Postmortem serum levels of amylase and gamma glutamyl transferase (GGT) as markers of systemic tissue damage in forensic autopsy

Serum amylase (AMY) and gamma glutamyl transferase (GGT) are routine clinical markers for investigating pancreatic and hepatobiliary disorders, respectively, but are also increased in systemic deterioration following critical trauma and diseases. The present study investigated the postmortem levels in bilateral cardiac blood of medicolegal autopsy cases without decomposition (n = 163), excluding those with pancreatic or hepatic injury, or preexisting pathologies, as well as prolonged death cases, to evaluate the changes due to systemic deterioration in the death process after fatal insults with special regard to intoxication, hyperthermia (heatstroke) and hypothermia (cold exposure). Serum AMY and GGT levels were virtually independent of postmortem interval. Serum AMY level was mostly higher than the clinical reference range, predominantly including salivary fractions, but was usually below 1000 U/L except for fatal intoxication, which showed significant increases of total AMY as well as salivary and pancreatic fractions in bilateral cardiac blood. Serum levels of salivary and pancreatic AMY fractions showed tendencies to be related to pancreatic subcapsular and interstitial bleeding, respectively, which were relatively frequent and evident in mechanical asphyxiation, intoxication and hyperthermia (heatstroke). Serum GGT was often elevated (mostly below 300 U/L) in cases other than hypothermia (cold exposure). These findings suggest postmortem serum AMY and GGT as indicators of the severity of systemic organ damage in death processes, especially in intoxication; however, elevated serum AMY and GGT levels over 1000 and 300 U/L might indicate significant pancreatic and hepatobiliary pathologies, respectively, except for an elevated serum AMY level in intoxication.     

Time-related change evaluation of the cerebrospinal fluid using postmortem CT

PurposeWe retrospectively evaluated the cerebro-spinal fluid (CSF) CT density at the lateral ventricle to compare the postmortem intervals in cadavers.Materials and methodsThe number of cadavers enrolled in this study was 189 (male 120, female 69). According to the estimated postmortem time, the cadavers were divided into 13 groups (postmortem day 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 7, 10, 14, 21, 30), and were also re-grouped into 3 groups according to the postmortem time-width: group A (postmortem day 0.5–2.5), group B (day 3–7), and group C (day 10–30). Comparisons between the CSF density and estimated postmortem time were also analyzed.ResultsThe CSF density was around 20 HU up to day 2.5, and it increased gradually after day 3. Day 3 and 4 presented higher CSF density than day 1 and 1.5 (p < 0.05). Day 7 presented higher CSF density than day 3 (p < 0.05).According to the postmortem time-width, the CSF density increased with postmortem time (p < 0.05).The simple linear regression equations presented negative correlation between CSF density and estimated postmortem time, and R² was 0.119.ConclusionThe CSF density increased, but not linearly, according to the postmortem time, and the 3rd postmortem day was the earliest time allowing the difference to be detected. The CSF density needs further evaluation to enable estimation of the postmortem time.     

Cardiothoracic ratio in postmortem chest radiography with regard to the cause of death

It is difficult to examine the intact in situ status of thoracic organs, including the heart and lungs, after opening the chest at autopsy. The present study investigated the pathological diagnostic significance of the cardiothoracic ratio (CTR) with regard to heart and lung weight in postmortem plain chest radiography. The pathological diagnostic significance of the CTR in postmortem plain chest radiography using serial forensic autopsy cases of adults (>19 years of age, n = 367, within 72 h postmortem) was retrospectively investigated. In natural deaths, CTR was larger for heart diseases, and was smaller for pulmonary infection and gastrointestinal bleeding, showing correlations to the heart weight except in cases of hemopericardium. In traumatic deaths, CTR was larger in cases of fire fatality and acute methamphetamine intoxication, and varied in cases of blunt injury, showing correlations to the heart weight. However, CTR was smaller for sharp instrument injury and drowning, independently of the heart weight. These findings suggest that postmortem CTR (median, 55.6%, measured using a mobile X-ray apparatus) primarily depends on the heart weight, but is substantially modified during the process of death: the CTR may be enlarged by cardiac dilatation due to terminal congestive heart failure, but may be reduced by inflated lungs in drowning or hypovolemia due to fatal hemorrhage. CTR showed a mild correlation to the right diaphragm level, which was also related to the cause of death, but was independent of the left diaphragm level. Plain chest radiographic findings may also be helpful in investigating the pathophysiology of death, and are to some extent comparable with clinical findings. This also suggests the potential usefulness of postmortem CT and MRI for analysis of terminal cardiac function.     

