A model for predicting unscheduled caesarean section in nulliparae.

OBJECTIVE: The objective of the study is to analyze the predictors of unplanned cesarean section in nulliparae. DESIGN: Prospective cohort study. SETTING: Institute for the Care of Mother and Child in Prague. METHODS: This study consisted of nulliparae giving birth between the 37th and 42nd weeks of singleton low-risk pregnancy, with the fetus in vertex position and without primary indication for CS. Selected prenatal and intranatal factors were analyzed in relation to acute CS due to a failure to progress in labor and/or fetal distress. Using logistic regression analysis (LR1-3) and the classification tree method (chi-square automatic interaction detector 1-2), five prediction models were tested. RESULTS: Of 3,728 nulliparae, 908 (24.4%) had an acute CS. All logistic regression models were comparable (receiver operating characteristic (ROC) 0.837-0.0881) and identified the occiput posterior position (OPP) of the fetus, maternal age, and epidural analgesia as the most influential risk factors. Spontaneous onset of labor, oxytocin administration, and maternal body height decreased are likely indicated for acute CS. The ability to predict a vaginal delivery was 95.7-96.3% and CS was 58.5-61.8%. The classification tree method (ROC 0.860-0.861) identified similar risk factors such as the OPP, peridural analgesia, and spontaneous onset of labor. The prediction abilities were similar at 94.5-96.4% for vaginal delivery and 64.6-59.0% for CS. CONCLUSION: OPP of the fetus was the strongest risk factor for the unsuccessful trial of vaginal labor.

Management of Medical Termination of Pregnancy (MToP) up until the 7th week of gestation in the Czech Republic.

OBJECTIVE: In the Czech Republic (CR), it is possible, to carry out Medical Termination of Pregnancy (MToP) in the 1st trimester since June 2014, in case a woman submits a written request for it and in case the ultrasound examination confirms an intrauterine singleton prosperous pregnancy, between day 42 and 49 of gestation, crown-rump length (CRL) of the embryo 2-9 mm. The aim of the study is to analyze the management of MToP up until the 7th week of gestation in five centres in the CR. DESIGN: Multicenter cohort (prospective) study. SETTING: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child, Charles University in Prague, Third faculty of Medicine; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, General University Hospital in Prague; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, Hospital Na Bulovce, Prague; Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine, University Hospital Brno. METHODS: In 2014-2016, a total of 1820 pregnant women requested MToP. The diagnosis of an intrauterine singleton prosperous pregnancy was set by transvaginal ultrasound, CRL 2-9 mm. MToP was carried out by combination of mifepristone (600 mg orally) and misoprostol (400 mcg orally) within 48 hours. MToP follow up (exclusion of ongoing pregnancy) after 2-3 weeks was carried out by transvaginal ultrasound as well. RESULTS: In 11.0% of women (201/1820) who requested MToP, CRL > 9 mm, unprosperous, multiple or ectopic pregnancy was diagnosed. In the remaining 1619 women MToP was carried out, but in 221 cases (13.7%) at least one additional pre-first visit was needed before the diagnosis of intrauterine singleton prosperous pregnancy CRL 2-9 mm could be established, in 19 cases (1.2%) two pre-first visits and in 5 cases (0.3%) even three. Gestational age was 42-49 days (average 47.1, median 47), the women were 14-47 years of age (average 30.7, median 30). In 20.8% of women (336/1619) MToP follow up was missed and of the remaining 1283 women, ongoing pregnancy (MToP failure) was diagnosed in 1.6% (24/1283), incomplete abortion in 6.5% (83/1283) and complete abortion in 91.9% (1179/1283). A subsequent surgical intervention was carried out in 7.1 % of women (91/1283). CONCLUSION: A medical facility performing MToP in the 1st trimester should develop its own methodology in accordance with the legislation in force, Summaries of Product Characteristics, and recommendations of professional associations. The methodology should also include a method of evaluation of the result and management. The subsequent surgical intervention should only be performed in indicated cases. The main goal of MToP follow up is to exclude ongoing pregnancy (MToP failure), and the patient should be informed in detail about the risks involved and possibilities of their solution, it is necessary to obtain an informed consent.

[Management of Medical Termination of Pregnancy (MToP) up until the 7th week of gestation in the Czech Republic]. / Management umelého ukoncení tehotenství Farmakologickou metodou, nepresahuje-li tehotenství 7 týdnu, v Ceské republice.

