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Background Knowledge of the factors that influence the willingness of patients considering elective orthopaedic surgery is essential for patient-centered care. To date, however, these factors remain undefined in the orthopaedic population with shoulder and elbow disorders. Questions/purposes In a cohort of patients seeking surgical consultation for shoulder or elbow conditions, we sought to identify factors that influenced the willingness and decision to undergo surgery. Methods In this prospective study, 384 patients completed a questionnaire collecting socioeconomic and health status data before consultation from June 2009 to December 2010. An additional 120 patients who were offered surgery after consultation completed a second questionnaire on their perceptions and concerns regarding surgery. Logistic regression analyses were used to identify factors influencing the willingness and decision to undergo surgery. Results Lower income (odds ratio [OR], 0.02; CI, 0.02–0.08; p < 0.001) and living alone (OR, 0.25; CI, 0.08–0.77; p = 0.015) were negative predictors of willingness to consider surgery. Physical functioning did not influence willingness (p = 0.994). A greater perceived level of the likelihood of surgical success by the patient (OR, 41.84; CI, 5.24–333.82; p < 0.001) and greater fluency in the English language (OR, 28.39; CI, 3.49–230.88; p = 0.002) were positive predictors of willingness. Willingness to consider surgery as a possible treatment option before the consultation was a predictor of patients’ ultimate decisions to undergo surgery (OR, 4.56; CI, 1.05–19.76; p = 0.042). Patients expressing concern about surgery being an inconvenience to daily life, however, were less likely to decide to proceed with surgery (OR, 0.12; CI, 0.02–0.68; p = 0.017). Conclusions Many of the identified factors may act as barriers to potentially beneficial surgical interventions. Although most are not modifiable, an awareness of the influence of individual demographics and possible perceptions of patients’ choices may show that more in-depth questioning and provisions for cultural differences may be required during the consultation to enable patients to make fully informed decisions. Future studies using qualitative methods would provide a greater in-depth understanding of patients’ perceptions regarding surgery and their decision to proceed. Larger or more homogeneous cohorts also would enable additional identification of these factors for different shoulder and elbow conditions. Level of Evidence Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

The goal of this study was to compare the accuracy of abduction-external rotation magnetic resonance arthrography (ABERMRA) with standard MRA in the diagnosis of intra-articular shoulder pathology. One hundred three consecutive patients undergoing preoperative direct MRA and subsequent arthroscopic examination were included in the study. Seventy-eight patients underwent standard MRA and 25 underwent ABERMRA. Specialist-trained musculoskeletal radiologists reported all scans, and attending shoulder surgeons performed all arthroscopies. Arthroscopic assessment revealed 11 partial-thickness rotator cuff tears, 3 full-thickness tears, 64 labral lesions (48 soft tissue and 16 significant bony), and 17 superior labrum anterior-posterior (SLAP) tears. The sensitivity/specificity for standard MRA was 0.56/0.99 for partial-thickness rotator cuff tears, 1.00/1.00 for full-thickness rotator cuff tears, 0.75/0.91 for soft tissue labral tears, 0.58/1.00 for significant bony glenoid lesions, and 0.50/0.91 for SLAP tears. Abduction-external rotation magnetic resonance arthrography increased the sensitivity/specificity to 1.00/0.85 for soft tissue labral tears, 0.75/1.00 for significant bony glenoid lesions, and 1.00/1.00 for SLAP tears, although it missed 2 of 2 partial-thickness rotator cuff tears. This study suggests that standard MRA is a valuable investigation tool for instability, SLAP tears, and rotator cuff tears, although limitations exist. Additional ABERMRA sequences appear to improve the diagnostic accuracy of soft tissue anterior and posterior labral tears, SLAP tears, and significant bony glenoid lesions and should be routinely requested by shoulder surgeons when ordering MRAs to obtain the maximum benefit from this invasive investigation.

