A Spontaneous Canine Model of Mucous Membrane (Cicatricial) Pemphigoid, an Autoimmune Blistering Disease Affecting Mucosae and Mucocutaneous Junctions

Mucous membrane pemphigoid (MMP) is a rare autoimmune blistering dermatosis of humans that was previously known as cicatricial pemphigoid. It is characterized by vesicles, ulcers and scarring that affect predominantly mucosae and mucocutaneous junctions. Circulating autoantibodies recognize epitopes on basement membrane proteins such as collagen XVII or laminin-5/6. Herein, we describe the clinico-pathological and immunological characteristics of 17 dogs afflicted with a dermatosis homologous to MMP of humans. Patients exhibited vesicles and erosions predominantly on mucous membranes or mucocutaneous junctions of the mouth, nose, eyes, genitalia or anus. Histopathology revealed subepithelial vesicles with variable dermal inflammation. Direct immunofluorescence demonstrated IgG or complement at the dermoepithelial junction. Indirect immunofluorescence using salt-split epithelia permitted the detection of circulating basement membrane-specific IgG autoantibodies in 15 cases. In 11 patients, autoantibodies recognized the NC16A segment of collagen XVII, as determined by salt-split indirect immunofluorescence, immunoblotting using canine keratinocytes and ELISA with synthetic canine peptides. In one dog, autoantiodies bound to the dermal side of salt-split epithelia and recognized epitopes within the 30 kDa carboxy-terminal segment of human collagen XVII. Canine MMP, like its human counterpart, exhibits distinctive clinical signs and histopathological lesions, yet circulating autoantibodies target different antigenic epitopes. This spontaneous canine model of MMP could prove useful for studies on the pathogenesis or therapy of this human disease.     

应用重复扩张术修复大面积瘢痕性秃发

目的：探讨重复扩张术修复大面积瘢痕性秃发的临床应用方法。方法：对7例大面积瘢痕性秃发的患者，进行2～3次的头皮重复扩张，每次扩张间隔时间1年左右，分次修复剩余瘢痕。结果：7例患者，均获得满意结果，与单次性扩张相比，无额外的并发症发生。重复扩张的皮瓣具有良好的伸展性和存活能力，随访0．5～1年，见头发虽较未扩张部位稀疏，但生长良好。结论：重复扩张术是修复大面积瘢痕性秃发的安全有效的方法，可获得良好结果。     

胸骨后横结肠代食管260例报告

报告260例胸骨后横结肠代食管术的临床经验,总并发症率14.2％,死亡率2.3％。根据结肠血管解剖特征,常规选用横结肠作移植肠段,首选左结肠动脉升支供血,行顺蠕动吻合,移植肠段置于胸骨后进行食管重建利于术后放疗。我们认为横结肠长度足够、血运良好、基础代谢率低、体积较小、易游离,足以代替食管全长,且使胃能保持正常生理位置,是食管理想的替代物。文中也对手术操作体会及并发症的预防进行了探讨。     

异体巩膜条睑板延长术治疗复发性瘢痕性睑内翻

目的：探讨异体巩膜条睑板延长术治疗复发性瘢痕性上睑内翻的手术疗效。方法：对27例(36只眼)复发性瘢痕性上睑内翻患者采用从睑板沟切断睑板的方法，在睑板铁损区嵌入异体巩膜条，延长睑板，松解瘢痕。结果：28只眼内翻矫正，8只眼复发，3只眼再次手术后矫正。结论：采用异体巩膜条睑板延长术治疗复发性瘢痕性眼睑内翻，手术方法简便，损伤小，可反复操作，疗效满意，异体巩膜易于获得及保存，是一种值得推广的手术方法。     

眼睑瘢痕畸形的手术治疗

目的探讨不同类型瘢痕性眼睑畸形的手术方式及治疗效果。方法瘢痕性眼睑畸形10例（15眼）,分别行瘢痕松解及游离皮瓣移植术4例（7眼）,瘢痕松解游离皮瓣移植同时行羊膜移植1例（1眼）,瘢痕松解联合“Z”字皮瓣转位2例（3眼）,瘢痕松解联合带蒂皮瓣转位1例（1眼）;瘢痕松解联合眼轮匝肌蒂皮瓣修复1例（1眼）,瘢痕松解联合睑板楔形切除联合双下眼睑成形术1例（2眼）。结果10例（15眼）手术后获得不同程度满意的外观和功能恢复。结论在眼睑瘢痕修复时,只要能使皮肤缺损和结膜囊完整性得到修复,瘢痕性眼睑畸形恢复眼睑功能及外观,效果良好。     

