Background In 2021, the Global Lung Function Initiative (GLI) has published new reference equations for static lung volumes (GLI-2021). Many learned societies recommend the use of GLI reference values for interpreting pulmonary function tests (PFT), while pointing out the need for clinicians to be aware of the consequences for their routine practice. We aimed to compare the GLI-2021 reference values and the 1993 European Coal and Steel Community (ECSC) standards on the interpretation of static lung volume data in patients with a probable static hyperinflation or a probable restrictive ventilatory disorder. Methods We analyzed plethysmographic PFT data from 2 groups of patients: a group of patients with symptoms compatible with chronic bronchitis (CB) and a group of patients with symptoms compatible with interstitial lung disease (ILD). We investigated discrepancies in the evaluations of static lung volumes when using the ECSC vs. the GLI-2021 reference values. Results 2,897 sets of PFT results (including 1,598 in men) were included. In the CB group, the proportion of hyperinflation was higher for both sexes with the GLI-2021 standards. In the ILD group, the proportion of restrictive ventilatory disorders was higher in women but lower in men with the GLI-2021 standards. Conclusion A move from use of the ECSC standards for static lung volumes to the GLI-2021 standards might lead to a higher estimated proportion of hyperinflation (particularly in participants with CB), together with changes in the proportion of restrictive ventilatory disorders (a lower value in men and a higher value in women with ILD).

ObjectifÉvaluer l’impact de l’exposition professionnelle à la silice cristalline sur la fonction ventilatoire dans une population de sujets du Nord de la France.MéthodesNous avons inclus 1428 hommes âgés de 40 à 65 ans de l’étude transversale ELISABET, recrutés en population générale par tirage au sort sur liste électorale, ayant réalisé une spirométrie (normes Global Lung Function Initiative 2012 [GLI-2012]) et un questionnaire. L’indice d’exposition cumulée à la silice cristalline (IEC Silice) exprimé en mg.m−3. années a été calculé avec la matrice emploi-exposition (MEE) matgéné silice cristalline. Les co-expositions aux vapeurs, gaz, fumées et poussières (hors silice) (VGFP) ont été estimées avec une MEE créée pour cette étude. Les relations entre l’IEC silice et les indices spirométriques ont été étudiées à l’aide de modèles de régression logistique et linéaire ajustés sur l’âge, l’indice de masse corporelle, le statut tabagique, le centre, l’antécédent d’asthme, la saison et les co-expositions aux VGFP.RésultatsLa proportion de sujets exposés à la silice était de 20,5 % (293/1428). En régression linéaire multiple, les z-scores ajustés du VEMS/CVF (rapport du volume expiré maximal pendant la 1re seconde [VEMS] sur la capacité vitale forcée [CVF]) et du débit expiratoire moyen entre 25 et 75 % de la capacité vitale forcée (DEM25–75) diminuaient de manière significative à mesure que l’IEC silice augmentait. Après ajustement, les z-scores du VEMS/CVF (β : 0,426 (intervalle de confiance à 95 % [IC95 %] : 0,792–0,060) par augmentation de 1mg.m−3. année) et du DEM25–75 (β : 0,552 [IC95 % : 0,947–0,157]) étaient significativement plus faibles chez les sujets ayant un IEC silice ≥ 1mg.m−3.années que chez les sujets non exposés. En régression logistique multivariée, le risque de présenter un trouble ventilatoire obstructif (TVO) était significativement augmenté chez les sujets ayant un IEC silice≥1mg.m−3.années par rapport aux non-exposés (ORajusté=3,06 [IC95 %=1,10–7,63] ; p=0,022) ainsi que le risque de présenter une altération du DEM25–75 (ORajusté=4,31 [IC95 %=1,39–11,79] ; p=0,007).ConclusionCette étude renforce l’indication à réaliser une surveillance spirométrique pendant la carrière et lors du suivi post-professionnel chez les sujets atteignant ou dépassant un seuil d’exposition à la silice de 1mg.m−3.année, afin d’identifier une obstruction des petites voies aériennes ou un TVO.

