Do false positive thallium-201 scans lead to unnecessary catheterization? outcome of patients with perfusion defects on quantitative planar thallium-201 scintigraphy

AbstractObjectives. We postulated that artifactually abnormal thallium-201 scans are well identified at the time of initial clinical interpretation by experienced readers and do not lead to unnecessary coronary angiography.Background. Exercise thallium-201 scintigraphy employing quantitative imaging techniques has yielded sensitivity and specificity values of 80% to 90%. There are image artifacts, such as breast shadows, and variants of normal that, if not correctly identified, can lead to a high false positive rate for detection of coronary artery disease.Methods. Data from 338 consecutive patients with one or more focal thallium-201 defects on quantitative planar Images were reviewed. All patients had undergone symptom-limited exercise scintigraphy and were classified as having either artifactual or nonartifactual thallium-201 defects after review of clinical reports.Results. Of the 265 patients with defects judged to be nonartifactual on clinical readings, 167 underwent coronary angiography, which demonstrated significant coronary artery disease (≥50% stenosis) in 161 (96%) and normal findings in 6. Four of the latter six had documented prior myocardial infarction. The remaining 73 patients (85% female) had thallium-201 defects deemed to be artifactual on clinical readings, chiefly as a result of breast (66%) and diaphragmatic (8%) attenuation or variants of normal (26%). Only 4 (5%) of the 73 patients underwent subsequent coronary angiography; none had coronary artery disease. One had aortic stenosis and two had variant angina. Follow-up (mean 20 ± 2 months) of the 69 patients in this group who did not undergo coronary angiography revealed no deaths and one nonfatal non-Q wave myocardial infarction.Conclusions. Artifactual defects on quantitative planar thallium-201 scintigraphy are well recognized by experienced interpreters and do not result in a high false positive rate leading to unnecessary cardiac catheferization. The incidence of coronary artery disease is high in patients with thallium-201 defects judged to be nonartifactual, and many patients with perfusion defects and angiographically normal coronary arteries have organic heart disease

Complementarity and Scientific Rationality

Bohr's interpretation of quantum mechanics has been criticized as incoherent and opportunistic, and based on doubtful philosophical premises. If so Bohr's influence, in the pre-war period of 1927-1939, is the harder to explain, and the acceptance of his approach to quantum mechanics over de Broglie's had no reasonable foundation. But Bohr's interpretation changed little from the time of its first appearance, and stood independent of any philosophical presuppositions. The principle of complementarity is itself best read as a conjecture of unusually wide scope, on the nature and future course of explanations in the sciences (and not only the physical sciences). If it must be judged a failure today, it is not because of any internal inconsistency.Comment: 29 page

Patients’ experiences of vulvar cancer diagnosis and treatment: results from a consumer-guided qualitative study

Background:Despite increased attention for the use of sentinel node biopsy (SNB) for the management of vulvar cancer as a less invasive technique compared with lymph node dissection (LND), patient views on this technique are unknown. This study explored patients’ experiences of being diagnosed and treated for vulvar cancer and to enhance our understanding of the patient view of SNB.Methods:Ten women who had received surgery (with or without lymph node removal) for vulvar cancer in the previous five years participated in a semi-structured qualitative interview in 2022. A consumer-led research group guided thematic analysis of the data.Results:Ten women were interviewed ranging in age (41–82 years). Treatment included either lymph node removal during initial surgery (n = 4), or following a routine scan identifying a change (n = 2); four vulvar cancer patients were being monitored with ultrasound at the time of the interview. Five main themes were identified: (1) difficult diagnostic experiences; (2) lack of support and information; (3) challenges with treatment decision-making; (4) patients’ perspectives of LND and SNB with monitoring; (5) trauma of treatment.Conclusions:SNB seems acceptable to patients and potentially offers a less invasive alternative to standard treatment, which should be further investigated

Nonlocality, Bell's Ansatz and Probability

Quantum Mechanics lacks an intuitive interpretation, which is the cause of a generally formalistic approach to its use. This in turn has led to a certain insensitivity to the actual meaning of many words used in its description and interpretation. Herein, we analyze carefully the possible mathematical meanings of those terms used in analysis of EPR's contention, that Quantum Mechanics is incomplete, as well as Bell's work descendant therefrom. As a result, many inconsistencies and errors in contemporary discussions of nonlocality, as well as in Bell's Ansatz with respect to the laws of probability, are identified. Evading these errors precludes serious conflicts between Quantum Mechanics and both Special Relativity and Philosophy.Comment: 8&1/2 pages revtex; v2: many corrections, clairifications & extentions, all small; v3: editorial scru

Microbiota functional activity biosensors for characterizing nutrient metabolism in vivo

Methods for measuring gut microbiota biochemical activities in vivo are needed to characterize its functional states in health and disease. To illustrate one approach, an arabinan-containing polysaccharide was isolated from pea fiber, its structure defined, and forward genetic and proteomic analyses used to compare its effects, versus unfractionated pea fiber and sugar beet arabinan, on a human gut bacterial strain consortium in gnotobiotic mice. We produced \u27Microbiota Functional Activity Biosensors\u27 (MFABs) consisting of glycans covalently linked to the surface of fluorescent paramagnetic microscopic glass beads. Three MFABs, each containing a unique glycan/fluorophore combination, were simultaneously orally gavaged into gnotobiotic mice, recovered from their intestines, and analyzed to directly quantify bacterial metabolism of structurally distinct arabinans in different human diet contexts. Colocalizing pea-fiber arabinan and another polysaccharide (glucomannan) on the bead surface enhanced in vivo degradation of glucomannan. MFABs represent a potentially versatile platform for developing new prebiotics and more nutritious foods

Inducible CRISPR-targeted knockdown of human gut Bacteroides in gnotobiotic mice discloses glycan utilization strategies

Understanding how members of the human gut microbiota prioritize nutrient resources is one component of a larger effort to decipher the mechanisms defining microbial community robustness and resiliency in health and disease. This knowledge is foundational for development of microbiota-directed therapeutics. To model how bacteria prioritize glycans in the gut, germfree mice were colonized with 13 human gut bacterial strains, including seven saccharolyti

Being in front is good—but where is in front? Preferences for spatial referencing affect evaluation

Speakers of English frequently associate location in space with valence, as in moving up and down the “social ladder.” If such an association also holds for the sagittal axis, an object “in front of” another object would be evaluated more positively than the one “behind.” Yet how people conceptualize relative locations depends on which frame of reference (FoR) they adopt—and hence on cross‐linguistically diverging preferences. What is conceptualized as “in front” in one variant of the relative FoR (e.g., translation) is “behind” under another variant (reflection), and vice versa. Do such diverging conceptualizations of an object's location also lead to diverging evaluations? In two studies employing an implicit association test, we demonstrate, first, that speakers of German, Chinese, and Japanese indeed evaluate the object “in front of” another object more positively than the one “behind.” Second, and crucially, the reversal of which object is conceptualized as “in front” involves a corresponding reversal of valence, suggesting an impact of linguistically imparted FoR preferences on evaluative processes.publishedVersio