Antimicrobial and disinfectant resistance of Escherichia coli isolated from giant pandas

AIMS

The study aims to demonstrate the antimicrobial and disinfectant resistance phenotypes and genotypes of Escherichia coli isolates obtained from giant pandas (Ailuropoda melanoleuca).

METHODS AND RESULTS

Antimicrobial testing was performed according to the standard disk diffusion method. The minimal inhibitory concentrations (MICs) of disinfectants were determined using the agar dilution method. All isolates were screened for the presence of antimicrobial and disinfectant resistance genes and further analysed for genetic relatedness by pulse-field gel electrophoresis (PFGE). Results showed that 46·6% of the isolates were resistant to at least one antimicrobial. Escherichia coli isolates showed resistance to fewer antimicrobials as panda age increased. Among antimicrobial-resistant E. coli isolates, the antimicrobial resistance genes blaCTX-M (88·2%) and sul1 (92·3%) were most prevalent. The disinfectant resistance genes emrE, ydgE/ydgF, mdfA and sugE(c) were commonly present (68·2-98·9%), whereas qac and sugE(p) were relatively less prevalent (0-21·3%). The frequencies of resistance genes tended to be higher in E. coli isolated in December than in July, and PFGE profiles were also more diverse in isolates in December. The qacEΔ1 and sugE(p) genes were higher in adolescent pandas than in any other age groups. PFGE revealed that antimicrobial resistance correlated well with sampling time and habitat.

CONCLUSIONS

This study demonstrated that antimicrobial and disinfectant resistance was common in giant panda-derived E. coli, and the antimicrobial resistance was associated with sampling time and habitat. Escherichia coli could serve as a critical vector in spreading disinfectant and antimicrobial resistance.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study that demonstrated the phenotypic and genetic characterizations of antimicrobial and disinfectant resistance in E. coli isolates from more than 60 giant pandas. Frequent transfer of pandas to other cages may lead to the dissemination of antimicrobial resistance. The study highlights the need for regularly monitoring the antimicrobial and disinfectant resistance in bacteria from giant pandas.

Is a polymer semiconductor having a "perfect" regular structure desirable for organic thin film transistors?

This study utilized high temperature NMR and matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) mass spectrometry to reveal that appreciable amounts of structural defects are present in the diketopyrrolopyrrole (DPP)-quaterthiophene copolymers (PDQT) synthesized by the Stille coupling polymerization with Pd(PPh₃)₂Cl₂, Pd₂(dba)₃/P(o-tol)₃, and Pd(PPh₃)₄ catalyst systems. It was proposed that these structural defects were produced via homocoupling side reactions of the C-Br bonds and the organostannane species. Model Stille coupling reactions further substantiated that the amount of structural defects are catalyst-dependent following the order of Pd(PPh₃)₂Cl₂ > Pd₂(dba)₃/P(o-tol)₃ > Pd(PPh₃)₄. To verify the structural assignments, "perfect" structurally regular PDQT polymers were prepared using Yamamoto coupling polymerization. When compared to the structurally regular polymers, the polymers containing defects exhibited notable redshifts in their absorption spectra. Surprisingly, the "perfect" structurally regular polymers showed poor molecular ordering in thin films and very low charge transport performance as channel semiconductors in organic thin film transistors (OTFTs). On the contrary, all the "defected" polymers exhibited much improved molecular ordering and significantly higher charge carrier mobility.

Annealing Dependence of Solution-Processed Ultra-Thin ZrOx Films for Gate Dielectric Applications

Ultra-thin ZrOx thin films on Si substrates were prepared by sol-gel technique and processed with different methods (baked on hot plate at 150 °C, annealed at 500 °C in furnace, and photo-annealed under UV light). The decomposition of the organic groups and the formation of Zr-O bonding in the ZrOx thin films were confirmed by Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. It is found that the ZrOx thin film annealed under UV light shows decent characteristics, including an ultra-small surface roughness, a low leakage current density of 10(-9) A/cm2 at 1 MV/cm, a large breakdown electric field of 9.5 MV/cm, and a large areal capacitance of 775 nF/cm2.

