Imaging of sudden unexpected death in infancy: a comprehensive nationwide French survey.

RATIONALE AND OBJECTIVES: Introduction of post-mortem imaging has helped improve sudden unexpected death in infancy (SUDI) management in Europe. French guidelines were issued in 2007 to homogenise SUDI investigations including imaging. The aim of this study was to evaluate current imaging management of SUDI in France. MATERIAL AND METHODS: Between January 2022 and July 2022, all 35 SUDI French referral centres were invited to answer an e-mailed online survey including 29 questions divided into four different sections covering imaging practices for SUDI including radiology department organisation, imaging modalities performed, methods of reading, and current training resources. Partial responses were secondarily completed by a personal call to the SUDI imaging consultant. The current implementation of the 2007 recommendations was compared with a previous evaluation from 2015 and with current North American practices. RESULTS: The participation rate of centres performing SUDI imaging was 100% (35/35). Imaging was systematically performed in 94.3% (33/35) of the centres: 74.3% (26/35) using radiography; 5.7% (2/35) using ultrasound; 94.3% (33/35) using computed tomography (CT), including 89% (31/35) whole-body CT and 5.7% (2/35) brain CT; and 20% (7/35) using magnetic resonance imaging (MRI). Two centres (5.7%, 2/35) did not systematically perform brain imaging. One (2.9%, 1/35) used ultrasound-guided biopsy. In comparison with 2015, rates of brain imaging increased by 25.4% (P=0.008). There was no significant difference in the number of forensic MRIs performed between France and North America (P=0.663). CONCLUSION: Despite improvements since 2015, full compliance with French guidelines for SUDI investigations remains incomplete. The use of imaging, particularly CT and brain imaging, has increased. Further efforts are needed to standardise imaging practices for optimal SUDI investigations.

Is intimate partner sexual violence a singular violence?

OBJECTIVE: This study aims to examine the specificities of intimate partner sexual violence among heterosexual partners, as well as to contrast them to the sexual violence perpetrated by strangers or acquaintances. METHOD: A narrative review was conducted to identify relevant findings in the scientific and medical literature to inform about intimate partner sexual violence. Findings were also analysed with the lens of the clinical experience of the authors working with men convicted of intimate partner sexual violence. RESULTS: Intimate partner sexual violence was legally recognized by article 222-22 of the French Penal Code in 2006. In France rape committed by intimate partners accounts for 34% of rapes of adult women. Intimate partner sexual violence is likely to be underestimated due to variables of individual, relationship, community, and societal levels. Despite a common perception that intimate partner sexual violence is located at the lower end of the severity continuum compared with other forms of sexual violence, studies have shown that intimate sexual violence is as or even more harmful to a woman. Compared to victims of other types of sexual violence, women sexually abused by an intimate partner experience more severe mental health outcomes such as depression, anxiety, anger, self-blame, increased feelings of shame, post-traumatic stress disorder, substance abuse to cope or suicide attempt. Intimate partner sexual violence is also associated with humiliation and betrayal of trust, greater physical violence, greater risk of sexually transmitted infections, re-victimization, higher risk of serious injury or homicide. Beyond the legal definition of sexual rape, intimate partner sexual violence encompasses a wide range of subtle and complex behaviors such as coercive tactics, blackmail, implicit threat or reproductive control. The COVID-19 pandemic lockdown seems to have played a "revealing" or "aggravating" role rather than a "triggering" of intimate violence. The treatment of intimate partner sexual violence is complex and should consider diverse therapeutic strategies to deconstruct the offenders' societal misrepresentations and to make them aware of their partner's inter-subjectivity. CONCLUSIONS: Identifying and understanding intimate partner sexual violence need to be improved both to refine the treatment of the offender-victim dyad and to break down the toxic relational dynamics maintaining abusive behaviors.

No mercy for victims: Exploring the link between dark personality traits, aggressive video game behavior, and severe traffic violations.

This study investigates the relationship between dark personality traits, aggressive behavior in violent video games, and severe traffic violations among 200 driving offenders from Tehran, Iran, participating in a rehabilitation program. Participants engaged in a computerized shooting decision task, where their tendency to shoot unarmed targets (innocent victims), compared to armed targets (criminals), was used as an indicator of aggressive behavior toward innocent victims. Additionally, they completed self-report measures of narcissism, Machiavellianism, psychopathy, and sadism to evaluate the impact of Dark Tetrad personality traits on their behavior. Bivariate analyses revealed associations between Dark Tetrad personality traits and aggressive behavior in the video game with serious traffic offenses. Multivariate analyses identified Machiavellianism, sadism, and aggressive behavior in video games as significant predictors of severe traffic offenses. The results suggest that dark personality traits and aggressive behavior in video games may aid in better identifying road traffic offenders with the most severe violations. Potential implications for preventing repeated traffic offenses by tailoring rehabilitation programs are discussed.

Baseline Clinical and Neuroimaging Biomarkers of Treatment Response to High-Frequency rTMS Over the Left DLPFC for Resistant Depression.

Background: Repetitive transcranial magnetic stimulation (rTMS) has proven to be an efficient treatment option for patients with treatment-resistant depression (TRD). However, the success rate of this method is still low, and the treatment outcome is unpredictable. The objective of this study was to explore clinical and structural neuroimaging factors as potential biomarkers of the efficacy of high-frequency (HF) rTMS (20 Hz) over the left dorso-lateral pre-frontal cortex (DLPFC). Methods: We analyzed the records of 131 patients with mood disorders who were treated with rTMS and were assessed at baseline at the end of the stimulation and at 1 month after the end of the treatment. The response is defined as a 50% decrease in the MADRS score between the first and the last assessment. Each of these patients underwent a T1 MRI scan of the brain, which was subsequently segmented with FreeSurfer. Whole-brain analyses [Query, Design, Estimate, Contrast (QDEC)] were conducted and corrected for multiple comparisons. Additionally, the responder status was also analyzed using binomial multivariate regression models. The explored variables were clinical and anatomical features of the rTMS target obtained from T1 MRI: target-scalp distance, DLPFC gray matter thickness, and various cortical measures of interest previously studied. Results: The results of a binomial multivariate regression model indicated that depression type (p = 0.025), gender (p = 0.010), and the severity of depression (p = 0.027) were found to be associated with response to rTMS. Additionally, the resistance stage showed a significant trend (p = 0.055). Whole-brain analyses on volume revealed that the average volume of the left part of the superior frontal and the caudal middle frontal regions is associated with the response status. Other MRI-based measures are not significantly associated with response to rTMS in our population. Conclusion: In this study, we investigated the clinical and neuroimaging biomarkers associated with responsiveness to high-frequency rTMS over the left DLPFC in a large sample of patients with TRD. Women, patients with bipolar depressive disorder (BDD), and patients who are less resistant to HF rTMS respond better. Responders present a lower volume of the left part of the superior frontal gyrus and the caudal middle frontal gyrus. These findings support further investigation into the use of clinical variables and structural MRI as possible biomarkers of rTMS treatment response.

Major cerebral hypoperfusion on an internal carotid loop during an otologic surgery: A case report.

An aberrant course of the internal carotid artery, such as a carotid loop or kinking, is a rare type of malformation. These malformations are typically asymptomatic, their occurrence is unpredictable, and they can exacerbate clinical disorders such as heart failure. We report the case of a seven-year-old child who died consecutively to cardiac arrest during otologic surgery for a cholesteatoma. After rapid and effective cardiorespiratory resuscitation, the child was transferred to a paediatric intensive care unit. In the following days, pronounced cerebral hypoperfusion led to the death of the child. The autopsy revealed a right carotid loop and a left carotid kink that presumably led to the cerebral hypoperfusion.

[Autopsy legal under the law]. / L'autopsie médico-légale au regard de la loi.

Only a physician specialized in forensic medicine is allowed to process a autopsy legal. The 2011 reform of forensic medicine aimed to homogenize and enhance thanatological practices over French state territory. According to the law, biological samples withdrawn during an autopsy can't be given back to the families after analysis(art. 230-30 CPP). Respecting the human body and restoring their physical aspect are mandatory by law (art. 230-29 CPP). After a autopsy legal, dead bodies must be given back to their relatives as soon as possible.

[Stalking: From "romantic pursuit" to sexual predation]. / Le stalking : de la « poursuite romantique ¼ à la prédation sexuelle.

Deriving from the English verb "to stalk", stalking denotes an unwelcome, repetitive, and intrusive harassing and/or threatening behavior directed toward a specific individual, and can result in physical and/or sexual offending - even leading to homicide. French harassment legislation has evolved over the years, and the last law closest to the international anti-stalking laws had been promulgated in 2014. According to a review, up to 16% of women and 7% of men are stalked in their life, and 80% of the stalkers are known to their victims. Stalkers are a heterogeneous population, either seeking an intimate relationship with someone the stalker knows or with a celebrity, or being revenge-motivated, or tracking their victims with the aim of offending them. Stalkers threat their victims in about half of the cases, and physically offend them in a third of the cases, violence being more often directed against ex-intimates. Sexual offending would be the consequence of harassment behavior for some stalkers, and would be the initial aim of the stalking for others.