Analyse des céphalées post- ponction de la dure-mère en obstétrique à la Maternité du CHUV

Contexte : L'analgésie péridurale lors d'un accouchement est très fréquente et peut notamment se compliquer d'une brèche de la dure-mère pouvant se manifester par des céphalées post-ponction. Le but de ce travail est de calculer l'incidence des perforations involontaires, d'analyser les facteurs de risque ainsi que les modalités de traitement des céphalées post-ponction durale, et ainsi améliorer le contrôle de Qualité. Méthode : Nous avons utilisé les données de contrôle de Qualité récoltées prospectivement à la Maternité du CHUV entre 2011 et 2014, que nous avons saisies dans une base de données et analysées statistiquement, puis comparées à la littérature. Résultats : Dans notre population, l'incidence des brèches de la dure-mère est de 1.3%, dont 83% sont devenues symptomatiques. La nuit, la fin de service d'un anesthésiste, ainsi que les jours non- ouvrables, ne sont statistiquement pas des facteurs de risque. L'analyse des différents volumes des blood patchs ne montre pas statistiquement d'avantages d'un certain volume sur un autre. Les taux de réussite des blood patchs sont de 67.6% après un blood patch et de 83.8% après deux blood patchs. Nos résultats sont comparables à la littérature récente. Conclusions : Il serait intéressant de pouvoir regrouper des données de plusieurs hôpitaux suisses ainsi que continuer le contrôle de Qualité adapté et standardisé sur une plus longue durée pour permettre de meilleures analyses statistiques. Il faudrait mettre en place un essai clinique pour permettre d'identifier la meilleure prise en charge par blood patch qui reste encore peu evidence- based medicine mais empirique

Pre-contractual justice in a comparative perspective: Striking the right balance

One of the most important reasons for doing comparative work in the field of law is to get a better understanding of the legal jurisdictions of other countries. Studying the law of another country also enables one to understand one's own legal jurisdiction better. It helps one to see well-established principles in a new light and to ask questions about the continued applicability of such principles

WZIS – Wasserzeichen-Informationssystem: Verwaltung und Präsentation von Wasserzeichen und ihrer Metadaten

Das Projekt Wasserzeichen-Informationssystem (WZIS) wurde in zwei Phasen von der Deutschen Forschungsgemeinschaft unterstützt. Mit Abschluss der ersten Phase liegt seit 2012 die Software Wasserzeichen Studio als »Backend« für die dezentrale Eingabe von Wasserzeichen und ihrer Metadaten vor, die daneben auch verschiedene Möglich- keiten einer Bildbearbeitung bietet. Gemeinsame Richtlinien und eine verbindliche hierarchische Klassi kation gewährleisten eine homogene Erschließung. Die Online- Präsentation auf www.wasserzeichen-online.de bietet breit angelegte Möglichkeiten zur Abfrage der Inhalte. Piccard-Online sowie die digital vorliegenden Bände der ge- druckten Piccard-Findbücher wurden in das Angebot eingebunden, so dass damit ein Werkzeug zur Erforschung von Wasserzeichen vorliegt, das einer fächer- und institu- tionenübergreifenden Verständigung über Fragen der Erschließung, Dokumentation und Auswertung von Wasserzeichen den Weg ebnen kann. Der vorliegende Beitrags erläutert die Umsetzung der 2009 von Christina Wolf vorgestellten Planungen

