Genome-wide association studies and Mendelian randomization analyses provide insights into the causes of early-onset colorectal cancer.

BACKGROUND: The incidence of early-onset colorectal cancer (EOCRC; diagnosed <50 years of age) is rising globally; however, the causes underlying this trend are largely unknown. CRC has strong genetic and environmental determinants, yet common genetic variants and causal modifiable risk factors underlying EOCRC are unknown. We conducted the first EOCRC-specific genome-wide association study (GWAS) and Mendelian randomization (MR) analyses to explore germline genetic and causal modifiable risk factors associated with EOCRC. PATIENTS AND METHODS: We conducted a GWAS meta-analysis of 6176 EOCRC cases and 65 829 controls from the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO), the Colorectal Transdisciplinary Study (CORECT), the Colon Cancer Family Registry (CCFR), and the UK Biobank. We then used the EOCRC GWAS to investigate 28 modifiable risk factors using two-sample MR. RESULTS: We found two novel risk loci for EOCRC at 1p34.1 and 4p15.33, which were not previously associated with CRC risk. We identified a deleterious coding variant (rs36053993, G396D) at polyposis-associated DNA repair gene MUTYH (odds ratio 1.80, 95% confidence interval 1.47-2.22) but show that most of the common genetic susceptibility was from noncoding signals enriched in epigenetic markers present in gastrointestinal tract cells. We identified new EOCRC-susceptibility genes, and in addition to pathways such as transforming growth factor (TGF) ß, suppressor of Mothers Against Decapentaplegic (SMAD), bone morphogenetic protein (BMP) and phosphatidylinositol kinase (PI3K) signaling, our study highlights a role for insulin signaling and immune/infection-related pathways in EOCRC. In our MR analyses, we found novel evidence of probable causal associations for higher levels of body size and metabolic factors-such as body fat percentage, waist circumference, waist-to-hip ratio, basal metabolic rate, and fasting insulin-higher alcohol drinking, and lower education attainment with increased EOCRC risk. CONCLUSIONS: Our novel findings indicate inherited susceptibility to EOCRC and suggest modifiable lifestyle and metabolic targets that could also be used to risk-stratify individuals for personalized screening strategies or other interventions.

Candidate gene association study for noise-induced hearing loss in two independent noise-exposed populations.

Millions of people are daily exposed to high levels of noise. Consequently, noise-induced hearing loss (NIHL) is one of the most important occupational health hazards worldwide. In this study, we performed an association study for NIHL based on a candidate gene approach. 644 Single Nucleotide Polymorphisms (SNPs) in 53 candidate genes were analyzed in two independent NIHL sample sets, a Swedish set and part of a Polish set. Eight SNPs with promising results were selected and analysed in the remaining part of the Polish samples. One SNP in PCDH15 (rs7095441), resulted in significant associations in both sample sets while two SNPs in MYH14 (rs667907 and rs588035), resulted in significant associations in the Polish sample set and significant interactions with noise exposure level in the Swedish sample set. Calculation of odds ratios revealed a significant association of rs588035 with NIHL in the Swedish high noise exposure level group. Our studies suggest that PCDH15 and MYH14 may be NIHL susceptibility genes, but further replication in independent sample sets is mandatory.

Otitis media microbes: culture, PCR, and confocal laser scanning microscopy.

OBJECTIVES: To assess the presence of middle ear pathogens in nasopharynx (NP), middle ear fluid (MEF), and middle ear mucosal swabs (MES) of 14 patients undergoing middle ear surgery. METHODOLOGY: Bacteria were assessed by culture and species specific PCR. Biofilm was investigated by confocal laser scanning microscopy (CLSM) of middle ear biopsies (MEBs). RESULTS: Bacteria were absent in CLSM of MEBs in three of the four closed and healthy middle ears. Bacteria occurred in the ear with a foreign body (middle ear prosthesis), which showed localized living and dead bacteria, indicating biofilm. Bacterial growth was present in ten patient ears, but biofilm occurred in only one patient. CLSM indicated biofilm in the middle ear of two patients for whom PCR detected Haemophilus influenzae in the MEF. The three classical pathogens could frequently be found in the nasopharynx, by culture and PCR, but not from the middle ear. Alloiococcus otitidis was detected in the MEF of all five patients with open inflamed ears, though virtually absent from the nasopharynx. Pseudomonas aeruginosa was present in seven. It was the only pathogen found on several occasions in all three locations in one patient. CONCLUSIONS: This study confirms the association of H. influenzae with middle ear biofilm, and indicates a potential role of P. aeruginosa in middle ear inflammation and biofilm formation. Biofilm does not seem to cause inflammation. It is unclear whether the predominance of A. otitidis in chronically inflamed open middle ears indicates a pathogenic or contaminant role for this organism.

