L’expert judiciaire et l’irresponsabilité pénale. Débats et controverses au cours du temps et questions contemporaines

IntroductionSince the creation of the Société Médico-Psychologique, an accumulation of discussions at the national level has resulted in legislative changes, which concern people with mental disorders. Public opinion has now become a stakeholder, prompting us, as judicial experts, to address criminal irresponsibility. The authors wish to give an account of the evolution of the ideas and professional practices in alienism and forensic psychiatry regarding criminal liability, irresponsibility, and the evolution of legislative measures in this realm.MethodsTo do so, they rely on the use of their forensic psychiatric and medico-psychological expertise, which has been effective for many years and remains relevant today, as well as on their clinical and theoretical research activities. The methodology is based on the analysis of language and the critical approach of historical and clinical epistemology.Forensic IssuesThey are examined taking into account the cultural and scientific context from the middle of the 19th century to the beginning of the 21st century. Criminal responsibility and irresponsibility are ancient principles codified in Roman law by Marcus Aurelius and which evolved with the political, social and religious conjunctions of each epoch. Whether the reason given for the recognition of criminal irresponsibility is referred to as madness, degeneration, insanity, dementia, psychic abnormality or discernment, it has always been the subject of research by physicians, alienists, and then psychiatrists. The authors analyze the role of the dissemination of the debates from the creation of the Annales Médico-Psychologiques (in 1843) and of the Société Médico-Psychologique (in 1852), illustrating them with some famous cases in specialized literature. The importance of forensic discussions at the Société Médico-Psychologique animated the end of the nineteenth century and the first part of the twentieth century, contributing to the enrichment of psychiatric semiology and to the opening up of new research, notably methodological. This will lead to an evolution of the conceptions relative to what induces the criminal act and will no longer limit irresponsibility to a diagnosis of insanity or dementia ; the study of psychic functioning will be put forward with the notion of discernment and those of self-control of one's actions. If numerous theoretical debates within the profession have fueled “expert disputes” sometimes disqualifying the role of experts, they remained, however, in the medical and judicial field. Over the past decade, these issues have been broadened to include societal debates around issues related to dangerousness and recidivism. This has become a dominant theme in scientific gatherings, before the eruption into the criminal field, of the increasing role played by victims and victims’ associations. Law No. 92-683 of 22 July 1992 introduced into the Penal Code Article 122-1 (1994 Penal Code) replacing Article 64, by inserting the notions of alteration or abolition of discernment. This distinction has given rise to new difficulties and tensions in expert practice ; the law came into force in 1994. During the 2000s, a series of high-profile homicides involving people with serious mental disorders, sometimes carried out in a recidivist situation, hit the headlines in France. This resulted in a shift in public opinion that led to the law of 25 February 2008 on criminal irresponsibility. The law put an end to the judicial dismissal of cases on the grounds of criminal irresponsibility, by introducing other provisions in the form of security measures (judicial supervision and detention of security). This law creates new interferences between legal procedural issues and psychiatric practice ; it also emphasized the importance of the role of experts by creating new missions, including the expertise of dangerousness. The movement linked to the consideration of the place of victims has been accentuated, both by the objective of obtaining a judgment for the perpetrator of the acts, and by the solicitation of their participation in the successive phases of the procedure. We have recently moved on to questions and controversies about the lack of accountability leading to the law of 24 January 2022. The current article 122 did not specify the origin of the psychic disorder causing the abrogation of discernment, which was interpreted by the Minister of Justice as “a legal void”, which must be “filled with urgency”. Title I states: “Provisions limiting criminal irresponsibility in cases of mental disorder resulting from self-induced psychoactive substances”. All these new provisions, as well as the creation of new incriminations and qualifications, certainly engender debates between magistrates and experts, but they are above all part of a concern of the public authorities about the necessity of setting up “provisions limiting criminal liability in the case of mental disorder”. The interpretation of the contribution of the law to a criminal act remains complex, according to the authors, in terms of psychopathological and etiopathogenic research. Within the context of expert practice, this new law will make it necessary to add new questions for the current missions, and it can only result in an increase in the complexity of these missions and in a risk of confusion in the answers.ConclusionThe authors show that the question of criminal liability does not solicit the same questions and problems in the judicial field (the point of view of the forensic psychiatrist, during the expert examination) or in the societal field with the confrontation with all the representations that are attached both to madness and to the passage to the criminal act, which since the beginning of the twentieth century involves other emerging disciplines. From their point of view, the assertion that a psychic disorder can be of such severity so as to affect the free will and discernment of the perpetrator of a criminal act at the time of the offence, must remain within the domain of psychiatry, even if the new law of 24 January 2022, through several of its provisions, would attempt to eliminate this necessity.     

网状减张小切口缝合法提高大鼠背部张力皮瓣存活机制

Foropenseverewoundandthewoundafterdebridement,mostscholarsthinkthewoundshouldbeclosedindelayedfirst-phase.Meshrelaxingshortincision(MRSI)methodcanclosemoreskindeficiencyandhightensionopenwound,andavoidsubcutaneoushematomaandskinflapdrift.Intheexperiment,theexperimentalmodelonrattensionskinflaphasbeeninvolved,andthecontentofendothelin(ET)inratskinflaptissuehasbeenmeasuredinvariousperiodofwoundhealingaftermeshedrelaxingshortincisionsuturewithimmunohistochemistry,inordertodiscussprobablemechani…     

胸椎错位并心律异常13例临床报告

目的 探讨脊柱源性心律紊乱的主要发病部位。方法 对13例脊柱病变引发的心律紊乱，主要以纠正上胸段错位为主，采用理筋、整脊和功能锻炼治疗。结果 经治疗均临床治愈，随访半年以上无复发。结论 脊源性心律紊乱主要部位在胸椎。     

科技期刊邮件推送的用户调研与策略分析

【目的】 从读者和期刊两方面进行调研,对比分析科技期刊通过邮件推送进行宣传,从而促进学术成果有效传播,增强用户黏性的策略,为我国科技期刊宣传提供参考。【方法】 通过问卷调查、实例调研、案例分析及对比,分析不同做法对邮件推送结果的影响,给出优化的方法和建议。【结果】 问卷调研结果反映的用户需求与同行期刊和中国激光杂志社邮件推送实例的分析结果相互印证。科技期刊在进行邮件推送时,要先了解邮件推送目标用户的需求,并根据需求对邮件推送活动进行合理优化。【结论】 精准性是邮件推送工作首先要考虑的因素;合适的主题、时效性强、恰当的推送频率也是推送工作需注意的要素。     

Top 100. Revisión de los artículos más citados sobre cirugía laparoscópica del páncreas

IntroductionThe number of citations is considered as an indirect indicator of the merit of an article, journal or researcher, although it is not an infallible method to determine scientific quality. Our goal is to determine the characteristics of the articles most cited about pancreas and laparoscopy.MethodsWe performed a search of all articles published in any journal about pancreas and laparoscopy until September 2019 and selected the 100 most cited papers. We recorded number of citations, journal, year of publication, quartil, impact factor, institution, country, authors type of paper, type of surgery, topic and area.ResultsThe top 100 citations account 10,970 citations in total. The journal with the most articles is Surgical Endoscopy and 2007 is the year with the highest number of articles in the top 100 citations. The percentage of publications from America and Europe are similar.Case series is the most frequently paper, outcomes/morbidity is the most frequently discussed topic, and distal pancreatectomy is the most frequently type of surgery.ConclusionsThis bibliometric study on pancreas and laparoscopy is conditioned by the time factor, since laparoscopy has arrived later at pancreatic surgery, probably due to the morbidity and mortality associated with pancreatic surgery and the need for a high specialization in this field. The literature is recent and scarce. More and better-quality studies are needed in this field.     

高原地区首例新型冠状病毒肺炎CT诊断分析并文献复习

目的回顾性分析高原地区首例新型冠状病毒肺炎的CT影像特征及临床表现,以提高对该病的认识。方法回顾性分析高原地区1例确诊新型冠状病毒患者的CT影像及临床资料并进行文献复习。结果患者患病过程中早期、进展期及转归期的CT表现较为典型,与内地文献报道无明显差异,但诊断时应与高原性病种相互鉴别。结论新型冠状病毒肺炎的诊断除结合临床特征、实验室检查、流行病学史及核酸检测外,CT扫描在治疗后的复查及早期的诊断可以提供必要的补充资料,熟悉该病CT诊断的分期表现有助于诊断。     

内毒素休克大鼠肝线粒体H+-ATP酶活性变化的研究

目的：研究内毒素休克时线粒体呼吸功能的变化及其与 Ｈ＋ Ａ Ｔ Ｐ酶活性变化的关系。方法：测定内毒素休克大鼠肝线粒体呼吸控制率（ Ｒ Ｃ Ｒ）、磷氧比（ Ｐ／ Ｏ）和 Ｈ＋ Ａ Ｔ Ｐ酶活性的变化;并通过体外孵育实验研究离体情况下不同浓度梯度细菌内毒素（ Ｌ Ｐ Ｓ）对线粒体 Ｒ Ｃ Ｒ、 Ｐ／ Ｏ 和 Ｈ＋ Ａ Ｔ Ｐ酶活性的影响。结果：内毒素休克早期,大鼠肝线粒体 Ｒ Ｃ Ｒ、 Ｐ／ Ｏ 及 Ｈ＋ Ａ Ｔ Ｐ酶活性显著增强,晚期则显著减弱。而 Ｌ Ｐ Ｓ与线粒体共同孵育导致线粒体 Ｒ Ｃ Ｒ、 Ｐ／ Ｏ 和 Ｈ＋ Ａ Ｔ Ｐ酶活性下降。线粒体 Ｈ＋ Ａ Ｔ Ｐ酶活性的变化和 Ｒ Ｃ Ｒ、 Ｐ／ Ｏ 的变化有较好的一致性。结论： Ｈ＋ Ａ Ｔ Ｐ酶活性的变化可能是内毒素休克线粒体功能变化的重要原因之一;提出了内毒素休克时线粒体功能早期增强晚期减弱的观点。     

《中华消化外科杂志》2002—2012年载文著者分析

目的从载文、著者的角度研究《中华消化外科杂志》的学术水平和影响力。方法利用万方数据库、中国知网数据库,检索2002年至2012年《中华消化外科杂志》刊出论文情况,对全文进行浏览并保存,录入Excel软件进行各项数据统计,用文献计量学的方法对该杂志2002年至2012年的载文和著者情况进行统计分析。结果《中华消化外科杂志》11年载文1917篇,每期平均载文量29．05篇,基金项目论文占30．62％,被引率为58．52％;著者来自32个省、直辖市及中国香港特别行政区,重庆、北京、上海3个地区作者发文分别为446篇（23．27％）、240篇（12．52％）、203篇（10．59％）,位居前3位,其次为四川省、江苏省和广东省。医学院校附属医院发文1382篇（72．09％）。合著率为90．03％,合作度为4．37。结论《中华消化外科杂志》是一个高质量的学术期刊,具有一定的社会影响力。该刊著者分布范围广,合作率高,但总体分布尚不均衡。     

《中华消化杂志》2004-2006年载文、引文及著者统计分析

目的 统计分析《中华消化杂志》载文、引文及著者的特点。方法 用文献计量学方法对2004至2006年《中华消化杂志》的载文、引文和著者情况进行统计分析。结果 《中华消化杂志》3年载文1079篇，期均载文量30篇，篇密度0．45，平均发表时滞为9．0个月，基金项目论文占19．3％。著者来自23个省、自治区、直辖市，合著率为92．0％，合作度为4．38。引文率为83．6％，96．4％的引文来自期刊，引文语种主要为英文，普赖斯指数为65．1％。中英文文献引用半衰期分别为3．75和3．38。结论 《中华消化杂志》是一个高质量的学术期刊，具有广泛的社会影响力，在推动我国消化医学的发展和建设方面发挥着积极的作用。