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As a corporation under public law, the federally established Medical Service (MD) is an organizationally and substantively independent socio-medical expert organization. It uses its expertise to support the health and nursing care insurance companies as well as their associations and other clients from the healthcare system nationwide in ensuring medical and nursing care within the social law solidarity community consisting of statutory health and social care insurance. In relation to the 12.

[Hip Fractures in Adults - Contemporary Clinical Management Based on International Standards].

Background: Patients with hip fractures, often of advanced age and with multimorbidity-trauma, require early surgery and interdisciplinary treatment in order to avoid complications and reduce morbidity and mortality. "Time to surgery" is a sensitive quality indicator (QI) for the treatment process, reflecting multiple factors. Due to persistently noticeable problems in relation to this QI in external inpatient quality assurance in Germany, a special need for action was identified by the Federal Joint Committee (Gemeinsamer Bundesausschuss - G-BA).

[The MDK as an Institution for Quality Assurance in the German Health System: A Practice Report on Quality Audits Based on the Guideline on Minimally Invasive Heart Valve Interventions of the G-BA].

Introduction: In 2015, the Federal Joint Committee (G-BA) adopted a guideline on minimally invasive heart valve interventions (MHI-RL). Every year, hospitals have to declare compliance with the quality requirements of the guideline in the form of checklists vis-à-vis the social service providers, who can have the data checked by the medical service of the health insurance (MDK) on site. Here we report on the experience with these tests in Hessian hospitals.

[Quality Controls in Hospitals by MDK Hessen: A Practice Report of Experiences and Outlook].

Introduction: The Hospital Structure Act introduced § 275a SGB V into the German Social Code. It specifies and expands the legal requirements for future quality controls in hospitals performed by the Medical Review Board of the Statutory Health Insurance Funds (MDK). These controls are intended to ensure high-quality, patient-centered and needs-based medical care of the population.

[DGSMP - Interdisciplinarity to Advance Social Medicine and Prevention of Illness].

The German Society for Social Medicine and Prevention (DGSMP) refers back to a tradition of over more than 100 years, nevertheless having a critical look at it. As a scientific medical society the DGSMP promotes cross-sectoral configuration of contemporary social medicine to the benefit of both, general welfare and individual health in form of prevention, rehabilitation, re-integration, palliation and long-term care. Human medicine is the lead discipline in the interdisciplinary approach by the DGSMP in order to create - facing the dynamics in the health care system - professional prerequisites to maintain and update solidarity and equity in medical services on a scientific basis.

[Consistency and Reliability of MDK Expertise Examining the Encoding in the German DRG System].

Introduction: Hospital inpatient stays are reimbursed on the basis of German diagnosis-related groups (G-DRG). The G-DRG classification system is based on complex coding guidelines. The Medical Review Board of the Statutory Health Insurance Funds (MDK) examines the encoding by hospitals and delivers individual expertises on behalf of the German statutory health insurance companies in cases in which irregularities are suspected.

Mechanisms involved in cholesterol-induced neuronal insulin resistance.

Insulin receptors (IRs) are highly expressed in the central nervous system (CNS) and play an important role in normal brain functions, such as learning and memory. Due to the increasing rate of obesity in western societies and overall high fat diets, the incidents of neuronal insulin resistance is also on the rise, but the underlying mechanism is still poorly characterized. We found that cholesterol treatment produces robust insulin signaling resistance that is characterized by the marked reduction in insulin-stimulated tyrosine phosphorylation of the IR and its downstream targets insulin receptor substrate 1 (IRS1) and 2 (IRS2).

Role of the N- and C-lobes of calmodulin in the activation of Ca(2+)/calmodulin-dependent protein kinase II.

Understanding the principles of calmodulin (CaM) activation of target enzymes will help delineate how this seemingly simple molecule can play such a complex role in transducing Ca (2+)-signals to a variety of downstream pathways. In the work reported here, we use biochemical and biophysical tools and a panel of CaM constructs to examine the lobe specific interactions between CaM and CaMKII necessary for the activation and autophosphorylation of the enzyme. Interestingly, the N-terminal lobe of CaM by itself was able to partially activate and allow autophosphorylation of CaMKII while the C-terminal lobe was inactive.

A community resource for high-throughput quantitative RT-PCR analysis of transcription factor gene expression in Medicago truncatula.

Background: Medicago truncatula is a model legume species that is currently the focus of an international genome sequencing effort. Although several different oligonucleotide and cDNA arrays have been produced for genome-wide transcript analysis of this species, intrinsic limitations in the sensitivity of hybridization-based technologies mean that transcripts of genes expressed at low-levels cannot be measured accurately with these tools. Amongst such genes are many encoding transcription factors (TFs), which are arguably the most important class of regulatory proteins.

Acidic/IQ motif regulator of calmodulin.

The small IQ motif proteins PEP-19 (62 amino acids) and RC3 (78 amino acids) greatly accelerate the rates of Ca(2+) binding to sites III and IV in the C-domain of calmodulin (CaM). We show here that PEP-19 decreases the degree of cooperativity of Ca(2+) binding to sites III and IV, and we present a model showing that this could increase Ca(2+) binding rate constants. Comparative sequence analysis showed that residues 28 to 58 from PEP-19 are conserved in other proteins.