Abstract Introduction Following the publication of the French National Agency for Safety, for Food, Environment and Work (Anses) collective expertise report ‘Dangers, expositions et risques relatifs à la silice cristalline’ in 2019, the Société Française de Santé au Travail, in partnership with the Société de Pneumologie de Langue Française, the Société Française de Radiologie, and the Société Nationale Française de Médecine Interne, wished to draw up recommendations for good practice on the medical survey of workers exposed, or who have been exposed, to crystalline silica (CS). Materials and Methods These recommendations for good practice were drafted using the ‘Recommendation for Clinical Practice’ method recommended by the French National Authority for Occupational Health (HAS). Results These statements have made it possible to describe the occupational situations currently exposing workers to CS, and the diseases likely to be caused or aggravated by exposure to CS, to discuss the arguments including exposure characteristics currently available for proposing or not screening for each of the diseases caused by exposure to CS, the tools or examinations recommended for such screening, in particular the use of chest X-rays, to present the objectives and the schedule of the medical monitoring, the methods of primary prevention and finally to determine the research priorities to be promoted to optimize medical monitoring of populations exposed, or having been exposed, to CS. Conclusions This best practice recommendation has been awarded the HAS label, and are now progressively used in practice by occupational health services.

Objective To describe the proportions of subjects exposed to crystalline silica and the sectors of activity concerned between 1965 and 2010 in a sample of the general French population. Methods We included 2942 participants aged 40 to 65 years, recruited at random from electoral rolls, from the French general population in the cross-sectional ELISABET study between 2011 and 2013. The proportions of subjects exposed to crystalline silica and their sectors of activity were determined on the basis of their career history and the use of the Matgéné job-exposure matrix. Results In the total sample, occupational exposure to crystalline silica was found for 291 subjects (9.9%) between 1965 and 2010, with a predominance of men (20.2% of exposed subjects among men (282 out of 1394) versus 0.6% among women (9 out of 1548)). The highest proportion of participants exposed to crystalline silica was reached in 1980 with 6.1% and then decreases to 4.4% in 2010. Among men, the most frequently exposed sectors of activity were manufacture of basic metals (41.5% of exposed men (117 out of 282)), specialised construction activities (23.1% of exposed men (65 out of 282)) and construction of buildings (14.2% of exposed men (40 out of 282)). Conclusions Although the proportion of workers exposed to crystalline silica has been decreasing since the 1980s, it is still significant at least until 2010, particularly in the construction sector, and further research is needed to improve the monitoring of workers who are or have been exposed to crystalline silica.

INTRODUCTION:Although several studies have studied the relationship between occupational exposure to crystalline silica dust and respiratory mortality, few have examined the relationship with impairments in respiratory function and the exposure threshold triggering spirometric monitoring in exposed workers. The objective of the present study was to evaluate the impact of exposure to crystalline silica dust on respiratory function. METHODS:We included 1428 male participants (aged 40 to 65) recruited from the French general population, at random from electoral rolls, in the cross-sectional ELISABET study and for whom data on forced expiratory flow-volume curve indices z-scores (calculated using the Global Lung Function Initiative 2012 equations) and exposure (via a questionnaire) were available. A cumulative exposure index (CEI) for crystalline silica dust (CEIsilica, expressed in mg.m-3.year) was calculated using the Matgéné occupational exposure matrix. RESULTS:293 of the 1428 participants (20.52%) reported exposure to silica dust. We found that the adjusted z-scores for the forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio decreased significantly as CEIsilica increased. After adjustment, the adjusted z-scores for FEV1/FVC (β: -0.426 (95% confidence interval (CI): -0.792, -0.060) per 1 mg m-3.year increment) and the mean forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75) (β: -0.552 (95% CI: -0.947, -0.157)) were significantly lower in the participants with CEIsilica ≥1 mg m-3.year than in non-exposed participants. The likelihoods of having airway obstruction (odds ratio (OR): 3.056 (95% CI: 1.107, 7.626)) or having an impaired FEF25-75 (OR: 4.305 (95% CI: 1.393, 11.79)) were also significantly higher in participants with CEIsilica ≥1 mg m-3.year. CONCLUSION:Our results emphasize the importance of spirometry-based monitoring in workers exposed to more than 1 mg m-3.year of crystalline silica dust, in order to identify small airway obstruction or airway obstruction as early as possible.

