Chao Wang

BACKGROUND: Antiplatelet agents are the mainstay for secondary prevention of non-cardioembolic stroke. This systematic review examined the safety and efficacy of short-, middle-, and long-term aspirin in combination with clopidogrel as secondary prevention of stroke or transient ischemic attack (TIA) of presumed arterial origin. METHODS: PubMed, EmBase, and CENTRAL were searched up to May 2014. Randomized controlled trials (RCTs) that compared aspirin plus clopidogrel versus aspirin or clopidogrel as secondary prevention of stroke or TIA of arterial origin were included. The analyses were stratified into short-term (≤3 months), middle-term (>3 months and <1 year), and long-term (≥1 year). Outcomes were compared using risk ratio (RR) and 95% confidence interval (95% CI). RESULTS: Eight RCTs (20,728 patients) were included in the overall analysis. Compared with aspirin or clopidogrel alone, the complete analysis of all the data indicated that the combination therapy significantly reduced the risk of stroke recurrence (RR, 0.82; 95% CI 0.70-0.96, p = 0.01) and major vascular events (RR, 0.84; 95% CI 0.73-0.96, p < 0.01). But the risk of hemorrhagic stroke (RR, 1.59; 95% CI 1.08-2.33, p = 0.02) and major bleeding (RR, 1.83; 95% CI 1.37-2.45, p < 0.01) was increased. No RCT studied middle-term combination therapy. The analyses were therefore stratified into only two subgroups, short- and long-term treatment. Stratified analysis of short-term treatment showed that relative to monotherapy, the drug combination reduced the risk of stroke recurrence (RR, 0.69; 95% CI 0.59-0.81, p < 0.01) and did not increase the risk of hemorrhagic stroke (RR, 1.23; 95% CI 0.50-3.04, p = 0.65) and major bleeding events (RR, 2.17; 95% CI 0.18-25.71, p = 0.54). Short-term combination therapy was associated with a significantly lower risk of major vascular events (RR, 0.70; 95% CI 0.69 to 0.82, p < 0.01). Stratified analysis of long-term treatment revealed that the combination treatment did not decrease the risk of stroke recurrence (RR, 0.92; 95% CI 0.83-1.03, p = 0.15), but was associated with a significantly higher risk of hemorrhagic stroke (RR, 1.67; 95% CI 1.10-2.56, p = 0.02) and major bleeding events (RR, 1.90; 95% CI 1.46-2.48, p < 0.01). Long-term combination therapy failed to reduce the risk of major vascular events (RR, 0.92; 95% CI 0.84-1.03, p = 0.09). CONCLUSIONS: Compared with monotherapy, short-term aspirin in combination with clopidogrel is more effective as secondary prevention of stroke or TIA without increasing the risk of hemorrhagic stroke and major bleeding events. Long-term combination therapy does not reduce the risk of stroke recurrence, and is associated with increased major bleeding events. The clinical applicability of the findings of this systematic review, however, needs to be confirmed in future clinical trials.

Raman spectra have been measured for a number of nitrates, nitrites, sulfates, ferrocyanides, and ferricyanides, both in the solid phase and in aqueous solution. Accurate locations of peak maxima are given. Limits of detection for some of the compounds are given for solutions and for solid mixtures in NaNO 3 . Preliminary measurements have been made on core material recovered from the storage tanks on the Hanford site in Richland, Washington. Representative spectra are presented, showing that it is possible to observe responses of individual components from measurements made directly on untreated cores, with the use of a fiberoptic sampling probe.

Zinc oxide (ZnO), although known for its stability and safety, has shown limited catalytic activity in the two-electron oxygen reduction reaction (2e– ORR). In this context, we synthesized a robust defective-engineered ZnO/N-doped graphene heterojunction (ZnO-NG) featuring abundant Zn–N bonds at the interface. The engineered composite exhibited a remarkable H2O2 yield of 13.1 mg h–1 cm–2 at 25 mA cm–2 with H2O2 selectivity of 85.0%, surpassing NG and ZnO counterparts. Furthermore, the exceptional long-term stability of ZnO-NG was validated through chronoamperometric measurements and 10 successive runs, highlighting its great potential for large-scale H2O2 synthesis. Density functional theory calculations and X-ray absorption near-edge structure analysis revealed that interfacial bridging N regulated the local electron distribution, transferring the unpaired electrons from Zn sites to the adjacent N/C atoms. The configuration facilitated the hydrogenation step of O2-to-OOH* and more importantly inhibited the O*-to–OH* conversion, thereby improving the selectivity in 2e– ORR toward water remediation.