287 results on '"Hirotaro Iwase"'
Search Results
2. Changes in SARS-CoV-2 viral load and titers over time in SARS-CoV-2-infected human corpses
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Sayaka Nagasawa, Yuichiro Hirata, Sho Miyamoto, Seiya Ozono, Shun Iida, Harutaka Katano, Shigeki Tsuneya, Kei Kira, Susumu Kobayashi, Makoto Nakajima, Hiroyuki Abe, Masako Ikemura, Isao Yamamoto, Kimiko Nakagawa, Kazumi Kubota, Shinji Akitomi, Iwao Hasegawa, Tetsuo Ushiku, Tadaki Suzuki, Hirotaro Iwase, Yohsuke Makino, and Hisako Saitoh
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Medicine ,Science - Published
- 2024
3. Biotransformation of se-methylselenocysteine into volatile selenocompounds by bacteria isolated from rat gut microflora
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Kazuaki Takahashi, Sakie Horiai, Yoshikazu Yamagishi, Sayaka Nagasawa, Hirotaro Iwase, and Yasumitsu Ogra
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Selenium ,Dimethyldiselenide ,Dimethylselenide ,M. morganii ,GC–MS ,Gut microflora ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Selenium (Se) is an essential micronutrient that exists in various chemical forms in nature. Because of this property, animals must metabolize diverse Se species to utilize them as selenoproteins. Although gut microflora is suggested to play a role in Se metabolism in host animal, the biotransformation of Se by gut microflora in animal gut is not fully understood. In this study, we isolated Morganella morganii from rat feces under the condition that Se-methylseleno-L-cysteine (MeSeCys), one of the major Se sources in vegetables, was present in excess. Then, we examined the biotransformation of MeSeCys by M. morganii. Two volatile selenocompounds, dimethyldiselenide (DMDSe) and dimethylselenide (DMSe), were detected by GC–MS in the headspace of M. morganii culture. We speculate that M. morganii cleaved off the methylselenyl group from MeSeCys. Taken together, we conclude that gut microflora plays a role in the biotransformation of MeSeCys, and seems to support efficient metabolism in animals.
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- 2023
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4. High titers of infectious SARS-CoV-2 in corpses of patients with COVID-19
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Hisako Saitoh, Yuko Sakai-Tagawa, Sayaka Nagasawa, Suguru Torimitsu, Kazumi Kubota, Yuichiro Hirata, Kiyoko Iwatsuki-Horimoto, Ayumi Motomura, Namiko Ishii, Keisuke Okaba, Kie Horioka, Hiroyuki Abe, Masako Ikemura, Hirofumi Rokutan, Munetoshi Hinata, Akiko Iwasaki, Yoichi Yasunaga, Makoto Nakajima, Rutsuko Yamaguchi, Shigeki Tsuneya, Kei Kira, Susumu Kobayashi, Go Inokuchi, Fumiko Chiba, Yumi Hoshioka, Aika Mori, Isao Yamamoto, Kimiko Nakagawa, Harutaka Katano, Shun Iida, Tadaki Suzuki, Shinji Akitomi, Iwao Hasegawa, Tetsuo Ushiku, Daisuke Yajima, Hirotaro Iwase, Yohsuke Makino, and Yoshihiro Kawaoka
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SARS-CoV-2 ,COVID-19 ,Infectious titer ,Virus isolation ,Autopsy ,Postmortem interval ,Infectious and parasitic diseases ,RC109-216 - Abstract
Objectives: The prolonged presence of infectious SARS-CoV-2 in deceased patients with COVID-19 has been reported. However, infectious virus titers have not been determined. Such information is important for public health, death investigation, and handling corpses. The aim of this study was to assess the level of SARS-CoV-2 infectivity in the corpses of patients with COVID-19. Methods: We collected 11 nasopharyngeal swabs and 19 lung tissue specimens from 11 autopsy cases with COVID-19 in 2021. We then investigated the viral genomic copy number by real-time reverse transcription-polymerase chain reaction and infectious titers by cell culture and virus isolation. Results: Infectious virus was present in six of 11 (55%) cases, four of 11 (36%) nasopharyngeal swabs, and nine of 19 (47%) lung specimens. The virus titers ranged from 6.00E + 01 plaque-forming units/ml to 2.09E + 06 plaque-forming units/g. In all cases in which an infectious virus was found, the time from death to discovery was within 1 day and the longest postmortem interval was 13 days. Conclusion: The corpses of patients with COVID-19 may have high titers of infectious virus after a long postmortem interval (up to 13 days). Therefore, appropriate infection control measures must be taken when handling corpses.
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- 2023
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5. SARS-CoV-2 Transmission from Virus-Infected Dead Hamsters
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Kiyoko Iwatsuki-Horimoto, Hiroshi Ueki, Mutsumi Ito, Sayaka Nagasawa, Yuichiro Hirata, Kenichiro Hashizume, Kazuho Ushiwata, Hirotaro Iwase, Yohsuke Makino, Tetsuo Ushiku, Shinji Akitomi, Masaki Imai, Hisako Saitoh, and Yoshihiro Kawaoka
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SARS-CoV-2 ,COVID-19 ,dead body ,transmission ,embalming ,animal model ,Microbiology ,QR1-502 - Abstract
ABSTRACT Although it has been 2.5 years since the coronavirus disease 2019 (COVID-19) pandemic began, the transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a dead infected body remains unclear, and in Japan, bereaved family members are often not allowed to view in person a loved one who has died from COVID-19. In this study, we analyzed the possibility of SARS-CoV-2 transmission from a dead body using a hamster model. We also analyzed the effect of “angel care”––in which the pharynx, nostrils, and rectum are plugged––and embalming on reducing transmissibility from dead bodies. We found that SARS-CoV-2 could be transmitted from the bodies of animals that had died within a few days of infection; however, angel care and embalming were effective in preventing transmission from the dead bodies. These results suggest that protection from infection is essential when in contact with a SARS-CoV-2-infected dead body and that sealing the cavities of a dead body is an important infection control step if embalming is not performed. IMPORTANCE We found that SARS-CoV-2 could be transmitted from a dead body, presumably via postmortem gases. However, we also found that postmortem care, such as plugging the pharynx, nostrils, and rectum or embalming the corpse, could prevent transmission from the dead body. These results indicate that protection from infection is essential when handling infected corpses and that appropriate care of SARS-CoV-2-infected corpses is important.
