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C C Wu

Publications and source records attributed to C C Wu.

At least 181 records · Page 10Linked to original sources

Apoptotic signal of Fas is not mediated by ceramide.

Ceramide has been suggested as the secondary messenger mediating the apoptotic signal for Fas engagement. By using different inhibitors, we demonstrated here that ceramide is unlikely a mediator of Fas-initiated apoptosis. First, cAMP prevented cell death induced by ceramide but not by Fas. Second, ceramide-triggered, but not Fas-triggered, apoptosis was antagonized by the free radical scavenger C60. Third, the metal chelator pyrrolidinedithiocarbamate suppressed ceramide-initiated DNA fragmentation but had no effect on the Fas-induced cell death. Fourth, the SAPK/ERK kinase dominant negative mutant, which attenuated ceramide-induced cell death, did not prevent Fas-induced apoptosis. Finally, activation of NF-kappaB inhibited ceramide-induced but not Fas-initiated apoptosis. The fact that many antagonists of ceramide-induced apoptosis could not suppress Fas-mediated cell death clearly indicates that ceramide is not the mediator for Fas-initiated apoptotic signal.

Apoptosis↗

Dyslipidemias have a detrimental effect on left ventricular systolic function in patients with a first acute myocardial infarction.

Several large-scale clinical trials have shown that lipid-lowering interventions are associated with reduced coronary events and mortality. However, whether dyslipidemias have a detrimental effect on the evolution of myocardial infarction (MI) is still unknown. To examine whether dyslipidemias can aggravate myocardial vulnerability following MI, 165 patients with a first MI were studied. All patients underwent measurements of serum lipid profiles 1 week and 3 months after MI, a radionuclide ventriculographic study, and a coronary angiographic study. The patients were divided into 3 groups according to their 3-month serum cholesterol levels (group 1, <200 mg/dl; group 2, 200 to 240 mg/dl; group 3, >240 mg/dl). Groups 1, 2, and 3 consisted of 66, 59, and 40 patients, respectively. Group 3 had a higher Gensini score than groups 1 and 2, although this was not statistically significant (p = 0.13). The postinfarct left ventricular ejection fraction (LVEF) was highest in group 1 (53 +/- 13%), at mid level in group 2 (43 +/- 14%), and lowest in group 3 (35 +/- 11%) (p < 0.0001). A significant negative correlation between 3-month low-density lipoprotein (LDL) cholesterol (r = -0.55, p < 0.0001) and the postinfarct LVEF was found. The product of peak creatine kinase (CK(MAX)) and time to CK(MAX) (p = 0.001), and patency of the infarct-related artery (p = 0.009), rather than variables of coronary atherosclerosis, were also independent predictors of the postinfarct LVEF. Increases in 1-week LDL cholesterol and decreases in 1-week high-density lipoprotein cholesterol were associated with a higher CK(MAX) and a lower patency rate of the infarct-related artery, respectively. This study revealed that dyslipidemias per se, especially LDL cholesterol, had a detrimental effect on the postinfarct LVEF; this effect might be independent of the atherogenic properties of dyslipidemias.

Aged↗

Prediction and limitation of hepatic tumor resection without blood transfusion in cirrhotic patients.

BACKGROUND: The need for blood transfusion in cirrhotic liver resection is difficult to determine because of inaccurate estimation of operative blood loss. Moreover, blood transfusion is detrimental to cirrhotic patients. OBJECTIVE: To investigate the predictors and limitations of hepatectomy without blood transfusion for cirrhotic patients. DESIGN: Retrospective study. SETTING: University hospital, a tertiary referral center. PATIENTS: A consecutive 163 cirrhotic patients underwent resection for liver tumor(s) under a policy of restrictive blood transfusion. INTERVENTIONS: Estimated blood losses and clinicopathological features of patients who received and those who did not receive a blood transfusion were compared. MAIN OUTCOME MEASURES: Estimated operative blood losses, preoperative assessments, and operative procedures. RESULTS: There were 48 patients in the group who received a blood transfusion, with 1275 +/- 650 mL (mean +/- SE) of blood transfused, and 115 patients in the group who did not receive a blood transfusion. From discriminant analysis, the cutoff value of estimated blood loss for blood transfusion was 1685 mL. Tumor size and site of hepatectomy were found to be independent variables influencing blood transfusion under logistic regression analysis. CONCLUSIONS: Most cirrhotic patients tolerate hepatectomy without blood transfusion when the estimated operative blood loss is less than 1600 mL. Hepatectomy can be performed in cirrhotic patients without blood transfusion if the tumor is small (<5 cm), and/or the resection area is confined to Couinaud segments II, III, and VI. In this study, the largest amount of estimated blood loss in cirrhotic liver resection without blood transfusion was 2350 mL, but the uppermost limit remains to be determined.

