BACKGROUND Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. FINDINGS Between March 12, 2013, and May 10, 2016, we ; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043). INTERPRETATION Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. FUNDING Bayer AG. Methods This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, i...
A morphotropic phase boundary driven by epitaxial strain has been observed in lead‐free multiferroic BiFeO3 thin films and the strain‐driven phase transitions have been widely reported as iso‐symmetric Cc‐Cc by recent works. In this paper, it is suggested that the tetragonal‐like BiFeO3 phase identified in epitaxial films on (001) LaAlO3 single crystal substrates is monoclinic MC. This MC phase is different from the MA type monoclinic phase reported in BiFeO3 films grown on low mismatch substrates, such as SrTiO3. This is confirmed not only by synchrotron X‐ray studies but also by piezoresponse force microscopy measurements. The polarization vectors of the tetragonal‐like phase lie in the (100) plane, not the (110) plane as previously reported. A phenomenological analysis is proposed to explain the formation of MC Phase. Such a low‐symmetry MC phase, with its linkage to MA phase and the multiphase coexistence open an avenue for large piezoelectric response in BiFeO3 films and shed light on a complete understanding of possible polarization rotation paths and enhanced multiferroicity in BiFeO3 films mediated by epitaxial strain. This work may also aid the understanding of developing new lead‐free strain‐driven morphotropic phase boundary in other ferroic systems.
We present the design and describe the operation of a scanning probe microscope which simultaneously provides the attractive mode force and near-field optical images of objects. In this technique, the force signal is used to track the topography, thus allowing the optical signal primarily to show variations in transmissivity. A number of results are presented on the application of the technique to imaging different samples.
Doped‐HfO2 thin films with ferroelectricity have attracted great attention due to their potential application in semiconductor industry as negative capacitance and resistance switching memory. Despite Hf0.5Zr0.5O2 (HZO) thin films having the most robust ferroelectric properties among all doped‐HfO2 thin films, the realization of single orthorhombic phase HZO thin films is not achieved, while the direct evidence between the structural–properties relationship of orthorhombic phase HZO and ferroelectricity is not confirmed. In this work, the growth of single orthorhombic phase HZO thin films with decent ferroelectricity and resistive switching behavior is reported. With the aid of advanced structural characterization techniques, the HZO thin film is confirmed to be in the single orthorhombic phase. Next, using scanning probe microscopy techniques and macroscopic ferroelectric measurements, the single phase HZO thin films exhibit ferroelectric properties with a remanent polarization of about 20 µC cm−2. Interestingly, the HZO thin film shows ferroelectric resistive switching with an ROFF/RON ratio of about 16 100% with excellent device performance. Furthermore, brain‐like learning behavior is also observed in the HZO thin film. These results may serve to stimulate the study of ferroelectric properties of HZO thin films and their application in the electronic industry.
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