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Background The concentrations of disinfection by-products (DBPs) are varied by different water sources, disinfectants, or treatment processes in Wuxi, and the associated health risks are also different. Objective To understand the levels of trihalomethanes (THMs) and haloacetamides (HAcAms) in drinking water in Wuxi, and their variations by water sources, seasons, disinfectants or treatment processes, aiming to provide technical support for ensuring the safety of drinking water. Methods In dry period (December 2019) and wet period (July 2020), the finished water and tap water (from the beginning, middle, and end of the drinking water distribution network) from 12 centralized water treatment plants in Wuxi were collected to detect the concentrations of THMs and HAcAms in water samples. A purge and trap-gas chromatography-mass spectrometry method was applied to detect trichloromethane (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and tribromomethane (TBM), and a solid-phase extraction-gas chromatography-mass spectrometry method to detect dichloroacetamide (DCAcAm), trichloroacetamide (TCAcAm), bromochloroacetamide (BCAcAm), dibromoacetamide (DBAcAm), bromodichloroacetamide (BDCAcAm), dibromochloroacetamide (DBCAcAm), and tribromoacetamide (TBAcAm). Analyses and comparisons were made on the concentrations of THMs and HAcAms in drinking water by water sources (the Yangtze River/the Taihu Lake/reservoir), wet/dry seasons, disinfection methods (liquid chlorine/sodium hypochlorite), and treatment processes (conventional treatment/conventional+advanced treatment). Results A total of 96 drinking water samples were collected in Wuxi. THMs were positive in all the water samples (100%), with concentration ranging from 1.027 to 40.225 μg·L−1 and the M (P25, P75) concentration being 24.782 (17.784, 30.932) μg·L−1. None of the 4 THMs exceeded the standard limit of the Standards for drinking water quality (GB 5749-2022 ), and the order of the 4 THMs concentrations from high to low was TCM > BDCM > DBCM > TBM. Five of the 7 HAcAms were detected, the total concentration ranged from 0.137 to 3.288 μg·L−1, and the M (P25, P75) was 0.808 (0.482, 1.704) μg·L−1. The DCAcAm concentration was the highest (2.448 μg·L−1), followed by BCAcAm, while TCAcAm and DBCAcAm were not detected. The M (P25, P75) of the total concentration of THMs in the drinking water from the Taihu Lake was 33.353 (26.649, 36.217) μg·L−1, that of the Yangtze River was 27.448 (24.312, 31.393) μg·L−1, and both were higher than the level of the reservoir [16.359 (2.305, 21.553) μg·L−1] (P<0.05), while the M (P25, P75) of the total concentration of HAcAms in the drinking water from the Taihu Lake was 0.616 (0.363, 0.718) μg·L−1, which was lower than those of the Yangtze River [0.967 (0.355, 2.283) μg·L−1] and the reservoir [1.071 (0.686, 1.828) μg·L−1] (P<0.05). There were no statistically significant differences in the total concentrations of THMs and HAcAms between wet season and dry season, or between different disinfection methods (P>0.05). The M (P25, P75) concentrations of THMs and HAcAms in drinking water after advanced treatment process involving ozone, activated carbon, and membrane were 20.565 (3.316, 27.185) μg·L−1 and 0.623 (0.452, 1.286) μg·L−1 respectively, and were lower than the corresponding values after conventional treatment process, 28.740 (23.431, 35.085) μg·L−1 and 0.934 (0.490, 2.116) μg·L−1 respectively (P＜0.05). Conclusion The concentrations of THMs and HAcAms in drinking water in Wuxi are generally at a low level. The levels of controlled THMs meet the requirements of national standards, and the levels of uncontrolled HAcAms as new DBPs are up to μg·L−1. The concentrations of the two kinds of DBPs in drinking water vary by water sources. The concentrations of THMs and HAcAms produced by the advanced treatment process are lower than that by the conventional treatment process.
