Minimally Invasive Surgery Center

Cáceres, Spain

Minimally Invasive Surgery Center

Cáceres, Spain
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News Article | April 18, 2017
Site: www.prweb.com

Saint Francis Hospital is proud to have been named to Healthgrades’ 2017 Patient Safety Excellence Award class, recognized as the top 10 percent of facilities in the nation for patient safety. Saint Francis joins more than 400 hospitals across the nation on the list, but is only one of three Delaware hospitals to receive this honor, having the lowest occurrences of 14 preventable patient safety events. According to Healthgrades, “this distinction places an elite group of hospital recipients within the top 10% of all hospitals evaluated for their superior performance in safeguarding patients from serious, potentially preventable complications during their hospital stays.” The organizations acknowledged are highlighted as being above their peers when it comes to limiting deadly medical errors and other preventable patient harm incidents. “No matter how innovative and progressive a healthcare organization is, without good policies and procedures in place to ensure patient safety, it won’t succeed,” said Dr. Michael Polnerow, Chief Medical Officer of Saint Francis Healthcare. “Patient safety is our number one priority at Saint Francis, and it’s truly gratifying for us to be recognized by Healthgrades.” Saint Francis attributes its high patient safety rating to its mission of excellence and quality patient experience and care. The hospital was acknowledged in December 2016 by Kaiser Health News for having dramatically reduced the number of hospital-acquired conditions over the past year, implementing new practices with its infection prevention team to provide safety to patients and employees. Saint Francis Healthcare, a part of Trinity Health, operates Delaware’s only Catholic hospital serving Wilmington and Northern New Castle County since 1924. Services provided include Partners in CardioVascular Health and Cardiovascular Services, 24-hour Emergency Services, Ambulance Service, Bariatric Surgery Center of Excellence, the da Vinci™ Surgical System, Gastroenterology Services, Hematology-Oncology Services, Minimally Invasive Surgery Center, Advanced Wound Center, Imaging Services, Sleep/Neurodiagnostics Center, Home Care, Outpatient Physical Therapy, Comprehensive Women’s Health Services and three community outreach programs. Saint Francis Healthcare is affiliated with the Saint Francis Foundation and Saint Francis LIFE (Living Independently for Elders), a PACE (Program for All-inclusive Care for the Elderly) model.


News Article | February 19, 2017
Site: www.prweb.com

Saint Francis Healthcare has received accolades from prominent healthcare sources for its dramatic reduction in the number of hospital-acquired conditions (HACs) over the past year. The hospital was lauded on the Kaiser Health News website in December 2016 for having zero catheter-associated urinary tract infections, central line-associated bloodstream infections or MRSA in the intensive care unit as well as one of the lowest Clostridium difficile (C. diff) rates in the state of Delaware. In its January issue, Consumer Reports gave Saint Francis one of its highest ratings for the system’s drastic reduction in central line-associated bloodstream infections. Every year, the Centers for Medicare and Medicaid Services (CMS) publishes a list of hospitals across the U.S. with the worst rates of HACs based on six quality measures. Saint Francis Healthcare was not cited on the CMS list in 2015, 2016 and 2017. According to Becker’s Hospital Review, 769 other hospitals in the U.S. made the list in 2017 and will have 1% of their Medicare payments cut. To achieve such high standards, Saint Francis Health’s infection prevention team revamped its protocols and collaborated with its environmental services department, the first line of defense against HACs. According to the system’s Infection Prevention Director, Helene M. Paxton, MS, MT (ASCP), PhD, CIC, the C. diff bacterium has a 30%-50% chance of infecting other people even after a room is cleaned. The infection prevention team targeted the stubborn bug using a novel cleaning system that mists an entire room with activated peroxide OH ions. The system kills bacteria and viruses on contact and leaves no residue. “These devices … will actually reduce the transmission of these organisms remaining on surfaces or hard to reach areas as seen with spray-and-wipe techniques,” Paxton wrote in a blog. “Recent evidence in Delaware hospitals has seen a marked reduction of C. diff with the use of a non-wipe, activated peroxide-based system.” The infection prevention team replaced old linen curtains in its facilities with disposable curtains that contain disinfectant to prevent visitors or hospital staff from contaminating them. The team also implemented insertion and daily care bundles, a series of steps that everyone involved in patient care at Saint Francis Health takes to prevent central line-associated bloodstream infections and catheter-associated urinary tract infections. Saint Francis Healthcare, a member of Trinity Health, operates Delaware’s only Catholic hospital serving Wilmington and Northern New Castle County since 1924. Services provided include Partners in CardioVascular Health and Cardiovascular Services, 24-hour Emergency Services, Ambulance Service, Bariatric Surgery Center of Excellence, the da Vinci™ Surgical System, Gastroenterology Services, Hematology-Oncology Services, Minimally Invasive Surgery Center, Advanced Wound Center, Imaging Services, Sleep/Neurodiagnostics Center, Home Care, Outpatient Physical Therapy, Comprehensive Women’s Health Services and three community outreach programs. Saint Francis Healthcare is affiliated with the Saint Francis Foundation and Saint Francis LIFE (Living Independently for Elders), a PACE (Program for All-inclusive Care for the Elderly) model.