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- 2023
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6. Dental characteristics associated with methamphetamine use: analysis using forensic autopsy data
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Satomi Mizuno, Sachiko Ono, Ayumi Takano, Hideo Yasunaga, and Hirotaro Iwase
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Oral hygiene ,Periodontal disease(s)/periodontitis ,Computed tomography ,Caries ,Public health ,Risk factor(s) ,Dentistry ,RK1-715 - Abstract
Abstract Background Little is known regarding the oral conditions in nonelderly methamphetamine users, such as the presence of dental caries and periodontitis. We aimed the oral conditions between methamphetamine users and non-users stratified by age groups. Methods In this cross-sectional study, computed tomography images were obtained from 3,338 decedents at two forensic medicine departments in Japan. Decedents aged > 20 or ≤ 64 years were included in the study and categorised into methamphetamine-detected (MA) and undetected (control) groups based on toxicological examinations. Decedents in the MA and control groups were matched for age and sex in a 1:4 ratio. The matched pairs were further categorised into young adults (20–44 years) and middle-aged adults (45–64 years). Oral characteristics, including the decayed, missing, and filled teeth (DMFT) index; periodontitis; distributional patterns of each tooth condition; and occlusal status, were compared between the MA and control groups for each age category. Among 3,338 decedents, 37 young and 55 middle-aged adults in the MA group were matched with 148 and 220 adults in the control group, respectively. Results In the young adult group, methamphetamine use was significantly associated with higher DMFT index (mean [standard deviation], 14.2 [7.6] vs 11.0 [6.1]; p = 0.007), smaller number of filled teeth (2.8 [2.9] vs 5.3 [4.0]; p = 0.001), higher proportion of periodontitis (39.0% vs 6.8%; p
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- 2022
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7. Cadmium body burden and health effects after restoration of cadmium-polluted soils in cadmium-polluted areas in the Jinzu River basin
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Masaru Sakurai, Yasushi Suwazono, Kazuhiro Nogawa, Yuuka Watanabe, Miyuki Takami, Yasumitsu Ogra, Yu-Ki Tanaka, Hirotaro Iwase, Kayo Tanaka, Masao Ishizaki, Teruhiko Kido, and Hideaki Nakagawa
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urinary cadmium ,β2-microglobulin ,nag ,restoration of cadmium-polluted soils ,the jinzu river basin ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Itai-itai disease is caused by environmental cadmium (Cd) pollution in the Jinzu River basin in Japan. To reduce the Cd contamination of rice, soil restoration of paddy fields was carried out. We evaluated the effect of soil restoration on the health status of residents of the former Cd-polluted area. Methods: Participants were 1,030 men and 944 women who lived in the area of restoration of Cd-polluted rice paddies. First morning urine was collected and urinary Cd, β2-microglobulin (β2MG), and N-acetyl-β-D-glucosaminidase (NAG) levels were measured. Associations among age, years of residence before and after soil restoration, and urinary Cd, β2MG, and NAG levels were evaluated by multiple regression analysis. Results: The geometric mean (interquartile range) of urinary Cd (µg/g Cr) was 1.00 (0.58–1.68) in men and 1.67 (1.02–2.91) in women. The geometric means of urinary β2MG (µg/g Cr) and NAG (U/g Cr) were 174.6 (92.6–234.2) and 1.47 (0.72–3.14) in men, and 217.6 (115.3–28.7) and 1.48 (0.73–2.96) in women, respectively. Urinary Cd, β2MG, and NAG were significantly positively correlated (p < 0.01 all). Age and duration of residence in the Cd-polluted area before soil restoration were independently associated with urinary Cd, β2MG, and NAG. Among the 916 participants who had resided in the area before the soil restoration, urinary Cd concentrations were significantly higher, thus by 1.03-fold (95% CI, 1.01–1.04) in men and 1.03-fold (95% CI, 1.01–1.05) in women, when the years of residence before soil restoration by each 5-years increment. By contrast, urinary Cd concentrations were significantly lower, thus 0.97-fold (95% CI, 0.96–0.99) lower in men and 0.97-fold (95% CI, 0.95–0.99) lower in women, by each 5-year increment of residence after soil restoration. A similar association was observed for urinary β2MG concentration, and no significant association was observed for urinary NAG levels in men or women. Conclusions: Cd exposure and associated renal tubular dysfunction in residents of a former Cd-polluted area were influenced by Cd exposure from the environment prior to soil restoration. Soil restoration in Cd-polluted areas reduced the Cd exposure of local residents.
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- 2023
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8. Increased Myosin light chain 9 expression during Kawasaki disease vasculitis
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Hironobu Kobayashi, Motoko Y. Kimura, Ichita Hasegawa, Eisuke Suganuma, Yuzuru Ikehara, Kazuhiko Azuma, Toshihiro Ito, Ryota Ebata, Yosuke Kurashima, Yohei Kawasaki, Yuki Shiko, Naoki Saito, Hirotaro Iwase, Youngho Lee, Magali Noval Rivas, Moshe Arditi, Masahiko Zuka, Hiromichi Hamada, and Toshinori Nakayama
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Kawasaki disease ,coronary artery ,vasculitis ,children ,platelet ,Myl9 ,Immunologic diseases. Allergy ,RC581-607 - Abstract
IntroductionKawasaki disease (KD) is an acute systemic vasculitis that predominantly afflicts children. KD development is known to be associated with an aberrant immune response and abnormal platelet activation, however its etiology is still largely unknown. Myosin light chain 9 (Myl9) is known to regulate cellular contractility of both non-muscle and smooth muscle cells, and can be released from platelets, whereas any relations of Myl9 expression to KD vasculitis have not been examined.MethodsPlasma Myl9 concentrations in KD patients and children with febrile illness were measured and associated with KD clinical course and prognosis. Myl9 release from platelets in KD patients was also evaluated in vitro. Myl9 expression was determined in coronary arteries from Lactobacillus casei cell wall extract (LCWE)-injected mice that develop experimental KD vasculitis, as well as in cardiac tissues obtained at autopsy from KD patients.Results and discussionPlasma Myl9 levels were significantly higher in KD patients during the acute phase compared with healthy controls or patients with other febrile illnesses, declined following IVIG therapy in IVIG-responders but not in non-responders. In vitro, platelets from KD patients released Myl9 independently of thrombin stimulation. In the LCWE-injected mice, Myl9 was detected in cardiac tissue at an early stage before inflammatory cell infiltration was observed. In tissues obtained at autopsy from KD patients, the highest Myl9 expression was observed in thrombi during the acute phase and in the intima and adventitia of coronary arteries during the chronic phase. Thus, our studies show that Myl9 expression is significantly increased during KD vasculitis and that Myl9 levels may be a useful biomarker to estimate inflammation and IVIG responsiveness to KD.
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- 2023
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9. Effects of human serum albumin on post-mortem changes of malathion
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Yoshikazu Yamagishi, Hirotaro Iwase, and Yasumitsu Ogra
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Medicine ,Science - Abstract
Abstract Malathion, diethyl 2-[(dimethoxyphosphinothioyl)thio]butanedioate, is one of most widely used organophosphoryl pesticide, and it has been detected in several clinical cases of accidental exposure and suicide. It is reported that the observed malathion concentration in blood of persons who suffer from malathion poisoning is smaller than the expected concentration. Because malathion is bound to human serum albumin (HSA), recovery of malathion in the free form is insufficient. We detected malathion adducts in HSA by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-Q/TOF–MS). The mass spectra showed that malathion was preferably bound to the lysine (K) and cysteinylproline (CP) residues of HSA. The K- and CP-adducts of malathion were increased in vitro with a dose-dependent fashion when its concentration was smaller than the lethal dose. Further, the K-adduct was also detected in post-mortem blood of an autopsied subject suffering from intentional malathion ingestion. These results suggest that the K-adduct seems to be available to use a biomarker of malathion poisoning, and the determination of the K-adduct could make possible to estimate the amount of malathion ingestion.
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- 2021
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10. Lipiodol remnants misinterpreted as a metal device on postoperative abdominal X‐ray images
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Chieko Kurimoto, Shunji Goto, Yoshikazu Yamagishi, Fumiko Chiba, Hirotaro Iwase, and Eiji Kato
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hysterosalpingogram ,lipiodol ,mass spectrometry ,remnant ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract We experienced a case of pregnancy after hysterosalpingogram and residual lipiodol in the extraperitoneal space. Initially, we suspected a metallic remnant; however, analysis by mass spectrometer confirmed that it was a remnant of lipiodol.
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- 2022
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11. Children’s death survey using death certificates in the Chiba prefecture
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Shumari Urabe, Kenji Ishihara, Fumiko Chiba, Rutsuko Yamaguchi, Yuki Shiko, Yohei Kawasaki, and Hirotaro Iwase
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Child Death Review ,Cause of death ,Death certificate ,Death Investigation ,Public Health ,Criminal law and procedure ,K5000-5582 - Abstract
In recent years, Child Death Review (CDR) has attracted attention in Japan. It is necessary to consider not only hospital deaths but also out-of-hospital deaths. However, recommending preventive measures may be difficult because statistics on Japanese child mortality are limited. We examined cause of death (COD) and its application in preventive medicine based on death certificates (DCs) in the Chiba Prefecture. Death documents (DDs) and death slips (DSs) were created for individuals aged under 20 years who died between January 2012 and December 2016. They were based on DCs submitted to the Chiba Prefecture. We examined the trend of COD, occurrence of extrinsic mortality, and characteristics of doctors and compared CODs mentioned in DCs with autopsy results. For 1149 cases, the descriptions of DSs and DDs matched. Half of the extrinsic and undetermined deaths, which were examined by police doctors, occurred out-of-hospital. The autopsy rate was 13.5%. The COD mentioned in DCs did not match the autopsy results for 26 out of 69 autopsies performed at our institute. Approximately 70% of sudden infant death syndromes were diagnosed without autopsy. Low autopsy rate, incorrect writings, and errors during the death diagnosis cannot be ignored while conducting CDR. As more than half of the preventable deaths occurred out-of-hospital and there is no system to collect detailed information on them, the Japanese CDR system may not be reliable. It is necessary to improve the death investigation system by promoting autopsies for children and constructing a comprehensive database.
