Uncovering the (un-)occupied electronic structure of a buried hybrid interface.

The energy level alignment at organic/inorganic (o/i) semiconductor interfaces is crucial for any light-emitting or -harvesting functionality. Essential is the access to both occupied and unoccupied electronic states directly at the interface, which is often deeply buried underneath thick organic films and challenging to characterize. We use several complementary experimental techniques to determine the electronic structure of p -quinquephenyl pyridine (5P-Py) adsorbed on ZnO(1 0 -1 0). The parent anchoring group, pyridine, significantly lowers the work function by up to 2.9 eV and causes an occupied in-gap state (IGS) directly below the Fermi level E F. Adsorption of upright-standing 5P-Py also leads to a strong work function reduction of up to 2.1 eV and to a similar IGS. The latter is then used as an initial state for the transient population of three normally unoccupied molecular levels through optical excitation and, due to its localization right at the o/i interface, provides interfacial sensitivity, even for thick 5P-Py films. We observe two final states above the vacuum level and one bound state at around 2 eV above E F, which we attribute to the 5P-Py LUMO. By the separate study of anchoring group and organic dye combined with the exploitation of the occupied IGS for selective interfacial photoexcitation, this work provides a new pathway for characterizing the electronic structure at buried o/i interfaces.

[Implementation of intersectional field 13: a survey of medical faculties in Germany]. / Implementierung des Querschnittsbereichs 13: Umfrage an den medizinischen Fakultäten in Deutschland.

BACKGROUND: In 2013 palliative medicine (PM) will be integrated into the undergraduate curriculum as part of the mandatory education in German medical universities. The aim of this study is to determine the current state of implementation at German medical faculties (MF). METHODS: All German MFs were contacted using a written postal survey in June 2012. RESULTS: A total of 32 out of 36 MFs participated. Teaching staff consists of 15 or more lecturers in 8 MFs (30 %) and includes psychologists in 24 MFs (75 %) and also nurses in 18 MFs (56 %). Participating physicians are specialized in anesthesiology, internal medicine and general medicine. Teaching staff include palliative outpatient (20 MFs, 63 %) and consultation services (22 MFs, 69 %). Bedside teaching is provided in 15 MFs (47 %). Multiple choice tests are the major form of assessment (29 MFs, 84 %). The total number of teaching units in PM is between 12 and 43 and is usually provided at the end of medical school education. Nurses are employed in the education significantly more in MFs with a chair in PM. General practitioners were engaged only by faculties without a chair in PM. CONCLUSIONS: The implementation of the mandatory training in PM at MFs in Germany is inhomogeneous. Further steps include in particular the development of a competence-based curriculum and assessment.

Palliative Care teaching in Germany - concepts and future developments.

BACKGROUND: Following recent modifications of the Medical Licensure Act (ÄApprO) in the year 2009, palliative care was introduced as a compulsory 13(th) cross-disciplinary subject (Q13) in the undergraduate curriculum. Its implementation must have taken place before the beginning of the final year ('practical year') in August 2013 and has to be substantiated for the medical exams taking place in October 2014. Very diverse structures pertaining to palliative care teaching were described in previous surveys at various medical faculties in Germany. As a result, the current and future plans and concepts related to content and exams of a mandatory Q13 course at the respective faculty sites should be ascertained. METHODS: Since 2006, the German Medical Students' Association (bvmd) has been carrying out a bi-annual survey at all medical faculties in Germany regarding the current situation of teaching in the field of palliative care. After designing and piloting an online survey in May 2010, a one-month online survey took place. The data was assessed using a descriptive approach. RESULTS: 31 of 36 medical faculties took part in the survey. At the time of questioning, 15 faculties already taught courses according to the requirements of the new ÄApprO; at three sites the Q13 is yet to be introduced commencing in 2012. A teaching curriculum for Q13 already existed at 15 faculty sites, partly based on the curricular requirements of the German Association for Palliative Medicine (DGP). Six sites described an implementation process as yet without an independent curriculum. Most of the faculties aim for 21-40 course hours, which will for the most part be provided as lectures, seminars or less often in more assisted and intense formats. The majority of the participating faculties intend an examination containing multiple choice questions. At 8 universities there is an independent Chair for palliative medicine (5 more are planned); this was linked with a higher degree of mandatory teaching in alignment with the requirements of the ÄApprO. A broad spectrum of educationally-involved occupational groups, specialist disciplines and external co-operating partners, were mentioned. CONCLUSION: The infrastructural prerequisites of the present curricular concepts and the degree of implementation of the Q13 according to the requirements of the new ÄApprO diverge significantly among the various medical faculties. The efforts made to produce a qualitatively high standard of teaching with regard to the multifaceted questions concerning the support for severely and terminally ill patients is as much reflected in the survey, as the special implications of an independent Chair for palliative medicine for the implementation of the requirements by law. The participation of various occupational groups in this survey as well as the broad spectrum of those involved highlights the interdisciplinary and multi-professional dimension of teaching in palliative care.

