BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
Inflammatory bowel disease(IBD),encompassing Crohn’s disease and ulcerative colitis,manifests as a chronic,recurrent,and refractory intestinal inflammatory condition significantly impacting patients’quality of life....Inflammatory bowel disease(IBD),encompassing Crohn’s disease and ulcerative colitis,manifests as a chronic,recurrent,and refractory intestinal inflammatory condition significantly impacting patients’quality of life.Despite ongoing research,its etiology and pathogenesis remain incompletely understood.Recent advancements in medical research highlight the critical role of drug combination therapies in managing IBD.This paper employs the strengths,weaknesses,opportunities,and threats framework to evaluate the four strategic elements(strengths,weaknesses,opportunities,and threats)pertaining to combination therapies for IBD.Among the strengths,the paper underscores the efficacy of multi-targeted strategies,the advancement of personalized medicine,and the mitigation of drug resistance.Nonetheless,the analysis identifies significant weaknesses,including the prohibitive cost of treatment,issues with patient compliance,and the necessity for comprehensive long-term safety data.The paper also delineates opportunities to augment therapeutic success through the incorporation of biomarkers,the application of artificial intelligence,and extensive international collaborative efforts.In contrast,the paper does not shy away from addressing the threats,which include the potential for therapeutic resistance and the logistical challenges inherent in global therapy deployment.These initiatives aim to refine future therapeutic practices,fostering safer,more effective,and personalized treatment paradigms for IBD patients.展开更多
[Objective] This study aimed to explore the histological effects of Guchangcuzhang powder on intestine and spleen in experiment piglets with spleen weakness.[Method] The 12 piglets with diarrhea were divided into two ...[Objective] This study aimed to explore the histological effects of Guchangcuzhang powder on intestine and spleen in experiment piglets with spleen weakness.[Method] The 12 piglets with diarrhea were divided into two groups,namely the Guchangcuzhang powder group and the control group,six in each.On two and eight days after the drug discontinuance respectively,three piglets were selected from each of the group and killed by bloodletting from the jugular vein.Afterwards,paraffin sections of intestine and spleen were made and stained by HE staining solution,followed by observation of the histological changes.[Result] The structures of intestine and spleen in piglets drenched with Guchangcuzhang powder restored or approachedto normal.[Conlusion] Guchangcuzhang powder has the function of healing piglet diarrhea.展开更多
The development of eco-agricultural sightseeing in Baise City shows a sound foundation and outstanding advantages as well as a rapid growth trend in recent years, however, there are also problems to be settled, such a...The development of eco-agricultural sightseeing in Baise City shows a sound foundation and outstanding advantages as well as a rapid growth trend in recent years, however, there are also problems to be settled, such as shortage of talents, insufficient planning, low level of development, limited products and lack of competitive products. In view of such a condition, development concepts should be reformed first, competitive and special products made, marketing and propaganda enhanced to promote the healthy, coordinated and ordered development of eco-agricultural sightseeing in Baise City, Guangxi Zhuang Nationality Autonomous Region.展开更多
As seemingly persuasive as Chomsky's theory is, it is significantly flawed in four aspects: 1. ignoring a much fundamental creative force in early infancy; 2. equation of first-language learning with second-langua...As seemingly persuasive as Chomsky's theory is, it is significantly flawed in four aspects: 1. ignoring a much fundamental creative force in early infancy; 2. equation of first-language learning with second-language learning; 3. methodology; 4. employment of terms.展开更多
Quantitative inversion of fracture weakness plays an important role in fracture prediction.Considering reservoirs with a set of vertical fractures as horizontal transversely isotropic media,the logarithmic normalized ...Quantitative inversion of fracture weakness plays an important role in fracture prediction.Considering reservoirs with a set of vertical fractures as horizontal transversely isotropic media,the logarithmic normalized azimuthal elastic impedance(EI)is rewritten in terms of Fourier coefficients(FCs),the 90°ambiguity in the azimuth estimation of the symmetry axis is resolved by judging the sign of the second FC,and we choose the FCs with the highest sensitivity to fracture weakness and present a feasible inversion workflow for fracture weakness,which involves:(1)the inversion for azimuthal EI datasets from observed azimuthal angle gathers;(2)the prediction for the second FCs and azimuth of the symmetry axis from the estimated azimuthal EI datasets;and(3)the estimation of fracture weakness combining the extracted second FCs and azimuth of the symmetry axis iteratively,which is constrained utilizing the Cauchy sparse regularization and the low-frequency regularization in a Bayesian framework.Tests on synthetic and field data demonstrate that the 90°ambiguity in the azimuth estimation of the symmetry axis has been removed,and reliable fracture weakness can be obtained when the estimated azimuth of the symmetry axis deviates less than 30°,which can guide the prediction of fractured reservoirs.展开更多
Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clar...Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clarify the effectiveness of NMES in preventing ICU-AW.Methods:The Cochrane Library,PubMed,EMBASE,MEDUNE,Web of Science,Ovid,CNKI,Wanfang,VIP,China Biology Medicine disc(CBMdisc)and other databases were searched for randomized controlled trials on the influence of NMES on ICU-AW.The studies were selected according to the inclusion and exclusion criteria.After data and quality were evaluated,a meta-analysis was performed by RevMan 5.3 software.Results:A total of 11 randomized controlled trials with 576 patients were included.The meta-analysis results showed that NMES can improve muscle strength[MD=1.78,95%CI(0.44,3.12,P=0.009);shorten the mechanical ventilation(MV)time[SMD=-0.65,95%CI(-1.03,-0.27,P=0.001],ICU length of stay[MD=-3.41,95%CI(-4.58,-4.24),P<0.001],and total length of stay[MD=-3.97,95%CI(-6.89,-1.06,P=0.008];improve the ability of patients to perform activities of daily living[SMD=0.9,95%CI(0.45,1.35),P=0.001];and increase walking distance[MD=239.03,95%CI(179.22298.85),P<0.001].However,there is no evidence indicating that NMES can improve the functional status of ICU patients during hospitalization,promote the early awakening of patients or reduce mortality(P>0.05).Conclusion:Early implementation of the NMES intervention in ICU patients can prevent ICU-AW and improve their quality of life by enhancing their muscle strength and shortening the MV duration,length of stay in the ICU and total length of stay in the hospital.展开更多
BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective pr...BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.展开更多
Background Despite high relapse rate among methamphetamine (MA) abusers, there still have been little empirical data to date detecting the risk factors related to craving and relapse from the perspective of MA abusers...Background Despite high relapse rate among methamphetamine (MA) abusers, there still have been little empirical data to date detecting the risk factors related to craving and relapse from the perspective of MA abusers. Therefore, the aim of this study was to use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors that could facilitate or impede individuals' abstinence in a real-life context from the perspectives of MA abusers. Aim To use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors relating to individuals' abstinence in a real-life context. Method Semistructured interviews were conducted with 32 MA abusers recruited in Shanghai guided by open-ended questions on narrating the real-life catalysts and inhibitors related to craving, initiation, relapse and abstinence. All data were transcribed verbatim and analysed using a strengths, weaknesses, opportunities and threats (SWOT) analysis. Results The results of the SWOT analysis revealed that contextual factors including peer influence, prevalence and availability of MA, familiar venue of MA use, discrimination, sexual behaviours, alcohol, emotional states and their attitudes towards smoking MA were important factors that contribute to reinitiation and relapse. Surveillance systems, antidrug social workers, vocational skills trainings, moving to another city and family responsibility might serve as counter measures targeti叩 those mentioned weaknesses and threats above. Conclusion This SWOT analysis highlights the complex nature of relapse. Comprehensive interventions strengtheni叩 coping skills such as virtual reality techniques are desperately needed to facilitate individuals1 sustained abstinence.展开更多
The elasticity, viscosity, and the relationships derived from rheology weakness properties are taken into account in mechanics. Comparing with the corresponding relationships derived from damage mechanics, we find the...The elasticity, viscosity, and the relationships derived from rheology weakness properties are taken into account in mechanics. Comparing with the corresponding relationships derived from damage mechanics, we find the weakness factor has the same significance as the damage factor. We simulate the wave field using a staggered-grid pseudospectral method to show the influence of the weakness factor qualitatively. Applying the analytical solution of plane waves, we give the velocity and attenuation coefficient of three body waves, which are affected by the wave frequency and the weakness factor of saturated discrete media. Our results show that velocity decreases with increasing weakness factor, the attenuation coefficient increases with an increase in the weakness factor, and that the influence of weakness depends on the mode of the body waves.展开更多
Heavy-duty machine tools are composed of many subsystems with different functions,and their reliability is governed by the reliabilities of these subsystems.It is important to rank the weaknesses of subsystems and ide...Heavy-duty machine tools are composed of many subsystems with different functions,and their reliability is governed by the reliabilities of these subsystems.It is important to rank the weaknesses of subsystems and identify the weakest subsystem to optimize products and improve their reliabilities.However,traditional ranking methods based on failure mode effect and critical analysis(FMECA)does not consider the complex maintenance of products.Herein,a weakness ranking method for the subsystems of heavy-duty machine tools is proposed based on generalized FMECA information.In this method,eight reliability indexes,including maintainability and maintenance cost,are considered in the generalized FMECA information.Subsequently,the cognition best worst method is used to calculate the weight of each screened index,and the weaknesses of the subsystems are ranked using a technique for order preference by similarity to an ideal solution.Finally,based on the failure data collected from certain domestic heavy-duty horizontal lathes,the weakness ranking result of the subsystems is obtained to verify the effectiveness of the proposed method.An improved weakness ranking method that can comprehensively analyze and identify weak subsystems is proposed herein for designing and improving the reliability of complex electromechanical products.展开更多
BACKGROUND The DYNC1H1 gene encodes a part of the dynamic protein,and the protein mutations may further affect the growth and development of neurons,resulting in degeneration of anterior horn cells of the spinal cord,...BACKGROUND The DYNC1H1 gene encodes a part of the dynamic protein,and the protein mutations may further affect the growth and development of neurons,resulting in degeneration of anterior horn cells of the spinal cord,and a variety of clinical phenotypes finally resulting in axonal Charcot-Marie-Tooth disease type 20(CMT20),mental retardation 13(MRD13)and spinal muscular atrophy with lower extremity predominant 1(SMA-LED).The incidence of the disease is low,and it is difficult to diagnose,especially in children.Here,we report a case of DYNC1H1 gene mutation and review the related literature to improve the pediatrician’s understanding of DYNC1H1 gene-related disease to make an early correct diagnosis and provide better services for children.CASE SUMMARY A 4-mo-old Chinese female child with adducted thumbs,high arch feet,and epileptic seizure presented slow response,delayed development,and low limb muscle strength.Electroencephalogram showed abnormal waves,a large number of multifocal sharp waves,sharp slow waves,and multiple spasms with a series of attacks.High-throughput sequencing and Sanger sequencing identified a heterozygous mutation,c.5885 G>A(p.R1962H),in the DYNC1H1 gene(NM 001376)of the proband,which was not identified in her parents.Combined with the clinical manifestations and pedigree of this family,this mutation is likely pathogenic based on the American Academy of Medical Genetics and Genomics guidelines.The child was followed when she was 1 year and 2 mo old.The magnetic resonance imaging result was consistent with the findings of white matter myelinated dysplasia and congenital giant gyrus.The extensive neurogenic damage to the extremities was considered,as the results of electromyography showed that the motor conduction velocity and sensory conduction of the nerves of the extremities were not abnormal,and the degree of fit of the children with severe contraction was poor.At present,the child is 80 cm in length and 9 kg in weight,with slender limbs and low muscle strength,and still does not raise her head.She cannot sit or speak.Speech,motor,and mental development was significantly delayed.There is still no effective treatment for this disease.CONCLUSION We herein report a de novo variant of DYNC1H1 gene,c.5885 G>A(p.R1962H),leading to overlapping phenotypes(seizure,general growth retardation,and muscle weakness)of CMT20,MRD13,and SMA-LED,but there is no effective treatment for such condition.Our case enriches the DYNC1H1 gene mutation spectrum and provides an important basis for clinical diagnosis and treatment and genetic counseling.展开更多
Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length...Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,which are closely related to ICU-acquired weakness(ICUAW).It is suggested that the length of ICU stay and the duration of mechanical ventilation are the main factors.ICU-AW is the most common neuromuscular injury in the ICU,which affects clinical progression and outcomes of patients.This manuscript helps to improve the early recognition of ICU-AW,thereby reducing mortality and improving prognosis.展开更多
In this paper,an elasto-plastic constitutive model is employed to capture the shear failure that may occur in a rock mass presenting mechanical discontinuities,such as faults,fractures,bedding planes or other planar w...In this paper,an elasto-plastic constitutive model is employed to capture the shear failure that may occur in a rock mass presenting mechanical discontinuities,such as faults,fractures,bedding planes or other planar weak structures.The failure may occur in two modes:a sliding failure on the weak plane or an intrinsic failure of the rock mass.The rock matrix is expected to behave elastically or fail in a brittle manner,being represented by a non-associated Mohr-Coulomb behavior,while the sliding failure is represented by the evaluation of the Coulomb criterion on an explicitly defined plane.Failure may furthermore affect the hydraulic properties of the rock mass:the shearing of the weakness plane may create a transmissive fluid pathway.Verification of the mechanical submodel is conducted by comparison with an analytical solution,while the coupled hydro-mechanical behavior is validated with field data and will be applied within a model and code validation initiative.The work presented here aims at documenting the progress in code development,while accurate match of the field data with the numerical results is current work in progress.展开更多
This paper presents an algebraic method to attack the projected C*? cryptographic scheme.The attack applies the affine parts of the private keys and the weakness caused by the structures of the private keys to find a ...This paper presents an algebraic method to attack the projected C*? cryptographic scheme.The attack applies the affine parts of the private keys and the weakness caused by the structures of the private keys to find a large number of linear equations.The attack can recover the private keys efficiently when the parameters are small enough.Meanwhile,the weak keys of the scheme are found and the private keys can be recovered efficiently once the weak keys are used.The paper also proposes a new modification of C*? cryptographic scheme,which is not only as efficient as original projected C*? scheme,but also resistant to the differential attack and the attack proposed in this paper.展开更多
BACKGROUND Guillain-Barrésyndrome(GBS)is an autoimmune-mediated peripheral neuropathy characterized by symmetric weakness.Asymmetric weakness in GBS is uncommon and may be easily confused with other differential ...BACKGROUND Guillain-Barrésyndrome(GBS)is an autoimmune-mediated peripheral neuropathy characterized by symmetric weakness.Asymmetric weakness in GBS is uncommon and may be easily confused with other differential diagnoses.We herein present three cases of asymmetric GBS and review the literature on this atypical subtype of GBS in order to describe the characteristics of asymmetric GBS and to provide experience for clinicians.CASE SUMMARY Different from patients in the previous reports,our patients showed persistent asymmetric limb weakness from the onset to recovery phase.All three patients were serologically positive for antecedent infections.Two of the three cases had IgG antibodies against ganglioside GM1.Two patients received immunotherapy including intravenous immunoglobulin and plasma exchange,while one patient received only supportive treatment.Autoantibodies against gangliosides,asymmetry of congenital development of blood-nerve barrier and limb use may contribute to the development of asymmetric limb weakness in GBS.CONCLUSION Asymmetric GBS may be a rare clinical variant and should be considered when a patient develops acute and progressive asymmetric limb weakness.The differences in clinical features and prognosis between asymmetric GBS and classic GBS deserve further investigation in a large study.展开更多
In this editorial,comments are made on an interesting article in the recent issue of the World Journal of Clinical Cases by Wang and Long.The authors describe the use of neural network model to identify risk factors f...In this editorial,comments are made on an interesting article in the recent issue of the World Journal of Clinical Cases by Wang and Long.The authors describe the use of neural network model to identify risk factors for the development of intensive care unit(ICU)-acquired weakness.This condition has now become common with an increasing number of patients treated in ICUs and continues to be a source of morbidity and mortality.Despite identification of certain risk factors and corrective measures thereof,lacunae still exist in our understanding of this clinical entity.Numerous possible pathogenetic mechanisms at a molecular level have been described and these continue to be increasing.The amount of retrievable data for analysis from the ICU patients for study can be huge and enormous.Machine learning techniques to identify patterns in vast amounts of data are well known and may well provide pointers to bridge the knowledge gap in this condition.This editorial discusses the current knowledge of the condition including pathogenesis,diagnosis,risk factors,preventive measures,and therapy.Furthermore,it looks specifically at ICU acquired weakness in recipients of lung transplantation,because–unlike other solid organ transplants-muscular strength plays a vital role in the preservation and survival of the transplanted lung.Lungs differ from other solid organ transplants in that the proper function of the allograft is dependent on muscle function.Muscular weakness especially diaphragmatic weakness may lead to prolonged ventilation which has deleterious effects on the transplanted lung–ranging from ventilator associated pneumonia to bronchial anastomotic complications due to prolonged positive pressure on the anastomosis.展开更多
In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(I...In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(ICUAW),a neuromuscular disorder affecting critically ill patients,by employing a novel processing strategy based on repeated machine learning.The editorial presents a dataset comprising clinical,demographic,and laboratory variables from intensive care unit(ICU)patients and employs a multilayer perceptron neural network model to predict ICUAW.The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW.This editorial contributes to the growing body of literature on predictive modeling in critical care,offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.展开更多
Background:Females are typically less fatigable than males during sustained isometric contractions at lower isometric contraction intensities.This sex difference in fatigability becomes more variable during higher int...Background:Females are typically less fatigable than males during sustained isometric contractions at lower isometric contraction intensities.This sex difference in fatigability becomes more variable during higher intensity isometric and dynamic contractions.While less fatiguing than isometric or concentric contractions,eccentric contractions induce greater and longer lasting impairments in force production.However,it is not clear how muscle weakness influences fatigability in males and females during sustained isometric contractions.Methods:We investigated the effects of eccentric exercise-induced muscle weakness on time to task failure(TTF)during a sustained submaximal isometric contraction in young(18-30 years)healthy males(n=9)and females(n=10).Participants performed a sustained isometric contraction of the dorsiflexors at 35°plantar flexion by matching a 30%maximal voluntary contraction(MVC)torque target until task failure(i.e.,falling below 5%of their target torque for>2 s).The same sustained isometric contraction was repeated 30 min after 150 maximal eccentric contractions.Agonist and antagonist activation were assessed using surface electromyography over the tibialis anterior and soleus muscles,respectively.Results:Males were~41%stronger than females.Following eccentric exercise both males and females experienced an~20%decline in maximal voliuntary contraction torque.TTF was-34%longer in females than males prior to eccentic exercise-induced muscle weakness.However,following eccentric exercise-induced muscle weakness,this sex-related difference was abolished,with both groups having an"45%shorter TTF.Notably,there was~100%greater antagonist activation in the female group during the sustained isometric contraction following exercise-induced weakness as compared to the males.Conclusion:This increase in antagonist activation disadvantaged females by decreasing their TTF,resulting in a blunting of their typical fatigability advantage over males.展开更多
Acute neuromuscular paralysis(ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks(less than 4 wk).Bulbar and respiratory muscle weakne...Acute neuromuscular paralysis(ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks(less than 4 wk).Bulbar and respiratory muscle weakness may or may not be present.It is a common neurological emergency which requires immediateand careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis.Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia.Also,the arterial blood gas finding of severe hypoxemia,hypercapnia,and acidosis may not be apparent until respiratory failure is profound.Hence,the requirement for respiratory assistance should also be intensively and promptly investigated in all patients with neuromuscular disease.The disorder is classified based on the site of defect in motor unit pathway,i.e.,anterior horn cells,nerve root,peripheral nerve,neuromuscular junction or muscle.Identification of the cause is primarily based on a good medical history and detailed clinical examination supplemented with neurophysiologic investigations and sometimes few specific laboratory tests.Medical history and neurological examination should be focused on the onset,progression,pattern and severity of muscle weakness as well as cranial nerves testing and tests for autonomic dysfunction.Associated non neurological features like fever,rash or other skin lesions etc.should also be noted.Globally,Guillain-Barré syndrome is the most frequent cause of ANMP and accounts for the majority of cases of respiratory muscles weakness associated with neuromuscular disorders.Newly acquired neuromuscular weakness in intensive care unit patients consist of critical illness polyneuropathy,critical illness myopathy and drug induced neuromuscular weakness which may arise as a consequence of sepsis,multi-organ failure,and exposure to certain medications like intravenous corticosteroids and neuromuscular blocking agents.展开更多
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
文摘Inflammatory bowel disease(IBD),encompassing Crohn’s disease and ulcerative colitis,manifests as a chronic,recurrent,and refractory intestinal inflammatory condition significantly impacting patients’quality of life.Despite ongoing research,its etiology and pathogenesis remain incompletely understood.Recent advancements in medical research highlight the critical role of drug combination therapies in managing IBD.This paper employs the strengths,weaknesses,opportunities,and threats framework to evaluate the four strategic elements(strengths,weaknesses,opportunities,and threats)pertaining to combination therapies for IBD.Among the strengths,the paper underscores the efficacy of multi-targeted strategies,the advancement of personalized medicine,and the mitigation of drug resistance.Nonetheless,the analysis identifies significant weaknesses,including the prohibitive cost of treatment,issues with patient compliance,and the necessity for comprehensive long-term safety data.The paper also delineates opportunities to augment therapeutic success through the incorporation of biomarkers,the application of artificial intelligence,and extensive international collaborative efforts.In contrast,the paper does not shy away from addressing the threats,which include the potential for therapeutic resistance and the logistical challenges inherent in global therapy deployment.These initiatives aim to refine future therapeutic practices,fostering safer,more effective,and personalized treatment paradigms for IBD patients.
