BACKGROUND AND AIMS:Post-traumatic stress disorder (PTSD) comorbid with depression is a prevalent, treatment-refractory clinical syndrome. Emerging evidence indicates shared microglial alterations in PTSD and depression, suggesting it may represent a common pathological substrate. However, the underlying neuroimmune mechanisms remain unclear. METHODS:PTSD- and depression-like behaviors were induced in rats by using single prolonged stress combined with foot shock (SPS&S). Cellular activity, spatial distribution, and morphology were assessed using qPCR, immunofluorescence, and Golgi-Cox staining. Microglial activity was inhibited using clodronate liposomes (CDSlip) and minocycline. Bulk RNA sequencing was performed to profile neuroimmune-related signaling molecules. RESULTS:Stress induced PTSD- and depression-like behaviors, accompanied by region-specific enhanced microglial activity in the anterior-medial NAC core (amNACc) and lateral NAC shell (LNACsh). Selective depletion of microglia in amNACc and LNACsh via CDSlip specifically alleviated stress induced PTSD- and depression-like behaviors, respectively. Morphological and functional analyses in each region revealed that microglia reshaped the spatial pattern of neuronal structure and function, manifested by enhanced in amNAC and inhibited in LNACsh, via differentially pruning adjacent inhibitory synapses in corresponding region. Further transcriptomic analysis of synaptic pruning relevant signaling pathway showed upregulated expression of "Eat me" signal molecules (particularly Mertk) in the amNAC and downregulated expression of "Find me" signal molecules (particularly Cx3cr1) in the LNACsh, consistent with the observed spatial synaptic pruning profiles. Minocycline administration reversed stress-induced PTSD and depression-like behaviors while normalizing the region-specific alterations in synaptic pruning signaling molecules. CONCLUSION:Stress may elicit two regionally heterogeneous microglial subpopulations within NAC: phagocytosis-enhanced and recognition-impaired, which remodel the structure and function of local neural networks by differential pruning of inhibitory synapses, thereby driving the manifestation of PTSD- and depression-like behaviors, separately. These findings deepen our understanding of the neuroinflammatory mechanisms underlying trauma-related psychiatric disorders and identify novel targets for immunomodulation-based targets for transdiagnostic interventions .

Mercury intoxication is not uncommon and often presents with diverse symptoms of multiple systems. While neurological disorders and renal impairments have been examined in isolation, the concurrent occurrence of systemic symptoms linked to immune dysregulation is infrequently observed. Here, we report an unusual case that a 55-year-old male patient, who is a scrap merchant, was admitted to our center for neuropsychiatric disturbances, including incoherent speech and hallucinations. He was initially diagnosed with autoimmune encephalitis (AE) because of double positivity for CASPR2 and LGl1 antibodies in serum. The patient later presented with pruritus and nephrotic syndrome, where renal biopsy revealed membranous nephropathy (MN). In view of the mercury exposure history and elevated urinary mercury level, AE and MN were suspected to be related to mercury poisoning. The patient achieved a full recovery following a four-month treatment regimen comprising immunosuppressants and mercury-chelating agents, underscoring the significance of recognizing environmental toxins such as mercury in the coexisting diseases of different systems such as AE and MN.

BACKGROUND:Major depressive disorder (MDD) is a leading cause of disability worldwide. Investigating early-stage alterations in cerebral intrinsic activity among drug-naive patients may enhance our understanding of MDD's neurobiological mechanisms and contribute to early diagnosis and intervention. AIMS:To examine alterations in the amplitude of low-frequency fluctuation (ALFF) in first-episode, drug-naive MDD individuals and explore associations between ALFF changes and clinical parameters, including depression severity and illness duration. METHOD:A total of 30 first-episode, drug-naive MDD individuals (mean illness duration 14 weeks) and 52 healthy controls were included in this study. Resting-state functional magnetic resonance imaging was used to obtain whole-brain ALFF measurements. Voxel-based ALFF maps were compared between MDD and healthy control groups using a two-sample t-test. Simple regression analysis was performed to assess associations between ALFF and clinical measures, including Hamilton Rating Scale for Depression (HAMD) scores and illness duration. RESULTS:MDD individuals exhibited significantly increased ALFF in the dorsal anterior cingulate cortex and vermal subregion V3 of the cerebellum. Additionally, ALFF in the right dorsolateral prefrontal cortex was negatively correlated with HAMD scores (r = -0.591, P < 0.001). However, no significant association was found between ALFF and illness duration. CONCLUSIONS:This study demonstrates early-stage ALFF alterations in drug-naive MDD patients, particularly in brain regions implicated in cognitive and emotional regulation. These findings suggest potential neuroimaging biomarkers for the early diagnosis and intervention of MDD.

