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PubMed1994

Pattern of injury in those dying from traumatic amputation caused by bomb blast.

Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products.

Amputation, Traumatic↗
PubMed1989

Molecular analyses of in vivo hprt mutant T cells from atomic bomb survivors.

In vivo-derived hprt-deficient mutant T cells isolated from three nonirradiated controls and two atomic bomb survivors were studied by Southern blot analysis to investigate the molecular spectra of the mutations. Mutant frequencies for the three controls were 1.8, 2.3, and 7.3 x 10(-6), and those for the two survivors (who had received radiation doses of 2.46 and 2.15 Gy, based upon the revised atomic bomb shielded kerma estimates) were 9.3 and 14.4 x 10(-6), respectively. Fourteen (13%) of 105 mutant T-cell colonies from the controls showed various structural changes in the hprt gene. The frequency of mutants with hprt gene structural changes in one atomic bomb survivor, who exhibited a mutant frequency of 9.3 x 10(-6), was 26% (16/61), which was significantly higher than that of the controls. However, the frequency of structural changes in the other survivor (14%, 8/59) was not higher than that of the controls. Two sets of mutants (in total, eight mutants) from the survivor, who showed a significantly higher frequency of mutants with hprt gross alterations than did the controls, had the same hprt changes and the same rearrangements of T-cell receptor (TcR) beta- and gamma-chain genes, indicating a clonal expansion from one progenitor mutant. This phenomenon may reflect an in vivo recovery process of T cells in the periphery after exposure to atomic bomb radiation. However, when comparing the frequency of mutations, these two sets of mutants should be reduced. After reducing the total number of mutants from the number of gross hprt changes, the frequency was not significantly higher than that of the controls.

Blotting, Southern↗
PubMed1992

The use of an oxygen bomb as an alternative method for digestion of fish tissue for total mercury analysis.

One of the major time consuming steps in many of the methods used for the analysis of fish tissue for total mercury is the wet oxidation by concentrated acids. This paper compares the use of an oxygen bomb with the nitric/sulfuric acid wet oxidation technique for the determination of total mercury in fish tissue. No significant differences existed in the concentrations obtained by wet oxidation and bomb oxidation with absorption by deionised distilled water. When only a small number of samples (< 5) is to be analysed the oxidation bomb is quicker than published techniques. The oxygen bomb technique lacks the hazardous problems associated with the use of concentrated acids and produces a digest suitable for the determination of other elements but has a requirement for added capital cost.

Animals↗
PubMed2004

Deaths due to terrorist bombings in Istanbul (Turkey).

Our study was based on a retrospective analysis of terrorist bombing related deaths in Istanbul (Turkey) between 1976 and 2000. A total of 45,714 autopsy case reports from the Morgue Department of Council of Forensic Medicine were reviewed for this study. There were 120 (0.26%) deaths due to terrorist bombing. Terrorist bombing related deaths were significantly higher during the years of increasing terrorism events in Turkey. Ninety-eight (81.7%) of cases were male and 22 (18.3%) of cases were female. The most frequent age groups of victims and terrorists was between 21 and 30 years of age (n=60; 50% of the total cases). In 49 events only one death occurred. The highest mortality was 24 in a single event. In this study, we have renewed of characteristics traumatic lesion to ascertain the cause of deaths and other autopsy findings in victims and terrorists. We also emphasize that scene investigation and medico-legal autopsy are the most important procedures provide appropriate information about deaths due to terrorist bombings.

Autopsy↗
PubMed2004

Three modules of zebrafish Mind bomb work cooperatively to promote Delta ubiquitination and endocytosis.

Precise regulation of Notch signaling activity is critical for development of many different tissues. Here, we show that the zebrafish insertional mutation Hi904 attenuates Notch signaling, and is allelic to mind bomb. We show that Mind bomb protein displays E3 ubiquitin ligase activity in vitro and that it is associated with Delta and enhances its ubiquitination and internalization in transfected cells. Furthermore, by functional analysis of three conserved regions of Mind bomb, we show that the N-terminal half is required for Delta association, the ankyrin repeats are important for Delta internalization, and the ring fingers are required for Delta ubiquitination. Thus, the three functionally distinct modules of Mind bomb work cooperatively to regulate Notch signaling by associating with, ubiquitinating, and internalizing Delta.

Amino Acid Sequence↗
PubMed2000

Longevity of atomic-bomb survivors.