Ji W.,Yale University | Li Y.,Sun Yat Sen University | Wan T.,Yale University | Wang J.,Minimally Invasive Surgery Center | And 4 more authors.
Arteriosclerosis, Thrombosis, and Vascular Biology | Year: 2012

Objective-The proinflammtory cytokine tumor necrosis factor (TNF), primarily via TNF receptor 1 (TNFR1), induces nuclear factor-κB (NF-κB)-dependent cell survival, and c-Jun N-terminal kinase (JNK) and caspase-dependent cell death, regulating vascular endothelial cell (EC) activation and apoptosis. However, signaling by the second receptor, TNFR2, is poorly understood. The goal of this study was to dissect how TNFR2 mediates NF-κB and JNK signaling in vascular EC, and its relevance to in vivo EC function. Methods and Results-We show that TNFR2 contributes to TNF-induced NF-κB and JNK signaling in EC as TNFR2 deletion or knockdown reduces the TNF responses. To dissect the critical domains of TNFR2 that mediate the TNF responses, we examine the activity of TNFR2 mutant with a specific deletion of the TNFR2 intracellular region, which contains conserved domain I, domain II, domain III, and 2 TNFR-associated factor-2-binding sites. Deletion analyses indicate that different sequences on TNFR2 have distinct roles in NF-κB and JNK activation. Specifically, deletion of the TNFR-associated factor-2-binding sites (TNFR2-59) diminishes the TNFR2-mediated NF-κB, but not JNK activation; whereas, deletion of domain II or domain III blunts TNFR2-mediated JNK but not NF-κB activation. Interestingly, we find that the TNFR-associated factor-2-binding sites ensure TNFR2 on the plasma membrane, but the di-leucine LL motif within the domain II and aa338-355 within the domain III are required for TNFR2 internalization as well as TNFR2-dependent JNK signaling. Moreover, domain III of TNFR2 is responsible for association with ASK1-interacting protein-1, a signaling adaptor critical for TNF-induced JNK signaling. While TNFR2 containing the TNFR-associated factor-2-binding sites prevents EC cell death, a specific activation of JNK without NF-κB activation by TNFR2-59 strongly induces caspase activation and EC apoptosis. Conclusion-Our data reveal that both internalization and ASK1-interacting protein-1 association are required for TNFR2-dependent JNK and apoptotic signaling. Controlling TNFR2-mediated JNK and apoptotic signaling in EC may provide a novel strategy for the treatment of vascular diseases. © 2012 American Heart Association, Inc.


PubMed | Red Cross, Fukuoka University, Lin Kou Chang Gung Memorial Hospital, Yokohama City University and 41 more.
Type: Journal Article | Journal: Journal of hepato-biliary-pancreatic sciences | Year: 2016

Serious complications continue to occur in laparoscopic cholecystectomy (LC). The commonly used indicators of surgical difficulty such as the duration of surgery are insufficient because they are surgeon and institution dependent. We aimed to identify appropriate indicators of surgical difficulty during LC.A total of 26 Japanese expert LC surgeons discussed using the nominal group technique (NGT) to generate a list of intraoperative findings that contribute to surgical difficulty. Thereafter, a survey was circulated to 61 experts in Japan, Korea, and Taiwan. The questionnaire addressed LC experience, surgical strategy, and perceptions of 30 intraoperative findings listed by the NGT.The response rate of the survey was 100%. There was a statistically significant difference among nations regarding the duration of surgery and adoption rate of safety measures and recognition of landmarks. The criteria for conversion to an open or subtotal cholecystectomy were at the discretion of each surgeon. In contrast, perceptions of the impact of 30 intraoperative findings on surgical difficulty (categorized by factors related to inflammation and additional findings of the gallbladder and other intra-abdominal factors) were consistent among surgeons.Intraoperative findings are objective and considered to be appropriate indicators of surgical difficulty during LC.


