BackgroundBoth modified Suanzaoren Decoction and estazolam serve as effective treatments for chronic insomnia disorder （CID）. Default mode network （DMN） dysfunction is recognized as the primary pathophysiological mechanism underlying CID. However， it remains unclear whether the two treatments exert their therapeutic effects via convergent modulation of DMN functional connectivity. ObjectiveTo investigate the convergent remodeling characteristics of bidirectional effective connectivity （EC） of core DMN nodes with both the intra-network and the remaining whole-brain regions in CID patients with Yin-deficiency and fire-hyperactivity syndrome following the treatment with modified Suanzaoren Decoction or estazolam， so as to provide neuroimaging evidence for the convergent neural mechanisms underlying the therapeutic effects of both therapies in treating CID. MethodsEighty-two patients diagnosed with CID according to the International Classification of Sleep Disorder， third edition （ICSD-3） were consecutively recruited from the outpatient clinic of the Inner Mongolia Autonomous Region Mental Health Center from October 2020 to September 2023. Based on treatment preference， patients were assigned to receive a 6-week intervention in either the modified Suanzaoren Decoction group （n=52） or the estazolam group （n=30）. Ultimately， 66 patients completed follow-up assessments （modified Suanzaoren Decoction group， n=41； estazolam group， n=25）. All CID patients underwent resting-state functional magnetic resonance imaging scanning before and after treatment. Core DMN nodes including medial prefrontal cortex （mPFC）， bilateral inferior parietal lobule （IPL）， and precuneus （PCUN） were selected as seed regions. Granger causality analysis （GCA） was employed to assess bidirectional EC between the seed regions and both the other intra-DMN nodes and the remaining whole-brain regions. Hepatic and renal function indices were detected pre- and post-treatment to evaluate the safety profiles of both treatments. ResultsAt baseline， significant between-group differences were identified in EC from the left IPL to the left middle fronto-orbital gyrus/gyrus rectus （t=5.24， Z=4.84， voxel-level P<0.001， cluster-level P<0.05， GRF-corrected）， with the modified Suanzaoren Decoction group exhibiting stronger EC than the estazolam group. No significant between-group differences were observed in EC between other core DMN nodes and remaining whole-brain regions （P>0.05）. Within-group pre- to post-treatment comparisons demonstrated consistent connectivity alterations in both groups. Specifically， EC from the left IPL to the supplementary motor area （SMA） decreased after treatment （modified Suanzaoren Decoction group： t=-6.28， Z=5.208； estazolam group： t=-5.58， Z=4.425）. Conversely， EC from the SMA to the left IPL increased （modified Suanzaoren Decoction group： t=5.89， Z=4.968； estazolam group： t=6.15， Z=4.720）. Furthermore， both groups demonstrated reduced EC from the PCUN to the left IPL （modified Suanzaoren Decoction group： t=-5.85， Z=4.94； estazolam group： t=-5.75， Z=4.515）， and elevated EC from the left IPL to the PCUN （modified Suanzaoren Decoction group： t=5.29， Z=4.579； estazolam group： t=4.55， Z=3.826） （voxel-level P<0.001， cluster-level P<0.05， GRF-corrected）. No significant pre- to post-treatment differences were observed in hepatic or renal function indices in either group （P>0.05）. ConclusionIn CID patients with Yin-deficiency and fire-hyperactivity syndrome， both modified Suanzaoren Decoction and estazolam induce convergent bidirectional remodeling of EC between the left IPL and the SMA and the PCUN. ［Funded by Natural Science Fund Project of Inner Mongolia Autonomous Region （number， 2019MS08099）； ClinicalTrials.gov number， NCT06452953］

Objective To explore the structure changes of white matter in the first-episode schizo-phrenic patients with never-medicated(FESZ)and the relationship between facial emotion perception and white matter(WM)integrity.Methods Sixty-three schizophrenic patients and thirty health control subjects underwent diffusion tensor imaging(DTI)scans.Voxel-based analysis was used to compared fractional ani-sotropy(FA)map between the two groups.Correlations were analyzed with pearson relative analysis between impaired facial emotion perception tested by facial emotion categorization(FEC)and severity of symptoms measured by the Positive and Negative Syndrome Scale(PANSS).Results (1)Compared with controls, FESZ patients showed overall decreased FA in WM of the body of left ventral frontal lobe((MNI(x,y,z):-18,26,-4;t=4.43)),right supramarginal gyrus((MNI(x,y,z):32,-50,26;t=4.27)),left middle oc-cipital gyral((MNI(x,y,z):-26,-60,0;t=4.89)),right middle occipital gyral((MNI(x,y,z):28,-70, 14;t=4.18)),left fusiform gyrus((MNI(x,y,z):-40,-50,0;t=3.92)),left cerebellum anterior lobe ((MNI(x,y,z):-32,-56,-28;t=4.57)),right parahippocampa gyrus1((MNI(x,y,z):32,-10,-14;t=4.16)),right parahippocampa gyrus2((MNI(x,y,z):16,-6,-14;t=4.56)),left anterior cingulate ((MNI(x,y,z):-2,4,-6;t=4.41)),left extra-nuclear((MNI(x,y,z):-2,-10,-6;t=4.44)),right thalamus((MNI(x,y,z):10,-10,2;t=4.20)),left thalamus((MNI(x,y,z):-22,-28,12;t=4.01)), and right caudate((MNI(x,y,z):14,12,8;t=4.87)).