A dysfunctional larynx dilemma: Carcinoma recurrence or radiation-induced damage?

@#A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.

Atypical lipomatous tumor of the oropharynx: A case report.

Atypical lipomatous tumor or well-differentiated liposarcoma is a rare condition in the laryngopharynx. We present a case of a 63 year-old male with progressive dysphagia who later manifested with a mass that regurgitates outside the oral cavity. Surgical removal was done via a transoral approach, followed by adjuvant radiotherapy.

Redox-Switchable Behavior of Transition-Metal Complexes Supported by Amino-Decorated N-Heterocyclic Carbenes.

The coordination chemistry of the N-heterocyclic carbene ligand IMes(NMe2)2, derived from the well-known IMes ligand by substitution of the carbenic heterocycle with two dimethylamino groups, was investigated with d6 [Mn(I), Fe(II)], d8 [Rh(I)], and d10 [Cu(I)] transition-metal centers. The redox behavior of the resulting organometallic complexes was studied through a combined experimental/theoretical study, involving electrochemistry, EPR spectroscopy, and DFT calculations. While the complexes [CuCl(IMes(NMe2)2)], [RhCl(COD)(IMes(NMe2)2)], and [FeCp(CO)2 (IMes(NMe2)2)](BF4) exhibit two oxidation waves, the first oxidation wave is fully reversible but only for the first complex the second oxidation wave is reversible. The mono-oxidation event for these complexes occurs on the NHC ligand, with a spin density mainly located on the diaminoethylene NHC-backbone, and has a dramatic effect on the donating properties of the NHC ligand. Conversely, as the Mn(I) center in the complex [MnCp(CO)2 ((IMes(NMe2)2)] is easily oxidizable, the latter complex is first oxidized on the metal center to form the corresponding cationic Mn(II) complex, and the NHC ligand is oxidized in a second reversible oxidation wave.

Helical Chiral N-Heterocyclic Carbene Ligands in Enantioselective Gold Catalysis.

The first chiral helicene-NHC gold(I) complexes efficient in enantioselective catalysis were prepared. The L-shaped chiral ligand is composed of an imidazo[1,5-a]pyridin-3-ylidene (IPy) scaffold laterally substituted by a configurationally stable [5]-helicenoid unit. The chiral information was introduced in a key post-functionalization step of a NHC-gold(I) complex bearing a symmetrical anionic fluoreno[5]helicene substituent, leading to a racemic mixture of complexes featuring three correlated elements of chirality, namely central, axial and helical chirality. After HPLC enantiomeric resolution, X-ray crystallography and theoretical calculations enabled structural and stereochemical characterization of these configurationally stable NHC-gold(I) complexes. The high potential in asymmetric catalysis is demonstrated in the benchmark cycloisomerization of N-tethered 1,6-enynes with up to 95 : 5 er.

Systematic review of intraoperative radiation therapy for head and neck cancer.

Multidisciplinary treatments with surgery, radiation therapy, and chemotherapy are the cornerstones in the management of locally advanced head and neck malignancies. In most cases, radiation is delivered via external beam radiation therapy (EBRT). Intraoperative radiation therapy (IORT), on the other hand, is the delivery of precise doses of radiation to selected target volumes within the exposed surgical field while at the operating room. Most studies on its use on head and neck cancers are limited to single-institutional retrospective case series. We performed a systematic review to consolidate the existing literature on IORT for head and neck malignancies. Fifty-two studies representing a mixed population of 2,389 patients were included in this review. IORT via electrons (intraoperative electron radiation therapy), brachytherapy (intraoperative high dose-rate brachytherapy) or photons was administered in numerous settings, but most commonly as part of a reirradiation regimen following salvage surgery for recurrent tumours. Often, additional EBRT was also planned postoperatively. This review illustrates that IORT is a promising treatment modality in head and neck cancer. Multiple single-institutional studies spanning several decades have demonstrated benefit in terms of local control with reasonable toxicity. However, randomised trials comparing it with current standards of care are still needed.

Half-sandwich manganese complexes Cp(CO)2Mn(NHC) as redox-active organometallic fragments.