Lung cancer (LC) screening has been shown to be effective to reduce specific mortality in at-risk populations but its performances could be improved by using non-invasive biomarkers such as the analysis of volatile organic compounds (VOCs) in exhaled air from screened subjects. Some limited studies suggest that VOCs could be used to detect LC patients (LCP). Our project aims at determining which VOCs profile could be used to differentiate LCP from healthy controls (HC) in a much larger series of cases.

Occupational exposure is associated with elevated morbidity and lower quality of life in patients with chronic obstructive pulmonary disease (COPD). Static hyperinflation is an independent risk factor for all-cause mortality in COPD and for COPD exacerbation. In a multicentre, cross-sectional study (BPROFETIO), we sought to analyse the relationship between static hyperinflation and occupational exposure in patients with COPD with or without occupational exposure.MATERIAL AND METHODS:An overall 'whole working life' cumulative exposure index was calculated for occupational patients with COPD. Spirometry indices and lung volumes were measured according to the 2005 American Thoracic Society/European Respiratory Society guidelines.RESULTS:After adjustment for age, sex, height, body mass index, smoking and coexposure, the analysis for each occupational hazard showed a higher risk for hyperinflation and FEV1 decline or progression of COPD or GOLD stage for patients with COPD exposed to non-metallic inorganic dusts.CONCLUSION:Occupational exposures should be more investigated in clinical practice and studies as they contribute to the COPD heterogeneity and are associated for some with the development of a static hyperinflation; a condition that is known to have a negative impact on quality of life and survival.

Le cancer broncho-pulmonaire (CBP) présente un pronostic défavorable lorsqu’il est diagnostiqué à un stade avancé ou métastatique. Le dépistage par tomodensitométrie thoracique à faible dose montre des résultats encourageants pour les populations à risque mais rapporte des taux de faux positifs encore élevés. Les composés organiques volatils (COVs) de l’air exhalé sont des produits du catabolisme cellulaire ayant diffusé dans le compartiment alvéolaire. L’ensemble des COVs dans l’air expiré d’un sujet est le « volatolome » ; celui-ci se modifie si le métabolisme cellulaire change, notamment au cours de la carcinogenèse. Les études disponibles sur l’utilisation du volatolome dans le diagnostic du CBP présentent de faibles effectifs ainsi que des méthodologies disparates d’identification des COVs. Peu de COVs sont donc formellement identifiés comme biomarqueurs d’intérêt dans la détection précoce du CBP. L’objectif de l’étude CATOCOV est d’identifier les COVs marqueurs de CBP dans une large population de patient atteints de CBP (n = 750). Dans cette étude cas-témoins en cours, les sujets atteints de CBP sont recrutés au sein de plusieurs services de pneumologie-oncologie thoracique et les sujets témoins au sein de l’Institut Pasteur de Lille. Chacun répond à un questionnaire et bénéficie du prélèvement d’air exhalé pendant 10 minutes. Ce recueil s’effectue à l’aide du masque ReCIVA® (Owlstone Medical) qui piège les COVs dans des tubes de sorbants. Ceux-ci sont analysés en chromatographie gazeuse par spectrométrie de masse (GC-MS) par TERA Environnement afin de qualifier et quantifier les COVs piégés. Une collaboration avec le laboratoire ORKAD (Université de Lille) permettra de sélectionner au mieux les COVs marqueurs de CBP grâce à des algorithmes d’optimisation combinatoire multi-objectifs déjà éprouvés (antibiorésistance). A date, plus de 600 sujets témoins et 200 cas ont été recrutés. Une analyse intermédiaire sur 300 témoins et 100 cas définira un nombre restreint de COVs (n = 50) pour les futures interprétations. Le reste de la population permettra d’éprouver le potentiel de détection du panel sélectionné. Ce projet ciblera les COVs les plus pertinents pour détecter précocément le CBP afin d’anticiper le diagnostic et optimiser les chances de prise en charge chirurgicale, à visée curative. Nous espérons ainsi améliorer la survie globale de ces patients.