Adult↗

End-systolic pressure-dimension relationship of in situ mouse left ventricle.

The increasing popularity of genetically engineered mice in cardiovascular research has made it important to evaluate cardiac function in small animals. We have developed a system to enable simultaneous pressure-dimension analysis of the mouse left ventricle. The chest was opened under anesthesia, and a 1.4 F micromanometer catheter was inserted into the left ventricle through the apex. A pair of sonomicrometry crystals were attached to the anterior and posterior walls using tissue adhesive. Pressure and dimension were recorded simultaneously at baseline and after isoproterenol injection (1 micro g, intraperitoneally). The ascending aorta was occluded transiently to estimate the end-systolic pressure-dimension relationship (ESPDR), which was parameterized subsequently by the quadratic equation: Pes=C2 X (Des-D0)2+E0 X (Des-D0), where Pes is end-systolic pressure, Des is end-systolic dimension, D0 is the dimension axis intercept, E0 is the local slope at D0, and C2 is the curvilinearity coefficient. The maximum and minimum external dimensions at baseline were 5.82+/-0.50 (s.d.) mm and 5.49+/-0.46 mm with fractional shortening of 0.057+/-0.014 (n=12). The ESPDR was significantly curvilinear and increased convexity after isoproterenol injection (C2, -444+/-281 to -1113+/-780 mmHg/mm2, P<0. 05; E0, 536+/-175 to 889+/-276 mmHg/mm, P<0.001), while the dimension axis intercept remained relatively constant (D0, 5.39+/-0. 46 to 5.37+/-0.52 mm). In conclusion, the combination of miniature piezo-electric crystals and a micromanometer enables continuous measurement of pressure and dimension of in situ mouse left ventricle. This technology may be useful in evaluating the cardiac phenotype of genetically engineered mice.

Animals↗

Dantrolene inhibits nitric oxide synthase in rat alveolar macrophages treated with lipopolysaccharide and interferon-gamma.

PURPOSE: To examine the effects of dantrolene on nitric oxide (NO) production and on the activity and protein expression of inducible nitric oxide synthase (iNOS) induced by lipopolysaccharide (LPS) plus interferon-gamma (IFN gamma) in rat alveolar macrophages. METHODS: Pulmonary alveolar macrophages isolated from Sprague-Dawley rats were used. After incubation of macrophages with dantrolene (1 to 100 microM) and LPS (1 microgram.ml-1) and IFN-gamma (100 u.ml-1) for 24 hr, the cell-free medium was removed for measuring the nitrite and tumour necrosis factor-alpha (TNF-alpha) levels by Griess reaction and ELISA kit, respectively. The harvested macrophages were also used to determine the activity of iNOS by using the conversion of [3H]-L-arginine to [3H]-L-citrulline method. Protein expression of iNOS was detected by Western blot analysis. RESULTS: In rats alveolar macrophages, (i) dantrolene (1 to 100 microM) caused a dose-dependent suppression of the production of nitrite and TNF-alpha induced by LPS (1 microgram.ml-1) plus IFN-gamma (100 u.ml-1) and (ii) dantrolene (100 microM) inhibited the activity (by 37 +/- 5%, P < 0.01) and protein expression (by 39 +/- 12%, P < 0.01) of iNOS in response to LPS plus IFN-gamma. CONCLUSION: Dantrolene inhibits NO production as well as the activity and expression of iNOS in alveolar macrophages treated with LPS plus IFN-gamma, which may be associated with the reduction of TNF-alpha production.

Animals↗

Treatment of cutout of a lag screw of a dynamic hip screw in an intertrochanteric fracture.

