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Bronchial distribution in the upper lobe of the right lung is subject to many anatomical variations. The control of these variations is essential for the interpretation of endoscopic examinations. It also offers a better guarantee for safe surgery during segmentations in the right upper lobe. In this preliminary work, the operation of 30 heart-lung blocks treated by the injection-corrosion method, 100 CT chest and dissections of 3 resected specimen of right upper lobectomy, allowed us to study the bronchial distribution in the upper lobe of the right lung as well as their anatomical variations in melanoderm subjects. Our results were as follows: out of the 133 specimens, the right upper lobar bronchus was born on average 1.8 cm from the tracheal bifurcation, with an average length of 1.75 cm. There were 6 termination modes, dominated by bifurcations, which involved 52% of the specimens, and in 5 modes. Trifurcation accounted for 47.37% of cases. There was a case of quadrifurcation. These results allowed us to discuss anatomical variations of the bronchial shaft of the upper lobe of the right lung. Taking into account these variations will allow to avoid pitfalls and accidents during endoscopic examinations, medical imaging and pulmonary exeresis. KEY WORDS: Bronchi-Right Upper Lobe-Anatomy-Variations- Endoscopy-Imaging-Surgery.

Objectifs. Le but de cette enquête était d’évaluer le degré d’implémentation des principes et approches de merchandising au niveau des pharmacies d’officine au Maroc, et d’en déduire l’intérêt d’une étude à large échelle qui pourrait aboutir à l’élaboration d’un modèle conceptuel efficace et adapté aux spécificités du contexte Marocain. Matériels et Méthode. Nous avons établi un questionnaire anonyme s’adressant aux titulaires d’officines. Ce questionnaire semi directif renfermant 14 questions, repartis en 6 principales parties : La 1ère renseigne sur le profil de l’officine en question, La 2ème et la 3ème partie évalue le degré de connaissance et d’utilisation des techniques de marchandising par les pharmaciens d’officine. La 4ème et la 5ème partie portent sur la gestion du merchandising au sein de la pharmacie et l’utilité commerciale de cette technique. Enfin, la dernière partie porte sur la formation en merchandising. Résultats et discussion. 62 pharmaciens d’officine ont répondu au questionnaire. La majorité des pharmaciens titulaires ont déclaré l’utilisation des techniques du merchandising pour les raisons suivantes : Augmenter les ventes, et clarifier l’offre. 59,6 % des pharmaciens pensent que le merchandising a une place importante surtout pour les produits parapharmaceutiques. Le merchandising à l’officine a un impact positif sur la pharmacie. Ainsi 79,2% des pharmaciens affirment que l’amélioration du merchandising dans leur espace de vente leur a permis d’apprécier une augmentation de la rentabilité de l’officine (vente, fidélisation, panier d’achat). Cette étude auprès des pharmaciens titulaires a permis de montrer l’intérêt que les pharmaciens commencent à donner au Merchandising et à ses techniques. La grande majorité des interrogés ont affirmé que le merchandising est devenu une méthode indispensable dans la stratégie de différenciation et un outil incontestable de développement de la pharmacie. Mots clés : Techniques Merchandising, Pharmacie d’officine, ventes.

La pathologie coronarienne est une pathologie grave posant un véritable problème de santé publique. De nombreux facteurs de risques sont à l’origine ou aggravent cette affection. L’incrimination de l’hyperuricémie comme facteur du risque cardiovasculaire reste un sujet discuté. Nous avons réalisé une étude rétrospective sur 95 prélèvements de patients collectés au niveau du service de cardiologie du centre hospitalo-universitaire de Batna Algérie, afin d’évaluer l’importance et les associations possibles entre l’hyperuricémie et les autres facteurs du risque cardiovasculaire à savoir : diabète, hypertension artérielle, insuffisance rénale, obésité, tabagisme, dyslipidémie, et son rôle directe ou non dans le syndrome coronarien aigu. L’automate cobas e411 roche diagnostics® est utilisé pour le dosage de la Troponine T ultrasensible et l'automate cobas 6000 module c501 roche diagnostics® pour le dosage de l’acide urique, du cholestérol total, du HDL direct, des triglycérides, de l’urée, de la créatinine, de l’Apo A, de l’Apo B100, de la protéine C réactive ultrasensible et l’homocystéine. L’estimation du LDL est effectuée par la formule de Friedewald. Nous avons également calculé le risque relatif cardiovasculaire (RR) par la formule de QRISK®2-2017. Nous avons estimé le débit de filtration glomérulaire selon la formule Modification of Diet in Renal Disease (MDRD) Study equation. L'analyse statistique des donnés est réalisée le logiciel SPSS statistic version 20 (test de Kruskal-Wallis, test d’indépendance du Chi-deux et Phi). Les valeurs de p inférieures à 0,05 ont été considérées comme statistiquement significatives. L’effet causal direct de l'hyperuricémie dans les maladies cardiovasculaires n’a pas pu être tranché. Néanmoins, il semble que l’hyperuricémie est fortement associée aux maladies cardiovasculaires chez la population féminine. Des associations entre l’hyperuricémie et l’élévation de la protéine C reactive (p= 0,063) (Chi-deux : 3,49, p=0,194, Phi=0,174) et la baisse de l’apo B (p=0,008) (Chi-deux : 6,23, p=0,044, Phi=0,256) confortent l’idée des effets pro inflammatoires de l’acide urique et soulèvent la question de la possibilité que des concentrations réduites de l'apo B100 soit un facteur favorisant l’hyperuricémie.

Contexte : Parmi les dispositifs pédagogiques utilisés dans l’enseignement de la relation médecin-malade en faculté de médecine, certains se réfèrent dans leur conception, leur organisation pratique et leur animation, à la « méthode des cas », mise en pratique et théorisée par le médecin psychiatre et psychanalyste Michael Balint. Objectif : Enoncer, sous forme d’une liste de repères pédagogiques et de conseils pratiques, les bases de l’animation de groupe selon la méthode Balint en faculté de médecine. Exégèse : Cet article présente un corpus de recommandations, rédigé par un collectif de professionnels de santé et d’enseignants issu des principales associations balintiennes françaises, dans le but de préciser les éléments essentiels de la méthode et de fournir aux enseignants qui l’utilisent des références et des conseils. Conclusion : Articulant les principes d’accompagnement des praticiens par les groupes Balint avec leur utilisation dans le contexte universitaire de formation des étudiants, ce texte est une contribution à la recherche sur les dispositifs pédagogiques visant à former les étudiants à la relation médecin malade.

