The usefulness of measuring n-butyric acid concentration as a new indicator of blood decomposition in forensic autopsy.

In forensic medicine, although various alcohols have been reported as indicators of decomposition in collected blood, no studies have examined short-chain fatty acids as indicators. In this study, the blood n-butyric acid concentration was quantified, and the association between n-butyric acid and decomposition was investigated to determine whether the detection of n-butyric acid could be a new indicator of decomposition. Among the forensic autopsies performed from 2016 to 2018 in our laboratory, the cases were divided into decomposed (n = 20) and non-decomposed (n = 20) groups based on macroscopic findings. Blood samples collected at the time of autopsy were derivatized with 3-nitrophenylhydrazine hydrochloride after solid-phase extraction. The n-butyric acid concentration was measured using liquid chromatography-tandem mass spectrometry. In addition, ethanol and n-propanol were measured using a gas chromatography-flame ionization detector. There was a significant difference (p < 0.01) in the concentrations of n-butyric acid between the decomposed and non-decomposed groups (0.343 ± 0.259 [0.030-0.973] and 0.003 ± 0.002 [0.001-0.007] mg/mL, respectively). In the decomposed group, n-butyric acid was detected at high concentrations, even in cases where n-propanol was low. These results suggest that n-butyric acid is more likely to be an indicator of blood decomposition than n-propanol.

Clinical and brain structural effects of the Illness Management and Recovery program in middle-aged and older patients with schizophrenia.

AIMS: In this study, we implemented the Illness Management and Recovery (IMR) program for middle-aged and older patients with schizophrenia hospitalized for long periods and assessed the effect of the IMR program on psychiatric symptoms and psychosocial function. The effects of the IMR program on brain structure were also evaluated. METHODS: The IMR program was implemented for 19 patients with schizophrenia; 17 patients with schizophrenia receiving treatment as usual (TAU) were also recruited as controls. In all patients, mean age was 61.4 years (range, 50-77 years) and mean hospitalization duration was 13.1 years (range, 1-31 years) at enrollment. Structural magnetic resonance images and Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores as clinical variables were obtained at the beginning and end of the IMR program. Longitudinal analyses were performed to compare the effects of the IMR program on clinical symptoms and cortical thickness in the superior temporal gyrus (STG) between the IMR and TAU groups. RESULTS: Significant improvements in GAF scores and the total, Insight and Judgment, and Positive components of the PANSS were found in the IMR group compared with the TAU group. Cortical thickness in the left STG was preserved in the IMR group compared with the TAU group. CONCLUSIONS: This is the first report demonstrating the effectiveness of the IMR program for improving psychotic symptoms and psychosocial function and protecting brain structure in middle-aged and older inpatients with schizophrenia hospitalized for long periods.

Lung weight estimation with postmortem CT in forensic cases.

Postmortem computed tomography (CT) is a minimally invasive technique to examine internal organs before a forensic autopsy. The purpose of our study was to estimate lung weight in a forensic setting in cases of various lung states, including fluid accumulation (congestion, edema, hypostasis, and inflammation etc.) using postmortem CT. From January 2016 to July 2018, 111 deceased bodies (62 males and 59 females, aged from 18 to 95 (average 59.6) years) were examined by CT before autopsy. Both lungs of the 111 deceased were analyzed separately, making it a total of 222 samples. We extracted lung fields from CT images manually after semi-automatic detection using an image workstation. The total lung volume and 6 categories of lung volume divided according to their CT density were measured. Multiple regression analysis was performed with lung weight in autopsy as the response variable, while the 6 categories were labelled as explanatory variables. The relation between lung weight in autopsy and lung weight estimated using postmortem CT showed a high Pearson's correlation coefficient (R2 = 0.9106). Using postmortem CT, the lung weight can be estimated in forensic settings.

Estimating normal lung weight measurement using postmortem CT in forensic cases.

PURPOSE: The aim of this study is to estimate the lung weight using postmortem CT in well aerated lung autopsy cases. The correlation coefficients to the lung weight were also evaluated for the cadavers' height, weight, whole body surface area (WBSA), body mass index, and estimated lung volume. MATERIALS AND METHODS: From October 2015 to July 2016, 31 cadavers (male 12, female 19, age 20-98 (mean 66.9) y.o., postmortem interval 0.3-75.0 (5.7) days) were compared as regards body weight, height, whole body surface area (WBSA), body mass index (BMI), lung volume on CT, and total lung volume classified into several CT number categories, with their lung weight in autopsy. RESULTS: The lung weight (mean ±â€¯SE) was 284.9 ±â€¯14.8 g in right lung and 249.3 ±â€¯12.9 g in left lung. The %ALV was 79.9 ±â€¯0.9 HU (mean ±â€¯standard error (SE)) in both lungs, 80.3 ±â€¯1.3 HU in right lung, and 77.6 ±â€¯2.0 HU in left lung. Using a simple linear regression test, there was no statistically significant correlation between the lung weight and the categories (R2: body height 0.234, weight 0.224, WBSA 0.309, BMI 0.046, lung volume 0.059). The volume for each individual CT density category showed no significant correlation, but the stepwise regression test yielded an excellent correlation coefficient (R2 = 0.840). CONCLUSION: The well aerated lung weight was 284.9 ±â€¯14.8 g in right lung and 249.3 ±â€¯12.9 g in left lung, and the postmortem CT could estimate the lung weight with high correlation coefficient.

Gender differences in muscle blood volume reduction in the tibialis anterior muscle during passive plantarflexion.

Physical flexibility, such as joint range of motion and muscle extension, may influence muscle blood volume. Women have been shown to have a greater degree of flexibility than men. We examined whether there is a gender difference in the relationship between fascicle length and muscle blood volume or oxygenation in untrained men and women. In 16 untrained men and thirteen untrained women, we measured the total-[haemoglobin (Hb) + myoglobin (Mb)] (total-[Hb + Mb]) and relative oxy-[Hb + Mb] after calibrating baseline and arterial occlusion deoxygenation levels with near-infrared spectroscopy. Also, fascicle length was measured with B-mode ultrasonography at the tibialis anterior muscle during passive plantarflexion. Increases in fascicle length from baseline (ankle joint angle 120°, composed from the caput fibulae, the malleolus (pivot), and the distal epiphysis of the fifth metatarsal bone) were greater in women than in men during plantarflexion of 140° and 160° and the maximal angle without pain. However, the decreases in total-[Hb + Mb] and relative oxy-[Hb + Mb] from baseline were not different between women and men at any degree of plantarflexion. Moreover, fascicle length and total-[Hb + Mb]/muscle thickness (men > women) showed a similar relationship, with muscle thickness increasing capillary compression. These findings indicate the possibility of a mechanical function underlying muscle blood volume during muscle stretching, which is greater in women than in men.

Implementing the illness management and recovery program in Japan.

OBJECTIVE: This study investigated the feasibility and outcomes of the illness management and recovery program in Japan. METHODS: Thirty-five patients with schizophrenia were recruited. Participants were assigned (not randomly) to the intervention and wait-list comparison groups. Symptom severity, functioning, activation level in self-management, quality of life, satisfaction, self-efficacy in community living, and satisfaction with services were measured before and after the intervention. RESULTS: Over two years 25 patients completed the intervention (some after being wait-listed). In the pre-post comparison, they showed significant improvement in symptoms and functioning, self-reported activation in self-management, quality of life, satisfaction, and self-efficacy in community living. Compared with the ten participants in a wait-list comparison group, the eight participants in the first intervention group showed an increased quality of life in social functioning, satisfaction in living, and self-efficacy for social relationships in community living. CONCLUSIONS: Findings suggest that the program is effective for participants with severe mental illness in Japan.