Background: Optical coherence tomography angiography (OCTA) provides quantitative metrics of the retinal microvasculature, most prominently vessel density (VD), that are increasingly used as biomarkers in ocular, systemic, and cerebrovascular disease. Because OCTA relies on the detection of flow-related motion contrast, image quality has emerged as a pervasive determinant of these metrics, yet its effect has been reported in fragmentary and non-comparable ways across the literature. Methods: We identified OCTA studies indexed in PubMed that examined the relationship between image quality and quantitative OCTA parameters, and we summarised their methods and findings across the macular, foveal avascular zone, and peripapillary regions and across vascular layers. We integrated directly comparable per-unit scan-quality effects using random-effects meta-analysis and separately synthesized direct cross-sectional Pearson correlations between manufacturer-reported image quality and macular vessel-density outcomes from independent healthy cohorts. Results: Higher image quality was associated with higher measured vessel density in every contributing dataset. On the Optovue scan-quality (SQ, 0–10) scale, superficial macular VD increased by 3.46% (95% CI 1.85–5.07) per SQ unit in controlled signal-attenuation experiments and by covariate-adjusted observational estimates ranging from 0.90% to 2.16% per SQ unit; a combined order-of-magnitude estimate across both estimator types was 1.64% (95% CI 1.15–2.12). Peripapillary estimates were heterogeneous and derived from only two independent cohorts; they were therefore summarised descriptively rather than pooled. Across three independent externally authored healthy cohorts reporting direct cross-sectional Pearson correlations, higher image quality was strongly associated with higher macular vessel-density outcomes (random-effects pooled r = 0.64, 95% CI 0.50–0.75; I2 = 49%). Conclusions: Image quality is an important, directional confounder of VD-based OCTA metrics whose magnitude can rival the biological or physiological signal of interest. Platform-appropriate standardisation, transparent reporting, and consideration of image quality in acquisition and analysis are therefore important for the valid interpretation of vessel-density measurements, particularly in functional and longitudinal studies.
Fractures are among the most common injuries in childhood, yet the immature skeleton differs fundamentally from the adult skeleton. A thick periosteum, open physes, and a powerful capacity for remodeling mean that most pediatric fractures unite and realign without surgery. Despite this, national registries document an increasing use of operative fixation, including in some fracture groups with substantial remodeling potential. This narrative review synthesizes the contemporary evidence on the limits within which fractures throughout the growing skeleton can be treated conservatively. The literature was identified through structured searches of PubMed, Scopus, Web of Science, and the Cochrane Library. For each region we summarize the accepted thresholds of angulation, rotation, shortening, and displacement, together with the age- and site-specific modifiers that determine whether a deformity will remodel, and we present these thresholds in comparative tables. We also delineate the genuine indications for surgical treatment, so that the boundary between conservative and surgical management is defined rather than blurred. A secure command of these region-specific limits lets the treating physician exploit the child’s remarkable remodeling potential and avoid both under- and over-treatment.
Background/Objectives: Minimally verbal autistic children face profound communication challenges that significantly affect daily functioning, including social interaction, behavioral regulation, and overall well-being. Identifying effective interventions is a key clinical-educational priority. This systematic review examines communication-focused interventions for these children, including both spoken language approaches and augmentative and alternative communication (AAC) strategies. Methods: The review was registered in PROSPERO and conducted following PRISMA-S guidelines. Four electronic databases were searched, and 18 studies met the inclusion criteria. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was conducted, with subgroup analyses exploring sample characteristics, intervention types, targeted outcomes, and reported effects. Methodological quality of randomized controlled trials was assessed using the Cochrane Risk of Bias tool. Results: Interventions were implemented across clinical, educational, and home settings, using strategies such as Joint Attention, Symbolic Play, and Emotion Regulation, often combined with AAC technologies. Most included studies reported improvements in at least one communication outcome, although findings were heterogeneous and several studies reported mixed, subgroup-specific, or non-significant effects. The most consistent improvements were observed in spontaneous communication, particularly in interventions integrating developmental approaches with technological support. Conclusions: These findings highlight the value of individualized interventions. Future research should establish standardized definitions of “minimally verbal”, assess long-term outcomes, and adopt broader measures capturing both language and social-emotional development to enhance quality of life and inclusion.
BACKGROUND:Prognostic stratification remains challenging in patients with stage IIIC non-small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy (CCRT), and the relative performance of host-related prognostic indices in this setting is unclear. The CARWL (C-reactive Protein, Albumin, and Recent Weight Loss) score and the Naples prognostic score (NPS) have each been proposed as prognostic tools, but direct comparisons are lacking. This study compared their prognostic performance. METHODS:We retrospectively analyzed 795 patients with stage IIIC NSCLC treated with CCRT between 2010 and 2020. Patients were stratified into three prognostic groups according to CARWL and NPS. Overall survival (OS) was the primary endpoint; progression-free survival (PFS) and locoregional PFS (LRPFS) were secondary endpoints. Survival was assessed using Kaplan-Meier analysis and Cox regression. RESULTS:Both CARWL and NPS significantly stratified OS, PFS, and LRPFS (all p < 0.001). CARWL demonstrated modestly higher discriminatory performance across endpoints. The OS difference between unfavorable and favorable groups was larger with CARWL than with NPS (19.3 vs. 12.3 months). CARWL also provided greater separation for PFS (5.3 vs. 3.2 months) and LRPFS (4.9 vs. 3.4 months). In multivariable analyses, both indices retained independent prognostic significance; however, CARWL consistently exhibited stronger hazard gradients and maintained prognostic value when modeled alongside NPS. CONCLUSIONS:Both CARWL and NPS offered meaningful prognostic stratification in stage IIIC NSCLC treated with CCRT, but CARWL demonstrated a modest but more consistent prognostic discrimination than NPS. Pending external validation, CARWL represents a practical and biologically grounded tool for risk stratification in this population.
Background: Pregnancies tend to progress without any serious complications. Nonetheless, for a subset of women, obstetric complications may develop, ranging in severity. The most critical of these life-threatening events is referred to as Maternal Near Miss (MNM). To identify the epidemiological and obstetric characteristics, as well as clinical outcomes of MNM cases reported over the year 2021 in the Brazilian state of Paraná. This quantitative, population-based study analyzed 888 notifications that occurred in 2021, obtained from the MNM Notification System. Descriptive statistics and a one-sample Chi-square goodness-of-fit test were applied to the data. Among the women reported, 92.6% were pregnant, the mean age was 29 years, 67.1% identified as white, and 45.2% had preexisting health conditions. Regarding obstetric characteristics, 41.6% were classified as high-risk pregnancies, but nearly one-third (32.3%) of MNM cases occurred in women initially classified as usual risk. The clinical worsening event occurred most frequently during the third trimester (71.9%), and emergency cesarean section was indicated in 60.1% of cases with complete information for this variable. Cesarean delivery predominated over vaginal delivery, with an emergency-to-elective cesarean ratio of approximately 4.7:1. Most women (75%) were discharged after recovery. MNM events are not restricted to women initially classified as high-risk, underscoring the need to strengthen early detection strategies and ensure appropriate management at all levels of care. Improved training of healthcare professionals responsible for reporting and the standardization of MNM monitoring systems in Brazil are also essential.