Sixteen consecutive patients with cutout of a lag screw of a dynamic hip screw fixation in an intertrochanteric fracture were treated with reinsertion of a lag screw, bone cement supplementation in the neck-trochanter, and subtrochanteric valgus osteotomy. Postoperatively, patients were permitted to ambulate with protected weight-bearing. Fourteen patients were followed-up for at least 1 year (median 2 years; range 1-3 years), and all had a solid union. The union period took a median of 5 months, with a range of 3-7 months. Usually, union of an intertrochanteric fracture was faster than that of subtrochanteric osteotomy (P < 0.01). There were no complications of wound infection, loss of reduction, cutout of a lag screw, or osteonecrosis of the femoral head. From clinical and theoretical considerations, we conclude that despite cutout of a lag screw of a dynamic hip screw fixation being difficult to treat, out technique still can provide an excellent outcome. Therefore, we strongly recommend its wide use.

Aged↗

Staple augmentation to treat a humeral nonunion after failed Seidel locked nailing.

Seidel locked nailing has been successfully used to treat a humeral shaft fracture or nonunion. However, if union fails despite this treatment, the next approach to try has not been well defined. We, therefore, developed a technique using a staple to enforce the local stability without removing the failed nail. The technique was very simple, and the outcome was always satisfactory.

Adult↗

Assessment of coronary artery disease in women by dobutamine stress echocardiography: comparison with stress thallium-201 single-photon emission computed tomography and exercise electrocardiography.

BACKGROUND: Dobutamine stress echocardiography (DSE) is sensitive and specific in detecting myocardial ischemia of male patients. However, there have been few reports about the use of DSE for the detection of coronary artery disease (CAD) in women. METHODS: DSE was evaluated in 51 consecutive women who underwent concomitant quantitative coronary angiography. Forty-four of the 51 patients received stress thallium-201 single-photon emission computed tomography (SPECT), and 30 of the 51 patients had interpretable results (exercise level > or = 85% of age-predicted maximal heart rate) of treadmill exercise. Twenty-nine patients had angiographically documented CAD defined as > or = 50% diameter stenosis. RESULTS: The overall sensitivity of DSE and stress 201Tl SPECT in detecting CAD was 93% and 79% (p = nonsignificant), and the specificity was 82% and 75% (p = nonsignificant), respectively. A combination of both tests increased the sensitivity (96%) at the expense of some decrease in specificity (60%). The agreement of DSE and 201Tl SPECT was 68% (30 of 44; kappa statistic = 0.35; p < 0.0001). The overall sensitivity, specificity, and accuracy in detecting CAD by treadmill exercise test and DSE were 71% vs 93% (p = nonsignificant), 44% vs 82% (p = 0.036), and 57% vs 88% (p = 0.003). In patients with abnormal results of treadmill exercise testing, the false-positive rate in detecting CAD was 2 (18%) of 11 in patients with abnormal results of DSE and 7 (88%) of 8 in those with normal results of DSE (p = 0.005). In patients with normal results of treadmill exercise testing, the false-negative rate in detecting CAD was 4 (100%) of 4 in patients with abnormal results of DSE and 0 (0%) of 7 in those with normal results of DSE (p = 0.003). CONCLUSION: The diagnostic accuracy of DSE was similar to that of stress 201Tl SPECT in women. DSE was able to stratify female patients with either abnormal or normal results of treadmill exercise testing and to avoid unnecessary cardiac catheterization.

Cardiotonic Agents↗

Metabolic detriment in donor heart valves induced by ischemia and cryopreservation.

BACKGROUND: The injury resulting from postmortem ischemia is a critical deterrent to the availability of donor valves. Using the reduction of XTT-tetrazolium salt as a marker of metabolic sequelae, we assessed the injurious effect of ischemia and the metabolic sequelae in 156 porcine semilunar leaflets. METHODS: The leaflets were randomly allocated to noncryoprocessed (n = 72) or cryoprocessed (n = 72) groups. At each preservation temperature of 4 degrees C, 24 degrees C, or 37 degrees C, 24 leaflets each were exposed to one of four storage periods of 9, 17, 30, or 60 hours. Twelve fresh aortic leaflets served as baseline reference samples. RESULTS: There was a progressive loss in the metabolic functioning of valve leaflet cells in both noncryopreserved and cryopreserved tissue as the storage times increased. Cryopreserved tissue showed a greater loss of function than noncryopreserved tissue did. The metabolic injury was mainly a consequence of cryoprocessing. The greatest loss in metabolic functioning occurred in the valves stored for 60 hours. The least favorable combination of variables was cryopreservation and a precryopreservation storage time of 60 hours. CONCLUSIONS: We conclude that 30- to 60-hour delays do not have a significant metabolic effect on cardiac leaflets. Thus it may be possible to safely extend the permissible ischemic periods after organ harvest.

