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.

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.

Intervertebral disc creep behavior assessment through an open source finite element solver.

Degenerative Disc Disease (DDD) is one of the largest health problems faced worldwide, based on lost working time and associated costs. By means of this motivation, this work aims to evaluate a biomimetic Finite Element (FE) model of the Intervertebral Disc (IVD). Recent studies have emphasized the importance of an accurate biomechanical modeling of the IVD, as it is a highly complex multiphasic medium. Poroelastic models of the disc are mostly implemented in commercial finite element packages with limited access to the algorithms. Therefore, a novel poroelastic formulation implemented on a home-developed open source FE solver is briefly addressed throughout this paper. The combination of this formulation with biphasic osmotic swelling behavior is also taken into account. Numerical simulations were devoted to the analysis of the non-degenerated human lumbar IVD time-dependent behavior. The results of the tests performed for creep assessment were inside the scope of the experimental data, with a remarkable improvement of the numerical accuracy when compared with previously published results obtained with ABAQUS(®). In brief, this in-development open-source FE solver was validated with literature experimental data and aims to be a valuable tool to study the IVD biomechanics and DDD mechanisms.

3D non-affine finite strains measured in isolated bovine annulus fibrosus tissue samples.

Understanding of the mechanics of disc tissue calls for measurement of strains in physiological conditions. Because the intervertebral disc is gripped between two vertebrae, the swelling is constrained in vivo, resulting in a intradiscal pressure of 0.1-0.2 MPa in supine position. The excision of isolated disc tissue samples results often in non-physiological swelling. The purpose of the present study is to measure 3D finite strains in isolated bovine disc tissue specimens under physiological osmolarity and pressure, particularly around discontinuities of the collagen network. The collagen is stained by means of CNA35 probe, and the (dead) cells are stained by means of propidium iodide. The tissue is observed under confocal microscopy, under an externally applied pressure generated by a PEG solution. The 3D finite strains are obtained through correlation of the texture of the 3D images. The correlation technique yields principal strains in all areas except within collagen-free areas. The deformation is strongly non-affine. Especially around discontinuities, the strain field is non-homogeneous. Macroscopic strains as computed from finite element analysis of whole discs are insufficient to predict microstrains around clefts or cells. Because of the small number of specimens, the present results should be considered preliminary.

Inherited mitochondrial variants are not a major cause of age-related hearing impairment in the European population.

Mitochondrial DNA (mtDNA) mutations have been implicated in various age-related diseases. To further clarify the role of mtDNA variants in age-related hearing impairment (ARHI), we determined the DNA sequence of the entire mitochondrial genome of 400 individuals using the Affymetrix Human Mitochondrial Resequencing Array. These were the 200 worst hearing and the 200 best hearing from a collection of 947 Belgian samples. We performed association tests with individual mitochondrial variants, comparison of the mutation load, and association with European haplogroups and their interaction with environmental risk factors. We also tested the influence of rare variants on ARHI. None of these tests showed any association with ARHI.

Singularity solution of Lanir's osmoelasticity: verification of discontinuity simulations in soft tissues.

The literature characterizes cartilaginous tissues as osmoviscoelastic. Understanding the damage and failure of these tissues is essential for designing treatments. To determine tissue strength and local stresses, experimental studies-both clinical and animal-are generally supported by computational studies. Verification methods for computational studies of ionized porous media including cracks are hardly available. This study provides a method for verification and shows its performance. For this purpose, shear loading of a finite crack is addressed analytically and through a commercial finite element code. Impulsive shear loading by two-edge dislocation of a crack was considered in a 2D plane strain model for an ionized porous medium. To derive the analytical solution, the system of equation is decoupled by stress functions. The shear stress distribution at the plane of the crack is derived using Fourier and Laplace transformations. The analytical solution for the shear stress distribution is compared with computer simulations in ABAQUS version 6.4-5. Decoupling of the equations makes it possible to solve some boundary value problems in porous media taking chemical effects into account. The numerical calculations underestimate the shear stress at the crack-tips. Mesh refinement increases accuracy, but is still low in the neighborhood of the crack-tips.

A biochemical/biophysical 3D FE intervertebral disc model.