L’épidémie COVID-19 a placé le personnel des établissements de santé en première ligne mais, à ce jour, il existe peu de données dans la littérature sur la prévalence de l’infection à SARS-CoV-2 combinant la réalisation d’une RT-PCR et d’une sérologie. L’objectif de cette étude est de déterminer la prévalence de l’infection à SARS-CoV-2 chez le personnel du centre hospitalo-universitaire (CHU) de Lille. L’objectif secondaire est de décrire les déterminants d’expositions professionnelles et environnementaux de cette infection. Dans cette étude monocentrique transversale répétée réalisée entre le 4 mai et le 16 juillet 2020, un prélèvement nasopharyngé pour analyse par RT-PCR, une sérologie SARS-CoV-2 et un questionnaire clinico-professionnel ont été proposés à chaque participant. Ont été inclus les personnels du CHU de Lille travaillant sur site, présentant ou non des symptômes évocateurs d’une infection à SARS-CoV-2. Les sujets ont été classés dans l’un des trois groupes suivants selon les données du questionnaire : haut risque (personnel travaillant dans une unité accueillant spécifiquement des patients infectés par le SARS-CoV-2 ou suspects de l’être) ; risque intermédiaire (personnel travaillant dans une unité pouvant accueillir des patients infectés ou suspects de l’être) ; risque faible (personnel hors des unités de soins). Au total, 3786 sujets ont été inclus (3415 (90,2 %) RT-PCR et 3550 (93,8 %) sérologies) : 66 (1,7 %) avaient une RT-PCR positive ; 191 (5 %) une sérologie positive en IgM/A et/ou IgG. On dénombre 57,7 %, 31 % et 11,3 % de séropositifs dans le groupe à haut risque, dans le groupe intermédiaire et dans le groupe à risque faible respectivement ( p = 0,054). Parmi les séropositifs du groupe à haut risque, les gestes les plus fréquemment réalisés sur patients suspects ou confirmés étaient les aérosols (58,5 %), les soins de bouche (48,8 %) et les prélèvements urinaires (46,3 %) ; les types de contacts les plus fréquents étaient la manipulation du patient (73,2 %), les échanges verbaux (70,7 %) et la manipulation de linge sale (68,3 %) ; les équipements de protection individuelle les moins fréquemment utilisés étaient les surchaussures (39 %), la visière (46,3 %) et le tablier en plastique (73,2 %). La prévalence de l’infection à SARS-CoV-2 est faible dans notre échantillon de personnel du CHU de Lille (RT-PCR positives : 1,7 % ; sérologie positive : 5 %), y compris chez les personnels les plus exposés. Cette faible proportion peut être expliquée par la bonne compliance du personnel à utiliser les moyens de préventions mis en place.

BACKGROUND:The single-breath diffusing capacity of the lung for carbon monoxide (DLCO) interpretation needs the comparison of measured values to reference values. In 2017, the Global Lung Function Initiative published new reference values (GLI-2017) for DLCO, alveolar volume (VA) and transfer coefficient of the lung for carbon monoxide (KCO). We aimed to assess the applicability of GLI-2017 reference values for DLCO on a large population by comparing them to the European Community of Steel and Coal equations of 1993 (ECSC-93) widely used. METHODS:In this retrospective study, spirometric indices, total lung capacity, DLCO, VA and KCO were measured in adults classified in 5 groups (controls, asthma, chronic bronchitis, cystic fibrosis, and interstitial lung diseases (ILD)). Statistical analysis comparing the 2 equations sets were stratified by sex. RESULTS:4180 tests were included. GLI-2017 z-scores of the 3 DLCO indices of the controls (n = 150) are nearer to 0 (expected value in a normal population) than ECSC-93 z-scores. All groups combined, in both genders, DLCO GLI-2017 z-scores and %predicted are significantly higher than ECSC z-scores and %predicted. In the ILD group, differences between the 2 equation sets depend on the DLCO impairment severity: GLI-2017 z-scores are higher than ECSC z-scores in patients with no or "mild" decrease in DLCO, but are lower in "moderate" or "severe" decrease. CONCLUSION:GLI-2017 reference values for DLCO are more suitable to our population and influence the diagnostic criteria and severity definition of several lung diseases.

