Diagnostic cutoff values of synovial fluid biomarkers for acute postoperative prosthetic joint infection: a systematic review and meta-analysis.

Introduction: The assessment of white blood cell (WBC) count and polymorphonuclear cell (PMN) percentage in synovial fluid can help in the diagnosis of acute postoperative peri-prosthetic joint infection (PJI). Their cutoff values, which would differ from those for chronic PJI, have not yet been determined in acute postoperative PJI. The aim of this study was (1) to analyse studies reporting the optimal cutoff values for WBC count and the PMN percentage in synovial fluid and (2) to determine which is the best diagnostic tool for acute postoperative PJI. Methods: We performed a systematic review (SR) of primary studies analysing WBC count and the PMN percentage for diagnosis of acute postoperative PJI. A search was performed in MEDLINE and EMBASE. We studied the risk of bias and quality assessment. We extracted data on cutoff values, sensitivity, specificity, positive and negative predictive value, area under the curve, and accuracy. We calculated the diagnosis odds ratio (DOR), performed the meta-analysis and summarized receiver operating curves (sROCs) for WBC count and the PMN percentage. Results: We included six studies. WBC count showed a DOR of 123.61 (95 % CI: 55.38-275.88), an sROC with an area under the curve (AUC) of 0.96 (SE: 0.009) and a Q index of 0.917. The PMN percentage showed a summary DOR of 18.71 (95 % CI: 11.64-30.07), an sROC with an AUC 0.88 (SE: 0.018) and a Q index of 0.812. Conclusion: We concluded that WBC count and the PMN percentage are useful tests for the diagnosis of acute PJI; WBC is the more powerful of the two. Studies centred on other synovial fluid biomarkers not yet studied could help in this diagnosis.

Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT / Resumen ejecutivo: Guía de diagnóstico y tratamiento de la artritis séptica en adultos y niños de GEIO (SEIMC), SEIP y SECOT

Infection of a native joint, commonly referred to as septic arthritis, is a medical emergency because of the risk of joint destruction and subsequent sequelae. Its diagnosis requires a high level of suspicion. These guidelines for the diagnosis and treatment of septic arthritis in children and adults are intended for use by any physician caring for patients with suspected or confirmed septic arthritis. They have been developed by a multidisciplinary panel with representatives from the Bone and Joint Infections Study Group (GEIO) belonging to the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Paediatric Infections (SEIP) and the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT), and two rheumatologists. The recommendations are based on evidence derived from a systematic literature review and, failing that, on the opinion of the experts who prepared these guidelines. A detailed description of the background, methods, summary of evidence, the rationale supporting each recommendation, and gaps in knowledge can be found online in the complete document.(AU)

La infección de una articulación nativa, generalmente denominada artritis séptica, constituye una urgencia médica por el riesgo de destrucción articular y las consecuentes secuelas. Su diagnóstico requiere un alto nivel de sospecha. Esta guía de diagnóstico y tratamiento de la artritis séptica en niños y adultos está destinada a cualquier médico que atienda pacientes con sospecha de artritis séptica o artritis séptica confirmada. La guía ha sido elaborada por un panel multidisciplinar en el que están representados el Grupo de Estudio de Infecciones Osteoarticulares (GEIO) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), la Sociedad Española de Infectología Pediátrica (SEIP) y la Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT); además han participado dos reumatólogos. Las recomendaciones se basan en la evidencia proporcionada por una revisión sistemática de la literatura y, en su defecto, en la opinión de los expertos que han elaborado la presente guía. En el texto completo online se hace una descripción detallada de los antecedentes, métodos, resumen de la evidencia, fundamentos que apoyan cada recomendación y las lagunas de conocimiento existentes.(AU)

Tailoring Single-Mode Random Lasing of Tin Halide Perovskites Integrated in a Vertical Cavity.