OBJECTIVE: In the Czech Republic (CR), it is possible, to carry out Medical Termination of Pregnancy (MToP) in the 1st trimester since June 2014, in case a woman submits a written request for it and in case the ultrasound examination confirms an intrauterine singleton prosperous pregnancy, between day 42 and 49 of gestation, crown-rump length (CRL) of the embryo 2-9 mm. The aim of the study is to analyze the management of MToP up until the 7th week of gestation in five centres in the CR. DESIGN: Multicenter cohort (prospective) study. SETTING: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child, Charles University in Prague, Third faculty of Medicine; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, General University Hospital in Prague; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, Hospital Na Bulovce, Prague; Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine, University Hospital Brno. METHODS: In 2014-2016, a total of 1820 pregnant women requested MToP. The diagnosis of an intrauterine singleton prosperous pregnancy was set by transvaginal ultrasound, CRL 2-9 mm. MToP was carried out by combination of mifepristone (600 mg orally) and misoprostol (400 mcg orally) within 48 hours. MToP follow up (exclusion of ongoing pregnancy) after 2-3 weeks was carried out by transvaginal ultrasound as well. RESULTS: In 11.0% of women (201/1820) who requested MToP, CRL > 9 mm, unprosperous, multiple or ectopic pregnancy was diagnosed. In the remaining 1619 women MToP was carried out, but in 221 cases (13.7%) at least one additional pre-first visit was needed before the diagnosis of intrauterine singleton prosperous pregnancy CRL 2-9 mm could be established, in 19 cases (1.2%) two pre-first visits and in 5 cases (0.3%) even three. Gestational age was 42-49 days (average 47.1, median 47), the women were 14-47 years of age (average 30.7, median 30). In 20.8% of women (336/1619) MToP follow up was missed and of the remaining 1283 women, ongoing pregnancy (MToP failure) was diagnosed in 1.6% (24/1283), incomplete abortion in 6.5% (83/1283) and complete abortion in 91.9% (1179/1283). A subsequent surgical intervention was carried out in 7.1 % of women (91/1283). CONCLUSION: A medical facility performing MToP in the 1st trimester should develop its own methodology in accordance with the legislation in force, Summaries of Product Characteristics, and recommendations of professional associations. The methodology should also include a method of evaluation of the result and management. The subsequent surgical intervention should only be performed in indicated cases. The main goal of MToP follow up is to exclude ongoing pregnancy (MToP failure), and the patient should be informed in detail about the risks involved and possibilities of their solution, it is necessary to obtain an informed consent.

Deep nasal inspirations increase the cough threshold in children with mild asthma.

Asthma is a chronic inflammatory disease characterized by bronchospasms accompanied with frequent coughing, the pathogenesis of which is not clear. In healthy adults deep inspirations (DIs) provide a protective effect against bronchoconstriction triggered by methacholine inhalation, which correlates with the number of accompanying cough efforts. The aim was to study the effect of deep nasal inspirations representing the voluntary equivalent of the sniff-like aspiration reflex on the capsaicin-induced cough in children with mild asthma. The cough reflex sensitivity to capsaicin was determined using a compressed air-driven nebulizer in 21 children (8 girls and 13 boys of median age 13.3 year) suffering from mild asthma (FEV(1)∼80%). The effect of five previous DIs through the nose was examined on the elicitability of two and five or more cough efforts (C2, C5). Under control conditions, the concentration of 20.86 (14.58-29.8) µmol/l of capsaicin provoked two cough efforts (C2). After five DIs similar reaction required significantly higher concentrations of capsaicin: 29.02 (18.88-44.6) µmol/l; P=0.016. Five or more cough efforts (C5) were not significantly changed after previous DIs 161.49 (77.31-337.33) µmol/l and without DIs 141.52 (68.77-291); P=0.54. A series of five deep inspirations decreases the cough reflex sensitivity to evoke two efforts (C2) in children with mild asthma. The inhibitory effect of similar DIs disappeared after repeated applications of increasing doses of capsaicin, aiming to evoke five or more cough efforts, suggesting a reflex character of protective effect of DIs.

Workshop: tuning the 'cough center'.

