Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy. METHODS:Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts. RESULTS:A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes (Gateway effect) at the population level. This sub-cohort design prohibits highlighting any Diversion effect, which is the most likely mechanism accounting for the competition between these two products. CONCLUSIONS:While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.

Pulmonary Langerhans cell histiocytosis (PLCH) belongs to the spectrum of diffuse interstitial cystic pneumonias; it affects young people of both sexes and occurs almost exclusively in tobacco smokers or co-users of tobacco and cannabis. The management of this severe chronic disease is undertaken in specialized centers. A better understanding of the pathogenic mechanisms of the disease has opened up prospects for targeted therapies. However, supporting the abstinence from inhaling noxious materials which determine its prognosis remains the cornerstone of treatment. Patients with PLCH who persist in smoking despite the diagnosis maybe very dependent on tobacco, experience significant difficulties in stopping smoking, and must have access to specialist smoking cessation clinics. (C) 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Our objective was to compare patient’s expectations to their experience and to identify factors predictive of patient’s perception of long-term LMWH for the treatment of cancer-associated thrombosis (CAT).

Tobacco use is not just about manufactured cigarettes. Rolling tobacco, highly prized in the wake of price increases, is estimated to carry more toxic agents than its counterpart. This study shows that the use of cigar, pipe, cigarillos and narghile also leads to a cohort of pathologies similar to or more than what is known for smoking single cigarettes. Exotic, liquid or heated forms do just as much. The non-smoked tobacco, often fallen into disuse in France is very used in the United States and especially in Scandinavia. Denuded of inhaled products, it is often pointed as a form of reduction of smoking risks. Its use by athletes in all countries as a doping attitude, especially in ski disciplines, required a campaign of prevention within the federations concerned. (C) 2018 Elsevier Masson SAS. All rights reserved.

There is emerging evidence that Omega-3 polyunsaturated fatty acids (PUFA) supplements can decrease aggression. However, experimental studies with adults from non-specific populations are scarce. We hypothesized that Omega-3 supplements would decrease self-reported aggression among non-clinical participants. In a double-blind randomized trial, two groups of participants (N = 194) aged 18-45 from the general population followed a 6-weeks treatment with 638 mg docosahexaenoic acid (DHA) and 772 mg eicosapentaenoic acid (EPA) per day or the equivalent quantity of copra oil (placebo). Self-reported aggressiveness was measured at baseline and after the 6-week treatment period. Findings showed that Omega-3 supplements significantly decreased self-reported aggressiveness at the end of the 6-week period (d = 0.31). In conclusion, this experiment indicates that Omega-3 administration has beneficial effects in reducing aggression among the general population.

This retrospective cohort study deals with the causes of death among 57,000 military personnel who served in the French Navy surface vessels and were observed over the period 1975-2000. We successively compared the mortality rate and the specific causes of death between two groups differing in their potential exposure levels to radar. Occupational exposure was defined according to the on-board workplace (radar and control groups). The age-adjusted death ratios of the navy personnel were compared. For all causes of death, the results showed that 885 deaths in the radar group and 299 in the control group occurred (RR=1.00 (95% CI: 0.88-1.14)). RRs were 0.92 (95% CI: 0.69-1.24) for neoplasms. For the duration of follow-up, the results did not show an increased health risk for military personnel exposed to higher levels of radio frequencies in the radar group, but the number of deaths was very small for some cancer sites.

In case of a mass casualty radiation event, there is a need to distinguish total-body irradiation (TBI) and partial-body irradiation (PBI) to concentrate overwhelmed medical resources to the individuals that would develop an acute radiation syndrome (ARS) and need hematologic support (i.e., mostly TBI victims). To improve the identification and medical care of TBI versus PBI individuals, reliable biomarkers of exposure could be very useful. To investigate this issue, pairs of baboons (n = 18) were exposed to different situations of TBI and PBI corresponding to an equivalent of either 5 Gy 60Co gamma irradiation (5 Gy TBI; 7.5 Gy left hemibody/2.5 right hemibody TBI; 5.55 Gy 90% PBI; 6.25 Gy 80% PBI; 10 Gy 50% PBI, 15 Gy 30% PBI) or 2.5 Gy (2.5 Gy TBI; 5 Gy 50% PBI). More than fifty parameters were evaluated before and after irradiation at several time points up to 200 days. A partial least square discriminant analysis showed a good distinction of TBI from PBI situations that were equivalent to 5 Gy. Furthermore, all the animals were pooled in two groups, TBI (n = 6) and PBI (n = 12), for comparison using a logistic regression and a non parametric statistical test. Nine plasmatic biochemical markers and most of hematological parameters turned out to discriminate between TBI and PBI animals during the prodromal phase and the manifest illness phase. The most significant biomarkers were aspartate aminotransferase, creatine kinase, lactico dehydrogenase, urea, Flt3-ligand, iron, C-reactive protein, absolute neutrophil count and neutrophil-to-lymphocyte ratio for the early period, and Flt3-ligand, iron, platelet count, hemoglobin, monocyte count, absolute neutrophil count and neutrophil-to-lymphocyte ratio for the ARS phase. These results suggest that heterogeneity could be distinguished within a range of 2.5 to 5 Gy TBI.