[Lifting capacity with low back pain : Discrepancy between self-rated and real lifting capacity in patients with back pain and pain-free controls]. / Hebefähigkeit bei Rückenschmerzen : Diskrepanz zwischen Selbsteinschätzung und tatsächlich gezeigter Hebefähigkeit bei Rückengesunden und Patienten mit Rückenschmerzen.

BACKGROUND: The fear-avoidance model implies that in situations with physical demands patients with back pain will overestimate the demand and underestimate their own capacities. PATIENTS AND METHODS: A total of 71 patients with back pain and 48 pain-free control subjects carried out a standardized lifting test with a preceding estimation of their lifting capacity. RESULTS: In both groups the self-estimation and real lifting capacity were in concordance for most group members with patients showing less disconcordance than controls. In the control group 35% of the subjects even underestimated their lifting capacity, which was the case in only 14% of the patients. Patients more frequently overestimated their capacity than pain-free controls (14% vs. 2%). Within the patients subgroups could be identified where patients in general either underestimated or overestimated their own capacity. A comparison between the groups demonstrated significant differences in pain intensity, fear avoidance beliefs and effort. CONCLUSION: As an explanation for these unexpected results it can be hypothesized that in cases of back pain, patients' attention is focused on pain-relevant issues which enables a more realistic estimation of their lifting capacity.

[From GRIP to multimodal pain therapy. A concept asserts itself]. / Vom GRIP zur multimodalen Schmerztherapie. Ein Konzept setzt sich durch.

Low back pain is still a big medical and social problem. During the last few decades a change of paradigm in treating non-specific low back pain has happened: physical activity and exercise therapy are now recommended as the first-line treatment in all relevant national and international guidelines. In chronic cases only biopsychosocial treatment concepts are successful, which have been introduced in Germany in 1990 in the form of the GRIP (Göttingen intensive low back program) for the first time. Meanwhile, this treatment has now been recommended by all evidence-based guidelines but we are still in the beginning of a full coverage care in Germany.

Aquaporin 0-calmodulin interaction and the effect of aquaporin 0 phosphorylation.

Aquaporin 0 (AQP0), also known as major intrinsic protein of lens, is the most abundant membrane protein in the lens and it undergoes a host of C-terminally directed posttranslational modifications. The C-terminal region containing the major phosphorylation sites is a putative calmodulin-binding site, and calmodulin has been shown to regulate AQP0 water permeability. The purpose of the present study was to elucidate the role of AQP0 phosphorylation on calmodulin binding. AQP0 C-terminal peptides were synthesized with and without serine phosphorylation on S231 and S235, and the ability of these peptides to bind dansyl-labeled calmodulin and the calcium dependence of the interaction was assessed using a fluorescence binding assay. The AQP0 C-terminal phosphorylated peptides were found to have 20-50-fold lower affinities for calmodulin than the unphosphorylated peptide. Chemical cross-linking studies revealed specific sites of AQP0-calmodulin interaction that are significantly reduced by AQP0 phosphorylation. These data suggest that AQP0 C-terminal phosphorylation affects calmodulin binding in vivo and has a role in regulation of AQP0 function.

Cross-talk of phosphoinositide- and cyclic nucleotide-dependent signaling pathways in differentiating avian nasal gland cells.

In many bird species, the nasal glands secrete excess salt ingested with drinking water or food. In ducks ( Anas platyrhynchos), osmotic stress results in adaptive cell proliferation and differentiation in the gland. Using 'naive' nasal gland cells isolated from animals that had never ingested excess salt or 'differentiated' cells from animals fed with a 1% NaCl solution for 48 h, we investigated the allocation of metabolic energy to salt excretory processes and to other cellular activities. Activation of muscarinic acetylcholine receptors (carbachol) or beta-adrenergic receptors (isoproterenol) in nasal gland cells resulted in a transient peak in metabolic rate followed by an elevated plateau level that was maintained throughout the activation period. Activation of cells using vasoactive intestinal peptide, however, had only marginal effects on metabolic rate. In differentiated cells, sequential stimulation with carbachol and isoproterenol resulted in additive changes in metabolic rate during the plateau phase. Naive cells, however, developed supra-additive plateau levels in metabolic rates indicating cross-talk of both signaling pathways. Using bumetanide, TEA or barium ions to block different components of the ion transport machinery necessary for salt secretion, the relative proportion of energy needed for processes related to ion transport or other cellular processes was determined. While differentiated cells in the activated state allocated virtually all metabolic energy to processes related to salt secretion, naive cells reserved a significant amount of energy for other processes, possibly sustaining cellular signaling and regulating biosynthetic mechanisms related to adaptive growth and differentiation.