文摘[Objective] This study aimed to explore the histological effects of Guchangcuzhang powder on intestine and spleen in experiment piglets with spleen weakness.[Method] The 12 piglets with diarrhea were divided into two groups,namely the Guchangcuzhang powder group and the control group,six in each.On two and eight days after the drug discontinuance respectively,three piglets were selected from each of the group and killed by bloodletting from the jugular vein.Afterwards,paraffin sections of intestine and spleen were made and stained by HE staining solution,followed by observation of the histological changes.[Result] The structures of intestine and spleen in piglets drenched with Guchangcuzhang powder restored or approachedto normal.[Conlusion] Guchangcuzhang powder has the function of healing piglet diarrhea.
基金Sponsored by Key Program of Baise University(2009KA04)~~
文摘The development of eco-agricultural sightseeing in Baise City shows a sound foundation and outstanding advantages as well as a rapid growth trend in recent years, however, there are also problems to be settled, such as shortage of talents, insufficient planning, low level of development, limited products and lack of competitive products. In view of such a condition, development concepts should be reformed first, competitive and special products made, marketing and propaganda enhanced to promote the healthy, coordinated and ordered development of eco-agricultural sightseeing in Baise City, Guangxi Zhuang Nationality Autonomous Region.
文摘As seemingly persuasive as Chomsky's theory is, it is significantly flawed in four aspects: 1. ignoring a much fundamental creative force in early infancy; 2. equation of first-language learning with second-language learning; 3. methodology; 4. employment of terms.
基金the sponsorship of the National Natural Science Foundation of China(41674130)National Grand Project for Science and Technology(2016ZX05002-005)for funding this research.
文摘Quantitative inversion of fracture weakness plays an important role in fracture prediction.Considering reservoirs with a set of vertical fractures as horizontal transversely isotropic media,the logarithmic normalized azimuthal elastic impedance(EI)is rewritten in terms of Fourier coefficients(FCs),the 90°ambiguity in the azimuth estimation of the symmetry axis is resolved by judging the sign of the second FC,and we choose the FCs with the highest sensitivity to fracture weakness and present a feasible inversion workflow for fracture weakness,which involves:(1)the inversion for azimuthal EI datasets from observed azimuthal angle gathers;(2)the prediction for the second FCs and azimuth of the symmetry axis from the estimated azimuthal EI datasets;and(3)the estimation of fracture weakness combining the extracted second FCs and azimuth of the symmetry axis iteratively,which is constrained utilizing the Cauchy sparse regularization and the low-frequency regularization in a Bayesian framework.Tests on synthetic and field data demonstrate that the 90°ambiguity in the azimuth estimation of the symmetry axis has been removed,and reliable fracture weakness can be obtained when the estimated azimuth of the symmetry axis deviates less than 30°,which can guide the prediction of fractured reservoirs.
基金This work was supported by the Chinese Nursing Association research program[ZHKY201611].
文摘Objective:The early use of neuromuscular electrical stimulation(NMES)to prevent intensive care unit-acquired weakness(ICU-AW)in critical patients is still a controversial topic.We conducted a systematic review to clarify the effectiveness of NMES in preventing ICU-AW.Methods:The Cochrane Library,PubMed,EMBASE,MEDUNE,Web of Science,Ovid,CNKI,Wanfang,VIP,China Biology Medicine disc(CBMdisc)and other databases were searched for randomized controlled trials on the influence of NMES on ICU-AW.The studies were selected according to the inclusion and exclusion criteria.After data and quality were evaluated,a meta-analysis was performed by RevMan 5.3 software.Results:A total of 11 randomized controlled trials with 576 patients were included.The meta-analysis results showed that NMES can improve muscle strength[MD=1.78,95%CI(0.44,3.12,P=0.009);shorten the mechanical ventilation(MV)time[SMD=-0.65,95%CI(-1.03,-0.27,P=0.001],ICU length of stay[MD=-3.41,95%CI(-4.58,-4.24),P<0.001],and total length of stay[MD=-3.97,95%CI(-6.89,-1.06,P=0.008];improve the ability of patients to perform activities of daily living[SMD=0.9,95%CI(0.45,1.35),P=0.001];and increase walking distance[MD=239.03,95%CI(179.22298.85),P<0.001].However,there is no evidence indicating that NMES can improve the functional status of ICU patients during hospitalization,promote the early awakening of patients or reduce mortality(P>0.05).Conclusion:Early implementation of the NMES intervention in ICU patients can prevent ICU-AW and improve their quality of life by enhancing their muscle strength and shortening the MV duration,length of stay in the ICU and total length of stay in the hospital.