Oxidation of the half-sandwich MnI complexes Cp(CO)2Mn(NHC) bearing dialkyl-, arylalkyl- and diarylsubstituted N-heterocyclic carbene ligands (NHC = IMe, IMeMes, IMes) affords the corresponding stable MnII radical cations [Cp(CO)2Mn(NHC)](BF4) isolated in 92-95% yield. Systematic X-ray diffraction studies of the series of MnI and MnII NHC complexes revealed the expected characteristic structural changes upon oxidation, namely the elongation of the Mn-CO and Mn-NHC bonds as well as the diminution of the OC-Mn-CO angle. ESR spectra of [Cp(CO)2Mn(IMes)](BF4) in frozen solution (CH2Cl2/toluene 1 : 1, 70 K) allowed the identification of two conformers for this complex and their structural assignment using DFT calculations. The stability of these NHC complexes in both metal oxidation states, moderate oxidation potentials and the ease of detection of MnII species by a variety of spectroscopic techniques (UV-Vis, IR, paramagnetic 1H NMR, and ESR) make these compounds promising objects for applications as redox-active organometallic fragments.

Experimental and Theoretical Insights into the Electronic Properties of Anionic N-Heterocyclic Dicarbenes through the Rational Synthesis of Their Transition Metal Complexes.

The lithiation of the NHC ligand backbone in Cp(CO)2Mn(IMes) followed by transmetalation on the C4 carbenic position with Cp(CO)2FeI led to the heterobimetallic complex Cp(CO)2Mn(µ-dIMes)Fe(CO)2Cp bearing the anionic ditopic imidazol-2,4-diylidene dIMes ligand. Subsequent treatment of the later with TfOH induced a selective decoordination of the [Cp(CO)2Mn] fragment to form the cationic abnormal NHC complex [Cp(CO)2Fe(aIMes)](OTf), which was further derivatized to the bis(iron) dIMes complex [Cp(CO)2Fe(µ-dIMes)Fe(CO)2Cp](OTf) by reaction with tAmOK and Cp(CO)2FeI. The effect of the metalation at the C4 or C2 position on the imidazole ring on the electronic donation properties of the associated C2 and C4 carbenic centers in the dIMes ligand was quantified through systematic experimental and theoretical studies of IMes, aIMes, and dIMes complexes. The evaluation of the catalytic activity of the series of cationic Fe(II) complexes based on IMes, aIMes, and dIMes ligands in a benchmark ketone hydrosilylation showed the superiority of the bimetallic derivative.

Synthesis and Properties of Partially Saturated Fluorenyl-Derived [n]Helicenes Featuring an Overcrowded Alkene.

The straightforward, multigram-scale synthesis of the partially saturated H6 -fluoreno[n]helicenes (n=5 or 7) featuring a central, overcrowded alkene is described. The key cyclization step was based on an intramolecular McMurry reaction from the corresponding 1,5-diketones. Chiral stationary phase HPLC analysis and isomer separation indicate that each helicenic compound is constituted of three diastereoisomers at room temperature, i. e. the configurationally stable (R,R,P)/(S,S,M) pair of enantiomers and an apparently achiral compound resulting from the rapid interconversion between the (R,S,P) and (S,R,M) enantiomers. The partially saturated H6 -fluoreno[n]helicenes are oxidatively aromatized to give an efficient access to the corresponding fluoreno[n]helicenes. The chiroptical properties (vibrational and electronic circular dichroism) of the chiral, enantiopure compounds have been measured and analyzed by quantum-chemical calculations, confirming their helicoidal nature.

Phosphorescent Cationic Heterodinuclear IrIII /MI Complexes (M=CuI , AuI ) with a Hybrid Janus-Type N-Heterocyclic Carbene Bridge.

A novel class of phosphorescent cationic heterobimetallic IrIII /MI complexes, where MI =CuI (4) and AuI (5), is reported. The two metal centers are connected by the hybrid bridging 1,3-dimesityl-5-acetylimidazol-2-ylidene-4-olate (IMesAcac) ligand that combines both a chelating acetylacetonato-like and a monodentate N-heterocyclic carbene site coordinated onto an IrIII and a MI center, respectively. Complexes 4 and 5 have been prepared straightforwardly by a stepwise site-selective metalation with the zwitterionic [(IPr)MI (IMesAcac)] metalloproligand (IPr=1,3-(2,6-diisopropylphenyl)-2H-imidazol-2-ylidene) and they have been fully characterized by spectroscopic, electrochemical, and computational investigation. Complexes 4 and 5 display intense red emission arising from a low-energy excited state that is located onto the "Ir(C^N)" moiety featuring an admixed triplet ligand-centered/metal-to-ligand charge transfer (3 IL/1 MLCT) character. Comparison with the benchmark mononuclear complexes reveals negligible electronic coupling between the two distal metal centers at the electronic ground state. The bimetallic systems display enhanced photophysical properties in comparison with the parental congeners. Noteworthy, similar non-radiative rate constants have been determined along with a two-fold increase of radiative rate, yielding brightly red-emitting cyclometalating IrIII complexes. This finding is ascribed to the increased MLCT character of the emitting state in complexes 4 and 5 due to the smaller energy gap between the 3 IL and 1 MLCT manifolds, which mix via spin-orbit coupling.