Association of PS1 1/2, ACE I/D, and LRP C/T polymorphisms with Alzheimer's disease in the Chinese population: a meta-analysis of case-control studies

The objective of this study was to assess the associations of presenilin 1 (PS1) 1/2, angiotensin I-converting enzyme (ACE) insertion/deletion (I/D), and low-density lipoprotein receptor-related protein (LRP) C/T polymorphisms with the risk of Alzheimer's disease (AD) in the Chinese population. PS1 1/2, ACE I/D, and LRP C/T, which are commonly investigated polymorphisms, were evaluated to obtain summary estimates regarding their associations with AD. In total, the data from 24 studies (2611 patients with AD and 2822 control subjects from 23 provinces and special districts in China) that were obtained from the Chinese Biomedicine Database, China National Knowledge Infrastructure, PubMed, and Medline were included. Different models (i.e., dominant, recessive, etc.) of these polymorphisms were analyzed using the Cochrane Review Manager. Statistically significant associations among patients with AD for the 1/1 genotype of the PS1 1/2 polymorphism [odds ratio (OR) = 1.77, 95% confidence interval (CI) = 1.03-3.04; P = 0.04] and the I/I genotype of the ACE I/D polymorphism (OR = 2.44, 95%CI = 1.78-3.35; P < 0.01) were identified. Statistically significant associations were also found for the PS1 1/2 polymorphism in both the dominant and recessive genetic models, whereas no association was found for the LRP C/T polymorphism. All studies exhibited heterogeneity (P < 0.05). This meta-analysis suggests that the 1/1 genotype of the PS1 1/2 polymorphism and the I/I genotype of the ACE I/D polymorphism are significantly associated with an increased risk of AD in the Chinese population.

A novel biodegradable polymeric surfactant synthesized from carbon dioxide, maleic anhydride and propylene epoxide

Novel biodegradable polymeric surfactants were synthesized by the sulfonation of gradient structured terpolymers of CO₂, propylene epoxide and maleic anhydride.

Semi-crystalline terpolymers with varying chain sequence structures derived from CO2, cyclohexene oxide and ε-caprolactone: one-step synthesis catalyzed by tri-zinc complexes

Novel semi-crystalline terpolymers with varying chain sequence structures derived from cyclohexene oxide (CHO), CO₂ and ε-caprolactone (CL) were synthesized and reported.

A novel lithium–sulfur battery cathode from butadiene rubber-caged sulfur-rich polymeric composites

Novel sulfur-rich polymeric materials were readily preparedviafacile solution vulcanization of the commercial butadiene rubber (BR) and sulfur element, and were investigated as cathode materials for lithium–sulfur batteries.

Search for a light sterile neutrino at Daya Bay

A search for light sterile neutrino mixing was performed with the first 217 days of data from the Daya Bay Reactor Antineutrino Experiment. The experiment's unique configuration of multiple baselines from six 2.9 GW(th) nuclear reactors to six antineutrino detectors deployed in two near (effective baselines 512 m and 561 m) and one far (1579 m) underground experimental halls makes it possible to test for oscillations to a fourth (sterile) neutrino in the 10(-3) eV(2)<|Δm(41)(2) |< 0.3 eV(2) range. The relative spectral distortion due to the disappearance of electron antineutrinos was found to be consistent with that of the three-flavor oscillation model. The derived limits on sin(2) 2θ(14) cover the 10(-3) eV(2) ≲ |Δm(41)(2)| ≲ 0.1 eV(2) region, which was largely unexplored.

IL-6 gene promoter polymorphisms and risk of coronary artery disease in a Chinese population

We investigated the relationships between single nucleotide polymorphisms (SNPs) of the interleukin (IL)-6 gene 174 G>C (rs1800795), 572 G>C (rs1800796), and 597 G/A (rs1800797) and coronary artery disease (CAD) risk in a Chinese population. This case-control study recruited 296 CAD patients and 327 controls between January 2009 and May 2012. Genotyping of IL-6 174 G>C (rs1800795), 572 G>C (rs1800796), and 597 G/A (rs1800797) was performed on a 384-well plate format using the Sequenom MassARRAY platform. CAD patients were more likely to be older and male, with a higher body mass index, diabetes, and hypertension, and presented higher triglycerides, and lower total cholesterol, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol. We found that the IL-6 174CC genotype was associated with a significantly increased risk of CAD compared to the wild-type GG genotype in a codominant model [odds ratio (95% confidence interval) = 1.94 (1.13-3.37)], whereas IL-6 174 G>C polymorphisms presented an increased risk of CAD in dominant and recessive models. However, we did not find that the IL-6 572 CC and 597 AA genotypes were correlated with an increased risk of CAD. IL-6 174 G>C rs1800795 was associated with CAD risk in a Chinese population. Further large-scale studies are required to determine whether IL-6 SNPs interact with environmental factors in the development of CAD.

