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Aim Unsurprisingly, much of the medical profession has focussed on treating covid-19 over the past year often to the detriment of other pathologies. Engagement with academic literature may follow a similar trend; this paper used standard social media attention and citations metrices to assess whether the pandemic has affected engagement with surgical literature. Method Twitter Mentions and Mendeley Readers Data were retrieved for all papers published in Annals of Surgery, BJS and JAMASurgery between January 2019 and October 2020. The non-parametric Mann-Whitney U test was used to compare Twitter Mentions and Mendeley Readers for COVID surgical vs non-COVID surgical publications (in 2020) and all surgical papers published before and after the advent of COVID-19. A control database of all papers published in NEJM, BMJ and Lancet over the same period of time was also created. Results There was no difference in Twitter mentions between COVID-19 and non-COVID-19 papers (p-value 0.604); however there were significantly more Mendeley readers of COVID-19 papers than non-COVID-19 papers in 2020 (55 vs 5 median readers, p Analysis of the non-surgical control dataset revealed the opposite trend; papers published in 2020 received significantly more attention than those published in 2019 (39 vs 30 median Twitter citations, p Conclusion Surgical papers published during the COVID-19 pandemic received significantly fewer social media mentions. Such reduced visibility has the potential to affect future citation metrics and dissemination of surgical knowledge

Aim Nail bed injuries are the commonest paediatric hand injuries. Optimal management is essential to restoring form and function of the nail and fingertip, however high-level evidence of nail bed injury management is lacking, leading to large discrepancies in clinical practice. This paper evaluates the 100 most cited papers in nail bed injury and analyses their study characteristics to assess current research focus and evidence levels. Method A Web of Science search was carried out using the search term “nail bed injury”. All article types were included, and no language or publication date restrictions were applied. Results were ranked by overall citation number. All abstracts were screened for study relevance and the top 100 eligible studies were analysed for study type, main study theme, journal, and year of publication. Result The three most common study types included retrospective studies (n = 33), literature reviews (n = 25), case reports/series (n = 20). The three main study themes included evaluation of repair techniques (n = 72), aetiology and epidemiology of nail bed injuries (n = 12), and anatomical assessments (n = 7). The most frequently represented journals include Journal of Hand Surgery (n = 30), Plastic and Reconstructive Surgery (n = 7) and Hand Clinics (n = 4). Conclusions The most influential papers in nail bed injury are those describing repair techniques. There remains a lack of high level evidence with most papers presenting level 3-5 evidence. This paper demonstrates a continued need for more higher level robust evidence in the field of nail bed injuries.

Objective Recent interest has focused on the role of the methyl-arginines, endogenous inhibitors of nitric oxide, as adverse prognostic indicators. To date, few studies have assessed the role of symmetric dimethyl-arginine (SDMA) in patients with peripheral arterial disease. We aimed to determine the relationship, if any, of SDMA to all-cause mortality and disease severity as assessed by the ankle-brachial index (ABI) in patients with symptomatic peripheral arterial disease (PAD). Methods In 238 patients with symptomatic PAD and an ABI of Results The median follow-up was 6 years 11 months (interquartile range [IQR], 4 years 5 months-7 years 10 months). SDMA and ADMA levels were higher in those who died compared with those who survived (0.51 [IQR, 0.44-0.66] μmol/L vs 0.46 [IQR, 0.39-0.55] μmol/L, P ≤ .001; and 0.48 [IQR, 0.41-0.55] μmol/L vs 0.45 [IQR, 0.39-0.50] μmol/L, P = .007, respectively). l-arginine levels were similar in the two groups. On multivariate analysis, SDMA and ADMA as continuous variable were significantly associated with mortality ( P = .001). For SDMA and ADMA, the highest compared with the lowest quartile levels were significantly associated with mortality (SDMA: hazard ratio, 3.855; 95% confidence interval, 1.625-9.143; P = .002; ADMA: hazard ratio, 2.277; 95% confidence interval, 1.114-4.654; P = .024). ADMA and SDMA showed a negative correlation with severity of PAD as assessed by ABI ( r = −0.236, N = 216, P r = −0.209, N = 208, P = .002, respectively). Conclusions The novel finding of this study is that SDMA levels were predictive of all cause-mortality and correlated with disease severity. Further studies should assess the role of nitric oxide donors in patients with high levels of SDMA.