[Novel revision of the training regulations for German physicians-Consequences for trainees and trainers in rheumatology]. / Neue Musterweiterbildungsordnung ­ Konsequenzen für die Weiterzubildenden und die Weiterbilder in der Rheumatologie.

Rheumatology training is reorganized with the implementation of the revision of the training regulations for German physicians (MWBO) to become a specialist in internal medicine and rheumatology. This article focusses on novel aspects including far-reaching waiver of reference numbers, the professionally recommended training plan, the e­logbook, the regulation of specific training periods and the requirement of reapplication for the training authorization in addition to the contents of training. These aspects involve direct consequences for trainees and trainers.

[Implementation of an early geriatric rehabilitation in acute inpatient pneumology]. / Implementierung einer geriatrischen frührehabilitativen Komplexbehandlung (GFK) in der akutstationären Pneumologie.

BACKGROUND: In order to counter the rapidly developing loss of function especially in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the concept "early geriatric rehabilitation in acute inpatient pneumology" was developed. An essential aspect of the project was a targeted approach making use of multi-professional expertise and standards. METHODS: This 1-year feasibility study included a total of 58 patients with AE-COPD in advanced age (mean: 74.8 ± 6.8 years) with typical geriatric multimorbidity and necessity for acute medical as well as rehabilitation treatment. The results of the early geriatric rehabilitation by a multi-professional rehabilitation team were analyzed in a prospective study approach using standardized assessments. RESULTS: The early geriatric rehabilitation started on median day 3 (range: 1st - 22nd) and lasted in median 16 days (range: 9 - 29). It achieved a significant improvement, particularly in mobility [timed up-and-go, median 19 (range: 10 - 150) vs. 15 (range: 7 - 120) seconds, p < 0.0001], self-help ability [Barthel index, median 73 (range: 5 - 95) vs. 95 (range: 45 - 100) points, p < 0.0001] and social care. CONCLUSIONS: Early geriatric rehabilitation in a cohort of AE-COPD patients is feasible and can be integrated in an acute inpatient pulmonary care system.

Release of protoplasts in the yeast phase of Histoplasma capsulatum without added enzyme.

Cells of the yeast phase of the dimorphic systemic fungus pathogen Histoplasma capsulatum readily released large numbers of intact protoplasts without degradation of their cell walls by snail or microbial enzymes, previously regarded as a requirement for all yeast and mycelial fungal forms. Over 90 percent of "B" type yeast cells in the early logarithmic phase of growth released living protoplasts when incubated at 37 degrees C with 2 molar magnesium sulfate, whereas "A" type yeast cells required prior exposure for 24 hours to 2-deoxy-D-glucose before incubation in the 2 molar magnesium sulfate.

[Compliance--(no) topic in pain therapy?]. / Compliance--(k)ein Thema in der Schmerztherapie?

Patients' compliance or adherence to medical therapy recommendations has been identified to be a pivotal element in achievement of treatment success. Nonadherence is a commonly-found phenomenon among patients suffering chronic pain. Its negative impact on the individual health status and on health systems has put forth strategies to improve adherence in the therapy of chronicpain. These include the use of medications with reliable and high efficacy combined with low rate and severity of side effects, limited need of medication to manage breakthrough pain as well as the reduction of application frequency.

Chlorophyll fluorescence measurements to assess the competition of substituted anthraquinones for the QB binding site.

As analogs of the Photosystem II plastoquinone electron acceptor, QB, substituted quinones compete with QB for a common binding domain and thereby inhibit QB function. Substituted quinones interact with the QB binding niche via hydrogen bonds, and the extent of hydrogen bond formation is determined by quinone structure. We have previously shown that the quinone inhibitory activity can be quantitated using measurements of chlorophyll fluorescence quenching. To assess competition for the QB binding site, we report here measurements of the action of various pairs of substituted anthraquinones on the chlorophyll fluorescence emission of barley chloroplasts. The degree of competition between quinones for the QB binding site is classified as competition, partial competition, or no competition. Two quinones were classified as undergoing competition, i.e., interacting for the same or overlapping sites, if the chlorophyll fluorescence level in the presence of the two quinones was not as low as that achieved in the presence of either one of the quinones individually. Non-competitive quinones with different binding sites quenched chlorophyll fluorescence to the level expected if the quenching effects of the individual quinones were additive. Partial competition, or some interaction for the same or overlapping sites, was characterized by an extent of fluorescence quenching in the presence of two quinones that was more effective than either quinone alone but not as sizable as that expected when the two quinones act independently. These results reflect an interesting situation whereby substitution patterns can alter the binding characteristics within a single class of inhibitors. In an accompanying manuscript we report the results of CNDO molecular orbital calculations to demonstrate that the pi charge distribution in substituted quinones governs their binding properties.

Analysis of pi charge distribution in substituted anthraquinones to assess affinity for the QB binding site.