Novel hierarchically porous carbon materials obtained from natural biopolymer as host matrixes for lithium-sulfur battery applications

Novel hierarchically porous carbon materials with very high surface areas, large pore volumes and high electron conductivities were prepared from silk cocoon by carbonization with KOH activation. The prepared novel porous carbon-encapsulated sulfur composites were fabricated by a simple melting process and used as cathodes for lithium sulfur batteries. Because of the large surface area and hierarchically porous structure of the carbon material, soluble polysulfide intermediates can be trapped within the cathode and the volume expansion can be alleviated effectively. Moreover, the electron transport properties of the carbon materials can provide an electron conductive network and promote the utilization rate of sulfur in cathode. The prepared carbon-sulfur composite exhibited a high specific capacity and excellent cycle stability. The results show a high initial discharge capacity of 1443 mAh g(-1) and retain 804 mAh g(-1) after 80 discharge/charge cycles at a rate of 0.5 C. A Coulombic efficiency retained up to 92% after 80 cycles. The prepared hierarchically porous carbon materials were proven to be an effective host matrix for sulfur encapsulation to improve the sulfur utilization rate and restrain the dissolution of polysulfides into lithium-sulfur battery electrolytes.

First Report of Aphelenchoides besseyi Causing White Tip Disease of Rice in Jilin Province, China

White tip disease of rice caused by the plant-parasitic nematode Aphelenchoides besseyi is an important domestic quarantine issue causing heavy yield losses of rice. During a survey for rice diseases in 2013, suspect white tip disease of rice was observed in the cities of Changchun and Gongzhuling, Jinlin Province, China. Leaf tips of susceptible rice varieties were white or yellow, becoming brown or black as necrosis set in. Tips of developing leaves were twisted and wrinkled. The flag leaf became twisted above the panicle until development was inhibited. General stunting of the plant accompanied leaf injury. Panicles were severely reduced and produced small deformed kernels while spikelets were reduced in number. Maturity of panicles was delayed, and secondary panicles arising from the lower nodes of the panicle were sterile. Nematodes were isolated from rice grains of diseased panicles. Key morphological features were determined for females and males. Measurements of females (n = 15) were: body length 612.50 to 735.00 μm (mean 673.75 μm), body width 17.37 to 22.21 μm (mean 19.79 μm), esophagus to gland 64.44 to 68.07 μm (mean 66.26 μm), and tail 34.41 to 41.29 μm (mean 37.85 μm). Females had a relatively short ovary with oocytes arranged in several lines; posterior uterine branch two to four times as long as body width; and tail tapering, conoid, with terminus bearing a mucro with four processes arranged in a shape somewhat that of a star. Measurements of males (n = 22) were: body length 483.39 to 580.00 μm (mean 531.70 μm), body width 14.46 to 17.12 μm (mean 15.79 μm), esophagus to gland 63.97 to 66.42 μm (mean 65.20 μm), and tail 30.38 to 36.45 μm (mean 33.41 μm). Males had a curved tail about 180° when relaxed, three pairs of ventrosubmedian papillae with the first one adanal, spicula curved with a slight basal process, and terminus bearing four mucrones arranged variably. Both males and females had lateral field occupying one fourth of the body width, marked by four incisures; delicate cephalic framework; small spear with moderate-size basal knobs; excretory pore was anterior to nerve ring; and intestine joined to esophagus immediately behind median bulb (3). All morphological data and characters were consistent with A. besseyi. Molecular diagnosis as A. besseyi was confirmed after DNA was extracted from nematodes (n = 16) and the templates were used in PCR analysis. The internal transcribed spacer region (ITS) of rDNA was amplified with primers TW81 and AB28 (2). The size of PCR product was 842 bp, and this sequence (KJ009342) was submitted to GenBank and was 98% similar with that of A. besseyi isolates from India (JF826519, JF93390, JF826517, JF826518) and Russia (EU186069). Molecular identification was further confirmed by amplifying part of the ITS region and part of the 5.8 gene of rDNA using the A. besseyi-specific primers BSF and BSR (1). The amplification yielded a 312-bp product specific to A. besseyi. Morphological and molecular data confirmed that the pathogen responsible for white tip disease in Changchun and Gongzhuling was A. besseyi. While this nematode has been reported from many rice-producing areas in China, this is the first detection of A. besseyi in Jilin Province, China. References: (1) R. Q. Cui et al. Plant Quarantine (Chinese) 24:10-12, 2010. (2) S. A. Subbotin et al. Nematology 2:153, 2000. (3) G. Thorne. Principles of Nematology. McGraw-Hill, New York, 1972.

