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The pink teeth phenomenon was first reported in people who died by hanging or drowning in 1829. In recent years, there have been many reports that the occurrence of postmortem pink teeth is closely related to the condition of surroundings and time after death rather than to the cause of death, as had previously been thought. We observed pink teeth in 68 of 324 unidentified cadavers autopsied during 2015–2021, and we investigated the relationship of pink teeth with age, sex, cadaveric condition, time after death, tooth type, and cause of death. The results showed no significant differences in the occurrence of pink teeth according to sex or place of discovery (indoors, outdoors, or in water). Pink teeth tended to be observed below the age of 60 years. In the 68 cases with pink teeth, 29.1% of all vital teeth were affected, with the anterior teeth being most common. No evidence was found that supported an association between pink teeth and cause of death. These results are largely consistent with recent reports on postmortem pink teeth. As it stands, the pink teeth phenomenon may be nonspecific and must not be misinterpreted in medico‐legal investigations. This case series provides further evidence supporting recent reports and contributes to clarifying in greater detail the mechanisms of the coloration and fading of pink teeth. [ABSTRACT FROM AUTHOR]

Diagnosis of sepsis-related death by autopsy is often a complex process. Presepsin (PSEP) is typically used as a marker for diagnosing sepsis after death; however, its efficacy remains unclear. In the present study, we compared the levels of PSEP, C-reactive protein (CRP), and procalcitonin (PCT) in the postmortem serum of femoral blood to determine their efficacies as biomarkers for the postmortem differentiation of sepsis. Patients (n = 93; 48 males, 45 females with a mean age: 62.8 ± 19.2 years) who were admitted to and died in hospitals were screened for sepsis based on the sequential organ failure assessment score, and those with clinically confirmed sepsis were assessed in this study. All patients underwent autopsy within 48 h (n = 44 patients) or 48-96 h (n = 49 patients) of death. The cadavers were divided into two groups using the Sepsis-3 criteria: control group (n = 74) comprising patients without clinically diagnosed sepsis, and the group of patients who were clinically diagnosed with sepsis (n = 19). The area under the curve values (AUCs) for CRP, PCT, and PSEP levels in the sepsis group were 0.83, 0.817, and 0.977, respectively, with optimal cutoff levels of 7 mg/dL (sensitivity: 78.9%, specificity: 77.0%) for CRP, 0.07 ng/mL (sensitivity: 84.2%, specificity: 68.9%) for PCT, and 1250 pg/mL (sensitivity: 100.0%, specificity: 91.9%) for PSEP. No significant differences were noted for PSEP levels for gender, age, elapsed time after death, and the presence or absence of postmortem trauma. The present study demonstrated that compared to CRP and PCT, PSEP is a superior biomarker for the postmortem differentiation of sepsis and that a concentration >1250 pg/mL is highly likely to indicate sepsis within 96 h of death. This is the first report confirming the superiority of PSEP for diagnosing sepsis after death. [ABSTRACT FROM AUTHOR]

• PSA tests are used in forensics to screen for the presence of semen. • Of 52 PSA-positive autopsy vaginal swab samples, 63% had no sperm detected. • The proportion of false-positives in positive PSA results increased with the age of the subject. • The proportion of false-positives in positive PSA results was not associated with the cause of death or postmortem interval. • The proportion of false-positives in positive PSA results was not associated with drug/alcohol in the blood/urine. Prostate-specific antigen (PSA) tests are used in forensics to conduct rapid screening for semen in vaginal swab samples from alleged victims of sexual abuse. Although PSA membrane tests have been applied to autopsy specimens, no study has evaluated predictors of false-positive test results in relation to factors such as age, cause of death, postmortem interval, drugs, and alcohol. This study describes the results obtained with the Seratec® PSA SemiQuant Kit test in 283 deceased women, with or without a history of sexual assault. Overall, 18.4% (52/283) of the vaginal swab samples tested positive for PSA. However, 63.5% (33/52) of the PSA-positive vaginal swab samples had no sperm detected. The proportion of false-positives in positive PSA results was 94.4% in those aged over 60 years. Multivariate logistic regression for PSA-positive samples showed that the proportion of false-positives in positive PSA results increased with the age of the deceased. However, the cause of death, postmortem interval, and presence of drugs or alcohol in the blood or urine of the deceased did not affect the PSA determination. These results show that PSA membrane tests are relatively unreliable and can be misleading, especially when derived from vaginal swab samples of older women, obtained at autopsy. In forensic cases, positive PSA screening test results may have an impact on subsequent legal actions and criminal charges brought against the accused. These findings are important for both forensic pathologists and the police to ensure accurate screening of older women in cases of suspected sex crimes. [ABSTRACT FROM AUTHOR]

