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The German Quality Assurance Directive for Dialysis (QSD-RL) stipulates that no more than 15 % of all patients treated in a dialysis unit in any quarter may have a hemoglobin (Hb) value lower than 10 g/dl. For approximately 90 % of dialysis patients, this Hb threshold value can be simply achieved by administering erythropoiesis-stimulating agents (ESA). However, the question is raised as to wether this Hb threshold accords with the current state of knowledge. It is now evident from four randomized controlled trials (above all the TREAT study) and three meta-analyses that an ESA-induced increase in Hb does not produce any significant survival benefit in cases of chronic kidney disease (CKD), but may actually be detrimental. Critical attention must be focused in this regard on the higher risk of cardiovascular and cerebrovascular events, as well as malignoma-associated risks. In 2011, in response to these findings, the American Food and Drug Administration (FDA), the Drug Directive (AM-RL) of the German Federal Joint Committee and KDIGO (Kidney Disease: Improving Global Outcomes) amended guidelines for the treatment of renal anemia. Very restrictive recommendations were made regarding the use of ESA in CKD, according to which the Hb threshold value of 10 g/dl stipulated in the Quality Assurance Directive is now obsolete, thus necessitating prompt revision of the Directive. Two alternatives are available in this regard: either the 10 g/dl Hb threshold value applicable hitherto is withdrawn without replacement, and individualized treatment of renal anemia is practised ("individualization") instead, or a threshold value of 9 g/dl (modified "standardization") is applied in future.

The aim of this study was to calculate, for the first time, minimum provider volumes in total knee replacement using routine German data.In patients with primary total knee replacement (TKR), the relationship between hospital volume per year and risk of "insufficient mobility" (primary quality indicator) and "wound infection" (secondary quality indicator) was calculated by means of logistic regression models.For both indicators, a statistically significant relationship between hospital volume and outcome could be demonstrated. Other risk factors such as age and ASA status also had a significant influence, but did not appear as important confounders. The risk for the secondary quality indicator "infection" decreased constantly with increasing hospital volume, thus the curve was very flat. This supports the hypothesis that high volume hospitals have a higher quality level than low volume hospitals. A threshold value could be calculated. However, the explanation value for hospital volume was too low to derive a threshold level that clearly discriminates between good and bad quality of care. The relationship between the primary quality indicator "insufficient mobility" and hospital volume unexpectedly showed a U-shaped distribution. This questions the concept of a minimum provider volume regulation for primary total knee replacement for the quality indicator "insufficient mobility". Therefore, in this case no quantitative threshold values were calculated.This analysis supports the hypothesis of a volume-outcome relationship in primary total knee replacement. However, a minimum provider volume that clearly discriminates between good and bad quality of care could not be calculated on the basis of these German quality assurance data.

The article describes critical investigations concerning the threshold value between endogenous and exogenous concentrations of gamma-hydroxybutyric acid (GHB/"liquid ecstasy") in human blood. The values of GHB in the blood samples of 50 blood donors and 50 postmortem cases were measured with a validated gas-chromatographic/mass-spectrometric procedure according to the guidelines of the GTFCh (Society of Toxicological and Forensic Chemistry). GHB-concentrations were found to range between 0.11 and 1.56 mg/L (mean value 0.54 mg/L/standard deviation 0.37 mg/L/coefficient of variation 68.4 %) in the donors' blood, and between 2.2 and 116 mg/L (mean value 32.4 mg/L/standard deviation 25.6 mg/L/coefficient of variation 79 %) in the postmortem samples, respectively.

In der vorliegenden Studie wurden 39 Patientinnen (24.-41. Schwangerschaftswoche) untersucht, um die Auswirkungen vibroakustischer Stimulationen (VAS) auf Kurz- und Langzeitreaktivität des Feten in Abhängigkeit von der Reizintensität zu überprüfen. Eine Schallintensität von 50 dB reichte aus, um eine zuverlässige Reizantwort zu erzielen. Zudem wurde abhängig von der Stimulationsanzahl eine Habituation beobachtet. Ferner wurde überprüft inwieweit die Treffsicherheit der CTG-Interpretation mittels Fischer-Score, FIGO-Richtlinien und NST durch VAS verbessert werden konnte. Bei nicht dekompensierten Feten nahm die fetale Aktivität nach VAS signifikant zu, was zu einer Verkürzung der Untersuchungszeiten und zu einer Reduzierung falsch positiver Befunde beitragen kann. The present study examined 39 women from 24. to 41. gestational age. We studied the fetal short- and long- term- variability after different intensities of vibroacoustic stimulation (VAS). A sound intensity of only 50 dB evoke a reliable fetal response. It could also be demonstrated a habituation after several VAS. Furthermore we examined the accuracy of the CTG- Interpretation by Fischer- Score, FIGO- guidelines and NST after VAS. The fetal activity of healthy fetuses increased significantly after VAS. This could reduce investigationtime and the number of false- positive results.

