Pentobarbital overdose: A case of contract killing.

Suicides by pentobarbital overdose have increased since about 2012, which appear to be influenced by technical information on active euthanasia that has spread over the Internet. We encountered a pentobarbital poisoning case of a patient with amyotrophic lateral sclerosis. A caregiver found the patient unconscious immediately after two visitors left the room. The patient was immediately transferred to the emergency hospital but eventually declared dead. A fatal concentration of pentobarbital was detected in peripheral blood samples collected in the emergency hospital and during autopsy (53.8 µg/mL and 29.4 µg/mL, respectively). Because the ratios of pentobarbital concentrations between the gastric contents and peripheral blood were 35 and 29 in the hospital and autopsy samples, respectively, it is likely that pentobarbital was administered via the gastrostomy tube. The patient had contacted the visitors through social media. Although the patient had requested the doctor perform active euthanasia and expressed a desire to end their life on social media, nobody had noticed the plan to commit suicide.

Two cases of novel coronavirus infection (COVID-19) with transient viral elevation using semi-quantitative real-time reverse transcription PCR and symptom relapse after completion of 10 days of favipiravir treatment.

The coronavirus disease of 2019 (COVID-19), which began in Wuhan, China, at the end of 2019, is spreading around the world and causing many deaths, mainly from pneumonia. Currently, there are no specific drugs to treat COVID-19, and existing antiviral drugs are being used as an alternative. One of these is favipiravir, a new type of influenza drug. However, its efficacy, dosage, and duration of administration are still under study. In this case study, we administered favipiravir to patients with COVID-19 and determined the viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the COVID-19 pathogen, using semi-quantitative real-time reverse transcription PCR in sputum samples. We report on two patients in whom the viral load increased again after completion of 10 days of favipiravir treatment and a transient relapse of symptoms was observed.

Relationship between serum prostate-specific antigen and age in cadavers.

OBJECTIVES: An increase in number of unidentified cadavers is a growing problem. To identify these cadavers, a simple objective method is required to estimate cadaveric age. We examined the correlations between postmortem serum prostate-specific antigen levels and cadaveric age to determine whether serum prostate-specific antigen levels can be used in age estimation of unidentified cadavers. METHODS: Total serum prostate-specific antigen was measured in 140 male autopsy cases aged from 0 to 94 years. RESULTS: The serum prostate-specific antigen levels of cadavers correlated with age at death to the same degree as with the age of living individuals (r = 0.393, P < 0.01). Prostate-specific antigen levels also correlated with prostate weight, but not with psoas muscle index and body mass index. Cause of death did not influence postmortem serum prostate-specific antigen levels. CONCLUSION: Age estimation based on prostate-specific antigen provides a simple, objective, and rapid method to determine age at death estimation of cadavers, and is expected to greatly contribute to the identification of cadavers.

Perforation rates in double latex gloves and protective effects of outer work gloves in a postmortem examination room: A STROBE-compliant study.

Medical staff face the risk of exposure to blood-borne infectious agents during postmortem examinations. This study investigated the effectiveness of non-slip work gloves worn over 2 layers of surgical latex gloves (outer and inner gloves) as a means of reducing hand and finger injuries. Complete sets of outer and inner gloves worn during postmortem examinations were collected from participating forensic staff. Latex gloves were categorized into 2 groups based on the users' actions during the examination: the wearing group if the wearer wore their work gloves continuously without interruption, and the taking-off group if the wearer removed them at least once. Perforation rates, locations, and shapes were compared between these groups. Outer-glove perforation occurred significantly more often in the taking-off group (n = 102 pairs) than in the wearing group (n = 91 pairs) (30.4% vs 3.8%, P < .001). Inner-glove perforation occurred at rates of 2.0% and 0.5% (P = .38), respectively. The wearers did not incur hand or finger injuries. Perforation rates were similar between the dominant and non-dominant hands (P = .18). Regarding location, gloves were punctured most frequently at the thumb, followed by the index finger. Most examiners (85.6%) did not notice the perforation when the damage occurred. Therefore, we could not confirm that a specific operation within a set of plural operations affected the rate of perforation. Additionally, we could not prove a relationship between glove perforation and each operation performed with/without work gloves. The perforation appearances varied greatly in shape and size, suggesting multiple causes of perforation. The continuous (i.e., uninterrupted) wear of work gloves during postmortem examinations reduced the incidence of perforations in both latex glove layers and thus reduced the risk of hand and finger injury.

