6-6-2020: A date that went viral among ophthalmologists

6-6-2020 was a landmark date for the ophthalmology community, not only because of the normal visual acuity connotation of 6/6 and 20/20, but because it genuinely reflects every ophthalmologist’s dream to bring back perfect vision for every patient. The Covid-19 pandemic had forced ophthalmologists to “refuse to operate” albeit for a short period. This narrative describes how, during a telemedicine call, a surgeon experienced the distress of refusing to operate on a mature cataract. It reveals the trauma caused by the disordered goals of eye care during the pandemic, when elective procedures were abandoned and only emergency services were provided.

Adaptação e validação da escala de perfeccionismo Almost Perfect Scale-Revised para o português brasileiro / Adaptation and validation for Brazilian Portuguese of the Revised Almost Perfect Scale / Adaptación y validación de la escala de perfeccionismo Almost Perfect Scale-Revised para el portugués brasileño

O perfeccionismo é um construto multidimensional cujo estudo vem aumentando desde os anos de 1990. Uma das escalas mais utilizadas para sua mensuração é a Almost Perfect Scale - Revised (APS-R), composta por três dimensões: Padrões, Discrepância e Ordem. Devido à ausência de medidas como essa no Brasil, este estudo objetivou adaptar e analisar as propriedades psicométricas da APS-R em uma amostra brasileira, por meio da análise de sua estrutura interna e levantamento de sua confiabilidade. Participaram 787 universitários (79,3% do sexo feminino), idade média de 25,98 anos (DP = 7,29) que responderam à APS-R e a um questionário sociodemográfico. Os itens adaptados mostraram IVC adequados: equivalência semântica (0,99), cultural (0,94) e conceitual (0,94). Dentre os modelos estruturais testados, o bifatorial mostrou-se superior aos demais (χ2 = 452,371; TLI = 0,94; CFI = 0,96; RMSEA = 0,047). Assim, a escala apresentou propriedades psicométricas satisfatórias para uso no Brasil, tanto no que se refere à sua validade quanto confiabilidade. São discutidas limitações e implicações do estudo. (AU)

The study of perfectionism as a multidimensional construct has increased since the 1990's. The Almost Perfect Scale (APS-R) is widely used across studies to measure perfectionism; it is composed by three dimensions: High Standards, Discrepancy, and Order. However, despite increasing interest in the measurement of perfectionism, there were no scales available for Brazilian-Portuguese. Accordingly, we aimed to adapt the APS-R and to analyze the psychometric properties and test confirmatory models for the Brazilian version of the Almost Perfect Scale (APS-R Brasil). A sample of university students (n=787) with a mean age 25.98 years (SD=7.29), 79.3% women, completed the APS-RB. The adapted items demonstrated semantic, cultural and conceptual adequacy (all CVI <90). The ESEM two factor model, showed the better fit index (χ²= 452.371; TLI=0.94; CFI=0.96; RMSEA=0.047). The Brazilian version of APS-R was shown to be valid and reliable. Limitations and implications of the study are discussed. (AU)

El estudio del perfeccionismo como un constructo multidimensional ha aumentado desde los años 90. La escala Almost Perfect Scale-Revised (APS-R), que se usa ampliamente en los estudios del perfeccionismo, está compuesta por tres factores: altos estándares, la percepción de la discrepancia y el orden. Sin embargo, a pesar del creciente interés en la medición del perfeccionismo, todavía no hay escalas disponibles para el portugués brasileño. Por lo tanto, el objetivo de esta investigación fue adaptar y analizar las propiedades psicométricas, y probar modelos confirmatorios para la APS-R en una muestra brasileña. Dicha muestra se compuso por estudiantes universitarios (n = 787) con una edad media de 25,98 años (DE = 7,29) y 79,3% mujeres. Los ítems adaptados demostraron adecuación semántica, cultural y conceptual (todos los IVC <90). El modelo ESEM Bifactor mostró el mejor índice de ajuste (χ2 = 452,371; TLI = 0,94; CFI = 0,96; RMSEA = 0,047). La versión brasileña de APS-R demostró ser válida y fiable. Aparte, se discute las limitaciones e implicaciones del estudio. (AU)

Study of the corruption risk control mechanism at public hospitals / 中华医院管理杂志

The paper analyzed the internal causes of the corruption risk control mechanism at public hospitals in China. Based on the current development of such mechanism, the authors proposed such measures as pre-warning, intermediate supervision and follow-up actions against the corruption risk exposure commonly found at such hospitals. These efforts aim at further improvement of the corruption risk control of the hospitals.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

O tempo em Lacan / Weather in Lacan

Para encaminhar de maneira adequada a reflexão de Jacques Lacan acerca do tempo faz-se necessário retornar a 1945, quando o psicanalista enuncia pela primeira vez o conceito de tempo lógico. A fim de identificar aquilo que no interior da elaboração lacaniana a respeito do tempo será decisivo para o debate acerca deste fenômeno, também se fazem necessárias considerações acerca da temporalidade da situação analítica como fomentada pelo futuro anterior, que, por sua vez, parte de uma releitura do processo de Nachtrãglichkeit proposto inicialmente por Freud.

