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Tue, 21 Nov 2023 22:15:17 -0800 (PST) X-Received: by 2002:a17:902:f7d2:b0:1cb:d9ff:e26f with SMTP id h18-20020a170902f7d200b001cbd9ffe26fmr324766plw.5.1700633717202; Tue, 21 Nov 2023 22:15:17 -0800 (PST) X-Original-Sender: unrealyan-Re5JQEeQqe8AvxtiuMwx3w@public.gmane.org Precedence: list Mailing-list: list pandoc-discuss-/JYPxA39Uh5TLH3MbocFFw@public.gmane.org; contact pandoc-discuss+owners-/JYPxA39Uh5TLH3MbocFFw@public.gmane.org List-ID: X-Google-Group-Id: 1007024079513 List-Post: , List-Help: , List-Archive: , List-Unsubscribe: , Xref: news.gmane.io gmane.text.pandoc:33363 Archived-At: ------=_Part_12028_342585243.1700633716219 Content-Type: multipart/alternative; boundary="----=_Part_12029_1115796299.1700633716219" ------=_Part_12029_1115796299.1700633716219 Content-Type: text/plain; charset="UTF-8" Content-Transfer-Encoding: quoted-printable The full log: pandoc -f latex -t jats_archiving main.tex --resource-path=3D. --verbose [INFO] Could not load include file extsizes.sty at template.tex line 1=20 column 28 [INFO] Could not load include file multicol.sty at template.tex line 3=20 column 22 [INFO] Could not load include file amsmath.sty at template.tex line 4=20 column 21 [INFO] Could not load include file color.sty at template.tex line 6 column= =20 19 [INFO] Could not load include file xcolor.sty at template.tex line 7 column= =20 22 [INFO] Could not load include file hyperref.sty at template.tex line 8=20 column 62 [INFO] Could not load include file titlesec.sty at template.tex line 10=20 column 22 [INFO] Could not load include file authblk.sty at template.tex line 11=20 column 21 [INFO] Skipped '\definecolor{sectiontitlecolor}{rgb}{0.2,0.4,0.8}' at=20 template.tex line 14 column 50 [INFO] Skipped '\definecolor{editorial}{rgb}{0.08,0.28,0.53}' at=20 template.tex line 15 column 45 [INFO] Skipped '\definecolor{cite}{rgb}{0.98,0.9,0.8}' at template.tex line= =20 16 column 38 [INFO] Could not load include file url.sty at template.tex line 19 column 1= 7 [INFO] Could not load include file lipsum.sty at template.tex line 23=20 column 20 [INFO] Could not load include file geometry.sty at template.tex line 25=20 column 63 [INFO] Skipped '\NeedsTeXFormat{LaTeX2e}' at template.tex line 28 column 25 [INFO] Could not load include file fancyhdr.sty at main.tex line 9 column 2= 3 [INFO] Skipped '\pagestyle{fancy}' at main.tex line 12 column 18 [INFO] Skipped '\fancyhf{}' at main.tex line 15 column 11 [INFO] Skipped '\fancyhead[L]{\textbf{Translational Pediatrics, Vol 12, No= =20 8 August 2023 }}' at main.tex line 18 column 76 [INFO] Skipped '\setcounter{page}{1450}' at main.tex line 23 column 24 [INFO] Skipped '\fancyhead[R]{\textbf{\thepage}}' at main.tex line 25=20 column 33 [INFO] Skipped '\fancyfoot[L]{=C2=A9 Translational Pediatrics. All rights= =20 reserved. }' at main.tex line 33 column 65 [INFO] Skipped '\fancyfoot[R]{Transl Pediatr 2023;12(8):1450-1453 |=20 https://dx.doi.org/10.21037/tp-23-264 }' at main.tex line 34 column 92 [INFO] Skipped '\thispagestyle{empty}' at main.tex line 40 column 22 [INFO] Skipped '\makeatletter' at main.tex line 43 column 14 [INFO] Skipped '\makeatother' at main.tex line 45 column 13 [INFO] Skipped '\makeatletter' at main.tex line 47 column 14 [INFO] Skipped '\noindent' at main.tex line 102 column 14 [INFO] Skipped '\makebox[0.3\linewidth][l]{% \setlength{\parskip}{1em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E9= =97=B4=E8=B7=9D \setlength{\parindent}{1em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E7= =BC=A9=E8=BF=9B \textcolor{white}{Editorial} }' at main.tex line 106 column 6 [INFO] Skipped '\bgroup' at main.tex line 129 column 5 [INFO] Skipped '\setlength{\parindent}{0pt}' at main.tex line 129 column 5 [INFO] Skipped '\LARGE' at main.tex line 129 column 5 [INFO] Skipped '\LARGE' at main.tex line 129 column 5 [INFO] Skipped '\@title' at main.tex line 129 column 5 [INFO] Skipped '\begin{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\end{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\@author' at main.tex line 129 column 5 [INFO] Skipped '\begin{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\end{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\vspace{2ex}' at main.tex line 134 column 17 [INFO] Skipped '\noindent{\textit{Correspondence to:} Frank-Martin Haecker,= =20 MD, Professor of Pediatric Surgery. Chest Wall Unit at the Department of=20 Pediatric Surgery, Children=E2=80=99s Hospital of Eastern Switzerland, Claudiusstrasse 6, CH-9006 St. Gallen,= =20 Switzerland. Email: frank-martin.haecker-kpaEHHRHYO5yDzI6CaY1VQ@public.gmane.org}' at main.tex line 140= =20 column 125 [INFO] Skipped '\noindent{\textit{Comment on}: Scalise PN, Demehri FR. The= =20 management of pectus excavatum in pediatric patients: a narrative review.= =20 Transl Pediatr 2023;12:208-20.}' at main.tex line 142 column 149 [INFO] Skipped '\vspace{2ex}' at main.tex line 144 column 17 [INFO] Skipped '\noindent{\textbf{\textcolor[RGB]{21,72,135}{Keywords:}}=20 Pectus excavatum; pediatric patients; Nuss procedure; vacuum bell;=20 cryoablation}' at main.tex line 145 column 95 [INFO] Skipped '\vspace{2ex}' at main.tex line 147 column 17 [INFO] Skipped '\noindent{Submitted Apr 26, 2023. Accepted for publication= =20 Jul 19, 2023. Published online Jul 28, 2023}' at main.tex line 149 column 9= 9 [INFO] Skipped '\noindent{doi: 10.21037/tp-23-264}' at main.tex line 151=20 column 29 [INFO] Skipped '\noindent{\textbf{View this article at: }}' at main.tex=20 line 153 column 5 [INFO] Skipped '\vspace{4ex}' at main.tex line 155 column 17 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\vspace{2ex}' at main.tex line 312 column 4 [INFO] Skipped '\noindent' at main.tex line 312 column 4 [INFO] Skipped '\normalfont' at main.tex line 312 column 4 [INFO] Skipped '\Large' at main.tex line 312 column 4 [INFO] Skipped '\vspace{2ex}' at main.tex line 312 column 4 [INFO] Skipped '\vspace{2ex}' at main.tex line 316 column 4 [INFO] Skipped '\noindent' at main.tex line 316 column 4 [INFO] Skipped '\normalfont' at main.tex line 316 column 4 [INFO] Skipped '\Large' at main.tex line 316 column 4 [INFO] Skipped '\vspace{2ex}' at main.tex line 316 column 4 [INFO] Skipped '\vspace{1ex}' at main.tex line 322 column 17 [INFO] Skipped '\vspace{2ex}' at main.tex line 329 column 17 [INFO] Skipped '\vspace{2ex}' at main.tex line 336 column 17 [INFO] Skipped '\begin{multicols}{2} { \indent The majority of congenital chest wall deformities (CWD) affects the anterior chest wall. The most common anterior CWD is pectus excavatum (PE), followed by Pectus carinatum (PC). The incidence of PE is approximately 1 in every 300=E2=80=93400 births, affecting male patients with an approx. 4:1 ratio (\cite{pmid36891368}). For the last 70 to 80 years,= =20 open surgical repair such as the Ravitch technique and its modifications (\cite{pmid35820596,pmid35455522}) was the preferred method= =20 to correct CWDs. An essential paradigm shift occurred with the inauguration of the minimally invasive repair of pectus excavatum (MIRPE) by Nuss (\cite{pmid35377161}). In contrast to open repair, MIRPE does not require cartilage or sternal resection. Flexibility and elasticity of the chest wall which are preserved applying MIRPE, were identified as relevant parameters for successful treatment of CWD. Furthermore, an increasing number of patients presented with thoracic chondrodystrophy as a long-term side effect after open surgical repair. As a consequence, the management of CWD including diagnostic work-up as well as conservative and surgical treatment options has made substantial progress during the past two decades. Today, treatment of CWD includes all age groups with pediatric, adolescent and adult patients, covered by a dedicated multidisciplinary team (in particular pediatric and thoracic surgeons) based in a specialized chest wall unit, what is the most important pillar of present time. The physiologic effects of CWD are still discussed controversially. There is an ongoing controversial debate concerning effects of MIRPE on exercise tolerance, lack of endurance, shortness of breath, cardiopulmonary function, body posture, etc. Even if the number of articles reporting on different aspects of CWD treatment went up from approximately 300 (1980 to 1989) to more than 1,000 published papers (2012 to 2021), the controversial debate will continue (\cite{pmid34942673}). Information on new diagnostic and therapeutic modalities provided by online platforms and social media circulates not only among surgeons and paediatricians, but also rapidly among patients. Not only different surgical techniques, but also conservative treatment options are available. In almost the same manner, postoperative pain management is an important part of an effective and successful treatment protocol. Several modifications were introduced over the past years. For a long time, regional analgesia such as paravertebral nerve blocks or catheters, epidurals as well as patient-controlled analgesia (PCA) represented the preferred anesthesia method. Nowadays, cryoablation became a more and more applied alternative technique (\cite{pmid33853733,pmid32753276}).