Hongyu Xie

Accurate differentiation between unresponsive wakefulness syndrome/vegetative state (UWS/VS) and minimally conscious state or emergence from the minimally conscious state (MCS/EMCS) remains clinically challenging in prolonged disorders of consciousness (pDoC), particularly when behavioral responses fluctuate or motor output is limited. We investigated whether short-term heart rate variability (HRV) responses to a standardized 40-Hz auditory perturbation could provide complementary bedside physiological information. Fifty-five patients with pDoC underwent a 10-minute protocol consisting of a 5-minute resting baseline followed by 5 minutes of binaural 40-Hz amplitude-modulated auditory stimulation, with continuous ECG recording. Resting HRV features showed no clear group-level separation between UWS/VS and MCS/EMCS, whereas stimulus-evoked time-domain changes, particularly ΔNN50 and ΔpNN50, differed between groups after false-discovery-rate correction. Exploratory logistic regression models based on NN50- and pNN50-related response features showed measurable internal held-out test performance. These findings suggest that standardized auditory-evoked HRV dynamics may provide a low-burden physiological complement to repeated Coma Recovery Scale-Revised assessment. The results remain exploratory and require validation in larger independent cohorts.

BACKGROUND Chlorfenapyr poisoning is a highly lethal condition that damages high-energy-demand organs such as the central nervous system. Only a few surviving patients have been reported. Survivors may develop focal neurological symptoms, including motor and urinary dysfunction, and the prognosis for these deficits remains unclear. CASE REPORT A 55-year-old man developed chest tightness, profuse sweating, dyskinesia, and paresthesia in both lower limbs, as well as urinary dysfunction, after working for 2 months in a chlorfenapyr production facility. Laboratory toxicology tests confirmed chlorfenapyr and its metabolite in his blood. Magnetic resonance imaging showed diffuse leukoencephalopathy and thoracic cord edema. After repeated detoxification, the patient became clinically stable and was transferred to the Rehabilitation Department of our hospital. Magnetic resonance imaging on admission revealed resolution of central nervous system lesions. After 2 months of pharmacologic treatment, intensive physical therapy, and neuromodulation, the patient progressed from being unable to stand to walking independently, and from indwelling catheterization to voluntary urination. However, abnormal sensations in the lower limbs and excessive sweating showed no significant improvement. CONCLUSIONS This case demonstrates the reversibility of chlorfenapyr-induced leukoencephalopathy and spinal cord lesions. It indicates that chlorfenapyr poisoning-induced motor and urinary dysfunction can be substantially improved through early and multidisciplinary rehabilitation. The persistence of abnormal sensations and sweating suggests that further investigation is required to clarify the underlying mechanisms and optimize management of these symptoms.

Diagnosing prolonged disorders of consciousness (DoC) remains a significant challenge in neurorehabilitation. Heart rate variability (HRV), a noninvasive measure of cardiac autonomic regulation, has been increasingly recognized as relevant to the mechanisms underlying consciousness. However, long-term HRV data in DoC patients remain scarce. This study aimed to investigate the relationship between long-term HRV metrics and the severity of consciousness impairment in patients with prolonged DoC. In this cross-sectional study, 49 patients with prolonged DoC were enrolled. Each participant underwent five assessments using the Coma Recovery Scale-Revised (CRS-R) and one 24-hour electrocardiographic (ECG) monitoring session within one week of enrollment. Based on their highest CRS-R subscale scores, patients were categorized into three groups: unresponsive wakefulness syndrome (UWS, n = 17), minimally conscious state (MCS, n = 19), and emergence from MCS (EMCS, n = 13). HRV time-domain and frequency-domain indices were extracted from the 24-hour ECG recordings. Differences in HRV metrics among the consciousness groups were analyzed, and correlations between HRV parameters and CRS-R scores were examined. Significant differences in HRV metrics were observed among the three consciousness groups (P < 0.05), including both time-domain indices (SDNN, SDANN, SDNN Index) and frequency-domain indices (HF, LF, VLF, ULF, and Total power). Furthermore, these HRV indices were significantly correlated with CRS-R scores (P < 0.05), indicating a strong association between autonomic function and the level of consciousness. Long-term HRV monitoring reveals significantly greater heart rate variability in EMCS patients compared to those in UWS and MCS, highlighting its potential utility as a supplementary biomarker for assessing consciousness in patients with prolonged DoC.