The time in Lacan. To comment on the conception of time in Jacques Lacan it is necessary to go back to 1945 when the psychoanalyst enunciated for the first time the concept of logical time. In order to identify what is crucial to the debate about this phenomenon in the Lacanian elaboration on time, it is necessary to consider the temporality of the analytic situation as marked by the future perfect, which has, in turn, its origin in the process of Nachtrãglichkeit, initially proposed by Freud.

Effect of improving nursing evaluation and implementation on the quality of life in patients with advanced non small cell lung cancer / 中国基层医药

Objective To explore the effect of improving nursing evaluation system on the quality of life in patients with stage Ⅲ and Ⅳ stage non small cell lung cancer (NSCLC).Methods From January 2011 to December 2014,100 patients with NSCLC were randomly divided into observation group and control group , 5 0 cases in each group.The observation group was treated with 1 month as a treatment course.The control group was treated with rou-tine treatment and nursing.Before treatment and 2 months after treatment,serum tumor markers (CEA,CYFRA21 -1,NSE,CA125) were detected,the clinical symptom score,quality of life (KPS score) and body weight were recor-ded.Results (1)The total effective rates of the observation group and the control group were 88% and 90% respec-tively,the difference was not statistically significant (χ2 =0.381,P >0.05);(2)There were no significant differences in the clinical symptoms between the two groups (t =0.382,1.521,all P >0.05) before and after intervention.After intervention,the clinical symptoms of the two groups were lower than before intervention,the difference was statistical-ly significant (t =6.493,4.398,all P 0.05);After 6 months of intervention,the KPS score and body weight of the observation group were significantly higher than those in the control group,the differences were statistically significant (t =5.493,4.326,all P 0.05);(4) Before the intervention,there were no significant differences in serum tumor markers (t =0.483,1.264,1.762,1.264,1.795,1.678,1.253,1.469,all P >0.05);After intervention,ser-um markers in the two groups were significantly lower than before intervention,the differences were statistically signifi-cant (t =6.393,3.490,4.728,7.943,4.883,5.478,7.684,11.383,all P 0.05).Conclusion For patients with stage III,IV NSCLC,improving nursing evaluation and implementation system has no significant difference in reduce the level of tumor markers and long -term survival compared with the control group,and improve the nursing evaluation and implementation system has certain advantages in maintaining the quality of life of patients.

Direito à vida sem tortura: direitos humanos para humanos direitos? / Derecho a la vida sin tortura: ¿derechos humanos para los humanos derechos? / For the right to a life free from torture: human rights for the \"right\" humans?

Em pleno século XXI, a tortura sobrevive no Brasil de forma ampla e sistemática. Não é mero resquício da ditadura, ou exceção num "pico de criminalidade" como incitado pela mídia; pelo contrário, tem sido regra, um dos símbolos da perpetuação do terrorismo de Estado contra as classes subalternas, que se inscreve tanto na seletividade dos corpos torturáveis, quanto na história, mediante o discurso excepcionalista. Nesse sentido, aproxima-se do crime perfeito, que, na perspectiva de Baudrillard, expressa o banimento do real e a instauração da ordem do simulacro. Ao tomar como exemplo pesquisa realizada no Distrito Federal em 2004, este artigo busca entender como a opinião pública sobre a tortura participa deste cenário criminoso, ou seja, a forma pela qual os sujeitos se inscrevem sutilmente nessa ordem dos simulacros na qual a razão cínica se estabelece. É dessa forma que se imbricam as dimensões política e psicológica desse cenário, no qual a maior ameaça é o discurso da inevitabilidade.