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Good sleep is essential for children′s physical and mental health, growth, and development.Adequate and high-quality sleep positively impacts children′s quality of life, memory, learning, attention, mood, and behavior.Children of different ages have different sleep needs.Children have various sleep problems in different cultures.Therefore, it is significant to guide children to get healthy sleep by popularizing the sleep problems of Chinese children of all ages and in all dimensions.Based on China′s social and cultural background, this paper summarizes the contents related to children′s sleep physiology, good sleep habits, common sleep problems, sleep apnea disorders, hypnagogic sleep, narcolepsy, insomnia, and other issues that interfere with children′s sleep.Chinese sleep experts summarize and interpret the 100 sleep health problems of children that medical workers and parents are most concerned about.To promote children′s sleep health and popularize solutions to sleep problems.
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Objective:To explore the brain electrical activity and its correlation with polysomnography monitoring parameters in children with obstructive sleep apnea syndrome (OSAS) and primary snoring.Methods:It was a prospective observational study involving children aged 6-12 years who presented to the Sleep Center of Beijing Children′s Hospital, Capital Medical University for polysomnography monitoring due to snoring at sleep from July 1 to December 31, 2019.Clinical data, polysomnography monitoring and 6-min measurement of brain electrical activity were collected from all the subjects.According to the results of polysomnography monitoring, the subjects were divided into the primary snoring group and the OSAS group at varying degrees.Based on the electroencephalogram (EEG) wavelet analysis, the brain injury index obtained by EEG synchronization and complexity analysis was used to reflect the changes of brain electrical activity in children in the resting state.Rank sum test was used to test the differences in brain injury index and the percentage of each frequency band of brainwave.Multivariate linear regression method was used to analyze risk factors for EEG activity.Results:A total of 149 children were recruited, including 110 males and 39 females.There was no significant difference in the proportions of α, θ, β and δ waves among OSAS children at varying degrees(all P>0.05). The brain injury index of the primary snoring group, mild OSAS group, moderate OSAS group and severe OSAS group was 0 (0, 3), 14 (9, 16), 26 (24, 28), and 34(30, 44), respectively.There were statistically significant differences in the brain injury index among groups ( H=129.70, P<0.01). The brain injury index gradually increased from the primary snoring group to the severe OSAS group.Multivariate linear regression analysis showed that the obstructive apnea hypopnea index (OAHI), mean oxygen saturation and minimum oxygen saturation were independently correlated with the brain injury index (all P<0.05). Conclusions:There were no significant differences in the ratios of α, θ, β and δ waves among OSAS children at varying degrees, while the EEG complexity and synchronicity varied a lot.With the increase of OAHI, the brain injury index gradually increased.The brain injury index was independently correlated with OAHI, mean oxygen saturation and minimum oxygen saturation.
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Childhood is an important period of the development of attention, memory, intelligence and other neurocognitive functions in life.A normal neurocognitive development can have a positive impact on children′s long-term learning and life.Therefore, it is very important to concern the development process of neurocognition in children, which is challenging to be objectively assessed without an accurate and efficient index.Sleep slow wave activity, as a kind of electroencephalogram measurement index, is of great significance to the evaluation of brain structure and function in children, and it is also a high-quality index to evaluate children′s neurocognitive development.This study mainly reviews the evaluation of sleep slow wave activity in children′s neurocognitive development, aiming to provide refe-rence for exploring the normal and abnormal process of children′s neurocognitive development.
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Respiratory support is the treatment of respiratory diseases.Currently, the commonly used methods of respiratory support include nasal catheter oxygen or mask oxygen, noninvasive and invasive ventilation, etc.High flow nasal cannula oxygen (HFNC) is a new kind of therapy, which was commonly used in preterm infants as the instead of continuous positive airway pressure (CPAP). However, in recent years, HFNC is more commonly used in children′s intensive care unit and general wards.In this paper, the efficacy and safety of HFNC in pediatric are reviewed.
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@#Mixed reality is a new digital hologram technology after virtual reality and augmented reality, which combines the real world with the virtual world to form a new visualization environment. At present, mixed reality has been applied in various fields, but its application in medical field is still in the exploratory stage. With the rapid development of the digital age, the prospect of the combination of mixed reality and medicine is boundless. It is believed that mixed reality will bring subversive changes in medical training, disease diagnosis, doctor-patient communication, clinical diagnosis, treatment and so on in the near future. In this paper, the application of mixed reality in medicine was summarized.
