Impact of signal-to-noise ratio and contrast definition on the sensitivity assessment and benchmarking of fluorescence molecular imaging systems.

Significance: Standardization of fluorescence molecular imaging (FMI) is critical for ensuring quality control in guiding surgical procedures. To accurately evaluate system performance, two metrics, the signal-to-noise ratio (SNR) and contrast, are widely employed. However, there is currently no consensus on how these metrics can be computed. Aim: We aim to examine the impact of SNR and contrast definitions on the performance assessment of FMI systems. Approach: We quantified the SNR and contrast of six near-infrared FMI systems by imaging a multi-parametric phantom. Based on approaches commonly used in the literature, we quantified seven SNRs and four contrast values considering different background regions and/or formulas. Then, we calculated benchmarking (BM) scores and respective rank values for each system. Results: We show that the performance assessment of an FMI system changes depending on the background locations and the applied quantification method. For a single system, the different metrics can vary up to ∼ 35 dB (SNR), ∼ 8.65 a . u . (contrast), and ∼ 0.67 a . u . (BM score). Conclusions: The definition of precise guidelines for FMI performance assessment is imperative to ensure successful clinical translation of the technology. Such guidelines can also enable quality control for the already clinically approved indocyanine green-based fluorescence image-guided surgery.

Integrating pretest probability for rheumatoid arthritis with likelihood ratios of RF and ACPA to improve clinical utility of rheumatoid arthritis autoantibody testing.

BACKGROUND AND AIMS: Rheumatoid arthritis (RA) manifests through various symptoms and systemic manifestations. Diagnosis involves serological markers like rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). Past studies have shown the added value of likelihood ratios (LRs) in result interpretation. LRs can be combined with pretest probability to estimate posttest probability for RA. There is a lack of information on pretest probability. This study aimed to estimate pretest probabilities for RA. MATERIALS AND METHODS: This retrospective study included 133 consecutive RA patients and 651 consecutive disease controls presenting at a rheumatology outpatient clinic. Disease characteristics, risk factors associated with RA and laboratory parameters were documented for calculating pretest probabilities and LRs. RESULTS: Joint involvement, erosions, morning stiffness, and positive CRP, ESR tests significantly correlated with RA. Based on these factors, probabilities for RA were estimated. Besides, LRs for RA were established for RF and ACPA and combinations thereof. LRs increased with antibody levels and were highest for double high positivity. Posttest probabilities were estimated based on pretest probability and LR. CONCLUSION: By utilizing pretest probabilities for RA and LRs for RF and ACPA, posttest probabilities were estimated. Such approach enhances diagnostic accuracy, offering laboratory professionals and clinicians insights in the value of serological testing during the diagnostic process.

Interval-specific likelihood ratios and probability-based models for interpreting combined CSF biomarkers for Alzheimer's disease.

BACKGROUND: In Alzheimer's disease (AD) diagnosis, a cerebrospinal fluid (CSF) biomarker panel is commonly interpreted with binary cutoff values. However, these values are not generic and do not reflect the disease continuum. We explored the use of interval-specific likelihood ratios (LRs) and probability-based models for AD using a CSF biomarker panel. METHODS: CSF biomarker (Aß1-42, tTau and pTau181) data for both a clinical discovery cohort of 241 patients (measured with INNOTEST) and a clinical validation cohort of 129 patients (measured with EUROIMMUN), both including AD and non-AD dementia/cognitive complaints were retrospectively retrieved in a single-center study. Interval-specific LRs for AD were calculated and validated for univariate and combined (Aß1-42/tTau and pTau181) biomarkers, and a continuous bivariate probability-based model for AD, plotting Aß1-42/tTau versus pTau181 was constructed and validated. RESULTS: LR for AD increased as individual CSF biomarker values deviated from normal. Interval-specific LRs of a combined biomarker model showed that once one biomarker became abnormal, LRs increased even further when another biomarker largely deviated from normal, as replicated in the validation cohort. A bivariate probability-based model predicted AD with a validated accuracy of 88% on a continuous scale. CONCLUSIONS: Interval-specific LRs in a combined biomarker model and prediction of AD using a continuous bivariate biomarker probability-based model, offer a more meaningful interpretation of CSF AD biomarkers on a (semi-)continuous scale with respect to the post-test probability of AD across different assays and cohorts.

