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Background The purpose of this study was to identify the long-term durability of the Kerboull-type reinforcement device (KT plate) in acetabular reconstruction for massive bone defects, assessing the remodeling of structural bone grafts. Methods This study retrospectively evaluated 106 hips that underwent acetabular reconstruction using a KT plate between November 2000 and December 2010. Thirty-eight primary total hip arthoplasties (THAs) and 68 revised THAs were performed, and the mean duration of clinical follow-up was 8 years (5-14 years). Regarding reconstructing the acetabular bone defects, autografts were used in 37 hips, allografts in 68 hips, and A-W glass ceramics in 2 hips. Results One hip exhibited radiological migration and no revision for aseptic loosening. The mean Merle d'Aubigne Clinical Score improved from 7.5 points (4-12 points) preoperatively to 10.9 points (9-18 points) at the last follow-up. The Kaplan–Meier survival rate for radiological migration of primary and revised THAs at 10 years was 100% and 97% (95% confidence interval: 96%-100%), respectively. Bone remodeling was evaluated using the radiological demarcation at the bone-to-bone interface, and an improvement of 100% in primary THAs and 94% in revised THAs was observed. Conclusion For massive bone defects, acetabular reconstruction using the KT plate with a structural bone grafting can yield successful results.

Prosthetic hands with multiple degrees of freedom are aesthetically pleasing and capable of selecting prehensile forms. However, the hands are not fully useful in daily living activities which is caused by the lack of design consideration of hand-arm coordination within tasks. A functional hand design priority should be based on evidence gained from observation and analysis on the coordination of reach and grasp motions of target objects. In this research, daily hand activities were recorded with body mounted video camera and analyzed to confirm the cadence of grasp used. Furthermore, the grasping direction was analyzed regarding the relative coordination of the two 3-dimensional coordinate systems: trunk and forearm coordinate systems. As result, the highest contribution ratio of grasping in the forearm coordinate was 23.1%. Next, based on the normalized frequency of each grasping direction, the contribution rate were investigated, in the case of having two grasping directions and the case of the grasping direction changes by the rotation function. As a result, if the grasping direction is single, the highest contribution rate was 42.6% when adding wrist motion. In condition where terminal device has two grasping directions, the highest contribution rate was 87.2% when adding pronation/supination. Calculating the contribution rate of deskwork, hook shape was 87.2%, hand shape was 49.4%. This difference suggests that there is an influence of the grasping direction, in addition to the shape of the fingers.

Previous studies suggested substantial postmortem interference with pulmonary CT findings. The present study evaluated postmortem CT (PM-CT) morphology of the lung, compared with histology, in autopsy cases of sudden cardiac death without recovery from cardiac arrest (SCD, n=22) with regard to the posture at the time of death and postmortem interference from a forensic pathological viewpoint. In witnessed cases (n=5), a case of SCD in a prone position had anterior consolidation with weak hypostatic opacification in the posterior about 18 h later. Among unwitnessed deaths (n=17), 8 cases of death lying prone, sitting facedown and lying laterally had possible gravity-dependent opacity about 15-38 h postmortem. Hypostatic opacification with 'niveau' formation was not evident in more than half of the cases (n=15). Histological findings for ground glass opacification and consolidation on PM-CT varied by case, involving intraalveolar edema and hemorrhages, accompanied by marked congestion; however, possible postmortem hypostatic opacification mostly represented intraalveolar edema. CT morphology of acute pulmonary congestion in SCD may often remain without serious postmortem interference in cases without clinical intervention involving massive fluid infusion, suggesting plain PM-CT findings of the lung to be useful for investigating the death process when combined with histology; however, the possible influence of the hydration status of the lungs at the time of death should be assessed by evaluation of CT and autopsy findings.

