Wavelength-dependent orientation of the principal axes of photonic crystal fibers measured by windowed Fourier-transform spectral interferometry.

We present a novel polarization alignment technique based on windowed Fourier-transform (WFT) spectral interferometry to determine the wavelength-dependent orientation of the principal polarization axes of photonic crystal fibers (PCFs). To test the technique, a commercially available, 82.5-cm-long HC-800-02 type hollow-core PCF was measured. The angles belonging to the fast and the slow principal axes of the fiber were determined from the peak intensity values of the ridges in the WFT map at different wavelengths. We demonstrate that the orientation of the principal polarization axes of the tested PCF is wavelength-dependent. The precision of the angle measurement was better than 0.3°.

Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis.

Balneotherapy is appreciated as a traditional treatment modality in medicine. Hungary is rich in thermal mineral waters. Balneotherapy has been in extensive use for centuries and its effects have been studied in detail. Here, we present a systematic review and meta-analysis of clinical trials conducted with Hungarian thermal mineral waters, the findings of which have been published by Hungarian authors in English. The 122 studies identified in different databases include 18 clinical trials. Five of these evaluated the effect of hydro- and balneotherapy on chronic low back pain, four on osteoarthritis of the knee, and two on osteoarthritis of the hand. One of the remaining seven trials evaluated balneotherapy in chronic inflammatory pelvic diseases, while six studies explored its effect on various laboratory parameters. Out of the 18 studies, 9 met the predefined criteria for meta-analysis. The results confirmed the beneficial effect of balneotherapy on pain with weight bearing and at rest in patients with degenerative joint and spinal diseases. A similar effect has been found in chronic pelvic inflammatory disease. The review also revealed that balneotherapy has some beneficial effects on antioxidant status, and on metabolic and inflammatory parameters. Based on the results, we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for lower back pain, as well as for knee and hand osteoarthritis.

Seasonal characteristics of flood regimes across the Alpine-Carpathian range.

The aim of this paper is to analyse the differences in the long-term regimes of extreme precipitation and floods across the Alpine-Carpathian range using seasonality indices and atmospheric circulation patterns to understand the main flood-producing processes. This is supported by cluster analyses to identify areas of similar flood processes, both in terms of precipitation forcing and catchment processes. The results allow to isolate regions of similar flood generation processes including southerly versus westerly circulation patterns, effects of soil moisture seasonality due to evaporation and effects of soil moisture seasonality due to snow melt. In many regions of the Alpine-Carpathian range, there is a distinct shift in flood generating processes with flood magnitude as evidenced by a shift from summer to autumn floods. It is argued that the synoptic approach proposed here is valuable in both flood analysis and flood estimation.

Comorbidity clusters in generalized osteoarthritis among female patients: A cross-sectional study.

OBJECTIVES: To investigate the prevalence of comorbidities among female patients with generalized osteoarthritis (GOA) in comparison to an age- and sex matched control group. To identify clusters of comorbidities in both groups. METHODS: An observational, cross-sectional study was conducted. Consecutive female patients with hand and knee osteoarthritis according to the American College of Rheumatology (ACR) classification criteria were invited to participate in the study. A control group of participants without musculoskeletal symptoms, history or evidence of osteoarthritis or inflammatory rheumatic disease were also included. Cardiovascular, obstructive pulmonary, gastrointestinal, endocrine, neurological, malignant diseases and depression were recorded in both groups. In both study groups comorbidity cluster and factor analysis was performed. RESULTS: The study population included 200 GOA and 200 control participants. The following comorbidities were observed adjusted to Bonferroni correction with a significantly higher prevalence among individuals with GOA: hypertension, uterine leiomyoma, gastroesophageal reflux disease, diverticulosis, upper gastrointestinal tract ulcers, depression, diseases with vertigo (benign paroxysmal positional vertigo and vertebrobasilar insufficiency) and surgery due to otoclerosis. In the GOA group 5 clusters were identified with different comorbidity patterns. CONCLUSION: We report a high comorbidity rate in GOA. Cluster analysis allowed us to identify different comorbidity subsets for vascular, gastrointestinal and malignant gynaecological disorders. Further research is required to understand the links between GOA and non-musculoskeletal comorbidities.

