BACKGROUND Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results.
METHODSWe performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality.
RESULTSA meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89 % (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65 % (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54 % (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's value of 1.0. No deaths were caused directly by complications with the stent placement. CONCLUSION Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.
The difference between the project PRACTICA with these simulators lies in that PRACTICA has been conceived as a tool for the creation of simulation environments of free access to the community of developers and creatives, with the differential value regarding existing solutions, that the goal of PRACTICA is to provide a means for the creation of these simulators without the need to write a line of code. This facilitates access to a tool for the creation of simulators based on virtual reality for (non-ICT) professionals. PRACTICA provides a scene editing system, fully parameterize and configurable through visual elements. This article describes how the PRACTICA project works, from its conception, design and development, to the results obtained in the creation of prototype simulators adapted to the needs of real cases of companies that carry out training for professionals that have improved the content of the courses they provide to their students, given by access to a system of practices that simulates the operation of high-cost machinery and that puts students in situations that could actually pose a risk to their integrity.
Los profesores de matemáticas, frecuentemente, encuentran problemas en la representación de símbolos para comunicarse de manera virtual con sus estudiantes. En este sentido y con el objetivo de facilitar la comunicación tanto oral como escrita, presentamos diversas opciones realistas de afrontar una tutoría virtual que utilice simbología matemática. Se analiza de forma práctica la comunicación con el uso de ordenador, tableta, webcams y la videoclase según el formato de la Universitat Jaume I de Castellón.
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