Rapid point-of-care detection of SARS-CoV-2 infection in exhaled breath using ion mobility spectrometry: a pilot study

BACKGROUND

An effective testing strategy is essential for pandemic control of the novel Coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Breath gas analysis can expand the available toolbox for diagnostic tests by using a rapid, cost-beneficial, high-throughput point-of-care test. We conducted a bi-center clinical pilot study in Germany to evaluate breath gas analysis using multi-capillary column ion mobility spectrometry (MCC-IMS) to detect SARS-CoV-2 infection.

METHODS

Between September 23, 2020, and June 11, 2021, breath gas measurements were performed on 380 patients (SARS-CoV-2 real-time polymerase chain reaction (PCR) positive: 186; PCR negative: 194) presenting to the emergency department (ED) with respiratory symptoms.

RESULTS

Breath gas analysis using MCC-IMS identified 110 peaks; 54 showed statistically significant differences in peak intensity between the SARS-CoV-2 PCR-negative and PCR-positive groups. A decision tree analysis classification resulted in a sensitivity of 83% and specificity of 86%, but limited robustness to dataset changes. Modest values for the sensitivity (74%) and specificity (52%) were obtained using linear discriminant analysis. A systematic search for peaks led to a sensitivity of 77% and specificity of 67%; however, validation by transferability to other data is questionable.

CONCLUSIONS

Despite identifying several peaks by MCC-IMS with significant differences in peak intensity between PCR-negative and PCR-positive samples, finding a classification system that allows reliable differentiation between the two groups proved to be difficult. However, with some modifications to the setup, breath gas analysis using MCC-IMS may be a useful diagnostic toolbox for SARS-CoV-2 infection.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov on September 21, 2020 (NCT04556318; Study-ID: HC-N-H-2004).

Clinical diversity and treatment approaches to blastic plasmacytoid dendritic cell neoplasm: a retrospective multicentre study

BACKGROUND

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive type of haematologic precursor malignancy primarily often manifesting in the skin. We sought to provide a thorough clinical characterization and report our experience on therapeutic approaches to BPDCN.

METHODS

In the present multicentric retrospective study, we collected all BPDCN cases occurring between 05/1999 and 03/2018 in 10 secondary care centres of the German-Swiss-Austrian cutaneous lymphoma working group.

RESULTS

A total of 37 BPDCN cases were identified and included. Almost 90% of the patients had systemic manifestations (bone marrow, lymph nodes, peripheral blood) in addition to skin involvement. The latter presented with various types of cutaneous lesions: nodular (in more than 2/3) and bruise-like (in 1/3) skin lesions, but also maculopapular exanthema (in circa 1/6). Therapeutically, 22 patients received diverse combinations of chemotherapeutic regimens and/or radiotherapy. Despite initial responses, all of them ultimately relapsed and died from progressive disease. Eleven patients underwent haematopoietic stem cell transplantation (HSCT; autologous HSCT n = 3, allo-HSCT n = 8). The mortality rate among HSCT patients was only 33.33% with a median survival time of 60.5 months.

CONCLUSION

Our study demonstrates the clinical diversity of cutaneous BPDCN manifestations and the positive development observed after the introduction of HSCT.

133Xe-DSPECT: Bedeutung der zerebrovaskulären Reservekapazität für Diagnostik und Therapie der chronischen zerebralen Ischämie

Using 133Xe-DSPECT, measurements of regional cerebral blood flow (rCBF) were performed before and after stimulation with 1 g of Diamox® in 55 patients with symptomatic occlusion of the internal carotid artery (ICA) and 26 patients without evidence of brain disease (normals). In normals, a negative correlation (r = -0,74) of the Diamox-induced increase of hemispheric blood flow (reserve capacity) and rCBF at rest was observed. In 48 of the 55 patients (87%) with ICA-occlusion a reduced reserve capacity was found. The extent of reduction, however, did not correlate with the findings of transmission CT, because 15 of 21 patients (71 %) with normal CT-scans presented a moderate to severe reduction of reserve capacity. In contrast, reserve capacity corresponded to the extent of arterial collateralisation as documented by cerebral panangiography. In 31 patients EC/IC-bypass surgery was performed. In follow-up studies reserve capacity increased, especially in patients who had a severe reduction preoperatively. Therefore, the combined measurement of rCBF at rest and of reserve capacity is a sensitive, non-invasive method for the diagnosis of (even bilateral) cerebrovascular disease and can be helpful to identify patients with hemodynamic ischemia, who may benefit from EC/IC-bypass surgery.