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- 2021
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12. Age estimation using aortic measurements in a contemporary Japanese population
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Suguru Torimitsu, Fumiko Chiba, Yohsuke Makino, Rutsuko Yamaguchi, Shigeki Tsuneya, Kei Kira, Daisuke Yajima, Go Inokuchi, Ayumi Motomura, Yumi Hoshioka, Hisako Saitoh, and Hirotaro Iwase
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Pathology and Forensic Medicine - Published
- 2023
13. Identification, measurement, and evaluation of blood concentrations of insulin glargine and insulin lispro by <scp>UPLC–MS–MS</scp> in a dead body suspected of insulin overdose
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Sayaka Nagasawa, Rutsuko Yamaguchi, Fumiko Chiba, Suguru Torimitsu, and Hirotaro Iwase
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Genetics ,Pathology and Forensic Medicine - Published
- 2023
14. Impact of the COVID‐19 pandemic on pathological autopsy practices in Japan
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Yuichiro Hirata, Shun Iida, Takeshi Arashiro, Sayaka Nagasawa, Hisako Saitoh, Hiroyuki Abe, Masako Ikemura, Yohsuke Makino, Rintaro Sawa, Hirotaro Iwase, Tetsuo Ushiku, Tadaki Suzuki, and Shinji Akitomi
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General Medicine ,Pathology and Forensic Medicine - Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, autopsies have provided valuable insights into the pathogenesis of COVID-19. The precise effect of this pandemic on autopsy procedures in Japan, especially in instances unrelated to COVID-19, has not yet been established. Therefore, we conducted a questionnaire survey from December 2020 to January 2021 regarding the status of pathological autopsy practices in Japan during the first year of the COVID-19 pandemic. The questionnaire was sent to 678 medical facilities with pathologists, of which 227 responded. In cases where a confirmed diagnosis of COVID-19 was not made at the time of autopsy, many facilities counted them as suspected COVID-19 cases if pneumonia was suspected clinically. At around half of the sites, autopsies were prohibited for suspected COVID-19 cases. In addition, the number of autopsies of non-COVID-19 cases during the pandemic period was also investigated, and a significant decrease was observed compared with the incidence in the pre-pandemic period. The COVID-19 pandemic has affected not only the autopsies of COVID-19 cases but also the entire practice of pathological autopsies. It is necessary to establish a system that supports the implementation of pathological autopsy practices during the pandemic of an emerging infectious disease.
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- 2023
15. Carrion flies (Insecta: Diptera) found on human cadavers in Chiba prefecture, Honshu, Japan, with the first record of Fannia prisca from a human corpse
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Shumari Urabe, Hiromu Kurahashi, Go Inokuchi, Fumiko Chiba, Ayumi Motomura, Yumi Hoshioka, Suguru Torimitsu, Rutsuko Yamaguchi, Shigeki Tsuneya, and Hirotaro Iwase
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Adult ,Insecta ,Japan ,Diptera ,Postmortem Changes ,Muscidae ,Cadaver ,Genetics ,Animals ,Humans ,Pathology and Forensic Medicine - Abstract
Forensic entomology (FE) involves the collection and analysis of necrophagous insects and arthropods for postmortem interval estimation based on their growth and succession. In Japan, research on FE is limited, and the predominant species of necrophagous insects and their distribution have not been clarified. The present study aimed to clarify the actual situation of insects, targeting Diptera collected from human cadavers, in Chiba Prefecture. We targeted the cases for which specimens could be collected from forensic autopsies conducted at the Legal Medicine Department of Chiba University Graduate School of Medicine or from human bodies handled by the Chiba Police in 2019. We specifically chose cases from which adult insects could be bred. Fifty cases were applicable, and 47 cases were successful in rearing adult flies. Sixteen species of Diptera were identified: six species of Calliphoridae, four species of Sarcophagidae, and a few species of Fanniidae, Muscidae, Phoridae, Piophilidae, and Stratiomyidae. The most frequently observed species were Lucilia sericata (20 cases) and Chrysomya pinguis (18 cases). For the first time, globally, we recorded the presence of Fannia prisca in a human cadaver. In conclusion, this is the first report to reveal the presence of carrion flies in human death cases in Chiba Prefecture, Japan. Research in FE is important in the context of the Japanese natural and social environment since this can aid forensic investigations conducted by authorities.
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- 2022
16. A case of fatal fulminant fat embolism syndrome following multiple fractures resulting from a fall
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Yuichiro Hirata, Go Inokuchi, Shigeki Tsuneya, Yumi Hoshioka, Fumiko Chiba, Maiko Yoshida, Yohsuke Makino, and Hirotaro Iwase
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Genetics ,Pathology and Forensic Medicine - Published
- 2022
17. Age estimation by evaluating median palatine suture closure using postmortem CT
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Susumu Kobayashi, Yohsuke Makino, Suguru Torimitsu, Rutsuko Yamaguchi, Fumiko Chiba, Shigeki Tsuneya, and Hirotaro Iwase
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Pathology and Forensic Medicine - Published
- 2023
18. Supplementary Table S4 from High-Throughput Functional Evaluation of Variants of Unknown Significance in ERBB2
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Hiroyuki Mano, Masahito Kawazu, Hirotaro Iwase, Kanju Saka, Shinya Kojima, Toshihide Ueno, Shinji Kohsaka, and Masaaki Nagano
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Raw data of Fig. 2A.
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- 2023
19. Supplementary Data from High-Throughput Functional Evaluation of Variants of Unknown Significance in ERBB2
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Hiroyuki Mano, Masahito Kawazu, Hirotaro Iwase, Kanju Saka, Shinya Kojima, Toshihide Ueno, Shinji Kohsaka, and Masaaki Nagano
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Supplementary Figures S1-S13
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- 2023
20. Sixty‐eight cases of postmortem pink teeth observed in dental autopsies of unidentified cadavers
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Saki Minegishi, Hajime Utsuno, Jun Ohta, Shuuji Namiki, Maiko Toya, Nozomi Sumi, Kana Unuma, Hisako Saitoh, Hirotaro Iwase, Koichi Uemura, and Koichi Sakurada
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Genetics ,Pathology and Forensic Medicine - Published
- 2022
21. Age estimation by evaluation of osteophytes in thoracic and lumbar vertebrae using postmortem CT images in a modern Japanese population
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Hirotaro Iwase, Ayaka Sakuma, Mei Kono, Yumi Hoshioka, Suguru Torimitsu, Fumiko Chiba, Go Inokuchi, Rutsuko Yamaguchi, Hisako Saitoh, and Yohsuke Makino
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Estimation ,Orthodontics ,Standard error ,medicine.anatomical_structure ,Receiver operating characteristic ,Age estimation ,medicine ,Cutoff ,Forensic anthropology ,Lumbar vertebrae ,Regression ,Pathology and Forensic Medicine ,Mathematics - Abstract
Estimation of age at death is important in forensic investigations of unknown remains. There have been several reports on applying the degree of osteophyte formation—an age-related change in the vertebral body—for age estimation; however, this method is not yet established. This study investigated a method for age estimation of modern Japanese individuals using osteophytes measured on CT images. The sample included 250 cadavers (125 males) aged 20–95 years. The degree of osteophyte formation was evaluated as score O (0–5 points), and the degree of fusion of the osteophytes between the upper and lower vertebrae was evaluated as score B (0–2 points). Age estimation equations were developed using regression analyses with seven variables, determined by scores O and B, and the equation with the smallest standard error of estimate (SEE) was obtained when the number of vertebrae with score O ≥ 2 was used as the explanatory variable. Age estimation with SEE of about 10 years was possible even when partial vertebrae with a high degree of osteophyte formation were used, showing its potential for practical application. The cutoff value for age estimation was established using the receiver operating characteristic curve analysis, wherein good results were obtained for all variables (area under the curve ≥ 0.8). The combination of the estimation equation and the cutoff value can narrow the range of age estimates.