The Workshop considered the mechanisms whereby the 'cough center' could be tuned by various afferent inputs. There were particular presentations on the effects of inputs from the nose, mouth, respiratory tract and lungs, cerebral cortex, somatic tissues and the pharynx. From all these sites cough induced from the lungs could be increased or decreased in its strength or modified in its pattern. Thus 'tuning' of cough could be due to the interaction of afferent inputs, or to the sensitization or desensitization of brainstem neural pathways. The pattern of response depended on the 'type' of cough being studied and, in some instances, on the timing of the sensory input into the brainstem. Cough inputs could also affect various 'non-cough' motor outputs from the brain, although this was not the main theme of the Workshop. The main conclusion was that cough is not a stereotyped output from the medullary 'cough center', but that its pattern and strength depend on many afferent inputs acting on the 'cough center'.

[Contraceptive methods used by women in the period before and after giving birth]. / Praxe v pouzívání kontracepcních metod u zen v období pred porodem a po porodu.

GOAL OF THE STUDY: To provide information on the knowledge and practices involving the use of the contraceptive methods employed by women of a fertile age, especially in the period of lactation. DESIGN: A cross-section, descriptive study. SETTING: Institute for the Care of Mother and Child, Prague; Department of Gynaecology and Obstetrics at the Institute of Postgraduate Education in Healthcare, Prague; Cegedim Strategic Data CZ s.r.o., Prague. METHODOLOGY: The method involved a written questionnaire in a structured form. The investigation was undertaken in two phases; the first round took place directly after giving birth, while the second took place 6 months after giving birth. The group consisted of 4535 women who gave birth at the Institute for the Care of Mother and Child in the period between 15. 11. 2006 - 15. 11. 2007. RESULTS: 2540 women (56.0%) answered the questions in the first round; 85% of them were in the 26-35 age group, 44.3% were secondary school graduates and 36.7% were university graduates. 61.3% were first-time mothers, 32.3% were second-time mothers and 5.4% were third-time mothers. Contraception used before current gravidity: (n=2540) oral hormonal contraception 59.7%, a condom 11.1%, intrauterine contraception 1.0% and 20.6% of the women used no contraceptive method. The users of oral hormonal contraception (n=1517) were most frequently prescribed (12.8% of the women) a preparation containing 20 microg ethinylestradiol and 150 eLg desogestrel (Mercilon). The contraception used during the course of lactation after a birth in the group of mothers of more than one child (n=982): oral hormonal contraception 19.6%, a condom 17.1%, intrauterine contraception 1.3%, no contraceptive method 54.5%. Breastfeeding users of oral hormonal contraception (n=192) were most frequently prescribed (20.3% of women) a preparation containing 500 microg lynestrenol (Exluton) and a preparation containing 75 microg desogestrel (Cerazette) (16.1% of women). The contraceptive methods planned by women after birth (n=2540): oral hormonal contraceptive 36.5%, a condom 18.8%, intrauterine contraception 18.8%, no method 20.1%. 1440 women (56.7%) answered the questions in the second round; 83.5% of them were in the 26-35 age group, 45.0% were secondary school graduates and 37.0% were university graduates. 64.4% were first-time mothers, 30.6% were second time mothers and 4.2% were third-time mothers. 74.6% of women were still breastfeeding 6 months after giving birth. Contraception used by breastfeeding women (n=1074): oral hormone contraception 27.6%, a condom 21.8%, an intrauterine system with levonorgestrel 2.8%, intrauterine contraception 2.4%, no method 39.5%. Contraception used by non-breastfeeding women (n=366): oral hormonal contraception 42.1%, a condom 15.0%, an intrauterine system with levonorgestrel 2.7%, intrauterine contraception 2.7%, no method 31.4%. In both groups of women, the users of oral hormonal contraception were most frequently prescribed a preparation containing 75 pg desogestrel (Cerazette); this accounted for 99.3% of the breastfeeding women and 18.8% of those not breastfeeding. 40.0% of breastfeeding and 48.4% of non-breastfeeding women are planning to use hormonal contraception in the coming period. The self-evaluation of the knowledge of contraception methods (n=2540): 61.6% of women evaluated their knowledge as good, but 77.6% of women did not know a suitable hormonal contraceptive for the period of lactation. According to 80.7% of the women, their main source of expert information in the area of family planning is their gynaecologist. CONCLUSION: The prevalence of breastfeeding women 6 months after giving birth is high in the monitored group. Oral hormonal contraceptives are the most frequently used contraceptive method in general, including during the lactation period when women prefer a preparation containing 75 microg desogestrel regardless of whether or not they are breastfeeding. The women's knowledge of suitable methods of contraception during the period of lactation is unsatisfactory and represents a challenge for healthcare providers to improve the amount of information available to women in this area

The expiration reflex from the trachea and bronchi.

