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After Japan's post-war reconstruction, in the early 1950s, cases of double suicide, in which two people (particularly young lovers) leave a suicide note and die together, were a relatively frequent occurrence. During the three-year period between 1954 and 1956, 5466 suicides were recorded in the special wards of Tokyo, including 79 cases of double suicides, accounting for 158 deaths. In these double suicide cases (2.89% of all deaths by suicide), the evidence revealed that 65.8% involved lovers and 29.1% involved married couples. By contrast, contemporary data indicate a large drop in suicide pacts between lovers to 15.9% and an increase between spouses to 48.8%. Conceivably, the relatively high double-suicide rate after post-war reconstruction reflected difficulties for the younger generation in reconciling ‘marriage based primarily on love’ and the traditional family system, specifically marriage problems and stress caused by rapidly changing post-war values. One notable difference between victims of double suicide in 1954–1956 and the contemporary period is the younger average age of the former. Another important shift was found in the most common causes of death among victims of double suicide: in 1954–1956 these were poisoning by cyanide or hypnotic drugs, compared to carbon monoxide poisoning and hanging in modern times. We discuss similarities and differences concerning double suicides in relation to social and economic conditions in Japan in the 1950s and today.

BackgroundSudden unexpected death in infancy (SUDI) comprises both natural and unnatural causes of death. However, a few epidemiological surveys have investigated SUDI in Japan.ObjectiveThis retrospective study was conducted to investigate the recent trends of circumstances and risk factors of sleep-related SUDI cases.MethodsForensic pathology sections from eight universities participated in the selection of subjects from 2013 to 2018. Data obtained from the checklist form were analyzed based on information at postmortem.ResultsThere were 259 SUDI cases consisting of 145 male infants and 114 female infants with a mean birth weight of 2888 ± 553 and 2750 ± 370 g, respectively. Deaths most frequently occurred among infants at 1 month of age (18%). According to population-based analyses, the odds ratio (95% confidence interval) of mother’s age ≤19 years was 11.1 (6.9–17.7) compared with ages 30–39. The odds ratio for the fourth- and later born infants was 5.2 (3.4–7.9) compared with the frequency of first-born infants. The most frequent time of day for discovery was between 7 and 8 o’clock. Co-sleeping was recorded for 61%, and the prone position was found for 40% of cases at discovery. Mother’s smoking habit exhibited an adds ratio of 4.5 (2.9–5.8).ConclusionThis study confirmed the trends that have been observed for sudden infant death syndrome; particularly, very high odds ratios were evident for teenage mothers and later birth order in comparison with those in other developed countries. The child of a young mother tended to die within 2 months of age. To our knowledge, this is the first report of an extensive survey of sleep-related SUDI in Japan.

Background Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG). Objective To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness. Methods Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis. Results Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs. Conclusions For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs. Implications for practice Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.

The RapidHIT™ ID system produces GlobalFiler™ analysis results after a short operating time. This device is effective because it automatically extracts DNA from oral mucosal cells or from blood stains and saliva collected at a crime scene, with subsequent polymerase chain reaction performed to produce a DNA profile. Two types of dedicated cartridges are available for RapidHIT™ ID: the RapidHIT™ ID ACE GlobalFiler Express sample cartridge for oral cells and other samples and the RapidINTEL™ sample cartridge for minute samples, such as blood stains. Previously validated specimens include oral mucosa cells and blood stains left at crime scenes. There have been no reports of blood and nail clipping samples collected from the postmortem bodies at the time of death. This report summarizes the results of using the RapidHIT™ ID system by collecting a variety of actual forensic samples from postmortem bodies at different stages of decomposition, which were subsequently analyzed using these cartridges.

