Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases

Daiko Onitsuka; Takuma Nakamae; Midori Katsuyama; Machiko Miyamoto; Eri Higo; Masahiko Yatsushiro; Takahito Hayashi

doi:10.1371/journal.pone.0261348

Peer Review History

Original SubmissionAugust 28, 2021
22 Sep 2021 Decision Letter - Stephen Raverty, Editor PONE-D-21-27906Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning casesPLOS ONE Dear Dr. Hayashi, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 06 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. Additional Editor Comments: Both reviewers identified merit with your manuscript and provided valuable insights and suggestions to improve the content. Additional details have been requested for the introduction by one reviewer. Please review the comments and address accordingly in your revision. Thank you for submitting this manuscript to PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Manuscript Number: PONE-D-21-27906 Title: Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases General comments This study is the statistical analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases. Based on previous research reports, this paper found that intramuscular bleeding had a significant difference in temperature and age. This is a very interesting report. However, some amendments are needed to make it public. Major comments 1. Drowning in fresh water is known to cause premature death by fatal arrhythmia due to hemolysis of red blood cells and hyperkalemia. The author should discuss the difference in intramuscular hemorrhage between freshwater and seawater drowning.　 2. In the cases of the river, it is a brackish water area at the mouth of the river, so it should separate from the river. Minor comments 1. Please set the month corresponding to every seasons. 2. On page 6, line 126, “In patients” should be “in victims” or “in deceased”. Reviewer #2: 1. The introduction is way to short because the diagnosis of drowning is a challenging issue with so much literature to introduce. The morphological findings, that leads to the diagnosis 'drowning' must be more explained. Moreover the difficulty of the diagnosis drowning are untouched. (see e.g. Schneppe et al 2021) 2. The detection of diatomes is questioned critically, that must be mentioned (e.g. Spitz, WU 1963, Schneider, V 1980) . 3. The authors conclude, that intramuscular hemorrhages are an auxilary finding for the diagnosis of drowning. It must be clearly explained, that intramuscular hemorrhages can occur under variant other circumstances linked to suffocation. Blunt external force must be excluded. The interpretation of such hemorrhages is difficult (see e.g. Püschel, K 1999). 4. The presence of fluid blood or blood with clots is, in cases of drowning, not appropriate to estimate the survival time, because fluid blood can occur as a result of drowning. (see Keil, W 2015 in Madea 2015 Rechtsmedizin). The length of the drowning process is thought to affect the expression of the drowning sights, detectable by autopsy (see Schneppe et al 2021). The passage must be changed or removed. 5. Please check in-depth that there is no correlation between temperature and age and after that please ad an suitable advice in your text. 6. Are there any correlations between the occurance of intramuscular hemorrhages and pathological findings or the medical history (e.g. cirrhosis of the liver or anticoagulants)? 7. Please check, that phrases in your text are in a logical order: i.e. "As a result, the frequency of intramuscular hemorrhage was significantly higher (p=0.0295) in cases aged ≥65 years than in those aged <65 years (Fig 3a, frequency, 0.24 vs. 0.41). The number of muscles with hemorrhage was also significantly higher (p=0.00945) in patients 128 ≥65 years than in those aged <65 years (Fig 3b, 0.38 vs. 1.0)." The order of the details the text 1. >65 years an 2. <65 years must be the same in the brackets. 8. The conclusion, that hemorrhages in the respiratory muscles of unidentified drowned bodies is an auxiliary finding of drowning and a useful finding for age estimation needs essentials revision. 1. These hemorrhages can not be understood as "real" drowning signs (see above). 2. Age estimation is a very challenging issue, that must be performed carefully and individually. Due to the fact, that these hemorrhages even occur your cases with younger victims, they are not helpful for age estimation in a particular case. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0261348.r001
Revision 1
2 Nov 2021 Author Response Dear Academic Editor and Reviewers, We would like to thank you for your critical and instructive comments. We read the comments carefully and revised the manuscript in accordance with the reviewer’s comments, as follows. In the revised manuscripts, we indicate the modified points with highlights. Answers to Editor 1. Following the editor's comment, we checked that our manuscript format conformed to the PLOS ONE’s format and corrected any non-conformities. 2. In accordance with the editor’s comment, we ensured that we have discussed whether all data/samples/autopsy reports were fully anonymized before we accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. 3. Following the editor's comment, I obtained an ORCID ID and clicked on the Fetch/Validate link next to the ORCID field in “Update my Information” page. 4. Figure 1 shows a representative selection of autopsy photographs taken by the authors during the autopsy, with information on the sex and age of the study sample added to the legend of Figure 1 (please see page 6, lines136-138). The use of autopsy photographs in the article has been approved by the Ethics Committee as long as no individual is identified. Therefore, the images are not copyrighted. Answers to Reviewer #1: Major comments 1. In accordance with your suggestion, we added discussion concerning the difference in intramuscular hemorrhage between freshwater and seawater drowning (please see page 13, lines 284-289 of Discussion). 