Production of the Cytotoxic Cardenolide Glucoevatromonoside by Semisynthesis and Biotransformation of Evatromonoside by a Digitalis lanata Cell Culture

Recent studies demonstrate that cardiac glycosides, known to inhibit Na⁺/K⁺-ATPase in humans, have increased susceptibility to cancer cells that can be used in tumor therapy. One of the most promising candidates identified so far is glucoevatromonoside, which can be isolated from the endangered species Digitalis mariana ssp. heywoodii. Due to its complex structure, glucoevatromonoside cannot be obtained economically by total chemical synthesis. Here we describe two methods for glucoevatromonoside production, both using evatromonoside obtained by chemical degradation of digitoxin as the precursor. 1) Catalyst-controlled, regioselective glycosylation of evatromonoside to glucoevatromonoside using 2,3,4,6-tetra-O-acetyl-α-D-glucopyranosyl bromide as the sugar donor and 2-aminoethyldiphenylborinate as the catalyst resulted in an overall 30 % yield. 2) Biotransformation of evatromonoside using Digitalis lanata plant cell suspension cultures was less efficient and resulted only in overall 18 % pure product. Structural proof of products has been provided by extensive NMR data. Glucoevatromonoside and its non-natural 1-3 linked isomer neo-glucoevatromonoside obtained by semisynthesis were evaluated against renal cell carcinoma and prostate cancer cell lines.

Back Cover: Deeper Insight into the Six-Step Domino Reaction of Aldehydes with Malononitrile and Evaluation of Antiviral and Antimalarial Activities of the Obtained Bicyclic Products (ChemistryOpen 3/2017)

The Back Cover picture highlights the easy generation of complex azabicyclic and carbobicyclic molecules from two simple compounds in a single operation through a highly efficient six‐step domino reaction. Within a multi‐step domino reaction, one transformation triggers the next, similar to a row of dominoes where one tile hits the next. The in vitro studies against the herpes virus and malaria reveal domino products as highly active compounds, outperforming the clinical reference drugs ganciclovir and chloroquine. More information can be found in the Full Paper by S. B. Tsogoeva and co‐workers on page 364 in Issue 3, 2017 (10.1002/open.201700005).

Deeper Insight into the Six-Step Domino Reaction of Aldehydes with Malononitrile and Evaluation of Antiviral and Antimalarial Activities of the Obtained Bicyclic Products

The straightforward and efficient synthesis of complex aza‐ and carbobicyclic compounds, which are of importance for medicinal chemistry, is a challenge for modern chemical methodology. An unprecedented metal‐free six‐step domino reaction of aldehydes with malononitrile was presented in our previous study to provide, in a single operation, these bicyclic nitrogen‐containing molecules. Presented here is a deeper investigation of this atom‐economical domino process by extending the scope of aldehydes, performing post‐modifications of domino products, applying bifunctional organocatalysts and comprehensive NMR studies of selected domino products. The thermodynamic aspects of the overall reaction are also demonstrated using DFT methods in conjunction with a semi‐empirical treatment of van der Waals interactions. Furthermore, biological studies of seven highly functionalized and artemisinin‐containing domino products against human cytomegalovirus (HCMV) and Plasmodium falciparum 3D7 are presented. Remarkably, in vitro tests against HCMV revealed five domino products to be highly active compounds (EC₅₀ 0.071–1.8 μm), outperforming the clinical reference drug ganciclovir (EC₅₀ 2.6 μm). Against P. falciparum 3D7, three of the investigated artemisinin‐derived domino products (EC₅₀ 0.72–1.8 nm) were more potent than the clinical drug chloroquine (EC₅₀ 9.1 nm).