Animals↗

A comparison of two RNA isolation methods for double-stranded RNA of infectious bursal disease virus.

Infectious bursal disease virus (IBDV), a member of the birnaviridae family, contains a bisegmented double-stranded RNA (dsRNA) genome. The segments are linked covalently at 5' termini by a large (90 kDa) viral genomic protein that migrates similar to viral RNA dependent RNA polymerase of IBDV. A proteinase K digestion based approach and acid-guanidium-phenol-chloroform (AGPC) RNA extraction method were used to extract dsRNA of IBDV from infected bursae. After extraction, dsRNA of IBDV was purified by precipitation with lithium chloride. The yield and purity of dsRNA of IBDV extracted by AGPC method was lower than that of proteinase K digestion based approach. This observation correlates with the presence of a genome-linked protein in IBDV. Although dsRNA obtained by both methods are suitable for reverse transcription-polymerase chain reaction (RT-PCR) amplification of at least up to 1201 base pairs (bp) of cDNA, dsRNA extracted by the proteinase K digestion method is more suitable than that by AGPC method for the amplification of longer fragments (1958 bp) of IBDV cDNA by PCR.

Animals↗

Ultrasonic tissue characterization for coronary care unit patients with acute myocardial infarction.

The ultrasonic integrated backscatter of myocardium changes in infarction and ischemia. On the third day after acute myocardial infarction, 30 patients underwent ultrasonic tissue characterization from the parasternal short-axis view. With a composite parameter, the phase-weighted variation, sensitivity, specificity, and accuracy for diagnosing multivessel coronary artery disease were 84.6%, 52.9% and 66.6%, respectively. Using 67 degrees as the cutoff value for the phase deviation of the backscatter power curve, the recanalization of the infarct-related artery could be detected with a positive predictive value of 77.7% and a negative predictive value of 66.6%. Ultrasonic tissue characterization is a feasible technique for detecting the multivessel coronary artery diseases and the recanalization of infarct-related artery for patients with acute myocardial infarction. The diminished cardiac cycle-dependent variation in integrated backscatter and increased phase deviation can differentiate patent coronary arteries from those coronary arteries with anatomically significant stenoses.

Aged↗

Ultrasonic tissue characterization in predicting residual ischemia and myocardial viability for patients with acute myocardial infarction.

The identification of viable myocardium and residual ischemia in patients with acute myocardial infarction has important prognostic implications. The ultrasonic tissue characterization with integrated backscatter and dobutamine-atropine stress echocardiography were performed 8.3+/-3 days after AMI in 30 patients. After coronary angioplasty for the residual stenosis of infarct-related artery, both modalities were repeated. The parameter obtained from ultrasonic tissue characterization, phase-weighted variation, could differentiate the myocardium with residual coronary stenosis or nonviable myocardium from the viable myocardium without residual coronary stenosis (p < 0.001). Using the cutoff value of 5.8 dB, the sensitivity, specificity and accuracy for detecting viable myocardium without residual coronary stenosis were 75%, 100% and 90.2%, respectively. The phase-weighted variation of the viable infarction zone restored after the coronary stenosis was relieved. In contrast, the nonviable myocardium had a small phase-weighted variation that was irrelevant to the patency of the infarct-related artery. The ultrasonic tissue characterization may be used in identifying patients with acute myocardial infarction whose infarction zones are viable without residual ischemia.

Angioplasty↗

Comparison of two soluble guanylyl cyclase inhibitors, methylene blue and ODQ, on sodium nitroprusside-induced relaxation in guinea-pig trachea.