The results of the Cryo-ROP group showed that cryotherapy significantly reduces the rate of adverse morphological and functional outcome of eyes with threshold retinopathy of prematurity. Structural status and visual acuity of 48 eyes which consecutively underwent cryocoagulation in our hospital between 1990 and 1994 were examined at 2 years corrected gestational age.Visual acuity and fundus morphology were examined by Teller acuity-cards test, retinoscopy, orthoptic status and fundus examination. A favourable grating acuity was defined asor = 2.2 cy/degree, a favourable morphology as no pathological or mild findings at the level of the posterior pole or stage 4 a.Fifty-six % of cases reached a quantifiable grating acuity between 0.32 and 13.0 cy/degree, 42% reached a favourable functional outcome, and 69% of the eyes had a morphologically favourable outcome. Fifty-five % of the measurable eyes were myopic, and 29% had a high myopiaor = -6.0 D. 47% showed a heterotropia.Our results show a discrepancy between morphological and functional outcome. Especially for zone 1 eyes, cryocoagulation of the avascular retina does not seem to allow a favourable morphological and functional outcome.

We compared the standard suprathreshold strategy to the so-called threshold splitting strategy with 5 and 2 dB steps. The aim of the study was to establish whether the threshold splitting strategy had advantages over the suprathreshold strategy that has been used to date.We examined the 30 degrees visual field in 49 volunteers using suprathreshold perimetry and on the same day threshold splitting perimetry on the Tübinger Automatic Perimeter CC. A total of 191 test points were examined in suprathreshold strategy. Using the threshold splitting strategy, 67 test points were examined, with a test-point design similar to other perimeters with the threshold splitting strategy. The criteria for inclusion in the study were central light sensitivity differences greater than 25 dB, fixation better than 80% and an illumination class density2.The average duration of the examination using the suprathreshold strategy was 2-3 min quicker than the threshold splitting strategy in normal visual fields or small scotomas, but it took up to 15 min longer if large scotomas were presents. Interpretation of the scotoma configuration showed subjective differences: the smaller the scotoma, the greater the differences because of the fact that threshold splitting perimetry utilizes test points that are farther apart than those used in suprathreshold perimetry.

1.) A reduction of the threshold value concerning the absolute driving unfitness because of a presumed amelioration of the quality of the forensic blood alcohol determination seems not to be justified. 2.) A reduction of the threshold value because of other reasons seems to be well-founded.