=20 Cryoablation may be applied thoracoscopically during MIRPE (\cite{pmid31600804}), or a= s ultrasound guided percutaneous intercostal injection=20 (\cite{pmid31199434}). After its introduction, MIRPE was well established in the first decade of this century and subsequently performed with increasing frequency worldwide. Today, MIRPE represents the worldwide used =E2=80=9Cgold-standard=E2=80=9D for surgical repair of PE. Applying the technique in different age groups, the method experienced numerous modifications. Modifications include patient selection and indication, preoperative evaluation, as well as age at time of surgical repair. Positioning of the patient on the OR table, intubation (single lumen vs. double lumen tubus) were modified. Number, location and size of skin incisions, shape/size or number of bars and bar fixation as well as bar passage (intra vs. extrapleural placement) were modified (\cite{pmid29672193}). To reduce the risk of secondary bar displacement and/or to correct complex CWDs, placement of more than 1 bar including the so called cross-bar technique was introduced (\cite{pmid28822540}). Two fundamental techniques were introduced to reduce the risk of intraoperative cardiac injuries: routine unilateral and/or bilateral thoracoscopy (\cite{pmid25814003}), and routine sternal elevation (\cite{pmid18582824,pmid11877663}). Whereas in the initial=20 publication by Nuss retrosternal dissection was described as =E2=80=9Cblunt=E2=80=9D usi= ng a long-curved clamp without thoracoscopy (4), the same group reported their experience using routine thoracoscopy 4 years later, achieving improved safety during mediastinal dissection (\cite{pmid10803339}). In particular the risk of cardiac=20 perforation as the most severe complication could be decreased with the routine use of thoracoscopic guidance (\cite{pmid9574749}). Even more than 2 decades after its introduction there is no evidence-based data available concerning the protective effect of thoracoscopy on the true incidence of near fatal complications like cardiac injuries. However, the majority of articles and studies reporting on catastrophic complications were all published before 2011 (5). Furthermore, the widespread use of routine intraoperative sternal elevation must be considered as an additional effective measure to improve safety of MIRPE (13). Visualization across the mediastinum during retrosternal dissection may be compromised in severe defects. Notably in older adult PE patients, decreased flexibility and stiffness of the anterior chest wall as well as the corresponding force required to elevate the sternum may make retrosternal dissection difficult and sometimes nearby impossible. Applying routine sternal elevation during MIRPE, the safety of the procedure has improved clearly as there was no near-fatal and/or fatal incident reported anymore when the technique was applied intraoperatively (13). Evolution in the management of congenital CWD and modifications of newly introduced techniques have made significant progress over the past 2=E2=80=933 decades, and as a consequence patients outcome improved substantially. The aim of the narrative review presented by Scalise and Demehri (\cite{pmid18582824}) is to outline current practice concerning diagnostic work-up, conservative and surgical treatment as well as management in general of pediatric PE patients. Since we may find numerous publications dealing with this topic, it is nearby impossible to review all the literature, covering all different age groups. In particular no randomized double-blind studies are available. Therefore, the quality of evidence regarding this topic remains relatively low with still many unexplored and unknown pathways. Different objective criteria were screened, verified and added to identify PE patients that would benefit from surgery. An increasing number of studies accentuating the cardiopulmonary consequences of PE. Notably, more than 275 papers have been published in the last 10 years focusing on functional changes prior to and after surgical correction of PE. Due to different reasons (e.g., retrospective and/or small cohort studies), the results are still heterogenous and of low evidential quality (\cite{pmid18582824}). Based on this generally= =20 poor evidence, the controversial debate on the cardiopulmonary impact of PE and whether patients may benefit from surgical repair or not will continue as long as we may be able to provide double blind randomized studies. However, IRB approval for such a study has to be considered as difficult or nearby impossible. This is aggravated by the fact that PE is many times considered as an =E2=80=9Conly=E2=80=9D esthet= ic disorder and in particular associated with body image disturbances. In contrast, among surgeons and confirmed by recently published studies it is clearly acknowledged that subjective improvement in exercise intolerance is often reported after MIRPE (\cite{pmid18582824}). Thus, despite above mentioned facts as well as current believes, reviews such as presented by Scalise and Demehri may help to bridge the lack of convincing high-quality evidence which remains a critical concern that could potentially interfere with future management of PE. As concluded by Scalise and Demehri in their narrative review, there is still a lack of international consensus guidelines concerning preoperative diagnostic work-up, conservative and surgical treatment as well as postoperative management. A recently published study by Janssen et al. reported on a consensus statement for perioperative care for PE based on a multi-round Delphi survey (\cite{pmid18582824}). Pectus surgeons all around the world are encouraged to draw up standardized consensus guidelines to establish a high-level algorithm for preoperative diagnostic protocol, indications for conservative and/or surgical treatment as well as postoperative management. } \amesection{Acknowledgments} Funding: None. \amesection{Footnot} \textit{Provenance and Peer Review:} This article was commissioned by the editorial office, Translational Pediatrics. The article did not undergo external peer review. \vspace{1ex} \textit{Conflicts of Interest: }The author has completed the ICMJE uniform disclosure form (available at \url{https://tp.amegroups. com/article/view/10.21037/tp-23-264/coif} ). The author has no conflicts of interest to declare. \vspace{2ex} \textit{Ethical Statement:} The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. \vspace{2ex} \textit{Open Access Statement:} This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non- commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:=20 \href{https://creativecommons.org/licenses/by-nc-nd/4.0}{https://creativeco= mmons.org/licenses/by-nc-nd/4.0} Let's cite! Einstein's journal paper and Dirac's book \cite{dirac} are=20 physics-related items. \titleformat{\section} {\color{sectiontitlecolor}\normalfont\Large\bfseries} {\thesection}{1em}{} \bibliographystyle{unsrt} \bibliography{main} %=20 \cite{pmid18582824,pmid10803339,pmid9574749,pmid35455522,pmid31600804,pmid2= 9672193,pmid33853733,pmid34942673,pmid35820596,pmid25814003,pmid31199434,pm= id32753276,pmid11877663,pmid28822540,pmid36891368,pmid35377161} % =E5=9C=A8=E6=96=87=E4=B8=AD=E6=8F=92=E5=85=A5=E5=BC=95=E7=94=A8=E4= =BF=A1=E6=81=AF \noindent\colorbox{cite}{ % \begin{minipage}{\dimexpr\textwidth-2\fboxsep} %=E5=8D=95=E6=A0=8F=E6= =A8=A1=E5=BC=8F \begin{minipage}{\dimexpr0.5\textwidth-2\fboxsep} \setlength{\parskip}{0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E9= =97=B4=E8=B7=9D \setlength{\parindent}{0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E7= =BC=A9=E8=BF=9B Cite this article as: Haecker FM. Evolution in the management of=20 pectus excavatum in pediatric patients. Transl Pediatr=20 2023;12(8):1450-1453. doi: 10.21037/tp-23-264 \end{minipage}} \end{multicols}' at main.tex line 157 column 22

