Going toe-to-toe with a rare case of a complex regional pain syndrome limited to the hallux

We report the first case of a complex regional pain syndrome (CRPS) limited to the hallux using the Budapest criteria. Limited forms of CRPS are scarce in the literature and probably overlooked. There is currently no consensus to define these forms. Due to the particular metameric topography, common to the hand and the foot, we suggest the term ‘metameric’ CRPS to describe them. A uniform nomenclature would promote future research to study its prevalence and specific treatment in more detail.

A Survey of Encoding Techniques for Signal Processing in Spiking Neural Networks

Biologically inspired spiking neural networks are increasingly popular in the field of artificial intelligence due to their ability to solve complex problems while being power efficient. They do so by leveraging the timing of discrete spikes as main information carrier. Though, industrial applications are still lacking, partially because the question of how to encode incoming data into discrete spike events cannot be uniformly answered. In this paper, we summarise the signal encoding schemes presented in the literature and propose a uniform nomenclature to prevent the vague usage of ambiguous definitions. Therefore we survey both, the theoretical foundations as well as applications of the encoding schemes. This work provides a foundation in spiking signal encoding and gives an overview over different application-oriented implementations which utilise the schemes.

The Adequacy of Pelvic Lymphadenectomy During Radical Cystectomy for Carcinoma Urinary Bladder: A Narrative Review of Literature

An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.

Management of primary acquired melanosis (PAM) of the eye (State of Research Paper)

With regard to acquired melanosis of the conjunctiva, there is still neither a worldwide uniform nomenclature nor reliable data on how frequent this type of pigment disorder is. This is even more true for the estimation of the risk of progression into cancer as well as the clinical management of this entity. This short paper presents the current, partly contradictory scientific knowledge which is available.

Paragangliomas the Forgotten Neuroendocrine Neoplasms: A Retrospective Review of 237 Cases From 2 Centers in 2 Years

Background: paragangliomas (PGN) (including adrenal PGN or pheochromocytomas) are uncommon neuroendocrine neoplasias. Their ubiquity and lack of uniform nomenclature has resulted in systematic sub-registry and limited resources for patients and clinicians. However, 40% of them are hereditary, 10–20% are hormonally active and 50% result in treatment-related complications. Objectives: to describe the clinical and biochemical characteristics of PGN in two referral centers in a 2-year period. Materials and Methods: a retrospective review of the files of patients evaluated in the Centro Medico Nacional Siglo XXI or the Instituto Nacional de Neurología y Neurocirugia between June 2018 and May 2020, even if diagnosis was prior to those dates. The search was performed using ICD-10 terms in the outpatient registries. Data is described using non-parametric statistics, including medians (interquartilic ranges, IQR). According to the reported incidences we expected to find 35 new cases per year in each hospital. Results: 237 patients, 86.4% female with a median age at diagnosis of 54 years (IQR 45–64) were found. The tumors were located in the head 23.9%, neck 63.3%, thorax 0.4%, adrenal in 11.1%, other sites in the abdomen 1.3%. The most common symptoms in head PGN were hypoacusia (85.2%) and cranial nerve palsies (39.3%), in the neck, a visible mass and pain (30.6%) while the “classic” catecholaminergic symptoms were more common in thoracic and abdominal tumors (>50%). Tumors were large or invasive in 50.1% of the cases and at least one hormone was above the upper limit of normal (ULN) in 40.6% of the 64 evaluated cases, mostly urinary dopamine (70% of cases tested, 1.1–2.1 ULN) and plasma and urine metanephrines (60% of cases tested, 1.1- 33.7 ULN and 50% cases, 1.1–22 ULN, respectively). Severe systolic hypertension was more frequent in male patients <30 years of age and 41.6% were candidates to genetic testing due to the tumor characteristics or patient history. Surgery was performed in 55.6%, radiotherapy in 25.2% and 12.1% are under surveillance or pending surgery, 7.1% were lost to follow up. Only 5 cases with metastasis were documented in 1215 patient-years of follow-up. Treatment-related complications were reported in 14.7% and persistence in 32.2%. Conclusions: despite the retrospective nature of the study and sub registry, we found more tumors than expected. The frequency of hormonal production was high, but it is likely related to patient selection bias (mostly symptomatic cases studied). Dopamine and metanephrines are useful in the evaluation of PGN. Endocrinologists should be aware of these common tumors and be part of the multidisciplinary team.

Simple Interrupted Microvascular Anastomosis: Review of Four Sutures Placement Sequences

Background Microsurgical anastomosis is a delicate, highly nuanced procedure that can be done in several different ways; the most basic approach to performing microsurgical anastomoses is by using simple interrupted sutures, but even within that approach, there are different sequences by which the sutures can be placed. To date, there is no review of these sequences and the advantages and disadvantages of each. Methods A PubMed search was performed in October 2019 that sought all published descriptions of simple interrupted microsurgery techniques. Keywords included were “microvascular anastomosis,” “microvascular anastomosis technique,” “simple interrupted,” and “microsurgery.” Results Four simple interrupted microsurgery techniques were identified: triangulation, 12 o'clock to 6 o'clock, posterior-wall-first, and 3 o'clock to 9 o'clock-side-side. Additionally, there is no uniform nomenclature that describes the techniques for simple interrupted microvascular anastomoses. Conclusion This study identified four distinct sequences for the placement of simple interrupted sutures for microsurgical anastomosis and the advantages and disadvantages of each, and for the first time described them utilizing standardized nomenclature.

Legal Status of Academic Researchers in Russia and Foreign Countries

The article deals with the legal status of researchers in Russia and some foreign countries, classifies categories of researchers in Russia and highlights the main aspects of their legal status, identifies some problems of their legal status associated with short-term employment contracts. The author analyses the legislation covering each category of researchers on the basis of the division of the categories of researchers proposed by the author and the problems associated with unreasonable differentiation in the status of researchers. Special attention is paid to scientific workers working in educational institutions of higher and additional vocational education due to additional rights and duties, as well as in connection with the qualification requirements specified in the Professional Standard. Also, the paper highlights the problems of terminological nature, for elimination of which the author proposes to approve a uniform nomenclature of positions of researchers. The article critically evaluates the practice of transition to the conclusion of short-term employment contracts with researchers, analyzes the phenomenon of conclusion of fixed-term employment contracts in foreign countries.