Postmortem urinary catecholamine levels with regard to the cause of death

Previous studies suggested that serum catecholamines are useful for investigating stress responses in the death process. The present study analyzed postmortem urinary adrenaline (Ad), noradrenaline (Nad) and dopamine (DA) in serial forensic autopsy cases (n = 199: 154 males and 45 females; age >9 years; survival time <0.5–168 h; within 10 days postmortem) to investigate the differences among the causes of death with special regard to hyperthermia (heatstroke; n = 11) and hypothermia (cold exposure; n = 10); other cases included fatalities from injury (n = 47), mechanical asphyxiation (n = 18), drowning (n = 14), intoxication (n = 31), fire fatality (n = 33) and natural death (n = 35). Each catecholamine level in urine was independent of the age or gender of the subjects, postmortem interval over 10 days or survival time, and did not correlate with the blood level. Urinary Adr and Nad levels were similar to those of clinical serum reference ranges, while DA was higher in all cases. Adr and Nad were higher in blunt head injury, methamphetamine abuse, hypothermia (cold exposure) and hyperthermia (heat stroke), but were low in mechanical asphyxia, drowning, fire fatality, sedative-hypnotic intoxication and acute cardiac death. DA was higher in injury, drowning, fire fatality, methamphetamine abuse and acute cardiac death, but was lower in mechanical asphyxiation and sedative-hypnotic intoxication. These profiles were quite different from those of serum levels, involving a predominant increase of DA, and may be useful for differentiating hyperthermia (heatstroke) and hypothermia (cold exposure) from drowning, sedative-hypnotic intoxication and sudden cardiac death.     

Immunohistochemistry of catecholamines in the hypothalamic–pituitary–adrenal system with special regard to fatal hypothermia and hyperthermia

Catecholamines are involved in various stress responses. Previous studies have suggested applicability of the postmortem blood levels to investigations of physical stress responses or toxic/hyperthermic neuronal dysfunction during death process. The present study investigated cellular immunopositivity for adrenaline (Adr), noradrenaline (Nad) and dopamine (DA) in the hypothalamus, adenohypophysis and adrenal medulla with special regard to fatal hypothermia (cold exposure) and hyperthermia (heat stroke) to examine forensic pathological significance. Medicolegal autopsy cases (n = 290, within 3 days postmortem) were examined. The proportions of catecholamine (Adr, Nad and DA)-positive cells (% positivity) in each tissue were quantitatively estimated using immunostaining. Hyperthermia cases (n = 12) showed a lower neuronal DA-immunopositivity in the hypothalamus than hypothermia cases (n = 20), while Nad- and DA-immunopositivities in the adrenal medulla were higher for hyperthermia than for hypothermia. Rates of Nad-immunopositivity in the adrenal medulla were very low for hypothermia. No such difference between hypothermia and hyperthermia was seen in the adenohypophysis. In hypothermia cases, cellular Nad-immunopositivity in the adrenal medulla correlated with the Nad level in cerebrospinal fluid (r = 0.591, p < 0.01). These observations suggest a characteristic immunohistochemical pattern of systemic stress response to fatal hypothermia and hyperthermia, involving the hypothalamus and adrenal medulla.     

Laboratory experiments to characterize radiochloride diffusion in unsaturated soils

Diffusion transport of ³⁶Cl was examined in seven soils under unsaturated conditions in tubes packed with two portions of each soil having different ³⁶Cl activity concentrations. Apparent diffusion coefficients (D_a) derived from diffusion profiles varied within a narrow range (from 3×10^?10 to 7×10^?10 m² s^?1) confirming the minor effect of soil properties on the diffusion of a non-reactive radionuclide like ³⁶Cl. Instead, packing conditions had a major effect. Solid–liquid distribution coefficients (K_d) derived from D_a (0.02–0.2 L kg^?1) were systematically lower than those obtained from batch experiments (0.6–1.0 L kg^?1), but with a similar variation pattern among soils. The low values of K_d (Cl) confirmed an almost negligible radiochloride–soil interaction.     