ABSTRACTBackgroundPost‐traumatic stress disorder (PTSD) is a complex psychiatric condition that emerges following exposure to trauma and significantly affects daily functioning. Current research is focused on identifying effective treatments for PTSD. Advances in bioinformatics provide opportunities to elucidate the underlying mechanisms of PTSD.MethodsRNA sequencing (RNA‐seq) datasets were retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified using GEO2R. Weighted gene co‐expression network analysis (WGCNA) was employed to examine gene correlation patterns. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed for functional annotation and enrichment analysis, respectively. The MCODE plugin in Cytoscape software was utilized to analyze the protein–protein interaction (PPI) network. Anxiety and depression in a mice stress model were assessed using the open‐field test (OFT), elevated plus maze test (EPMT), and forced swimming test (FST). Real‐time quantitative PCR (qRT‐PCR) was conducted to validate key genes in stress‐exposed models.ResultsA total of 157 common upregulated DEGs and 53 common downregulated DEGs were identified in the amygdala (AMY) and the hippocampus (HIP). Notably enriched pathways included neuroactive ligand‐receptor interaction, mechanistic target of rapamycin (mTOR) signaling pathway, nicotine addiction, and dopaminergic synapse. The PPI network identified four hub genes, with key pathways associated with nicotine addiction and dopaminergic synapse. qRT‐PCR validation confirmed that the expression trends of these four genes were consistent with microarray data. Behavioral tests (OFT, EMPT, and FST) revealed significant changes.ConclusionThis study utilized bioinformatics and in vitro experiments to identify genes and pathways potentially crucial for PTSD development. Key genes were validated in a mouse model, providing insights into potential target genes for PTSD treatment.

Predicting the survival time of patients at the end of life can provide more accurate treatment and care programs for patients. The purpose of this study was to investigate the factors impacting 14-day survival at the end of life. This was a retrospective study. Patients with advanced cancer admitted to the Department of Palliative Medicine in a tertiary hospital in China in 2021 were included and classified into group A (survival time ≤ 14 days) or group B (survival time > 14 days). Patient demographic characteristics, palliative performance scale (PPS) scores, Barthel index scores, Fracture Risk Assessment Scale (FRAIL) scale scores, clinical features and laboratory test results were extracted from medical records. Univariable and multivariable logistic regression analyses were used to identify predictors of death within 14 days. Survival time was compared between frail and nonfrail patients. A total of 261 patients were included (122 in group A and 139 in group B), with a median survival time of 17 (13.04, 20.96) days. There were significant differences in age, FRAIL score, PPS, Barthel index, dyspnea, edema, C-reactive protein and white blood cell count between the two groups. According to the multivariable logistic regression analysis, the PPS could predict the risk of death within 14 days (OR = 6.818, 95

Rhabdomyosarcoma (RMS) is a common soft tissue malignant tumor, especially in young patients. Alveolar rhabdomyosarcoma (ARMS) is a subtype of RMS that is prevalent in adolescents. This malignant tumor usually develops in the extremities and can also involve the trunk, perineum, and pelvis. Now, we report a rare case of pelvic lymph node metastatic alveolar RMS in a young patient, which was determined by fine needle aspiration cytology (FNAC). To the best of our knowledge, this is the first case in which the definite diagnosis of ARMS was initially made by FNAC.

Periventricular nodular heterotopia (PNH) is a common type of heterotopia usually characterized by epilepsy. Previous studies have identified alterations in structural and functional connectivity related to this disorder, but its local functional neural basis has received less attention. The purpose of this study was to combine univariate analysis and a Gaussian process classifier (GPC) to assess local activity and further explore neuropathological mechanisms in PNH‐related epilepsy.

