Positive experience with TNF-α inhibitor in toxic epidermal necrolysis resistant to high-dose systemic corticosteroids

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially life-threatening syndromes characterized by the development of necrotic epidermal and mucosal lesions. The most common etiologic cause of SJS/TEN is drug-induced mechanisms. The group of drugs with high potential risk includes sulfonamides, anticonvulsants, non-steroidal anti-inflammatory drugs (NSAIDs), allopurinol, phenobarbital, etc. There is no gold standard treatment algorithm for SJS/TEN. In medical practice, systemic glucocorticosteroids (sGCS), intravenous immunoglobulin (IVIG), plasmapheresis, and cyclosporine are used empirically and in various combinations. Recently published studies have demonstrated the efficacy of TNF-α inhibitors as a promising approach in SJS/TEN, including cases resistant to high-dose sGCS, with etanercept and infliximab being the most commonly used drugs. In a large multicenter study by Zhang J et al. (XXXX), 242 patients treated with etanercept, sGCS, or a combination of both had lower mortality compared to the control group. A shorter skin healing time was documented compared to sGCS monotherapy, thus reducing the risk of secondary infections. The published data show a high efficacy with THF-α inhibitor blockade, but the safety of TNF-α inhibitors in patients with SJS/TEN is still questionable due to the paucity of available information. As all clinical research data should be accumulated to provide reliable evidence that the use of TNF-α inhibitors may be beneficial in SJS/TEN, we report a case of etoricoxib-associated SJS with progression to TEN in a 50-year-old woman who was refractory to high-dose sGCS therapy

Non-reciprocal ultrafast laser writing

Photosensitivity is a material property that is relevant to many phenomena and applications, from photosynthesis and photography to optical data storage and ultrafast laser writing. It was commonly thought that, in a homogeneous medium, photosensitivity and the corresponding light-induced material modifications do not change on reversing the direction of light propagation. Here we demonstrate that when the direction of the femtosecond laser beam is reversed from the +z to -z direction, the structures written in LiNbO3 crystal when translating the beam along the +y and -y directions are mirrored. In a non-centrosymmetric medium, modification of the material can therefore differ for light propagating in opposite directions. This is the first evidence of a new optical phenomenon of non-reciprocal photosensitivity. We interpret this effect in terms of light pressure and associated heat flow, resulting in a temperature gradient in homogeneous media without inversion symmetry under uniform intense irradiation