The incidence of autoimmune diseases is increasing. Antinuclear antibody (ANA) testing is a critical tool for their diagnosis. However, ANA prevalence in healthy persons has increased over the last decades, especially among young people. ANA in health occurs in low concentrations, with a prevalence up to 50% in some populations, which demands a cutoff revision. This review deals with the origin and probable physiological or compensatory function of ANA in health, according to the concept of immunological clearance, theory of autoimmune regulation of cell functions, and the concept of functional autoantibodies. Considering ANA titers ≤1:320 as a serological marker of autoimmune diseases seems inappropriate. The role of anti-DFS70/LEDGFp75 autoantibodies is highlighted as a possible anti-risk biomarker for autoimmune rheumatic disorders. ANA prevalence in health is different in various regions due to several underlying causes discussed in the review, all influencing additive combinations according to the concept of the mosaic of autoimmunity. Not only are titers, but also HEp-2 IFA) staining patterns, such as AC-2, important. Accepting autoantibodies as a kind of bioregulator, not only the upper, but also the lower borders of their normal range should be determined; not only their excess, but also a lack of them or "autoimmunodeficiency" could be the reason for disorders.

Antinuclear Autoantibodies in Health: Autoimmunity Is Not a Synonym of Autoimmune Disease

Antinuclear Autoantibodies in Health: Autoimmunity Is Not a Synonym of Autoimmune Disease.

Background and Objectives
3D-printed models are increasingly used for surgical planning. We assessed the utility, accuracy, and reproducibility of 3D printing to assist visualization of complex thoracic tumors for surgical planning.

Methods
Models were created from pre-operative images for three patients using a standard radiology 3D workstation. Operating surgeons assessed model utility using the Gillespie scale (1 = inferior to 4 = superior), and accuracy compared to intraoperative findings. Model variability was assessed for one patient for whom two models were created independently. The models were compared subjectively by surgeons and quantitatively based on overlap of depicted tissues, and differences in tumor volume and proximity to tissues.

Results
Models were superior to imaging and 3D visualization for surgical planning (mean score = 3.4), particularly for determining surgical approach (score = 4) and resectability (score = 3.7). Model accuracy was good to excellent. In the two models created for one patient, tissue volumes overlapped by >86.5%, and tumor volume and area of tissues ≤1 mm to the tumor differed by <15% and <1.8 cm2, respectively. Surgeons considered these differences to have negligible effect on surgical planning.

Conclusion
3D printing assists surgical planning for complex thoracic tumors. Models can be created by radiologists using routine practice tools with sufficient accuracy and clinically negligible variability.

Utility and reproducibility of 3-dimensional printed models in pre-operative planning of complex thoracic tumors.

Interstitial lung disease (ILD) may occur in patients with a rheumatic autoimmune disease (AD), increasing their risk of morbidity and mortality. However, little is known about the prevalence of AD in patients diagnosed with an ILD. In this prospective study, we determined the spectrum of ILD associated with AD (AD-ILD) among patients sent for assessment to a single clinic of ILD and lung transplantation from a referral center between May 2016 and December 2019. ILD diagnosis was made by pneumologists based on clinical and radiological findings and pulmonary function test abnormalities. All patients with ILD were also assessed by experienced rheumatologists. During the period of assessment, 338 patients were diagnosed with ILD. Among them, 32.8% fulfilled definitions for an AD. Most cases with AD-ILD had a diagnosis of rheumatoid arthritis (27.0%), systemic sclerosis (26.1%) or anti-synthetase syndrome (17.1%). Interestingly, 18% of the patients with AD-ILD were diagnosed as having an interstitial pneumonia with autoimmune features. Antinuclear antibodies and non-specific interstitial pneumonia were the most frequent positive autoantibodies and radiological pattern found in AD-ILD patients, respectively. In conclusion, our study indicates that a high number of ILD patients have a related AD. Consequently, close collaboration among rheumatologists and pneumologists is needed.

The Spectrum of Interstitial Lung Disease Associated with Autoimmune Diseases: Data of a 3.6-Year Prospective Study from a Referral Center of Interstitial Lung Disease and Lung Transplantation.

Pulmonary Carcinosarcoma: A Surveillance, Epidemiology, and End Results (SEER) Analysis.

Carcinosarcoma is an uncommon malignant biphasic tumor that accounts for less than 1% of all lung cancers. It is defined by coexisting histologic elements of carcinomatous and sarcomatous components. We report two cases of carcinosarcoma in a 68-year-old patient and a 78-year-old patient explored for lung masses. Macroscopically, the resected tumors were 7 and 10 cm in diameter. Histologically, they consisted in adenosquamous carcinoma with osteosarcoma in one case and adenocarcinoma with chondrosarcoma in the other case.

/pdf/pulmonary-carcinosarcoma-with-heterologous-component-report-38m9c8viin.pdf

Pulmonary carcinosarcoma with heterologous component: report of two cases with literature review

Synovial sarcoma is a malignant soft-tissue tumor that most commonly occurs in the extremities of young adults. Synovial sarcoma arising from the chest wall is rare and only some cases had been reported in the literature. We present a 57-year-old woman who presented with chest pain. Radiologic evaluation revealed a right parietal tumor destructing the mid-portion of the 8 th rib, with heterogeneous enhancement and invasion of the pectoral muscle and extra pleural fat. A surgical resection consisting in parietectomy was achieved. The histological and immunohistochemical findings were consistent with synovial sarcoma. An adjuvant chemotherapy was prescribed but the patient was lost of view. She presented 6 months later with a recurrent huge parietal mass.

