Do-Si-Do

Dan Christensen a painter whose paintings were known for their festivity and bright colors was born in Nebraska.  He completed his studies at the Kansas City Art Institute in 1964 and moved to New York shortly thereafter.

Although his brilliant spray-painted bands were well received; he strived to find new ways to express his fascination with color.   Thus his paintings of rectangular blocks came to be known as his “plaid” series. The plaid series evolved into another technique in which he layered different colors thus he created a sense of depth, a technique he called “slab” paintings.   In the 1990s, his work evolved to the “circle” paintings of radiant rounded forms.

An example of the glowing disks that characterized his circle technique is “Do-Si-Do”, in which a series of concentric circles was depicted and shows his long obsession with color.  In this painting Christensen was recalling childhood memories of hot summer days dominated by a relentless sun in the sky. An alternate interpretation of the work involves consideration of the “Do-Si-Do” dance maneuver in which participants move around one another or as the planets rotate around the sun in our solar system occasionally exhibiting paradoxical travels like they are intoxicated from the overpowering brilliance of Ηλιος the Sun-God.

   

Dan Christensen (1942-2007), Do-Si-Do, 1991, American. Acrylic on canvas. 177.8 × 177.8 cm. Courtesy of the Wichita Art Museum (https://www.wichitaartmuseum.org/), Wichita, Kansas.

Excerpt from the article by Jeanette M. Smith, MD JAMA. 2015;313(11):1084-1085

Anatomical versus Functional Testing for Coronary Artery Disease

Douglas et al in their article in NEJM compared the outcomes of anatomical versus functional tests in patients with coronary artery disease. 

They randomly assigned 10,003 symptomatic patients to an initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure.

The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group. CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P=0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001).

In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years suggesting that patients with chest pain have no less risk of heart attack, dying or being hospitalized than those who take a simple stress test.  

Race and ethnicity play a role in the outcome of patients with Breast Cancer

Javaid et al report in a JAMA article the findings of an observational study of women diagnosed with invasive breast cancer from 2004 to 2011, that were identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (N = 452 215).   The patients belonged in 8 racial/ethnic groups, who had small-sized tumors of 2.0 cm or less with biological aggressiveness (triple-negative cancers, lymph node metastases, and distant metastases).

The odds ratio for being diagnosed at stage I compared with a later stage and the hazard ratio for death from stage I breast cancer by racial/ethnic group were determined.

Breast cancer stage at diagnosis and 7-year breast cancer–specific survival, adjusted for age at diagnosis, income, and estrogen receptor status was assessed.

Of 373 563 women with invasive breast cancer, 268 675 (71.9%) were non-Hispanic white; 34 928 (9.4%), Hispanic white; 38 751 (10.4%), black; 25 211 (6.7%), Asian; and 5998 (1.6%), other ethnicities. Mean follow-up time was 40.6 months (median, 38 months). Compared with non-Hispanic white women diagnosed with stage I breast cancer (50.8%), Japanese women (56.1%) were more likely to be diagnosed and black women (37.0%) were less likely to be diagnosed. Actuarial risk of death from stage I breast cancer at 7 years was higher among black women (6.2%) than non-Hispanic white women (3.0%), and lower among South Asian women (1.7%). Black women were more likely to die of breast cancer with small-sized tumors (9.0%) than non-Hispanic white women (4.6%); the difference remained after adjustment for income and estrogen receptor status.

Among US women diagnosed with invasive breast cancer, the likelihood of diagnosis at an early stage, and survival after stage I diagnosis, varied by race and ethnicity.

Diagnostic Disagreement among Pathologists Interpreting Breast Biopsies

Elmore et al in their article published in JAMA report their findings on diagnostic disagreement among 115 pathologists compared with a consensus panel.

The participating pathologists independently interpreted 240 cases, that included 23 cases of invasive breast cancer, 73 cases of ductal carcinoma in situ (DCIS), 72 cases with atypical hyperplasia (atypia), and 72 benign cases without atypia. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%.

  

Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3%. Among invasive carcinoma cases 96% were concordant; among DCIS cases 84% were concordant, with 3% were over interpreted, and 13% were under interpreted; among atypia cases 48% were concordant, with 17% were over interpreted, and 35% were under interpreted; and among benign cases without atypia 87% were concordant. Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women whose breasts were dense on prior mammograms.

In this study overall agreement between the individual pathologists’ interpretations and the expert consensus-derived reference diagnoses-was 75.3 percent, with the highest level of agreement 96 percent for invasive carcinoma and lower levels of agreement for DCIS 87 percent.  However, with atypical ductal hyperplasia the pathologists matched the experts only in 48 percent of the time.