Optically active P5-deltacyclenes: selective oxidation, ligand properties, and a diastereoselective rearrangement reaction

Cage-chiral tetra-tert-butyl-P5-deltacyclene is accessible as a pair of highly enriched enantiomers and . The only secondary phosphorus atom P1 of the cage can be selectively oxidized by reaction with t-BuOOH. The P1-oxo species and , allow the direct determination of their ee values. Oxidation occurs with the complete retention of the optical activity of the compounds. The chiroptical properties of and are strongly dominated by their cage chirality, the oxygen atom does not contribute significantly. Elemental sulfur and selenium oxidize P5 with high preference to yield P5-thio- and P5-seleno-P5-deltacyclenes and of the intact cages again. Longer reaction time and more than stoichiometric amounts of selenium, leads to tri-seleno-P5-tetracycloundecane , a partially opened oxidized rearrangement product. The ligand properties of racemic were determined. Diphosphetane phosphorus atom P2 of is the active donor center to bind a Cr(CO)5 fragment, but a tautomerization of takes place if [(benzene)RuCl2]2 is added. A hydrogen atom migrates from P1 to the oxygen atom to form a phosphinous acid ligand. The lone pair of P1 is regenerated and acts as the active ligand function of the cage in this case. As for , the base n-BuLi induces an efficient cage rearrangement reaction of , where P1 and the neighboring carbon atom C4 containing its t-Bu substituent change places. C4 moves to its new position without breaking the bond with P5, this way forming the novel P1-oxo-P5-norsnoutene cage in a highly diastereoselective process.

Synthesis and Atropisomerism of Cascaded Tetraphenylporphyrin-[60]Fullerene Hybrids

Flexible, linked dendritic tetraphenylporphyrin (TPP)-fullerene hybrids were synthesized. They were designed to gain insight into and mimic the primary events in the natural photosynthetic reaction center. These multiporphyrin moieties are based on a light-harvesting concept. Moreover, they incorporate multiple redox components aligned along a redox gradient. Newkome-type dendrons were added to these TPP-fullerene hybrids. In principle they can mediate pH-dependent water solubility, which, however, could not be observed in this case. A protecting-group strategy using tert-butyldiphenylsilyl groups allows convergent synthesis of the dendritic compounds. The dendritic multiporphyrins were synthesized separately and can be used as individual building blocks. Atropisomerism was observed in the dendritic compounds, and single atropisomers could be assigned to the corresponding peaks of a characteristic pattern in the NMR spectra. Deprotection of the Newkome-type dendrons was shown to be feasible under mild conditions that leave the redox gradient intact.

Fused perylene-phthalocyanine macrocycles: a new family of NIR-dyes with pronounced basicity

The synthesis and characterization of a new type of chromophore, namely PePc consisting of a central phthalocyanine core and four fused perylene-bisimide (PBI) units is described for the first time. The entire architecture represents a highly extended conjugated heterocyclic π-system with C4h symmetry. In order to guarantee pronounced solubility in organic solvents the corresponding PBI units were bay-functionalized with tert-butylphenoxy substituents. Next to the metal-free macrocycle, PePcH2 , also metallated macrocycles PePcM (M=Zn, Ni, Pb, Ru, Fe) were synthesized. The extensive fusion of the corresponding aromatic building blocks to the very large extended π-system leads to a very narrow HOMO-LUMO gap and as a consequence to transparency in the visible but light absorption in the NIR region. Significantly, the azomethine N-atoms N1N4 of PePcM and PePcH2 are highly basic. The corresponding tetraprotonated systems can only be deprotonated with very strong non-nucleophilic bases such as phosphazene bases. In the protonated forms PePcMH4 (4+) and PePcMH6 (4+) the absorption maximum is shifted back to the visible region due to the loss of conjugation. The experimental findings were corroborated with quantum mechanical calculations.

Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†

BACKGROUND

The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses.

PATIENTS AND METHODS

Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms.

RESULTS

With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups.

CONCLUSIONS

Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients.

CLINICAL TRIAL NUMBER

NCT 00567554, www.clinicaltrials.gov.

Chemie polyfunktioneller Moleküle, 114 [1]. Synthese und Struktur eines ionischen und nichtionischen, cyclischen Carbaphosphazens und eines Cobalt(III)phosphazen-Komplexes / Chemistry of Polyfunctional Molecules, 114 [1]. Synthesis and Structure of an Ionic and Non Ionic Cyclic Carbaphosphazene and of a Cobalt(III)phosphazene Complex