/pdf/synovial-sarcoma-of-the-chest-wall-a-case-report-and-1blzby2snm.pdf

Synovial sarcoma of the chest wall: a case report and literature review.

Introduction The diagnosis of interstitial lung disease (ILD) requires elimination of underlying connective tissue disease. Consequently, antinuclear antibodies (ANA) are routinely screened in patients with idiopathic interstitial pneumonia. However the clinical usefulness of this practice is not well clear. Aim In this study, we evaluated the frequency of ANA in ILD's patients and investigated the clinical significance of the ANA's presence in these patients. Methods We conducted a retrospective study of hospitalized patients diagnosed ILD at pulmonary department and for which ANA was performed in the immunology laboratory of our institution. Demographic features, clinical symptoms, biological and radiologic findings and CTD-ILD diagnoses were compared between patients with positive ANA versus negative ANA. Results We enrolled 73 patients. The ANA's prevalence was 32%. There were no significant differences in demographics, pulmonary function test values and radiologic findings between patients with and without ANA. Patients with positive ANA had more cutaneous manifestations (p꞊0.011) and Raynaud's phenomenon (p꞊0.029). The diagnosis of connective tissue disease was made in 42% of patients with positive ANA versus 8% with negative ANA (p꞊ 0.001). ANA's titer higher than 1/320 was predictive of CTD diagnosis (OR꞊14.4) (p Conclusions The research of ANA in PID's patients is an important tool of CTD diagnosis specially in those with suggestive symptoms of autoimmune disease.

Antinuclear antibodies in interstitial lung disease: Prevalence and clinical significance.

Introduction: Eosinophilic lung diseases are a rare group of heterogeneous diseases characterized by the increase of the eosinophil ratio in airways and lung parenchyma. Objective: To describe clinical, radiological and laboratory finding in Eosinophilic lung diseases. Methods: The clinical-radiological findings, treatments performed, treatment responses, and prognoses of patients diagnosed with eosinophilic lung disease via bronchoalveolar lavage (BAL) between 2005 and 2015 were retrospectively evaluated. Results: Ten cases were diagnosed (8 women, 2 men). The mean age was 47 years (23-56). The main clinical manifestations were dyspnea and cough. Fever was found in 4 cases. Peripheral eosinophilia and total IgE elevation were present during the admission of all cases. The mean eosinophil ratio in BAL was 42% (35-62%). Asthma was present at diagnosis in all cases. Extra-pulmonary manifestations were rhinosinusitis (n=2), skin lesion (n=1) and cardiac involvement (n=1). In CT scans, all patients had bilateral involvement. The most common radiological pictures were ground-glass opacity, nodular lesions, and consolidation. Proximal bronchectasis was found in two cases. Etiologic diagnosis were chronic eosinophilic pneumonia (n=7), allergic broncho-pulmonary aspergilosis (n=2) and eosinophilic granulomatosis with polyangiitis (EGPA) (n=1). Prednisolone treatment was started for all cases associated with Cyclophosphamide in patient with EGPA. The outcome was favorable in eight patients. One patient developed corticodependant asthma. The patient with EGPA was dead for severe cardiomyopathy. Conclusion: Clinical pictures in pulmonary eosinophilia syndromes are on a wide spectrum, a specific diagnosis is important to predict treatment response and prognosis.

Eosinophilic lung disease

INTRODUCTION Obstructive sleep apnea-hypopnea syndrome (OSAS) and cardiovascular disease are public health problems. The objective of our study was to evaluate the frequency of OSAS in patients with hypertension and atrial fibrillation (AF) and to investigate the factors associated with OSAS in this population. METHODS It's a cross-sectional study including 73patients with hypertension and AF. All patients underwent a respiratory polygraphy. RESULTS Seventy-Threepatients were included (57 women). The mean age was 66.6±10.7 years. Obesity was found in 75% of patients. The mean duration of hypertension and AF evolution was respectively 8.7±7.3 years and 4.5±5.6 years.A resistant hypertension was found in 16% of patients. AF was paroxysmal in 34% of patients, persistent in 33% and permanent in 33% of patients.The mean Epworth score was 6.7±6.1 with excessive diurnal somnolence found in 30% of patients. According to the Berlin questionnaire, OSAS was "very likely" in 84% of patients. The prevalence of OSAS in patients with hypertension and AF was 77% with an average HAI of 23.26±19.57 per hour of sleep. OSAS was severe in 44% of patients, moderate in 15% of patients, and mild in 18% of patients. Factors associated with OSAS in our population were cognitive disorders (21% vs 0%, p=0.03), diurnal excessive sleepiness (21% vs. 0%, p=0.05), antiarrythmic therapy (63% vs 29%, p=0.016, OR=4.13, 95% CI 1.25-13.64) and nocturnal desaturation (25.86±17.68 vs 9.15±14.3 / H, p<0.0001). Our study did not find any significant difference between the groups regarding demographic characteristics, anthropometric, ultrasound data of patients and characteristics of hypertension and AF. CONCLUSION OSAS is common among patients followed for hypertension and atrial fibrillation. Its screening is necessary to improve the management and prognosis of these two diseases. However, in the absence of predictive factors for OSA, a polygraph could be recommended for this population.

Samira Aouadi

Papers

Pulmonary carcinosarcoma with heterologous component: report of two cases with literature review

Synovial sarcoma of the chest wall: a case report and literature review.

Antinuclear antibodies in interstitial lung disease: Prevalence and clinical significance.

Eosinophilic lung disease

Hypertension and Atrial Fibrillation: What is the prevalence of obstructive sleep apnea syndrome?