Laurent Fanton - Academia.edu (original) (raw)

Papers by Laurent Fanton

La Revue de Médecine Légale, 2020

The French Law of August 3, 2018 on sexual and gender-based violence was made urgent by increasin... more The French Law of August 3, 2018 on sexual and gender-based violence was made urgent by increasing criticism of legal rulings relating to sexual offenses. The main advances comprise: tightening up action against rape, broadening the concept of penetration and redefining that of coercion, lengthening the statute of limitations for sexual offenses against minors, improving the definition of harassment, creating an offense of voyeurism and an offense of sexual insult, and defining the existing offense of non-disclosure of offenses against minors. By not enshrining a presumption of non-consent in minors, the Law did not meet all expectations, and also poses unresolved problems of legal interpretation.

Metabolites

α-MT is a hallucinogenic and stimulant tryptamine that was involved in several overdose fatalitie... more α-MT is a hallucinogenic and stimulant tryptamine that was involved in several overdose fatalities in the United States and Europe. Analytical toxicology, and particularly the identification of metabolite biomarkers in biological samples, often is the only way to prove tryptamine use in clinical and forensic caseworks. We aimed to identify optimal α-MT metabolite biomarkers of consumption in humans. We identified α-MT metabolites in 10-donor-pooled human hepatocyte incubations and postmortem urine and blood from an α-MT overdose case using in silico metabolite predictions, liquid chromatography high-resolution-tandem mass spectrometry (LC-HRMS/MS), and software-assisted data mining. Nine metabolites were identified in vitro and eight additional metabolites were found in urine; five metabolites were found in blood. Metabolic transformations were hydroxylation, O-sulfation, O-glucuronidation, N-glucuronidation, and N-acetylation, consistent with the metabolism of structural analogues....

Toxicologie Analytique et Clinique

Medical Image Analysis, 2019

We present a novel algorithm for Fast Registration Of image Groups (FROG), applied to large 3D im... more We present a novel algorithm for Fast Registration Of image Groups (FROG), applied to large 3D image groups. Our approach extracts 3D SURF keypoints from images, computes matched pairs of keypoints and registers the group by minimizing pair distances in a hubless way i.e. without computing any central mean image. Using keypoints significantly reduces the problem complexity compared to voxel-based approaches, and enables us to provide an in-core global optimization, similar to the Bundle Adjustment for 3D reconstruction. As we aim to register images of different patients, the matching step yields many outliers. Then we propose a new EM-weighting algorithm which efficiently discards outliers. Global optimization is carried out with a fast gradient descent algorithm. This allows our approach to robustly register large datasets. The result is a set of diffeomorphic half transforms which link the volumes together and can be subsequently exploited for computational anatomy and landmark detection. We show experimental results on whole-body CT scans, with groups of up to 103 volumes. On a benchmark based on anatomical landmarks, our algorithm compares favorably with the star-groupwise voxel-based ANTs and NiftyReg approaches while being much faster. We also discuss the limitations of our approach for lower resolution images such as brain MRI.

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Archives of Sexual Behavior, 2021

The aim of this paper is to provide a model illustrating how regretful consensual intercourse may... more The aim of this paper is to provide a model illustrating how regretful consensual intercourse may lead to false rape allegations (FRA). An intrapersonal perspective of regret based on cognitive dissonance is added to the interpersonal factors already mentioned in the literature. The intrapersonal perspective is discussed in terms of the reduction of a state of cognitive dissonance induced by the gap between social norms and the shamefully perceived behavior. First, we start with the review of the different motives that may lead to a FRA, insisting on regret caused by cognitive dissonance. We then develop the emergence of regret from a state of cognitive dissonance. Second, we describe the means used to build the model: a literature review, an extraction of the factors at play in regret-based FRA, a chronological structure of the various factors, as some are necessarily the source of others. We then build the model. Third, we illustrate how the model could encompass many possible and usual scenarios. Thirteen plausible scenarios were developed to show the relevance of the model. Finally, we comment and discuss the model for future research and prevention.

Annals of Translational Medicine, 2021

Background: In the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infect... more Background: In the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, data from autopsy in subjects who died at home during lockdown are scarce. We here report the first forensic autopsy series of coronavirus disease 2019 (COVID-19)-related out-of-hospital cardiac arrest (OHCA). Methods: Between March and April 2020, four COVID-19-related OHCA were autopsied at the Institute of Legal Medicine of the metropolitan area of Lyon (France) according safe recommended procedures. Results: Four Caucasian individuals (3 men/1 woman; age: 56.8±2.1 years, body mass index: 29.5±7.4 kg/m 2), presenting symptomatic COVID-19 were autopsied. Autopsies of 3 individuals reported natural death by acute respiratory failure implicating SARS-CoV-2 with typical COVID-19 pulmonary aspect of gross findings and pulmonary microscopy findings, i.e., diffusely congestive edematous lungs with peripheral thrombi and diffuse alveolar damage (DAD) at different stages of inflammatory reaction. For one individual, autopsy concluded of violent death due to suicidal acute alcohol intoxication in a patient that could no longer endure COVID-19 lockdown. No significant lesions were found in the heart. Conclusions: We report here OHCAs of non-cardiac cause directly implicating COVID-19 at various stages of SARS-CoV-2-related DAD. Thus, autopsy remain of interest during this epidemic, both legally and medically to better understand the pathogenic processes of this emerging infectious disease.

Forensic Science International, 2021

Pholcodine is an opioid antitussive reputed for its low toxicity and absence of addictive effect.... more Pholcodine is an opioid antitussive reputed for its low toxicity and absence of addictive effect. We report three cases of pholcodine intoxication with fatal outcome. Large concentrations of pholcodine were quantified by gas chromatography coupled to mass spectrometry (GC/MS) in peripheral postmortem blood (respectively 2890 ng/mL, 979 ng/mL and 12,280 ng/mL). Segmental hair analyses by GC/MS and detected pholcodine in three 1.5-2 cm segments (38-161 ng/mg, 8.54-41.6 ng/mg, and 0.26-2.66 ng/mg, respectively). These findings underline that pholcodine can be involved in fatal poisoning and raise the question of misuse or abuse and of taking account of this drug in opioid overdose prevention policies.

Toxicologie Analytique et Clinique, 2020

Objectifs Presenter un cas de deces impliquant un analogue de l’insuline et discuter les apports ... more Objectifs Presenter un cas de deces impliquant un analogue de l’insuline et discuter les apports respectifs et limites des analyses immunochimiques et chromatographiques de l’insuline humaine (IH) et de ses analogues. Methode Description du cas Une infirmiere de 47 ans est retrouvee decedee dans un champ. Dans son vehicule, stationne proche du corps, ont ete retrouves differents contenants de medicaments et une seringue d’insuline asparte. La victime n’etait pas diabetique. Les constatations autopsiques ont mis en evidence un foie de choc, une congestion polyviscerale ainsi qu’un point d’injection au dos d’une main. Ce dernier a ete preleve, ainsi que les matrices usuelles en vue d’une expertise toxicologique. Methodes Une toxicologie de reference et une estimation de l’etat glycemique au moment du deces ont ete realisees. Le dosage de l’IH et de ses analogues dans le serum a ete effectue par immunochimie de types ECLIA (ElectroChimiLuminescent ImmunoAssay)(Cobas E411) (LDD = 1.0 mU/L) et IRMA (Cisbio) (LDD = 0.2 mU/L) et par LC-HRMS (phase inverse) apres preparation associant precipitation (ACN/MeOH 50 :50 v/v), filtration et immunopurification par kit iso-insulin (Mercodia) (LDD = 28,8 mU/L). Resultats Le dosage d’ethanol etait negatif dans le sang peripherique (SP). Differentes molecules medicamenteuses psychotropes ont ete retrouvees dans le sang cardiaque (SC) : amitriptyline (52 ng/mL), nortriptyline (83 ng/mL), diazepam (30 ng/mL), nordazepam (53 ng/mL), oxazepam (262 ng/mL), venlafaxine (129 ng/mL) et zopiclone (511 ng/mL). Les parametres glycemiques etaient les suivants : Hemoglobine glyquee (HbA1c) = 5,3 %, glucose et lactates dans l’humeur vitree = 0,38 mmol/L et 9,0 mmol/L respectivement. Dans le SC, le peptide-C a ete dose a 0,047 nmol/L. Le dosage d’insuline etait negatif ( Conclusion Les kits immunochimiques disponibles en clinique presentent des limites qualitatives et quantitatives. Les reactions croisees avec les analogues propres a chaque kit peuvent mener a des resultats tres variables allant d’une quantification erronee jusqu’a la non detection. Au contraire, la spectrometrie de masse permet d’identifier les insulines et donc de realiser un dosage specifique. En revanche, elle necessite des analyseurs de haute performance et une preparation complexe de l’echantillon. Les auteurs preconisent l’analyse par 2 kits presentant des reactivites croisees differentes et par une technique chromatographique couplee a la spectrometrie de masse pour documenter les cas medicolegaux impliquant l’insuline ou ses analogues.

Toxicologie Analytique et Clinique, 2020

Objectifs Decrit par Meadow en 1977 sous la designation de syndrome de Munchhausen par procuratio... more Objectifs Decrit par Meadow en 1977 sous la designation de syndrome de Munchhausen par procuration, le trouble factice par procuration (TFpP) est une forme rare de maltraitance. Elle consiste a inventer ou produire des symptomes, le plus souvent chez un enfant, dans le but de creer une relation ambivalente de dependance et d’hostilite avec le corps medical. Un cas de TFpP par administration de substances nuisibles a un nourrisson est presente dans lequel les resultats toxicologiques capillaires ont pu etre confrontes aux donnees medicales et aux declarations de l’auteur des faits. Methode Un nourrisson de 3 mois est adresse aux urgences pediatriques pour une diminution de la prise alimentaire et des malaises recidivants. Ces derniers, dont la mere est le seul temoin, sont decrits comme des tremblements, suivis d’une hypertonie des membres inferieurs, d’une revulsion oculaire et d’une perte de contact. L’enfant est hospitalise, pour la seconde fois pour ce meme motif. Devant un bilan etiologique negatif et au decours d’un nouveau malaise, un bilan toxicologique sanguin est realise. La mise en evidence de codeine (0,46 μg/mL, recherche de morphine non rapportee) et d’oxazepam (2,74 μg/mL) conduit a un signalement judiciaire. Deux prelevements de cheveux sont realises : J + 1 suivant l’intoxication et 3 mois apres la mesure d’eviction parentale (M + 3). Sur cette matrice capillaire, un criblage LC/MSMS cible de 44 molecules psychotropes (n’incluant pas la codeine) est requis parallelement a des expertises medicales et toxicologiques. Les cheveux J + 1 bruns et longs de 4 cm, non orientes, ont ete analyses sans segmentation. Les cheveux M + 3, bruns et longs de 8 cm ont ete decoupes en 5 segments de 1,2 cm (S1-racine a S5, 16 a 27 mg) et un segment distal de 2,4 cm (S6, 11 mg). Resultats L’analyse des cheveux J + 1 a mis en evidence de l’oxazepam (658 pg/mg), de l’hydroxyzine (139 pg/mg), de la cetirizine (20 pg/mg), du nordazepam (8,9 pg/mg), du midazolam (5,5 pg/mg) ainsi que des traces ( Conclusion Ce cas souligne l’interet des analyses toxicologiques systematiques, meme chez le tres jeune enfant, devant un tableau clinique inexplique. Les analyses toxicologiques capillaires ont montre toute leur utilite pour documenter une exposition a de multiples molecules psychotropes malgre la prudence qui s’impose en ce qui concerne la determination de leur origine, leur frequence et leur datation.

Physics in Medicine & Biology, 2018

Diffusion tensor imaging (DTI) is a non-invasive technique used to obtain the 3D fiber structure ... more Diffusion tensor imaging (DTI) is a non-invasive technique used to obtain the 3D fiber structure of whole human hearts, for both in vivo and ex vivo cases. However, by essence, DTI does not measure directly the orientations of myocardial fibers. In contrast, polarized light imaging (PLI) allows for physical measurements of fiber orientations, but only for ex vivo case. This work aims at quantitatively comparing the myocardial fiber orientations of whole human hearts obtained from cardiac DTI with those measured by PLI. Whole human neonatal and infant hearts were first imaged using DTI. The same whole hearts were then imaged using PLI. After DTI and PLI data are registered, the orientations of fibers from the two imaging modalities were finally quantitatively compared. The results show that DTI and PLI have similar variation patterns of elevation and azimuth angles, with some differences in transmural elevation angle range. DTI itself induces an underestimation of the range of transmural elevation angles by a factor of about 25° at the basal and equatorial slices and the reduction of spatial resolution further decreases this range. PLI data exhibit a 15° ± 5° (P < 0.01) narrower transmural elevation angle range at apical slices than in basal or equatorial slices. This phenomenon is not observed in DTI data. In both modalities, the azimuth angle maps exhibit curved or twisting boundaries at the basal and apical slices. The experimental results globally enforce DTI as a valid imaging technique to reasonably characterize fiber orientations of the human heart noninvasively.

International Journal of Legal Medicine, 2018

Background After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (S... more Background After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to infants aged under 3 years. Methods and results We studied a retrospective multicenter collection of 235 infants who died between the ages of 0 and 36 months, diagnosed with SDH by forensic pathological examination and with known posttraumatic interval (PTI). Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims (31 girls, 42 boys) whose median age was 3.8 months. Histopathological changes were significantly correlated with PTI for the appearance of red blood cells (RBCs) and the presence or absence of siderophages, and regarding the dura mater, the quantity of lymphocytes, macrophages, and siderophages; presence or absence of hematoidin deposits; collagen and fibroblast formation; neomembrane thickness; and presence or absence of neovascularization. Dating systems for SDH in adults are not applicable to infants. Notably, neomembrane of organized connective tissue is formed earlier in infants than in adults. Conclusion Our dating system improves the precision and reliability of forensic pathological expert examination of NAHI, particularly for age estimation of SDH in infants. However, the expert can only define a time interval. Histopathology is indispensable to detect repetitive trauma.

Journal of Forensic Sciences, 2018

Fatalities implicating psychedelic mushrooms are not a common clinical situation in everyday fore... more Fatalities implicating psychedelic mushrooms are not a common clinical situation in everyday forensic medicine. Despite classification as an illegal drug in many countries, psilocybin mushrooms have the reputation of being safe. We report the case of a young man who jumped from a second story balcony under the influence of psilocybin mushrooms. The psilocin assay was performed by gas chromatography coupled to an electron-impact ionization time-of-flight detector (GC-EI-TOF) after solid-phase extraction. Total psilocin was quantified in peripheral and cardiac blood as 60 and 67 ng/mL, respectively, and in urine (2230 ng/mL), bile (3102 ng/mL), and vitreous humor (57 ng/mL). This case report and review of literature highlights the danger of psilocybin mushrooms. Isolated use of psilocybin mushrooms by a regular consumer without psychiatric history, even under "safe" circumstances, can lead to a fatal outcome.

Medical image analysis, May 1, 2017

This paper presents a methodology to access the 3D local myocyte arrangements in fresh human post... more This paper presents a methodology to access the 3D local myocyte arrangements in fresh human post-mortem heart samples. We investigated the cardiac micro-structure at a high and isotropic resolution of 3.5 µm in three dimensions using X-ray phase micro-tomography at the European Synchrotron Radiation Facility. We then processed the reconstructed volumes to extract the 3D local orientation of the myocytes using a multi-scale approach with no segmentation. We created a simplified 3D model of tissue sample made of simulated myocytes with known size and orientations, to evaluate our orientation extraction method. Afterwards, we applied it to 2D histological cuts and to eight 3D left ventricular (LV) cardiac tissue samples. Then, the variation of the helix angles, from the endocardium to the epicardium, was computed at several spatial resolutions ranging from 3.6(3) mm(3) to 112(3) µm(3). We measure an increased range of 20° to 30° from the coarsest resolution level to the finest level i...

Forensic Science, Medicine, and Pathology, 2015

2014 12th International Conference on Signal Processing (ICSP), 2014

Fiber tracking plays an essential role in cardiac diffusion tensor magnetic resonance imaging (DT... more Fiber tracking plays an essential role in cardiac diffusion tensor magnetic resonance imaging (DTI). Most conventional fiber tracking studies are based on using main eigenvectors for tracking fibers. These approaches do not account for enough uncertainties caused by noise or other artifacts present in DTI images. We propose a novel maximum energy fiber tracking approach which consists in constructing an energy field from ex-vivo cardiac DTI images and estimating its influence on final fiber orientation. The theory for estimating the global energy to find final fiber tracts is formulated, and new criteria are defined to assess fiber tracking performance. The results show the proposed approach can reduce disturbance, decrease wrong paths and overcome influence from partial volume effects that may easily block the fiber tracking process in principal diffusion direction (PDD) approaches.

Annales de Toxicologie Analytique, 2011

-Au printemps 1944, Kurt Von Gottberg, le chef de la police SS à Minsk, fut blessé par balles par... more -Au printemps 1944, Kurt Von Gottberg, le chef de la police SS à Minsk, fut blessé par balles par deux agents soviétiques. Bien que légèrement touché, il mourra 6 heures plus tard. Les balles utilisées étaient creuses et contenaient une substance cristalline. Ces balles de 4 g, semi-chemisées en cupronickel, renfermaient 28 mg de nitrate d'aconitine, plus tard connu sous l'appellation de akonitinnitratgeschosse. La SIPO (SIcherheits POlizei) ordonna alors la production de balles Parabellum de 9 mm contenant du Ditran, un anticholinergique aux propriétés hallucinogènes provoquant une confusion mentale intense. Plus tard, le QNB (codé BZ par l'OTAN) sera produit. Saddam Hussein aurait utilisé cette molécule (codé agent 15) contre les Kurdes d'Iraq. Les forces serbes disposaient aussi de telles munitions et auraient été utilisées lors du conflit bosniaque, particulièrement à Srebrenica. Les auteurs poursuivent leur exposé par les armes déployées lors de la guerre froide et développées pour le compte du KGB afin d'éliminer discrètement les opposants au régime réfugiés à l'Ouest. Ces armes incluent le lanceur PSZh-13, le pistolet séquentiel Troïka et l'ingénieux dispositif de lancement 4-S110T à piston captif mis au point par Stechkin. Dissimulé sous l'apparence d'un paquet à cigarettes, il pouvait projeter silencieusement une charge de cyanure de potassium. Enfin, le célèbre parapluie empoisonné pouvant injecter une bille remplie de ricine (ou une autre phytalbumine de toxicité identique telle que abrine ou curcine) est présenté à l'occasion de l'assassinat du dissident bulgare Georgi Markov le 7 septembre 1978. Lors de l'autopsie, la découverte d'un projectile ayant éclaté en 4 ou 5 morceaux doit immédiatement alerter le médecin légiste sur l'éventualité d'une munition toxique. Le toxicologue doit s'attacher en premier lieu à la détection de l'aconitine, du cyanure, du suxaméthonium, du ditran du BZ ou d'une phytalbumine toxique. L'emploi de telles armes doit faire suspecter une organisation puissante telle que les services de renseignements gouvernementaux, l'armée ou un groupe terroriste. L'existence actuelle du lanceur pyroliquide russe UDAR montre bien que ces armes n'ont pas disparu. Il ne serait notamment pas très difficile de produire artisanalement une charge au cyanure adaptée à partir des charges civiles ou militaires existantes.

Journal of Forensic and Legal Medicine, 2012

La Revue de Médecine Légale, 2020

The French Law of August 3, 2018 on sexual and gender-based violence was made urgent by increasin... more The French Law of August 3, 2018 on sexual and gender-based violence was made urgent by increasing criticism of legal rulings relating to sexual offenses. The main advances comprise: tightening up action against rape, broadening the concept of penetration and redefining that of coercion, lengthening the statute of limitations for sexual offenses against minors, improving the definition of harassment, creating an offense of voyeurism and an offense of sexual insult, and defining the existing offense of non-disclosure of offenses against minors. By not enshrining a presumption of non-consent in minors, the Law did not meet all expectations, and also poses unresolved problems of legal interpretation.

Metabolites

α-MT is a hallucinogenic and stimulant tryptamine that was involved in several overdose fatalitie... more α-MT is a hallucinogenic and stimulant tryptamine that was involved in several overdose fatalities in the United States and Europe. Analytical toxicology, and particularly the identification of metabolite biomarkers in biological samples, often is the only way to prove tryptamine use in clinical and forensic caseworks. We aimed to identify optimal α-MT metabolite biomarkers of consumption in humans. We identified α-MT metabolites in 10-donor-pooled human hepatocyte incubations and postmortem urine and blood from an α-MT overdose case using in silico metabolite predictions, liquid chromatography high-resolution-tandem mass spectrometry (LC-HRMS/MS), and software-assisted data mining. Nine metabolites were identified in vitro and eight additional metabolites were found in urine; five metabolites were found in blood. Metabolic transformations were hydroxylation, O-sulfation, O-glucuronidation, N-glucuronidation, and N-acetylation, consistent with the metabolism of structural analogues....

Toxicologie Analytique et Clinique

Medical Image Analysis, 2019

We present a novel algorithm for Fast Registration Of image Groups (FROG), applied to large 3D im... more We present a novel algorithm for Fast Registration Of image Groups (FROG), applied to large 3D image groups. Our approach extracts 3D SURF keypoints from images, computes matched pairs of keypoints and registers the group by minimizing pair distances in a hubless way i.e. without computing any central mean image. Using keypoints significantly reduces the problem complexity compared to voxel-based approaches, and enables us to provide an in-core global optimization, similar to the Bundle Adjustment for 3D reconstruction. As we aim to register images of different patients, the matching step yields many outliers. Then we propose a new EM-weighting algorithm which efficiently discards outliers. Global optimization is carried out with a fast gradient descent algorithm. This allows our approach to robustly register large datasets. The result is a set of diffeomorphic half transforms which link the volumes together and can be subsequently exploited for computational anatomy and landmark detection. We show experimental results on whole-body CT scans, with groups of up to 103 volumes. On a benchmark based on anatomical landmarks, our algorithm compares favorably with the star-groupwise voxel-based ANTs and NiftyReg approaches while being much faster. We also discuss the limitations of our approach for lower resolution images such as brain MRI.

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Archives of Sexual Behavior, 2021

The aim of this paper is to provide a model illustrating how regretful consensual intercourse may... more The aim of this paper is to provide a model illustrating how regretful consensual intercourse may lead to false rape allegations (FRA). An intrapersonal perspective of regret based on cognitive dissonance is added to the interpersonal factors already mentioned in the literature. The intrapersonal perspective is discussed in terms of the reduction of a state of cognitive dissonance induced by the gap between social norms and the shamefully perceived behavior. First, we start with the review of the different motives that may lead to a FRA, insisting on regret caused by cognitive dissonance. We then develop the emergence of regret from a state of cognitive dissonance. Second, we describe the means used to build the model: a literature review, an extraction of the factors at play in regret-based FRA, a chronological structure of the various factors, as some are necessarily the source of others. We then build the model. Third, we illustrate how the model could encompass many possible and usual scenarios. Thirteen plausible scenarios were developed to show the relevance of the model. Finally, we comment and discuss the model for future research and prevention.

Annals of Translational Medicine, 2021

Background: In the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infect... more Background: In the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, data from autopsy in subjects who died at home during lockdown are scarce. We here report the first forensic autopsy series of coronavirus disease 2019 (COVID-19)-related out-of-hospital cardiac arrest (OHCA). Methods: Between March and April 2020, four COVID-19-related OHCA were autopsied at the Institute of Legal Medicine of the metropolitan area of Lyon (France) according safe recommended procedures. Results: Four Caucasian individuals (3 men/1 woman; age: 56.8±2.1 years, body mass index: 29.5±7.4 kg/m 2), presenting symptomatic COVID-19 were autopsied. Autopsies of 3 individuals reported natural death by acute respiratory failure implicating SARS-CoV-2 with typical COVID-19 pulmonary aspect of gross findings and pulmonary microscopy findings, i.e., diffusely congestive edematous lungs with peripheral thrombi and diffuse alveolar damage (DAD) at different stages of inflammatory reaction. For one individual, autopsy concluded of violent death due to suicidal acute alcohol intoxication in a patient that could no longer endure COVID-19 lockdown. No significant lesions were found in the heart. Conclusions: We report here OHCAs of non-cardiac cause directly implicating COVID-19 at various stages of SARS-CoV-2-related DAD. Thus, autopsy remain of interest during this epidemic, both legally and medically to better understand the pathogenic processes of this emerging infectious disease.

Forensic Science International, 2021

Pholcodine is an opioid antitussive reputed for its low toxicity and absence of addictive effect.... more Pholcodine is an opioid antitussive reputed for its low toxicity and absence of addictive effect. We report three cases of pholcodine intoxication with fatal outcome. Large concentrations of pholcodine were quantified by gas chromatography coupled to mass spectrometry (GC/MS) in peripheral postmortem blood (respectively 2890 ng/mL, 979 ng/mL and 12,280 ng/mL). Segmental hair analyses by GC/MS and detected pholcodine in three 1.5-2 cm segments (38-161 ng/mg, 8.54-41.6 ng/mg, and 0.26-2.66 ng/mg, respectively). These findings underline that pholcodine can be involved in fatal poisoning and raise the question of misuse or abuse and of taking account of this drug in opioid overdose prevention policies.

Toxicologie Analytique et Clinique, 2020

Objectifs Presenter un cas de deces impliquant un analogue de l’insuline et discuter les apports ... more Objectifs Presenter un cas de deces impliquant un analogue de l’insuline et discuter les apports respectifs et limites des analyses immunochimiques et chromatographiques de l’insuline humaine (IH) et de ses analogues. Methode Description du cas Une infirmiere de 47 ans est retrouvee decedee dans un champ. Dans son vehicule, stationne proche du corps, ont ete retrouves differents contenants de medicaments et une seringue d’insuline asparte. La victime n’etait pas diabetique. Les constatations autopsiques ont mis en evidence un foie de choc, une congestion polyviscerale ainsi qu’un point d’injection au dos d’une main. Ce dernier a ete preleve, ainsi que les matrices usuelles en vue d’une expertise toxicologique. Methodes Une toxicologie de reference et une estimation de l’etat glycemique au moment du deces ont ete realisees. Le dosage de l’IH et de ses analogues dans le serum a ete effectue par immunochimie de types ECLIA (ElectroChimiLuminescent ImmunoAssay)(Cobas E411) (LDD = 1.0 mU/L) et IRMA (Cisbio) (LDD = 0.2 mU/L) et par LC-HRMS (phase inverse) apres preparation associant precipitation (ACN/MeOH 50 :50 v/v), filtration et immunopurification par kit iso-insulin (Mercodia) (LDD = 28,8 mU/L). Resultats Le dosage d’ethanol etait negatif dans le sang peripherique (SP). Differentes molecules medicamenteuses psychotropes ont ete retrouvees dans le sang cardiaque (SC) : amitriptyline (52 ng/mL), nortriptyline (83 ng/mL), diazepam (30 ng/mL), nordazepam (53 ng/mL), oxazepam (262 ng/mL), venlafaxine (129 ng/mL) et zopiclone (511 ng/mL). Les parametres glycemiques etaient les suivants : Hemoglobine glyquee (HbA1c) = 5,3 %, glucose et lactates dans l’humeur vitree = 0,38 mmol/L et 9,0 mmol/L respectivement. Dans le SC, le peptide-C a ete dose a 0,047 nmol/L. Le dosage d’insuline etait negatif ( Conclusion Les kits immunochimiques disponibles en clinique presentent des limites qualitatives et quantitatives. Les reactions croisees avec les analogues propres a chaque kit peuvent mener a des resultats tres variables allant d’une quantification erronee jusqu’a la non detection. Au contraire, la spectrometrie de masse permet d’identifier les insulines et donc de realiser un dosage specifique. En revanche, elle necessite des analyseurs de haute performance et une preparation complexe de l’echantillon. Les auteurs preconisent l’analyse par 2 kits presentant des reactivites croisees differentes et par une technique chromatographique couplee a la spectrometrie de masse pour documenter les cas medicolegaux impliquant l’insuline ou ses analogues.

Toxicologie Analytique et Clinique, 2020

Objectifs Decrit par Meadow en 1977 sous la designation de syndrome de Munchhausen par procuratio... more Objectifs Decrit par Meadow en 1977 sous la designation de syndrome de Munchhausen par procuration, le trouble factice par procuration (TFpP) est une forme rare de maltraitance. Elle consiste a inventer ou produire des symptomes, le plus souvent chez un enfant, dans le but de creer une relation ambivalente de dependance et d’hostilite avec le corps medical. Un cas de TFpP par administration de substances nuisibles a un nourrisson est presente dans lequel les resultats toxicologiques capillaires ont pu etre confrontes aux donnees medicales et aux declarations de l’auteur des faits. Methode Un nourrisson de 3 mois est adresse aux urgences pediatriques pour une diminution de la prise alimentaire et des malaises recidivants. Ces derniers, dont la mere est le seul temoin, sont decrits comme des tremblements, suivis d’une hypertonie des membres inferieurs, d’une revulsion oculaire et d’une perte de contact. L’enfant est hospitalise, pour la seconde fois pour ce meme motif. Devant un bilan etiologique negatif et au decours d’un nouveau malaise, un bilan toxicologique sanguin est realise. La mise en evidence de codeine (0,46 μg/mL, recherche de morphine non rapportee) et d’oxazepam (2,74 μg/mL) conduit a un signalement judiciaire. Deux prelevements de cheveux sont realises : J + 1 suivant l’intoxication et 3 mois apres la mesure d’eviction parentale (M + 3). Sur cette matrice capillaire, un criblage LC/MSMS cible de 44 molecules psychotropes (n’incluant pas la codeine) est requis parallelement a des expertises medicales et toxicologiques. Les cheveux J + 1 bruns et longs de 4 cm, non orientes, ont ete analyses sans segmentation. Les cheveux M + 3, bruns et longs de 8 cm ont ete decoupes en 5 segments de 1,2 cm (S1-racine a S5, 16 a 27 mg) et un segment distal de 2,4 cm (S6, 11 mg). Resultats L’analyse des cheveux J + 1 a mis en evidence de l’oxazepam (658 pg/mg), de l’hydroxyzine (139 pg/mg), de la cetirizine (20 pg/mg), du nordazepam (8,9 pg/mg), du midazolam (5,5 pg/mg) ainsi que des traces ( Conclusion Ce cas souligne l’interet des analyses toxicologiques systematiques, meme chez le tres jeune enfant, devant un tableau clinique inexplique. Les analyses toxicologiques capillaires ont montre toute leur utilite pour documenter une exposition a de multiples molecules psychotropes malgre la prudence qui s’impose en ce qui concerne la determination de leur origine, leur frequence et leur datation.

Physics in Medicine & Biology, 2018

Diffusion tensor imaging (DTI) is a non-invasive technique used to obtain the 3D fiber structure ... more Diffusion tensor imaging (DTI) is a non-invasive technique used to obtain the 3D fiber structure of whole human hearts, for both in vivo and ex vivo cases. However, by essence, DTI does not measure directly the orientations of myocardial fibers. In contrast, polarized light imaging (PLI) allows for physical measurements of fiber orientations, but only for ex vivo case. This work aims at quantitatively comparing the myocardial fiber orientations of whole human hearts obtained from cardiac DTI with those measured by PLI. Whole human neonatal and infant hearts were first imaged using DTI. The same whole hearts were then imaged using PLI. After DTI and PLI data are registered, the orientations of fibers from the two imaging modalities were finally quantitatively compared. The results show that DTI and PLI have similar variation patterns of elevation and azimuth angles, with some differences in transmural elevation angle range. DTI itself induces an underestimation of the range of transmural elevation angles by a factor of about 25° at the basal and equatorial slices and the reduction of spatial resolution further decreases this range. PLI data exhibit a 15° ± 5° (P < 0.01) narrower transmural elevation angle range at apical slices than in basal or equatorial slices. This phenomenon is not observed in DTI data. In both modalities, the azimuth angle maps exhibit curved or twisting boundaries at the basal and apical slices. The experimental results globally enforce DTI as a valid imaging technique to reasonably characterize fiber orientations of the human heart noninvasively.

International Journal of Legal Medicine, 2018

Background After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (S... more Background After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to infants aged under 3 years. Methods and results We studied a retrospective multicenter collection of 235 infants who died between the ages of 0 and 36 months, diagnosed with SDH by forensic pathological examination and with known posttraumatic interval (PTI). Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims (31 girls, 42 boys) whose median age was 3.8 months. Histopathological changes were significantly correlated with PTI for the appearance of red blood cells (RBCs) and the presence or absence of siderophages, and regarding the dura mater, the quantity of lymphocytes, macrophages, and siderophages; presence or absence of hematoidin deposits; collagen and fibroblast formation; neomembrane thickness; and presence or absence of neovascularization. Dating systems for SDH in adults are not applicable to infants. Notably, neomembrane of organized connective tissue is formed earlier in infants than in adults. Conclusion Our dating system improves the precision and reliability of forensic pathological expert examination of NAHI, particularly for age estimation of SDH in infants. However, the expert can only define a time interval. Histopathology is indispensable to detect repetitive trauma.

Journal of Forensic Sciences, 2018

Fatalities implicating psychedelic mushrooms are not a common clinical situation in everyday fore... more Fatalities implicating psychedelic mushrooms are not a common clinical situation in everyday forensic medicine. Despite classification as an illegal drug in many countries, psilocybin mushrooms have the reputation of being safe. We report the case of a young man who jumped from a second story balcony under the influence of psilocybin mushrooms. The psilocin assay was performed by gas chromatography coupled to an electron-impact ionization time-of-flight detector (GC-EI-TOF) after solid-phase extraction. Total psilocin was quantified in peripheral and cardiac blood as 60 and 67 ng/mL, respectively, and in urine (2230 ng/mL), bile (3102 ng/mL), and vitreous humor (57 ng/mL). This case report and review of literature highlights the danger of psilocybin mushrooms. Isolated use of psilocybin mushrooms by a regular consumer without psychiatric history, even under "safe" circumstances, can lead to a fatal outcome.

