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Kuwahara A, Hitosugi M, Takeda A, Nakamura M. Does abdominal protrusion in pregnant women affect abdominal injury severity in motor vehicle collisions? A nationwide database study. Aust N Z J Obstet Gynaecol 2024. [PMID: 38794792 DOI: 10.1111/ajo.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
AIMS Some pregnant women avoid vehicle driving owing to the risk of contact between their protruding abdomen and steering wheel. This study was performed to determine whether abdominal protrusion in late-term pregnant car users affects the occurrence and severity of abdominal injuries in motor vehicle collisions using a national crash database. METHODS The National Automotive Sampling System/Crashworthiness Data System was used to analyse maternal background, collision characteristics, outcome and Abbreviated Injury Scale (AIS) scores for the body regions of all persons involved in the collision. RESULTS Comparison of pregnant and non-pregnant women in the driver's seat showed no significant differences in the rate of AIS scores of ≥2 (2+) for abdominal injuries and female outcomes. Comparison of use of the driver's seat and front passenger's seat by pregnant women showed no significant difference in rate of AIS 2+ injuries or in maternal and fetal outcomes. Comparison of pregnant women with a gestational age of ≤27 and >27 weeks in the driver's seat showed no significant differences in rate of AIS 2+ injuries or in maternal and fetal outcomes. CONCLUSIONS Based on the data from relatively low-speed frontal collisions, obstetrician/gynaecologists should advise pregnant women that they do not need to change their preferred car seat from the driver's seat to another seat because of fear of contact between their protruding abdomen and the vehicle interior.
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Affiliation(s)
- Ayumu Kuwahara
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Arisa Takeda
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
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Hitosugi M, Takashima K, Ito E. Child death reviews should not require parental consent. Leg Med (Tokyo) 2024; 66:102360. [PMID: 38039657 DOI: 10.1016/j.legalmed.2023.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
| | - Kohei Takashima
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan
| | - Eisuke Ito
- Department of Pediatrics, Saiseikai Shiga Hospital, 2-4-1 Oh-hashi, Ritto, Shiga 520-3046, Japan
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Kandori K, Okada A, Nakajima S, Matsuyama T, Kitamura T, Narumiya H, Iizuka R, Hitosugi M, Okada Y. Association between eGFR and neurological outcomes among patients with out-of-hospital cardiac arrest: A nationwide prospective study in Japan. Acute Med Surg 2024; 11:e952. [PMID: 38638891 PMCID: PMC11024449 DOI: 10.1002/ams2.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Aim We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out-of-hospital cardiac arrest patients and explore the heterogeneity of the association. Methods Patients experiencing out-of-hospital cardiac arrest due to medical causes and registered in the JAAM-OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1-month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model. Results Of the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1-month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45-59 mL/min/1.73 m2, 0.61 [0.47-0.79]; 30-44 mL/min/1.73 m2, 0.45 [0.32-0.62]; 15-29 mL/min/1.73 m2, 0.35 [0.20-0.63]; and <15 mL/min/1.73 m2, 0.14 [0.07-0.27]). Estimated glomerular filtration rate was associated with neurological outcomes in patients aged <65 years with initial shockable rhythm but not in those aged >65 years or patients with initial pulseless electrical activity or asystole. Conclusion The estimated glomerular filtration rate is associated with neurological prognosis in out-of-hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non-shockable rhythm.
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Affiliation(s)
- Kenji Kandori
- Department of Emergency and Critical Care MedicineJapanese Red Cross Society, Kyoto Daini HospitalKyotoJapan
- Department of Legal MedicineShiga University of Medical ScienceOtsu, ShigaJapan
| | - Asami Okada
- Department of Emergency and Critical Care MedicineJapanese Red Cross Society, Kyoto Daini HospitalKyotoJapan
| | - Satoshi Nakajima
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tasuku Matsuyama
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Hiromichi Narumiya
- Department of Emergency and Critical Care MedicineJapanese Red Cross Society, Kyoto Daini HospitalKyotoJapan
| | - Ryoji Iizuka
- Department of Emergency and Critical Care MedicineJapanese Red Cross Society, Kyoto Daini HospitalKyotoJapan
| | - Masahito Hitosugi
- Department of Legal MedicineShiga University of Medical ScienceOtsu, ShigaJapan
| | - Yohei Okada
- Department of Preventive Services, Graduate School of MedicineKyoto UniversityKyotoJapan
- Health Services and Systems Research, Duke‐NUS Medical SchoolNational University of SingaporeSingapore
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Nagai S, Kitahara T, Kito K, Hitosugi M. HIV/AIDS knowledge level, awareness of public health centers and related factors: a cross-sectional study among Brazilians in Japan. BMC Public Health 2023; 23:2379. [PMID: 38037053 PMCID: PMC10691059 DOI: 10.1186/s12889-023-17308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Accurate information is essential so that HIV infection can be detected in time for initiation of HIV/AIDS treatment. Immigrants are at high risk for delayed HIV testing and diagnosis, but foreign residents in Japan also seem to face barriers to accessing HIV/AIDS care. We aimed to assess their knowledge level of HIV/AIDS and awareness of public health centers in Japan (PHCs), and to explore factors related to these items. METHODS We conducted a cross-sectional study of Brazilians, the largest group of foreigners living in Shiga, using an anonymous, self-administered questionnaire survey in Brazilian Portuguese and Japanese via the Internet and mail. A multiple logistic regression analysis was used to examine the factors related to "Knowledge of HIV/AIDS" and "Awareness of PHCs". RESULTS A total 182 Brazilians responded. More than half of them were beginners in Japanese. Most respondents were familiar with HIV/AIDS, but only 58% knew the existence of PHCs, and only 25% knew that HIV testing is available at PHCs free of charge and anonymously. A multiple logistic regression analysis showed that PHCs were less recognized by those with intermediate (odds ratio: 5.70, 95% confidence interval: 1.53-21.23) and beginner (odds ratio: 6.81, 95% confidence interval: 1.98-23.45) Japanese proficiency than by those with advanced. CONCLUSIONS This survey revealed the knowledge level of HIV/AIDS and awareness of PHC among Brazilians in Shiga. Their lack of awareness of PHCs due to language barriers may lead to delays in HIV testing among them. Therefore, it is important for PHCs to disseminate information about medical services related to HIV/AIDS in Portuguese and plain Japanese to facilitate their access to HIV testing. However, PHC efforts alone are not enough. Medical interpreters who are familiar with Brazilian culture and customs, and the clinics that employ them, could help the Brazilian community and PHCs to overcome the language barrier and provide efficient and appropriate medical care to Brazilians. This would be one way to eliminate delays in HIV testing for Brazilians in Shiga.
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Affiliation(s)
- Shiho Nagai
- Division of Occupational and Environmental Health, Department of Social Medicine, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, 520- 2192, Shiga, Japan
- Department of Hematology, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, Shiga, Japan
| | - Teruyo Kitahara
- Division of Occupational and Environmental Health, Department of Social Medicine, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, 520- 2192, Shiga, Japan.
| | - Katsuyuki Kito
- Department of Hematology, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, Shiga, Japan
| | - Masahito Hitosugi
- Division of Legal Medicine, Department of Social Medicine, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, Shiga, Japan
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Machida Y, Tomioka T, Koshinuma S, Nakamura M, Yamamoto G, Hitosugi M. Factors predicting oral and maxillofacial fractures after falling and factors predicting the duration of treatment. Dent Traumatol 2023; 39:418-424. [PMID: 37232513 DOI: 10.1111/edt.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIM The first objective of this study was to identify predictive factors for oral and maxillofacial fractures at the initial response to the patient. The second objective was to determine the factors influencing the incidence of treatment duration of more than 1 month using the information shown in the medical record. MATERIALS AND METHODS Hospital records from 2011 to 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries by falling or falling from a height. Patterns and types of oral and maxillofacial injury, injury severity, and background of the injury were collected from the hospital records. The variables independently associated with a treatment duration of more than 1 month were determined by logistic regression analysis. RESULTS In total, 282 patients (150 men, 132 women; median age, 17.5 years) were selected for analysis. Maxillofacial fractures were observed in 20.9% of patients (59/282); among these, mandibular fractures were the most common (47/59). Logistic regression analysis showed that age (odds ratio [OR], 1.026), nighttime occurrence (OR, 2.192), and upper face injury (OR, 20.704) were independent predictive factors for having a maxillofacial fracture. Additionally, the number of injured teeth (OR, 1.515) and the use of intermaxillary fixation (OR, 16.091) were independent predictors of treatment duration of more than 1 month. CONCLUSIONS These results may be useful in the initial management of maxillofacial injuries in terms of better-informing patients injured by falling their expected treatment duration and managing the psychological impacts of a long treatment duration.