Objectives: This study aimed to investigate how motor preparation impacted brain activation in individuals with differing cognitive statuses. Methods: We investigated the cortical activation pattern of 57 individuals with mild cognitive impairment (MCI) and 67 healthy controls (HCs) using functional near-infrared spectroscopy (fNIRS) during prepared walking (PW) and single walking (SW) tasks. The study focused on assessing brain activity in four regions of interest (ROIs): the prefrontal cortex (PFC), primary motor cortex, secondary motor cortex, and parietal lobe. Additionally, we examined the behavioral performance—gait speed—during the tasks, analyzed variations in cortical activation intensity, and conducted correlation analyses between Montreal Cognitive Assessment (MoCA) scores, gait speed, and oxygenation levels. Results: There was no significant difference in gait speed between patients with MCI and HCs. The MCI group exhibited lower activation in the primary motor cortex, secondary motor cortex, and parietal regions compared to HCs during the motor execution stage of PW (q < 0.05, FDR-corrected). Additionally, activation in the primary (r = 0.23, p = 0.02) and secondary motor cortices (r = 0.19, p = 0.04) during the motor execution stage of PW correlated significantly with MoCA scores. Furthermore, brain activity in the PFC (r = 0.22, p = 0.02), primary motor cortex (r = 0.22, p = 0.01), secondary motor cortex (r = 0.20, p = 0.02), and parietal lobe (r = 0.19, p = 0.03) during the motor preparation stage of gait was positively correlated with gait speed. Conclusions: Our results revealed that preparing for motor tasks modulated the neural activation patterns of patients with MCI and HCs without affecting their behavioral performance.

Background: This study investigates the reliability of functional near-infrared spectroscopy (fNIRS) in detecting resting-state brain network characteristics in patients with mild cognitive impairment (MCI), focusing on static resting-state functional connectivity (sRSFC) and dynamic resting-state functional connectivity (dRSFC) patterns in MCI patients and healthy controls (HCs) without cognitive impairment. Methods: A total of 89 MCI patients and 83 HCs were characterized using neuropsychological scales. Subject sRSFC strength and dRSFC variability coefficients were evaluated via fNIRS. The study evaluated the feasibility of using fNIRS to measure these connectivity metrics and compared resting-state brain network characteristics between the two groups. Correlations with Montreal Cognitive Assessment (MoCA) scores were also explored. Results: sRSFC strength in homologous brain networks was significantly lower than in heterologous networks (p < 0.05). A significant negative correlation was also observed between sRSFC strength and dRSFC variability at both the group and individual levels (p < 0.001). While sRSFC strength did not differentiate between MCI patients and HCs, the dRSFC variability between the dorsal attention network (DAN) and default mode network (DMN), and between the ventral attention network (VAN) and visual network (VIS), emerged as sensitive biomarkers after false discovery rate correction (p < 0.05). No significant correlation was found between MoCA scores and connectivity measures. Conclusions: fNIRS can be used to study resting-state brain networks, with dRSFC variability being more sensitive than sRSFC strength for discriminating between MCI patients and HCs. The DAN-DMN and VAN-VIS regions were found to be particularly useful for the identification of dRSFC differences between the two groups. Clinical Trial Registration: ChiCTR2200057281, registered on 6 March, 2022; https://www.chictr.org.cn/showproj.html?proj=133808.

