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We read with interest the paper by Thibodeau et al. [(1)][1] describing the role of the clinical examination in patients with heart failure. Zema [(2)][2] should also be commended for his letter emphasizing the role of the Valsalva maneuver in the diagnosis of heart failure. We regularly perform

A system for the synthesis of α-alkylidene-γ-butyrolactones via a one-pot C–H insertion/olefination sequence is described. The process is based on the rhodium catalysed C–H insertion reaction of α-diazo-α-(diethoxyphosphoryl)acetates. The mild reaction conditions, operational simplicity and ready availability of starting materials are all key features. A wide range of successful reaction systems are reported (41 examples) highlighting the generality of the method. The application of this method in the total synthesis of the natural products (±)-cedarmycins A and B is also described.