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Affiliation(s)
- Yoshisato Machida
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takahiro Tomioka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinya Koshinuma
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Gaku Yamamoto
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Hitosugi M, Takaso M, Masumitsu A. Fatalities of Pedestrians Lying on the Road. Am J Forensic Med Pathol 2023; 44:144. [PMID: 36877069 DOI: 10.1097/paf.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Masumitsu A, Hitosugi M, Baba M, Nakamura M, Koike K, Ida H, Aoki M. Predictive Factors of the Fatality of Motor Vehicle Passengers Involved in Far-Side Lateral Collisions: A National Crash Database Study. Healthcare (Basel) 2023; 11:healthcare11101496. [PMID: 37239782 DOI: 10.3390/healthcare11101496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Although the risks faced by passengers in near-side lateral collisions are understood, and despite the presence of side airbags for injury prevention, passengers involved in far-side lateral collisions also suffer serious and fatal injuries. The objective of this study was to determine the independent predictive factors of fatality of motor vehicle passengers involved in far-side lateral collisions. Using 2010 records from the National Automotive Sampling System/Crashworthiness Data System (NASS/CDS), we selected 86 fatal and 325 non-fatal passengers with an Abbreviated Injury Scale (AIS) score of 2 or more. The background and injury severity of the passengers and collision characteristics were compared between the two groups. In a multivariable logistic regression analysis, variables independently associated with fatalities were female sex (Ref, male) (odds ratio [OR], 0.396), age (OR, 1.029), body mass index (OR, 1.057), total delta-V (OR, 1.031), head AIS score (OR, 1.679), chest AIS score (OR, 1.330), and abdomen AIS score (OR, 1.294). This is the first report to determine factors affecting fatality in passengers involved in far-side lateral collisions. Improving the safety of the vehicle interior, such as by including additional seatbelt systems or a side airbag that deploys between seats, might help to avoid fatalities, and reduce injury severity.
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Affiliation(s)
- Akane Masumitsu
- Department of Critical Care Medicine, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
| | - Kaoru Koike
- Department of Critical Care Medicine, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Hitoshi Ida
- Toyoda Gosei Co., Ltd., 1 Haruhinagahata, Kiyosu 452-8564, Japan
| | - Masashi Aoki
- Toyoda Gosei Co., Ltd., 1 Haruhinagahata, Kiyosu 452-8564, Japan
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Tanaka K, Hitosugi M, Takaso M, Nakamura M, Takeda A. Affecting Factors of Prostate Volume in Forensic Autopsied Decedents. Healthcare (Basel) 2023; 11:healthcare11101486. [PMID: 37239771 DOI: 10.3390/healthcare11101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Because decedents undergoing forensic autopsies would have behaved normally before death, prostate volume according to age group can be confirmed with forensic autopsy materials. The objectives of this study were to first confirm the current prostate volume by age and then determine diseases that can influence prostate volume using forensic autopsy materials. Prostate specimens were collected from forensic autopsies performed at Shiga University of Medical Science, Japan, between January 2015 and December 2019. Overall, 207 decedents were included in the study. Prostate volume was measured by the Archimedes' principle. Concomitant diseases were determined by the past medical histories and autopsy results. The mean crude prostate volume was 29.1 ± 10.3 mL (range, 2.8-88.0 mL). The crude prostate volume increased with age. The mean corrected prostate volume (divided by body surface area) was significantly higher in patients with atherosclerosis than in those without. However, multiple regression analysis revealed that only age influenced the corrected prostate volume. Age was the only significant influencing factor for prostate volume. We propose applying age estimation using prostate volume for forensic medicine purposes. Because prostate volume was not influenced by concomitant disease, it would be valuable to estimate the decedent's age using the prostate volume.
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Affiliation(s)
- Kota Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Arisa Takeda
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
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Ishii W, Hitosugi M, Kandori K, Miyaguni M, Iizuka R. Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan. Healthcare (Basel) 2023; 11:healthcare11091240. [PMID: 37174781 PMCID: PMC10178139 DOI: 10.3390/healthcare11091240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.
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Affiliation(s)
- Wataru Ishii
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
| | - Kenji Kandori
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Michitaro Miyaguni
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Ryoji Iizuka
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
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Soh JEC, Shimizu A, Molla MR, Zankov DP, Nguyen LKC, Khan MR, Tesega WW, Chen S, Tojo M, Ito Y, Sato A, Hitosugi M, Miyagawa S, Ogita H. RhoA rescues cardiac senescence by regulating Parkin-mediated mitophagy. J Biol Chem 2023; 299:102993. [PMID: 36758801 PMCID: PMC10020657 DOI: 10.1016/j.jbc.2023.102993] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Heart failure is one of the leading causes of death worldwide. RhoA, a small GTPase, governs actin dynamics in various tissue and cell types, including cardiomyocytes; however, its involvement in cardiac function has not been fully elucidated. Here, we generated cardiomyocyte-specific RhoA conditional knockout (cKO) mice, which demonstrated a significantly shorter lifespan with left ventricular dilation and severely impaired ejection fraction. We found that the cardiac tissues of the cKO mice exhibited structural disorganization with fibrosis and also exhibited enhanced senescence compared with control mice. In addition, we show that cardiomyocyte mitochondria were structurally abnormal in the aged cKO hearts. Clearance of damaged mitochondria by mitophagy was remarkably inhibited in both cKO cardiomyocytes and RhoA-knockdown HL-1 cultured cardiomyocytes. In RhoA-depleted cardiomyocytes, we reveal that the expression of Parkin, an E3 ubiquitin ligase that plays a crucial role in mitophagy, was reduced, and expression of N-Myc, a negative regulator of Parkin, was increased. We further reveal that the RhoA-Rho kinase axis induced N-Myc phosphorylation, which led to N-Myc degradation and Parkin upregulation. Re-expression of Parkin in RhoA-depleted cardiomyocytes restored mitophagy, reduced mitochondrial damage, attenuated cardiomyocyte senescence, and rescued cardiac function both in vitro and in vivo. Finally, we found that patients with idiopathic dilated cardiomyopathy without causal mutations for dilated cardiomyopathy showed reduced cardiac expression of RhoA and Parkin. These results suggest that RhoA promotes Parkin-mediated mitophagy as an indispensable mechanism contributing to cardioprotection in the aging heart.
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Affiliation(s)
- Joanne Ern Chi Soh
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Akio Shimizu
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Md Rasel Molla
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Dimitar P Zankov
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Le Kim Chi Nguyen
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Mahbubur Rahman Khan
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Wondwossen Wale Tesega
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Si Chen
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan; Department of Emergency, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Misa Tojo
- Division of Legal Medicine, Department of Social Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yoshito Ito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Sato
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Division of Legal Medicine, Department of Social Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hisakazu Ogita
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan.
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Ishii W, Hitosugi M, Kandori K, Miyaguni M, Iizuka R. Physiological status and anatomical severity factors associated with child versus adult bicyclist fatalities based on a national trauma dataset. Sci Rep 2022; 12:18354. [PMID: 36319680 PMCID: PMC9626561 DOI: 10.1038/s41598-022-21949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Bicyclists still account for the majority of child deaths in traffic accidents, despite a gradual decrease in incidence. Therefore, we investigated factors associated with child and adult bicyclist fatalities. In this retrospective study, we used data from a national hospital-based database, the Japan Trauma Data Bank. Data from 2004 to 2019 were obtained for child cyclists (5-18 years; n = 4832) and adult cyclists (26-45 years; n = 3449). In each age group, physiological variables, outcomes, and injury severity were compared between fatal and non-fatal cases. Multivariate logistic regression was performed to determine factors associated with fatality. In adults, fatality was associated with lower values for body temperature, Glasgow Coma Scale score, and Abbreviated Injury Scale (AIS) score for the neck and upper extremities, and with higher values for respiratory rate, heart rate, focused assessment with sonography for trauma positivity rate, and AIS scores for the head, chest, and abdomen. In children, fatality was associated with lower values for body temperature and the Glasgow Coma Scale score, and with higher values for the AIS chest score. These findings point to factors associated with bicyclist fatalities and may help in the development of effective strategies to reduce these fatalities.
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Affiliation(s)
- Wataru Ishii
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
| | - Masahito Hitosugi
- grid.410827.80000 0000 9747 6806Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192 Japan
| | - Kenji Kandori
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
| | - Michitaro Miyaguni
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
| | - Ryoji Iizuka
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
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Tanaka K, Motozawa Y, Takahashi K, Maki T, Nakamura M, Hitosugi M. Severity of Placental Abruption in Restrained Pregnant Vehicle Drivers: Correct Seat Belt Use Confirmed by Finite Element Model Analysis. Int J Environ Res Public Health 2022; 19:13905. [PMID: 36360785 PMCID: PMC9656600 DOI: 10.3390/ijerph192113905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Despite wearing a seat belt, pregnant drivers often suffer from negative fetal outcomes in the event of motor accidents. In order to maintain the safety of pregnant drivers and their fetuses, we assessed the severity of placental abruption caused by motor vehicle collisions using computer simulations. We employed a validated pregnant finite element model to determine the area of placental abruption. We investigated frontal vehicle collisions with a speed of 40 km/h or less involving restrained pregnant drivers with a gestational age of 30 weeks. For a crash speed of 40 km/h, the placental abruption area was 7.0% with a correctly positioned lap belt across the lower abdomen; it was 36.3% with the belt positioned at the umbilicus. The area of placental abruption depended on collision speed, but we found that with a correctly positioned belt it likely would not lead to negative fetal outcomes. We examined the effects on placental abruptions of reconfiguring seat belt width and force limiter setting. A wider lap belt and lower force limiter setting reduced the area of placental abruption to 3.5% and 1.1%, respectively; however, they allowed more forward movement upon collision. A 2.5 kN force limiter setting may be appropriate with respect to both forward movement and reduced placental abruption area. This study confirmed the importance of correctly using seat belts for pregnant drivers. It provides valuable evidence about improving safety equipment settings.
