Subjective risk and associated electrodermal activity of a self-driving car passenger in an urban shared space

Shared spaces are urban areas without physical separation between motorised and non-motorised users. Previous research has suggested that it is difficult for users to appropriate these spaces and that the advent of self-driving cars could further complicate interactions. It is therefore important to study the perception of these spaces from the users' perspectives to determine which conditions may promote their acceptance of the vehicles. This study investigates the perceived collision risk of a self-driving car's passenger when pedestrians cross the vehicle's path. The experiment was conducted with a driving simulator. Seven factors were manipulated to vary the dynamics of the crossing situations in order to analyse their influence on the passenger's perception of collision risk. Two measures of perceived risk were obtained. A continuous subjective assessment, reflecting an explicit risk evaluation, was reported in real time by participants. On the other hand, their skin conductance responses, which reflects implicit information processing, were recorded. The relationship between the factors and the risk perception indicators was studied using Bayesian networks. The best Bayesian networks demonstrate that subjective collision risk assessments are primarily influenced by the factors that determine the relative positions of the vehicle and the pedestrian as well as the distance between them when they are in close proximity. The analysis further reveals that variations in skin conductance response indicators are more likely to be explained by variations in subjective assessments than by variations in the manipulated factors. These findings could benefit the development of self-driving navigation among pedestrians by improving understanding of the factors that influence passengers' feelings.

Evaluation of risk management in a natalizumab home infusion procedure

Natalizumab is a well-established disease-modifying therapy used in active multiple sclerosis (MS). The most serious adverse event is progressive multifocal leukoencephalopathy. For safety reasons, hospital implementation is mandatory. The SARS-CoV-2 pandemic has deeply affected hospital practices leading French authorities to temporarily authorize to administer the treatment at home. The safety of natalizumab home administration should be assessed to allow ongoing home infusion. The aim of the study is to describe the procedure and assess the safety in a home infusion natalizumab model. Patients presenting relapsing-remitting MS treated by natalizumab for over two years, non-exposed to John Cunningham Virus (JCV) and living in the Lille area (France) were included from July 2020 to February 2021 to receive natalizumab infusion at home every four weeks for 12 months. Teleconsultation occurrence, infusion occurrence, infusion cancelling, JCV risk management, annual MRI completion were analyzed. The number of teleconsultations allowing infusion was 365 (37 patients included in the analysis), all home infusions were preceded by a teleconsultation. Nine patients did not complete the one-year home infusion follow-up. Two teleconsultations canceled infusions. Two teleconsultations led to a hospital visit to assess a potential relapse. No severe adverse event was reported. All 28 patients who have completed the follow-up benefited from biannual hospital examination and JCV serologies and annual MRI. Our results suggested that the established home natalizumab procedure was safe using the university hospital home-care department. However, the procedure should be evaluated using home-based services outside the university hospital.

Evaluation of epigenetic methylation biomarkers for the detection of colorectal cancer using droplet digital PCR

Colorectal cancer (CRC) is the third most common cancer worldwide. Screening programs allow early diagnosis and have improved the clinical management of this disease. Aberrant DNA methylation is increasingly being explored as potential biomarkers for many types of cancers. In this study we investigate the methylation of ten target genes in 105 CRC and paired normal adjacent colonic tissue samples using a MethylLight droplet digital PCR (ML-ddPCR) assay. Receiver operator characteristic (ROC) curves were used to determine the diagnostic performance of all target genes individually and in combination. All 515 different combinations of genes showed significantly higher levels of methylation in CRC tissue. The combination of multiple target genes into a single test generally resulted in greater diagnostic accuracy when compared to single target genes. Our data confirms that ML-ddPCR is able to reliably detect significant differences in DNA methylation between CRC tissue and normal adjacent colonic tissue in a specific selection of target genes.

