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Magnetic resonance imaging (MRI) plays a role in assessing retears of previously treated lateral menisci (LM). We aim to characterize the rate and pattern of arthroscopically confirmed LM retears in children with and without discoid morphology. 288 patients (312 knees) who underwent arthroscopic repair of isolated LM tears between 2018 and 2023 were identified. 20 patients (21 knees) had arthroscopically confirmed isolated LM retear. This included 11 retears of discoid lateral meniscus (DLM) and 10 retears of non-DLM. MRI correctly identified retear in 81.8% of DLM cases (n = 9) and 100% of non-DLM cases (overall 90.5%, P = 0.476). 78% of DLM cases (n = 7) had residual discoid elements. MRI is highly accurate in diagnosing retears in isolated LM injuries (90.5%). We suggest that the radiological approach to assessing meniscal retears can be similarly applied to treated discoid and non-discoid menisci. However, special attention to residual discoid elements is crucial in previously treated DLMs. [ABSTRACT FROM AUTHOR]

BackgroundThe incidence of systemic lupus in children with discoid lupus is unknown.ObjectiveThis study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE).MethodsMedical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of 1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE + SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE + SLE were older at the time of rash onset (median, 12.9 vs 8.9 years; P

The rheological behavior of anode slurries for lithium-ion batteries, containing both natural and synthetic graphite as active material, was investigated with a focus on the different graphite morphologies. When the solid content is low, slurries containing synthetic graphite with a discotic shape display greater viscoelasticity than slurries containing natural graphite with a relatively more spherical shape. This result is attributed to the anisotropic geometry and interparticle force of the synthetic graphite. When the solid content is high, slurries comprising synthetic graphite exhibit lower viscoelasticity than slurries containing natural graphite. Tap density and sedimentation experiments reveal that, due to discotic shape and surface-to-surface attraction, synthetic graphite aggregates to a more densely packed aggregate than natural graphite. Consequently, in conditions of high solid contents where graphite has a greater chance of formation of densely packed aggregates, it is expected that synthetic graphite will have a more compact aggregate structure and a smaller effective volume. The smaller viscoelasticity of synthetic graphite slurries at more concentrated regions, where the effective volume of clusters plays more important role than in dilute regions, is attributed to the surface-to-surface aggregated structure of the synthetic graphite and the resulting small effective volume. Although the effective volume fraction of the graphite aggregates is reduced, slurries made of synthetic graphite demonstrate significant strain stiffening. Our findings suggest that the strain stiffening observed may originate from the anisotropic morphology, which possesses a significant surface area and is accompanied by jamming and high friction. [ABSTRACT FROM AUTHOR]

BackgroundThe evaluation of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive test (CAT) in adults with systemic lupus erythematous (SLE) is an emerging field of research. We aimed to examine the test-retest reliability and construct validity of the PROMIS CAT in a Canadian cohort of patients with SLE.MethodsTwo hundred twenty-seven patients completed 14 domains of PROMIS CAT and seven legacy instruments during their clinical visits. Test-retest reliability of PROMIS was evaluated 7-10 days from baseline using intraclass correlation coefficient (ICC (2; 1)). The construct validity of the PROMIS CAT domains was evaluated against the commonly used legacy instruments, and also in comparison to disease activity and disease damage using Spearman correlations. A multitrait-multimethod matrix (MMM) approach was used to further assess construct validity comparing selected 10 domains of PROMIS and SF-36 domains.ResultsModerate to excellent reliability was found for all domains (ICC [2;1] ranging from lowest, 0.66 for Sleep Disturbance and highest, 0.93 for the Mobility domain). Comparing seven legacy instruments with 14 domains of PROMIS CAT, moderate to strong correlations (0.51-0.91) were identified. The average time to complete all PROMIS CAT domains was 11.7 min. The MMM further established construct validity by showing moderate to strong correlations (0.55-0.87) between select PROMIS and SF-36 domains; the average correlations from similar traits (convergent validity) were significantly greater than the average correlations from different traits.ConclusionsThese results provide evidence on the reliability and validity of PROMIS CAT in SLE in a Canadian cohort.

Refractory cutaneous manifestations constitute a significant unmet need in patients with cutaneous lupus (CLE), even in the setting of systemic lupus erythematosus (SLE) with otherwise good control of inflammatory manifestations. Anifrolumab, an anti-interferon I receptor monoclonal antibody has recently been approved for serologically positive SLE with or without CLE, but real-life efficacy and safety data are currently limited. In addition, relatively limited evidence exists about the spectrum of cutaneous manifestations potentially benefitting from anifrolumab treatment and about the optimal clinimetrics to monitor treatment efficacy. While summarising current evidence on the topic in the literature, we report on four patients with SLE and refractory CLE who were successfully treated with anifrolumab. We also describe the potential usefulness and complementarity of the cutaneous lupus activity investigator's global assessment (CLA-IGA) in assessing cutaneous activity in patients treated with anifrolumab. [ABSTRACT FROM AUTHOR]