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Affiliation(s)
- Katsunori Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yasuki Motozawa
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | | | - Tetsuo Maki
- Department of Mechanical Engineering, Tokyo City University, Tokyo 158-8557, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
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13
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Murayama H, Hitosugi M, Motozawa Y, Ogino M, Koyama K. Practical Prevention Of Severe Head Trauma In Judo By Maintaining Neck Flexion While Being Thrown. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000880624.11562.f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Kuwahara A, Hitosugi M, Takeda A, Tsujimura S, Miyata Y. Comparison of the Injury Mechanism between Pregnant and Non-Pregnant Women Vehicle Passengers Using Car Crash Test Dummies. Healthcare (Basel) 2022; 10:884. [PMID: 35628021 PMCID: PMC9141164 DOI: 10.3390/healthcare10050884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 02/01/2023] Open
Abstract
This paper analyzes the kinematics and applied forces of pregnant and non-pregnant women dummies sitting in the rear seat during a frontal vehicle collision to determine differences in the features of abdominal injuries. Sled tests were conducted at 29 and 48 km/h with pregnant and non-pregnant dummies (i.e., MAMA IIB and Hybrid III). The overall kinematics of the dummy, resultant acceleration at the chest, transrational acceleration along each axis at the pelvis, and loads of the lap belt and shoulder belt were examined. The belt loads were higher for the MAMA IIB than for the Hybrid III because the MAMA IIB had a higher body mass than the Hybrid III. The differences in the lap belt loads were 1119 N at 29 km/h and 1981-2365 N at 48 km/h. Therefore, for restrained pregnant women sitting in the rear seat, stronger forces may apply to the lower abdomen during a high-velocity frontal collision. Our results suggest that for restrained pregnant women sitting in the rear seat, the severity of abdominal injuries and the risk of a negative fetal outcome depend on the collision velocity.
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Affiliation(s)
- Ayumu Kuwahara
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (A.K.); (A.T.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (A.K.); (A.T.)
| | - Arisa Takeda
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (A.K.); (A.T.)
| | - Seiji Tsujimura
- Joyson Safety Systems Japan K.K. Echigawa Plant, Otsu 529-1388, Japan; (S.T.); (Y.M.)
| | - Yasuhito Miyata
- Joyson Safety Systems Japan K.K. Echigawa Plant, Otsu 529-1388, Japan; (S.T.); (Y.M.)
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15
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Nakamura M, Takaso M, Takeda A, Hitosugi M. A fatal case of intoxication from a single use of eutylone: clinical symptoms and quantitative analysis results. Leg Med (Tokyo) 2022; 58:102085. [DOI: 10.1016/j.legalmed.2022.102085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
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16
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Takashima K, Hitosugi M. Underestimation of Trisomy 18 and 13 Syndromes in Vital Statistics from Inadequate Death Certificates. Neonatology 2022; 119:133-134. [PMID: 34808633 DOI: 10.1159/000520216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kohei Takashima
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan.,Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
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17
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Uno AT, Mukaisho KI, Hitosugi M. Dysmenorrhea due to undiagnosed obstructed hemi-vagina and ipsilateral renal anomaly syndrome can become a cause of suicide. Environ Health Prev Med 2022; 27:8. [PMID: 35288492 PMCID: PMC9093615 DOI: 10.1265/ehpm.21-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A Japanese woman in her early twenties had committed suicide, jumped from a 25-meter high bridge into a lake. She had been suffering from severe dysmenorrhea and general fatigue monthly. Results A forensic autopsy revealed indications of a bicorporeal uterus, obstructed hemi-vagina, and ipsilateral renal agenesis, which lead to a diagnosis of obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) syndrome. On the right side of the uterus, an enclosed cavity composed of black clots was observed. Histological findings suggested that her endometrium was in the early proliferative phase, implying that she was in the menstrual phase just before her death. She may have been suffering from severe lower abdominal pain from the increased pressure of the closed uterus cavity. Conclusions This case indicates that dysmenorrhea from undiagnosed OHVIRA syndrome can possibly lead to a suicide attempt. In Japan, because suicide was the leading cause of death for people aged 15 to 39 in 2019, preventive measures for suicide should be promoted. The present case also suggests that intervention for dysmenorrhea may prevent this in adolescent woman.
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Affiliation(s)
- Akari Takaya Uno
- Department of Legal Medicine, Shiga University of Medical Science
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18
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Tanaka K, Motozawa Y, Takahashi K, Maki T, Hitosugi M. Factors Affecting the Severity of Placental Abruption in Pregnant Vehicle Drivers: Analysis with a Novel Finite Element Model. Healthcare (Basel) 2021; 10:healthcare10010027. [PMID: 35052190 PMCID: PMC8775634 DOI: 10.3390/healthcare10010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
We clarified factors affecting the severity of placental abruption in motor vehicle collisions by quantitively analyzing the area of placental abruption in a numerical simulation of an unrestrained pregnant vehicle driver at collision velocities of 3 and 6 m/s. For the simulation, we constructed a novel finite element model of a small 30-week pregnant woman, which was validated anthropometrically using computed tomography data and biomechanically using previous examinations of post-mortem human subjects. In the simulation, stress in the elements of the utero–placental interface was computed, and those elements exceeding a failure criterion were considered to be abrupted. It was found that a doubling of the collision velocity increased the area of placental abruption 10-fold, and the abruption area was approximately 20% for a collision velocity of 6 m/s, which is lower than the speed limit for general roads. This result implies that even low-speed vehicle collisions have negative maternal and fetal outcomes owing to placental abruption without a seatbelt restraint. Additionally, contact to the abdomen, 30 mm below the umbilicus, led to a larger placental abruption area than contact at the umbilicus level when the placenta was located at the uterus fundus. The results support that a reduction in the collision speed and seatbelt restraint at a suitable position are important to decrease the placental abruption area and therefore protect a pregnant woman and her fetus in a motor vehicle collision.
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Affiliation(s)
- Katsunori Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
| | - Yasuki Motozawa
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
| | | | - Tetsuo Maki
- Department of Mechanical Engineering, Tokyo City University, Tokyo 158-8557, Japan;
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
- Correspondence: ; Tel./Fax: +81-77-581-2200
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19
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Ishii W, Hitosugi M, Baba M, Kandori K, Arai Y. Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers. Healthcare (Basel) 2021; 9:healthcare9111431. [PMID: 34828478 PMCID: PMC8624717 DOI: 10.3390/healthcare9111431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Saving children from motor vehicle collisions is a high priority because the injury rate among motor vehicle passengers has been increasing in Japan. This study aimed to examine the factors that influence death and serious injury in child motor vehicle passengers to establish effective preventive measures. To identify these factors, we performed a retrospective study using a nationwide medical database. The data of child motor vehicle passengers younger than 15 years (n = 1084) were obtained from the Japanese Trauma Data Bank, registered from 2004 to 2019. Physiological variables, outcomes, and injury severity were compared between fatal and non-fatal patients and between those with and without severe injuries. Multivariate logistic regression analysis was performed to determine factors affecting fatality and severe injury. The Glasgow Coma Scale score (odds ratio (OR): 1.964), body temperature (OR: 2.578), and the Abbreviated Injury Scale score of the head (OR: 0.287) were identified as independent predictors of a non-fatal outcome. Systolic blood pressure (OR: 1.012), the Glasgow Coma Scale score (OR: 0.705), and Focused Assessment with Sonography for Trauma positivity (OR: 3.236) were identified as independent predictors of having severe injury. Decreasing the severity of head injury is the highest priority for child motor vehicle passengers to prevent fatality and severe injury.
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Affiliation(s)
- Wataru Ishii
- Kyoto Daini Red Cross Hospital, Critical Care Center, Emergency of Medicine, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan; (K.K.); (Y.A.)
- Correspondence: ; Tel.: +81-75-231-5171
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan;
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Kenji Kandori
- Kyoto Daini Red Cross Hospital, Critical Care Center, Emergency of Medicine, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan; (K.K.); (Y.A.)
| | - Yusuke Arai
- Kyoto Daini Red Cross Hospital, Critical Care Center, Emergency of Medicine, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan; (K.K.); (Y.A.)