The development of random lasing (RL) with predictable and controlled properties is an important step to make these cheap optical sources stable and reliable. However, the design of tailored RL characteristics (emission energy, threshold, number of modes) is only obtained with complex photonic structures, while the simplest optical configurations able to tune the RL are still a challenge. This work demonstrates the tuning of the RL characteristics in spin-coated and inkjet-printed tin-based perovskites integrated into a vertical cavity with low quality factor. When the cavity mode is resonant with the photoluminescence (PL) peak energy, standard vertical lasing is observed. More importantly, single mode RL operation with the lowest threshold and a quality factor as high as 1 000 (twenty times the quality factor of the resonator) is obtained if the cavity mode lies above the PL peak energy due to higher gain. These results can have important technological implications toward the development of low-cost RL sources without chaotic behavior.

Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT.

Infection of a native joint, commonly referred to as septic arthritis, is a medical emergency because of the risk of joint destruction and subsequent sequelae. Its diagnosis requires a high level of suspicion. These guidelines for the diagnosis and treatment of septic arthritis in children and adults are intended for use by any physician caring for patients with suspected or confirmed septic arthritis. They have been developed by a multidisciplinary panel with representatives from the Bone and Joint Infections Study Group (GEIO) belonging to the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Paediatric Infections (SEIP) and the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT), and two rheumatologists. The recommendations are based on evidence derived from a systematic literature review and, failing that, on the opinion of the experts who prepared these guidelines. A detailed description of the background, methods, summary of evidence, the rationale supporting each recommendation, and gaps in knowledge can be found online in the complete document.

Large-Area, Flexible, Lead-Free Sn-Perovskite Solar Modules.

For the first time, large-area, flexible organic-inorganic tin perovskite solar modules are fabricated by means of an industry-compatible and scalable blade-coating technique. An 8-cell interconnected mini module with dimensions of 25 cm2 (active area = 8 × 1.5 cm2) reached 5.7% power conversion efficiency under 1000 W/m2 (AM 1.5G) and 9.4% under 2000 lx (white-LED).

Antimicrobials in polymethylmethacrylate: from prevention to prosthetic joint infection treatment: basic principles and risk of resistance.

BACKGROUND: Excellent revisions about antibiotic-loaded bone cement (ALBC) have been recently published. In the present article, we review the principles and limitations of local antibiotic delivery in the context of recent advances in the pathogenesis of prosthetic joint infections (PJI), with particular attention paid to the potential association between ALBC and antimicrobial resistance. MAIN BODY: Recalcitrance of PJI is related to the ability of pathogens to adapt to particular environments present in bone tissue and protect themselves from host immunity in different ways. Accordingly, delivery of high local antimicrobial concentrations using ALBC is needed. Most relevant clinical data showing the efficacy of ALBC for PJI prophylaxis and treatment are reviewed, and we dissected the limitations on the basis of the recent findings from animal models and suggested that aminoglycosides, in particular, could not be the best option. One of the major concerns associated with ALBC is the emergence of resistance because of theoretical prolonged exposure to low antibiotic concentrations. We summarize the mechanisms for the selection of resistant microorganisms, and we critically reviewed the evidence from animal models and clinical data from observational and registry studies and concluded that there is no evidence to support this association. CONCLUSION: While waiting for better evidence from well-designed clinical trials, ALBC shows a beneficial effect as a prophylaxis in arthroplasty, and to avoid the colonization of spacers used for two-stage revision in patients with PJI. Experimental models and clinical evidence suggest the need to achieve high local antimicrobial concentrations to obtain the highest prophylactic and therapeutic effect. The current evidence does not support the risk of increasing resistance with use of ALBC. In the future, it is necessary to evaluate new carriers and different antimicrobials to improve clinical outcomes.

The morphofunctional implications of the glenoid labrum of the glenohumeral joint in hominoids.