BACKGROUND: Conflicting claims have been made regarding biological and health consequences of exposure to low doses of radiation. Studies have suggested that certain low-dose exposed atomic-bomb survivors live longer than their peers. Earlier studies in other radiation-exposed populations demonstrated life shortening from mortality from cancer but lacked dosimetry and relied on comparison groups which may introduce bias because of lack of comparability. We have re-examined the effect of radiation on life expectancy in one cohort of survivors of the atomic bombings of Hiroshima and Nagasaki, Japan. METHODS: We did a prospective cohort study of 120,321 survivors. The study encompasses 45 years of mortality follow-up with radiation-dose estimates available for most cohort members. We calculated relative mortality rates and survival distribution using internal comparison (cohort-based estimation of background mortality). FINDINGS: Median life expectancy decreased with increasing radiation dose at a rate of about 1.3 years per Gy, but declined more rapidly at high doses. Median loss of life among cohort members with estimated doses below 1 Gy was about 2 months, but among the small number of cohort members with estimated doses of 1 Gy or more it was 2.6 years. Median loss of life among all individuals with greater-than-zero dose estimates was about 4 months. INTERPRETATION: These results are important in light of the recent finding that radiation significantly increases mortality rates for causes other than cancer. The results do not support claims that survivors exposed to certain doses of radiation live longer than comparable unexposed individuals. Because the cohort was intentionally constructed to contain a higher proportion of high-dose atomic-bomb survivors, average loss of life among all exposed atomic-bomb survivors would be less than the 4 months found for the study cohort.

Aged↗
PubMed2000

Ocular injuries sustained by survivors of the Oklahoma City bombing.

OBJECTIVE: The purpose of this study is to provide a review of the ocular injuries sustained by survivors of the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The authors retrospectively evaluated data collected on all surviving persons receiving ocular injuries during the bombing and on all at-risk occupants of the federal building and four adjacent buildings. METHODS: Injury data from survivors were collected from multiple sources to include hospital medical records, a physician survey, emergency medical services run reports, written survivor accounts, building occupant survey, telephone interviews, and mail surveys. MAIN OUTCOME MEASURES: The types of ocular injuries, the associated systemic injuries, and the location of the injured at the time of the blast were evaluated. RESULTS: Fifty-five (8%) of the 684 injured bombing survivors sustained an ocular injury. Persons injured in the Murrah building were more than three times more likely to sustain an ocular injury than other injured persons. Seventy-one percent of ocular injuries occurred within 300 feet of the point of detonation. The most common serious ocular injuries included lid/brow lacerations (20 patients, 23 eyes), open globe injuries (12 eyes), orbital fractures (6 eyes), and retinal detachment (5 eyes). A retained intraocular foreign body accounted for only two of the injuries (4%). Glass accounted for nearly two thirds of the ocular injuries. CONCLUSIONS: Blasts involving explosions inflict severe ocular injury, mostly as a result of secondary blast effects from glass, debris, etc. Eye injuries in bombings can probably be prevented by increasing the distance from and orientation away from windows (i.e., by facing desks away from windows). Use of such products as laminated glass, toughened window glazing, and Mylar curtains may reduce glass projectiles in the blast vicinity.

Adolescent↗
PubMed2003

HLA haplotype is associated with diabetes among atomic bomb survivors.

We examined radiation effects on the relationship between diabetes development and genetic background in atomic-bomb (A-bomb) survivors. Our main aim in this study was to shed light on the role of genetic background in diabetes onset among A-bomb survivors by studying possible relationships between human leukocyte antigen (HLA) genotypes and the diabetes in patients and controls. We examined the effects of different HLA haplotypes on type 2 diabetes development by determining the DQA1 and DRB1 alleles of Hiroshima A-bomb survivors (111 diabetic patients and 774 controls) using the polymerase chain reaction-sequence specific oligonucleotide probes (PCR-SSOP) method. We noted an increased risk of diabetes in the higher dose group among these patients (trend p = 0.001). The risk of the most heavily exposed group was significantly higher than that of the unexposed group or the low-dose group especially in survivors with the DQA1*03-DRB1*09 or DQA1*0401-DRB1*08 haplotypes (trend p = 0.002 or p = 0.05, respectively). By contrast, in people with other haplotypes, the risk did not increase significantly with increasing dose. These results suggest that individuals with specific HLA haplotypes may have an increased risk of diabetes with increased-dose categories.

