Amniotic membrane transplantation for Stevens–Johnson syndrome/toxic epidermal necrolysis: the Toronto experience
Bibliographic record
Abstract
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of vesiculobullous disorders affecting skin and mucous membranes. Although rare, they are associated with a high mortality rate of up to 35% in adults and up to 17% in children.1 2 Ocular involvement is common and is present acutely in 43–81% of hospitalised patients.3 4 This ranges from conjunctival injection and membrane formation to epithelial sloughing of eyelid, conjunctiva and cornea. Chronic ocular complications occur in 20–79% of patients.1 Fusion between bulbar conjunctiva and fornices leads to symblepharon, while tarsal conjunctival scarring is associated with lid keratinisation and cicatricial lid changes including entropion, trichiasis and distichiasis.5 All of these changes contribute to corneal complications including limbal stem cell deficiency (LSCD) and eventual ocular surface failure with poor visual prognosis.6 Prompt treatment during the acute inflammatory stage of SJS/TEN is important in preventing chronic sequelae.1 Use of amniotic membrane transplantation (AMT) to suppress inflammation and promote healing during the acute phase was first reported by John et al in 2002.7 Amniotic membrane contains anti-inflammatory cytokines and suppresses innate immunity, thus having anti-inflammatory as well as anti-scarring effects.8 Its effectiveness has also been demonstrated in other ocular surface disorders such as chemical burns, persistent epithelial defect and ocular cicatricial pemphigoid.9–12 Since then, AMT has been shown to reduce inflammation and promote healing in the acute stage of SJS/TEN in several case series.8 13–15 In a large retrospective study, Hsu et al have showed the benefit of early AMT in patients with moderate and severe ocular involvement from SJS/TEN compared with medical management alone.16 Recently, Shanbhag et al reported that patients who received AMT in the acute period had significantly reduced vision-threatening complications; however, complications still occurred in this group mostly …
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".