Recent Progress in Basic and Clinical Research on Disorders of Consciousness

Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward

Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.

Transcutaneous Auricular Vagus Nerve Stimulation: From Concept to Application

Whether in the West or the East, the connection between the ear and the rest of the body has been explored for a long time. Especially in the past century or more, the relevant theoretical and applied research on the ear has greatly promoted the development of ear therapy, and finally the concept of transcutaneous auricular vagus nerve stimulation (taVNS) has been proposed. The purpose of taVNS is to treat a disease non-invasively by applying electrical current to the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear. In the past two decades, taVNS has been a topic of basic, clinical, and transformation research. It has been applied as an alternative to drug treatment for a variety of diseases. Based on the rapid understanding of the application of taVNS to human health and disease, some limitations in the development of this field have also been gradually exposed. Here, we comprehensively review the origin and research status of the field.

Fine-Grained Topography and Modularity of the Macaque Frontal Pole Cortex Revealed by Anatomical Connectivity Profiles

The frontal pole cortex (FPC) plays key roles in various higher-order functions and is highly developed in non-human primates. An essential missing piece of information is the detailed anatomical connections for finer parcellation of the macaque FPC than provided by the previous tracer results. This is important for understanding the functional architecture of the cerebral cortex. Here, combining cross-validation and principal component analysis, we formed a tractography-based parcellation scheme that applied a machine learning algorithm to divide the macaque FPC (2 males and 6 females) into eight subareas using high-resolution diffusion magnetic resonance imaging with the 9.4T Bruker system, and then revealed their subregional connections. Furthermore, we applied improved hierarchical clustering to the obtained parcels to probe the modular structure of the subregions, and found that the dorsolateral FPC, which contains an extension to the medial FPC, was mainly connected to regions of the default-mode network. The ventral FPC was mainly involved in the social-interaction network and the dorsal FPC in the metacognitive network. These results enhance our understanding of the anatomy and circuitry of the macaque brain, and contribute to FPC-related clinical research.