Large-scale gene-centric analysis identifies novel variants for coronary artery disease

Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in ∼2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10−33; LPA:p<10−19; 1p13.3:p<10−17) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5×10−7). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06–1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other ∼4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular functions and clarified the literature with regard to many previously suggested genes

Large-scale gene-centric analysis identifies novel variants for coronary artery disease

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in ∼2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10(-33); LPA:p<10(-19); 1p13.3:p<10(-17)) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5×10(-7)). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06-1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other ∼4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular functions and clarified the literature with regard to many previously suggested genes

An Unusually Large Submandibular Gland Stone. A Case Report.

A Case of 65 year old man that presented with 40 years history of right lower jaw swelling, that became associated with pain two weeks prior to presentation. Examination revealed an elderly man with an enlarged tender right submandibular gland. The medial margin was suppurating. X-ray of the right lower jaw revealed large stone, while ultrasound scan of the right submandibular region revealed an associated abscess. The latter was incised and drained, while excision of the right submandibular gland and calculus was carried out three weeks later. 5.0cm - sized stone was excised. This turned out to be the second largest salivary gland stone recorded in literature. Conclusion Giant salivary gland stone which ( greater than 1.5cm) is rare. To the best of our knowledge, our index patient with a calculus measuring 5.0 x 3.0cm is the second largest stone in literature is remarkable KeyWords: Giant Salivary Gland Stone, Submandibular Glan

Large-Scale Gene-Centric Analysis Identifies Novel Variants for Coronary Artery Disease

Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in ∼2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10−33; LPA:p<10−19; 1p13.3:p<10−17) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5×10−7). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06–1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other ∼4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular functions and clarified the literature with regard to many previously suggested genes

Gene-centric meta-analyses of 108,912 individuals confirm known body mass index loci and reveal three novel signals

Recent genetic association studies have made progress in uncovering components of the genetic architecture of body mass index (BMI). We used the ITMAT-Broad-CARe (IBC) array comprising up to 49,320 single nucleotide polymorphisms (SNPs) across ~2,100 metabolic and cardiovascular-related loci to genotype up to 108,912 individuals of European ancestry (EA), African Americans, Hispanics, and East Asians, from 46 studies, to provide additional insight into SNPs underpinning BMI. We used a five-phase study design: Phase I focused on meta-analysis of EA studies providing individual level genotype data; Phase II performed a replication of cohorts providing summary level EA data; Phase III meta-analyzed results from the first two phases; associated SNPs from Phase III were used for replication in Phase IV; finally in Phase V, a multi-ethnic meta-analysis of all samples from four ethnicities was performed. At an array-wide significance (P<2.40E-06), we identify novel BMI associations in loci TOMM40-APOE-APOC1 (rs2075650, P=2.95E-10), SREBF2 (a sterol regulatory element binding transcription factor gene, rs5996074, P=9.43E-07) and NTRK2 (a BDNF receptor, rs1211166, P=1.04E-06) in the Phase IV meta-analysis. Of ten loci with previous evidence for BMI association represented on IBC array, eight were replicated, with the remaining two showing nominal significance. Conditional analyses revealed two independent BMI associated signals in BDNF and MC4R regions. Of the 11 array-wide significant SNPs, three are associated with gene expression levels in both primary B-cells and monocytes; with rs4788099 in SH2B1 notably being associated with the expression of multiple genes in cis. These multi-ethnic meta-analyses expand our knowledge of BMI genetics

A practical method for optimum seismic design of friction wall dampers

Friction control systems have been widely used as one of the efficient and cost effective solutions to control structural damage during strong earthquakes. However, the height-wise distribution of slip loads can significantly affect the seismic performance of the strengthened frames. In this study, a practical design methodology is developed for more efficient design of friction wall dampers by performing extensive nonlinear dynamic analyses on 3, 5, 10, 15, and 20-story RC frames subjected to seven spectrum-compatible design earthquakes and five different slip load distribution patterns. The results show that a uniform cumulative distribution can provide considerably higher energy dissipation capacity than the commonly used uniform slip load pattern. It is also proved that for a set of design earthquakes, there is an optimum range for slip loads that is a function of number of stories. Based on the results of this study, an empirical equation is proposed to calculate a more efficient slip load distribution of friction wall dampers for practical applications. The efficiency of the proposed method is demonstrated through several design examples