https://dx.doi.org/10.21037/tp-23-264

root@983a0296ac13:/usr/src/app/server/files/0976f9f8-c926-4d7b-afc2-ea95fbc= 7d486/store#=20 pandoc -f latex -t jats_archiving main.tex=20 --resource-path=3D/usr/src/app/server/files/0976f9f8-c926-4d7b-afc2-ea95fbc= 7d486/store=20 --verbose [INFO] Could not load include file extsizes.sty at template.tex line 1=20 column 28 [INFO] Could not load include file multicol.sty at template.tex line 3=20 column 22 [INFO] Could not load include file amsmath.sty at template.tex line 4=20 column 21 [INFO] Could not load include file color.sty at template.tex line 6 column= =20 19 [INFO] Could not load include file xcolor.sty at template.tex line 7 column= =20 22 [INFO] Could not load include file hyperref.sty at template.tex line 8=20 column 62 [INFO] Could not load include file titlesec.sty at template.tex line 10=20 column 22 [INFO] Could not load include file authblk.sty at template.tex line 11=20 column 21 [INFO] Skipped '\definecolor{sectiontitlecolor}{rgb}{0.2,0.4,0.8}' at=20 template.tex line 14 column 50 [INFO] Skipped '\definecolor{editorial}{rgb}{0.08,0.28,0.53}' at=20 template.tex line 15 column 45 [INFO] Skipped '\definecolor{cite}{rgb}{0.98,0.9,0.8}' at template.tex line= =20 16 column 38 [INFO] Could not load include file url.sty at template.tex line 19 column 1= 7 [INFO] Could not load include file lipsum.sty at template.tex line 23=20 column 20 [INFO] Could not load include file geometry.sty at template.tex line 25=20 column 63 [INFO] Skipped '\NeedsTeXFormat{LaTeX2e}' at template.tex line 28 column 25 [INFO] Could not load include file fancyhdr.sty at main.tex line 9 column 2= 3 [INFO] Skipped '\pagestyle{fancy}' at main.tex line 12 column 18 [INFO] Skipped '\fancyhf{}' at main.tex line 15 column 11 [INFO] Skipped '\fancyhead[L]{\textbf{Translational Pediatrics, Vol 12, No= =20 8 August 2023 }}' at main.tex line 18 column 76 [INFO] Skipped '\setcounter{page}{1450}' at main.tex line 23 column 24 [INFO] Skipped '\fancyhead[R]{\textbf{\thepage}}' at main.tex line 25=20 column 33 [INFO] Skipped '\fancyfoot[L]{=C2=A9 Translational Pediatrics. All rights= =20 reserved. }' at main.tex line 33 column 65 [INFO] Skipped '\fancyfoot[R]{Transl Pediatr 2023;12(8):1450-1453 |=20 https://dx.doi.org/10.21037/tp-23-264 }' at main.tex line 34 column 92 [INFO] Skipped '\thispagestyle{empty}' at main.tex line 40 column 22 [INFO] Skipped '\makeatletter' at main.tex line 43 column 14 [INFO] Skipped '\makeatother' at main.tex line 45 column 13 [INFO] Skipped '\makeatletter' at main.tex line 47 column 14 [INFO] Skipped '\noindent' at main.tex line 102 column 14 [INFO] Skipped '\makebox[0.3\linewidth][l]{% \setlength{\parskip}{1em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E9= =97=B4=E8=B7=9D \setlength{\parindent}{1em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E7= =BC=A9=E8=BF=9B \textcolor{white}{Editorial} }' at main.tex line 106 column 6 [INFO] Skipped '\bgroup' at main.tex line 129 column 5 [INFO] Skipped '\setlength{\parindent}{0pt}' at main.tex line 129 column 5 [INFO] Skipped '\LARGE' at main.tex line 129 column 5 [INFO] Skipped '\LARGE' at main.tex line 129 column 5 [INFO] Skipped '\@title' at main.tex line 129 column 5 [INFO] Skipped '\begin{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\end{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\@author' at main.tex line 129 column 5 [INFO] Skipped '\begin{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\end{flushleft}' at main.tex line 129 column 5 [INFO] Skipped '\vspace{2ex}' at main.tex line 134 column 17 [INFO] Skipped '\noindent{\textit{Correspondence to:} Frank-Martin Haecker,= =20 MD, Professor of Pediatric Surgery. Chest Wall Unit at the Department of=20 Pediatric Surgery, Children=E2=80=99s Hospital of Eastern Switzerland, Claudiusstrasse 6, CH-9006 St. Gallen,= =20 Switzerland. Email: frank-martin.haecker-kpaEHHRHYO5yDzI6CaY1VQ@public.gmane.org}' at main.tex line 140= =20 column 125 [INFO] Skipped '\noindent{\textit{Comment on}: Scalise PN, Demehri FR. The= =20 management of pectus excavatum in pediatric patients: a narrative review.= =20 Transl Pediatr 2023;12:208-20.}' at main.tex line 142 column 149 [INFO] Skipped '\vspace{2ex}' at main.tex line 144 column 17 [INFO] Skipped '\noindent{\textbf{\textcolor[RGB]{21,72,135}{Keywords:}}=20 Pectus excavatum; pediatric patients; Nuss procedure; vacuum bell;=20 cryoablation}' at main.tex line 145 column 95 [INFO] Skipped '\vspace{2ex}' at main.tex line 147 column 17 [INFO] Skipped '\noindent{Submitted Apr 26, 2023. Accepted for publication= =20 Jul 19, 2023. Published online Jul 28, 2023}' at main.tex line 149 column 9= 9 [INFO] Skipped '\noindent{doi: 10.21037/tp-23-264}' at main.tex line 151=20 column 29 [INFO] Skipped '\noindent{\textbf{View this article at: }}' at main.tex=20 line 153 column 5 [INFO] Skipped '\vspace{4ex}' at main.tex line 155 column 17 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\indent ' at main.tex line 159 column 13 [INFO] Skipped '\vspace{2ex}' at main.tex line 312 column 4 [INFO] Skipped '\noindent' at main.tex line 312 column 4 [INFO] Skipped '\normalfont' at main.tex line 312 column 4 [INFO] Skipped '\Large' at main.tex line 312 column 4 [INFO] Skipped '\vspace{2ex}' at main.tex line 312 column 4 [INFO] Skipped '\vspace{2ex}' at main.tex line 316 column 4 [INFO] Skipped '\noindent' at main.tex line 316 column 4 [INFO] Skipped '\normalfont' at main.tex line 316 column 4 [INFO] Skipped '\Large' at main.tex line 316 column 4 [INFO] Skipped '\vspace{2ex}' at main.tex line 316 column 4 [INFO] Skipped '\vspace{1ex}' at main.tex line 322 column 17 [INFO] Skipped '\vspace{2ex}' at main.tex line 329 column 17 [INFO] Skipped '\vspace{2ex}' at main.tex line 336 column 17 [INFO] Skipped '\begin{multicols}{2} { \indent The majority of congenital chest wall deformities (CWD) affects the anterior chest wall. The most common anterior CWD is pectus excavatum (PE), followed by Pectus carinatum (PC). The incidence of PE is approximately 1 in every 300=E2=80=93400 births, affecting male patients with an approx. 4:1 ratio (\cite{pmid36891368}). For the last 70 to 80 years,= =20 open surgical repair such as the Ravitch technique and its modifications (\cite{pmid35820596,pmid35455522}) was the preferred method= =20 to correct CWDs. An essential paradigm shift occurred with the inauguration of the minimally invasive repair of pectus excavatum (MIRPE) by Nuss (\cite{pmid35377161}). In contrast to open repair, MIRPE does not require cartilage or sternal resection. Flexibility and elasticity of the chest wall which are preserved applying MIRPE, were identified as relevant parameters for successful treatment of CWD. Furthermore, an increasing number of patients presented with thoracic chondrodystrophy as a long-term side effect after open surgical repair. As a consequence, the management of CWD including diagnostic work-up as well as conservative and surgical treatment options has made substantial progress during the past two decades. Today, treatment of CWD includes all age groups with pediatric, adolescent and adult patients, covered by a dedicated multidisciplinary team (in particular pediatric and thoracic surgeons) based in a specialized chest wall unit, what is the most important pillar of present time. The physiologic effects of CWD are still discussed controversially. There is an ongoing controversial debate concerning effects of MIRPE on exercise tolerance, lack of endurance, shortness of breath, cardiopulmonary function, body posture, etc. Even if the number of articles reporting on different aspects of CWD treatment went up from approximately 300 (1980 to 1989) to more than 1,000 published papers (2012 to 2021), the controversial debate will continue (\cite{pmid34942673}). Information on new diagnostic and therapeutic modalities provided by online platforms and social media circulates not only among surgeons and paediatricians, but also rapidly among patients. Not only different surgical techniques, but also conservative treatment options are available. In almost the same manner, postoperative pain management is an important part of an effective and successful treatment protocol. Several modifications were introduced over the past years. For a long time, regional analgesia such as paravertebral nerve blocks or catheters, epidurals as well as patient-controlled analgesia (PCA) represented the preferred anesthesia method. Nowadays, cryoablation became a more and more applied alternative technique (\cite{pmid33853733,pmid32753276}).