Contribution of the N-acetyltransferase 2 polymorphism NAT2*6A to age-related hearing impairment.

BACKGROUND: Age-related hearing impairment (ARHI) is the most common sensory impairment in older people, affecting 50% of those aged 80 years. The proportion of older people is increasing in the general population, and as a consequence, the number of people affected with ARHI is growing. ARHI is a complex disorder, with both environmental and genetic factors contributing to the disease. The first studies to elucidate these genetic factors were recently performed, resulting in the identification of the first two susceptibility genes for ARHI, NAT2 and KCNQ4. METHODS: In the present study, the association between ARHI and polymorphisms in genes that contribute to the defence against reactive oxygen species, including GSTT1, GSTM1 and NAT2, was tested. Samples originated from seven different countries and were combined into two test population samples, the general European population and the Finnish population. Two distinct phenotypes for ARHI were studied, Z(low) and Z(high), representing hearing in the low and high frequencies, respectively. Statistical analysis was performed for single polymorphisms (GSTM1, GSTT1, NAT2*5A, NAT2*6A, and NAT2*7A), haplotypes, and gene-environment and gene-gene interactions. RESULTS: We found an association between ARHI and GSTT1 and GSTM1 in the Finnish population sample, and with NAT2*6A in the general European population sample. The latter finding replicates previously published data. CONCLUSION: As replication is considered the ultimate proof of true associations in the study of complex disorders, this study provides further support for the involvement of NAT2*6A in ARHI.

Depth-dependent compressive equilibrium properties of articular cartilage explained by its composition.

For this study, we hypothesized that the depth-dependent compressive equilibrium properties of articular cartilage are the inherent consequence of its depth-dependent composition, and not the result of depth-dependent material properties. To test this hypothesis, our recently developed fibril-reinforced poroviscoelastic swelling model was expanded to include the influence of intra- and extra-fibrillar water content, and the influence of the solid fraction on the compressive properties of the tissue. With this model, the depth-dependent compressive equilibrium properties of articular cartilage were determined, and compared with experimental data from the literature. The typical depth-dependent behavior of articular cartilage was predicted by this model. The effective aggregate modulus was highly strain-dependent. It decreased with increasing strain for low strains, and increases with increasing strain for high strains. This effect was more pronounced with increasing distance from the articular surface. The main insight from this study is that the depth-dependent material behavior of articular cartilage can be obtained from its depth-dependent composition only. This eliminates the need for the assumption that the material properties of the different constituents themselves vary with depth. Such insights are important for understanding cartilage mechanical behavior, cartilage damage mechanisms and tissue engineering studies.

Familial aggregation of tinnitus: a European multicentre study.

INTRODUCTION AND AIM: Tinnitus is a common condition affecting approximately 20% of the older population. There is increasing evidence that changes in the central auditory system following cochlear malfunctioning are responsible for tinnitus. To date, few investigators have studied the influence of genetic factors on tinnitus. The present report investigates the presence of a familial effect in tinnitus subjects. METHODS: In a European multicentre study, 198 families were recruited in seven European countries. Each family had at least 3 siblings. Subjects were screened for causes of hearing loss other than presbyacusis by clinical examination and a questionnaire. The presence of tinnitus was evaluated with the question "Nowadays, do you ever get noises in your head or ear (tinnitus) which usually last longer than five minutes". Familial aggregation was tested using three methods: a mixed model approach, calculating familial correlations, and estimating the risk of a subject having tinnitus if the disorder is present in another family member. RESULTS: All methods demonstrated a significant familial effect for tinnitus. The effect persisted after correction for the effect of other risk factors such as hearing loss, gender and age. The size of the familial effect is smaller than that for age-related hearing impairment, with a familial correlation of 0.15. CONCLUSION: The presence of a familial effect for tinnitus opens the door to specific studies that can determine whether this effect is due to a shared familial environment or the involvement of genetic factors. Subsequent association studies may result in the identification of the factors responsible. In addition, more emphasis should be placed on the effect of role models in the treatment of tinnitus.

