Batch-Mode Clinical-Scale Optical Hyperpolarization of Xenon-129 Using an Aluminum Jacket with Rapid Temperature Ramping

We present spin-exchange optical pumping (SEOP) using a third-generation (GEN-3) automated batch-mode clinical-scale 129Xe hyperpolarizer utilizing continuous high-power (∼170 W) pump laser irradiation and a novel aluminum jacket design for rapid temperature ramping of xenon-rich gas mixtures (up to 2 atm partial pressure). The aluminum jacket design is capable of heating SEOP cells from ambient temperature (typically 25 °C) to 70 °C (temperature of the SEOP process) in 4 min, and perform cooling of the cell to the temperature at which the hyperpolarized gas mixture can be released from the hyperpolarizer (with negligible amounts of Rb metal leaving the cell) in approximately 4 min, substantially faster (by a factor of 6) than previous hyperpolarizer designs relying on air heat exchange. These reductions in temperature cycling time will likely be highly advantageous for the overall increase of production rates of batch-mode (i.e., stopped-flow) 129Xe hyperpolarizers, which is particularly beneficial for clinical applications. The additional advantage of the presented design is significantly improved thermal management of the SEOP cell. Accompanying the heating jacket design and performance, we also evaluate the repeatability of SEOP experiments conducted using this new architecture, and present typically achievable hyperpolarization levels exceeding 40% at exponential build-up rates on the order of 0.1 min–1

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Multiscale Lithium and Counterion Transport in an Electrospun Polymer-Gel Electrolyte

We explore fundamental lithium ion (Li⁺) and triflate counterion (CF₃SO₃^–) transport properties within an electrospun UV-cross-linked poly­(ethylene oxide) polymer-gel electrolyte. With modulation of cross-linker (10–30 wt %), the fully swollen fibrous framework swells and retains between 1700 and 1200 wt % liquid electrolyte and exhibits room temperature ionic conductivity up to 6 mS cm^–1. ⁷Li and ¹⁹F spin–spin relaxation (<i>T</i>₂) measurements reveal the presence of inter- and intrafiber lithium ions, where the long- and short-<i>T</i>₂ lithium ion and counterion components enable quantification of the fractions of free liquid electrolyte between fibers and liquid electrolyte within fibers. Pulsed-field-gradient NMR diffusometry shows increases in lithium and triflate diffusion coefficients with cross-linker content, suggestive of enhanced ion transport within the free liquid electrolyte phase due to a reduction in morphological restrictions. Arrhenius fits to temperature-dependent diffusion experiments show that lithium and triflate values for the activation energy of diffusion (15 and 12 kJ mol^–1, respectively) are identical for ions in pure liquid solutions and for ions within the electrospun gel, showing that the framework does not influence the local energetics of ion transport. The present study thus offers new insights into understanding ion transport properties within lithium-ion battery materials on length scales ranging from sub-nanometer to micrometer scales

Unraveling the local energetics of transport in a polymer ion conductor

We compare diffusion activation energy measurements in a hydrated perfluorosulfonate ionomer and aqueous solutions of triflic acid. These measurements provide insight into water transport dynamics on sub-nm length scales, and gauge the contribution of the polymer sidechain terminal group. Future membrane materials design will hinge on detailed understanding of transport dynamics

Humidity-Modulated Phase Control and Nanoscopic Transport in Supramolecular Assemblies

Supramolecular assembly allows for enhanced control of bulk material properties through the fine modulation of intermolecular interactions. We present a comprehensive study of a cross-linkable amphiphilic wedge molecule based on a sulfonated trialkoxybenzene with a sodium counterion that forms liquid crystalline (LC) phases with ionic nanochannel structures. This compound exhibits drastic structural changes as a function of relative humidity (RH). Our combined structural, dynamical, and transport studies reveal deep and novel information on the coupling of water and wedge molecule transport to structural motifs, including the significant influence of domain boundaries within the material. Over a range of RH values, we employ 23Na solid-state NMR on the counterions to complement detailed structural studies by grazing-incidence small-angle X-ray scattering. RH-dependent pulsed-field-gradient (PFG) NMR diffusion studies on both water and the wedge amphiphiles show multiple components, corresponding to species diffusing within LC domains as well as in the domain boundaries that compose 10% of the material. The rich transport and dynamical behaviors described here represent an important window into the world of supramolecular soft materials, carrying implications for optimization of these materials in many venues. Cubic phases present at high RH show fast transport of water (2 × 10–10 m2/s), competitive with that observed in benchmark polymeric ion conductors. Understanding the self-assembly of these supramolecular building blocks shows promise for generating cross-linked membranes with fast ion conduction for applications such as next-generation batteries