La Dapsone est une molécule à propriétés antibiotiques et immunomodulatrices. Son utilisation en médecine humaine est connue pour le traitement de la lèpre, de certaines dermatoses, du lupus bulleux et d’autres maladies. Cependant, son effet hématoxique, même à dose thérapeutique est avéré comme la survenue de l’hémolyse, d’une anémie hémolytique et de l’élévation du taux de la méthémoglobinémie. Cette dernière est d’autant plus importante que la Dapsonémie est élevée, d’où l’intérêt de déterminer le taux sanguin de la méthémoglobine chez les intoxiqués ou lors du traitement par la Dapsone. Le tableau clinique d’une intoxication par la Dapsone associe une cyanose, une dyspnée, des troubles neurologiques et cardiaques. L’arrêt du traitement permet la régression des symptômes et un retour au taux normal de la méthémoglobinémie. Le traitement repose sur la vidange gastrique ou le charbon actif, l’assistance respiratoire et le traitement spécifique (Bleu de méthylène). Plusieurs cas cliniques d’intoxication par la Dapsone sont décrits dans la littérature.

Introduction. Le diabète est un problème de Santé publique qui intéresse le monde entier, de par sa fréquence, son caractère ubiquitaire, ses conséquences à long terme, ainsi que le coût du traitement. Deux types de diabète sont connus, le diabète de type 1 et le diabète de type 2. L’objectif de notre travail est une mise au point des stratégies thérapeutiques du diabète de type 2. Méthodes. Une recherche bibliographique a été réalisée sur les nouvelles stratégies thérapeutiques adoptées. L’ensemble des résultats de recherche a été étudié afin de faire une synthèse sur l’actualité pour la prise en charge du diabète type 2. Résultats. L'activité physique, l'alimentation et l'éducation restent les pierres angulaires du traitement du diabète de type 2 tout au long de l'évolution. Quand l'objectif fixé n'est pas atteint avec ces moyens simples, un traitement médicamenteux doit être introduit. L’approche thérapeutique consiste à Stimuler la sécrétion d’insuline, Favoriser l’utilisation périphérique du glucose et diminuer sa production hépatique, Réduire la résorption intestinale des hydrates de carbones. Plusieurs molécules sont proposées, le choix du traitement thérapeutique repose sur plusieurs critères, notamment, le terrain du patient, son âge, les comorbidités et le traitement associés. Conclusion. Une des nouveautés qui apparaissent dans la prise en charge du diabète est la multiplicité des choix thérapeutiques, ce qui impose une réévaluation systématique de la réponse individuelle au traitement. Le pharmacien a un rôle à jouer dans l’amélioration de la qualité de vie du diabétique par son implication dans le suivi du traitement et les règles d’hygiène de vie

Introduction. Le bilan lipidique correspond à un ensemble d’analyses permettant de mettre en évidence des anomalies du métabolisme des lipides et d’optimiser la prise en charge diététique et/ou le besoin thérapeutique pour le suivi, la surveillance et l’évaluation du risque athérogène. L’objectif de cette étude est d’évaluer la place du jeûne dans les recommandations pré analytiques du dosage des paramètres lipidiques. Matériels et Méthodes. Notre étude prospective a été réalisée sur 27 prélèvements sanguins sur tube hépariné, des patients en deux temps : à jeun et non à jeun après la prise d’un repas consistant. Le dosage des deux paramètres : Triglycérides et le Cholestérol total, ont été réalisé par la méthode colorimétrique enzymatique. Résultats. Nos résultats ont été classés en deux groupes pour chaque paramètre. L’étude statistique a été réalisée sur le logiciel Graph Pad Prism7. La comparaison des deux groupes TG par l’application du test non paramétrique de Wilcoxon retrouve p

Introduction. La douleur est un motif de consultation très fréquent, chaque syndrome algique justifie des modalités particulières de prise en charge thérapeutique, selon son origine, ses caractéristiques et le terrain. L’objectif de l’étude est d’évaluer la prise en charge de la douleur à l’hôpital afin de déceler d’éventuelles déficiences. Matériel et méthodes. Un questionnaire a été destiné aux médecins de tous les services de l’hôpital. Les principaux thèmes étaient : le statut du médecin prescripteur, les méthodes et le temps consacré pour l’évaluation de la douleur, les antalgiques prescrits ainsi que les voies d’administration, la douleur chez l’enfant et enfin l’objectif de la prise en charge de la douleur. Résultats. On a reçu 100 réponses, avec 22% généralistes, 40% résidents et 17% des professeurs, dont 37% ont reçu une formation sur la douleur. 62% ont un protocole de prise en charge de la douleur dans leurs services. 81% prescrivent un antalgique dès l’expression de la douleur par les patients. La moyenne du temps, pour évaluer la douleur a été de 5,82 minutes avec un écart type de 4,92. 52% utilisent la méthode EVA, 4% l’EN, 66% évaluent la douleur selon les plaintes des patients, 35% selon les réactions des patients, 23% selon les mouvements des patients, 20% selon l’expression faciale des patients. 98% prescrivent le paracétamol en première intention, 45% de la morphine, 72% des AINS, 30% du tramadol et 24% utilisent en plus de ces analgésiques, d’autres molécules tel que le néfopam, la codéine. Les obstacles rencontrés lors de la prise en charge de la douleur sont 27% d’ordre économique, 24% dû à la non adhésion des patients, 36% la non disponibilité de certains antalgiques. 89% estiment que le niveau de prise en charge de la douleur dans le service est excellent, contre 56% avec un niveau moyen et 8% un niveau insuffisant. 83% affirment que la prise en charge de la douleur est obligatoire et 82% faisant partie d’une assurance qualité des soins. Conclusion. La prise en charge de la douleur est pluridisciplinaire, les professionnels de santé doivent avoir une formation sur la nécessité de prise en charge de la douleur qui entre dans le cadre de l’assurance qualité des soins et devient obligatoire pour la prise en charge du patient.

