Binucleating Jäger-type {(N2O2)2}4- ligands: magnetic and electronic interactions of Fe(II), Ni(II) and Cu(II) across an in-plane TTF-bridge.

The simultaneous presence of different electrophores provides an interesting playground for responsive materials. Herein, we present the incorporation of a twice-reversibly oxidizable tetrathiafulvalene (TTF) unit into a binucleating ligand, bridging two metal centers in a fully conjugated plane. A two-step synthesis scheme gave the D2h symmetric Schiff base-like ligand H4L in moderate yields from which the corresponding copper(II) [Cu2L], nickel(II) [Ni2L], [Ni2L(py)4] and iron(II) complexes [Fe2L(py)4], [Fe2L(dmap)4] and [Fe2L(bpee)2]·1 Tol could be obtained. Characterization was performed through 1H-NMR, IR, UV-vis and 57Fe-Mössbauer spectroscopy, SQUID magnetometry and cyclic voltammetry, supported by density functional theory (DFT) calculations. Single crystal X-ray analysis of [Ni2L(py)4] revealed six-coordinate paramagnetic centers, whereas [Ni2L] underwent gradual coordination induced spin state switching (CISSS) in solution. The magnetic independence of both metal centers is echoed by close-to-ideal Curie-plots of the [Cu2L] system and the gradual spin crossover of all iron(II) compounds. By contrast, cyclic voltammetry measurements in solution indicated oxidation-dependent TTF-metal interactions, as well as metal-metal interactions. The reversible TTF-borne events in H4L and [Ni2L] are overlaid with metal-borne events in the case of [Fe2L(py)4], as is corroborated by an analysis of the frontier orbital landscapes and through diagnostic spectral features upon chemical oxidation.

Triflate vs Acetonitrile: Understanding the Iron(II)-Based Coordination Chemistry of Tri(quinolin-8-yl)amine.

In this study, a synthesis route of tri(quinolin-8-yl)amine (L), a recent member of the tetradentate tris(2-pyridylmethyl)amine (TPA) ligand family, is reported. With the neutral ligand L bound to an iron(II) center in κ4 mode, two cis-oriented coordination sites remain vacant. These can be occupied by coligands such as counterions and solvent molecules. How sensitive this equilibrium can be is most evident if both triflate anions and acetonitrile molecules are available. All three combinations─bis(triflato), bis(acetonitrile), and mixed coligand species─could be characterized by single-crystal X-ray diffraction (SCXRD), which is unique so far for this class of ligand. While at room temperature, the three compounds tend to crystallize concomitantly, the equilibrium can be shifted in favor of the bis(acetonitrile) species by lowering the crystallization temperature. Removed from their mother liquor, the latter is very sensitive to evaporation of the residual solvent, which was observed by powder X-ray diffraction (PXRD) and Mössbauer spectroscopy. The solution behavior of the triflate and acetonitrile species was studied in detail using time- and temperature-resolved UV/vis spectroscopy, Mössbauer spectroscopy of frozen solution, NMR spectroscopy, and magnetic susceptibility measurements. The results indicate a bis(acetonitrile) species in acetonitrile showing a temperature-dependent spin-switching behavior between high- and low-spin. In dichloromethane, the results reveal a high-spin bis(triflato) species. In pursuit of understanding the coordination environment equilibria of the [Fe(L)]2+ complex, a series of compounds with different coligands was prepared and analyzed with SCXRD. The crystal structures indicate that the spin state can be controlled by changing the coordination environment─all of the {N6}-coordinated complexes display geometries expected for low-spin species, while any other donor atom in the coligand position induces a shift to the high-spin state. This fundamental study sheds light on the coligand competition of triflate and acetonitrile, and the high number of crystal structures allows further insights into the influence of different coligands on the geometry and spin state of the complexes.

Spin crossover modulation in a coordination polymer with the redox-active bis-pyridyltetrathiafulvalene (py2TTF) ligand.

