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Query: UMLS:C0001511 (Adhesion)
 5,955 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rheumatoid arthritis (RA) is characterized by marked infiltration of the synovium by T-cells. The mediator of joint inflammation has been shown to be both cellular and soluble and the concept of cross-talk between adhesion molecules and cytokines, and its relevance to inflammation, is emerging. The expression and function of adhesion molecules are tightly regulated via intracellular signaling induced by cytokine or chemokine stimulation, a process which is designated "inside-to-out signaling". Such regulation is particularly important in inflammatory processes in which T-cells migrate from the circulation into the tissue. Adhesion molecules not only function as glue, but also transduce extracellular information into cytoplasmic organelles via the "outside-to-in signal", resulting in cell activation and cytokine production. For instance, the abundant intracellular adhesion molecule ICAM-1 and CD44 on RA synoviocytes not only potentially facilitate the interaction with T-cells or extracellular matrix, but also induce cytokine gene transcription in synovial cells. Thus, the two-directional cross-talk among adhesion molecules and cytokines appears to be significant for the initiation and prolongation of inflammatory processes through T-cell migration into RA synovial tissues and activation of both T-cells and synovial cells in this region. The concept proposed would greatly help in clarifying the pathological processes in rheumatoid synovitis, as well as in discovering new pharmacological approaches to more specifically control synovial inflammation. (c) 2001 Prous Science. All rights reserved.
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PMID:The role of chemokines and adhesion molecules in the pathogenesis of rheumatoid arthritis. 1275 Jul 65

There is an increasing incidence of cesarean scar (CS) defect/niche and its sequelae, probably not entirely explained by better diagnosis or rising cesarean rate. Discussion of possible etiological factors has received scant attention but would be important to formulate preventive strategies. Meaningful informative studies on long-term sequelae of cesarean section are very difficult and none are available for causation of CS defect. Hence, it is crucial to identify key areas in etiology of CS defect for focused research. This practical review proposes an "ischemia and mal-apposition hypothesis for CS niche", stating that the surgical technique of uterine incision closure is the most important determinant of CS defect formation. Other factors such as cervical location incision, adhesion formation and patient specific factors seem far less important in etiology. Rather than the headline theme of "single versus double-layer closure of uterus", the finer details of surgical technique which achieve good apposition without inducing tissue ischemia seem more important. Different techniques are discussed and it is proposed that continuous, non-locking absorbable sutures in two layers, without including much of decidua and without undue tight (constricting/devasculaizing) pulling of sutures are likely to result in good healing of uterine scar. Single-layer technique may be best reserved for thin myometrial edges especially during repeat cesareans. Adhesions between uterine isthmus and bladder/abdominal wall seem common associations but not causative for CS niche. It would be desirable to prove these surgical principles by good quality prospective randomized "quantitative" studies but the wait may be very long and this should not hinder the adoption of good surgical principles. Science is much cognitive and not just empirical. To consider a related example, the current recommendation of non-suturing of peritoneal layers during cesarean is mistakenly based on short-term irrelevant surrogate outcomes like analgesic requirements and time-saving, many of which have been already disproven. Evidence is presented recommending simple quick techniques of peritoneal closure to prevent adhesions. More analytical debate in surgical techniques is needed to inspire engaged, critical and insightful practitioners rather than unquestioning dependence on weak evidence/guidance.
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PMID:Etiology of Cesarean Uterine Scar Defect (Niche): Detailed Critical Analysis of Hypotheses and Prevention Strategies and Peritoneal Closure Debate. 2941 72