A case of hemorrhage at the junctions of the posterior intercostal arteries-a vital sign?

The authors present the case of a 58-year-old man found hanging from a radiator by his shoelaces. The time of death was approximately 6 h before the body was discovered. An autopsy was performed approximately 24 h after the body was found, which revealed hemorrhages in the thoracic aorta at the junctions of the posterior intercostal arteries. Before autopsy, a routine whole-body CT scan was performed. Histologic examination of the aorta and the posterior intercostal arteries revealed a fresh hemorrhage into the tunica adventitia of the aorta. To our knowledge, there is no case description of such findings in hanged persons in the literature. Conclusion: Hemorrhages into the tunica adventitia of the junction of the posterior costal arteries may occur in association with suicidal hanging. The significance of these hemorrhages as a sign of vitality may be debated.

Challenge in optimizing robotic pancreaticoduodenectomy including nerve plexus hanging maneuver: a Japanese single center experience of 76 cases.

BACKGROUND: Robotic pancreaticoduodenectomy (RPD) is technically demanding, and 20-50 cases are required to surpass the learning curve. This study aimed to show our experience of 76 cases from the introduction of RPD and report the changes in surgical results owing to the accumulation of cases and optimization of surgical techniques. METHODS: A total of 76 patients who underwent RPD between November 2009 and May 2023 at the Fujita Health University Hospital were divided into three groups: competency (n = 23, Nov 2009-Mar 2020), proficiency (n = 31, Apr 2020-Jun 2022), and mastery (n = 22, Jul 2022-May 2023) phases. In the mastery phase, for the education of new surgeons and maintenance of surgical quality, optimization of the procedure, including hanging maneuver with or without stapling transection of the retropancreatic tissue was implemented. The surgical outcomes were compared between the groups. RESULTS: The mean operation time decreased over time despite of the participation of newly started operators in mastery phase [competency: 921.5 min (IQR 775-996 min) vs. proficiency: 802.8 min (IQR 715-887 min) vs. mastery: 609.2 min (IQR 514-699 min), p < 0.001]. Additionally, Clavien-Dindo ≥ grade IIIa complications decreased from 52.2% in competency phase to 35.5% and 9.1% in proficiency and mastery phases, respectively (p = 0.005). CONCLUSION: Operation time and major complications decreased along the learning curve from the introduction of RPD. In addition, optimization of the procedure, including hanging maneuver of the retropancreatic tissue seemed to be effective in reducing operation time and educating new RPD surgeons.

Development and validation of a human bronchial epithelial spheroid model to study respiratory toxicity in vitro.

The use of laboratory animals in research has been extensively criticized. While most of the critique has been centered around the ethical aspect, also the economic and scientific aspects have been frequently mentioned as points of concern. As a result, the use of alternative methods has gradually become more enticing. The most used alternatives to laboratory animals are the 2D monolayer cell cultures. However, the limited translatability of these monolayer cell cultures to in vivo has led to the development of 3D cell cultures that are believed to better capture the in vivo physiology and pathology. Here we report on the development of a physiologically more relevant 3D cell model (spheroids) comprised of human bronchial epithelial (16HBE14o-) cells, for use in respiratory toxicity research. Culturing 16HBE14o-cells as hanging-drops led to the formation of stable spheroids which showed an increased expression of CLDN1 when compared to 2D monolayer cultured cells. In addition, cell-cycle analysis revealed an increased sub-G0 population and signs of G0/G1 arrest in spheroids. Afterwards, standard operating procedures (SOPs) were established, and existing protocols optimized, for compatibility with spheroids. Spheroids were successfully used to assess cytotoxicity, genotoxicity, apoptosis/necrosis, and oxidative stress after exposure to known cytotoxic or genotoxic compounds. The development of the bronchial epithelial spheroids and the establishment of SOPs can contribute to a more reliable toxicity assessment of chemicals and may aid in bridging the gap between in vivo and in vitro experiments.

The prevalence of complicated cervical injuries in near-hanging patients without abnormal levels of consciousness or neck signs.