Postmortem computed tomography findings in the thorax – Experimental evaluation

ObjectiveExperimental fatal models were prepared to investigate the time-related course of lung changes using postmortem CT (PMCT). This study was approved by our institutional animal ethics committee.Materials and methodsTwenty-four NZW rabbits (female 24, 2.30–4.30 (mean 3.10) kg) were divided into 4 fatal groups; drowning, hypothermia, bag suffocation, and Potassium Chloride intravenous (control) group. All individuals were examined by CT (Aquilion CX, Toshiba, Japan) on postmortem time course until detection of putrefaction air. The percent of aerated lung volume (%ALV = 100 * (ALV/total lung volume)) was measured and the pleural space fluid was investigated by axial imaging. A paired t-test and Bonferroni/Dunn study were employed for statistical evaluation.ResultsIn intra-group analysis, the %ALV showed statistically different periods compared with each pre-image: 4–48 h in control, 1–24 h in drowning, 5–6 h in hypothermia, and 1–4 h in bag suffocation. In inter-group comparison (compared with control group), the %ALV increased in suffocation and decreased in drowning within 12 h. The %ALV remained significantly high in hypothermia until 24 h. The earliest detection times of pleural space fluid collection were different in each group: control (20 h), drowning (18 h), suffocation (36 h), and hypothermia (95 h).ConclusionThe lung hypostasis and the appearance of pleural space fluid collection presented differently in individual causes of death and depending on the postmortem time.     

A new approach in virtopsy: Postmortem ventilation in multislice computed tomography

Although postmortem imaging has gained prominence in the field of forensic medicine, evaluation of the postmortem lung remains problematic. Specifically, differentiation of normal postmortem changes and pathological pulmonary changes is challenging and at times impossible.In this study, five corpses were ventilated using a mechanical ventilator with a pressure of 40 mbar (40.8 cm H₂O). The ventilation was performed via an endotracheal tube, a larynx mask or a continuous positive airway pressure mask. Postmortem computed tomographic images of the lungs before and with a ventilation of 40 mbar (40.8 cm H₂O) were evaluated and the lung volumes were measured with segmentation software.Postmortem ventilation led to a clearly visible decrease of both the density in the dependant parts of the lungs and ground glass attenuation, whereas consolidated areas remained unchanged. Furthermore, a mean increase in the lung volume of 2.10 l was seen. Pathological changes such as septal thickening or pulmonary nodules in the lung parenchyma became more detectable with postmortem ventilation.Intracorporal postmortem mechanical ventilation of the lungs appears to be an effective method for enhancing detection of small pathologies of the lung parenchyma as well as for discriminating between consolidation, ground glass attenuation and position-dependent density.     

Postmortem serum tenascin-C (TN-C) concentrations in forensic autopsy cases: A pilot study

In forensic investigations, autopsy findings offer major clues for the diagnosis of the cause of death. Thus, various clinical biochemical markers are now being tested to complement conventional investigation in the field of forensic medicine. In this study, we focused on tenascin-C (TN-C), a glycoprotein present in the extracellular matrix and expressed in pathological states. We reviewed autopsy cases for a 4-year period (2006–2009) using autopsy records, and analyzed the blood serum concentrations of TN-C and C-reactive protein (CRP) in these cases (N = 101). The TN-C levels were relatively higher in the postmortem serum samples than in the samples from healthy individuals, and in cases of head injury, both TN-C and CRP levels were high in the postmortem serum sample. Moreover, high TN-C levels were observed particularly in cases with a long survival period. These findings indicate that postmortem serum TN-C levels may represent a useful tool for identifying the cause of specific fatal traumas.     