[Does unspecific low back pain really exist?]. / Gibt es einen unspezifischen Rückenschmerz?

Only 20 % of low back pain or sciatica is of a specific origin. These specific pain conditions include tumours, spondylitis, rheumatic and metabolic diseases as well as radicular syndromes. By far the most pain from discs, facet and sacroiliac joints, ligaments and muscles must be considered as unspecific, because no anamnestic information or clinical signs exist (radiological changes included) to assign pain to structural or functional correlates. In addition, the therapeutic consequences from the assignment of structural changes to pain remain unclear. In acute pain situations the specificity of the pain is not important because of the fast relief of the disease, in chronic pain situations, fear avoidance beliefs and pain behaviour seem to be much more important than structural and functional changes.

[Pain treatment facilities in Germany. Ambulatory, day care and inpatient facilities for patients with chronic pain]. / Schmerztherapeutische Angebote an Kliniken in Deutschland. Ambulanzen, teilstationäre und stationäre Einrichtungen für Patienten mit chronischen Schmerzen.

Specialised pain treatment is available at inpatient, daycare and outpatient units at hospitals in Germany. A total of 579 hospitals in Germany offer at least one of the three pain treatment options. The main treatment involves outpatient care, but inpatient wards and daycare institutions have become more common. The type and number of pain treatment facilities differ regionally. Five of the 16 counties do not officially offer inpatient care at all, although pain treatment sites have been opened on the initiative of the hospitals themselves. Since specialised pain treatment is insufficiently defined by diagnosis (ICD-10) or procedures (OPS) in the German DRG system, it is not possible to recognise its availability when the facilities are not officially named. Pain treatment should be differentiated dependent on whether patients are treated within a single area of expertise or by specialised multi-professional pain facilities. At hospitals, systematic multimodal pain treatment is possible. Inpatient and daycare pain treatment programs are suitable when outpatient treatment has failed. An overview of the pain therapies offered is a prerequisite for their optimal use, the demonstration of their necessity and for their continued development throughout Germany. This study was planned and supervised by the commission for quality assurance of the German IASP chapter and was sponsored by the German IASP chapter.

[Musculature as a source of back pain]. / Die Muskulatur als Ursache für Rückenschmerzen.

Lumbar muscle function is considered to be an important component of chronic low back pain (CLBP). Many studies have documented compromised muscle function in patients with CLBP. Although the mechanism associating muscle insufficiency to CLBP is not clearly understood, it is commonly held that the passive tissues of the spine are increasingly stressed with increasing functional muscle insuffiency. Functional instability of the spine plays a major role in the development of back pain. During the last few years, objective evaluation of the fatigue of back muscles by surface electromyography (EMG) with quantitative spectral techniques, evaluation of fibre type and size of the back muscles and quantifying of postural control of the lumbar spine during different tasks documented the failure of the spine in CLBP patients by a deficit of motor control more objectively. Besides this deficit, many patients show severe psychosocial problems and fear-avoidance beliefs. On this basis, treatment of CLBP with active rehabilitation, which includes educational, psychological, and social components along with the therapeutic exercises, has been increasingly advocated during recent years.

[Tension-free methods of surgery of primary inguinal hernias. Comparison of endoscopic, total extraperitoneal hernioplasty with the Lichtenstein operation]. / Spannungsfreie Methoden der Operation primärer Leistenbrüche. Vergleich der endoskopischen, total extraperitonealen Hernioplastik mit der Operation nach Lichtenstein.

INTRODUCTION: Surgery of inguinal hernia has fundamentally changed since the concept of "tension-free" laparoscopic and open repair was introduced in the previous decade. Until now, final judgement of the new methods was difficult because of lack of appropriate studies. METHODS: In a prospective clinical study, we compared the results of endoscopic, total extraperitoneal (TEP) (72 hernias) with Lichtenstein hernioplasty (66 hernias). Follow-up was done daily in the hospital and 6 weeks and 12 months after operation. RESULTS: Operation time was equal in the case of unilateral hernias, but higher surgical qualification was required in the TEP group. Intraoperative and early postoperative complication rates were without significant difference, but late ( P=0.013) and total ( P=0.031) complication rates were significantly higher in the TEP group. There were no clear advantages for TEP in patient comfort, social criteria, or cosmetic appearance. The costs for TEP were 2,428 Euros, 440 Euros more than for the Lichtenstein operation. CONCLUSION: As a result of the study, the Lichtenstein operation can be recommended as regular operative therapy of primary inguinal hernia because, compared with TEP, it is a simple, safe, effective and economical procedure.