The effect of fine grits and fine debris concentrations on the MLVSS/MLSS ratio of an activated sludge system.

This study embarks on an explorative investigation into the effects of typical concentrations and varying particle sizes of fine grits (FG, the involatile portion of suspended solids) and fine debris (FD, the volatile yet unbiodegradable fraction of suspended solids) within the influent on the mixed liquor volatile suspended solids (MLVSS)/mixed liquor suspended solids (MLSS) ratio of an activated sludge system. Through meticulous experimentation, it was discerned that the addition of FG or FD, the particle size of FG, and the concentration of FD bore no substantial impact on the pollutant removal efficiency (denoted by the removal rate of COD and ammonia nitrogen) under constant operational conditions. However, a notable decrease in the MLVSS/MLSS ratio was observed with a typical FG concentration of 20 mg/L, with smaller FG particle sizes exacerbating this reduction. Additionally, variations in FD concentrations influenced both MLSS and MLVSS/MLSS ratios; a higher FD concentration led to an increased MLSS and a reduced MLVSS/MLSS ratio, indicating FD accumulation in the system. A predictive model for MLVSS/MLSS was constructed based on quality balance calculations, offering a tool for foreseeing the MLVSS/MLSS ratio under stable long-term influent conditions of FG and FD. This model, validated using data from the BXH wastewater treatment plant (WWTP), showcased remarkable accuracy.

Establishment and verification of anthropogenic speciated VOCs emission inventory of Central China.

Improving the accuracy of anthropogenic volatile organic compounds (VOCs) emission inventory is crucial for reducing atmospheric pollution and formulating control policy of air pollution. In this study, an anthropogenic speciated VOCs emission inventory was established for Central China represented by Henan Province at a 3 km × 3 km spatial resolution based on the emission factor method. The 2019 VOCs emission in Henan Province was 1003.5 Gg, while industrial process source (33.7%) was the highest emission source, Zhengzhou (17.9%) was the city with highest emission and April and August were the months with the more emissions. High VOCs emission regions were concentrated in downtown areas and industrial parks. Alkanes and aromatic hydrocarbons were the main VOCs contribution groups. The species composition, source contribution and spatial distribution were verified and evaluated through tracer ratio method (TR), Positive Matrix Factorization Model (PMF) and remote sensing inversion (RSI). Results show that both the emission results by emission inventory (EI) (15.7 Gg) and by TR method (13.6 Gg) and source contribution by EI and PMF are familiar. The spatial distribution of HCHO primary emission based on RSI is basically consistent with that of HCHO emission based on EI with a R-value of 0.73. The verification results show that the VOCs emission inventory and speciated emission inventory established in this study are relatively reliable.

Author Response: Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters!

How to cite this article: Mishra S, Kothari N, Sharma A, Goyal S. Author Response: Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters! Indian J Crit Care Med 2024;28(8):803.

A myriad of methods to determine temporal summation of pain in people with musculoskeletal pain and healthy participants: a scoping review.

