Among the many educational materials produced by the European Society of Human Reproduction and Embryology (ESHRE) are guidelines. ESHRE guidelines may be developed for many reasons but their intent ...is always to promote best quality practices in reproductive medicine. In an era in which preimplantation genetic diagnosis (PGD) has become a reality, we must strive to maintain its efficacy and credibility by offering the safest and most effective treatment available. The dominant motivators for the development of current comprehensive guidelines for best PGD practice were (i) the absence of guidelines and/or regulation for PGD in many countries and (ii) the observation that no consensus exists on many of the clinical and technical aspects of PGD. As a consequence, the ESHRE PGD Consortium undertook to draw up guidelines aimed at giving information, support and guidance to potential, fledgling and established PGD centres. The success of a PGD treatment cycle is the result of great attention to detail. We have strived to provide a similar level of detail in this document and hope that it will assist staff in achieving the best clinical outcome for their patients.
Molecular organization: Chiral benzene tricarboxamides with methyl substituents at defined positions self‐assemble into supramolecular polymers of preferred helicity by three‐fold α‐helical‐type ...hydrogen bonding. The odd–even effect is operative and all derivatives are liquid crystalline showing a Colho phase (see figure).
Asymmetric benzene‐1,3,5‐tricarboxamides (aBTAs) comprising two n‐octyl and one chiral methyl–alkyl side chain were synthesised and characterised. The influence of the position and the configuration of the chiral methyl group (methyl at the α, β or γ position) in the aliphatic side chains on the liquid‐crystalline properties and the aggregation behaviour of the aBTAs was systematically studied and compared to symmetrical benzene‐1,3,5‐tricarboxamides (sBTAs). Solid‐state characterisation (polarised optical microscopy, IR spectroscopy, X‐ray diffraction and differential scanning calorimetry) revealed that all aBTAs show threefold, α‐helical‐type intermolecular hydrogen bonding between neighbouring molecules and exhibit a columnar hexagonal organisation from room temperature to well above 200 °C. Moving the chiral methyl group closer to the amide group stabilises the liquid‐crystalline state, as evidenced by a higher clearing temperature and corresponding enthalpy. The self‐assembly of dilute solutions of the aBTAs in methylcyclohexane (≈10−5 mol L−1) was investigated with circular dichroism (CD) spectroscopy. The sign of the Cotton effect demonstrated a pronounced odd–even effect, whereas the value of the molar ellipticity, Δε, in the aBTAs was independent of the position of the methyl group. Subsequent temperature‐dependent CD measurements showed that the aggregation of all aBTAs can quantitatively be described by the nucleation‐growth model and that the stability of the aggregates increases when the chiral methyl group is closer to the amide moiety. The results presented herein illustrate that even small changes in the molecular structure of substituted benzene‐1,3,5‐tri‐carboxamides affect their solid‐state properties and their self‐assembly behaviour in dilute solutions.
Molecular organization: Chiral benzene tricarboxamides with methyl substituents at defined positions self‐assemble into supramolecular polymers of preferred helicity by three‐fold α‐helical‐type hydrogen bonding. The odd–even effect is operative and all derivatives are liquid crystalline showing a Colho phase (see figure).
Here, we report on the strong amplification of chirality observed in supramolecular polymers consisting of benzene-1,3,5-tricarboxamide monomers and study the chiral amplification phenomena as a ...function of temperature. To quantify the two chiral amplification phenomena, i.e., the sergeants-and-soldiers principle and the majority-rules principle, we adapted the previously reported sergeants-and-soldiers model, which allowed us to describe both amplification phenomena in terms of two energy penalties: the helix reversal penalty and the mismatch penalty. The former was ascribed to the formation of intermolecular hydrogen bonds and was the larger of the two. The latter was related to steric interactions in the alkyl side chains due to the stereogenic center. With increasing temperature, the helix reversal penalty was little affected and remained rather constant, showing that the intermolecular hydrogen bonds remain intact and are directing the helicity in the stack. The mismatch penalty, however, was found to decrease when the temperature was increased, which resulted in opposite effects on the degree of chiral amplification when comparing the sergeants-and-soldiers and the majority-rules phenomena. While for the former a reduction in mismatch penalty resulted in a decrease in degree of chiral amplification, for the latter it resulted in a stronger chiral amplification effect. By combining the sergeants-and-soldiers and majority-rules phenomena in a diluted majority-rules experiment, we could further determine the effect of temperature on the degree of chiral amplification. Extending the experiments to different concentrations revealed that the relative temperature, i.e., the temperature relative to the critical temperature of elongation, controls the degree of chiral amplification. On the basis of these results, it was possible to generate a general “master curve” independent of concentration to describe the temperature-dependent majority-rules principle. As a result, unprecedented expressions of amplification of chirality are recorded.