Eukaryotic-like gephyrin and cognate membrane receptor coordinate corynebacterial cell division and polar elongation

The order Corynebacteriales includes major industrial and pathogenic actinobacteria such as Corynebacterium glutamicum or Mycobacterium tuberculosis . Their elaborate multi-layered cell wall, composed primarily of the mycolyl-arabinogalactan-peptidoglycan complex, and their polar growth mode impose a stringent coordination between the septal divisome, organized around the tubulin-like protein FtsZ, and the polar elongasome, assembled around the tropomyosin-like protein Wag31. Here, we report the identification of two new divisome members, a gephyrin-like repurposed molybdotransferase (GLP) and its membrane receptor (GLPR). We show that the interplay between the GLPR/GLP module, FtsZ and Wag31 is crucial for orchestrating cell cycle progression. Our results provide a detailed molecular understanding of the crosstalk between two essential machineries, the divisome and elongasome, and reveal that Corynebacteriales have evolved a protein scaffold to control cell division and morphogenesis similar to the gephyrin/GlyR system that in higher eukaryotes mediates synaptic signaling through network organization of membrane receptors and the microtubule cytoskeleton.

Risk Assessment by a Passenger of an Autonomous Vehicle Among Pedestrians: Relationship Between Subjective and Physiological Measures

Autonomous navigation becomes complex when it is performed in an environment that lacks road signs and includes a variety of users, including vulnerable pedestrians. This article deals with the perception of collision risk from the viewpoint of a passenger sitting in the driver's seat who has delegated the total control of their vehicle to an autonomous system. The proposed study is based on an experiment that used a fixed-base driving simulator. The study was conducted using a group of 20 volunteer participants. Scenarios were developed to simulate avoidance manoeuvres that involved pedestrians walking at 4.5 kph and an autonomous vehicle that was otherwise driving in a straight line at 30 kph. The main objective was to compare two systems of risk perception: These included subjective risk assessments obtained with an analogue handset provided to the participants and electrodermal activity (EDA) that was measured using skin conductance sensors. The relationship between these two types of measures, which possibly relates to the two systems of risk perception, is not unequivocally described in the literature. This experiment addresses this relationship by manipulating two factors: The time-to-collision (TTC) at the initiation of a pedestrian avoidance manoeuvre and the lateral offset left between a vehicle and a pedestrian. These manipulations of vehicle dynamics made it possible to simulate different safety margins regarding pedestrians during avoidance manoeuvres. The conditional dependencies between the two systems and the manipulated factors were studied using hybrid Bayesian networks. This relationship was inferred by selecting the best Bayesian network structure based on the Bayesian information criterion. The results demonstrate that the reduction of safety margins increases risk perception according to both types of indicators. However, the increase in subjective risk is more pronounced than the physiological response. While the indicators cannot be considered redundant, data modeling suggests that the two risk perception systems are not independent.

Incidence, risk factors and outcomes of atrial arrhythmias in adult patients with atrioventricular septal defect

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): French Federation of Cardiology

Background

The number of adults with atrioventricular septal defects (AVSD) is growing, with however, very few data regarding the natural history of atrial arrhythmias in this specific population. We aimed to assess the incidence, associated factors and outcomes of atrial arrhythmias among adult patients with AVSD.

Methods

Multicentric retrospective cohort of patients with AVSD from 3 referral centers specialized in adult congenital heart disease. Unbalanced AVSD, univentricular hearts, and Eisenmenger syndromes were excluded. Lifetime cumulative incidences of different types of atrial arrhythmia (>30 seconds) were analyzed (atrial fibrillation [AF] and intra atrial reentrant tachycardia/focal atrial tachycardia [IART/FAT]). Multiple logistic regression models were used to identify risk factors for atrial arrhythmias.

Results

The cohort comprised of 391 patients (61.6% of women) with a mean age of 36.3 ± 16.3 years and 17.3 ± 14.2 years of follow-up after surgical repair in operated patients, including 333 (85.1%) partial/intermediate and 58 (1.0%) complete AVSD. Overall, atrial arrhythmias were documented in 98 patients (25.1%).

The lifetime risks for developing atrial arrhythmia to ages 20, 40, and 60 were 3.7%, 17.6%, and 54.8%. IART/FAT was the leading arrhythmia until the age of 45 then AF surpassed IART/FAT.