A one-dimensional FeII coordination polymer (CP) has been formed which includes the redox-active ligand bis-pyridyltetrathiafulvalene (py2TTF) and a Schiff base-like N2O2 ligand. This CP is both spin crossover (SCO) and redox-active in the solid-state, and chemical oxidation results in SCO modification.

Iron(II) Spin Crossover Complexes Based on a Redox Active Equatorial Schiff-Base-Like Ligand.

In this work, two iron(II) coordination compounds with a N2O2 coordinating Schiff base-like ligand bearing a redox active tetrathiafulvalene (TTF) unit and pyridine or trans-1,2-bis(4-pyridylethylene) as an axial ligand are synthesized. Crystals suitable for single X-ray structure analysis were obtained for the new ligand. The complexes were characterized by magnetic susceptibility measurements, T-dependent UV-vis spectroscopy, and cyclic voltammetry. Both complexes display spin transition behavior below room temperature with T1/2 values of 146 and 156 K. The mononuclear iron(II) complex [FeTTFL(py)2] is relatively stable up to 400 K compared to similar complexes, showing no loss of axial ligands upon heating. Temperature dependent Mössbauer spectroscopy was conducted for the coordination polymer {[FeTTFL(bpee)]}n to get more information regarding the origin of the stepwise spin crossover (SCO) behavior observed in the magnetic measurements. The change of the spin state is accompanied by a change of the optical properties, which can be monitored by VT-UV-vis spectroscopy for the mononuclear complex and has been analyzed in theoretical studies. The redox behavior of the iron(II) complexes reveals three reversible redox steps which are located at the iron center and at the TTF unit of the ligand. Oxidation of the TTF unit induces characteristic changes in the UV-vis spectrum that can be followed by spectroelectrochemical UV-vis spectroscopy. Addressing the potential of the iron-centered redox process results in similar changes in the UV-vis spectrum, which indicates an electronic coupling of the redox active unit with the metal center under certain circumstances.

Iron(II) complexes with N2O2 coordinating Schiff base-like equatorial ligand and 1,2-bis(pyridin-2-ylethynyl)benzene as axial pincer ligand.

Three new unique mononuclear iron(II) pincer complexes were synthesized using 1,2-bis(pyridin-2-ylethynyl)benzene as axially coordinating pincer ligand and N2O2 coordinating Schiff base-like equatorial ligands. Magnetic susceptibility measurements reveal that all three complexes remain in the high spin state throughout the entire temperature range investigated. Reasons for this are restraining sterical interactions revealed in the single crystal x-ray structure analysis and extended DFT-computational studies of one of the pincer complexes. Those interactions also lead to the formation of unexpected side products during the synthesis such as a complex with two ethanol molecules as axial ligand, whose x-ray structure was determined.

Procalcitonin guidance in patients with lower respiratory tract infections: a systematic review and meta-analysis.

Although effective for bacterial lower respiratory tract infections (LRTIs), antibiotic treatment is often incorrectly prescribed for non-bacterial LRTIs. Procalcitonin has emerged as a promising biomarker to diagnose bacterial infections and guide antibiotic treatment decisions. As part of a regulatory submission to the U.S. Food and Drug Administration, this systematic review and meta-analysis summarizes the effects of procalcitonin-guided antibiotic stewardship on antibiotic use and clinical outcomes in adult LRTI patients. PubMed and the Cochrane Database of Systematic Reviews were searched for English-language randomized controlled trials published between January 2004 and May 2016. Random and fixed effects meta-analyses were performed to study efficacy (initiation of antibiotics, antibiotic use) and safety (mortality, length of hospital stay). Eleven trials were retained, comprising 4090 patients. Procalcitonin-guided patients had lower odds of antibiotic initiation (odds ratio: 0.26; 95% confidence interval [CI]: 0.13-0.52) and shorter mean antibiotic use (weighted mean difference: -2.15 days; 95% CI: -3.30 to -0.99) compared to patients treated with standard care. Procalcitonin use had no adverse impact on mortality (relative risk: 0.94; 95% CI: 0.69-1.28) and length of hospital stay (weighted mean difference: -0.15 days; 95% CI: -0.60 to 0.30). Procalcitonin guidance reduces antibiotic initiation and use among adults with LRTIs with no apparent adverse impact on length of hospital stay or mortality.