OBJECTIVES: A morphocline of the glenoid cavity has been used to infer differences in locomotor behaviors; however, the glenoid cavity is surrounded by the glenoid labrum, a fibrocartilaginous structure that could influence the functionality of the glenoid. The objectives of this study are to explore the effects of the glenoid labrum on the area, depth, and morphology of the glenoid cavity in primates. MATERIALS AND METHODS: Photogrammetry was used to build 3D models of the glenoid, with and without the labrum, and three- (3D) and two-dimensional (2D) geometric morphometrics (GM) was applied. 2D areas were collected from zenithal images for glenoids with and without labrum to evaluate the availability of articular surface area. RESULTS: In the 2D GM the morphocline is present in the dry-bone sample but not with the presence of the glenoid labrum. In the 3D GM there are differences between species mainly concerning the depth of the glenoid cavity. 2D areas reveal that the amount of articular area of the glenoid cavity increases with the presence of the labrum, particularly in humans. DISCUSSION: The glenoid labrum changes the shape, increases the depth and the surface area of the glenoid cavity, particularly in humans. Therefore, the glenoid labrum might hold a functional role, increasing the stability of the glenohumeral joint of primates in general, and especially in humans.

Antimalarial phytochemicals as potential inhibitors of SARS-CoV-2 guanine N7-methyltransferase (nsp 14): an integrated computational approach.

The inhibition of capping enzymes such as guanine-N7-methyltransferase (GMT) is an attractive target for regulating viral replication, transcription, virulence, and pathogenesis. Thus, compounds that target the Severe Acute Respiratory Syndrome Corona Virus 2 GMT (S2GMT) will enhance drug development against COVID-19. In this study, an in-house library of 249 phytochemicals from African medicinal plants was screened using computational approaches including homology modeling, molecular docking, molecular dynamic simulations, binding free energy calculations based on molecular mechanics/Poisson-Boltzmann surface area (MMPBSA) and Absorption-Distribution-Metabolism-Excretion-Toxicity (ADMET) analysis for inhibitors of S2GMT. The top-ten ranked phytochemicals (TTRP) obtained from the docking analysis to S2GMT were further docked to SARS-COV N7-MTase. Among the TTRP, the top-four ranked phytocompounds (TFRP) viz: 3 alkaloids (Isocryptolepine, 10'-Hydroxyusambarensine and Isostrychnopentamine) and a flavonoid (Mulberrofuran F) interacted strongly with critical catalytic residues whose interference either reduce or completely abolish N7-MTase activity, indicating their potential as capping machinery disruptors. The interactions of TFRP with the catalytic residues of S2GMT were preserved in a 100 ns simulated dynamic environment, thereby, demonstrating high degree of structural stability. The MMPBSA binding free energy calculations corroborated the docking scores with biscryptolepine having the highest binding free energy to S2GMT. The TFRP showed favourable drug-likeness and ADMET properties over a wide range of molecular descriptors. Therefore, the TFRP can be further explored as potential S2GMT inhibitors in in vitro and in vivo experiments.Communicated by Ramaswamy H. Sarma.

Unusual Spectrally Reproducible and High Q-Factor Random Lasing in Polycrystalline Tin Perovskite Films.

An unusual spectrally reproducible near-IR random lasing (RL) with no fluctuation of lasing peak wavelength is disclosed in polycrystalline films of formamidinium tin triiodide perovskite, which have been chemically stabilized against Sn2+ to Sn4+ oxidation. Remarkably, a quality Q-factor as high as ≈104 with an amplified spontaneous emission (ASE) threshold as low as 2 µJ cm-2 (both at 20 K) are achieved. The observed spectral reproducibility is unprecedented for semiconductor thin film RL systems and cannot be explained by the strong spatial localization of lasing modes. Instead, it is suggested that the spectral stability is a result of such an unique property of Sn-based perovskites as a large inhomogeneous broadening of the emitting centers, which is a consequence of an intrinsic structural inhomogeneity of the material. Due to this, lasing can occur simultaneously in modes that are spatially strongly overlapped, as long as the spectral separation between the modes is larger than the homogeneous linewidth of the emitting centers. The discovered mechanism of RL spectral stability in semiconductor materials, possessing inhomogeneous broadening, opens up prospects for their practical use as cheap sources of narrow laser lines.

Prevalence of mutualism in a simple model of microbial coevolution.