Age (OR = 1.4, 95%CI = 1.2-1.6 by 5 years increment), the number of cardiac surgeries (OR = 4.1, 95%CI = 2.5-6.9), left atrial dilatation (OR = 3.1, 95%CI = 1.4-6.8), right atrial dilatation (OR = 4.1, 95%CI = 1.7-10.3), and moderate or severe left AV valve regurgitation (OR = 3.7, 95%CI = 1.2-11.7) were independently associated with a higher risk of atrial arrhythmias. Patients with atrial arrhythmias more frequently had pacemaker implantation (41.8% vs. 8.5%, p < 0.001), heart failure (24.5% vs 1.0%, p < 0.001) and cerebrovascular accidents (11.2% vs 3.4%, p = 0.007).

Conclusions

The lifetime risk of atrial arrhythmias in patients with AVSD is considerable with more than half of patients who will develop an atrial arrhythmia by the age of 60. Atrial arrhythmias are associated with a significant morbidity in this population. Abstract Figure. Central Illustration AVSD

FRI0630-HPR ONE-YEAR FOLLOW-UP OF A NURSE-LED TEAM INTERVENTION EFFECTIVE IN REDUCING THE NOCEBO EFFECT WHEN SWITCHING FROM ORIGINATOR INFLIXIMAB TO A BIOSIMILAR

Background:

Nonspecific subjective adverse effects and symptoms (NSAE/NSS), usually considered as related to a nocebo effect (NE), have been identified as a barrier to the acceptability of switches from biologic originators (BO) to biosimilars (BS) in rheumatology. A multidisciplinary team intervention with a prominent role of nurses has provided a reduction of the NE assessed in the short-term during a systematic switch from originator Infliximab (OI) to the biosimilar infliximab SB2 (ref.1).

Objectives:

To assess the intervention outcomes after one-year follow up in comparison with a historical cohort.

Methods:

The intervention was developed after a literature search and semi-directive interviews of patients, and included consensual communication towards patients, with a prominent role of nurses (Ref.1). All patients with chronic inflammatory rheumatic diseases (CIRD) treated by OI were included and followed-up in routine care. The outcomes were I) SB2 retention rate (RR) II) SB2 discontinuation rate due to a presumed NE, defined as lack of efficacy with no objective criteria for increased inflammation or non-objective and non-specific adverse event, either occurring after the switch and disappearing after back-switch or change of biologic. Criteria for NSAE/NSS in the historical cohort were the same lack of efficacy or subjective adverse events and disappearance after change of biologic BD. Medium-term (12 months) SB2 outcomes were assessed and compared with I) the data obtained in the short-term (34 weeks) II) the data from an historical cohort of CIRD patients treated by OI in the same rheumatology department, using Kaplan-Meier survival curve.

Results:

Forty-five patients were prospectively included for the switch from March 2018 to August 2018: 17 with rheumatoid arthritis (RA), 28 with spondylarthritis (SpA); 55% were women, mean age was 53.2 (SD: 2,1), and mean time under OI was 113.5 (SD9.3). For the historical cohort, the 52 patients treated with OI between December 2016 and January 2017 were included and their data collected at baseline and one year. Fifty-nine percent were women, mean age at inclusion was 50.25 (1.2), and mean time under OI was 94.8 (9.4).

SB2 RR did not differ from the OI RR in the historical cohort: 91.2% and 96.2% respectively at 34 weeks (p = 0.41); 84.4% and 88.5% respectively at 12 months (p = 0.52) (figure 1). The SB2 RR was significantly higher than in three other European cohorts at 34 weeks (mean RR 73.6%, p<0.05, ref.1) but not at 12 months (mean RR 80.9%, ref.2,3,4).

SB2 and OI discontinuations due to NSAE/NSS at 34 weeks were 2,2 % and 1.9% respectively; at 12 months 6,6% and 1.9% respectively (p= 0.6).

Conclusion:

An intervention based on a tailored communication with a prominent role of nurses was effective in reducing the NE when switching from OI to SB2 in the short term, compared with an historical cohort and other European cohorts. The one-year follow-up showed no statistical difference in RR or NE compared with our historical cohort. The present study shows that appropriate interventions may be developed to improve the outcome of switches to biosimilars.

Figure 1:

Treatment withdrawal free survival curves (SB2 in switched cohort and OI in historical cohort).

Kaplan Meir survival curves. Comparison with Log-Rank test between OI to SB2 cohort and historical OI cohort, p = 0.520. OI : original infliximab.