Sulfonic acid-functionalized α-zirconium phosphate single-layer nanosheets as a strong solid acid for heterogeneous catalysis applications

Solid acids have received considerable attention as alternatives to traditional corrosive and hazardous homogeneous acids because of their advantages in practical applications, including their low corrosion of equipment and high catalytic activity and recyclability. In this work, a strong solid acid was prepared by anchoring thiol group terminated chains on layered α-zirconium phosphate (ZrP) single-layer nanosheets, followed by oxidation of thiol groups to form sulfonic acid groups. The obtained solid acids were thoroughly characterized and the results proved that sulfonic acid group terminated chains were successfully grafted onto the ZrP nanosheets with a high loading density. Such a strong solid acid based on inorganic nanosheets can be well-dispersed in polar solvents, leading to high accessibility to the acid functional groups. Meanwhile, it can be easily separated from the dispersion system by centrifugation or filtration. The strong solid acid can serve as an effective heterogeneous catalyst for various reactions, including the Bayer-Villiger oxidation of cyclohexanone to ε-caprolactone in the absence of organic solvents.

Spectral measurement of electron antineutrino oscillation amplitude and frequency at Daya Bay

A measurement of the energy dependence of antineutrino disappearance at the Daya Bay reactor neutrino experiment is reported. Electron antineutrinos (ν¯(e)) from six 2.9  GW(th) reactors were detected with six detectors deployed in two near (effective baselines 512 and 561 m) and one far (1579 m) underground experimental halls. Using 217 days of data, 41 589 (203 809 and 92 912) antineutrino candidates were detected in the far hall (near halls). An improved measurement of the oscillation amplitude sin(2)2θ(13)=0.090(-0.009)(+0.008) and the first direct measurement of the ν¯(e) mass-squared difference |Δm(ee)2|=(2.59(-0.20)(+0.19))×10(-3)  eV2 is obtained using the observed ν¯(e) rates and energy spectra in a three-neutrino framework. This value of |Δm(ee)2| is consistent with |Δm(μμ)2| measured by muon neutrino disappearance, supporting the three-flavor oscillation model.

Production and characterization of recombinant glucose oxidase from Aspergillus niger expressed in Pichia pastoris

Recombinant glucose oxidase from Aspergillus niger expressed in Pichia pastoris by fed-batch fermentation was purified and assessed with 1·26 purification fold to homogeneity using Q-Sepharose F.F. chromatography. The enzyme was determined by SDS-PAGE and gradient PAGE, which showed a dimeric form of 150 kDa. The purified rGOD was proved to be a glycoprotein, and the content of which was estimated to be 36·7 and 25·14% by phenol-sulfuric acid and anthrone-sulfuric acid methods. Characteristics demonstrated that the highest activity was in pH 6·0 at 40°C and was stable at a broad pH range from 4·0 to 9·0 at 55°C or below. The optimum substrate for this enzyme was d-glucose, and the Km was 21·06 mmol l(-1) as well as the Vmax was 359 μmol min(-1) mg(-1). rGOD possessed high resistance to various chemicals except for Hg(2+), Fe(2+), Ag(+), Cu(2+), 1,4-dithiothreitol, sodium dodecyl sulfate and ascorbic acid. In addition, the inhibitors also exhibited intensive fluorescence quenching effect on rGOD.