Bridging Effective Stress and Soil Water Retention Equations in Deforming Unsaturated Porous Media: A Thermodynamic Approach.

The finite deformation of an unsaturated porous medium is analysed from first principles of mixture theory. An expression for Bishop's effective stress is derived from (1) the deformation-dependent Brooks and Corey's water retention curve and (2) the restrictions on the constitutive relationships of an unsaturated medium subject to finite deformation. The resulting expression for the effective stress parameter χ is reasonably consistent with experimental data from the literature. Hence, it is shown that Bishop's equation is constitutively linked to water retention curves in deforming media.

A computational spinal motion segment model incorporating a matrix composition-based model of the intervertebral disc.

The extracellular matrix of the intervertebral disc is subjected to changes with age and degeneration, affecting the biomechanical behaviour of the spine. In this study, a finite element model of a generic spinal motion segment that links spinal biomechanics and intervertebral disc biochemical composition was developed. The local mechanical properties of the tissue were described by the local matrix composition, i.e. fixed charge density, amount of water and collagen and their organisation. The constitutive properties of the biochemical constituents were determined by fitting numerical responses to experimental measurements derived from literature. This general multi-scale model of the disc provides the possibility to evaluate the relation between local disc biochemical composition and spinal biomechanics.

1D Measurement of Sodium Ion Flow in Hydrogel After a Bath Concentration Jump.

NMR is used to measure sodium flow driven by a 1D concentration gradient inside poly-acrylamid (pAA) hydrogel. A sodium concentration jump from 0.5 M NaCl to 0 M NaCl is applied at the bottom of a cylindrical pAA sample. The sodium level and hydrogen level are measured as a function of time and position inside the sample for 5 days. Then a reversed step is applied, and ion flow is measured for another 5 days. During the measurement, the cylindrical sample is radially confined and allowed to swell in the axial direction. At the same time, sodium and moisture in the sample are measured on a 1D spatial grid in the axial direction. A quadriphasic mixture model (Huyghe and Janssen in Int J Eng Sci 35:793, 1997) is used to simulate the results and estimate the diffusion coefficient of sodium and chloride. The best fit results were obtained for D[Formula: see text] cm(2)/s and D[Formula: see text] cm(2)/s, at 25 degrees centigrade. Different time constants were observed for swelling and deswelling.

Partition and diffusion of sodium and chloride ions in soft charged foam: the effect of external salt concentration and mechanical deformation.

The partition and diffusion characteristics of an acrylic acid/acrylamide hydrogel, copolymerized in the pores of a polyurethane foam with sodium and chloride ions, were studied by radiochemical methodologies. The hydrogel foam swells by 51%, 80%% and 260% relative to its raw state under bath salt concentrations of 2.0, 1.0, and 0.15 M, respectively. The corresponding partition coefficients are 1.13, 1.29, and 1.99 for sodium (Na+) and 0.89, 0. 85, and 0.65 for chloride (Cl-). The diffusion coefficients are independent of bath concentration and increase linearly with hydration towards their values in water. Deformation affects partition and diffusion solely by dilatation, which determines the swelling and hydration. Comparison of the hydrogel foam with cartilage and intervertebral disc shows considerable similarities and suggests that the same mechanisms control their function.

Alpha-1-antitrypsin (AAT) deposits in gall bladder adenocarcinoma and liver in partial AAT deficiency (Pi SZ phenotype).

