Chengwu Yang

Background: In the United States and worldwide, chronic pain affects a vast number of people and is one of the leading reasons adults seek medical care. In the United States, 24.3% of adults reported experiencing chronic pain in the prior 3 months in 2023. Chronic pain is defined as pain that lasts ≥3 months, significantly disrupting one’s daily functioning and quality of life. Chronic pain can also be accompanied by other conditions, including anxiety and depression. Health care providers should be aware of several limitations in their current treatment modalities. Although opioid analgesics are used for moderate to severe pain management, they cause many serious adverse effects, including sedation, respiratory depression, constipation, and a high risk of dependence and addiction. Other pain medications, such as nonopioid analgesics, including nonsteroidal anti-inflammatory drugs, adjuvant analgesics, and corticosteroids, also cause a range of side effects and organ toxicity. Objective: We conducted a single-arm exploratory pilot study to explore the potential role of a noninvasive, transdermal, audio-based therapeutic system among 24 police professionals aged 21 to 65 years with chronic pain and/or associated conditions, including migraine, sleep disorders, stress, anxiety, and conventional headaches. Methods: In this STROBE (Strengthening the Reporting of Observational Studies in Epidemiology)–guided pilot study, we explored the feasibility and perceived effectiveness of a self-administered intervention based on the Transdermal Acoustic Pain Suppression (TAPS) system among police personnel in West Palm Beach, Florida. Participants completed a flexible 30-day protocol integrated into their work schedules, with data collection spanning 5 months due to operational constraints. We used percentages as measures of effect and the chi-square test and Fisher exact test for significance testing. All P values were 2-sided, with a level of significance of .05. Results: In this small pilot study, following TAPS therapy, more than one-third (n=9, 37.5%) of participants experienced improvement in their condition, and half (n=12, 50%) reported reduced symptoms, including notable pain reduction. Conclusions: Although the findings from this small pilot study are preliminary, we believe they support the rationale for larger analytic studies designed a priori to test the hypothesis.

BACKGROUND In the United States (US) and worldwide, chronic pain affects a vast number of people and is one of the leading reasons adults seek medical care. In the US, 24.3% of adults reported chronic pain in the past three months in 2023. Chronic pain is defined as lasting three months or longer, significantly disrupting one’s daily functioning and quality of life. Chronic pain can also be accompanied by other conditions, including anxiety and depression. Health care providers should be aware of several limitations in their array of current treatment modalities. While opioid analgesics are used for moderate to severe pain management, they cause many serious adverse effects, including sedation, respiratory depression, and constipation, and a high risk of dependence and addiction. Other pain medications, such as non-opioid analgesics including nonsteroidal anti-inflammatory drugs, adjuvant analgesics, and corticosteroids, similarly cause a range of side effects and organ toxicity. OBJECTIVE We conducted a pilot study to explore the potential role of a non-invasive and safe transdermal audio-based therapeutic system among 24 police professionals aged 21 to 65 years old with chronic pain, and/or associated conditions of migraine, sleep disorders, stress/anxiety, and conventional headaches. METHODS This STROBE-guided pilot study evaluated the feasibility and perceived effectiveness of a self-administered Transdermal Acoustic Pain Suppression (TAPS) intervention among police personnel in West Palm Beach, Florida. Participants completed a flexible 30-day protocol integrated into their work schedules, with data collection spanning five months due to operational constraints. Descriptive and non-parametric analyses indicated patterns of symptom reduction, perceived pain relief, and user satisfaction, supporting the usability of TAPS in this occupational setting. RESULTS Our pilot study findings showed that following therapy, more than one-third of participants (37.5%) experienced condition improvement and half reported reduced symptoms, including notable pain reduction. CONCLUSIONS The findings from this small pilot study support the rationale for larger analytic studies, designed a priori to test the hypothesis. CLINICALTRIAL Not applicable

Importance: Implicit bias recognition and management (IBRM) training is a promising strategy for improving clinician communication but is underevaluated.Objective: To describe the development and psychometric properties of the Respect, Empathize, Listen, Ask, Talk, and Engage (RELATE) rating scale, based on a theoretical framework of communication skills, to mitigate negative influences of implicit bias by using strategies for interrupting unconscious decision-making in patient-centered communication.Design, Setting, and Participants: In this cross-sectional study, between September 2019 and April 2022, standardized patients used the RELATE rating scale to evaluate communication skills of participating clinical trainees at an academic medical center who completed an IBRM training and engaged in simulated clinical encounters with standardized patients representing those with low socioeconomic status and African American, Latino or Hispanic, and African immigrant patients. Statistical analyses were ongoing from June 2021 to January 2024.Main Outcome and Measures: Gwet agreement coefficient (AC) was calculated using data from the 2019 to 2020 cohort year to assess standardized patient interrater reliability (IRR). To assess construct validity and internal consistency reliability, factor analysis techniques were used, and Cronbach α was calculated using data from 3 cohorts (2019-2020, 2020-2021, and 2021-2022).Results: Twenty-seven standardized patients generated 226 independent RELATE ratings for 123 consenting clinical trainees (14 family medicine residents [11.4%], 48 internal medicine residents [39.0%], and 61 doctor of nursing practice students [49.6%]; mean [SD] age, 30.4 [4.1] years; 82 [66.7%] female), who each had 2 RELATE scores. Of the 3-level item responses of whether a behavior was observed (“present,” “partial,” or “absent”), for all 19 items, at least 1 trainee (0.4%) was noted who did not complete the evaluated behavior, and all items had some responses of “partial” (range, 13 [5.8%] to 70 [31.0%]). Twelve of the 19 RELATE items (63.2%) showed either substantial or almost perfect IRR (Gwet AC, >0.60), and 6 items (31.6%) had moderate IRR (Gwet AC, 0.41-0.60). Factor analyses resulted in a final 4-factor solution with excellent model fit indices and strong factor loadings: respect (4 items), empathy (5 items), listening and talking (6 items), and engaging in partnership with patients (4 items). Each factor showed sound internal consistency (Cronbach α range, 0.64-0.77).Conclusions and Relevance: This cross-sectional study of the RELATE rating scale demonstrated high construct validity and good internal consistency in simulated clinician-patient encounters. The findings suggest that the RELATE rating scale is an efficient, theoretically consistent tool to evaluate implicit bias–management communication behavior among clinicians.