We report a case of sudden death in a patient who developed extensive gastric necrosis secondary to acute gastric dilatation. A 36-year-old man with mental retardation (but without difficulties in activities of daily living), developed an illness after a meal out with friends, necessitating 3 hospital visits. He returned home after receiving drug therapy; however, his condition deteriorated, and he was transferred to our hospital via ambulance. Whole-body computed tomography performed upon admission revealed gastric dilatation. A stomach tube was inserted, and 2000 mL of gastric aspirate was obtained. The patient died approximately 5 h later despite receiving treatment. Autopsy revealed 1000 mL of gastric contents and extensive gastric necrosis. He was diagnosed with extensive gastric necrosis secondary to acute gastric dilatation.

A man aged in his twenties was found dead on the floor in his room. A package containing dried herbal blend labeled “Fairy evolution” and smoking devices were found in the room. The postmortem interval of the deceased was estimated to be 3 days. The autopsy disclosed no marked findings explaining the cause of death. Toxicological analyses by gas chromatography–mass spectrometry and liquid chromatography–tandem mass spectrometry revealed the presence of N-1-naphthalenyl-1-pentyl-1H-indole-3-carboxamide (NNEI) in the herbal blend and in specimens taken from the victim. The concentrations in the blood and adipose tissue specimens were 0.64–0.99 and 42.9 ng/ml, respectively. To our knowledge, this is the first report to describe NNEI concentrations in human specimens in the fatal poisoning case.

We attempted the simultaneous determination of 5 drugs, mirtazapine, sertraline, chlorpromazine, amoxapine and zolpidem, detected in a gas chromatography–mass spectrometry screening test in an autopsy case. The solid-phase extraction of the analytes from biological samples was achieved using Oasis®HLB cartridges (Waters, Milford, MA, USA). Gas chromatography was performed on a HP-5MS fused silica capillary column (30 m × 0.25 mm i.d., 0.25 μm film thickness, Agilent Technologies). The mass spectrometer was operated with an electron energy of 70 eV in electron impact mode. The qualitative and quantitative analyses were performed in full-scan mode and the selected ion monitoring mode, respectively. The total ion chromatogram showed good separation of these drugs. Linear graphs were obtained with good correlation coefficients for these drugs from 0.001 to 2.0 μg/mL (r2 = 0.9909–0.9986) using imipramine-d6 as an internal standard. The recoveries of these drugs were found to be 62.8–88.0% in spiked whole blood. Mirtazapine, sertraline, chlorpromazine, amoxapine and zolpidem were found in post-mortem samples of the deceased at concentrations of 2.67, 0.07, 0.25, 0.32 and 0.68 μg/mL, respectively. The concentration of mirtazapine was within the lethal level and those of amoxapine and zolpidem were within the toxic level. We diagnosed that the cause of death was acute multiple drug poisoning. The simple and practical procedure used in this study is useful for the simultaneous determination of psychotropic drugs of various types in post-mortem biological samples.

Sudden cardiac death is a serious problem in public health but the overall survival rate of out-of-hospital cardiac arrests (OHCAs) remains low. In this study, we identified clinical parameters to predict the prognosis of OHCA patients and proposed a simple prognostication score for prediction of their prognoses. The study population consisted of 750 consecutive patients with OHCAs of internal cause who were transported to our institute from July 2008 to June 2010. They were divided into survivors and nonsurvivors, and clinical parameters were compared between them to detect significant parameters for prediction of their prognoses. The population of those who survived at 1 month numbered 34. Multivariate analysis exhibited 10 independent predictive factors of survival, which included witnessed cardiac arrest and bystander-initiated CPR. When the prognostication score was calculated from these independent predictive factors, a score of ≥ 6 points indicated survival with a sensitivity of 88.6% and a specificity of 97.6%. When the patients were divided into younger and older populations with a threshold of 70 years, these values were 94.1% and 96.1% in younger but 70.0% and 98.4% in older patients, respectively. In retrospective observation, a simple prognostication score was useful to predict patient prognoses in OHCAs, but its usefulness was limited in an older population.