Present research focuses on different strategies to preserve the degenerated disc. To assure long-term success of novel approaches, favorable mechanical conditions in the disc tissue are essential. To evaluate these, a model is required that can determine internal mechanical conditions which cannot be directly measured as a function of assessable biophysical characteristics. Therefore, the objective is to evaluate if constitutive and material laws acquired on isolated samples of nucleus and annulus tissue can be used directly in a whole-organ 3D FE model to describe intervertebral disc behavior. The 3D osmo-poro-visco-hyper-elastic disc (OVED) model describes disc behavior as a function of annulus and nucleus tissue biochemical composition, organization and specific constituent properties. The description of the 3D collagen network was enhanced to account for smaller fibril structures. Tissue mechanical behavior tests on isolated nucleus and annulus samples were simulated with models incorporating tissue composition to calculate the constituent parameter values. The obtained constitutive laws were incorporated into the whole-organ model. The overall behavior and disc properties of the model were corroborated against in vitro creep experiments of human L4/L5 discs. The OVED model simulated isolated tissue experiments on confined compression and uniaxial tensile test and whole-organ disc behavior. This was possible, provided that secondary fiber structures were accounted for. The fair agreement (radial bulge, axial creep deformation and intradiscal pressure) between model and experiment was obtained using constitutive properties that are the same for annulus and nucleus. Both tissue models differed in the 3D OVED model only by composition. The composition-based modeling presents the advantage of reducing the numbers of material parameters to a minimum and to use tissue composition directly as input. Hence, this approach provides the possibility to describe internal mechanical conditions of the disc as a function of assessable biophysical characteristics.

The prevalence of middle ear pathogens in the outer ear canal and the nasopharyngeal cavity of healthy young adults.

Culturing middle ear fluid samples from children with chronic otitis media with effusion (OME) using standard techniques results in the isolation of bacterial species in approximately 30-50% of the cases. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, the classic middle ear pathogens of acute otitis media, are involved but, recently, several studies suggested Alloiococcus otitidis as an additional pathogen. In the present study, we used species-specific PCRs to establish the prevalence, in both the nasopharyngeal cavity and the outer ear, of H. influenzae, M. catarrhalis, S. pneumoniae and A. otitidis. The study group consisted of 70 healthy volunteers (aged 19-22 years). The results indicate a high prevalence (>80%) of A. otitidis in the outer ear in contrast to its absence in the nasopharynx. H. influenzae was found in both the outer ear and the nasopharynx (6% and 14%, respectively), whereas S. pneumoniae and M. catarrhalis were found only in the nasopharynx (9% and 34%, respectively).A. otitidis, described as a fastidious organism, were able to be cultured using an optimized culture protocol, with prolonged incubation, which allowed the isolation of A. otitidis in five of the nine PCR-positive samples out of the total of ten samples tested. Given the absence of the outer ear inhabitant A. otitidis from the nasopharynx, its role in the aetiology of OME remains ambiguous because middle ear infecting organisms are considered to invade the middle ear from the nasopharynx through the Eustachian tube.

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.

On the thermodynamical admissibility of the triphasic theory of charged hydrated tissues.

The triphasic theory on soft charged hydrated tissues (Lai, W. M., Hou, J. S., and Mow, V. C., 1991, "A Triphasic Theory for the Swelling and Deformation Behaviors of Articular Cartilage," ASME J. Biomech. Eng., 113, pp. 245-258) attributes the swelling propensity of articular cartilage to three different mechanisms: Donnan osmosis, excluded volume effect, and chemical expansion stress. The aim of this study is to evaluate the thermodynamic plausibility of the triphasic theory. The free energy of a sample of articular cartilage subjected to a closed cycle of mechanical and chemical loading is calculated using the triphasic theory. It is shown that the chemical expansion stress term induces an unphysiological generation of free energy during each closed cycle of loading and unloading. As the cycle of loading and unloading can be repeated an indefinite number of times, any amount of free energy can be drawn from a sample of articular cartilage, if the triphasic theory were true. The formulation for the chemical expansion stress as used in the triphasic theory conflicts with the second law of thermodynamics.

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.

Experimental and model determination of human intervertebral disc osmoviscoelasticity.

Finite element (FE) models have become an important tool to study load distribution in the healthy and degenerated disc. However, model predictions require accurate constitutive laws and material properties. As the mechanical properties of the intervertebral disc are regulated by its biochemical composition and fiber-reinforced structure, the relationship between the constitutive behavior of the tissue and its composition requires careful consideration. While numerous studies have investigated the annulus fibrosus compressive and tensile properties, specific conditions required to determine model parameters for the osmoviscoelastic model are unavailable. Therefore, the objectives of this study were (1) to complement the existing material testing in the literature with confined compression and tensile tests on human annulus fibrosus and (2) to use these data, together with existing nucleus pulposus compression data to tune a composition-based, osmoviscoelastic material constitutive law. The osmoviscoelastic material constitutive law and the experimental data were used to describe the fiber and nonfiber properties of the human disc. The compressive material properties of normal disc tissue were G(m) = 1.23 MPa, M = 1.57, and alpha = 1.964 x 10(-16) m(4)/Ns; the tensile fiber material parameters were E(0) = 77.0 MPa; E(epsilon) = 500 MPa, and eta = 1.8 x 10(3) MPa(-s). The goodness of fit ranged from 0.88 to 0.96 for the four experimental conditions evaluated. The constitutive law emphasized the interdependency of the strong swelling ability of the tissue and the viscoelastic nature of the collagen fibers. This is especially important for numerical models to further study the load sharing behavior with regard to disc degeneration and regeneration.