Purpose: In adolescent patients, meniscal tear injury can occur either in isolation (e.g., discoid lateral meniscus tears) or in association with other traumatic injuries including tibial eminence fracture or ACL tear. Damage to meniscal integrity has been shown to increase contact pressure in articular cartilage, increasing risk of early onset osteoarthritis. In symptomatic patients failing conservative management, surgical intervention via meniscus repair or meniscus transplant is indicated. The purpose of this study was to evaluate the radial dimensions of pediatric menisci throughout development. The hypothesis was that the average radial meniscus dimensions will increase as specimen age increases, and mean medial and lateral region measurements will increase at a linear rate. Methods: Seventy-eight skeletally immature knee cadaver specimens under age 12 years were included in this study. The meniscal specimens were photographed in the axial view with ruler in the plane of the tibial plateau and analyzed using computer-aided design (CAD) software (Autodesk Fusion 360). Measurements were taken from inner to outer meniscus rims at five 45 degree intervals using the clockface as a reference (12:00, 1:30, 3:00, 4:30, 6:00), and total area of meniscus and tibial plateau was recorded. Generalized linear models were used to evaluate the associations of radial width measurements with age, tibial coverage, and lateral vs. medial meniscus widths. Results: All radial width measurements increased significantly with specimen age (p ≤ 0.002), and all lateral-medial meniscal widths increased (p < 0.001). The anterior zones of the meniscus were found to increase at the slowest rate compared to other regions. Tibial plateau coverage was found to not significantly vary with age. Conclusions: Meniscus radial width and lateral–medial meniscus width are related to age. The anterior width of the meniscus varied least with age. Improved anatomic understanding may help surgeons more effectively plan for meniscus repair, discoid resection/saucerization/repair, and also support appropriate selection of meniscus allograft for transplantation. [ABSTRACT FROM AUTHOR]

Purpose: To compare post-operative clinical outcomes of discoid meniscus tear procedures such as saucerization with or without repair with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries. Methods: Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient-reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Clinical outcome data on Lysholm, Tegner, International Knee Documentation Committee (IKDC), revision rates, and complications were recorded, with MINORS and Detsky scores used for quality assessment. Results: A total of 38 studies comprising 2213 patients were included with a mean age of 38.6 years (range: 9.0–64.4). The mean follow-up time was 54.1 months (range: 1–234) and the average percentage of female participants was 46.8% (range: 9.5–95.5). The mean change between pre-operative and post-operative Lysholm scores ranged from 21.0–39.0, 7.4–24.1, and 24.2–48.4 in the discoid, non-discoid meniscectomy, and non-discoid repair groups, respectively. The mean change in Tegner scores ranged from 0.0 to 2.3, 1.3, and 0.4–1.3 in the discoid, non-discoid meniscectomy, and non-discoid repair groups, respectively. Pre-operative IKDC scores were not reported, however mean post-operative IKDC scores ranged from 77.4 to 96.0, 46.9 to 85.7, and 63.1 to 94.0 in discoid, non-discoid meniscectomy, and non-discoid repair groups, respectively. Revision rates for discoid procedures, non-discoid meniscectomies, and non-discoid meniscus repairs ranged from 3.2 to 44.0%, 8.3 to 56.0%, and 5.9 to 28.0%, respectively. The most common reasons for revision were acute trauma and persistent pain. Conclusion: Discoid saucerization procedures with or without repair leads to similar Lysholm scores as non-discoid repair procedures, and similar IKDC scores and revision rates compared to non-discoid meniscectomy or repair procedures. Patients undergoing discoid procedures appeared to have slightly higher Tegner activity scores compared to patients undergoing non-discoid procedures; however this is to be considered in the context of a younger population of patients undergoing discoid procedures than non-discoid procedures. This information can help guide surgeons in the decision-making process when treating patients with discoid menisci, and should guide further investigations on this topic. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

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There are a number of conditions that follow the lines of Blaschko. Linear discoid lupus erythematosus is a rare variant of chronic lupus erythematosus with less than 20 cases reported in children. It can be misdiagnosed as lichen striatus or linear morphea. We describe a 15-year-old boy with a confirmed histologic diagnosis of linear chronic discoid lupus erythematosus following the lines of Blaschko, with no signs of systemic involvement.

Objective: Unusual clinical course Background: Lupus erythematosus (LE) is mainly clinically divided into cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE) depending on the presence of multi-system manifestations. The most common subtype of CLE is discoid lupus erythematosus (DLE). Graves' disease (GD) is immunologically characterized by lymphocytic infiltration of the thyroid gland and the presence of thyroid-stimulating hormone (TSH) receptor antibodies (TSH-R-Ab), and is the most common autoimmune pathogenic cause of hyperthyroidism. Autoimmune thyroid dysfunction has been widely described in association with rheumatic diseases. A certain rate of coexistence of GD with LE, mainly SLE, has been reported in the literature. Herein, we present a rare case of Graves' hyperthyroidism complicated with DLE. Case Report: A 30-year-old female patient, with a history of hyperthyroidism and discontinued methimazole treatment, initially presented with symptoms of infection and oral ulcers. Thyroid hormone, thyroid-stimulating hormone receptor antibody, and immunological tests were consistent with a diagnosis of Graves' hyperthyroidism-associated DLE. Corticosteroids and radioactive iodine (RAI) were used to treat DLE and GD, respectively. Posttreatment evaluation suggested the remission of her hyperthyroidism and active DLE. Conclusions: Autoimmune thyroid diseases have been previously described in association with rheumatic diseases. This association shows the importance of prompt awareness of the increased risk of DLE when evaluating autoimmune thyroid dysfunction, especially under certain conditions, such as after treatment with anti-thyroid drugs (ATDs), or in the absence of multiple organ damage manifestations of SLE. [ABSTRACT FROM AUTHOR]

Purpose of Review: Discoid lateral meniscus (DLM) is a well-known meniscus variant, and comprises excess and thickened meniscal tissue, altered collagen ultrastructure, and peripheral instability. This article presents a comprehensive review on current knowledge of DLM, focusing on pathology in parallel with surgical techniques and outcomes. Recent Findings: A paradigm shift in surgical management of DLM is taking place as knee surgeons are seeing more patients with long-term sequelae of partial lateral meniscectomy, the standard treatment for DLM for many years. Surgical treatment has evolved alongside the understanding of DLM pathology. A new classification system has been proposed and optimal surgical techniques described in recent years. This article highlights up-to-date evidence and techniques in management of both acute DLM tears and joint restoration following subtotal meniscectomy for DLM. Summary: Surgical management of DLM must be tailored to individual pathology, which is variable within the diagnosis of DLM. We present an algorithm for management of DLM and discuss future directions for the understanding and treatment of this debilitating condition. [ABSTRACT FROM AUTHOR]