基金Supported by Science and Technology Support Program of Qiandongnan Prefecture,No.Qiandongnan Sci-Tech Support[2021]12Guizhou Province High-Level Innovative Talent Training Program,No.Qiannan Thousand Talents[2022]201701.
文摘BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.
基金National Key R&D Program of China (2017YFC1310400), National Nature Science Foundation of China (U150222& 81501148)Shanghai Municipal Health and Family Planning Commission (2014ZYJB0002)+3 种基金Shanghai Health and Family Planni叩 Commission Clinical Research Project (20184Y0134)Program of Shanghai Academic Research Leader (17XD1403300)Shanghai Key Laboratory of Psychotic Disorders (13DZ2260500)Qihang Project of Shanghai Mental Health Center (2018-QH-02).
文摘Background Despite high relapse rate among methamphetamine (MA) abusers, there still have been little empirical data to date detecting the risk factors related to craving and relapse from the perspective of MA abusers. Therefore, the aim of this study was to use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors that could facilitate or impede individuals' abstinence in a real-life context from the perspectives of MA abusers. Aim To use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors relating to individuals' abstinence in a real-life context. Method Semistructured interviews were conducted with 32 MA abusers recruited in Shanghai guided by open-ended questions on narrating the real-life catalysts and inhibitors related to craving, initiation, relapse and abstinence. All data were transcribed verbatim and analysed using a strengths, weaknesses, opportunities and threats (SWOT) analysis. Results The results of the SWOT analysis revealed that contextual factors including peer influence, prevalence and availability of MA, familiar venue of MA use, discrimination, sexual behaviours, alcohol, emotional states and their attitudes towards smoking MA were important factors that contribute to reinitiation and relapse. Surveillance systems, antidrug social workers, vocational skills trainings, moving to another city and family responsibility might serve as counter measures targeti叩 those mentioned weaknesses and threats above. Conclusion This SWOT analysis highlights the complex nature of relapse. Comprehensive interventions strengtheni叩 coping skills such as virtual reality techniques are desperately needed to facilitate individuals1 sustained abstinence.
基金0ur work is supported by the 0pen Fund of the CNPC Key Lab of Geophysical Exploration （GPKL0202）, the 0pen Fund of the State Key Laboratory of 0il and Gas Reservoir Geology and Exploitation （PLC200304）, and the Natural Science Foundation of Hubei Province （2002AB018）.
文摘The elasticity, viscosity, and the relationships derived from rheology weakness properties are taken into account in mechanics. Comparing with the corresponding relationships derived from damage mechanics, we find the weakness factor has the same significance as the damage factor. We simulate the wave field using a staggered-grid pseudospectral method to show the influence of the weakness factor qualitatively. Applying the analytical solution of plane waves, we give the velocity and attenuation coefficient of three body waves, which are affected by the wave frequency and the weakness factor of saturated discrete media. Our results show that velocity decreases with increasing weakness factor, the attenuation coefficient increases with an increase in the weakness factor, and that the influence of weakness depends on the mode of the body waves.
基金Supported by National Nat ural Science Foundation of China(Grant Nos.51675227,51975249)Jilin Province Science and Technology Development Funds(Grant Nos.20180201007GX,20190302017GX)+2 种基金Technology Development and Research of Jilin Province(Grant No.2019C037-01)Changchun Science and Technology Planning Project(Grant No.19SS011)National Science and technology Major Project(Grant No.2014ZX04015031).
文摘Heavy-duty machine tools are composed of many subsystems with different functions,and their reliability is governed by the reliabilities of these subsystems.It is important to rank the weaknesses of subsystems and identify the weakest subsystem to optimize products and improve their reliabilities.However,traditional ranking methods based on failure mode effect and critical analysis(FMECA)does not consider the complex maintenance of products.Herein,a weakness ranking method for the subsystems of heavy-duty machine tools is proposed based on generalized FMECA information.In this method,eight reliability indexes,including maintainability and maintenance cost,are considered in the generalized FMECA information.Subsequently,the cognition best worst method is used to calculate the weight of each screened index,and the weaknesses of the subsystems are ranked using a technique for order preference by similarity to an ideal solution.Finally,based on the failure data collected from certain domestic heavy-duty horizontal lathes,the weakness ranking result of the subsystems is obtained to verify the effectiveness of the proposed method.An improved weakness ranking method that can comprehensively analyze and identify weak subsystems is proposed herein for designing and improving the reliability of complex electromechanical products.