Although many deep learning models-based medical applications are performance-driven, i.e., accuracy-oriented, their explainability is more critical. This is especially the case with neuroimaging, where we are often interested in identifying biomarkers underlying brain development or disorders. Herein we propose an explainable deep learning approach by elucidating the information transmission mechanism between two layers of a deep network with a joint feature selection strategy that considers several shallow-layer explainable machine learning models and sparse learning of the deep network. At the end, we apply and validate the proposed approach to the analysis of dynamic brain functional connectivity (FC) from fMRI in a brain development study. Our approach can identify the differences within and between functional brain networks over age during development. The results indicate that the brain network transits from undifferentiated structures to more specialized and organized ones, and the information processing ability becomes more efficient as age increases. In addition, we detect two developmental patterns in the brain network: the FCs in regions related to visual and sound processing and mental regulation become weakened, while those between regions corresponding to emotional processing and cognitive activities are enhanced.

Background Although the specific role of the uncinate fasciculus (UF) in emotional processing in patients with obsessive–compulsive disorder (OCD) has been investigated, the exact focal abnormalities in the UF have not been identified. The aim of the current study was to identify focal abnormalities in the white matter (WM) microstructure of the UF and to determine the associations between clinical features and structural neural substrates. Methods In total, 71 drug-naïve patients with OCD and 81 age- and sex-matched healthy controls (HCs) were included. Automated fiber quantification (AFQ), a tract-based quantitative approach, was adopted to measure alterations in diffusion parameters, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD), along the trajectory of the UF. Additionally, we utilized partial correlation analyses to explore the relationship between the altered diffusion parameters and clinical characteristics. Results OCD patients showed significantly higher FA and lower RD at the level of the temporal and insular portions in the left UF than HCs. In the insular segments of the left UF, increased FA was positively correlated with the Hamilton Anxiety Scale (HAMA) score, while decreased RD was negatively correlated with the duration of illness. Conclusion We observed specific focal abnormalities in the left UF in adult patients with OCD. Correlations with measures of anxiety and duration of illness underscore the functional importance of the insular portion of left UF disturbance in OCD patients.

BACKGROUND:Age of onset may be an important feature associated with distinct subtypes of obsessive-compulsive disorder (OCD). The amygdala joined neurocircuitry models of OCD for its role in mediating fear and regulating anxiety. The present study aims to identify the underlying pathophysiological specifics in OCD with different onset times by assessing amygdala subregional functional connectivity (FC) alterations in early-onset OCD (EO-OCD) and late-onset OCD (LO-OCD).METHODS:Resting-state functional magnetic resonance imaging data were acquired from 88 medication-free OCD patients (including 30 EO-OCD and 58 LO-OCD) and age- and sex-matched healthy controls (HC) for each patient group. Onset-by-diagnosis interactions were examined and comparisons between each OCD group and the corresponding HC group were performed regarding the FC of amygdala subregions including the basolateral amygdala (BLA), centromedial amygdala (CMA), superficial amygdala (SFA) and amygdalostriatal transition area (Astr).RESULTS:Significant onset-by-diagnosis interactions were found in FC between bilateral SFA, right CMA, left Astr and the cerebellum. EO-OCD patients showed abnormally increased BLA/SFA-cerebellum, BLA-precuneus and BLA/SFA-fusiform connectivity in addition to decreased BLA/SFA-orbitofrontal cortex connectivity. In contrast, LO-OCD patients exhibited increased CMA/Astr-precentral/postcentral gyrus and CMA-cuneus connectivity as well as decreased CMA/Astr-cerebellum and BLA-striatum connectivity.LIMITATIONS:The exclusion of comorbidity may reduce the generalizability of our results.CONCLUSIONS:These findings emphasized the different patterns of amygdala subregional connectivity alterations associated with EO-OCD and LO-OCD patients. These results provide unique insights into constructing evidence-based distinct OCD subtypes based on brain intrinsic connectivity and point to the need of specified management for EO-OCD and LO-OCD in clinical setting.

Structural neuroimaging studies have identified brain areas implicated in the pathogenesis of major depressive disorder (MDD). However, findings have been inconsistent, potentially due to variable illness duration and effects of antidepressant treatment. Using a meta-analytic approach, we compared gray matter (GM) volumes in patients grouped by medication status (naïve and treated) and illness duration (early course and long-term ill) to identify potential treatment and illness duration effects on brain structure. A total of 70 studies were included, including 3682 patients and 3469 controls. The pooled analysis found frontal, temporal and limbic regions with decreased GM volume in MDD patients. Additional analyses indicated that larger GM volume in the right striatum and smaller GM volume in the right precuneus are likely to be associated with drug effects, while smaller GM volume in the right temporal gyrus may correlate with longer illness duration. Similar GM decreases in bilateral medial frontal cortex between patient subgroups suggest that this alteration may persist over the course of illness and drug treatment.