Health Economic Modelling of Treatment Sequences for Rheumatoid Arthritis: A Systematic Review

The objective of the work reported in this paper was to critically assess how sequential disease-modifying anti-rheumatic drugs (DMARDs) have been modelled in the context of economic evaluation of the use of DMARDs for treatment of rheumatoid arthritis (RA). A secondary purpose was to identify the methodological challenges of modelling sequential therapies. Systematic searches of 10 databases were undertaken in February 2013. Studies were included if they were in the English language and a full comparative economic evaluation was reported. They were appraised by use of the Drummond checklist (Appendix to this paper). Data extracted included economic evaluation data, data relating to sequential treatment, and data on the modelling methods used. Fifty-seven studies were identified, with 25 (44 %) modelling a sequence of treatments. Forty-three (75 %) were cost–utility analyses. Eleven (19 %) were UK studies and 11 (19 %) were US. The remainder were mainly European (26 (46 %)). A distinction was made between studies of recent-onset RA (14 (25 %)) and those of established RA (42 (74 %)). One study (1 %) was unclear. Individual-level models were more likely to meet the Drummond criteria and evaluate sequences. No study identified an optimum sequence of multiple treatments given a set of treatment options. The level of reporting of the methods and evidence used to assess the effect of downstream treatments in the sequence was generally poor. When lifelong models and downstream treatment sequences were considered, evidence gaps were identified. The review discovered that methods have not been consistently applied, leading to varied estimates of cost-effectiveness. Treatment sequences have not been fully considered and modelled, potentially resulting in inaccurate estimates of cost-effectiveness

Uncertainties in dynamic response of buildings with non-linear base-isolators

Dynamic response of base-isolated buildings under uni-directional sinusoidal base excitation is numerically investigated considering uncertainties in the isolation and excitation parameters. The buildings are idealized as single degree of freedom (SDOF) system and multi-degrees of freedom (MDOF) system with one lateral degree of freedom at each floor level. The isolation system is modeled using two different mathematical models such as: (i) code-recommended equivalent linear elastic-viscous damping model and (ii) bi-linear hysteretic model. The uncertain parameters of the isolator considered are time period, damping ratio, and yield displacement. Moreover, the amplitude and frequency of the sinusoidal base excitation function are considered uncertain. The uncertainty propagation is investigated using generalized polynomial chaos (gPC) expansion technique. The unknown gPC expansion coefficients are obtained by non-intrusive sparse grid collocation scheme. Efficiency of the technique is compared with the sampling method of Monte Carlo (MC) simulation. The stochastic response quantities of interest considered are bearing displacement and top floor acceleration of the building. Effects of individual uncertain parameters on the building response are quantified using sensitivity analyses. Effect of various uncertainty levels of the input parameters on the dynamic response of the building is also investigated. The peak bearing displacement and top floor acceleration are more influenced by the amplitude and frequency of the sinusoidal base excitation function. The effective time period of the isolation system also produces a considerable influence. However, in the presence of similar uncertainty level in the time period, amplitude and frequency of the sinusoidal forcing function, the effect of uncertainties in the other parameters of the isolator (e.g., damping ratio and yield displacement) is comparatively less. Interestingly, the mean values of the response quantities are found to be higher than the deterministic values in several instances, indicating the need of conducting stochastic analysis. The gPC expansion technique presented here is found to be a computationally efficient yet accurate alternative to the MC simulation for numerically modeling the uncertainty propagation in the dynamic response analyses of the base-isolated buildings