Introduction. Les mutations délétères (classe 5) des gènes BRCA1 et BRCA2 sont des mutations inactivatrices, qui entraînent une perte de la fonction de la protéine. Ces mutations constitutionnelles entrainent une augmentation du risque tumoral de cancer du sein et /ou de cancer de l’ovaire. Dans certaines situations la présence simultanée de deux variants de classe 1 (POLYMORPHISME) des gènes BRCA1 et ou BRCA2, sont responsables d’une augmentation du risque tumoral ovarien. Matériels et Méthodes. Nous avons réalisé le test génétique BRCA1 et BRCA2 par séquençage direct Sanger ; chez 88 cas index de cancer familiaux sein et ou ovaire provenant de tout le territoire national. Résultats. Trois situations d’association de variants polymorphes de classe 1 ont été identifiées. Il s’agit de l’association des deux polymorphismes : (c.2612C>T ; p.Pro871Leu) et (c.1067A>G ; p.Gln356Arg). Conclusion. Cette association dangereuse de variants polymorphes doit être prise en considération par le clinicien afin d’assurer une surveillance étroite, adaptée, dans le but d’un diagnosticprécoceducancerdel’ovaire ou de proposer une chirurgie ovarienne prophylactique aux femmesquiportentcesvariations.

La chirurgie d’exérèse de la glande thyroïde repose sur les principes d’une chirurgie vasculaire fine avec en conséquence une hémostase parfaite ainsi que sur la préservation des nerfs laryngés et les glandes parathyroïdes ; le coût des moyens techniques doit aussi être mis en exergue. Notre étude tient à montrer qu’outre l’hémostase parfaite sans drainage post opératoire, la recherche des nerfs récurrents n’est pas indispensable en utilisant une technique dite « Thyroïdectomie par technique de microchirurgie vasculaire », avec un coût de prise en charge réduit. Patients et méthodes : Il s’agit d’une étude prospective, comprenant 41 patients ; la technique chirurgicale mise à l’oeuvre est dite : technique de microchirurgie vasculaire thyroïdienne. Les paramètres étudiés sont : l’indication opératoire concertée, l’état antérieur et post-opératoire de la mobilité des cordes vocales et de la calcémie, la technique chirurgicale (type d’hémostase et la recherche ou non des nerfs récurrents), la place du drainage, la durée d’hospitalisation et le coût de prise en charge globale. Résultats : 62 lobo-isthmectomies ont été réalisées. L’état antérieur et post-opératoire de la mobilité des cordes vocales et de la calcémie était bien notifié. La quasi-totalité des patients n’avaient pas été drainés. Il n’y avait aucune complication hémorragique et aucune paralysie récurrentielle, on a relevé 3 cas d’hypocalcémie transitoire. Conclusion : la Thyroïdectomie par technique de microchirurgie vasculaire trouverait bien une place parmi les autres techniques chirurgicales. Notre mode de prise en charge s’avère assez concurrentiel, notamment en termes d’économies de santé.

Objectifs : Nos objectifs sont de décrire le profil épidémio-clinique des traumatismes thoraciques afin de déterminer ses critères de gravité et de proposer un algorithme de prise en charge diagnostique et thérapeutique de cette pathologie dans notre centre. Patients et méthode : Il s’agit d’une étude rétrospective descriptive et analytique à propos de 175 cas de patients traumatisés thoraciques graves admis en service de réanimation chirurgicale du CHU/JRA, Tananarive, Madagascar sur une période de 4 ans allant de Janvier 2009 à Décembre 2012. Résultats : Une prédominance masculine à 82,29% était observée. La tranche d’âge entre 21 et 30 ans était la plus touchée (29,71%). L’accident de la voie publique représente la principale étiologie (46,86% des cas). L’hémothorax était la lésion thoracique la plus fréquente (60%). Les patients traumatisés thoraciques dans notre étude ont présenté des lésions associées dans 53,71% des cas. Le taux de mortalité est de 15,43%. Conclusion : L’âge supérieur à 60 ans, le score de Glasgow initial ≤ 8, l’existence de comorbidité (cardio-vasculaire, pulmonaire et hépatique) et la présence d’une ou plusieurs lésion(s) associée(s) constituent les facteurs de risque de mortalité importants dans la prise en charge de ces traumatismes. L’acquisition des matériels d’équipement nécessaire en salle de réanimation peut améliorer le pronostic vital des traumatisés thoraciques graves.

Among the various types of known drug interactions, those involving pharmacokinetic processes are more complex and dangerous. From digestive pH changes to plasma protein binding and induction or inhibition phenomena; current data used to define, with precision, the sites of interaction. The enzymes involved in metabolism, the transporters involved in tissue distribution and excretion of drugs, and nuclear receptors that regulate the expression of these enzymes and transporters are keys determinants that should be defined for each drug. The clinical relevance of a pharmacokinetic interaction is related to the magnitude of changes in drug concentrations and pharmacological properties of these. Good knowledge of the pharmacokinetic properties of drugs and the mechanisms involved in the genesis of these interactions is, then, needed to prevent and avoid theme.

Compatibility problems are frequently encountered in hospitals, particularly in intensive care units. Physico-chemical incompatibilities (PCI) may have different origins and several types. The result is inactivation of the active ingredient reacted training or derivative(s) more or less toxic. The issue of PCI is made complex, moreover, by the fact that the reactions involved may be influenced by many factors. This chemical problem becomes a public health concern because it poses a risk to the patient.

Pharmacodynamic interactions are manifested by a change in pharmacological effect at the site of action. There may be a synergistic action, a potentiation or antagonism. Pharmacodynamic interactions are predictable and preventable since the mechanisms of drug action are defined in advance, the interaction drug-target is systematically described and various effectors and signal transduction systems are highlighted. Any time the plurality of molecular targets of the same drug should be considered when prescribing. The wide diffusion of pharmacological information and the updating of knowledge are then two tools to manage this kind of interaction.

Adverse drug reactions are numerous and steadily increasing as the emergence of new drugs on the market, the wide use within the population, and/or polypharmacy. Even if many drug interactions have an insignificant impact on the patient, others are causing an increase in hospitalization, morbidity, and mortality and therefore the cost. This article is a non-exhaustive review of published literature regarding adverse events related to drug interactions: their impacts, the factors favoring their occurrence, and the problematic around this theme. Most published studies are pharmaco-epidemiological and results vary depending on various factors.

