RESUMEN
Stage I breast carcinoma is classified when an invasive breast carcinoma is ≤2 cm in diameter (T1), with no regional (axillary) lymph node metastases (N0) and no distant metastases (M0). The most common sites for metastases from breast cancer are the skeleton, lung, liver, and brain. In general, women and health care professionals prefer intensive screening and surveillance after a diagnosis of breast cancer. Screening protocols include conventional imaging such as chest radiography, bone scan, ultrasound of the liver, and MRI of brain. It is uncertain whether PET/CT will serve as a replacement for current imaging technologies. However, there are no survival or quality-of-life differences for women who undergo intensive screening and surveillance after a diagnosis of stage I breast carcinoma compared with those who do not. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Detección Precoz del Cáncer/normas , Mamografía/normas , Metástasis de la Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Guías de Práctica Clínica como Asunto , Medicina Basada en la Evidencia , Femenino , Humanos , Oncología Médica/normas , Metástasis de la Neoplasia/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Radiología/normas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Vigilancia de Guardia , Estados UnidosRESUMEN
Stage I breast carcinoma is classified when an invasive breast carcinoma is ≤2 cm in diameter (T1), with no regional (axillary) lymph node metastases (N0) and no distant metastases (M0). The most common sites for metastases from breast cancer are the skeleton, lung, liver, and brain. In general, women and health care professionals prefer intensive screening and surveillance after a diagnosis of breast cancer. Screening protocols include conventional imaging such as chest radiography, bone scan, ultrasound of the liver, and MRI of brain. It is uncertain whether PET/CT will serve as a replacement for current imaging technologies. However, there are no survival or quality-of-life differences for women who undergo intensive screening and surveillance after a diagnosis of stage I breast carcinoma compared with those who do not. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/secundario , Diagnóstico por Imagen/normas , Adhesión a Directriz/normas , Tamizaje Masivo/normas , Radiología/normas , Femenino , Humanos , Estadificación de NeoplasiasRESUMEN
Voltage-dependent anion channels (VDACs) are the porins in the outer mitochondrial membrane allowing metabolite flux between mitochondria and the cytoplasm. The permeabilities of the VDACs to ATP(-4), ADP(3-), creatine phosphate2-, Pi2-, Pi-, and other charged metabolites depend on the membrane potential. But neither the existence of the electrical potential across the outer membrane of mitochondria, nor its generation mechanisms have been experimentally shown. In this work, the concept of metabolically-derived potential that could be generated on the outer membrane was developed further. The computational study of the quantitative models shows that a steady-state membrane potential above 40 mV may be generated across a membrane with VDACs, if the VDACs are considered to be non-permeable to K+ and Cl-. Free permeability of VDACs to these inorganic ions, mimicking VDACs biological behavior, decreases the potential to nearly 12 mV. This decrease does not result from the electrical shortening of the potential by K+ and Cl- fluxes, but is caused by the electrodynamic compartmentation of the charged metabolites influencing the Goldman fluxes and the enzyme activity determining the fluxes. The interaction of two cyclic steady-state fluxes of charged metabolites due to the synergetic superposition of the potentials generated by each of these fluxes was obtained, and the effect of amplification of one flux by the other was theoretically demonstrated. These calculations based on VDACs' known permeability-voltage characteristics indicate that there is a certain possibility that the cell energy metabolism is regulated on the outer membrane of mitochondria by the electrical potential generated by various metabolically-dependent mechanisms.