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@#Objective To investigate the short-term follow-up results of inflatable mediastinoscopy combined with laparoscopy in the treatment of esophageal cancer. Methods Clinical data of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy were enrolled in our hospital from January 2017 to January 2019. Patients were divided into two groups according to different surgical methods, including a single-port inflatable mediastinoscopy combined with laparoscopy group (group A, n=59, 53 males and 6 females, aged 63.3±7.6 years, ranging from 45 to 75 years) and a video-assisted thoracoscopy combined with laparoscopy group (group B, n=43, 35 males and 8 females, aged 66.7±6.7 years, ranging from 50-82 years). The short-term follow-up results of the two groups were compared. Results Compared with the group A, the rate of postoperative pulmonary complication of the group B was significantly lower (18.64% vs. 4.65%, P<0.05). There was no significant difference between the two groups in other postoperative complications (P>0.05). The 6-month, 1-year, and 2-year survival rates were 96.61%, 89.83%, and 73.33%, respectively in the group A, and were 95.35%, 93.02%, and 79.17%, respectively in the group B. There was no significant difference in short-term survival rate after operation (P>0.05). Conclusion In the treatment of esophageal cancer, the incidence of pulmonary complications of inflatable mediastinoscopy combined with laparoscopy is lower than that of traditional video-assisted thoracoscopy combined with laparoscopy, and there is no significant difference in other postoperative complications or short-term survival rate between the two methods. Inflatable mediastinoscopy combined with laparoscopy for radical esophageal cancer is a relatively safe surgical method with good short-term curative effects, and long-term curative effects need to be further tested.
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@#Objective To investigate the safety and efficacy of 3D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer. Methods Clinical data of 28 patients, including 25 males and 3 females, aged 51-76 years, with esophageal squamous cell carcinoma undergoing single-portal inflatable mediastinoscopic and laparoscopic esophagectomy from June 2018 to June 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a 3D mediastinoscopic group (3D group, 10 patients) and a 2D mediastinoscopic group (2D group, 18 patients). The perioperative outcome of the two groups were compared. Results Compared with the 2D group, the 3D group had shorter operation time (P=0.017), more lymph nodes resected (P=0.005) and less estimated blood loss (P=0.015). There was no significant difference between the two groups in the main surgeon's vertigo and visual ghosting (P>0.05). The other aspects including the indwelling time, postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic fistula, recurrent laryngeal nerve injury were not statistically significant between the two groups (P>0.05). Conclusion The 3D inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer, which optimizes the surgical procedures of 2D, is safe and feasible, and is worthy of clinical promotion in the future.
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Objective@#To evaluate the endothelial function in obstructive sleep apnea syndrome(OSAS) children and to identify related factors of endothelial dysfunction.@*Methods@#This was a cross-sectional study. Children with habitual snoring (snoring ≥3 nights per week) admitted to the ward of otolaryngology, head and neck surgery, Beijing Children′s Hospital were recruited to this study between 1st June 2015 and 1st March 2016. All children aged 3 to 11 years and of them 245 were boys and 110 were girls. All subjects underwent an overnight polysomnography (PSG), as well as endothelial function testing. All subjects were grouped into primary snoring (PS) and OSAS group according to the obstructive apnea hypopnea index (OAHI). T test or Wilcoxon test were used to compare the differences in PSG results between the two groups, and univariate and multivariate correlation analyses were used to explore the relevant factors affecting the endothelial function.@*Results@#A total of 355 subjects were enrolled and 248 had OSAS, and 107 had PS. There were no significant differences in age, gender and body mass index (BMI) Z-score between the two groups (all P>0.05). OSAS group had higher OAHI, oxgen desaturation index and respiratory related arousal index (5.2 (2.2, 13.2) vs. 0.4 (0.1, 0.7), 4.1 (2.0, 13.1) vs. 0.5 (0.1, 1.0), 2.5 (1.0, 4.8) vs. 0.4 (0.1, 0.9), Z=-14.957, -11.790, -10.378, all P<0.01), and lower minimum oxygen saturation and reactive hyperemia index (RHI) than those of PS (0.89 (0.85, 0.92) vs. 0.94 (0.91, 0.95), 1.2±0.2 vs. 1.1±0.1, Z=-9.337, t=5.354, P<0.01). Univariate regression analysis showed that RHI was linearly correlated with age (parameter estimate=0.017, P<0.01), gender (parameter estimate=0.065, P<0.01), OAHI (parameter estimate=-0.023, P<0.01), oxygen desaturation index (parameter estimate=-0.019, P<0.01), respiratory related arousal index (parameter estimate=-0.031, P<0.01), and oxygen saturation nadir (parameter estimate=0.067, P=0.045). The relationship between BMI Z-score and RHI was quadratic. Multivariate regression analysis showed that age (parameter estimate=0.015, P<0.01), BMI Z-score (parameter estimate=0.040, P<0.01), BMI Z-score quadratic form (parameter estimate=-0.010, P<0.01), respiratory related arousal index (parameter estimate=-0.020, P<0.01) were independently correlated with RHI.@*Conclusions@#Children with OSAS have significant endothelial dysfunction compared with PS. Frequent arousals due to obstructive respiratory events during sleep may be a candidate risk factor for endothelial dysfunction in children with OSAS.
