Background Progressive supranuclear palsy is a neurodegenerative condition that worsens over time. Given the lack of targeted treatments, patients with severe progressive supranuclear palsy have very low life expectancy. Case presentation We present a case of a 61-year-old Chinese man with severe progressive supranuclear palsy and treated with umbilical cord blood stem cells transplantation. After the umbilical cord blood stem cells therapy, his neurologic symptoms stopped deteriorating, his muscle rigidity was mildly improved, and he remains alive for more than 8 years. Conclusions Umbilical cord blood stem cells transplantation may be an alternative therapy for patients with severe progressive supranuclear palsy.

Background: Currently there is variability in diagnostic procedures across countries. Our aim was to compare guidelines of brain death determination in adults among five countries: China, UK, US, France, and Germany.Method: This is a retrospective study based on a prospective database of consecutive coma patients who received brain death determination. The technical specifications, completion rates, and positive rates of brain death determination according to criteria of different countries were compared. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each ancillary test for the identification of brain death diagnosed according to different criteria were investigated.Results: One hundred and ninety-nine patients who received brain death determination from June 2018 to June 2020 were included in this study. One hundred and thirty-one (65.8%) patients were diagnosed with brain death according to French criteria, 132 (66.3%) according to Chinese criteria, and 135 (67.7%) according to criteria of US, UK, and Germany. The sensitivity and PPV of EEG (92.2% - 92.3%) and SLSEP (95.5% - 98.5%) were higher than TCD (84.3% - 86.0%), and all these three tests have a very low specificity and NPV.Conclusions: The duration of apnea test and requirements of ancillary tests vary among countries. The discrepancy in brain death determination between clinical assessments and additional confirmation of ancillary tests is small.

Background: Currently there is variability in diagnostic procedures across countries. Our aim was to compare guidelines of brain death determination in adults among ve countries: China, UK, US, France, and Germany.Method: This is a retrospective study based on a prospective database of consecutive coma patients who received brain death determination. The technical speci cations, completion rates, and positive rates of brain death determination according to criteria of different countries were compared. The accuracy, sensitivity, speci city, positive predictive value (PPV), and negative predictive value (NPV) of each ancillary test for the identi cation of brain death diagnosed according to different criteria were investigated.Results: One hundred and ninety-nine patients who received brain death determination from June 2018 to June 2020 were included in this study. One hundred and thirty-one (65.8%) patients were diagnosed with brain death according to French criteria, 132 (66.3%) according to Chinese criteria, and 135 (67.7%) according to criteria of US, UK, and Germany. The sensitivity and PPV of EEG (92.2% -92.3%) and SLSEP (95.5% -98.5%) were higher than TCD (84.3% -86.0%), and all these three tests have a very low speci city and NPV.Conclusions: The duration of apnea test and requirements of ancillary tests vary among countries. The discrepancy in brain death determination between clinical assessments and additional con rmation of ancillary tests is small. BackgroundThe concept of death has been a philosophical debate as well as a medical controversy for millennia. The rapid development of technology in life support continues to blur the line between life and death. A major confusion among the public is the difference between death of the person and death of the human organs. In 1968, the Harvard Ad Hoc Committee proposed that death of the individual could be determined as the cessation of brain function (irreversible coma), despite the persistent respiration and circulation supported by mechanical ventilation 1 . This visionary widely accepted concept opened up the avenue for exploring criteria and tools for brain death determination.Most countries have implemented laws giving a legal de nition of brain death, however, the legalization of brain death is still on the way in China 2 . Medical consensuses have been reached across countries that the determination of brain death is to diagnose the irreversible cessation of the entire brain function by con rming the absence of consciousness due to a known cause, brainstem re exes, and spontaneous breath. Only in the United Kingdom, brain death was de ned as the irreversible cessation of brain-stem function 3,4 . On the operational level, there are still a few disparities in the diagnostic procedures across countries. In this study, we compared national guidelines of brain death in adults among ve countries with different criteria: China, United Kingdom (UK), United States (US), France, and Germany. Methods Study designThis retrospective study was based on a prosp...

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Background Stroke is currently the second most common cause of death and disability-adjusted life years worldwide. However, there have been few comprehensive models reported for evaluating the short-term mortality of acute moderate and severe stroke patients. In this study, we aimed to investigate blood-based biomarkers of inflammation, immunity, nutritional metabolism and blood brain barrier damage at the early stages, explore the association of these biomarkers with 30-day mortality in acute moderate and severe stroke patients, and develop a nomogram specifically for 30-day mortality prediction in these patients. Methods A prospective observational study was conducted, enrolling 152 acute stroke patients (including acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH)) who had NIHSS ＞14 or GCS＜8. The study was conducted between January 2020 and November 2022 in the neurological intensive care unit (NICU), and patients were consecutively enrolled. The laboratory parameters and clinical characteristics of the patients were collected by the research team. Blood biomarkers, including IL-10, MIP-1β, TNF-α, nNOS, iNOS, MMP-9, S-100β, and ET-1, were measured using ELISA within the first 24 hours following symptom onset. The least absolute shrinkage and selection operator (LASSO) regression optimized predictive clinical, biomarker, and combined models.Univariate and multivariate logistic regression analyses were performed to construct a nomogram model for predicting the 30-day mortality risk of acute moderate and severe stroke patients.The bootstrapping validation method, a resampling technique, was used to internally validate the nomogram model. The performance of the nomogram was evaluated on the basis of its calibration, discrimination, and clinical usefulness. Results The 30-day mortality rate of acute moderate and severe stroke patients in the neurological intensive care unit (NICU) was 23.68%. Surviving stroke patients showed lower neutrophils, neutrophil-to-lymphocyte ratio (NLR), platelet count/platelet volume ratio (PPR), procalcitonin (PCT), IL-6, IL-10, TNF-α, and higher lymphocytes/monocytes ratio(LMR), lymphocytes than non-surviving patients, while there were no significant differences in monocyte, albumin, prealbumin, transferrin, MIP-1β, nNOS, iNOS, MMP-9, S-100β and ET-1 between non-surviving and surviving patients. The LASSO regression identified 3 variables (IL-10 (P<0.001), NIHSS (P=0.015) and cerebral herniation (P<0.001)), and a predictive model of 30-day mortality in acute moderate and severe stroke patients was subsequently established. The area under the curve (AUC) of the predictive model was 0.885 (95% CI: 0.808-0.963). The model achieved a concordance index of 0.877 [95% CI (0.775, 0.979)] and had a well-fitted calibration curve and good clinical application value. Conclusions This study found that blood biomarkers, including neutrophils, NLR, PPR, PCT, IL-6, IL-10, TNF-α, LMR, and lymphocytes measured within the first 24 hours following symptom onset, were associated with 30-day mortality in acute moderate and severe stroke patients. Specifically, higher levels of IL-10 exhibited a greater predictive power.Furthermore, we constructed a predictive nomogram model, which may facilitate early prognosis identification, enhance communication between patients and clinicians, and improve patient management.