A man aged in his thirties was found dead in his room, wearing a gas mask connected with two plastic bags. An empty canister of Air Duster was in one of the plastic bags. Toxicological analysis by gas chromatography (GC)-mass spectrometry and GC-flame ionization detection revealed the presence of 1,1-difluoroethane (HFC-152a), which is a component of the Air Duster aerosol. Quantitative analysis showed that the concentration of 1,1-difluoroethane in his heart blood was as high as 546 μg/ml. The cause of death was diagnosed as acute poisoning by 1,1-difluoroethane. It was supposed that he abused the Air Duster product to obtain euphoria and inhaled 1,1-difluoroethane at excessive concentrations with the peculiar tight-fitting gas inhalation device, resulting in his death.

A man in his sixties, who developed CPA at home, was transferred to the emergency center. Since CT images revealed a tube-shaped foreign body in the pulmonary artery, pulmonary embolism was initially suspected; however, this did not lead to a definite diagnosis. Autopsy revealed that the foreign body in the cadaver was a fragment of a V-A shunt catheter implanted about 30 years previously for the treatment of hydrocephalus. Although fibrous adhesion of a part of the catheter to the pulmonary artery wall was seen, suggesting that a fracture of the catheter had occurred a long time before, it was not known when the fracture had occurred. Since no pulmonary arterial obstruction secondary to the catheter or new thrombi, which had been initially suspected, were observed, the cause of death was determined to be ischemic cardiac failure. A fracture of a shunt catheter may be typically associated with some clinical manifestations, which are often found and treated. In this case, however, no symptoms appeared and the fracture of the shunt catheter remained untreated for a long time. This case was therefore considered to be extremely rare, and is an example of how a serious iatrogenic disease could occur.

A high-performance liquid chromatography–tandem mass spectrometry (LC/MS/MS) technique was developed for the simultaneous determination of five non-steroidal anti-inflammatory oxicam drugs (ampiroxicam, tenoxicam, piroxicam, meloxicam and lornoxicam) in human plasma. These five oxicam drugs and isoxicam (internal standard) were extracted from human plasma with an Oasis ® MAX cartridge column and analysed on a Unison UK-C18 column (2.0mm×100mm, 3μm) with an acetonitrile:10mM formic ammonium buffer (pH 3.0) (50:50) mobile phase at 0.20ml/min at 37°C. The analytes were detected using a tandem mass spectrometer, equipped with an electrospray ion source (ESI). The instrument was used in multiple-reaction-monitoring (MRM) mode. The extraction yields from a 200μl human plasma sample (containing 10ng of each drugs) with the Oasis ® MAX cartridge column were 93.3–102.5%. The detection limits were 0.01–6.5ng/ml (S/N=3). Our developed method is very useful for the simultaneous determination of five oxicam (non-steroidal anti-inflammatory) drugs in human plasma by LC/MS/MS.

Two siblings were found from the burnt house as charred remain and DNA profiling was performed with their sister. However, we could not discriminate which remain would be the elder or younger brother only by DNA profiling, because they died simultaneously. Fortunately, dental chart of younger brother was found by later police search in this case. Therefore, dental identification was performed and one remain was determined as younger brother. Although, DNA profiling is becoming a standard method for identification of missing person, it is not sufficient tool for resolving such deficiency cases. Since there were 20 years differences between the 2 brothers, analyzing of genetic indicator of human age estimation might assist the identification by DNA profiling. The procedure of detecting the biomarkers is still in the early research stage, the improvement of the study would be a powerful assist tool for a reliable identification.

The mitochondrial DNA control region has been analyzed to obtain the haplotype frequencies data in 97 unrelated Japanese individuals living in Kanagawa by means of the mitoSEQr™ resequencing system, followed by capillary electrophoresis using the ABI PRISM 310 genetic analyzer. A total of 91 haplotypes were detected, of which 85 haplotypes were unique and the others were occurred two times. The polymorphic profiles in the present study were essentially the same as those obtained from Japanese former studies. The nucleotide subsutitution at the position 16,519 (nucleotide transition from T to C) was found at the rate of 52.6%. The genetic diversity and the probability of identity were calculated as 0.9987 and 0.0116, respectively. From the present study, the mitoSEQr™ resequencing system was applicable to routine casework.