Evolutionary transitions among ecological interactions are widely known, although their detailed dynamics remain absent for most population models. Adaptive dynamics has been used to illustrate how the parameters of population models might shift through evolution, but within an ecological regime. Here we use adaptive dynamics combined with a generalized logistic model of population dynamics to show that transitions of ecological interactions might appear as a consequence of evolution. To this purpose, we introduce a two-microbial toy model in which population parameters are determined by a bookkeeping of resources taken from (and excreted to) the environment, as well as from the byproducts of the other species. Despite its simplicity, this model exhibits all kinds of potential ecological transitions, some of which resemble those found in nature. Overall, the model shows a clear trend toward the emergence of mutualism.

Elbow Extensor Muscles in Humans and Chimpanzees: Adaptations to Different Uses of the Upper Extremity in Hominoid Primates.

The anatomical and functional characteristics of the elbow extensor muscles (triceps brachii and anconeus) have not been widely studied in non-human hominoid primates, despite their great functional importance. In the present study, we have analyzed the muscle architecture and the expression of the myosin heavy chain (MHC) isoforms in the elbow extensors in humans and chimpanzees. Our main objective was to identify differences in these muscles that could be related to the different uses of the upper extremity in the two species. In five humans and five chimpanzees, we have analyzed muscle mass (MM), muscle fascicle length (MFL), and the physiological cross-sectional area (PCSA). In addition, we have assessed the expression of the MHC isoforms by RT-PCR. We have found high MM and PCSA values and higher expression of the MHC-IIx isoform in the triceps brachii of chimpanzees, while in humans, the triceps brachii has high MFL values and a higher expression of the MHC-I and MHC-IIa isoforms. In contrast, there were no significant differences between humans and chimpanzees in any of the values for the anconeus. These findings could be related to the participation of the triceps brachii in the locomotion of chimpanzees and to the use of the upper extremity in manipulative functions in humans. The results obtained in the anconeus support its primary function as a stabilizer of the elbow joint in the two species.

Revealing Giant Exciton Fine-Structure Splitting in Two-Dimensional Perovskites Using van der Waals Passivation.

Organic-inorganic layered perovskites are currently some of the most promising 2D van der Waals materials. Low crystal quality usually broadens the exciton line width, obscuring the fine structure of the exciton in conventional photoluminescence experiments. Here, we propose a mechanical approach to reducing the effect of spectral diffusion by means of hBN capping on layered perovskites, revealing the exciton fine structure. We used a stochastic model to link the reduction of the spectral line width with the population of charge fluctuation centers present in the organic spacer. van der Waals forces between both lattices cause the partial clamping of the perovskite organic spacer molecules, and hence the amplitude of the overall spectral diffusion effect is reduced. Our work provides a low-cost solution to the problem of accessing important fine-structure excitonic state information, along with an explanation of the important carrier dynamics present in the organic spacer that affect the quality of the optical emission.

A Decision Support System (DSS) for the Prediction and Selection of Optimum Operational Parameters in Pressure Die-Casting Processes.

A large number of material and process parameters affect both the part quality and the process performance in pressure die-casting (PDC) processes. The complex relations between most of these variables make PDC process optimisation a difficult issue which has been widely studied for many years. Although there are several analytical and numerical models to optimise certain process parameters, it is difficult to establish a specific operational configuration for PDC machines that ensures the joint optimisation of these variables. Therefore, in this study, some of these optimisation models have been implemented in a Decision Support System (DSS) that allows us to define an operational region that establishes a setup of machine parameters that ensures the manufacture of quality parts. By using this DSS, the user can set the values of the input variables related to the casting material, the die, or the casting machine. Then the corresponding calculations are made by the system and the results are expressed in terms of certain output variables such as the maximum filling time, maximum filling fraction, or the plunger velocity profile among others. The DSS allows the user to estimate the influence between input and output variables and find proper values for the input variables to achieve an optimum operational range. Consequently, improved process performance can be achieved taking into account productivity, part quality, and economic aspects.

Tin perovskite solar cells with >1,300 h of operational stability in N2 through a synergistic chemical engineering approach.