A precise understanding of amygdala-centered subtle networks may help refine neurocircuitry models of obsessive-compulsive disorder (OCD). We applied connectivity-based parcellation methodology to segment the amygdala based on resting-state fMRI data of 92 medication-free OCD patients without comorbidity and 90 matched healthy controls (HC). The amygdala was parcellated into two subregions corresponding to basolateral amygdala (BLA) and centromedial amygdala (CMA). Amygdala subregional functional connectivity (FC) maps were generated and group differences were evaluated with diagnosis-by-subregion flexible factorial ANOVA. We found significant diagnosis × subregion FC interactions in insula, supplementary motor area (SMA), midcingulate cortex (MCC), superior temporal gyrus (STG) and postcentral gyrus (PCG). In HC, the BLA demonstrated stronger connectivity with above regions compared to CMA, whereas in OCD, the connectivity pattern reversed to stronger CMA connectivity comparing to BLA. Relative to HC, OCD patients exhibited hypoconnectivity between left BLA and left insula, and hyperconnectivity between right CMA and SMA, MCC, insula, STG, and PCG. Moreover, OCD patients showed reduced volume of left BLA and right CMA compared to HC. Our findings characterized disorganized functional architecture of amygdala subregional networks in accordance with structural defects, providing direct evidence regarding the specific role of amygdala subregions in the neurocircuitry models of OCD.

Obsessive-compulsive disorder (OCD) displays widespread disruption across brain regions revealed by resting-state functional connectivity (rsFC) with inconsistent results between studies. We performed a systematic review of 47 seed-based rsFC studies (1863 patients; 1795 healthy controls) to explore brain intrinsic connectivity alterations. Quantitative coordinate-based meta-analysis was conducted for seed regions in the striatum (putamen, caudate, nucleus accumbens [Nac]), thalamus, and anterior cingulate cortex (ACC) because there were an adequate number of studies. We found that OCD patients demonstrated (1) characteristic dysconnectivity between striatum and cortical networks (i.e., caudate hyperconnectivity with the fronto-limbic network and hypoconnectivity with frontoparietal network regions; Nac hypoconnectivity with fronto-limbic network regions), (2) hypoconnectivity between thalamus and striatum (putamen and caudate), and (3) dysconnectivity between the ACC and fronto-limbic network regions. Furthermore, there were negative correlations between particular connectivities and symptom severity and onset age. Our results characterize the traditional cortico-striato-thalamo-cortical circuit model of OCD pathophysiology through the cerebral intrinsic connectivity, and unified neurocircuitry and brain network models into one integrity to elaborate the neural mechanism of OCD.

Altered topological organization of brain structural covariance networks has been observed in attention deficit hyperactivity disorder (ADHD). However, results have been inconsistent, potentially related to confounding medication effects. In addition, since structural networks are traditionally constructed at the group level, variabilities in individual structural features remain to be well characterized. Structural brain imaging with MRI was performed on 84 drug-naive children with ADHD and 83 age-matched healthy controls. Single-subject gray matter (GM) networks were obtained based on areal similarities of GM, and network topological properties were analyzed using graph theory. Group differences in each topological metric were compared using nonparametric permutation testing. Compared with healthy subjects, GM networks in ADHD patients demonstrated significantly altered topological characteristics, including higher global and local efficiency and clustering coefficient, and shorter path length. In addition, ADHD patients exhibited abnormal centrality in corticostriatal circuitry including the superior frontal gyrus, orbitofrontal gyrus, medial superior frontal gyrus, precentral gyrus, middle temporal gyrus, and pallidum (all p < .05, false discovery rate [FDR] corrected). Altered global and nodal topological efficiencies were associated with the severity of hyperactivity symptoms and the performance on the Stroop and Wisconsin Card Sorting Test tests (all p < .05, FDR corrected). ADHD combined and inattention subtypes were differentiated by nodal attributes of amygdala (p < .05, FDR corrected). Alterations in GM network topologies were observed in drug-naive ADHD patients, in particular in frontostriatal loops and amygdala. These alterations may contribute to impaired cognitive functioning and impulsive behavior in ADHD.

