Siponimod is a sphingosine 1-phosphate receptor (S1P) modulator used to treat secondary progressive multiple sclerosis (SPMS). We report 3 SPMS patients treated with siponimod who developed new or worsening peripheral oedema soon after commencing treatment. In one case, peripheral oedema resulted in immobility. Siponimod-related peripheral oedema deserves wider recognition due to the potential for morbidity and over-investigation. Clinicians should assess for pre-existing oedema and coexisting conditions that may predispose to developing peripheral oedema prior to commencing siponimod.

The prognosis of children with acute myeloid leukemia (AML) has improved incrementally over the last few decades. However, at relapse, overall survival (OS) is approximately 40-50% and is even lower for patients with chemo-refractory disease. Effective and less toxic therapies are urgently needed for these children. The Pediatric Acute Leukemia (PedAL) program is a strategic global initiative that aims to overcome the obstacles in treating children with relapsed/refractory acute leukemia and is supported by the Leukemia and Lymphoma Society in collaboration with the Children\'s Oncology Group, the Innovative Therapies for Children with Cancer consortium, and the European Pediatric Acute Leukemia (EuPAL) foundation, amongst others. In Europe, the study is set up as a complex clinical trial with a stratification approach to allocate patients to sub-trials of targeted inhibitors at relapse and employing harmonized response and safety definitions across sub-trials. The PedAL/EuPAL international collaboration aims to determine new standards of care for AML in a first and second relapse, using biology-based selection markers for treatment stratification, and deliver essential data to move drugs to front-line pediatric AML studies. An overview of potential treatment targets in pediatric AML, focused on drugs that are planned to be included in the PedAL/EuPAL project, is provided in this manuscript.

Canine cutaneous lupus erythematosus (CCLE) is a well-described, yet uncommon, autoimmune disease which can present clinically with different variants. This case report describes the clinical and histopathological presentation, and treatment response, of CCLE affecting a novel location, the interdigital skin, in two unrelated greyhounds.
犬皮肤红斑狼疮(CCLE)是一种被充分描述但不常见的自身免疫病，临床上可出现不同的变异。本病例报告描述了两只不相关的灰猎犬，在新的位置--即趾间皮肤发生CCLE，报告其临床和组织病理学表现以及治疗反应。.
犬皮膚エリテマトーデス(CCLE)はよく知られているがまれな自己免疫疾患であり、臨床的にはさまざまな病型を呈することがある。この症例報告では、血縁関係のない2頭のグレイハウンドにおいて、趾間皮膚という新たな部位に発症したCCLEの臨床症状、病理組織像、および治療効果について述べる。.
O lúpus eritematoso cutâneo canino (LECC) é uma doença autoimune bem descrita, porém incomum, que pode se apresentar clinicamente com diferentes variantes. Este relato de caso descreve a apresentação clínica e histopatológica, e a resposta ao tratamento, do LECC afetando uma nova localização, a pele interdigital, em dois galgos não aparentados.
El lupus eritematoso cutáneo canino (CCLE) es una enfermedad autoinmune bien descrita, aunque poco frecuente, que puede presentarse clínicamente con diferentes variantes. Este informe de caso describe la presentación clínica e histopatológica, y la respuesta al tratamiento, de CCLE que afecta a una nueva ubicación, la piel interdigital, en dos galgos no relacionados.
Le lupus érythémateux cutané canin (LECC) est une maladie auto-immune bien documentée, mais peu fréquente, qui peut se présenter cliniquement sous différents variants. Ce rapport clinique décrit la présentation clinique et histopathologique, ainsi que la réponse au traitement, du LECC affectant une nouvelle localisation, la peau interdigitée, de deux lévriers non apparentés.
Der canine kutane Lupus erythematosus (CCLE) ist eine gut beschriebene, jedoch seltene Autoimmunerkrankung, die sich klinisch in unterschiedlichen Varianten präsentieren kann. Dieser Fallbericht beschreibt die klinischen und histopathologischen Charakeristika sowie Behandlungserfolge eines CCLE, welcher bei zwei nicht verwandten Greyhounds neue Hautstellen, nämlich die interdigitale Haut, betraf.

Postoperative chylothorax is a well-known rare complication of thoracic surgery. It is a serious complication that is fatal in cases of inadequate treatment. The authors present 2 cases of postoperative chylothorax that were successfully treated by performing pedal and/or intranodal lymphography. In one case, the patient underwent lymphography after previous unsuccessful surgical ligation of the thoracic duct. The presented case reports describe therapeutic importance of conventional lymphography as a minimally invasive treatment of the postoperative chylothorax.

Pool toes, a sport-related dermatosis, are caused by mechanical friction and water exposure, resulting in a special variant of irritant contact dermatitis. It is common in children, often misdiagnosed, and rarely reported. Here we report a case of a 7-year-old girl who developed this unusual type of frictional dermatitis; a pool toes diagnosis has been made. With topical corticosteroids, favorable results have been achieved. The recovery and healing process will be facilitated if one is aware of the underlying causes of such dermatitis and ceases the triggering factors.