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- 2021
22. Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy
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Rutsuko Yamaguchi, Yohsuke Makino, Maiko Yoshida, Yumi Hoshioka, Hirotaro Iwase, Go Inokuchi, Naoki Saito, and Fumiko Chiba
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Forensic pathology ,medicine.medical_specialty ,business.industry ,General surgery ,Postmortem ct ,Autopsy ,Postmortem Changes ,Pathology and Forensic Medicine ,Unnatural death ,Genetics ,medicine ,Image acquisition ,Forensic radiology ,business ,Cause of death - Abstract
Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as 'of internal origin' based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.
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- 2021
23. Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review
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Hirotaro Iwase, Yuko Kihara, Yohsuke Makino, Fumiko Chiba, Suguru Torimitsu, and Rutsuko Yamaguchi
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Lung Diseases ,Male ,medicine.medical_specialty ,Forensic pathology ,Lung ,business.industry ,Electroacupuncture ,medicine.medical_treatment ,Pneumothorax ,Autopsy ,Acupuncture treatment ,medicine.disease ,Pathology and Forensic Medicine ,Surgery ,medicine.anatomical_structure ,Genetics ,medicine ,Acupuncture ,Humans ,Gold ,business ,Adverse effect - Abstract
Acupuncture is practiced as a complementary medicine worldwide. Although it is considered a safe practice, pneumothorax is one of its most common serious complications. However, there have been few reports of deaths due to pneumothorax after acupuncture treatment, especially focused on electroacupuncture. We report an autopsy case of a man in his 60s who went into cardiopulmonary arrest and died immediately after receiving electroacupuncture. Postmortem computed tomography (PMCT) showed bilateral pneumothoraces, as well as the presence of numerous gold threads embedded subcutaneously. An autopsy revealed two ecchymoses in the right thoracic cavity and a pinhole injury on the lower lobe of the right lung, suggesting that the needles had penetrated the lung. There were marked emphysematous changes in the lung, suggesting that rupture of bullae might also have contributed to bilateral pneumothoraces and fatal outcome. The acupuncture needles may have been drawn deeper into the body than at the time of insertion due to electrical pulses and muscle contraction, indicating the need for careful determination of treatment indications and technical safety measures, such as fail-safe mechanisms. This is the first case report of fatal bilateral pneumothoraces after electroacupuncture reported in the English literature. This case sheds light on the safety of electroacupuncture and the need for special care when administering it to patients with pulmonary disease who may be at a higher risk of pneumothorax. This is also the first report of three-dimensional reconstructed PMCT images showing the whole-body distribution of embedded gold acupuncture threads, which is unusual.
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- 2021
24. Ropinirole involved in a fatal case: blood and urinary concentrations
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Yoshikazu Yamagishi, Hirotaro Iwase, Ayumi Motomura, Sayaka Nagasawa, Daisuke Yajima, Go Inokuchi, Kanju Saka, Yasumitsu Ogra, Kei Kira, Suguru Torimitsu, Fumiko Chiba, and Rutsuko Yamaguchi
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business.industry ,Urinary system ,Biochemistry (medical) ,Femoral vein ,Autopsy ,Urine ,Toxicology ,Pathology and Forensic Medicine ,Ropinirole ,Urinary levels ,Anesthesia ,Shock (circulatory) ,medicine ,medicine.symptom ,business ,medicine.drug ,Cause of death - Abstract
Ropinirole is an antiparkinsonian drug and has recently been suggested to be effective in amyotrophic lateral sclerosis. It is expected that ropinirole prescriptions will increase in the near future. However, the fatal concentration in blood is unclear at this time. Therefore, we report a fatal case involving ropinirole intoxication and discuss the fatal concentrations with reference to several autopsy cases involving ropinirole. Ropinirole was quantified in femoral vein blood, cardiac blood, and urine from five autopsy cases in which ropinirole was detected by drug screening in our laboratory. One is a ropinirole intoxication case (this report) and the others were non-intoxication cases. Their ropinirole concentrations were compared and discussed. The ropinirole concentration in this case was 100 ng/mL in femoral blood, 160 ng/mL in cardiac blood, and 1840 ng/mL in urine. The ropinirole concentrations in the four non-ropinirole poisoning cases were 7–35 ng/mL (mean: 24 ng/mL) in femoral blood, 13–100 ng/mL (mean: 60 ng/mL) in cardiac blood, and 140–1090 ng/mL (mean: 640 ng/mL) in urine. Cardiac/peripheral ratios were in the range of 1.6–2.1 (mean 1.8). There were no obvious signs of overdose, and the high cardiac/peripheral blood ratio suggested that postmortem redistribution may have occurred, but the peripheral blood ropinirole concentration (100 ng/mL) was obviously higher than that reported in the previous fatal case of ropinirole poisoning (64 ng/mL). Based on these results, the cause of death in this case was considered to be shock and fatal arrhythmia due to ropinirole poisoning. This case provides important data on postmortem blood and urinary levels of ropinirole poisoning.
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- 2021
25. High titers of infectious SARS-CoV-2 in COVID-19 corpses
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Hisako Saitoh, Yuko Sakai-Tagawa, Sayaka Nagasawa, Suguru Torimitsu, Kazumi Kubota, Yuichiro Hirata, Kiyoko Iwatsuki-Horimoto, Ayumi Motomura, Namiko Ishii, Keisuke Okaba, Kie Horioka, Hiroyuki Abe, Masako Ikemura, Hirofumi Rokutan, Munetoshi Hinata, Akiko Iwasaki, Yoichi Yasunaga, Makoto Nakajima, Rutsuko Yamaguchi, Shigeki Tsuneya, Kei Kira, Susumu Kobayashi, Go Inokuchi, Fumiko Chiba, Yumi Hoshioka, Aika Mori, Isao Yamamoto, Kimiko Nakagawa, Harutaka Katano, Shun Iida, Tadaki Suzuki, Shinji Akitomi, Iwao Hasegawa, Tetsuo Ushiku, Daisuke Yajima, Hirotaro Iwase, Yohsuke Makino, and Yoshihiro Kawaoka
- Abstract
BackgroundThe prolonged presence of infectious severe acute respiratory syndrome coronavirus (SARS-CoV-2) in deceased coronavirus disease 2019 (COVID-19) patients has been reported. However, infectious virus titers have not been determined. Such information is important for public health, death investigation, and handling corpses.AimThe aim of this study was to assess the level of SARS-CoV-2 infectivity in COVID-19 corpses.MethodsWe collected 11 nasopharyngeal swabs and 19 lung tissue specimens from 11 autopsy cases with COVID-19 in 2021. We then investigated the viral genomic copy number by real-time reverse transcription-polymerase chain reaction and infectious titers by cell culture and virus isolation.ResultsInfectious virus was present in 6 of 11 (55%) cases, 4 of 11 (36%) nasopharyngeal swabs, and 9 of 19 (47%) lung specimens. The virus titers ranged from 6.00E + 01 plaque-forming units (PFU)/mL to 2.09E + 06 PFU/g. In all cases in which an infectious virus was found, the time from death to discovery was within 1 day and the longest postmortem interval was 13 days.ConclusionCOVID-19 corpses may have high titers of infectious virus after a long postmortem interval (up to 13 days). Therefore, appropriate infection control measures must be taken when handling corpses.