=20 Cryoablation may be applied thoracoscopically during MIRPE (\cite{pmid31600804}), or a= s ultrasound guided percutaneous intercostal injection=20 (\cite{pmid31199434}). After its introduction, MIRPE was well established in the first decade of this century and subsequently performed with increasing frequency worldwide. Today, MIRPE represents the worldwide used =E2=80=9Cgold-standard=E2=80=9D for surgical repair of PE. Applying the technique in different age groups, the method experienced numerous modifications. Modifications include patient selection and indication, preoperative evaluation, as well as age at time of surgical repair. Positioning of the patient on the OR table, intubation (single lumen vs. double lumen tubus) were modified. Number, location and size of skin incisions, shape/size or number of bars and bar fixation as well as bar passage (intra vs. extrapleural placement) were modified (\cite{pmid29672193}). To reduce the risk of secondary bar displacement and/or to correct complex CWDs, placement of more than 1 bar including the so called cross-bar technique was introduced (\cite{pmid28822540}). Two fundamental techniques were introduced to reduce the risk of intraoperative cardiac injuries: routine unilateral and/or bilateral thoracoscopy (\cite{pmid25814003}), and routine sternal elevation (\cite{pmid18582824,pmid11877663}). Whereas in the initial=20 publication by Nuss retrosternal dissection was described as =E2=80=9Cblunt=E2=80=9D usi= ng a long-curved clamp without thoracoscopy (4), the same group reported their experience using routine thoracoscopy 4 years later, achieving improved safety during mediastinal dissection (\cite{pmid10803339}). In particular the risk of cardiac=20 perforation as the most severe complication could be decreased with the routine use of thoracoscopic guidance (\cite{pmid9574749}). Even more than 2 decades after its introduction there is no evidence-based data available concerning the protective effect of thoracoscopy on the true incidence of near fatal complications like cardiac injuries. However, the majority of articles and studies reporting on catastrophic complications were all published before 2011 (5). Furthermore, the widespread use of routine intraoperative sternal elevation must be considered as an additional effective measure to improve safety of MIRPE (13). Visualization across the mediastinum during retrosternal dissection may be compromised in severe defects. Notably in older adult PE patients, decreased flexibility and stiffness of the anterior chest wall as well as the corresponding force required to elevate the sternum may make retrosternal dissection difficult and sometimes nearby impossible. Applying routine sternal elevation during MIRPE, the safety of the procedure has improved clearly as there was no near-fatal and/or fatal incident reported anymore when the technique was applied intraoperatively (13). Evolution in the management of congenital CWD and modifications of newly introduced techniques have made significant progress over the past 2=E2=80=933 decades, and as a consequence patients outcome improved substantially. The aim of the narrative review presented by Scalise and Demehri (\cite{pmid18582824}) is to outline current practice concerning diagnostic work-up, conservative and surgical treatment as well as management in general of pediatric PE patients. Since we may find numerous publications dealing with this topic, it is nearby impossible to review all the literature, covering all different age groups. In particular no randomized double-blind studies are available. Therefore, the quality of evidence regarding this topic remains relatively low with still many unexplored and unknown pathways. Different objective criteria were screened, verified and added to identify PE patients that would benefit from surgery. An increasing number of studies accentuating the cardiopulmonary consequences of PE. Notably, more than 275 papers have been published in the last 10 years focusing on functional changes prior to and after surgical correction of PE. Due to different reasons (e.g., retrospective and/or small cohort studies), the results are still heterogenous and of low evidential quality (\cite{pmid18582824}). Based on this generally= =20 poor evidence, the controversial debate on the cardiopulmonary impact of PE and whether patients may benefit from surgical repair or not will continue as long as we may be able to provide double blind randomized studies. However, IRB approval for such a study has to be considered as difficult or nearby impossible. This is aggravated by the fact that PE is many times considered as an =E2=80=9Conly=E2=80=9D esthet= ic disorder and in particular associated with body image disturbances. In contrast, among surgeons and confirmed by recently published studies it is clearly acknowledged that subjective improvement in exercise intolerance is often reported after MIRPE (\cite{pmid18582824}). Thus, despite above mentioned facts as well as current believes, reviews such as presented by Scalise and Demehri may help to bridge the lack of convincing high-quality evidence which remains a critical concern that could potentially interfere with future management of PE. As concluded by Scalise and Demehri in their narrative review, there is still a lack of international consensus guidelines concerning preoperative diagnostic work-up, conservative and surgical treatment as well as postoperative management. A recently published study by Janssen et al. reported on a consensus statement for perioperative care for PE based on a multi-round Delphi survey (\cite{pmid18582824}). Pectus surgeons all around the world are encouraged to draw up standardized consensus guidelines to establish a high-level algorithm for preoperative diagnostic protocol, indications for conservative and/or surgical treatment as well as postoperative management. } \amesection{Acknowledgments} Funding: None. \amesection{Footnot} \textit{Provenance and Peer Review:} This article was commissioned by the editorial office, Translational Pediatrics. The article did not undergo external peer review. \vspace{1ex} \textit{Conflicts of Interest: }The author has completed the ICMJE uniform disclosure form (available at \url{https://tp.amegroups. com/article/view/10.21037/tp-23-264/coif} ). The author has no conflicts of interest to declare. \vspace{2ex} \textit{Ethical Statement:} The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. \vspace{2ex} \textit{Open Access Statement:} This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non- commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:=20 \href{https://creativecommons.org/licenses/by-nc-nd/4.0}{https://creativeco= mmons.org/licenses/by-nc-nd/4.0} Let's cite! Einstein's journal paper and Dirac's book \cite{dirac} are=20 physics-related items. \titleformat{\section} {\color{sectiontitlecolor}\normalfont\Large\bfseries} {\thesection}{1em}{} \bibliographystyle{unsrt} \bibliography{main} %=20 \cite{pmid18582824,pmid10803339,pmid9574749,pmid35455522,pmid31600804,pmid2= 9672193,pmid33853733,pmid34942673,pmid35820596,pmid25814003,pmid31199434,pm= id32753276,pmid11877663,pmid28822540,pmid36891368,pmid35377161} % =E5=9C=A8=E6=96=87=E4=B8=AD=E6=8F=92=E5=85=A5=E5=BC=95=E7=94=A8=E4= =BF=A1=E6=81=AF \noindent\colorbox{cite}{ % \begin{minipage}{\dimexpr\textwidth-2\fboxsep} %=E5=8D=95=E6=A0=8F=E6= =A8=A1=E5=BC=8F \begin{minipage}{\dimexpr0.5\textwidth-2\fboxsep} \setlength{\parskip}{0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E9= =97=B4=E8=B7=9D \setlength{\parindent}{0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E7= =BC=A9=E8=BF=9B Cite this article as: Haecker FM. Evolution in the management of=20 pectus excavatum in pediatric patients. Transl Pediatr=20 2023;12(8):1450-1453. doi: 10.21037/tp-23-264 \end{minipage}} \end{multicols}' at main.tex line 157 column 22