BACKGROUND: Cervical injuries are important complications of near-hanging, which is defined as self-injury by hanging if the patient survives at admission. Previous studies have reported that complicated cervical injuries due to near-hanging are uncommon. The primary aim of this study was to evaluate whether cervical imaging can be safely omitted for near-hanging patients who are alert and have no abnormal neck symptoms or signs. METHODS: This was a retrospective observational study to investigate the prevalence of cervical injuries among hospitalized near-hanging patients between April 2014 and June 2023. The primary outcome was the prevalence of any complicated cervical injuries, which included laryngeal fractures, laryngeal deviations, spinal cord injuries, cervical spine fractures, and blunt cerebrovascular injuries. The primary aim of this study was to determine the primary outcome among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs. RESULTS: During the study period, a total of 63 near-hanging patients were hospitalized. Of these, 11 patients (18%) with normal levels of consciousness and no neck symptoms or signs at admission were included. The median age of the patients was 37 years (IQR 27 to 53); 5 (45%) were women, and none had cardiac arrest at the scene. For the primary outcome, no complicated cervical injuries (0%; 95% CI, 0% to 27%) occurred among the small number of near-hanging patients who had normal levels of consciousness and no abnormal neck symptoms or signs at admission. CONCLUSIONS: There were no cases of complicated cervical injuries among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs. Further prospective multicenter studies are warranted to investigate whether cervical imaging can be safely omitted in assessments of these patients.

The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study.

PURPOSE: To measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007-2019 and identify risk factors for these methods of self-harm. METHOD: Data on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning. RESULTS: The age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15-24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72-3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16-1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17-1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58-1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41-2.99). CONCLUSION: The incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

Suicide mortality according to occupation and method of suicide, Massachusetts, 2010-2019.

BACKGROUND: Suicide rates in the United States have been increasing. Work-related factors may contribute to risk for suicide. These work-related factors may be reflected in a varied risk for different suicide methods between occupations. This study sought to assess occupational differences in suicide rates according to the method used. METHODS: Death certificate data about suicide deaths in Massachusetts between 2010 and 2019 were used to calculate mortality rates and rate ratios with univariable and multivariable models controlling for age, sex, race ethnicity, and educational attainment for suicides overall, and for three specific methods of suicide (hanging/strangulation/suffocation, firearms, and poisoning) by occupation. RESULTS: In multivariate models, the risk for suicide was significantly elevated for workers in arts, design, entertainment, sports, and media (relative risk [RR] = 1.84, 95% confidence interval [CI] = 1.53, 2.22); construction trades (RR = 1.68, 95% CI = 1.53, 1.84); protective services (RR = 1.49, 95% CI = 1.26, 1.77); and healthcare support occupations (RR = 1.55, 95% CI = 1.25, 1.93). Occupational risk for suicide differed across different methods. For hanging/strangulation/suffocation, workers in arts, design, entertainment, sports, and media occupations had the highest RR (2.09, 95% CI = 1.61, 2.71). For firearms, workers in protective service occupations had the highest RR (4.20, 95% CI = 3.30, 5.34). For poisoning, workers in life, physical, and social science occupations had the highest RR (2.32, 95% CI = 1.49, 3.60). CONCLUSIONS: These findings are useful for identifying vulnerable working populations for suicide. Additionally, some of the occupational differences in the risk for suicide and for specific methods of suicide may be due to workplace factors. Further research is needed to understand these workplace factors so that interventions can be designed for prevention.

Live Imaging of 3D Hanging Drop Arrays through Manipulation of Light-Responsive Pyroelectric Slippery Surface and Chip Adhesion.

Three-dimensional (3D) hanging drop cell culture is widely used in organoid culture because of its lack of selection pressure and rapid cell aggregation. However, current hanging drop technology has limitations, such as a dependence on complex microfluidic transport channels or specific capillary force templates for drop formation, which leads to unchangeable drop features. These methods also hinder live imaging because of space and complexity constraints. Here, we have developed a hanging drop construction method and created a flexible 3D hanging drop construction platform composed of a manipulation module and an adhesion module. Their harmonious operation allows for the easy construction of hanging drops of varying sizes, types, and patterns. Our platform produces a cell hanging drop chip with small sizes and clear fields of view, thereby making it compatible with live imaging. This platform has great potential for personalized medicine, cancer and drug discovery, tissue engineering, and stem cell research.