Locked posterior shoulder dislocation is a rare injury and is often missed on examination, usually due to inadequate imaging and potentially resulting in significant loss of shoulder function. An important feature of the physical examination is identification of the patient's inability to externally rotate their arm. These injuries are associated with defects in the humeral head articular surface, also known as reverse Hill-Sachs lesions. Medium-sized defects involving 25% to 50% of the articular surface can be reconstructed using several methods, including subscapularis or lesser tuberosity transfer, rotational osteotomy of the humerus, osteochondral autografting, and allograft reconstruction. We describe reconstruction of a 40% anteromedial humeral head articular surface defect associated with a missed locked posterior shoulder dislocation. Our technique used a deltopectoral approach with soft tissue dissection through the rotator interval to enable direct access to the defect with preservation of the rotator cuff muscles. The impacted articular surface was elevated, and the void was filled with moldable putty consisting of tricalcium phosphate with carboxymethylcellulose (Calstrux; Stryker Biotech, Hopkinton, Massachusetts). The articular fragment was then secured in position with size 5 Ethibond (Ethicon, Inc, Somerville, New Jersey) bone sutures. The patient regained excellent function and range of motion, with computed tomography scanning at 9 months demonstrating a smooth humeral articular surface with excellent graft incorporation. This technique avoids donor site morbidity and potential risks with allograft use while maintaining normal shoulder joint anatomy with preservation of the rotator cuff muscles for less complicated prosthetic reconstruction if required in the future.

Partial-thickness articular-sided rotator cuff tears have a multifactorial etiology and are associated with degeneration of the tendon. They are often described as an injury of the young athlete, although they are also found in the older population. The aim of this study was to investigate the frequency and associations of partial-thickness articular-sided tears in patients over the age of 35 years. Retrospective A retrospective study of all arthroscopic procedures for rotator cuff pathology in patients over the age of 35 years over a 2-year period by a single surgeon was performed. The included patients were divided into two groups based on the arthroscopic findings: those with a partial-thickness articular-sided rotator cuff tear and those with pure tendinopathy. The groups were then compared to identify the associated pathology with the rotator cuff lesions. 2×2 contingency table analysis and unpaired Student's t-test were used for statistical analysis. One hundred patients were included in the study of whom 62 had a partial articular-sided tear. Those with a partial articular-sided tear were older (P=0.0001), were more commonly associated with a documented injury (P=0.03), and more commonly had biceps degeneration (P=0.001) and synovitis (P=0.02) within the joint. Partial-thickness articular-sided tears are a common occurrence in patients requiring arthroscopic surgery for rotator cuff pathology over the age of 35 years. This probably reflects an injury in an already degenerate cuff. This would support the theory of intrinsic degeneration of the tendon in this age group and probably represent a different etiology to those seen in the young athletes. Level 3.

The deadly dozen The lethal six Airway obstruction Tension pneumothorax Cardiac tamponade Massive haemothorax Open pneumothorax Flail chest The hidden six Thoracic aortic disruption Tracheobronchial disruption Oesophageal disruption Myocardial contusion Pulmonary contusion Diaphragmatic tear The lethal six injuries are immediately life threatening and need to be treated during the primary survey to avoid irreversible deterioration. Research in a large US trauma centre shows that survival rates are higher for patients with penetrating trauma compared with patients with blunt trauma (14% v 2%) when performing thoracotomy in the emergency department. Studies have shown that transoesophageal echocardiography, although more invasive, gives an accurate diagnosis in a short time and is inexpensive, compared with the lower diagnostic yield using transthoracic echocardiography.