Abstract Background A discoid medial meniscus is rare in comparison with a discoid lateral meniscus. We encountered a new type of incomplete discoid with an oversized posterior segment. Therefore, this study aimed to report cases of medial meniscus with an oversized posterior segment and analyze the morphological characteristics by comparing them to cases with a discoid medial meniscus and normal medial meniscus. Methods Four patients with an oversized posterior segment medial meniscus (oversize group, mean age: 25.3 ± 12.0 years) and seven patients with a discoid medial meniscus (discoid group, mean age: 34.4 ± 19.6) were identified using magnetic resonance imaging (MRI) and diagnosed by arthroscopic findings in our hospital. Fifty patients without medial meniscal injury were retrospectively selected as the normal group (normal group, mean age: 24.0 ± 11.3 years). The clinical symptoms were examined. The anteroposterior (AP) length of both the anterior and posterior segments, AP length ratio of the posterior segment to the AP length of the medial tibial plateau, and mediolateral (ML) width of the mid-body of the medial meniscus were also evaluated using MRI and compared among the three groups. Results All patients in the oversize group complained of medial knee pain during deep knee flexion. In sagittal MRI, posteriorly deviated indentations were also observed at the medial tibial plateau in all cases in the oversize group. There was a significant difference in the AP length of the posterior segment between the normal and oversize groups (14.3 ± 2.8 vs. 23.6 ± 2.8 mm, P

Lithic artefacts are usually associated with the different knapping methods used in their production. Flakes exhibit metric and technological features representative of the flaking method used to detach them. However, lithic production is a dynamic process in which discrete methods can be blurred, and in which features can vary throughout the process. An intermediate knapping method between the discoid and Levallois is commonly referred to under an umbrella of terms (the present research uses the term hierarchical discoid), and is associated with a broad geographical and chronological distribution throughout the Early and Middle Palaeolithic. This intermediate knapping strategy exhibits features of both the discoid and Levallois knapping methods, raising the question of the extent to which flakes from the three knapping methods can be differentiated and, when one is mistaken for another, the direction of confusion. An experimental assemblage of flakes detached by means of the three methods was used along with an attribute analysis and machine learning models in an effort to identify the knapping methods employed. In general, our results were able to very effectively differentiate between the three knapping methods when a support vector machine with polynomial kernel was used. Our results also underscored the singularity of flakes detached by means of Levallois reduction sequences, which yielded outstanding identification values, and were rarely erroneously attributed to either of the other two knapping methods studied. Mistaking the products of the discoid and hierarchical discoid methods was the most common direction of confusion, although a good identification value was achieved for discoid flakes and an acceptable value for hierarchical discoid flakes. This shows the potential applicability of machine learning models in combination with attribute analysis for the identification of these knapping methods among flakes.

Meniscal pathology is widely prevalent in the adult population, secondary to acute trauma and chronic degeneration. It is less commonly seen in children, although its incidence is rising. The true prevalence in children remains unknown, as pathologies such as discoid menisci often go undiagnosed, or are found only incidentally. The rising incidence can be attributed to increased participation in sports at younger ages, both in intensity and frequency, with potentially year-round competition. Meniscal tears lead to pain and mechanical symptoms in the short to medium term, but more significantly, have been shown to lead to compartmental chondral degeneration and early arthritis in the long term. With advancing arthroscopic techniques, and children's propensity for better healing, osteoarthritis secondary to meniscal pathology is a potentially preventable problem. This article discusses meniscal injuries in children and adolescents and their management. [ABSTRACT FROM AUTHOR]

• Seven species recognized. • One new species described (Cotula tuberculata Jakoet & Magee). • Cotula melaleuca Bolus is here reduced into synonymy with C. barbata DC. • C. leptalea DC. and C. tenella E Mey ex DC. are here reduced into synonymy with C. laxa DC. • Detailed morphological descriptions, typification, illustrations of diagnostic characters and distribution maps indicating the known geographical ranges of these species are included. A taxonomic revision of the Cotula barbata group is presented. At the onset of the study nine species were recognised within this group, which is defined by a combination of an annual life history, usually homogamous discoid capitula, mostly basal leaves that are not sheathing at the base, and naked peduncles that are not inflated apically. These species are restricted to the Greater Cape Floristic Region of South Africa. The species are variable in cypselae morphology, which is shown herein to be taxonomically informative. Through extensive investigation, we here recognize seven species, one of which is described as new. Cotula melaleuca Bolus is reduced into synonymy with C. barbata DC. , C. leptalea DC. and C. tenella E Mey ex DC. are reduced into synonymy with C. laxa DC., and C. tuberculata Jakoet & Magee is described as new. An identification key is provided for the seven species, with detailed morphological descriptions, typification, illustrations of diagnostic characters and distribution maps. [ABSTRACT FROM AUTHOR]

En el transcurso de una intervención arqueológica en el solar nº 6 de la calle Artekale 6 de la villa de Plentzia (Bizkaia) se localizó un conjunto lítico sobre el sustrato rocoso y bajo un depósito de arcillas de 40 cm de espesor. En este trabajo se describe este conjunto de núcleos y lascas, y se propone una atribución del conjunto al Paleolítico Medio, probablemente reciente. Además, se discute el papel de estos breves asentamientos en las estrategias de asentamiento de los Neandertales en esta región. ABSTRACT: In the course of an archaeological intervention in the site of Artekale Street 6 in the town of Plentzia (Bizkaia), a lithic assemblage was found on the bedrock below 40 cm of clayey sediment. This paper describes the assemblage of cores and flakes, and proposes an attribution to the Middle Palaeolithic, probably recent. In addition, the role of these short-term occupations in regional Neanderthal settlement strategies is discussed.