In the accompanying paper (Biochim. Biophys. Acta (1990) 1020, 163-168), we have determined the degree of competition between substituted 9,10-anthraquinones for the QB binding niche through measurements of the additivity of quinone-quenching effects on chlorophyll fluorescence. Quinones inhibit QB function by competitively displacing QB through hydrogen-bond formation with the QB binding protein. The sign of the net pi-charge density on atoms adjacent to the carbonyl moieties is believed to determine the particular hydrogen-bond(s) that result(s). In this study we report CNDO molecular orbital calculations of pi electronic charge distribution in substituted 9,10-anthraquinones to explore the relationship of inhibitor activity and competition to sign of net pi-charge density. We find that the substitution patterns of 9,10-anthraquinones alter the signs of the net pi-charge densities on the carbon atoms adjacent to the carbonyl moieties and thus determine the binding properties of the anthraquinones in the QB niche. While most experimentally studied 9,10-anthraquinones use both carbonyl oxygens to hydrogen bond to the histidine-215 and serine-264 regions of the D-1 QB binding protein, some quinones appear to hydrogen-bond to only one site. Thus, 9,10-anthraquinones constitute a class of QB inhibitors that function as either members of the histidine or serine family of QB inhibitors or as simultaneous representatives of both inhibitor groups.

Bone marrow transplantation without total-body irradiation in patients aged 40 and older.

We evaluated relapse-free survival and the incidence and type of complications in 17 patients aged 40 or older with chronic myelogenous leukemia, acute myelogenous leukemia, or lymphoma who underwent allogeneic marrow transplantation following busulfan 16 mg/kg and cyclophosphamide 120 mg/kg. Nine patients are disease-free survivors 5-38 months (median 26 months) following transplantation. The incidence of grades II-IV acute graft-versus-host disease was 35%. No significant difference was detected in the incidence of GVHD or interstitial pneumonia between patients aged 40 and older and a group of younger patients transplanted over the same time period. These observations should encourage consideration of allogeneic marrow transplantation in older patients and suggest that this busulfan-cyclophosphamide regimen is a promising alternative to regimens containing total-body irradiation in older individuals.

Synthetic studies toward phorboxazole A. stereoselective synthesis of the C(28)-C(46) side chain fragment.

A stereoselective synthesis of the C(28)-C(46) fragment (3) of phorboxazole A is described. Key advances include an enantioselective allylation to establish the stereochemistry of the tetrahydropyran unit and a useful SmI(2)-mediated modification of the Barbier reaction of iodomethyloxazole 15 with aldehyde 14.

Vitamin D receptor genotypes are not associated with rheumatoid arthritis or biochemical parameters of bone turnover in German RA patients.

OBJECTIVE: Vitamin D is known to exert immunomodulatory effects. An overrepresentation of the b allele of the vitamin D receptor (VDR) has been detected in autoimmune diseases as type-1-diabetes and multiple sclerosis. VDR polymorphisms have been shown to influence bone metabolism and bone density. The aim of the present study was to examine the distribution of VDR alleles in German rheumatoid arthritis (RA) patients and their relation to bone turnover parameters. METHODS: 62 German RA patients were included and compared to 40 controls. Three VDR alleles were examined (Bsm I, Taq I and Fok I). In addition, serum intact osteocalcin (OC), parathyroid hormone, bone specific alkaline phosphatase (B-ALP), the carboxyterminal extension peptide of type I procollagen, 25-OH-vitamin D and urinary deoxypyridinoline (DPD) excretion were measured. Furthermore, C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor were measured. RESULTS: We found a slightly higher frequency of the bB and tT-genotype in RA patients compared to controls, which was not statistically significant. OC and B-ALP were found to be significantly higher in RA patients with positive correlations between bone formation and resorption parameters indicating higher bone turnover in RA patients with maintained coupling. CRP in RA patients correlated with DPD and inversely with PTH. VDR genotype showed no association with bone turnover, family history or the presence of rheumatoid factor. CONCLUSIONS: Our results suggest that VDR polymorphisms do not play a major role in RA predisposition in Germans.

[Thermotherapy in rheumatic diseases]. / Thermotherapie bei rheumatischen Erkrankungen.

Heat and cold treatment are often used in the physical therapy of rheumatic diseases. Thermotherapy influences perfusion, muscular tone, pain, and inflamed arthritic joints. Cold applications are preferable in treating active arthritis. Heat treatment is advantageous in the management of less active arthritis and non-inflammatory rheumatic disorders. Current investigations demonstrate that thermotherapy influences the endocrine--an immune systems.

[Pharmacological treatment of fibromyalgia syndrome]. / Medikamentöse Therapie des Fibromyalgiesyndroms.

BACKGROUND: An interdisciplinary guideline for the treatment of fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) was developed in cooperation with ten German medical and psychological associations and two patients' self-help organizations. METHODS: Using the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/ 2006) a systematic literature search was performed, which included all randomised controlled trials (RCT) evaluating multicomponent therapy in FMS and CWP. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of recommendation was graded according to the German program for disease management guidelines. Consensus was achieved using a multi-step nominal group procedure. RESULTS: The short-term use of amitriptyline is strongly recommended (grade A) and the short-term use of fluoxetine und duloxetine is recommended (grade B). CONCLUSIONS: The recommendations regarding pharmacological treatment of FMS are limited by the short duration of the RCT, the lack of follow-ups and absence of cost-effectiveness studies.