Chlorpromazine-induced alterations in hypothalamic amine metabolism and stress responses in severe cold

To investigate the effects on the central nervous system of severe cold stress with and without chlorpromazine, guinea pigs were treated with chlorpromazine or 0.9% NaCl and exposed to -20 degrees C or +23 degrees C for 1 h. Hypothalamic noradrenaline (NA), dopamine (DA), 5-hydroxy-tryptamine (5-HT), 3-methoxy-4-hydroxyphenyl ethylene glycol (MHPG), homovanillinic acid (HVA) and 5-hydroxy-indoleacetic acid (5-HIAA) were determined by high-performance liquid chromatography. Serum, urinary and vitreous fluid catecholamines, muscle and liver glycogen, and blood glucose were also measured. Chlorpromazine caused distinct hypothermia at -20 degrees C and slight hypothermia at +23 degrees C. The rise in hypothalamic MHPG, 5-HIAA and MHPG/NA and in 5-HIAA/5-HT ratios in the cold indicate increased noradrenergic and serotonergic activity. The latter was inhibited by chlorpromazine and a drug-induced inhibition of noradrenergic neurons could not be ruled out. Chlorpromazine increased the turnover of DA at room temperature and the same tendency was seen in the cold. The hypothermic animals had low serum catecholamines, indicating diminished sympathetic activity. The chlorpromazine-treated cold-exposed animals did not react to the environmental stress by sympathetic activation, as urinary NA and adrenaline were not elevated, but DA was excreted by all the drug-treated animals. Vitreous fluid NA and DA were elevated as an indicator of cold stress, and no drug effect was seen in this fluid.     

Working Smarter on Cold Cases: Identifying Factors Associated with Successful Cold Case Investigations

Cold case squads have garnered much attention; however, they have yet to undergo significant empirical scrutiny. In the present study, the authors interviewed investigators and reviewed 189 solved and unsolved cold cases in Washington, D.C., to determine whether there are factors that can predict cold case solvability. In the interviews, new information from witnesses or information from new witnesses was cited as the most prevalent reason for case clearance. The case reviews determined that there were factors in each of the following domains that predicted whether cases would be solved during cold case investigations: Crime Context, Initial Investigation Results, Basis for Opening Cold Case, and Cold Case Investigator Actions. The results suggest that it is possible to prioritize cold case work based on the likelihood of investigations leading to clearances.     

Chemical estimation of fresh water immersion intervals

Postmortem vitreous humor chemistry studies were reviewed in 25 cases in which death was followed by submersion in fresh water for known lengths of time. The potassium concentrations in cold temperature cases initially increased in a linear manner, but appeared to level off or decline after about 1 week. In hot weather cases, potassium levels rose rapidly during the first few days postmortem. The sodium and chloride levels decreased in a fairly regular fashion, with less temperature variation. Increasing variation in values began to occur at about 7 days. The data show that dilution of the contents of the eye by fresh water begins at about that time in cases of cold water submersion. A formula employing the weighted average of the potassium and chloride concentrations can be used to determine the duration of submersion in cold water over the range of 2-10 days.     

Experimental studies of the development of linear electric current marks

By means of reconstructing electric current pathways electrophysical conditions were explored causing electrocution death in the bathtub, according to many authors quite often indicated by linear electric lesions. In our experimental settings we observed appearance of circumscribed linear marks of pallor similar to electric lesions in the region of postmortem lividity of corpses at the same level as bathtub water. None of typical histological indicators could be seen in skin samples. So no evidence was given for electric burns even under conditions of high density and extended duration of current. Similar linear marks and equivalent histological results were found when corpses were put into the bathtub filled with cold water without any experimental electric contact. CONCLUSIONS: Linear marks of pallor may occur at water level even without any electric contact to corpse or water neither bathtub. IMPLICATIONS: According to specific conditions mentioned above linear so called electric lesions at water level do not indicate electric current yet lethal electric damage.     