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- 2022
26. Effect of ethanol on the diatom test using nitric acid or sodium hypochlorite
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Shigeki Tsuneya, Makoto Nakajima, Yohsuke Makino, Suguru Torimitsu, Rutsuko Yamaguchi, and Hirotaro Iwase
- Subjects
Issues, ethics and legal aspects ,Pathology and Forensic Medicine - Abstract
To study the quantitative effect of ethanol on the diatom test for water and lung samples.In experiment 1, we tested 20 water samples taken from natural water areas. In experiments 1-1 and 1-2, each sample was digested with sodium hypochlorite (NaClO) solution (Purelox) and fuming nitric acid (HNOIn experiments 1-1, 1-2, 1-3, 1-4, and 2, the geometric means of the ratios derived from the two methods (with/without ethanol) were 0.70 (95 % confidence interval [CI]: 0.65-0.77, P 0.001), 0.83 (95 % CI: 0.73-0.93, P = 0.005), 3.00 (95 % CI: 2.31-3.91, P 0.001), 0.91 (95 % CI: 0.79-1.04, P = 0.164), and 3.06 (95 % CI: 2.28-4.41, P 0.001), respectively.Our experiments suggest that ethanol would be useless in diatom tests of water samples or in the conventional (HNO
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- 2022
27. Can SARS-CoV-2 transmit from a dead body?
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Kiyoko Iwatsuki-Horimoto, Hiroshi Ueki, Mutsumi Ito, Sayaka Nagasawa, Yuichiro Hirata, Kenichiro Hashizume, Kazuho Ushiwata, Hirotaro Iwase, Yohsuke Makino, Tetsuo Ushiku, Shinji Akitomi, Masaki Imai, Hisako Saitoh, and Yoshihiro Kawaoka
- Abstract
Although it has been 2.5 years since the COVID-19 pandemic began, the transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a dead infected body remains unclear, and often, in Japan bereaved family members are not allowed to view in-person a loved one who has died from COVID-19. In this study, we analyzed the possibility of SARS-CoV-2 transmission from a dead body by using the hamster model. We also analyzed the effect of Angel-care––in which the pharynx, nostril, and rectum are plugged––and embalming on reducing transmissibility from dead bodies. We found that SARS-CoV-2 could be transmitted from the body of animals that died within a few days of infection; however, Angel-care and embalming were effective in preventing transmission from the dead body. These results suggest that protection from infection is essential when in contact with a SARS-CoV-2-infected dead body, and that sealing the cavities of a dead body is an important infection control step if embalming is not done.ImportanceWe found that SARS-CoV-2 could be transmitted from a dead body presumably via postmortem gases. However, we also found that postmortem care, such as plugging the pharynx, nostrils, and rectum, or embalming could prevent transmission from the dead body. These results indicate that protection from infection is essential when handling infected corpses, and that appropriate care of SARS-CoV-2-infected corpses is important.
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- 2022
28. An autopsy case of fatal insulin preparation overdose
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Sayaka, Nagasawa, primary, Rutsuko, Yamaguchi, additional, Fumiko, Chiba, additional, Suguru, Torimitsu, additional, and Hirotaro, Iwase, additional
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- 2022
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29. X-ray analytic microscopy with CT-guided sample extraction to analyze potential projectile fragments in a dead serow
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Yuko Kihara, Yohsuke Makino, Masaaki Yokoyama, Fumiko Chiba, Aki Tanaka, Shouta M.M. Nakayama, Shin-ichi Hayama, Mayumi Ishizuka, Kurt B. Nolte, and Hirotaro Iwase
- Subjects
Issues, ethics and legal aspects ,Pathology and Forensic Medicine - Published
- 2023
30. Age estimation by palatal suture using modified Kamijo’s method
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Susumu Kobayashi, Yohsuke Makino, Suguru Torimitsu, Satomi Mizuno, Rutsuko Yamaguchi, Fumiko Chiba, Shigeki Tsuneya, and Hirotaro Iwase
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Law ,Pathology and Forensic Medicine - Published
- 2023
31. Fatal cocaine body packer syndrome depicted on antemortem and postmortem CT: A case report
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Maiko Yoshida, Yumi Hoshioka, Yohsuke Makino, Yoshikazu Yamagishi, Sayaka Nagasawa, Fumiko Chiba, Rutsuko Yamaguchi, Go Inokuchi, and Hirotaro Iwase
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Radiology, Nuclear Medicine and imaging ,Pathology and Forensic Medicine - Published
- 2023
32. Statistical analysis of biomechanical properties and size of the sternum and its fracture risk in a Japanese sample
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Suguru Torimitsu, Yoshifumi Nishida, Daisuke Yajima, Go Inokuchi, Yohsuke Makino, Ayumi Motomura, Fumiko Chiba, Rutsuko Yamaguchi, Yumi Hoshioka, and Hirotaro Iwase
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Issues, ethics and legal aspects ,Pathology and Forensic Medicine - Published
- 2023
33. Trends and Characteristics in Health Care-related Deaths Investigated through Medico-legal Autopsies after System Changes in Japan
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Rutsuko, Yamaguchi, Yohsuke, Makino, Go, Inokuchi, Kenji, Ishihara, Suguru, Torimitsu, Fumiko, Chiba, Yumi, Hoshioka, Syumari, Urabe, Yukiko, Oya, Ayumi, Motomura, Daisuke, Yajima, and Hirotaro, Iwase
- Subjects
Japan ,Cause of Death ,Autopsy ,Delivery of Health Care ,Retrospective Studies - Abstract
In Japan, a new cause-of-death investigation system and related new laws were enacted in the mid-2010s. These laws provided for an autopsy system for non-criminal unnatural deaths and a medical accident investigation system outside the criminal justice process for health care-related deaths. We retrospectively explored changes in the number and characteristics of medico-legal autopsy cases of health care-related deaths in Chiba Prefecture, Japan, and examined trends over time during these reforms. We found that the percentage of forensic autopsies based on the Code of Criminal Procedure for health care-related deaths had decreased significantly. The number of autopsies of accidental and unintentional deaths in nursing homes, which are not covered by the newly established medical accident investigation system, has been increasing, reflecting the ageing of society. The trend toward decriminalisation of health care-related deaths was expected to contribute more to medical safety if the scope was expanded and a system for disclosure of autopsy information was established.