BACKGROUND AND AIM: Availability of up-to-date methods, models, and exposure data is critical to realistically estimate human exposure to environmental contaminants. Exposure factors (EF) are human characteristics and behaviors that are needed for reliable exposure and, thus, risk assessments (RA). These factors determine exposure time, frequency, and intensity. They are usually considered as effect modifiers in epidemiological studies. While the US-EPA Exposure Factors Handbook is under updating, there is no European equivalent that meets RA needs. Therefore, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) launched a working group to define the reference values of specific EFs for the French population. METHODS: We defined priority EFs based on an inventory of needs identified by ANSES. For each EF, we defined the method, including a systematic review, quality assessment of studies, individual data retrieval, and specific modeling approaches, including descriptive statistics and generalized additive models for location, scale and shape, to derive population distributions for reference values by sex, age, and region. We also conducted uncertainty analyses. RESULTS:We prioritized three EFs: body mass, time-activity-location patterns, and inhalation rate (IR). For body mass, we pooled individual data from nine large studies to yield age-related distribution per sex, region, and socio-professional categories. For time-activity-location patterns, we estimated the practising individuals fraction and duration of all activities/locations, and frequency of some, as reported in the French Time Use Survey (2009-2010) (FTUS), per age-group (from 11 years), sex and region. For IR, we applied an energy-based approach. We determined energy expenditure per activity (professional and personal) from the FTUS using metabolic equivalent tasks and derived 24-hour IR and per physical activity level (sedentary, light, moderate, vigorous) by age-group, sex, and BMI. CONCLUSIONS:The output will allow more precise RA, facilitate the implementation of probabilistic RA approaches and improve comparability of RA results at the international level. KEYWORDS: body mass, time-activity-location patterns, inhalation rate, energy expenditure, (pooled) analysis of individual data, reference percentiles

Many associations were reported between air pollution and daily mortality rates for cardiopulmonary diseases. Humans are exposed to a mixture of oxidizing gases and particles, both anthropogenic and natural. Exposure to air toxics causes or exacerbates cardiovascular damages and respiratory diseases. Numerous studies have identified the induction of oxidative stress and sustained inflammatory response as among the main known underlying pathophysiological mechanisms of air pollutants. More recently, the relationship between these mechanisms of action and the secretion of extracellular vesicles (EVs) by lung cells has been revealed. EVs have been shown to be important mediators of cellular communication in the body. The purpose of this review is to first recall the main air pollutants. Then, the cardiopulmonary diseases caused by exposure to air pollution and the pathophysiological mechanisms are presented before showing, through an exhaustive review of the literature, the involvement of EVs in the toxicity of air pollutants and the initiation of cardiopulmonary diseases.

