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Background and objectives The prevalence of non-suicidal self-injury (NSSI) is high among adolescents. Parents have significant impact on the development of NSSI. Many quantitative studies have demonstrated the relationship between parental factors such as parenting behaviors and adolescents’ NSSI. However, few studies have explored parents’ responses and adolescent-parent reciprocal interaction during repeated NSSI. This study aimed to explore parents’ cognition, behaviors and adolescent-parent reciprocal interaction during repeated NSSI. Methods This is a phenomenological study. By purposive sampling, 24 parents of adolescents with repeated NSSI were recruited from a child and adolescent psychiatric ward in a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using thematic analysis. Findings Three themes were identified: parents’ attribution, perceptions and coping behaviors of NSSI. Chronic stress of adolescents and triggers of NSSI were associated with parental expectations. Parents initially perceived NSSI as a manifestation of puberty, a way of making needs met or a coping strategy of negative emotions, and gradually realized that it was a condition requiring psychological assistance. Parents’ coping behaviors of NSSI were divided into 4 stages, namely denial, dissuasion, reflection and adaptation, and working as a team. To be more specific, parents’ coping strategies at dissuasion stage included criticizing and conciliating, while those at reflection and adaptation stage included neglecting, avoiding conflicts and increasing control. Conclusions These findings suggest that adjusting parents’ expectation and negative perceptions of NSSI is beneficial to reduce adolescent-parent conflict and adolescents’ inner conflict and prevent NSSI. Furthermore, it’s necessary to publicize NSSI related knowledge to promote the early detection and treatment of NSSI.

Background Non-suicidal self-injury (NSSI) is common among adolescents and is associated with substantial psychological distress and elevated suicide risk. From an ecological-developmental perspective, adolescent NSSI may arise from interacting influences across individual vulnerabilities, developmental adversity, family relationships, and social resources. However, most previous studies have examined these factors using variable-centered approaches, which may overlook psychosocial heterogeneity within clinical populations. This study aimed to examine three-year transitions in NSSI among psychiatric adolescents and to investigate whether multidomain psychosocial profiles identified at baseline were associated with these transition outcomes. Methods A two-wave longitudinal cohort study was conducted among 432 adolescent psychiatric inpatients (mean age = 14.6 years; 81.3% female) with a three-year follow-up interval. NSSI was assessed at baseline and follow-up, and transitions were categorized as stable no NSSI, new-onset NSSI, remission, or persistence. Latent profile analysis was used to identify psychosocial profiles based on multidomain indicators including emotional symptoms, trauma exposure, stressful life events, psychosocial resources, coping styles, and perceived parenting. Multinomial logistic regression models examined predictors of transition outcomes. Results NSSI prevalence declined from 22.9% at baseline to 14.1% at follow-up. Transition patterns included stable no NSSI (64.1%), remission (21.8%), new onset (13.0%), and persistence (1.2%). Latent profile analysis identified three psychosocial subgroups: a lower-risk/high-resource profile, an intermediate-risk profile, and a high-stress/low-support profile. Transition distributions differed significantly across profiles, with the lower-risk profile showing the highest remission proportion and the high-stress/low-support profile showing the lowest remission proportion. In multivariable models, low household economic status (RRR = 2.64), personal suicide history (RRR = 2.96), and lower paternal emotional warmth (RRR = 0.52) independently predicted current NSSI, whereas greater childhood trauma (RRR = 0.35) and stressful life events (RRR = 0.68) were associated with lower odds of remission. Conclusions NSSI among adolescents receiving psychiatric care shows heterogeneous transition patterns and distinct psychosocial profiles. Multidomain psychosocial characteristics, including socioeconomic adversity, prior suicidality, trauma exposure, life stress, and paternal emotional warmth, appear to be important correlates of NSSI transitions. These findings highlight the value of incorporating multidomain psychosocial assessment into clinical risk evaluation and intervention planning. Clinical trial number Not applicable.