Hyperpolarizing DNA Nucleobases via NMR Signal Amplification by Reversible Exchange

The present work investigates the potential for enhancing the NMR signals of DNA nucleobases by parahydrogen-based hyperpolarization. Signal amplification by reversible exchange (SABRE) and SABRE in Shield Enables Alignment Transfer to Heteronuclei (SABRE-SHEATH) of selected DNA nucleobases is demonstrated with the enhancement (ε) of 1H, 15N, and/or 13C spins in 3-methyladenine, cytosine, and 6-O-guanine. Solutions of the standard SABRE homogenous catalyst Ir(1,5-cyclooctadeine)(1,3-bis(2,4,6-trimethylphenyl)imidazolium)Cl (“IrIMes”) and a given nucleobase in deuterated ethanol/water solutions yielded low 1H ε values (≤10), likely reflecting weak catalyst binding. However, we achieved natural-abundance enhancement of 15N signals for 3-methyladenine of ~3300 and ~1900 for the imidazole ring nitrogen atoms. 1H and 15N 3-methyladenine studies revealed that methylation of adenine affords preferential binding of the imidazole ring over the pyrimidine ring. Interestingly, signal enhancements (ε~240) of both 15N atoms for doubly labelled cytosine reveal the preferential binding of specific tautomer(s), thus giving insight into the matching of polarization-transfer and tautomerization time scales. 13C enhancements of up to nearly 50-fold were also obtained for this cytosine isotopomer. These efforts may enable the future investigation of processes underlying cellular function and/or dysfunction, including how DNA nucleobase tautomerization influences mismatching in base-pairing

Tuning Biocompatible Block Copolymer Micelles by Varying Solvent Composition: Dynamics and Populations of Micelles and Unimers

Optimization of micellar molecular encapsulation systems, such as drug delivery vehicles, can be achieved through fundamental understanding of block copolymer micelle structure and dynamics. Herein, we present a study of PEO–PCL block copolymer spherical micelles that self-assemble at 1% wt/vol in D₂O–THF-<i>d</i>₈ mixtures. Varying solvent composition as a function of cosolvent THF-<i>d</i>₈ at constant polymer concentration (1% wt/vol) allows sensitive study of how small molecule additives influence micelle structure and dynamics. We conduct nuclear magnetic resonance spectroscopy and diffusometry on two block copolymer (2k series: PEO_2k–PCL_3k; 5k series: PEO_5k–PCL_8k) spherical micelles that show drastically different behaviors. Unimers and micelles coexist in solution from 10–60 vol % THF-<i>d</i>₈ for the 2k series but only coexist at 60 vol % THF-<i>d</i>₈ for the 5k series. At ≥ 60 vol % THF-<i>d</i>₈ micelles disassemble into free unimers for both series. We observe relatively flat micelle diffusion coefficients (∼1 × 10^–10 m²/s) with increasing THF-<i>d</i>₈ below 60 vol % for both 2k and 5k series, with only small changes in micelle hydrodynamic radius (≈14 nm) over this range. We compare these results to a detailed SANS and microscopy study described in a companion paper. These fundamental molecular dynamics, unimer population, and diffusion results, as a function of polymer composition and solution environment, provide critical fodder for controlled design of block copolymer self-assembly

Facile Removal of Homogeneous SABRE Catalysts for Purifying Hyperpolarized Metronidazole, a Potential Hypoxia Sensor

Here, we report a simple and effective method to remove IrIMes homogeneous polarization transfer catalysts from solutions where NMR signal amplification by reversible exchange (SABRE) has been performed, while leaving intact the substrate’s hyperpolarized state. Following microtesla SABRE hyperpolarization of ¹⁵N spins in metronidazole, addition of SiO₂ microparticles functionalized with 3-mercaptopropyl or 2-mercaptoethyl ethyl sulfide moieties provides removal of the catalyst from solution well within the hyperpolarization decay time at 0.3 T (<i>T</i>₁ > 3 min) and enabling transfer to 9.4 T for detection of enhanced ¹⁵N signals in the absence of catalyst within the NMR detection region. Successful catalyst removal from solution is supported by the inability to “rehyperpolarize” ¹⁵N spins in subsequent attempts, as well as by ¹H NMR and inductively coupled plasma mass spectrometry. Record-high ¹⁵N nuclear polarization of up to ∼34% was achieved, corresponding to >100 000-fold enhancement at 9.4 T (or >320,000-fold enhancement at 3.0 T), and approximately 5/6th of the ¹⁵N hyperpolarization is retained after ∼20 s long purification procedure. Taken together, these results help pave the way for future studies, involving in vivo molecular imaging using agents hyperpolarized via rapid and inexpensive parahydrogen-based methods