Early time-related course of image findings in postmortem MRI: Typical findings and observer agreement in a porcine model

PurposeTo assess early time-related image findings in postmortem magnetic resonance imaging (MRI) and to evaluate observer agreement in a porcine model.Material and MethodsThree pigs were examined by MRI at 15 different time points in the first 36 h after death. Two observers independently recorded the postmortem interval (PMI) to the appearance of fluid collection (pleural space, interlobar and interlobular pulmonary fissures and hepatic interlobar fissures), gas accumulation (intrahepatic and intracardial) and blood clotting (aorta and intrahepatic venous vessels). Cohen’s Kappa statistics and intraclass correlation coefficient (ICC) were used to evaluate intra- and interobserver agreement.ResultsIntrahepatic gas was evident after 12, 17 and 30 h. Also, intracardiac gas was present in all animals. However, no chronological appearance has been observed. Blood clotting in the hepatic vein was observed within 3 min, aortic clotting with a delay of 2–12 h after death. Interlobular pulmonary fluid (median PMI: 2 h, range 2–2 h), pleural effusion (median PMI: 10.5 h, range 9-12 h) and hepatic interlobar fissure fluid (median PMI: 11.5 h, range 11–12 h) displayed a chronological appearance pattern. Qualitative and quantitative detection of most postmortem findings showed excellent intra- and interobserver agreement with Kappa values > 0.8 or ICC > 0.75.ConclusionPulmonary and hepatic fissural fluid collection as well as intravasal gas accumulation are early time-related image findings in postmortem MRI. The chronological appearance of these findings can be assessed with excellent observer agreement in a porcine model.     

Experimental drowning lung images on postmortem CT – Difference between sea water and fresh water

PurposeExperimental drowning models were prepared to investigate the time-related course of lung changes using postmortem CT. This study was approved by our institutional animal ethics committee.Materials and methodsFifteen NZW rabbits (female fifteen, 2.6–4.3 (mean 3.3) kg) were divided into 3 groups: fresh water drowning (FRESH), sea water drowning (SEA), and sea water drowning with anterior chest compression (ACC). All individuals were examined by CT (Aquilion CX, Toshiba, Japan) on postmortem time course. The rabbit’s head was submerged in a water bath for a total of 10 min. In ACC, cardiopulmonary resuscitation was performed for 2 min, additionally. The percentage of aerated lung volumes (%ALV = 100 (aerated lung volume/total lung volume)) were statistically evaluated and the lung CT image patterns and pleural fluid appearance time were investigated.ResultsAll lungs had decreased their %ALV within 24 h, and there were no statistical differences in and among the 3 groups. After 36 h, %ALV tended to increase in all groups, and only ACC presented a statistical difference between 1 h and 36 h (p < 0.005).On postmortem lung CT, all lungs presented ground-glass opacity with interstitial thickening spread pattern (100%) and no pattern change during the follow-up period. After presenting pleural space fluid collection, the %ALV tended to increase.ConclusionThere were no differences among FRESH, SEA, and ACC in %ALV within 24 h. Only ground-glass opacity could be detected on postmortem lung CT, experimentally.     

The effect of an early dismissal on player work-rate in a professional soccer match

The aim of this study was to examine the effects of an early dismissal (after 5-min play) on work-rate in a professional soccer match. A computerised player tracking system was used to assess the work-rates of seven players who completed the match on a team with 10 players. A minute-by-minute analysis of the remaining 91 min following the dismissal was performed for the total distance covered, the distance covered in five categories of movement intensity and the recovery time between high-intensity efforts for each player. The data were calculated for each half and for three equal intervals within each half and profiled against normative data for the same players obtained from the analysis of 15 games in the same season. Following the dismissal, the players covered a greater total distance than normal (p < 0.025), particularly in moderate-intensity activities (p < 0.01) and had shorter recovery times between high-intensity efforts (p < 0.025). In contrast, there was a significant reduction between game halves for total distance covered at both the highest (p < 0.025) and lowest running intensities (p < 0.01). However, there were no differences in high-intensity activities across the three intervals in the second-half. These findings suggest that in 11 vs. 11, players may not always utilise their full physical potential as this match illustrated an increase in overall work-rate when reduced to 10 players. However, as a team with 10 players is likely to incur higher levels of fatigue, tactical alterations may be necessary and/or players may adopt a pacing strategy to endure the remainder of the match.     