Lopez-Sanchez C.,University of Extremadura | Franco D.,University of Jaén | Bonet F.,University of Jaén | Garcia-Lopez V.,Minimally Invasive Surgery Center | And 2 more authors.
Developmental Biology | Year: 2015

It is known that secreted proteins from the anterior lateral endoderm, FGF8 and BMP2, are involved in mesodermal cardiac differentiation, which determines the first cardiac field, defined by the expression of the earliest specific cardiac markers Nkx-2.5 and Gata4. However, the molecular mechanisms responsible for early cardiac development still remain unclear. At present, microRNAs represent a novel layer of complexity in the regulatory networks controlling gene expression during cardiovascular development. This paper aims to study the role of miR130 during early cardiac specification.Our model is focused on developing chick at gastrula stages. In order to identify those regulatory factors which are involved in cardiac specification, we conducted gain- and loss-of-function experiments in precardiac cells by administration of Fgf8, Bmp2 and miR130, through in vitro electroporation technique and soaked beads application. Embryos were subjected to in situ hybridization, immunohistochemistry and qPCR procedures. Our results reveal that Fgf8 suppresses, while Bmp2 induces, the expression of Nkx-2.5 and Gata4. They also show that Fgf8 suppresses Bmp2, and vice versa. Additionally, we observed that Bmp2 regulates miR-130 -a putative microRNA that targets Erk1/2 (Mapk1) 3'UTR, recognizing its expression in precardiac cells which overlap with Erk1/2 pattern. Finally, we evidence that miR-130 is capable to inhibit Erk1/2 and Fgf8, resulting in an increase of Bmp2, Nkx-2.5 and Gata4. Our data present miR-130 as a necessary linkage in the control of Fgf8 signaling, mediated by Bmp2, establishing a negative feed-back loop responsible to achieve early cardiac specification. © 2015 Elsevier Inc.


Oshiro T.,Minimally Invasive Surgery Center | Kasama K.,Minimally Invasive Surgery Center | Umezawa A.,Minimally Invasive Surgery Center | Kanehira E.,Minimally Invasive Surgery Center | Kurokawa Y.,Minimally Invasive Surgery Center
Obesity Surgery | Year: 2010

The esophagogastric junction (EGJ) is a potential site of leakage after a sleeve gastrectomy which is usually difficult to treat conservatively. Two patients underwent a laparoscopic sleeve gastrectomy. A subphrenic abscess due to a staple line leakage was detected by CT at 3 weeks and 10 days after the operation, respectively. The abscess was drained laparoscopically. Intractable leakage required several endoscopic treatments, including clipping and sealing. However, a persisting fistula was found on radiographic studies. A covered self-expandable and retrievable stent (HANAROSTENT®) was finally placed over the leakage site at 15 and 6 weeks after the reoperation, respectively. Oral intake was achieved from poststent day 1, and they were discharged 2 weeks after stenting. Three months later, the stent was endoscopically removed and the leakage was successfully sealed. The HANAROSTENT is therefore considered to be a safe and effective therapeutic option for the management of staple line leakage at the EGJ. © 2009 Springer Science + Business Media, LLC.


Zhao Z.,Minimally Invasive Surgery Center | Ma W.,Minimally Invasive Surgery Center | Zeng G.,Minimally Invasive Surgery Center | Qi D.,Minimally Invasive Surgery Center | And 2 more authors.
Prostate | Year: 2012

Background: Early prostate cancer antigen (EPCA) has been shown a prostate cancer (PCa)-associated nuclear matrix protein, however, its serum status and prognostic power in patients with PCa are unknown. The goals of this study are to measure preoperative serum EPCA levels in a cohort of PCa patients who were treated with radical prostatectomy (RP), and to investigate whether serum EPCA levels would independently predict cancer prognosis after the surgery. Methods: The study group consisted of 109 consecutive patients with clinically localized PCa who were candidates for RP. Serum EPCA levels were measured by ELISA prior to the surgery, and were correlated with pathologic parameters and clinical outcomes postoperatively. RESULTS A total of 106 patients underwent RP. Preoperative mean serum EPCA level in RP patients (15.84±3.63ng/ml) was significantly higher than that in healthy subjects (4.62±1.15ng/ml) (P<0.001), but serum EPCA levels in the both groups were statistically lower than the levels in patients with PCa metastatic to regional lymph nodes (27.83±6.22ng/ml) and metastatic to bone (28.50±6.67ng/ml) (all P's<0.001). In patients who progressed during follow-up, preoperative serum mean EPCA levels were higher in those with aggressive disease progression (27.64±5.48ng/ml) compared with nonaggressive disease progression (18.15±4.63ng/ml; P<0.001). In pre- and postoperative multivariate analyses, preoperative serum EPCA level was an independent predictor for disease progression (Hazards Ratio=5.016, P<0.001 and Hazards Ratio=4.305, P<0.001, respectively). Conclusions: Preoperative serum EPCA level is significantly elevated in localized PCa patients with metastatic disease and strongly predicts cancer progression postoperatively. © 2011 Wiley Periodicals,Inc.


