A case of complete decapitation in suicidal hanging : the mechanism and condition of decapitation.

Complete decapitation due to suicide by hanging is rare. We report the case of a decapitated man who was found in the sea near an estuary. A polyethylene rope was tied to the handrail of the bridge across a strait near the site of the body. The rope was 12 mm in diameter and 19 m in length from the handrail. It ended with a slip knot noose, and skin and mustache-like hair fragments were attached to it. The decapitated head was not found. The deceased weighed 82 kg and was 152 cm long without the head. The autopsy revealed coarse abrasions and intramuscular hemorrhage around the severed edge. The third cervical spine was not fractured. We reviewed the literature and suggested the conditions of body weight, fall height, rope diameter, and number of rolls in cases of decapitation by hanging. We calculated the hanging decapitation index (HDI) as the fall height (m) multiplied by the body weight (kg), divided by the rope diameter (mm), divided by the number of rolls ; and discussed the differences between complete and incomplete decapitation cases. J. Med. Invest. 70 : 290-293, February, 2023.

A case of fatal multi-organ inflammation following COVID-19 vaccination.

A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. Autopsy findings showed congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. Since there was no preceding infection, allergy, or drug toxicity exposure, the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis. Although neither type of inflammation is fatal by itself, arrhythmia is reported to be the most common cause of death in patients with atrial myopericarditis. In the present case, arrhythmia of atrial origin was assumed as the cause of cardiac failure and death. In sudden post-vaccination deaths, aggressive autopsy systemic search and histological examination involving extensive sectioning of the heart, including the atrium, are indispensable.

Determining falling patterns by estimation of horizontal distance and height.

Whether by accident or foul play virtually thousands of fall-related fatalities occur each year. While a number of past studies addressed the relationship between falls, injury, and death, only a small fraction sought to establish an objective index geared specifically towards determining the cause of a particular fall. The primary objective in the present study was to determine the range of attainable horizontal distances in various forms of active and passive falling patterns. The secondary objective involved the capturing of physical motions at the point of impact via 3D motion analyses in order to identify the defining physical characteristics of a particular form of fall. The introduction of live test subjects to these series of experiments added the advent of fear and other psychological factors to the study which are crucial in simulating real-life cases. To corroborate this point, five subjects (three male and two female) expressed their wishes to withdraw from the study, attributing their decision to feeling an inherent danger and fear of the physical aspects of the present study. The ten subjects were made to fall from a height of 3.65 m under 13 conditions of various natures. Footage of the subjects falling was captured on two high-speed video cameras which markedly improved the calculation of 3D coordinates along the subjects' flight path. After extensive calculations, we were successful in determining the maximum attainable horizontal distances in passive falling patterns. Additionally, we found that force applied to the abdominal area results in shorter horizontal distances in comparison to falls where force is directly applied to the posterior side of the body.

[Resident training program of coroner's office and trauma quality assurance in Los Angeles County, California, USA].

The author attended a practical training program at the Los Angeles County Coroner's Office for 2 weeks in June 2008. The systems of investigating the cause of death in the USA are not unified because every state has its own laws and systems, with Los Angeles County having a mixed system of Coroner and Medical Examiner. This report is presented to introduce the training course for medical residents at the Institute of LA. To begin, a tour through the office was provided. All residents then underwent a mask-fit-test in order to prevent infections. A conference to present cases for the day was held each morning, as well as lectures once or twice per week. The whole staff instructed the trainees with care, not only in the Institute but also at the death scene and the court. Additionally, the author also attended the LAC + USC Medical Center Combined Trauma Death Review Committee as an observer. This committee is very important for trauma quality assurance. The report of the coroner's autopsy is handed to the committee and the chairperson, a coroner, assesses the results of the emergency medical treatment. This greatly improves the quality of emergency medicine and reduces the number of preventable deaths.

Influence on the suicide rate two years after a devastating disaster: a report from the 1995 Great Hanshin-Awaji Earthquake.

AIMS: The relationship between suicide and disaster is an important problem but it's not clear. We conducted this study to determine whether a natural disaster affects suicide rates. METHODS: We collected data on suicides during the 84 months before and the 60 months after the earthquake and compared the suicide rate in Kobe to that in Japan as a whole. We also examined what groups were significantly affected. RESULTS: Compared with Japan as a whole, the suicide rates in Kobe significantly decreased in the 2 years after the earthquake. CONCLUSIONS: An influence on suicide rate after the disaster clearly appeared in middle-aged men.

Lipid hydroperoxides in human plasma after ethanol consumption.