Kurzfassung Diese Arbeit beschäftigt sich mit der Auswirkung der Segmentierungsparameter auf den Wirbelkörper, basierend aus einem CT-Datensatz. Zielsetzung: Ziel dieser Arbeit ist es, den Einfluss der manuellen und standardmäßigen Schwellenwertauswahl auf die Zuverlässigkeit und Genauigkeit der Foramen intervertebrale (IVF) zu untersuchen. Dieses wird durch die Messungen der Durchmesser, der digitalen 3D IVF durchgeführt. Hier wird untersucht wie sich der Durchmesser mit unterschiedlichen Schwellenwerten und wie sich das digitale 3D-Modell sich von der Darstellung ändert. Abschließend wird recherchiert ob die rekonstruierten 3D-Modelle als Hilfestellung im Operativen Bereich geeignet ist. Methode: Neben einer ausführlichen Literaturrecherche in Datenbanken für wissenschaftliche Quellen (Pubmed, Sciencedirect, CINAHL und SpringerLink), wurde auch in unterschiedlichen Bibliotheken recherchiert. Publizierte Quellen aus dem Zeitraum 2010 bis 2020 wurden für diese Arbeit herangezogen. Mit Hilfe von sogenannten Keywords, wurde eine Auflistung angefertigt, um relevante Literatur, bzw. Studien heraus finden zu können. Es wurden Keywords wie „CT Spine“, „Segmentation“, „Segmentation spine“, „Threshold CT“, „Spine 3D-Model“ und „Threshold Spine“ gesucht. Der Empirische Teil der Arbeit wird mit der Software Mimics Innovation Suite, Version 22.0, der Firma Materialise realisiert. Abschließend wird der Durchmesser des digitalen 3D IVF gemessen und miteinander verglichen. Ergebnisse: Die Ergebnisse dieser Arbeit haben gezeigt, das die Auswirkungen der Segmentierungsparameter, in den einzelnen Schichten, am selben 3D-Modell, die gleichen Effekte haben. Letztlich hat der Vergleich von unterschiedlichen 3D- Modellen gezeigt, das der Durchmesser der einzelnen Foramina intervertebralia, sich unterschiedlich Verhalten, trotz derselben Segmentierungsparametern. Diskussion : Obwohl Softwarepakete bereits vordefinierte Schwellenwerte haben, sind diese nicht für alle Elemente geeignet. Deshalb sollte eine individuelle selektive Schwellenwertenauswahl für die einzelnen Elemente betrachtet werden. Ebenfalls berücksichtigt die Software nicht die unterschiedlichen Grauwerte der unterschiedlichen CT-Scannern. Letztlich um Knochenlücken auszugleichen, sind Schwellenwerte, näher am Weichteilgewebe zu wählen, als die vordefinierte Einstellung des Knochens. Abstract This thesis deals with the effect of the segmentation parameters on the vertebral body, based on a CT dataset. Aim: The aim of this thesis is to investigate the influence of manual and standard threshold selection on the reliability and accuracy of Intervertebral foramen (IVF). This is done by measuring the diameters, of the digital 3D IVF. Here it is investigated how the diameter changes with different thresholds and how the digital 3D model changes from the representation. Finally, it is investigated whether the reconstructed 3D models are suitable as an aid in the operative field. Method: In addition to an extensive literature search in databases for scientific sources (Pubmed, Sciencedirect, CINAHL and SpringerLink), research was also conducted in various libraries. Published sources from the period 2010 to 2020 were used for this work. With the help of so-called keywords, a list was compiled in order to find relevant literature and studies. Keywords like "CT Spine", "Segmentation", "Segmentation spine", "Threshold CT", "Spine 3D-Model" and "Threshold Spine" were searched. The empirical part of the work is realized with the software Mimics Innovation Suite, Version 22.0, from Materialise. Finally, the diameter of the digital 3D IVF is measured and compared. Results: The results of this thesis have shown that the effects of the segmentation parameters, in the different layers, on the same 3D model, have the same effects. Finally, the comparison of different 3D models has shown that the diameter of each intervertebral foramina, behave differently, despite the same segmentation parameters. Discussion: Although software packages already have predefined thresholds, these are not suitable for all elements. Therefore, an individual selective threshold value selection should be considered for each element. Also, the software does not take into account the different gray values of the different CT scanners. Finally, to compensate for bone gaps, threshold values closer to the soft tissue should be selected than the predefined setting of the bone.

The German Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area has re-evaluated peracetic acid [79-21-0] considering all toxicological end points. Peracetic acid is commercially available only in aqueous solutions, in which it exists in equilibrium with hydrogen peroxide and acetic acid. Therefore, all three substances contribute to toxicity. No specific systemic effects were observed, which is plausible because peracetic acid immediately oxidizes the tissues at the point of contact and is thereby converted to acetic acid. Peracetic acid is a promotor of skin tumours in mice. Valid long-term carcinogenicity studies with peracetic acid, particularly studies using an inhalation route, are not available. The mechanisms by which peracetic acid may induce carcinogenic effects are, as has already been demonstrated for hydrogen peroxide, local cytotoxicity leading to tissue damage and genotoxicity; both are due to the strong oxidation potency. These mechanisms do not come into play unless the endogenous detoxification capacities are overloaded. Due to this mechanism of action, hydrogen peroxide was classified in Carcinogen Category 4. As the same mechanism is likewise plausible for peracetic acid, it has also been classified in Carcinogen Category 4. Peracetic acid is the strongest irritant of the substances in the equilibrium mixture. If sensory irritation is excluded, it is also ensured that the detoxifying enzymes are not overloaded and thus neither tissue-damaging nor genotoxic effects occur. Based on the RD for pure peracetic acid in mice of 4.6 ml/m, the maximum concentration at the workplace (MAK value) for peracetic acid is set at 0.1 ml/m. The available human data are not sufficient to derive a MAK value, but do not contradict it either. As the critical effect of peracetic acid is local, Peak Limitation Category I has been designated. By analogy with hydrogen peroxide and as the data for the human experience with peracetic acid are of only limited validity, an excursion factor of 1 has been set. The few positive results for genotoxicity in vitro obtained with peracetic acid occurred at cytotoxic concentrations or in the absence of detoxification systems. All valid in vivo genotoxicity tests were negative, but the significance of the negative test results is questionable since peracetic acid induces a rapid local reaction. Therefore, it can also be concluded that classification in a category for germ cell mutagens is not required. The NOAEL for developmental toxicity in rats is 30.4 mg/kg body weight and day, which corresponds to a concentration of 53 mg/m at the workplace. Therefore, damage to the embryo or foetus is unlikely when the MAK value is not exceeded and peracetic acid is assigned to Pregnancy Risk Group C. Skin contact is expected to contribute only slightly to systemic toxicity. With respect to skin sensitization, there are no positive findings in humans and no reliable positive findings in animals. The respiratory symptoms that occur in exposed workers are caused by irritation.