Although previous forensic pathological studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction, there appears to be insufficient data with regard to its cardiac pathology. The present study analyzed the heart blood, peripheral blood and pericardial fluid levels of cardiac troponin T (cTnT) in sudden cardiac deaths (n = 96) within 48h postmortem in relation to pathological findings of acute myocardial infarction (AMI, n = 34), recurrent myocardial infarction (RMI, n = 23), ischemic heart disease without any pathological evidence of infarction (IHD, n = 24) and other heart diseases (OHD, n = 15). Control groups (n = 75, survival time

The aim of the present study was to examine the factors that contribute to the postmortem lung weight in acute fire fatalities (n=149) including those with lower (60%) and higher (60%) blood carboxyhemoglobin (COHb) levels (n=94 and 55, respectively). The control groups consisted of acute myocardial infarction/ischemia (AMI, n=99) and mechanical asphyxiation (n=85). For all cases (n=333), the lung and heart weights were independent of the postmortem time (4.5-72 h) and charring of the body. The combined weight of both lobes of the lung showed a significant gender difference (malesfemales, P0.001), negative regression with respect to age (R=0.167, P0.01) and positive regression with respect to heart weight (R=0.316, P0.001). The gender difference was also significant for each cause of death even after being corrected using body height measurements. When the lung-heart weight ratio was estimated to diminish the influence of possible cardiogenic factors, the gender difference was insignificant for each cause of death among the non-elderly (60 years of age). However, for elderly fire fatalities (60 years of age), there was a gender difference (malesfemales) for the lower COHb group (P0.05) and higher COHb group (P0.001). A significant age-dependent difference (non-elderlyelderly) in the lung-heart weight ratio was observed for fire fatalities with a lower COHb and AMI among males and for fire fatalities with a higher COHb among females. Such gender- and/or age-dependent influences were not significant for fatal mechanical asphyxiation. These findings suggest that a person's heart weight may be a possible contributory factor to an increase in the lung weight in acute death, and that gender- and/or age-dependent susceptibilities may be additional factors that contribute to fire fatalities and AMI. In addition, elderly females appear to be most susceptible among fire casualties, and extreme cardiomegaly may also be a potential fatal risk factor.

The aim of the present study was to investigate the differences in postmortem blood biochemistry between fresh-, saltwater drowning and acute myocardial infarction/ischemia (AMI) (n=11, n=15 and n=23, respectively; postmortem interval

Chronic kidney disease and elevated serum C-reactive protein (CRP) have been suggested as clinical risk factors for cardiac attacks. The present study investigated postmortem blood urea nitrogen (BUN), creatinine (Cr) and CRP levels in the peripheral blood of sudden cardiac death cases. Adult autopsy cases of ischemic heart diseases (n=153, >20 years of age), including acute myocardial infarction (AMI, n=71), recurrent myocardial infarction (RMI, n=47), acute ischemic heart disease without infarction (AIHD, n=27) and chronic ischemic heart disease (CIHD, n=8), were examined and compared with chronic congestive heart disease (CHD, n=24), spontaneous cerebral hemorrhage (SCH, n=17) and mechanical asphyxiation (n=32). BUN was slightly higher for RMI and CHD, although Cr was slightly higher for SCH. CRP was higher for AMI than for AIHD. The correlation between BUN and Cr levels was significant for AMI, AIHD and CHD, but insignificant for RMI and CIHD. Heart weight was larger for all heart diseases and SCH than for asphyxiation, and was larger for RMI and CHD but lower for AIHD and CIHD among them. Body mass index (BMI) was slightly higher for AMI, RMI, AIHD and CHD, remaining within the reference interval in most cases, but was lower for CIHD. These findings suggest different risk factors or etiologies, including active atherosclerosis, latent renal failure, dehydration and cardiac hypertrophy, for sudden deaths due to these heart diseases.

To investigate fatal factors involved in labor-related accidents and events, forensic postmortem cases ( n =874) during the past 6 years (1996–2001) at our institute were reviewed. Among them, there were 67 labor-related fatalities, showing a varied annual incidence (6–15 cases per year). All the victims were males (19–68 years of age). The most common sites of the accidents were manufacturing factories ( n =21, 31.3%), warehouses ( n =14, 20.9%), construction and demolition sites ( n =11 and n =5, 16.4 and 7.5%, respectively). There were some characteristic types of accidents: falls from heights at work during construction and maintenance, and crushes by heavy materials and moving vehicles in transportation, by collapsing structures at demolition sites or by working machinery in factories. The most severely injured body regions were usually the head in falls ( n =13/23) and the chest/abdomen in crushes ( n =19/32). Most of the victims ( n =54, 80.6%) died within 24 h. Alcohol was detected only in four cases. Most accidents were considered to be due to carelessness and simple fault of the workers without any significant relationship to their professional training and career.