References:

[1] Petit J. Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1447

[2] Glintborg B. et al. Ann Rheum Dis 2017;76:1426–31.

[3] Nikiphorou E. et al. Expert Opin Biol Ther 2015;15:1677–83.

[4] Boone NW. et al. Eur J Clin Pharmacol 2018;:1–7.

Acknowledgments:

Dr Margaux Boisson Service de rhumatologie du Professeur Kahan, Hôpital Cochin, APHP.

Disclosure of Interests:

Juliette Petit: None declared, Marie Antignac: None declared, Karine Louati: None declared, Sandra Desouches: None declared, Nathalie DEPARIS: None declared, Regine Baratto: None declared, Rosemarie POILVERD: None declared, Sylvie Dartout: None declared, Francis Berenbaum Grant/research support from: TRB Chemedica (through institution), MSD (through institution), Pfizer (through institution), Consultant of: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Bone Therapeutics, Regulaxis, Peptinov, 4P Pharma, Paid instructor for: Sandoz, Speakers bureau: Novartis, MSD, Pfizer, Lilly, UCB, Abbvie, Roche, Servier, Sanofi-Aventis, Flexion Therapeutics, Expanscience, GSK, Biogen, Nordic, Sandoz, Regeneron, Gilead, Sandoz, Catherine Beauvais Speakers bureau: Abbvie, MSD, Roche, UCB, Mylan, Sanofi

Conical Interfaces between Two Immiscible Fluids Induced by an Optical Laser Beam

We demonstrate the existence of conical interface deformations induced by a laser beam that are similar to Taylor cones in the electrical regime. We show that the cone morphology can be manipulated by fluid and laser parameters. A theory is proposed to quantitatively describe these dependences in good agreement with experimental data obtained for different fluid systems with low interfacial tensions. Counterintuitively, the cone angle is proved to be independent of the refractive index contrast at leading order. These results open a new optofluidic route towards optical spraying technology-an analogue of electrospraying-and more generally for the optical shaping of interfaces.

Social cognition in autism is associated with the neurodevelopment of the posterior superior temporal sulcus

OBJECTIVE

The posterior superior temporal sulcus (pSTS) plays a critical role in the 'social brain'. Its neurodevelopment and relationship with the social impairment in autism spectrum disorders (ASD) are not well understood. We explored the relationship between social cognition and the neurodevelopment of the pSTS in ASD.

METHOD

We included 44 adults with high-functioning ASD and 36 controls. We assessed their performances on the 'Reading the mind in the eyes' test (for 34 of 44 subjects with ASD and 30 of 36 controls), their fixation time on the eyes with eye tracking (for 35 of 44 subjects with ASD and 30 of 36 controls) and the morphology of the caudal branches of the pSTS (length and depth), markers of the neurodevelopment, with structural MRI.

RESULTS

The right anterior caudal ramus of the pSTS was significantly longer in patients with ASD compared with controls (52.6 mm vs. 38.3 mm; P = 1.4 × 10^-3 ; Cohen's d = 0.76). Its length negatively correlated with fixation time on the eyes (P = 0.03) in the ASD group and with the 'Reading the mind in the eyes' test scores in both groups (P = 0.03).

CONCLUSION

Our findings suggest that the neurodevelopment of the pSTS is related to the ASD social impairments.

Accuracy of stress measurement by Laue microdiffraction (Laue-DIC method): the influence of image noise, calibration errors and spot number

Laue microdiffraction, available at several synchrotron radiation facilities, is well suited for measuring the intragranular stress field in deformed materials thanks to the achievable submicrometer beam size. The traditional method for extracting elastic strain (and hence stress) and lattice orientation from a microdiffraction image relies on fitting each Laue spot with an analytical function to estimate the peak position on the detector screen. The method is thus limited to spots exhibiting ellipsoidal shapes, thereby impeding the study of specimens plastically deformed. To overcome this difficulty, the so-called Laue-DIC method introduces digital image correlation (DIC) for the evaluation of the relative positions of spots, which can thus be of any shape. This paper is dedicated to evaluating the accuracy of this Laue-DIC method. First, a simple image noise model is established and verified on the data acquired at beamline BM32 of the European Synchrotron Radiation Facility. Then, the effect of image noise on errors on spot displacement measured by DIC is evaluated by Monte Carlo simulation. Finally, the combined effect of the image noise, calibration errors and the number of Laue spots used for data treatment is investigated. Results in terms of the uncertainty of stress measurement are provided, and various error regimes are identified.