Refractory cutaneous manifestations constitute a significant unmet need in patients with cutaneous lupus (CLE), even in the setting of systemic lupus erythematosus (SLE) with otherwise good control of inflammatory manifestations. Anifrolumab, an anti-interferon I receptor monoclonal antibody has recently been approved for serologically positive SLE with or without CLE, but real-life efficacy and safety data are currently limited. In addition, relatively limited evidence exists about the spectrum of cutaneous manifestations potentially benefitting from anifrolumab treatment and about the optimal clinimetrics to monitor treatment efficacy. While summarising current evidence on the topic in the literature, we report on four patients with SLE and refractory CLE who were successfully treated with anifrolumab. We also describe the potential usefulness and complementarity of the cutaneous lupus activity investigator’s global assessment (CLA-IGA) in assessing cutaneous activity in patients treated with anifrolumab.

Discoid meniscus is the most common congenital variant of the meniscus. Its variability in pathology leads to a spectrum of clinical presentations in patients. Treatment must be tailored to the specific pathology of the discoid meniscus. Imaging studies such as radiographs and magnetic resonance imaging can be useful in confirming the diagnosis, but may be the most accurate in determining specific pathology. Thorough intraoperative evaluation of the discoid is critical to appropriate surgical management. Rim preservation and repair is preferred to prevent degenerative changes in the knee. [ABSTRACT FROM AUTHOR]

The quartz component of the Champs de Bossuet (CdB) industry has been the subject of technological and techno-functional analyses focused on the ergonomic characterization of percussive tools related to their morphologies, their dimensions and masses but especially on their Active Percussion Zone (APZ) (morphology, extent, location). After assessing the position held by the percussive tools in the quartz component, they will be described on the basis of a subdivision into two large families correlated to their function and mode of operation: sharp percussion tools and blunt percussion tools (Viallet et al. 2022). Among this last group, constituting the panoply of percutors (of sensu lato size), ergonomic specificities could be highlighted in a correlation with a specialization of the lithic flint production mode for which they were used: discoid debitage with pseudo-Levallois point and its ramifications (Bourguignon et al. 2000; Lenoble et al. 2000; Bourguignon & Turq 2003). Each of the characteristics (weights, size and morphology) and their grouping by categories will be described and quantified and their function evaluated. Finally, we will propose, for classes of hammerstones with very specific size and ergonomic characteristics, a terminology derived from the current technical vocabulary describing the «striking tools» and in particular hammers for purposes of differentiation in the rich panoply of percussive tools and comparisons in other archaeological records. [ABSTRACT FROM AUTHOR]

Karishma Desai, Mariya Miteva Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USACorrespondence: Karishma DesaiDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Ave., RMSB Building Room 2023C, Miami, FL, 33136, USATel +1 305 243-5523Fax +1 305 243-5810Email kdesai66@med.miami.eduAbstract: Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.Keywords: discoid, hair loss, cicatricial, scarring, non-scarring

Background: A discoid medial meniscus is rare in comparison with a discoid lateral meniscus. We encountered a new type of incomplete discoid with an oversized posterior segment. Therefore, this study aimed to report cases of medial meniscus with an oversized posterior segment and analyze the morphological characteristics by comparing them to cases with a discoid medial meniscus and normal medial meniscus. Methods: Four patients with an oversized posterior segment medial meniscus (oversize group, mean age: 25.3 ± 12.0 years) and seven patients with a discoid medial meniscus (discoid group, mean age: 34.4 ± 19.6) were identified using magnetic resonance imaging (MRI) and diagnosed by arthroscopic findings in our hospital. Fifty patients without medial meniscal injury were retrospectively selected as the normal group (normal group, mean age: 24.0 ± 11.3 years). The clinical symptoms were examined. The anteroposterior (AP) length of both the anterior and posterior segments, AP length ratio of the posterior segment to the AP length of the medial tibial plateau, and mediolateral (ML) width of the mid-body of the medial meniscus were also evaluated using MRI and compared among the three groups. Results: All patients in the oversize group complained of medial knee pain during deep knee flexion. In sagittal MRI, posteriorly deviated indentations were also observed at the medial tibial plateau in all cases in the oversize group. There was a significant difference in the AP length of the posterior segment between the normal and oversize groups (14.3 ± 2.8 vs. 23.6 ± 2.8 mm, P < 0.001), whereas there was no significant difference in the AP length of the anterior segment (9.1 ± 2.1 vs. 9.5 ± 1.9 mm, P = 0.869). The ML width of the mid-body in the normal, oversize, and discoid groups was 9.3 ± 1.8, 19.9 ± 2.6, and 25.8 ± 1.9 mm, respectively (normal vs. oversize group: P < 0.001, oversize vs discoid group: P = 0.01, normal vs. discoid group: P < 0.001). Conclusions: Oversized posterior and normal anterior segments characterize this new type of incomplete discoid medial meniscus as a morphological abnormality. [ABSTRACT FROM AUTHOR]

Discoid lupus erythematosus (LED) is rare in children. In the prepubertal period, the classic signs of follicular hyperkeratosis and atrophy may be missing. We describe a case of LED with erythematous plaques in an 8-year-old child and review 3 other similar cases observed in the last 8 years. [ABSTRACT FROM AUTHOR]

Abstract Background: Clinical and histological features may overlap between lichen planopilaris-associated and discoid lupus erythematosus-associated scarring alopecia. Objectives: The aim of this study was to demonstrate the cutaneous infiltration of plasmacytoid dendritic cells and to compare their distribution pattern in discoid lupus erythematosus and lichen planopilaris. Methods: Twenty-four cases of discoid lupus erythematosus and 30 cases of lichen planopilaris were examined for immunostaining of the CD123 marker. The percentage and distribution pattern of plasmacytoid dendritic cells and the presence of the plasmacytoid dendritic cells clusters were evaluted in the samples. Results: The number of plasmacytoid dendritic cells was higher in the discoid lupus erythematosus specimens. Aggregations of 10 cells or more (large cluster) were observed in half of the discoid lupus erythematosus specimens and only 2 lichen planopilaris, with 50% sensitivity and 93% specificity for differentiating discoid lupus erythematosus from lichen planopilaris. Study limitations: Incidence and prevalence of discoid lupus erythematosus-associated scarring alopecia in the scalp are low, so the samples size of our study was small. Conclusions: We suggest that a plasmacytoid dendritic cells cluster of 10 cells or more is highly specific for distinguishing discoid lupus erythematosus from lichen planopilaris. It also appears that CD123 immunolabeling is valuable in both active and late stages of the disease.

