Autoimmune/Inflammatory Syndrome Induced by Adjuvants (<scp>ASIA</scp>or Shoenfeld's Syndrome) Due to Polypropylene Mesh Implants
Bibliographic record
Abstract
The implantation of synthetic mesh to repair weak tissue started in the 1940s. In 1963, polypropylene (PP) mesh was initially used to perform a tensionless hernia repair of abdominal wall defects. The tension-free prosthetic repairs of groin and/or abdominal hernia were further popularized in the 1980s and constitute a major and indispensable share of such defects since then. At present, it is estimated that there are over 20 million hernia repair procedures performed every year worldwide, with PP mesh repair utilized for most of them. From the early 1990s, transvaginal implantation of PP mesh was also used to reinforce a weak pelvic muscle floor stemming from stress urinary incontinence (SUI) and pelvic organ prolapse (POP). In addition, midurethral mesh slings using a PP tension-free vaginal tape (TVT) has been utilized globally for managing female SUI. In this chapter, systemic symptoms and signs of mesh implant-mediated systemic disease will be discussed. We and others have reported that polypropylene mesh could act as a trigger for autoimmune/inflammatory syndrome induced by adjuvants (ASIA), immune deficiency, and autoimmunity. Most patients with ASIA also have more severe localized inflammatory reactions prior to the onset of their systemic ones – suggesting that the systemic symptoms may reflect persistent inflammatory reactions to mesh implantation. In this chapter, systemic symptoms and signs of mesh implant-mediated systemic disease will be discussed. In addition, the pathophysiology of mesh implant-induced ASIA will be discussed. Finally, the biological plausibility of mesh implants as a cause of ASIA will be discussed using the Bradford Hill criteria. We conclude that a causal association between mesh implants and systemic reactions such as those observed in ASIA (autoimmune/inflammatory syndrome induced by adjuvants) is likely. Pathophysiology of the foreign body-induced immune reaction is established, and data from other medical implants support a causal relationship.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".