Aim: To describe the design and creation of a high-fidelity thoracic trauma surgery simulation model incorporating 3D printing technology using a cadaveric human torso as a model. Materials and Method: This is a descriptive study that aims to illustrate the creation process of a thoracic trauma surgery simulation model throughout the incorporation of prototypes and dynamic iteration technologies. Results: A high-fidelity reusable thoracic trauma surgery simulation model was created from the digitalization of a cadaveric torso using a computed tomography scan. Throughout digital reconstruction tools, the subcutaneous, muscular, and skeletal structures were modeled from images obtained before and after an anterolateral thoracotomy. Using 3D printing and synthetic materials, a high-fidelity thoracic cavity was built so that perfused and ventilated porcine heart and lungs could be placed. A thoracotomy patch for the anterolateral thoracotomy was designed in a reusable and low-cost fashion. This simulation model is suitable for high fidelity training in the surgical management of cardiopulmonary traumatic injuries. Conclusion: The described methodology allowed the creation of a simulation model for training and assessment of surgical skills in thoracic trauma. The main components of the simulation model are made from reusable materials, broadening access to low-cost, high fidelity training.

Resumen Objetivo: Presentar la elaboración de un simulador de trauma torácico de alta fidelidad elaborado mediante modelamiento e impresión 3D a partir de un torso humano cadavérico. Materiales y Método: Estudio descriptivo del desarrollo de un simulador de trauma torácico utilizando metodología centrada en el prototipado y la iteración basada en testeos. Resultados: Se elaboró un simulador reutilizable mediante la digitalización de un torso cadavérico utilizando tomografía computada. Se realizó una reconstrucción digital del torso diseñando los planos subcutáneos, muscular y óseo en base a las imágenes del paciente pre y postoracotomía anterolateral. Utilizando impresión 3D y materiales sintéticos, se elaboró la caja torácica para luego instalar un corazón y pulmón porcino ventilado y perfundido. Los parches de la toracotomía son reemplazables y de bajo costo. En conjunto, este simulador permite el entrenamiento en manejo de lesiones traumáticas cardiacas y pulmonares de alta fidelidad. Conclusión: La metodología presentada permite la creación de un modelo para el entrenamiento y evaluación de habilidades quirúrgicas en trauma torácico. Los elementos principales del simulador son reutilizables y permiten mantener bajos los costos del entrenamiento.

RESUMO Racional: Trauma é uma das principais causas de morte no mundo e cuidados cirúrgicos adequados são críticos para determinar a mortalidade. No Chile, morte associada a trauma é a primeira causa de mortalidade na população entre 20 e 59 anos. Para lidar com esses pacientes complexos, são necessárias habilidades cirúrgicas precisas para esses procedimentos. Autoconfiança de cirurgiões recentemente graduados na Residência em Cirurgia Geral para práticas de procedimentos de trauma no nosso país não tem sido reportada. Objetivo: Descrever nível de autoconfiança para lidar com procedimentos de trauma em cirurgiões recentemente graduados na residência de cirurgia geral. Método: Estudo transversal. Foi desenhada e aplicada uma enquete em 2015, 2016 e 2017 a cirurgiões recentemente graduados para pesquisar sobre autoconfiança e habilidades cirúrgicas para lidar com cenários de trauma. Foram avaliados 18 procedimentos cirúrgicos de trauma (incluindo procedimentos cervicais, torácicos, abdominais e vasculares) usando a 5-grade Likert Scale. O número total de procedimentos feitos durante a residência foi avaliado. Resultados: Foram incluídos 88 cirurgiões recentemente graduados. O nível de competência foi reportado como alto em procedimentos como trauma intestinal, onde 98% sentiu-se competente ou muito competente em sua reparação. Por outro lado, em traumas complexos como dano vascular maior, até 76% reportaram não se sentirem competentes. A autoconfiança nos procedimentos esteve diretamente associada com o número de procedimentos realizados. Conclusões: Cirurgiões recentemente graduados na residência de cirurgia geral reportam níveis altos de confiança para lidar com traumas de complexidade baixa e média, mas um nível menor de confiança para tratar casos de complexidade alta.

ABSTRACT Background: Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.

Abstract An optimized synthetic procedure for preparing photostable nanocrystalline methylammonium lead halide materials is reported. The procedure was developed by adjusting the lead halide to methylammonium/octylammonium halide precursor ratio. At a high precursor ratio (1:3), a blue-shifted photoinduced luminescence peak is measured at 642 nm for CH3NH3PbI3 with 0.01 to 12 mJ pulsed-laser irradiation. The appearance of this peak is reversible over 300 min upon blocking the irradiation. In order to determine if the peak is the result of a phase change, in situ x-ray diffraction measurements were performed. No phase change was measured with an irradiance that causes the appearance of the photoinduced luminescence peak. Luminescence microscpectroscopy measurements showed that the use of a lower precursor ratio (1:1.5) produces CH3NH3PbI3 and CH3NH3PbBr3 perovskites that are stable over 4 min of illumination. Given the lack of a measured phase change, and the dependence on the precursor ratio, the photoinduced luminesce peak may derive from surface trap states. The enhanced photostability of the resulting perovskite nanocrystals produced with the optimized synthetic procedure supports their use in stable optoelectronic devices.

Resumen Se reporta un proceso sintético optimizado para preparar materiales haluros de metilamonioplomo nanocristalinos fotoestables. El proceso fue desarrollado ajustando la relación entre los precursores de haluro de metilamonio y haluro de octilamonio. Con una relación de precursores alta (1:3), un pico luminiscente desviado al azul a 642 nm fue detectado para CH3NH3PbI3 con irradiación de láser de pulso entre 0.01 y 12 mJ. La aparición de éste pico es reversible hasta por 300 min después de cesar la irradiación. Para determinar si éste pico se debe a una transición de fase, se hicieron mediciones de difracción de rayos-X in situ. Ningún cambio de fase fue detectado con niveles de irradiación a los cuales se observa el pico luminiscente. Mediciones luminiscentes macroespectroscópicas muestran que con una relación de precursores más baja (1:1.5) se producen perovskitas CH3NH3PbI3 y CH3NH3PbBr3 que son estables hasta con 4 min de iluminación. Dado que no se observa un cambio de fase, y la dependencia sobre la relación de precursores, el pico luminiscente generado bajo iluminación podría derivarse de estados trampa de superficie. La fotoestabilidad incrementada de los nanocristales de perovsita obtenidos por el procedimiento sintético optimizado ayudan a su aplicación en dispositivos optoelectrónicos más estables.