[Psychometric properties of the pain drawing and the Ransford technique in patients with chronic low back pain]. / Gütekriterien der qualitativen Bewertung von Schmerzzeichnungen (Ransford-Methode) bei Patienten mit Rückenschmerzen.

BACKGROUND: The aim of our study was the analysis of the psychometric properties of the Ransford technique which is a qualitative scoring method of the pain drawing. It has been suggested that this method could be used as a brief screening technique for psychological involvement in pain complaints. METHODS: 109 patients with chronic back pain filled in the pain drawing which was rated according to the technique described by Ransford and colleagues in 1976. As external criterium of validity we chose a differentiated expert rating of psychological interference. RESULTS: The Ransford technique showed moderate to good coefficients of reliability (re-test, inter and intra-rater). On the other hand, the Ransford technique demonstrated very low indices of validity in order to give a prognosis about psychological interference. Sensitivity and specificity of the Ransford technique demonstrated inadequate values, which furthermore were independent from cut-off points. CONCLUSION: The pain drawing and the Ransford technique are not sufficiently sensitive and therefore allow no screening for psychological interference in complaints of back pain.

[Delayed occurrence of subdural malposition of epidural catheter]. / Sekundäre subdurale Fehllage eines Epiduralkatheters.

We describe a case of postoperative subdural dislocation (between dura and arachnoidea spinalis) of an epidural catheter. After 24 h of normal functioning of the catheter, the injection of 5 ml lidocaine caused an extensive unilateral sensory block including the cranial nerves. X-ray control excluded an epidural or intrathecal position of the catheter. A delayed dislocation of the epidural catheter into the subdural space can occur but this complication only usually becomes evident after injection of a normal dose of local anaesthetic into the catheter and can have catastrophic consequences. The safety of patients can only be guaranteed if epidural catheters are managed solely by professional anaesthesiological personnel. Anatomy, mechanisms of complications and clinical differential diagnosis are discussed.

[Guidelines in pain treatment--methodical quality of guidelines for treatment of pain patients]. / Leitlinien zur Schmerztherapie--Methodische Qualität von Leitlinien zur Therapie von Patienten mit Schmerzen.

The committee for quality assurance of the German IASP chapter (DGSS) evaluated all relevant guidelines concerning pain treatment. Quality of guidelines was analysed according to the checklist "Methodical quality of guidelines" by Ollenschläger and the user manual released by the German Medical Centre for Quality Assurance. The guideline for the treatment of back pain released by the German Medical Association was examined as well as the one released by the German Association for physical therapy and rehabilitation, the guideline on cervical and lumbal nerve root compression syndrome of the German Association of Neurosurgeons, the guideline for cancer pain of the Drug Committee of the German Medical Association was compared with the one of the German Interdisciplinary Association for Pain Treatment. The guideline for the treatment of chronic headache and facial pain of the Medical Association was evaluated and the guideline for the treatment of trigeminal neuralgia of the German Association of Neurosurgery and Neurology, also the guideline for the treatment of acute postoperative and posttraumatic pain. All guidelines show deficiencies in different aspects and of different severity. At first there are deficiencies in interdisciplinary formulation of the guidelines and identification and interpretation of evidence of multimodal pain treatment options. The most prominent deficiency is the lack of implementation and application trials or impulses by all author associations. This way all expenditure on releasing guidelines is given away without improving quality of pain treatment. The authors' recommendation is to adjust to guidelines and, if they are working or not, tell the authors and improve interdisciplinary in pain treatment guidelines.

Identification of a region in G protein gamma subunits conserved across species but hypervariable among subunit isoforms.

The heterotrimeric GTP binding proteins, G proteins, consist of three distinct subunits: alpha, beta, and gamma. There are 12 known mammalian gamma subunit genes whose products are the smallest and most variable of the G protein subunits. Sequencing of the bovine brain gamma(10) protein by electrospray mass spectrometry revealed that it differs from the human protein by an Ala to Val substitution near the N-terminus. Comparison of gamma isoform subunit sequences indicated that they vary substantially more at the N-terminus than at other parts of the protein. Thus, species variation of this region might reflect the lack of conservation of a functionally unimportant part of the protein. Analysis of 38 gamma subunit sequences from four different species shows that the N-terminus of a given gamma subunit isoform is as conserved between different species as any other part of the protein, including highly conserved regions. These data suggest that the N-terminus of gamma is a functionally important part of the protein exhibiting substantial isoform-specific variation.