Temporal summation of pain (TSP) is a human proxy for wind-up of dorsal horn neurons as assessed in animals. The common paradigm for eliciting TSP is evoked by repetitive nociceptive stimuli of equal intensity. Various stimulation and assessment protocols have been used. This scoping review aims to provide insight into key elements of TSP stimulation and assessment: modality, instruments, test location, familiarization, train characteristics, and calculations. PubMed, Embase, and Ebsco/CINAHL were searched for studies that measured TSP in adults with musculoskeletal conditions and healthy people. Four hundred six studies were included. Mechanical stimuli were the most commonly used modality (250 studies), followed by thermal stimuli (125 studies). Forty-six different instruments were used. Disregarding studies on widespread musculoskeletal pain and healthy participants, 40 studies evaluated TSP at painful sites, 77 in remote areas, and 66 in both locations. Of the 13 tested locations in patients, the hand (74 studies), lower leg (64 studies), and forearm (59 studies) were most commonly tested. A single practice round was the most common familiarization method (46 studies). Repeated stimuli were applied using 31 different frequencies (0.03-200 Hz) and sustained stimulations ranging from 5 to 1080 seconds were used. Twenty-two different train lengths, 63 different calculations (37 absolute, 19 relative, and 7 alternatives using data directly), and 14 different outcome measures (eg, self-reported pain rating scales and reflex thresholds) were used. Temporal summation of pain protocols vary excessively, hindering the comparison and pooling of results. None of the studies provided substantiation for their protocol choice.

Association between the C-reactive protein to albumin ratio with asthma and mortality in adult: a population-based study.

Asthma is a prevalent chronic disease characterized by airflow obstruction, causing breathing difficulties and wheezing. This study investigates the association between the C-reactive protein to albumin ratio (CAR) and asthma prevalence, as well as all-cause and respiratory mortality among asthma patients, using data from the 2001-2018 National Health and Nutrition Examination Survey. We included participants aged 20 years and older with complete CAR data, excluding those who were pregnant or lost to follow-up. The analysis employed weighted logistic regression and Cox proportional hazards models with stepwise adjustment, restricted cubic spline analysis for nonlinear relationships, and time-dependent ROC curves for predictive accuracy. Results showed that the highest CAR quartile significantly increased the risk of asthma (OR 1.56, 95% CI 1.38-1.78), all-cause mortality (HR 2.20, 95% CI 1.67-2.89), and respiratory mortality (HR 2.56, 95% CI 1.30-5.38). The impact of CAR on all-cause mortality was particularly significant in hypertensive patients. These findings highlight CAR's potential as a valuable biomarker for predicting asthma prevalence and mortality, underscoring its role in asthma management and prognostication.

Associations between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hyperuricemia: a cross-sectional study.

BACKGROUND AND OBJECTIVE: The value of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) assessment in the context of metabolic abnormalities is growing in importance. Nevertheless, the relationship between NHHR and hyperuricemia (HUA) is unknown. This study seeks to investigate the relationship between NHHR and HUA. METHODS: The data derived from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) included 7,876 adult participants. The multivariable logistic regression model, subgroup analysis and smooth fitting curve were utilized in order to investigate the association between NHHR and HUA. RESULTS: In the fully adjusted model 3, NHHR was significantly associated with HUA. Specifically, participants in the highest quartile of NHHR had 1.95 times higher odds of HUA prevalence compared to those in the lowest quartile [2.95 (2.39, 3.64), P < 0.0001]. Although the overall trend suggested a positive association, further analysis using smooth fitting curves and threshold effect analysis indicated that this association was nonlinear, with an inflection point at 5.8. The positive association persisted across different HUA definitions and after removing outliers. Subgroup analysis showed significant interactions between NHHR and HUA in different races and diabetes statuses. The odds of HUA prevalence were higher among non-diabetic participants [1.40 (1.32, 1.49), P < 0.0001] compared to diabetic participants [1.18 (1.06, 1.32), P = 0.0031]. Mexican Americans had the lowest odds of HUA prevalence [1.09 (0.92, 1.27), P = 0.2413] compared to other races. CONCLUSIONS: There is a significant positive association between NHHR and HUA, indicating that NHHR may serve as a potential risk assessment maker for HUA, although further prospective studies are needed for validation.

Pan-Immune-Inflammatory Value is Superior to Other Inflammatory Indicators in Predicting Inpatient Major Adverse Cardiovascular Events and Severe Coronary Artery Stenosis after Percutaneous Coronary Intervention in STEMI Patients.

