2019 Chinese expert consensus statement on left atrial appendage closure in patients with atrial fibrillation.

The left atrial appendage closure (LAAC), the efficacy and safety of which has been proved by a number of randomized controlled trials and registries, is recommended by several guidelines to prevent stroke in high-risk patients with non-valvular atrial fibrillation. However, current guidelines only discuss the indications and contraindications of LAAC, as an emerging technology, there still lacks comprehensive recommendations involved with LAAC, including devices, image assessment modality, identification and treatment of complications, perioperative medication, and postoperative management. Therefore, the Chinese Society of Cardiology (CSC) of Chinese Medical Association (CMA) and the Editorial Board of Chinese Journal of Cardiology jointly issued the expert consensus statement on LAAC in the prevention of stroke in patients with atrial fibrillation after comprehensive discussion by experts with different backgrounds. This consensus provided three levels of recommendations to guide and standardize the clinical application of LAAC based on existing evidence and clinical practice experience, including appropriate (more potential benefits or fewer harms), uncertain (somehow reasonable but need more evidence), and inappropriate (unlikely to benefit, or have more complications).

Comparison of GRACE and TIMI risk scores in the prediction of in-hospital and long-term outcomes among East Asian non-ST-elevation myocardial infarction patients.

BACKGROUND: Risk stratification in non-ST segment elevation myocardial infarction (NSTEMI) determines the intervention time. Limited study compared two risk scores, the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores in the current East Asian NSTEMI patients. METHODS: This retrospective observational study consecutively collected patients in a large academic hospital between 01/01 and 11/01/2017 and followed for 4 years. Patients were scored by TIMI and GRACE scores on hospital admission. In-hospital endpoints were defined as the in-hospital composite event, including mortality, re-infarction, heart failure, stroke, cardiac shock, or resuscitation. Long-term outcomes were all-cause mortality and cardiac mortality in 4-year follow-up. RESULTS: A total of 232 patients were included (female 29.7%, median age 67 years), with a median follow-up of 3.7 years. GRACE score grouped most patients (45.7%) into high risk, while TIMI grouped the majority (61.2%) into medium risk. Further subgrouping the TIMI medium group showed that half (53.5%) of the TIMI medium risk population was GRACE high risk (≥ 140). Compared to TIMI medium group + GRACE < 140 subgroup, the TIMI medium + GRACE high-risk (≥ 140) subgroup had a significantly higher in-hospital events (39.5% vs. 9.1%, p < 0.05), long-term all-cause mortality (22.2% vs. 0% p < 0.001) and cardiac death (11.1% vs. 0% p = 0.045) in 4-year follow-up. GRACE risk scores showed a better predictive ability than TIMI risk scores both for in-hospital and long-term outcomes. (AUC of GRACE vs. TIMI, In-hospital: 0.82 vs. 0.62; long-term mortality: 0.89 vs. 0.68; long-term cardiac mortality: 0.91 vs. 0.67, all p < 0.05). Combined use of the two risk scores reserved both the convenience of scoring and the predictive accuracy. CONCLUSION: GRACE showed better predictive accuracy than TIMI in East Asian NSTEMI patients in both in-hospital and long-term outcomes. The sequential use of TIMI and GRACE scores provide an easy and promising discriminative tool in predicting outcomes in NSTEMI East Asian patients.

Dual-Modified Compact Layer and Superficial Ti Doping for Reinforced Structural Integrity and Thermal Stability of Ni-Rich Cathodes.

Nickel-rich layered oxides have been regarded as a potential cathode material for high-energy-density lithium-ion batteries because of the high specific capacity and low cost. However, the rapid capacity fading due to interfacial side reactions and bulk structural degradation seriously encumbers its commercialization. Herein, a highly stable hybrid surface architecture, which integrates an outer coating layer of TiO2&Li2TiO3 and a surficial titanium doping by incorporated Ti2O3, is carefully designed to enhance the structural stability and eliminate lithium impurity. Meanwhile, the surficial titanium doping induces a nanoscale cation-mixing layer, which suppresses transition-metal-ion migration and ameliorates the reversibility of the H2 → H3 phase transition. Also, the Li2TiO3 coating layer with three-dimensional channels promotes ion transportation. Moreover, the electrochemically stable TiO2 coating layer restrains side reactions and reinforces interfacial stability. With the collaboration of titanium doping and TiO2&Li2TiO3 hybrid coating, the sample with 1 mol % modified achieves a capacity retention of 93.02% after 100 cycles with a voltage decay of only 0.03 V and up to 84.62% at a high voltage of 3.0-4.5 V. Furthermore, the ordered occupation of Ni ions in the Li layer boosts the thermal stability by procrastinating the layered-to-rock salt phase transition. This work provides a straightforward and economical modification strategy for boosting the structural and thermal stability of nickel-rich cathode materials.