Alpha-1-antitrypsin (AAT) immunoreactive inclusions were found in an adenocarcinoma of a gall bladder of a patient with Pi SZ phenotype who also had globular AAT accumulation in the liver. The inclusions did not react with antibodies against other plasma proteins, thus suggesting a primary synthesis of AAT in these cells. The presence of AAT in the tumor cells may represent resurgence of an oncofetal antigen, or, indirectly, may mean that AAT-containing cells normally exist in the human non-neoplastic gall bladder. The accumulation of AAT in tumor cells might be a basic process in malignant transformation.

The constitutive behaviour of passive heart muscle tissue: a quasi-linear viscoelastic formulation.

A quasi-linear viscoelastic law with a continuous relaxation spectrum describing triaxial constitutive behaviour of heart muscle tissue is presented. The elastic response of the viscoelastic law is anisotropic, while the relaxation behaviour is assumed isotropic. The law is designed for a biphasic description (fluid-solid) of the myocardial tissue. Biaxial and uniaxial stress-strain curves from the literature are used to evaluate the parameters of the model. The non-linear elastic response, the difference between fibre and cross-fibre stiffness, the phenomenon of stress relaxation, the stiffening of the stress-strain relationship with increasing strain rate and the weak frequency dependency of the dissipated energy during cyclic loading are fairly well described by the proposed law. However, it is found that the model produces realistic values for the dissipated energy during cyclic loading only when relaxation parameter values are chosen which result in an overestimation of the stress relaxation data by more than 100%. This finding may indicate non-quasi-linearity of viscoelasticity of passive heart muscle tissue.

Dependence of local left ventricular wall mechanics on myocardial fiber orientation: a model study.

The dependence of local left ventricular (LV) mechanics on myocardial muscle fiber orientation was investigated using a finite element model. In the model we have considered anisotropy of the active and passive components of myocardial tissue, dependence of active stress on time, strain and strain rate, activation sequence of the LV wall and aortic afterload. Muscle fiber orientation in the LV wall is quantified by the helix fiber angle, defined as the angle between the muscle fiber direction and the local circumferential direction. In a first simulation, a transmural variation of the helix fiber angle from +60 degrees at the endocardium through 0 degrees in the midwall layers to -60 degrees at the epicardium was assumed. In this simulation, at the equatorial level maximum active muscle fiber stress was found to vary from about 110 kPa in the subendocardial layers through about 30 kPa in the midwall layers to about 40 kPa in the subepicardial layers. Next, in a series of simulations, muscle fiber orientation was iteratively adapted until the spatial distribution of active muscle fiber stress was fairly homogeneous. Using a transmural course of the helix fiber angle of +60 degrees at the endocardium, +15 degrees in the midwall layers and -60 degrees at the epicardium, at the equatorial level maximum active muscle fiber stress varied from 52 kPa to 55 kPa, indicating a remarkable reduction of the stress range. Moreover, the change of muscle fiber strain with time was more similar in different parts of the LV wall than in the first simulation. It is concluded that (1) the distribution of active muscle fiber stress and muscle fiber strain across the LV wall is very sensitive to the transmural distribution of the helix fiber angle and (2) a physiological transmural distribution of the helix fiber angle can be found, at which active muscle fiber stress and muscle fiber strain are distributed approximately homogeneously across the LV wall.

Influence of endocardial-epicardial crossover of muscle fibers on left ventricular wall mechanics.

The influence of variations of fiber direction on the distribution of stress and strain in the left ventricular wall was investigated using a finite element model to simulate the mechanics of the left ventricle. The commonly modelled helix fiber angle was defined as the angle between the local circumferential direction and the projection of the fiber path on the plane perpendicular to the local radial direction. In the present study, an additional angle, the transverse fiber angle, was used to model the continuous course of the muscle fibers between the inner and the outer layers of the ventricular wall. This angle was defined as the angle between the circumferential direction and the projection of the fiber path on the plane perpendicular to the local longitudinal direction. First, a reference simulation of left ventricular mechanics during a cardiac cycle was performed, in which the transverse angle was set to zero. Next, we performed two simulations in which the spatial distribution of either the transverse or the helix angle was varied with respect to the reference situation, the spatially averaged variations being about 3 and 14 degrees, respectively. The changes in fiber orientation hardly affected the pressure-volume relation of the ventricle, but significantly affected the spatial distribution of active muscle fiber stress (up to 50% change) and sarcomere length (up to 0.1 micron change). In the basal and apical region of the wall, shear deformation in the circumferential-radial plane was significantly reduced by introduction of a nonzero transverse angle. Thus, the loading of the passive tissue may be reduced by the endocardial-epicardial crossover of the muscle fibers.

