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Gross pathology was negative and the liver, heart, kidney, stomach, and duodenum had normal histology. Plasma urea concentrations ranged from 6 to 7 mg/mL at 20? 30 minutes after injection to 2?3 mg/mL just prior to the next injection. Following urea injection, the only symptoms noted were mild drowsiness and a reduction of spontaneous movements. During the test period, diuresis was increased and the animals drank more water, but there were no obvious gastrointestinal disturbances and the dogs ate normally. Weights, hematocrit values, platelet counts, and bleeding times did not change over the course of study. The authors concluded that urea does not induce severe toxicity in dogs at blood concentrations up to 7 g/L. In an earlier study of the role of urea in canine uremia, Grollman and Grollman (1959) removed both kidneys from six dogs with an interval of 7?14 days recovery between each kidney removal. One liter of commercially available sterile peritoneal lavage solution was administered i. Anorexia, weakness, diarrhea, and vomiting were early symptoms followed by hemorrhage from the bowel, coma, and death. Two piglets received meal containing doses up to 10% urea in feed over a 15-day period. One piglet received doses up to 5% urea in feed over a 10-day period followed by two additional doses of urea (8 and 16 g urea/kg) by mouth on days 12 and 14. The authors reported no diarrhea or symptoms of urea intoxication for any of the study animals. However, no incidence data were provided, nor was there information with regard to food consumption. Cardiotoxicity Studies have evaluated the effects of urea on the cardiovascular system. Overall, the studies indicate that urea and its metabolites have various cardiotoxic effects including protein carbamylation, nitric oxide synthase inhibition, and mechanical and electrical alterations. The active form of cyanate, isocyanic acid, may then react with nonprotonated amino groups of proteins. The carbamylation of these proteins can lead to altered protein structure and activity. Hemodialysis patients with advanced renal disease (n = 13) exhibited elevated levels of protein carbamylation when compared with controls (n = 11) (42 4 vs. Cellular proliferation was assessed 3 by cell counting, incorporation of [ H]-thymidine, protein expression (as assessed by Western blots), and apoptosis. A concomitant decrease in cell viability was not observed (>95% cell viability at concentrations up to 9 g/L [150 mmol/L]). Additionally, urea was shown to significantly stimulate macrophage proliferation at concentrations ranging from 0. At 8 weeks of age, mice were divided into two groups, uremic (8 males and 14 females) and nonuremic control (6 males and 19 females).
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In [235] it is stated, that "edge detection can be a low-level technique towards the goal of boundary detection". The motivation for this is that any intensity gradient, which is in an image boundary, can only be caused by a geometric gradient or by a change in re? To simplify the operators used in the algorithm, the color image is transformed into a gray scale image. Mathematically, the image matrix is reduced from three color to one intensity dimension. To achieve this, a weighted sum of the color components for each pixel is calculated via I1 = 0. This transformation causes no loss of relevant information although the color is neglected. The intensity information is conserved during this transformation which carries all information about relevant gradients and connectivity of pixel. This is done by generating an intermediate image which is obtained after applying a Gaussian low-pass? Since the intermediate image will only contain low spatial frequency parts and the intensity values are inverted, those pixel in tensities will be reduced. The resulting image I2 will contain pixels with high gradients and high intensities and pixels with low gradients and low intensities. The original pixel value receives the heaviest weight (having the highest Gaussian value) and neighboring pixels receive smaller weights as their distance to the original pixel increases. The convolution is calculated with the formula X2 X2 Iintermediate(x,y) = I1(x,y)? Not the complete image but rather a local pixel neighborhood should be processed to even out the differences and hence to improve the detection proba bility. This means, a mapping function T which produces a new image I3 after applying onto the original image I2 I3 = T I2 (7. The mapping function will map the narrow range of pixel values to the whole range of the target histogram [238]. The output of this algorithm is a binary image of the same size as the input image. Every foreground pixel will have the value 1 and the background pixels have the value 0. The aim of this step is to decide which pixels are connected and form a single object, like a grain boundary. A row (or column) in a binary image can be represented as a sequence of ones and zeros, where a connected sequence of ones is called a run.
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Definitive radiotherapy alone is considered for an individual with no evidence of metastatic disease who cannot undergo a cystectomy or concurrent chemoradiation. In the preoperative setting, there remains insufficient data to determine the benefit of radiation therapy. For example, in an intergroup trial of 140 patients with invasive bladder cancer or recurrent superficial high-grade cancer, preoperative radiation (20 Gy in 5 fractions) was not associated with a survival advantage at five years (Smith, 1997). On the other hand, several publications have suggested a benefit to preoperative radiation in patients with high stage disease (Parsons, 1988; Cole, 1995). Data from a retrospective series demonstrate higher local recurrence rates in patients with T3-T4 disease, positive nodes or positive surgical margins (Herr, 2004). The benefit of postoperative radiation and reducing local recurrence and improving disease-free survival has been shown in several studies (Bayoumi, 2014; Zaghloul, 1992; Nasr 2015). As a result, the use of radiation in the postoperative setting is considered medically necessary for an individual with pT3-T4 disease, positive lymph nodes and/or positive surgical margins. In an individual with evidence of metastatic disease, palliative radiation is medically necessary, up to 20 fractions using 3D techniques. Page 63 of 263 References: 1. A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. Local control of muscle-invasive bladder cancer: preoperative radiotherapy and cystectomy versus cystectomy alone. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. Postoperative radiotherapy in bladder cancer patients: 5-year institutional experience of National Cancer Institute, Cairo University. Planned preoperative irradiation in the management of clinical stage B2-C (T3) bladder carcinoma. Radiochemotherapy after transurethral resection for high-risk T1 bladder cancer: an alternative to intravesical therapy or early cystectomy? Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease free survival through improving local control. Following simulation, a teletherapy isodose plan and monitor unit calculation is performed. Radium-223 (Xofigo) is medically necessary for the treatment of castration-resistant prostate cancer for an individual with all of the following: A. No evidence of visceral metastases or bulky regional lymph nodes greater than 3 cm on imaging performed within the past 30 days C. Who has received and exhausted all medical or surgical-ablative hormonal treatments.
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