Background: The inflammatory response to atherosclerosis is a process that leads to coronary artery disease. Pan-immune-inflammation value (PIV) has emerged as a new and simple biomarker of inflammation. However, studies on the predictive power of PIV for major adverse cardiovascular events (MACE) or the degree of coronary artery stenosis are scarce. We aimed to explore the predictive ability of PIV for MACE and the degree of coronary artery stenosis in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) during hospitalization. Methods: This study included 542 patients who were diagnosed with STEMI and who underwent PCI between 2016 and 2023 and whose PIV and other inflammatory markers were measured. Using univariate and multivariate logistic regression analysis, risk variables for MACE following PCI and severe coronary stenosis during hospitalization were assessed to create receiver operating characteristic (ROC) curves and determine the best thresholds for inflammatory markers. Spearman correlation analysis was used to evaluate the correlation of PIV and other inflammatory markers with the Gensini score (GS). Results: Compared with the systemic inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), the PIV may have greater predictive value in terms of the occurrence of MACE and the degree of coronary stenosis after PCI in hospitalized STEMI patients. The correlation between the PIV and GS was strong. Conclusions: PIV was superior to the SII, PLR, and NLR in predicting inpatient prognosis and severe coronary stenosis after PCI for STEMI patients.

Current Antithrombotic Treatments for Cardiovascular Diseases: A Comprehensive Review.

Antithrombotic therapies (ATT) play a pivotal role in the management of cardiovascular diseases, aiming to prevent ischemic events while maintaining a delicate balance with the patient's bleeding risk. Typically, ATT can be classified into antiplatelet and anticoagulant therapies. Their application spans a broad spectrum of cardiovascular conditions, ranging from ischemic heart disease to atrial fibrillation, encompassing venous thromboembolisms and innovative structural interventional cardiology procedures. The global burden of cardiovascular diseases is steadily increasing, often giving rise to overlapping clinical presentations. Accordingly, the adoption of combined pharmacological approaches becomes imperative, potentially disrupting the delicate equilibrium between ischemic and bleeding risk, thus leading to nuanced pharmacotherapeutic pathways. In this context, contemporary investigations strive to identify a convergence point that optimizes the duration of medical therapy while addressing the need for antithrombotic effects, especially in the context of ischemic heart disease. This review aims to comprehensively revisit the main antithrombotic strategies in cardiovascular diseases, with the intention of enhancing a systematic approach which is key for the effective clinical management of these patients. Also, the review will examine the most impactful studies that have established the groundwork for current scientific evidence, with acknowledgement of special populations. Finally, we will cast a gaze into the future of this dynamic and evolving research field, exploring forthcoming perspectives and advancements.

Plant competition cues activate a singlet oxygen signaling pathway in Arabidopsis thaliana.

Oxidative stress responses of Arabidopsis to reflected low red to far-red signals (R:FR ≈ 0.3) generated by neighboring weeds or an artificial source of FR light were compared with a weed-free control (R:FR ≈1.6). In the low R:FR treatments, induction of the shade avoidance responses (SAR) coincided with increased leaf production of singlet oxygen (1O2). This 1O2 increase was not due to protochlorophyllide accumulation and did not cause cell death. Chemical treatments, however, with 5-aminolevulinic acid (the precursor of tetrapyrrole biosynthesis) and glutathione (a quinone A reductant) enhanced cell death and growth inhibition. RNA sequencing revealed that transcriptome responses to the reflected low R:FR light treatments minimally resembled previously known Arabidopsis 1O2 generating systems that rapidly generate 1O2 following a dark to light transfer. The upregulation of only a few early 1O2 responsive genes (6 out of 1931) in the reflected low R:FR treatments suggested specificity of the 1O2 signaling. Moreover, increased expression of two enzyme genes, the SULFOTRANSFERASE ST2A (ST2a) and the early 1O2-responsive IAA-LEUCINE RESISTANCE (ILR)-LIKE6 (ILL6), which negatively regulate jasmonate level, suggested that repression of bioactive JAs may promote the shade avoidance (versus defense) and 1O2 acclimation (versus cell death) responses to neighboring weeds.