To clarify further the role of cyclic GMP in mediating the relaxant response in guinea-pig trachea induced by sodium nitroprusside (SNP), the effects of soluble guanylyl cyclase inhibitors, methylene blue and 1H-[1,2,4]oxadiazolo[4,3,-a]quinoxalin-1-one (ODQ) on SNP-induced muscle relaxation and cyclic GMP accumulation were determined. SNP (0.3-100 microM) evoked a concentration-dependent relaxation of guinea-pig isolated tracheas precontracted with 0.3 microM carbachol. Preincubation of the preparations with methylene blue (10, 30 and 100 microM) resulted in a slight but concentration-dependent prevention of the relaxant response to SNP. In contrast, the relaxation to SNP was extensively prevented by 3 microM ODQ and almost abolished by 10 microM ODQ. SNP (30 microM) induced a significant elevation of cyclic GMP accumulation (from 1.34+/-0.14 to 5.39+/-0.28 pmol mg(-1) protein, n= 5; P<0.001), which was partially attenuated by 100 microM methylene blue (3.11+/-0.51 pmol mg(-1) protein, n=5; P<0.05), whereas completely abolished by 10 microM ODQ (1.31+/-0.28 pmol mg(-1) protein, n = 5; P<0.001). Methylene blue, but not ODQ and Nomega-nitro-L-arginine methyl ester (L-NAME), caused a concentration-dependent contraction in the tracheal preparation. The tension produced by 100 microM methylene blue was 41.8+/-4.3% (0.3 microM carbachol as 100%; n = 12). Moreover, the non-selective muscarinic receptor antagonist atropine and the M3-selective antagonist 4-diphenylacetoxy-N-methylpiperidine methiodine greatly inhibited the contractile effect evoked by methylene blue (100 microM). In conclusion, this study provides substantial evidence that SNP-induced muscle relaxation in guinea-pig trachea is completely via a cyclic GMP-dependent mechanism. Furthermore, ODQ, but not methylene blue, will likely become an important tool in differentiating between cyclic GMP-dependent and -independent effects of nitric oxide.

Animals↗

Prospective randomized trial of systemic antibiotics in patients undergoing liver resection.

BACKGROUND: Systemic antibiotics are administered frequently after hepatectomy to prevent infective complications, but their effectiveness is uncertain. METHODS: A total of 127 patients with liver tumours were prospectively randomized into two groups after hepatectomy: in group 1 (62 patients) no antibiotics were given until the appearance of infective complications; in group 2 (65 patients) intravenous cephazolin 1 g every 6 h and gentamicin 80 mg every 8 h were given for 7 days. On the day before surgery all patients received bowel preparation by clear liquid diet and oral antibiotics (neomycin 1 g and erythromycin 1 g, given together in three doses). RESULTS: The infective complication rate was 23 per cent in both groups (P = 0.95). The hospital costs were higher in group 2 (P < 0.001). Of the group 1 patients, 51 (82 per cent) did not require antibiotic treatment. No patient in either group died after hepatectomy. CONCLUSION: Postoperative systemic antibiotics cannot prevent infective complications, and their routine use after hepatectomy is unnecessary and costly. The use of antibiotics should be delayed until infective complications and persistent septic symptoms occur.

Antibiotic Prophylaxis↗

Analysis of a ribosomal DNA intergenic spacer region from the yellow fever mosquito, Aedes aegypti.

We have sequenced the 1.8 kb intergenic spacer (IGS) region from an Aedes aegypti ribosomal DNA repeat and have identified conserved functional motifs shared with the related mosquito, Aedes albopictus. Despite the shorter length and greater homogeneity of the Ae. aegypti IGS region, the sequences of two potential RNA polymerase I core promoters and closely associated terminator elements were highly conserved. Primer extension analysis indicated that the predominant transcription initiation site in the Ae. aegypti rDNA repeat unit region lay at or near the A residue at nucleotide position 1003 in the 'upstream' RNA polymerase I promoter. This observation was supported by the higher sequence identity between the upstream promoters in Ae. aegypti and Ae. albopictus, relative to the downstream promoters. In contrast to strong similarities among proximal regulatory elements, the Ae. aegypti IGS sequence upstream of the transcription initiation site lacked the ordered array of contiguous approximately 200 nucleotide subrepeats previously found in the IGS of Ae. albopictus. In Ae. aegypti, only 4 approximately 50 nucleotide R subrepeats separated by unique sequences, followed by 2 approximately 50 nucleotide E subrepeats, occurred upstream of the transcription initiation site. Despite their differences in size and sequence, however, the four Ae. aegypti R subrepeats shared an internal structural organization that included a conserved core with 'spacer' promoters and recombinogenic elements similar to those in the longer Ae. albopictus subrepeats. These observations provide an important basis for further characterization of transcription specificity among mosquito RNA polymerase I promoters and associated regulatory elements, and contribute towards the eventual use of these elements in transgenic applications.

Aedes↗

Research notes: ELISPOT assay for detection of antibody secreting cells to infectious bursal disease virus in chickens.

