Cotransplantation of marginal mass allogeneic islets with 3D culture-derived adult human skin cells improves glycemia in diabetic mice

Islet transplantation represents a therapeutic option for type 1 diabetes (T1D). Long-term viability of transplanted islets requires improvement. Mesenchymal stromal cells (MSCs) have been proposed as adjuvants for islet transplantation facilitating grafting and functionality. Stem cell aggregation provides physiological interactions between cells and enhances the in situ concentration of modulators of inflammation and immunity. We established a hanging-drop culture of adult human skin fibroblast-like cells as spheroids, and skin spheroid-derived cells (SphCs) were characterized. We assessed the potential of SphCs in improving islet functionality by cotransplantation with a marginal mass of allogeneic islets in an experimental diabetic mouse model and characterized the secretome of SphCs by mass spectrometry-based proteomics. SphCs were characterized as multipotent progenitors and their coculture with anti-CD3 stimulated mouse splenocytes decreased CD4+ T cell proliferation with skewed cytokine secretion through an increase in the Th2/Th1 ratio profile. SphCs-conditioned media attenuated apoptosis of islets induced by cytokine challenge in vitro and importantly, intratesticular SphCs administration did not show tumorigenicity in immune-deficient mice. Moreover, SphCs improved glycemic control when cotransplanted with a marginal mass of allogeneic islets in a diabetic mouse model without pharmacological immunosuppression. SphCs' protein secretome differed from its paired skin fibroblast-like counterpart in containing 70% of up- and downregulated proteins and biological processes that overall positively influenced islets such as cytoprotection, cellular stress, metabolism, and survival. In summary, SphCs improved the performance of transplanted allogeneic islets in an experimental T1D model, without pharmacological immunosuppression. Future research is warranted to identify SphCs-secreted factors responsible for islets' endurance.

Use of sail excision in Alar Morphology modification of asian noses

@#Globular hanging nasal alae, described as convex round shaped alar lobule which may be an aesthetic nuisance in the final result of rhinoplasty, are commonly seen among Southeast Asian noses. Such alar lobule morphology is an important part of nasal aesthetics and should not be disregarded. Surgical techniques used to address a hanging ala include direct external approaches. External rim excision was proposed to address hidden columella, sigmoid alae, small nostrils, dropped rim and foreshortened nose.1,2 Rim tissue was excised in full thickness fashion and sutured in one layer. Others proposed alar groove excision followed by alar repositioning and full-thickness skin grafting to reposition the alar base and correct hanging alae.3 Although these approaches have been proven to correct hanging alae, they leave a visible scar and/or permanent alar rim deformity if not done cautiously, especially on thick skinned patients.1-3 The alar rim may not be natural looking since it is lined by a scar, thus losing the lobular texture of the rim. A vestibular incision has been proposed to correct a hanging ala with unsightly scar.4 A maximum of 3mm elliptical vestibular skin was recommended to be removed to lift the alar rim with significant results. However, this recommendation was based on estimates and surgeon’s experience in western noses and may be insufficient for Asian noses. In addition, performing this technique without specific landmarks is difficult in achieving accurate results, especially when performed by a novice surgeon. Hence, further modification is important to address these concerns. Attempting to address the hanging alae in Asian noses, the senior author (ECY) modified the vestibular incision and came up with the sail excision technique based on the patient’s nasal anatomy.5 By presenting definite landmarks, the technique resulted in an alar lift procedure with reproducible outcomes. Furthermore, after performing sail excision in several patients, the authors noted the effect of this technique on alar morphology. This procedure is done by excising a precisely marked piece of inner nasal vestibular skin that is shaped like the sail of a boat to achieve a symmetrical and redictable result. This creates a lifting effect and improves the alar columellar disproportion specially when combined with septal advancement techniques.6,7 Furthermore, limiting the excision along the inner vestibular area and rolling the alar rim skin inwards results in correction of hanging ala (with a hidden scar) without an obvious, external scar. After performing the technique on several patients, we observed that in addition to its effect on lifting a hanging ala, the sail excision technique also changes the alar morphology from a globular-shaped lobule to a more aesthetically pleasing ridge-shaped lobule. To the best of our knowledge, such an effect of sail excision on alar morphology has not been described in the literature. This article aims to demonstrate the effect of the sail excision technique on alar rim morphology of Asian noses by describing the step-by-step procedure, surgical landmarks, and pearls in performing this technique.

Suicidios en el Perú: Descripción epidemiológica a través del Sistema Informático Nacional de Defunciones (SINADEF) en el periodo 2017-2021 / Suicides in Perú: Epidemiological description through SINADEF in the period 2017-2021

RESUMEN Objetivo: Descripción de características epidemiológicas de suicidios ocurridos en el Perú durante el periodo 2017-2021. Material y Métodos: Estudio de tipo descriptivo-comparativo, basado en la revisión del Sistema Informático Nacional de Defunciones entre los años 2017-2021; la muestra final incluyó un total de 2579 suicidios. Resultados: El 69,5% de los suicidios ocurrieron en el género masculino, el promedio de edad fue 34,87 años, 79,5% solteros y 26,6% con instrucción secundaria completa. Los departamentos con mayor frecuencia de suicidio fueron Lima (20,3%), Arequipa (19,2%), Cusco (9,5%) y Junín (7,8%). Según CIE-10 la causa principal de muerte fue edema cerebral (20,06%) y el domicilio, el lugar más frecuente (63,4%). Las modalidades utilizadas fueron ahorcamiento (56,6%), envenenamiento (29,2%), arma de fuego (4,0%), precipitación (3,1%) y arma blanca (1,7%). Se pudo establecer diferencias significativas con un p < 0,05 entre tipo de suicidio y género, identificando un 74% de casos por ahorcamiento en el sexo masculino; entre tipo de suicidio y región natural: 60% de ahorcamientos en la costa; entre rango etario y tipo de suicidio: ahorcamiento 10-19 años (27,7%) y envenenamiento 20-29 años (26,5%), La mayoría (70,7%) cometió suicidio por ahorcamiento en su domicilio, seguida por envenenamiento en establecimientos de salud (56,9%) y por precipitación en la vía pública (16,8%). Conclusiones: El tipo más frecuente de suicidio fue por ahorcamiento, en personas jóvenes-adultas de sexo masculino y por envenenamiento en personas de sexo femenino.

SUMMARY Objectives: Description of epidemiological features of suicides in Peru between the years 2017-2021. Material and Methods: Descriptive-comparative study based on the review of the national computerized registry of SINADEF deaths between the years 2017-2021; the final sample included a total of 2579 suicides. Results: Male gender reached 69.5%, average age 34.87 years, 79.5% were single, and 26.6% had complete secondary education. The departments with highest frequency of suicides were Lima (20.3%), Arequipa (19.2%), Cusco (9.5%) and Junín (7.8%). According to ICD-10, the main cause of death was cerebral edema (22.71%), and place of death at home (63.4%). Suicide modalities included hanging (56.6%), poisoning (29.2%), firearm (4%), precipitation (3.1%), and knife (1.7%). It was possible to establish significant differences with a p<0.05 value in: type of suicide and gender, 74% of hangings among males; type of suicide and natural region: hanging in the coast (60%); type of suicide and age range: hanging 10-19 years (27.7%) and poisoning 20-29 years (26.5%). A majority (70.7%) died at home by hanging, followed by poisoning in health facilities (56.9%), and by precipitation (16.8%) on public roads. Conclusions: The most frequent type of suicide was by hanging in young-adult males, and poisoning among females.

Análisis comparativo de casos de suicidio por ahorcadura, precipitación e intoxicación atendidos en la Morgue Judicial en la provincia de Ancón, Panamá de marzo del 2019 a febrero de 2020 y marzo del 2020 a febrero de 2021 / Comparative analysis of suicide by hanging, precipitation and intoxication cases attended at the Judicial Morgue in the province of Ancón, Panama from March 2019 to February 2020 and March 2020 to February 2021

Resumen Introducción: La crisis por la Covid-19, en muchas maneras, podría exacerbar ciertas dimensiones del proceso suicida a través de su impacto psicológico, social, económico o, incluso, biológico. El estudio comparará los casos de suicidio por ahorcadura, precipitación e intoxicación atendidos en la morgue judicial de la provincia de Panamá, entre marzo del 2019 a febrero del 2020 y marzo del 2020 a febrero del 2021. Material y métodos: Se trata de un estudio descriptivo, transversal y retrospectivo; cuya población de análisis comprende todas las autopsias médico-legales realizadas en la Morgue Judicial de Panamá por casos de ahorcadura, precipitación e intoxicación, de marzo del 2019 a febrero del 2021. Resultados: En el estudio se registró un total de 117 casos. De estos, 73 practicados de marzo del 2019 a febrero del 2020, de los cuales el 78 % (n=57) correspondió al sexo masculino, con una media de 41 años, y el 22 % (n=16) al sexo femenino, con una media de 36 años; mientras que, en el lapso de marzo del 2020 a febrero del 2021 la muestra fue de 44 casos, lo que representó el 93 % (n=41), de sexo masculino, con una media de 42 años y el 7 % (n=3) de sexo femenino, con una media de 47 años. Conclusión: Durante el año posterior al inicio de la pandemia y la aplicación de las medidas de cuarentena en la provincia de Panamá hubo una disminución de la frecuencia de los casos de suicidios por ahorcadura e intoxicación en comparación con el año previo y un aumento en cuanto a los casos por precipitación.

Abstract Introduction: The Covid-19 crisis in many ways could exacerbate certain dimensions of the suicidal process through its psychological, social, economic or even biological impact. In this study we will compare the cases of suicide by hanging, precipitation and intoxication carried out in the Judicial Morgue of Ancon from March 2019 to February 2020 and from March 2020 to February 2021. Materials and methods: This is a descriptive, cross-sectional and retrospective study; the population studied will be all the medicolegal autopsies performed in the Judicial Morgue of Panama, due to hanging, precipitation and intoxication in the period from March 2019 to February 2021. Results: A total of 117 cases were recorded in this period studied; 73 cases from March 2019 to February 2020 of which 78% (n=57) corresponded to the male sex, with an average of 41 years and 22% (n=16) to the female sex, with an average of 36; while, in the period from March 2020 to February 2021, of the sample of 44 cases 93% (n=41) corresponded to the male sex, with an average of 42 and 7% (n=3) to the female sex, with an average of 47 years. Conclusión: During the year after the beginning of the pandemic and the quarantine measures in the Province of Panama, there was a decrease in the frequency of suicide cases by hanging, precipitation and intoxication compared to the previous year.

Lesiones laringotraqueales por ahorcamiento fallido / Laryngotracheal lesions by near-hanging

Introducción: La lesión por ahorcamiento se inscribe dentro del traumatismo cerrado de la tráquea cervical. Objetivo: Presentar seis enfermos tratados por secuelas de un intento fallido de ahorcamiento y revisión la literatura sobre los métodos diagnósticos y terapéuticos. Métodos: Se realizó un estudio descriptivo de seis pacientes tratados entre 1989 y 2011 en el Hospital "Hermanos Ameijeiras". Todos fueron remitidos de diferentes hospitales, con una traqueostomía para el control de la vía respiratoria. Las variables estudiadas fueron: sexo, edad, diagnóstico definitivo, técnicas quirúrgicas empleadas, evolución posoperatoria, complicaciones y mortalidad. Resultados: Todos los pacientes fueron del sexo masculino, con edad entre 16 y 66 años (mediana 28,5). Cuatro tenían menos de 30 años, uno 38 y el último 66. El diagnóstico se hizo mediante traqueoscopia flexible y tomografía axial computarizada. La lesión se localizó en subglotis (2) y tráquea (4). Dos pacientes fueron operados antes de la remisión: resección traqueal (1) y laringotraqueal (1). El tratamiento definitivo, en nuestro centro, consistió en resección traqueal (4) y subglótica (2). No se presentaron complicaciones ni fallecidos. Durante el seguimiento postoperatorio (7 a 26 meses), cinco lesionados tuvieron resultados excelentes y uno satisfactorio, asociado con voz débil. Conclusiones: El traumatismo traqueal por ahorcamiento fallido es muy raro. El tratamiento oportuno y adecuado puede reducir las complicaciones y la mortalidad. Un equipo quirúrgico con experiencia puede lograr resultados satisfactorios en un grupo importante de lesionados. La traqueostomía, con anestesia local, es el método de elección para controlar la VR en pacientes con traumatismo cervical(AU)

Introduction: The hanging injury is considered a closed trauma of the cervical trachea. Objective: To present the cases of six patients treated for sequelae after failed hanging attempt, and to review the literature about diagnostic and therapeutic methods. Methods: A descriptive study was carried out of six consecutive patients treated between 1989 and 2011 at Hermanos Ameijeiras Hospital. All were referred from different hospitals, with a tracheostomy for controlling the airway. The variables studied were sex, age, definitive diagnosis, surgical techniques used, postoperative evolution, complications and mortality. Results: All patients were male, aged between 16 and 66 years (median: 28.5). Four were less than 30 years old; one, 38; and the last, 66. The diagnosis was made by flexible tracheoscopy and computerized axial tomography. The injury was located in the subglottis (2) and the trachea (4). Two patients were operated on before referral, through tracheal (1) and laryngotracheal (1) resection. Definitive treatment in our center consisted of tracheal (4) and subglottic (2) resection. There were no complications or deaths. During the postoperative follow-up (7-26 months), five injured patients had excellent outcomes and one had satisfactory outcomes, associated with a weak voice. Conclusions: Tracheal trauma after failed hanging is very rare. Timely and appropriate managment can reduce complications and mortality. An experienced surgical team can achieve satisfactory outcomes in a large group of injured people. Tracheostomy, under local anesthesia, is the method of choice for controlling the airways in patients with cervical trauma(AU)

Preparation of personalized traditional Chinese medicine condensed water pill without excipients based on correlation between concentrate viscosity and molding quality / 中国中药杂志

To explore the correlation between concentrate viscosity and molding quality of personalized traditional Chinese medicine(TCM) condensed water pill, this study established a concentrate viscosity characterization method with rotational rheometry. Seven model prescriptions were respectively concentrated to different degrees and the viscosity of each concentrate was determined. The pre-sence of 'viscosity jump' in the middle stage of 'flag hanging' of all the model prescriptions implied that there might be an ideal viscosity range in the preparation of condensed water pill. The further study of 22 model prescriptions demonstrated that the optimum viscosity range of concentrate was 5-15 Pa·s(25 ℃) for approximately 82% of the prescriptions. About 18% of the prescriptions had a wide range, which might be caused by the high proportions of mineral and crustacean drugs in the crushing part and sugar and fibrous drugs in the decocting part. This study clarified the optimum viscosity range for concentrates of personalized TCM condensed water pills and achieved a preparation technology without any excipient, laying a foundation for the on-line control of the preparation.

Epidemiological characteristics of acute dehydrating diarrhea during an epidemic of cholera: a study from North India

Background: Cholera is an acute diarrheal disease which continues to be a public health problem since inception. It is a disease related to poverty, overcrowding, poor sanitation and inaccessibility to clean water. India forms a fertile ground for the sustenance and transmission of cholera. However the diagnosis of cholera doesn’t easily come to mind when dealing with cases of dehydrating diarrheas.Methods The study was a prospective cohort study conducted in a tertiary care center of North India. All patients presenting to the medicine department of this hospital with acute dehydrating diarrhea were enrolled for the study. Stool samples for hanging drop test and culture were sent in all patients to rule this cholera.Results: Eighty four patients presenting to the medicine department of this hospital with acute dehydrating diarrhea were included in this study. All the patients had loose watery stools but classical rice water stools were seen in only 20.2% of patients. Patients with rice water stools were more likely to be positive for stool culture (70.6%, n = 12/17) and hanging drop preparations (82.3%, n = 14/17) as compared to those with watery stools. The difference was found to be statistically significant for culture (70.6% vs 40.3%, p-value = 0.02) as well as hanging drop preparation (82.3% vs 47.8%, p-value = 0.01).Conclusions: The prevalence of culture positive cholera cases was found to be 46.4% out of all the cases presenting with acute dehydrating diarrhea which is quite high. Rice water stools which are considered characteristic for cholera were found in less than half of culture positive cases of cholera (43.6%, n = 17/39). Hanging drop preparation was found to have a sensitivity of 87.2% and a specificity of 86.5% in comparison to stool culture which is regarded as gold standard for diagnosis of cholera. Cholera may be considered as an ongoing epidemic with periodic surge in cases and should be suspected whenever cases of acute watery diarrhea present in increased numbers with features of severe dehydration, especially when the cases are clustered together and from a poor socio-economic background.

Insight into pathophysiology and management of partial hanging

Background: Many methods are available for committing suicide. Hanging is one of the methods to committee suicide. The incidence of hanging for committing suicide is increasing. This is a retrospective study carried out at KDN Gohil Hospital, Navsari (Gujarat) to know about the outcome of this type of suicidal attempts and to review the management of such type of patients. Management of this type of injury is not found in many standard textbooks, so this small study will help to compare mortality rate and management protocol with other larger studies.Methods: All patients with history of hanging and accidental strangulation were brought to hospital, after they were released from strangulating agent were included in this study. Various aspects of agents used for hanging, the characteristic findings and management protocol of the patients were studied retrospectively.Results: Results in the form of survival rate and occurrence of complications. Out of 30 patients 24 patients survived and 6 died. Non had cervical spine injury. One patient had laryngeal injury and developed laryngeal stenosis.Conclusions: Suicidal hanging is different from judicial hanging. Most of the time suicidal hanging survival are high; once the patient is brought to the hospital alive in time. Early endotracheal intubations, management of hypotension, ventilator support and anti-oedema drugs are main steps of management.

Three-dimensionalhanging-drop culture of mesenchymal stem cells in the treatment of tissue injury / 中国组织工程研究

BACKGROUND: In recent years, mesenchymal stem cells (MSCs) have been widely used in varieties of tissue repairs due to its easy accessibility, exceptional ability to proliferate, remarkable potential to multi-differentiate, and considerable effects on immunoregulation. However, cell pluripotency and secretory function are often severely impaired when the cells are cultured using the traditional two-dimensional method. Nevertheless, three-dimensionally cultured mesenchymal stem cells cannot only derive the advantages of mesenchymal stem cells per se, but maintain and potentiate cell capacity of proliferation, differentiation and secretion, which therefore enhance the ability to repair various tissue injuries. OBJECTIVE: To review the recent studies of three-dimensional cultured mesenchymal stem cells in the treatment of multiple tissue injuries via various aspects including its biological characteristics, underlying mechanisms of tissue repair, culture methods as well as the application in various diseases, in order to elucidate the possibility of its future application and provide theoretical support for the clinical application of three-dimensional mesenchymal stem cells in the future. METHODS: We retrieved the main databases including PubMed, CNKI, and WanFang for relevant literature published in recent 10 years. The keywords were “mesenchymal stem cells, three-dimensional culture, hanging-drop culture, tissue repair” both in Chinese and English. The type of the article was not limited. Finally, 51 articles were included for result analysis. RESULTS AND CONCLUSION: It has been widely demonstrated that compared with the two-dimensional cultured cells, three-dimensional cultured mesenchymal stem cells show stronger effects on cell proliferation, differentiation, paracrine secretion, and immunoregulation. With the rapid development of three-dimensional sphenoid culture system and stem cell transplantation, three-dimensional cultured mesenchymal stem cells will show its great potential in the treatment of multiple tissue injuries.

The system for directional and stable differentiation of amniotic fluid stem cells into neuron-like cells / 中国组织工程研究

BACKGROUND: Neuronal regeneration using stem cell differentiation has gained a lot of attentions from researchers. Although embryonic stem cells and induced pluripotent stem cells have good potential for neuronal differentiation, a high risk of tumor development in vivo limits the further study. OBJECTIVE: To establish a stable system for sorting, culture and neuronal differentiation of amniotic fluid stem cells, and to explore the feasibility as seed cells for neuronal regeneration. METHODS: Amniotic fluid sample (10 mL) was obtained at 19-22 weeks of pregnancy under B-ultrasound guidance, and amniotic fluid stem cells were isolated by c-Kit magnetic beads. The markers Oct-4 and Sox2 of amniotic fluid stem cells were identified by immunofluorescence. The expression levels of c-Kit, Oct-4, Sox2 and Nestin in amniotic fluid stem cells after multiple passages were detected by RT-PCR. Then, the cells were cultured by hanging drop for 4 days to observe the embryoid bodies-like structures. Amniotic fluid stem cells were induced to differentiate into neurons using two-stage method. The expression levels of Neuro D and Tuj1 were observed by immunofluorescence. RESULTS AND CONCLUSION: (1) About 1% of amniotic fluid stem cells were positive for c-Kit. (2) (75.0±4.6)% of amniotic fluid stem cells expressed Oct-4 and (86.0±2.8)% of the cells expressed Sox2. (3) The expression levels of c-Kit, Oct-4, Sox2 and Nestin detected by RT-PCR did not change with passage times. (4) Embryoid bodies-like structures formed after hanging drop culture. (5) Immunofluorescence results showed that amniotic fluid stem cells expressed neuronal marker Tuj1, but without the typical morphological features. RT-PCR detected the expression of Tuj1 in different amniotic fluid stem cell specimens as well as in the same sample after several passages. (6) Amniotic fluid stem cells could have the characteristics of neuron-like cells after induction with basic fibroblast growth factor, brain-derived neurotrophic factor, and neurotrophin factor 3 in two stages, and could express neural stem cell marker Neuro D and neuronal marker Tuj1.

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases / 法医学杂志

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

Unusual Suicide Cases of Asphyxiation by Ligature within the Vehicle / 대한법의학회지

One of the most common methods of suicide is hanging, and suicide by ligature strangulation is quite rare. Vehicles have a confined space, making them an unusual place for committing suicide by hanging or ligature strangulation, because they are more typically the location of suicide by carbon monoxide intoxication by briquette or drug intoxication. Here, we present three cases of unusual suicide by ligature strangulation, discuss the mechanism of asphyxia in each case, and review the literature. In case 1, the victim used a backpack to perform reverse hanging by wrapping the shoulder strap of the backpack around his neck and then tossing the backpack behind the backrest of the driver's seat. In case 2, the victim did not use the internal structures of the vehicle, but pulled down on a ligature wrapped around both his knees and neck. In case 3, the victim hanged himself using a package line fixed to the roof handle grab of the back passenger seat.

Trends of suicidal hanging in Western Mumbai region

Background: The present study was conducted with aims to determine various epidemiological factors of death due to hanging in the western Mumbai region and variation in types of hanging deaths.Methods: Four year study conducted at H. B. T. Medical College & cooper Hospital, Mumbai for period of January 2015 to December 2018. During study period total 6338 of medico-legal autopsies were conducted, of which 228 (3.59%) autopsies were of death due to hanging.Results: T228 out of 6338 medicolegal autopsies were of death due to hanging making incidence rate 3.59 % of hanging. Age group most commonly involved in hanging was 21-30 years constitutes 41.22% cases of hanging deaths. Male victims constitute of 59.64% cases and female victims were 40.36% cases. In 96.5% cases place of hanging was closed place inside room 3.5% cases hangings takes place in open place. Most common ligature material used for hanging was dupatta/odani constitute 46.5% cases followed by rope in 20.17% cases.Conclusions: Young age group population between 21-40 years are more susceptible victims of suicides by hanging constitute 65.78% cases. Proper parental and social guidance and support could prevent suicides in this age group. Timely counselling of such vulnerable group victims could preventable. Effective prevention strategies are needed to promote awareness of prevention of suicides in young age group.

Ahorcamiento con soga. Presentación de un caso atípico / Hanging with rope. Presentation of an atypical case

RESUMEN Las asfixias mecánicas son aquellas que resultan de un impedimento mecánico a la penetración del aire en las vías respiratorias. Suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina, y a su modo de actuar. El ahorcamiento no es más que la constricción del cuello, ejercida por un lazo sujeto a un punto fijo, sobre el cual ejerce tracción el propio peso del cuerpo. La muerte, según las circunstancias del caso, puede ocurrir por un mecanismo asfíctico, circulatorio, inhibitorio o por lesión medular (caso raro de presentación). El presente trabajo constituyó un caso atípico de ahorcamiento. El ciudadano que resultó fallecido, al dejarse caer bruscamente del balcón de su vivienda, con el dogal en el cuello (soga) y quedar pendiendo el cuerpo, ocasionó un traumatismo raquimedular severo; lo que trajo como consecuencia que se produjera una fractura de la 3ra vértebra cervical, y una contusión medular que lo llevó a la muerte de forma instantánea por el shock medular ocasionado. Para la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, y el examen del cadáver externa e internamente.

ABSTRACT Mechanical asphyxias are those resulting from a mechanical interruption of air penetration to the respiratory tract. They are usually classified according to the nature of the mechanical mean originating them and the way they perform. Hanging is no more that the neck constriction, executed by a lace attached to a fixed point, on which the proper weight of the body applies traction. Death, according to the circumstances of the case, may occur by an asphyxiating, circulatory, inhibitory mechanism or by medullar lesion (a rare case of presentation). The current work reports a case of atypical hanging. The person who died, when abruptly jumped down the balcony of his house with the rope around the neck and the body was left pending, suffered a severe spinomedullar trauma, causing a fracture of the 3rd cervical vertebra, and a medullar contusion causing an instantaneous death due to the medullar shock. To discuss the case, the authors took into account elements of the location where it took place, and the external and internal examination of the body.

Epidemiological Factors Assessment and Study on Neck Structures Injury in Hanging Deaths

Most of the hanging cases are considered as suicidal until the homicidal and accidental are proved, because both homicidal and accidental hanging are rare. In these cases a careful forensic examination plays an important role to determine the ante mortem character of the lesion and to exclude causes of hanging other than suicidal hanging. Aim: This study we carried to know the internal and external examination findings among hanging cases. Methods: Hanging deaths with external neck injuries along with ligature mark were included in this study. In this study a total of 60 cases of deaths due to hanging, was subjected to medico legal autopsy. Results: Majority of the cases were observed in the age group of 21-40 years i.e., 41 (69.4%) out of 59 hanging deaths. Out of 59 deaths, 32 (54.2%) were females and 27 (45.7%) were males. Among neck structure injuries, majority of hanging cases had rupture / contusion of sternocleidomastoid and other strap muscles of neck, it was 57.6%. 33.8% cases had carotid intimal tear, 5% cases showed hyoid bone fracture and 3.3% thyroid cartilage. No fractures noted in Cricoid cartilage and cervical vertebra. Conclusion: Social awareness, problem solving and family support of most common age group is extremely necessary

A Complex Suicide by Ligature Strangulation and Hanging Using Two Different Ligatures / 대한법의학회지

Hanging is the most common method of suicide in Malaysia. However, hanging in combination with suicidal ligature strangulation is uncommon. The victim is a 31-year-old man, with no previous medical or psychiatric disorders. He accomplished self-strangulation using a shoelace and hanging himself with a High-Definition Multimedia Interface cable. Three loops of a shoelace ligature were present around the neck. A single knot was present on the front, and a double knot at the back of the neck. Internal examination of the neck revealed small bilateral hemorrhages of the sternocleidomastoid muscles. No laryngeal cartilage or hyoid bone fractures were observed. No other evidence of injury was noted other than moderate pulmonary edema. The post-mortem toxicology results were negative. The cause of death was ascertained as neck compression due to ligatures. Scene assessment and post-mortem findings concur with suicide. This report describes an unusual case of suicidal ligature strangulation, in combination with hanging using two different ligatures.

Pattern Of Medicolegal Autopsy At Kamrup, Assam: A Retrospective Study

This retrospective study was conducted over 620 death victims brought to the mortuary of Gauhati Medical College in the district of st th Kamrup,Assam during the period from 1 December 2013 to 28 February 2014, to know the pattern, trend, causes and other aspects relating to death. The highest incidence, of death occurred in road traffic incidents, followed by hanging. The male and female ratios were 3:1. The urban victims outnumbered the rural with a ratio of 1.7:1 Avery few cases (3.99%) opined as a negative autopsies. The age group, 21-30 years topped the list of involved cases in all section followed by 30- 40 years. Head injury was the single most common injury that ultimately led to coma resulting in death in RTA section. Based on the outcome from this study, preventive measures can be formulated for better management of the cases and homogenous social sustenance, etc. However a thorough multi-disciplinary study is much needed, relating to each section for an excellent outcome.

Predictors of functional outcome after hanging injury / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases.</p><p><b>METHODS</b>All patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test.</p><p><b>RESULTS</b>Glasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome.</p><p><b>CONCLUSION</b>GCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.</p>

Incidence of Suicide by Hanging in Klang Valley from 2007 to 2016 / Jurnal Sains Kesihatan Malaysia

@#Malaysia was ranked at 148 by World Health Organization (WHO) in suicide statistic for 2012, where males had a highertendency to commit suicide, recording a 4.7 per 100,000 in comparison to female (1.5 per 100,000). As hanging is one ofthe most common methods to commit suicide, this retrospective study was conducted to observe the incidence of suicideby hanging in Klang Valley from four different hospitals. The current study is conducted to provide local database ofsuicide occurrence by hanging in Klang Valley. A total of 893 suicide cases by hanging from 2007 to 2016 were recordedfrom post mortem records and analysed. Suicide rates in Klang Valley showed a rising trend from 2007 to 2016. Malesfrom age group 30 to 34 years old and females from 20 to 24 years old have the highest number of suicide fatalitiescompared to other age groups. Meanwhile, fatalities from the age group of 10 to 14 years old and 80 years old and aboveshowed similar result which is only 7%. 78% of the fatalities were recognized as Malaysian and half of them were Indian.Majority of the victims/cases (45%) who committed suicide by hanging are of Hindu religious denomination. Non-citizenin Malaysia that have the highest suicide rates were from Nepal, Indonesia and Myanmar. Victims also committed suicidemore during the day and the peak hours being at 12.00 pm to 5.59 pm.