SIGNIFICANCE AND IMPACT OF THE STUDY

Glucose oxidase is a very important enzyme produced by several species. However, large-scale applications have always been postponed by its complexity in fermentation and purification. Our research focused on developing new purification strategy of recombinant GOD from A. niger expressed in P. pastoris. Here, we described this novel one-step purification method and subsequent research in the characteristics of rGOD which showed different results from previous work. These can open new opportunities to increase its application.

3,3′-(Ethane-1,2-diylidene)bis(indolin-2-one) based conjugated polymers for organic thin film transistors

3,3′-(Ethane-1,2-diylidene)bis(indolin-2-one) (EBI) is used as a new electron acceptor for constructing polymer semiconductors for organic thin film transistors.

Mechanism studies of terpolymerization of phthalic anhydride, propylene epoxide, and carbon dioxide catalyzed by ZnGA

Monomer reactivity ratios of CO₂ and phthalic anhydride (PA) are evaluated and a mechanism is discussed for ZnGA catalyzed PA/CO₂/PO terpolymerizations.

Limits on spin-dependent WIMP-nucleon cross sections from 225 live days of XENON100 data

We present new experimental constraints on the elastic, spin-dependent WIMP-nucleon cross section using recent data from the XENON100 experiment, operated in the Laboratori Nazionali del Gran Sasso in Italy. An analysis of 224.6 live days×34 kg of exposure acquired during 2011 and 2012 revealed no excess signal due to axial-vector WIMP interactions with 129Xe and 131Xe nuclei. This leads to the most stringent upper limits on WIMP-neutron cross sections for WIMP masses above 6 GeV/c², with a minimum cross section of 3.5×10(-40) cm² at a WIMP mass of 45 GeV/c², at 90% confidence level.

ER stress-mediated apoptosis induced by celastrol in cancer cells and important role of glycogen synthase kinase-3β in the signal network

HeLa cells treated with celastrol, a natural compound with inhibitive effect on proteasome, exhibited increase in apoptotic rate and characteristics of apoptosis. To clarify the signal network activated by celastrol to induce apoptosis, both the direct target proteins and undirect target proteins of celastrol were searched in the present study. Proteasome catalytic subunit β1 was predicted by computational analysis to be a possible direct target of celastrol and confirmed by checking direct effect of celastrol on the activity of recombinant human proteasome subunit β1 in vitro. Undirect target-related proteins of celastrol were searched using proteomic studies including two-dimensional electrophoresis (2-DE) analysis and iTRAQ-based LC-MS analysis. Possible target-related proteins of celastrol such as endoplasmic reticulum protein 29 (ERP29) and mitochondrial import receptor Tom22 (TOM22) were found by 2-DE analysis of total cellular protein expression profiles. Further study showed that celastrol induced ER stress and ER stress inhibitor could ameliorate cell death induced by celastrol. Celastrol induced translocation of Bax into the mitochondria, which might be related to the upregulation of BH-3-only proteins such as BIM and the increase in the expression level of TOM22. To further search possible target-related proteins of celastrol in ER and ER-related fractions, iTRAQ-based LC-MS method was use to analyze protein expression profiles of ER/microsomal vesicles-riched fraction of cells with or without celastrol treatment. Based on possible target-related proteins found in both 2-DE analysis and iTRAQ-based LC-MS analysis, protein–protein interaction (PPI) network was established using bioinformatic analysis. The important role of glycogen synthase kinase-3β (GSK3β) in the signal cascades of celastrol was suggested. Pretreatment of LiCL, an inhibitor of GSK3β, could significantly ameliorate apoptosis induced by celastrol. On the basis of the results of the present study, possible signal network of celastrol activated by celastrol leading to apoptosis was predicted.

First-order liquid-liquid phase transition in cerium

We report the first experimental observation of a liquid-liquid phase transition in the monatomic liquid metal cerium, by means of in situ high-pressure high-temperature x-ray diffraction experiments. At 13 GPa, upon increasing temperature from 1550 to 1900 K high-density liquid transforms to a low-density liquid, with a density difference of 14%. Theoretic models based on ab initio calculations are built to investigate the observed phase behavior of the liquids at various pressures. The results suggest that the transition primarily originates from the delocalization of f electrons and is deemed to be of the first order that terminates at a critical point.

