Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (AAV) are a group of inflammatory disorders in which autoantibodies damage small arteries throughout the body, including in the upper and lower respiratory system, kidneys, as well as the skin. AAV may be precipitated by a variety of causes, including infections. In this report, we examine the case of a patient who developed AAV that was suspected primarily based on mucocutaneous hemorrhagic bullae, elevated ANCA levels, and subsequently confirmed by kidney biopsy, while recovering from coronavirus disease 2019 (COVID-19) infection. AAV and COVID-19 infections may present with similar symptoms, rendering an accurate diagnosis challenging. Additionally, only a few other cases describing a similar onset of AAV post-COVID-19 infection have been described in the literature. Initial presenting features of AAV in such cases have varied considerably, which makes the diagnosis even more challenging. We also engage in a review of such cases to assess key similarities, different treatment options, and outcomes. Lastly, the fact that several mechanisms have been proposed for AAV highlights the need for continued research to help clarify the pathophysiology while also identifying the optimal therapy.
Objective
The degree decision aids (DAs) can promote active surveillance (AS) for prostate cancer (PCa) remains poorly understood. Herein, we surveyed radiation oncologists (RO) and urologists (URO) about their attitudes towards DAs in counselling patients about AS for low‐risk PCa.
Methods
We conducted a national survey of RO (n = 915) and URO (n = 940) to assess their attitudes about DAs for AS for patients with low‐risk PCa. Respondents were queried about their attitudes towards DAs and proportion of PCa patients managed with AS. Multivariable logistic regression models were used to examine physician characteristics related to attitudes about DAs.
Results
The overall response rate was 37.3% (n = 691). Most respondents strongly agreed or agreed that DAs helped patients with low‐risk PCa make informed decisions (93.9%) and also increased patient support for AS (86.6%). Having a high volume of their low‐risk PCa patients on AS (>15%) was associated with endorsing the statement that use of DAs increased the likelihood of recommending AS (OR: 1.83; 95% CI: 1.00–4.61; p = .05) and being a URO versus a RO (OR: 3.37; 95% CI: 2.46–5.79; p < .001).
Conclusions
Most specialists view DAs as effective tools to facilitate more informed treatment decisions and facilitate greater use of AS in appropriately selected patients.
Cytochrome P450 IV (CYP4) are a family of omega‐hydroxylase enzymes. We have previously shown that these fatty acid omega‐hydroxylases function in the hydroxylation of various chain‐length saturated and unsaturated fatty acids in the endoplasmic reticulum. These dicarboxylate products then undergo peroxisomal β‐oxidation, yielding shorter chain fatty acids. In humans, the CYP4F family members hydroxylate long‐chain fatty acid (>C16) and the bioactive eicosanoids, arachidonic acid (HETE) and pro‐inflammatory leukotrienes B4 (LTB4). In the human liver, CYP4F2a metabolizes long‐chain fatty acids and arachidonic acid to the vasoactive 20‐HETE. We have identified a new variant, CYP4F2b from human hepatic carcinoma that is produced from the CYP4F2 gene by exon switching. We have compared the expression of CYP4 members in human HCC and matched healthy human liver. We observed increased expression of CYP4F2b in HCC compared to controls, as well as increased fatty acid omega‐hydroxylation, with associated elevations of acetyl‐CoA/acetate in HCC, and decreased activity and expression of the acetyl‐CoA thioesterase 12 (ACOT12). Increased acetyl‐CoA levels activate the basic helix‐loop‐helix (bHLH) transcription factor Twist2, which initiates an epithelial‐mesenchymal cell transition (EMT). We propose that increased omega‐hydroxylation of fatty acids by CYP4F2b and subsequent peroxisomal β‐oxidation increases cellular acetyl‐CoA levels in HCC, leading to activation of Twist2 and progression of EMT.
Support or Funding Information
NEOMED foundation
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