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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.

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.

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.

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.

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.

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.

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).

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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.

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

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.

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

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: While telemedicine is seen as an emerging practice that will outlast the COVID-19 pandemic, it can reduce health services for those with limited internet and technological devices access or sufficient literacy. Objective(s): The aim of this study was to explore the feasibility of using telehealth with people who inject drugs (PWID). Methods: A survey on availability and accessibility of different methods of communication was administered to a sample of PWID from an ongoing longitudinal cohort in Montréal, Canada. Results: Among the 96 respondents, phone calls were generally considered acceptable (89.6%) although availability was low (50%). Acceptability and availability of social media were 26% and 41.7%, respectively. Internet-based communication applications were considered acceptable to use for telehealth in 28.1% of participants, even if not frequently available (8.3%). Conclusions: Telehealth is an acceptable form of treatment for PWID, but may be challenging due to low availability of phone or internet access.

Objectives To determine the prevalence of undiagnosed hepatitis C virus (HCV) and HIV cases in a population sample tested in the emergency room (ER) and to evaluate linkage-to-care. Setting Canadian university hospital. Participants Adults born after 1945 who consulted at ER for any condition and on any shift were included. Patients unable to opt-out were excluded. Interventions ER nurse confirmed patients’ eligibility and provided them with the option to opt-out. A physician met patients with a new diagnosis. Linkage-to-care was assessed 3 months postdiagnosis. Patients newly diagnosed with HCV were considered linked if they had an HCV RNA test, genotype, liver fibrosis evaluation, and if indicated, treatment prescription. Patients newly diagnosed with HIV were considered linked to care if they had an HIV serology confirmation test, viral load, CD4 cell count and started antiretroviral therapy. Primary and secondary outcome measures Primary objective: to determine the prevalence (overall and undiagnosed cases) of HIV and HCV among the patients who consult the ER. Secondary objectives: to determine the proportion of patients who opt-out, assess the adherence of emergency staff to the offer of testing, determine the proportion of patients linked to care at 3 months. Results Among 6350 eligible patients informed of the screening programme, 62.1% of patients were tested for at least one virus (HIV: 3905; HCV: 3910). 25% patients opted-out, 12% were not tested for organisational reasons, 0.3% (18) patients were HCV-HIV coinfected. Overall prevalence of HCV and HIV cases were 1.9% and 1.2%, respectively. Prevalence of new cases was 0.23% (95% CI 0.12% 0.45%) for HCV and 0.05% (95% CI 0.01% to 0.20%) for HIV. Among the new cases, only two HCV-infected and one HIV-infected patients were linked-to-care 3 months postdiagnosis. Conclusions Identification of new cases of HCV and HIV through universal screening at the ER and linkage-to-care were both low. Trial registration number NCT03595527; Results.

Aims Ventricular fibrillation (VF) occurring in the acute phase of ST-elevation myocardial infarction (STEMI) is the leading cause of sudden cardiac death worldwide. Several studies showed that reduced connexin 43 (Cx43) expression and reduced conduction velocity increase the risk of VF in acute myocardial infarction (MI). Furthermore, genetic background might predispose individuals to primary VF (PVF). The primary objective was to evaluate the presence of GJA1 variants in STEMI patients. The secondary objective was to evaluate the arrhythmogenic impact of GJA1 variants in STEMI patients with VF. Methods and results The MAP-IDM prospective cohort study included 966 STEMI patients and was designed to identify genetic predisposition to VF. A total of 483 (50.0%) STEMI patients with PVF were included. The presence of GJA1 variants increased the risk of VF in STEMI patients [from 49.1 to 70.8%, P = 0.0423; odds ratio (OR): 0.40; 95% confidence interval: 0.16–0.97; P = 0.04]. The risk of PVF decreased with beta-blocker intake (from 53.5 to 44.8%, P = 0.0085), atrial fibrillation (from 50.7 to 26.4%, P = 0.0022), and with left ventricular ejection fraction >50% (from 60.2 to 41.4%, P < 0.0001). Among 16 GJA1 variants, three novel heterozygous missense variants were identified in three patients: V236I, H248R, and I327M. In vitro studies of these variants showed altered Cx43 localization and decreased cellular communication, mainly during acidosis. Conclusion Connexin 43 variants are associated with increased VF susceptibility in STEMI patients. Restoring Cx43 function may be a potential therapeutic target to prevent PVF in patients with acute MI. Clinical trial registration Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00859300

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.