https://dx.doi.org/10.21037/tp-23-264

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[INFO] Skipped '\noindent{\textit{C= orrespondence to:} Frank-Martin Haecker, MD, Professor of Pediatric Surgery= . Chest Wall Unit at the Department of Pediatric Surgery, Children=E2=80=99= s
=C2=A0 Hospital of Eastern Switzerland, Claudiusstrasse 6, CH-9006 S= t. Gallen, Switzerland. Email: frank-martin.haecker-kpaEHHRHYO5yDzI6CaY1VQ@public.gmane.org}' at main.te= x line 140 column 125
[INFO] Skipped '\noindent{\textit{Comment on}: S= calise PN, Demehri FR. The management of pectus excavatum in pediatric pati= ents: a narrative review. Transl Pediatr 2023;12:208-20.}' at main.tex line= 142 column 149
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[INFO] Skipped '\noindent{\textbf{\textcolor[RGB]{21,72,135}{Ke= ywords:}} Pectus excavatum; pediatric patients; Nuss procedure; vacuum bell= ; cryoablation}' at main.tex line 145 column 95
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[INFO] Skipped '\noindent{Submi= tted Apr 26, 2023. Accepted for publication Jul 19, 2023. Published online = Jul 28, 2023}' at main.tex line 149 column 99
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=C2=A0 = =C2=A0 =C2=A0 {
=C2=A0 =C2=A0 =C2=A0 \indent The majority of congenita= l chest wall deformities (CWD)
=C2=A0 affects the anterior chest wall.= The most common anterior
=C2=A0 CWD is pectus excavatum (PE), followe= d by Pectus
=C2=A0 carinatum (PC). The incidence of PE is approximatel= y
=C2=A0 1 in every 300=E2=80=93400 births, affecting male patients wi= th
=C2=A0 an approx. 4:1 ratio (\cite{pmid36891368}). For the last 70 = to 80 years, open
=C2=A0 surgical repair such as the Ravitch technique= and its
=C2=A0 modifications (\cite{pmid35820596,pmid35455522}) was t= he preferred method to correct
=C2=A0 CWDs. An essential paradigm shif= t occurred with the
=C2=A0 inauguration of the minimally invasive repa= ir of pectus
=C2=A0 excavatum (MIRPE) by Nuss (\cite{pmid35377161}). I= n contrast to open
=C2=A0 repair, MIRPE does not require cartilage or = sternal
=C2=A0 resection. Flexibility and elasticity of the chest wall= which
=C2=A0 are preserved applying MIRPE, were identified as relevan= t
=C2=A0 parameters for successful treatment of CWD. Furthermore,
=C2=A0 an increasing number of patients presented with thoracic
=C2= =A0 chondrodystrophy as a long-term side effect after open
=C2=A0 surg= ical repair. As a consequence, the management of CWD
=C2=A0 including = diagnostic work-up as well as conservative and
=C2=A0 surgical treatme= nt options has made substantial progress
=C2=A0 during the past two de= cades. Today, treatment of CWD
=C2=A0 includes all age groups with ped= iatric, adolescent and adult
=C2=A0 patients, covered by a dedicated m= ultidisciplinary team
=C2=A0 (in particular pediatric and thoracic sur= geons) based in a
=C2=A0 specialized chest wall unit, what is the most= important pillar
=C2=A0 of present time.
=C2=A0 The physiologic = effects of CWD are still discussed
=C2=A0 controversially. There is an= ongoing controversial debate
=C2=A0 concerning effects of MIRPE on ex= ercise tolerance, lack
=C2=A0 of endurance, shortness of breath, cardi= opulmonary
=C2=A0 function, body posture, etc. Even if the number of a= rticles
=C2=A0 reporting on different aspects of CWD treatment went=C2=A0 up from approximately 300 (1980 to 1989) to more than
=C2=A0= 1,000 published papers (2012 to 2021), the controversial
=C2=A0 debat= e will continue (\cite{pmid34942673}). Information on new diagnostic
= =C2=A0 and therapeutic modalities provided by online platforms
=C2=A0 = and social media circulates not only among surgeons
=C2=A0 and paediat= ricians, but also rapidly among patients. Not
=C2=A0 only different su= rgical techniques, but also conservative
=C2=A0 treatment options are = available. In almost the same manner,
=C2=A0 postoperative pain manage= ment is an important part of
=C2=A0 an effective and successful treatm= ent protocol. Several
=C2=A0 modifications were introduced over the pa= st years. For a
=C2=A0 long time, regional analgesia such as paraverte= bral nerve
=C2=A0 blocks or catheters, epidurals as well as patient-co= ntrolled
=C2=A0 analgesia (PCA) represented the preferred anesthesia=C2=A0 method. Nowadays, cryoablation became a more and
=C2=A0 mor= e applied alternative technique (\cite{pmid33853733,pmid32753276}). Cryoabl= ation
=C2=A0 may be applied thoracoscopically during MIRPE (\cite{pmid= 31600804}), or as
=C2=A0 ultrasound guided percutaneous intercostal in= jection (\cite{pmid31199434}).
=C2=A0 After its introduction, MIRPE wa= s well established
=C2=A0 in the first decade of this century and subs= equently
=C2=A0 performed with increasing frequency worldwide. Today,<= br />=C2=A0 MIRPE represents the worldwide used =E2=80=9Cgold-standard=E2= =80=9D
=C2=A0 for surgical repair of PE. Applying the technique in
=C2=A0 different age groups, the method experienced numerous
=C2=A0 = modifications. Modifications include patient selection
=C2=A0 and indi= cation, preoperative evaluation, as well as age
=C2=A0 at time of surg= ical repair. Positioning of the patient on
=C2=A0 the OR table, intuba= tion (single lumen vs. double lumen
=C2=A0 tubus) were modified. Numbe= r, location and size of skin
=C2=A0 incisions, shape/size or number of= bars and bar fixation as
=C2=A0 well as bar passage (intra vs. extrap= leural placement) were
=C2=A0 modified (\cite{pmid29672193}). To reduc= e the risk of secondary bar
=C2=A0 displacement and/or to correct comp= lex CWDs, placement
=C2=A0 of more than 1 bar including the so called = cross-bar
=C2=A0 technique was introduced (\cite{pmid28822540}).
=
=C2=A0 Two fundamental techniques were introduced to reduce
=C2= =A0 the risk of intraoperative cardiac injuries: routine unilateral
= =C2=A0 and/or bilateral thoracoscopy (\cite{pmid25814003}), and routine ste= rnal
=C2=A0 elevation (\cite{pmid18582824,pmid11877663}). Whereas in t= he initial publication by
=C2=A0 Nuss retrosternal dissection was desc= ribed as =E2=80=9Cblunt=E2=80=9D using
=C2=A0 a long-curved clamp with= out thoracoscopy (4), the same
=C2=A0 group reported their experience = using routine thoracoscopy
=C2=A0 4 years later, achieving improved sa= fety during mediastinal
=C2=A0 dissection (\cite{pmid10803339}). In pa= rticular the risk of cardiac perforation
=C2=A0 as the most severe com= plication could be decreased with
=C2=A0 the routine use of thoracosco= pic guidance (\cite{pmid9574749}). Even
=C2=A0 more than 2 decades aft= er its introduction there is no
=C2=A0 evidence-based data available c= oncerning the protective
=C2=A0 effect of thoracoscopy on the true inc= idence of near fatal
=C2=A0 complications like cardiac injuries. Howev= er, the majority of
=C2=A0 articles and studies reporting on catastrop= hic complications
=C2=A0 were all published before 2011 (5). Furthermo= re, the
=C2=A0 widespread use of routine intraoperative sternal elevat= ion
=C2=A0 must be considered as an additional effective measure
= =C2=A0 to improve safety of MIRPE (13).

