Formation of CNHC∧Calkyl and CNHC∧Caryl κ2-Chelate Complexes through Competitive sp3- and sp2-CH Activations: An Experimental and Computational Study.

Depending on the chelate ring present, cyclometalated complexes are useful catalysts for various reactions. The reactivity of IrIII and RhIII NHC complexes bearing aliphatic or aromatic N,N'-substituents and thus featuring various metalation sites toward cyclometalation has been investigated. The RhIII complex bearing an N-mesityl-N'-benzyl-NHC does not participate in any cyclometalation, while the IrIII complex reacts under metalation of an ortho-methyl group of the Mes substituent to give complex [3] with a six-membered chelate ring. The RhIII and IrIII complexes bearing an N-o-tolyl,N-benzyl-NHC undergo sp2-CH activation to yield the cyclometalated complexes [4] and [5] featuring a five-membered CNHC∧C chelate ring. Density functional theory (DFT) studies corroborated the experimental findings.

Impact of Clonal Hematopoiesis in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction.

BACKGROUND: Clonal hematopoiesis of indeterminate potential (CHIP) is common in elderly individuals and is associated with an increased risk of both hematologic malignancies and cardiovascular disease. The impact of CHIP on the outcomes for patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains undetermined. OBJECTIVES: The purpose of this study was to determine the prognostic impact of CHIP in CS after AMI. METHODS: Blood samples were obtained at randomization from 446 patients included in the CULPRIT-SHOCK (Culprit Lesion Only vs Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock; NCT01927549) trial. CHIP was assessed using a next-generation sequencing approach targeting the most commonly mutated genes; the primary outcome at 30 days comprised all-cause mortality and renal replacement therapy. RESULTS: CHIP variants at ≥2% variant allele frequency were detected in 29% (n = 129), most commonly in the DNMT3A or TET2 genes, which harbored 47% and 36% of all mutations, respectively. Compared to non-CHIP patients, CHIP carriers were older and had decreased renal function and increased levels of N-terminal pro-B-type natriuretic peptide and inflammatory biomarkers. CHIP carriers had worse short-term outcomes measured either as mortality or as the combined clinical endpoint of mortality or severe renal failure within 30 days. Association of CHIP with the combined endpoint was independent of age and biomarkers reflecting kidney function, heart failure severity, and inflammation (OR: 1.83; 95% CI: 1.05-3.21; P = 0.03) but not significant regarding all-cause mortality (OR: 1.67; 95% CI: 0.96-2.90; P = 0.069). CONCLUSIONS: CHIP is frequent among AMI and CS patients and is associated with impaired clinical outcome. CHIP assessment may facilitate risk stratification in patients with CS and imply novel treatment targets. (Culprit Lesion Only vs Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock [CULPRIT-SHOCK]; NCT01927549).

Palladium-Catalyzed Three-Component Dearomatization/Sulfonylation Cascade.

The diastereoselective synthesis of sulfonylated indolines is reported. A palladium-catalyzed dearomative sulfination of (aza)indole-tethered aryl iodides generates reactive benzylic sulfinates. These intermediates react with electrophiles in a one-pot, two-step process to generate sulfonylated products in good yields and excellent diastereoselectivity. This three-component sequence demonstrates good scalability and can be applied toward the synthesis of sulfonamides. Additionally, further derivatizations of aryl iodide containing products furnish spiro- and alkynylated indoline products.

Synthesis of N-Heterocyclic Carbenes and Their Complexes by Chloronium Ion Abstraction from 2-Chloroazolium Salts Using Electron-Rich Phosphines.

N-Heterocyclic carbenes (NHCs) are commonly prepared by deprotonation of azolium salts using strong anionic bases. This reaction is often unselective, yielding alkali metal NHC complexes or dimerized NHCs. Alternatively, free NHCs are obtained by the dechlorination of 2-chloroazolium salts using electron-rich phosphines. PPh3 , PCy3 , and PtBu3 are unsuitable for Cl+ abstraction, while the sterically encumbered tris(1,3-tert-butylimidazolidin-2-ylidenamino)phosphine 1 selectively removes Cl+ from 2-chloroazolium salts. Since bulky 1 does not bind to metal complexes, it was used for the preparation of NHC complexes via in situ Cl+ abstraction from 2-chloroazolium salts. The dechlorination was employed for the site-selective monometallation with IrI , IrIII , RhI , RhIII , and RuII of a bis-NHC precursor composed of a 2-chlorobenzimidazolium and a 2-chlorobenzimidazole group, followed by the preparation of the heterobimetallic IrIII /PdII complex [18](BF4 )2 by a dechlorination/oxidative addition reaction sequence.

Immune-Based Therapeutic Strategies for Acute Myeloid Leukemia.

The development and design of immune-based strategies have become an increasingly important topic during the last few years in acute myeloid leukemia (AML), based on successful immunotherapies in solid cancer. The spectrum ranges from antibody drug conjugates, immune checkpoint inhibitors blocking programmed cell death protein 1 (PD1), cytotoxic T lymphocyte antigen 4 (CTLA4) or T cell immunoglobulin and mucin domain containing-3 (TIM3), to T-cell based monoclonal and bispecific T-cell engager antibodies, chimeric antigen receptor-T-cell (CAR-T) approaches and leukemia vaccines. Currently, there are many substances in development and multiple phase I/II studies are ongoing. These trials will help us to deepen our understanding of the pathogenesis of AML and facilitate the best immunotherapeutic strategy in AML. We discuss here the mode of action of immune-based therapies and provide an overview of the available data.

Results of extracorporeal shock wave lithotripsy with a new electrohydraulic shock wave generator.

OBJECTIVE: Since 1999, the lithotriptor LDM (Philips, Germany) is used routinely for treatment of urinary stones in our department. We evaluated the complication rate and treatment success of extracorporeal stone treatment with the new lithotriptor. MATERIAL AND METHODS: We performed a prospective, two-step clinical study: (1) Complication rate: From January to May 1999, 312 consecutive treatments in 225 patients (136 male, 89 female) were evaluated. (2) Success rate: From February to April 2000, 88 consecutive patients (61 male, 27 female) with 113 concrements were evaluated. RESULTS: (1) Complication rate: Overall complication rate was 10%. Most of them were minor complications. Most significant complications were subcapsular renal hematomas, which were detected by routinely performed renal ultrasound in 1%. (2) Success rate: After single treatment, overall success rate was 87%. 15 of 16 in situ treated ureteral stones (94%) were sufficiently disintegrated by a single treatment. Disintegration rates after single treatment were 93.6% for renal stones smaller than 1 cm and 86% for renal stones 1-2 cm, respectively. CONCLUSIONS: Stone therapy by SWL with the new lithotriptor LDM is a highly effective therapy of renal and ureteral stones and has a low complication rate.