The purpose of this study is to assess risk factors for the acquisition of extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) colonization and infection (AI) in ICUs with low ESBL-GNB prevalence rate. We conducted a retrospective observational study in three ICUs in Bretagne, France. All patients admitted from January 2016 to September 2017 with a length of stay of 2 days or more were included. Universal screening for ESBL-GNB colonization was performed in all participating ICUs. Of the 3250 included patients, 131 (4.0%) were colonized at admission, 59 acquired colonization while hospitalized (1.9%; 95% CI [1.5–2.5%]), and 15 (0.5%; 95% CI [0.3–0.8%]) acquired ESBL-GNB infections. In the case of infection, the specificity and the negative predictive values of preexistent colonization for the ESBL-GNB etiology were 93.2% [91.5–95.1%] and 95.2% [93.5–97.1%], respectively. Colonization was the main risk factor for ESBL-GNB AI (OR = 9.61; 95% CI [2.86–32.29]; p

International audience; The ideal treatment for multiple sclerosis (MS) would target both the neuroinflammatory component of the disease (peripheral and central) and its neurodegenerative component, via modulation of a ubiquitous and pleiotropic common target. Sphingosine-1-phosphate (S1P), a product of sphingosine metabolism, regulates many biological functions (including cell proliferation and survival, cell migration, the immune response and cardiovascular function) via five subtypes of receptor. These receptors are expressed in all types of brain cells where they modulate a number of processes involved in neuronal plasticity, including myelination, neurogenesis and neuroprotection. This profile has aroused interest in modulation of S1P function as a therapeutic target in many brain diseases, particularly those in which the immune system plays a role in the development of brain lesions. Fingolimod, a S1P receptor modulator, exerts its beneficial effects in MS through its anti-inflammatory and anti-neurodegenerative effects. This review discusses recent evidence indicating that fingolimod may target both the inflammatory and neurodegenerative components of the disease process in MS.

International audience; The design of maps for communication purposes or, more generally, data visualization is a relatively old field of research that has undergone profound changes in recent years. While a great deal of research has been devoted to this field, very little of it has focused on another major current trend: the use or hijacking of games for communication purposes. This paper deals with this issue by examining the case of an informational medium reminiscent of a strategy board game developed to inform people about a new cancer treatment: photodynamic therapy.; La conception de cartes à des fins de communication ou, de manière plus générale, la visualisation de données est un champ de recherches relativement ancien qui a subi de profonds changements au cours de ces dernières années. Si de nombreuses recherches y sont consacrées, très peu d’entre elles s’intéressent à une autre tendance forte du moment : l’emploi ou le détournement du jeu à des fins de communication. Ce papier traite de cette question en abordant le cas d’un support informationnel rappelant un jeu de stratégie sur plateau développé dans un but d’information à propos d’un nouveau procédé de lutte contre le cancer : la thérapie photodynamique.; コミュニケーションのための地図の作成、またはより一般的にはデータの可視化は、比較的古い研究分野であり、ここ数年で大きな変化を経験してきました。多くの研究がこの分野に取り組んでいますが、最近のもう一つの重要なトレンドであるゲームの活用や転用に関心を寄せている研究はほとんどありません。この論文では、がん治療の新しい手法である光ダイナミック療法に関する情報を提供するために開発された戦略ボードゲームについて取り上げながら、この問題について論じます。

International audience; Wired electrocardiogram monitors are an important component of current perioperative monitoring. Wireless monitoring units could help reduce the number of cables attached to patients and thus improve anesthesia ergonomics and patient management. However, there is concern that electromagnetic interference generated by electrosurgical units may prevent effective wireless signals in the operating room. To evaluate the extent of this problem, we developed a Bluetooth electrocardiogram prototype monitor and compared its electrocardiogram traces to those captured with a standard wired electrocardiogram monitor in our operating room. METHODS: Bluetooth electrocardiogram and standard electrocardiogram traces captured from 10 patients undergoing surgical procedures that required use of an electrosurgical unit were compared by analysis of the durations of the P wave, QRS complex, and T wave and the position of the ST segment from the isoelectric line. The impact of the electrosurgical units on the Bluetooth electrocardiogram and S-electrocardiogram recordings was also assessed. RESULTS: There were no clinically relevant differences in P wave, QRS complex, or T-wave durations (0.006, 0.004, and 0.017 seconds, respectively) between Bluetooth electrocardiogram and standard electrocardiogram or in the position of the ST segment from the isoelectric line (0.02 mV). Mean differences were near zero, and Bland-Altman limits of agreement for individual differences were narrow (-0.035 to 0.047, -0.03 to 0.038, and -0.112 to 0.078 seconds for P wave, QRS complex, and T-wave durations, respectively, and -0.13 to 0.17 mV for ST segment position). Electrosurgical units use electrically disrupted Bluetooth electrocardiogram and standard electrocardiogram signals, but there was no electromagnetic interference effect on the Bluetooth electrocardiogram signals. CONCLUSIONS: Wireless electrocardiogram using Bluetooth can be reliably used in the operating room. The electrosurgical unit induces electric rather than electromagnetic artifacts, thus affecting wired and wireless electrocardiogram in a similar fashion.