Reaction of (1) in CH2Cl2 with benzimidazole yields . The salt [4]+BPh4 - has been prepared in THF by metathesis of [4]+Cl- with NaBPh4. Deprotonation of the cationic ring in [4]+BPh4 - was accomplished using 1,8-diazabicyclo[5.4.01,7]undec-7-ene and resulted in the six-membered carbacyclophosphazene (6). Treating 1 with 8 -hydroxyquinoline in CH2Cl2 yields the octahedral cis-complex = 8-oxyquinolinate group). The com pounds [4]+BPh4 -, 6 and 7 are characterized by their IR, Raman, 31P{1H} NMR, 13C{1H} NMR, 1H NMR and mass spectra. Crystals suitable for X-ray structure analyses have been obtained for [4]+BPh4 - and 7×0.5 CH2Cl2. The colourless plates of [4]+BPh4 - crystallize in the triclinic space group P1̄, with the lattice constants a = 1172.7(3), b = 1326.2(3), c = 1806.1(6) pm; α = 100.79(2), β = 103.71(3), γ = 108.18(2)°. The black blocks of 7×0.5 CH2Cl2 crystallize in the monoclinic space group P 21/c with the lattice constants a = 1159.0(10), b = 2008.9(10), c = 2034.6(12) pm; β = 105.86(5)°.

Chemie polyfunktioneller Moleküle, 127 PPh2-Eliminierung aus dem PP-verknüpften Phosphazen Ph2P-N=PPh2-PPh2=N-PPh2 mit [C5H5Fe(CO)(μ-CO)]2; Kristallstrukturanalyse des Phosphazen-Derivats /Chemistry of Polyfunctional Molecules, 127 PPh2 Elimination from the PP Connected Phosphazene Ph2P-N=PPh2-PPh2=N-PPh2, with [C5H5Fe(CO)(μ-CO)]2; Crystal Structure of the Phosphazene Derivative

The reaction of Ph2P-N=PPh2-PPh2=N-PPh2 (Ph = C6H5, 2) with [CpFe(CO)(μ-CO)]2 (Cp = C5H5, 3) yields under elimination of a PPh2-group from 2 and cleavage of the Fe-Fe bond in 3 the monocyclic ferraphosphazene complex Cp(OC) (4) and Ph2P-PPh2 (5). In a side reaction the P-P bond of 2 is also cleaved in a redox process to give Cp(OC) (7). Compound 4 has been characterized by a crystal structure determination.

Chemie polyfunktioneller Moleküle, 98. Oxidative Ringerweiterung des P3-Nortricyclans, 4-Methyl-1,2,6-triphosphatricycIo[2.2.1.02,6]heptan, mit Schwefel und Selen zu Hetero-Noradamantanen und -Adamantanen/ Chemistry of Polyfunctional Molecules, 98. Oxidative Ring Enlargement of the P3-Nortricyclane, 4-Methyl-1,2,6-triphosphatricyclo- [2.2.1.02,6]heptane, by Sulfur and Selenium to Hetero Noradamantanes and Adamantanes

4-Methyl-1,2,6-triphosphatricyclo[2.2.1.02.6]heptane, CH3C(CH2P)3 (1) reacts with sulfur or selenium in the molar ratios of 1:3, 1:5 and 1:6 to yield the chalcogeno-dichalcogenatriphosphanoradamantanes CH3C (CH2P)3E2(E ) (E = S, Se; 2a, b), the dichalcogeno-trichalcogenatriphospha- adamantanes CH3C(CH2PE)3(E)2 (E = S, Se; 3a, b) and the trichalcogeno-trichalcogenatriphospha- adam antanes CH3C(CH2PE)3(E )3 (E = S, Se; 4a, b). The selenium derivative 4b could be detected only by 31P{1H} NM R spectroscopy. Main product in the 1:6 reaction of 1 with selenium is 3b.

Configurational Flexibility of Epimeric β-Aminothioether-chelated Ruthenium(II) η6-Arene Complex Salts

Five chiral β -aminothioethers were obtained via different routes orientated on literature protocols. Three of these β -aminothioethers were reacted with two di-μ-chloro-bis{chloro[η6-arene]- ruthenium(II)} derivatives, resulting in the title complex salts. The complex cations exhibit three stereocenters, viz. ruthenium and sulfur atoms and the chiral benzylic carbon atom of the chelate ligand backbone. Both, ruthenium and sulfur stereocenters epimerize into a mixture of four NMR distinguishable diastereomers in equilibrium, but the designed chiral benzylic carbon atom is stable under all conditions applied so far. The relative diastereomer concentrations in solution depend mainly on the spatial requirements of the η6-arene ligand rather than on the thioether moiety. Diastereomer ratios and the absolute configurations in solution were studied by NMR and CD spectroscopy. The spectroscopic results fit to the absolute X-ray crystal structure parameters determined for the diastereomers present in the crystalline state.

