Primary intestinal lymphangiectasia (Waldmann's disease)

Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. PIL is generally diagnosed before 3 years of age but may be diagnosed in older patients. Prevalence is unknown. The main symptom is predominantly bilateral lower limb edema. Edema may be moderate to severe with anasarca and includes pleural effusion, pericarditis or chylous ascites. Fatigue, abdominal pain, weight loss, inability to gain weight, moderate diarrhea or fat-soluble vitamin deficiencies due to malabsorption may also be present. In some patients, limb lymphedema is associated with PIL and is difficult to distinguish lymphedema from edema. Exsudative enteropathy is confirmed by the elevated 24-h stool α1-antitrypsin clearance. Etiology remains unknown. Very rare familial cases of PIL have been reported. Diagnosis is confirmed by endoscopic observation of intestinal lymphangiectasia with the corresponding histology of intestinal biopsy specimens. Videocapsule endoscopy may be useful when endoscopic findings are not contributive. Differential diagnosis includes constrictive pericarditis, intestinal lymphoma, Whipple's disease, Crohn's disease, intestinal tuberculosis, sarcoidosis or systemic sclerosis. Several B-cell lymphomas confined to the gastrointestinal tract (stomach, jejunum, midgut, ileum) or with extra-intestinal localizations were reported in PIL patients. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL medical management. The absence of fat in the diet prevents chyle engorgement of the intestinal lymphatic vessels thereby preventing their rupture with its ensuing lymph loss. Medium-chain triglycerides are absorbed directly into the portal venous circulation and avoid lacteal overloading. Other inconsistently effective treatments have been proposed for PIL patients, such as antiplasmin, octreotide or corticosteroids. Surgical small-bowel resection is useful in the rare cases with segmental and localized intestinal lymphangiectasia. The need for dietary control appears to be permanent, because clinical and biochemical findings reappear after low-fat diet withdrawal. PIL outcome may be severe even life-threatening when malignant complications or serous effusion(s) occur

Reproductive inequality in humans and other mammals

Data, Materials, and Software Availability: All study data are included in the article and/or supporting information available online at https://www.pnas.org/lookup/doi/10.1073/pnas.2220124120#supplementary-materials .Copyright © 2023 the Author(s). To address claims of human exceptionalism, we determine where humans fit within the greater mammalian distribution of reproductive inequality. We show that humans exhibit lower reproductive skew (i.e., inequality in the number of surviving offspring) among males and smaller sex differences in reproductive skew than most other mammals, while nevertheless falling within the mammalian range. Additionally, female reproductive skew is higher in polygynous human populations than in polygynous nonhumans mammals on average. This patterning of skew can be attributed in part to the prevalence of monogamy in humans compared to the predominance of polygyny in nonhuman mammals, to the limited degree of polygyny in the human societies that practice it, and to the importance of unequally held rival resources to women’s fitness. The muted reproductive inequality observed in humans appears to be linked to several unusual characteristics of our species—including high levels of cooperation among males, high dependence on unequally held rival resources, complementarities between maternal and paternal investment, as well as social and legal institutions that enforce monogamous norms.This work was conducted as a part of the “Emergence of Hierarchy and Leadership in Mammalian Societies” group at the National Institute for Mathematical and Biological Synthesis, supported by NSF Award DBI-1300426 and the University of Tennessee, Knoxville. It was supported by NSF awards SMA-1329089 and SMA-1743019, and the Santa Fe Institute, as well as the Max Planck Institute for Evolutionary Anthropology, Department of Human Behavior, Ecology and Culture. S.G. was supported by the US Army Research Office grants W911NF-14-1-0637, W911NF-17-1-0150, and the Office of Naval Research grant W911NF-18-1-0138. Additional funding for data collection was provided by the Wenner-Gren Foundation for Anthropological Research awards: 8913 and 7970, by NSF awards: BCS-0924630, BCS-0925910, BCS-0848360, BCS-0514559, BCS-0613226, BCS-0827277, SES-9870429, and DDRIG-1357209, by the National Geographic Society awards: HJ-099R-17, 20113909, 8671-09, and 7968-06, by the Kone Foundation awards: 086809, 088423, and 088423, and by the Jacobs Foundation, the UCSB Broom Center for Demography, and the UCSB Department of Anthropology