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We examined the distribution of melanin during the development of the larvae of Schizothorax o'connori except the eyes with histological method. The results showed that after hatching, the appearance sequence of melanin in different organs were following an order of the outer membrane of neurocranium, the pericardial cavity and the dorsal skin, and the peritoneum and the spinal cord. Specifically, melanin appeared in the outer membrane of neurocranium around 5 DAH (days after hatching), in the pericardial cavity and the back skin at 7 DAH, and in the peritoneum and the spinal cord at 10 DAH. Melanin was found in the skin and internal organs (the outer membrane of neurocranium, the pericardial cavity, the peritoneum, the spinal cord) of S. o'connori at 10 DAH, which was mainly distributed on the back. The appearance and distribution of melanin in the postembryonic development of S. o'connori might be related to the high ultraviolet radiation. Our results could provide reference for further research on the UV protection mechanism of melanin for fish and provide theoretical support for the optimization of rearing conditions for larvae in the plateau.

New Insights into the Mechanism of Enhanced Performance of Li[Ni0.8Co0.1Mn0.1]O2 with a Polyacrylic Acid-Modified Binder.

A binder is an important component in lithium-ion batteries and plays a significant role in maintaining the properties of active substances. Most studies in the field of binders have only focussed on physical properties such as bonding performance. Here, a polyacrylic acid-modified binder was designed and adapted to Li[Ni0.8Co0.1Mn0.1]O2, which enhanced the electrochemical stability of Li[Ni0.8Co0.1Mn0.1]O2 from 30.2 to 66.6% (300 cycles at 1 C). We for the first time discovered that this was caused by a chemical reaction between polyacrylic acid and the residual lithium on the surface during the cycling, which formed a lithium propionic acid coating layer and maintained the stability of the layered structure.

Hydrangea-Like CuS with Irreversible Amorphization Transition for High-Performance Sodium-Ion Storage.

Metal sulfides have been intensively investigated for efficient sodium-ion storage due to their high capacity. However, the mechanisms behind the reaction pathways and phase transformation are still unclear. Moreover, the effects of designed nanostructure on the electrochemical behaviors are rarely reported. Herein, a hydrangea-like CuS microsphere is prepared via a facile synthetic method and displays significantly enhanced rate and cycle performance. Unlike the traditional intercalation and conversion reactions, an irreversible amorphization process is evidenced and elucidated with the help of in situ high-resolution synchrotron radiation diffraction analyses, and transmission electron microscopy. The oriented (006) crystal plane growth of the primary CuS nanosheets provide more channels and adsorption sites for Na ions intercalation and the resultant low overpotential is beneficial for the amorphous Cu-S cluster, which is consistent with the density functional theory calculation. This study can offer new insights into the correlation between the atomic-scale phase transformation and macro-scale nanostructure design and open a new principle for the electrode materials' design.

Interfacial Regulation of Ni-Rich Cathode Materials with an Ion-Conductive and Pillaring Layer by Infusing Gradient Boron for Improved Cycle Stability.

Ni-rich cathodes LiNixCoyAl1-x-yO2 (0.8 < x < 1) with high energy density, environmental benignity, and low cost are regarded as the most promising candidate materials for next-generation lithium batteries. Unfortunately, capacity fading derived from unstable surface properties and intrinsic structural instability under extreme conditions limits large-scale commercial utilization. Herein, an interface-regulated Ni-rich cathode material LiNi0.87Co0.10Al0.03O2 with a layer (R3̅m) core, a NiO salt-like (Fm3̅m) phase, and an ultrathin amorphous ion-conductive LiBO2 (LBO) layer is constructed by gradient boron incorporation and lithium-reactive coating during calcination. The ultrathin LBO layer not only exhausts residual lithium species but also acts as a layer for Li+ transport and insulation of detrimental reaction. The NiO salt-like phase in the subsurface could enhance the structural stability of the layer core for the pillar effects. With the positive role provided by the functional hybrid surface layer and boron doping, the modified cathode exhibits enhanced Li+ conductivity, structural stability, reversibility of the H2-H3 phase transition, suppressed side reactions, ameliorated transition-metal dissolution, and excellent electrochemical performance. Especially, a 1% wt boron-modified cathode delivers a discharge capacity of 211.99 mA h g-1 in the potential range of 3.0-4.3 V at 0.2 C and excellent cycle life with a capacity retention of 89.43% after 200 cycles at 1 C.