Aged↗
PubMed2006

The phenomenon of suicide bombing: a review of psychological and nonpsychological factors.

This article reviews the literature on the phenomenon of suicide bombing. It addresses the question of just how much a psychological understanding of the individuals involved can aid in prevention. The article looks at historical, epidemiological, and cultural perspectives and compares the nonpsychological and psychological approaches to suicide bombing. On the basis of the material available it seems that social processes such as group-dynamic indoctrination and political factors are decisive in analyzing this problem. Cultural, nationalistic, and religious factors are important. The conclusion is that in suicidal bombing, suicide is instrumental in the context of war, not in the context of psychopathology. Suicide bombing is instrumental in realizing fatalities, and it is only one of many weapons. The act of killing in warfare is more important to understanding suicidal terrorism than the act of suicide. This explains why psychological profiling of suicidal terrorists has to date not been successful.

Explosive Agents↗
PubMed2002

The proportion of thyroid cancers in the Japanese atomic bomb survivors associated with natural background radiation.

Generalised absolute and relative risk models (with adjustment to the excess absolute risk for time since exposure and age at exposure, and with adjustment to the excess relative risk for age at exposure) are fitted to the Japanese atomic bomb survivor thyroid cancer incidence data followed up over the period 1958-87, taking account of natural background radiation. Thyroid cancers associated with natural background radiation and atomic bomb radiation are overwhelmingly accounted for by exposure at young ages. Over 50% of the excess cases associated with either the atomic bomb radiation or natural background radiation are linked to exposures under the age of 20, irrespective of the assumed risk model or natural background dose rate. The excess risk is overwhelmingly concentrated among females, again irrespective of the assumed model or natural background dose rate. Depending on the assumed natural background dose rate (in the range 0.5-2.0 mSv/year) between 17.3 and 32.0% of the thyroid cancer in this cohort may be associated with natural background radiation if an absolute risk model applies; between 4.2 and 17.1% of the thyroid cancers may be associated with natural background radiation if the relative risk model applies. The proportion of the thyroid tumours attributed to the atomic bomb radiation is between 21.1 and 22.0% for the absolute risk model, and is between 18.7 and 19.1% for the relative risk model, in both cases irrespective of the assumed background radiation dose. In particular, these proportions are not very different from the proportions calculated when fitting models that do not take account of natural background radiation, namely 22.0% for the absolute risk model and 18.6% for the relative risk model. The proportion of thyroid cancers accounted for by natural background radiation progressively increases with attained age, from 0.3% of cancers among those under the age of 15 to 30.5% for those over the age of 60, assuming that the absolute risk model applies. There is a similar increase in this percentage, if to a rather lower level (from 0.2 to 10.2%), assuming that the relative risk model applies.

Adolescent↗
PubMed1995

Spectrum of in vivo hprt mutations in T lymphocytes from atomic bomb survivors. I. Sequence alterations in cDNA.

Recently, we found an elevated frequency of 6-thioguanine-resistant (TGr) mutations at the hyoxanthine-guanine phosphoribosyltransferase (hprt) gene in T cells of peripheral blood from atomic bomb survivors and a slight, but significant, positive correlation between the frequency of mutation and radiation dose. Southern blot analysis of DNA from TGr mutant T cells of atomic bomb survivors, however, failed to show a significant difference between the control and survivor groups. We here report mutational events at the hprt locus of TGr mutant T cell clones from atomic bomb survivors as found by (i) the multiplex polymerase chain reaction (PCR) and (ii) the reverse transcription (RT)-PCR of cDNA and sequencing. The numbers of independent TGr mutant T cell clones examined were 41 from a control group of 18 individuals who had received less than 0.005 Gy and 50 from an exposed group of 24 individuals who had received more than 1.5 Gy (mean dose 2.45 +/- 0.85 Gy). Gross structural alterations, which were detected by multiplex PCR as a loss of or shift in hprt exon-containing fragments of genomic DNA, were found in 10-15% of the clones from both groups, thus indicating that there was no significant difference between them. The altered sequences in the HPRT cDNAs recovered from both groups were of various types. Similar proportions of base substitutions (approximately 45%), deletions or insertions (approximately 25%) and exon skipping (approximately 20%) were found in both groups, indicating that neither the gross structural alterations in the genomic DNA nor sequence alterations in the hprt cDNA of both groups differ significantly. These results confirm our previous observation that A-bomb-induced HRT- mutant T cells have mostly been eliminated from the peripheral blood over the decades that have elapsed since exposure. Some unique features of the mutational sequence alterations found are also described.