Although a growing body of evidence suggests that chronic exposure to outdoor air pollution is linked to a decline in lung function, data on flow at low lung volumes that may be more specific of small airway obstruction are still scarce. We aimed to study the associations between residential exposure to air pollution and lung function, with specific focus on small airways obstruction. We assessed 2995 French participants (aged between 40 and 65) in the ELISABET cross-sectional survey. Residential exposures to nitrogen dioxide (NO2), particulate matter with a diameter < 10 mu m (PM10) and sulphur dioxide (SO2) were assessed. The spirometric parameters were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC (FEF25-75) and at 75% of FVC (FEF75). Coefficients in linear regression models were expressed as the z-score [95% confidence interval] for an increment of 5 mu g/m(3) in NO2 and 2 mu g/m(3) in PM10 and SO2. NO2 was associated with significantly lower values of FEV1 (-0.10 [-0.15;-0.05]), FVC (-0.06 [-0.11;0.02]), FEV1/FVC (-0.07 [-0.11;-0.03]), FEF25-75 (-0.09 [-0.14;-0.05]) and FEF75 (-0.08 [-0.12;-0.04]). PM10 was associated with significantly lower values of FEV1 (-0.10 [-0.15;-0.04]), FVC (-0.06 [-0.11;-0.01]), FEV1/FVC (-0.06 [-0.11;-0.01]), FEF25-75 (-0.08 [-0.13;-0.03]) and FEF75 (-0.08 [-0.12;-0.04]). SO2 was associated with significantly lower values of FEV1 (-0.09 [-0.16;-0.02]), FEV1/FVC (-0.07 [-0.13;-0.01]), FEF25-75 (-0.09 [-0.15;-0.02]) and FEF75 (-0.08 [-0.14;-0.03]) but not FVC (-0.05 [-0.11; 0.009]). Even though spatial variations in pollutant levels were low, residential exposure to outdoor air pollution was associated with lower lung function, including lower FEF25-75 and FEF75 suggesting small airway obstruction.

Background: the air we breathe is composed of volatile and non-volatile compounds whose composition varies according to the metabolism of the respiratory epithelium in response to the aggression of inhaled toxicants. Nonvolatile compounds can be collected by cooling the exhaled air to obtain Exhaled Breath Condensate (EBC) which contains a small proportion of the airway lining fluid. Endogenous volatile compounds (including volatile organic compounds) present in exhaled air are derived from cellular metabolism of the respiratory epithelium or after diffusion through the alveolo-arterial membrane. The profile of these compounds can be modified in response to aggression (inhaled particles, viruses, bacteria) or when the cell type changes (neoplastic cell, tissue remodeling). Objective: to link early indicators of respiratory disorders with occupational or environmental exposure by exhaled air analysis. The research on these biomarkers first required the validation of the concept of these different matrices (EBC and CV) by assaying biomarkers of effect (inflammation and oxidative stress) in homogeneous populations of patients (COPD, scleroderma, asthma, pulmonary interstitial pathologies) as well as in an experimental model in rats (analysis of EBC after exposure to ozone and nitrogen dioxide). Results: the application of these methods to homogeneous exposure groups allowed us to show that it was possible to detect and quantify different types of particles in the EBC (mica, metal particles from welding fumes and materials containing beryllium, quartz particles or soapstone) and that these concentrations were correlated with those measured in the working atmosphere. Regarding volatile compounds, we studied the exhaled fraction of nitric oxide (FeNO) for which we have demonstrated in particular that a high level of alveolar NO had a detrimental effect on the chronotropic capacity of patients waiting for a liver transplant. Perspectives: we complete this data by analyzing the metallic content of the EBC of workers exposed to cutting fluids in the OxIGenoCOM study during which it was possible to supervise a Master 2 student and a student in University Thesis. We are currently trying to identify VOC profiles as early diagnosis markers of lung cancers and consider doing so for respiratory or systemic diseases of exposed workers.

Exposure to environmental and occupational particulate matter (PM) induces health effects on the cardio-pulmonary system. In addition, associations between exposure to PM and metabolic syndromes like diabetes mellitus or obesity are now emerging in the literature. Collection of exhaled breath condensate (EBC) is an appealing non-invasive technique to sample pulmonary fluids. This hypothesis-generating study aims to (1) validate an ion chromatography method allowing the robust determination of different metabolism-related molecules (lactate, formate, acetate, propionate, butyrate, pyruvate, nitrite, nitrate) in EBC; (2) apply this method to EBC samples collected from workers exposed to quartz (a known inflammatory particle), to soapstone (a less inflammatory particle than quartz), as well as to controls. A multi-compound standard solution was used to determine the linearity range, detection limit, repeatability and bias from spiked EBC. The biological samples were injected without further treatment into an ion chromatograph with a conductivity detector. RTube ® were used for field collection of EBC from 11 controls, 55 workers exposed to soapstone and 12 volunteers exposed to quartz dust. The analytical method used proved to be adequate for quantifying eight anions in EBC samples. Its sub-micromolar detection limits and repeatability, combined with a very simple sample preparation, allowed an easy and fast quantification of different glycolysis or nitrosative stress metabolites. Using multivariate discriminant analysis to maximize differences between groups, we observed a different pattern of anions with a higher formate/acetate ratio in the EBC samples for quartz exposed workers compared to the two other groups. We hypothesize that a modification of the metabolic signature could be induced by exposure to inflammatory particles like quartz and might be observed in the EBC via a change in the formate/acetate ratio.

