Sonographic Evaluation of Muscle Echogenicity for the Detection of Intensive Care Unit-Acquired Weakness: A Pilot Single-Center Prospective Cohort Study

Qualitative assessment by the Heckmatt scale (HS) and quantitative greyscale analysis of muscle echogenicity were compared for their value in detecting intensive care unit-acquired weakness (ICU-AW). We performed muscle ultrasound (MUS) of eight skeletal muscles on day 3 and day 10 after ICU admission. We calculated the global mean greyscale score (MGS), the global mean z-score (MZS) and the global mean Heckmatt score (MHS). Longitudinal outcome was defined by the modified Rankin scale (mRS) and Barthel index (BI) after 100 days. In total, 652 ultrasound pictures from 38 critically ill patients (18 with and 20 without ICU-AW) and 10 controls were analyzed. Patients with ICU-AW had a higher MHS on day 10 compared to patients without ICU-AW (2.6 (0.4) vs. 2.2 (0.4), p = 0.006). The MHS was superior to ROC analysis (cut-off: 2.2, AUC: 0.79, p = 0.003, sensitivity 86%, specificity 60%) in detecting ICU-AW compared to MGS and MZS on day 10. The MHS correlated with the Medical Research Council sum score (MRC-SS) (r = −0.45, p = 0.004), the mRS (r = 0.45; p = 0.007) and BI (r = −0.38, p = 0.04) on day 100. Qualitative MUS analysis seems superior to quantitative greyscale analysis of muscle echogenicity for the detection of ICU-AW.

[The olfactory region of the bat Scotophilus heathi. Light and electron microscopic studies]

The present investigation reports light and electron microscopical aspects of the main olfactory epithelium (MOE) of the insectivorous bat Scotophilus heathi. Serial frontal sections of the nose and associated structures reveal: 1) that the MOE is located on most of the ethmoturbinals and on the proximal upper portion of the nasal septum; and 2) that the vomeronasal organ is absent in this species. The ultrastructure of the MOE of Scotophilus heathi is similar to that observed in other vertebrates. Moreover, we did not observe significant morphological differences between the MOE of male and female animals. Nevertheless, the supra-nuclear region of the supporting cells of males and females shows a different amount and distribution of "lysosome-like" cell organelles at the two times of the year investigated.