Direct measurement of local constitutive relations, at the micrometre scale, in bulk metallic alloys

Multiscale models involving crystal plasticity are essential to predict the elastoplastic behavior of structural materials with respect to their microstructure. However, those models are often limited by a poor knowledge of the local constitutive behavior. This article reports a method to measure the mechanical behavior directly, at the micrometre scale, in bulk crystalline materials. Local strain and stress states were evaluated at the surface of a bent stainless steel crystal by combining total strain measurements – performed with the digital image correlation technique on optical images – with elastic strain measurements obtained by Laue microdiffraction. A local constitutive relation was measured, in an efficient nondestructive way, without the need for full-field simulations. The method was validated by a comparison between the measured local behavior and the macroscopic behavior of the single crystal.

Predicting the distribution of whey protein fouling in a plate heat exchanger using the kinetic parameters of the thermal denaturation reaction of β-lactoglobulin and the bulk temperature profiles

Fouling of plate heat exchangers (PHE) is a severe problem in the dairy industry, notably because the relationship between the build-up of protein fouling deposits and the chemical reactions taking place in the fouling solution has not yet been fully elucidated. Experiments were conducted at pilot scale in a corrugated PHE, and fouling deposits were generated using a model β-lactoglobulin (β-LG) fouling solution for which the β-LG thermal denaturation reaction constants had been previously determined experimentally. Then 18 different bulk temperature profiles within the PHE were imposed. Analysis of the fouling runs shows that the dry deposit mass per channel versus the ratio R=k_unf/k_agg (with k_unf and k_agg representing, respectively, the unfolding and aggregation rate constants computed from both the identification of the β-LG thermal denaturation process and knowledge of the imposed bulk temperature profile into the PHE channel) is able to gather reasonably well the experimental fouling mass data into a unique master curve. This type of representation of the results clearly shows that the heat-induced reactions (unfolding and aggregation) of the various β-LG molecular species in the bulk fluid are essential to capture the trend of the fouling mass distribution inside a PHE. This investigation also illustrates unambiguously that the release of the unfolded β-LG (also called β-LG molten globule) within the bulk fluid (and the absence of its consumption in the form of aggregates) is a key phenomenon that controls the extent of protein fouling as well as its location inside the PHE.

Similar white matter but opposite grey matter changes in schizophrenia and high-functioning autism

OBJECTIVE

High-functioning autism (HFA) and schizophrenia (SZ) are two of the main neurodevelopmental disorders, sharing several clinical dimensions and risk factors. Their exact relationship is poorly understood, and few studies have directly compared both disorders. Our aim was thus to directly compare neuroanatomy of HFA and SZ using a multimodal MRI design.

METHODS

We scanned 79 male adult subjects with 3T MRI (23 with HFA, 24 with SZ and 32 healthy controls, with similar non-verbal IQ). We compared them using both diffusion-based whole-brain tractography and T1 voxel-based morphometry.

RESULTS

HFA and SZ groups exhibited similar white matter alterations in the left fronto-occipital inferior fasciculus with a decrease in generalized fractional anisotropy compared with controls. In grey matter, the HFA group demonstrated bilateral prefrontal and anterior cingulate increases in contrast with prefrontal and left temporal reductions in SZ.

CONCLUSION

HFA and SZ may share common white matter deficits in long-range connections involved in social functions, but opposite grey matter abnormalities in frontal regions that subserve complex cognitive functions. Our results are consistent with the fronto-occipital underconnectivity theory of HFA and the altered connectivity hypothesis of SZ and suggest the existence of both associated and diametrical liabilities to these two conditions.

