways remain incompletely understood. Despite its biological rationale, the clinical efficacy of HSA in severe neurological disorders remains inconclusive, and few guidelines provide specific recommendations for its use in neurological care. This uncertainty stems primarily from the complex etiology and heterogeneous pathophysiology of neurological disorders, as well as inconsistent findings across existing studies. This narrative review aims to summarize the current evidence on HSA use in traumatic brain injury, acute ischemic stroke, and aneurysmal subarachnoid hemorrhage, identify existing knowledge gaps, and provide insights for future research and clinical practice. We screened records from PubMed, Embase, the Cochrane Library, CNKI, and Yiigle, as well as ClinicalTrials.gov, ChiCTR, and ChinaDrugTrials. A total of 29 human and animal studies were included. Collectively, available evidence supports a biological rationale for HSA therapy in neurocritical care, yet its clinical benefit remains incompletely established and substantial challenges persist. Prospective randomized controlled trials are warranted to clarify the efficacy and safety of HSA and determine whether preliminary encouraging findings can inform standardized guidelines and expert consensus recommendations, particularly regarding optimal concentration, timing, and patient selection.

Standardized pathologic sampling and reporting are essential for pancreatic cancer staging, prognosis assessment, and comparable clinical data. This guideline aimed to develop evidence-based recommendations for standardized pathologic sampling and diagnostic reporting of pancreatic cancer in China. Literature searches were conducted in English and Chinese databases, guideline websites, Google, and reference lists for records published before December 31, 2023. Two investigators screened and extracted the evidence; methodological quality and certainty were assessed using AMSTAR/AGREE II and GRADE, respectively; and recommendations were formulated through two rounds of modified Delphi consultations, with an agreement threshold of ≥ 75% for consensus. The final guideline includes 11 recommendations, including six strong and five weak recommendations, addressing margin and surface assessment, sampling methods, histologic classification and grading, lymphovascular and perineural invasion, TNM staging, tumor regression grading after neoadjuvant therapy, background lesions, and structured reporting. These recommendations provide a standardized framework for pathologic assessment and reporting of pancreatic cancer resection specimens and may support more consistent prognostic evaluation and clinical decision-making.

Watertight-intent dural reconstruction may reduce incisional cerebrospinal fluid (CSF) leakage after decompressive craniectomy but may prolong surgery. We aimed to evaluate whether watertight-intent reconstruction, compared with non-watertight management, was associated with direct postoperative incisional CSF leakage and operative time.

Five databases were searched through August 1, 2026. Comparative studies with explicit watertight or sealing-intent reconstruction and non-watertight comparators were included. The primary outcome was direct incisional CSF leakage; secondary outcomes included operative time, wound or surgical-site infection, hydrocephalus, mortality, and functional outcomes. Binary outcomes were expressed as risk ratios (RRs), and continuous outcomes as mean differences. Random-effects meta-analysis used restricted maximum likelihood estimation with Wald 95% confidence intervals (CIs); randomized and observational studies were examined as subgroups, with Hartung–Knapp sensitivity analyses. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.

Twelve studies were included; nine (1,314 participants) reported direct incisional CSF leakage. Watertight-intent reconstruction was associated with fewer reported leaks (RR, 0.54; Wald 95% CI, 0.34–0.86; I² = 23.3%), although the prediction interval included the null value (0.24–1.20). The randomized subgroup was imprecise (RR, 0.75; 95% CI, 0.32–1.73), whereas the observational subgroup favored reconstruction (RR, 0.43; 95% CI, 0.20–0.90); its Hartung–Knapp interval (0.14–1.32) crossed 1. Infection and hydrocephalus estimates were imprecise; mortality and function were not pooled. Reconstruction was associated with longer operative time (mean difference, 39.85 minutes; 95% CI, 25.14–54.56; I² = 97.4%). Certainty was very low for all key outcomes.

Watertight-intent reconstruction is associated with fewer reported incisional CSF leaks and longer operations, although certainty is very low. Limited study and event numbers, imprecise design subgroups, and multicomponent techniques preclude causal or universal treatment conclusions. Effects on infection, hydrocephalus, mortality, and function remain uncertain.