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20
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Takaso M, Fujii M, Hitosugi M. Cerebral Tissue Pulmonary Embolism in Elderlies. Am J Forensic Med Pathol 2021; 42:311-312. [PMID: 33346971 DOI: 10.1097/paf.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
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21
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Fujii M, Shirakawa T, Nakamura M, Baba M, Hitosugi M. Factors influencing the injury severity score and the probability of survival in patients who fell from height. Sci Rep 2021; 11:15561. [PMID: 34330987 PMCID: PMC8324820 DOI: 10.1038/s41598-021-95226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
In Japan, falls from height result in the second highest trauma mortality rate after traffic motor vehicle collisions and the highest trauma-related mortality rate amongst young people. We aimed to identify factors that worsen injury severity and lower survival probability of patients who fell from height and to contribute to the improvement of their prehospital and in-hospital care. This retrospective analysis retrieved hospital records of 179 patients aged ≥ 15 years who were transported to our hospital after a fall from height during April 2014–March 2020. On multiple regression analysis, fall height ≥ 5 m more significantly resulted in higher the injury severity score. Logistic regression analysis revealed that fall height ≥ 5 m with the reference of 2–3 m significantly resulted in lower the survival probability with odds ratio (95% confidence interval) of 0.10 (0.02–0.55). Using ‘feet-first’ as the reference body position, the odds ratios (95% confidence interval) of survival for those who impacted the surface on the lateral or dorsal regions were 0.11 (0.02–0.64) and 0.17 (0.03–0.99), respectively. Collecting information on the abovementioned factors at pre-hospitalisation may facilitate prompt diagnosis and treatment. These results may help improve prehospital and in-hospital care, avoiding preventable trauma deaths.
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Affiliation(s)
- Masashi Fujii
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae, Nagahama, Otsu, Shiga, 526-8585, Japan. .,Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Tsutomu Shirakawa
- Department of Orthopaedic Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mineko Baba
- Centre for Integrated Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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22
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Fujino M, Ishii M, Taniguchi T, Chiba H, Kimata M, Hitosugi M. The Value of Interleukin-6 among Several Inflammatory Markers as a Predictor of Respiratory Failure in COVID-19 Patients. Diagnostics (Basel) 2021; 11:diagnostics11081327. [PMID: 34441262 PMCID: PMC8392120 DOI: 10.3390/diagnostics11081327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 01/20/2023] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure within a short period during the clinical course. It is essential to predict respiratory deterioration in the short term. We investigated the use of inflammatory markers to predict respiratory distress within three days from their analysis in COVID-19 patients. This retrospective observational study included 81 patients admitted with COVID-19. Patients were divided into two groups according to whether the maximum fraction of inspired oxygen (FiO2) for three days from the blood marker measurements was ≥0.4 (high FiO2 group; HFG) or <0.4 (low FiO2 group; LFG). Interleukin-6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase (LDH), white blood cell, D-dimer, and creatinine levels were compared between the two groups. The levels of all markers were significantly higher in HFG patients. Areas under the receiver operating characteristic curve of IL-6, CRP, and LDH had high values of 0.85, 0.82, and 0.81, respectively. The odds ratio of IL-6 which was crude and adjusted for dexamethasone administration initiated before laboratory measurement, showed the high value of 29.1 (5.6-295.6) and 53.9 (4.5-3242.8), respectively. IL-6 can be used as a reliable marker for predicting respiratory illness within three days after assessment.
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Affiliation(s)
- Mitsuhiro Fujino
- Department of Critical Care and Emergency Medicine, Otsu City Hospital, 2-9-9, Motomiya, Otsu 520-0804, Japan;
- Correspondence: ; Tel.: +81-77-522-4607; Fax: +81-77-522-0192
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu City Hospital, 2-9-9, Motomiya, Otsu 520-0804, Japan;
| | - Takuya Taniguchi
- Department of Cardiology, Otsu City Hospital, 2-9-9, Motomiya, Otsu 520-0804, Japan; (T.T.); (M.K.)
| | - Hiroya Chiba
- Department of Critical Care and Emergency Medicine, Otsu City Hospital, 2-9-9, Motomiya, Otsu 520-0804, Japan;
| | - Masaki Kimata
- Department of Cardiology, Otsu City Hospital, 2-9-9, Motomiya, Otsu 520-0804, Japan; (T.T.); (M.K.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan;
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23
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Baba M, Hitosugi M. Tightening legal restrictions for drivers with epilepsy in Japan. Acta Neurol Scand 2021; 143:673-674. [PMID: 33644860 DOI: 10.1111/ane.13408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Abstract
Epilepsy is a highly prevalent condition around the world, and many countries impose restrictions on drivers with epilepsy. After toughening the law in Japan, the number of refused driving license applications for patients with epilepsy increased markedly. However, the number of collisions caused by drivers with epilepsy did not decrease.
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Affiliation(s)
- Mineko Baba
- Center of Integrated Medical Research School of Medicine Keio University Tokyo Japan
| | - Masahito Hitosugi
- Department of Legal Medicine Shiga University of Medical Science Otsu Japan
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24
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Beppu S, Hitosugi M, Ueda T, Koh M, Nishiyama K. Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents: A retrospective analysis. Chin J Traumatol 2021; 24:148-152. [PMID: 33781635 PMCID: PMC8173571 DOI: 10.1016/j.cjtee.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Lengthy hospitalization places a burden on patients and healthcare resources. However, the factors affecting the length of hospital stay (LHoS) and length of emergency room stay (LERS) in non-fatal bicycle accidents are currently unclear. We investigated these factors to inform efforts to minimize hospitalization. METHODS We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016. We measured LHoS, LERS, mechanism of injury, head injury prevalence, polytrauma, operations performed, injury severity score (ISS), abbreviated injury scale (AIS) score, maximum AIS score, and trauma and injury severity score probability of survival. We conducted multiple regression analysis to determine predictors of LHoS and LERS. RESULTS Within the study period, 82 victims met the inclusion and exclusion criteria and were included. Mean age was (46.0 ± 24.7) years. Overall mean LHoS was (16.8 ± 25.2) days, mean LERS was (10.6 ± 14.7) days, median ISS was 9 (interquartile range (IQR): 3-16), median maximum AIS was 3 (IQR: 1-4), and median trauma and injury severity score probability of survival was 98.0% (IQR: 95.5%-99.6%). Age, maximum AIS, ISS, and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group (p < 0.05). Performance of surgery independently explained LHoS (p = 0.0003) and ISS independently explained LERS (p = 0.0009). CONCLUSION Surgery was associated with long hospital stays and ISS was associated with long emergency room stays. To improve the quality life of the bicyclists, preventive measures for reducing injury severity or avoiding injuries needing operation are required.
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Affiliation(s)
- Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan; Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Tadahiro Ueda
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan
| | - Mirae Koh
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan
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25
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Sato M, Kobayashi Y, Hitosugi M. Visual texture agnosia caused by bilateral posterior cerebral artery stroke: a case study. Neurocase 2021; 27:190-195. [PMID: 33851569 DOI: 10.1080/13554794.2021.1909068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 57-year-old man presented with a bilateral posterior cerebral artery attack and was visually impaired. He had a hard time identifying familiar faces and shades. He also felt that the familiar building looked different, and complained that it was not possible to tell from visual information alone whether the food was cooked or the kimono fabric was soft.We assessed the patient's visual function using real materials and material images and was diagnosed with visual texture agnosia. There are few reports of visual texture agnosia, detailed evaluation is considered important because perceiving texture is important for activities of daily living.
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Affiliation(s)
- Mamiko Sato
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui, Japan
| | - Yasutaka Kobayashi
- Graduate School of Health Science, Fukui Health Science University, Fukui, Japan
| | - Masahito Hitosugi
- Division of Legal Medicine, Shiga University of Medical Science, Shiga, Japan
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26
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Hattori S, Hitosugi M, Moriguchi S, Baba M, Takaso M, Nakamura M, Tsujimura S, Miyata Y. Factors Influencing Pregnant Women's Injuries and Fetal Loss Due to Motor Vehicle Collisions: A National Crash Data-Based Study. Healthcare (Basel) 2021; 9:healthcare9030273. [PMID: 33802545 PMCID: PMC8001010 DOI: 10.3390/healthcare9030273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
To examine the factors that influence substantial injuries for pregnant women and negative fetal outcomes in motor vehicle collisions (MVCs), a retrospective analysis using the National Automotive Sampling System/Crashworthiness Data System was performed in Shiga University of Medical Science. We analyzed data from 736 pregnant women who, between 2001 and 2015, had injuries that were an abbreviated injury scale (AIS) score of one or more. The mean age was 25.9 ± 6.4 years and the mean gestational age was 26.2 ± 8.2 weeks. Additionally, 568 pregnant women had mild injuries and 168 had moderate to severe injuries. Logistic regression analysis revealed that seatbelt use (odds ratio (OR), 0.30), airbag deployment (OR, 2.00), and changes in velocity (21–40 km/h: OR, 3.03; 41–60 km/h: OR, 13.47; ≥61 km/h: OR, 44.56) were identified as independent predictors of having a moderate to severe injury. The positive and negative outcome groups included 231 and 12 pregnant women, respectively. Injury severity in pregnant women was identified as an independent predictor of a negative outcome (OR, 2.79). Avoiding moderate to severe maternal injuries is a high priority for saving the fetus, and education on appropriate seatbelt use and limiting vehicle speed for pregnant women is required.
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Affiliation(s)
- Shinobu Hattori
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
- Correspondence: ; Tel./Fax: +81-77-548-2200
| | - Shingo Moriguchi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
| | - Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Seiji Tsujimura
- Joyson Safety Systems Japan K.K. Echigawa Plant, 658 Echigawa, Aisho-cho, Echi-gun, Shiga 529-1388, Japan; (S.T.); (Y.M.)
| | - Yasuhito Miyata
- Joyson Safety Systems Japan K.K. Echigawa Plant, 658 Echigawa, Aisho-cho, Echi-gun, Shiga 529-1388, Japan; (S.T.); (Y.M.)