目的 系统评价n-3多不饱和脂肪酸(n-3PUFAs)、n-6多不饱和脂肪酸(n-6PUFAs)及其比例与乳腺癌发病风险的关系.方法 系统检索Pubmed、Embase、Web of Science、知网、万方等数据库截止至2022年1月1日有关n-3及n-6多不饱和脂肪酸与乳腺癌关系的研究,对最终纳入的文献进行数据提取与质量评价,采用Stata 15.1软件进行Meta分析.结果 共纳入33项针对n-3及n-6PUFAs和乳腺癌发病风险关联的观察性流行病学研究,其中队列研究14项,病例对照研究20项,共纳入研究对象1 077 178例,患者19 207例.Meta分析结果显示:n-3多不饱和脂肪酸(OR=0.933,95％CI:0.858～1.014)、n-6 多不饱和脂肪酸(OR=1.018,95％CI:0.914～1.133)与乳腺癌发病风险无统计学关联(P＞0.05),而较高的n-6/n-3PUFAs比值会显著增加乳腺癌的发病风险(OR=1.166,95％CI:1.047～1.299,P=0.005).结论n-6/n-3多不饱和脂肪酸的比值与乳腺癌的发病风险呈正相关,提示合理的膳食脂肪摄入比可能会降低乳腺癌的患病风险.而n-3及n-6多不饱和脂肪酸与乳腺癌发病风险的单独效应关系尚不明确,仍需更多前瞻性实验流行病学证据进行支持.

Major depressive disorder (MDD) shows sex differences in terms of incidence and symptoms, but the neurobiological basis underlying these sex differences remains to be clarified. High resolution T1-weighted Magnetic Resonance Imaging (MRI) scans were obtained from 123 non-comorbid treatment-naïve individuals with MDD and 81 age-, sex-, and handedness-matched healthy controls (HCs). MRI data were preprocessed with FreeSurfer software and four cortical measures were extracted: cortical thickness (CT), surface area (SA), cortical volume (CV), and local gyrification index (LGI). We tested for both sex-specific and sex-nonspecific patterns of cortical anatomic alterations. Regardless of sex, individuals with MDD showed significantly higher LGI in posterior cortex relative to HCs. Significant sex-by-group interactions were observed, and subsequent post-hoc analyses revealed that female individuals with MDD showed significantly lower SA in left ventrolateral prefrontal cortex (vlPFC), lower CV in right rostromedial prefrontal cortex (rmPFC), and higher LGI in left visual cortex compared with sex-matched HCs, whereas the opposite patterns of significant effects were seen in male individuals with MDD relative to their sex-matched HCs. Thus, sex-nonspecific and specific morphometric differences from HCs were found in posterior cortex, while in PFC alterations were highly sex-specific early in the illness course. This may involve sex-specific alterations in brain development or processes related to illness onset. These findings highlight the presence and regional distribution of generalized as well as sex-specific alterations of brain neurobiology in MDD.

Posttraumatic stress disorder (PTSD) is associated with dysfunction in large-scale brain functional networks, as revealed by resting-state functional connectivity studies. However, it remains unclear which networks have been most consistently affected and, more importantly, what role disease and trauma may play in the disrupted functional networks. We performed a systematic review of studies exploring network alterations using seed-based functional connectivity analysis, comparing individuals with PTSD to controls in general as well as trauma-exposed or nonexposed controls specifically, and quantitative meta-analysis was conducted when the number of studies was appropriately high. We found that hypoconnectivity within the default-mode network (DMN) as well as between the affective network (AN) and DMN were specifically associated with traumatic experience. Additionally, hyperconnectivity between the AN and somatomotor network (SMN) and between the DMN and SMN were specifically related to PTSD. Our results emphasize the effect of trauma itself on alterations in intrinsic brain networks and highlight disease-associated network alterations, which may help us better understand the neural mechanisms of trauma and PTSD.