• This is the first forensic autopsy report of fatal anaphylaxis after first cetuximab administration. • A male patient with metastatic colon cancer died soon after initial cetuximab administration. • The patient had high blood tryptase level after receiving cetuximab. • Cetuximab- and beef-specific IgE were detected in his blood before administration. • Cetuximab-induced anaphylaxis due to α-gal syndrome may be the cause of death. Cetuximab is mainly used for the treatment of advanced and metastatic colorectal cancer. Owing to the oligosaccharide galactose-α-1,3-galactose (α-gal) in its heavy chain, cetuximab can induce severe IgE-dependent anaphylaxis. α-Gal is also the antigen responsible for α-gal syndrome, known as mammalian meat allergy. Patients with α-gal syndrome may suffer from cetuximab-induced anaphylaxis at the first administration because of developed α-gal-specific IgE antibodies. A male patient in his 50 s with metastatic colon cancer was receiving chemotherapy involving scheduled cetuximab administration. However, he died soon after the first administration. Forensic autopsy confirmed rectal cancer, metastatic rectal cancer in the liver, and renal cancer. Laboratory blood tests revealed the presence of cetuximab- and beef-specific IgE antibodies before cetuximab administration and an extremely high level of tryptase after administration. Thus, we determined that the death was caused by cetuximab-induced anaphylaxis due to the preexisting α-gal syndrome. To the best of our knowledge, this is the first autopsy case report in forensic medicine of fatal anaphylaxis after initial cetuximab administration. [ABSTRACT FROM AUTHOR]

Acupuncture is one of the most popular oriental medical techniques in China, Korea and Japan. This technique is also popular as alternative therapy in the Western World. Serious adverse events are rare following acupuncture, and fatal cases have been rarely reported. A male in his late forties died right after acupuncture treatment. A medico-legal autopsy disclosed severe haemorrhaging around the right vagus nerve in the neck. Other organs and laboratory data showed no significant findings. Thus, it was determined that the man could have died from severe vagal bradycardia and/or arrhythmia resulting from vagus nerve stimulation following acupuncture. To the best of our knowledge, this is the first report of a death due to vagus nerve injury after acupuncture. [ABSTRACT FROM AUTHOR]

Abstract: A 64-year-old male was found dead in his house with his face covered with blood and a 38-caliber revolver between his legs. He had been suffering from type 2 diabetes mellitus and aftereffects of cerebral infarction. Autopsy revealed a normal round contact wound in the left lateral cervical region. A bullet from the firearm had entered through the left lateral cervical region and traveled to the outer right sternocleidomastoid muscle. This also triggered another wound from the fifth cervical vertebra to the muscle tissue near the right cartilage thyroid. At the end of this channel, there were three bone fragments. Here, we report this interesting case with two channels caused by a bullet and by a resulting bone fragment. We also discuss the characteristics of an ear lobe injury found on the victim and show how this injury and blood and skin on the revolver were used as clues to determine the posture at the time of the shot. [Copyright &y& Elsevier]

Abstract: A 54-year-old man, who lived alone, was hospitalized due to rapid deterioration of the general condition over a three-week period caused by alcoholic cirrhosis. One month after he left hospital, he was found dead in his house by his friend. Three days before he was found dead, he had met his friend and seemed to be in poor condition. Autopsy was conducted by a medical examiner to clarify the cause of death. Externally, signs of severe jaundice were apparent over the whole body, along with extensive abdominal swelling and edema of the extremities. Autopsy findings demonstrated that the abdominal cavity contained an amount of massive turbid and slight pale reddish brown ascites (23l). There were no findings of severe peritoneal inflammation. The liver (650g) was elastic hard and had a micro-nodular surface, which showed severe atrophy. Microscopic examination of the liver showed clear pseudolobule with severe fibrosis in the stroma. There were no significant changes in the heart or brain. The stomach was empty and only a slight amount of intestinal contents. There was no ethanol detected in the blood or urine. The direct cause of his death was circulatory dysfunction due to massive accumulation of the ascites. The reasons for the massive ascites accumulation over 20l in this case were (1) that he had no serious complications other than ascites; and (2) he did not have any medical treatment just before his death. [Copyright &y& Elsevier]

Abstract: In medical practice, many clinical accidents due to blood transfusion reactions have been reported, among which, nonhemolytic transfusion reactions (NHTRs) have been mainly reported in recent years. NHTRs induce reactions such as anaphylactic shock and transfusion-related acute lung injury (TRALI); however, few forensic autopsy case reports with blood transfusion reactions including anaphylactic shock have been published. A marker for anaphylactic shock is serum tryptase, which indicates systematic mast cell activation in living patients. In forensic medicine, serum tryptase has been used in the postmortem diagnosis of anaphylactic shock. In this autopsy case report, the blood tryptase level was elevated to 49.0ng/mL (reference standard level <13.5ng/mL). When considered comprehensively with autopsy findings and blood typing, we concluded that this patient was suspected to have suffered from anaphylactic shock as a result of blood transfusion. [Copyright &y& Elsevier]

Abstract: We report a fatal case of acute esophageal necrosis (black esophagus) in an elderly male with alcohol abuse who was found dead with coffee-ground vomiting. A postmortem examination revealed severe anemia and marked black coloring of the esophagus from the upper to the bottom end. This was accompanied by histologic evidence of extensive mucosal necrosis. Alcohol abuse and esophagitis-related vomiting were both considered to be factors that led to the acute fatal esophageal necrosis. The cause of death was undetermined. We discuss the possible role of acute esophageal necrosis in the cause of sudden death. [Copyright &y& Elsevier]