Computed Tomography Fluoroscopy-guided Biopsy of Lung Nodules: Comparison of the Step-wise and Realtime Techniques

The present study aimed to compare the step-wise and real-time techniques for computed tomography (CT) fluoroscopy-guided biopsy of lung nodules. It included 72 consecutive patients (50 men, 22 women; mean age: 71.8 years; range: 45–89 years) with lung nodules. Between March 2017 and April 2019, 72 CT fluoroscopy-guided biopsy procedures were performed using either the step-wise (n = 34) or real-time technique (n = 38). The diagnostic accuracy was 97.1% for biopsies performed using the step-wise technique and 94.7% for those performed using the real-time technique (p = 0.39). The mean CT dose index was 48.8 ± 16.9 mGy/s for the step-wise method and 59.9 ± 25.6 mGy/s for the real-time method; the dose length product was 1956 ± 729 mGy and 2613 ± 1300 mGy for the two techniques, respectively (p < 0.05). There was a significant difference in mean exposure time (81 ± 43 s for the step-wise technique and 162 ± 120 s for the real-time technique; p < 0.05). The mean lung nodule size was also significantly different (29.9 ± 17.6 mm for the step-wise method and 17.8 ± 12.2 mm for the real-time method; p < 0.01). Of the 34 step-wise procedures, 11 (32.4%) resulted in pneumothorax, as did 24 of 38 (63.2%) real-time procedures (p < 0.01). The real-time technique is particularly useful in patients with small nodules. The CT dose, exposure time, and incidence of pneumothorax were significantly lower when the step-wise technique was applied to CT fluoroscopy-guided biopsy of lung nodules

Belly roll, a GPI-anchored Ly6 protein, regulates Drosophila melanogaster escape behaviors by modulating the excitability of nociceptive peptidergic interneurons

Appropriate modulation of escape behaviors in response to potentially damaging stimuli is essential for survival. Although nociceptive circuitry has been studied, it is poorly understood how genetic contexts affect relevant escape responses. Using an unbiased genome-wide association analysis, we identified an Ly6/α-neurotoxin family protein, Belly roll (Bero), which negatively regulates Drosophila nociceptive escape behavior. We show that Bero is expressed in abdominal leucokinin-producing neurons (ABLK neurons) and bero knockdown in ABLK neurons resulted in enhanced escape behavior. Furthermore, we demonstrated that ABLK neurons responded to activation of nociceptors and initiated the behavior. Notably, bero knockdown reduced persistent neuronal activity and increased evoked nociceptive responses in ABLK neurons. Our findings reveal that Bero modulates an escape response by regulating distinct neuronal activities in ABLK neurons

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo