ABSTRACT
To determine the diagnostic bias between clinical and forensic radiology in cases of nonfatal hanging and determine and describe typical underreported imaging findings. In a retrospective, single-center study, all patients admitted for attempted suicide with near-hanging or fatal hanging between January 2008 and December 2020 who received CT or MRI of head and neck were reviewed and missed findings in the original report were documented. A binary regression with disagreement as dependent variable was fitted for the imaging modality, fatality, age, and sex. A total of 123 hanging incidents were retrospectively analyzed. The vast majority (n = 108; 87.8%) had attempted suicide with a nonfatal outcome. Fatal outcome occurred in 15 (12.0%). The extra- and intracranial injuries documented on CT and MRI scans were laryngeal (n = 8; 6.5%), soft tissue (n = 42; 34.1%), and vascular injuries (n = 1; 0.8%). Intracranial pathology was evident on 18 (14.6%) scans. Disagreement occurred in 36 (29.3%) cases and represented 52 (69.2%) of all cases with a radiological finding. Disagreement was strongly associated with fatality (OR: 2.7-44.9.4, p = 0.0012). In most cases, nonfatal hangings cause no or only minor injuries. Fatal cases are associated with a greater probability of missed minor imaging findings. This suggests that findings deemed clinically irrelevant are probably not reported in such severe emergency cases. This association indicates that minor abnormalities are underreported when major pathologies are evident on imaging in victims of strangulation.
ABSTRACT
Both brain-derived neurotrophic factor (BDNF) and the serotonin receptor 2A (5-HT(2A)) have been related to depression pathology. Specific 5-HT(2A) receptor changes seen in BDNF conditional mutant mice suggest that BDNF regulates the 5-HT(2A) receptor level. Here we show a direct effect of BDNF on 5-HT(2A) receptor protein levels in primary hippocampal neuronal and mature hippocampal organotypic cultures exposed to different BDNF concentrations for either 1, 3, 5 or 7 days. In vivo effects of BDNF on hippocampal 5-HT(2A) receptor levels were further corroborated in (BDNF +/-) mice with reduced BDNF levels. In primary neuronal cultures, 7 days exposure to 25 and 50ng/mL BDNF resulted in downregulation of 5-HT(2A), but not of 5-HT(1A), receptor protein levels. The BDNF-associated downregulation of 5-HT(2A) receptor levels was also observed in mature hippocampal organotypic cultures, excluding confounding effects of BDNF on immature tissue. BDNF +/- mice showed significant increased 5-HT(2A) receptor levels in hippocampus confirming the association between 5-HT(2A) receptor and BDNF levels in vivo. In conclusion, our results point to a regulatory role of BDNF on 5-HT2A receptor levels. This interaction may be an important mechanism in the role of BDNF in affective disorders emphasizing the need for further elucidating the specificity and the mechanism behind this regulation.