ABO genotyping have become common tools for forensic casework. We developed a new rapid ABO genotyping method using a fast real-time PCR system with the TaqMan® Sample-to-SNP™ Kit. Eight single nucleotide polymorphism (SNP) sites in the ABO gene (nt 261, 297, 467, 657, 703, 829, 930 and 1061) were selected to determine the ABO genotypes. ABO genotypes were easily determined by examining allelic discrimination patterns. This method enabled analyses to be completed in about 1h per plate with no postmortem change influences. The detection limit in each SNP site was examined as 100pg per reaction. ABO genotyping from 1000 Japanese individuals was also examined to determine the distribution of ABO genotypes and allele frequencies. Thus, 31 genotypes were clearly identified, and these were controlled by four common and seven rare alleles. The power of discrimination, heterozygosity and polymorphism information contents were 0.913, 0.775 and 0.812, respectively. Therefore, selecting these eight SNP sites could be useful for high specific ABO genotyping. This rapid, sensitive and accurate genotyping method is useful for forensic casework.

A simultaneous analytical method for etizolam and its main metabolites (alpha-hydroxyetizolam and 8-hydroxyetizolam) in whole blood was developed using solid-phase extraction, TMS derivatization and ion trap gas chromatography tandem mass spectrometry (GC-MS/MS). Separation of etizolam, TMS derivatives of alpha-hydroxyetizolam and 8-hydroxyetizolam and fludiazepam as internal standard was performed within about 17 min. The inter-day precision evaluated at the concentration of 50 ng/mL etizolam, alpha-hydroxyetizolam and 8-hydroxyetizolam was evaluated 8.6, 6.4 and 8.0% respectively. Linearity occurred over the range in 5-50 ng/mL. This method is satisfactory for clinical and forensic purposes. This method was applied to two unnatural death cases suspected to involve etizolam. Etizolam and its two metabolites were detected in these cases.

Resent molecular genetic study revealed that defects in sarcomeric genes causes cardiomyopathies. Comprehensive screening of 3 sarcomeric genes: TTN (titin), TCAP (telethonin) and TPM1 (alpha-tropomyosin) were performed in 35 consented autopsy cases diagnosed as cardiomyopathy. One nonsynonymous mutation p.Val9710Ile detected in TTN, which located on binding region to cardiac ankyrin repeat protein was found in one DCM case. It was suggested that the mutation might alter interaction of the Z-disc components and caused cardiomyopathy. A single nucleotide polymorphism p.Ala151= found in TCAP had significant differences in gene frequency between DCM and control cases. It is necessary to analyze the other sarcomeric genes and clarify the relationship with aetiology.

Bones and teeth would be the only available samples from highly decomposed bodies and several methods are reported for the DNA extractions. TBONE EX KIT was used as a new extraction kit for identification of 7 degraded skeletal remains. More than 23 pg DNA/μl was extracted from all samples. It was efficient for autosomal STR and mtDNA analysis and the results confirmed the alleged relationship between missing person and their relatives in 5 cases. This kit could be a simple, useful and reliable tool for forensic caseworks.

Developments in the molecular genetic studies of cardiomyopathy (CM) have led to discovery of a large number of mutations in the genes encoding the sarcomeric proteins. In this study, comprehensive screening of TNNT2, TNNI3 and TNNC1 was performed in 36 consented autopsy cases diagnosed as CM, in order to evaluate the prevalence of gene mutations in sudden death caused by CM. A total of 12 mutations and 15 single nucleotide polymorphisms (SNPs) were detected. It was indicated that this study contribute to genetic based diagnosis, risk stratification and prevention of sudden death caused by CM.