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@#Objective To introduce the application of mixed reality technique to the preoperative and intraoperative pulmonary nodules surgery. Methods One 49-year female patient with multiple nodules in both lobes of the lung who finally underwent uniportal thoracoscopic resection of superior segment of left lower lobe and wedge resection of left upper lobe was taken as an example. The Mimics medical image post-processing software was used to reconstruct the patient's lung image based on the DICOM data of the patient's chest CT image before the surgery. The three-dimensional reconstructed image data was imported into the HoloLens glasses, and the preoperative discussions were conducted with the assistance of mixed reality technology to formulate the surgical methods, and the preoperative conversation with the patients was also conducted. At the same time, mixed reality technology was used to guide the surgery in real time. Results Mixed reality technology can clearly pre-show the important anatomical structures of blood vessels, trachea, lesions and their positional relationship. With the help of mixed reality technology, the operation went smoothly. The total operation time was 49 min, the precise dorsal resection time was 27 min, and the intraoperative blood loss was about 39 mL. The patient recovered well and was discharged from hospital smoothly after surgery. Conclusion Mixed reality technology has certain application value before and during the surgery for pulmonary nodules. The continuous maturity of this technology and its further application in clinics will not only bring a new direction to the development of thoracic surgery, but also provide a wide prospect.
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@#Objective To investigate the safety and efficacy of 3D thoracoscopic surgery in uniportal lobectomy. Methods Clinical data of 248 patients with lung cancer who underwent uniportal thoracoscopic lobectomy in our hospital from September 2018 to May 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods, a 3D thoracoscopic group (76 patients, including 52 males and 24 females with an average age of 58.59±7.62 years) and a 2D thoracoscopic group (172 patients, including 102 males and 70 females with an average age of 57.75±8.59 years). Statistical analysis of clinical and pathological data, lymph node dissection, surgical complications, postoperative hospital stay, etc was performed. Results Compared with the 2D thoracoscopic group, the 3D thoracoscopic group had shorter operation time, more lymph nodes dissected and pleural effusion on the first day after operation (P<0.05). There was no significant difference in the postoperative chest tube duration, postoperative hospital stay, incidence of pulmonary infection, arrhythmia, bronchopleural fistula, or recurrent laryngeal nerve injury between the two groups. Conclusion Compared with the traditional 2D thoracoscopic minimally invasive surgery, uniportal lobectomy with 3D thoracoscopic surgery is safer and more efficient during operation, and lymph node dissection is more thorough, which is worth promoting.
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Objective:To establish a method for rapid determination of iodine in whole blood by direct alkali dilution inductively coupled plasma mass spectrometry (ICP-MS).Methods:Totally 0.50 ml whole blood sample was collected, and 2% ammonia and 0.01% Triton X-100 solution were added to constitute a total volume of 10.0 ml. After shaking to uniformity, 1.0 μg/ml rhodium and 20% isopropanol were used as on-line internal standard solution. The flow ratio of internal standard solution to the solution to be measured was 1∶16. The sample was quantitatively determined by ICP-MS. The linear range, limit of detection (LOD), accuracy and precision of the method were evaluated.Results:Iodine in whole blood could be determined and had a good linear relationship within the range of 0-200 μg/L, with correlation coefficient ( r) > 0.999. The LOD of the method was 0.1 μg/L, the limit of quantitation (LOQ) was 0.3 μg/L, the recovery rate of iodine in whole blood was 88.5%-106.1%, and the relative standard deviation was 2.2%-4.7% ( n=7). Conclusions:A method for rapid determination of iodine in whole blood by direct alkali dilution ICP-MS is successfully established. This method is accurate, simple, rapid, and highly automatic, and it can be widely applied in determination of iodine in whole blood.