Dual Elements Coupling Effect Induced Modification from the Surface into the Bulk Lattice for Ni-Rich Cathodes with Suppressed Capacity and Voltage Decay.

Injection of phase transition from a layered to rock-salt phase into the bulk lattice and side reactions on the interfacial usually causes structure degradation, quick capacity/voltage decay, and even thermal instability. Here, a self-formed interfacial protective layer coupled with lattice tuning was constructed for Ni-rich cathodes by simultaneous incorporation of Zr and Al in a one-step calcination. The migration energy between Zr and Al from the surface into the bulk lattice induces dual modifications from the surface into the bulk lattice, which effectively decrease the formation of cation mixing, the degree of anisotropic lattice change, and the generation of microcracks. With the stabilization role provided by the doped Zr-Al ions and protective function endowed by the surface layer, the modified cathode material exhibits significantly enhanced capacity and voltage retention. Specifically, the capacity retention for the modified cathode material reaches 99% after 100 cycles at 1 C and 25 °C in a voltage range of 3.0-4.3 V, which outperformed that for the pristine cathode (70%). The declination values of the average voltage for the modified cathode are only 0.025 and 0.097 V after 100 cycles at 1 C in voltage ranges of 3.0-4.3 and 2.8-4.5 V, respectively, which are much lower than those for the pristine cathode (0.230 and 0.405 V). The synchronous accomplishment of modification from the surface into the bulk lattice for Ni-rich materials with multiple elements in a one-step calcination process would provide some referenced value for the preparation of other cathode materials.

Deciphering an Abnormal Layered-Tunnel Heterostructure Induced by Chemical Substitution for the Sodium Oxide Cathode.

Demands for large-scale energy storage systems have driven the development of layered transition-metal oxide cathodes for room-temperature rechargeable sodium ion batteries (SIBs). Now, an abnormal layered-tunnel heterostructure Na0.44 Co0.1 Mn0.9 O2 cathode material induced by chemical element substitution is reported. By virtue of beneficial synergistic effects, this layered-tunnel electrode shows outstanding electrochemical performance in sodium half-cell system and excellent compatibility with hard carbon anode in sodium full-cell system. The underlying formation process, charge compensation mechanism, phase transition, and sodium-ion storage electrochemistry are clearly articulated and confirmed through combined analyses of in situ high-energy X-ray diffraction and ex situ X-ray absorption spectroscopy as well as operando X-ray diffraction. This crystal structure engineering regulation strategy offers a future outlook into advanced cathode materials for SIBs.

Suppressing Manganese Dissolution via Exposing Stable {111} Facets for High-Performance Lithium-Ion Oxide Cathode.

Spinel-type LiMn2O4 cathode materials commonly suffer from manganese dissolution due to the severe interfacial side reactions especially at elevated temperature. Here, a 3D hollow fusiform LiMn2O4 cathode material is reported with preferentially exposed stable {111} facets and seamless outer structure, which is clearly confirmed by microfocused ion beam scanning electron microscopy, high-resolution transmission electron microscopy as well as scanning transmission electron microscopy with atomic resolution. Owing to the optimal geometrical structure design and the preferentially exposed stable {111} facets, the electrode delivers excellent rate capability (107.6 mAh g-1 at 10 C), remarkable cycling stability (83.3% capacity retention after 1000 cycles at 1 C), and outstanding high-temperature performance. Together with the analyses of electrochemical behaviors, in situ X-ray diffraction at different temperatures, and ex situ X-ray photoelectron spectra, the underlying working mechanism for suppressing manganese dissolution is clearly articulated. These findings could provide significant guidelines for precisely designing highly stable cathode materials for LIBs.

Ion-Doping-Site-Variation-Induced Composite Cathode Adjustment: A Case Study of Layer-Tunnel Na0.6MnO2 with Mg2+ Doping at Na/Mn Site.