The expiration reflex (ER) is a forced expiratory effort against a closed glottis that subsequently opens to eject laryngeal debris and prevent aspiration of material. It is distinct from the cough reflex. Its source is usually assumed to be restricted to the larynx and vocal folds, and its possible origin from the tracheobronchial (TB) tree has been suggested but never studied. The current authors re-analysed previous records with mechanical or chemical stimulation of the TB tree to see if an ER can consistently be elicited, and to see whether it has properties similar to that from the larynx and vocal folds. A random review was made of some of the extensive literature on TB "cough" to see if it confirmed the authors' conclusions. The TBER was consistently seen in cats and rabbits, either alone or followed by cough. These results are consistent with many studies in other species, including humans. It was enhanced, relative to cough, by inflation of the lungs and by general anaesthesia. Tracheobronchial expiration reflex occurs frequently with mechanical stimulation of the tracheobronchial tree. It differs fundamentally from many of the properties of "true" cough. Its features similar to the laryngeal expiration reflex suggest that both should be labelled "expiration reflexes" and not cough. Its existence should be taken into account in experimental, and possibly clinical, studies on tracheobronchial cough.

Role of gender and pubertal stage on cough sensitivity in childhood and adolescence.

Studies in healthy adult volunteers and patients with chronic cough have shown that women have increased cough sensitivity to inhaled tussigenic stimuli, including capsaicin. The explanation for this phenomenon remains unknown, although the influence of pubertal changes (dimensional, hormonal) may play a role. In the present study we set out to examine the effect of the pubertal status on cough reflex sensitivity in a population of male and female children and adolescents. The study consisted of cough reflex sensitivity (CRS) testing, spirometry, and a children-completed pubertal status questionnaire. The inclusion criteria were no current symptoms of respiratory disease, no respiratory infection in the preceding 2 weeks, no allergic disease, and no other disease that could modulate CRS. All children were non-smokers. For assessing the CRS we used a compressed air-driven nebuliser controlled by a dosimeter with an inspiratory flow regulator valve. Each subject inhaled up to 12 capsaicin aerosol concentrations (0.61-1250 micromol/l) during 400 ms at 1 min intervals. CRS was defined as the lowest capsaicin concentration that evoked minimally 2 coughs. 225 children (median age 13 yr, 103 girls/122 boys) were divided according to the pubertal status (prepubertal, early pubertal, and late pubertal) and gender. We found that CRS [geometric mean (95%CI)] was similar in prepubertal and early pubertal girls and boys. However, CRS was significantly higher in late pubertal girls (n=56) than in boys (n=26) [53.57 (35.62-80.64) micromol/l vs. 119.7 (70.74-208.55) micromol/l; respectively; P=0.017]. We conclude that puberty and gender have a significant influence on the cough threshold to capsaicin. It seems, however, hard to determine what factors are responsible for the observed gender differences in cough reactivity adolescents.

Influence of chest gamma-irradiation on cough response in awake guinea pigs.

Radiotherapy of tumors in the chest and neck regions may have serious pulmonary side effects. It is well known that inflammation is an essential manifestation of radiation-induced injury. This can heal spontaneously, by specific treatment, or it may progress to more intensive inflammation up to irreversible pulmonary fibrosis. To prevent such complications, it would be useful to have a simple non-invasive and sensitive method for monitoring the course of airway and lung post-irradiation inflammation. This study is devoted to search for such a method. We supposed that cough response intensity (CRI) could be one of the methods, which we are looking for. Guinea pigs (Trik strain, n=32) were used in the study. Animals were divided into two subgroups. Animals of a non-untreated (NT) group (n=14; M=7, F=7) were submitted to sham chest irradiation. The animals of a treated (XRT) group (n=18; M=9, F=9) were exposed to a single dose of gamma rays. Cough was provoked by exposure of animals to citric acid aerosol (CA) in gradually increasing concentrations (0.05-1.6M). CRI testing was performed two days before sham/real chest irradiation, than on 1st, 3rd, 10th, 15th, 21st, and 28th days following the day of irradiation. CRI was quantified in each animal by counting the number of coughs induced by all used concentration of CA. We found a significant increase of CRI in the animals of XRT group on 10th and 21st day compared with the NT animals. An increase of CRI also was found inside the XRT group on the 10th day after irradiation compared with the pre-irradiation value of CRI.