Postmortem plasma pentraxin 3 is a useful marker of fatal acute coronary syndrome.

Pentraxin 3 (PTX3) is an acute-phase protein that belongs to the pentraxin superfamily. Recently, many clinical studies have demonstrated that plasma PTX3 concentrations rapidly increase in patients with the acute coronary syndrome (ACS). The aim of this study was to evaluate the forensic utility of postmortem plasma PTX3 as a marker of fatal ACS. We compared the plasma PTX3 concentration in cadavers with suspected fatal ACS to that exhibited in control cases (e.g., asphyxia and immediate death due to a fatal injury). The ACS groups included a coronary stenosis group, which exhibited apparent coronary stenosis, but an absence of coronary thrombi, a coronary thrombi group with thrombi found in the coronary artery, and a group of myocardial rupture following an acute myocardial infarction. The plasma PTX3 concentration was significantly higher in the coronary thrombi group than the control group and other ACS groups. The postmortem plasma PTX3 concentration was higher than the clinical reference values, which appeared to be caused by a postmortem release from circulating neutrophils. In conclusion, although the clinical reference value cannot be applied to postmortem samples, the postmortem plasma PTX3 concentration may be a useful marker of death occurring immediately after the onset of fatal ACS.

The genome profiling method can be applied for species identification of biological materials collected at crime scenes.

BACKGROUND: Various biological materials unrelated to humans are found at crime scenes and it is often important to elucidate the origin of these materials. A genetic locus common to several species is conventionally PCR-amplified with universal primers to identify species. However, not all species can be identified using a single locus. In this study, DNA from 13 commonly handled taxa was analyzed to identify species by a genome profiling (GP) method, which involves random PCR and temperature gradient gel electrophoresis. RESULTS: In a clustering analysis, we successfully obtained a single cluster for each species. CONCLUSION: The GP method is cost-effective and does not require advanced techniques and knowledge in molecular biology. The random sampling of the whole genome using multiple primers provides substantial genomic information. Therefore, the method is effective for classifying a wide range of species, including animals, plants, and insects, and is useful for crime scene investigations.

Autoerotic asphyxia using a plastic bag loosely covering the head over a gas mask.

Autoerotic death is defined as the accidental death of an individual while masturbating, caused by a device or material used to enhance the sexual response. Here we report an autopsy case of autoerotic death and review the literature. A healthy, single, 33-year-old Japanese male was found dead in his room in a prone position. He was wearing a used gas mask and a plastic bag over his head; the opening of that bag was loosely secured around the neck with a belt. He had no underwear beneath his upper and lower work clothes and the zipper of his pants was open. Adult magazines and DVDs featuring male subjects and other adult toys were found in his room. Images of people wearing gas masks and rubber suits, as well as of individuals whose whole bodies were tied with ropes, were discovered on his personal computer. Records of purchasing full-body tights were also found. Lesions and injuries that could have caused his death were not found in the autopsy or in any of the various examinations. The cause of death was determined to be suffocation assumed to be caused by the plastic bag covering the mask's ventilation. Suicide and homicide were ruled out based on the police investigation of the scene of the victim's death and the attendant circumstances and environment. The death was thus determined to be an accident. We see no major differences in the feature of autoerotic death between Japanese cases and those in the Western countries.

Age estimation based on visual parameters of the skin of cadavers.

BACKGROUND: Previous studies have reported relationships between various visual parameters of the skin and changes due to aging. Due to an increase in the discovery of unidentified bodies, the field of forensic medicine anticipates the development of a rapid method for estimating age. The present study measured various visual parameters of the skin in human remains and investigated the correlation between these parameters and age. MATERIALS AND METHODS: Skin images were taken of four body parts (cheek, chin, brachium, and thigh) of 414 forensic cases. We interpreted eight visual parameters of the skin (smoothness, roughness, texture, dullness, brightness, erythema, color phase, and sagging) from skin photograph images, and constructed three age-prediction models, categorized by sex, postmortem interval, and age. RESULTS: Significant correlations were observed in the erythema of the cheek and chin, the roughness of the brachium, and the texture of the brachium and thigh among the visual parameters calculated in four body parts, using the three models. The root-mean-square errors, which indicate the precision of the three prediction models, were 13.06, 13.80, and 13.77. The only model that demonstrated a correlation with the visual parameters was sex (but not age or postmortem interval). CONCLUSION: Similar to living subjects, we observed a correlation with age for a number of visual parameters. The parameters that correlate with age depend on whether the site being measured was exposed to sunlight. Age estimation based on visual parameters requires measurement of visual parameters for skin both exposed and not exposed to sunlight.