(2)Compared with controls,the patients with schizo-phrenia showed a higher shift point and a steeper slope than control subjects in FEC.Correlational analysis re-vealed that the negative correlations were found between the slope and negative factor(r=-0.298,P=0.036),between positive factor and the FA value in WM of the right middle occipital gyral(r=-0.322,P=0.023)and the left middle occipital gyral(r=-0.288,P=0.043),and between the FA value in the left cere-bellum anterior lobe and shift point(r=-0.393,P=0.005),but the positive correlation was found between disorganized/concrete factor and the FA value in the right parahippocampal gyrus(r=0.429,P=0.002).Con-clusions There are extensive microstructural abnormalities in WM of patients with FESZ.Disrupted WM in-tegrity in these regions may constitute a potential neural pathological basis for the facial emotion perception impairments in schizophrenia.

Objective To explore facial emotion cognition character and the correlation to frontal lobe white matter fiber tracts in first-episode of schizophrenia patients in comparison with healthy control.Method The diffusion tensor imaging data were obtained from 56 patients with untreated first-episode schizophrenia and 30 healthy controls subjects.Fiber tracking was performed in the whole cerebral cortex of brain.The parameter of impairment white matter fiber tracts were obtained,such as fractional anisotropy,mean diffusivity,radial diffusivity,axial diffusivity.Computer-based facial emotion cognition test was used to evaluate difference of facial emotion identification.The correlation between ability of identifying ambiguous emotion and the parameter of impairment white matter fiber tracts,and the correlation between ability of identifying ambiguous emotion and PANSS scale were explored by linear correlation analysis.Result (1) Between patients and healthy control,there was no significant difference in the proportion of recognition as happy emotion to mixture of 50％ happy emotion plus 50％ angry emotion.In patients group,the number of regarding 100％ happy emotion plus 0 angry emotion (9.96±2.42) and regarding 75％ happy emotion plus 25％ angry emotion (9.91 ± 2.33) both as happy emotion were significantly lower than the healthy control (11.40 ± 1.48,11.30± 1.44;t=-3.332,-3.325;all P＜0.01).The number of regarding 25％ happy emotion and 75％ angry emotion as happy emotion(2.24±2.57),and the number of regarding 0 happy emotion and 100％ angry emotion as happy emotion(1.78 ± 2.66) were higher than healthy control(0.83 ± 2.21,0.70±2.02;t=2.537,2.056;P＜0.05 or P＜0.01).The total response time for all images on screen was significantly longer than healthy control(t=6.441,P＜0.01).(2)There are five relative serious fiber tracts impaired.Patients with schizophrenia were demonstrated lower activation in right dorsolateral frontal gyru,right inferior frontal operculum,right medial frontal gyrus,left precentral gyrus,left olfactory cortex (t=-2.993 0-2.830 0,P＜0.01 or P＜0.05),in comparison with healthy controls,except FA value of right inferior frontal operculum and AD value of left precentral gyrus were found higher in patients group.(3) There was no correlation between identifying facial emotion and PANSS.(4)The correlation between identifying ambiguous emotion and the parameter of impairment or white matter fiber tracts was explored by linear correlation analysis,which found FA value of left precentral gyrus positively correlated to the number of identifying happy emotion from 25％ happy emotion plus 75％ angry emotion (r=0.362,P=0.007),and from 0 happy emotion plus 100％ angry emotion (r=0.476,P=0.000).Conclusion This study suggests that schizophrenia patients could not identify facial emotion accurately and their white matter fiber tracts in the frontal lobe are damaged significantly.The impairment of facial emotion recognition is correlated with the abnormality of white matter fiber tracts.