Obstructive sleep apnea (OSA) is highly prevalent in the French overall population, and more specifically in males and obeses, but limited data are available in elderly despite their increasing proportion. Aims and objectives : describe clinical aspects and long term treatment of OSA (continuous positive airway pressure ventilation) in apneic subjects over 75 years old and compare these data with apneic patients under 60 years old. Methods : retrospective, descriptive monocenter study over a 6 months period. All patients underwent a respiratory polygraphy at the time of diagnosis and after 6 months of treatment. Results : 73 patients were included, 35 in the study arm and 38 in the control arm. Cardiovascular (82,9% vs 63,2%, p=0,037), neurological (37,&% vs 15,8%, p=0,026) and urological (76,7% vs 23,3%, p=0,0001) comorbidities are significantly higher identified in the study arm. The sleep quality, the fatigue symtom and the apnea-hypopnea index (2,8 vs 6,5, p l 0,05) were significantly improved in the control arm. The 6 months follow up evaluation pointed out a poorer adherence of continuous positive airway pressure ventilation in the study group (67,6% vs 97,4%, p = 0,001). Conclusion : in our center, clinical presentation of OSA in elderly and its treatment are clearly different compared with a "standard" cohort of patients under 60 years old. Continuous positive airway pressure ventilation remains the only validated treatment for the elderly patients but the 6 months adherence is poorer.

Conclusion Humoral response against hepatitis C virus linear epitopes is partly modified according to the disease state. This study highlights the importance of considering relative quantities of antibodies with different specificities rather than the amount of each antibody. Hepatitis C virus infection leads to liver disease whose severity can range from mild to serious lifelong illness. However the parameters involved in the evolution of the disease are still unknown. Among other factors, the virus-elicited antibody profile is suspected to play a role in the outcome of the disease. Analysis of the relationship between anti-virus antibodies and disease state requires the analysis of a large number of serums from patients (hepatitis C virus+) and of epitopes from the viral proteins. Such a study would benefit from microarray-based screening systems that are appropriate for high-throughput assays. We used a method combining peptide chips and surface plasmon resonance imaging previously shown to be suitable for analyzing complex mediums and detecting peptide-protein interactions. 56 peptides covering the entire viral proteome were grafted on chips and their interaction with antibodies present in the 68 injected serums from infected and non-infected donors was measured. Statistical analyses were conducted to determine a possible relationship between antibodies (specificity and amount) and disease states. A good discrimination between infected and non-infected donors validated our approach, and several correlations between antibodies profiles and clinical parameters have been identified. In particular, we demonstrated that ratios between particular antibodies levels allow for accurate discrimination of patients according to their pathologic states.

BACKGROUND:Liver fibrosis, now assessed by liver biopsy or using non-invasive methods, might be different in chronic hepatitis B (CHB) and chronic hepatitis C (CHC). AIM:To compare histological amount and pattern of fibrosis in CHB and CHC. METHODS:Sixty CHB and sixty CHC biopsies from naïve patients, standardized for the spectrum of Metavir fibrosis stages, were analysed for (1) semi-quantitative Metavir activity, steatosis, perisinusoidal fibrosis, alpha-smooth muscle actin immunoreactivity, (2) quantitative morphometry of total and perisinusoidal fibrosis ratio (FR and PFR). RESULTS:Biopsy quality, activity, steatosis, Fibrotest(®) values were not different between the two groups. Correlation between FR and fibrosis stage was stronger in CHB (r = 0.90) than CHC (r = 0.81). Mean FR was 1.5-fold higher in CHC than CHB for early fibrosis stages (F ≤ 2, P = 0.001), with higher PFR in CHC for F0 (P = 0.001), F1 (P = 0.08) and F2 (P = 0.004). Hepatic stellate cell activation index was also higher in CHC than in CHB (P = 0.007). Diagnosis performance of FR for significant fibrosis was not statistically different in CHB than CHC (AUROC 0.92 and 0.87 respectively), but cut-offs optimizing sensitivity and specificity were higher in CHC and their extrapolation to CHB led to 10% decrease in sensitivity. In F ≤ 2 patients, correlation between FR and Fibrotest(®) was only significant in CHC. CONCLUSIONS:As compared to CHB, amount of fibrosis is greater in CHC for F ≤ 2 patients, mainly because of higher perisinusoidal fibrosis. These data illustrate difficulty to assess early fibrosis stages by non-invasive methods, and support the need for specific cut-offs in CHB.