The "facie sympathique" sign in hanging: historical background, forensic review, and perspectives.

The "facie sympathique" is a vital sign first described by Etienne Martin in 1899 referring to unilateral miosis, with or without ptosis, at the opposite side from the knot in hanging. This mark is scarcely reported in legal medicine textbooks and scientific papers. Moreover, when cited, it is referred to differently from its original meaning, both as unilateral contraction (miosis) and dilatation (mydriasis) of the pupil depending on the antemortem firmness of the ligature's neck pressure in hanging with little attention to ptosis. Due to the sympathetic nervous pathway supplying the eye, the review of this ocular sign in hanging supports the importance of revitalizing the "facie sympathique" in research on lesion vitality in mechanical asphyxia.

Suicide by ligature strangulation and/or hanging inside a motor vehicle: a comprehensive review.

Suicide by ligature strangulation/hanging inside vehicles is uncommon, and only few cases have been reported in the literature. This study aimed to conduct a comprehensive review of reported cases of suicide by ligature strangulation/hanging inside vehicles, analyzing the features of the death scene, of the ligature and furrow, autopsy findings, and causes of death. The comprehensive review was performed following the PRISMA guidelines by using the most common scientific databases. According to inclusion criteria, a total of 20 cases of vehicle-assisted strangulation/hanging were reviewed: 13 cases were assessed as ligature strangulation resulting in 7 complete decapitations and 7 other cases as hanging. All victims were young or adult males, except for one 48-year-old female. Death was assessed as suicide in all cases, except for a possible accidental autoerotic death. In 8 cases, a history of depression or other psychiatric disorders was reported. Toxicological analysis were positive in 7 cases. Hard ligature materials (nylon, steel, plastic, hemp ropes) were used in most cases, but only 13 cases had a well-demarcated furrow. In 2 cases, no internal findings of asphyxia were found. An additional case of ligature strangulation inside a motor vehicle off is also presented, where no autopsy findings of asphyxia were observed, except for a broad pale furrow and monolateral conjunctival petechiae. This study highlights the challenges in classifying suicidal hanging and ligature strangulation in motor vehicles.

[Mechanical asphyxia in the structure of violent death in the Russian Federation from 2013 to 2022 years]. / Mekhanicheskaya asfiksiya v strukture nasil'stvennoi smerti v Rossiiskoi Federatsii s 2013 po 2022 g.

The objective of the study is to examine the death incidence from mechanical asphyxia in the Russian Federation in the period from 2013 to 2022 yr., to determine the dynamics of changes in indicators of its main types and to reveal territorial specificity. The results obtained with the use of medical statistics methods can be applied to implement measures for health protection, prevent risk factors of fatal outcome among population, to improve the training of forensic medical experts.

Suspension-associated dislocation of the jaw in hanging.

Hanging is a common type of death, and the role of the medical investigation of such deaths by a forensic pathologist not only requires the determination of the cause of death but providing information to assist in the determination of the manner of death. The forensic pathologist should be well versed in the spectrum of injuries known to be associated with neck compression, to document injuries known to be associated with hanging, but also to identify those that are inconsistent with self-inflicted hanging or that may suggest the involvement of a third party in the death. Comprehensive identification and correct interpretation of external and internal injury are crucial for the appropriate degree of police and coroner/medical examiner investigation. We present two cases of deaths believed to be caused by self-inflicted hanging that were observed to have unexpected unilateral dislocation of the temporomandibular joint identified on routine post-mortem computed tomography, without any evidence of involvement of a third party. This injury was unexplained and had not been previously observed at our Forensic Institute nor was it identified after a review of the published biomedical research literature. Issues regarding the cause of this abnormality, possible mechanisms, and the medicolegal significance of this finding will be discussed.

Can the size of the contact area body-ground influence the presence of acute pulmonary emphysema in cases of incomplete hanging?