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Hitosugi M, Kagesawa E, Narikawa T, Nakamura M, Koh M, Hattori S. Hit-and-runs more common with pedestrians lying on the road: Analysis of a nationwide database in Japan. Chin J Traumatol 2021; 24:83-87. [PMID: 33317929 PMCID: PMC8071722 DOI: 10.1016/j.cjtee.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/25/2020] [Accepted: 11/14/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine the trends with fatally or otherwise injured pedestrians lying on the road and the relationship to hit-and-run incidents in Japan. METHODS We extracted data for 2012-2016 from the records of the Institute for Traffic Accident Research and Data Analysis, Japan, a nationwide traffic accident database. All the injured and fatally injured pedestrians were selected. We examined the levels of pedestrian injury, vehicle speed immediately before the collision, whether or not the pedestrian was lying on the road, and hit-and-run incidents. Chi-square test was employed to make a statistical comparison between the two groups. RESULTS The database contained data on 286,383 pedestrian casualties and 7256 fatalities; 8.3% of fatalities (602 persons) and 0.6% of casualties (1827 persons) involved pedestrians lying on the road. The rates of fatalities and severe injuries were significantly higher for pedestrians who were lying on the road than for those who were not. Hit-and-run incidents were evident in 4.0% of casualties and 7.3% of fatalities. The rate of hit-and-run cases was also significantly higher among pedestrians who were lying on the road. Among fatally injured pedestrians not lying on the road, the rates with speeds of ≥30 km/h did not differ significantly between hit-and-run and other cases. However, when the pedestrians were lying on the road, the rate was significantly increased in hit-and-run cases. CONCLUSION This is the first report to focus on pedestrians lying on the road and being involved in hit-and-run incidents. In addition to preventing hit-and-run incidents, prevention of pedestrians lying on the road could also decrease fatalities.
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Affiliation(s)
- Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan,Corresponding author.
| | - Eiko Kagesawa
- Institute for Traffic Accident Research and Data Analysis, Sarugaku, Kanda Chiyoda-ku, Tokyo, 101-0064, Japan
| | - Takahiro Narikawa
- Institute for Traffic Accident Research and Data Analysis, Sarugaku, Kanda Chiyoda-ku, Tokyo, 101-0064, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan
| | - Mirae Koh
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan
| | - Shinobu Hattori
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan
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Nakamura M, Hitosugi M. Emerging COVID-19-related deaths during home recuperation in Japan. Geriatr Gerontol Int 2021; 21:436-437. [PMID: 33620126 PMCID: PMC8014687 DOI: 10.1111/ggi.14143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
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Nakamura M, Tojo M, Takaso M, Hitosugi M. A regional approach for infection prevention in death investigations during the COVID-19 era. Leg Med (Tokyo) 2020; 48:101829. [PMID: 33360406 PMCID: PMC7833559 DOI: 10.1016/j.legalmed.2020.101829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
| | - Misa Tojo
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
| | - Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
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Uno AT, Hitosugi M, Nakamura M, Nakanishi T, Mima T, Higuchi Y. Complement C9 expression is associated with damaged myocardial cells in pediatric sudden death cases of fulminant myocarditis. Egypt J Forensic Sci 2020. [DOI: 10.1186/s41935-020-00211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Background
Because disease progression is so fast in sudden death of acute fulminant myocarditis, damage of myocardial cells is not evident in routine hematoxylin and eosin staining. To understand damage to myocardial cells and the mechanism of sudden death, immunohistochemical staining was performed for two forensic autopsy cases.
Case presentation
The patients were a healthy 5-year-old girl and 8-year-old boy. They suddenly died within 2 days of appearance of flu-like symptoms. An autopsy showed accumulation of yellowish-clear pericardial fluid containing fibrin deposits, fluid blood in the heart, and congestion of visceral organs. Histologically, minor necrosis or degeneration of myocardial cells with mainly lymphocytic infiltration was observed sometimes in tissue sections. Immunohistochemically, positive complement C9 staining and negative sirtuin 1 staining were found. These findings suggested wide damage of myocardial cells, even in regions with no marked changes in myocardial cells with hematoxylin and eosin staining. These areas corresponded to those with strong accumulation of lymphocytes.
Conclusions
Immunohistochemistry for complement C9 and sirtuin 1 might become a new tool for evaluating damage of myocardial cells of fulminant acute myocarditis.
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Tsutsumi Y, Ito D, Nakamura M, Koshinuma S, Yamamoto G, Hitosugi M. Maxillofacial Injuries in Cyclists: A Biomechanical Approach for the Analysis of Mechanisms of Mandible Fractures. J Oral Maxillofac Surg 2020; 79:871-879. [PMID: 33306963 DOI: 10.1016/j.joms.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The investigators characterized the occurrence of maxillofacial injuries in cyclists and biomechanically analyzed the mechanisms of mandible fractures. METHODS We retrospectively analyzed injury data and performed biomechanical analyses with finite element models. Hospital records from 2011 through 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries while riding a bicycle. Patients with maxillofacial fractures were compared to those without. Logistic regression analysis was performed to identify which variables were independently associated with the occurrence of maxillofacial fractures. To reconstruct the injury scenario (one in which a person falls from a bicycle and contacts the road surface with their face), computer simulations using The Total Human Model for Safety model were performed. RESULTS The hospital records of 94 patients (62 men, 32 women; 26.1 ± 17.3 years of age) who sustained oral and maxillofacial injuries while riding a bicycle were reviewed. Twenty patients (21.3%) sustained maxillofacial fractures; mandible fractures were most common (16 patients). Patients with maxillofacial fractures were significantly older and had higher severity injuries; however, logistic regression analysis showed that only age was an independent predictor of the occurrence of maxillofacial fracture (odds ratio, 1.03; P = .025). In simulations, higher von Mises stresses were found in the mandible when the cyclist fell with the neck extended and the body horizontal, and consequently, the center of mandibular body strikes the road surface. Contact forces were approximately 8 kN. High tensile stresses occurred laterally and high compressive stresses occurred medially in the mandibular ramus, which indicated that the mandibular ramus deformed in the transverse plane. CONCLUSION Biomechanical analyses show that mandible fractures can occur when a cyclist falls from a bicycle and their lower face strikes the road's surface.
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Affiliation(s)
- Yasuhiko Tsutsumi
- Clinical Instructor, Department of Oral Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Daisuke Ito
- Associate Professor, Faculty of Societal Safety Sciences, Kansai University, Osaka, Japan
| | - Mami Nakamura
- Associate Professor, Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Shinya Koshinuma
- Associate Professor, Department of Oral Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Gaku Yamamoto
- Professor and Chair, Department of Oral Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Professor and Chair, Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan.
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Hirobe Y, Koshinuma S, Nakamura M, Baba M, Yamamoto G, Hitosugi M. Factors influencing the long-term hospitalization of bicyclists and motorcyclists with oral and maxillofacial injuries. Dent Traumatol 2020; 37:234-239. [PMID: 33185329 DOI: 10.1111/edt.12622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM Because bicyclists and motorcyclists with oral and maxillofacial injuries often suffer from disabilities requiring long-term treatment, reducing the severity of such injuries is a valuable objective for improving these people's quality of life (QOL). The aims of this study were, first, to present the prevalence and patterns of oral and maxillofacial injuries of bicyclists and motorcyclists and to compare the features of these injuries and, second, to determine the factors contributing to long-term hospitalization for these patients and to propose effective preventive measures. MATERIAL AND METHODS This was a single-center retrospective analysis. Hospital records from 2011 through 2018 were reviewed for all patients who had sustained oral and maxillofacial injuries in bicycle or motorcycle collisions and had presented at a university hospital which was the only hospital in the region attended 24 hours per day by oral and maxillofacial surgeons. Characteristics of the oral and maxillofacial injuries, injury severity, and factors influencing the length of hospitalization were examined. RESULTS Records of 130 patients (82 bicyclists and 48 motorcyclists) with a mean age of 28.0 years were analyzed. Thirty-three patients (25.4%) had maxillofacial fractures, with 41 fracture lines while 103 patients (79.2%) had dental injuries and 57 patients (43.8%) had soft-tissue injuries. The distribution and prevalence of oral and maxillofacial injuries were similar for bicyclists and motorcyclists. However, motorcyclists had significantly higher Abbreviated Injury Scale (AIS) scores for facial injuries and the maximum AIS score than did bicyclists. According to a multiple regression analysis, the number of fracture lines and the requirement for intermaxillary fixation were independent factors influencing long-term hospitalization (standard regression coefficients: 6.795 and 6.715, respectively; P < .001). CONCLUSIONS The number of fracture lines and the use of intermaxillary fixation were independent factors influencing long-term hospitalization of both bicyclists and motorcyclists with oral and maxillofacial injuries.