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- 2022
34. Evaluation of Post-Mortem Interaction between Hemoglobin and Oxime-Type Carbamate Pesticides
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Yoshikazu Yamagishi, Sayaka Nagasawa, Hirotaro Iwase, and Yasumitsu Ogra
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Hemoglobins ,Methomyl ,Oximes ,Humans ,General Medicine ,Autopsy ,Carbamates ,Cholinesterase Inhibitors ,Amino Acids ,Pesticides ,Toxicology ,Aldicarb - Abstract
Oxime-type carbamate pesticides having an oxime moiety such as aldicarb, butocarboxim, methomyl, oxamyl, and thiofanox are widely used and have been detected in many fatal cases of accidental exposure or suicide. In forensic toxicology, the accurate determination of blood pesticide concentration is obligatory to prove death by oxime-type carbamate pesticide poisoning. However, the fatal pesticide concentration in blood at autopsy differs from that at the time of death. In this study, we found that oxime-type carbamate pesticides were decomposed by Hb in a temperature-dependent fashion. The mechanism underlying methomyl, aldicarb, oxamyl, and thiofanox decomposition involves the formation of adducts with the amino acids in Hb. With regard to butocarboxim, its decomposition involves the oxidation of the free form and the formation of adducts with the amino acids in Hb. The mass spectra obtained by liquid chromatography quadrupole time-of-flight mass spectrometry revealed that carbamylated amino acid adducts such as W
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- 2022
35. Fatal airway obstruction due to Ludwig's angina from severe odontogenic infection during antipsychotic medication: A case report and a literature review
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Maiko Yoshida, Suguru Torimitsu, Yohsuke Makino, Hisako Saitoh, Koichi Sakurada, Satomi Mizuno, Hirotaro Iwase, and Rutsuko Yamaguchi
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Adult ,Ludwig's Angina ,Epiglottis ,medicine.medical_specialty ,medicine.medical_treatment ,01 natural sciences ,Pathology and Forensic Medicine ,Angina ,Asphyxia ,03 medical and health sciences ,0302 clinical medicine ,Genetics ,medicine ,Edema ,Humans ,Obesity ,030216 legal & forensic medicine ,Abscess ,Odontogenic infection ,Focal Infection, Dental ,business.industry ,010401 analytical chemistry ,Cellulitis ,Airway obstruction ,medicine.disease ,0104 chemical sciences ,Surgery ,Airway Obstruction ,medicine.anatomical_structure ,Psychotic Disorders ,Female ,Airway management ,Ludwig's angina ,business ,Antipsychotic Agents - Abstract
Ludwig's angina is characterized by inflammation of the sublingual and submandibular spaces and is mainly caused by odontogenic infection, which leads to cellulitis of the soft tissues of the floor of the mouth and the neck. This causes asphyxia due to elevation and posterior deviation of the tissues of the floor of the mouth. We report a fatal case of airway obstruction due to Ludwig's angina. A woman in her forties who had no physical complications, but had a mental illness, was undergoing outpatient dental treatment for caries in the first premolar of the left mandible. She was admitted to a psychiatric hospital because of insomnia caused by pain, where she developed cardiopulmonary arrest while sleeping and died 14 days after onset of the dental infection. Postmortem computed tomography (PMCT) prior to autopsy showed swelling of the soft tissues-from the floor of the mouth to the oropharyngeal cavity, the supraglottic larynx, and the prevertebral tissue. Autopsy revealed a markedly swollen face and neck, an elevated tongue, and a highly edematous epiglottis and laryngopharyngeal mucosa. There was also cellulitis and abscess of the facial, suprahyoid, and neck musculature, which suggested that the cause of death was asphyxiation due to airway obstruction. This was an alarming case, with mental illness leading to risk of severe odontogenic infection, and in which obesity and use of antipsychotic medication might have acted synergistically leading to airway obstruction. This is also a case of Ludwig's angina captured by PMCT, which has rarely been reported.
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- 2021
36. Statistical analysis of the thickness and biomechanical properties of Japanese children’s skulls
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Suguru Torimitsu, Yoshifumi Nishida, Tachio Takano, Daisuke Yajima, Go Inokuchi, Yohsuke Makino, Ayumi Motomura, Fumiko Chiba, Rutsuko Yamaguchi, Yumi Hoshioka, and Hirotaro Iwase
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Law ,Pathology and Forensic Medicine - Published
- 2023
37. Methamphetamine-related forensic autopsy cases in a Japanese prefecture over a 7-year period: Characteristics of deaths and blood concentrations
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Go, Inokuchi, Fumiko, Chiba, Yumi, Hoshioka, Naoki, Saito, Maiko, Yoshida, Sayaka, Nagasawa, Yoshikazu, Yamagishi, Yohsuke, Makino, Suguru, Torimitsu, Rutsuko, Yamaguchi, Shigeki, Tsuneya, Hiroyuki, Inoue, Ayumi, Motomura, Daisuke, Yajima, and Hirotaro, Iwase
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Issues, ethics and legal aspects ,Pathology and Forensic Medicine - Abstract
Understanding the actual conditions of methamphetamine (MA)-related death is important from the perspectives of criminal justice and public health. In this report, we review 104 cases of MA-related death handled by our departments between January 2014 and December 2020. Based on information from police and autopsy examinations, we classified the cases into the following categories: "accidental intoxication" ("MA only" and "multiple drugs or alcohol"), "fatal disease" ("definitively MA-related," "possibly MA-related," and "unlikely MA-related"), "accident," "suicide," "homicide," and "undetermined." The total number and annual trends for each category and their respective femoral blood concentrations were investigated. "Fatal disease" was the most common category (48 cases), followed by "suicide" (25 cases), "accidental intoxication" (14 cases), and "accident" (11 cases). "Definitively MA-related" in which MA may have played a role in their onset or exacerbation accounted for the majority of "fatal disease": 12 cases of heart disease, 4 cases of aortic dissection, 12 cases of cerebral hemorrhage, and 4 cases of subarachnoid hemorrhage. Cases classified as "definitively MA-related" died with lower femoral blood concentrations of MA compared with "MA only." Cases with "fatal disease" might have been misdiagnosed as "death by natural causes" if a proper autopsy and toxicology examinations were not performed. In death investigations, it is necessary to keep in mind that there are some MA-related deaths, and efforts should be made to increase awareness about the risk of death in using this drug.
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- 2023
38. Relevance of diatom testing on closed organs of a drowned cadaver who died after receiving treatment for 10 days: A case report
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Shigeki Tsuneya, Maiko Yoshida, Yumi Hoshioka, Fumiko Chiba, Go Inokuchi, Suguru Torimitsu, and Hirotaro Iwase
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Issues, ethics and legal aspects ,Pathology and Forensic Medicine - Published
- 2023
39. Postmortem magnetic resonance imaging revealed bilateral globi pallidi lesions in a death associated with prolonged carbon monoxide poisoning: a case report
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Hirotaro Iwase, Hiroki Mukai, Shinya Hattori, Fumiko Chiba, Yohsuke Makino, Takashi Kishimoto, Masatoshi Kojima, Shigeki Tsuneya, and Maiko Yoshida
- Subjects
Pathology ,medicine.medical_specialty ,Forensic pathology ,medicine.diagnostic_test ,business.industry ,Carbon monoxide poisoning ,010401 analytical chemistry ,Magnetic resonance imaging ,Autopsy ,medicine.disease ,01 natural sciences ,0104 chemical sciences ,Pathology and Forensic Medicine ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Coagulative necrosis ,medicine ,Forensic radiology ,030216 legal & forensic medicine ,business ,Cause of death - Abstract
A man and a woman were found dead in the same car with a burned coal briquette. The cause of death of the woman was assigned to acute carbon monoxide (CO) poisoning without difficulty based on typical findings associated with this condition, including elevation of carboxyhaemoglobin (COHb). However, the man had an unremarkable elevation of COHb and a higher rectal temperature compared to that of the woman. Postmortem computed tomography (PMCT) revealed ambiguous low-density areas in the bilateral globi pallidi. Further analysis by postmortem magnetic resonance (PMMR) imaging showed these lesions more clearly; the lesions appeared as marked high signal intensity areas on both the T2-weighted images and the fluid-attenuated inversion recovery sequences. A subsequent autopsy revealed signs of pneumonia, dehydration, starvation, and hypothermia, suggesting that the man died from prolonged CO poisoning. Both globi pallidi contained grossly ambiguous lesions, and a detailed neuropathologic investigation revealed these lesions to be coagulative necrotic areas; this finding was compatible with a diagnosis of prolonged CO poisoning. This case report shows that postmortem imaging, especially PMMR, is useful for detecting necrotic lesions associated with prolonged CO poisoning. This report further exemplifies the utility of PMMR for detecting brain lesions, which may be difficult to detect by macroscopic analysis.