Bond Activation in Iron(II) and Nickel(II) Complexes of Polypodal Phosphanes

A pyridine-derived tetraphosphane ligand (donor set: NP4) has been found to undergo remarkably specific C-P bond cleavage reactions, thereby producing a ligand with an NP3 donor set. The reaction may be reversed under suitable conditions, with regeneration of the original NP4 ligand. In order to investigate the mechanism of this reaction, the NP3 donor ligand C5H3N[CMe(CH2PMe2)2][CMe2(CH2PMe2)] (11) was prepared, and its iron(II) complex 4 generated from Fe(BF4)2 ・6H2O, with methyl diethylphosphinite (7) as an additional monodentate ligand. Ligand 11 has, in addition to the NP3 donor set, one methyl group in close contact with the iron center, reminiscent of an agostic M・ ・ ・H-C interaction. Depending on the stoichiometric amount of iron(II) salt, a side product 15 is formed, which has a diethylphosphane ligand instead of the phosphinite 7 coordinated to iron(II). While attempts to deprotonate the metal-coordinated methyl group in 4 were unsuccessful, the reaction was shown to occur in an alternative complex (18), which is similar to 4 but has a trimethylphosphane ligand instead of the phosphinite 7. The reaction of complex 15 with CO gave two different products, which were both characterized by single-crystal X-ray diffraction. One (19) is the dicarbonyl iron(II) complex of the triphosphane ligand 11, the other (3) is the carbonyl iron(II) complex of the tetraphosphane C5H3N[CMe(CH2PMe2)2]2 (1). This suggests an intermolecular mechanism for the C-P bond formation in question.

Tetrapodal Pentadentate Ligands with NS4 and NP4 Donor Sets: An Elusive Tetrathiol, and a Sterically Encumbered Tetraphosphane

With the intention of preparing tetrapodal pentadentate ligands having NS4 or NP4 donor sets, we investigated reactions of the previously reported tetratosylate 2,6-C5H3N[CMe(CH2OTs)2]2 (2) with thiourea or diphenylphosphide, but found them not to proceed cleanly, and to give mixtures of products. A derivative of 2 better suited to nucleophilic substitution is the corresponding tetrabromide 2,6-C5H3N[CMe(CH2Br)2]2(2,6-bis-(2-bromo-1-bromomethyl-1- methyl-ethyl)-pyridine, 3), which is obtained in excellent yield from 2 by treatment with LiBr in dimethylsulfoxide. The reaction of 3 with 4 eq of thiourea in refluxing ethanol gives a single product. Substitution is not quantitative, however, and the product likely is a bis(thiouronium) bis(bromide) salt. Similarly, the reaction of 3 with 4 eq of potassium O-ethyl xanthogenate displaces only two out of the four bromo substituents under the chosen conditions; workup then leads to what is formulated as a bis(thietane) derivative formed by intramolecular cyclisation. By contrast, nucleophilic substitution with NaSEt in ethanol is quantitative, and the thioether 2,6-C5H3N[CMe(CH2SEt)2]2(2,6-bis-(2-ethylsulfanyl-1-ethylsulfanylmethyl- 1-methyl-ethyl)-pyridine, 4) has been isolated in close to 60% yield. Likewise, and in spite of the considerable steric bulk amassed in the molecule, the reaction of 3 with an excess of KPPh2 in THF proceeds smoothly (even at -50 "C), to give the tetraphosphane 2,6-C5H3N[CMe(CH2PPh2)2]2(2,6-bis-{2-(diphenyl-phosphanyl)-1-[(diphenyl-phosphanyl)- methyl]-1-methyl-ethylg-pyridine, 5) in 65% yield. In order to assess possible pathways of oxidative degradation relevant to the coordination chemistry of this ligand, 5 was treated with NO in CH2Cl2 or ether at different temperatures. In two cases, reaction was observed to produce the oxide 2,6-C5H3N[CMe(CH2P(=O)Ph2)2]2 (6) as a colourless solid in near quantitative yield, with concomitant formation of N2O. All compounds have been characterised by 1H, 13C and 31P NMR spectroscopy (as applicable); IR spectroscopic and elemental analysis data are reported, and the crystal structure of 6 has been determined.