Postmortem biochemistry performed on vitreous humor after postmortem CT-angiography

Postmortem angiography is becoming increasingly essential in forensic pathology as an adjunct to conventional autopsy. Despite the numerous advantages of this technique, some questions have been raised regarding the influence of the contrast agent injected on the results of toxicological and biochemical analyses. The aim of this study was to investigate the effect of the injection of the contrast agent Angiofil®, mixed with paraffin oil, on the results of postmortem biochemical investigations performed on vitreous humor. Postmortem biochemical investigations were performed on vitreous samples collected from bodies that had undergone postmortem angiography (n = 50) and from a control group (n = 50). Two vitreous samples were analyzed for each group and the results compared. Glucose, urea, creatinine, 3-β-hydroxybutyrate, sodium and chloride were tested. Different values were observed between the first and second samples in each group. However, these differences were not clinically relevant, suggesting that the injection of this contrast agent mixture does not modify the concentration of the analyzed substances in the vitreous humor.     

Running mechanics adjustments to perceptually-regulated interval runs in hypoxia and normoxia

ObjectivesWe determined whether perceptually-regulated, high-intensity intermittent runs in hypoxia and normoxia induce similar running mechanics adjustments within and between intervals.DesignWithin-participants repeated measures.MethodsNineteen trained runners completed a high-intensity intermittent running protocol (4 × 4-min intervals at a perceived rating exertion of 16 on the 6–20 Borg scale, 3-min passive recoveries) in either hypoxic (FiO₂ = 0.15) or normoxic (FiO₂ = 0.21) conditions. Running mechanics were collected over 10 consecutive steps, at constant velocity (∼15.0 ± 2.0 km.h⁻¹), at the beginning and the end of each 4-min interval. Repeated measure ANOVA were used to assess within intervals (onset vs. end of each interval), between intervals (interval 1, 2, 3 vs. 4) and FiO₂ (0.15 vs. 0.21) main effects and any potential interaction.ResultsParticipants progressively reduced running velocity from interval 1–4, and more so in hypoxia compared to normoxia for intervals 2, 3 and 4 (P < 0.01). There were no between intervals (across all intervals P > 0.298) and FiO₂ (across all intervals P > 0.082) main effects or any significant between intervals × within intervals × FiO₂ interactions (all P > 0.098) for any running mechanics variables. Irrespective of interval number or FiO₂, peak loading rate (+10.6 ± 7.7%; P < 0.001) and duration of push-off phase (+2.0 ± 3.1%; P = 0.001) increased from the onset to the end of 4-min intervals, whereas peak push-off force decreased (−4.0 ± 4.0%; P < 0.001).ConclusionsWhen carrying out perceptually-regulated interval treadmill runs, runners adjust to progressively slower velocities in hypoxia compared to normoxia. However, only subtle constant-velocity modifications of their mechanical behaviour occurred within each set, independently of FiO₂ or interval number.     

The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests

The diagnosis of carpal tunnel syndrome (CTS) is mainly based on clinical findings and electrodiagnostic tests (EDT). However, EDT results do not support clinical findings in some cases. It has been recently suggested that ultrasonography (US) can be used to diagnose CTS. In this study, we aimed to investigate whether US has a diagnostic value for CTS in patients with negative EDT findings or not. EDT was performed on 319 wrists with clinical CTS findings in electrophysiology laboratory. Median and ulnar nerve conduction velocities were measured in all cases and electromyography was performed in patient with tenar atrophy and having suspicion involvement of brachial plexus as EDT. Fifty-nine wrists with negative EDT (study group) and 30 wrists from 15 healthy individuals (control group) were examined using US. The mean of cross-sectional areas (CSAs) measurements were found 8.83 ± 3.05 mm² by tracing method (TM) and 8.51 ± 3.13 mm² by ellipsoid formula (EF) in study group, and 7.63 ± 1.52 mm² by TM and 7.66 ± 1.42 mm² by EF in control group. The differences between study group and control group according to both TM and EF were significant (t-test p = 0.0079, p = 0.0460, respectively). In study group, CSAs were larger than 10.5 mm² in 18 (30.51%) and 16 (27.12%) wrists according to TM and EF findings, respectively, and in only one wrist (3.33%) in control group by both TM and EF. The differences of ultrasonographic CTS numbers between study group and control group were significant (p = 0.0024 by TM, p = 0.0086 by EF). We confirmed the usefulness of quantitative US assessment in the diagnosis of CTS in the patients with negative EDT findings. If EDT findings are inadequate to confirm the CTS in the patients with clinical CTS, US studies may be helpful to diagnose.     