A two-phase finite element model of the diastolic left ventricle.

A porous medium finite element model of the passive left ventricle is presented. The model is axisymmetric and allows for finite deformation, including torsion about the axis of symmetry. An anisotropic quasi-linear viscoelastic constitutive relation is implemented in the model. The model accounts for changing fibre orientation across the myocardial wall. During passive filling, the apex rotates in a clockwise direction relative to the base for an observer looking from apex to base. Within an intraventricular pressure range of 0-3 kPa the rotation angle of all nodes remained below 0.1 rad. Diastolic viscoelasticity of myocardial tissue is shown to reduce transmural differences of preload-induced sarcomere stretch and to generate residual stresses in an unloaded ventricular wall, consistent with the observation of opening angles seen when the heart is slit open. It is shown that the ventricular model stiffens following an increase of the intracoronary blood volume. At a given left ventricular volume, left ventricular pressure increases from 1.5 to 2.0 kPa when raising the intracoronary blood volume from 9 to 14 ml (100 g)-1 left ventricle.

Spatial interaction between tissue pressure and skeletal muscle perfusion during contraction.

The vascular waterfall theory attributes decreased muscle perfusion during contraction to increased intramuscular pressure (P(IM)) and concomitant increase in venous resistance. Although P(IM) is distributed during contractions, this theory does not account for heterogeneity. This study hypothesises that pressure heterogeneity could affect the interaction between P(IM) rise and perfusion. Regional tissue perfusion during submaximum (100kPa) tetanic contraction is studied, using a finite element model of perfused contracting skeletal muscle. Capillary flow in muscles with one proximal artery and vein (SIM(1)) and with an additional distal artery and vein (SIM(2)) is compared. Blood flow and pressures at rest and P(IM) during contraction ( approximately 25kPa maximally) are similar between simulations, but capillary flow and venous pressure differ. In SIM(2), venous pressure and capillary flow correspond to P(IM) distribution, whereas capillary flow in SIM(1) is less than 10% of flow in SIM(2), in the muscle half without draining vein. This difference is caused by a high central P(IM), followed by central venous pressure rise, in agreement with the waterfall theory. The high central pressure (SIM(1)), obstructs outflow from the distal veins. Distal venous pressure rises until central blood pressure is reached, although local P(IM) is low. Adding a distal vein (SIM(2)) restores the perfusion. It is concluded that regional effects contribute to the interaction between P(IM) and perfusion during contraction. Unlike stated by the vascular waterfall theory, venous pressure may locally exceed P(IM). Although this can be explained by the principles of this theory, the theory does not include this phenomenon as such.

Mechanical blood-tissue interaction in contracting muscles: a model study.

A finite element (FE) model of blood perfused biological tissue has been developed. Blood perfusion is described by fluid flow through a series of 5 intercommunicating vascular compartments that are embedded in the tissue. Each compartment is characterized by a blood flow permeability tensor, blood volume fraction and vessel compliance. Local non-linear relationships between intra-extra vascular pressure difference and blood volume fraction, and between blood volume fraction and the permeability tensor, are included in the FE model. To test the implementation of these non-linear relations, FE results of blood perfusion in a piece of tissue that is subject to increased intramuscular pressure, are compared to results that are calculated with a lumped parameter (LP) model of blood perfusion. FE simulation of blood flow through a contracting rat calf muscle is performed. The FE model used in this simulation contains a transversely isotropic, non-linearly elastic description of deforming muscle tissue, in which local contraction stress is prescribed as a function of time. FE results of muscle tension, total arterial inflow and total venous outflow of the muscle during contraction, correspond to experimental results of an isometrically and tetanically contracting rat calf muscle.