Adult↗
PubMed2004

Experimental simulation of A-bomb gamma ray spectra: revisited.

It has been reported recently that the A-bomb gamma ray spectra received by the colon of the average Japanese survivor of Hiroshima and Nagasaki may be experimentally simulated using a hospital-based Philips SL15 linear accelerator. The simulated A-bomb gamma radiation may be used in radiobiology experiments to determine, amongst other things, the biological effectiveness of the A-bomb gamma radiation. However, in that study, the electron beams from the linear accelerator were poorly defined and photon contamination was ignored. In the study reported here, a Varian Clinac 2100C linear accelerator has been used for the same purpose but with photon contamination included in better defined output electron beams. It is found that the A-bomb gamma radiation can still be matched to an acceptable degree (<10%). The cause of the slightly poorer fit was due mainly to the different ranges of energies available from the linear accelerators used. The absorbed dose received by model breasts was also estimated in this study for the same situations as in the previous study. The ratio of the breast to colon doses was found to be only (3.9 +/- 4.0)% low compared with the expected values of 1.17 and 1.16 for Hiroshima and Nagasaki, respectively. These results provide further confirmation of the acceptability of the simple cylindrically symmetrical body models employed in these studies to represent the average Japanese survivor.

Breast↗
PubMed1988

Terrorist bombings. Lessons learned from Belfast to Beirut.

Experience in the management of mass casualties following a disaster is relatively sparse. The terrorist bombing serves as a timely and effective model for the analysis of patterns of injury and mortality and the determination of the factors influencing casualty survival in the wake of certain forms of disaster. For this purpose, a review of the published experience with terrorist bombings was carried out, providing a study population of 3357 casualties from 220 incidents worldwide. There were 2934 immediate survivors of these incidents (87%), of whom 881 (30%) were hospitalized. Forty deaths ultimately occurred among these survivors (1.4%), 39 of whom were among those hospitalized (4.4%). Injury severity was determined from available data for 1339 surviving casualties, 251 of whom were critically injured (18.7%). Of this population evaluable for injury severity, there were 31 late deaths, all of which occurred among those critically injured, accounting for an overall "critical mortality" rate of 12.4%. Overall triage efficiency was characterized by a mean overtriage rate (noncritically injured among those hospitalized or evacuated) of 59%, and a mean undertriage rate (critically injured among those not hospitalized or evacuated) of .05%. Multiple linear regression analysis of all major bombing incidents demonstrated a direct linear relationship between overtriage and critical mortality (r2 = .845), and an inversely proportional relationship between triage discrimination and critical mortality (r2 = 0.855). Although head injuries predominated in both immediate (71%) and late (52%) fatalities, injury to the abdomen carried the highest specific mortality rate (19%) of any single body system injury among immediate survivors. These data clearly document the importance of accurate triage as a survival determinant for critically injured casualties of these disasters. Furthermore, the data suggest that explosive force, time interval from injury to treatment, and anatomic site of injury are all factors that correlated with the ultimate outcome of terrorist bombing victims. Critical analysis of past disasters should allow for sufficient preparation so as to minimize casualty mortality in the future.

Abdominal Injuries↗
PubMed1987

Delayed effects of low-dose radiation on cellular immunity in atomic bomb survivors residing in the United States.

Several parameters of cellular immune function were assessed among persons who survived the 1945 atomic bombs in Hiroshima and Nagasaki but who now reside in the United States. The subjects in this study were exposed to various low doses (T65D) of radiation at the time of the bomb. More than half received an estimated 0 Gy (S0 group). Of those exposed to more radiation (S+ group), nearly 90% received less than 0.50 Gy (50 rad). Lymphocytes were isolated from the peripheral blood of these individuals and were assessed for the following parameters of cellular immunity: mitogenic response to phytohemagglutinin, mitogenic response to allogeneic lymphocytes, natural cell-mediated cytotoxicity (NCMC), and interferon production. In every case, the response of the S+ group was greater than that of the S0 group, although only the difference for NCMC was statistically significant. Results of studies presently being performed on A-bomb survivors residing in Hiroshima do not confirm this difference. Therefore, it is difficult to say whether the increase in natural cytotoxicity observed among the American and not the Japanese A-bomb survivors exposed to very low doses of radiation is a hormetic effect which was modulated by post-radiation environmental conditions or a result of selective migration.