In the 21st century, torture survives in Brazil in a wide and systematic manner. It is not a mere residue of the military dictation or exception in a "peak of criminality" as incited by the media. On the contrary, it has been a rule, one of the symbols of the perpetuation of State terrorism against the subaltern classes, which translates in the selectivity of the "torturable bodies" as well as in history, through an exceptionalist discourse. In this sense, torture renders the prefect crime, which, in Baudrillard's perspective, expresses the banishment of the real and the instauration of the order of simulacra. Taking research held in the Federal District of Brazil in 2004 as an example, this article intends to understand how public opinion on torture participates of this criminal scenario, in other words, by what means do subjects subtly inscribe themselves in the order of simulacra in which cynical reason is established. This is how political and psychological dimensions imbricate in a scenario in which the greatest threat is the discourse of inevitability.

En pleno siglo XXI, la tortura sobrevive en Brasil de forma amplia y sistemática. No se trata de un mero resquicio de la dictadura, o la excepción en la "cima de criminalidad" incitada por los medios; por el contrario, ha sido una regla, uno de los símbolos de la perpetuación del terrorismo de Estado contra las clases subalternas, que se inscribe tanto en la selectividad de los cuerpos torturables, como en la historia, mediante el discurso excepcionalista. En ese sentido, se aproxima al crimen perfecto, que, desde la perspectiva de Baudrillard, expresa el desvanecimiento de lo real y la instauración del orden del simulacro. Al tomar como ejemplo una investigación realizada en el Distrito Federal en 2004, este artículo busca entender cómo la opinión pública alrededor del tema de la tortura, participa de este escenario criminal, o sea, la forma por la cual los sujetos se inscriben sutilmente en ese orden de los simulacros en el cual se establece la razón cínica. Es de esa forma que se imbrican las dimensiones política y psicológica de ese escenario, en el cual la mayor amenaza resulta ser el discurso de la inevitabilidad.

Systems with the integer rounding property in normal monomial subrings

Let C be a clutter and let A be its incidence matrix. If the linear system x > 0; x A < 1 has the integer rounding property, we give a description of the canonical module and the a-invariant of certain normal subrings associated to C. If the clutter is a connected graph, we describe when the aforementioned linear system has the integer rounding property in combinatorial and algebraic terms using graph theory and the theory of Rees algebras. As a consequence we show that the extended Rees algebra of the edge ideal of a bipartite graph is Gorenstein if and only if the graph is unmixed.

Seja C uma desordem (família de Sperner) e seja A sua matriz de incidência. Se o sistema linear x > 0; x A < 1 tem a propriedade do arredondamento inteiro, fornecemos a descrição do módulo canônico e do a-invariante de certos subaneis monomiais associados a C. Se a desordem é um grafo conexo, descreve-se quando o supra-mencionado sistema linear tem a propriedade do arredondamento inteiro em termos combinatórios e algébricos, usando a teoria dos grafos e a teoria das álgebras de Rees. Como consequência, mostra-se que a álgebra de Rees estendida do ideal de arestas de um grafo bipartido é um anel de Gorenstein se e somente se o grafo é de altura pura.

The Ultimate Objective of Education in University: Cultivating Perfect Personality / 中华医学教育探索杂志

The Personality decides the particularity of people's acclimatization,which is the power organization in individual immanent psychology physics system.Human kind must gain a harmonious development in every field including trueness,goodness and fairness——this is the Marx's thought about the human general development,and it is also the ultimate objective of education in university.To achieve this target depends on attaching importance to humanities education.

Nuclear protein binding patterns in the 5'-upstream regulatory elements of HLA class I genes

The expression of MHC class I genes has been thought to be regulated by two major cis-acting regulatory elements. The first region, enhancer A (Enh A) spanning from positions -210 to -165 contains perfect palindrome (PP), TGGGGATTCCCCA. The PP is well-conserved both in mouse and human MHC class I genes, even though the PP is disrupted by 2 bp substitutions (TGAGGATTCTCCA) in HLA-C genes. Three proteins binding to the Enh A of HLA-A and -B locus genes, but very weakly or nearly not to the Enh A of HLA-C locus gene have been identified. To determine functional importance of the PP for binding of trans-acting protein, mutant DNA probes were made by site-directed in vitro mutagenesis and then electrophoretic mobility shift assay was performed. HLA-A mutant DNA probe, in which the PP is disrupted, shows the same nuclear protein binding pattern as that of the HLA-C gene, and HLA-C mutant DNA probe, in which the PP is introduced, shows the same nuclear protein binding pattern as that of the wild type HLA-A gene. These data suggest that the perfect palindrome and its cognate DNA binding nuclear protein play an important role in the HLA class I gene regulation, and thus the lower expression of HLA-C antigen may be ascribed to no or very weak factor binding to the nonpalindromic sequences of HLA-C upstream DNA.