Head, thoracic, abdominal, and pelvic polytrauma is clinically complex and requires coordinated multidisciplinary care, creating an urgent need for standardized guidance. This guideline aims to provide an evidence-based foundation and clinical pathway for the diagnosis, assessment, damage control, surgical timing, and acute-phase management of patients with head, thoracic, abdominal, and pelvic polytrauma. Led by the Senior Department of Neurosurgery, Chinese PLA General Hospital, a multidisciplinary working group comprising experts in thoracic surgery, general surgery, orthopedics, critical care medicine, anesthesiology, radiology, emergency medicine, nursing, and related disciplines developed the guideline through systematic review of the relevant literature, consideration of the characteristics of trauma care in China’s military and civilian medical systems, and two rounds of expert voting and consensus decision-making. The guideline addresses 22 key clinical questions covering imaging assessment, damage-control resuscitation, prioritization of craniocerebral and torso injury management, anticoagulation and hemostatic management, intensive care, and early rehabilitation. A total of 22 recommendations were formulated by integrating evidence quality, clinical feasibility, and implementability, together with corresponding implementation points and quality-control indicators. The guideline emphasizes stabilization of vital signs, damage-control principles, multidisciplinary collaboration, standardized clinical pathways, and a tiered trauma-care system. Implementation of these recommendations may improve the consistency and timeliness of multidisciplinary care and provide a framework for reducing early mortality while preserving neurological and functional outcomes.

The widespread assumption that “natural” equals “safe” has been repeatedly challenged by adverse events associated with medicinal plant-derived products. Unlike synthetic pharmaceuticals, these natural products present distinct safety concerns because of their compositional complexity, inherent variability, and batch-to-batch inconsistency. Consequently, a one-size-fits-all approach to toxicological assessment is insufficient. In this narrative review, we propose a pragmatic “classify-then-evaluate” framework that stratifies natural products into three operational categories according to compositional complexity and degree of chemical characterization—TCM compound formulae, active fractions/extracts, and purified single compounds. This framework enables safety evaluations to be tailored to product complexity by integrating conventional toxicological assays with emerging new approach methodologies. By linking chemical characterization, hazard identification, quality control, and risk assessment within a tiered system, this framework bridges the gap between evidence generation and regulatory decision-making, offering a scientifically grounded and proportionate pathway for evaluating the safety of natural products used in integrative medicine, with a primary focus on herbal and TCM-related products. The review does not aim to provide a comprehensive systematic evidence map; further validation of the proposed framework is required

Therapeutic hypothermia (TH) is widely used as a neuroprotective strategy, but variability in bedside implementation may limit its optimal application. This study aimed to develop a standardized TH management protocol for patients with neurocritical illness and evaluate the clinical outcomes associated with its implementation.

An evidence-based TH protocol was developed through a two-round Delphi consensus process. A subsequent observational before-and-after study included 244 patients with neurocritical illness receiving TH. The historical control group (n = 120) received routine care, whereas the TH protocol group (n = 124) was managed according to the standardized protocol. No single primary endpoint was prespecified for the final comparative analysis. Outcomes were interpreted as exploratory and included temperature-management process indicators, individual TH-related complications requiring intervention, and neurological outcomes assessed using the Glasgow Outcome Scale.

Protocol implementation was associated with more favorable temperature-management process indicators, including earlier TH initiation, a shorter recorded time to target temperature, fewer unplanned treatment interruptions, a longer controlled rewarming phase, and greater adherence to rewarming criteria. In exploratory analyses, the TH protocol group had lower incidences of selected TH-related complications and more favorable Glasgow Outcome Scale outcomes at discharge than the historical control group.

Implementation of a consensus-derived TH management protocol was associated with more consistent temperature-management processes, fewer selected TH-related complications, and more favorable short-term neurological outcomes. These findings support prospective evaluation of protocolized TH management in larger multicenter cohorts.

Large-scale critical care databases have expanded opportunities for clinical research. Previous reviews have summarized open-access intensive care unit databases and specific analytical methods, but integrated, practice-oriented guidance on commonly used and emerging methods and their selection remains limited. The objective of this narrative review is to provide a practice-oriented overview of commonly used and emerging statistical and modeling methods in critical care database research, with emphasis on their appropriate applications, strengths, limitations, and considerations for method selection. This narrative review summarizes commonly used and emerging methods in critical care database research, focusing on their applications, strengths, limitations, and practical considerations. The methods reviewed range from descriptive and regression analyses to prediction modeling, longitudinal analysis, causal inference, and artificial intelligence-based approaches. Common problems include missing data, temporal bias, confounding, overfitting, and limited external validation. Careful method selection and appropriate validation are therefore important when working with complex critical care data. Closer coordination of clinical questions, data structures, analytical methods, and reporting standards can strengthen research using intensive care unit databases. Paying closer attention to data quality, causal hypotheses, validation, reproducibility, and generalizability may improve the methodological rigor and translational value of these studies.