Introduction: Complete mesocolic excision (CME) consists in the dissection on embryologic planes in order to achieve a complete resection of the mesocolic envelope and performing a central vascular ligation (CVL) with a D3 lymphadenectomy which is not routinely done for standard right colectomies. CME has been associated with better overall survival and disease-free survival in comparison with conventional surgery in retrospective studies. However, there is no data on its implementation in Chile. The aim of this study is to assess the perioperative results of the implementation of CME in our center. Methods: A retrospective cohort study was conducted. Consecutive patients undergoing a laparoscopic right hemicolectomy with CME-CVL between January 2022 and June 2023 were included. Demographic, perioperative, postoperative and histopathological data were collected. Results were analyzed using descriptive statistics. Results: During the study period, 34 patients underwent CME; 29 of them underwent laparoscopic CMECVL (median age 66 (57-76) and 15 (52%) female). The median operating time was 202,9 minutes. There were no cases of conversion, anastomotic leakage or mortality. There was morbidity in 9 cases (31%) and one of these (3,4%) was a Clavien-Dindo III morbidity (reoperation due to a Pfannenstiel haematoma). There were no intraoperative vascular injuries. The median length of stay was 3 days. Twelve cases (41%) were stage II and 8(28%) stage III. The median number of lymph nodes harvested was 23(18-28). Conclusion: This series demonstrate that the implementation of laparoscopic CME-CVL for right and transverse colon cancer is feasible in centers with experience in advanced laparoscopic colorectal cancer.

Resumen Introducción: La técnica de resección completa del mesocolon (RCM) en la hemicolectomía derecha consiste en la disección por planos embriológicos para lograr la resección completa del envoltorio mesocolónico, además de una ligadura vascular central (LVC) con linfadenectomía D3, que no se realiza normalmente con la técnica estándar. Esta técnica se asocia a mejores resultados de sobrevida global y libre de enfermedad que la cirugía convencional en trabajos retrospectivos. Sin embargo, no existen datos de su implementación a nivel nacional. El objetivo de este estudio es evaluar los resultados perioperatorios de la implementación del RCM en un centro universitario en nuestro medio. Materiales y Método: Estudio retrospectivo de cohorte de pacientes consecutivos sometidos a hemicolectomía derecha laparoscópica con técnica de RCM-LVC entre Enero 2022 y Junio 2023. Se recopilaron variables demográficas, perioperatorias, postoperatorias e histopatológicas. Los resultados se analizaron utilizando estadística descriptiva. Resultados: En el periodo, 29 pacientes se sometieron a RCM laparoscópica (mediana de edad 66(57-76) y 15(52%) sexo femenino). La mediana del tiempo quirúrgico fue 202,9 minutos. No hubo casos de conversión, filtración anastomótica, ni mortalidad. Hubo morbilidad en 9 casos (31%) y de estos solo 1(3,4%) fue Clavien-Dindo III (hematoma Pfannenstiel reintervenido). No hubo lesiones vasculares intraoperatorias. Mediana de hospitalización de 3 días. Doce casos (41%) eran etapa II y 8(28%) etapa III. La mediana de linfonodos resecados fue 23(18-28). Conclusión: Esta serie demuestra que la implementación de la RCM-LVC por vía laparoscópica para el tratamiento del cáncer de colon derecho y transverso es factible en centros con experiencia en cirugía colorrectal laparoscópica avanzada.

ABSTRACT Based on a study of the law and case law concerning collective labor relations, this document describes the types of collective bargaining at the centralized and decentralized levels in the public sector, analyzing arbitration as an alternative to settle economic labor disputes. After describing the structure of the arbitration award and its execution, it is concluded that it is a mistake to grant executory force to an arbitration award derived from a public collective bargaining, since it does not recognize a certain and enforceable obligation in favor of a worker, but general obligations in favor of a group of workers.

RESUMEN A partir de un estudio legal y jurisprudencial de las relaciones colectivas del trabajo se describen las clases de negociación colectiva de nivel centralizado y descentralizado en el sector estatal, analizando el arbitraje como alternativa para la resolución de conflictos laborales económicos. Luego de describir la estructura del laudo arbitral y su forma de ejecución, se concluye que es un error otorgar mérito de título ejecutivo al laudo arbitral derivado de una negociación colectiva estatal, pues este no reconoce una obligación cierta y exigible a favor de un trabajador, sino obligaciones de carácter general a favor de una colectividad de trabajadores.

RESUMO Com base em um estudo jurídico e jurisprudencial das relações coletivas de trabalho, descrevem-se os tipos de negociação coletiva centralizada e descentralizada no setor estatal, analisando a arbitragem como uma alternativa para a resolução de conflitos trabalhistas de natureza econômica. Após descrever a estrutura do laudo arbitral e sua forma de execução, conclui-se em que é um equívoco conceder o mérito como título executivo ao laudo arbitral derivado de uma negociação coletiva estatal, uma vez que não se reconhece uma obrigação certa e exigível em favor de um trabalhador, mas sim obrigações de natureza geral em favor de uma coletividade de trabalhadores.

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.