In a recently published study, we showed that acute pulmonary emphysema (APE) was present in cases of death by incomplete hanging and absent in cases of complete hanging. This result suggested a possible role of the hanging position on the respiratory distress of these victims. To further investigate this hypothesis, in the present study, we compared cases of incomplete hanging with a small contact area between body and ground (group A) to cases of incomplete hanging with a large contact area (group B). As positive and negative control group, we investigated cases of freshwater drowning (group C) and acute external bleeding (group D) respectively. Pulmonary samples were histologically examined, and the mean alveolar area (MAA) for each group was measured by digital morphometric analysis. MAA was 23,485 µm2 for group A and 31,426 µm2 for group B (p < 0.05). MAA of group B was similar to MAA of positive control group (33,135 µm2) and MAA of group A was similar to MAA of negative control group (21,991 µm2). These results seem to confirm our hypothesis and suggest that the size of the contact area between body and ground influences the presence of APE. Furthermore, the present study showed that APE can be proposed as a vitality sign in incomplete hanging, but only in cases with a large contact area between body and ground.

Epidemiological profile, temporal analysis, and future projections of suicide cases in rural cities in the extreme south of Brazil.

The present study aimed to verify the time series (2000-2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority.

Hanging droplets from liquid surfaces.

Natural and man-made robotic systems use the interfacial tension between two fluids to support dense objects on liquid surfaces. Here, we show that coacervate-encased droplets of an aqueous polymer solution can be hung from the surface of a less dense aqueous polymer solution using surface tension. The forces acting on and the shapes of the hanging droplets can be controlled. Sacs with homogeneous and heterogeneous surfaces are hung from the surface and, by capillary forces, form well-ordered arrays. Locomotion and rotation can be achieved by embedding magnetic microparticles within the assemblies. Direct contact of the droplet with air enables in situ manipulation and compartmentalized cascading chemical reactions with selective transport. Applications including functional microreactors, motors, and biomimetic robots are evident.

Type-III Hangman's fracture combined with serious cerebrovascular injury after near-hanging: a first case report and review of the literature.

Cervical fractures are rare after non-judicial hangings. Type-III Hangman's fracture (HF) is an unstable injury caused typically by motor vehicle accidents or falls. We describe the first reported case of a Type-III HF combined with occlusion of the right vertebral artery and non-occlusive dissection of both internal carotid arteries caused by near-hanging. We performed a posterior approach open reduction of dislocated C2 facets and C1 to C3 fusion. Carotid dissections were managed conservatively with long-term antiplatelet therapy. The patient survived without any neurological deficit and without any significant restriction of cervical motion.

Analysis of the Hanging Actions and Operating Heights of Storage Furniture Suitable for the Elderly.

The current functional scale design of storage furniture which the elderly use does not meet their needs, and unsuitable storage furniture may bring many physiological and psychological problems to their daily lives. The purpose of this study is to start with the hanging operation, to study the factors influencing the hanging operation heights of elderly people undergoing self-care in a standing posture and to determine the research methods to be used to study the appropriate hanging operation height of the elderly so as to provide data and theoretical support for the functional design scale of storage furniture suitable for the elderly. This study quantifies the situations of elderly people's hanging operation through an sEMG test performed on 18 elderly people at different hanging heights combined with a subjective evaluation before and after the operation and a curve fitting between the integrated sEMG indexes and the test heights. The test results show that the height of the elderly subjects had a significant effect on the hanging operation, and the main power muscles of the suspension operation were the anterior deltoid, upper trapezius and brachioradialis. Elderly people in different height groups had their own performance of the most comfortable hanging operation ranges. The suitable range for the hanging operation was 1536-1728 mm for seniors aged 60 or above whose heights were within the range of 1500-1799 mm, which could obtain a better action view and ensure the comfort of the operation. External hanging products, such as wardrobe hangers and hanging hooks, could also be determined according to this result.

FOXO3 Depletion as a Marker of Compression-Induced Apoptosis in the Ligature Mark: An Immunohistochemical Study.