Few standardized tools are available for evaluation of disorders of consciousness (DOC). The potential of heart rate variability (HRV) during head‐up tilt (HUT) test was investigated as a complementary evaluation tool. Twenty‐one DOC patients and 21 healthy participants were enrolled in this study comparing clinical characteristics and HRV time‐ and frequency‐domain outcomes and temporal changes during HUT test. During the 1st–5th min of the HUT, DOC group showed a significant increase and decrease in log low frequency (LF) (p = 0.045) and log normalized high frequency (nHF) (p = 0.02), respectively, compared to the supine position and had lower log normalized LF (nLF) (p = 0.004) and log ratio of low‐to‐high frequency (LF/HF) (p = 0.001) compared to healthy controls. As the HUT continued from the 6th to the 20th min, DOC group exhibited a significant increase in log LF/HF (16th–20th min) (p < 0.05), along with a decrease in log nHF (6th–10th and 16th–20th min) (p < 0.05) and maintained lower log LF, log nLF, and log LF/HF than controls (p < 0.05). 1st–10th min after returning to the supine position, DOC group demonstrated a significant decrease in log nHF (p < 0.01) and increases in log LF/HF (p < 0.01) and had lower log LF (p < 0.01) and log nLF (p < 0.05) compared to controls. In contrast, the control group exhibited a significant decrease in log nHF (p < 0.05) and increase in log LF/HF (p < 0.05) throughout the entire HUT test. Notably, no significant differences were observed when comparing time‐domain outcomes reflecting parasympathetic nervous system between the two groups. HRV during HUT test indicated a delayed and attenuated autonomic response, particularly in the sympathetic nervous system, in DOC patients compared with healthy individuals.

Background: Subcortical white matter lesions are exceedingly common in cerebral small vessel disease and lead to significant cumulative disability without an available treatment. Here, we tested a rho-kinase inhibitor on functional recovery after focal white matter injury. Methods: A focal corpus callosum lesion was induced by stereotactic injection of N ⁵ -(1-iminoethyl)-L-ornithine in mice. Fasudil (10 mg/kg) or vehicle was administered daily for 2 weeks, starting one day after lesion induction. Resting-state functional connectivity and grid walk performance were studied longitudinally, and lesion volumes were determined at one month. Results: Resting-state interhemispheric functional connectivity significantly recovered between days 1 and 14 in the fasudil group ( P <0.001), despite worse initial connectivity loss than vehicle before treatment onset. Grid walk test revealed an increased number of foot faults in the vehicle group compared with baseline, which persisted for at least 4 weeks. In contrast, the fasudil arm did not show an increase in foot faults and had smaller lesions at 4 weeks. Immunohistochemical examination of reactive astrocytosis, synaptic density, and mature oligodendrocytes did not reveal a significant difference between treatment arms. Conclusions: These data show that delayed fasudil posttreatment improves functional outcomes after a focal subcortical white matter lesion in mice. Future work will aim to elucidate the mechanisms.

Objective: Recent studies have shown that irisin, a novel peptide hormone derived from muscles, could be used as a potential therapeutic drug against ischemic stroke. Moreover, electroacupuncture (EA) is widely used in the treatment of ischemic stroke. Yet, whether irisin is involved in the EA neuroprotection remains unclear. The following study investigated the association between serum and peri-lesional cortex irisin and EA-induced post-stroke motor recovery in rats. Methods: The middle cerebral artery occlusion (MCAO) method was used to induce ischemic stroke in rats. Rats were randomly divided into two groups: a middle cerebral artery occlusion (MCAO) group (MCAO rats without treatment) and an electroacupuncture (EA) group (MCAO rats treated with EA). On the 3rd day post-stroke, infarct volume, behavioral deficits, surviving neurons, irisin protein expression in peri-infarction cortex, muscle tissue, and serum were evaluated to identify the neuroprotective of EA in acute ischemic stroke. Results: Compared with the MCAO group, the EA group showed better behavioral performance, a smaller cerebral infarct volume, more surviving neurons, and a significant increase in irisin expression in the peri-infarction cortex and serum (p< 0.05). However, no difference in irisin expression in the muscle tissue was found between the MCAO group and the EA group (p> 0.05). Conclusion: EA promotes motor function recovery, reduces the volume of cerebral infarction, and alleviates neuronal death following ischemic stroke by enhancing the expression of irisin in both the blood and peri-lesional cortex.