The ELISPOT assay was used to enumerate antibody secreting cells (ASC) in spleens of chickens infected with infectious bursal disease virus (IBDV). In the first experiment, chickens were orally challenged with IBDV. Spleens were collected 14 d later and used for ELISPOT assay. The assay detected 16 to 28 IgG ASC per 10(6) splenocytes and 3 to 6 IgM ASC per 10(6) splenocytes. In the second experiment, chickens were vaccinated against IBDV and orally challenged with IBDV 14 d after vaccination. Spleens were collected 7 d postchallenge. The ELISPOT assay detected 18 to 128 IgG ASC per 10(6) splenocytes and 4 to 6 IgM ASC per 10(6) splenocytes. The results indicated that the ELISPOT assay can be used to measure isotype-specific antibody responses to IBDV or other avian pathogens.

Animals↗

The inhibition by dantrolene of L-arginine transport and nitric oxide synthase in rat alveolar macrophages.

UNLABELLED: Dantrolene decreases the free cytosolic Ca2+ level via inhibition of calcium release from the sacroplasmic reticulum. However, the effect of dantrolene on L-arginine transport and nitric oxide synthase (NOS) activity is still unknown. In this study, we examined the effects of dantrolene on L-arginine transport and activity of inducible nitric oxide synthase (iNOS) induced by lipopolysaccharide (LPS) and interferon gamma (IFN-gamma) in rat alveolar macrophages. Incubation of cells with LPS (1 microg/mL) and IFN-gamma (100 u/mL) for 24 h resulted in significant increases in nitrite production and L-arginine transport. In the presence of dantrolene (100 microM) or inhibitors of NOS, such as aminoguanidine (100 microM), N(G)-monomethyl-L-arginine (100 microM), the nitrite production and L-arginine transport were significantly inhibited compared with that in the LPS + IFN-gamma group. Furthermore, the results of kinetic analysis indicate that the suppression of L-arginine transport by dantrolene was caused by selective decrease of the velocity of transport (Vmax) without affecting the affinity (Km) for L-arginine. In addition, dantrolene also attenuated the activity of iNOS in a dose-dependent manner. We conclude that the mechanisms by which dantrolene attenuated NO synthesis may be associated with the inhibition of availability of L-arginine by reducing the affinity for L-arginine, accompanied by a parallel decrease of the activity of iNOS. IMPLICATIONS: In this study, we demonstrated that dantrolene, a drug that reduces the intracellular Ca2+ level, can inhibit L-arginine availability and inducible nitric oxide synthase activity in macrophages. Our finding may provide a novel therapeutic approach using dantrolene to prevent hypotension associated with an activation of inducible nitric oxide synthase in endotoxemia.

Animals↗

Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques.

OBJECTIVE: The aim of this retrospective study was to investigate and compare the effects of plating and intramedullary nailing in the treatment of clavicular aseptic nonunion. METHODS: Thirty-three consecutive patients with middle-third clavicular aseptic nonunions with previous nonoperative treatment were treated by plating (13 patients) and intramedullary nailing (20 patients) with supplementary cancellous bone grafting. The indications for such treatment were middle-third aseptic nonunions without previous operative treatment and with local pain or tenderness, deformity, or neurologic complaint. The choice of plating or intramedullary nailing was according to the surgeon's individual preference. RESULTS: Twenty-nine patients were followed for at least 1 year (range, 1-7 years; median, 3 years; plating, 11; intramedullary nailing, 18). The union rate was 81.8% (9 of 11) for plating and 88.9% (16 of 18) for intramedullary nailing (p = 0.35, Fisher's exact test). The union period was 4.0 +/- 1.3 months for plating and 4.1 +/- 1.1 months for intramedullary nailing (p = 0.80, unpaired Student's t test). The complication rate was 27.3% (3 of 11) for plating and 11.1% (2 of 18) for intramedullary nailing (p = 0.21, Fisher's exact test). There were no significant differences in other parameters. CONCLUSION: Intramedullary nailing may have a higher union rate with a lower complication rate than plating (p > 0.05). At least in common situations, it is not inferior to plating. Whenever possible, therefore, intramedullary nailing should be used preferentially to treat clavicular aseptic nonunion without previous operative treatment. Nevertheless, both techniques have relatively higher nonunion rates in the treatment of clavicular nonunion than in the treatment of other long-bone nonunions. Gentle handling of surrounding soft tissues to reduce bony fragments should be strictly executed.

Adult↗