A theoretical study on excited-state dynamical properties and laser cooling of zinc monohydride including spin-orbit couplings.

By means of highly accurate ab initio and dynamical calculations, we identify a suitable laser cooling candidate that contains a transition metal element, namely zinc monohydride (ZnH). The internally contracted multireference configuration interaction method is employed to compute the five lowest-lying Λ-S states of ZnH with the spin-orbit coupling effects included, and very good agreement is obtained between our calculated and experimental spectroscopic data. Our findings show that the position of crossing point of the A2Π and B2Σ+ states of ZnH is above the v' = 2 vibrational level of the A2Π state indicating that the crossings with higher electronic states will have no effect on laser cooling. Hence, we construct a feasible laser-cooling scheme for ZnH using five lasers based on the A2Π1/2 → X2Σ+ 1/2 transition, which features a large vibrational branching ratio R 00 (0.8458), a large number of scattered photons (9.8 × 103) and an extremely short radiative lifetime (64 ns). The present work demonstrates the importance of electronic state crossings and spin-orbit couplings in the study of molecular laser cooling.

Effect of Diffuse Idiopathic Skeletal Hyperostosis on the Occurrence of Thoracolumbar Vertebral Fragility Fractures at Different Ages.

STUDY DESIGN: Retrospective Case control Study. OBJECTIVES: To analyze the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the occurrence of new thoracolumbar vertebral fragility fractures (VFFs) at different ages. METHODS: A retrospective analysis of 564 patients, including 189 patients who presented with new-onset thoracolumbar VFFs and 375 patients without spinal fractures, was performed in 4 age groups (50-59 years, 60-69 years, 70-79 years, and 80+ years). DISH was diagnosed based on computed tomography findings, and the Mata score of each disc space level combined with the maximum number of consecutive ossified segments (MNCOS) for each patient was recorded. Data were compared between the fracture and control groups, and odds ratios (ORs) were calculated for each of the 4 age groups using logistic regression. RESULTS: Both the crude ORs and the adjusted ORs of DISH for VFFs decreased with age, with statistical significance shown in the 50-59 years group (crude OR = 4.373, P = 0.017; adjusted OR = 7.111, P = 0.009) and the 80+ years group (crude OR = 0.462, P = 0.018; adjusted OR = 0.495, P = 0.045). The Mata scores and the MNCOS were significant risk factors for VFFs (P < 0.05) in the 50-59 years group, but they were protective factors in the 80+ years group, which was more significant in the T11/12-L5/S1 subsegment. CONCLUSIONS: The effect of DISH on the occurrence of thoracolumbar VFFs is complex, and in patients above 50 years, it changes from a risk factor to a protective factor with increasing age.

ℒ1adaptive resonance ratio control for series elastic actuator with guaranteed transient performance.

Series elastic actuator (SEA) technology is promising for the development of compliant robotic joints. Despite advancements in the realization of precise tracking, challenges persist in controlling the vibration and transient performance. This study enhanced the resonance ratio control (RRC) algorithm by integrating it with the L1 adaptive control (L1AC) method to address overshoot, static error, and vibration in SEA position control. Initially, the resonance between the motor and link sides caused by the elastic transmission structure was analyzed, which can result in overshoots and vibrations that affect the transient performance of the SEA control. Subsequently, a control scheme based on L1AC was introduced to enhance the performance. The stability of the proposed algorithm was demonstrated through a comprehensive exploration of key control parameters. Furthermore, the algorithm was augmented with gravity compensation, effectively reducing the predicted and reference errors. Consequently, the transient performance was improved. The efficacy of this enhanced algorithm was validated through simulations and experimental platforms, and comparisons with the RRC and model reference adaptive control algorithms. In all the experiments, the overshoot did not exceed 1.1%, the maximum jitter amplitude on the link side was within 0.2° , and a larger time constant in the controller could effectively eliminate the overshoot and vibration with a small response time delay. Furthermore, the algorithm exhibited a protective response during link side collisions by moderating link velocity and limiting motor current, to safeguard the contact environment, humans, and the SEA itself, which take advantage of the L1AC's low-pass filter (LPF) properties in disturbance handling.