Effect of Avemar--a fermented wheat germ extract--on rheumatoid arthritis. Preliminary data.

OBJECTIVE: To investigate the effect of the fermented wheat germ extract (Avemar)in patients with severe rheumatoid arthritis (RA). METHODS: Fifteen female RA (Steinbrocker II-III) patients, who had unsuccessfully tried two different DMARD treatments, were enrolled in an open-label, 1-year long, pilot clinical study. DMARD and steroid therapies were recorded and continued. All patients received Avemar as additional therapy. For measurement of efficacy the Ritchie Index, the Health Assessment Questionnaire (HAQ) and the assessment of morning stiffness were applied. Patients were evaluated at baseline, 6 and 12 months. For statistical analyses the Wilcoxon test was used. RESULTS: At both 6 and 12 months, Ritchie index, HAQ and morning stiffness showed significant improvements compared with the baseline values. Dosages of steroids could be reduced in about half of the patients. No side effects of Avemar were observed. CONCLUSION: Supplementation of standard therapies with a continuous administration of Avemar is beneficial for RA patients.

A possible molecular basis for the effect of gastric anti-ulcerogenic drugs.

The exact mechanism of action of the anti-ulcerogenic drugs is still under debate. According to the literature, under normal conditions the cAMP:cGMP ratio in the rat gastric mucosa is approximately 8:10. Following prostacyclin administration, this ratio transiently decreases but later shows a strong elevation, indicating profound changes in the intracellular cyclic nucleotide balance. There is evidence that this elevation or 'shift' in the cAMP:cGMP ratio is linked, on a cellular or molecular level, to the anti-ulcerogenic, cytoprotective processes in the stomach. Cimetidine and ranitidine (widely used H2 receptor-blocking drugs) administered at doses that are too low to interfere with gastric acid secretion, cause an elevation in the cAMP:cGMP ratio, an effect that is also observed with other prostaglandin derivatives and anti-ulcerogenic drugs. In this article, Gabor A. Balint discusses these data and how the elevation of the gastric mucosal cAMP:cGMP ratio is a useful molecular marker that could provide insights into the effects of anti-ulcerogenic drugs.

Artemisinin and its derivatives: an important new class of antimalarial agents.

Artemisinin and its derivatives are a potent new class of antimalarials, originated from Artemisia annua, L. The clinical efficacy of these drugs is characterized by an almost immediate onset and rapid reduction of parasitaemia. Their efficacy is high in such areas as well where multidrug-resistance is rampant, but in these areas, their combination with other (effective) antimalarials (e.g., mefloquine) is highly recommended. In this short review, the chemical structures, pharmacological properties, and clinical uses of artemisinin drugs are discussed.

Antiretroviral therapeutic possibilities for human immunodeficiency virus/acquired immunodeficiency syndrome.

In human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) illness, the reverse transcriptase and protease (PRT) enzymes of HIV are currently the targets of antiretroviral (ARV) therapy. Nucleoside analogues were the first group of ARV drugs that exerted antiviral activity in patients. More recently, PRT inhibitors have provided new approaches in the treatment of HIV infection and AIDS. Impressive clinical results have been obtained with combination therapies of three ARV drugs, including one PRT inhibitor. It is worth mentioning also that apart from these two main drug groups, there are many new compounds under development, including a vaccine(s) against HIV.

Diagnosis of osteoarthritis. Guidelines and current pitfalls.

