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Sudden infant deaths might be attributable to adverse reaction to vaccination, but separating them from coincidental occurrences is difficult. This study retrospectively investigated vaccination-related details and postmortem findings for 57 cases of sudden death in children 2 years or younger. Data were extracted from autopsy files at the Department of Forensic Medicine, Tokai University School of Medicine. Vaccination histories were available in 50 cases based on the maternity passbook. Of the 32 cases in which any vaccines were administered, 7 infants (21.9%) had received immunization within 7 days of death. The most frequent vaccine cited as the last immunization before death was Haemophilus influenzae B. Although a temporal association of vaccines with sudden death was present for two 3-month-old and one 14-month-old infants in whom death occurred within 3 days of receiving the H. influenzae type b and other vaccinations, a definitive relationship between the vaccine and death could not be identified. Histopathological examinations revealed pneumonia and upper respiratory infection as contributing to death in their cases. Moreover, all 3 cases showed hemophagocytosis in the spleen and lymph nodes, which are similar features to hemophagocytic lymphohistiocytosis. Judgment of the disorders as truly related to vaccination is difficult, but suspicious cases do exist. Forensic pathologists must devote more attention to vaccination in sudden infant death cases.
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Muerte Súbita del Lactante/epidemiología , Vacunación/efectos adversos , Encefalopatías/mortalidad , Enteritis/mortalidad , Femenino , Patologia Forense , Cardiopatías Congénitas/mortalidad , Humanos , Ileus/mortalidad , Lactante , Recién Nacido , Virus de la Influenza A/aislamiento & purificación , Japón/epidemiología , Ganglios Linfáticos/patología , Masculino , Fagocitosis , Neumonía/mortalidad , Infecciones del Sistema Respiratorio/mortalidad , Estudios Retrospectivos , Bazo/patología , Streptococcus/aislamiento & purificaciónRESUMEN
BACKGROUND: The solitary death rate in Japan is expected to continue increasing because of its growing super-aged society and the rapid growth of home care in the country. To accurately determine the actual status of solitary deaths, we used a novel analysis method of combining vital statistics and ambulatory care information in Yokohama City. METHODS: Data of persons who died at home in 2013 were obtained from death certificate notifications. We also obtained the emergency transportation records that matched the cases of these death certificate notifications. Then, we gathered information regarding age, gender, marital status, and cause of death for the matched cases. RESULTS: There were 1890 "suspected unnatural deaths," in which most solitary deaths could be included, among all citizens who died at home (n = 4847). We were able to match 1503 of these cases with emergency transportation records. These 1503 cases were divided into two groups, "solitary death" (n = 349) and "un-solitary death" (n = 1154) according to the postmortem interval until finding (PMI-f). Pearson's χ2 tests conducted for the two groups revealed that there were significant differences regarding the proportion of persons who were elderly, unmarried, male, and had a hepatic disease and senility. A logistic regression analysis also showed that an increased likelihood of a prolonged PMI-f was associated with males and an unmarried status with hepatic diseases. CONCLUSIONS: Unmarried, male sex, and liver diseases are independent risks for solitary death in Yokohama City.
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Muerte , Mortalidad , Distribución por Edad , Causas de Muerte , Certificado de Defunción , Diagnóstico , Asesoramiento de Urgencias Médicas/estadística & datos numéricos , Femenino , Humanos , Japón/epidemiología , Masculino , Estado Civil , Mortalidad/tendencias , Factores de Riesgo , Distribución por SexoRESUMEN
BACKGROUND: No study has yet been performed on the importance of the rate of pure "attended deaths at home," excluding examined deaths subjected to a postmortem examination. Therefore, in the present study, we investigated actual state of pure "attended deaths at home," in order to provide reference data for the future development of end-of-life care at home. METHODS: We performed a detailed survey in Yokohama City according to the type of death, age, and underlying cause of death in cases of home deaths, based on the detailed version of the Vital Statistics Survey Death Forms. Then, we divided deaths occurring in each municipality in Kanagawa Prefecture into two categories: "examined deaths" or "attended deaths," which were also stratified by the place of death, based on the Vital Statistics, and data on number of death cases subjected to postmortem examination from the Kanagawa Prefectural Police Headquarters. RESULTS: In 2013, the survey in Yokohama City showed large differences in age distribution and cause of death between examined and attended deaths. In 2014, home deaths accounted for 15.7% of all deaths in the prefecture, whereas the overall proportion of attended deaths at home was 6.9%. CONCLUSIONS: We should utilize the rate of pure "attended deaths at home" for objective outcome indicator.
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Causas de Muerte , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Japón , Persona de Mediana Edad , Características de la Residencia , Adulto JovenRESUMEN
PURPOSE: Japanese society has reached an unprecedented level of aging, with elderly people accounting for 25.1% of the population in October 2013. These changes have created concerns regarding deaths among the elderly. In this study, we compared recent forensic autopsy cases with cases from about 20 years ago, with the goal of understanding the context of death among the elderly within Japanese society today. METHODS: We investigated the forensic autopsy records of 297 people aged 65 years or above. In order to examine the effect of residential circumstances, we classified these cases into two groups: people who lived alone (group A) and those who lived with their family (group B). Forty-five of these autopsy cases were conducted about 20 years ago (1989 to 1993) and 252 cases were recent (2009 to 2013). The cases were limited to people who had been found dead or in a critical situation at home. We investigated the first finder, the period of time elapsed between death and discovery, and the cause of death. RESULTS: The incidence of the first finder being a family member was more than 20% greater in group B compared with group A. The proportions of cases for which it took more than three days for someone to find the body or an abnormal situation were about 14% and 7% in groups A and B, respectively, 20 years ago, and about 48% and 19% among the recent cases. These proportions were significantly higher among the recent cases. Among recent cases, a post-mortem elapsed time of more than 3 days occurred more often in group A than group B (p=0.0002). None of the older cases had an unknown cause of death in either group. However, among the recent cases from both groups, 20-30% of cases resulted in unknown causes of death. The incidences of unknown causes of death were significantly higher among the recent cases in both groups (p=0.015) and in group B alone (p=0.037). The incidences of murder cases were significantly lower in group B among the recent cases (p=0.0022). DISCUSSION: Elderly people who live alone are not easily found or aided when in critical situations, and they may only be discovered after death. Prolongation of the postmortem interval (PMI) results in the deterioration of the corpse making determination of cause of death problematic. The results of this study suggest that there are three factors that isolate elderly people and increase the difficulty in determining their cause of death: reduced communication with family members, reduced communication with neighbors or the community, and the increasing prevalence of the nuclear family. In group B, the prolonged discovery time and the increased incidence of unknown causes of death suggest reduced communication with family members, even though the incidence of being found by a family member was higher than in group A. The murder rate was significantly lower in group B, which may suggest that cases of domestic murder were overlooked. Support for a safe life and peaceful ending for the elderly requires a system based on three factors: remote monitoring to ensure safety, the establishment of elderly groups providing mutual support, and increased visits from welfare workers. Understanding the circumstances of the elderly who die alone is beneficial to countries facing an aging society with weakened family or community structures, and who hope for better support for the elderly.
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Causas de Muerte/tendencias , Aislamiento Social , Anciano , Humanos , Japón/epidemiología , Dinámica Poblacional , Cambios Post MortemRESUMEN
Caffeine-containing drinks are popular daily beverages worldwide and highly concentrated caffeine in the form of tablets is easily obtainable in local chemists. It is common to detect caffeine in toxicological screens in autopsy cases, but we always have to take in account that caffeine itself possesses toxicity which may sometimes lead to death The case was a 44-year-old woman who was found dead in her room one day in June. Empty packages of 'Estaron Mocha 12®, accounting for 14 tablets, were found at the scene. The autopsy showed nothing remarkable suggesting external forces, apart from white granules in her stomach. Toxicological analysis revealed 127 mg/L of caffeine concentration in the deceased's blood, which was considered to be fatal. Caffeine intoxication cases have been reported from many countries. Some are caused by accidental overtake of energy drinks, and many others are caused by intentional intake of caffeine tablets. We think that some restrictions will be effective to prevent this kind of death.
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Cafeína/toxicidad , Adulto , Autopsia , Cafeína/sangre , Femenino , Humanos , Comprimidos , Tomografía Computarizada por Rayos XRESUMEN
Fine needle aspiration (FNA) and core needle biopsy (CNB) are recognized to be safe, useful, and inexpensive diagnostic tools for the evaluation of thyroid nodules. However, complications can arise during the procedure, albeit rarely and typically minor in nature. We report here an unusual fatal case of massive hematoma of the neck after FNA and CNB that may have caused airway obstruction. A 68-year-old Japanese woman underwent both procedures and was found dead at home later the same day. Although severe complications of FNA or CNB such as major bleeds or deaths are rarely reported, clinicians and forensic pathologists should be cognizant that complications can arise.
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Obstrucción de las Vías Aéreas/etiología , Biopsia con Aguja Fina/efectos adversos , Hemorragia/etiología , Glándula Tiroides/patología , Anciano , Resultado Fatal , Femenino , Hematoma/etiología , Hematoma/patología , Hemorragia/patología , HumanosRESUMEN
INTRODUCTION: In Japan, many cases occur wherein housemates fail to report dead bodies found in their homes. However, only individual cases are reported through press and court records, and analysis including unreported cases has not been conducted. In this study, we evaluated cases handled by our Forensic Science Department in which housemates did not immediately report a dead body found in their home. We analyzed the overall picture and forensic characteristics of such cases, stratifying whether the abandoners were estimated hikikomori. METHODS: Of the 1,179 legal autopsy cases handled by the Department of Forensic Medicine of Tokai University from January 1, 2017, to July 1, 2023, we evaluated 45 cases in which housemates did not immediately report dead bodies. The characteristics analyzed were body age, cause of death, autopsy findings, duration from the body's discovery by the abandoner to the police report, the reason for the lack of report in the first body discovery by the abandoner, and the reason for the report. In this study, the criteria for estimating whether a hikikomori abandoned the body were (1) the police provided the information that the person was a hikikomori or (2) the person met the following four criteria: 20-64 years old, unemployed, not in school, and living with parents. RESULTS: Positive significant differences were found in the body's decomposition and the time from the body's discovery to the report to the police when the abandoner was suspected to be a hikikomori for more than one, four, or eight days. No significant differences were found in the cause of death. Regarding the reported characteristics, when the abandoner was an estimated hikikomori, positive and significant differences were found for recognizing the body and did not report immediately due to shock. Conversely, negative and significant differences were found for the person who reported as the abandoner. CONCLUSION: This is the first study that reports on body abandonment by housemates and elaborates on its complications to forensic doctors. The incidence rate of abandonment is higher than expected. This study suggests that hikikomori are more likely to hide the bodies for longer, which hinders the death cause investigation.
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An 11-year-old boy presented with vomiting and abdominal pain. Ultrasonography and blood tests revealed no abnormalities. He was diagnosed with viral gastroenteritis; however, the following morning, he was found dead in bed. Postmortem examination revealed that a 1,900 mL hemorrhage with strong coagulation from the diaphragm was the cause of death. He had no traumatic episodes, injuries, or a medical history of hemorrhagic diathesis. The presence of a fibrin-like clot indicated coagulation activation; however, most criteria for disseminated intravascular coagulation were not observed. Fibrolamellar carcinoma, a rare hepatocellular carcinoma, was found; however, liver disorder was not estimated based on the pathological findings. In conclusion, the mechanism of hemorrhage could not be explained. Although we were unable to identify the cause of the hemorrhage, we could not completely rule out the possibility that fibrolamellar carcinoma had an unknown influence on the hemorrhage. Given the limited number of studies on fibrolamellar carcinoma, we present a case of a boy with undiagnosed fibrolamellar carcinoma who died due to severe hemorrhage.
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Background: Most cancers are lifestyle-related and are thus preventable. Lifestyle habits can be improved by individual efforts; for example, because oral health is suggested to play a preventive role in cancer risk, toothbrushing is considered a critical and fundamental measure for controlling oral health. This study aimed to investigate the association between toothbrushing and cancer risk. Methods: Cross-sectional data from the Japan COVID-19 and Society Internet Survey, a large-scale (n = 32,000) online survey conducted in 2022, were used. From September 12 to October 19, 2022, questionnaires were distributed to candidates selected by simple random sampling from a Japanese Internet research company's panelists to represent the Japanese population. The association between toothbrushing and cancer risk according to cancer prevalence was then analyzed. Results: Among all 32,000 participants, 2,495 (7.8%) who had any cancer previously were analyzed. Multivariable logistic regression analysis revealed a significant association between toothbrushing habit and cancer risk. Conclusion: The findings of this study suggest that daily toothbrushing is essential for maintaining oral health and preventing cancer.
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Introduction Most people would prefer end-of-life care to be provided at home. Although Japan has tried to promote home care and end-of-life care, very few people die at home in Japan. On the other hand, deaths at home are not necessarily attended deaths at home by end-of-life care because they include many deaths, such as deaths from external causes and solitary deaths. We obtained the data on the number of postmortem examinations at home in the main areas of Osaka City and calculated the estimated number of attended deaths at home by subtracting the number of postmortem examinations at home from the number of total deaths at home. We analyzed the contribution of medical resources to end-of-life care from a forensic perspective for a closer analysis of the actual situation. Methods The data about the population, the number of total deaths, deaths at home, and medical resources related to home care in Osaka City was obtained from the website of a public institution in Japan. The data about the number of postmortem examinations in Osaka City was obtained from the Osaka Medical Examiner's Office. The estimated number of attended deaths at home was calculated by subtracting postmortem examinations at home from total deaths at home. We conducted univariate and multivariate analyses between the number of medical resources and the prevalence of attended deaths at home. Results In the univariate analysis of the prevalence of attended deaths at home, a high positive correlation was observed in "doctors," "total clinics," "clinics except HCSC," and "general beds." A high negative correlation was observed in "long-term care beds." In the multivariate analysis, a positive coefficient was observed in "clinics except HCSC," and a negative one was observed in "HCSC or HCSH." Conclusion The policy of shifting general clinics and hospitals to HCSC and HCSH may not be as effective for end-of-life care because the criteria do not include any restrictions on the number or use of beds. However, general clinics may have played an important role in end-of-life care, even if they were not HCSC.
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Background: There is no global consensus on whether pandemic-related factors are related to child abuse. How the pandemic reinforces the risk factors of child abuse might depend largely on individuals' current and past lifestyles in each country. Some changes of lifestyles continue after the pandemic, and it is important to understand which factors are strongly associated with child abuse. We analyzed the pandemic-related characteristics of offenders and non-offenders of self-reported child physical abuse from Internet survey data in Japan and discussed how the pandemic affected physical child abuse and what caused the difference by gender. Methods: We conducted a cross-sectional study on physical child abuse by caregivers based on the Internet survey conducted from September to October 2021. We divided the participants who were living with their child aged less than 14 years into offenders and non-offenders based on the answer to the question about physical child abuse. The population distribution of the sample was compared to that of caregivers under the same conditions in a large Japanese dataset. The association between their characteristics and physical child abuse was analyzed by univariable and multivariable analysis. Results: The caregivers analyzed in the cohort had similar population distributions to those in the large Japanese dataset. As risk factors of male offenders, "work from home 4-7 days/week," "decreased work," "normal relationships with household members (compared to good relationships)," "COVID-19 infected, both themselves and household members, within a year," "unwillingness to receive COVID-19 vaccination because the license process of the vaccine is doubtful," "high levels of benevolent sexism," and "history of child abuse" were observed. As risk factors of female offenders, "bad relationships with household members (compared to good relationships)," "fear of COVID-19," "COVID-19 infected, both themselves and household members, within a year," "feelings of discrimination related to COVID-19 in the past two months," and "history of child verbal abuse" were observed. Conclusions: Among male offenders, a significant relationship was observed regarding work-related changes, which may have been reinforced by the pandemic. Furthermore, the extent of the influence and fear of losing jobs caused by these changes may have varied according to the strength of gender roles and financial support in each country. Among female offenders, a significant relationship was observed regarding fear of infection itself, which is consistent with the findings of other studies. In terms of factors related to dissatisfaction with families, in some countries with prominent stereotyped gender roles, men are thought to experience difficulties adapting to work-related changes induced by crises, while women are thought to experience intense fear of the infection itself.
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COVID-19 , Maltrato a los Niños , Niño , Humanos , Masculino , Femenino , COVID-19/epidemiología , Pandemias , Autoinforme , Abuso Físico , Estudios Transversales , Japón/epidemiología , Vacunas contra la COVID-19 , Miedo , Factores de RiesgoRESUMEN
PURPOSE: During the Coronavirus Disease 2019 (COVID-19) pandemic, there has been concern about nosocomial infections acquired through dental practice, where machines - such as air turbines - that generate aerosols are used, and where there are many opportunities to come into contact with saliva and blood. Because there is no report to date on whether dental treatment is associated with a risk of SARS-CoV-2 infection in Japan, the aim of the present cross-sectional study was to examine the risk of SARS-CoV-2 infection associated with dental treatment. MATERIALS AND METHODS: Cross-sectional data were gathered from the Japan COVID-19 and Society Internet Survey (JACSIS), a large-scale internet survey conducted in 2021 (n=28,175). From September 27, 2021, to October 30, 2021, the questionnaires were distributed to candidates selected from the panelists of a Japanese Internet research company to represent the Japanese population regarding age, sex, and residential prefecture using a simple random sampling procedure. The risk of SARS-CoV-2 infection related to dental treatment was examined and analysed. RESULTS: Multivariable logistic regression analysis showed that younger age, male sex and living alone were statistically significant factors positively associated with SARS-CoV-2 infection, whereas the presence or absence of dental treatment was not statistically significantly correlated with SARS-CoV-2 infection. CONCLUSION: The present epidemiological study showed that dental treatment is not a positive risk factor for SARS-CoV-2 infection in Japan.
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COVID-19 , Infección Hospitalaria , Humanos , Masculino , COVID-19/epidemiología , Estudios Transversales , Japón/epidemiología , SARS-CoV-2RESUMEN
Background: The existence of social withdrawal (Hikikomori), which meets the conditions "not attending school", "not working", and "isolated at home for more than 6 months", is gradually being discovered by the world, and their mental health and healing is being highlighted. However, there are very few Hikikomori-related surveys searching their physical health, as it is generally believed that most Hikikomori are adolescents. Middle-aged Hikikomori are also found outside Japan, and their physical health is more important, because Hikikomori have difficulty managing their health due to the socially isolated circumstances and lack of sociability. Although "isolated at home for more than 6 months" could not be used, we extracted a group with low social independence with reference to Hikikomori-related surveys. We estimate that people with low social independence have similar characteristics and problems to Hikikomori, because they share many causes for the problem of difficulty in managing their own health. People with low social independence were identified, and their physical health, such as smoking and drinking status, consultation rates of various diseases, and how often they attend cancer screenings, was analyzed. Methods: We extracted middle-aged people with low social independence and a control group from the national survey in Japan and stratified them by sex and age. Their health risks were assessed by univariate analysis. Criteria for the experimental group were set with reference to Hikikomori-related surveys. Criteria for the control group included "aged 40-69", "living with parents", "not receiving care for disabilities", and "working". Results: Low-social-independent men had higher consultation rates for diabetes, stroke or cerebral hemorrhage, myocardial infarction or angina, gastric and duodenum diseases, kidney disease, anemia, and depression, while lower consultation rates for dyslipidemia and hypertension. The tendency of non-smoking and non-drinking was found among them. They seldom attended cancer screenings. Low-social-independent women had higher consultation rates for liver and gallbladder diseases, other digestive diseases, kidney diseases, anemia, osteoporosis, and depression. The tendency of non-drinking was the same as men. More heavy smokers were found among those aged 40-49 years, with no significant differences in other age groups. They seldom attended cancer screenings, as well as men. Conclusions: In terms of current physical health, low-social-independent men have more fatal diseases. Both sexes with low social independence seldom attend cancer screenings and have an increased risk of developing progressive cancer in the future. At least in terms of non-smoking and non-drinking, they live healthier lives than the control group, and what makes low-social-independent men have various fatal diseases is still unclear.
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Neoplasias , Fobia Social , Masculino , Persona de Mediana Edad , Adolescente , Humanos , Femenino , Detección Precoz del Cáncer , Aislamiento Social/psicología , Salud Mental , Neoplasias/diagnósticoRESUMEN
Aims Since it is known that oral problems affect various medical diseases, the effects of restrictions on visits for dental treatment on exacerbations of various systemic medical diseases were examined.Method and materials The data were used from the Japan COVID-19 and Society Internet Survey, a large-scale internet survey conducted in 2021 (n = 28,175). The questionnaires were distributed to 33,081 candidates who were selected to represent the Japanese population regarding age, sex and residential prefecture using a simple random sampling procedure. Patients currently undergoing treatment for diabetes mellitus, hypertension, asthma, cardiocerebrovascular disease, hyperlipidemia, atopic dermatitis, and mental illness, such as depression, were extracted from the total participants. Then, whether discontinuation of dental treatment affected the exacerbation of their systemic disease was examined.Results Overall, 50-60% of patients with each systemic disease had continued to receive dental treatment, and 4-8% of them had discontinued dental treatment. On univariate and multivariate analyses, discontinuation of dental treatment is a risk factor in the exacerbation of diabetes mellitus, hypertensive conditions, asthma, cardiocerebrovascular disease and hyperlipidemia.Conclusion The present epidemiological study showed the relationship between oral health and systemic health, which can provide meaningful insights regarding future medical-dental collaboration in Japan.
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AIMS: Psychological distress is associated with poor prognosis in patients with cardiovascular disease (CVD). However, factors related to psychological distress in elderly patients with CVD are less understood. We aim to investigate the rate of psychological distress in elderly patients with CVD in comparison with that of patients without CVD and to examine the clinical, socio-economic, and lifestyle factors associated with this condition. METHODS AND RESULTS: Data from a nationwide population-based study in Japan of patients aged ≥60 years were extracted, and 1:1 propensity score matching was conducted of patients with and without CVD. Psychological distress was assessed using the K6 scale, on which a score ≥6 was defined as psychological distress. Of the 24 388 matched patients, the rate of psychological distress was significantly higher among patients with CVD compared with those without CVD (29.8 vs. 20.5%, P < 0.0001). The multivariate analysis revealed that female sex, comorbidities, except for hypertension, current smoking status, daily sleep duration of <6 vs. ≥8 h, home renter vs. owner, retired status, having a walking disability, and lower monthly household expenditure were independently associated with psychological distress. Walking disability was observed to be in greatest association with psychological distress (odds ratio 2.69, 95% confidence interval 2.46-2.93). CONCLUSION: Elderly patients with CVD were more likely to have psychological distress compared with those without CVD. Multiple factors, including clinical, socio-economic, and lifestyle variables, were associated with psychological distress. These analyses may help healthcare providers to identify high-risk patients with psychological distress in a population of older adults with CVD.
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Enfermedades Cardiovasculares , Hipertensión , Distrés Psicológico , Anciano , Humanos , Femenino , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Factores de Riesgo , Japón/epidemiología , Estrés Psicológico/etiologíaRESUMEN
BACKGROUND: Cardiovascular disease and cancer share a number of risk factors and pathophysiologic mechanisms. Although risk management and early detection of cancer in patients with cardiovascular disease are important, preventive efforts in cardiology and oncology have been relatively disconnected. This study aimed to investigate the rate of cancer screening in a population of older adults with cardiovascular disease. METHODS: This study used data from the 2019 Comprehensive Survey of Living Conditions. Data on participants aged 60â¯years or older were extracted. The rate of cancer screening and cancer type were investigated between participants with and without cardiovascular disease. RESULTS: Of the 132,442 individuals, participants with cardiovascular disease had a significantly lower rate of cancer screening than those without cardiovascular disease [male: 4401 of 7972 participants (55.2%) vs. 33,744 of 52,106 participants (64.8%), pâ¯<â¯0.001; female: 2500 of 4984 participants (50.2%) vs. 41,319 of 67,380 participants (61.3%), pâ¯<â¯0.001]. The rate of cancer screening was significantly lower in participants with cardiovascular disease than in those without cardiovascular disease, regardless of cancer type, including gastric, colorectal, lung, breast, and gynecologic cancer screening. A history of cardiovascular disease was a negative factor for cancer screening (odds ratio 0.71, 95% confidence interval 0.67-0.74 in male participants; odds ratio 0.80, 95% confidence interval, 0.75-0.85 in female participants). CONCLUSIONS: The rate of cancer screening in elderly participants with cardiovascular disease was lower than that in participants without cardiovascular disease. Physicians should raise awareness regarding early cancer detection in patients with cardiovascular disease.
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Enfermedades Cardiovasculares , Neoplasias , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Tamizaje Masivo , Neoplasias/diagnóstico , Neoplasias/epidemiología , Factores de RiesgoRESUMEN
The incidence of death by drowning greatly varies among different prefectures in Japan, mainly due to climate difference. However, there could be other factors affecting the incidence of deaths besides climate, for example, differences in regional death investigation systems. Here, we aimed to elucidate other such factors affecting the mortality data of drowning in the bathtub, especially the effects of discontinuing the medical examiner system. Police data in Kyoto and ambulatory care information in Yokohama were used. Data on cases of elderly individuals found dying or dead in the bathtub at home in winter 2014-2015 were obtained. The following data were collected for each case: age, gender, presence/absence of ambulatory transport, performance of autopsy, and cause of death. The autopsy and drowning rates in Kyoto were 0%, whereas both values in Yokohama were significantly higher at 93.1% and 89.4%, respectively (the denominator of each of the rates is the total number of elderly (aged 65 or over) individuals found dying or dead in the bathtub at home in each city during each winter). Despite no significant difference of incidence of total bath-related death, the proportion of drowning-related deaths was overwhelmingly higher in Yokohama than in Kyoto. The difference can be attributed to the difference in autopsy rates between the two cities, mainly caused by the presence/absence of a medical examiner system. Therefore, we should pay careful attention to future changes in autopsy/drowning rates in Yokohama, and ascertain whether the change might be continuously influenced by the abolishment of this system.
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Accidentes Domésticos/mortalidad , Autopsia/estadística & datos numéricos , Baños , Médicos Forenses , Ahogamiento/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Japón/epidemiología , Masculino , Estaciones del AñoRESUMEN
OBJECTIVE: (1) To determine feature vector representations (geometric pattern parameters) that are effective in describing human nasal profiles, (2) to determine the number of code vectors (typical nasal patterns) that are mathematically optimized by applying the vector quantization method to each feature vector extracted for each subject, and (3) to determine the morphological traits of each code. MATERIALS AND METHODS: Lateral facial photographs of 200 Japanese women recorded for orthodontic diagnosis were selected. Five anatomic landmarks were identified on each image together with a set of data points that constituted the contour of the facial profile. An eight-dimensional feature vector effective in distinguishing differences in nasal profile patterns was extracted from the data set using experts' knowledge of the anatomic traits of the nose. The vector quantization technique was applied to the feature vectors to provide the optimum number of nasal profile patterns. RESULTS: The number of code vectors mathematically optimized was six, and the differences between vectors were maximized by morphological traits of the root, dorsum, tip, and base of the nose. Proportions of the number of image records classified into each code were 25.5%, 24.5%, 21.5%, 15.0%, 10.0%, and 3.5% from code 1 to code 6, respectively. CONCLUSIONS: Classifying nasal profile patterns based on knowledge from a linguistic description was found to be more effective than a method based on uniform sectioning. The differences between vectors were maximized by morphological traits of the root, the dorsum, the tip, and the base of the nose.
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Cefalometría/métodos , Nariz/anatomía & histología , Adolescente , Adulto , Análisis de Varianza , Femenino , Humanos , Persona de Mediana Edad , Fotografía DentalRESUMEN
We report here lessons learned from an autopsy case involving radioactive materials. We performed an autopsy of an unidentified mummified man with no available medical history whom from imaging findings we suspected had received radioactive seed implants for prostate brachytherapy. We returned the excised prostate and seeds to the body. A few days later, the body was identified by DNA matching and cremated. According to the man's medical record, he had undergone iodine-125 seeds implantation for prostate cancer 11 months earlier. We should have removed the radioactive seeds from the body to prevent radiation exposure to the bereaved family and/or environmental pollution due to cremation. Surprisingly, one seed was found in the stored prostate specimen. Forensic experts should be cognizant of the risk of both radiation exposure in the autopsy room and environmental pollution. We must remain abreast of the latest advances in medicine.
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Braquiterapia , Radioisótopos de Yodo , Exposición Profesional/prevención & control , Neoplasias de la Próstata/radioterapia , Exposición a la Radiación/prevención & control , Cremación , Patologia Forense/normas , Humanos , Japón , Masculino , Eliminación de Residuos Sanitarios/normas , Persona de Mediana Edad , Salud Laboral/normasRESUMEN
The toxicological detection of the new synthetic cathinone 4'-methyl-α-pyrrolidinohexanophenone (MPHP) in urine samples has been impossible, because much of MPHP is metabolized before its excretion into urine. In this study, we successfully quantified unmetabolized MPHP in urine of an autopsy case using a sensitive method by liquid chromatography-time-of-flight-mass spectrometry. The quantification method showed good linearity in the range of 1.00-100 ng/mL, and the limit of detection was 0.5 ng/mL in human urine. In the autopsy case, the concentrations of MPHP in urine, plasma, and liver tissue samples were determined to be 60.1, 32.9 ng/mL, and 63.1 ng/g, respectively.