Data-efficient Deep Reinforcement Learning for Vehicle Trajectory Control

Advanced vehicle control is a fundamental building block in the development of autonomous driving systems. Reinforcement learning (RL) promises to achieve control performance superior to classical approaches while keeping computational demands low during deployment. However, standard RL approaches like soft-actor critic (SAC) require extensive amounts of training data to be collected and are thus impractical for real-world application. To address this issue, we apply recently developed data-efficient deep RL methods to vehicle trajectory control. Our investigation focuses on three methods, so far unexplored for vehicle control: randomized ensemble double Q-learning (REDQ), probabilistic ensembles with trajectory sampling and model predictive path integral optimizer (PETS-MPPI), and model-based policy optimization (MBPO). We find that in the case of trajectory control, the standard model-based RL formulation used in approaches like PETS-MPPI and MBPO is not suitable. We, therefore, propose a new formulation that splits dynamics prediction and vehicle localization. Our benchmark study on the CARLA simulator reveals that the three identified data-efficient deep RL approaches learn control strategies on a par with or better than SAC, yet reduce the required number of environment interactions by more than one order of magnitude

From Research to Diagnostic Application of Raman Spectroscopy in Neurosciences: Past and Perspectives

In recent years, Raman spectroscopy has been more and more frequently applied to address research questions in neuroscience. As a non-destructive technique based on inelastic scattering of photons, it can be used for a wide spectrum of applications including neurooncological tumor diagnostics or analysis of misfolded protein aggregates involved in neurodegenerative diseases. Progress in the technical development of this method allows for an increasingly detailed analysis of biological samples and may therefore open new fields of applications. The goal of our review is to provide an introduction into Raman scattering, its practical usage and also commonly associated pitfalls. Furthermore, intraoperative assessment of tumor recurrence using Raman based histology images as well as the search for non-invasive ways of diagnosis in neurodegenerative diseases are discussed. Some of the applications mentioned here may serve as a basis and possibly set the course for a future use of the technique in clinical practice. Covering a broad range of content, this overview can serve not only as a quick and accessible reference tool but also provide more in-depth information on a specific subtopic of interest

ラット静脈虚血モデ、ルにおけるペナンブラ領域でのセフトリアキソンの神経保護効果

OBJECTIVE: Glutamate transporter-1 (GLT-1) maintains low concentrations of extracellular glutamate by removing glutamate from the extracellular space. It is controversial, however, whether upregulation of GLT-1 is neuroprotective under all ischemic/hypoxic conditions. Recently, a neuroprotective effect of preconditioning with a β-lactam antibiotic ceftriaxone (CTX) that increases expression of GLT-1 has been reported in animal models of focal ischemia. On the other hand, it is said that CTX does not play a neuroprotective role in an in vitro study. Thus, we examined the effect of CTX on ischemic injury in a rat model of two-vein occlusion (2VO). This model mimics venous ischemia during, e.g. tumor surgery, a clinical situation that is best suitable for pretreatment with CTX. METHODS: CTX (100mg/kg, 200mg/kg per day) or vehicle (0.9% NaCl) was intraperitoneally injected into Wistar rats for 5days before venous ischemia (n=57). Then, animals were prepared for occlusion of two adjacent cortical veins (2VO) by photothrombosis with rose bengal that was followed by KCl-induced cortical spreading depression (CSD). Infarct volume was evaluated with hematoxylin and eosin (H&E) staining 2days after venous occlusion. [(3)H]MK-801, [(3)H]AMPA and [(3)H]Muscimol ligand binding were examined autoradiographically in additional two groups without 2VO (n=5/group). Animals were injected either with NaCl (vehicle) or CTX 200mg/kg for 5days in order to evaluate whether NMDA, AMPA and GABAA ligand binding densities were affected. RESULTS: CTX pretreatment reduced infarct volume compared to vehicle pretreatment (p<0.05). The effect of CTX pretreatment was attenuated by administration of the GLT-1 inhibitor, dihydrokainate (DHK) 30min before 2VO. CTX had no effect on the number of spontaneous spreading depressions after 2VO. Analysis of quantitative receptor autoradiography showed no statistically significant difference between rats after administration with CTX compared to control rats. CONCLUSIONS: Pretreatment with CTX has neuroprotective potential without effect on NMDA, AMPA and GABAA receptor density and spontaneous spreading depression. This effect can be abolished by GLT-1 inhibition, indicating that upregulation of GLT-1 is an important mechanism for neuroprotective action in penumbra-like conditions, e.g. if neurosurgeons plan to occlude cerebral veins during tumor surgery.博士（医学）・乙第1320号・平成25年11月27