Cytotoxicity, Immunologic↗
PubMed1988

Medical x-ray exposure doses as contaminants of atomic bomb doses.

Since 1967 at the times of their biennial ABCC/RERF radiological examinations, all Adult Health Study (AHS) subjects have been interviewed to determine the exposures to medical x-rays they experienced in institutions other than RERF in order to estimate the numbers of examinations and corresponding doses which they received. These data have been stored on computer tapes together with the doses these subjects received during their radiological examinations in the ABCC/RERF Department of Radiology. Thus, their medical x-ray doses are available along with their atomic bomb doses (tentative 1965 doses revised, T65DR) for assessment of the role of ionizing radiation in the development of diseases. The medical x-ray doses incurred at RERF were assessed by means of phantom dosimetry. Those at other institutions were determined using phantom dosimetry data and results of surveys for trends in radiological examinations in Hiroshima and Nagasaki. By the end of 1982, the average medical x-ray doses to the active bone marrow were 12.04 mGy for A-bomb exposed groups and 8.92 mGy for control groups (not-in-cities); to the male gonads, 2.26 mGy and 1.89 mGy, respectively; and to the female gonads, 17.45 mGy and 12.58 mGy, respectively. Results for Hiroshima and Nagasaki were similar. The main impact of medical x-ray doses was in the lowest T65DR group. Medical x-ray active bone marrow doses ranged from 0.05-500% (mean, 35%) of A-bomb doses in the 10-99 mGy T65DR group. In the 100-999 mGy T65DR group, medical x-ray active bone marrow doses ranged from 0.005-50% (mean, 5%) of their T65DR. In the greater than 1,000-mGy T65DR group, medical x-ray exposures were proportionally less. Female active bone marrow and gonad doses were similar in magnitude to the male active bone marrow doses. Medical x-ray exposures produced smaller doses to the gonads of males than to those of the females. The use of medical x-rays is steadily increasing. Careful consideration of doses from medical sources is essential for reliable assessments of the effects from exposures to the atomic bombs.

Adult↗
PubMed1999

A method to detect low-level 63Ni activity for estimating fast neutron fluence from the Hiroshima atomic bomb.

The Hiroshima and Nagasaki atomic bombs resulted in the worst reported exposure of radiation to the human body. The data of survivors have provided the basis for the risk estimation for ionizing radiation, and thus are widely used as the basis of radiation safety. In this report we have studied a new method to detect the low-level 63Ni activity in copper samples in order to estimate the fast neutron fluence from the Hiroshima atomic bomb. Only 0.8 x 10(-3) Bq g(-1) of 63Ni is expected to be produced by the atomic bomb in a copper sample with the 63Cu(n, p)63Ni reaction at a distance of 500 m from the hypocenter. Our method has the required level of sensitivity for determination of the fast neutron fluence out to distances of at least 500 m, and perhaps as far as 1,000 m. We have already investigated and collected some bomb-irradiated copper samples for further study.

Beta Particles↗
PubMed2005

Medical consequences of terrorist bombs containing spherical metal pellets: analysis of a suicide terrorism event.

OBJECTIVE: Various metal objects added to explosives increase and diversify the wounding from bombing; especially favoured are spherical missiles for their special injuring characteristics. Our objective was to study the medical consequences and ballistic effects on human tissue of spherical metal pellets used in terrorist bombings. METHODS: The clinical and forensic data of all bodily injured casualties of a suicide terrorist bombing in a crowded hotel dining room were analysed retrospectively. RESULTS: Of the 250 people at the scene, 164 were injured, with 91 (55.5%) suffering bodily injuries; 30 of them died. The immediately deceased had disseminated tissue damage and their bodies were saturated with steel spheres. Thirty-two immediate survivors sustained severe injuries (Injury Severity Score > or =16), and all suffered tissue penetration by the pellets. Twenty-three (32%) underwent surgery and 15 (21%) required intensive care. CONCLUSIONS: Metal pellets propelled by the explosion enhanced the secondary pattern of injury and injured even patients remote from the origin. Tissue destruction and specific organ injuries among survivors were limited. To evaluate and manage victims of terrorist bombings properly, medical teams should become familiar with these severe injuries.

Abbreviated Injury Scale↗
PubMed1999

Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing.

OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.

Adolescent↗