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Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, predominantly drug-induced, acute life-threatening diseases of skin and mucosae. SJS and TEN are nowadays considered as variants of one disease entity with varying degrees of severity called epidermal necrolysis (EN). EN is associated with high morbidity and mortality and constitutes a major disease burden for affected patients. The guideline "Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis)" was developed under systematic consideration of existing scientific literature and in a formal consensus process according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF) to establish an evidence-based framework to support clinical decision-making. The interdisciplinary guideline commission consisted of representatives from various specialist societies and of patient representatives. The guideline is aimed at specialists in the fields of dermatology, ophthalmology, plastic surgery, intensive care, and pediatrics in hospitals and offices, as well as other medical specialties involved in the diagnosis and treatment of EN. The guideline is also aimed at patients, their relatives, insurance funds, and policymakers. The second part is concerned with the topics of supportive therapy in the acute phase of EN and outpatient follow-up treatment., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, predominantly drug-induced, acute, life-threatening diseases of skin and mucosae. SJS and TEN are nowadays considered variants of one disease entity with varying degrees of severity called epidermal necrolysis (EN). EN is associated with high morbidity and mortality and constitutes a major disease burden for affected patients. The guideline "Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis)" was developed under systematic consideration of existing scientific literature and in a formal consensus process according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF) to establish an evidence-based framework to support clinical decision-making. The interdisciplinary guideline commission consisted of representatives from various specialist societies and patient representatives. The guideline is aimed at specialists in the fields of dermatology, ophthalmology, plastic surgery, intensive care, and pediatrics in hospitals and offices, as well as other medical speciallved in the diagnosis and treatment of EN. The guideline is also aimed at patients, their relatives, insurance funds, and policymakers. This first part focuses on the diagnostic aspects, the initial management as well as the immunomodulating systemic therapy., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Darwinian fitness, the capacity of a variant type to establish itself in competition with the resident population, is determined by evolutionary entropy, a measure of the uncertainty in age of the mother of a randomly chosen newborn. This article shows that the intensity of natural selection, as measured by the sensitivity of entropy with respect to changes in the age-specific fecundity and mortality variables, is a convex function of age, decreasing at early and increasing at later ages. We exploit this result to provide quantitative evolutionary explanations of the large variation in survivorship curves observed in natural populations. Previous studies to explain variation in survivorship curves have been based on the proposition that Darwinian fitness is determined by the Malthusian parameter. Hence the intensity of natural selection will be determined by the sensitivity of the Malthusian parameter with respect to changes in the age-specific fecundity and mortality variables. This measure of the selection gradient is known to be a decreasing function of age, with implications which are inconsistent with empirical observations of survivorship curves in human and animal populations. The analysis described in this paper point to the mitigated import of sensitivity studies based on the Malthusian parameter. Our analysis provides theoretical and empirical support for the ecological and evolutionary significance of sensitivity analysis based on entropy, which is the appropriate measure of Darwinian fitness.

We develop a model of the process of thinking in the presence of noise (which is produced by the simultaneous action of a huge number of neurons in the brain as well as by external information and internal cognitive processes). Our model is based on Freud's idea on the splitting of cognitive processes into two (closely connected) domains: consciousness and subconsciousness. We represent the process of thinking as a random dynamical process in a space of ideas endowed with a non-Euclidean geometry (which differs extremely from the ordinary Euclidean geometry of spatial location of neurons in the brain). The so-called p-adic geometry on a space of ideas describes the ability of cognitive systems to form associations. We show that random dynamical thinking systems on a p -adic space of ideas still generate only deterministic ideas. We also study positive and negative effects of noise (in particular, creativeness and stress)., (Copyright 1999 Academic Press.)