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- 2021
40. Effects of hemoglobin on post-mortem oxidation of bromazepam
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Yoshikazu Yamagishi, Hirotaro Iwase, and Yasumitsu Ogra
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medicine.medical_specialty ,Bromazepam ,Endocrinology ,Chemistry ,Internal medicine ,medicine ,Hemoglobin ,medicine.drug - Published
- 2021
41. Fatal Intoxication with a mixture of para-methoxyamphetamine, N-ethylpentylone, and ketamine
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Kanako Noritake, Kanju Saka, Kana Unuma, Takeshi Funakoshi, Ruri Kikura-Hanajiri, Yohsuke Makino, Hirotaro Iwase, and Koichi Uemura
- Subjects
Health, Toxicology and Mutagenesis ,Toxicology - Published
- 2022
42. Prevalence of blood-borne infections in forensic samples: Epidemiology in areas of Chiba, Japan
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Keisuke Okaba, Ayumi Motomura, Kie Horioka, Go Inokuchi, Fumiko Chiba, Yumi Hoshioka, Naoki Saito, Yohsuke Makino, Suguru Torimitsu, Rutsuko Yamaguchi, Shigeki Tsuneya, Daisuke Yajima, and Hirotaro Iwase
- Subjects
Blood-Borne Infections ,Japan ,Cadaver ,Prevalence ,Humans ,HIV Infections ,General Medicine ,Hepacivirus ,Law ,Hepatitis C ,Pathology and Forensic Medicine ,Methamphetamine ,Retrospective Studies - Abstract
To statistically clarify the prevalence and risk factors of infections in forensic autopsy cases in Chiba Prefecture, Japan. The aim was to improve preventive measures against infection in forensic autopsies.We retrospectively investigated the positive detection rates of five infections (hepatitis B, HBV; hepatitis C, HCV; human immunodeficiency virus, HIV; human T-lymphotropic virus, HTLV; Treponema pallidum, TP) using 1491 samples obtained in forensic autopsy at our facility from 2014 to 2018. In addition, risk factors related to infection such as methamphetamine and tattoos were analyzed. Pearson's chi-square test was used for statistical analysis, and the difference was judged to be significant at p 0.05.Among our samples, 9.0% of cadavers tested positive for infection, and the prevalence rates for HBV, HCV, HIV, HTLV, and TP were 1.0%, 6.7%, 0.3%, 0.7%, and 1.1% respectively. Statistically, cadavers linked to information about methamphetamine use had a 7.2 times higher rate of infection, and those with tattoos had a 5.6 times higher rate of infection, with HCV being the predominant cause.To limit the risk of infection among autopsy workers, cadavers and samples should be handled on the presupposition that the bodies are at risk of infections. It is also important to obtain as much information as possible about the medical history and potential illegal drug use to help assess the risk of infection in a patient during forensic autopsy. We propose that all autopsy cases should be screened for infections whenever possible.
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- 2022
43. Detection of lisdexamfetamine and its metabolite d-amphetamine in urine and gastric contents collected from a cadaver at forensic autopsy
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Suguru Torimitsu, Kanju Saka, Kanako Noritake, Akira Namera, Yohsuke Makino, Rutsuko Yamaguchi, and Hirotaro Iwase
- Subjects
Biochemistry (medical) ,Toxicology ,Pathology and Forensic Medicine - Abstract
Purpose Lisdexamfetamine (LDX), which is used for the treatment of attention-deficit/hyperactivity disorder and narcolepsy, is composed of l-lysine attached to dextroamphetamine (d-amphetamine). In this article, we report a forensic autopsy case in which prescription drugs were unknown at autopsy. While amphetamine was detected, methamphetamine could not be detected by liquid chromatography–tandem mass spectrometry (LC–MS/MS) in any of samples collected. Thus, we aimed to quantify LDX concentrations in autopsy samples and to prove that the amphetamine detected in this case was due to metabolized LDX. Methods Femoral vein blood, cardiac whole blood, urine, and gastric content samples were taken at autopsy for toxicological analysis. Qualitative and quantitative analyses were performed using LC–MS/MS. In addition, optical isomer separation for the amphetamine detected was conducted. The stability of LDX in whole blood and urine was also examined at three different temperatures. Results The concentrations of LDX were d-amphetamine by optical isomer separation. The d-amphetamine detected was considered to be derived from LDX. Stability experiments revealed that LDX in whole blood decreased at ambient temperature. Conclusions The results in the present case report may be useful in interpreting whether or not the amphetamine detected in a cadaver is a metabolite of LDX.
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- 2022
44. Post-mortem interaction between methidathion and human serum albumin in blood
- Author
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Yoshikazu Yamagishi, Sayaka Nagasawa, Hirotaro Iwase, and Yasumitsu Ogra
- Subjects
Organophosphorus Compounds ,Humans ,Organothiophosphorus Compounds ,Serum Albumin, Human ,Pesticides ,Toxicology - Abstract
Methidathion [3-(dimethoxyphosphinothioylsulfanylmethyl)-5-methoxy-1,3,4-thiadiazol-2-one; hereinafter DMTP], one of the most widely used organophosphorus pesticides, has been detected in some clinical cases of accidental exposure and suicide in Japan. It has been reported that DMTP concentration is decreased in blood. In this study, it is difficult to recover DMTP in the free form because DMTP is bound to human serum albumin (HSA). We detected DMTP adducts in HSA by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-Q/TOF-MS). The mass spectra showed that DMTP was preferably bound to the lysine (K), tyrosine (Y), and cysteinylproline (CP) residues of HSA. The concentrations of K-adduct, DMTP-Y-adduct and DMTP-CP-adduct were increased in vitro in a dose-dependent fashion when DMTP concentration was lower than the lethal dose. Furthermore, the DMTP-Y-adduct and DMTP-CP-adduct were also detected in post-mortem blood of an autopsied subject who died by intentional DMTP ingestion. The results suggested that the DMTP-Y-adduct and DMTP-CP-adduct could be used as a biomarker of DMTP poisoning, and the decrease concentration of DMTP in blood after death could be determined on the basis of the concentration of the DMTP-CP-adduct in blood.
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- 2022
45. Sudden death due to tension pneumothorax associated with pulmonary tuberculosis
- Author
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Shigeki Tsuneya, Yohsuke Makino, Fumiko Chiba, Go Inokuchi, and Hirotaro Iwase
- Subjects
medicine.medical_specialty ,Lung ,business.industry ,Autopsy ,General Medicine ,medicine.disease ,Tension pneumothorax ,Sudden death ,respiratory tract diseases ,Pathology and Forensic Medicine ,Lesion ,medicine.anatomical_structure ,Pneumothorax ,Pulmonary tuberculosis ,medicine ,Radiology ,medicine.symptom ,business ,Complication - Abstract
A man in his seventies who lived alone was found dead in his home. Postmortem computed tomography (CT) performed prior to autopsy showed right-sided tension pneumothorax. Autopsy revealed an active pulmonary tuberculosis (TB) lesion. Macroscopic and histopathological findings showed pleural infiltration by TB lesions, suggesting that tension pneumothorax developed in association with TB infection. Routine postmortem CT performed prior to autopsy is useful in screening for TB because the presence of TB lesions can be confirmed from characteristic pulmonary findings. However, it may be difficult to identify tuberculous pulmonary lesions on CT if pneumothorax occurs and the lung collapses completely as in this case. Thus, forensic pathologists and radiologists should be cognizant of this rare complication of TB.
- Published
- 2020
46. Reform of the death investigation system in Japan
- Author
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Kenji Ishihara and Hirotaro Iwase
- Subjects
Successor cardinal ,Government ,Medicolegal autopsy ,Health Policy ,media_common.quotation_subject ,World War II ,Medical examiner ,History, 19th Century ,Forensic Medicine ,History, 20th Century ,History, 18th Century ,Administration (probate law) ,Issues, ethics and legal aspects ,Promotion (rank) ,Japan ,Law ,Political science ,Humans ,Autopsy ,media_common ,Cause of death - Abstract
The autopsy rate in Japan is lower than that in other countries, and most death investigations have historically been conducted by police officers through external inspection. Although medicolegal autopsy was not performed during the samurai administration, the European death investigation system was adopted in the second half of the 19th century and judicial autopsy began in universities’ forensic medicine departments. After World War II, the medical examiner system was introduced under US influence, but it was only adopted in certain areas. Further reforms were introduced in the 21st century—in 2012, two laws relating to death investigation were enacted: The Act on Promotion of Death Investigation (Promotion Act), which provided foundational principles and included measures for investigating the causes of death and identification of bodies, and the Act on the Investigation of Cause of Death and on Identification of Bodies Handled by the Police, which recommended a procedure for death investigation, including a new autopsy system. The Death Investigation Promotion Program was to meant to be decided by the government in 2014. However, the relevant Act expired after it ran out of time. Later, in 2019, the Basic Act for Promotion of Death Investigation, the successor to the Promotion Act, was passed. This Act is significant because it sets the basic foundational principle and imposes plans created by the government. However, it remains unclear how these measures can be implemented, so further discussion and financial investment are now required.