[Treatment of chronic low back pain through intensive activation - an assessment of 10 years]. / Die Behandlung chronischer Rückenschmerzen durch ein intensives Aktivierungskonzept (GRIP) - eine Bilanz von 10 Jahren*

AIM OF THE STUDY: Treatment of chronic low back pain is a difficult problem and usually of low effectiveness. Aim of the study was to analyse the effectiveness of a multimodal treatment procedure. METHODS: From the basis of functional restoration concepts primarily established in the USA we conceptualized a treatment program which initially was funded by the German ministry of research. Over the years the regimen was modified in several respects (programs of different intensity). From 1990 to 2000 762 patients were treated in this way with one-year follow-up examination. RESULTS: Patients who were off work had significant differences in psychosocial and pain-related variables in comparison to those patients who were still working. Treatment procedures were in general very effective, although a modification of the program with less treatment (no work-hardening) failed in repeating the same effects. Pain intensity, disability, amount of depression and psychological distress improved significantly as well as work capability and use of the health care system. Nearly all results were seen to stabilize at the 12-month evaluation. DISCUSSION: Functional restoration programs for treatment of chronic low back pain have demonstrated effectiveness in several countries. By early use of these programs the high amount of costs due to back pain disability may be consequently reduced. Up to now in Germany these concepts are not well-known and insurance companies as well as the health system do not yet acknowledge them.

Determination of regional ventilation and perfusion in the lung using xenon and computed tomography.

We propose a model to measure both regional ventilation (V) and perfusion (Q) in which the regional radiodensity (RD) in the lung during xenon (Xe) washin is a function of regional V (increasing RD) and Q (decreasing RD). We studied five anesthetized, paralyzed, mechanically ventilated, supine sheep. Four 2.5-mm-thick computed tomography (CT) images were simultaneously acquired immediately cephalad to the diaphragm at end inspiration for each breath during 3 min of Xe breathing. Observed changes in RD during Xe washin were used to determine regional V and Q. For 16 mm(3), Q displayed more variance than V: the coefficient of variance of Q (CV(Q)) = 1.58 +/- 0.23, the CV of V (CV(V)) = 0.46 +/- 0.07, and the ratio of CV(Q) to CV(V) = 3.5 +/- 1.1. CV(Q) (1.21 +/- 0.37) and the ratio of CV(Q) to CV(V) (2.4 +/- 1.2) were smaller at 1,000-mm(3) scale, but CV(V) (0.53 +/- 0.09) was not. V/Q distributions also displayed scale dependence: log SD of V and log SD of Q were 0.79 +/- 0.05 and 0.85 +/- 0.10 for 16-mm(3) and 0.69 +/- 0.20 and 0.67 +/- 0.10 for 1,000-mm(3) regions of lung, respectively. V and Q measurements made with CT and Xe also demonstrate vertically oriented and isogravitational heterogeneity, which are described using other methodologies. Sequential images acquired by CT during Xe breathing can be used to determine both regional V and Q noninvasively with high spatial resolution.

Muscarinic receptors of the M2 subtype in human and bovine trabecular meshwork.

BACKGROUND: The trabecular meshwork is a tissue actively involved in the regulation of intraocular pressure via contractile mechanisms. The present study was performed to investigate the effects of muscarinic m2-receptor antagonists on trabecular meshwork contractility and to identify the m2 muscarinic receptor in human and bovine trabecular meshwork cells. METHODS: Isometric tension measurements of bovine trabecular meshwork strips were performed using a custom-made force length transducer. Western blot and immunoprecipitation analysis was used to detect the m2-receptor proteins in membrane preparations of human and bovine trabecular meshwork cells. RESULTS: Immunoblotting results showed the expression of an m2-receptor protein band at 56 kDa in both human and bovine trabecular meshwork cells. Two different m2-receptor antagonists were tested on trabecular meshwork contractility. After carbachol-induced contraction (10(-6) M set to 100% contractile force), specific m2-receptor antagonists were applied. 3 alpha-Chloroimperaline (10(-6) M) had no effect on the maximal carbachol-induced contraction in trabecular meshwork strips. Methoctramine induced a significant relaxation at concentrations of 10(-7), 10(-6) and 5 x 10(-6) M even in the presence of m1- and m3-receptor antagonists. CONCLUSION: These data indicate that in addition to the m3-receptor subtype present in the trabecular meshwork this tissue also features the m2 receptor. This receptor is partly involved in the regulation of trabecular meshwork contractility, suggesting that outflow facility might be influenced through this receptor.