=C2=A0 Visualization acr= oss
=C2=A0 the mediastinum during retrosternal dissection may be
= =C2=A0 compromised in severe defects. Notably in older adult PE
=C2=A0= patients, decreased flexibility and stiffness of the anterior
=C2=A0 = chest wall as well as the corresponding force required
=C2=A0 to eleva= te the sternum may make retrosternal dissection
=C2=A0 difficult and s= ometimes nearby impossible. Applying routine
=C2=A0 sternal elevation = during MIRPE, the safety of the procedure
=C2=A0 has improved clearly = as there was no near-fatal and/or fatal
=C2=A0 incident reported anymo= re when the technique was applied
=C2=A0 intraoperatively (13).
= =C2=A0 Evolution in the management of congenital CWD and
=C2=A0 modifi= cations of newly introduced techniques have made
=C2=A0 significant pr= ogress over the past 2=E2=80=933 decades, and as a
=C2=A0 consequence = patients outcome improved substantially.
=C2=A0 The aim of the narrati= ve review presented by Scalise and
=C2=A0 Demehri (\cite{pmid18582824}= ) is to outline current practice concerning
=C2=A0 diagnostic work-up,= conservative and surgical treatment
=C2=A0 as well as management in g= eneral of pediatric PE patients.
=C2=A0 Since we may find numerous pub= lications dealing with this
=C2=A0 topic, it is nearby impossible to r= eview all the literature,
=C2=A0 covering all different age groups. In= particular no
=C2=A0 randomized double-blind studies are available. T= herefore,
=C2=A0 the quality of evidence regarding this topic remains<= br />=C2=A0 relatively low with still many unexplored and unknown
=C2= =A0 pathways. Different objective criteria were screened, verified
=C2= =A0 and added to identify PE patients that would benefit from
=C2=A0 s= urgery. An increasing number of studies accentuating the
=C2=A0 cardio= pulmonary consequences of PE. Notably, more than
=C2=A0 275 papers hav= e been published in the last 10 years focusing
=C2=A0 on functional ch= anges prior to and after surgical correction
=C2=A0 of PE. Due to diff= erent reasons (e.g., retrospective and/or
=C2=A0 small cohort studies)= , the results are still heterogenous and
=C2=A0 of low evidential qual= ity (\cite{pmid18582824}). Based on this generally poor
=C2=A0 evidenc= e, the controversial debate on the cardiopulmonary
=C2=A0 impact of PE= and whether patients may benefit from
=C2=A0 surgical repair or not w= ill continue as long as we may be
=C2=A0 able to provide double blind = randomized studies. However,
=C2=A0 IRB approval for such a study has = to be considered as
=C2=A0 difficult or nearby impossible. This is agg= ravated by the
=C2=A0 fact that PE is many times considered as an =E2= =80=9Conly=E2=80=9D esthetic
=C2=A0 disorder and in particular associa= ted with body image
=C2=A0 disturbances. In contrast, among surgeons a= nd confirmed
=C2=A0 by recently published studies it is clearly acknow= ledged
=C2=A0 that subjective improvement in exercise intolerance is=C2=A0 often reported after MIRPE (\cite{pmid18582824}). Thus, despite = above
=C2=A0 mentioned facts as well as current believes, reviews such= as
=C2=A0 presented by Scalise and Demehri may help to bridge the
=C2=A0 lack of convincing high-quality evidence which remains a
=C2= =A0 critical concern that could potentially interfere with future
=C2= =A0 management of PE. As concluded by Scalise and Demehri
=C2=A0 in th= eir narrative review, there is still a lack of international
=C2=A0 co= nsensus guidelines concerning preoperative diagnostic
=C2=A0 work-up, = conservative and surgical treatment as well as
=C2=A0 postoperative ma= nagement. A recently published study
=C2=A0 by Janssen et al. reported= on a consensus statement for
=C2=A0 perioperative care for PE based o= n a multi-round Delphi
=C2=A0 survey (\cite{pmid18582824}). Pectus sur= geons all around the world are
=C2=A0 encouraged to draw up standardiz= ed consensus guidelines to
=C2=A0 establish a high-level algorithm for= preoperative diagnostic
=C2=A0 protocol, indications for conservative= and/or surgical
=C2=A0 treatment as well as postoperative management.=
=C2=A0 =C2=A0 =C2=A0 }

=C2=A0 =C2=A0 =C2=A0\amesection{Ack= nowledgments}

=C2=A0 =C2=A0 =C2=A0Funding: None.

=C2= =A0 =C2=A0 =C2=A0\amesection{Footnot}

=C2=A0 =C2=A0 =C2=A0\texti= t{Provenance and Peer Review:} This article was commissioned
=C2=A0 by= the editorial office, Translational Pediatrics. The article
=C2=A0 di= d not undergo external peer review.

=C2=A0 =C2=A0 =C2=A0 \vspace= {1ex}

=C2=A0 =C2=A0 =C2=A0 \textit{Conflicts of Interest: }The a= uthor has completed the ICMJE
=C2=A0 =C2=A0 =C2=A0 uniform disclosure = form (available at \url{https://tp.amegroups.
=C2=A0 =C2=A0 =C2=A0 com= /article/view/10.21037/tp-23-264/coif} ). The author has
=C2=A0 =C2=A0= =C2=A0 no conflicts of interest to declare.

=C2=A0 =C2=A0 =C2= =A0 \vspace{2ex}

=C2=A0 =C2=A0 =C2=A0 \textit{Ethical Statement:= } The author is accountable for all
=C2=A0 aspects of the work in ensu= ring that questions related
=C2=A0 to the accuracy or integrity of any= part of the work are
=C2=A0 appropriately investigated and resolved.<= br />
=C2=A0 =C2=A0 =C2=A0 \vspace{2ex}

=C2=A0 =C2=A0 =C2= =A0 \textit{Open Access Statement:} This is an Open Access article
=C2= =A0 distributed in accordance with the Creative Commons
=C2=A0 Attribu= tion-NonCommercial-NoDerivs 4.0 International
=C2=A0 License (CC BY-NC= -ND 4.0), which permits the non-
=C2=A0 commercial replication and dis= tribution of the article with
=C2=A0 the strict proviso that no change= s or edits are made and the
=C2=A0 original work is properly cited (in= cluding links to both the
=C2=A0 formal publication through the releva= nt DOI and the license).
=C2=A0 See: \href{https://creativecommons.org= /licenses/by-nc-nd/4.0}{https://creativecommons.org/licenses/by-nc-nd/4.0}<= br />
=C2=A0 Let's cite! Einstein's journal paper and Dirac's book \ci= te{dirac} are physics-related items.


=C2=A0 =C2=A0 =C2=A0 = \titleformat{\section}
=C2=A0 =C2=A0 =C2=A0 =C2=A0 {\color{sectiontitl= ecolor}\normalfont\Large\bfseries}
=C2=A0 =C2=A0 =C2=A0 =C2=A0 {\these= ction}{1em}{}

=C2=A0 =C2=A0 =C2=A0 \bibliographystyle{unsrt}
=C2=A0 =C2=A0 =C2=A0 \bibliography{main}




=C2= =A0 =C2=A0 =C2=A0 % \cite{pmid18582824,pmid10803339,pmid9574749,pmid3545552= 2,pmid31600804,pmid29672193,pmid33853733,pmid34942673,pmid35820596,pmid2581= 4003,pmid31199434,pmid32753276,pmid11877663,pmid28822540,pmid36891368,pmid3= 5377161}

=C2=A0 =C2=A0 =C2=A0 % =E5=9C=A8=E6=96=87=E4=B8=AD=E6= =8F=92=E5=85=A5=E5=BC=95=E7=94=A8=E4=BF=A1=E6=81=AF
=C2=A0 \noindent\c= olorbox{cite}{
=C2=A0 % \begin{minipage}{\dimexpr\textwidth-2\fboxsep}= %=E5=8D=95=E6=A0=8F=E6=A8=A1=E5=BC=8F
=C2=A0 \begin{minipage}{\dimexp= r0.5\textwidth-2\fboxsep}
=C2=A0 =C2=A0 =C2=A0 \setlength{\parskip}{0e= m} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E9=97=B4=E8=B7=9D
=C2=A0 =C2= =A0 =C2=A0 \setlength{\parindent}{0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90= =BD=E7=BC=A9=E8=BF=9B
=C2=A0 =C2=A0 =C2=A0 Cite this article as: Haeck= er FM. Evolution in the management of pectus excavatum in pediatric patient= s. Transl Pediatr 2023;12(8):1450-1453. doi: 10.21037/tp-23-264