In a prospective longitudinal study with 218 Parkinson’s disease (PD) patients in the discovery cohort and 84 in the validation cohort, we aimed to identify novel blood biomarkers predicting disability milestones in PD. Through Least Absolute Shrinkage and Selection Operator-Cox (Lasso-Cox) regression, developed nomogram predictive model and Linear mixed-effects models, we identified low level of plasma fibronectin (pFN) as one of the best-performing risk markers in predicting disability milestones. A low level of pFN was associated with a short milestone-free survival period in PD. Longitudinal analysis showed an annual decline in the rate of pFN was significantly associated with the annual elevation rate in the Hoehn-Yahr stage. Moreover, pFN level was negatively correlated with phosphorylated α-synuclein, and a low level of pFN was associated with BBB disruption in the striatum on neuroimaging, providing evidence for pFN’s role in PD progression. We finally identified pFN as a novel blood biomarker that predicted first-milestone disability in PD.

Objects: To assess the safety and effectiveness of subnuclear phacoemulsification (SNP), a new technique for reducing corneal injury in nuclear cataract surgery. Methods: This randomized controlled trial (RCT) was designed in March 2020 and carried it out from April 1 to September 30, 2020, including a 3 months’ follow‐up. We recruited 256 age‐related hard nucleus cataract patients and randomly assigned them to two groups: the experimental group receiving SNP, and the control group receiving conventional phacoemulsification (CP). A single surgeon performed all the surgeries. We compared the two groups on the cumulative dissipated energy (CDE), phacoemulsification ultrasound time (UST), and complications for safety, as well as at multiple postsurgery follow‐up timepoints on three major outcomes for effectiveness: visual acuity, central corneal thickness, and central corneal endothelial cell density. Results: The two groups were well‐matched in terms of demographics, nuclear density, and safety measures (ultrasound energy, phacoemulsification time, and complications). For effectiveness after surgery, compared to the CP group, the SNP group had better visual acuity and thinner central cornea postsurgery within 1 week and had higher central corneal endothelial cell density at the 1‐ and 3‐month follow‐up. Conclusions: Compared to CP, SNP is more effective for reducing corneal injury in cataract surgery. The widespread application of this technology will greatly improve the safety of cataract surgery, especially hard cataract surgery. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000031114

Donor stem cell health may be critically important to the success of hematopoietic stem cell transplantation (HSCT). Herein, we performed this systematic review and meta-analysis including meta-regression to assess the impact of donor-engrafted clonal hematopoiesis (CH) in allogeneic HSCT (allo-HSCT) and impact of pre-transplant CH in autologous HSCT (auto-HSCT). We applied random-effects models to analyze 5 allo-HSCT studies with 3192 donor-recipient pairs and 9 auto-HSCT studies with 2854 patients. We found that donor-engrafted CH after allo-HSCT decreased the risk of disease relapse [Hazard Ratio (HR) = 0.79, 95% Confidence Interval (CI): (0.67, 0.93)], but did not affect overall survival (OS) [HR = 0.91, 95% CI: (0.75, 1.11)], progression-free survival (PFS) [HR = 0.94, 95% CI: (0.63, 1.41)], or non-relapse mortality [HR = 1.06, 95% CI: (0.81, 1.39)]. In contrast, pre-transplant CH in auto-HSCT recipients resulted in inferior OS [HR = 1.30, 95% CI: (1.16, 1.46)], inferior PFS [HR = 1.35, 95% CI: (1.18, 1.54)], and higher risk for therapy-related myeloid neoplasm [HR = 4.85, 95% CI: (2.39, 9.82)] when compared to auto-HSCT recipients without CH. This study sheds light onto the debate about prospective “CHIP screening” for stem cell donors and addresses the impact of CH as a transmissible phenomenon.

Through a two-year follow-up study among 2,845 middle school students, we examined the impact of baseline negative life events (NLE) on follow-up negative copying style (NCS) and Internet addiction (IA), and the mediation of NCS between NLE and IA. We found that all NLE, NCS, and IA were correlated, and that both NLE and NCS were risk factors for IA. Structural equation modeling (SEM) results showed that NLE were associated with increased NCS (β = 0.17, p < 0.01) and IA (β = 0.16, p < 0.01), that NCS was associated IA ( β = 0.33, p < 0 0.01), and that NCS partially mediated the effect of NLE on IA ( β = 0.17, p < 0.01). This large longitudinal study provided solid empirical evidence that NLE and NCS played important roles in IA among middle school students. Educators and policy makers may adopt corresponding approaches to address IA among this population.