Background Postherpetic neuralgia (PHN) is common in elderly patients and can be alleviated by pulsed radiofrequency (PRF). However, PRF treatments display different efficacy on different nerves. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided PRF modulation on thoracic dorsal root ganglion (DRG) or intercostal nerve (ICN) for PHN in aged patients and to provide a theoretical basis for clinical treatment. Methods We classified aged patients into two groups, DRG group and ICN group, based on the needle tip position. Visual analogue scale (VAS) and concise health status questionnaire (Short-form 36 health/survey questionnaire, SF-36) were used to evaluate the pain intensity and the life quality of the patients before and 2, 4 and 12 weeks after the PRF treatments. We also recorded the adverse reactions during the treatments. Results After the PRF treatment, the scores of VAS and SF-36 (assessing general health perception, social function, emotional role, mental health, and pain) improved significantly in both groups ( P  < 0.05). The mean VAS score in the DRG group was significantly lower than that in the ICN group 2 weeks after treatment, and remained for 12 weeks. The SF-36 scores in the DRG group were significantly higher than those in the ICN group ( P  < 0.05). We found a similar incidence of adverse reactions between the two groups ( P  > 0.05). Conclusions PRF therapy is safe and effective for elderly patients with postherpetic neuralgia. However, PRF treatment in dorsal root ganglion is superior to that in intercostal nerve with improving VAS and SF-36 scores to a greater extent in older patients. Trial registration ChiCTR2100044176 .

Background Influenza remains a significant public health concern globally. We assessed the impact of multifaceted health education on influenza vaccination rates and health literacy among primary school students in China. Methods This cluster randomized controlled trial enrolled fourth- and fifth-grade students from 20 primary schools in Dongguan, China. Schools were randomly allocated (1:1) by a computer program to either the intervention group, receiving multifaceted health education, or the control group, receiving standard health education. Data were collected at baseline and post-intervention. The primary outcome was influenza vaccination rate. Secondary outcomes included health literacy, influenza incidence, influenza-like illness incidence, and influenza vaccine protection rate. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed. Results A total of 3463 students (1544 [44.6%] females; mean [SD] age, 9.9 [0.7] years) were enrolled. The ITT analysis included 3463 participants (control group [ n  = 1811]; intervention group [ n  = 1652]) while the PP analysis included 3275 participants (control group [ n  = 1717]; intervention group [ n  = 1558]). The influenza vaccination rate was significantly higher in the intervention group than the control group (ITT: 173 [10.9%] vs 130 [7.4%], adjusted risk ratios 1.54 [95% CI, 1.23–1.93], P  < 0.001; PP: 165 [10.6%] vs 116 [6.8%], adjusted risk ratios 1.61 [95% CI, 1.27–2.03], P  < 0.001). The knowledge component of children’s health literacy scores significantly increased in the intervention group post-intervention (ITT: mean differences 0.12 [95% CI 0.04–0.20], P  < 0.01; PP: mean differences 0.12 [95% CI 0.04–0.21], P  < 0.01). No significant differences were observed for other secondary outcomes. Conclusions The multifaceted health education significantly enhanced influenza vaccination uptake in primary school students. However, the increase was modest, indicating that more effective school-based influenza prevention programs are urgently needed to improve vaccine uptake in children. Trial registration Registered at ClinicalTrials.gov on 09/08/2023 (registration number: NCT06048406).

Objective: Postherpetic neuralgia (PHN) is a clinical puzzle, especially in patients who still suffered from moderate and severe pain after standard treatment. This single-center, double-blinded, randomized controlled, prospective, and non-inferiority study observed the safety and effectiveness of the epidural application of morphine or hydromorphone, trying to provide an alternative method for those patients with refractory PHN. Methods: Eighty PHN patients with a visual analogue scale (VAS) still greater than 50 mm after routine management were randomly divided into two groups according to 1:1, respectively. One group received epidural morphine (EMO group), and the other group received epidural hydromorphone (EHM group). VAS, the number of breakthrough pain, quality of life (QOL), and anxiety/depression assessment (GAD-7 and PHQ-9 scores) were also observed before treatment, at 1, 3, 7, 14, 21, 28, 60, and 90 days after treatment, as well as side effects. Opioid withdrawal symptoms (OWSs) were also measured from 3 to 28 days after treatment. Results: The EHM group was non-inferior to the EMO group in terms of the VAS decrease relative to baseline (VDRB) after 1-week treatment. The VAS of the two groups on all days after treatment was significantly lower than the corresponding baseline findings ( p < 0.05). The breakthrough pain (BTP) decreased significantly after treatment and lasted until 14 days after treatment ( p < 0.05). There was no significant difference in BTP between the two groups at each time point ( p > 0.05). In terms of the QOL, GAD-7, and PHQ-9 outcomes, those were significantly improved after treatment ( p < 0.05), and there was no difference between the two groups ( p > 0.05). No significant AE difference across the two groups was observed in this study. Few reports of OWS were found in this trial, and there were no significant differences between the two groups ( p > 0.05). Conclusion: EHM was non-inferior to EMO in terms of the VDRB after 1-week treatment. For patients with VAS still greater than 50 mm after standard treatment, short-term application of EMO or EHM can ameliorate intractable pain, improve the quality of life, and have no obvious side effects. Short-term epidural opioid application will not lead to the appearance of OWS.