Honda G.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital | Hasegawa H.,Tokai Hospital | Umezawa A.,Minimally Invasive Surgery Center
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2016

An incorrect approach to the critical view of safety can cause bile duct and/or vascular injury. However, only superficial anatomical features have been proposed as surgical landmarks to initiate laparoscopic cholecystectomy (LC) safely in previous reports. Accordingly, we have proposed a novel surgical anatomical definition of the gallbladder wall, in which the subserosal (SS) layer is divided into the inner layer of the SS (SS-Inner) layer consisting of vasculature and fibrous tissue, and the outer layer of the SS (SS-Outer) layer consisting of abundant fat tissue. By dissecting the gallbladder along the SS-Inner layer after exposure at a safe region, bile duct and/or vascular injury can be avoided, even in cholecystitis cases. Furthermore, recognition of this surgical anatomy reveals several aspects. In cholecystitis cases associated with severe fibrotic change, completion of LC by dissecting along the SS-Inner layer is impossible, resulting in abandonment of regular LC. An abscess in the liver bed associated with acute cholecystitis usually forms in the SS-Outer layer, thus, the gallbladder can be dissected easily. In the dome-down technique, the right hepatic duct is endangered by whole-layer dissection, in which the SS-Outer layer is also removed. The proposed procedure should become the universal standard for LC. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery


PubMed | Tokai Hospital, Minimally Invasive Surgery Center and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
Type: Journal Article | Journal: Journal of hepato-biliary-pancreatic sciences | Year: 2016

An incorrect approach to the critical view of safety can cause bile duct and/or vascular injury. However, only superficial anatomical features have been proposed as surgical landmarks to initiate laparoscopic cholecystectomy (LC) safely in previous reports. Accordingly, we have proposed a novel surgical anatomical definition of the gallbladder wall, in which the subserosal (SS) layer is divided into the inner layer of the SS (SS-Inner) layer consisting of vasculature and fibrous tissue, and the outer layer of the SS (SS-Outer) layer consisting of abundant fat tissue. By dissecting the gallbladder along the SS-Inner layer after exposure at a safe region, bile duct and/or vascular injury can be avoided, even in cholecystitis cases. Furthermore, recognition of this surgical anatomy reveals several aspects. In cholecystitis cases associated with severe fibrotic change, completion of LC by dissecting along the SS-Inner layer is impossible, resulting in abandonment of regular LC. An abscess in the liver bed associated with acute cholecystitis usually forms in the SS-Outer layer, thus, the gallbladder can be dissected easily. In the dome-down technique, the right hepatic duct is endangered by whole-layer dissection, in which the SS-Outer layer is also removed. The proposed procedure should become the universal standard for LC.


PubMed | Minimally Invasive Surgery Center and University of Extremadura
Type: Journal Article | Journal: Brain structure & function | Year: 2016

Cytochrome b 5 reductase (Cb 5R) and cytochrome b 5 (Cb 5) form an enzymatic redox system that plays many roles in mammalian cells. In the last 15years, it has been proposed that this system is involved in the recycling of ascorbate, a vital antioxidant molecule in the brain and that its deregulation can lead to the production of reactive oxygen species that play a major role in oxidative-induced neuronal death. In this work, we have performed a regional and cellular distribution study of the expression of this redox system in adult rat brain by anti-Cb 5R isoform 3 and anti-Cb 5 antibodies. We found high expression levels in cerebellar cortex, labeling heavily granule neurons and Purkinje cells, and in structures such as the fastigial, interposed and dentate cerebellar nuclei. A large part of Cb 5R isoform 3 in the cerebellum cortex was regionalized in close proximity to the lipid raft-like nanodomains, labeled with cholera toxin B, as we have shown by fluorescence resonance energy transfer imaging. In addition, vestibular, reticular and motor nuclei located at the brain stem level and pyramidal neurons of somatomotor areas of the brain cortex and of the hippocampus have been also found to display high expression levels of these proteins. All these results point out the enrichment of Cb 5R isoform 3/Cb 5 system in neuronal cells and structures of the cerebellum and brain stem whose functional impairment can account for neurological deficits reported in type II congenital methemoglobinemia, as well as in brain areas highly prone to undergo oxidative stress-induced neurodegeneration.

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