Official American Thoracic Society/Japanese Respiratory Society Clinical Practice Guidelines: Lymphangioleiomyomatosis Diagnosis and Management

"BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease that primarily affects women. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of LAM. METHODS: Systematic reviews were performed to summarize evidence pertinent to our questions. The evidence was summarized and discussed by a multidisciplinary panel. Evidence-based recommendations were then formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: After considering the panel's confidence in the estimated effects, the balance of desirable (i.e., benefits) and undesirable (i.e., harms and burdens) consequences of treatment, patient values and preferences, cost, and feasibility, recommendations were formulated for or against specific interventions. These included recommendations for sirolimus treatment and vascular endothelial growth factor D testing and recommendations against doxycycline and hormonal therapy. CONCLUSIONS: Evidence-based recommendations for the diagnosis and treatment of patients with LAM are provided. Frequent reassessment and updating will be needed."

Thermodynamics of Cationic Surfactant Sorption onto Natural Clinoptilolite.

Sorption enthalpies of hexadecyltrimethylammonium bromide (HDTMA) as monomers and micelles and tetraethylammonium bromide (TEA) were used with surfactant, counterion, and co-ion sorption isotherms to infer the conformation, sorption mechanism, and relative stability of the sorbed surfactants on natural clinoptilolite. The average value of the sorption enthalpy was -10.38 kJ/mol for monomers, -11.98 kJ/mol for micelles, and +3.03 kJ/mol for TEA. Sorption of monomers produced a lower sorption plateau than equivalent micelle sorption (maxima 145 mmol/kg, 225 mmol/kg). Analysis of the sorption data demonstrated a change in the sorption mechanism at the external cation exchange capacity (ECEC) of clinoptilolite. Sorption data from below and above the ECEC were fit to a simple polynomial model and the Gibbs free energy of sorption (DeltaG0m) and sorption entropies were calculated. Resultant values of DeltaG0m were -9.27 and -14.38 kJ/mol for HDTMA monomers and micelles, respectively, for sorption below the ECEC, and -16.11 and -23.10 kJ/mol, respectively, for sorption above the ECEC. The value for TEA was -1.04 kJ/mol, indicating weaker sorption than for HDTMA. Monomer sorption to clinoptilolite exceeded the ECEC, even when the solution concentration was below the critical micelle concentration. Hydrophobic (tail-tail) components of DeltaG0m were the driving force for sorption of HDTMA, both below and above the ECEC. A significant kinetic effect was observed in the sorption isotherms with a period of rapid sorption followed by slow equilibration requiring 7 days to achieve steady state for HDTMA; TEA equilibration occurred within 24 h. Copyright 1998 Academic Press.