= =C2=A0 \end{minipage}}

=C2=A0 \end{multicols}' at main.tex line = 157 column 22
<p> <styled-content style=3D"background-color: = editorial">
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<p>https://dx.doi.org/= 10.21037/tp-23-264</p>
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[INFO] Skipped '\noinde= nt{\textit{Correspondence to:} Frank-Martin Haecker, MD, Professor of Pedia= tric Surgery. Chest Wall Unit at the Department of Pediatric Surgery, Child= ren=E2=80=99s
=C2=A0 Hospital of Eastern Switzerland, Claudiusstrasse = 6, CH-9006 St. Gallen, Switzerland. Email: frank-martin.haecker-kpaEHHRHYO5yDzI6CaY1VQ@public.gmane.org}= ' at main.tex line 140 column 125
[INFO] Skipped '\noindent{\textit{Co= mment on}: Scalise PN, Demehri FR. The management of pectus excavatum in pe= diatric patients: a narrative review. Transl Pediatr 2023;12:208-20.}' at m= ain.tex line 142 column 149
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[INFO] Skipped '\noindent{\textbf{\textcolor[RGB]{2= 1,72,135}{Keywords:}} Pectus excavatum; pediatric patients; Nuss procedure;= vacuum bell; cryoablation}' at main.tex line 145 column 95
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[INFO] Skipped '\no= indent{Submitted Apr 26, 2023. Accepted for publication Jul 19, 2023. Publi= shed online Jul 28, 2023}' at main.tex line 149 column 99
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[INFO] Skipped '\begin{multicols}{2}<= br />=C2=A0 =C2=A0 =C2=A0 {
=C2=A0 =C2=A0 =C2=A0 \indent The majority = of congenital chest wall deformities (CWD)
=C2=A0 affects the anterior= chest wall. The most common anterior
=C2=A0 CWD is pectus excavatum (= PE), followed by Pectus
=C2=A0 carinatum (PC). The incidence of PE is = approximately
=C2=A0 1 in every 300=E2=80=93400 births, affecting male= patients with
=C2=A0 an approx. 4:1 ratio (\cite{pmid36891368}). For = the last 70 to 80 years, open
=C2=A0 surgical repair such as the Ravit= ch technique and its
=C2=A0 modifications (\cite{pmid35820596,pmid3545= 5522}) was the preferred method to correct
=C2=A0 CWDs. An essential p= aradigm shift occurred with the
=C2=A0 inauguration of the minimally i= nvasive repair of pectus
=C2=A0 excavatum (MIRPE) by Nuss (\cite{pmid3= 5377161}). In contrast to open
=C2=A0 repair, MIRPE does not require c= artilage or sternal
=C2=A0 resection. Flexibility and elasticity of th= e chest wall which
=C2=A0 are preserved applying MIRPE, were identifie= d as relevant
=C2=A0 parameters for successful treatment of CWD. Furth= ermore,
=C2=A0 an increasing number of patients presented with thoraci= c
=C2=A0 chondrodystrophy as a long-term side effect after open
= =C2=A0 surgical repair. As a consequence, the management of CWD
=C2=A0= including diagnostic work-up as well as conservative and
=C2=A0 surgi= cal treatment options has made substantial progress
=C2=A0 during the = past two decades. Today, treatment of CWD
=C2=A0 includes all age grou= ps with pediatric, adolescent and adult
=C2=A0 patients, covered by a = dedicated multidisciplinary team
=C2=A0 (in particular pediatric and t= horacic surgeons) based in a
=C2=A0 specialized chest wall unit, what = is the most important pillar
=C2=A0 of present time.
=C2=A0 The p= hysiologic effects of CWD are still discussed
=C2=A0 controversially. = There is an ongoing controversial debate
=C2=A0 concerning effects of = MIRPE on exercise tolerance, lack
=C2=A0 of endurance, shortness of br= eath, cardiopulmonary
=C2=A0 function, body posture, etc. Even if the = number of articles
=C2=A0 reporting on different aspects of CWD treatm= ent went
=C2=A0 up from approximately 300 (1980 to 1989) to more than<= br />=C2=A0 1,000 published papers (2012 to 2021), the controversial
= =C2=A0 debate will continue (\cite{pmid34942673}). Information on new diagn= ostic
=C2=A0 and therapeutic modalities provided by online platforms=C2=A0 and social media circulates not only among surgeons
=C2=A0 = and paediatricians, but also rapidly among patients. Not
=C2=A0 only d= ifferent surgical techniques, but also conservative
=C2=A0 treatment o= ptions are available. In almost the same manner,
=C2=A0 postoperative = pain management is an important part of
=C2=A0 an effective and succes= sful treatment protocol. Several
=C2=A0 modifications were introduced = over the past years. For a
=C2=A0 long time, regional analgesia such a= s paravertebral nerve
=C2=A0 blocks or catheters, epidurals as well as= patient-controlled
=C2=A0 analgesia (PCA) represented the preferred a= nesthesia
=C2=A0 method. Nowadays, cryoablation became a more and
=C2=A0 more applied alternative technique (\cite{pmid33853733,pmid32753276= }). Cryoablation
=C2=A0 may be applied thoracoscopically during MIRPE = (\cite{pmid31600804}), or as
=C2=A0 ultrasound guided percutaneous int= ercostal injection (\cite{pmid31199434}).
=C2=A0 After its introductio= n, MIRPE was well established
=C2=A0 in the first decade of this centu= ry and subsequently
=C2=A0 performed with increasing frequency worldwi= de. Today,
=C2=A0 MIRPE represents the worldwide used =E2=80=9Cgold-st= andard=E2=80=9D
=C2=A0 for surgical repair of PE. Applying the techniq= ue in
=C2=A0 different age groups, the method experienced numerous
=C2=A0 modifications. Modifications include patient selection
=C2=A0= and indication, preoperative evaluation, as well as age
=C2=A0 at tim= e of surgical repair. Positioning of the patient on
=C2=A0 the OR tabl= e, intubation (single lumen vs. double lumen
=C2=A0 tubus) were modifi= ed. Number, location and size of skin
=C2=A0 incisions, shape/size or = number of bars and bar fixation as
=C2=A0 well as bar passage (intra v= s. extrapleural placement) were
=C2=A0 modified (\cite{pmid29672193}).= To reduce the risk of secondary bar
=C2=A0 displacement and/or to cor= rect complex CWDs, placement
=C2=A0 of more than 1 bar including the s= o called cross-bar
=C2=A0 technique was introduced (\cite{pmid28822540= }).

=C2=A0 Two fundamental techniques were introduced to reduce<= br />=C2=A0 the risk of intraoperative cardiac injuries: routine unilateral=
=C2=A0 and/or bilateral thoracoscopy (\cite{pmid25814003}), and routi= ne sternal
=C2=A0 elevation (\cite{pmid18582824,pmid11877663}). Wherea= s in the initial publication by
=C2=A0 Nuss retrosternal dissection wa= s described as =E2=80=9Cblunt=E2=80=9D using
=C2=A0 a long-curved clam= p without thoracoscopy (4), the same
=C2=A0 group reported their exper= ience using routine thoracoscopy
=C2=A0 4 years later, achieving impro= ved safety during mediastinal
=C2=A0 dissection (\cite{pmid10803339}).= In particular the risk of cardiac perforation
=C2=A0 as the most seve= re complication could be decreased with
=C2=A0 the routine use of thor= acoscopic guidance (\cite{pmid9574749}). Even
=C2=A0 more than 2 decad= es after its introduction there is no
=C2=A0 evidence-based data avail= able concerning the protective
=C2=A0 effect of thoracoscopy on the tr= ue incidence of near fatal
=C2=A0 complications like cardiac injuries.= However, the majority of
=C2=A0 articles and studies reporting on cat= astrophic complications
=C2=A0 were all published before 2011 (5). Fur= thermore, the
=C2=A0 widespread use of routine intraoperative sternal = elevation
=C2=A0 must be considered as an additional effective measure=
=C2=A0 to improve safety of MIRPE (13).