Abstract Discoid lupus erythematosus is an autoimmune connective‐tissue disease that represents a subset of conditions on the cutaneous lupus spectrum. The lesions are characterized by disk‐shaped plaques on photo‐exposed skin with inflammatory hyperpigmentation and adherent scale. Here, we present a patient with a rare manifestation of discoid lesions on the palms.

Skin conditions are more common as people age, with approximately 70% of older people having a treatable skin condition. Ageing related changes to the skin and health conditions can make it difficult for older people to care for their skin, causing eczema to develop. An inability to care for age related skin conditions can lead to infection, discomfort and can affect the persons quality of life. This article explores how ageing affects the skin, how different types of eczema can develop and how these are managed. [ABSTRACT FROM AUTHOR]

Cutaneous lupus erythematosus (CLE) is a chronic inflammatory skin disease characterized by a diverse cadre of clinical presentations. CLE commonly occurs in patients with systemic lupus erythematosus (SLE), and CLE can also develop in the absence of systemic disease. Although CLE is a complex and heterogeneous disease, several studies have identified common signaling pathways, including those of type I interferons (IFNs), that play a key role in driving cutaneous inflammation across all CLE subsets. However, discriminating factors that drive different phenotypes of skin lesions remain to be determined. Thus, we sought to understand the skin-associated cellular and transcriptional differences in CLE subsets and how the different types of cutaneous inflammation relate to the presence of systemic lupus disease. In this study, we utilized two distinct cohorts comprising a total of 150 CLE lesional biopsies to compare discoid lupus erythematosus (DLE), subacute cutaneous lupus erythematosus (SCLE), and acute cutaneous lupus erythematosus (ACLE) in patients with and without associated SLE. Using an unbiased approach, we demonstrated a CLE subtype-dependent gradient of B cell enrichment in the skin, with DLE lesions harboring a more dominant skin B cell transcriptional signature and enrichment of B cells on immunostaining compared to ACLE and SCLE. Additionally, we observed a significant increase in B cell signatures in the lesional skin from patients with isolated CLE compared with similar lesions from patients with systemic lupus. This trend was driven primarily by differences in the DLE subgroup. Our work thus shows that skin-associated B cell responses distinguish CLE subtypes in patients with and without associated SLE, suggesting that B cell function in skin may be an important link between cutaneous lupus and systemic disease activity.

Cutaneous lupus erythematosus (CLE) is a chronic inflammatory skin disease characterized by a diverse cadre of clinical presentations. CLE commonly occurs in patients with systemic lupus erythematosus (SLE), and CLE can also develop in the absence of systemic disease. Although CLE is a complex and heterogeneous disease, several studies have identified common signaling pathways, including those of type I interferons (IFNs), that play a key role in driving cutaneous inflammation across all CLE subsets. However, discriminating factors that drive different phenotypes of skin lesions remain to be determined. Thus, we sought to understand the skin-associated cellular and transcriptional differences in CLE subsets and how the different types of cutaneous inflammation relate to the presence of systemic lupus disease. In this study, we utilized two distinct cohorts comprising a total of 150 CLE lesional biopsies to compare discoid lupus erythematosus (DLE), subacute cutaneous lupus erythematosus (SCLE), and acute cutaneous lupus erythematosus (ACLE) in patients with and without associated SLE. Using an unbiased approach, we demonstrated a CLE subtype-dependent gradient of B cell enrichment in the skin, with DLE lesions harboring a more dominant skin B cell transcriptional signature and enrichment of B cells on immunostaining compared to ACLE and SCLE. Additionally, we observed a significant increase in B cell signatures in the lesional skin from patients with isolated CLE compared with similar lesions from patients with systemic lupus. This trend was driven primarily by differences in the DLE subgroup. Our work thus shows that skin-associated B cell responses distinguish CLE subtypes in patients with and without associated SLE, suggesting that B cell function in skin may be an important link between cutaneous lupus and systemic disease activity. [ABSTRACT FROM AUTHOR]