Oxidative stress contributes to the pathogenesis of alcoholic liver disease. The purpose of this study is to estimate the amount of oxidative stress that is present when healthy humans consume moderate amounts of ethanol. Blood was collected from healthy volunteers before, 1 h, and 3 h after drinking 400 ml of Japanese rice wine at the rate of 100 ml per 5 min. The aldehyde dehydrogenase 2 genotype and the concentrations of blood ethanol, total lipid hydroperoxides (LOOH), and cholesterol hydroperoxides were determined. The plasma LOOH was found to have significantly increased 1h after drinking. Cholesterol hydroperoxides were not detected in plasma, either before or after drinking. There was no relationship between the LOOH and the ethanol concentration. We showed that one-shot of moderate ethanol consumption temporarily increases the plasma LOOH in healthy volunteers but excessive plasma LOOH compounds were eliminated within a short time.

Suicide by a circular saw.

The case of a suicide of a 32-year-old female using an electric circular saw is herein described. The decedent was suffering from depression and was found dead in her room. Beside her right hand was lying a circular saw, which was not running. The autopsy revealed a large gaping wound measuring 15.5 cm in length on the right side of her neck. The right external carotid artery, the right internal jugular vein, and the right internal carotid artery were cut and the injury reached to the cervical vertebra. Therefore, the cause of death was exsanguination. An individual who commits suicide with an electric saw, such as a chain saw, band saw, and circular saw is rare; in particular females rarely select this method as the means of suicide. However, we herein report the case of a female patient with a psychiatric disease who successfully committed suicide with a circular saw.

Association of alpha2A-adrenergic receptor gene polymorphism with susceptibility to suicide in Japanese females.

OBJECTIVES: It has been suggested that noradrenergic system abnormalities are involved in suicide. Postmortem brain studies have shown that molecular and functional alterations in alpha2A-adrenergic receptor-induced signal transduction are associated with suicide and depression. Recently, a single nucleotide polymorphism (SNP) within a coding region of the alpha2A-adrenergic receptor gene (ADRA2A), which results in an Asn-to-Lys change at amino acid 251 (N251K), has been implicated in susceptibility to suicide in Caucasians. The aim of our study is to determine whether genetic variants of the ADRA2A gene are also associated with suicide in a Japanese population. METHODS: Three SNPs, C-1291G, N251K and rs3750625C/A, and one insertion/deletion polymorphism in the ADRA2A gene were genotyped in 184 completed suicides and 221 control subjects with the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: Neither variation of the N251K SNP nor the insertion/deletion polymorphism was found in our Japanese samples. The C-1291G SNP in the promoter region was found to be significantly associated with suicide in females (P=0.043 and 0.013 for genotypic and allelic comparisons, respectively). One of the common haplotypes, CC of C-1291G and rs3750625C/A, was also associated with suicide in females (P=0.015). These associations were also significant in the female violent suicide victims (P=0.009 and 0.009 for allelic and CC haplotypic comparisons, respectively). Although the significance was nominal, it was maintained even after correction for multiple comparisons. By contrast, neither of these two SNPs showed any association with violent and/or non-violent suicide in males. CONCLUSION: Our results raise the possibility that promoter genetic variation in the ADRA2A gene is associated with either suicide or violent suicide in females.

Rupture of a jejunal artery aneurysm.

Aneurysm of the superior mesenteric artery or its branches is rare. We herein present a case of a ruptured aneurysm of the jejunal artery, a branch of the superior mesenteric artery, and we also review 19 cases of jejunal artery aneurysm reported in the English literature. A 66-year-old male who had received a fist blow to the face presented in the emergency ward of his local hospital. His physical examination was unremarkable and he went back home after treatment of his facial wound. Two hours later he again visited the hospital, this time for severe abdominal pain, and he was hospitalized for suspicion of an intraperitoneal hemorrhage. Selective arteriography of the superior mesenteric artery revealed a ruptured aneurysm in the first branch of the jejunal artery. An emergency laparotomy was performed, but the patient died 29h after the injury. Because there was no evidence of any trauma to the abdomen, we concluded that the cause of death was exsanguination due to a ruptured aneurysm, and was not directly related to the earlier trauma. This case is considered to be of medico-legal interest regarding whether the rupture resulted from a natural disease or was due to an assault.

Adipocere formation via hydrogenation of linoleic acid in a victim kept under dry concealment.

Adipocere formation is well known as a later post-mortem change. We experienced a female victim who had been sealed up in a clothes box for approximately 4 years. We collected several subcutaneous fats as well as visceral fats from the victim to investigate adipocere formation. Fresh subcutaneous fats of one female and five male victims who suddenly died were used as the control. These samples were homogenized and the lipids were extracted with chloroform and methanol followed by injection into gas chromatography-mass spectrometry and gas chromatography. We detected a hydroxy fatty acid in the fat of the case, but not in the controls. Using standard synthetic hydroxy fatty acid, the lipid extract component was identified as 10-hydroxyoctadecanoic acid (10-OH 18:0) and this concentration was quantified. Consequently we confirmed that adipocere was formed much slowly in dry concealment. In addition, the fatty acid composition was compared with the control. Most of the linoleic acid (18:2) disappeared and a peak developed instead. Using standard synthetic fatty acid, this peak was identified as cis-12-octadecenoic acid (cis-12-18:1). This suggests that linoleic acid is hydrogenated to cis-12-octadecenoic acid in the process of adipocere formation.

Association of RGS2 gene polymorphisms with suicide and increased RGS2 immunoreactivity in the postmortem brain of suicide victims.

Regulators of G-protein signaling are a family of proteins that negatively regulate the intracellular signaling of G protein-coupled receptors, such as the serotonin receptor. Recent studies have suggested that one of these proteins, the regulator of G-protein signaling 2 (RGS2), plays an important part in anxiety and/or aggressive behavior. To explore the involvement of the RGS2 gene in the vulnerability to suicide, we screened Japanese suicide victims for sequence variations in the RGS2 gene and carried out an association study of RGS2 gene polymorphisms with suicide victims. In the eight identified polymorphisms that were identified by mutation screening, we genotyped four common single-nucleotide polymorphisms (SNPs) in the RGS2 gene, and found significant differences in the distribution of the SNP3 (C+2971G, rs4606) genotypes and alleles of the SNP2 (C-395G, rs2746072) and the SNP3 between completed suicides and the controls. The distribution of the haplotype was also significantly different between the two groups (global p<0.0001). Furthermore, RGS2 immunoreactivity significantly increased in the amygdala and the prefrontal cortex (Brodmann area 9 (BA9)) of the postmortem brain of the suicide subjects. These findings suggest that RGS2 is genetically involved in the biological susceptibility to suicide in the Japanese population.

Lack of association between endoplasmic reticulum stress response genes and suicidal victims.

As lithium has been shown to have a protective effect against suicidal behavior, genes on which mood stabilizers act may be involved in biological susceptibility to suicide. A recent study showed that endoplasmic reticulum (ER) stress response was impaired in the bipolar disorders and the impairment was ameliorated by a mood stabilizer, valproate. We hypothesized that an alteration of ER stress response is involved in the biological susceptibility to suicide through genetic polymorphisms, and examined the association of polymorphisms of X-box binding protein 1 (XBP1) and heat shock 70-kDa protein 5 (HSPA5) genes with suicide. We found no significant difference in the distribution of these polymorphisms between the suicide victims and the controls. These results suggest that the polymorphisms examined in this study are not involved in the susceptibility to suicide of the Japanese.

Analysis of phosphatidylcholine oxidation products in human plasma using quadrupole time-of-flight mass spectrometry.

We report here an application of the previous method for the analysis of phosphatidylcholine (PC) and lysophosphatidylcholine (lysoPC) oxidation products in human plasma using quadrupole time of flight (Q-TOF) mass spectrometry with electrospray ionization. We separated these products using an HPLC C8 column with a gradient of methanol and 10 mM aqueous ammonium acetate. Monohydroperoxides, epoxyhydroxy derivatives, oxo derivatives, and trihydroxides of palmitoyl-linoleoyl (C16:0/C18:2) PC and stearoyl-linoleoyl (C18:0/C18:2) PC were detected mainly as MH+ and [M+Na]+ ions in the plasma of alcoholic patients. Using standard synthetic PC-OH (C16:0/C18:2-OH), the lipid extract component was identified as (C16:0/C18:2-OH) PC based on the product ions of ESI-MS-MS. Using standard synthetic PCOOH (C16:0/C18:2-OOH) as a reference, the PCOOH concentration in plasma was quantified. Two oxidatively modified lysoPCs were also detected. This is the first report showing the presence of epoxyhydroxy derivatives, monohydroperoxides, oxo derivatives, and trihydroxides of (C16:0/C18:2) PC and (C18:0/C18:2) PC, and PC-OH (C16:0/C18:0-OH) in human plasma.

Differences in characteristics between suicide victims who left notes or not.

BACKGROUND: Suicide notes (SN) are one of markers of the severity of a suicide attempt and are said to provide a valuable insight into the thinking of suicide victims before the fatal act [Shah, A., De, T., 1998. Suicide and the elderly. Int. J. Psychiat. Clin Pract. 2, 3-18]. To examine whether suicide victims who wrote notes (note writers: NW) differ from those who did not, we investigated the characteristics of a sample of more than 5000 Japanese suicides using multiple logistic regression analysis. METHODS: For all suicide victims (5161 cases), we examined the following information: gender, age, suicide method, reason for suicide, marital status, residential status, history of psychiatric disorders, previous suicidal behavior, physical disease, and content of suicide notes. RESULTS: Mean incidence of NW was 30.1% (male: 29.7%, female: 30.8%). NW in Japan had the following characteristics; higher proportion in female and living alone, suicide by more lethal methods such as carbon monoxide, hanging or sharp instruments. On the other hand, non-NW had tendencies to commit suicide for reasons of physical illness and psychiatric disorder, and/or history of previous psychiatric disorders. LIMITATIONS: This study is observational and discusses only completed, not attempted, suicide. Medical and psychiatric comorbidity are judged only by the history of diagnosis and the information about the problems in relationships is based not on valid criteria for inclusion. CONCLUSIONS: Although these findings show ethnic differences, it is possible that SN may be considered an indicator of a serious suicide attempt. Further studies of SN are needed to confirm this.

No evidence of an association between tyrosine hydroxylase gene polymorphisms and suicide victims.

Functional alternations of noradrenergic and dopaminergic neurotransmission have been implicated in suicidal behavior. A tetranucleotide repeat polymorphism in the first intron of the tyrosine hydroxylase (TH) gene, encoding a rate-limiting enzyme for the synthesis of catecholamines, is reported to have the potential to control expression of the gene and to be associated with suicidal behavior in patients with adjustment disorders. To test the hypothesis that TH gene polymorphisms are involved in suicide through an alteration of TH function, this tetranucleotide repeat polymorphism and the other two SNPs that cause a change in amino acid sequence were examined in suicide victims who completed suicide and control subjects. No significant differences in genotype distribution or allele frequencies were found between the two groups in the three polymorphisms. These findings suggest that these functional polymorphisms are not involved in a biological susceptibility to suicide.

Lack of an association between 5-HT receptor gene polymorphisms and suicide victims.

An association between serotonergic dysfunction in the brain and suicidal behavior has previously been suggested. The high affinity of some antipsychotic and antidepressant drugs to serotonin 6 (5-HT6) receptors, and the predominant localization of 5-HT6 receptors in some limbic regions, suggest that 5-HT6 receptors play a role in the pathogenesis of suicide. The objective of the present study was to examine the association between suicide victims and two polymorphisms of the 5-HT6 receptor gene: a biallelic polymorphism (267C/T) in exon 1 and a trinucleotide repeat polymorphism ([GCC](2/3)) in the 5'-upstream region of the gene. The two polymorphisms were genotyped in 163 suicide victims and 166 controls, and the distribution of genotype and allele frequencies between the two groups were compared. Haplotype frequencies of these two polymorphisms were estimated from genotypic data by the maximum-likelihood method. In both polymorphisms, there were no significant differences in genotype or allele frequencies between the suicide victims and the controls. Moreover, there were no significant differences in the haplotype distributions of these polymorphisms between the two groups. These findings suggest that it is unlikely that the 5-HT6 receptor gene is involved in the susceptibility to suicide.

Incidence of note-leaving remains constant despite increasing suicide rates.

Suicide notes (SN) are potentially valuable sources of information about the psychological states of the suicidal person. It was hypothesized that there was a significant relation between suicide rate and note-leaving rate and that the incidence of note-leaving was increased during prolonged economic recession. During 21 years (1981-2001) in Kobe, of a total of 18 558 violent deaths, 5161 were due to suicide (27.8%), with 3417 male cases (66.2%) and 1754 female cases (33.8%). For each year the annual suicide rates and note-leaving rates were calculated, and this represents the percentage of committed suicides in which SN were left, among all suicide victims. In spite of the prolonged economic slump, the note-leaving rate remained almost constant (23.4-36.2%). Pearson's correlation coefficient showed no significant correlation between suicide rate and note-leaving rates (r = 0.27, P = 0.23). The finding that the incidence of note-leaving remains constant despite increasing suicide rates may suggest that the reasons for suicide do not affect note-leaving. There are cross-cultural, ethnic, and racial variations in suicidal behaviors. Although this finding may be specific in Japan, further studies of SN are needed to help clarify the suicidal states of mind.