[Evolutionary psychiatry applied to autism spectrum disorder]. / Evolutionaire psychiatrie toegepast op autismespectrumstoornis.

BACKGROUND: Considering an evolutionary perspective, psychiatric conditions present us with a paradox. How can the high prevalence of those conditions be explained, given the importance of genetic factors in many of them? Evolutionary principles predict that traits with an adverse effect on reproduction undergo negative selection. AIM: To try to formulate an answer to this paradox from the perspective of evolutionary psychiatry by integrating different disciplines. METHOD: We describe some important evolutionary models: the adaptive and maladaptive model, the mismatch model, the trade-off model and the balance model. By way of illustration, we have searched the literature for evolutionary perspectives on autism spectrum disorder. RESULTS: In this narrative review we describe several evolutionary hypotheses about autism spectrum disorder with a framing within the different evolutionary models. We discuss, among others, evolutionary hypotheses regarding gender differences in social skills, the link with more recent evolutionary cognitive development, and autism spectrum disorder as an extreme cognitive outlier. CONCLUSION: We conclude that evolutionary psychiatry offers a complementary point of view on psychiatric conditions and specifically on autism spectrum disorder. A link to neurodiversity and an impetus to clinical translation is made.

Impact of antithrombotics on the fecal immunochemical test for colorectal cancer screening : a multi-center Belgian experience.

Background: Impact of antithrombotics on the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening remains unclear. Methods: Patients undergoing colonoscopy for positive FIT in 2015 were assessed at 3 Belgian centers. Significant findings were advanced polyps (AP) (sessile serrated, tubular or villous adenomas >1cm or high-grade dysplasia) and CRC. False positive FIT and detection of AP/CRC with antithrombotics were calculated. Results: 510 patients (64% male, median (IQR) age 63.2 (60.2 - 66.4) years) were included. Colorectal pathology in 371/510 (73%) was associated with male gender (70% vs. 48% ; p= .0001) and family history (16% vs. 8% ; p= .02). Antithrombotics in 125/510 (25%) were associated with male gender (78% vs. 59% ; p= .0001), older age (65.2 (62.2-70.3) vs. 62.3 (58.7-66.3) years ; p= .0001) and GI-symptoms (18% vs. 11% ; p= .04). False positive FIT (25% vs. 28% ; p= .52) and detection of AP (42% vs. 36% ; p=.27) or CRC (6% vs. 5% ; p= .69) were similar in patients with vs. no antithrombotics. Use of antithrombotics did not predict a higher chance of colorectal pathology after adjusting for confounders. Conclusion: Although antithrombotics were prescribed more frequently in male and older patients, detection of AP/CRC was similar. Despite increased GI symptoms, false positive FIT was similar with antithrombotics.

Second primary malignancies in patients with a gastrointestinal neuroendocrine tumour: a case report and review of the literature.

A second primary malignancy (SPM) is frequently reported in patients with a gastrointestinal neuroendocrine tumour (NET). The majority of SPM are located in the gastrointestinal tract, but malignancies at other sites are described as well. This phenomenon might just be coincidental due to high incidence rates of asymptomatic NET lesions in patients who are operated or who undergo autopsy for another primary malignancy. However, other theories have been developed since the observed incidences rates seem to be double as high as expected. Some authors suggest a common genetic predisposition, while others report tumourigenic properties of various neuroendocrine peptides, including secretin, gastrin and cholecystokinin. This review is illustrated by a case report of a patient in whom the radiological diagnosis of a diffuse liver metastasized adenocarcinoma of the rectum changed dramatically after positron emission tomography and explorative laparoscopy to a curable adenocarcinoma of the rectum with a simultaneous well-differentiated neuroendocrine carcinoma.

Clinical skills training in a skills lab compared with skills training in internships: comparison of skills development curricula.

CONTEXT: The necessity of learning skills through "integrated skills training" at an undergraduate level has been supported by several studies. The University of Antwerp implemented undergraduate skills training in its renewed curriculum in 1998, after it was demonstrated that Flemish students did not master their medical skills as well as Dutch students who received "integrated skills training" as part of their undergraduate medical course. AIM: The aim of this study was to compare the skill outcome levels of two different student populations: students who had been trained in basic clinical skills mainly through clinical internships in year 7 with students who had learned these skills through an integrated longitudinal programme in a special learning environment in years 1-5 prior to their internship experience. STUDY SAMPLE: Students of the traditional curriculum learned skills through a 75 hour programme in years 4 and 5, through plenary sessions followed by a 12 month period of internships during which skills could be further practiced. We tested this group right after completion of their internships. Students from the renewed curriculum followed a 200 hour intensive small group skills training programme offered in years 1-5. This group was tested before starting their internships. RESULTS: On global OSCE-scores, renewed curriculum students had significantly higher overall scores (p<0.001) and they scored significantly higher at 6 of 15 stations. There was no significant difference at 8 stations, while traditional curriculum students scored better at station 1. DISCUSSION: 5 years and 200 hours of integrated undergraduate skills training is more effective as a method of learning basic clinical skills, compared to learning these skills through 75 hours of traditional skill training and reinforcement of these skills in 12 month clinical internships, when measured by means of an OSCE.

