Microvascular flow alterations in critically ill COVID-19 patients: A prospective study.

BACKGROUND: Data on microcirculatory pattern of COVID-19 critically ill patients are scarce. The objective was to compare sublingual microcirculation parameters of critically ill patients according to the severity of the disease. METHODS: The study is a single-center prospective study with critically ill COVID-19 patients admitted in ICU. Sublingual microcirculation was assessed by IDF microscopy within 48 hours of ICU admission. Microcirculatory flow index (MFI), proportion of perfused vessel (PPV), total vessel density (TVD), De Backer score (DBS), perfused vessel density (PVD) and heterogeneity index (HI) were assessed. Patients were divided in 2 groups (severe and critical) according to the World health organization definition. FINDINGS: From 19th of March to 7th of April 2020, 43 patients were included. Fourteen patients (33%) were in the severe group and twenty-nine patients (67%) in the critical group. Patients in the critical group were all mechanically ventilated. The critical group had significantly higher values of MFI, DBS and PVD in comparison to severe group (respectively, PaCO2: 49 [44-45] vs 36 [33-37] mmHg; p<0,0001, MFI: 2.8 ± 0.2 vs 2.5 ± 0.3; p = 0.001, DBS: 12.7 ± 2.6 vs 10.8 ± 2.0 vessels mm-2; p = 0.033, PVD: 12.5 ± 3.0 vs 10.1 ± 2.4 mm.mm-2; p = 0.020). PPV, HI and TVD were similar between groups Correlation was found between microcirculatory parameters and PaCO2 levels. CONCLUSION: Critical COVID-19 patients under mechanical ventilation seem to have higher red blood cell velocity than severe non-ventilated patients.

The Case of Cruse Affair for the Bordeaux Wines (Winegate) and Its Consequences on the Burgundy Wine Industry.

BACKGROUND: The aim of the study is to show how the Cruse affair known as the "Winegate" has changed the wine industry in Burgundy. Cruse, one of the major Bordeauxsellers, was caught by the Customs Office in 1973 and condemned for fraud involving 20'000 hl of Bordeaux wine. This affair has generated a loss of trust between consumers and producers and also between small wine-growers who were selling their wine to the Négociants. METHODS: The objective of this study is to focus on the consequences that this affair has generated for Burgundy growers and Négociants. The method used is the analysis of historical documents (press articles and books on Bordeaux wines) to understand through a review the Cruise affair and its consequences. RESULTS: Under consumer but also retailer pressure, more and more winegrowers in Burgundy decided to bottle the production of their estate and sell it under their own label. To a certain extent, this new development entailed a competition with Négociants. The structure of estates moved from farm style companies to small SME's in charge of vinification, ageing, selling and exporting. Finally, some recent patents related to the wine fraud and mechanisms to create the trust in the wine chain, with specific regard to intelligent label and distribution, have been considered.

Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients.

INTRODUCTION: The aim of this study was to evaluate the prognostic value of optic nerve sheath diameter (ONSD) measured on the initial brain computed tomography (CT) scan for intensive care unit (ICU) mortality in severe traumatic brain injury (TBI) patients. METHODS: A prospective observational study of all severe TBI patients admitted to a neurosurgical ICU (over a 10-month period). Demographic and clinical data and brain CT scan results were recorded. ONSD for each eye was measured on the initial CT scan. The group of ICU survivors was compared to non-survivors. Glasgow Outcome Scale (GOS) was evaluated six months after ICU discharge. RESULTS: Seventy-seven patients were included (age: 43±18; 81% males; mean Injury Severity Score: 35±15; ICU mortality: 28.5% (n=22)). Mean ONSD on the initial brain CT scan was 7.8±0.1 mm in non-survivors vs. 6.8±0.1 mm in survivors (P<0.001). The operative value of ONSD was a good predictor of mortality (area under the curve: 0.805). An ONSD cutoff≥7.3 had a sensitivity of 86.4% and a specificity of 74.6% and was independently associated with mortality in this population (adjusted odds ratio 95% confidence interval: 22.7 (3.2 to 159.6), P=0.002). There was a relationship between initial ONSD values and six-month GOS (P=0.03). CONCLUSIONS: ONSD measured on the initial brain CT scan is independently associated with ICU mortality rate (when ≥7.3 mm) in severe TBI patients.See related commentary by Masquère et al.,http://ccforum.com/content/17/3/151.