Depuis quelques années, l’armée française a mis en place des moyens de lutte contre l’utilisation de substances psychoactives. Notre étude porte sur les militaires des régiments de l’armée de terre en région Nord Est venant passer leur visite systématique annuelle. Du premier juin au 31 août 2008, nous leur avons proposé des questionnaires à questions fermées sur l’usage du cannabis et d’autres substances psycho-actives. Les résultats retrouvent un taux d’usagers problématiques (usage abusif et dépendance) de 8,25% principalement parmi les jeunes hommes, militaires du rang célibataires, et sans enfant. Ces usagers problématiques ressentent une perte de contrôle dans 32 % des cas ; ils éprouvent des difficultés d’arrêt de la consommation pour 40 % d’entre eux. La poly consommation est présente chez 28 % des sujets consommateurs. Enfin, la consommation des usagers problématiques est augmentée de 25 % au cours des missions intérieures et de 16 % lors des opérations extérieures. Les principales raisons évoquées sont l’ennui (63 %) et l’éloignement familial (58 %). Ces résultats nous permettent d’envisager une politique de prévention plus ciblée sur ce type de conduites de consommation dans le contexte opérationnel actuel varié. Nous proposons finalement un mémento à la disposition des médecins d’unité.

Les expertises collectives de l’Inserm (2001 et 2003) sur les effets sur la santé et les effets sociaux de l’alcoolisation excessive ont permis d’établir des recommandations pour les pratiques professionnelles tant au niveau du repérage que de la prise en charge des sujets en difficultés avec l’alcool. Les médecins généralistes et les médecins du travail occupent des postes-clés pour faciliter les bilans de consommations et aider l’orientation des personnes vers les Centres de cure ambulatoire en alcoologie (CCAA). L’étude épidémiologique nationale faite par l’Inserm et l’Anpaa auprès des CCAA vise à analyser la contribution des médecins du travail à l’orientation des patients et les caractéristiques des personnes adressées au secteur spécialisé en alcoologie. La comparaison de ces patients avec les personnes adressées par les médecins généralistes ou après dépistage de l’alcoolémie routière permet d’analyser différentes conditions de repérage des situations à risque vis-à-vis de l’alcool.Les CCAA de l’Anpaa ont accueilli, pour l’année 2002, 22 169 consultants dont près de la moitié ont une activité professionnelle (48 %). Un questionnaire individuel proposé lors des premiers entretiens contient les caractéristiques socio-démographiques, l’origine et les raisons de la démarche, les consommations de psychotropes licites ou illicites et les difficultés rencontrées. Trois groupes sont comparés suivant l’origine de la démarche : médecine du travail, médecine générale et route.En 2002, 2, 2 % des consultants actifs des CCAA sont adressés par la médecine du travail (n = 229) et 20,6 % par l’alcoolémie routière (n = 2170). Les consultants adressés par la médecine du travail sont plus âgés, plus nombreux à exercer la profession d’employés mais moins nombreux dans les autres catégories socio-professionnelles. Les difficultés rencontrées sont plus anciennes et concernent surtout le travail. La consommation d’alcool est majoritairement quotidienne dans le sous-groupe de la médecine du travail.Par ailleurs, 8,8 % des consultants de CCAA en activité sont adressés par les médecins généralistes (n = 916). Les consultants adressés par la médecine du travail sont plus âgés. Ils comptent plus d’hommes. Ils sont plus nombreux à exercer la profession d’employés ou ouvriers mais moins nombreux dans les autres catégories socio-professionnelles. Près de 4 sur 10 disent rencontrer des difficultés dans leur travail, c’est leur principal problème, alors que ceux qui viennent par l’intermédiaire des généralistes notent la santé et les relations familiales comme principales difficultés. Les difficultés sont aussi anciennes. Il n’y a pas de différence de mode d’alcoolisation entre les deux sous-groupes et il y a autant de fumeurs.Les deux groupes venant de la médecine du travail et de la médecine générale apparaissent proches sur les plans sanitaire et comportemental, illustrant la filière de la santé au travail vers le médecin traitant en cas d’alcoolisation excessive. La différence avec le recrutement dû au dépistage de l’alcoolémie routière est nette et montre la nécessité de la complémentarité des démarches de repérage et d’orientation pour des groupes de personnes aux caractéristiques et besoins aussi différents.The Inserm collective experts reports (2001 and 2003) on the professional and social risks of alcohol abuse, have allowed to set some recommendations to detect and assume people who are in difficulty with alcohol. The general practitioners and occupational health physicians (industrial medicine) fill very important posts to make the consumption balances and the individual guidance to CCAA (Centres of Alcohol Ambulatory Cures) easier. The national epidemiology survey which is carried out by Inserm and Anpaa in CCAA, studies the assistance of occupational health physicians to the guidance and the characteristics of patients who are recommended to the specialized area. The comparison between these patients and persons who come from general practitioners or after a detection of alcohol abuse on the roads, allows to analyze various conditions of identification of risk situation towards alcohol.During the year 2002, the CCAA of Anpaa received 22 169 consultants, 48% of whom are in an active job. An individual questionnaire is proposed during the first conversations, it involves the socio-demographic characteristics, origin and motives of the step, licit and illicit psychotropes consumptions and difficulties. The three groups: occupational health physicians, general practitioner and alcohol abuse on the roads are analysed and compared.2.2% of active consultants are directed by occupational health physicians (n = 299) and 20.6% by the roadside breath tests (n = 2170). The consultants sent by occupational health physicians are older, mostly employees and less numerous in the other professional classes. Their difficulties are older and affect mainly the workplace. Alcohol consumption is daily in the occupational health physicians group in majority.Moreover, 8.8% of active CCAA consultants are directed by general practitioners (n = 916). The consultants who are directed by the occupational health physicans are older and men are more numerous. There are more employees or workmen too, but the other professional classes are less numerous. Nearly 4 in 10 are encountering some difficulties at work, it is their main problem. The patients who are directed by general practitioners indicate health and familial relations as principal difficulties. These difficulties are older too. There are no difference between these two groups about the mode of alcoholisation and the number of smokers.The two groups directed by occupational health physicians and general practitioners appear very near concerning the medical and behavioural aspects and show an usual health channel from work to the usual doctor in case of alcohol abuse. The difference with recruitment of alcohol abuse on the roads is clear and shows the very important complementarity of detection and guidance steps when the groups offer very different characteristics and needs.

