{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T05:18:34Z","timestamp":1779340714363,"version":"3.51.4"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Minimally-invasive repair of pectus excavatum (MIRPE) has been shown to be associated with high release of trace metals into patient\u2019s body. The aim of our study was to analyze the kinetics of metal contamination after MIRPE and after bar removal.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We prospectively assessed nickel and chromium changes in blood, urine, and local tissue in patients undergoing MIRPE with stainless-steel bar(s). Baseline samples were taken prior to surgery, further samples were taken at six defined time points until 30 months after bar removal. Clinical symptoms were evaluated at the time of every sample collection.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>28 patients were included (mean age 16.4 years). At four weeks after MIRPE and persisting up to bar removal, we found significantly elevated trace metal levels in blood and urine. Tissue nickel and chromium levels were significantly elevated at the time of bar removal. After bar removal, the concentration of trace metal in urine and the concentration of chromium in plasma decreased gradually. In contrast, nickel levels in blood further increased. Five patients showed irritative symptoms after MIRPE, all symptomatic patients had elevated metal levels.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Following MIRPE, we found a rapid systemic increase of nickel and chromium. Our data indicate that trace metal release could cause irritative symptoms. The prolonged elevated systemic nickel levels beyond bar removal necessitate further investigations of the long-term side effects of MIRPE.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0275567","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T17:31:15Z","timestamp":1665423075000},"page":"e0275567","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Nickel contamination after minimally-invasive repair of pectus excavatum persists after bar removal"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2289-5330","authenticated-orcid":true,"given":"Caroline","family":"Fortmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8226-9227","authenticated-orcid":true,"given":"Thomas","family":"Goeen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman","family":"Zinne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soeren","family":"Wiesner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benno M.","family":"Ure","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim F.","family":"Kuebler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"issue":"3","key":"pone.0275567.ref001","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.athoracsur.2016.03.105","article-title":"Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (\u226530 Years)","volume":"102","author":"DE Jaroszewski","year":"2016","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"pone.0275567.ref002","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jpedsurg.2006.09.056","article-title":"When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum","volume":"42","author":"GD Rushing","year":"2007","journal-title":"J Pediatr Surg"},{"issue":"3","key":"pone.0275567.ref003","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jpedsurg.2013.07.014","article-title":"High rates of metal allergy amongst Nuss procedure patients dictate broader pre-operative testing","volume":"49","author":"B Shah","year":"2014","journal-title":"J Pediatr Surg"},{"key":"pone.0275567.ref004","article-title":"Recent Modifications of the Nuss Procedure. 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