Proximal segment position after distraction with the MD-DOS device.

We investigated cephalometrically the movement of the proximal segment in the sagittal plane in patients treated with distraction (MD-DOS device) for mandibular lengthening. The proximal segment was anteriorly rotated, whilst the distal segment was posteriorly rotated after the lengthening procedure. Thus the angle of the jaw was advanced half the distance of the advancement of the distal segment. One possible reason for the anterior rotation of 3.3 degrees on average is the repositioning of the proximal segment during application of the anterior fixation unit in the cases where mobilization was complete. Another more plausible reason is the anterior pull by the masticatory muscles and elastic bands being greater than the reactive distraction vector component in concert with a flexible telescopic distraction module and a single posterior screw anchorage. The positional movements of both distal and proximal segments were similar to those observed after mandibular advancement with bilateral sagittal split osteotomies.

Cloning and characterization of Manduca sexta and Plutella xylostella midgut aminopeptidase N enzymes related to Bacillus thuringiensis toxin-binding proteins.

We report the purification, cloning and characterization of an aminopeptidase N from the midgut epithelium of Manduca sexta that binds Cry1Ab5, an insecticidal crystal protein [ICP] from Bacillus thuringiensis. Sequence information derived from this M. sexta aminopeptidase N was used for the cloning of an aminopeptidase N from the midgut brush-border membrane of Plutella xylostella, an insect species of which some populations acquired resistance against Cry1Ab5. Affinity chromatography on a Cry1Ab5 matrix was used to isolate a 120-kDa glycoprotein from the larval midgut of the lepidopteran M. sexta. On ligand blots the purified 120-kDa protein discriminates between the lepidopteran-specific Cry1Ab5 and the coleopteran-specific Cry3A delta-endotoxin. Internal amino acid sequences from the 120-kDa protein were used for the design of degenerate oligonucleotides. From a nested PCR with M. sexta midgut cDNA as template, a DNA fragment was obtained which shows similarity to prokaryotic and eukaryotic aminopeptidase N genes. This PCR fragment was used to screen cDNA libraries of larval midguts from M. sexta and P. xylostella. From the M. sexta midgut cDNA library a 2973-bp nucleotide sequence was cloned. The ORF of the sequence encodes a 942-residue aminopeptidase N (M. sexta Apn2) containing two hydrophobic regions. The NH2-terminal hydrophobic region corresponds to a secretory signal sequence and the COOH-terminal hydrophobic region is typical of glycosylphosphatidylinositol (glycosyl-PtdIns)-anchored proteins. Low-stringency hybridization of the P. xylostella midgut cDNA library with M. sexta apn2 probes enabled the isolation of a 3118-bp sequence with an ORF encoding a 946-residue preproprotein. This aminopeptidase N (P. xylostella Apn1) displays 61% amino acid identity to M. sexta Apn2 and contains a COOH-terminal signal peptide for glycosyl-PtdIns anchor addition. Both M. sexta Apn2 and P. xylostella Apn1 contain four Cys residues, which are highly conserved among eukaryotic aminopeptidase N molecules. Treatment of Sf9 cells expressing the P. xylostella apn1 gene with PtdIns-specific phospholipase C demonstrated that P. xylostella Apn1 is attached to the insect cell membrane by a glycosyl-PtdIns anchor.

Corneal astigmatism after clear corneal and corneoscleral incisions for cataract surgery.

PURPOSE: To compare the astigmatism induced by clear corneal incisions (CCIs) and corneoscleral tunnel incisions (CSIs) for cataract surgery over 6 months. SETTING: Rotterdam Eye Hospital, rotterdam, The Netherlands. METHODS: Thirty-five patients having phacoemulsification were recruited prospectively; 15 had CCIs and 20, CSIs. Corneal topography was performed by computerized videokeratoscopy preoperatively and 6 months postoperatively. The change in keratometric astigmatism was calculated using the absolute magnitude and vector analysis methods. RESULTS: There was no significant difference between the change in astigmatism produced by the two incisions (Student's t-test). CONCLUSION: The CCI for cataract surgery did not produce significantly greater astigmatism than the CSI. Concern over CCIs having a greater risk of increasing corneal astigmatism is unfounded and does not justify withholding the technique from patients it could benefit.

False positive immunostaining of Locusta neurosecretory cells with a variety of preimmune sera.