By systematic variation of the chemical structure of benzene-1,3,5-tricarboxamide (BTA) derivatives, the effect of chemical structure on the amplification of chirality was studied and quantified. In ...combination with temperature-dependent amplification experiments, the limits of the majority-rules principle were also investigated. For all BTA derivatives a high, constant helix reversal penalty was determined, which is related to the intermolecular hydrogen bonds that are present in all studied derivatives. For asymmetrically substituted BTA derivatives an odd−even effect was found in the degree of chiral amplification when changing the position of the stereogenic center with respect to the amide functionality. It was found that the mismatch penalty could be directly related to the number of stereocenters present in the molecules. Increasing this number from one to three resulted in an increase in this energy penalty while leaving the helix reversal penalty unaffected. For the majority-rules principle this implies that a single stereocenter present in the molecule contains sufficient chiral information at the molecular level to result in a chirally amplified state at the supramolecular level. Further evidence that the mismatch penalty is directly related to the number of stereocenters was obtained from mixed majority-rules experiments where two BTA derivatives with different numbers of stereocenters with opposite stereoconfiguration were studied in a majority-rules experiment. Finally, the ultimate limits of chiral amplification for the majority-rules principle were investigated, revealing that, given a certain helix reversal penalty, there is an optimum to which the mismatch penalty can be reduced while also enhancing the degree of chiral amplification. Temperature-dependent majority-rules experiments could indeed confirm these simulations. These findings show the relevance of both energy penalties when trying to enhance the degree of chiral amplification for the majority-rules principle in a one-dimensional helical supramolecular polymer.
N,N',N″-trialkylbenzene-1,3,5-tricarboxamides (BTAs) self-assemble by means of strong, threefold α-helix-type intermolecular hydrogen bonding into well-defined, helical, one-dimensional columnar ...aggregates. When a stereogenic centre is introduced into the alkyl side chains of these BTAs, strong Cotton effects are observed in dilute apolar solutions, indicating the preference for one helical conformation over the other. Here, we report the creation of a helical sense preference in self-assembled BTAs by introducing deuterium/hydrogen isotope chirality into the alkyl side chains. We determine the relative stabilities of the left- and right-handed helical conformations of these deuterated supramolecular polymers by performing a conformational analysis. Our findings show that the results of deuterium/hydrogen substitution in BTA-based supramolecular polymers and helical polyisocyanates are very similar, although the formation mechanisms differ. The selectively deuterated BTAs discussed here represent the first example of supramolecular chirality resulting from isotope substitution.
N‐Centred benzene‐1,3,5‐tricarboxamides (N‐BTAs) composed of chiral and achiral alkyl substituents were synthesised and their solid‐state behaviour and self‐assembly in dilute alkane solutions were ...investigated. A combination of differential scanning calorimetry (DSC), polarisation optical microscopy (POM) and X‐ray diffraction revealed that the chiral N‐BTA derivatives with branched 3,7‐dimethyloctanoyl chains were liquid crystalline and the mesophase was assigned as Colho. In contrast, N‐BTA derivatives with linear tetradecanoyl or octanoyl chains lacked a mesophase and were obtained as crystalline compounds. Variable‐temperature infrared spectroscopy showed the presence of threefold, intermolecular hydrogen bonding between neighbouring molecules in the mesophase of the chiral N‐BTAs. In the crystalline state at room temperature a more complicated packing between the molecules was observed. Ultraviolet and circular dichroism spectroscopy on dilute solutions of N‐BTAs revealed a cooperative self‐assembly behaviour of the N‐BTA molecules into supramolecular polymers with preferred helicity when chiral alkyl chains were present. Both the sergeants‐and‐soldiers as well as the majority‐rules principles were operative in stacks of N‐BTAs. In fact, the self‐assembly of N‐BTAs resembles closely that of their carbonyl (CO)‐centred counterparts, with the exception that aggregation is weaker and amplification of chirality is less pronounced. The differences in the self‐assembly of N‐ and CO‐BTAs were analysed by density functional theory (DFT) calculations. These reveal a substantially lower interaction energy between the monomeric units in the supramolecular polymers of N‐BTAs. The lower interaction energy is due to the higher energy penalty for rotation around the PhNH bond compared to the PhCO bond and the diminished magnitude of dipole–dipole interactions. Finally, we observed that mixed stacks are formed in dilute solution when mixing N‐BTAs and CO BTAs.
The chain gang! N‐Centred benzene‐1,3,5‐tricarboxamides were synthesised and their self‐assembly into dynamic supramolecular polymers was investigated with a combined experimental and theoretical approach. The dynamic aggregates show similar behaviour compared to their CO‐centred counterparts although the self‐assembly is weaker and less cooperative and amplification of chirality is less pronounced.