Despite the promising properties of tin-based halide perovskites, one clear limitation is the fast Sn+2 oxidation. Consequently, the preparation of long-lasting devices remains challenging. Here, we report a chemical engineering approach, based on adding Dipropylammonium iodide (DipI) together with a well-known reducing agent, sodium borohydride (NaBH4), aimed at preventing the premature degradation of Sn-HPs. This strategy allows for obtaining efficiencies (PCE) above 10% with enhanced stability. The initial PCE remained unchanged upon 5 h in air (60% RH) at maximum-power-point (MPP). Remarkably, 96% of the initial PCE was kept after 1,300 h at MPP in N2. To the best of our knowledge, these are the highest reported values for Sn-based solar cells. Our findings demonstrate a beneficial synergistic effect when additives are incorporated, highlight the important role of iodide in the performance upon light soaking, and, ultimately, unveil the relevance of controlling the halide chemistry for future improvement of Sn-based perovskite devices.

Implication of Different Tumor Biomarkers in Drug Resistance and Invasiveness in Primary and Metastatic Colorectal Cancer Cell Lines.

Protein expression profiles are directly related to the different properties of cells and are conditioned by the cellular niche. As an example, they are the cause of the characteristic cell plasticity, epithelium-mesenchymal transition (EMT), and drug resistance of cancer cells. This article characterizes ten biomarkers related to these features in three human colorectal cancer cell lines: SW-480, SW-620, and DLD-1, evaluated by flow cytometry; and in turn, resistance to oxaliplatin is studied through dose-response trials. The main biomarkers present in the three studied lines correspond to EpCAM, CD-133, and AC-133, with the latter two in low proportions in the DLD-1 line. The biomarker CD166 is present in greater amounts in SW-620 and DLD-1 compared to SW-480. Finally, DLD-1 shows high values of Trop2, which may explain the aggressiveness and resistance of these cells to oxaliplatin treatments, as EpCAM is also highly expressed. Exposure to oxaliplatin slows cell growth but also helps generate resistance to the treatment. In conclusion, the response of the cell lines is variable, due to their genetic variability, which will condition protein expression and cell growth. Further analyses in this area will provide important information for better understanding of patients' cellular response and how to prevent resistance.

Usefulness of serum D-dimer and platelet count to mean platelet volume ratio to rule out chronic periprosthetic joint infection.

Background: Diagnosing periprosthetic joint infection (PJI) is challenging and usually requires the evaluation of several biomarkers. Our main aim was to evaluate the usefulness of D-dimer levels as well as the platelet count (PC) to mean platelet volume (MPV) ratio serum as biomarkers to rule out chronic knee and hip infection. Methods: The study enrolled a prospective cohort of 93 patients undergoing hip or knee revision. D-dimer values, PC to MPV ratio, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were preoperatively determined and evaluated as a predictor of PJI. The definitive diagnosis of PJI was established according to the 2018 International Consensus Meeting criteria. Results: A total of 24 (25.8 %) cases were postoperatively diagnosed with PJI. The median D-dimer value was significantly higher ( p   <  0.001) for patients with PJI (1950 ng mL - 1 ) than for patients with aseptic failure (700 ng mL - 1 ). The area under the receiver operating characteristic curves for D-dimer, CRP and ESR was 0.820, 0.793 and 0.791 respectively. D-dimer  ≥  950 ng mL - 1 (91 % sensitivity, 64 % specificity), CRP  ≥  1.95 mg dL - 1 (61 % sensitivity, 90 % specificity) and ESR  >  20 (74 % sensitivity, 82 % specificity) were identified as the values with the best balance between sensitivity and specificity. The mean PC to MPV ratio was 37.0 for PJI patients and 29.8 for patients in the aseptic revision cohort ( p = 0 .067). Conclusions: Serum D-dimer levels appear very unlikely to remain normal in the presence of chronic PJI. The 91 % sensitivity when considering 950 ng mL - 1 as the threshold highlights D-dimer as the most accurate initial test to rule out chronic PJI. Conversely, the PC to MPV ratio may be of limited value for accurately diagnosing PJI.

Anatomical and molecular analyses of the deltoid muscle in chimpanzees (Pan troglodytes) and modern humans (Homo sapiens): Similarities and differences due to the uses of the upper extremity.