Le cancer représente la deuxième cause de mortalité dans le monde. Sa prise en charge est multidisciplinaire dont la part du biologiste est non négligeable. Le dosage des marqueurs tumoraux sériques permet d’identifier dans le sang des substances pouvant indiquer la présence d’un cancer. En pratique médicale, on assiste souvent à des prescriptions fréquentes du dosage de marqueurs tumoraux et qui ne sont pas toujours appropriées, entrainant ainsi un surcout financier important. Dans cet article, sont passés en revue les points particuliers concernant les dosages des marqueurs tumoraux sériques : classification, indications et intérêt de la prescription, ainsi que les bonnes pratiques que chaque médecin doit connaitre et bien maitriser.

Introduction : L’intégration de pharmaciens cliniciens au sein des services cliniques s’avère indispensable pour lutter contre les problèmes d’évènements iatrogènes médicamenteux. Dans ce contexte, cette étude a été menée afin de décrire et analyser les risques liés aux prescriptions et d’évaluer la pertinence des interventions pharmaceutiques. Matériels et méthodes : Cette étude transversale, descriptive, a porté sur 119 patients atteints de cardiopathies ischémiques dans le service de cardiologie du CHU de Batna durant la période allant du 09/02/2014 au 24/04/2014. Les données personnelles des patients et celles liées au diagnostic et aux thérapeutiques étaient recueillies sur des fiches de questionnaire, les prescriptions analysées et les interventions rapportées sur des fiches d’interventions et cotées afin de déterminer leur impact. Résultats : La prévalence des interactions médicamenteuses était de 99,1% dont 59,8% sont du niveau à prendre en compte. Une ou plusieurs non conformités de prescription ont été signalées dans 47,9% des cas. 33 interventions pharmaceutiques ont été réalisées relevant 44 problèmes différents à la tête desquels se trouve l’inobservance du traitement et la présence d’indication non traitée. Les interventions consistaient principalement en l’ajout de médicament (52,3%) et ont été considérées à impact clinique significatif à 41,6%. Le taux d’acceptabilité de ces interventions est de 81,6%.

We appreciate the editorial comments by Pimenta and Calhoun1 and the correspondence by Sechi et al2 on our work. Attempts to clarify the discrepancies between available studies on the metabolic effects of hyperaldosteronism are welcome. Indeed, our results challenge the prevailing hypothesis that primary aldosteronism (PA) is associated with clinically meaningful metabolic consequences.3 Pimenta and Calhoun1 appropriately point out several limitations that may threaten the validity of our study. On the other hand and in keeping with our data, Sechi et al2 …

La fin du XXeme siecle a ete marquee par un essor sans precedent des Nouvelles Technologies de l’Information et de la Communication (NTIC). Courriels, forums de discussion, blogs, SMS, tchats sont autant de situations nouvelles de communication ecrite nees du developpement et de la diffusion des outils electroniques (ordinateur et telephone mobile). L’utilisation de plus en plus etendue de ces outils, que ce soit dans le cadre prive, professionnel voire scolaire, est a l’origine de nouveaux codes et de manieres differentes de traiter l’ecrit. De fait, les conditions techniques de la communication electronique ont une influence sur les pratiques scripturales et le rapport que les individus entretiennent avec la langue ecrite.

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Objectives: Our study aimed to describe “how” and “why” the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders.Methods: A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environ-ment, and accessing documents available on the LTC community’s public website. A thematic content analysis was used for data analysis.Results: The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in mean-ingful activities, and d) empowering care providers by offering essential resources.Conclusions: Applying and implementing the PCC approach within an LTC community to manage clients’ RBs is a long-term multi-dimensional process that requires a solid foundation.Clinical implications: These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.

Musculoskeletal simulations are useful in biomechanics to investigate the causes of movement disorder, to estimate non-measurable physiological quantities or to study the optimality of human movement. We introduce Bioptim, an easy-to-use Python framework for biomechanical optimal control, handling musculoskeletal models. Relying on algorithmic differentiation and the multiple shooting formulation, Bioptim interfaces nonlinear solvers to quickly provide dynamically consistent optimal solutions. The software is both computationally efficient (C++ core) and easily customizable, thanks to its Python interface. It allows to quickly define a variety of biomechanical problems such as motion tracking/prediction, muscle-driven simulations, parameters optimization, multiphase problems, etc. It is also intended for real-time applications such as moving horizon estimation and model predictive control. Six contrasting examples are presented, comprising various models, dynamics, objective functions and constraints. They include data-driven simulations (i.e., a multiphase muscle driven gait cycle and an upper-limb real-time moving horizon estimation of muscle forces) and predictive simulations (i.e., a muscle-driven pointing task, a twisting somersault with a quaternion-based model, a position controller using external forces, and a multiphase torque-driven maximum-height jump motion).

International audience

Background Patients with cirrhosis suffer from many complications, including malnutrition, which must be managed promptly and effectively by the healthcare team. Educating patients about their medical condition, the risk of malnutrition and other complications of cirrhosis, could contribute to optimal nutritional status, quality of life and general health. Objective This review provides an overview of the literature on a variety of nutritional education strategies used with patients suffering from cirrhosis. This review also identifies barriers and facilitators which impact the adherence in using these strategies. Patient involvement A patient-partner contributed to this review by providing insights on different issues and concerns that patients with cirrhosis might ask themselves regarding nutritional education strategies. The patient-partner was also involved in the overall revision of the review. Methods Articles published between the years 2000–2023 focusing on nutritional education strategies in patients living with cirrhosis were identified using Google Scholar and PubMed and were screened for inclusion in the study. All selected studies were intervention studies. A quality assessment of the included studies was conducted using the Mixed Methods Appraisal Tool (MMAT). Results Only a few nutritional education strategies in patients with cirrhosis were documented in the literature. The strategies ranged from using traditional printed materials to advanced technologies. These strategies may prove beneficial in complementing routine interventions provided by health professionals, such as registered dietitians, in their clinical practice. Discussion This narrative review clearly highlights the need for further research to elaborate and evaluate nutritional education strategies for people living with cirrhosis. Practical value Elaborating and evaluating educational strategies in nutrition for patients living with cirrhosis will be an adjuvant to health professionals and dietitians in their clinical practice by providing them, and the patients, with targeted education resources.