N-Cyclopropenio-imidazol-2-ylidene: An N-heterocyclic carbene bearing an N-cationic substituent.

A cationic NHC 1+ bearing an N-bound 2,3-bis(diisopropylamino)cyclopropenium group is reported. From an easily available dicationic imidazolium precursor, the coordination abilities and stereo-electronic properties of 1+ are evaluated by the formation of Pd(ii), Rh(i) and Au(i) complexes. The cationic gold(i) complex is implemented in representative intramolecular Au(i)-catalyzed cyclizations.

Otorhinolaryngology Out-Patient Practice in the “Post”-COVID-19 Era: Ensuring a Balance Between Service and Safety

Objective@#To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff.@*Data Sources@#Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations.@*Methods@#A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion.@*Conclusion@#These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

A dysfunctional Larynx dilemma: Carcinoma recurrence or radiation-induced damage?

@#A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.

N-Heterocyclic Carbenes as Key Intermediates in the Synthesis of Fused, Mesoionic, Tricyclic Heterocycles.

Coupling between 5-bromoimidazo[1,5-a]pyridinium salts and malonate or arylacetate esters leads to a facile and straightforward access to the new mesoionic, fused, tricyclic system of imidazo[2,1,5-cd]indolizinium-3-olate. Mechanistic studies show that the reaction pathway consists of nucleophilic aromatic substitution on the cationic, bicyclic heterocycle by an enolate-type moiety and in the nucleophilic attack of a transient free N-heterocyclic carbene (NHC) species on the ester group; the relative order of these two steps depends on the nature of the starting ester. This work highlights the valuable implementation of free NHC species as key intermediates in synthetic chemistry, beyond their classical use as stabilizing ligands or organocatalysts.

An Original L-shape, Tunable N-Heterocyclic Carbene Platform for Efficient Gold(I) Catalysis.

The synthesis and characterization of original NHC ligands based on an imidazo[1,5-a]pyridin-3-ylidene (IPy) scaffold functionalized with a flanking barbituric heterocycle is described as well as their use as tunable ligands for efficient gold-catalyzed C-N, C-O, and C-C bond formations. High activity, regio-, chemo-, and stereoselectivities are obtained for hydroelementation and domino processes, underlining the excellent performance (TONs and TOFs) of these IPy-based ligands in gold catalysis. The gold-catalyzed domino reactions of 1,6-enynes give rise to functionalized heterocycles in excellent isolated yields under mild conditions. The efficiency of the NHC gold 5Me complex is remarkable and mostly arises from a combination of steric protection and stabilization of the cationic AuI active species by ligand 1Me .

Manganese catalyzed α-methylation of ketones with methanol as a C1 source.

The direct α-methylation of ketones with methanol under hydrogen borrowing conditions using a well-defined manganese PN3P complex as a pre-catalyst was, for the first time, achieved. The reactions typically proceed at 120 °C for 20 h with 3 mol% pre-catalyst loading and in the presence of NaOtBu (50 mol%) as base. The scope of the reaction was extended to the α-methylation of esters.

Unveiling the redox-active character of imidazolin-2-thiones derived from amino-substituted N-heterocyclic carbenes.

IMes-derived thioureas in which the imidazolyl ring is directly substituted by one or two dimethylamino groups are redox-active, exhibiting one and two oxidized states, respectively. The structure, stability, and electronics of the oxidized species are investigated, emphasizing the decisive role of the amino substituents.

Oxidative Coupling of Anionic Abnormal N-Heterocyclic Carbenes: Efficient Access to Janus-Type 4,4'-Bis(2H-imidazol-2-ylidene)s.

The oxidative coupling of anionic imidazol-4-ylidenes protected at the C2 position with [MnCp(CO)2 ] or BH3 led to the corresponding 4,4'-bis(2H-imidazol-2-ylidene) complexes or adducts, in which the two carbene moieties are connected through a single C-C bond. Subsequent acidic treatment of the later species led to the corresponding 4,4'-bis(imidazolium) salts in good yields. The overall procedure offers practical access to a novel class of Janus-type bis(NHC)s. Strikingly, the coplanarity of the two NHC rings within the mesityl derivative 4,4'-bis(IMes), favored by steric hindrance along with stabilizing intramolecular C-H⋅⋅⋅π aryl interactions, allows the alignment of the π-systems and, as a direct consequence, significant electron communication through the bis(carbene) scaffold.