Low radiation dose multislice CT colonography in children: Experience after 100 studies

The purpose of this study was to determine the sensitivity (S) and specificity (sp) of virtual colonoscopy in the detection of elevated lesions in children, and to compare these results with conventional colonoscopy. Between April 2000 and January 2003, 100 patients (mean: 6 years old) were evaluated with virtual colonoscopy and conventional colonoscopy. All patients presented rectal bleeding and both methods were performed the same day. All patients had received a standard bowel cleansing the day before. Virtual colonoscopies were carried out with 2.5 mm thick slices, 1.3 mm reconstruction intervals, 15 mA s, and 90 kV. The acquisition time ranged from 5–10 s depending on the age of the patient. For each method, two scans were performed in both a supine and a prone position. After the acquisitions, images were reprocessed using two-dimensional, volume rendering, and virtual endoscopy reconstructions.Findings of the two methods were compared blinded. They were classified in two groups: (1) normal studies, and (2) elevated lesions studies. The second group was subdivided according to the diameter of the lesions: (2a) <5 mm, (2b) 5–9 mm, and (2c) >9 mm.All studies were performed without complications. Forty-eight patients were normal. In the other 52 patients, virtual colonoscopy detected 86 lesions, whereas conventional colonoscopy depicted only 80 lesions. There were 70 true-positive findings, 48 true-negative findings, 12 false-positive findings, and 8 false-negative findings. The global S was 89%, sp: 80%, positive predictive value: 85%, and negative predictive value: 85%. In group (2a), sensitivity, specificity, positive predictive value, and negative predictive value were 81, 90, 81, and 90% respectively; in group (2b), 90, 90, 85, and 94%, respectively; and in group (2c), 100, 96, 90, and 100%, respectively.We concluded that virtual colonoscopy is an alternative method for the evaluation of children with elevated lesions. It is fast, has no complications, and uses a low radiation dose.     

Postmortem virtual volumetry of the heart and lung in situ using CT data for investigating terminal cardiopulmonary pathophysiology in forensic autopsy

Postmortem CT (PM–CT) is useful to investigate the viscera in situ before opening the body cavity at autopsy. The present study investigated heart and lung volumes in situ with regard to the cause of death as possible indexes of terminal cardiopulmonary dysfunction by means of PM–CT data analysis of forensic autopsy cases within 3 days postmortem (n = 70). Estimated heart volume was larger in sudden cardiac death (SCD; n = 10) and fatal methamphetamine abuse (n = 5) than in other groups, including mechanical asphyxiation (n = 12), drowning (n = 11), acute alcohol/sedative–hypnotic intoxication (n = 8), fire fatality (n = 12), hyperthermia (heatstroke; n = 6) and fatal hypothermia (cold exposure; n = 6). Estimated combined lung volume was larger in drowning, smaller in fire fatality due to carbon monoxide intoxication and SCD, and intermediate in other groups. Volume ratio of the lung to heart was higher in drowning, lower in SCD, and intermediate or varied in other groups; high and low ratios can indicate predominant/antecedent pulmonary and cardiac dysfunctions, respectively. These findings provide quantitative data that are not available at conventional autopsy or by routine two-dimensional CT morphology to assess three-dimensional gross heart and lung morphologies for interpreting terminal cardiopulmonary pathophysiology, detecting significant difference between SCD and other causes of death, especially mechanical asphyxiation and drowning.     