International audience

International audience; In the era of immune checkpoint inhibitors, understanding the metastatic microenvironment of proficient mismatch repair/microsatellite stable (pMMR/MSS) colorectal cancer (CRC) is of paramount importance to both prognostication and the development of more effective novel therapies. In this study, primary and paired metastasis tissue samples were collected from patients with resectable metastatic CRC treated with adjuvant FOLFOX or peri-operative chemotherapy in the MIROX phase III prospective study. In total, 74 cancer tissues were stained for CD3, CD8, Forkhead box protein 3 (FOXP3), programmed cell death protein-1 (PD-1, invasive front, stromal, intra-epithelial compartments), and programmed death-ligand 1 (PD-L1, tumor, immune cells). The immune profiling of primary CRC had a limited value to predict the immune context of paired metastases for all markers but CD3+. The expression of CD8 and PD-L1 was higher in metastases after neoadjuvant FOLFOX. In metastases, both CD3 T cells at the invasive front and PD-L1 expressions on immune cells were predictive of better disease-free survival. These results show that the effect of FOLFOX on modifying the immune microenvironment in resected CRC metastases and measurement of PD-L1 expression and tumor-infiltrating CD8 T cells in pMMR/MSS metastatic tissue samples could improve treatment strategies of metastatic CRC patients.

Resume Contexte Nous rapportons l’observation d’une patiente de 47 ans souffrant d’un trouble neurologique fonctionnel (TNF) avec une tetraparesie, des tremblements mixtes et des crises psychogenes non-epileptiques (CPNE), traitee par un protocole de psychotherapie augmentee par stimulation magnetique transcrânienne repetee (rTMS). Intervention Nous avons realise un protocole de psychotherapie biofeedback augmentee par rTMS (vingt seances a raison de deux seances par jour pendant dix jours avec un protocole de stimulation : 1 Hz, 150 % du seuil moteur, sessions de vingt minutes, 300 pulses par sessions) au cours duquel la patiente visualisait l’activite motrice de ses membres superieurs pendant une stimulation de l’aire motrice primaire (AMP). L’evolution de la symptomatologie neurologique a ete evaluee a l’aide de l’echelle MRC pour la force musculaire (Medical Research Council Scale for Muscle Strength). Resultats La symptomatologie a ete amelioree entre les quatrieme et sixieme jours de traitement (huitieme et douzieme seances) avec premierement une levee de la paresie, puis une amelioration secondaire en cascade des autres symptomes fonctionnels. A deux mois, la patiente ne presentait plus de symptome neurologique fonctionnel. Discussion & conclusion Nous proposons plusieurs hypotheses concernant l’efficacite de ce type de protocole de biofeedback utilisant la rTMS. Nous suggerons egalement que ce type de protocole devrait etre systematiquement associe a un accompagnement psychotherapeutique travaillant sur les elements biographiques pour une prise en charge holistique. Cette observation souligne l’interet de potentialiser les psychotherapies cognitivo-comportementales utilisant le principe du conditionnement operant a l’aide de la stimulation cerebrale dans les troubles neurologiques fonctionnels, et motive la realisation d’etudes futures.

Citation suggérée : Anses. 2023. Avis de l’Anses relatif à « des intoxications à la vitamine D chez des nourrissons par mésusage de compléments alimentaires » (saisine 2022-VIG-0166). Maisons-Alfort: Anses, 13 p; Dans le cadre de son dispositif de nutrivigilance créé en 2009 et depuis la publication de sonavis du 28 juillet 2021 relatif à trois cas de signalements d’effets indésirables sévèresa chezdes nourrissons à la suite du mésusage de compléments alimentaires contenant de lavitamine Db (Anses 2021b), l’Anses a reçu trois nouveaux signalements d’effets indésirablessévères (sévérité de niveau 3, dont deux cas avec menace du pronostic vital) chez desnourrissons susceptibles d’être liés au mésusage de compléments alimentaires achetés surinternet contenant 5 000 UI et 10 000 UI par goutte de vitamine D. Ces trois cas, enregistrésdans la base de données de nutrivigilance sous les numéros 2022-140, 2022-335 et 2022-380ont été jugés d’imputabilité très vraisemblable.En raison de la sévérité des effets indésirables rapportés (hypercalcémies sévères associéesà une néphrocalcinose, anorexie, hypokaliémie, trouble de la repolarisation cardiaque),l’Anses s’est à nouveau autosaisie le 21 septembre 2022, estimant nécessaire de porter cescas de mésusage à la connaissance du public, des metteurs en marché et des professionnelsde santé, dans un but d’amélioration de la sécurité sanitaire du consommateur.

International audience; No abstract available

We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series. Level of evidence: IV

Newly emerging infectious diseases, such as the coronavirus (COVID-19), create new challenges for public healthcare systems. Before effective treatments, countering the spread of these infections depends on mitigating, protective behaviours such as social distancing, respecting lockdown, wearing masks, frequent handwashing, travel restrictions, and vaccine acceptance. Previous work has shown that the enacting protective behaviours depends on beliefs about individual vulnerability, threat severity, and one's ability to engage in such protective actions. However, little is known about the genesis of these beliefs in response to an infectious disease epidemic, and the cognitive mechanisms that may link these beliefs to decision making. Active inference (AI) is a recent approach to behavioural modelling that integrates embodied perception, action, belief updating, and decision making. This approach provides a framework to understand the behaviour of agents in situations that require planning under uncertainty. It assumes that the brain infers the hidden states that cause sensations, predicts the perceptual feedback produced by adaptive actions, and chooses actions that minimize expected surprise in the future. In this paper, we present a computational account describing how individuals update their beliefs about the risks and thereby commit to protective behaviours. We show how perceived risks, beliefs about future states, sensory uncertainty, and outcomes under each policy can determine individual protective behaviours. We suggest that these mechanisms are crucial to assess how individuals cope with uncertainty during a pandemic, and we show the interest of these new perspectives for public health policies.

Detailed characterization of the spatially and temporally varying inherent optical properties (IOPs) of sea ice is necessary to better predict energy and mass balances, as well as ice-associated primary production. Here we present the development of an active optical probe to measure IOPs of a small volume of sea ice (dm3) in situ and non-destructively. The probe is derived from the diffuse reflectance method used to measure the IOPs of human tissues. The instrument emits light into the ice by the use of an optical fibre. Backscattered light is measured at multiple distances away from the source using several receiving fibres. Comparison to a Monte Carlo simulated lookup table allows, in theory, retrieval of the absorption coefficient, the reduced scattering coefficient and a phase function similarity parameter γ, introduced by Bevilacqua and Depeursinge (1999). γ depends on the two first moments of the Legendre polynomials, allowing the analysis of the backscattered light not satisfying the diffusion regime. The depth reached into the medium by detected photons was estimated using Monte Carlo simulations: the maximum depth reached by 95 % of the detected photons was between 40±2 and 270±20 mm depending on the source–detector distance and on the ice scattering properties. The magnitude of the instrument validation error on the reduced scattering coefficient ranged from 0.07 % for the most scattering medium to 35 % for the less scattering medium over the 2 orders of magnitude we validated. Fixing the absorption coefficient and γ, which proved difficult to measure, vertical profiles of the reduced scattering coefficient were obtained with decimetre resolution on first-year Arctic interior sea ice on Baffin Island in early spring 2019. We measured values of up to 7.1 m−1 for the uppermost layer of interior ice and down to 0.15±0.05 m−1 for the bottommost layer. These values are in the range of polar interior sea ice measurements published by other authors. The inversion of the reduced scattering coefficient at this scale was strongly dependent on the value of γ, highlighting the need to define the higher moments of the phase function. This newly developed probe provides a fast and reliable means for measurement of scattering in sea ice.

The aims of this study were to i) evaluate proximal-to-distal sequencing (PDS) in pianists’ attack and release movements during pressed-staccato keystrokes, and ii) investigate if trunk motion facilitates PDS of upper-limb movements. Nine expert pianists performed a series of loud pressed-staccato keystrokes. Kinematic data was recorded with a 3 D motion capture system. PDS was assessed by comparing temporal organization of peak velocities from the pelvis to the wrist. Evidence of PDS was found across the kinematic chain. Pianists’ use of PDS differed mainly between scapula and shoulder movements. Trunk motion facilitated PDS by increasing anticipatory shoulder movements and by preceding shoulder-girdle attack and release movements. Implications might relate to research on performance optimization and injury prevention strategies.

The diagnostic work-up for non-small cell lung cancer (NSCLC) requires biomarker testing to guide therapy choices. This article is the second of a two-part series. In Part 1, we summarised evidence-based recommendations for obtaining and processing small specimen samples (i.e. pre-analytical steps) from patients with advanced NSCLC. Here, in Part 2, we summarise evidence-based recommendations relating to analytical steps of biomarker testing (and associated reporting and quality assessment) of small specimen samples in NSCLC. As the number of biomarkers for actionable (genetic) targets and approved targeted therapies continues to increase, simultaneous testing of multiple actionable oncogenic drivers using next-generation sequencing (NGS) becomes imperative, as set forth in European Society for Medical Oncology guidelines. This is particularly relevant in advanced NSCLC, where tissue specimens are typically limited and NGS may help avoid tissue exhaustion compared with sequential biomarker testing. Despite guideline recommendations, significant discrepancies in access to NGS persist across Europe, primarily due to reimbursement constraints. The use of increasingly complex testing methods also has implications for the reporting of results. Molecular testing reports should include clinical interpretation with additional commentary on sample adequacy as appropriate. Molecular tumour boards are recommended to facilitate the interpretation of complex genetic information arising from NGS, and to collaboratively determine the optimal treatment for patients with NSCLC. Finally, whichever testing modality is employed, it is essential that adequate internal and external validation and quality control measures are implemented. ispartof: VIRCHOWS ARCHIV vol:481 issue:3 pages:351-366 ispartof: location:Germany status: published

International audience; Objective: To characterize the current profile of gonococcal infections in France, and to describe their management. Patients and method: A population-based retrospective study of all gonococcal infections documented by PCR in two French departments (Île-et-Vilaine, Morbihan), in 2014–2016. Cases were identified through hospital databases and the Rénago sentinel network. Results: We enrolled 245 patients (96 females, 149 males), with a median age of 25 years [interquartile range, 21–33]. The incidence rate was estimated at 4.54 per 100,000 inhabitants-year. Cases were diagnosed mostly by a general practitioner (n = 122, 49.8%) or a gynecologist (n = 45, 18.4%). The main clinical presentations included urethritis (n = 59), pelvic inflammatory disease (n = 40), cervicitis (n = 12), and anorectitis (n = 11). The main coinfections were Chlamydia trachomatis (n = 40) and HIV (n = 8). Ceftriaxone MIC was ≤ 0.12 mg/L in 146/147 patients with positive culture. Treatment was appropriate in 52/74 (70.2%) patients with available data. Conclusions: In France, general practitioners are at the front line in management of gonococcal infections. © 2020 Elsevier Masson SAS

International audience; Comment on doi: 10.1186/s13613-022-01003-x

IntroductionContext: From the will of six ministries in France (health, education, interior, defense, justice, higher education and research) was created in 2019 a National Resource and Resilience Center for Psychotrauma (CN2R) with the particularity of wishing to work in partnership with people experiencing psychotrauma. Aims Objectives Theory or MethodsThe CN2R was created with the aim of deepening the knowledge on the psychotrauma and the resiliency processes according to an approach of course in its globality; it has for that four strong axes that are the research, the training and the identification of good practice, the diffusion of the knowledge and the animation of the places of care that are the regional centers of the psychotraumatisms created simultaneously to the CN2R. From its creation, the functioning of this center has been created a transversal axis to the presented axes, the partnership with the people leave… with and a coordinator Highlights or Results or Key FindingsThis coordinator, who has experience in the partnership between scientific and professional knowledge on the one hand and experiential knowledge on the other hand, has created, according to a methodology that will be presented, a community of people with psychotrauma. A community that today actively participates in the partnership with each of the CN2R's axes, whose teams are learning to co-construct in partnership with members of the community in ways that will also be presented. Articles and audiovisual clips have been co-written, juries for research grants have been set up with their presence, and processes for the development of good practices in partnership with the High Health Autority(HAS) and a skills reference framework are underway. A last process for which a partnership is being organized with Montreal on autism and psychotrauma at the initiative of a think tank of the community of people who are experiencing. ConclusionsThat an entity created at the crossroads of 6 ministries and therefore according to a systemic and societal vision to accompany the citizens and society of an entire country towards resilience in partnership with the first concerned demonstrates a progress in the very perception of health. Implications for applicability/transferability sustainability and limitations In the perspective of transferring to other European states already interested, the partnerships initiated are methodologically constructed, they are thought to be transferable, the limits lie in the youth of this large-scale project.