刺激犬体表感受器对心脏表面神经元和心脏功能的影响

为了给“抑制死”提供实验根据和理论依据,模拟“抑制死”的体表刺激,用3.0kg触压麻醉开胸犬的心前区、剑突下,同步记录大右心房神经节丛神经元内单位放电的频数及心脏变时。变力性反应。静脉给入普来洛尔（1mg／kg）或阿托品（1mg／kg）及心脏急性会神经支配后,重复上述刺激。结果显示：触压犬心前区可直接引起心脏表面神经节丛内的副交感神经元兴奋,窦房结自律性降低,引起负性频率作用;在此基础上刺激兴奋心脏表面交感神经元可诱发室性心律失常。提示刺激心前区、剑突下引起的“抑制死”,不仅与迷走神经对心脏的抑制有关,可能还与交感神经元对心室的兴奋有关。     

Reactions of latent prints exposed to blood

We explored whether an undeveloped latent print (fingermark) exposed to blood and later developed by enhancement with blood reagents such as amido black (AB) or leucocrystal violet (LCV) could appear as a genuine blood mark. We examined three different experimental conditions. In Experiment I, fingermark residue only was tested, as a control to confirm that fingermark residue alone does not react with the blood reagents AB and LCV. Experiment II investigated whether latent fingermarks exposed to blood dilutions could be treated with AB or LCV and subsequently appear as a genuine blood mark enhanced with AB or LCV. Experiment III tested whether latent fingermarks exposed to whole blood could be processed with AB or LCV and subsequently appear as a genuine blood mark enhanced with AB or LCV.The present study found that indeed, fingermark residue alone does not react with the blood reagents AB and LCV. In Experiment II, an interaction occurred between the fingermark residue and the diluted blood that caused the ridges to appear a red color. In the present study, this interaction is called a faux blood mark. While the faux blood mark phenomenon occurred most often following exposure to diluted blood, it did not occur consistently, and a predictable pattern could not be established. However, the reaction occurred more frequently following extended fingermark residue drying times. Faux blood marks are distinguishable from genuine blood marks prior to enhancement with blood reagents. Following treatment with blood reagents, it became increasingly difficult to determine whether the enhanced mark was a genuine blood print or a latent fingermark exposed to diluted blood. Latent fingermarks exposed to whole blood often resulted in a void prior to enhancement, but following treatment with blood reagents, were difficult to distinguish from a genuine blood mark enhanced with blood reagents.     

The neuroendocrine effects of the TASER X26®: A brief report

IntroductionLaw enforcement officers use conducted electrical weapons (CEW) such as the TASER X26^® to control violently resistive subjects. There are no studies in the medical literature examining the effects of these weapons on the human stress response. This is the first study to compare the human stress response to conducted electrical weapons, oleoresin capsicum (O.C.), a cold-water tank immersion, and a defensive tactics drill.MethodsSubjects were randomized to one of the four interventions studied. Subjects received either a 5-s exposure from the TASER X26 CEW with the probes fired into the back from 7 ft, a 5-s spray of O.C., a skin and mucous membrane irritant, to the eyes, a 45-s exposure of the hand and forearm in a 0 °C cold water tank, or a 1-min defensive tactics drill.ResultsAlpha-amylase had the greatest increase from baseline at 10–15 min with the defensive tactics drill. Cortisol had the greatest increase at 15–20 min with O.C. Cortisol remained most elevated at 40–60 min in the defensive tactics drill group.ConclusionsOur preliminary data suggests that physical exertion during custodial arrest may be most activating of the human stress response, particularly the sympathetic–adrenal–medulla axis. This may suggest that techniques to limit the duration of this exertion may be the safest means to apprehend subjects, particularly those at high-risk for in-custody death. Conducted electrical weapons were not more activating of the human stress response than other uses of force.     

Limiting your risks in the new Russian roulette--discharging employees

Time was when an employer had the freedom to discharge employees for a good reason, a bad reason, or no reason at all. As more and more employees bring claims of "wrongful discharge" to courts, however, employers' discretion to terminate employees at will is being restricted. This is particularly so where cases are presented before juries, which tend to be more sympathetic to the employee's plight. In the following article, the author examines the circumstances under which courts are now finding employers responsible for wrongful discharge. He also discusses ways in which employers can limit their exposure to wrongful discharge claims.     

The Micro‐Taphonomy of Cold: Differential Microcracking in Response to Experimental Cold‐Stresses

Cold is a central feature of environments at higher latitudes and elevations. Thus, cold‐induced taphonomic changes are relevant in many forensic contexts. Fifty‐two lamb bone segments were used to assess the impact of cold, freeze‐thaw cycles, freeze‐drying, and water immersion on microstructural cracking of bone in a series of controlled exposure experiments. For each bone segment, three thin sections were examined under a light microscope. Cold exposure caused taphonomic changes in the form of microscopic cracking. Transverse cracks occurred in all treatments, whereas osteonal cracks were restricted to rapid freezing treatments. Type of cold exposure had a statistically significant effect on both the total number of cracks and each type of crack observed. Skeletal microcracking could potentially be used as a taphonomic indicator of postmortem bone exposure to sub‐zero temperatures. The type and prevalence of this damage could also be used to distinguish between different types of cold exposure.     

Empathy and Fairness: Psychological Mechanisms for Eliciting and Maintaining Prosociality and Cooperation in Primates

In the past, prosociality has been considered a hallmark of humans; however, recently, accumulating data have empirically revealed that non-human animals also show prosocial behavior. In situations in which animals cannot predict return benefits, prosocial behavior is probably driven by other-regarding motivation. A sense of fairness and empathy continue to draw attention as the most plausible candidates for the psychological mechanisms underlying such prosocial behavior. In this article, we first introduce comparative studies on prosocial behavior in non-human primates and discuss similarities and differences between humans and non-human primates. Then, we discuss the role of a sense of fairness and empathy. In this paper, we hypothesize that empathy may promote prosocial behavior, whereas a sense of fairness may play a role as a stabilizer, but not as a promoter of prosocial behavior in non-human animals. We further hypothesize that prosocial behavior motivated by sympathetic concerns can survive only with a sense of fairness, the inhibitory system for unnecessarily excessive expression of prosocial behavior. Without a sense of fairness, empathic animals might be exploited by free-riders, which might lead to the extinction of cooperation. Therefore, the interplay of a sense of fairness and empathy are both important to maintaining prosocial behavior and cooperation. This hypothesis seems to be supported by comparative studies with non-human primates and also by neural studies with humans.     

When Trumps Clash: Dworkin and the Doctrine of Proportionality

If there is one point on which defenders and critics of the doctrine of proportionality agree, it is that Dworkin's rights as trumps model stands as a radical alternative to the doctrine. Those who are sympathetic to proportionality reject the rights as trumps model for failing to acknowledge that there are conditions under which a right may be justifiably infringed. In turn, those who regard rights as trumps reject the doctrine of proportionality for failing to take rights seriously. This paper argues that each of these views is mistaken. On the one hand, Dworkin's rights as trumps model elides with a prominent version of the proportionality doctrine. On the other, this version takes rights seriously.     

Time of death of victims found in cold water environment

Limited data is available on the application of post-mortem temperature methods to non-standard conditions, especially in problematic real life cases in which the body of the victim is found in cold water environment. Here we present our experience on two cases with known post-mortem times. A 14-year-old girl (rectal temperature 15.5 degrees C) was found assaulted and drowned after a rainy cold night (+5 degrees C) in wet clothing (four layers) at the bottom of a shallow ditch, lying in non-flowing water. The post-mortem time turned out to be 15-16 h. Four days later, at the same time in the morning, after a cold (+/- 0 degrees C) night, a young man (rectal temperature 10.8 degrees C) was found drowned in a shallow cold drain (+4 degrees C) wearing similar clothing (four layers) and being exposed to almost similar environmental and weather conditions, except of flow (7.7 l/s or 0.3 m/s) in the drain. The post-mortem time was deduced to be 10-12 h. We tested the applicability of five practical methods to estimate time of death. Henssge's temperature-time of death nomogram method with correction factors was the most versatile and gave also most accurate results, although there is limited data on choosing of correction factors. In the first case, the right correction factor was close to 1.0 (recommended 1.1-1.2), suggesting that wet clothing acted like dry clothing in slowing down body cooling. In the second case, the right correction factor was between 0.3 and 0.5, similar to the recommended 0.35 for naked bodies in flowing water.     

Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury

Autonomic dysreflexia (AD) is an uncommon but potentially life-threatening clinical syndrome consisting of acute episodes of excessive, uncontrolled sympathetic output that may occur in quadriplegics and in paraplegics whose spinal cord lesions are above the level of T6. These uncontrolled bouts of sympathetic output can cause transient and pronounced elevations of blood pressure that on occasion can lead to serious sequela such as the precipitation of a hypertensive intracerebral hemorrhage. The episodes of AD are often triggered by some type of noxious stimulus such as a distended urinary bladder or a fecal impaction. We present the case of a 62-year-old man with a history of quadriplegia resulting from a diving accident 40 years ago that was complicated clinically by episodes of autonomic dysreflexia. While hospitalized, he experienced an episode of autonomic dysreflexia with severe hypertension, which was soon followed by neurologic deterioration and death. Antemortem imaging revealed a large hypertensive-type intracerebral hemorrhage originating in his right caudate nucleus. Although his death at first appeared to be a natural death due to a spontaneous hypertensive-type intracerebral hemorrhage, his clinically documented autonomic dysreflexia convincingly linked the remote spinal cord injury and the fatal intracerebral hemorrhage, engendering an accidental manner of death.     

Recreational Sporting Activity Vehicle‐Related Deaths

Deaths occurring in the setting of nonprofessional, vehicle‐related, recreational sporting activities occurring on land or in water during warm or winter months represent a diverse group of cases. These deaths tend to involve scenarios where the participants are purposefully attempting to enjoy themselves prior to experiencing sudden, catastrophic accidents resulting in lethal outcomes. Ultimately, many of the deaths are related to the high speed at which these vehicle‐related activities normally occur. Three broad categories of factors may play contributory roles in death: human factors, vehicle factors, and environmental factors. A series of selected cases are presented, representing examples of varying activity types, involving motorized and nonmotorized vehicles, land and water activities, and warm weather and cold weather environments. For each case, the various human, vehicle and environmental factors believed to be contributory to the accident are considered, and strategies for prevention of these and similar deaths involving recreational sporting vehicles are presented.     

Sudden death after a cold drink: case report

We report a case of sudden cardiac death in a 12-year-old boy after rapid ingestion of a frozen slurry drink. The cause of death was determined to be a cardiac arrhythmia secondary to a previously undiagnosed cardiac rhabdomyoma with associated myocardial scarring. Ingestion of cold liquids has been associated with syncope, but not sudden cardiac death. In this case, bradycardia induced by cold-induced vasovagal reflex may have precipitated the terminal arrhythmia. Ingestion of cold liquids should be considered a potential trigger for fatal cardiac arrhythmias in patients with underlying heart disease.     

Skeletal muscle activity of alcohol-treated rabbits in immersion hypothermia: adenine nucleotide concentrations and phosphorylation state

The effects of alcohol injection (0.5 g . kg-1 i.v.) on the core cooling and rewarming rates, concentration of the adenine nucleotides, and the phosphorylation state of the adenylate system (ATP/ADP X P) were studied in the skeletal muscle of anesthetized rabbits immersed in ice-cold water. NaCl-injected rabbits immersed in ice-cold water were used as cold controls, alcohol-treated animals at room temperature (20 degrees C) as alcohol warm controls, and NaCl-injected animals at room temperature as anesthesia controls, respectively. The fall of core temperature to 32 degrees C in the alcohol-treated rabbits and the cold controls took about 40 min. During this time the temperature of the alcohol warm and anesthesia controls fell by about 1 degree C. No difference in the rewarming rate was observed between the alcohol-treated and cold control rabbits. Serum glucose concentration was elevated in the cold controls (from 5.9 to 8.3 mmol/l) but not in the alcohol-treated rabbits. Cold exposure reduced the phosphorylation state in the skeletal muscle of the alcohol-treated rabbits by 32% (P less than 0.05), but the decrease (6%) was not significant in the cold controls. After rewarming the phosphorylation state decreased in the above groups by 71% and 15%, respectively, as compared with the initial values. No significant changes in the phosphorylation state were found in the warm control animals. The redox state of the cytosol in the skeletal muscle or liver did not change, nor was there any change observed in the arterial pO2 or pCO2 concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postmortem metabolic indices of antemortem adrenergic stimulation

Tissue lactate concentration has been reported to be a useful postmortem indicator of antemortem awareness of mortal danger. The purpose of this study was to determine further whether selected tissue metabolites could be used as postmortem markers of antemortem adrenergic stress. Sprague-Dawley albino rats were anesthetized with pentobarbital and then injected with 2.0 mg kg-1 i.p. epinephrine hydrochloride to induce experimentally a severe sympathetic response that may be associated with the awareness of mortal danger; 20 min after the injection of epinephrine, when the metabolic response was at its peak, the animals were killed by exsanguination. Samples of the following tissues were removed immediately prior to death (0 h) and 48 h postmortem: soleus, plantaris, kidney medulla, kidney cortex, liver, and heart. These samples were analyzed for glycogen, lactate, ATP, creatine phosphate, pH, and total protein concentration. Significant differences in lactate concentration were observed in all tissues except soleus at 0 h in the epinephrine-injected animals. Specific tissues also had significant reductions in glycogen, ATP, and creatine phosphate concentrations at 0 h. At 48 h postmortem, however, only the liver and soleus lactate concentrations were significantly different from the 48-h control samples. It is unlikely that these small differences found in some tissues at 48 h postmortem would be detected in an uncontrolled accident situation. We concluded from these findings that these selected tissue metabolites are not useful as long-term postmortem indicators of antemortem adrenergically induced hypermetabolism.     

“Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation

Many homemade tamper processes of medical codeine formulations are available on selected “forums” on the Internet, where recreational codeine users claim to be able to purify codeine by removing additives, such as acetaminophen, to avoid or limit adverse effects. In this work, it is reported and discussed a fatal case of codeine intoxication. The findings of objects such as jars, filters, and tablets, and amounts of unknown liquid material at the death scene investigation suggested a fatal codeine intoxication after the tampering procedure called “cold water extraction.” Toxicological results obtained from the analysis of both the nonbiological material and the body fluids of the decedent integrated with the information collected at the death scene investigation confirmed the above‐mentioned hypothesis. This report underlines the importance of a tight interconnection between criminalistics and legal medicine to strengthen the identification of the cause of death and the reconstruction of the event.     

Natural rubber-containing medical devices; user labeling; cold seal adhesives partial stay--FDA. Final rule

The final rule for user labeling requirements for natural rubber-containing medical devices, 21 CFR 801-437, was published on September 30, 1997, and becomes effective on September 30, 1998. The Food and Drug Administration (FDA) is adding a note to that rule to stay, for 270 days from the effective date, paragraphs (f) and (g) as those final rule requirements relate to device packaging that uses "cold seal" adhesives. Labeling changes required by other paragraphs of this final rule must be incorporated in the labeling of devices distributed after September 30, 1998, even if the devices are packaged in "cold seal" packages. Device packaging that uses natural rubber only on adhesives contained in the flaps of device packaging is not considered subject to the rule. Manufacturers of devices packaged with "cold seal" adhesives may, if necessary, submit a petition for an extension of the 270-day stay.     

Possible role of pseudoephedrine and other over-the-counter cold medications in the deaths of very young children

The Philadelphia Medical Examiners Office has reported a series of 15 deaths between February 1999 and June 2005 of infants and toddlers 16 months and younger in which drugs commonly found in over-the-counter (OTC) cold medications were present. A total of 10 different drugs were detected: pseudoephedrine, dextromethorphan, acetaminophen, brompheniramine, carbinoxamine, chlorpheniramine, ethanol, doxylamine and the anticonvulsants, phenobarbital, and phenytoin. The drugs were confirmed and quantified by gas chromatography (GC)-mass spectrometry, with the exception of ethanol, which was analyzed by headspace GC and of phenobarbital and phenytoin that were quantified by GC with a nitrogen phosphorus detector. The most predominant drug was pseudoephedrine, which was found in all of the cases (blood concentration, n=14, range=0.10-17.0 mg/L, mean=3.34 mg/L) and was the sole drug detected in three cases. Acetaminophen was detected in blood from each of the five cases with sufficient sample. Other drugs (with frequency of detection) were dextromethorphan (five cases), carbinoxamine (four cases), chlorpheniramine (two cases) and brompheniramine, doxylamine, and ethanol (one case each). In the majority of the cases, toxicity from drugs found in easily available OTC medications was listed either as the direct cause of death or as a contributory factor. The manner of death was determined to be natural in only two of the cases. This postmortem study supports previous evidence that the administration of OTC cold medications to infants may, under some circumstances, be an unsafe practice and in some cases may even be fatal. The treating physicians and the general public need to be made more aware of the dangers of using OTC cold medications to treat very young children so that these types of tragedies might be avoided.