Since ABO genotyping has been a helpful tool for DNA profiling, several kinds of method had reported. We developed a new ABO genotyping by TaqMan assay using the TaqMan Sample-to-SNP Kit. Eight SNPs sites were selected to detect 26 genotypes controlled by 10 alleles. The fast PCR was demonstrated to finish the whole progress in less than 60min by using a little volume of DNA. In addition, the genotypes of forensic samples such as blood, bloodstain, tissue and buccal swab were precisely determined and the affection of post-mortem changes of the blood and tissue collected from one day to 4 months and 2 months passed deposed body were so small. This developed method offers the advantages of rapid, cost efficiency and available genotyping that sufficiently used for forensic cases.

Comprehensive screening of mitochondrial DNA (mtDNA) was performed in sudden death cases with cardiac hypertrophy (SDCH), in order to evaluate the prevalence of mtDNA mutations in sudden death. Missense mutations detected only in SDCH were 18 alterations in 16 cases and 8 mutations were new. It was considered that these missense mutations in turn affected the ability of the essential components of the oxidative phosphorylation complexes. It may possibly be that these mutations are tended to have increased risk of SDCH compared to the controls.

Recently, numerous mutations in sarcomeric genes are reported as factor of cardiomyopathy. Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are general disease in cardiomyopathy and causes sudden death in young people. In this study, ventricular myosin regulatory light chain gene (MYL2) and ventricular myosin essential light chain gene (MYL3) were analyzed in order to elucidate the cause of cardiomyopathy. In MYL3, a significant missense mutation (Ala57Gly) was detected in HCM case. This mutation was located in the EF-hand domain calcium-binding site that regulates the cardiac contraction. No genetic mutation was found in our previous report except this gene, it indicated that the mutation of the MYL3 was the main factor for the HCM case. It is necessary to survey the other disease causing genes to clarify the relationship with etiology.

The allele frequencies of eight MiniFiler™ loci have been analyzed in 101 Japanese individuals living in Kanagawa with informed consent by means of ABI 310 Genetic Analyzer. A total of 7 alleles for D13S317, 8 alleles for D7S820, 11 alleles for D2S1338, 11 alleles for D21S11, 5 alleles for D16S539, 14 alleles for D18S51, 8 alleles for CSF1PO, and 13 alleles for FGA were observed. The polymorphic profiles of these MiniFiler™ loci in the present study were essentially the same as those obtained by using the AmpFlSTR® Identifiler® PCR Amplification kit. The combined matching probability of eight MiniFiler™ loci and cumulative probability of paternity exclusion were estimated as 1.97 × 10−10 and 0.9996, respectively. The MiniFiler™ kit was useful for individual identification in forensic analysis.

The mitochondrial DNA (mtDNA) hypervariable regions (HVRs) I and II have been analyzed to obtain the nucleotide variation data in eight skeletal remains unearthed from Northern area of Kanagawa Prefecture, followed by capillary electrophoresis using the ABI PRISM 310 genetic analyzer. The remains DNA were analyzed successfully, and several nucleotide substitutions and insertions were detected. The polymorphic profiles were essentially the same as those obtained from a modern Japanese living in Kanagawa.

Sarcomeric gene mutations are said to be important factor of cardiomyopathy. In those genes, β-myosin heavy chain gene (MYH7), troponin T gene (TNNT2) and myosin binding protein C gene (MYBPC3) account for most known mutations. In this study, we examined some cases of hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and arrhythmogenic right ventricular cardiomyopathy (ARVCM). There were various mutations in each gene and also detected new mutations. MYBPC3 was the most high frequency gene of the mutations and it was indicated that MYBPC3 was the general genetic cause of cardiomyopathy. Moreover, more than half of the cases of HCM and DCM had some mutations. From these results, genetic analysis of MYH7, TNNT2 and MYBPC3 were useful to diagnose cardiomyopathy for forensic autopsy cases.