BACKGROUND: Liver transplantation (LT) is the only curative treatment for cirrhosis. However, the presence of complications can impact outcomes following LT. Sarcopenia, or muscle mass loss, is highly prevalent in patients with cirrhosis and is associated with longer hospitalization stays and a higher infection rate post-surgery. We aimed to identify patients at higher risk of early sarcopenia post-LT. METHODS: This retrospective study included 79 cirrhotic patients who underwent LT. Muscle mass was evaluated using the third lumbar spine vertebra skeletal muscle index (SMI) and sarcopenia was defined using established cut-off values. Computerized tomography (CT) scans performed within a six-month peri-operative period (three months pre- and post-LT) were included in the study. Complications and comorbidities were collected and correlated to SMI post-LT and predictive models for SMI post-LT were constructed. RESULTS: The overall prevalence of sarcopenia was 46% and 62% before and after LT, respectively. Newly developed sarcopenia was found in 42% of patients. Post-LT sarcopenia was associated with longer hospital stays (54±37 versus 29±10 days, p = 0.002), higher number of infection (3±1 versus 1±2, p = 0.027), and greater number of complications (5±2 versus 3±2, p < 0.001) compared to absence of sarcopenia. Multivariate analyses showed that the SMI post-LT was independently associated with pre-LT renal function markers, the glomerular filtration rate (GFR) and creatinine (Model 1, GFR: β = 0.33; 95% CI 0.04–0.17; p = 0.003; Model 2, Creatinine: β = –0.29; 95% CI –0.10 to –0.02; p = 0.009). CONCLUSIONS: The present study highlights the potential role of renal dysfunction in the development and persistence of sarcopenia after LT.

Colorectal cancer (CRC) cells are traditionally considered unresponsive to TGFβ due to mutations in the receptors and/or downstream signaling molecules. TGFβ influences CRC cells only indirectly via stromal cells, such as cancer-associated fibroblasts. However, CRC cell ability to directly respond to TGFβ currently remains unexplored. This represents a missed opportunity for diagnostic and therapeutic interventions. Methods: We examined whether cancer cells from primary CRC and liver metastases respond to TGFβ by inducing TGFβ-induced protein ig-h3 (TGFBI) expression, and the contribution of canonical and non-canonical TGFβ signaling pathways to this effect. We then investigated in vitro and in vivo TGFBI impact on metastasis formation and angiogenesis. Using patient serum samples and an orthotopic mouse model of CRC liver metastases we assessed the diagnostic/tumor targeting value of novel antibodies against TGFBI. Results: Metastatic CRC cells, such as circulating tumor cells, directly respond to TGFβ. These cells were characterized by the absence of TGFβ receptor mutations and the frequent presence of p53 mutations. The pro-tumorigenic program orchestrated by TGFβ in CRC cells was mediated through TGFBI, the expression of which was positively regulated by non-canonical TGFβ signaling cascades. TGFBI inhibition was sufficient to significantly reduce liver metastasis formation in vivo. Moreover, TGFBI pro-tumorigenic function was linked to its ability to stimulate angiogenesis. TGFBI levels were higher in serum samples from untreated patients with CRC than in patients who were receiving chemotherapy. A radiolabeled anti-TGFBI antibody selectively targeted metastatic lesions in vivo, underscoring its diagnostic and therapeutic potential. Conclusions: TGFβ signaling in CRC cells directly contributes to their metastatic potential and stromal cell-independence. Proteins downstream of activated TGFβ, such as TGFBI, represent novel diagnostic and therapeutic targets for more specific anti-metastatic therapies., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Therapeutic drug monitoring (TDM) of the two calcineurin inhibitors (CNIs), tacrolimus (TAC) and cyclosporine A (CsA), has resulted in improvements in the management of patients who have undergone solid organ transplantation. As a result of TDM, acute rejection rates and treatment-related toxicities have been reduced. Irrespective, acute rejection and toxicity still occur in patients who have undergone transplantation showing blood CNI concentrations within the therapeutic range. Moreover, the acute rejection rate is no longer decreasing. Hence, smarter TDM approaches are necessary. As CNIs exert their action inside T-lymphocytes, intracellular CNIs may be a promising candidate for improving therapeutic outcomes. Intracellular CNI concentration may be more directly related to drug effect and has been favorably compared with the standard, whole-blood TDM for TAC in liver transplant recipients. However, measuring intracellular CNIs concentrations is not without pitfalls at both the pre-analytical and analytical stages, and standardization appears essential in this area. To date, there are no guidelines for the TDM of intracellular CNI concentrations. Methods Under the auspices of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology and its Immunosuppressive Drug committees, a group of leading investigators in this field have shared experiences and have presented pre-analytical and analytical recommendations for measuring intracellular CNI concentrations.

International audience; Objectives/Hypothesis: To investigate the profile of patients with laryngopharyngeal reflux (LPR) at hypopharyngeal–esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring and the relationship between hypopharyngeal-proximal reflux episodes (HREs) and saliva pepsin concentration. Study Design: Prospective non-controlled. Methods: Patients were recruited from three European hospitals from January 2018 to October 2019. Patients benefited from HEMII-pH monitoring and saliva collections to measure saliva pepsin concentration in the same time. Saliva pepsin concentration was measured in the morning (fasting), after lunch, and after dinner. The LPR profile of patients was studied through a breakdown of the HEMII-pH findings over the 24 hours of testing. The relationship between the concentrations of saliva pepsin and 24-hour HREs was studied through linear multiple regression. Results: One hundred twenty-six patients completed the study. The HEMII-pH analyses revealed that 73.99% of HREs occurred outside 1-hour postmeal times, whereas 20.49% and 5.52% of HREs occurred during the 1-hour postmeal and nighttime, respectively. Seventy-four patients (58.73%) did not have nighttime HREs. Patients with both daytime and nighttime HREs had more severe HEMII-pH parameters and reflux symptom score compared with patients with only daytime HREs. There were no significant associations between HREs and saliva pepsin concentration. Conclusions: Unlike gastroesophageal reflux disease, HREs occur less frequently after meals and nighttime. The analysis of the HEMII-pH profile of the LPR patients has to be considered to develop future personalized therapeutic strategies. Level of Evidence: 4 Laryngoscope, 131:268–276, 2021.