Cough reflex sensitivity in children with suspected and confirmed gastroesophageal reflux disease.

Experimental and clinical studies performed in adults revealed that gastresophageal reflux disease (GORD) is associated with an appreciable increase in cough reflex sensitivity (CRS). The association between respiratory diseases and GORD is also present in children, but there is little evidence that GORD without aspiration of refluxate (proximal reflux) is a frequent cause of cough in children. The aim of this study was to find out whether CRS in children with GORD will be changed compared with healthy children, and if so, to determine the role of proximal vs. distal reflux in these changes. CRS and 24-h esophageal pH monitoring were performed in 20 children of whom 13 had confirmed GORD and 7 were suspected to have GORD. The control group consisted of 27 healthy children. For assessing the CRS, each subject inhaled 12 capsaicin aerosol concentrations (0.61-1250 micromol/l) at 1 min intervals. CRS was defined as the lowest capsaicin concentration that evoked minimally 2 coughs (C2). CRS in the group of children with suspected GORD [C2: 17.0 micromol/l (6.4-45.6 micromol/l)] and with confirmed GORD [C2: 13.4 micromol/l (3.6-50.9 micromol/l)] were significantly elevated (P<0.05) compared with healthy children [C2: 72.1 micromol/l (25.5-203.9 micromol/l)]. According to the parameters of 24-h pH monitoring, a significantly higher exposure to acid was present in the distal compared with proximal oesophagus. CRS changes correlated negatively with the distal, but not proximal, esophageal acid exposure. In conclusion, CRS changes in children suffering from GORD are similar to those described in adult patients with GORD. It is plausible that the main role in increased CRS in children with GORD play episodes of distal acid refluxes.

The influence of autonomic neuropathy on cough reflex sensitivity in children with diabetes mellitus type 1.

Diabetic autonomic neuropathy (DAN) is manifested by dysfunction of one or more organ systems. Its subclinical form (sDAN) can be recognized with the use of noninvasive cardiovascular reflex tests. As the cough reflex is mediated via autonomic nervous system, there is a reason to suppose that it can also be changed due to presence of sDAN. The aim of the present study was to assess cough reflex sensitivity (CRS) in diabetic children with and without sDAN. A CRS test was performed in 35 children suffering from diabetes mellitus type 1 and the results were compared with those from age-matched 27 healthy children. Cough was induced by inhalation of capsaicin aerosol in doubling concentrations (0.61-1250 micromol/l) for 400 ms each. CRS was defined as the lowest capsaicin concentration that evoked 2 or more coughs (C2 parameter) and 5 or more coughs (C5 parameter). We found that CRS in the whole group of diabetic children was not significantly different from that in healthy children [diabetic children--C2: 75.1 micromol/l (95% CI: 42.0-134.2 micromol/l)] vs. healthy children--C2: 72.4 micromol/l (95% CI: 75.7-644.8 micromol/l)]. However, a significant decrease (P=0.005) in CRS was found in diabetic children with sDAN [n=12; C2: 221.0 micromol/l (95% CI: 75.7-644.8 micromol/l)] compared with diabetic children without sDAN [(n=23; C2: 42.7 micromol/l (95% CI: 23.1-79.0 micromol/l)]. We conclude that testing cough reflex sensitivity might be a way to establish the presence of diabetic neuropathy.

Effects of thorax irradiation on citric acid-induced cough in guinea pigs.