剖宫产在瘢痕子宫和非瘢痕子宫中应用效果对比

目的：对比分析剖宫产在瘢痕子宫和非瘢痕子宫中的临床应用效果。方法：选取2012年2月至2013年11月在我院妇产科进行剖宫产分娩的瘢痕子宫和非瘢痕子宫的产妇68例,分析探究其手术相关的临床资料,比较剖宫产在两种性质子宫产妇中的应用。结果：进行剖宫产分娩的产妇的临床资料中,瘢痕性子宫产妇的年龄明显比非瘢痕组产妇大,并且瘢痕性子宫产妇在手术过程中的出血量以及手术时长也明显大于非瘢痕性子宫产妇,术后腹腔粘连情况也重于非瘢痕性子宫产妇,其差异具有统计意义（P ＜0.05）;两组产妇分娩出的新生儿在出生时的体重以及1min、5min的 Apgar 评分均无显著差异（P ＞0.05）。结论：瘢痕子宫在剖宫产手术中的风险系数明显高于非瘢痕子宫,因此在瘢痕子宫产妇的分娩中需要更加注意手术中的相应风险因子,保证产妇顺利分娩。     

Bitemporal Scalp Hair Loss: Differential Diagnosis of Nonscarring and Scarring Conditions

BACKGROUND: Bitemporal hair loss can be a diagnostic challenge because several entities may affect this region of the scalp, including both scarring and nonscarring conditions. Although traction alopecia is the most common cause of bitemporal hair loss, no studies to date have outlined all of the potential causes. OBJECTIVE: We sought to review nonscarring and scarring conditions that have a clinical presentation of bitemporal hair loss, including traction alopecia, telogen effluvium, female pattern hair loss, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, and seborrheic dermatitis. METHODS: A Google Scholar and PubMed literature search were conducted for this review. The keywords used in the search included the following: “traction alopecia”, “telogen effluvium”, “androgenic alopecia”, “androgenetic alopecia”, “female pattern hair loss”, “alopecia areata”, “frontal fibrosing alopecia”, “central centrifugal cicatricial alopecia”, and “seborrheic dermatitis”. The scope of our search included all research articles published from 1957 to February 2019. In total, 94 articles regarding non-scarring and scarring hair loss were selected and included according to topic relevance. Exclusion criteria included articles that did not address the epidemiology and/or clinicopathologic or dermatoscopic findings of non-scarring and scarring forms of alopecia. Inclusion criteria included articles that addressed a clinical presentation of bitemporal hair loss; or addressed epidemiology, clinical presentation, dermatoscopic findings, and/or treatment. RESULTS: Bitemporal hair loss is a common and often distressing condition with a broad differential. CONCLUSION: Clinicians must be aware of the potential causes of bitemporal hair loss. Prompt diagnosis is essential to prevent further hair loss, especially in scarring conditions.     

Circulating IgA and IgE autoantibodies in antilaminin‐332 mucous membrane pemphigoid

Background Antilaminin‐332 mucous membrane pemphigoid (MMP) is a chronic autoimmune bullous disease that is often associated with internal malignancy. IgG autoantibodies against laminin‐332 in patients with MMP are well documented; however, IgA and IgE autoantibodies against laminin‐332 have not yet been described. Objectives To characterize IgA and IgE autoantibodies binding to laminin‐332 in sera from patients with antilaminin‐332 MMP. Methods Sera and skin samples from four patients who met the following criteria were used: (i) subepidermal blistering lesions present on the mucous membranes; (ii) in vivo deposition of IgG along the epidermal basement membrane zone of sampled skin; (iii) circulating IgG antibasement membrane zone antibodies that react with the dermal side of salt‐split normal human skin; and (iv) circulating IgG autoantibodies that do not show positivity against type VII collagen or 200‐kDa protein (p200 antigen) in immunoblot analysis using dermal extracts. Circulating IgG/IgA/IgE class autoantibodies against laminin‐332 were determined by immunoblotting. Results Circulating IgG autoantibodies against the γ2, α3/γ2, α3 and α3/β3/γ2 subunits of laminin‐332 were demonstrated in sera from four patients, respectively. Serum from one of the four patients showed IgA reactivity with the α3/β3/γ2 subunits of laminin‐332. Serum from one of the four patients showed IgE reactivity with the γ2 subunit of laminin‐332. The control sera failed to display IgG/IgA/IgE reactivity to laminin‐332. Conclusions In addition to IgG autoantibodies, circulating IgA and IgE autoantibodies against laminin‐332 are detectable in a subset of patients with antilaminin‐332 MMP.