Medical image analysis, May 1, 2017

This paper presents a methodology to access the 3D local myocyte arrangements in fresh human post... more This paper presents a methodology to access the 3D local myocyte arrangements in fresh human post-mortem heart samples. We investigated the cardiac micro-structure at a high and isotropic resolution of 3.5 µm in three dimensions using X-ray phase micro-tomography at the European Synchrotron Radiation Facility. We then processed the reconstructed volumes to extract the 3D local orientation of the myocytes using a multi-scale approach with no segmentation. We created a simplified 3D model of tissue sample made of simulated myocytes with known size and orientations, to evaluate our orientation extraction method. Afterwards, we applied it to 2D histological cuts and to eight 3D left ventricular (LV) cardiac tissue samples. Then, the variation of the helix angles, from the endocardium to the epicardium, was computed at several spatial resolutions ranging from 3.6(3) mm(3) to 112(3) µm(3). We measure an increased range of 20° to 30° from the coarsest resolution level to the finest level i...

Forensic Science, Medicine, and Pathology, 2015

2014 12th International Conference on Signal Processing (ICSP), 2014

Fiber tracking plays an essential role in cardiac diffusion tensor magnetic resonance imaging (DT... more Fiber tracking plays an essential role in cardiac diffusion tensor magnetic resonance imaging (DTI). Most conventional fiber tracking studies are based on using main eigenvectors for tracking fibers. These approaches do not account for enough uncertainties caused by noise or other artifacts present in DTI images. We propose a novel maximum energy fiber tracking approach which consists in constructing an energy field from ex-vivo cardiac DTI images and estimating its influence on final fiber orientation. The theory for estimating the global energy to find final fiber tracts is formulated, and new criteria are defined to assess fiber tracking performance. The results show the proposed approach can reduce disturbance, decrease wrong paths and overcome influence from partial volume effects that may easily block the fiber tracking process in principal diffusion direction (PDD) approaches.

Annales de Toxicologie Analytique, 2011

-Au printemps 1944, Kurt Von Gottberg, le chef de la police SS à Minsk, fut blessé par balles par... more -Au printemps 1944, Kurt Von Gottberg, le chef de la police SS à Minsk, fut blessé par balles par deux agents soviétiques. Bien que légèrement touché, il mourra 6 heures plus tard. Les balles utilisées étaient creuses et contenaient une substance cristalline. Ces balles de 4 g, semi-chemisées en cupronickel, renfermaient 28 mg de nitrate d'aconitine, plus tard connu sous l'appellation de akonitinnitratgeschosse. La SIPO (SIcherheits POlizei) ordonna alors la production de balles Parabellum de 9 mm contenant du Ditran, un anticholinergique aux propriétés hallucinogènes provoquant une confusion mentale intense. Plus tard, le QNB (codé BZ par l'OTAN) sera produit. Saddam Hussein aurait utilisé cette molécule (codé agent 15) contre les Kurdes d'Iraq. Les forces serbes disposaient aussi de telles munitions et auraient été utilisées lors du conflit bosniaque, particulièrement à Srebrenica. Les auteurs poursuivent leur exposé par les armes déployées lors de la guerre froide et développées pour le compte du KGB afin d'éliminer discrètement les opposants au régime réfugiés à l'Ouest. Ces armes incluent le lanceur PSZh-13, le pistolet séquentiel Troïka et l'ingénieux dispositif de lancement 4-S110T à piston captif mis au point par Stechkin. Dissimulé sous l'apparence d'un paquet à cigarettes, il pouvait projeter silencieusement une charge de cyanure de potassium. Enfin, le célèbre parapluie empoisonné pouvant injecter une bille remplie de ricine (ou une autre phytalbumine de toxicité identique telle que abrine ou curcine) est présenté à l'occasion de l'assassinat du dissident bulgare Georgi Markov le 7 septembre 1978. Lors de l'autopsie, la découverte d'un projectile ayant éclaté en 4 ou 5 morceaux doit immédiatement alerter le médecin légiste sur l'éventualité d'une munition toxique. Le toxicologue doit s'attacher en premier lieu à la détection de l'aconitine, du cyanure, du suxaméthonium, du ditran du BZ ou d'une phytalbumine toxique. L'emploi de telles armes doit faire suspecter une organisation puissante telle que les services de renseignements gouvernementaux, l'armée ou un groupe terroriste. L'existence actuelle du lanceur pyroliquide russe UDAR montre bien que ces armes n'ont pas disparu. Il ne serait notamment pas très difficile de produire artisanalement une charge au cyanure adaptée à partir des charges civiles ou militaires existantes.

Journal of Forensic and Legal Medicine, 2012