Tokyo Medical Examiner's Office

In Kawasaki disease (KD), coronary arteritis occurring in infancy can lead to long-term sequelae, such as luminal dilatation, stenosis, intimal thickening, and calcification. However, the long-term evolution of these lesions, particularly the effect of superimposed atherosclerosis in adulthood, remains poorly understood. This study aimed to investigate coronary artery lesions in adults with a history of KD and clarify the relationship between sequelae of vasculitis and atherosclerosis. We analyzed 7 autopsy cases of sudden cardiac death in adults with a confirmed history of KD and documented coronary artery aneurysms. Clinical data, including acute-phase treatment history, body mass index, heart weight, coronary risk factors, and detailed coronary histopathology, were evaluated. All aneurysms were located at the coronary ostia and showed marked intimal thickening with severe calcification, leading to luminal narrowing. Thrombotic occlusion within the aneurysm was identified in 1 case. In 3 patients aged older than 30 years, atherosclerotic changes were observed in the thickened intima of persistent aneurysmal segments or dilated portions. One patient with a regressed aneurysm died of acute myocardial infarction caused by plaque rupture. Sequelae of vasculitis were widely distributed in nonaneurysmal coronary branches, and atherosclerotic changes were also noted in these regions. In adults with persistent coronary aneurysms due to KD, atherosclerotic lesions may develop not only in aneurysmal segments but also in nondilated arteries with scarring due to vasculitis. Individuals with prior KD and coronary aneurysms may require long-term management for thrombotic risk and the prevention of atherosclerosis, beginning in early adulthood.

IntroductionEcological studies have suggested the protective effect of micro-dose lithium in drinking water against suicide, however, the association between body lithium level and suicide is unknown.ObjectivesWe aimed to compare body lithium levels between suicide and non-suicide fatalities.MethodsThis cross-sectional study included 12 suicides and 16 non-suicides who were examined or dissected at the Tokyo Medical Examiner’s Office from March 2018 to June 2021. The aqueous humor lithium concentration was measured twice using inductively coupled plasma mass spectrometry. Analysis of covariance (ANCOVA) was used to compare the lithium concentration between suicides and non-suicides. Mixed-effects model was conducted to account for all lithium concentration data.ResultsThe aqueous humor lithium concentration did not change after death (t(7)=-0.70, SE=0.03, 95% CI=[-0.09, 0.05], P=0.51, Cohen’s d=0.01). The aqueous humor lithium concentration was lower in suicides (mean 0.50 μg/L (variance s2 0.04)) than in non-suicides (mean 0.92 μg/L (s2 0.07)) (t(26)=4.47, SE=0.09, 95% CI=[0.22 to 0.61], P<0.001, Cohen’s d=1.71). The ANCOVA showed that death by suicide was significantly associated with lower lithium concentration (F(1, 24)=8.57, P=0.007), and the effect size was large (ηp2=0.26). The random intercept model showed a significant effect of suicide on aqueous humor lithium concentration (b=-0.261, SE=0.102, 95% CI=[-0.471 to -0.051], t(24)=-2.568, P=0.017).ConclusionsThe results of this study demonstrate that even micro-dose lithium is associated with suicide death. Clinical studies are warranted to examine the effects of micro-dose lithium on suicide prevention.Disclosure of InterestNone Declared

We tried to estimate individual mtDNA haplotypes in mixed DNA samples by combining MinION and MiSeq. The BAM files produced by MiSeq were viewed using Integrative Genomics Viewer (IGV) to verify mixed bases. By sorting the reads according to base type for each mixed base, partial haplotypes were determined. Then, the BAM files produced by MinKNOW were viewed using IGV. To determine haplotypes with IGV, only mixed bases determined by MiSeq were used as target bases. By sorting the reads according to base type for each target base, each contributor's haplotype was estimated. In mixed samples from two contributors, even a haplotype with a minor contribution of 5% could be distinguished from the haplotype of the major contributor. In mixed samples of three contributors (mixture ratios of 1:1:1 and 4:2:1), each haplotype could also be distinguished. Sequences of C-stretches were determined very inaccurately in the MinION analysis. Although the analysis method was simple, each haplotype was correctly detected in all mixed samples with two or three contributors in various mixture ratios by combining MinION and MiSeq. This should be useful for identifying contributors to mixed samples.

We report the case of a 2-month-old infant who was found moribund in her crib. Postmortem computed tomography (PMCT) was performed before autopsy. As the baby had a severe subdural hematoma, retinal hemorrhage, and encephalopathy on PMCT, abusive head trauma (AHT) was tentatively diagnosed. At autopsy, no scalp hemorrhages or skull fractures were found; however, the classic triad of AHT was present, mainly on the right side. Additionally, there was dark red discoloration around the heart, and the liver, spleen, and pancreas were enlarged. Peripheral blood was macroscopically cloudy with marked leukocytosis. After careful histological examination, B-cell precursor acute lymphoblastic leukemia (ALL) was diagnosed. All the macroscopic lesions could be attributed to ALL. The manner of death was natural. To the best of our knowledge, this is the first report of infantile ALL mimicking AHT on PMCT images. This case demonstrates the importance of a comprehensive systematic approach to considering differential diagnosis when PMCT shows multiple intracranial hemorrhages suggestive of AHT in an infant.