In the deltoid muscles of Pan troglodytes and Homo sapiens, we have analyzed the muscle architecture and the expression of the myosin heavy chain (MHC) isoforms. Our aim was to identify differences between the two species that could be related to their different uses of the upper limb. The deltoid muscle of six adult Pan troglodytes and six adult Homo sapiens were dissected. The muscle fascicle length (MFL) and the physiological cross-sectional area (PCSA) of each muscle were calculated in absolute and normalized values. The expression pattern of the MHC-I, MHC-IIa and MHC-IIx isoforms was analyzed in the same muscles by real-time polymerase chain reaction. Only the acromial deltoid (AD) presented significant architectural differences between the two species, with higher MFL values in humans and higher PCSA values in chimpanzees. No significant differences in the expression pattern of the MHC isoforms were identified. The higher PCSA values in the AD of Pan troglodytes indicate a greater capacity of force generation in chimpanzees than in humans, which may be related to a greater use of the upper limb in locomotion, specifically in arboreal locomotion like vertical climbing. The functional differences between chimpanzees and humans in the deltoid muscle are more related to muscle architecture than to a differential expression of MHC isoforms.

African derived phytocompounds may interfere with SARS-CoV-2 RNA capping machinery via inhibition of 2'-O-ribose methyltransferase: An in silico perspective.

Despite the ongoing vaccination against the life-threatening COVID-19, there is need for viable therapeutic interventions. The S-adenosyl-l-Methionine (SAM) dependent 2-O'-ribose methyltransferase (2'-O-MTase) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents a therapeutic target against COVID-19 infection. In a bid to profile bioactive principles from natural sources, a custom-made library of 226 phytochemicals from African medicinal plants with especially anti-malarial activity was screened for direct interactions with SARS-CoV-2 2'-O-MTase (S2RMT) using molecular docking and molecular dynamics (MD) simulations as well as binding free energies methods. Based on minimal binding energy lower than sinefungin (a reference methyl-transferase inhibitor) and binding mode analysis at the catalytic site of S2RMT, a list of 26 hit phytocompounds was defined. The interaction of these phytocompounds was compared with the 2'-O-MTase of SARS-CoV and MERS-CoV. Among these compounds, the lead phytocompounds (LPs) viz: mulberrofuran F, 24-methylene cycloartenol, ferulate, 3-benzoylhosloppone and 10-hydroxyusambarensine interacted strongly with the conserved KDKE tetrad within the substrate binding pocket of the 2'-O-MTase of the coronavirus strains which is critical for substrate binding. The thermodynamic parameters analyzed from the MD simulation trajectories of the LPs-S2RMT complexes presented an eminent structural stability and compactness. These LPs demonstrated favorable druggability and in silico ADMET properties over a diverse array of molecular computing descriptors. The LPs show promising prospects in the disruption of S2RMT capping machinery in silico. However, these LPs should be validated via in vitro and in vivo experimental models.

White light emission from lead-free mixed-cation doped Cs2SnCl6 nanocrystals.

We have designed a synthesis procedure to obtain Cs2SnCl6 nanocrystals (NCs) doped with metal ion(s) to emit visible light. Cs2SnCl6 NCs doped with Bi3+, Te4+ and Sb3+ ions emitted blue, yellow and red light, respectively. In addition, NCs simultaneously doped with Bi3+ and Te4+ ions were synthesized in a single run. Combination of both dopant ions together gives rise to the white emission. The photoluminescence quantum yields of the blue, yellow and white emissions are up to 26.5, 28, and 16.6%, respectively under excitation at 350, 390, and 370 nm. Pure white-light emission with CIE chromaticity coordinates of (0.32, 0.33) and (0.32, 0.32) at 340 and 370 nm excitation wavelength, respectively, was obtained. The as-prepared NCs were found to demonstrate a long-time stability, resistance to humidity, and an ability to be well-dispersed in polar solvents without property degradation due to their hydrophilicity, which could be of significant interest for wide application purposes.

Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review.

LAY ABSTRACT: This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.