Thoracic irradiation may cause an acute lymphocytic alveolitis or hypersensitivity pneumonitis. It is well known that cough reflex is sensitized by a number of inflammatory mediators. The purpose of the present study was to investigate the effect of the thoracic irradiation on the cough response in awake guinea pigs. Guinea pigs (Trik strain) were exposed to sham irradiation (n=16), a single irradiation dose of 10 Gy (n=12), and a fractionated irradiation dose (in five fractions) of 15 Gy (n=12) delivered to the thorax. Cough was induced by citric acid aerosol inhalation in gradually increasing concentrations (0.05-1.6 M) during the first week after thoracic irradiation. The cough response was expressed as a total number of coughs induced during all citric acid challenges. Irradiated animals with single dose of 10 Gy exhibited a time- dependent significant increase of citric acid-induced cough in the 6th day after irradiation compared with control animals (P=0.005), whereas cough was not altered significantly in irradiated animals with fractionated dose of 15 Gy. This study demonstrates that the increased cough response may be a determinant of the functional changes of airway nerve-endings mediating cough in the early phase after thoracic irradiation.

Changes of cough reflex sensitivity induced by cancer radiotherapy of chest and neck regions.

It is reasonable to suppose that airway mucosa can be damaged by irradiation applied to chest and neck regions. The inflammatory process is a consequence of an injury. Airway inflammation is one mechanism responsible for cough induction. So, one can suppose that radiotherapy (RT) focused on the patients' chest or neck may injure airway mucosa, which might change sensitivity of the nerve-endings mediating the cough reflex. The purpose of this study was to examine cough reflex sensitivity (CRS) in patients who underwent RT in the chest and neck regions. CRS test using capsaicin was performed in patients with breast cancer (Group A, n=19), and with lung or neck cancer in (Group B, n=14) who underwent RT. Capsaicin aerosol in doubled concentrations (0.49-1000 microM) was inhaled by a single breath. CRS was defined as the lowest capsaicin concentration that evoked 2 or more coughs (C2). Radiation doses ranged from 40 to 70 Gy. Capsaicin cough challenge was performed before and then in the 2(nd) and 5(th) week of RT. We observed a significantly reduced value of C2, i.e., increased cough reflex sensitivity, in Group B in the 2(nd) week of RT (P= 0.04). We conclude that CRS in the lung or neck cancer patients undergoing RT is significantly enhanced, which could result from injury to the nerve endings in airway mucosa.

Reliability of the capsaicin cough reflex sensitivity test in healthy children.

Testing cough reflex sensitivity (CRS) in children requires suitable methodology. A CRS test performed under control of inspiratory flow rate (IFR) shows excellent reliability in children, but it is difficult to perform, especially in younger children. The aim of the present study was to find whether the capsaicin CRS test performed without direct control of constant IFR in healthy children is reliable enough for practical use. The CRS test was performed in 27 healthy children, aged 7-17 yr three times within 8 days. Cough was induced by inhalation of capsaicin aerosol in doubling concentrations (0.61-1250 micromol/l) for 400 ms each. CRS was defined as the lowest capsaicin concentration that evoked 2 or more coughs (C2). Although the intraclass correlation coefficient values showed good to excellent reliability of this test, the within-subject standard deviation values revealed lower reliability of this method compared to the CRS test performed under control of IFR. From the results obtained it is reasonable to conclude that the method using uncontrolled IFR in CRS testing provides acceptable precision only when a bigger sample size is used or more tests are performed. Good to excellent reliability of this method was found in children with higher values of C2 and in those aged 13-17 yr.

The influence of hyperoxia on cough reflex intensity in guinea pigs treated with bleomycin.

Inhalation of high concentration of oxygen produces a lung injury in men and experimental animals. In our previous experiment we have found suppression of cough reflex in healthy guinea pigs after an exposure to 100% O2 for 60 hours. This study was designed to find the effect of hyperoxia on cough reflex in guinea pigs with lungs damaged by bleomycin. We used 48 animals (300-400 g) in two separated experiments. 32 of them were intratracheally injected with 1.5 mg bleomycin (Bleocin, Nippon Kayaku Co., Ltd., Tokyo, Japan) for induction of lung damage according to the method described by Parizada et al (20). 16 animals were given saline, only (control). Animals of experimental group were divided into two subgroups according to the lapse of time from bleomycin application. 13 days after bleomycin application animals of the 1st subgroup (16) were exposed to 100% O2 (8) or to room air (8) for 48 h. Similarly, 20 days after bleomycin application guinea pigs of the 2nd subgroup (16) were exposed to 100% O2 (8) or air (8), respectively. Cough was provoked in conscious animals placed in bodyplethysmograph box by inhalation of citric acid aerosol (0.3 mol/L) before, then 13 or 20 days after bleomycin application, and finally at the end of 48-h exposition to 100% O2 (air). The number of coughs was counted from airflow trace recorded by pneumotachograph. Cough was also induced by mechanical stimulation of laryngopharyngeal (LPh) and tracheobronchial (TBr) region in anaesthetized animals (Urethane, 1.1 g/kg, i.p.) just after the end of oxygen exposition and was evaluated from the interpleural pressure record. The results have shown a tendency to inhibition of citric acid cough reflex in animals 13 days treated with bleomycin and exposed to 100% O2, and significant decrease in citric acid induced cough in animals 20 days treated with bleomycin and exposed to 100% O2. Significant changes were present in cough intensity induced by mechanical stimulation of TBr region of the guinea pigs airway treated with bleomycin and exposed to oxygen, too. (Tab. 1, Fig. 3, Ref: 29.)