Determination of deviatoric elastic strain and lattice orientation by applying digital image correlation to Laue microdiffraction images: the enhanced Laue-DIC method

A new method of determining the deviatoric elastic strain and lattice orientation from Laue microdiffraction images is presented. Standard data treatment methods can suffer from the difficulty of precisely pinpointing the positions of diffraction peaks on two-dimensional Laue images. In a previous article, digital image correlation (DIC) was introduced for the treatment of Laue images, leading to the so-called Laue-DIC method. This performed better than the standard method in terms of the deviatoric elastic strain increment and relative rotation from one lattice to another, particularly when the shape of the Laue spots departs from regular ellipsoids. The present work intends to push forward the Laue-DIC method, aiming to determine the deviatoric elastic strain and lattice orientation, as well as the calibration parameters. The performance of this new method, named enhanced Laue-DIC, is assessed by modeling the spot displacements and accounting for random fluctuations relevant for typical experimental conditions. When the enhanced Laue-DIC method is applied to the case of anin situdeformed Si crystal, the obtained standard deviation of local stress is of the order of 1–2 MPa, while the calibration parameters are optimized to high accuracy.

Laue-DIC: a new method for improved stress field measurements at the micrometer scale

A better understanding of the effective mechanical behavior of polycrystalline materials requires an accurate knowledge of the behavior at a scale smaller than the grain size. The X-ray Laue microdiffraction technique available at beamline BM32 at the European Synchrotron Radiation Facility is ideally suited for probing elastic strains (and associated stresses) in deformed polycrystalline materials with a spatial resolution smaller than a micrometer. However, the standard technique used to evaluate local stresses from the distortion of Laue patterns lacks accuracy for many micromechanical applications, mostly due to (i) the fitting of Laue spots by analytical functions, and (ii) the necessary comparison of the measured pattern with the theoretical one from an unstrained reference specimen. In the present paper, a new method for the analysis of Laue images is presented. A Digital Image Correlation (DIC) technique, which is essentially insensitive to the shape of Laue spots, is applied to measure the relative distortion of Laue patterns acquired at two different positions on the specimen. The new method is tested on an in situ deformed Si single-crystal, for which the prescribed stress distribution has been calculated by finite-element analysis. It is shown that the new Laue-DIC method allows determination of local stresses with a strain resolution of the order of 10(-5).

Excitation of fountain and entrainment instabilities at the interface between two viscous fluids using a beam of laser light

We report on two instabilities, called viscous fountain and viscous entrainment, triggered at the interface between two liquids by the action of bulk flows driven by a laser beam. These streaming flows are due to light scattering losses in turbid liquids, and can be directed either toward or forward the interface. We experimentally and numerically investigate these interface instabilities and show that the height and curvature of the interface deformation at the threshold and the jet radius after interface destabilization mainly depend on the waist of the laser beam. Analogies and differences between these two instabilities are characterized.

Inline high frequency ultrasonic particle sizer

This paper reports the development of a new method of particle sizing in a liquid. This method uses high frequency focused ultrasounds to detect particles crossing the focal zone of an ultrasonic sensor and to determine their size distribution by processing the reflected echoes. The major advantage of this technique compared to optical sizing methods is its ability to measure the size of particles suspended in an opaque liquid without any dedicated sample preparation. Validations of ultrasonic measurements were achieved on suspensions of polymethyl methacrylate beads in a size range extending from a few micrometer to several hundred micrometer with a temporal resolution of 1 s. The inline detection of aggregate formation was also demonstrated.

De novo kidney graft tumors: results from a multicentric retrospective national study

De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis.

Adjuvant tamoxifen in breast-cancer-treatment in postmenopausal women - occurrence of thromboembolic complications

Of 441 postmenopausal breast cancer patients who received adjuvant tamoxifen, 19 had thromboembolic accidents (4.3%). All were in remission when thrombosis occurred. One patient died of bilateral pulmonary embolism. In the other cases, thromboembolic disorders were found to be reversible after the withdrawal of tamoxifen and anticoagulant treatment. Some patients had a history of vascular disorders, and others required prolonged bed rest which may have contributed as an aggravating circumstance to thrombotic events. Our study suggests that thromboembolic risk factors as well as potential vascular disorders induced by aggravating conditions have to be carefully examined in postmenopausal patients treated by adjuvant tamoxifen therapy. This is especially true in women with lobular breast cancer and aged more than 60 years.