Postmortem serum uric acid and creatinine levels in relation to the causes of death

Serum uric acid (UA) and creatinine (Cr) mainly derive from skeletal muscle tissues. Although, remarkable postmortem stability of the serum levels has been reported, there appears to be very poor knowledge of the diagnostic value in investigation of death, except for uremia. The aim of the present study was to evaluate postmortem serum UA and Cr levels using 395 forensic autopsy cases, in comparison with blood urea nitrogen (BUN), for investigation of the pathophysiology of death with special regard to the causes of death involving possible skeletal muscle damage, e.g. due to hypoxia, heat or agonal convulsions. Cr and BUN showed relatively good topographic stability in the cadaveric blood, whereas, UA was often much higher in the right heart blood than in the left heart and peripheral blood, independent of postmortem intervals. Moderate to marked elevation of Cr and BUN accompanied with hyperuricemia was observed in delayed death. In the acute death cases (survival time <30 min), UA, especially in the right heart blood, showed a considerable elevation in mechanical asphyxiation and drowning. The Cr level in fire victims with a lower carboxyhemoglobin (COHb) level (<60%) was significantly higher than in those with the possible fatal level (>60%). A similar elevation of Cr was observed in fatalities from heat stroke and methamphetamine (MA) poisoning. The observations suggested that hyperuricemia in acute death may be indicative of advanced hypoxia and that elevated Cr level may reflect the skeletal muscle damage, especially due to thermal influence.     

The Role of FDI,Exports and Spillover Effects in the Regional Development of China

The objective of this analysis is to assess the impacts of export expansion, inward FDI, domestic investment and labour on the growth of China's Eastern, Central and Western regions using panel data over the period 1984 to 1998. A major contribution of the study is its tests for the presence of interregional spillover effects. The study indicates that both inward FDI and domestic investment stimulate growth in all three regions and for the PRC as a whole and that export expansion stimulates the growth of the PRC, Eastern and Central China, but not the West. Labour enhances the growth of the more traditional Western region, but not the more capital intensive Eastern seaboard or the PRC in its entirety. Finally, output growth spills over from the East to Western and Central China and from the Central area to Western China. These results are fully explained in the text.     

Crimes Against Caring: Exploring the Risk of Secondary Traumatic Stress,Burnout, and Compassion Satisfaction Among Child Exploitation Investigators

Secondary traumatic stress (STS) and burnout are debilitating occupational hazards that inhibit helping professional’s overall well-being. Much of the extant scholarship on this topic has focused on mental health and child welfare workers and not law enforcement officials who investigate Internet child exploitation. This study used data from 433 Internet Crimes Against Children (ICAC) Task Force personnel to explore the impact of individual and work-related factors associated with the risk of STS, burnout, and compassion satisfaction. Findings indicated that nearly one in four ICAC personnel exhibited low compassion satisfaction and high levels of STS and burnout. Individual-level protective factors for increasing compassion satisfaction and mitigating symptoms of STS and burnout included having a strong social support system outside of work and the frequent use of positive coping mechanisms. Work-related risk factors such as frequent indirect exposure to disturbing materials, low organizational support, and frequently feeling overwhelmed at work were all associated with higher STS and burnout and lower levels of compassion satisfaction. Policy implications and future avenues of research are discussed.     

The Impact of Acceptance and Commitment Therapy on Positive Parenting Strategies Among Parents Who Have Experienced Relationship Violence

Evidence supports the use of acceptance and commitment therapy (ACT) for well-being and behavior change among parents. This study examined the impact of a brief ACT intervention on positive parenting strategies, psychological flexibility, and distress among parents who have experienced relationship violence.As part of a larger study, 43 parents were recruited from a community outreach center and completed measures of parenting, ACT processes, and distress. Participants were pseudo-randomly assigned to either receive their treatment-as-usual (TAU) or ACT plus TAU. Twenty-five participants received four weekly sessions of ACT plus TAU, and 18 received TAU only. Positive parenting behaviors among parents in the ACT?+?TAU group improved immediately following treatment compared to the TAU group. Improvements were maintained six weeks following treatment. The hypothesis that psychological flexibility would mediate improvements was not supported.The present study provides initial, preliminary support for the secondary benefits of brief, broad ACT interventions for positive parenting behaviors among parents who have experienced relationship violence. Clinical implications for implementing ACT for parents who have experienced relationship violence and methodological limitations are discussed.     

Fatal complications related to diagnostic barium enema

Thousands of barium enemas are performed in the United States each year without incident. Occasionally complications arise, only a few of which are fatal. Perforation is the most frequent serious complication of this procedure. Two instances of fatal perforation, one colonic and the other vaginal, are described, and the relevant literature is reviewed.     

Death following accidental sodium azide ingestion

Two college students developed symptoms of poisoning following ingestion of a salt solution during a college physiology laboratory exercise. Symptoms included nausea, vomiting, diarrhea, and altered consciousness. The ingested solution was identified as isotonic buffered saline containing sodium azide in a concentration of 1.0 g/L. The solution was commercially prepared for instrumentation use only and was used inadvertently for the exercise instead of freshly preparing sodium chloride in water. One student drank three sips of the solution and survived. The other student drank 700 to 800 mL and over several days became progressively ill, suffering myocardial damage and cardiac dysrhythmias, and, finally, died. Toxicologic studies confirmed the presence of azide in an antemortem urine sample from the deceased. Sodium azide is an uncommon but potent poison which can cause serious illness and death.     

Age-related variation in the interstitial tissues of the cardiac conduction system; and autopsy study of 230 Han Chinese

The amount of fatty and fibrous tissues in 230 Han Chinese who died of noncardio-vascular diseases has been studied by a semi-quantitative method and analysed by chi-square test. The results have shown some consistency. Generally, in the sino-atrial node (SAN), fibrosis and fatty influtratin appear only after 40 years of age and increase one grade with every 20 years. The atrio-ventricular node (AVN) showed fatty change after 30 years of age and fibrosis appeared after 60. In the His bundle (HB), fatty infiltration and fibrosis appear after 40 years. The left bundle branch (LBB) showed similar changes. The appearance of fibrosis in the AVN seems to be later than that reported by Lev.     

Mountaineering fatalities on Mount Rainier, Washington, 1977-1997: autopsy and investigative findings.

Mountain climbing is a popular recreational activity with a growing number of participants and associated fatalities. To define the characteristics of these fatal incidents and the typical autopsy findings in the victims, we reviewed the autopsy and investigative findings of all fatalities that occurred on Mount Rainier from 1977 through 1997. A total of 50 deaths occurred in 29 separate incidents. Fifty-eight percent of accident victims died as the result of a fall; another 34% died as a result of an avalanche. The incidents leading to death occurred at an average altitude of 3652 m (11,977 feet); range, 2073 to 4389 m (6800-14,400 feet). The average age of the victims was 31.2 years (range, 17-55 years), and 47 of the 50 were men (94%). Bodies were not recovered in 13 cases (26%). Autopsies were performed in 30 of the remaining 37 cases. At autopsy, the cause of death was ascribed to multiple injuries in 12 cases (40%), isolated head and neck injuries in 7 cases (23%), and chest injuries in 1 case (3%). Asphyxia and hypothermia were the cause of death in 8 cases (27%) and 2 cases (7%), respectively. The frequency of specific injuries is presented by anatomic region. The unique autopsy and investigative features of mountaineering deaths are discussed.