International audience; Congenital amusia is a neurodevelopmental disorder of music processing, which includes impaired pitch memory, associated to abnormalities in the right fronto-temporal network. Previous research has shown that tonal structures (as defined by the Western musical system) improve short-term memory performance for short tone sequences (in comparison to atonal versions) in non-musician listeners, but the tonal structures only benefited response times in amusic individuals. We here tested the potential benefit of tonal structures for short-term memory with more complex musical material. Congenital amusics and their matched nonmusician controls were required to indicate whether two excerpts were the same or different. Results confirmed impaired performance of amusic individuals in this short-term memory task. However, most importantly, both groups of participants showed better memory performance for tonal material than for atonal material. These results revealed that even amusics' impaired short-term memory for pitch shows classical characteristics of short-term memory, that is the mnemonic benefit of structure in the to-be-memorized material. The findings show that amusic individuals have acquired some implicit knowledge of regularities of their culture, allowing for implicit processing of tonal structures, which benefits to memory even for complex material.

International audience

Background Since the beginning of the COVID-19 pandemic, many countries, including Canada, have adopted unprecedented physical distancing measures such as closure of schools and non-essential businesses, and restrictions on gatherings and household visits. We described time trends in social contacts for the pre-pandemic and pandemic periods in Quebec, Canada. Methods CONNECT is a population-based study of social contacts conducted shortly before (2018/2019) and during the COVID-19 pandemic (April 2020 - February 2021), using the same methodology for both periods. We recruited participants by random digit dialing and collected data by self-administered web-based questionnaires. Questionnaires documented socio-demographic characteristics and social contacts for two assigned days. A contact was defined as a two-way conversation at a distance

BackgroundThe French Riviera has been declared free of Lyme Borreliosis (LB) for years. Many patients are referred for presumed LB, sometimes with atypical clinical signs and/or doubtful serology, calling the diagnosis into question.MethodsPatients were assessed for LB diagnosis, depending on clinical presentation, laboratory findings, and further examination by other medical professionals.ResultsAmong 255 patients, 45 (18%) were classified as confirmed LB cases [including 28 ongoing LB (10%) and 17 past LB (8%)], and for 210 (82%) a Lyme borreliosis diagnosis was ruled out. Among ongoing LB, 56% had been exposed to or bitten by ticks, exclusively in rural locations of the Alpes-Maritimes. As a result of the diagnostic procedure, 132 (52%) patients had been treated. An alternative diagnosis was established for 134 (52%) patients, covering a wide range of conditions, including mainly psychological (28%) and neurological conditions (25%) or inflammatory and systemic diseases (22%).ConclusionsOur results strongly suggest the endemicity of LB in the Alpes-Maritimes region. Confirmed LB accounted for 18% of patients while 52% were diagnosed with other conditions.

International audience; Background - While meningiomas often recur over time, the natural history of repeated recurrences and their management are not well described. Should recurrence occur, repeat surgery and/or use of adjuvant therapeutic options may be necessary. Here, we summarize current practice when it comes to meningioma recurrence after initial surgical management. Methods - A total of N = 89 articles were screened. N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review. Results - The articles were distributed as follows: studies on chemotherapy (N = 14), radiotherapy, protontherapy, and stereotaxic radiosurgery (N = 6), boron-neutron capture therapy (N = 2) and surgery (N = 3). No study seems to provide serious alternatives to surgery in terms of progression-free and overall survival. Recurrence can occur long after the initial surgery and also affects WHO grade 1 meningiomas, even after initial gross total resection at first surgery, emphasizing the need for a long-term and comprehensive follow-up. Conclusions - Surgery still seems to be the state-of-the-art management when it comes to meningioma recurrence, since none of the non-surgical alternatives show promising results in terms of progression-free and overall survival.

Background Moment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation. Methods The 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane). Findings We found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane). Interpretation The knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.