- Published
- 2020
47. The effect of ethanol or long-time reaction on the diatom test in water samples using sodium hypochlorite
- Author
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Shigeki Tsuneya, Makoto Nakajima, Yohsuke Makino, Suguru Torimitsu, Rutsuko Yamaguchi, and Hirotaro Iwase
- Subjects
Diatoms ,Issues, ethics and legal aspects ,Drowning ,Ethanol ,Sodium Hypochlorite ,Humans ,Water ,Kidney ,Forensic Pathology ,Lung ,Pathology and Forensic Medicine - Abstract
The diatom test method using sodium hypochlorite (NaClO) was equivalent to the conventional method in water samples. However, the method using NaClO was inferior to the conventional method in lung samples, in which ethanol was used and the reaction with NaClO was longer compared with the method in water samples. Using water samples, we aimed to clarify whether these differences affect the diatom test result.Thirteen water samples from natural water sources were each divided into four parts corresponding to four (2 × 2) digestion methods: 3 "digestion" vs. 1 "digestion" and with ethanol vs. without ethanol. After the base-2 logarithmic transformation, the diatom counts were analyzed using three-way analysis of variance (ANOVA); factor 1 was "digestion times," factor 2 was "ethanol," and factor 3 was "sample number," and the interaction between factors 1 and 2 was also analyzed.The geometric means of the diatoms from the 3 "digestion" with ethanol method, the 3 "digestion" without ethanol method, the 1 "digestion" with ethanol method, and the 1 "digestion" without ethanol method were 373.5, 551.8, 436.6, and 522.0, respectively. ANOVA showed a significant difference in factor 2 (P = 1.7 × 10Ethanol may decrease the diatom count in the diatom test using NaClO. In contrast, the diatom frustules do not dissolve through three-times digestion using NaClO.
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- 2022
48. Stature estimation by semi-automatic measurements of 3D CT images of the femur
- Author
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Kei Kira, Fumiko Chiba, Yohsuke Makino, Suguru Torimitsu, Rutsuko Yamaguchi, Shigeki Tsuneya, Ayumi Motomura, Maiko Yoshida, Naoki Saitoh, Go Inokuchi, Yumi Hoshioka, Hisako Saitoh, Daisuke Yajima, and Hirotaro Iwase
- Subjects
Pathology and Forensic Medicine - Abstract
Stature estimation is one of the most basic and important methods of personal identification. The long bones of the limbs provide the most accurate stature estimation, with the femur being one of the most useful. In all the previously reported methods of stature estimation using computed tomography (CT) images of the femur, laborious manual measurement was necessary. A semi-automatic bone measuring method can simplify this process, so we firstly reported a stature estimation process using semi-automatic bone measurement software equipped with artificial intelligence. Multiple measurements of femurs of adult Japanese cadavers were performed using automatic three-dimensional reconstructed CT images of femurs. After manually setting four points on the femur, an automatic measurement was acquired. The relationships between stature and five femoral measurements, with acceptable intraobserver and interobserver errors, were analyzed with single regression analysis using the standard error of the estimate (SEE) and the coefficient of determination (R2). The maximum length of the femur (MLF) provided the lowest SEE and the highest R2; the SEE and R2 in all cadavers, males and females, respectively, were 3.913 cm (R2 = 0.842), 3.664 cm (R2 = 0.705), and 3.456 cm (R2 = 0.686) for MLF on the right femur, and 3.837 cm (R2 = 0.848), 3.667 cm (R2 = 0.705), and 3.384 cm (R2 = 0.699) for MLF on the left femur. These results were non-inferior to those of previous reports regarding stature estimation using the MLF. Stature estimation with this simple and time-saving method would be useful in forensic medical practice.
- Published
- 2021
49. Children’s death survey using death certificates in the Chiba prefecture
- Author
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Rutsuko Yamaguchi, Kenji Ishihara, Shumari Urabe, Yohei Kawasaki, Fumiko Chiba, Yuki Shiko, and Hirotaro Iwase
- Subjects
Pediatrics ,medicine.medical_specialty ,Death diagnosis ,K5000-5582 ,business.industry ,Autopsy ,Cause of death ,Death certificate ,Pathology and Forensic Medicine ,Child mortality ,Criminal law and procedure ,Death Investigation ,medicine ,Child Death Review ,Public Health ,business ,Sudden infant death ,Preventive healthcare - Abstract
In recent years, Child Death Review (CDR) has attracted attention in Japan. It is necessary to consider not only hospital deaths but also out-of-hospital deaths. However, recommending preventive measures may be difficult because statistics on Japanese child mortality are limited. We examined cause of death (COD) and its application in preventive medicine based on death certificates (DCs) in the Chiba Prefecture. Death documents (DDs) and death slips (DSs) were created for individuals aged under 20 years who died between January 2012 and December 2016. They were based on DCs submitted to the Chiba Prefecture. We examined the trend of COD, occurrence of extrinsic mortality, and characteristics of doctors and compared CODs mentioned in DCs with autopsy results. For 1149 cases, the descriptions of DSs and DDs matched. Half of the extrinsic and undetermined deaths, which were examined by police doctors, occurred out-of-hospital. The autopsy rate was 13.5%. The COD mentioned in DCs did not match the autopsy results for 26 out of 69 autopsies performed at our institute. Approximately 70% of sudden infant death syndromes were diagnosed without autopsy. Low autopsy rate, incorrect writings, and errors during the death diagnosis cannot be ignored while conducting CDR. As more than half of the preventable deaths occurred out-of-hospital and there is no system to collect detailed information on them, the Japanese CDR system may not be reliable. It is necessary to improve the death investigation system by promoting autopsies for children and constructing a comprehensive database.
- Published
- 2021
50. Validity of dental findings for identification by postmortem computed tomography
- Author
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Satomi Mizuno, Sachiko Ono, Yohsuke Makino, Shigeki Tsuneya, Susumu Kobayashi, Namiko Ishii, Ayaka Sakuma, Koichi Sakurada, Saki Minegishi, Hajime Utsuno, Fumiko Chiba, Rutsuko Yamaguchi, Suguru Torimitsu, and Hirotaro Iwase
- Subjects
Predictive Value of Tests ,Cadaver ,Humans ,Tomography, X-Ray Computed ,Tooth ,Law ,Pathology and Forensic Medicine - Abstract
Postmortem computed tomography (PMCT) images help identify individuals and extract information from corpses. PMCT may substitute for a standard examination when bodies are severely damaged or when resources are limited in a mass fatality incident. In such situations, the dental information revealed by PMCT has the potential to narrow down candidates for identification further. However, the validity of the dental findings obtained from PMCT images remains unclear. In this study, we investigated the validity of dental findings on PMCT images compared to regular dental examinations as the reference standard. We routinely collected PMCT images of 148 unidentified corpses and compared the dental findings of each tooth obtained from PMCT with those of a regular dental examination. The validity of dental findings of PMCT was measured by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We also evaluated the accuracy of dental findings per corpse using 32 teeth as the denominator. The dental findings with high sensitivity and high specificity were a present tooth (0.96 and 0.97), a missing tooth (0.97 and 0.97), pontic (0.92 and 1.00), a dental implant (1.00 and 1.00), and a root filling (0.94 and 0.99). The mean accuracy of the dental findings per corpse in PMCT was 95.6% (standard deviation: 6.9, minimum ≤ median ≤ maximum: 65.6 ≤ 100 ≤ 100). The number of corpses with 100% accuracy in the dental findings was 81 (54.7%). The information obtained in this study highlights the potential use of PMCT during human identification in several settings with limited resources, such as the number of specialists present and the condition of the corpses.
- Published
- 2022
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