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Affiliation(s)
- Yu Hirobe
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Shinya Koshinuma
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine, Shinjuku, Japan
| | - Gaku Yamamoto
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
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Affiliation(s)
- Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science
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Fujita K, Kobayashi Y, Hitosugi M, Nomura T, Nishida T, Tsushima Y, Ogawa T, Kinoshita H, Hori H. Factors Influencing Gait Velocity Improvement Following Botulinum Toxin Injection for Spasticity of the Plantar Flexors in Patients with Stroke. Prog Rehabil Med 2020; 5:20200024. [PMID: 33033774 PMCID: PMC7536357 DOI: 10.2490/prm.20200024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022] Open
Abstract
Objective: In patients with hemiplegia, botulinum toxin type A injection for ankle spasticity of the plantar flexors reportedly improves walking speed. This improvement may be affected by background factors and patient baseline physical performance. This study aimed to clarify the factors affecting gait velocity improvement after botulinum toxin type A injection. Methods: Background and evaluation data were collected for 60 patients with stroke who received botulinum toxin type A injection for spasticity of the plantar flexors. The patients were divided into improvement (n=27) and non-improvement (n=33) groups based on the gait velocity change from before injection to 2 weeks after injection. Logistic regression analysis was performed with the improvement and non-improvement groups as response variables and background data and evaluation data at baseline as explanatory variables. Results: The presence or absence of physical therapy following botulinum toxin type A injection (odds ratio: 7.82) was the only significant explanatory variable for gait velocity change. Conclusion: Background factors and physical performance at baseline did not affect gait velocity improvement after botulinum toxin type A injection. If botulinum treatment of the ankle plantar flexors in patients with stroke is targeted at walking performance improvement, then physical therapy following botulinum toxin type A injection should be an essential part of the treatment strategy.
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Affiliation(s)
- Kazuki Fujita
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui, Japan
| | - Yasutaka Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Tomomi Nomura
- Department of Rehabilitation Physical Therapy, Fukui General Hospital, Fukui, Japan
| | - Tomoko Nishida
- Department of Rehabilitation Physical Therapy, Fukui General Hospital, Fukui, Japan
| | - Yuichi Tsushima
- Department of Rehabilitation Physical Therapy, Fukui General Hospital, Fukui, Japan
| | - Tomoki Ogawa
- Department of Rehabilitation Physical Therapy, Fukui General Hospital, Fukui, Japan
| | - Hirotaka Kinoshita
- Department of Rehabilitation Physical Therapy, Fukui General Hospital, Fukui, Japan
| | - Hideaki Hori
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui, Japan
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Hamanaka K, Nishiyama K, Nakamura M, Takaso M, Hitosugi M. Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation. Diagnostics (Basel) 2020; 10:diagnostics10090697. [PMID: 32942746 PMCID: PMC7556011 DOI: 10.3390/diagnostics10090697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022] Open
Abstract
Few studies have compared the sensitivities of autopsy and post mortem computed tomography (PMCT) in detecting rib fractures caused by cardiopulmonary resuscitation (CPR). We aimed to compare the characteristics between both modalities for accurately detecting CPR-related rib fractures. This single-centre observational study included adult patients with autopsy records and PMCT scans at our institution from January 2013 to March 2019. CPR-related rib fractures were evaluated using autopsy and PMCT findings. In 62 patients enrolled, 339 rib fractures were detected on autopsy and/or PMCT (222 fractures on both PMCT and autopsy, 69 on PMCT alone, and 50 on autopsy alone). The agreement of detection for both modalities was substantial (kappa coefficient, 0.78). In the logistic regression model, incomplete fractures detected by PMCT and age <75 years were significantly associated with findings that were negative on autopsy but positive on PMCT, while rib number (ribs 1–3 and 7–12) and fracture location (posterolateral and paravertebral) were significantly associated with negative PMCT findings but positive autopsy findings. Autopsy and PMCT showed complementary roles, and are thus necessary in accurately detecting CPR-related rib fractures. Combining both modalities may contribute to improved CPR quality and better understanding of discrepancy in characteristics between the two modalities.
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Affiliation(s)
- Kunio Hamanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
- Department of Trauma and Critical Care, Kyoto Medical Center, Kyoto 612-8555, Japan;
- Correspondence: ; Tel.: +81-75-751-4399; Fax: +81-75-751-4255
| | - Kei Nishiyama
- Department of Trauma and Critical Care, Kyoto Medical Center, Kyoto 612-8555, Japan;
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
| | - Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
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Murayama H, Hitosugi M, Motozawa Y, Ogino M, Koyama K. Appropriate Neck Flexion Without Head-hitting Decreases The Thrown Player’S Risk Of Brain Injury In Judo. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675608.50706.f8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fujita K, Kobayashi Y, Miaki H, Hori H, Tsushima Y, Sakai R, Nomura T, Ogawa T, Kinoshita H, Nishida T, Hitosugi M. Pedaling improves gait ability of hemiparetic patients with stiff-knee gait: fall prevention during gait. J Stroke Cerebrovasc Dis 2020; 29:105035. [PMID: 32807447 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.
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Affiliation(s)
- Kazuki Fujita
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Yasutaka Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Hiroichi Miaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa-city, Ishikawa, Japan.
| | - Hideaki Hori
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Yuichi Tsushima
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Ryo Sakai
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-city 910-3190, Fukui, Japan.
| | - Tomomi Nomura
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Tomoki Ogawa
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Hirotaka Kinoshita
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Tomoko Nishida
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu-city, Shiga, Japan.
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Hiraizumi S, Shiomi N, Echigo T, Oka H, Hino A, Baba M, Hitosugi M. Factors Associated with Poor Outcomes in Patients with Mild or Moderate Acute Subdural Hematomas. Neurol Med Chir (Tokyo) 2020; 60:402-410. [PMID: 32565532 PMCID: PMC7431873 DOI: 10.2176/nmc.oa.2020-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The factors influencing the outcomes of mild/moderate acute subdural hematoma (ASDH) are still unclear. Retrospective analyses were performed to identify such factors. The medical records of all patients who were admitted to Saiseikai Shiga Hospital with mild (Glasgow Coma Scale [GCS] score of 14–15) or moderate (GCS score of 9–13) ASDH between April 2008 and March 2017 were reviewed. Comparisons between the patients who exhibited favorable and poor outcomes were performed. Then, independent factors that contributed to poor outcomes were identified via logistic regression analyses. A total of 266 patients with a mean age of 70.2 were included in this study. The most common concomitant injuries were subarachnoid hemorrhages (SAHs; 56.8%). The patients’ Injury Severity Scores (ISS) ranged from 16 to 75 (median: 21). The 66 moderate ASDH patients exhibited significantly higher frequencies of surgery and mortality (24.2% and 13.6%, respectively) than the 200 mild ASDH patients (8.0% and 4.5%, respectively). The factors associated with poor outcomes were age (odds ratio [OR]: 1.06) and the ISS (OR: 1.24) in the mild ASDH patients, and older age (OR: 1.09) and the higher ISS (OR: 1.15) in the moderate group, too.
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Affiliation(s)
- Shiho Hiraizumi
- Emergency and Critical Care Medicine, Saiseikai Shiga Hospital.,Department of Legal Medicine, Shiga University of Medical Science
| | - Naoto Shiomi
- Emergency and Critical Care Medicine, Saiseikai Shiga Hospital
| | - Tadashi Echigo
- Emergency and Critical Care Medicine, Saiseikai Shiga Hospital
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine
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Hamanaka K, Shimoto M, Hitosugi M, Beppu S, Terashima M, Sasahashi N, Nishiyama K. Cerebral oxygenation monitoring during resuscitation by emergency medical technicians: a prospective multicenter observational study. Acute Med Surg 2020; 7:e528. [PMID: 32566238 PMCID: PMC7299661 DOI: 10.1002/ams2.528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 11/12/2022] Open
Abstract
Aim To assess the feasibility and predictive ability of regional cerebral oxygen saturation monitoring during cardiopulmonary resuscitation by emergency medical technicians. Methods This prospective observational study included 33 cardiac arrest patients who received cardiopulmonary resuscitation in a prehospital setting. Patients were connected to a near‐infrared spectrometer through two disposable probes immediately after entering the ambulance. The monitor, which showed regional cerebral oxygen saturation readings, was obscured by covering it with a sheet of paper. Regional cerebral oxygen saturation was measured continuously until hospital arrival. Outcome variables included the prehospital return of spontaneous circulation, survival to hospital admission, and survival at 90 days. Results For patients who survived >90 days after hospital admission (n = 2), the mean regional cerebral oxygen saturation values upon ambulance and hospital arrival were 24% and 60%, respectively; for patients who did not survive (n = 31), the mean regional cerebral oxygen saturation values were 15% and 17%, respectively. Regional cerebral oxygen saturation values increased to a greater extent between ambulance arrival and hospital arrival in patients who survived >90 days (median, 36%; interquartile range, 32–40%) than in those who did not survive (0; 0–6%; P = 0.07). Additionally, regional cerebral oxygen saturation values were not related to the prehospital return of spontaneous circulation or survival to hospital admission. Conclusion Regional cerebral oxygen saturation could be monitored during resuscitation by emergency medical technicians, and it can be used during physiological monitor‐guided cardiopulmonary resuscitation.