Successful aging depends upon maintaining executive functions, which enable flexible response coordination. Although flexible responses are required for both hands and feet, as in driving, few studies have examined executive functions and brain activity in older adults, in terms of foot responses. In this study, younger (mean age = 20.8) and older participants (mean age = 68.7) performed a newly developed bimanual/bipedal response-position selection compatibility task while we measured their brain activity using functional near-infrared spectroscopy. Participants had to press either a left or right button using either their left or right foot (or hand), as directed by a two-dimensional cue signal. They executed either a straight or diagonal press response that mimicked stepping on the accelerator or brake pedal in a car. Foot responses produced more errors, longer reaction times, and greater brain activation than hand responses. Greater brain activation in the left dorsolateral prefrontal cortex (BA 46) was observed in incongruent (i.e., diagonal) than in congruent (straight) trials for foot responses, but not for hand responses, suggesting that participants had difficulty executing a diagonal foot response (as braking in a car), but not a diagonal hand response. Older participants exhibited greater brain activation across the PFC than younger participants, indicating that older adults activate additional brain circuits to compensate for declining executive functions. We discuss potential relationships between declining executive functions of older adults and the frequent automobile accidents (i.e., missteps) in which they are involved.

Pool swimmers are susceptible to pedal dermatoses. The causes for these conditions are asteototic dermatitis, contact dermatitis, friction-induced injury, infections, keratoderma, pruritus, thermal injury, ultraviolet radiation exposure, and urticaria. The specific dermatoses include aquagenic keratoderma, aquagenic pruritus, aquagenic urticaria, cold-induced urticaria, contact urticaria, erosion interdigitalis blastomycetica, erythrasma, Mycobacterium abscessus hand and foot disease, onychomycosis, photosensitivity, pitted keratolysis, plantar verruca, pool dermatitis, pool feet, pool toes, pool water dermatitis, pseudomonas hot-foot syndrome, skin cancer, subcorneal hematoma, sunburn, swim fin dermatitis, tinea pedis, toe web infection, and xerosis. A seven-year-old girl developed erythema and superficial blisters on her feet after they were exposed to the surface of her new swimming pool. The friction-induced injury, referred to as pool toes, resulted in skin lesions not only on the plantar surface of her toes but also on the areas of her soles-including her heels-that came in contact with the rough pool surface. In addition to discussing the characteristics of pool toes, the features of the other pool-associated pedal dermatoses are reviewed.

OBJECTIVE: Compare a two sequence protocol to a standard protocol in the detection of pedal osteomyelitis (OM) and abscesses and to identify patients that benefit from a full protocol.
METHODS: One hundred thirty-two foot MRIs ordered to assess for OM were enrolled, and the following items were extracted from the clinical reports: use of IV contrast, the presence of OM, reactive osteitis, and a soft tissue abscess. Using only one T1 nonfat-suppressed and one fluid sensitive fat-suppressed sequences, two experienced musculoskeletal radiologists reviewed each case for the presence of OM, reactive osteitis, or an abscess. A Kappa test was calculated to assess for interobserver agreement, and diagnostic performance was determined. The McNemar test was used to assess for the effect of contrast.
RESULTS: Agreement between both observers and the clinical report on the presence of osteomyelitis was substantial ( k = 0.63 and 0.72, p < 0.001), while the agreement for abscess was fair (k = 0.29 and 0.38, p < 0.001). For osteomyelitis, both observers showed good accuracy (0.85 and 0.86). When screening bone for a normal versus abnormal case, this method was highly sensitive (0.97-0.98), but was less sensitive for abscess (0.63-0.75). Fifty-one percent of exams used contrast, and it did impact the diagnosis of abscess for one observer.
CONCLUSIONS: This rapid protocol is accurate in making the diagnosis of OM, and its high sensitivity makes it useful to screen for patients that would benefit from a full protocol.

Reasons for performing study: To investigate the racing performance of Thoroughbred horses with osseous cyst-like lesions (OCLLs) in the distal phalanx causing lameness and treated conservatively. Objectives: To assess horses\' ability to race and perform after radiographic identification of OCLL in the distal phalanx of Thoroughbred horses with lameness at the time of detection and undergoing conservative treatment. Study Design: Retrospective case control study. Methods: The clinical database of one equine clinic was reviewed in a 10-year period for Thoroughbreds showing lameness localized to the foot and a radiographic diagnosis of OCLL in the distal phalanx. Sex, age at time of detection of the OCLL, degree of lameness, affected limb, and treatment were recorded. Successful performance of horses was assessed by racing at least once after detection of the OCLL and maximum racing performance rating (RPR). Radiographic features such as size, location, sclerotic rim of the OCLL and irregularity of the articular surface of the distal phalanx were compared to successful performance using univariable statistical analysis. Successful performance of horses with OCLL was compared to a control group of maternal siblings by parametric testing. Results: Twenty-two horses met the inclusion criteria. Thirteen horses raced after the detection of OCLLs. Eight did not race, one case had not yet reached racing age, resulting in 62% (13/21) of racing age racing at least once. The number of successfully performing horses with an OCCL was significantly lower compared to their maternal siblings [p = 0.03, Odds ratio (OR) = 0.30]. If horses with OCLL in the distal phalanx raced, their RPR was similar to their maternal siblings. No significant association was found between radiographic features of OCLLs and successful performance, but OCLLs in the left forelimb carried a more favorable outcome for racing (p = 0.02, OR = 2.33 95%CI 1.27, 4.27) compared to OCLLs in any other limb. Conclusions: Horses with lameness and an OCLL in the distal phalanx managed conservatively are less likely to race when compared to their maternal siblings. If horses with OCLLs in the distal phalanx are able to race, their performance, measured as RPR, was comparable to their maternal siblings. Due to the small numbers in this study the results should be interpreted carefully.

Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each.