Healthy as a trout – as delicate as a dragon-fly

Travail créatif / Creative WorkLes hôpitaux de réadaptation offrent un contraste saisissant entre le personnel, qui est en grande partie jeune, en forme et en bonne santé, et les patients, qui ont subi des événements importants, souvent brutaux, qui changent leur vie. Combler le fossé entre ces deux mondes n’est pas facile, mais il peut aussi être difficile de concilier les valeurs des patients hospitalisés avant une blessure ou une maladie à ceux qui sont la voie de la guérison. Ceux qui travaillent dans la médecine de réadaptation promeuvent souvent un modèle de processus de consentement parce qu’ils comprennent que les patients avec des blessures fraîches peuvent avoir besoin de temps pour adapter leurs valeurs à leur nouvelle vie. Malgré cette compréhension, il peut être un défi de déterminer la meilleure façon de respecter l’autonomie du patient, tout en aidant ces mêmes patients à apprécier quelques-unes des limites de leurs capacités. La rédaction du récit personnel qui suit, tiré de ma propre expérience d'éthicienne de soins de santé et un patient réticent, m’a donné un meilleur aperçu de ces perplexités. Cette réflexion explore mon changement d’approche dans ma pratique professionnelle – et surtout dans ma vision de l’autonomie du patient – à la lumière de ma propre expérience avec la dépression post-partum.Rehabilitation hospitals provide a striking contrast between young, fit and largely able-bodied staff and patients who have experienced significant, often sudden, life-changing events. Bridging the gap between these worlds is not easy, but it can also be difficult to reconcile the values that the patients held before injury or illness with those that have begun to emerge on the road to recovery. Those working in rehabilitation medicine often endorse a process model of consent because they understand that patients with fresh injuries may need time for their values to adapt to their new lives. Despite this understanding, it can be a challenge to understand how best to respect patient autonomy whilst helping those same patients to appreciate some of the limits on their abilities. Drafting the following personal narrative, drawn from my own experience as a healthcare ethicist and reluctant patient, gave me greater insight into these perplexities. This reflection explores my changing approach to my professional practice – and especially my view of patient autonomy – in light of my own experience with post-partum depression

Neoflix: record, reflect, refine : next level recording and reviewing neonatal procedures

This thesis investigates the effectiveness of video review in the neonatal intensive care unit (NICU). By recording medical interventions on video, healthcare providers can reflect on their actions in detail. The unique, dynamic environment of a NICU makes this type of reflection particularly valuable. The LUMC is a pioneer in this field and has developed its own platform, Neoflix, for sharing and discussing these videos. By watching recordings together, such as the resuscitation of a newborn or an intubation, healthcare providers can learn from each other's experiences and optimize processes.The research shows that video reflection is a powerful tool for improving care. By creating a safe learning environment, this method promotes collaboration, communication, and continuous improvement within the care team. The results of this research can serve as a guideline for other hospitals that want to implement video review.The research described in this research was supported by a grant from ZonMw (recipient A.B. te Pas: 10130022010001). The publication of this thesis was financially supported by Universiteitsbibliotheek Leiden and Willem-Alexander KinderZiekenhuis.LUMC / Geneeskund

Specific fibroblastic niches in secondary lymphoid organs orchestrate distinct Notch-regulated immune responses.

Fibroblast-like cells of secondary lymphoid organs (SLO) are important for tissue architecture. In addition, they regulate lymphocyte compartmentalization through the secretion of chemokines, and participate in the orchestration of appropriate cell-cell interactions required for adaptive immunity. Here, we provide data demonstrating the functional importance of SLO fibroblasts during Notch-mediated lineage specification and immune response. Genetic ablation of the Notch ligand Delta-like (DL)1 identified splenic fibroblasts rather than hematopoietic or endothelial cells as niche cells, allowing Notch 2-driven differentiation of marginal zone B cells and of Esam(+) dendritic cells. Moreover, conditional inactivation of DL4 in lymph node fibroblasts resulted in impaired follicular helper T cell differentiation and, consequently, in reduced numbers of germinal center B cells and absence of high-affinity antibodies. Our data demonstrate previously unknown roles for DL ligand-expressing fibroblasts in SLO niches as drivers of multiple Notch-mediated immune differentiation processes

Statistical Methods in Computed Tomography Image Estimation

Purpose: There is increasing interest in computed tomography (CT) image estimations from magnetic resonance (MR) images. The estimated CT images can be utilised for attenuation correction, patient positioning, and dose planning in diagnostic and radiotherapy workflows. This study aims to introduce a novel statistical learning approach for improving CT estimation from MR images and to compare the performance of our method with the existing model based CT image estimation methods. Methods: The statistical learning approach proposed here consists of two stages. At the training stage, prior knowledges about tissue-types from CT images were used together with a Gaussian mixture model (GMM) to explore CT image estimations from MR images. Since the prior knowledges are not available at the prediction stage, a classifier based on RUSBoost algorithm was trained to estimate the tissue-types from MR images. For a new patient, the trained classifier and GMMs were used to predict CT image from MR images. The classifier and GMMs were validated by using voxel level 10-fold cross-validation and patient-level leave-one-out cross-validation, respectively. Results: The proposed approach has outperformance in CT estimation quality in comparison with the existing model based methods, especially on bone tissues. Our method improved CT image estimation by 5% and 23% on the whole brain and bone tissues, respectively. Conclusions: Evaluation of our method shows that it is a promising method to generate CT image substitutes for the implementation of fully MR-based radiotherapy and PET/MRI applications

Protocol for the isolation and purification of human follicular dendritic cells for functional assays

In this protocol, we detail how to isolate and purify human follicular dendritic cells (FDCs) from lymphoid tissues. FDCs play a vital role in antibody development by presenting antigens to B cells in germinal centers. The assay involves enzymatic digestion and fluorescence-activated cell sorting and is successfully applied to various lymphoid tissues, including tonsils, lymph nodes, and tertiary lymphoid structures. Our robust technique enables the isolation of FDCs and facilitates downstream functional and descriptive assays. For complete details on the use and execution of this protocol, please refer to Heesters et al

Associations of dry skin, skin care habits, well‐being, sleep quality and itch in nursing home residents : results of a multicentre, observational, cross‐sectional study

Aim: Dry skin is one of the most frequent cutaneous problems in aged long-term care residents. Although it is clinically relevant, the impact on quality of life is unclear. The objective was to measure well-being, sleep quality and itch in nursing home residents being 65 years and older and to explore possible associations with demographics, dry skin and skincare habits. Design: Multicentre, observational, cross-sectional. Methods: Sleep quality was assessed with the Richards-Campbell Sleep Quality Questionnaire, well-being with the WHO-Five Well-being Index and itch with the 5-D Itch scale. Skin dryness was measured using the Overall Dry Skin score. Results: A total of 51 residents were included. The item scores of the sleep quality and itch questionnaires were strongly associated with each other. Demographics, dry skin and skincare habits were not associated with the questionnaires. It is unclear whether basic skincare activities can improve the quality of life in this population