Composite cathodes have attracted great attention due to the integrated advantages of each pure structure. Also, the component ratio deserves a careful modulation to further improve the corresponding electrochemical performance. Mn-based layer-tunnel hybrid composite became a focus in sodium-ion batteries due to the superiority in terms of high performance, low cost, and nontoxicity. In the previous reports, the structure modulation was carried out via changing the synthesis condition, varying the transition-metal-element ratio, and different ion doping. Also, it is still challenging to explore a more feasible method to simplify the adjustment process. Herein, we introduced Mg2+ into Na sites or transition-metal sites in Na0.6MnO2 and first discovered the doping-site-variation-induced structural adjustment phenomenon. Specifically, Mg doping in transition-metal sites could be beneficial for the growth of the P2-type structure, while layer/tunnel component ratio decreased when locating Mg2+ in Na sites. The P2-O2 phase transformations could be effectively suppressed by locating Mg2+ in both sites in high-voltage regions and thus improve the cycling performance. The designed material, Na0.6Mn0.99Mg0.01O2, could attain a decent capacity of 100 mA h g-1 at 1000 mA g-1 and a satisfied retention of 76.6% after 500 cycles. Additionally, ex situ X-ray diffraction analysis experiments verify the excellent structural stability of Mg-substituted samples during charge-discharge processes. Moreover, the Na0.6Mn0.99Mg0.01O2 also displays superior sodium-ion full-cell properties when merged with hard carbon anode. Thus, this research may indicate a proper novel thread for designing high-performance composite electrodes.

Constructing a Protective Pillaring Layer by Incorporating Gradient Mn4+ to Stabilize the Surface/Interfacial Structure of LiNi0.815Co0.15Al0.035O2 Cathode.

Nickel-rich layered oxides are regarded as very promising materials as cathodes for lithium-ion batteries because of their environmental benignancy, low cost, and high energy density. However, insufficient cycle performance and poor thermotic characteristics induced by structural degradation at high potentials and elevated temperatures pose challenging hurdles for nickel-rich cathodes. Here, a protective pillaring layer, in which partial Ni2+ ions occupy Li slabs induced by gradient Mn4+, is integrated into the primary particle of LiNi0.815Co0.15Al0.035O2 to stabilize the surface/interfacial structure. With the stable outer surface provided by the enriched Mn4+ gradient concentration and the pillar effect of the NiO-like phase, Mn-incorporated quaternary cathodes show enhanced structural stability and improved Li+ diffusion as well as lithium-storage properties. Compared with the severe capacity fade of a pure layered structure, the cathode with gradient Mn4+ exhibits more stable cycling behavior with a capacity retention of 80.0% after 500 cycles at 5.0 C.

Exposing {010} Active Facets by Multiple-Layer Oriented Stacking Nanosheets for High-Performance Capacitive Sodium-Ion Oxide Cathode.

As one of the most promising cathodes for rechargeable sodium-ion batteries (SIBs), O3-type layered transition metal oxides commonly suffer from inevitably complicated phase transitions and sluggish kinetics. Here, a Na[Li0.05 Ni0.3 Mn0.5 Cu0.1 Mg0.05 ]O2 cathode material with the exposed {010} active facets by multiple-layer oriented stacking nanosheets is presented. Owing to reasonable geometrical structure design and chemical substitution, the electrode delivers outstanding rate performance (71.8 mAh g-1 and 16.9 kW kg-1 at 50C), remarkable cycling stability (91.9% capacity retention after 600 cycles at 5C), and excellent compatibility with hard carbon anode. Based on the combined analyses of cyclic voltammograms, ex situ X-ray absorption spectroscopy, and operando X-ray diffraction, the reaction mechanisms behind the superior electrochemical performance are clearly articulated. Surprisingly, Ni2+ /Ni3+ and Cu2+ /Cu3+ redox couples are simultaneously involved in the charge compensation with a highly reversible O3-P3 phase transition during charge/discharge process and the Na+ storage is governed by a capacitive mechanism via quantitative kinetics analysis. This optimal bifunctional regulation strategy may offer new insights into the rational design of high-performance cathode materials for SIBs.

Cu2+ Dual-Doped Layer-Tunnel Hybrid Na0.6Mn1- xCu xO2 as a Cathode of Sodium-Ion Battery with Enhanced Structure Stability, Electrochemical Property, and Air Stability.

