In recent years, survival rate of patients with severe brain injury has been improved with the development of emergency care skills, yet disorders of consciousness (DoC) patients still have poor outcome and need prolonged life support, burdening the families and society. There are still deficiencies in precise diagnosis, individualized treatment and end-of-life decision-making. Based on this, we give the following propositions: promoting multimodal assessment to reduce misdiagnosis; developing individualized plans based on assessment results, stratifying and managing patients at acute or chronic phases, classifying and managing patients with different consciousness levels, improving the legal and ethical framework, scientifically assessing end-of-life decisions, and implementing comprehensive care with multidisciplinary collaboration to enhance DoC patients' quality of life.

In recent years, survival rate of patients with severe brain injury has been improved with the development of emergency care skills, yet disorders of consciousness (DoC) patients still have poor outcome and need prolonged life support, burdening the families and society. There are still deficiencies in precise diagnosis, individualized treatment and end-of-life decision-making. Based on this, we give the following propositions: promoting multimodal assessment to reduce misdiagnosis; developing individualized plans based on assessment results, stratifying and managing patients at acute or chronic phases, classifying and managing patients with different consciousness levels, improving the legal and ethical framework, scientifically assessing end-of-life decisions, and implementing comprehensive care with multidisciplinary collaboration to enhance DoC patients' quality of life.

Near-death experience is a unique consciousness, a self-related, mysterious and unexplainable experience, which occurs in life-threatening and non-life-threatening situations, and could be classified as"classical near-death experiences"and"near-death-like experiences (NDEs-like)", respectively. The classical near-death experience corresponds to the internal awareness experienced in unresponsive conditions, which can be used to explore the disconnected states of consciousness of human beings. Meanwhile, the near-death-like experience is a more heterogeneous state, which brings more possibilities for future research. This article reviews the research progress of near-death experiences in different situations, such as cardiac arrest, syncope and meditative state, etc. Researchers found that people with rapid eye movement invasion are more likely to have NDEs and ketamine-induced general anesthesia can be used as a reversible and safe experimental model. Although many physiological and psychological explanations of near-death experiences have been proposed, the definition of the phenomenon, the mechanisms by which it occurs and the identification of near-death experiences remain controversial. Research on near-death experiences in China is still in its infancy. As a field of consciousness research, near-death experiences can be used to explore the mechanism of human consciousness in an unresponsive state, and to provide a new direction for the scientific research of clinical consciousness.

Near-death experience is a unique consciousness, a self-related, mysterious and unexplainable experience, which occurs in life-threatening and non-life-threatening situations, and could be classified as"classical near-death experiences"and"near-death-like experiences (NDEs-like)", respectively. The classical near-death experience corresponds to the internal awareness experienced in unresponsive conditions, which can be used to explore the disconnected states of consciousness of human beings. Meanwhile, the near-death-like experience is a more heterogeneous state, which brings more possibilities for future research. This article reviews the research progress of near-death experiences in different situations, such as cardiac arrest, syncope and meditative state, etc. Researchers found that people with rapid eye movement invasion are more likely to have NDEs and ketamine-induced general anesthesia can be used as a reversible and safe experimental model. Although many physiological and psychological explanations of near-death experiences have been proposed, the definition of the phenomenon, the mechanisms by which it occurs and the identification of near-death experiences remain controversial. Research on near-death experiences in China is still in its infancy. As a field of consciousness research, near-death experiences can be used to explore the mechanism of human consciousness in an unresponsive state, and to provide a new direction for the scientific research of clinical consciousness.

Objective To assess the pain of patients with disorders of consciousness(DOC) and e-valuate the reliability and validity of Chinese version of Nociception Coma Scale- revised ( NCS-R). Meth-ods Sixty-two patients with disorders of consciousness were assessed by NCS-R and the internal reliability, inter-rater reliability,test-retest reliability and concurrent validity was analyzed. Results Cronbach's alpha (α) of internal reliability was 0. 611, test-retest reliability for the NCS-R total scores by spearman was 0. 884. For the subscales,the reliability for the motor,verbal and facial subscale scores by Cronbach's kappa were 0. 856,0. 870 and 0. 856 respectively. Inter-rater reliability for the NCS-R total scores by spearman was 0. 662. For the subscales,the reliability for the motor,verbal and facial subscale scores by Cronbach's kappa were 0. 962,0. 867 and 0. 671 respectively. The spearman coefficient of concurrent validity was 0. 560 (all P<0. 01). Conclusion The NCS-R is a good valid scale and available for Chinese clinician and researchers to assess the pain of DOC patients.