Diagnostic and classification guidelines for osteoarthritis based on clinical and radiographic signs for the most frequently involved joints (knee, hip and hand) have been developed by the American College of Rheumatology. Excellent, new 'high tech' biochemical and imaging methods and guidelines for clinical evaluation of the condition and its therapy have recently been developed and validated. Accordingly, we have consistent and reliable methods for assessing the established condition, but they provide little help in making an early and correct diagnosis for the different forms of osteoarthritis. Both the diagnostic process and the differential diagnosis consist of careful history taking and detailed analysis of the complaints (especially pain), with proper physical examination including a search for the source of pain and tenderness. Not all deformities and pain in and around the joints are signs and symptoms of osteoarthritis, even if the patient is of 'osteoarthritis age' and the joint shows 'osteoarthritis signs' on the x-ray. On the other hand, even if the underlying disease is osteoarthritis, the symptoms and signs may be due to disorders secondary to the basic disease (e.g. enthesopathy or tendinopathy) and the patient's complaints can be helped more easily by physiotherapy and local injections. The course of the disease and close follow-up yield diagnostic clues in cases where the cross-sectional diagnostic measures fail to provide them. Analysis of serum, joint fluid and x-ray films can be of diagnostic value, and other imaging methods (ultrasound, radioisotope scanning, computerised tomography, magnetic resonance imaging, arthroscopy) are also useful tools. Differential diagnosis is not only of theoretical value; misdiagnosis of osteoarthritis leads to either omitted or unnecessary treatment, and causes psychological stress to the patient.

Further analysis of prostacyclin's effect on rat gastric mucosal nucleic acid content.

Graded single and multiple oral doses of prostacyclin enhance, in a direct dose-dependent manner, the DNA and RNA content of rat gastric (antral and fundic) mucosa, resulting in a decreased RNA/DNA ratio. This latter phenomenon is a convincing sign of new cell formation. The arithmetical (theory of functions) analysis of the data resulted in equations, defined mathematically, of prostacyclin's dose-dependent effect.

Cytoprotection and intracellular calcium.

It seems that prostacyclin has an increasing effect on gastric mucosal (antral and fundic) calmodulin level in rats. Using either the calcium channel blocker verapamil or anti-calmodulin drugs (diazepam, trifluoperazine,) the cytoprotective effect of prostacyclin can be inhibited. Therefore, it is probable that calcium ions and calcium-activated calmodulin play a role in the effect of prostacyclin.

On a possible new intracellular signal-system in rat gastric mucosa.

It is known that cAMP and cGMP, as an "intracellular second messenger system" play a significant role as a signal system, in the mechanism of action of anti-ulcerogenic (cytoprotective) drugs. According to our present, preliminary investigations it seems that during different experimental circumstances the gastric mucosal 3'-5'-cyclic-cytidine-mono-phosphate (cCMP) 3'-5'-cyclic-uridine-monophosphate and (cUMP) levels were changed--similarly to CAMP and cGMP--and these changes might be a possible indicator of a further, most probably secondary, signal- system role.

Gastric mucosal endogenous prostacyclin levels are different in Brattleboro rats compared with Wistar strain.

Homozygous Brattleboro rats were investigated and compared to normal (physiological) Wistar strain rats regarding their gastric mucosal endogenous prostacyclin (PG-I(2)) level. It seems that the Brattleboro animals have a significantly lower level of this important protective material. Wistar rats having an artificial pituitary stalk lesion (which is the artificial equivalent of homozygous Brattleboro animals) showed no differences in endogenous mucosal prostacyclin level compared to normal Wistar rats. Therefore, we concluded that this hitherto unknown property of the homozygous Brattleboro rats is genetically determined.

Prostaglandin F2 alpha and prostacyclin tissue levels in early phases of trypsin-induced acute pancreatitis in rats.

Local variations of prostaglandin (PG) I2 and F2 alpha were studied in the pancreatic tissue during the first hour of an acute experimental necrohemorrhagic pancreatitis. The local pancreatitis was induced by trypsin injection into the interstitium of the splenic part of rat pancreas, and a saline injection was given into the interstitium in the duodenal part of the same pancreas as control. PGF2 alpha level was measured by specific radioimmunoassay (RIA), and the stable degradation product of PGI2, the 6-keto-PGF1 alpha, was determined also by RIA as an index of PGI2 level. The results were compared between the two regions and with control intact pancreata. The PGI2 level transiently decreased, whereas the PGF2 alpha increased in the region of localized hemorrhagic pancreatitis when compared with the intact pancreata. By contrast, the quickly disappearing edematous reaction induced by saline injection was accompanied by opposite changes in the two PGs studied: PGI2 was transiently elevated and PGF2 alpha diminished. In consequence, the ratio of the two PGs was shifted in favor of PGI2 in a transient edematous reaction and in favor of PGF2 alpha in hemorrhagic pancreatitis. It was concluded that PGI2 plays some protective role while PGF2 alpha might be one of the aggressive mediators in the inflammatory process. Their biological importance must be limited since PGF2 alpha alone did not induce pancreatitis nor did PGI2 protect against the trypsin-induced local pancreatitis.