Neurocysticercosis with a single brain lesion in Germany: a case report

Neurocysticercosis is rare in Western Europe and a high degree of physician awareness is necessary for diagnosis. We describe a case of Neurocysticercosis with a single brain lesion acquired in Germany in which only surgical removal and subsequent histological examination allowed diagnosis whereas diagnostic investigation yielded no pathological findings

Senescence Is the Main Trait Induced by Temozolomide in Glioblastoma Cells.

First-line drug in the treatment of glioblastoma, the most severe brain cancer, is temozolomide (TMZ), a DNA-methylating agent that induces the critical damage O &lt;sup&gt;6&lt;/sup&gt; -methylguanine (O &lt;sup&gt;6&lt;/sup&gt; MeG). This lesion is cytotoxic through the generation of mismatch repair-mediated DNA double-strand breaks (DSBs), which trigger apoptotic pathways. Previously, we showed that O &lt;sup&gt;6&lt;/sup&gt; MeG also induces cellular senescence (CSEN). Here, we show that TMZ-induced CSEN is a late response which has similar kinetics to apoptosis, but at a fourfold higher level. CSEN cells show a high amount of DSBs, which are located outside of telomeres, a high level of ROS and oxidized DNA damage (8-oxo-guanine), and sustained activation of the DNA damage response and histone methylation. Despite the presence of DSBs, CSEN cells are capable of repairing radiation-induced DSBs. Glioblastoma cells that acquired resistance to TMZ became simultaneously resistant to TMZ-induced CSEN. Using a Tet-On glioblastoma cell system, we show that upregulation of MGMT immediately after TMZ completely abrogated apoptosis and CSEN, while induction of MGMT long-term (&amp;gt;72 h) after TMZ did not reduce apoptosis and CSEN. Furthermore, upregulation of MGMT in the senescent cell population had no impact on the survival of senescent cells, indicating that O &lt;sup&gt;6&lt;/sup&gt; MeG is required for induction, but not for maintenance of the senescent state. We further show that, in recurrent GBM specimens, a significantly higher level of DSBs and CSEN-associated histone H3K27me3 was observed than in the corresponding primary tumors. Overall, the data indicate that CSEN is a key node induced in GBM following chemotherapy

The Brainbox—a tool to facilitate correlation of brain magnetic resonance imaging features to histopathology

Magnetic resonance imaging (MRI) has limitations in identifying underlying tissue pathology, which is relevant for neurological diseases such as multiple sclerosis, stroke or brain tumours. However, there are no standardized methods for correlating MRI features with histopathology. Thus, here we aimed to develop and validate a tool that can facilitate the correlation of brain MRI features to corresponding histopathology. For this, we designed the Brainbox, a waterproof and MRI-compatible 3D printed container with an integrated 3D coordinate system. We used the Brainbox to acquire post-mortem ex vivo MRI of eight human brains, fresh and formalin-fixed, and correlated focal imaging features to histopathology using the built-in 3D coordinate system. With its built-in 3D coordinate system, the Brainbox allowed correlation of MRI features to corresponding tissue substrates. The Brainbox was used to correlate different MR image features of interest to the respective tissue substrate, including normal anatomical structures such as the hippocampus or perivascular spaces, as well as a lacunar stroke. Brain volume decreased upon fixation by 7% (P = 0.01). The Brainbox enabled degassing of specimens before scanning, reducing susceptibility artefacts and minimizing bulk motion during scanning. In conclusion, our proof-of-principle experiments demonstrate the usability of the Brainbox, which can contribute to improving the specificity of MRI and the standardization of the correlation between post-mortem ex vivo human brain MRI and histopathology. Brainboxes are available upon request from our institution