INTRODUCTION:Tenapanor is a first-in-class, minimally absorbed, small-molecule inhibitor of the gastrointestinal sodium/hydrogen exchanger isoform 3. This phase 3 trial assessed the long-term efficacy and safety of tenapanor 50 mg b.i.d. for the treatment of patients with irritable bowel syndrome with constipation (IBS-C). METHODS:In this randomized double-blind study (ClinicalTrials.gov identifier: NCT02686138), patients with IBS-C received tenapanor 50 mg b.i.d. or placebo b.i.d. for 26 weeks. The primary endpoint was the proportion of patients who had a reduction of ≥30.0% in average weekly worst abdominal pain and an increase of ≥1 weekly complete spontaneous bowel movement from baseline, both in the same week, for ≥6 of the first 12 treatment weeks (6/12-week combined responder). RESULTS:Of the 620 randomized patients with IBS-C, 593 (95.6%) were included in the intention-to-treat analysis set (tenapanor: n = 293; placebo: n = 300) and 481 patients (77.6%) completed the 26-week treatment period. In the intention-to-treat analysis set (mean age: 45.4 years; 82.1% women), a significantly greater proportion of patients treated with tenapanor were 6/12-week combined responders than those treated with placebo (36.5% vs 23.7%; P < 0.001). Abdominal symptoms and global symptoms of IBS were significantly improved with tenapanor compared with placebo. Diarrhea, the most common adverse event, was typically transient and mild to moderate in severity. Diarrhea led to study drug discontinuation for 19 (6.5%) and 2 patients (0.7%) receiving tenapanor and placebo, respectively. DISCUSSION:Tenapanor 50 mg b.i.d. improved IBS-C symptoms over 26 weeks and was generally well tolerated, offering a potential new long-term treatment option for patients with IBS-C (see Visual abstract, Supplementary Digital Content 1, http://links.lww.com/AJG/B797).
Ethnic/racial bias was found in MSPEs of general surgery residency applicants. However, which portion(s) of the MSPEs is/are associated with the bias remains unknown. We aim to answer the question: what portion(s) of the MSPEs is/are associated with ethnic/racial bias as measured by differential use of communal and agentic terms? Retrospective study evaluating the source of ethnic/race bias, as measured by differential use of agentic and communal terms, in all MSPEs of residency applicants to a single institution from two consecutive match cycles. A separate bias score was calculated for the different portions of the MSPE, and multivariable regression was used to assess the association between each score (of the different portions) and ethnicity/race (URiM versus non-URiM). US medical students applying for a categorical surgery residency position at a single academic institution for two consecutive Match cycles were included. 1314 MSPEs from 146 medical schools were included. Baseline characteristics were comparable between application cycles. Genders were similarly distributed (women, 51.6
Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease that requires tailored treatment strategies. This study investigates the correlation between T and N factors and postoperative recurrence patterns to refine therapeutic approaches. The subjects of this retrospective cohort study were 193 patients with LA-NSCLC, who underwent trimodality therapy between 1999 and 2021. Tumors were categorized as Nodal-Dominant (ND) LA-NSCLC (T1-2 with advanced nodal involvement) or Tumor-Dominant (TD) LA-NSCLC (T3-4 with limited nodal involvement). We compared recurrence patterns and survival outcomes between the two groups. The 193 patients comprised 83 with ND-LA-NSCLC and 110 with TD-LA-NSCLC. The patients with ND-LA-NSCLC had a significantly higher rate of distant metastasis than those with TD-LA-NSCLC (50.6