Effects of hyperoxia and allergic airway inflammation on cough reflex intensity in guinea pigs.

Toxic influence of high oxygen concentration on pulmonary function and structures has been known for many years. However, the influence of high oxygen concentration breathing on defensive respiratory reflexes is still not clear. In our previous experiments, we found an inhibitory effect of 100 % oxygen breathing on cough reflex intensity in healthy guinea pigs. The present study was designed to detect the effects of hyperoxia on cough reflex in guinea pigs with allergic airway inflammation. In the first phase of our experiment, the animals were sensitized with ovalbumin. Thirty-two sensitized animals were used in two separate experiments according to oxygen concentration breathing: 100 % or 50 % oxygen for 60 h continuously. In each experiment, one group of animals was exposed to hyperoxia, another to ambient air. The cough reflex was induced both by aerosol of citric acid before sensitization, then in sensitized animals at 24 h and 60 h of exposition to oxygen/air in awake animals, and by mechanical stimulation of airway mucosa in anesthetized animals just after the end of the experiment. In contrast to 50 % oxygen, 100 % oxygen breathing leads to significant decrease in chemically induced cough in guinea pigs with allergic inflammation. No significant changes were present in cough induced by mechanical stimulation of airways.

[Respiratory disorders during sleep in patients with diabetes mellitus]. / Poruchy dýchania pocas spánku u pacientov s diabetes mellitus.

Respiratory disorders during sleep are a serious medical, economic and social problem. In the submitted review the authors discuss the possible relationship between sleep disorders and diabetes. In the introduction they make the reader familiar with basic information on sleep apnoea, incl. the definition, classification and basic pathomechanisms leading to this disorder. In the subsequent part the authors discuss possible relations between the two diseases, the possible participation of diabetic autonomous neuropathy in the pathogenesis of sleep apnoea, the possible influence of hypoglycaemia on sleep quality and the possible influence of sleep apnoea on the development or deterioration of insulin resistance. The objective of the paper is to provide the professional public, but in particular diabetologists, with an overall review of the problem based on most recent data from the literature and to draw attention to the fact that respiratory sleep disorders in diabetics are relatively frequent and that to this problem attention must be paid in practice and in medical research.

Undergraduate medical education in Slovakia--present state and future needs.

There is a lot of problems related to undergraduate medical education (UME) at Slovak medical schools, e.g. low level co-ordination and integration of curriculum, isolation of teaching subjects, amateurish teaching methods, low level of management, which result in low level of effectivity, late and insufficient reactions to the needs of medical practice. There is urgent need for complex reform of UME if we like to be able to complete with high quality medical schools in Europe. The reform should be focused to the content of curriculum--to integrate preventive and acute medicine into the UME, to improve training of medical students for service in primary health care, to start with renaissance of humanistic education of medical students, to improve research training and teaching of medical informatics. For improving organisation of UME it is necessary to prepare modern profile of graduates from medical school, and from the profile to derive co-ordinated and integrated system of UME. The teachers at medical school should be professionals not only in medical specialization, but in pedagogy, psychology and management, too. Passive forms of education (e.g. lectures) should be partly substituted by active methods, e.g. problem--based learning. More attention should be devoted to elaboration of criteria for evaluation quality of teaching process. The reform of UME have to be done if we like to have a chance to be as good as the best medical schools in Europe. I believe, we want it all! (Ref. 31.)