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Granulomatosis with polyangiitis is a rare autoimmune disease that affects small to medium-sized blood vessels throughout the body. Here, we present a case of an infratemporal mass that was the result of granulomatosis with polyangiitis. A 51-year-old male presented to the emergency department due to right cheek and facial pain that he had been experiencing for 2 to 3 months. An MRI revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along the maxillary division of the trigeminal nerve (V2) and the vidian nerve causing concern for malignancy. Histology from an endoscopic biopsy demonstrated multiple arteries with luminal obliteration with non-necrotizing granulomas. The patient was started on steroids and immunosuppressive therapy, which improved his symptoms and decreased the size of the residual mass. This case illustrates the need for laboratory testing, imaging, and biopsy of the involved tissue in cases where GPA is suspected to prevent treatment delays that could lead to the destruction of vital organs. [ABSTRACT FROM AUTHOR]

Simple Summary: ANCA-associated vasculitis (AAV) is a rare disease and manifests in different organs. The exact mechanism of AAV is not fully understood, but it is speculated that it is induced by autoantibody production against proteinase-3 and myeloperoxidase. Patients diagnosed with ANCA-associated vasculitis are challenging to manage and experience several relapses during and after treatment. This systematic review represents the efficacy and safety profile of rituximab in AAV patients and provides evidence that rituximab can be considered the treatment of choice for AAV patients, especially for challenging patients with refractory releases. Background and aim: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare multisystem autoimmune disease developed by autoantibody production against human neutrophilic granulocytes, including proteinase-3 (PR3) and myeloperoxidase (MPO). The management of AAV patients is difficult due to the multiorgan involvement, high rate of relapse, and complications of immunosuppressive agents that make it challenging. This study aims to investigate the efficacy and safety of rituximab (RTX) therapy in patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) subtypes. Method: The PubMed/Medline database was searched for any studies related to RTX therapy in ANCA-associated vasculitis (GPA and MPA subtypes), from inception to 1 August 2022, and proceeded in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Our search resulted in 1082 initial records. After the elimination of review papers, irrelevant studies, and non-English records, 223 articles were included, and the data related to the efficacy and safety of RTX therapy were extracted. Several randomized and non-randomized studies showed that RTX is an effective treatment option for patients with AAV. Most of the studies showed the very effective effect of RTX in controlling disease in AAV patients, including pediatrics, adults, and elderlies, although RTX cannot completely prevent relapse. However, maintenance therapy helps delay the disease's relapse and causes sustained remission. Not only the licensed dose (375 mg/m2 intravenous per week for 4 weeks) could induce disease remission, but studies also showed that a single infusion of RTX could be effective. Although RTX could resolve many rare manifestations in AAV patients, there are few reports showing treatment failure. Additionally, few sudies have reported the unexpeted worsening of the disease after RTX administration. Generally, RTX is relatively safe compared to conventional therapies, but some serious adverse effects, mainly infections, cytopenia, hypogammaglobinemia, malignancy, and hypersensitivity have been reported. Conclusions: RTX is an effective and relatively safe therapeutic option for AAV. Studies on the evaluation of the safety profiles of RTX and the prevention of severe RTX-related side effects in AAV patients are required. [ABSTRACT FROM AUTHOR]

This essay proposes that action unaccompanied by the usual feeling of conscious agency constitutes a “mark of ultimacy.” Characteristically religious statements of “agentless action” find support in social psychological and cognitive scientific research that calls into question the intuitive belief that conscious thought causes action. An awareness of the limits of our powers of will lies at the the core of those limit experiences that provide the context for the meaningfulness of religious language.

Wegner and colleagues have offered an explanation of the sense of agency over one's bodily actions. If the orthodox view is correct and there is a sense of agency deficit associated with delusions of alien control, then Wegner and colleagues' model ought to extend to an explanation of this deficit. Data from intentional binding studies opens up the possibility that an abnormality in representing the timing of mental events leads to a violation of the principle of priority in those suffering from delusions of alien control. However, the model ultimately fails as it is unable to accommodate action monitoring deficits associated with delusions of alien control, in particular the theory of mind deficiencies predicted by such accounts have not materialised. There are theory of mind problems associated with schizophrenia but they are not associated with delusions of alien control. Such accounts thereby fail to adequately explain delusions of alien control. [ABSTRACT FROM AUTHOR]

This article addresses two influential lines of argument for what might be termed "scientific epiphenomenalism" about conscious intentions - the thesis that neither conscious intentions nor their physical correlates are among the causes of bodily motions - and links this thesis to skepticism about free will and moral responsibility. One line of argument is based on Benjamin Libet's neuroscientific work on free will. The other is based on a mixed bag of findings presented by social psychologist Daniel Wegner. It is argued that both lines of argument are unsuccessful.