Éternuements et démangeaisons ont émaillé nombre de films comiques dès les débuts du cinéma. À partir des années 1970, de nombreux épisodes d’attaques allergiques ont fait leur apparition sur les écrans, essentiellement dans des comédies. Nous expliquerons pourquoi l’allergie a une place si fréquente dans les comédies. . Notre démonstration s’appuiera sur des films tels que La Chèvre, Madame Doubtfire, Hitch, entre autres. Nous mentionnerons également des films d’animation. La série Les Simpson a très souvent abordé le sujet. Récemment la sortie du film d’animation, Peter Rabbit, a suscité une polémique que nous nous attacherons aussi à explorer. Enfin, nous proposerons un regard sur le film Safe, qui aborde un aspect plus tragique de la question, et nous en révèlerons les ressorts.Sneezing and itching have figured largely in many comic films since the very start of cinema. Beginning in the 1970s, many episodes of allergic attacks have appeared on screen, particularly in comedies. We shall explain why allergy is such a frequent device in comedies.. Our demonstration will be based on films such as La Chèvre (Knock on Wood), Mrs Doubtfire, Hitch, and others. We will also be discussing animated films. The series The Simpsons very often broached the subject. Recently, the release of the animation film, Peter Rabbit, caused a polemic that we shall also examine. Finally, we will take a look at the film Safe, which examines a more tragic aspect of the question, and we shall examine the underlying reasons.

Introduction: The association between cadmium levels in the body and diabetes has been extensively studied, with sometimes contrasting results. Smoking is the primary non-occupational source of cadmium, and constitutes a risk factor for diabetes. One can therefore hypothesize that the putative association with cadmium is actually explained by tobacco. To fully control for this confounding factor, we studied the relationship between blood cadmium and glycated haemoglobin (HbA1c) levels separately in never-, former and current smokers. Methods: We studied a sample of 2749 middle-aged adults from the cross-sectional ELISABET survey in and around the cities of Lille and Dunkirk; none had chronic kidney disease or a history of haematological disorders, and none were taking antidiabetic medication. The blood cadmium level-HbA1c associations in never-, former and current smokers were studied in separate multivariate models. The covariables included age, sex, city, educational level, tobacco consumption (or passive smoking, for the never-smokers), body mass index, estimated glomerular filtration rate, and (to take account of the within-batch effect) the cadmium batch number. Results: In the multivariate analysis, a significant association between cadmium and HbA1c levels was found in all three smoking status subgroups. A 0.1 mu g/L increment in blood cadmium was associated with an HbA1c increase [95% confidence interval] of 0.016% [0.003; 0.029] among never-smokers, 0.024% [0.010; 0.037] among former smokers, and 0.020% [0.012; 0.029] among current smokers. Conclusions: The observation of a significant association between the blood cadmium concentration and HbA1c levels in a group of never-smokers strengthens the hypothesis whereby diabetes is associated with cadmium per se and not solely with tobacco use. The small effect size observed in our population of never smokers with low levels of exposure to cadmium suggested that the risk attributable to this metal is not high. However, the impact of exposure to high cadmium levels (such as occupational exposure) on the risk of diabetes might be of concern.

L'éditeur a le regret de vous informer que cet article a déjà été publié dans Rev Mal Respir 2019;36:287–90. Doi : 10.1016/j.rmr.2018.12.005. Cette seconde publication faite par erreur a été retirée.