Sodium-ion batteries (SIBs) have been regarded as a promising candidate for large-scale renewable energy storage system. Layered manganese oxide cathode possesses the advantages of high energy density, low cost and natural abundance while suffering from limited cycling life and poor rate capacity. To overcome these weaknesses, layer-tunnel hybrid material was developed and served as the cathode of SIB, which integrated high capacity, superior cycle ability, and rate performance. In the current work, the doping of copper was adopted to suppress the Jahn-Teller effect of Mn3+ and to affect relevant structural parameters. Multifunctions of the Cu2+ doping were carefully investigated. It was found that the structure component ratio is varied with the Cu2+ doping amount. Results demonstrated that Na+/vacancy rearrangement and phase transitions were suppressed during cycling without sacrificing the reversible capacity and enhanced electrochemical performances evidenced with 96 mA h g-1 retained after 250 cycles at 4 C and 85 mA h g-1 at 8 C. Furthermore, ex situ X-ray diffraction has demonstrated high reversibility of the Na0.6Mn0.9Cu0.1O2 cathode during Na+ extraction/insertion processes and superior air stability that results in better storage properties. This study reveals that the Cu2+ doping could be an effective strategy to tune the properties and related performances of Mn-based layer-tunnel hybrid cathode.

Association of Immune Factors with Drug-Resistant Tuberculosis: A Case-Control Study.

BACKGROUND Presently, studies of factors associated with drug-resistant tuberculosis (TB) focus on patients' socio-demographic characteristics and living habits, to the exclusion of biochemical indicators, especially immune factors. This study was carried out to determine whether immune factors are associated with drug-resistant TB. MATERIAL AND METHODS A total of 227 drug-resistant pulmonary TB patients and 225 drug-susceptible pulmonary TB patients were enrolled in this study. Information on socio-demographic characteristics and biochemical indicators were obtained through their clinical records. Non-conditional logistic regression was used to analyze the association of these indicators with drug-resistant TB. RESULTS There were significant differences in re-treatment, marital status, alanine aminotransferase (ALT), blood uric acid (BUA), carcino-embryonic antigen (CEA), T-spot, and CD3 and CD4 counts between the 2 groups. In multivariable analysis, re-treatment [Odds Ratio (OR)=5.290, 95% Confidence Interval [CI]=2.652-10.551); CD3 (OR=1.034, 95% CI=1.001-1.068); CD4 (OR=1.035, 95% CI =1.001-1.070) and IgM (OR=1.845, 95% CI=1.153-2.952) were associated with drug-resistant TB. CONCLUSIONS These results suggest the need for greater attention to re-treatment cases and immune function when treating drug-resistant TB.

Mn-Based Cathode with Synergetic Layered-Tunnel Hybrid Structures and Their Enhanced Electrochemical Performance in Sodium Ion Batteries.

A synergistic approach for advanced cathode materials is proposed. Sodium manganese oxide with a layered-tunnel hybrid structure was designed, synthesized, and subsequently investigated. The layered-tunnel hybrid structure provides fast Na ion diffusivity and high structural stability thanks to the tunnel phase, enabling high rate capability and greatly improved cycling stability compared to that of the pure P2 layered phase while retaining the high specific capacity of the P2 layered phase. The hybrid structure provided a decent discharge capacity of 133.4 mAh g-1 even at 8 C, which exceeds the reported best rate capability for Mn-based cathodes. It also displayed an impressive cycling stability, maintaining 83.3 mAh g-1 after 700 cycles at 10 C. Theoretical calculation and the potentiostatic intermittent titration technique (PITT) demonstrated that this hybrid structure helps enhance Na ion diffusivity during charge and discharge, attaining, as a result, an unprecendented electrochemical performance.

Heterogeneous intergrowth xLi1.5Ni0.25Mn0.75O2.5·(1 - x)Li0.5Ni0.25Mn0.75O2 (0 ≤ x ≤ 1) composites: synergistic effect on electrochemical performance.