A large number of antisera directed against vertebrate neuropeptides have been reported to yield positive staining when applied to insect brains. In most cases, the preimmune serum of the same animal in which the antiserum was developed is not available for testing in control experiments. We have experienced that a large percentage of preimmune sera, as well as a culture medium for hybridomas, stain cell populations and fibers in the central nervous system of the insect Locusta migratoria. Purification of these preimmune sera on a Protein A and Protein G support indicates that the reaction is due to preexisting antibodies of the IgG class. Western analysis of brain and nervous tissue extracts indicates the presence of two immunoreactive 27-kDa bands. These bands could also be visualized in other tissue extracts such as muscle, midgut, Malpighian tubules, and fat body of Locusta. The brain of other insect species, such as Periplaneta americana, Leucophaea maderae, and Neobellieria bullata were devoid of the false immunopositive reaction. There is no easy way to eliminate this type of immunoreaction. It follows that when affinity chromatographic purification of the antibody is not feasible, it is essential to include in the control procedure, the preimmune serum of the animal that was used for the production of the antiserum. This means that it should become common practice to sell or exchange sera together with their corresponding preimmune sera.

Cumulative incidence of patients with disc hemorrhages in glaucoma and the effect of therapy.

PURPOSE: In this longitudinal study, the cumulative incidence of patients with glaucoma and disc hemorrhages was investigated. A possible effect of glaucoma therapy on the incidence rate of disc hemorrhages was evaluated. METHODS: A group consisting of 68 patients with primary open-angle glaucoma (POAG), 34 with normal-pressure glaucoma, and 125 with suspected glaucoma (mean follow-up, 7.3 +/- 2.5 years; range 3-13 years) was observed closely with quarterly examinations. RESULTS: In normal-pressure glaucoma, the cumulative incidence of patients with disc hemorrhages was 35.3%, which was significantly higher than for those with POAG (10.3%; P < 0.01) and for those with suspected glaucoma (10.4%; P < 0.001). The mean follow-up period before a first disc hemorrhage was detected was 2.5 +/- 2.8 years. In the bleeders, recurrent disc hemorrhages were observed in 67% of the patients with normal-pressure glaucoma, 29% of those with POAG, and 54% of glaucoma suspects. In normal-pressure glaucoma, therapy had no effect on the incidence rate of disc hemorrhages. In glaucoma suspects, a significant reduction of the incidence rate of disc hemorrhages per year (0.11 +/- 0.04) was observed during episodes with therapy compared with episodes without (0.43 +/- 0.15; P < 0.05). A concept of two populations (i.e., one with disc hemorrhages and the other never having them) seems to be valid for normal-pressure glaucoma, but not for POAG and suspected glaucoma. CONCLUSION: The cumulative incidence of initial disc hemorrhages increases with time in POAG and suspected glaucoma, but reaches a limit in normal-pressure glaucoma. Glaucoma therapy may reduce the incidence rate of all, initial and recurrent, disc hemorrhages in patients with high pressures, but not in patients with normal-pressure glaucoma.

Effects of Bacillus thuringiensis delta-endotoxin on the permeability of brush border membrane vesicles from tobacco hornworm (Manduca sexta) midgut.

1. The effect of two recombinant Bacillus thuringiensis delta-endotoxins on brush border membrane vesicles of Manduca sexta midgut was investigated using an in vitro assay system, based on ion-amino acid cotransport. 2. A CryIA(b)-toxin provoked an increase in the permeability of the vesicles. 3. A CryIB-toxin, not toxic to M. sexta larvae in vivo, had no effect in our assay. 4. In contrast to earlier reports, the increase in permeability was found to be neither selective for K+ nor specifically inhibited by Ca2+ or Ba2+. 5. Our data support the hypothesis that B. thuringiensis delta-endotoxins create non-specific pores.

[Analysis of severely injured patients admitted via an emergency service]. / Analyse van zwaar gekwetsten opgenomen via een spoedopnamedienst.

Data about the number and treatment of trauma-patients are, certainly in our country, very rare. In this study we showed that such a registration with grading of the severity of the injuries following the ISS-Score is feasible and useful. Further and more extensive registration seems necessary in order to obtain a better insight in epidemiology and treatment of trauma patients in our country.

Early versus late tocolytic treatment for preterm premature membrane rupture.

The effect of tocolytic therapy before labor was evaluated in 33 pregnant women with preterm premature rupture of the membranes. Either intravenous magnesium sulfate or oral terbutaline was administered at the time of presentation. Intensive surveillance to detect signs of infection was carried out for all patients. In 29 of the patients in this treatment group who were seen at less than 34 weeks, a significantly longer prolongation of pregnancy was achieved when compared with 24 similar women treated after onset of labor in the hospital (169 hours versus 77 hours, p = 0.05). Duration of infant hospitalization was less for those mothers receiving tocolytic agents before labor. Maternal and infant infection were not different in the two groups; nor was the cesarean section rate. When this treatment group was compared with another control group of 96 women already in labor at presentation, the difference in time from admission to delivery was substantial, but it did not achieve statistical significance. In this group the rate of maternal infection was significantly higher, but newborn morbidity was not. Aggressive early treatment with tocolytic agents in pregnant women with preterm premature membrane rupture is more productive but not more dangerous than conservative management.