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A 17-year-old male with no previous medical history was admitted 2 days before his death to a local hospital after mild dyspnea. Electrocardiography, chest radiography, and blood analysis revealed no abnormalities. Blood oxygen saturation was 99%, and SARS-CoV-2 nasopharyngeal swabs tested negative; thus, he was discharged without prescriptions. After 2 days, the subject died suddenly during a pool party. Forensic autopsy was performed analyzing all anatomical districts. Cardiac causes were fully excluded after deep macroscopic and microscopic evaluation; lung and brain analyses showed no macroscopic pathology. Finally, a large subglottic solid mass was detected. The whitish neoplasm showed an aggressive invasion pattern to the thyroid and adjacent deep soft tissues and occluded the trachea. High-power microscopy showed sheets of small, uniform cells with scant cytoplasm; round nuclei; and small, punctate nucleoli, with immunohistochemical expression of CK8-18, AE1/AE3, and CD99. Using FISH analysis, the break-apart molecular probes (EWSR1 (22q12) Break – XL, Leica Biosystem, Nussloch, Germany) showed distinct broken red and green fluorochromes, diagnostic of Ewing sarcoma. The neoplasm was characterized as adamantinoma-like Ewing sarcoma, and the mechanism of death was identified as airway obstruction. The rarity of the case resides in the circumstances of death, which pointed to the possibility of sudden unexpected death due to heart disease, but an oncological cause and the underlying mechanism were finally diagnosed. The best method to perform autopsies is still complete, extensive, and systematic macroscopic sampling of organs and districts followed by histopathological analysis, in addition to immunohistochemical and molecular investigations in those cases in which they are necessary. In fact, when neoplasms are detected, the application of advanced techniques such as immunohistochemistry and molecular diagnostics is fundamental to accurately certify death. [ABSTRACT FROM AUTHOR]

Near-infrared spectroscopy (NIRS) has been widely used in cardiac surgery to monitor cerebral oxygen supply. The initiation and perioperative management of cardiopulmonary bypass (CPB) constitute critical events in modifying the normal physiology of adequate blood and oxygen supply to the brain. First, little is known about how frequent NIRS is really used. Second, there are varying practices on how to initiate CPB. We therefore conducted a survey in Germany to get an idea of NIRS usage in cardiac surgery for the duration of initiation of CPB protocols. A web-based e-mail survey using commercial SurveyMonkeyVR (SurveyMonkey, San Mateo, CA) software was conducted in August 2017 including all German cardiac surgery centers. About 75% of the perfusion departments do not use NIRS as a standard monitoring device. It is usually reserved for clinical scenarios where cerebral perfusion might be impaired such as aortic arch surgery or carotid artery stenosis. Only onethird of the departments use a standardized duration of initiation of CPB despite a common belief of potential harm with fast initiation. The usual applied time to initiate CPB ranges from 30 to 120 seconds. Our survey revealed that the NIRS technology is only used in specific types of cardiac surgery to this date. In addition, there is a clear need for scientific studies on how to initiate CPB in the best way for the patient. [ABSTRACT FROM AUTHOR]

Purpose To validate weather regional differences in retinal vessel oxygenation depend on age. Methods Fifty three healthy individuals (age range 19‐61 years; mean age 35 (SD 11) years) underwent manual sphygmomanometry, non‐contact tonometry (Keeler Pulsair, UK) and retinal vessel oxygen saturation measurements using dual wavelength oximetry (ImedosSystems, Germany). In order to analyse regional saturation differences, all vessels were grouped according to their location into major superior and inferior artery and vein as well as into macula and peripheral feeders (MF and PF respectively for arteries) and macula and peripheral drainers (MD and MF respectively for veins). Results Multiple regression analysis revealed no influence of age, blood pressure (SBP: 116 (13)mmHg, DBP:73 (11)mmHg) and intraocular pressure (12 (3)mmHg) upon arterial and venous oxygen saturation measurements (p>0.05). Superior and inferior MF, PF, MD and PD were comparable (MF: 97 (9)% and 97 (8)%, p=0.955; PF: 92 (11)% and 91 (9)%, p=0.607; MD: 87 (14)% and 85 (13)%, p=0.594; PD: 61 (14)% and 58 (16)%, p=0.381). MF and PF were significantly different in the superior and inferior retina (p=0.006 and p=0.0002) as were MD compared to PD (p<0.0001 and p<0.0001). Conclusion Regional variations in oxygen saturation of retinal arterioles and venules are independent of age, blood pressure and intraocular pressure. [ABSTRACT FROM AUTHOR]

Purpose To measure the inter‐ocular agreement of retinal vessel oxygen saturation in the peripapillary retina of healthy individuals. Methods Twelve otherwise healthy individuals (mean age 36.5 (SD 10.5)) underwent dual wavelength retinal oximetry (ImedosSystems, Germany), non‐contact tonometry (Keeler Pulsair, UK) and manual shygomanometry in both eyes on the same day. For analyses purposes the major branches of the central retinal artery and vein crossing through a circular segment located one half disc diameter (DD) away from the optic nerve head (ONH) and 1DD in width were selected from 3 consecutively taken images. Arterial and venular oxygen saturation was then used to calculate the arterio‐venous oxygen saturation difference. Results Arterio‐venous difference of peri‐papillary retinal vessel oxygen saturation showed good inter‐ocular agreement and no dependence on age, blood pressure or intraocular pressure (Right eye 37 (7)% and left eye 38 (5) %, r=0.71). Conclusion There is good inter‐ocular agreement of peri‐papillary retinal oxygenation parameters in healthy individuals. [ABSTRACT FROM AUTHOR]