One of the most challenging issues in forensic pathology is lesion vitality demonstration, particularly in cases of hanging. Over the past few years, immunohistochemistry has been applied to this field with promising results. In particular, protein and transcription factors involved in the apoptotic process have been studied as vitality markers for the ligature mark. This study represents an implementation of our previous studies on ligature mark vitality demonstration. In this study, we evaluated the FOXO3 expression in post-mortem cervical skin samples through an immunohistochemical analysis. To evaluate FOXO3 expression, anti-FOXO3 antibodies (GTX100277) were used. The study group comprised 21 cases, 8 women and 13 men, whereas the control group consisted of 13 cases of subjects who died due to other causes. Decomposition and no clear circumstantial data were exclusion criteria. We found that FOXO3 is decreased in hanging cases compared with normal skin in other causes of death (p-value < 0.05). No differences were seen concerning the type of hanging material (hard or soft), type of hanging (complete or incomplete), and position of the knot. Our results suggest that FOXO3 depletion could be a valid immunohistochemical marker of ligature mark vitality.

Effects of Different Types of Stabilizers on the Properties of Foam Detergent Used for Radioactive Surface Contamination.

Compared with high-pressure water and reagent washing decontamination, foam decontamination has a promising application due to its ability to significantly reduce the volume of radioactive waste liquids and effectively decontaminate the inner surface of the pipes, the interior of the large cavities, and the vertical walls. However, the foam is less stable, leading to a low decontamination rate. Currently, three main types of stabilizers with different stabilizing mechanisms, namely nanoparticles, polymers, and cosurfactants, are used to improve foam stability and thus increase the decontamination rate. Nanosilica (NS), xanthan gum (XG), and n-tetradecanol (TD) were used as typical representatives of nanoparticles, polymers, and cosurfactants, respectively, to improve the stability of the foam detergent with pH < 2 and chelating agents. The differences in the effects of these three types of stabilizers on foam properties were investigated. Although NS, XG, and TD all increase the half-life of the foam from 7.2 min to about 40 min, the concentration of TD is much lower than that of NS and XG in the foaming solution, and TD foaming solution has the highest foaming ratio. Moreover, TD can markedly lower the surface tension, resulting in a significant reduction of the wetting contact angle on the surfaces of glass, ceramic tile, stainless steel, and paint, while NS and XG cannot signally change the surface tension and have no obvious effect on the wetting contact angle. At low shear rates, TD can increase the apparent viscosity of foam by two orders of magnitude, and the wall-hanging time of the foam on the vertical wall is more than 30 min. In contrast, NS and XG cause a limited increase in the apparent viscosity of the foam, and the wall-hanging times are both less than 5 min. In addition, TD foaming solution has excellent storage stability, and the storage time has no obvious effect on the performance of the foam. And after only three days of storage, NS undergoes severe agglomeration and precipitation in the foaming solution, resulting in a complete loss of the stabilizing effect. After 90 days of storage, the half-life of XG foam decreases by 26%. For simulated radioactive uranium contamination on both horizontal and vertical surfaces, TD can significantly improve the decontamination rate, especially for vertical surfaces, where TD can increase the single decontamination rate by more than 50%.

A retrospective matched case-control comparison of non-fatal hanging to non-fatal self-poisoning in a sample of Australian men and women.

OBJECTIVE: Our study examined the characteristics of individuals who survived attempted hanging and compared this group to a randomly selected comparison group of patients with non-fatal self-poisoning. METHOD: Non-fatal hanging cases were identified from case files from an Australian public hospital. They were matched by age, sex, and month of presentation with double the number of non-fatal self-poisoning cases. Patients were compared on demographic and clinical characteristics, as well as length of stay in hospital and discharge plan. RESULTS: Most non-fatal hanging patients were males with medium suicidal intent, and a significant proportion misused alcohol. In this group, women were more likely than men to have past psychiatric care, and men were more likely to misuse alcohol and stimulants. In comparison to the self-poisoning group, the non-fatal hanging group had higher suicidal intent but proportionally lower history of self-harm and psychiatric care, or benzodiazepine misuse. CONCLUSION: People who self-harm by hanging have higher suicidal intent, misuse alcohol more often, and are less likely to be in psychiatric care. They may benefit from a general community intervention, rather than one based upon interventions with people already in psychiatric care.

Suicide victims and alcohol-related consumption in Brazil: An observational study and a narrative review of the literature.

Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims.