Development of prevention strategies against bath-related deaths based on epidemiological surveys of inquest records in Kagoshima Prefecture.

Sudden death in the bathroom (bath-related death) occurs more frequently in Japan than in other countries. To clarify the epidemiological characteristics of bath-related deaths, we reviewed inquest records of deaths in Kagoshima Prefecture from 2006 to 2019. We identified 2689 cases of bath-related death. Of these cases, 90% were among people aged ≥ 65 years. The majority occurred in a home bathtub between 16:00 and 20:00. Most deaths (52.0%) occurred in winter (December-February), and there were extremely strong negative correlations with the environmental temperatures (maximum, minimum, and mean) on the day of death. We identified the environmental temperature during cold winter months that bath-related deaths are likely to occur in Kagoshima, although further investigation concerning the effects of other confounding factors is required. Forensic autopsies have only been performed in 29 cases and the cause of death was not diagnosed correctly in the majority of cases. Although autopsies are essential to elucidate the pathogenesis of the deaths, it is difficult to increase the rate of autopsies under the current Japanese death investigation system. Therefore, we suggest that the best way to prevent bath-related death is establishing an "Alert system" based on our results, and to have people refrain from bathing on dangerous days.

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases.

The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiological characteristics of 145 cases diagnosed as drowning, in which hemorrhage, not due to trauma, was found in the respiratory muscles and accessory respiratory muscles. Hemorrhage was observed in 31.7% of these cases, and the incidence did not differ by gender or drowning location. The frequency of hemorrhage was significantly higher in months with a mean temperature below 20°C than in months above 20°C, suggesting a relationship between the occurrence of hemorrhage and low environmental temperature. Moreover, the frequency of hemorrhage was significantly higher in the elderly (aged ≥65 years) compared to those <65 years old. In the elderly, the weakening of muscles due to aging may contribute to the susceptibility for intramuscular hemorrhage. Moreover, these intramuscular hemorrhages do not need to be considered in cases of a potential bleeding tendency due to disease such as cirrhosis or medication such as anticoagulants. Our results indicate that intramuscular hemorrhage in respiratory and accessory respiratory muscles can serve as an additional criterion to differentiate between fatal drowning and other causes of death, as long as no cutaneous or subcutaneous hematomas above the muscles with hemorrhages are observed. In addition, the epidemiological features that such intramuscular hemorrhage is more common in cold environments and in the elderly may provide useful information for the differentiation.

Primed neutrophil infiltrations into multiple organs in child physical abuse cases: A preliminary study.

Physical abuse of the elderly induces a massive primed neutrophil infiltration into the lung and liver through chemotaxis by interleukin (IL)-8, similar to cases of traumatic or hemorrhagic shock. Here, we used immunohistochemical analyses to investigate this infiltration in cases of physically abused children. In addition, we examined the expression of neutrophil elastase (NE) as the inflammatory mediator and α1-antitrypsin (AAT) as the elastase inhibitor. The number of neutrophils in the abuse cases was increased significantly in the heart, lung, liver, and kidney, compared with that of control cases. IL-8-positive cells and NE-positive cells in all organs of abuse cases were significantly greater than those in control cases. Large quantities of oxidized AAT, which fails to inactivate NE and results in tissue damage, was detected in the liver of abuse cases. Neutrophil infiltration showed positive correlation with the degree of systemic accumulation of non-fatal injuries caused by repetitive abusive behavior. Although further investigation using more autopsy samples is necessary, results of our preliminary study indicate that massive neutrophil infiltration induced by IL-8 in multiple organs is a new complementary diagnostic indicator of physical abuse in children. Moreover, the demonstration of NE-positive cells and oxidized AAT provides firm evidence of tissue damage.

Interleukin (IL)-8 immunoreactivity of injured axons and surrounding oligodendrocytes in traumatic head injury.

Interleukin (IL)-8 has been suggested to be a positive regulator of myelination in the central nervous system, in addition to its principal role as a chemokine for neutrophils. Immunostaining for beta-amyloid precursor protein (AßPP) is an effective tool for detecting traumatic axonal injury, although AßPP immunoreactivity can also indicate axonal injury due to hypoxic causes. In this study, we examined IL-8 and AßPP immunoreactivity in sections of corpus callosum obtained from deceased patients with blunt head injury and from equivalent control tissue. AßPP immunoreactivity was detected in injured axons, such as axonal bulbs and varicose axons, in 24 of 44 head injury cases. These AßPP immunoreactive cases had survived for more than 3h. The AßPP immunostaining pattern can be classified into two types: traumatic (Pattern 1) and non-traumatic (Pattern 2) axonal injuries, which we described previously [Hayashi et al. Int. J. Legal Med. 129 (2015) 1085-1090]. Three of 44 control cases also showed AßPP immunoreactive injured axons as Pattern 2. In contrast, IL-8 immunoreactivity was detected in 7 AßPP immunoreactive and in 2 non-AßPP immunoreactive head injury cases, but was not detected in any of the 44 control cases, including the 3 AßPP immunoreactive control cases. The IL-8 immunoreactive cases had survived from 3 to 24 days, whereas those cases who survived less than 3 days (n=29) and who survived 90 days (n=1) were not IL-8 immunoreactive. Moreover, IL-8 was detected as Pattern 1 axons only. In addition, double immunofluorescence analysis showed that IL-8 is expressed by oligodendrocytes surrounding injured axons. In conclusion, our results suggest that immunohistochemical detection of IL-8 may be useful as a complementary diagnostic marker of traumatic axonal injury.

Two different immunostaining patterns of beta-amyloid precursor protein (APP) may distinguish traumatic from nontraumatic axonal injury.

Immunostaining for beta-amyloid precursor protein (APP) is recognized as an effective tool for detecting traumatic axonal injury, but it also detects axonal injury due to ischemic or other metabolic causes. Previously, we reported two different patterns of APP staining: labeled axons oriented along with white matter bundles (pattern 1) and labeled axons scattered irregularly (pattern 2) (Hayashi et al. (Leg Med (Tokyo) 11:S171-173, 2009). In this study, we investigated whether these two patterns are consistent with patterns of trauma and hypoxic brain damage, respectively. Sections of the corpus callosum from 44 cases of blunt head injury and equivalent control tissue were immunostained for APP. APP was detected in injured axons such as axonal bulbs and varicose axons in 24 of the 44 cases of head injuries that also survived for three or more hours after injury. In 21 of the 24 APP-positive cases, pattern 1 alone was observed in 14 cases, pattern 2 alone was not observed in any cases, and both patterns 1 and 2 were detected in 7 cases. APP-labeled injured axons were detected in 3 of the 44 control cases, all of which were pattern 2. These results suggest that pattern 1 indicates traumatic axonal injury, while pattern 2 results from hypoxic insult. These patterns may be useful to differentiate between traumatic and nontraumatic axonal injuries.

Multielemental determination of GEOTRACES key trace metals in seawater by ICPMS after preconcentration using an ethylenediaminetriacetic acid chelating resin.

GEOTRACES is an international research project on marine biogeochemical cycles of trace elements and their isotopes. GEOTRACES key trace metals in seawater are Al (8-1000 ng/kg), Mn (4-300 ng/kg), Fe (1-100 ng/kg), Cu (30-300 ng/kg), Zn (3-600 ng/kg), and Cd (0.1-100 ng/kg), of which global oceanic distribution will be determined on a number of research cruises. This work introduces a novel method of solid-phase extraction to determine Al, Mn, Fe, Co, Ni, Cu, Zn, Cd, and Pb in seawater by adjusting the pH of the sample to 6 and carrying out a single preconcentration step. The trace metals were collected from approximately 120 mL of seawater using a column of a chelating resin containing the ethylenediaminetriacetic acid functional group and eluted with approximately 15 mL of 1 M HNO3. Mn and Fe in the eluate were measured by inductively coupled plasma mass spectrometry (ICPMS) using the dynamic reaction cell mode, and the other metals were measured using the standard mode. Using this procedure, the trace metals were collected quantitatively, while >99.9% of alkali and alkaline earth metals in seawater were removed. The procedural blank was <7% of the mean concentration in deep ocean waters, except 16% for Pb. The overall detection limit was <14% of the mean concentration in deep ocean waters. The RSD was <9%. Our values for the trace metals in the certified reference materials of seawater NASS-5 and nearshore seawater CASS-4 agreed with the certified values (except that there is no certified value for Al). This method was also successfully applied to the reference materials of open-ocean seawater produced by the SAFe program. Our Fe concentrations were 5.9 +/- 0.7 ng/kg for surface water (S1) and 50.4 +/- 2.9 ng/kg for deep water (D2), which are in agreement with the interlaboratory averages of 5.4 +/- 2.4 and 50.8 +/- 9.5 ng/L, respectively. The data for other metals were oceanographically consistent.