This biodosimetry study used irradiated baboons to investigate the efficacy of a kinetic multiparameter (clinical, physical, and biological) approach for discriminating partial-body irradiation (PBI) and total-body irradiation (TBI). Animals were unilaterally (front) exposed to 60Co gamma rays (8 to 32 cGy min) using either TBI or vertical left hemi-body irradiation (HBI), as follows: 2.5 Gy TBI (n = 2), 5 Gy TBI (n = 2), 5 Gy HBI (n = 2), and 10 Gy HBI (n = 2). Midline tissue doses were measured at the anterior iliac crest level with an ionization chamber, and body dosimetry was performed using thermoluminescent dosimeters. Blood samples were collected before exposure and from 1 h until 200 d after irradiation. Clinical status, complete blood cell count, biochemical parameters, and cytogenetic analysis were evaluated. The partial least square discriminant analysis chosen for statistical analysis showed that the four groups of irradiated baboons were clearly separated. However, the dicentric chromosome assay may not distinguish HBI from TBI in confounding situations where equivalent whole-body doses are similar and the time of exposure is sufficient for peripheral blood lymphocyte homogenization. Interestingly, as bone marrow shielding in HBI animals prevented aplasia from happening, hematologic parameters such as the platelet count and Flt-3 ligand level helped to distinguish HBI and TBI. Moreover, the ratio of neutrophil to lymphocyte counts, creatine kinase, and citrulline levels may be discriminating biomarkers of dose or injury. Both early and delayed clinical signs and bioindicators appear to be useful for assessment of heterogeneous irradiation.

Smoking represents a major public health problem because of its high morbidity and mortality rates. Nearly half of the deaths in the lower class are caused by smoking. The socially deprived are physically and psychologically vulnerable. The instability of their situation increases the difficulty to invest in smoking cessation and certain time orientations linked to this social deprivation represent negative factors in the prognosis. Socially deprived populations do not understand the consequences of smoking unless they are in denial of the risks. The motivation to stop is essentially financial. The perception of smoking cessation is taken as a deprivation of pleasure. Independently of the social deprivation factors, taking into account the time perspective conveys necessary information of appropriate care.

Alcohol is frequently related to interpersonal aggression, but information regarding the role of alcohol consumption by victims of severe aggression is however lacking. In order to better understand the dynamic of victimization, we investigated contextual, facilitator, and psychological impact variables related to victimization in a French sample composed of 1,033 females aged 18-74 years. The participants were recruited using quota sampling methodology, and responses were measured using Computer-Assisted Self-Interviewer. A logistic regression was conducted using a backward elimination procedure to identify the significant predictors of blows and wounds suffered in the past 24 months. The results indicated that victims, relative to nonvictims, did binge drink significantly more often, had a higher aggression trait, and had experienced more social hardships in the past. The study's limitations are noted.

Lactate is important in determining prognosis in acute liver failure.W. Bernal 211 Is lactate concentration of major value in determining the prognosis in patients with acute liver failure?Hardly.L.