A pilot pragmatic randomized controlled trial of a nicotine metabolite ratio-guided smoking cessation intervention in a lung health and screening program.

Introduction: Patients with pulmonary nodules detected through lung cancer screening or as incidental findings are often followed in lung health and screening programs. The use of personalized pharmacotherapy for smoking cessation informed by the nicotine metabolite ratio (NMR), a measure of nicotine metabolism, has not yet been evaluated in this setting. This pilot randomized controlled trial (RCT) evaluated the feasibility of conducting a larger trial. Methods: Through a pragmatic RCT design, participants were recruited from a Mid-Atlantic lung health and screening program. Eligible participants smoked >5 cigarettes per day and completed a blood draw to determine NMR before being randomized to standard or NMR-guided care treatment arms. Standard care participants were offered nicotine replacement therapy (NRT) or varenicline and a referral to phone-based smoking cessation counseling. NMR-guided participants received standard care except they were provided a personalized medication recommendation based on their NMR. Study outcomes included measures of feasibility, medication uptake, and treatment matching (i.e., uptake of the optimal medication). Results: More than 80 % of 205 screened patients were eligible. However, only 37 (22 %) of these patients enrolled in the study, with a mean age of 65 years, 43 % female, and 25 % Black. Nearly all patients who declined cited a disinterest in smoking cessation. Participants in both treatment arms had high rates of medication uptake (68 %), with NMR-guided participants showing a trend towards greater treatment matching (55 % vs. 29 %). Conclusions: The results of this pilot study provide support for conducting a larger RCT of an NMR-guided smoking cessation intervention in a lung health and screening setting. Consideration should be given to augmenting the intervention to address barriers to study entry.

Is the golden ratio present in the coxal bone? An anatomical pilot study.

The coxal bone is crucial for movement, stability, and childbirth. Although most morphometric studies estimate gender and age, ratio, correlation and index calculations, there are no studies on the golden ratios in the coxal bone. Inspired by this idea, we investigated the presence of the golden ratio in the coxal bones. In this study, 95 adult dry coxal bones were measured using a digital caliper. Morphometric measurements were conducted based on 18 identified parameters. 12 of these parameters were related to the distances between two points in various parts of the bone. New ratios were determined with those measurements. In our study, we detected a constant coefficient between the following lengths: anterior superior iliac spine (ASIS)- posterior superior iliac spine (PSIS) and anterior inferior iliac spine (AIIS)- posterior inferior iliac spine (PIIS), vertical and transverse diameters of the acetabulum (AC), ASIS-AC and AIIS-AC, PSIS-AC and PIIS-AC, ASIS-auricular surface and AIIS-auricular surface, ASIS-symphyseal surface and AIIS-symphyseal surface (respectively, 1.29, 1.05, 1.18, 2.32, 1.26, 1.32). In order to check the accuracy of this hypothesis, length of between AIIS-PIIS, transverse diameter of the acetabulum, length of between PIIS-AC, length of between AIIS-AC, shortest distance between AIIS-auricular surface, length of between AIIS-symphyseal surface were estimated with the help of new equations. We detected constant ratios between some lengths in the coxal bone. Estimated distances should be taken into account during surgical procedures to prevent complications. In this context, the constant ratios identified in our study will serve as a guide for surgeons.

A novel advanced hybrid fuzzy MPPT controllers for renewable energy systems.