IntroductionInfluenza is a major public health threat, and vaccination is the most effective prevention method. However, vaccination coverage remains suboptimal. Low health literacy regarding influenza vaccination may contribute to vaccine hesitancy. This study aims to evaluate the effect of health education interventions on influenza vaccination rates and health literacy.Methods and analysisThis cluster randomised controlled trial will enrol 3036 students in grades 4–5 from 20 primary schools in Dongguan City, China. Schools will be randomised to an intervention group receiving influenza vaccination health education or a control group receiving routine health education. The primary outcome is the influenza vaccination rate. Secondary outcomes include health literacy levels, influenza diagnosis rate, influenza-like illness incidence and vaccine protection rate. Data will be collected through questionnaires, influenza surveillance and self-reports at baseline and study conclusion.Ethics and disseminationEthical approval has been sought from the Ethics Committee of the School of Public Health, Sun Yat-sen University. Findings from the study will be made accessible to both peer-reviewed journals and key stakeholders.Trial registration numberNCT06048406.

Objectives This study evaluated the effectiveness, psychological effects, and sleep quality using intramuscular diazepam infusion compared with placebo in patients with herpes zoster (HZ)-related pain. Methods The patients were randomized to either the diazepam or control group. The diazepam group received an intramuscular injection of diazepam for 3 consecutive days, while the control group received an intramuscular injection of 0.9% normal saline. The primary outcome was pain relief on posttreatment day 4, as measured using the Visual Analog Scale (VAS). Moreover, anxiety and depression were evaluated using the Generalized Anxiety Disorder-7 (GAD7) and Patient Health Questionnaire-9 (PHQ9), respectively. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Results In total, 78 patients were enrolled in the trial. The mean differences in VAS scores between the two groups were 0.62 ( P  = 0.049) on posttreatment day 3 and 0.66 ( P  = 0.037) on posttreatment day 4. The effective rates of pain management in the diazepam group ranged from 10.26 to 66.67%, which were higher than those in the control group on posttreatment days 3 and 4 ( P  < 0.05). The mean difference in PSQI scores between the diazepam and control groups was 1.36 ( P  = 0.034) on posttreatment day 7. No differences were found in the incidence of analgesia-adverse 1reactions between the diazepam and placebo groups. Conclusions The intramuscular injection of diazepam for 3 consecutive days provides effective pain management and improves the quality of life. Our study suggests that diazepam is more effective than the placebo in patients with HZ-related pain. Trial registration The study was prospectively registered at https://www.isrctn.com/trialist(Registration date: 24/01/2018; Trial ID: ISRCTN12682696).

Activation of PPARD has been shown to inhibit depressive behaviors and enhances neurogenesis. However, whether PPARD is involved in the pathological development of major depressive disorder (MDD) is largely unknown. To explore the potential connection between PPARD and MDD, we first conducted a literature-based data mining to construct a PPARD-driven MDD regulating network. Then, we tested the PPARD expression changes in MDD patients from 18 independent MDD RNA expression datasets, followed by coexpression analysis, multiple linear regression analysis, and a heterogeneity analysis to study the influential factors for PPARD expression levels. Our results showed that overexpression of PPARD could inhibit inflammatory cytokine signaling pathways and the ROS and glutamate pathways that have been shown to play important roles in the pathological development of MDD. However, PPARD could also activate nitric oxide formation and ceramide synthesis, which was implicated as promoters in the pathogenesis of MDD, indicating the complexity of the relationship between PPARD and MDD. PPARG presented significant within- and between-study variations in the 18 MDD datasets (p value = 0.97), which were significantly associated with the population region (country) and sample source (p<2.67e−5). Our results suggested that PPARD could be a potential regulator rather than a biomarker in the pathological development of MDD. This study may add new insights into the understanding of the PPARD-MDD relationship.