Homo- and Heteropolymetallic Complexes of the Hybrid, Ambidentate N-Heterocyclic Carbene Ligand IMes-acac.

The anionic 5-acetylimidazol-2-ylidene-4-olate 1 -, named as "IMes-acac", is composed of fused diaminocarbene and acetylacetonato units in the same IMes-based imidazolyl ring. The bifunctional compound 1 - is shown to act as an effective, ditopic bridging ligand for transition metal centers. Several new complexes supported by this ligand were prepared, including the complex [RuCl(p-Cym)(κ2 O,O-1·H)](BF4) (2), which can be regarded as a metallated imidazolium salt, the homobimetallic complex [((COD)Rh)(RhCl(COD))(µ-1κ2 O,O:2κ1 C-1)] (4), the heterobimetallic complexes [((p-Cym)ClRu)(RhCl(COD))(µ-1κ2 O,O:2κ1 C-1)] (3), [((p-Cym)ClRu)(RhCl(CO)2)(µ-1κ2 O,O:2κ1 C-1)] (5), [((p-Cym)ClRu)(Cu(IPr))(µ-1κ2 O,O:2κ1 C-1)] (9), the anionic homoleptic Cu(I) complexes [Cu(κ1 C-1)2]K ([10]K) and [Cu(κ1 C-1)2](NEt4) ([10](NEt4)), and the heterotrimetallic complex [((p-Cym)RuCl)2(Cu)(µ-1κ2 O,O:3κ1 C-1)(µ-2κ2 O,O:3κ1 C-1)](PF6) (11). Preliminary studies on the possible preparation of supramolecular metallopolymers and electrochemical studies on the series of complexes are also reported.

Buttressing Effect as a Key Design Principle towards Highly Efficient Palladium/N-Heterocyclic Carbene Buchwald-Hartwig Amination Catalysts.

The backbone substitution of the standard 1,3-bis(2,6-diisopropylphenyl)-2H-imidazol-2-ylidene (IPr) ligand by dimethylamino groups was previously shown to induce a dramatic improvement in the catalytic efficiency of the corresponding Pd-PEPPSI (pyridine-enhanced pre-catalyst preparation, stabilization, and initiation) pre-catalysts in N-arylation reactions. Herein, a thorough structure/activity study towards rationalizing this beneficial effect has been described. In addition to the previously reported IPrNMe2 and IPr(NMe2)2 ligands, the new IPrNiPr2 and IPr(NMe2,Cl) ligands, which bear one bulkier diisopropylamino group and a combination of dimethylamino and chloro substituents, respectively, have been designed and analyzed in the study. The influence of the backbone substitution was found to be steric in origin and is related to the well-known buttressing effect encountered in arene chemistry. The usefulness and versatility of this approach was demonstrated through the development of a highly efficient catalytic system for the challenging arylation of bulky α,α,α-trisubstituted primary amines. The optimized system based on the [PdCl(η3 -cinnamyl)(IPr(NMe2)2 )] or [PdCl(η3 -cinnamyl)(IPrNiPr2 )] pre-catalysts operates under unprecedented mild conditions (catalyst loadings: 0.5-2 mol %, reaction temperatures: 40-60 °C) with a wide substrate scope.

Ruthenium Catalysts Supported by Amino-Substituted N-Heterocyclic Carbene Ligands for Olefin Metathesis of Challenging Substrates.

N-Heterocyclic carbene (NHC) ligands IMesNMe2 and IMes(NMe2)2 derived from the well-known IMes ligand by substituting the carbenic heterocycle with one and two dimethylamino groups, respectively, were employed for the synthesis of second-generation Grubbs- and Grubbs-Hoveyda-type ruthenium metathesis precatalysts. Whereas the stability of the complexes was found to depend on the degree of dimethylamino-substitution and on the type of complex, the backbone-substitution was shown to have a positive impact on their catalytic activity in ring-closing metathesis, with a more pronounced effect in the second-generation Grubbs-type series. The new complexes were successfully implemented in a number of challenging olefin metathesis reactions leading to the formation of tetra-substituted C=C double bonds and/or functionalized compounds.