Hospitalized patients often receive oxygen supplementation, which can lead to a supraphysiological oxygen tension (hyperoxia). Hyperoxia can have hemodynamic effects, including an increase in ...systemic vascular resistance. This increase suggests hyperoxia-induced vasoconstriction, yet reported direct effects of hyperoxia on vessel tone have been inconsistent. Furthermore, hyperoxia-induced changes in vessel diameter have not been studied in mice, currently the most used mammal model of disease. In this study we set out to develop a pressure-myograph model using isolated vessels from mice for investigation of pathways involved in hyperoxic vasoconstriction. Isolated conduit and resistance arteries (femoral artery and gracilis arteriole, respectively) from C57BL/6 mice were exposed to normoxia (PO2 of 80 mmHg) and three levels of hyperoxia (PO2 of 215, 375 and 665 mmHg) in a no-flow pressure myograph setup. Under the different PO2 levels, dose-response agonist induced endothelium-dependent vasodilation (acetylcholine, arachidonic acid), endothelium-independent vasodilation (s-nitroprusside), as well as vasoconstriction (norepinephrine, prostaglandin F2α) were examined. The investigated arteries did not respond to oxygen by a change in vascular tone. In the dose-response studies, maximal responses and EC50 values to any of the aforementioned agonists were not affected by hyperoxia either. We conclude that arteries and arterioles from healthy mice are not intrinsically sensitive to hyperoxic conditions. The present ex-vivo model is therefore not suitable for further research into mechanisms of hyperoxic vasoconstriction.
Abstract Background Concerns have been expressed regarding a possible association between arterial hyperoxia and adverse outcomes in critically ill patients. Oxygen status is commonly monitored ...noninvasively by peripheral saturation monitoring (SpO2 ). However, the risk of hyperoxia above specific SpO2 levels in critically ill patients is unknown. The purpose of this study was to determine a threshold value of SpO2 above which the prevalence of arterial hyperoxia distinctly increases. Methods This is a cross-sectional study in adult mechanically ventilated intensive care patients in a tertiary referral center. In 100 patients, we collected 200 arterial blood gases (ABG) and simultaneously registered SpO2 levels, as well as hemodynamic and ventilation parameters and vasoactive medication. Patients under therapeutic hypothermia were excluded. Results The risk of arterial hyperoxia, defined as PaO2 > 100 mm Hg or > 125 mm Hg, was negligible when SpO2 was ≤ 95% or ≤ 96%, respectively. The majority (89% and 54%, respectively for PaO2 > 100 mm Hg and 125 mm Hg) of ICU patients with SpO2 of 100% had arterial hyperoxia. The relation between SpO2 and PaO2 was not clearly affected by hemodynamic or other clinical variables (pH, pCO2 , body temperature, recent blood transfusion). Conclusion In critically ill patients, the prevalence of arterial hyperoxia increases when SpO2 is > 95%. Above this saturation level, supplemental oxygen should be administered with caution in patients potentially susceptible to adverse effects of hyperoxia.
Holoprosencephaly (HPE) is a common developmental anomaly of the human forebrain and midface where the cerebral hemispheres fail to separate into distinct left and right halves. We have previously ...reported haploinsufficiency for Sonic Hedgehog (SHH) as a cause for HPE. We have now performed mutational analysis of the complete coding region and intron-exon junctions of the SHH gene in 344 unrelated affected individuals. Herein, we describe 13 additional unrelated affected individuals with SHH mutations, including nonsense and missense mutations, deletions and an insertion. These mutations occur throughout the extent of the gene. No specific genotype-phenotype association is evident based on the correlation of the type or position of the mutations. In conjunction with our previous studies, we have identified a total of 23 mutations in 344 unrelated cases of HPE. They account for 14 cases of familial HPE and nine cases of sporadic HPE. Mutations in SHH were detected in 10 of 27 (37%) families showing autosomal dominant transmission of the HPE spectrum, based on structural anomalies. Interestingly, three of the patients with an SHH mutation also had abnormalities in another gene that is expressed during forebrain development. We suggest that the interactions of multiple gene products and/or environmental elements may determine the final phenotypic outcome for a given individual and that variations among these factors may cause the wide variability in the clinical features seen in HPE.
van Rij MC, de Die‐Smulders CEM, Bijlsma EK, de Wert GMWR, Geraedts JP, Roos RAC, Tibben A. Evaluation of exclusion prenatal and exclusion preimplantation genetic diagnosis for Huntington's disease ...in the Netherlands.
Individuals at 50% risk of Huntington's disease (HD) who prefer not to know their carrier status, might opt for exclusion prenatal diagnosis (ePND) or exclusion preimplantation genetic diagnosis (ePGD). This study aims to provide a better understanding of couples' motives for choosing ePND or ePND, and surveys couples' experiences in order to make recommendations for the improvement of counselling for exclusion testing. This qualitative retrospective interview study focussed on couples who underwent ePND or ePGD for HD in the period 1996–2010. Seventeen couples were included of which 13 had experienced ePND and 6 ePGD. Mean time‐interval since exclusion‐testing was 3.9 years. Couples' moral reservations regarding termination of pregnancy (TOP) or discarding healthy embryos were counterbalanced by the wish to protect their future child against HD. Seven couples had terminated a total of 11 pregnancies with a 50% HD risk, none showed regret. ePGD was used by couples who wanted to avoid (another) TOP. ePND and ePGD are acceptable reproductive options for a specific group of counsellees. To guarantee sound standards of care, it is imperative that candidate couples be given in‐depth non‐directive counselling about all possible scenarios, and adequate professional and psychological support prior to, during and after ePND/ePGD.
Section Editor: Aad Tibben, email: a.tibben@lumc.nl
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