A series of xLi1.5Ni0.25Mn0.75O2.5·(1 - x)Li0.5Ni0.25Mn0.75O2 (0 ≤ x ≤ 1) cathode materials have been synthesized. These compounds exhibit dramatic differences in structure, morphology and charge/discharge characteristics. As the x increases, the morphology shows an amazing trend: starting with an octahedral shape (x = 0), transforming to an octahedral/plate shape (0.1 ≤ x ≤ 0.9) in which both the spinel phase and the layered phase can be indexed in the XRD patterns, and ending up with a plate shape (x = 1.0). The particular layered-spinel composites xLi1.5Ni0.25Mn0.75O2.5·(1 - x)Li0.5Ni0.25Mn0.75O2 (0.1 ≤ x ≤ 0.9) exhibit better cycling stability than that of pristine spinel Li0.5Ni0.25Mn0.75O2 (x = 0) and layered Li1.5Ni0.25Mn0.75O2.5 (x = 1.0) materials. This improved cycling performance of these layered-spinel composites can be ascribed to the heterogeneous intergrowth of some layered phases and spinel phases in the parent structure as detected by TEM. Among these materials, Li0.5Ni0.25Mn0.75O2 and Li1.5Ni0.25Mn0.75O2.5 barely deliver the specific capacities of 90 mA h g(-1) and 117 mA h g(-1) at 5 C and show the capacity retentions of about 83% and 86% at 0.2 C after 50 cycles, respectively, while the layered-spinel 0.8Li1.5Ni0.25Mn0.75O2.5·0.2Li0.5Ni0.25Mn0.75O2 cathode shows the best rate capability of 162 mA h g(-1) at 5 C and the best cycling stability of 98% after 50 cycles at 0.2 C.

Hydrothermal synthesis, evolution, and electrochemical performance of LiMn0.5Fe0.5PO4 nanostructures.

LiMn0.5Fe0.5PO4 (LMFP) materials are synthesized by the hydrothermal approach in an organic-free and surfactant-free aqueous solution. The phase and morphological evolution of the material intermediates at different reaction temperatures and times are characterized by XRD, SEM and TEM, respectively. The results show that during temperature increase, the solubility product (Ksp) of the precursors (Li3PO4, Fe3(PO4)2 and (Mn,Fe)3(PO4)2) is the decisive parameter for the precipitation processes. Once the temperature locates at the range of 100-110 °C, the unstable precursors dissolve quickly and then LMFP nuclei are formed, followed by a dissolution-reprecipitation process. As the reaction progresses, the primary particles self-aggregate to form rod or plate particles to reduce the overall surface energy through oriented attachment (OA) and the Ostwald ripening (OR) mechanism. Moreover, the resultant concentration of the precursor significantly affects the crystal size of LMFP by altering the supersaturation degree of solution at the nucleation stage. The carbon coated LMFP nanostructure synthesized at 0.6 mol L(-1) (resultant concentration of PO4(3-)) delivers discharge capacities of 155, 100 and 81 mA h g(-1) at 0.1, 5 and 20 C rate, respectively. The understanding of nanostructural evolution and its influence on the electrochemical performance will pave a way for a high-performance LMFP cathode.

Clopidogrel versus aspirin in patients with recent ischemic stroke and established peripheral artery disease: an economic evaluation in a Chinese setting.

BACKGROUND AND OBJECTIVES: Clopidogrel or aspirin are indicated for patients with recent ischemic stroke (IS) or established peripheral artery disease (PAD). We compared the cost effectiveness of clopidogrel with that of aspirin in Chinese patients with recent IS or established PAD. METHODS: A discrete-event simulation was developed to evaluate the economic implications of secondary prevention with clopidogrel versus aspirin. All available evidence was derived from clinical studies. Costs from a Chinese healthcare perspective in 2013 US dollars and quality-adjusted life-years (QALYs) were projected over patients' lifetimes. Uncertainties were addressed using sensitivity analyses. RESULTS: Compared with aspirin, clopidogrel yielded a marginally increased life expectancy by 0.46 and 0.21 QALYs at an incremental cost-effectiveness ratio of $US5246 and $US9890 per QALY in patients with recent IS and established PAD, respectively. One-way sensitivity analyses showed that the evaluation of patients with PAD and recent IS was robust except for the parameter of patient age. Given a willingness-to-pay of $US19,877 per QALY gained, clopidogrel had a probability of 90 and 68% of being cost effective in the recent IS or established PAD subgroups compared with aspirin, respectively. CONCLUSIONS: The analysis suggests that clopidogrel for secondary prevention is cost effective for patients with either PAD or recent IS in a Chinese setting in comparison with aspirin.