Remodelling of continuously distributed collagen fibres in soft connective tissues.

Extracellular matrix remodelling plays an essential role in tissue engineering of load-bearing structures. The goal of this study is to model changes in collagen fibre content and orientation in soft connective tissues due to mechanical stimuli. A theory is presented describing the mechanical condition within the tissue and accounting for the effects of collagen fibre alignment and changes in fibre content. A fibre orientation tensor is defined to represent the continuous distribution of collagen fibre directions. A constitutive model is introduced to relate the fibre configuration to the macroscopic stress within the material. The constitutive model is extended with a structural parameter, the fibre volume fraction, to account for the amount of fibres present within the material. It is hypothesised that collagen fibre reorientation is induced by macroscopic deformations and the amount of collagen fibres is assumed to increase with the mean fibre stretch. The capabilities of the model are demonstrated by considering remodelling within a biaxially stretched cube. The model is then applied to analyse remodelling within a closed stented aortic heart valve. The computed preferred fibre orientation runs from commissure to commissure and resembles the fibre directions in the native aortic valve.

Strain distribution on rat medial gastrocnemius (MG) during passive stretch.

Deformation of the surface of passive medial gastrocnemius muscle (MG) was measured in vivo while performing a hysteresis test. The gastrocnemius muscle of male rats were dissected free and the distal tendon was cut. The lateral head was separated from the medial head. The muscle origins were left intact. 60-70 fluorescent, polystyrene spheres (diameter 0.7 mm) were attached to the surface of the MG. During the experiment, two-dimensional video recordings of the movements of the MG were made. The coordinates of the marker centroids were obtained by computer processing of digitized images and marker displacements as a function of time were calculated. Green-Lagrange strains in two principal directions were calculated (epsilon 1, epsilon 2) for three specimens. epsilon 1 had approximately the same direction as the muscle fibers. The longitudinal strain of the fibers (20-30%) was larger than the strain of the aponeurosis (1-5%); p < 0.001. No significant difference was found between the values of the transverse strains of muscle fibers and aponeurosis; the value of epsilon 2 was -6 to -9% for both tissue structures.

Nonhomogeneous permeability of canine anulus fibrosus.

STUDY DESIGN: This report examines the permeability coefficient and aggregate modulus of slices of anulus cut from canine lumbar intervertebral discs. OBJECTIVES: To examine the influence of radial position on the properties of these materials, including outer samples with intact anulus edge. SUMMARY OF BACKGROUND DATA: The outer edge of anulus fibrosus shows radial bulge during axial compression of motion segments. The radial bulge increases monotonically when the axial compression is sustained for several hours, until a plateau is reached. Triphasic modeling of axial compression shows that this time course of radial bulge can not be obtained using a uniform permeability coefficient according to values in the literature. METHODS: Confined consolidation experiments (controlled load) were designed to measure the time course of uniaxial deformation of samples of anulus that were 4 mm in diameter and 1 mm tall. The rotation symmetry axis of the samples was defined in the radial direction of the disc. The radial permeability coefficient and the aggregate modulus were determined using the consolidation data and the linear biphasic theory. RESULTS: The permeability coefficient was lower at the periphery than in deeper layers of the anulus. Outer samples with outer surfaces that were 0.0-0.5 mm from the anulus edge had an average permeability coefficient of (1.02 +/- 0.57) x 10(-16) m4/Ns (n = 24). Inner samples that were 2.0-2.5 mm from the anulus edge had an average permeability coefficient of (2.81 +/- 0.98) x 10(-16) m4/Ns (n = 13). The aggregate modulus HA of outer samples was significantly higher (HA = 1.56 +/- 0.34 MPa) than that of inner samples (HA = 1.31 +/- 0.47 MPa). CONCLUSIONS: The fact that the outer anulus is less permeable than the inner anulus may explain why radial bulge of anulus fibrosus increases monotonically in time to an equilibrium value during sustained axial compression of a motion segment.