Introduction: Due to the aging population and the governmental policy to substitute institutional care with home care, more community care nurses are needed in the Netherlands. In addition, new competences, for instance regarding promoting self-management and multidisciplinary collaboration, are required according to the new national professional profile of nurses. However, several aspects might hinder the education about these competences. Not all lecturers of the nursing schools currently have much experience in home care, and particularly the community care nurses already working in practice do not always have much experience with guiding student nurses in their internships. Therefore, collaboration and exchange between community care nurses and nursing lecturers is needed. Ten learning communities involving lecturers of nursing schools (bachelor level) and community care nurses, spread across the Netherlands, started in 2015 with learning communities to exchange knowledge and experiences and to enhance the new competences that are required. Aim: The aim of this symposium, organized by evaluators and project leaders involved in the learning communities, is to give an impression of the realization and the activities of the learning communities. For instance, it is discussed how learning communities promote new competences and leadership roles of community care nurses.

The surgical anatomy of the pelvis is highly complex. Anorectal and urogenital dysfunctions occur frequently after pelvic oncological surgery and are mainly caused by surgical damage of the autonomic nerves. A highly‐detailed 3D pelvic model could increase the anatomical knowledge and form a solid basis for a surgical simulation system. Currently, pelvic surgeons still rely on the preoperative interpretation of 2D diagnostic images. With a 3D simulation system, pelvic surgeons could simulate and train different scenes to enhance their preoperative knowledge and improve surgical outcome. To substantially enrich pelvic surgery and anatomical education, such a system must provide insight into the relation between the autonomic network, the lymphatic system, and endopelvic fasciae. Besides CT and MR images, Visible Human Datasets (VHDs) are widely used for 3D modeling, due to the high degree of anatomical detail represented in the cryosectional images. However, key surgical structures cannot be fully identified using VHDs and radiologic imaging techniques alone. Several unsolved anatomical problems must be elucidated as well. Therefore, adequate analysis on a microscopic level is inevitable. The development of a comprehensive anatomical atlas of the pelvis is no straightforward task. Such an endeavor involves several anatomical and technical challenges. This article surveys all existing 3D pelvic models, focusing on the level of anatomical detail. The use of VHDs in the 3D reconstruction of a highly‐detailed pelvic model and the accompanying anatomical challenges will be discussed Clin. Anat., 2013. © 2012 Wiley Periodicals, Inc.

Background: In the course of solid organ transplantation excessive production of reactive oxygen species (ROS) is a major contributor to the development of ischemia/reperfusion injury (IRI). Preventing ROS actions through the use of antioxidants so far proved unsatisfactory in the clinical setting, most likely due to the difficulty to timely and efficiently target these substances to the site of ROS production and action. In various in vivo (IR) and in vitro (hypoxia/reoxygenation, HR) models we observed a consistent pattern in the activation of key intracellular signaling pathways. We recently also obtained evidence, which linked the activation of p38MAPK to mitochondrial ROS accumulation and cell death during hypoxia/reoxygenation (HR). These data suggest that mitochondrial changes preceding the onset of cell death are subject to regulation by intracellular signaling pathways. This insight could be therapeutically exploited for the prevention of IR-induced organ damage. Here we further dissected the contribution of p38 to IR- and HR-induced damage and provide first evidence for a therapeutic benefit of p38 inhibition in vivo. Methods: Kidney transplantation and kidney clamping in the rat were used for the induction of IRI. HR was predominantly analyzed in HL-1 cardiomyocytes and primary MEFs. Intracellular signaling was monitored by using phosphorylation-specific antibodies. Mitochondrial ROS levels were determined by imaging of cells pre-loaded with Mitotracker Red CM-H2XROS. ROS/NOS-induced tissue damage was visualized by 3-nitrotyrosine specific antibodies. To assess acute kidney injury HSP70 expression was monitored by immunoblotting, serum creatinine and urea were measured in the clinical routine lab, and serum cystatin c and NGAL concentrations were determined by ELISA. Expression of cytokines and oxidative stress markers was measured by real time qPCR. Apoptosis of cells during IRI was assessed by TUNEL assay. Results: In the work presented here we provide further evidence for the involvement of p38 in causing redox stress and suggest MAPKAP-kinase 2 (MK2) as a downstream effector. Reperfusion following kidney clamping or transplantation was marked by a profound increase in the activity of p38 and the putative effector MK2 which was significantly prevented by the p38 inhibitor BIRB-796. p38 inhibition almost completely prevented functional impairment caused by IR during kidney clamping as measured by reduced serum creatinine, urea, cystatin c and NGAL levels. P38 inhibition also protected from oxidative damage and significantly reduced the percentage of apoptotic cells and the expression of TNFα and HO-1 during IR. Most importantly, a significant reduction of functional impairment was also achieved in the kidney transplant model. Conclusion: Inhibiting p38 signaling during IR may provide a potent strategy for limiting IRI. Supported by funds from the FWF and the Jubiliäumsfond OeNB.

Sucher, R; Smigelskaite, J; Gehwolf, P; Kuznetsov, A; Hermann, M; Doblander, C; Maglione, M; Ratschiller, T; Brandacher, G; Margreiter, R; Troppmair, J Author Information

BACKGROUND:The objective of this study was to obtain detailed anatomical information about the lateral lymph nodes, in order to determine whether they might play a role in presacral local recurrence of rectal cancer after total mesorectal excision without lateral lymph node dissection.METHODS:Ten serially sectioned human fetal pelvises were studied at high magnification and a three-dimensional reconstruction of the fetal pelvis was made.RESULTS:Examination of the histological sections and the three-dimensional reconstruction showed that lateral lymph node tissue comprises a major proportion of the pelvic tissue volume. There were no lymph nodes located in the presacral area. Connections between the mesorectal and extramesorectal lymph node system were found in all fetal pelvises, located below the peritoneal reflection on the anterolateral side of the fetal rectum. At this site middle rectal vessels passed to and from the mesorectum, and branches of the autonomic nervous system bridge to innervate the rectal wall.CONCLUSION:The findings of this study support the hypothesis that tumour recurrence might arise from lateral lymph nodes.

Hypothesis / aims of study Knowledge about the embryonic development of the pelvic floor, urethral sphincter, and bladder detrusor is very limited in the available literature. Systematic sampling of a human developmental series is very difficult because of paucity of available human material, although a recent study reported on early fetal development of the male urethra {1}. To see if a suitable animal model is available for developmental urethral sphincter complex studies we have attempted to study the urethral sphincter complex of wild type (WT) mice from embryonic to neonatal stages. We have attempted to study a urethral sphincter complex development in wilt type (WT) mice from the embryo to the neonate stage to see if a suitable animal model is available for urethral sphincter complex studies

HADES is a versatile magnetic spectrometer aimed at studying dielectron production in pion, proton and heavy-ion-induced collisions. Its main features include a ring imaging gas Cherenkov detector for electron-hadron discrimination, a tracking system consisting of a set of 6 superconducting coils producing a toroidal field and drift chambers and a multiplicity and electron trigger array for additional electron-hadron discrimination and event characterization. A two-stage trigger system enhances events containing electrons. The physics program is focused on the investigation of hadron properties in nuclei and in the hot and dense hadronic matter. The detector system is characterized by an 85% azimuthal coverage over a polar angle interval from 18° to 85° , a single electron efficiency of 50% and a vector meson mass resolution of 2.5%. Identification of pions, kaons and protons is achieved combining time-of-flight and energy loss measurements over a large momentum range ( 0.1 < p < 1.0 GeV/c . This paper describes the main features and the performance of the detector system.

1. Department of Anatomy & Embryology, Academic Medical Center, Amsterdam, The Netherlands, 2. Department of Anatomy, Leiden University Medical Centre, Leiden, the Netherlands, 3. Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands, 4. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands, 5. Department of Radiology, University Hospital Maastricht, Maastricht, the Netherlands., 6. Department of Anesthesiology and Pain Treatment, University Medical Center Utrecht, Utrecht, the Netherlands, 7. Department of Urology, Academic Medical Center, Amsterdam, The Netherlands, 8. Department of Pharmacology & Anatomy, University Medical Center Utrecht, Utrecht, the Netherlands, 9. Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands

Aims of study The pelvic floor plays a central role in continence and pelvic organ support. The striated muscles of the pelvic floor provide active support and the fascial connective tissue is believed to provide the passive support necessary to counteract the effects of constant and intermittent elevations of intra-abdominal pressure. The presence of smooth-muscle cells in the pelvic connective tissue has been demonstrated in several studies. Smooth muscle was found in the adult pubourethral, pubovesical and puboprostatic ligaments, the uterosacral ligaments and the tendinous arch of the pelvic fascia. A smooth muscle termed “rectourethralis” in the male and “rectovaginalis” in the female that is continuous with the longitudinal muscle layer of the rectum has also been reported. The longitudinal smooth-muscle layer of the rectum has a distal attachment in the perimysia of the muscle fibres of the LAM and external anal sphincter at the level of the levator hiatus. This layer anchors the rectum to the pelvic floor. This smooth muscle anchor of the posterior compartment (rectum) to the LAM has been previously described both in anatomical and embryological studies and has also been illustrated in anatomical atlases. Our main goal was to establish whether in addition to the posterior compartment, the anterior (urethra) and middle (vagina) compartments are also anchored to the pelvic floor by smooth muscle tissue.

The first measurements of (63)Ni produced by A-bomb fast neutrons (above approximately 1 MeV) in copper samples from Hiroshima encompassed distances from approximately 380 to 5062 m from the hypocenter (the point on the ground directly under the bomb). They included the region of interest to survivor studies (approximately 900 to 1500 m) and provided the first direct validation of fast neutrons in that range. However, a significant measurement gap remained between the hypocenter and 380 m. Measurements close to the hypocenter are important as a high-value anchor for the slope of the curve for neutron activation as a function of distance. Here we report measurements of (63)Ni in copper samples from the historic Hiroshima Atomic Bomb Dome, which is located approximately 150 m from the hypocenter. These measurements extend the range of our previously published data for (63)Ni providing a more comprehensive and consistent A-bomb activation curve. The results are also in good agreement with calculations based on the current dosimetry system (DS02) and give further experimental support to the accuracy of this system that forms the basis for radiation risk estimates worldwide.

Objectives: The contributions of the pudendal and levator ani nerves to the innervation of the levator ani muscle (LAM) are disputed. Because of the relatively large size of the nerves in early life, we investigated this issue in human fetuses.Methods: (immuno)histochemically stained serial sections of nine human fetuses (9-22 wk of gestation) were investigated. Both the left and right sides of the fetal pelves were studied individually and 3D reconstructions were prepared.Results: The levator ani nerve innervated the LAM in every pelvis, whereas a contribution of the pudendal nerve to the innervation of the LAM could be demonstrated in only 10 pelvic halves (56%,). In 10 halves, we observed a communicating nerve branch between the pudendal and levator ani nerves that pierced the pelvic floor between the LAM and the coccygeus muscle. No sex differences were observed, but the innervation pattern did differ between the left and right side of a pelvis.Conclusions: The LAM often has a dual somatic innervation with the levator ani nerve as its constant and main neuronal supply. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Traditionally, the pudendal nerve is considered to be the main contributor of pelvic floor innervation. Recent studies have, however, revealed that direct branches from the sacral plexus do innervate the main muscle of the pelvic floor - the levator ani - from its superior side. Detailed morphological studies are, however, lacking. Since such direct branches would be more prone to damage during surgical interventions or vaginal delivery, exact anatomical knowledge of this nerve supply is of clinical importance. As nerves are relatively large in foetuses, we undertook a study to examine whether a specific ‘levator ani nerve’ (LAN) can be demonstrated in human foetuses. Furthermore, we have described the macroscopic anatomy of the LAN in adult cadavers.