Purpose: Discoid menisci can be symptomatic from instability or a tear. A torn discoid meniscus is likely to require repair to preserve meniscal function and should not be missed. This is the first study to evaluate a range of pre-operative methods to predict the likelihood of a torn discoid meniscus. Methods: A retrospective analysis of prospectively collected data was performed. Clinical, radiographic and operative data were reviewed. Patients were grouped based on the presence of a tear or not during surgery. All patients underwent MRI scans pre-operatively which were validated with arthroscopy findings to calculate sensitivity. All patients completed Pedi-KOOS and Pedi-IKDC pre-operative scores. Results: There were 32 discoid menisci in 27 patients. Mean age at surgery was 10.4 years (6–16). Nineteen patients were female. Seventeen menisci were identified as torn at time of arthroscopy (53%), 15 were unstable but not torn. Clinical findings did not differentiate between the torn or unstable menisci. MRI was only 75% sensitive and 50% specific at identifying a torn discoid meniscus. There was no statistical difference between KOOS-child (n.s.) and Pedi-IKDC (n.s.) scores between the groups. Conclusion: MRI is neither sensitive nor specific at identifying tears in discoid menisci. There is no difference in pre-operative outcome scores for patients with a torn or unstable discoid meniscus; pre-operative PROMs are a poor predictor of a meniscal tear. This study emphasises that pre-operative tests and clinical findings are not conclusive for identifying a meniscal tear and the operating surgeon should be vigilant in identifying and repairing tears at the time of surgery. Pre-operative findings poorly correlate to arthroscopic findings and potential surgical interventions required. Patients and parents/carers should, therefore, be appropriately counselled prior to surgery that post-operative measures are dependent on intra-operative findings and not pre-operative findings in patients. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Frequently, clinical therapy fails to achieve hair regrowth.[[4], [6]] This article reports a case of hair regrowth of stable patches of scaring alopecia due to DLE after PCI sessions. Keywords: discoid; lupus erythematosus; alopecia; microneedling, percutaneous collagen induction, drug delivery EN discoid lupus erythematosus alopecia microneedling, percutaneous collagen induction, drug delivery 6479 6481 3 12/27/22 20221101 NES 221101 To the Editor, Microneedling is a percutaneous collagen induction (PCI) therapy studied as a complementary technique in several types of alopecia, with or without the use of drug delivery.[1] The multiple micro punctures reach the dermis, facilitating the absorption of larger molecules.[1] Microneedling increases the expression of genes related to the stimulation of hair growth, triggering the production of growth factors and collagen proliferation.[2] It has been successfully used for androgenetic alopecia (AGA), alopecia areata (AA), and even scarring alopecia.[[3]] For scarring alopecia on stable scalp discoid lupus erythematosus (DLE), it has yet to be studied. [Extracted from the article]

Background: Magnetic resonance imaging (MRI) criteria for evaluating discoid meniscus is limited in the pediatric population. Objective: To assess MRI features of intact discoid meniscus and correlate with clinical outcomes. Materials and methods: In this institutional review board (IRB)-approved retrospective cohort study, knee MRIs at our institution from 2008 to 2019 were reviewed. The inclusion criterion was diagnosis of discoid meniscus on MRI. Exclusion criteria were torn discoid meniscus at presentation, previous meniscal surgery and confounding knee conditions. MRI features of discoid meniscus collected were craniocaudal dimension, transverse dimension, transverse dimension to tibial plateau (TV:TP) ratio and increased intrameniscal signal. The clinical course was reviewed for knee pain, mechanical symptoms and treatment type. Results: Two hundred and nineteen of 3,277 (6.7%) patients had discoid meniscus. Of the 219 patients, 71 (32.4%) satisfied inclusion criteria. Seven patients had discoid meniscus of both knees resulting in 78 discoid menisci. The average patient age was 11.1 years (min: 2.0, max: 17.0). The average follow-up was 30.6 months. Of the 78 discoid menisci, 14 (17.9%) required surgery. Increased intrameniscal signal was found more in discoid meniscus requiring surgery (surgical: 10/14, nonsurgical: 19/64, P=0.009). Surgically treated discoid meniscus had a statistically significant increase in transverse dimension (surgical: 18.3±5.0 mm, nonsurgical: 15.7±4.3 mm, P=0.045) and TV:TP ratio (surgical: 0.55±0.15, nonsurgical: 0.47±0.12, P=0.036). Mechanical symptoms (surgical: 9/11, nonsurgical: 21/60, P=8.4×10−6) and pain ≥1 month (surgical: 11/11, nonsurgical: 17/60, P=0.006) were found more often in surgical patients. Clinical and imaging criteria of mechanical symptoms and knee pain ≥1 month and at least one of (1) increased intrameniscal signal or (2) TV:TP ratio greater than 0.47 identified discoid menisci that developed a tear and/or required surgery with a sensitivity of 0.86 and specificity of 0.88. Conclusion: Mechanical symptoms and knee pain ≥1 month, and at least one of (1) increased intrameniscal signal or (2) TV:TP ratio greater than or equal to 0.47, identified discoid menisci that would go on to tear and/or require surgery with a sensitivity and specificity of 0.86 and 0.88, respectively. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD). Objective: To examine trends, associations, and clinical relevance of ACD in patients with NE who were referred for patch testing. Methods: Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group. Results: Overall, 748 patients (1.9%) were diagnosed with NE; 23.9% had a concomitant diagnosis of ACD. The prevalence of NE fluctuated over time between 2001 and 2016, with no overall change in prevalence in diagnosed NE. In multivariable logistic regression models, NE increased steadily with age and was associated with male sex and Asian and other race/ethnicity, and inversely associated with a history of atopic dermatitis (AD) and hay fever. Patients with NE had lower proportions of one or more positive allergic reactions and lower odds of a positive reaction in multiple individual allergens. The most commonly relevant allergens in patients with NE were formaldehyde 2.0% aq., methylisothiazolinone, quaternium 15, fragrance mix I, and propylene glycol. Conclusion: NE is a heterogeneous disorder with distinct subsets of lesional distributions and a profile of relevant allergens, especially formaldehyde and formaldehyde releasers. Nearly one in four patients with NE had ACD, supporting the role of patch testing in patients with NE. [ABSTRACT FROM AUTHOR]

In this paper, we present an updated technological analysis of the lithic collection excavated in the 1980s in a high-altitude site in the Ebro Basin, Peña Miel level e. This level represents one of the latest occurrences of Middle Palaeolithic technology in the Iberian Peninsula, so it is of special interest for understanding the trajectories of late Neandertals in this region. The results show the use of local lithic resources combined with few quantities of medium–long distance–transported raw materials. The technological choices in level e include a majority discoid production in quartzite and limestone, less abundant Levallois production in quartzite, limestone, lydite and flint, all of this combined with the production of macro-tools in limestone and quartzite. The objective of these productions is to obtain functional blanks, fundamentally outrepassing or pseudolevallois flakes, ready for direct use or for use after light edge configuration. These technological features are consistent with a short occupation in a remote and high-altitude area by groups that occasionally, and probably seasonally, roamed through the mountainous region where the site is located. Also, the technological features show links with the late Middle Palaeolithic of the Franco-Cantabrian region. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of cumulative smoking in pack-years on systemic lupus erythematosus (SLE) cutaneous manifestations and damage. Methods: Our cohort study included 632 adult SLE patients at an academic center, meeting 1997 ACR or 2012 SLICC classification criteria. Outcomes were: (1) cutaneous SLICC Damage Index (SDI), (2) ACR and SLICC criteria. Smoking exposure was defined as low (<5 pack-years), medium (5-10), and high (>10), compared to non-smokers. Analysis used multivariable logistic regression to calculate odds ratios and confidence intervals (OR, (95% CI)). Results: Among 632 SLE patients, mean age 42±14, 91% were female, 82% White, and 40% were ever smokers. Black patients were more likely to have smoked (51% vs. 41% White, 11% Other). Chronic SLICC and SDI cutaneous criteria showed linear pack-year trends, meeting significance with high smoking exposure (OR 2.2, (1.2, 4.2); OR 4.2, (1.9, 9.2)). Those with medium exposure were more likely to meet acute SLICC cutaneous criteria (OR 2.3, (1.1, 5.1)). Low exposure predicted any cutaneous SLICC and ACR criteria (OR 3.7, (1.3, 10.6); OR 2.0 (1.03, 3.8)). Patients of color had more chronic SLICC cutaneous criteria (Other Race OR 3.6 (1.6, 8.1)) and SDI skin damage (Black OR 2.6 (1.1, 5.9)) even controlling for smoking exposure. Conclusions: Smoking was an independent risk factor for cutaneous SLE. High pack-year exposure and non-White race increased chronic skin manifestations and SDI damage. Findings suggested a dose relationship between smoking and cutaneous SLE damage, making cessation messaging important to potentially improve outcomes and reduce some disparities. [ABSTRACT FROM AUTHOR]

Lupus panniculitis occurs in 1–3% of the patients diagnosed with systemic lupus erythematosus (SLE) and 10% of the patients diagnosed with discoid lupus erythematosus (DLE). It is a disorder of autoimmune origin, manifesting as deep erythematous plaques and nodules involving the trunk, breasts, buttocks, face, and proximal extremities. It does not commonly ulcerate. This report highlights the case of a 22-year-old Asian female with a history of coeliac disease and significant family history of antiphospholipid antibody syndrome (APS) who presented with fever, malaise, weight loss, and subcutaneous non-tender nodules over the forearm, back, bilateral thighs, and feet. Laboratory investigations revealed positive antinuclear antibodies, anti-Ro/SSA antibody, and lupus anticoagulant, resulting in a diagnosis of APS. Biopsies of lesions were consistent with findings of lupus panniculitis. Every case of SLE and DLE with discrete skin lesions should be reviewed for any distinct entity such as lupus panniculitis, as it may be associated with greater risk of flares and systemic involvement. The purpose of this case report is to emphasise that early diagnosis and prompt treatment is crucial to improving the prognosis of such patients.

Discoid lupus erythematosus is an autoimmune connective‐tissue disease that represents a subset of conditions on the cutaneous lupus spectrum. The lesions are characterized by disk‐shaped plaques on photo‐exposed skin with inflammatory hyperpigmentation and adherent scale. Here, we present a patient with a rare manifestation of discoid lesions on the palms. [ABSTRACT FROM AUTHOR]

Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors. To assess demodex mite infestation in both clinical and histopathological findings in DLE patients. We retrospectively evaluated the files of 42 patients with DLE who had been diagnosed DLE based on clinical and histopathological findings between August 2018 and August 2019. Demodex positivity was detected 50% of patients (n = 21). Neutrophile percentages in the dermal and perivascular area were higher in the demodex positive patients (4.43%) than in the Demodex negative patients (2.19%). The intensity of demodex mites correlated positively with dermal neutrophile percentages. ANA was negative in 29 patients (69%) and positive in 13 patients (31%). Anti‐dsDNA was negative in serology and follicular plugging was positive in histopathology in all 42 patients (100%). This was a retrospective study. DLE and rosacea share common features in etiopathogenesis and clinical presentation. Inflammation and exacerbations caused by the demodex mites may increase the clinical severity of DLE. Although the position of demodex mites in DLE etiopathogenesis is not known exactly, the presence of high demodex in DLE patients has been determined. Standard skin surface biopsy can be a routine procedure for the evaluation of DLE patients in daily clinical practice. [ABSTRACT FROM AUTHOR]

Discoid lateral meniscus (DLM) is the most frequent congenital variant of the lateral meniscus, which is prone to degeneration and tears, and frequently causes knee osteoarthritis. The purpose of this article has been to analyze the publications made during 2023 on DLM. The main conclusions of the analysis were as follows: MRI assessment might be helpful to diagnose DLM and detect the presence of instability: two main factors in the decision to perform surgery. Arthroscopic assessment should be utilized in conjunction with MRI findings for complete DLM diagnosis. Restoring the normal shape, retaining adequate width and thickness, and ensuring the stability of the remnant DLM is essential to sustaining the physiological function of the meniscus and preserving the knee. Partial meniscectomy with or without repair should be the first-line treatment when feasible, given that the clinical and radiological long-run results of total or subtotal meniscectomy are worse., Competing Interests: None, (2024 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Purpose: Symptomatic discoid lateral meniscus without tears has traditionally been treated with excision of part or the entire meniscus. Resection of 15-34% of the meniscus increases tibiofemoral contact pressures by more than 350%. Treatment of discoid lateral meniscus with partial or total meniscectomy in childhood increases the risk of early-onset osteoarthritis in the knee. The incidence of osteoarthritis is directly proportional to the amount of meniscal tissue resected. This paper describes the meniscus-preserving technique of meniscopexy and presents the outcomes of all patients who have undergone this procedure in the management of lateral discoid meniscus in a single unit over a 14-year period.Methods: A retrospective study was carried out reviewing all patients who underwent meniscopexy for the treatment of MRI-confirmed discoid lateral meniscus without meniscal tear between 2001 and 2015 with a minimum of 1-year follow-up. Eleven patients (12 knees) were identified using a patient database of all patients that had undergone this procedure in our institution. Two patients were excluded from the final results, so nine patients (10 knees) were scored post-operatively at last follow-up using the Lysholm knee score. We reviewed all available post-operative MRI scans and recorded any complications.Results: Four patients were male and seven were female. The median age of the patients at the time of surgery was 9 (6-14), and the median follow-up was 4.5 years (2-14). The median Lysholm knee score was 91 (86-100). The outcome for all patients scored was either good or excellent.Conclusion: The established treatment options for symptomatic discoid lateral meniscus without associated tear involve resection of meniscal tissue. Using this technique, all the meniscal tissue is preserved, thus reducing the risk of arthritic change in the future. MRI studies performed post-operatively suggested normalisation of meniscal morphology with time. Meniscopexy offers an effective alternative to the established treatment options in the management of symptomatic discoid lateral meniscus without meniscal tears.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