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Affiliation(s)
- Kunio Hamanaka
- Department of Trauma and Critical Care Kyoto Medical Center Fushimi Japan
| | - Manabu Shimoto
- Department of Primary Care and Emergency Medicine Kyoto University Graduate School of Medicine Sakyou Japan
| | - Masahito Hitosugi
- Division of Legal Medicine Shiga University of Medical Science Otsu Japan
| | - Satoru Beppu
- Department of Trauma and Critical Care Kyoto Medical Center Fushimi Japan
| | - Mariko Terashima
- Department of Trauma and Critical Care Kyoto Medical Center Fushimi Japan
| | - Nozomu Sasahashi
- Department of Trauma and Critical Care Kyoto Medical Center Fushimi Japan
| | - Kei Nishiyama
- Department of Trauma and Critical Care Kyoto Medical Center Fushimi Japan
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Murayama H, Hitosugi M, Motozawa Y, Ogino M, Koyama K. Ukemi Technique Prevents the Elevation of Head Acceleration of a Person Thrown by the Judo Technique 'Osoto-gari'. Neurol Med Chir (Tokyo) 2020; 60:307-312. [PMID: 32404577 PMCID: PMC7301129 DOI: 10.2176/nmc.oa.2020-0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Biomechanical analysis was performed to evaluate the effectiveness of mastering ukemi in preventing severe head injury in judo. One judo expert (tori) threw another judo expert (uke) with a skilled break-fall (ukemi) four times. We obtained kinematic data of uke with a digital video camera. Both translational and rotational accelerations were measured with a six-degree-of-freedom sensor affixed to uke’s forehead. When Osoto-gari was performed, uke fell backward and his arm made contact with the tatami; the translational and rotational accelerations rose to peak values. The peak resultant translational and rotational accelerations were respectively 10.3 ± 1.6 G and 679.4 ± 173.6 rad/s2 (mean ± standard deviation). Furthermore, when comparing the values obtained for the judo experts with those obtained using an anthropomorphic test device (ATD: the POLAR dummy) that did not perform ukemi, both the peak resultant translational (P = 0.021) and rotational (P = 0.021) accelerations of uke were significantly lower than those for the ATD, whose head struck the tatami. Additionally, there was no significant difference among the three axis directions for either translational (ax: 7.4 ± 0.2, ay: 8.5 ± 2.1, az: 7.2 ± 0.8 G) or rotational (αx: 576.7 ± 132.7, αy: 401.0 ± 101.6, αz: 487.8 ± 66.6 rad/s2) acceleration. We confirmed that performing correct ukemi prevented the elevation of head acceleration by avoiding head contact with the tatami when a judoka is thrown by Osoto-gari. Judoka should therefore undertake intensive practice after they have acquired ukemi skills.
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Affiliation(s)
- Haruo Murayama
- Department of Health and Sports Sciences, Premedical Sciences, Dokkyo Medical University School of Medicine
| | | | - Yasuki Motozawa
- Department of Mechanical and Precision System, Teikyo University
| | - Masahiro Ogino
- Department of Neurosurgery, Dokkyo Medical University School of Medicine
| | - Katsuhiro Koyama
- Graduate School Department of Interdisciplinary Research, University of Yamanashi
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41
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Takaso M, Hitosugi M, Nakagawa R, Mukaisho K, Moriguchi S, Koh M, Sugihara H. Forensic Autopsies can Determine Latent Prostate Cancer Prevalence. J Forensic Sci 2020; 65:1557-1562. [PMID: 32501618 DOI: 10.1111/1556-4029.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
To evaluate the usefulness of forensic autopsies in determining latent prostate cancer (PC) prevalence, we examined latent PC prevalence from autopsies and compared our findings between decedents with and without cancer. Data from forensic autopsies performed in Japan from 2004 to 2014 were obtained. For each prostate, histopathological examinations were performed in both the base and the apex sections. Three hundred and seventeen Japanese decedents were selected for analysis. The mean age of decedents was 56.4 ± 17.8 years (range, 14-94 years). Among this population, 39.4% died suddenly of disease and 60.6% died of external causes. Latent PC was identified in 45 (14.2%) decedents, who ranged from 27 to 93 years old (mean, 71.1 ± 12.9 years). The prevalence of clinically significant PC with a Gleason score of 7 or more was 8.8%, and the rate increased with age. Fifteen males had cancers other than PC. The prevalence of overall latent PC was significantly higher for those with cancer compared with those without (40.0% vs. 12.9%; P = 0.003). In this study, the use of forensic autopsy materials provided the opportunity to obtain a more accurate natural history of PC, as the decedents in this situation would have been more likely to have died suddenly while behaving as normal prior to death, and less likely to have been impacted by long-term medical interventions.
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Affiliation(s)
- Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan
| | - Risako Nakagawa
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan
| | - Kenichi Mukaisho
- Department of Pathology, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, 520-2192, Japan
| | - Shingo Moriguchi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan
| | - Mirae Koh
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan
| | - Hiroyuki Sugihara
- Department of Pathology, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, 520-2192, Japan
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Shimizu A, Zankov DP, Sato A, Komeno M, Toyoda F, Yamazaki S, Makita T, Noda T, Ikawa M, Asano Y, Miyashita Y, Takashima S, Morita H, Ishikawa T, Makita N, Hitosugi M, Matsuura H, Ohno S, Horie M, Ogita H. Identification of transmembrane protein 168 mutation in familial Brugada syndrome. FASEB J 2020; 34:6399-6417. [PMID: 32175648 DOI: 10.1096/fj.201902991r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/30/2022]
Abstract
Brugada syndrome (BrS) is an inherited channelopathy responsible for almost 20% of sudden cardiac deaths in patients with nonstructural cardiac diseases. Approximately 70% of BrS patients, the causative gene mutation(s) remains unknown. In this study, we used whole exome sequencing to investigate candidate mutations in a family clinically diagnosed with BrS. A heterozygous 1616G>A substitution (R539Q mutation) was identified in the transmembrane protein 168 (TMEM168) gene of symptomatic individuals. Similar to endogenous TMEM168, both TMEM168 wild-type (WT) and mutant proteins that were ectopically induced in HL-1 cells showed nuclear membrane localization. A significant decrease in Na+ current and Nav 1.5 protein expression was observed in HL-1 cardiomyocytes expressing mutant TMEM168. Ventricular tachyarrhythmias and conduction disorders were induced in the heterozygous Tmem168 1616G>A knock-in mice by pharmacological stimulation, but not in WT mice. Na+ current was reduced in ventricular cardiomyocytes isolated from the Tmem168 knock-in heart, and Nav 1.5 expression was also impaired. This impairment was dependent on increased Nedd4-2 binding to Nav 1.5 and subsequent ubiquitination. Collectively, our results show an association between the TMEM168 1616G>A mutation and arrhythmogenesis in a family with BrS.
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Affiliation(s)
- Akio Shimizu
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Dimitar P Zankov
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan.,Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akira Sato
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Masahiro Komeno
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
| | - Futoshi Toyoda
- Division of Cell Physiology, Department of Physiology, Shiga University of Medical Science, Otsu, Japan
| | - Satoru Yamazaki
- Department of Molecular Pharmacology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshinori Makita
- Division of Cardiac Electrophysiology, Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Taichi Noda
- Animal Resource Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Masahito Ikawa
- Animal Resource Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Yoshihiro Asano
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yohei Miyashita
- Department of Legal Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiji Takashima
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Taisuke Ishikawa
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naomasa Makita
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroshi Matsuura
- Division of Cell Physiology, Department of Physiology, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Suita, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Hisakazu Ogita
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology, Shiga University of Medical Science, Otsu, Japan
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Takeda A, Koh M, Nakanishi T, Hitosugi M. Differences in severity of injuries between motorcyclist and bicyclist fatalities in single vehicle collisions. J Forensic Leg Med 2020; 70:101917. [PMID: 32090972 DOI: 10.1016/j.jflm.2020.101917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/22/2019] [Accepted: 01/26/2020] [Indexed: 11/16/2022]
Abstract
To understand the injury severity of bicyclists and motorcyclists in single vehicle collisions, we performed a retrospective analysis of forensic autopsy cases of 25 motorcyclists and 14 bicyclists performed from 1999 to 2018. Collision details, injury characteristics, and involvement of alcohol were examined. The injury severity between bicyclists and motorcyclists was compared. The average age of victims was 62.3 years. All motorcyclists and no bicyclists wore a helmet. Motorcyclists had more severe injuries than bicyclists (mean Injury Severity Score of 42 and 27, respectively). The motorcyclists had more severe chest injuries but fewer severe facial injuries than bicyclists, owing to the difference in collision velocity or rate of helmet use (p < 0.05). Alcohol was present in the blood of 52.0% of bicyclists but no motorcyclists. The mean blood alcohol concentration of these bicyclists was 1.59 mg/mL. The bicyclists under the influence of alcohol had more severe injuries to neck and upper extremities than non-drunken bicyclists (p < 0.05). Our results may be useful for determining the cause of death and reconstructing the mechanisms of fatal injuries in bicyclists and motorcyclists.