Objective To explore facial emotion cognition character and the correlation to frontal lobe white matter fiber tracts in first-episode of schizophrenia patients in comparison with healthy control.Method The diffusion tensor imaging data were obtained from 56 patients with untreated first-episode schizophrenia and 30 healthy controls subjects.Fiber tracking was performed in the whole cerebral cortex of brain.The parameter of impairment white matter fiber tracts were obtained,such as fractional anisotropy,mean diffusivity,radial diffusivity,axial diffusivity.Computer-based facial emotion cognition test was used to evaluate difference of facial emotion identification.The correlation between ability of identifying ambiguous emotion and the parameter of impairment white matter fiber tracts,and the correlation between ability of identifying ambiguous emotion and PANSS scale were explored by linear correlation analysis.Result (1) Between patients and healthy control,there was no significant difference in the proportion of recognition as happy emotion to mixture of 50％ happy emotion plus 50％ angry emotion.In patients group,the number of regarding 100％ happy emotion plus 0 angry emotion (9.96±2.42) and regarding 75％ happy emotion plus 25％ angry emotion (9.91 ± 2.33) both as happy emotion were significantly lower than the healthy control (11.40 ± 1.48,11.30± 1.44;t=-3.332,-3.325;all P＜0.01).The number of regarding 25％ happy emotion and 75％ angry emotion as happy emotion(2.24±2.57),and the number of regarding 0 happy emotion and 100％ angry emotion as happy emotion(1.78 ± 2.66) were higher than healthy control(0.83 ± 2.21,0.70±2.02;t=2.537,2.056;P＜0.05 or P＜0.01).The total response time for all images on screen was significantly longer than healthy control(t=6.441,P＜0.01).(2)There are five relative serious fiber tracts impaired.Patients with schizophrenia were demonstrated lower activation in right dorsolateral frontal gyru,right inferior frontal operculum,right medial frontal gyrus,left precentral gyrus,left olfactory cortex (t=-2.993 0-2.830 0,P＜0.01 or P＜0.05),in comparison with healthy controls,except FA value of right inferior frontal operculum and AD value of left precentral gyrus were found higher in patients group.(3) There was no correlation between identifying facial emotion and PANSS.(4)The correlation between identifying ambiguous emotion and the parameter of impairment or white matter fiber tracts was explored by linear correlation analysis,which found FA value of left precentral gyrus positively correlated to the number of identifying happy emotion from 25％ happy emotion plus 75％ angry emotion (r=0.362,P=0.007),and from 0 happy emotion plus 100％ angry emotion (r=0.476,P=0.000).Conclusion This study suggests that schizophrenia patients could not identify facial emotion accurately and their white matter fiber tracts in the frontal lobe are damaged significantly.The impairment of facial emotion recognition is correlated with the abnormality of white matter fiber tracts.