Dorsal ramus medial branch radiofrequency ablation is reported to be effective for refractory lumbar facet joint syndrome. However, as nerve fibers can regenerate, the therapeutic effect was reported to be short and last only 6 to 12 months. Previously, we reported a novel endoscopic joint capsule and articular process excision procedure. In that case, a satisfying effect was achieved by removing the culprit hyperplastic articular synovial entrapped in the joint space endoscopically. We presume this treatment is an etiologic treatment and can exert longer-term efficacy. This retrospective clinical trial aimed to elucidate the longer-term efficacy as well as the safety profile of the procedure. This was a retrospective descriptive study. The participants underwent endoscopic joint capsule and articular process excision procedures. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) before the operation, and at 3 months, 6 months, 1 year, and 2 years post-operation were recorded by reviewing medical charts and conducting telephone interviews. A total of 234 participants were evaluated in the trial. After participant screening, 13 participants were included in the final analysis. The VAS score was reduced from (median (P25, P75)) 6 (4.5, 6) at pre-operation to 2 (0, 4) at 1-year post-operation and 0 (0, 1) at 2-year pre-operation. The ODI score was reduced from 37.78 (27.09, 59.95) at pre-operation to 8.89 (2.22, 24.34) at 1-year post-operation and 6 (0.02, 11.11) at 2-year post-operation. The difference was statistically significant. Further subgroup analysis demonstrated that a narrowed intervertebral space was a possible relevant factor for poor outcomes. No procedure-related complications were reported. Endoscopic joint capsule and articular process excision is an effective and safe procedure for refractory lumbar facet joint syndrome. The effectiveness duration can last up to 1 to 2 years.

Our previous study reported the translocator protein to play a critical role in neuropathic pain and the possible mechanisms in the spinal cord. However, its mechanism in the peripheral nervous system is poorly understood. This study was undertaken to explore the distribution of translocator protein in the dorsal root ganglion and the possible mechanisms in peripheral nervous system in a rat model of spared nerve injury. Our results showed that translocator protein was activated in dorsal root ganglion after spared nerve injury. The translocator protein signals were primarily colocalized with neurons in dorsal root ganglion. A single intrathecal (i.t.) injection of translocator protein agonist (7-chloro-5–4-chlorophenyl)-1,3-dihydro-1-methyl-2-H-1,4-benzodiaze-pine-2) (Ro5-4864) exerted remarkable analgesic effect compared with the spared nerve injury group (P < 0.01). After i.t. administration of 2 µg Ro5-4864 on day 3, the expression of translocator protein in ipsilateral dorsal root ganglion was significantly increased on day 7(P < 0.01) but decreased on day 14 (P < 0.05) compared with the same point in time in the control group. The duration of translocator protein activation in dorsal root ganglion was remarkably shortened. Ro5-4864 also inhibited the activation of phospho-extracellular signal-regulated kinase 1(p-ERK1) (P < 0.01), p-ERK2 (D7: P < 0.01, D14: P < 0.05), and brain-derived neurotrophic factor (P < 0.05) in dorsal root ganglion. Meanwhile, i.t. administration of 2 µg Ro5-4864 on day 3 further accelerated the expression of myelin protein zero(P0) and peripheral myelin protein 22 (PMP22). Our results suggested Ro5-4864 could alleviate neuropathic pain and attenuate p-ERK and brain-derived neurotrophic factor activation in dorsal root ganglion. Furthermore, Ro5-4864 stimulated the expression of myelin regeneration proteins which may also be an important factor against neuropathic pain development. Translocator protein may present a novel target for the treatment of neuropathic pain both in the central and peripheral nervous systems.