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Affiliation(s)
- Arisa Takeda
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan.
| | - Mirae Koh
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Tomoyuki Nakanishi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Japan
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Murayama H, Hitosugi M, Motozawa Y, Ogino M, Koyama K. Biomechanical Analysis of the Head Movements of a Person Thrown by the Judo Technique 'Seoi-nage'. Neurol Med Chir (Tokyo) 2020; 60:101-106. [PMID: 31866665 PMCID: PMC7040429 DOI: 10.2176/nmc.oa.2019-0206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The present study examined the kinematics and biomechanical parameters of the head of a person thrown forward by the judo technique ‘Seoi-nage’. A judo expert threw an anthropomorphic test device (the POLAR dummy) five times. Kinematics data were obtained with a high-speed digital video camera. Linear and angular accelerations of the head were measured by accelerometers mounted at the center of gravity of the dummy’s head. When Seoi-nage was performed, the dummy fell forward accompanied by contacting the anterior parietal regions of the head to the tatami, and the linear and angular accelerations of most axes reached peak values when the head contacted the tatami. Peak resultant linear and angular accelerations were 20.3 ± 9.8 G and 1890.1 ± 1151.9 rad/s2, respectively (means ± standard deviation). Peak values in linear and angular acceleration did not significantly differ between the three directional axes. Absolute angular accelerations in all axes observed in Seoi-nage were high and the resultant value was approximately equal to the already reported in Ouchi-gari, one of the predominant techniques causing judo-related acute subdural hematoma. However, the remarkable increase of linear acceleration in the longitudinal direction and/or angular acceleration in the sagittal plane, as previously reported in techniques being thrown backward (i.e., Ouchi-gari and Osoto-gari), was not detected. The likely mechanism of acute subdural hematoma caused by Seoi-nage is that a large angular acceleration causes large strains and deformations of the brain surface and subsequent rupture of cortical vessels.
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Affiliation(s)
- Haruo Murayama
- Department of Health and Sports Sciences, Premedical Sciences, Dokkyo Medical University School of Medicine
| | | | - Yasuki Motozawa
- Department of Mechanical and Precision System, Teikyo University
| | - Masahiro Ogino
- Department of Neurosurgery, Dokkyo Medical University School of Medicine
| | - Katsuhiro Koyama
- Graduate School Department of Interdisciplinary Research, University of Yamanashi
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Murayama H, Hitosugi M, Motozawa Y, Ogino M, Koyama K. The Effect of Direct Head Impact in Judo on Internal of Cervical Spine. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560671.13366.7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Nakagawa R, Ishii W, Hitosugi M. Drowning of a patient with epilepsy while showering. Environ Health Prev Med 2019; 24:31. [PMID: 31084599 PMCID: PMC6515643 DOI: 10.1186/s12199-019-0792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/03/2019] [Indexed: 11/22/2022] Open
Abstract
In Japan, because the most common site of drowning among patients with epilepsy is the bathtub, showering is generally recommended as an alternative to bathing. We herein report a case involving a female patient with epilepsy who drowned while showering. She had been diagnosed with epilepsy approximately 25 years previously, and her condition had progressed to refractory epilepsy. Carbamazepine, levetiracetam, lamotrigine, clobazam, and perampanel were prescribed daily. One day while showering, the patient was found lying with her face immersed in water that had accumulated on the floor of the bathtub. A forensic autopsy revealed water in the stomach, trachea, and proximal regions of both lung bronchi as well as white and red foam on the pharynx and larynx. A total of 1.9 μg/mL of lamotrigine, 0.14 μg/mL of carbamazepine, and 0.069 μg/mL of perampanel were detected in the patient’s blood. The patient’s cause of death was determined to be drowning due to an epileptic seizure. Although the patient was prescribed five types of antiepileptic medication, only three were detected in her blood. The current case demonstrates that drowning can occur while showering, suggesting that it is unsafe for patients with medication nonadherence. To prevent unintentional deaths in the bathroom, we recommend that patients with epilepsy maintain high adherence to all prescriptions and are supervised by a family member, even when showering. The current case is the first autopsy report of a patient with epilepsy who drowned while showering.
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Affiliation(s)
- Risako Nakagawa
- Department of Legal Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Wataru Ishii
- Department of Legal Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
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Inoue T, Ooba H, Hirano M, Takehara I, Watanabe S, Hitosugi M. Assessment for resumed driving in stroke patients via Functional Independence Measure1. Work 2019; 60:393-399. [PMID: 30040778 DOI: 10.3233/wor-182747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Some stroke survivors hope to resume driving after hospital discharge. For those who had driven frequently before their stroke, a normal daily life depends on being able to drive. OBJECTIVE Our objective was to determine whether Functional Independence Measure (FIM) scores predict patient driving ability, which would make them a suitable index for determining if a stroke patient can resume driving. METHODS This was a retrospective study of 71 patients who suffered from stroke. We divided them into three groups based on their driving status after discharge: (1) resumed driving (Driver), (2) wish to resume driving (Wisher), and (3) no wish to resume driving (Non-wisher). We compared total FIM scores and subcategories of FIM scores across groups. RESULTS Scores on the Motor-FIM and Cognitive-FIM were highest in the Driver group, followed by the Wisher and Non-wisher groups. Moreover, scores on the 'problem solving' and 'memory' subcategories of the Cognitive-FIM were significantly higher in the Driver group than in the Wisher group. CONCLUSIONS The FIM could be a useful assessment tool for determining whether or not stroke patients can resume driving. Moreover, among the Cognitive-FIM sub-categories, problem solving and memory ability might be the scores most relevant for this decision.
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Affiliation(s)
- Takuya Inoue
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, Japan.,Department of Legal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hideki Ooba
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | | | - Itaru Takehara
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Shu Watanabe
- The Jikei University School of Medicine, Tokyo, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, Japan
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Mizuno K, Yoshida R, Nakajima Y, Tanaka Y, Ishigaki R, Hosokawa N, Tanaka Y, Hitosugi M. The Effects of Inboard Shoulder Belt and Lap Belt Loadings on Chest Deflection. Stapp Car Crash J 2018; 62:67-91. [PMID: 30608993 DOI: 10.4271/2018-22-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Chest injuries occur frequently in frontal collisions. During impact, tension in the lap belt is transferred to the inboard shoulder belt, which compresses the lower ribs of the occupant. In this research, inboard shoulder belt and lap belt geometries and forces were investigated to reduce chest deflection. First, the inboard shoulder belt geometry was changed by the lap/shoulder belt (L/S) junction for the rear seat occupant in sled tests using Hybrid III finite element simulation, sled tests and THOR simulation. As the L/S junction was closer to the ASIS (anterior superior iliac spine), chest deflection of the Hybrid III was smaller. The L/S junction around the ilium has the potential to reduce chest deflection without significant increase of head excursion. For THOR, although the chest deflection reduction effect due to closer L/S junction to the ASIS was observed, chest deflection was still substantially large since the lap belt overrode the ASIS. Second, measures to hook the ASIS of the THOR by the lap belt were examined. Sled tests at 30 and 50 km/h were conducted with THOR in the rear seat, and it was demonstrated that the outboard lap belt and buckle pretensioners improved the lap belt and ASIS interaction, and were also useful in reducing the deflection at the inboard-side of the lower chest. Finally, the lap belt overlap with the ASIS was compared among 10 volunteers, Hybrid III, and THOR. Some volunteers had the ASIS located at the torso-thigh junction, and the lap belt did not overlap the ASIS sufficiently. However, although the ASIS location of THOR is also at the torso-thigh junction, the lap belt overlapped the ASIS because of the abdomen's and femur's shape. In the future, it will be necessary to consider that the outboard lap belt and buckle pretensioners are also effective for the ASIS restraint of all human car occupants.
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Hitosugi M, Tojo M, Kane M, Shiomi N, Shimizu T, Nomiyama T. Criminal mercury vapor poisoning using heated tobacco product. Int J Legal Med 2018; 133:479-481. [PMID: 30178086 DOI: 10.1007/s00414-018-1923-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
We report an unusual case of mercury vapor poisoning from using a heated tobacco product. The suspect had added grains of mercury into 20 cigarettes in a pack. When a 36-year-old Japanese man inserted one of these cigarettes into the battery powered holder, it was heated to a temperature of 350 °C, and he inhaled vaporized mercury. After using 14 of the cigarettes over 16 h, he noticed he had flu-like symptoms so he visited the hospital. Although no physical abnormalities were revealed, 99 μg/L of mercury was detected in his serum sample. His general condition improved gradually and his whole blood mercury level had decreased to 38 μg/L 5 days later. When the remaining six cigarettes in the pack were examined, many metallic grains weighing a total of 1.57 g were observed. Energy dispersive X-ray fluorescence spectrometry confirmed the grains as elemental mercury. Accordingly, the victim was diagnosed with mercury poisoning. Because the mercury was incorporated into cigarettes, an unusual and novel intoxication occurred through the heating of the tobacco product. Both medical and forensic scientific examination confirmed this event as attempted murder.
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Affiliation(s)
- Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan.
| | - Misa Tojo
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Masateru Kane
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
- Forensic Science Laboratory, Shiga Prefectural Police Headquarters, Otsu, Shiga, 520-0106, Japan
| | - Naoto Shiomi
- Emergency and critical care medicine, Saiseikai Shiga Hospital, Ritto, Shiga, 520-3046, Japan
| | - Takeshi Shimizu
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine, Shinshu University School of Medicine, Matsumoto, 390-8621, Japan
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50
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Inoue T, Hitosugi M, Ooba H, Takehara I. Rate of Stroke Onset While Driving and Subsequent Collision. J Stroke Cerebrovasc Dis 2018; 27:2553-2554. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 04/03/2023] Open
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