At present, the availability of nonrenewable sources and their usage for electric vehicle technology is reducing gradually because of their disadvantages are more environmental pollution, direct effect on human health, less reliability, and taking more time to start functioning. So, in this article, the proton exchange membrane fuel cell (PEMFC) is considered for the automotive application because of its advantages quick startup, more power density, more safety to handle, high efficiency, and capability of operating at very low operational temperature conditions. However, the drawback of PEMFC is very difficult to identify the accurate MPP position of the fuel system. Here, the improved variable step genetic algorithm is added with the adaptive neuro-fuzzy inference system for tracking the operational point of the proposed system with high efficiency. These hybrid MPPT controller features are easy to understand, more accurate, have a better dynamic response, and have low design complexity. The evaluated proposed MPPT controller operational efficiency, and settling time of the converter voltage at different fuel stack temperature conditions are 98.7402%, and 0.01607 s respectively. Finally, the boost converter is used in this work to enhance the voltage supply capability of the entire system. The proposed system is investigated by applying the MATLAB tool.

The vastus medialis oblique compensates in current patellar dislocation patients with the increased femoral anteversion.

PURPOSE: The purpose of this study was to investigate whether the vastus medialis oblique (VMO) muscle compensates in patellar dislocation (PD) patients with the increased femoral anteversion angle (FAA). METHODS: Between 2021 and 2024, we included 60 patients with recurrent PD (RPD group). Inclusion criteria were at least two episodes of PD, as well as complete CT scans of the knee and hip. Exclusion criteria included traumatic or habitual dislocation, previous knee surgery, etc. Of these patients, 30 with excessive FAA (≥ 30°) were assigned to the A group, and 30 without excessive FAA (< 30°) to the B group. A control group of 120 patients without patellofemoral disorders was also included (C group). The cross-sectional areas of the VMO and vastus lateralis muscle (VLM) were measured 20 mm above the patella on CT scans, and the VMO/VLM area ratio was calculated. The correlation between FAA and the VMO/VLM ratio was analyzed. RESULTS: The RPD group had a significantly larger FAA (15.0 ± 1.9° vs. 30.1 ± 9.6°, P = 0.040) and a smaller VMO/VLM ratio (4.2 ± 1.5 vs. 3.5 ± 1.0, P = 0.014) compared to the C group. Within the RPD group, the A group had a higher VMO/VLM ratio than the B group (4.0 ± 1.1 vs. 3.0 ± 0.7, P = 0.029). The B group's VMO/VLM ratio was lower than that of the C group (3.0 ± 0.7 vs. 4.2 ± 1.5, P = 0.004). However, there was no significant difference in the VMO/VLM ratio between the A group and the C group. The VMO/VLM ratio showed a moderate positive correlation with FAA in the RPD group, with a correlation coefficient of r = 0.4 (P = 0.012), indicating a statistically significant relationship between the two. CONCLUSION: Patients with recurrent PD showed a smaller VMO/VLM ratio compared to controls. Increased FAA was correlated with compensatory thickening of the VMO and a higher VMO/VLM ratio in PD patients. This suggests that increased FAA may drive biomechanical adaptations in the quadriceps, stabilizing the patella. Clinicians should consider changes in FAA when assessing and treating PD. LEVEL OF EVIDENCE: Level III.

Common odds ratio test and interval estimation for stratified bilateral and unilateral data.

In clinical research, data are commonly collected bilaterally from paired organs or bodily parts within individual subjects. However, unilateral data arise when constraints or limiting factors impede the collection of complete bilateral data. In this article, we propose three large-sample tests and five confidence interval methods for making inferences on the common treatment effect, measured by the odds ratio, in a stratified design under integrated bilateral and unilateral data. Our simulation results show that the likelihood ratio-based and score-based tests, along with their associated confidence interval methods, demonstrate robust control of type I error and close-to-nominal coverage probabilities. We apply the proposed methods to real-world datasets of acute otitis media and myopic eyes to showcase their validity and applicability in clinical practice.