基金Supported by Jinan Science and Technology Project,No.201805014。
文摘BACKGROUND The DYNC1H1 gene encodes a part of the dynamic protein,and the protein mutations may further affect the growth and development of neurons,resulting in degeneration of anterior horn cells of the spinal cord,and a variety of clinical phenotypes finally resulting in axonal Charcot-Marie-Tooth disease type 20(CMT20),mental retardation 13(MRD13)and spinal muscular atrophy with lower extremity predominant 1(SMA-LED).The incidence of the disease is low,and it is difficult to diagnose,especially in children.Here,we report a case of DYNC1H1 gene mutation and review the related literature to improve the pediatrician’s understanding of DYNC1H1 gene-related disease to make an early correct diagnosis and provide better services for children.CASE SUMMARY A 4-mo-old Chinese female child with adducted thumbs,high arch feet,and epileptic seizure presented slow response,delayed development,and low limb muscle strength.Electroencephalogram showed abnormal waves,a large number of multifocal sharp waves,sharp slow waves,and multiple spasms with a series of attacks.High-throughput sequencing and Sanger sequencing identified a heterozygous mutation,c.5885 G>A(p.R1962H),in the DYNC1H1 gene(NM 001376)of the proband,which was not identified in her parents.Combined with the clinical manifestations and pedigree of this family,this mutation is likely pathogenic based on the American Academy of Medical Genetics and Genomics guidelines.The child was followed when she was 1 year and 2 mo old.The magnetic resonance imaging result was consistent with the findings of white matter myelinated dysplasia and congenital giant gyrus.The extensive neurogenic damage to the extremities was considered,as the results of electromyography showed that the motor conduction velocity and sensory conduction of the nerves of the extremities were not abnormal,and the degree of fit of the children with severe contraction was poor.At present,the child is 80 cm in length and 9 kg in weight,with slender limbs and low muscle strength,and still does not raise her head.She cannot sit or speak.Speech,motor,and mental development was significantly delayed.There is still no effective treatment for this disease.CONCLUSION We herein report a de novo variant of DYNC1H1 gene,c.5885 G>A(p.R1962H),leading to overlapping phenotypes(seizure,general growth retardation,and muscle weakness)of CMT20,MRD13,and SMA-LED,but there is no effective treatment for such condition.Our case enriches the DYNC1H1 gene mutation spectrum and provides an important basis for clinical diagnosis and treatment and genetic counseling.
基金the National Natural Science Foundation of China,No.81801284and the National Natural Science Foundation of Jilin Province,No.YDZJ202201ZYTS091.
文摘Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,which are closely related to ICU-acquired weakness(ICUAW).It is suggested that the length of ICU stay and the duration of mechanical ventilation are the main factors.ICU-AW is the most common neuromuscular injury in the ICU,which affects clinical progression and outcomes of patients.This manuscript helps to improve the early recognition of ICU-AW,thereby reducing mortality and improving prognosis.
基金the DECOVALEX-2019 funding organisations of Andra,BGR/UFZ,CNSC,US DOE,ENSI,JAEA,IRSN,KAERI,NWMO,RWM,SURAO,SSM and Taipower for their financial and technical support of the work described in this paper。
文摘In this paper,an elasto-plastic constitutive model is employed to capture the shear failure that may occur in a rock mass presenting mechanical discontinuities,such as faults,fractures,bedding planes or other planar weak structures.The failure may occur in two modes:a sliding failure on the weak plane or an intrinsic failure of the rock mass.The rock matrix is expected to behave elastically or fail in a brittle manner,being represented by a non-associated Mohr-Coulomb behavior,while the sliding failure is represented by the evaluation of the Coulomb criterion on an explicitly defined plane.Failure may furthermore affect the hydraulic properties of the rock mass:the shearing of the weakness plane may create a transmissive fluid pathway.Verification of the mechanical submodel is conducted by comparison with an analytical solution,while the coupled hydro-mechanical behavior is validated with field data and will be applied within a model and code validation initiative.The work presented here aims at documenting the progress in code development,while accurate match of the field data with the numerical results is current work in progress.
基金This work is supported by the National Natural Science Foundation of China under Grants No.60970119 and No.60803149, the Youth Science and Technology Foundation of Xi＇an University of Architecture and Technology （QN0831）, and the National Basic Research Program （973 Program） of China under Grants No.2007CB311201.
文摘This paper presents an algebraic method to attack the projected C*? cryptographic scheme.The attack applies the affine parts of the private keys and the weakness caused by the structures of the private keys to find a large number of linear equations.The attack can recover the private keys efficiently when the parameters are small enough.Meanwhile,the weak keys of the scheme are found and the private keys can be recovered efficiently once the weak keys are used.The paper also proposes a new modification of C*? cryptographic scheme,which is not only as efficient as original projected C*? scheme,but also resistant to the differential attack and the attack proposed in this paper.
基金Supported by Teacher Research Support Foundation of Jining Medical University,No.JYFC2018FKJ140Natural Science Foundation Youth Project of Shandong Province,No.ZR2020QH110.
文摘BACKGROUND Guillain-Barrésyndrome(GBS)is an autoimmune-mediated peripheral neuropathy characterized by symmetric weakness.Asymmetric weakness in GBS is uncommon and may be easily confused with other differential diagnoses.We herein present three cases of asymmetric GBS and review the literature on this atypical subtype of GBS in order to describe the characteristics of asymmetric GBS and to provide experience for clinicians.CASE SUMMARY Different from patients in the previous reports,our patients showed persistent asymmetric limb weakness from the onset to recovery phase.All three patients were serologically positive for antecedent infections.Two of the three cases had IgG antibodies against ganglioside GM1.Two patients received immunotherapy including intravenous immunoglobulin and plasma exchange,while one patient received only supportive treatment.Autoantibodies against gangliosides,asymmetry of congenital development of blood-nerve barrier and limb use may contribute to the development of asymmetric limb weakness in GBS.CONCLUSION Asymmetric GBS may be a rare clinical variant and should be considered when a patient develops acute and progressive asymmetric limb weakness.The differences in clinical features and prognosis between asymmetric GBS and classic GBS deserve further investigation in a large study.