Patient Characteristics and Outcomes Associated with Receiving an Earlier Versus Later Diagnosis of Probable Alzheimer's Disease.

BACKGROUND: Effectiveness of Alzheimer's disease (AD) treatments may depend critically on the timeliness of intervention. OBJECTIVE: To compare characteristics and outcomes of patients diagnosed with probable AD (prAD) based on time elapsed from first onset of cognitive decline. METHODS: Patients with ≥1 prAD diagnosis and ≥1 follow-up visit were selected from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS; 9/2005-6/2015) and stratified based on the time between the perceived onset of cognitive decline at baseline and first prAD diagnosis (i.e., earlier versus later diagnosis). Characteristics at baseline and prAD diagnosis, clinically meaningful progression, and medication use following prAD diagnosis were compared. RESULTS: Median time from perceived onset of cognitive decline to prAD diagnosis was 4.5 years (earlier diagnosis: ≤3.46; later diagnosis: >5.71). Earlier-diagnosed patients (n = 1,476) were younger at baseline (74.3 versus 76.3 years) and had better cognitive and functional scores than later-diagnosed patients (n = 1,474). At first prAD diagnosis, earlier-diagnosed patients had lower mean global Clinical Dementia Rating (CDR) score (0.8 versus 1.1), higher mean Mini-Mental State Examination (MMSE) (22.6 versus 20.0), and lower mean Functional Activities Questionnaire (11.6 versus 17.3). Earlier- and later-diagnosed patients experienced similar time to a decrease of ≥3 points in MMSE (median 23.2 versus 23.1 months, p = 0.83), but earlier-diagnosed patients had longer time to a CDR score of ≥2 points, and longer times to initiation of AD medication and antipsychotic agents (all p < 0.01). CONCLUSION: Earlier prAD diagnosis in NACC data is associated with higher cognitive function and lower functional impairment at diagnosis.

Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis.

OBJECTIVE: Sepsis is a leading cause of mortality in noncoronary ICUs. Although immediate start of antibiotics reduces sepsis-related mortality, antibiotics are often administered for too long, leading to suboptimal treatment and, importantly, contributes to antimicrobial resistance. Prior literature suggests that procalcitonin correlates with infection and thus may help to guide the decision on when to stop antibiotic treatment. This study was conducted as part of a regulatory submission to the U.S. Food and Drug Administration and aimed to summarize the evidence of procalcitonin guidance on efficacy and safety outcomes in adult patients with sepsis. DATA SOURCES: PubMed and the Cochrane Database of Systematic Reviews. STUDY SELECTION: English-language randomized controlled trials evaluating procalcitonin use among adult patients with suspected or confirmed sepsis published between January 2004 and May 2016. DATA EXTRACTION: Inverse-variance weighting fixed and random effects meta-analyses were performed on the following efficacy and safety endpoints: antibiotic duration, all-cause mortality, and length of ICU stay. Two reviewers independently extracted data elements from identified studies and measured risk of bias with the Cochrane Risk of Bias Tool. DATA SYNTHESIS: From a total of 369 potentially eligible articles, 10 randomized controlled trials containing 3,489 patients were used for analysis. Procalcitonin-guided patients had shorter antibiotics duration compared with controls (7.35 vs. 8.85 d; weighted mean difference, -1.49 d; 95% CI, -2.27 to -0.71; p < 0.001). Procalcitonin use had no adverse impact on mortality (risk ratio, 0.90; 95% CI, 0.79-1.03; p = 0.114) and length of ICU stay (11.09 d vs. 11.91 d; weighted mean difference, -0.84 d; 95% CI, -2.52 to 0.84; p = 0.329). CONCLUSIONS: In adult patients with suspected or confirmed sepsis, procalcitonin guidance reduces antibiotics duration with no observed adverse effects on patient outcomes.