To clarify drowning death, positive evidence for aspiration of the immersion medium and the subsequent fatal mechanism is necessary. This study investigated biochemical findings with regard to lung weight in drowning cases of adults (n=56, >18 years of age

The authors reported a case of a dural arteriovenous fistula (DAVF) in the left transverse-sigmoid sinus, in which 3-dimensional computed tomography (CT) angiograms (3D-CTAs) by a 64-section multidetector row CT scanner were useful for its diagnosis and treatment. The DAVF in the left transverse-sigmoid sinus appeared on the digital subtraction angiogram. 3D-CTAs were obtained by a 64-section multidetector row CT scanner before an endovascular treatment. The feeders and draining veins of the DAVF were clearly demonstrated on the 3D-CTAs, which clarified the relationship between the normal dural sinuses and DAVF. The DAVF was successfully treated with endovascular surgery, a transvenous embolization through the mastoid emissary vein, which was easily detected by using the 3D-CTA, showing both the subcutaneous vein and calvalium. 3D-CTAs by a 64-section multidetector row CT scanner are useful for both diagnosis and treatment of DAVFs.

The present study investigated cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) in the blood and pericardial fluid from medicolegal autopsy cases (n=234, within 48h postmortem) with regard to the cause of death. The cTnI and CK-MB levels in cardiac, peripheral blood and pericardial fluid generally showed a mild and gradual postmortem time-dependent elevation (r=0.231-0.449, P0.05-0.001). However, postmortem elevation of cTnI was larger for specific causes of death including acute myocardial infarction (AMI), cerebrovascular diseases (CVD), hyperthermia, fatal methamphetamine (MA) abuse and carbon monoxide (CO) intoxication and insignificant for recurrent myocardial infarction (RMI), chronic congestive heart diseases (CHD) and drowning, while that of CK-MB was greater for CO intoxication and insignificant for drowning. Cardiac blood and pericardial cTnI levels were relatively high for AMI, RMI, hyperthermia, MA abuse and CO intoxication, and was low for drowning. Elevated CK-MB level was observed for cardiac blood in asphyxiation and MA abuse cases and for peripheral blood in hyperthermia and MA abuse cases. When the cTnI/CK-MB ratio was estimated, it was independent of postmortem time, and the ratios for cardiac blood and pericardial fluid were significantly higher in cases of AMI, RMI, hyperthermia and CO intoxication but lower in cases of drowning. Elevations of cTnI levels in cardiac blood and pericardial fluid were related to the morphological severity of myocardial damage. These findings suggest that elevated cTnI and CK-MB levels in blood and pericardial fluid are related to ischemic, hypoxic and/or cytotoxic myocardial damage, which are characteristic of the cause of death, although the levels increase after death depending on myocardial damage at the time of death.

In forensic pathology, previous studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction. However, there appears to be insufficient practical data on other causes of death. The present study was a comprehensive analysis of the cardiac, peripheral blood and pericardial levels of cardiac troponin T (cTnT) in serial medicolegal autopsy cases (n = 405) with a survival time

Gastric dissecting aneurysm is a very rare lesion with a potential risk of fatal rupture. Differentiating this from a traumatic lesion may be important in forensic casework. We report an autopsy case of sudden death due to a clinically overlooked spontaneous rupture of gastric dissecting aneurysm. A 91-year-old Japanese male visited a hospital with complaints of back pain and general fatigue, and then died at his home about 4 h later. Postmortem examination revealed massive hemoperitoneum and a subserosal hematoma originating from a vascular lesion at the lesser gastric curvature with a serosal tear. The histological findings were compatible with segmental arterial mediolysis (SAM). The pathological findings and clinical course suggested the possible 'double-rupture phenomenon' (delayed fatal rupture). This case suggested the importance of careful investigation such a vascular lesion in medico-legal practice, not only to differentiate from traumatic injury but also to investigate the process of dying.

The aim of the present study was to investigate the lung-heart weight ratio in fresh- and saltwater drowning (n=67 and n=75, respectively) as a possible index of cardiopulmonary pathophysiology, in comparison with acute myocardial infarction/ischemia (AMI, n=75) and asphyxiation (n=85). In drowning cases, the total value of the combined lung weight and the amount of pleural effusion was regarded as a possible total lung weight. The median value of the combined/total lung weight was the highest in saltwater drowning, which was followed by freshwater drowning, AMI and asphyxiation, showing a tendency to be mildly increased depending on the heart weight. The lung-heart weight ratio was significantly higher in fresh-/saltwater drownings (3.944+/-1.538 and 4.825+/-2.242, respectively) than in asphyxiation (2.846+/-1.042) and AMI (2.641+/-0.916) (P

There are several controversial findings and arguments about the lung weight as a marker of drowning. The aim of the present study was to examine the difference in the lung weight and the amount of pleural effusion between freshwater and saltwater drownings (n=70 and n=75, respectively), in comparison with asphyxiation (n=85) and acute cardiac death (n=82), for the diagnosis of drowning. In drowning cases, a gradual postmortem time-dependent decrease in the lung weight and a reciprocal increase in the pleural effusion suggested postmortem transudation from the lungs. The decrease in the total value of the combined lung weight and the amount of pleural effusion was marked in saltwater immersion after 3 days postmortem, suggesting a leakage of the effusion out of the thoracic cavity under an osmotic effect of the immersion medium. In cases within 3 days postmortem, when the combined lung weight and amount of pleural effusion were added to estimate possible combined lung weight at the time of death, there was a gross difference among the causes of death: the value was the largest in saltwater drowning, followed by freshwater drowning, acute cardiac death and asphyxiation. However, the value depended on the gender and age of the subjects, suggesting a relation to the individual physical constitution and survival time or vital activity. These factors should be taken into consideration in evaluation of the lung weight in the diagnosis of drownings.

Hemorrhages in the root of the tongue have been considered to be a finding associated with asphyxiation. The aim of the present study was to examine the incidence and diagnostic value of the lingual hemorrhages in fire fatalities with reference to the related pathological and toxicological findings, in comparison with asphyxiation and drowning cases. In fire fatalities (n=90), small to marked hemorrhages were observed in 26 cases (28.9%). In the reference groups (asphyxiation and drowning), the hemorrhages were frequently observed in ligature strangulation (n=10/15), manual strangulation (n=5/7) and traumatic asphyxia (n=4/5). In fire fatalities, the hemorrhages were closely associated with a lower blood carboxyhemoglobin (COHb) level, suggesting an influence of fatal burns: n=16/32 (50.0%), n=8/26 (30.8%) and n=2/32 (6.2%), respectively, in cases of COHb30%, 30-60% and60%. These findings suggested possible acute hemodynamic disturbance in the head including brain (cranial congestion) in the dying process due to fires. A careful differentiation from neck compression may be necessary in such cases.

Transplantable gliomas of C57BL/6J mice were used in order to investigate the influence of immunological resistance against tumors transplanted in the right parietal lobe. Immunization was induced by subcutaneous inoculation of approximately 1 mm3 of tumor grafts, irradiated by 3, 000 watt.sec/cm2 ultrasound or 3, 000 rad X-ray, once a week for 2 weeks to normal animals. Immunization was assured by tumor rejection or no growth 2 to 3 weeks after challenge of non-treated tumor implants. The rates of immunization against tumor were 67% by ultrasound irradiation and 45% by X-ray irradiation. Passive transfer of resistance against the tumor was evaluated by IV injection of 1 × 108 spleen cells from immunized animals to normal isologous animals. The result showed a 40% rate of transfer. The rate of tumor growth transplanted in the brain was 71 % in immunized mice induced by subcutaneous inoculation with no significant difference from normal mice (81%). However, survival intervals after transplantation were significantly longer (P