ObjectivesTo decipher the phenotype of endothelial cells (ECs) derived from circulating progenitors issued from patients with rheumatoid arthritis (RA).MethodsRA and control ECs were compared according to their proliferative capacities, apoptotic profile, response to tumour necrosis factor (TNF)-α stimulation and angiogenic properties. Microarray experiments were performed to identify gene candidates relevant to pathological angiogenesis. Identified candidates were detected by RT-PCR and western blot analysis in ECs and by immunohistochemistry in the synovium. Their functional relevance was then evaluated in vitro after gene invalidation by small interfering RNA and adenoviral gene overexpression, and in vivo in the mouse model of methyl-bovine serum albumin-(mBSA)-induced arthritis.ResultsRA ECs displayed higher proliferation rate, greater sensitisation to TNF-α and enhanced in vitro and in vivo angiogenic capacities. Microarray analyses identified the NAD-dependent protein deacetylase sirtuin-1 (SIRT1) as a relevant gene candidate. Decreased SIRT1 expression was detected in RA ECs and synovial vessels. Deficient endothelial SIRT1 expression promoted a proliferative, proapoptotic and activated state of ECs through the acetylation of p53 and p65, and lead the development of proangiogenic capacities through the upregulation of the matricellular protein cysteine-rich angiogenic protein-61. Conditional deletion of SIRT1 in ECs delayed the resolution of experimental methyl-bovine serum albumin-(mBSA)-induced arthritis. Conversely, SIRT1 activation reversed the pathological phenotype of RA ECs and alleviates signs of experimental mBSA-induced arthritis.ConclusionsThese results support a role of SIRT1 in RA and may have therapeutic implications, since targeting angiogenesis, and especially SIRT1, might be used as a complementary therapeutic approach in RA.

Background and aims Baclofen is a promising drug for treating patients with alcohol-related disorders. Nevertheless, the first randomized clinical trials (mainly with target doses) reported inconsistent efficacy, possibly because of the effective dose widely varying between patients. The Bacloville study aimed to test the efficacy of titrated baclofen for achieving low-risk alcohol consumption. Design Twelve-month multicenter pragmatic double-blind randomized clinical trial from June 2012 to June 2014. Setting Sixty-two French primary care centers. Participants Out-patients with high-risk alcohol consumption (> 40 g/day for women and > 60 g/day for men). Intervention and comparator Patients were randomly assigned (1 : 1 ratio) to receive titrated baclofen up to 300 mg/day or placebo for 12 months. Switching to open-label baclofen was allowed in cases of perceived inefficacy. Measurements The primary outcome defined success as no or low-risk alcohol consumption (≤ 20 g/day for women and ≤ 40 g/day for men) during the last month of the 1-year follow up, with patients who switched to open-label baclofen classified as failures. Findings A total of 320 patients were randomized, 162 to baclofen and 158 to placebo (consumption 129 g/day in both arms). Discontinuation rates were 30 and 34% in the baclofen and placebo arms, respectively, and return rates of the last-month diaries were 42 and 34%, respectively. Primary success rates were 57 and 36% in the baclofen and placebo arms, respectively [difference: 21 percentage points, 95% confidence interval (CI) = 8-34, P = 0.003]. When switchers were not classified as failures unless they failed, the success rates were 62 versus 55% (difference: 6 percentage points, 95% CI = -7 to 20). Over 12 months, daily consumption differed between both arms (11 g less in the baclofen arm), as did the number of abstinence days (3.3 days more in the baclofen arm). Adverse events were more frequent with baclofen than placebo and were mostly drowsiness, fatigue and insomnia. Serious adverse events occurred in 85 (seven deaths) and 36 (three deaths) patients with baclofen and placebo, respectively. Conclusions Baclofen was more effective than placebo in reducing alcohol consumption to low-risk levels. The number of adverse events and more serious adverse events was greater with baclofen than placebo.

Hepatic encephalopathy (HE) is a decline in brain function arising due to liver insufficiency. The liver's diminished capacity to clear ammonia, and the subsequent accumulation of it, is highly implicated in pathogenesis of HE. Ammonia is endogenously generated from the catabolism of amino acids derived from dietary protein intake. Therefore, a conflict arises in cirrhosis where dietary protein intake may increase ammonia and precipitate HE, and at the same time, cirrhotic patients require high daily protein intake due to altered nutrient metabolism. A nutritional solution is needed to deliver sufficient doses of protein to patients without increasing the risk of HE. In order to address this issue, this review will discuss the catabolism of individual amino acids with a special focus on ammonia-generating steps and highlight a subset of amino acids that have the potential to generate multiple equivalents of ammonia. Following, studies investigating the effects of individual amino acids in cirrhosis on blood ammonia levels as well as development of HE will be reviewed.

International audience; Uterine transplantation is on the rise worldwide. In contrast to its arterial anatomy, venous drainage of the uterus is poorly defined in the literature. Our aim was to provide a standardized description of uterine veins through a multimodal approach to establish anatomical landmarks for the uterine transplantation surgeon. Data were obtained from: (1) an anatomical study of eight fresh female cadavers (16 hemipelves) studied separately by an extra fascial dissection from the iliac bifurcation to the uterine pedicle, with analysis of the urinary tract and nerve structures and (2) a virtual anatomical study from the Anatomage® Table comprising a high-fidelity virtual reconstruction of two deceased female subjects by imaging and anatomical methods. An inconstant duality of uterine veins was identified: a deep uterine vein of larger caliber and a superficial uterine vein observed in 25% of cases. A close relationship of the ureter passing posterior to the superficial uterine vein and anterior to the deep uterine vein was evident in the parametrium. The inferior hypogastric plexus was identified in all cases immediately behind the deep uterine vein. The data obtained from the fresh female cadavers were validated by the Anatomage® Table. We describe the close relationship of the uterine veins with the ureter and the inferior hypogastric plexus. This knowledge represents a surgical landmark to support the success of uterine transplantation by respecting both the graft and the safety of the living donor by limiting the risk of injuries during uterus procurement.