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Sleep disordered breathing (SDB) in children is the syndromes of upper airway dysfunction during sleep, which can be classified into primary snoring (PS) and obstructive sleep apnea syndrome (OSAS) depending on the severity.For moderate or severe OSAS, adenotonsillectomy is the most important treatment.However, the indications for the treatment of PS and mild OSAS are controversial, and the outcomes of the treatment are still unclear.Whether it is reasonable to perform watchful waiting on these patients has attracted more and more attention.Understanding the na-tural history of the disease and risk factors accelerating disease progression will provide a more scientific approach for treatments and guide the early intervention of the children with mild SDB.
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Objective:To investigate the basic information and implementation of medical assistance for children of illness-caused poverty families.Methods:From March through September 2019, a customized questionnaire was used to collect by means of both field survey and on-site verification, the information of the sick children from such families registered on file from 17 counties in 6 provinces. These counties were the first to carry out the assistance pilot work under " Chinese Children Poverty Alleviation by Healthcare Program" . The data so acquired were subject to descriptive analysis.Results:A total of 312 questionnaires were recovered, and the median age of these child patients was 8.54 years. Diseases causing family poverty were mostly those in the circulatory system, nervous system, neoplastic disease of childhood and hematological disease, while unaffordability of medical bills ranked the top challenge when they seek medical services. Hierarchical diagnosis and treatment was made for 251 children: 193(76.89%)of them could be admitted to provincial or lower medical institutions, 43 children needed chronic disease management, and 15 children needed to be admitted by the National Children′s Medical Center for further diagnosis.Conclusions:The assistance for such families in poverty-stricken areas can be upgraded, by such means as disease prevention publicity and education, publicity of healthcare poverty alleviation policy awareness, improvement of medical competency of primary medical institutions and rational application of medical resources.
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Establishing a targeted and suitable professional healthcare training model for pediatricians at primary level and exploring an effective, sustainable and innovative strategy for talent training are required in caring for children at large. The current study explored the methods and efficacy of " apprenticeship" mode originated from traditional Chinese medicine practice in primary pediatricians training. It is suggested that based on the framework of pediatric alliance, the " apprenticeship" mode could establish a fixed and precise one-to-one teaching mode in a short period, form a close, standard and persistent training system for talented pediatricians, thus effectively improving primary pediatric health care service.
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Objective@#To investigate the sleep quality of children in Beijing and to analyze the related factors.@*Methods@#The data were collected from the survey of 3-14 years old children in 7 urban districts of Beijing in 2015. By using multi-stage stratified cluster random sampling method, 26 kindergartens and primary and secondary schools in 7 districts and counties, including Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou, were randomly selected, with a total of 11 420 children. Children′s sleep status was investigated with Children′s Sleep Questionnaire (PSQ), and the proportion of children with sleep quality problems when the PSQ score was greater than 7. Various sleep related factors were investigated with self-made questionnaire. A multilevel model was used to analyze the relationship between PSQ score and related factors.@*Results@#The average PSQ score of the children was 3.60±2.69. The proportion of children with sleep quality problems was 8.87%(816/9 198). Multilevel model analysis showed that the younger the children, the higher the PSQ score (<6 years old vs. 6~12 years old vs. >12 years old: 3.94±2.58 vs. 3.58±2.66 vs. 3.30±2.84, F=33.015, P<0.001); male PSQ score higher than female (3.89±2.75 vs. 3.30±2.60, t=10.560, P<0.001); and snoring, obesity, father/mother snoring, playing games before bed, surfing the internet, eating and other factors were statistically related to PSQ.@*Conclusions@#Sleep quality of children in Beijing should not be neglected, especially preschool children with high PSQ scores. Parents should pay attention to children′s snoring problems and try to reduce some pre-sleep behaviors that may affect sleep quality.