Causes of death in forensic autopsy cases of malnourished persons

PurposeMedical examiners and forensic pathologists often encounter emaciated bodies in postmortem examinations. However, the main disease that caused death is often not clear and measures to prevent the unexpected death of malnourished persons have not been established. In this study, we examined the underlying causes of death among a large number of forensic autopsy cases that showed emaciation to clarify the features of sudden, unexpected death in malnourished persons.MethodsDocuments of autopsy cases without putrefaction handled during 2007–2010 by the Tokyo Medical Examiner’s Office were reviewed (n = 7227). The body mass index (BMI) was calculated for each case. The causes of death for cases with severe malnutrition (BMI < 16; n = 885) were closely examined.ResultsAbout 70% of all deaths in malnourished cases (BMI < 16) was due to disease, and the causative diseases are more varied than in those with less severe malnutrition and those without malnutrition (BMI ? 16). A higher proportion of malnutrition as the cause of death was observed in younger persons for both sexes, and a higher proportion of having a history of psychiatric diseases was observed in younger deceased women. In addition, a higher proportion of alcohol-related digestive diseases was observed especially in younger men, some of whom had a history of alcohol dependence. On the other hand, the proportion of organic diseases, such as neoplasms and gastroduodenal ulcer, was higher in older deceased persons, especially among men. Around 70% of all respiratory diseases comprised pneumonia in both sexes. Among non-disease-related causes of death, poisoning was the most frequent cause in women under 55 years old (35.3%), with the majority having had a history of psychiatric disease.ConclusionsBecause autopsy cases of malnourished persons show various causes of death, physicians have to pay more attention in making death diagnosis in such cases. From a preventative point of view, early detection of organic diseases, a better approach toward managing psychiatric diseases, and implementation of vaccination for pneumonia will contribute to reduction of future unexpected deaths among malnourished persons.     

Pedometer steps/min in physical education: Does the pedometer matter?

ObjectivesThe investigation sought to replicate previous Yamax physical education steps/min findings by quantifying physical activity via pedometry albeit with the Walk4Life (W4L) pedometer. Specifically, the objective was to determine steps/min cut point intervals for the 33% and 50% physical activity (i.e., percent of lesson time engaged in physical activity [%PA]) physical education guidelines via the W4L pedometer.DesignField-based criterion-referenced validation.MethodsData were collected from 75 lessons on 411 fifth- through twelfth-grade (M_age = 13.83 ± 2.17 y) participants who had concurrently measured pedometer and behavioural observation data. The W4L and Yamax pedometer outcome measure was steps/min, and observation measure was %PA. Pearson r correlation and diagnostic (i.e., sensitivity, specificity, and receiver-operating characteristic [ROC] curve) tests were conducted.Results(a) Steps/min and %PA demonstrated a strong relationship (W4L, r = 0.96, p = 0.0001; Yamax, r = 0.96, p = 0.0001), (b) W4L pedometer steps/min accurately discriminated (ROC area under curve ≥ 98%) between achievement or non-achievement of %PA guidelines, (c) the W4L steps/min cut point intervals for the 33%PA guideline (55.0–59.5) were significantly lower than those found for the Yamax pedometer (60.8–65.0), and (d) a borderline overlap was found between W4L (75.7–79.5) and Yamax (79.1–85.8) steps/min cut point intervals for the 50%PA guideline.ConclusionsW4L steps/min demonstrated a strong relationship with %PA, and outstanding accuracy for physical education physical activity guideline discrimination; however, steps/min values indicative of physical education physical activity guideline achievement is pedometer brand dependent, and should be considered for steps/min implementation and surveillance.     

Application of the drowning index to actual drowning cases

The drowning index (DI) was devised to diagnose drowning deaths, and is the weight ratio of the lungs and pleural effusion to the spleen. Among drowning (94 cases), mechanical asphyxia (47 cases), and acute cardiac (42 cases) deaths, within 2 weeks postmortem we compared six markers, the weight of each lung, pleural effusion weight, total weight of the lungs and pleural effusion, spleen weight, heart weight, and the DI. Statistical analysis revealed that the total weight was heavier, while spleen weight was lighter, and the DI was significantly larger in the drowning group (p < 0.05). We examined the relation between the postmortem time and these markers. We divided 94 drowning cases into three groups according to the postmortem duration, group A (0–3 days; 43 cases), group B (3–7; 29 cases), and group C (7–14; 22 cases). The cut-off point of the DI was analyzed using the receiver operating characteristic (ROC) curve. As a result, the DI cut-off point was 14.1 in cases within two postmortem weeks. Drowning is still a difficult autopsy diagnosis, but in our experience, DI is a valuable indicator.