文摘In this editorial,comments are made on an interesting article in the recent issue of the World Journal of Clinical Cases by Wang and Long.The authors describe the use of neural network model to identify risk factors for the development of intensive care unit(ICU)-acquired weakness.This condition has now become common with an increasing number of patients treated in ICUs and continues to be a source of morbidity and mortality.Despite identification of certain risk factors and corrective measures thereof,lacunae still exist in our understanding of this clinical entity.Numerous possible pathogenetic mechanisms at a molecular level have been described and these continue to be increasing.The amount of retrievable data for analysis from the ICU patients for study can be huge and enormous.Machine learning techniques to identify patterns in vast amounts of data are well known and may well provide pointers to bridge the knowledge gap in this condition.This editorial discusses the current knowledge of the condition including pathogenesis,diagnosis,risk factors,preventive measures,and therapy.Furthermore,it looks specifically at ICU acquired weakness in recipients of lung transplantation,because–unlike other solid organ transplants-muscular strength plays a vital role in the preservation and survival of the transplanted lung.Lungs differ from other solid organ transplants in that the proper function of the allograft is dependent on muscle function.Muscular weakness especially diaphragmatic weakness may lead to prolonged ventilation which has deleterious effects on the transplanted lung–ranging from ventilator associated pneumonia to bronchial anastomotic complications due to prolonged positive pressure on the anastomosis.
文摘In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(ICUAW),a neuromuscular disorder affecting critically ill patients,by employing a novel processing strategy based on repeated machine learning.The editorial presents a dataset comprising clinical,demographic,and laboratory variables from intensive care unit(ICU)patients and employs a multilayer perceptron neural network model to predict ICUAW.The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW.This editorial contributes to the growing body of literature on predictive modeling in critical care,offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.
基金supported by the Natural Sciences and Engineering Research Council of Canada(NSERC)。
文摘Background:Females are typically less fatigable than males during sustained isometric contractions at lower isometric contraction intensities.This sex difference in fatigability becomes more variable during higher intensity isometric and dynamic contractions.While less fatiguing than isometric or concentric contractions,eccentric contractions induce greater and longer lasting impairments in force production.However,it is not clear how muscle weakness influences fatigability in males and females during sustained isometric contractions.Methods:We investigated the effects of eccentric exercise-induced muscle weakness on time to task failure(TTF)during a sustained submaximal isometric contraction in young(18-30 years)healthy males(n=9)and females(n=10).Participants performed a sustained isometric contraction of the dorsiflexors at 35°plantar flexion by matching a 30%maximal voluntary contraction(MVC)torque target until task failure(i.e.,falling below 5%of their target torque for>2 s).The same sustained isometric contraction was repeated 30 min after 150 maximal eccentric contractions.Agonist and antagonist activation were assessed using surface electromyography over the tibialis anterior and soleus muscles,respectively.Results:Males were~41%stronger than females.Following eccentric exercise both males and females experienced an~20%decline in maximal voliuntary contraction torque.TTF was-34%longer in females than males prior to eccentic exercise-induced muscle weakness.However,following eccentric exercise-induced muscle weakness,this sex-related difference was abolished,with both groups having an"45%shorter TTF.Notably,there was~100%greater antagonist activation in the female group during the sustained isometric contraction following exercise-induced weakness as compared to the males.Conclusion:This increase in antagonist activation disadvantaged females by decreasing their TTF,resulting in a blunting of their typical fatigability advantage over males.
文摘Acute neuromuscular paralysis(ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks(less than 4 wk).Bulbar and respiratory muscle weakness may or may not be present.It is a common neurological emergency which requires immediateand careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis.Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia.Also,the arterial blood gas finding of severe hypoxemia,hypercapnia,and acidosis may not be apparent until respiratory failure is profound.Hence,the requirement for respiratory assistance should also be intensively and promptly investigated in all patients with neuromuscular disease.The disorder is classified based on the site of defect in motor unit pathway,i.e.,anterior horn cells,nerve root,peripheral nerve,neuromuscular junction or muscle.Identification of the cause is primarily based on a good medical history and detailed clinical examination supplemented with neurophysiologic investigations and sometimes few specific laboratory tests.Medical history and neurological examination should be focused on the onset,progression,pattern and severity of muscle weakness as well as cranial nerves testing and tests for autonomic dysfunction.Associated non neurological features like fever,rash or other skin lesions etc.should also be noted.Globally,Guillain-Barré syndrome is the most frequent cause of ANMP and accounts for the majority of cases of respiratory muscles weakness associated with neuromuscular disorders.Newly acquired neuromuscular weakness in intensive care unit patients consist of critical illness polyneuropathy,critical illness myopathy and drug induced neuromuscular weakness which may arise as a consequence of sepsis,multi-organ failure,and exposure to certain medications like intravenous corticosteroids and neuromuscular blocking agents.