Deep-layer autoencoder (DAE) provides a powerful way for medical image analysis, while it remains a daunting challenge due to the limited samples but high dimension. In this paper, a DAE with sparse and graph Laplacian regularization, termed as GSDAE, is presented to identify significant differences of dynamic functional connectivity (dFC) between child and young adult groups. The proposed model incorporates prior knowledge into sparse learning, i.e., the intrinsic structural information defined by manifold in the data. In this way, the reconstruction ability of unsupervised DAE can be improved, which facilitates the extraction of most discriminative features of dFC changing with age. Results on the fMRI data from the Philadelphia Neurodevelopmental Cohort project reveal essential differences lying in the reoccurrence patterns of dFC and in the connectivity of resting state networks with increasing age, e.g., there exist different trajectories of connectivity patterns in brain functions: those associated with complex cognitive functions generally decreased, while those associated with basic visual or motor control functions usually enhanced. In addition, the brain circuitry moves from segregation to integration during brain development.

目的 探讨重性抑郁症(major depressive disorder,MDD)患者灰白质表面面积改变的性别差异,并分析其与不同性别患者临床特征间的关系.材料与方法 前瞻性收集61例MDD患者和匹配的61例健康对照(两组均为男性25例、女性36例)行3D T1WI高分辨率磁共振扫描,用freeSurfer软件进行图像预处理,获得全脑各区域的灰、白质表面面积图像,采用双因素方差分析计算并提取四组间灰、白质表面面积的性别差异脑区,行post-hoc检验进行各组间两两比较,将男女性MDD性别差异脑区与临床资料进行相关分析.结果 性别差异主结果显示双侧额上回、颞中回及左侧额中回喙部、枕外侧回灰、白质表面面积均存在差异,且双侧颞上回、左侧中央前回、岛叶、右侧额叶三角部、眶额内侧回、梭状回、顶下小叶白质表面面积及左侧缘上回、右侧额中回喙部、中央前回、颞下回、梭状回、前缘扣带回、枕外侧回、顶下小叶灰质表面面积存在差异(P<0.01,Bonforroni校正).进一步post-hoc两两比较发现以上脑区女性MDD组灰、白质表面面积均小于男性MDD组(P<0.01,Bonforroni校正).相关分析显示男性MDD组右侧额中回喙部(r=-0.398,P=0.049)及梭状回(r=-0.440,P=0.028)灰质表面面积与汉密尔顿抑郁量表评分呈负相关,左侧颞中回灰质表面面积与男性MDD病程呈负相关(r=-0.419,P=0.037).结论 MDD患者灰、白质表面面积均存在性别差异,但是差异脑区并不完全重叠,这些差异脑区可能与男女性MDD患者临床表现和发病率的差异有关.

BACKGROUND:Preoperative anxiety in children is harmful. Despite this, there is a scarcity of studies examining the incidence of preoperative anxiety and its related effects in China. This study investigated preoperative anxiety in children aged 2 to 7 in the pediatric surgery department of a tertiary hospital in China. The factors influencing preoperative anxiety in these children were identified.METHODS:The researchers used the Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS) and the Short Form of CmYPAS (CmYPAS-SF) to assess the preoperative anxiety state of children aged 2 to 7 who underwent elective surgery in the pediatric department of a tertiary hospital in China from July 1, 2020 to September 30, 2020 were enrolled in this study. The generalized estimating equation model was used to analyze the factors influencing preoperative anxiety in children.RESULTS:The preoperative anxiety rate of 220 children in the tertiary hospital was 67.6%. Multivariate analysis revealed that children who attended elementary school had a lower risk of preoperative anxiety compared to children who did not attend school [odd ratio (OR) =0.39, 95% confidence interval (CI), 0.19 to 0.79, P=0.010]. Children whose caregivers felt very worried experienced an increased risk of preoperative anxiety compared to children whose caregivers were not worried about the surgery at all (OR =3.40, 95% CI, 1.35 to 8.56, P=0.009). Children who were very resistant, cried violently, twisted their bodies during puncturing the needle were 5.8 times more likely to experience preoperative anxiety compared to children who were very cooperative. The risk of preoperative anxiety in children who cooperated with a staff member was about 1.5 times higher than that of children who were very cooperative.CONCLUSIONS:The incidence of preoperative anxiety in children aged 2 to 7 in the tertiary hospital in China was similar to the children in other countries. The caregivers' degree of concern priored to the operation and the degree of cooperation from the children during puncturing the indwelling needle were the main factors influencing the occurrence of preoperative anxiety.