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Objective@#To investigate the snoring status and related family factors of children from 3 to 14 years old in Beijing.@*Methods@#From May to July, 2015, data of children from 3 to 14 years old were obtained from a status survey from 7 districts(Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing. A total of 11 420 children from 25 primary and middle schools were randomly selected. Pediatric Sleep Questionnaire (PSQ) and a self-administered questionnaire were carried out for the adopted children. Self-administered questionnaire included the snoring related family factors. Logistic regression was used to estimate the odd ratio(OR) with 95% confidence intervals for variables.@*Results@#A total of 9 198 children meet the inclusion criteria and are analyzed in the study, of whom 901 (9.80%) were found with snoring behavior. The incidence of boys is higher than girls. Obese children take higher risk of snoring. Compared with younger children (≤6 years old), older children (≥12 years old) have a significantly lower risk of snoring (OR=0.464, 95%CI 0.368-0.585). There is no statistical association between full-term infants, infant feeding pattern, parental cigarette smoking and child snoring.The children with family history of snoring have a significantly higher risk of snoring occurrence. The educational background of mother is statistically related to children snoring (OR=1.241, 95%CI 1.058-1.457).@*Conclusions@#The incidence of children snoring in Beijing is 9.80%, male gender, obesity, and young age are all risk factors for children snoring. There is a significantly statistical relationship between snoring and related family factors, such as family snoring history and education experience.
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Objective@#To investigate the snoring status of school-aged children in Beijing and explore the association of snoring and academic performance.@*Methods@#A total of 7 925 children aged from 6 to 14 were selected from 15 primary and middle schools at 7 districts (Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing in 2015, using multi-stage stratified cluster random sampling method. The recruited children were asked to complete the Pediatric Sleep Questionnaire (PSQ) and a questionnaire related to sleep behavior. The multiplelogistic regression was used to analyze the association of snoring and academic performance.@*Results@#A total of 794 (12.44%) children showed a decline in academic performance among 6 383 eligible respondentsfor data analysis. 580 (9.08%) children with snoring was identified, of which 333 and 247 were in frequency of 1-2 times per week and frequency of ≥3 times per week, respectively; 357, 170 and 53 were in snoring grade Ⅰ, grade Ⅱ and grade Ⅲ, respectively. Compared with the children without snoring, the OR (95%CI) for children with 1-2 times per week and ≥3 times per week was 1.363 (1.000-1.857) and 1.605 (1.135-2.269), respectively; and the OR (95%CI) for children with grade Ⅰ, grade Ⅱ and grade Ⅲ of snoring was 1.226 (0.893-1.683), 1.595 (1.062-2.397) and 2.31 (1.17-4.565), respectively.@*Conclusion@#There is a statistical relationship between snoring and the decline of academic performance. The decline of academic performance positively associated with increased frequency and grade of snoring.
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Non-invasive positive pressure ventilation(NPPV)can avoid upper respiratory tract trauma due to tracheotomy and reduce iatrogenic infection as well as minimize the pain of the patients. NPPV therapy has been in-creasingly developed in congenital and secondary disordered breathing diseases such as neuromuscular diseases,cranio-facial malformation,obstructive sleep apnea hypopnea syndrome and other aliments. Though this therapy method is available and effective,the compliance with home NPPV treatment is relatively low. Various factors can influence adhe-rence of NPPV therapy. Individual and family factors are associated with compliance with NPPV,such as the patient′s age,inherited metabolic diseases,family economic status and educational level of the main caretakers. The structure of ventilator along with physician-patient communication also affect the treatment compliance. Now,the influencing fac-tors of compliance with home NPPV treatment in children were reviewed.
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Many different types of neuromuscular disorders can affect respiratory function by either a muscle itself or the nerve(s) supplying that muscle.Patients with certain inherited neuromuscular diseases,such as spinal muscular atrophy,spinal muscular atrophy with respiratory distress type 1,SEPNl-related myopathies,can present with recurrent respiratory system infections,acute or chronic respiratory failure as well as sleep disordered breathing.The respiratory complications could show up even before the manifestation of neuromuscular diseases.The chest X-ray,blood gas analysis,spirometry,sleep studies etc can be used to assess the affected respiratory muscle function,and also can be used to prove the suspicion of the neuromuscular disorders.