Poromechanics of compressible charged porous media using the theory of mixtures.

Osmotic, electrostatic, and/or hydrational swellings are essential mechanisms in the deformation behavior of porous media, such as biological tissues, synthetic hydrogels, and clay-rich rocks. Present theories are restricted to incompressible constituents. This assumption typically fails for bone, in which electrokinetic effects are closely coupled to deformation. An electrochemomechanical formulation of quasistatic finite deformation of compressible charged porous media is derived from the theory of mixtures. The model consists of a compressible charged porous solid saturated with a compressible ionic solution. Four constituents following different kinematic paths are identified: a charged solid and three streaming constituents carrying either a positive, negative, or no electrical charge, which are the cations, anions, and fluid, respectively. The finite deformation model is reduced to infinitesimal theory. In the limiting case without ionic effects, the presented model is consistent with Blot's theory. Viscous drag compression is computed under closed circuit and open circuit conditions. Viscous drag compression is shown to be independent of the storage modulus. A compressible version of the electrochemomechanical theory is formulated. Using material parameter values for bone, the theory predicts a substantial influence of density changes on a viscous drag compression simulation. In the context of quasistatic deformations, conflicts between poromechanics and mixture theory are only semantic in nature.

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.

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.

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.

A composition-based cartilage model for the assessment of compositional changes during cartilage damage and adaptation.

OBJECTIVE: The composition of articular cartilage changes with progression of osteoarthritis. Since compositional changes are associated with changes in the mechanical properties of the tissue, they are relevant for understanding how mechanical loading induces progression. The objective of this study is to present a computational model of articular cartilage which enables to study the interaction between composition and mechanics. METHODS: Our previously developed fibril-reinforced poroviscoelastic swelling model for articular cartilage was combined with our tissue composition-based model. In the combined model both the depth- and strain-dependencies of the permeability are governed by tissue composition. All local mechanical properties in the combined model are directly related to the local composition of the tissue, i.e., to the local amounts of proteoglycans and collagens and to tissue anisotropy. RESULTS: Solely based on the composition of the cartilage, we were able to predict the equilibrium and transient response of articular cartilage during confined compression, unconfined compression, indentation and two different 1D-swelling tests, simultaneously. CONCLUSION: Since both the static and the time-dependent mechanical properties have now become fully dependent on tissue composition, the model allows assessing the mechanical consequences of compositional changes seen during osteoarthritis without further assumptions. This is a major step forward in quantitative evaluations of osteoarthritis progression.

A comparison between mechano-electrochemical and biphasic swelling theories for soft hydrated tissues.

Biological tissues like intervertebral discs and articular cartilage primarily consist of interstitial fluid, collagen fibrils and negatively charged proteoglycans. Due to the fixed charges of the proteoglycans, the total ion concentration inside the tissue is higher than in the surrounding synovial fluid (cation concentration is higher and the anion concentration is lower). This excess of ion particles leads to an osmotic pressure difference, which causes swelling of the tissue. In the last decade several mechano-electrochemical models, which include this mechanism, have been developed. As these models are complex and computationally expensive, it is only possible to analyze geometrically relatively small problems. Furthermore, there is still no commercial finite element tool that includes such a mechano-electrochemical theory. Lanir (Biorheology, 24, pp. 173-187, 1987) hypothesized that electrolyte flux in articular cartilage can be neglected in mechanical studies. Lanir's hypothesis implies that the swelling behavior of cartilage is only determined by deformation of the solid and by fluid flow. Hence, the response could be described by adding a deformation-dependent pressure term to the standard biphasic equations. Based on this theory we developed a biphasic swelling model. The goal of the study was to test Lanir's hypothesis for a range of material properties. We compared the deformation behavior predicted by the biphasic swelling model and a full mechano-electrochemical model for confined compression and 1D swelling. It was shown that, depending on the material properties, the biphasic swelling model behaves largely the same as the mechano-electrochemical model, with regard to stresses and strains in the tissue following either mechanical or chemical perturbations. Hence, the biphasic swelling model could be an alternative for the more complex mechano-electrochemical model, in those cases where the ion flux itself is not the subject of the study. We propose thumbrules to estimate the correlation between the two models for specific problems.