2. We did not include cases from estuarine areas in our study sample because, as the reviewer stated, the mechanism of death in brackish water may be different from that in seawater or freshwater drowning. We are sorry for the omission in the original version of manuscript. We have added a note in the results section that cases in brackish water were excluded (please see page 8, lines 174-175 of Result). Minor comments 1. In accordance with your suggestion, we set the month corresponding to every season (please see page 9, lines 194-196 of Result). 2. In accordance with your suggestion, we changed “in patients” to “in victims” in new page 8, line 164. We have also changed the legend in Figure 3 to reflect this (please see legend to Fig 3, page 8, line 168). Answers to Reviewer #2: 1. In accordance with your suggestion, we have included in the Introduction a more detailed description of the morphological findings suggestive of vital drowning and have added a description of the difficulties in diagnosing drowning death (please see pages 3-4, lines 46-76 of Introduction). We have also these contents to the Abstract, accordingly (please see page 2, line 23-25 of Abstract). 2. In reply to your suggestion, we noted that the usefulness of the plankton test is also debatable (please see page 4, lines 77-82 of Introduction). 3. Since we also believe that the possibility of blunt external force as a cause of the intramuscular hemorrhage assessed in this study should be ruled out, we have added descriptions in the Abstract (please see page 2, lines 38-41), Discussion (please see page 12, lines 263-266), and Conclusion sections (please see page 15, lines 333-336), respectively. We also added that intramuscular hemorrhage is also observed in other causes of death than drowning (please see page 12, lines 261-263). 4. In accordance with your suggestion, as it is inappropriate to estimate the elapsed time of drowning on the presence of fluid blood or blood with soft clots, we have deleted and modified those statements (please see page 14, lines 297-301). We have also deleted Suppl. Fig 2, accordingly. 5. In accordance with your suggestion, we examined the correlation between temperature and age and found no significant difference (please see page 5, lines 111-112 of Materials and methods, page 10, lines 214-215 of Results). Therefore, it is stated that low temperature and age are independent factors that predispose to intramuscular hemorrhage (please see page 2, lines 41-43 of Abstract, page 14, lines 310-311 of Discussion). 6. In accordance with your suggestion, we investigated the relationship between the occurrence of intramuscular hemorrhage and a potential bleeding tendency caused by disease (liver cirrhosis) and drugs (anticoagulants). The results showed that both the frequency of intramuscular hemorrhages and the number of muscles with hemorrhage were not affected by the presence or absence of bleeding tendency. This is a useful result and we have added a description of this to the Abstract (please see page 2, lines 36-38), Materials and methods (please see page 5, lines 100-101), Results (please see page 11, lines 231-236), new Fig 7 with legend (please see page 11, lines 238-240), and Discussion (please see page 15, lines 323-329, page 16, lines 340-341). 7. In reply to your suggestion, we modified the phrases in our text in a logical order (please see page 8, lines 163 and 165, page 10, lines 212 and 214, page 11, lines 225 and 226). 8. In accordance with your suggestion, we have revised the first draft because the conclusions were overstated. We have kept these intramuscular hemorrhages to the extent that they give us a clue to differentiate between drowning death and other causes of death, if we can completely rule out the possibility of trauma or other causes of death (please see page 2, lines 38-41, page 15, lines 333-336). We deleted the mention of age estimation. We hope that the revised manuscript is found to be much improved and suitable for the publication in PLOS ONE. We thank you in advance for your great kindness and look forward to your favorable reply. With my best regards, Attachments Attachment Submitted filename: Response to Reviewers.doc https://doi.org/10.1371/journal.pone.0261348.r002
1 Dec 2021 Decision Letter - Stephen Raverty, Editor Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases PONE-D-21-27906R1 Dear Dr. Hayashi, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Manuscript Number: PONE-D-21-27906 Title: Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases General comments This manuscript has been well revised, both in text and figures, in accordance reviewers' comments. As a result, the content of this paper has been further organized and made easier to understand. A reviewer consider this article has reached a level sufficient for adoption. Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No https://doi.org/10.1371/journal.pone.0261348.r003
Formally Accepted
6 Dec 2021 Acceptance Letter - Stephen Raverty, Editor PONE-D-21-27906R1 Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases Dear Dr. Hayashi: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Stephen Raverty Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0261348.r004

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