Optically active tetra-tert-butyl-P(5)-deltacyclene epimers: preparation, spectroscopy, dynamic equilibriums, H/D exchange, and transition-metal complex chemistry

On the basis of isolated diastereomeric triorganylstannyl-P5 -deltacyclenes 7' and 7'', almost pure enantiomers of their destannylation products 8' and 8'' are now available. These stereochemically inert cage chiral species contain a configurationally labile P1H1 group that defines two epimers 8 a and 8 b of each of the enantiomers, which are connected by a rapid equilibrium. Mirror-symmetric circular dichroism (CD) spectra of the enantiomeric cages are compatible with the identification of epimers. A simulation of the CD spectrum of the major epimer 8'a relates the cage chirality of the system to the observed chiroptical effects. Both cage epimers and two of the phosphorus cage atoms are active as ligands with respect to [M(CO)5 ] fragments of Cr, Mo, and W. Four almost isoenergetic regio- and stereoisomers of the resulting mononuclear complexes are formed for these metals, but only one of the isomers per metal crystallized in the case of the racemic series of the complexes. The enantiopure versions of cages and cage complexes, however, did not crystallize at all, a well-known phenomenon for chiral compounds. CD spectra of the optically active complex isomer mixtures are close to identical with the CD spectra of the related free cages and point again to the chiral cages as the dominant source of the CD effects of the complexes. [(Benzene)RuCl2 ] complexes of the cage ligand 8 behave totally differently. Only a single species 12=[(benzene)RuCl2 ⋅8 b] is formed in almost quantitative yield and the minor epimer 8 b plays the role of the ligand exclusively. The reaction works as well for the separated enantiomeric cage versions to yield the highly enriched enantiomers 12' and 12'' separately. An efficient kinetic resolution process was identified as the main reason for this finding. It is based on a high stereo- and regiochemical flexibility of the PC cage ligand that is capable of adjusting to the specific requirements of a suitable transition-metal complex fragment. Such ligand flexibility is regularly observed in metalloenzymes, but is a very rare case in classical and organometallic complex chemistry.

The changing face of internal medicine: patient centred care

Patient centred care is now considered the gold standard and there should be 'no decision about me, without me'. Internists who treat patients with complex multi-morbidities should consider patients' preferred outcomes, following a 'goal-oriented' principle. Perhaps the most important barrier to goal-oriented care is that medicine is deeply rooted in a disease-outcome-based paradigm. Rather than asking what patients want, the culture of modern medicine has prioritised optimal disease management according to guidelines and population goals. Doing what is right for the patient should be based on trust. Patients and internists must therefore meet as equals: 'I' and 'you' should be replaced by 'we'.

Sulfur species in graphene oxide

The structure of graphene oxide (GO) is of crucial importance for its chemical functionalization. However, the sulfur content present in GO prepared by Hummers' method has only been addressed by a few authors so far. It has been reported that hydrolysis of sulfur species takes place and that stable sulfonic groups are present in graphite oxide. In this manuscript, in contrast to earlier reports, sulfate species are identified that are covalently bound to GO and still present after extensive aqueous work-up. Additionally, we exclude the possibility that sulfonic groups are present in GO as major species after aqueous work up. Our results are based on bulk characterization of graphene oxide by thermogravimetry and subsequent analysis of the decomposition products using mass spectroscopy and infrared spectroscopy. Up to now, the combustion temperature between 200 and 300 °C remained almost unaddressed. In a temperature dependant experiment we reveal two main decomposition steps that differ in temperature and that are closely related to the sulfur species in GO. While the decomposition, between 200 and 300 °C, is related to the degradation of organosulfate, the other one, between 700 and 800 °C, is assigned to the pyrolysis of inorganic sulfate. Furthermore, organosulfate is to some extent responsible for the reactivity of GO. Therefore, the structural model of GO was extended by adding organosulfate in addition to epoxy and hydroxyl groups, which are predominantly covalently bound above and below the carbon skeleton. Furthermore, the identification of organosulfate groups beneath epoxy groups makes new molecular architectures feasible and can be used to explain the properties of GO in various applications.