The Grotte du Renne at Arcy-sur-Cure (Burgundy, France) has yielded remains from several occupation layers, extending from the end of the middle Palaeolithic to the upper Palaeolithic. The last Mousterian layer (XI), which precedes the Châtelperronian occupations (layers Xa, Xb, Xc, IX, VIII), was previously interpreted as a precursor of the transition complex. The new study of the lithic assemblage of layer XI, in the context of the other final Mousterian occupations in Arcy (Grotte du Bison, Galerie Schoepflin Rotonde, Grotte de l’Hyène) challenges this hypothesis. The Mousterian Arcy complex can be divided into three main techno-complexes: Levallois–Charentian, Discoid–Denticulate and Levallois Mousterian. We observed a rupture between the final Mousterian and Châtelperronian industries as regards all the aspects of the technical system; production methods, blank management, tool types, and some changes in raw material composition. [ABSTRACT FROM AUTHOR]

A total synthesis of atrovenetin has been achieved. The discoid tricyclic motif was constructed by a novel three-carbon annulation of naphthalene derivative and allenic acid under acidic conditions. An effective protocol for the conversion of atrovenetin into atrovenetinone has been established. [ABSTRACT FROM AUTHOR]

Establishing and interpreting patterns of lithic assemblage variability is of great interest to archaeologists as they shed light on cultural adaptations in the deep past. Nowhere has this topic provoked more interest and debate than in the Middle Palaeolithic of southwestern France. The region's rich archaeological record has produced numerous sites, many of which have been recently excavated and thus provide a reliable dataset for better structuring Mousterian lithic variability. Researchers working with these types of datasets frequently employ the chaîne opératoire concept to approach lithic assemblage variability; however, the validity of such analyses has recently been questioned. Here we present results of a combined quantitative and qualitative technological analysis of a large sample of assemblages from numerous well-contextualised sites in the northeastern Aquitaine Basin. We selected clearly identifiable diagnostic elements typical of different flake production systems that can be quantified by different analysts in a replicable fashion. Our results show strong differences in assemblage composition in terms of dominant production systems as well as a smaller number of mixed assemblages that combine two or more flake production methods. When considered together, these results provide not only a means for defining lithic technocomplexes and subsequently comparing assemblages but also for investigating elements of Neanderthal material culture variability. [ABSTRACT FROM AUTHOR]

Similar to other leaf beetles, rosemary beetles Chrysolina americana exhibit a distinct sexual dimorphism in tarsal attachment setae. Setal discoid terminals occur only in males, and they have been previously associated with a long-term attachment to the female's back (elytra) during copulation and mate guarding. For the first time, we studied living males and females holding to female's elytra. Pull-off force measurements with a custom-made tribometer featuring a self-aligning sample holder confirmed stronger attachment to female elytra compared with glass in both males and females; corresponding to 45 and 30 times the body weight, respectively. In line with previous studies, males generated significantly higher forces than females on convex elytra and flat glass, 1.2 times and 6.8 times, respectively. Convex substrates like elytra seem to improve the attachment ability of rosemary beetles, because they can hold more strongly due to favourable shear angles of legs, tarsi and adhesive setae. A self-aligning sample holder is found to be suitable for running force measurement tests with living biological samples.

Purpose: The purpose of this study was to compare the insertion sites of the posterior horn between discoid and non-discoid lateral meniscus using magnetic resonance imaging (MRI).Methods: Two hundred and twenty-seven patients who had MRI scans before surgery and underwent arthroscopy were enroled in this study. A coronal view showing the narrowest width of the midbody of the lateral meniscus was chosen to measure the widths of the entire tibial plateau and the midbody of the lateral meniscus. Considering the ratio of the meniscal width to the tibial plateau width, the patients were divided into non-discoid, incomplete discoid, and complete discoid groups. On a coronal view accurately showing the insertion of the posterior horn of the lateral meniscus, a distance between the peak of the lateral tibial eminence and the centre of the insertion of the posterior horn, and a width of the lateral tibial plateau between the lateral edge of the tibial plateau and the peak of the lateral tibial eminence were measured.Results: The insertion centre of the posterior horn was located more medially in the incomplete and complete discoid groups than in the non-discoid group (p = 0.003, 0.010, respectively). When individual differences in the knee size were corrected, the insertion centre of the posterior horn in the incomplete discoid and complete discoid groups was located more medially than in the non-discoid group (p = 0.009, 0.003, respectively).Conclusion: The insertion centre of the posterior horn of the lateral meniscus is located more medially to the apex of the lateral tibial eminence in the discoid group than in the non-discoid group. This finding needs to be considered for an accurate position of the posterior horn of lateral meniscus during the lateral meniscal allograft transplantation.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]