The effects of somatostatin and some of its tetrapeptide fragments on ethanol-induced gastric mucosal erosion in rat.

A study was made of the cytoprotective effects of somatostatin (SRIF) and its 3-6, 5-8, 7-10, 9-12 and 11-14 tetrapeptide fragments on absolute ethanol-induced haemorrhagic erosions in the stomach of rat. The SRIF molecule was found to prevent the gastric erosions induced by ethanol. The 7-10 and 11-14 fragments exhibited similar properties. There are two peaks in the cytoprotective dose-response curves. It is concluded that various fragments of SRIF can also exert cytoprotective effects.

Protective effect of an orally administered, highly potent somatostatin analog (RC-121) against absolute ethanol-induced hemorrhagic erosions of the rat gastric mucosa.

The cytoprotective effect of a highly potent somatostatin (SRIF) analog, RC-121 (H-D-Phe-Cys-Tyr-D-Trp-Lys-Val-Cys-Thr-NH2), was examined in the absolute ethanol-induced gastric erosion model in rat. This analog diminished the degree of gastric erosion by 50-55% when administered in i.p. doses of 2 x 10(-10)-10(-8) g/100 g body weight, or in oral doses of 10(-8)-2 x 10(-7) g/100 body weight. The orally active, highly potent SRIF analogs may be useful as therapeutic agents in the treatment of human peptic ulcer.

Buprenorphine treatment of patients with non-malignant musculoskeletal diseases.

Adequate pain control is vital in the treatment of patients with musculoskeletal disease. These diseases are characterised by a number of pain-induced vicious circles, and satisfactory control of pain acts to disrupt these self-perpetuating processes. Consequently, early mobilisation can be achieved in patients with painful osteoporotic vertebral fractures, low back pain and sciatica, for example. In other cases analgesics may act simply to maintain the mobility of patients and in this way preserve their quality of life. When simple analgesics are not sufficient, the use of opioid-type analgesics is justified. Buprenorphine transdermal therapeutic system (TDS) is a novel formulation of a well-tolerated and highly effective drug for satisfactory pain control that can also be used in patients with chronic non-malignant pain (CNMP) due to musculoskeletal diseases. Three case reports are presented to illustrate the effectiveness of buprenorphine TDS in such patients.

A legacy for rheumatology from Sir William Osler.

"Of the altruistic instincts, veneration is not the most developed at the present day; but I hold strongly with the statement that it is a sign of a dry age when the great men of the past are held in light esteem".

Ultrasound-guided aspiration in suspected sepsis of resection arthroplasty of the hip joint.

The authors described 17 patients who had had resection arthroplasty of the hip and who were suspected of having an infection. The resection arthroplasties had been performed for previous infection. All the patients were studied by ultrasonography to detect effusion in the pseudoarticular space. Thirteen of the 17 patients were found to have an effusion by ultrasonography. Fluid was obtained in 9 of the 13 patients by ultrasonographic-guided aspiration. The mean aspirated volume was 3 ml (range 1-25 ml). Five of the 9 aspirates proved to be septic. The echopattern in all but one of those five with sepsis was nonechofree. Of four other patients in whom it was not possible to aspirate fluid lavage of the pseudoarticular space one yielded a positive culture. The role of ultrasonography in the diagnosis and management of patients who have undergone resection arthroplasty of the hip and who are suspected of having an infected pseudoarticular space is discussed.