=C2=A0 Visualizati= on across
=C2=A0 the mediastinum during retrosternal dissection may be=
=C2=A0 compromised in severe defects. Notably in older adult PE
= =C2=A0 patients, decreased flexibility and stiffness of the anterior
= =C2=A0 chest wall as well as the corresponding force required
=C2=A0 t= o elevate the sternum may make retrosternal dissection
=C2=A0 difficul= t and sometimes nearby impossible. Applying routine
=C2=A0 sternal ele= vation during MIRPE, the safety of the procedure
=C2=A0 has improved c= learly as there was no near-fatal and/or fatal
=C2=A0 incident reporte= d anymore when the technique was applied
=C2=A0 intraoperatively (13).=
=C2=A0 Evolution in the management of congenital CWD and
=C2=A0 = modifications of newly introduced techniques have made
=C2=A0 signific= ant progress over the past 2=E2=80=933 decades, and as a
=C2=A0 conseq= uence patients outcome improved substantially.
=C2=A0 The aim of the n= arrative review presented by Scalise and
=C2=A0 Demehri (\cite{pmid185= 82824}) is to outline current practice concerning
=C2=A0 diagnostic wo= rk-up, conservative and surgical treatment
=C2=A0 as well as managemen= t in general of pediatric PE patients.
=C2=A0 Since we may find numero= us publications dealing with this
=C2=A0 topic, it is nearby impossibl= e to review all the literature,
=C2=A0 covering all different age grou= ps. In particular no
=C2=A0 randomized double-blind studies are availa= ble. Therefore,
=C2=A0 the quality of evidence regarding this topic re= mains
=C2=A0 relatively low with still many unexplored and unknown
=C2=A0 pathways. Different objective criteria were screened, verified
=C2=A0 and added to identify PE patients that would benefit from
=C2= =A0 surgery. An increasing number of studies accentuating the
=C2=A0 c= ardiopulmonary consequences of PE. Notably, more than
=C2=A0 275 paper= s have been published in the last 10 years focusing
=C2=A0 on function= al changes prior to and after surgical correction
=C2=A0 of PE. Due to= different reasons (e.g., retrospective and/or
=C2=A0 small cohort stu= dies), the results are still heterogenous and
=C2=A0 of low evidential= quality (\cite{pmid18582824}). Based on this generally poor
=C2=A0 ev= idence, the controversial debate on the cardiopulmonary
=C2=A0 impact = of PE and whether patients may benefit from
=C2=A0 surgical repair or = not will continue as long as we may be
=C2=A0 able to provide double b= lind randomized studies. However,
=C2=A0 IRB approval for such a study= has to be considered as
=C2=A0 difficult or nearby impossible. This i= s aggravated by the
=C2=A0 fact that PE is many times considered as an= =E2=80=9Conly=E2=80=9D esthetic
=C2=A0 disorder and in particular ass= ociated with body image
=C2=A0 disturbances. In contrast, among surgeo= ns and confirmed
=C2=A0 by recently published studies it is clearly ac= knowledged
=C2=A0 that subjective improvement in exercise intolerance = is
=C2=A0 often reported after MIRPE (\cite{pmid18582824}). Thus, desp= ite above
=C2=A0 mentioned facts as well as current believes, reviews = such as
=C2=A0 presented by Scalise and Demehri may help to bridge the=
=C2=A0 lack of convincing high-quality evidence which remains a
= =C2=A0 critical concern that could potentially interfere with future
= =C2=A0 management of PE. As concluded by Scalise and Demehri
=C2=A0 in= their narrative review, there is still a lack of international
=C2=A0= consensus guidelines concerning preoperative diagnostic
=C2=A0 work-u= p, conservative and surgical treatment as well as
=C2=A0 postoperative= management. A recently published study
=C2=A0 by Janssen et al. repor= ted on a consensus statement for
=C2=A0 perioperative care for PE base= d on a multi-round Delphi
=C2=A0 survey (\cite{pmid18582824}). Pectus = surgeons all around the world are
=C2=A0 encouraged to draw up standar= dized consensus guidelines to
=C2=A0 establish a high-level algorithm = for preoperative diagnostic
=C2=A0 protocol, indications for conservat= ive and/or surgical
=C2=A0 treatment as well as postoperative manageme= nt.
=C2=A0 =C2=A0 =C2=A0 }

=C2=A0 =C2=A0 =C2=A0\amesection{= Acknowledgments}

=C2=A0 =C2=A0 =C2=A0Funding: None.

= =C2=A0 =C2=A0 =C2=A0\amesection{Footnot}

=C2=A0 =C2=A0 =C2=A0\te= xtit{Provenance and Peer Review:} This article was commissioned
=C2=A0= by the editorial office, Translational Pediatrics. The article
=C2=A0= did not undergo external peer review.

=C2=A0 =C2=A0 =C2=A0 \vsp= ace{1ex}

=C2=A0 =C2=A0 =C2=A0 \textit{Conflicts of Interest: }Th= e author has completed the ICMJE
=C2=A0 =C2=A0 =C2=A0 uniform disclosu= re form (available at \url{https://tp.amegroups.
=C2=A0 =C2=A0 =C2=A0 = com/article/view/10.21037/tp-23-264/coif} ). The author has
=C2=A0 =C2= =A0 =C2=A0 no conflicts of interest to declare.

=C2=A0 =C2=A0 = =C2=A0 \vspace{2ex}

=C2=A0 =C2=A0 =C2=A0 \textit{Ethical Stateme= nt:} The author is accountable for all
=C2=A0 aspects of the work in e= nsuring that questions related
=C2=A0 to the accuracy or integrity of = any part of the work are
=C2=A0 appropriately investigated and resolve= d.

=C2=A0 =C2=A0 =C2=A0 \vspace{2ex}

=C2=A0 =C2=A0 = =C2=A0 \textit{Open Access Statement:} This is an Open Access article
= =C2=A0 distributed in accordance with the Creative Commons
=C2=A0 Attr= ibution-NonCommercial-NoDerivs 4.0 International
=C2=A0 License (CC BY= -NC-ND 4.0), which permits the non-
=C2=A0 commercial replication and = distribution of the article with
=C2=A0 the strict proviso that no cha= nges or edits are made and the
=C2=A0 original work is properly cited = (including links to both the
=C2=A0 formal publication through the rel= evant DOI and the license).
=C2=A0 See: \href{https://creativecommons.= org/licenses/by-nc-nd/4.0}{https://creativecommons.org/licenses/by-nc-nd/4.= 0}

=C2=A0 Let's cite! Einstein's journal paper and Dirac's book = \cite{dirac} are physics-related items.


=C2=A0 =C2=A0 =C2= =A0 \titleformat{\section}
=C2=A0 =C2=A0 =C2=A0 =C2=A0 {\color{section= titlecolor}\normalfont\Large\bfseries}
=C2=A0 =C2=A0 =C2=A0 =C2=A0 {\t= hesection}{1em}{}

=C2=A0 =C2=A0 =C2=A0 \bibliographystyle{unsrt}=
=C2=A0 =C2=A0 =C2=A0 \bibliography{main}




=C2=A0 =C2=A0 =C2=A0 % \cite{pmid18582824,pmid10803339,pmid9574749,pmid354= 55522,pmid31600804,pmid29672193,pmid33853733,pmid34942673,pmid35820596,pmid= 25814003,pmid31199434,pmid32753276,pmid11877663,pmid28822540,pmid36891368,p= mid35377161}

=C2=A0 =C2=A0 =C2=A0 % =E5=9C=A8=E6=96=87=E4=B8=AD= =E6=8F=92=E5=85=A5=E5=BC=95=E7=94=A8=E4=BF=A1=E6=81=AF
=C2=A0 \noinden= t\colorbox{cite}{
=C2=A0 % \begin{minipage}{\dimexpr\textwidth-2\fboxs= ep} %=E5=8D=95=E6=A0=8F=E6=A8=A1=E5=BC=8F
=C2=A0 \begin{minipage}{\dim= expr0.5\textwidth-2\fboxsep}
=C2=A0 =C2=A0 =C2=A0 \setlength{\parskip}= {0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8=90=BD=E9=97=B4=E8=B7=9D
=C2=A0 = =C2=A0 =C2=A0 \setlength{\parindent}{0em} % =E8=AE=BE=E7=BD=AE=E6=AE=B5=E8= =90=BD=E7=BC=A9=E8=BF=9B
=C2=A0 =C2=A0 =C2=A0 Cite this article as: Ha= ecker FM. Evolution in the management of pectus excavatum in pediatric pati= ents. Transl Pediatr 2023;12(8):1450-1453. doi: 10.21037/tp-23-264
=C2=A0 \end{minipage}}

=C2=A0 \end{multicols}' at main.tex li= ne 157 column 22
<p> <styled-content style=3D"background-colo= r: editorial">
</styled-content> </p>
<boxed-te= xt>
=C2=A0 <p><bold></bold></p>
</b= oxed-text>
<boxed-text>
=C2=A0 <p><bold><= /bold></p>
</boxed-text>
<p>https://dx.doi.o= rg/10.21037/tp-23-264</p>

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