Rare atlas fracture detected using postmortem computed tomography: A case report.

We report the autopsy of a traffic accident victim with a rare atlas fracture. The deceased was 52-year-old man found dead on the road because of a traffic accident. We performed a postmortem computed tomography and an autopsy on the body. The sagittal reformation image of postmortem computed tomography showed a vertically separated anterior arch of atlas, suggesting a "horizontal fracture." Therefore, we assumed that cervical hyperextension may have been one of the forces that affected him during the accident. Minor spinal cord injury was also noted. In this case, postmortem computed tomography played an important role in detecting the spinal cord injury, considering the mechanism of the traffic accident, and supported the autopsy.

Comparison of postmortem butane distribution between two fatal butane poisoning cases.

Fatal accidents during butane abuse frequently occur in Japan and in many countries around the world. Although analytical data about butane concentration in postmortem samples is being accumulated, when using the data to determine the cause of death, careful interpretation is required because the gas is easily diffused. Two fatal butane poisoning cases were encountered, and butane quantification of autopsy samples obtained from left and right heart blood, femoral blood, kidney, liver, lung, brain and fatty tissues was performed. In both cases, butane concentration in the left heart blood was lower than in the right heart blood or the femoral blood, despite gas inhalation. These findings may indicate that the deceased individuals interrupted gas inhalation and inhaled room air immediately before their death, therefore ruling out asphyxia due to anoxia as the mechanism of death. Case 1, which was suspected to be a not acute death, showed a very high butane concentration ratio of fatty tissues to femoral blood of over 70. Case 2 was considered an acute death, and the butane concentration ratio of fatty tissues to femoral blood was 8.2. These results are consistent with previously reported findings showing that much higher ratios of fatty tissues to blood are compatible with long survival time. In conclusion, the comparison of butane concentration among different samples, including left heart blood versus right heart blood and fatty tissues versus blood, is useful when interpreting the result of postmortem butane analysis to examine the mechanism of death and survival time.

Value of the serum thyroglobulin level for diagnosing neck compression in postmortem cases.

To investigate the relationship between blood thyroglobulin (Tg) levels and neck compression, the Tg levels of right cardiac blood were measured using a chemiluminescence immunoassay in 256 autopsy cases. There were 11 cases in which neck compression was confirmed based on autopsy findings and other information, in which the mean Tg level was 3155 ng/mL (range: 179-16,500 ng/mL). In the remaining cases, the mean Tg level was 4160 ng/mL (range: 0.3-139,000 ng/mL). There was no significant difference between the mean Tg levels of the two groups. In a comparison between the case groups with Tg levels of ≥200 ng/mL and <200 ng/mL, it was found that the frequency of neck compression was significantly higher (P < 0.05) in the ≥200 ng/mL group. The frequency of high Tg levels (≥200 ng/mL) was increased among the cases in which death was caused by neck compression or asphyxia. In a comparison of the median Tg values of right heart blood, left heart blood, whole blood, and femoral venous blood, the median Tg values of whole blood and right heart blood were shown to be about 10 times higher than those of left heart blood and peripheral blood. It is said that high postmortem blood Tg levels are caused by mechanical compression of the thyroid gland. However, high Tg levels were detected in the half of the cases without neck compression. Therefore, neck compression should be diagnosed carefully based on autopsy findings and other information.

Comparison between Temperature Gradient Gel Electrophoresis of Bacterial 16S rDNA and Diatom Test for Diagnosis of Drowning.

When a body is discovered in water, it is difficult to conclude whether the cause of death was drowning, even today. Although diatom testing by the digestive method is classical, we hypothesized that aquatic bacteria, as well as diatoms, might be detected in drowned bodies, and conducted temperature gradient gel electrophoresis (TGGE)-targeting 16S rDNA. DNA was extracted from the site water, and from heart blood and liver samples from 27 bodies concluded as drowning deaths by autopsy and subjected to TGGE after amplification of 16S rDNA by polymerase chain reaction. We observed whether the feature point of each 16S rDNA from the site water and blood or liver samples matched. Considerably higher correspondence was observed in drowned bodies, and the rate was higher than that achieved with the digestive method. Moreover, TGGE is safer than the digestive method. Our study suggests that this method can aid diagnosis of drowning.