This paper is a fundamental exploration of the dynamic area of nanocatalysis, offering a detailed analysis of recent advancements and practical applications. Tailored for researchers and professionals, this article begins with a historical overview, emphasizing nanocatalysis’ pivotal role in contemporary science and industry. It delves into foundational principles, covering nanoparticle synthesis, characterization, surface chemistry, and reactivity mechanisms at the nanoscale. Advanced sections explore the design of nanomaterials for catalysis, hybrid catalyst synthesis, and the integration of computational approaches. Mechanistic insights are presented through a detailed examination of reaction pathways and cutting-edge spectroscopic techniques. Practical applications span energy conversion, sustainable synthesis, and environmental remediation, with illustrative case studies. The article concludes by addressing current challenges, outlining future perspectives, and highlighting emerging trends, making it an essential guide for those navigating the multifaceted landscape of nanocatalysis.

In these days, conservation of the environment is the vital theme of the globe. For that green materials are being discovered to a greater extent. By dint of exclusive properties like optical and electronic properties, water solubility, exceptional biocompatibility, low toxicity and influential chemical inertness of carbon nanodots (CDs) have been extensively investigated systematically and applied in many fields. One can increase the applicability of photostable and biocompatible CDs by doping of nitrogen, sulfur and/or other organic or inorganic materials. In particular, CDs are at present intensifying as a class of potential fluorescent explore in account of their low photobleaching and versatile surfaces. In this review article, we discuss a range of “green” sources along with diverse synthetic routes and photo- and electron properties of this unique material and also provide further insight for improvement in their functionality using various dopants and arouse further research into their potential applications, such as photovoltaics, bioimaging, nanodots-sensitized solar cells, energy conversion, optoelectronics, supercapacitor and light-emitting devices. For each topic, the most relevant end results reported in the literature are accessed with some considerations on the future perspectives.

This study delves into the fabrication of carbon nanodots (CNDs) through a bottom-up approach, utilizing black seed powder as the precursor material and employing the pyrolysis method. CNDs were synthesized across four distinct temperature settings. The investigation encompasses an extensive characterization of the CNDs, including optical and structural attributes. UV-visible and fluorescence spectroscopy were utilized to assess their optical properties, while FT-IR and XRD analyses confirmed their structural integrity. To elucidate size, shape, and nature, HR-TEM imaging was employed. Furthermore, the functional applications of the synthesized CNDs were explored. The material’s antifungal potential was evaluated, and its viability for bioimaging was demonstrated by successfully labeling yeast cells with CNDs. This study underscores the multifaceted nature of CNDs, serving as a bridge between synthesis, comprehensive characterization, and practical applications. In summary, the investigation provides insights into the versatile applications of CNDs derived from black seed powder through pyrolysis. The study contributes to the understanding of their fundamental properties and establishes their potential for both antifungal treatments and cellular bioimaging. Graphical abstract

Background: Various minimally invasive surgeries were proposed for the management of herniated lumbar intervertebral disc. However, to choose optimal treatment modality to maximize patient benefit is a clinical challenge for the treatment givers. Objective: The objective was to study the role of ozone disc nucleolysis in the management of herniated lumbar intervertebral disc by retrospective analysis. Methodology: We conducted a retrospective analysis of patients of lumbar disc herniation treated by ozone disc nucleolysis during May 2007-May 2021. There were total of 2089 patients with 58% of males and 42% of females. The age ranged from 18 to 88 years. Outcome was measured on the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) along with modified MacNab method. Results: The mean baseline VAS score was 7.73, which became 3.07 at 1 month, 1.44 at 3 months, 1.42 at 6 months, and 1.36 at 1 year. Similarly, the mean ODI index was 35.92 at baseline, which improved to 9.17 at 1 month, 6.14 at 3 months, 6.10 at 6 months, and 6.09 at 1 year. VAS score and ODI analysis was found to be statistically significant with P < 0.05. Modified MacNab criterion showed successful treatment outcome in 85.6% with excellent recovery in 1161 (55.58%), good recovery in 423 (20.25%), and fair recovery in 204 (9.77%). Mediocre or no recovery was seen in the remaining 301 patients amounting to a 14.40% failure rate. Conclusion: This retrospective analysis confirms that ozone disc nucleolysis is an optimally effective and least invasive treatment option for herniated lumbar intervertebral disc with a significant reduction in disability.