Calpain-mediated mGluR1alpha truncation: a key step in excitotoxicity.

Excitotoxicity mediated by glutamate receptors plays crucial roles in ischemia and other neurodegenerative diseases. Whereas overactivation of ionotropic glutamate receptors is neurotoxic, the role of metabotropic glutamate receptors (mGluRs), and especially mGluR1, remains equivocal. Here we report that activation of NMDA receptors results in calpain-mediated truncation of the C-terminal domain of mGluR1alpha at Ser(936).

[The position of the sociomedical expert in the Medical Services of German Statutory Sickness Insurance Bodies (MDK) as influenced by changing challenges].

The "Medical Services of the German Statutory Sickness Insurance Bodies (MDK)" is a non-profit organisation providing socio-medical specialist advice to the German Statutory Health and Nursing Care Insurances. Facing demographic changes as well as progress in medicine, highly qualified expertises and consultations are of increasing importance to manage the social security system and to continue to develop its structure. Sociomedical assignments of the MDK as applied health science is so far mainly related to individual aspects of insured persons (case management) but more and more to general aspects such as quality, consumer protection, efficiency, guiding concepts and organisation of the health care system.

RC3/Neurogranin and Ca2+/calmodulin-dependent protein kinase II produce opposing effects on the affinity of calmodulin for calcium.

The interaction of calmodulin with its target proteins is known to affect the kinetics and affinity of Ca(2+) binding to calmodulin. Based on thermodynamic principles, proteins that bind to Ca(2+)-calmodulin should increase the affinity of calmodulin for Ca(2+), while proteins that bind to apo-calmodulin should decrease its affinity for Ca(2+). We quantified the effects on Ca(2+)-calmodulin interaction of two neuronal calmodulin targets: RC3, which binds both Ca(2+)- and apo-calmodulin, and alphaCaM kinase II, which binds selectively to Ca(2+)-calmodulin.

Comparative analyses of the three-dimensional structures and enzymatic properties of alpha, beta, gamma and delta isoforms of Ca2+-calmodulin-dependent protein kinase II.

Ca(2+)-calmodulin-dependent protein kinase II (CaM-kinase II) is a ubiquitous Ser/Thr-directed protein kinase that is expressed from a family of four genes (alpha, beta, gamma, and delta) in mammalian cells. We have documented the three-dimensional structures and the biophysical and enzymatic properties of the four gene products. Biophysical analyses showed that each isoform assembles into oligomeric forms and their three-dimensional structures at 21-25 A revealed that all four isoforms were dodecamers with similar but highly unusual architecture.

Wernicke's encephalopathy: unusual contrast enhancement revealed by magnetic resonance imaging.

Wernicke's encephalopathy is a serious neurologic disorder caused by vitamin-B1 or thiamine deficiency. The classical triad of clinical symptoms described by Wernicke (gait ataxia, ophthalmoplegia, and confusion) are found in only a third of patients upon initial examination. Typical findings upon MR imaging in patients with Wernicke's encephalopathy are well documented, with signal intensities in the medial thalami and periaqueductal regions of the midbrain.

A new role for IQ motif proteins in regulating calmodulin function.

IQ motifs are found in diverse families of calmodulin (CaM)-binding proteins. Some of these, like PEP-19 and RC3, are highly abundant in neuronal tissues, but being devoid of catalytic activity, their biological roles are not understood. We hypothesized that these IQ motif proteins might have unique effects on the Ca2+ binding properties of CaM, since they bind to CaM in the presence or absence of Ca2+.

[Classification of social medical products provided by the German Medical Services of the Statutory Health Insurance in Hessen].

Based on agreements presented by a task force the German Medical Services of the Statutory Health Insurance in Hessen developed its own classification of social medical assignments. According to economic systematics they were arranged in groups of external and internal products reflecting providing services in form of medical expertises and fulfilment of legal obligations. Further typologisation of the products can be achieved by relational marks.

Molecular cloning and functional expression of Xenopus laevis oocyte ATP-activated P2X4 channels.

All cells contain mechanosensitive ion channels, yet the molecular identities of most are unknown. The purpose of our study was to determine what encodes the Xenopus oocyte's mechanosensitive cation channel. Based on the idea that homologues to known channels might contribute to the stretch channels, we screened a Xenopus oocyte cDNA library with cation channel probes.

[The future of social medicine from the practical viewpoint].

Within the German statutory health care system the practice of sociomedicine as an applied health science is mainly related to individual aspects of theinsured persons. Combining factors due to medical and socio-economical developments it plays an important integrative role as so to say a lawyer of the patients. Furthermore, practical sociomedicine must provide consultant services to support the social insurance in the sphere of shaping the health care system.

["Managed care"--perspectives in Germany].

There is a public discussion in Politics and Health services whether managed care should be realized in Germany. The German Medical Services of the Statutory Health Insurance (MDK) are also involved and have great interest and an opinion about this topic because the introduction of managed care or elements of managed care will influence the cooperation between the MDK and the German Statutory Health Insurance. The following article informs on certain elements of managed care already practised in Germany and discusses which of these elements can be used more intensively in the future according to Social Laws and developed structures.