Novel quaternized poly(arylene ether sulfone)/Nano-ZrO₂ composite anion exchange membranes for alkaline fuel cells

A series of composite anion exchange membranes based on novel quaternized poly(arylene ether sulfone)/nanozirconia (QPAES/nano-ZrO₂) composites are prepared using a solution casting method. The QPAES/nano-ZrO₂ composite membranes are characterized by FTIR, X-ray diffraction (XRD), and scanning electron microscopy/energy-dispersive X-ray analysis (SEM/EDX). The ion exchange capacity (IEC), water uptake, swelling ratio, hydroxide ion conductivity, mechanical properties, thermal stability, and chemical stability of the composite membranes are measured to evaluate their applicability in fuel cells. The introduction of nano-ZrO₂ induces the crystallization of the matrix and enhances the IEC of the composite membranes. The modification with nano-ZrO₂ improves water uptake, dimension stability, hydroxide ion conductivity, mechanical properties, and thermal and chemical stabilities of the composite membranes. The QPAES/nano-ZrO₂ composite membranes show hydroxide ion conductivities over 25.7 mS cm⁻¹ at a temperature above 60 °C. Especially, the QPAES/nano-ZrO₂ composite membranes with the nano-ZrO₂ content above 7.5% display hydroxide ion conductivities over 41.4 mS cm⁻¹ at 80 °C. The E(a) values of the QPAES/nano-ZrO₂ composite membranes with the nano-ZrO₂ content above 5% are lower than 11.05 kJ mol⁻¹. The QPAES/7.5% nano-ZrO₂ composite membrane displays the lowest E(a) value and the best comprehensive properties and constitutes a good potential candidate for alkaline fuel cells.

Dark matter results from 225 live days of XENON100 data

We report on a search for particle dark matter with the XENON100 experiment, operated at the Laboratori Nazionali del Gran Sasso for 13 months during 2011 and 2012. XENON100 features an ultralow electromagnetic background of (5.3 ± 0.6) × 10(-3) events/(keV(ee) × kg × day) in the energy region of interest. A blind analysis of 224.6 live days × 34 kg exposure has yielded no evidence for dark matter interactions. The two candidate events observed in the predefined nuclear recoil energy range of 6.6-30.5 keV(nr) are consistent with the background expectation of (1.0 ± 0.2) events. A profile likelihood analysis using a 6.6-43.3 keV(nr) energy range sets the most stringent limit on the spin-independent elastic weakly interacting massive particle-nucleon scattering cross section for weakly interacting massive particle masses above 8 GeV/c(2), with a minimum of 2 × 10(-45) cm(2) at 55 GeV/c(2) and 90% confidence level.

Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication

BACKGROUND

A systematic review and network meta-analysis was undertaken to consider the evidence for the efficacy and tolerability of placebo, cilostazol, naftidrofuryl oxalate and pentoxifylline in patients with intermittent claudication due to peripheral arterial disease (PAD).

METHODS

MEDLINE, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Conference Proceedings, BIOSIS, National Research Register and MetaRegister databases were searched. Eligible studies were randomized controlled trials (RCTs) and published systematic reviews of patients with intermittent claudication due to PAD and whose symptoms persisted despite a period of conservative management. Study selection was conducted by one reviewer with involvement from a clinician. Data were extracted by one reviewer with no blinding to authors or journal, and checked by a second reviewer. Outcome measures were maximum walking distance (MWD) and pain-free walking distance (PFWD).

RESULTS

The review identified 1876 citations; 26 RCTs met the inclusion criteria for the systematic review. Eleven trials provided data relevant for the meta-analysis. Naftidrofuryl oxalate was ranked first for both MWD and PFWD (probability of 0·947 and 0·987, respectively, of being the best treatment) followed by cilostazol and pentoxifylline. For naftidrofuryl oxalate, cilostazol and pentoxifylline, MWD increased by 60 (95 per cent credible interval 20 to 114) per cent, 25 (11 to 40) per cent and 11 (-1 to 24) per cent respectively relative to placebo, and PFWD increased by 49, 13 and 9 per cent.

CONCLUSION

Naftidrofuryl oxalate and cilostazol are both effective treatments for claudication; naftidrofuryl oxalate is likely to be the most effective, with minimal serious adverse events.