Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi.

There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.

Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms.

BACKGROUND: The effect of time from stroke onset to thrombectomy in the extended time window remains poorly characterized. AIM: We aimed to analyze the relationship between time to treatment and clinical outcomes in the early versus extended time windows. METHODS: Proximal anterior circulation occlusion patients from a multicentric prospective registry were categorized into early (≤6 h) or extended (>6-24 h) treatment window. Patients with baseline National Institutes of Health Stroke Scale (NIHSS) ≥ 10 and intracranial internal carotid artery or middle cerebral artery-M1-segment occlusion and pre-morbid modified Rankin scale (mRS) 0-1 ("DAWN-like" cohort) served as the population for the primary analysis. The relationship between time to treatment and 90-day mRS, analyzed in ordinal (mRS shift) and dichotomized (good outcome, mRS 0-2) fashion, was compared within and across the extended and early windows. RESULTS: A total of 1603 out of 2008 patients qualified. Despite longer time to treatment (9[7-13.9] vs. 3.4[2.5-4.3] h, p < 0.001), extended-window patients (n = 257) had similar rates of symptomatic intracranial hemorrhage (sICH; 0.8% vs. 1.7%, p = 0.293) and 90-day-mortality (10.5% vs. 9.6%, p = 0.714) with only slightly lower rates of 90-day good outcomes (50.4% vs. 57.6%, p = 0.047) versus early-window patients (n = 709). Time to treatment was associated with 90-day disability in both ordinal (adjusted odd ratio (aOR), ≥ 1-point mRS shift: 0.75; 95%CI [0.66-0.86], p < 0.001) and dichotomized (aOR, mRS 0-2: 0.73; 95%CI [0.62-0.86], p < 0.001) analyses in the early- but not in the extended-window (aOR, mRS shift: 0.96; 95%CI [0.90-1.02], p = 0.15; aOR, mRS0-2: 0.97; 95%CI [0.90-1.04], p = 0.41). Early-window patients had significantly lower 90-day functional disability (aOR, mRS shift: 1.533; 95%CI [1.138-2.065], p = 0.005) and a trend towards higher rates of good outcomes (aOR, mRS 0-2: 1.391; 95%CI [0.972-1.990], p = 0.071). CONCLUSIONS: The impact of time to thrombectomy on outcomes appears to be time dependent with a steep influence in the early followed by a less significant plateau in the extended window. However, every effort should be made to shorten treatment times regardless of ischemia duration.

Clinical effectiveness of endovascular stroke treatment in the early and extended time windows.

BACKGROUND: The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. AIM: We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry. METHODS: A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label mechanical thrombectomy registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials according to the basic demographic and clinical criteria without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. RESULTS: As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of intravenous tissue plasminogen activator (IV-tPA) and general anesthesia were higher in DAWN- and DEFUSE-3 registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding randomized clinical trials (SWIFT-Prime, 64.5% vs. 60.2%; DAWN, 50.4% vs. 48.6%; Beyond-DAWN: 52.4% vs. 48.6%; DEFUSE 3, 52% vs. 44.6%, respectively; all P > 0.05). Registry-derived patients had significant less disability than the corresponding randomized clinical trial controls (ordinal modified Rankin Scale (mRS) shift odds ratio (OR), P < 0.05 for all). CONCLUSION: Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the "real-world" setting and supports that patients may be safely treated outside the constraints of randomized clinical trials.

New Class of Radially Adjustable Stentrievers for Acute Ischemic Stroke: Primary Results of the Multicenter TIGER Trial.

[Figure: see text].

Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows.

BACKGROUND AND PURPOSE: Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients. METHODS: Patients from a prospective multicentric registry (n=2008) with occlusions involving the intracranial internal carotid or the M1- or M2-segments of the middle cerebral arteries, premorbid modified Rankin Scale score 0 to 2 and time to treatment 0 to 24 hours were categorized according to treatment times within the early (0-6 hour) or extended (6-24 hour) window as well as imaging modality with noncontrast computed tomography (NCCT)±CT angiography (CTA) or NCCT±CTA and CT perfusion (CTP). The association between imaging modality and 90-day modified Rankin Scale, analyzed in ordinal (modified Rankin Scale shift) and dichotomized (functional independence, modified Rankin Scale score 0-2) manner, was evaluated and compared within and across the extended and early windows. RESULTS: In the early window, 332 patients were selected with NCCT±CTA alone while 373 also underwent CTP. After adjusting for identifiable confounders, there were no significant differences in terms of 90-day functional disability (ordinal shift: adjusted odd ratio [aOR], 0.936 [95% CI, 0.709-1.238], P=0.644) or independence (aOR, 1.178 [95% CI, 0.833-1.666], P=0.355) across the CTP and NCCT±CTA groups. In the extended window, 67 patients were selected with NCCT±CTA alone while 180 also underwent CTP. No significant differences in 90-day functional disability (aOR, 0.983 [95% CI, 0.81-1.662], P=0.949) or independence (aOR, 0.640 [95% CI, 0.318-1.289], P=0.212) were seen across the CTP and NCCT±CTA groups. There was no interaction between the treatment time window (0-6 versus 6-24 hours) and CT selection modality (CTP versus NCCT±CTA) in terms of functional disability at 90 days (P=0.45). CONCLUSIONS: CTP acquisition was not associated with better outcomes in patients treated in the early or extended time windows. While confirmatory data is needed, our data suggests that extended window endovascular stroke therapy may remain beneficial even in the absence of advanced imaging.

Endovascular therapy in the distal neurovascular territory: results of a large prospective registry.

BACKGROUND: There is a paucity of data regarding mechanical thrombectomy (MT) in distal arterial occlusions (DAO). We aim to evaluate the safety and efficacy of MT in patients with DAO and compare their outcomes with proximal arterial occlusion (PAO) strokes. METHODS: The Trevo Registry was a prospective open-label MT registry including 2008 patients from 76 sites across 12 countries. Patients were categorized into: PAO: intracranial ICA, and MCA-M1; and DAO: MCA-M2, MCA-M3, ACA, and PCA. Baseline and outcome variables were compared across the PAO vs DAO patients with pre-morbid mRS 0-2. RESULTS: Among 407 DAOs including 350 (86.0%) M2, 25 (6.1%) M3, 10 (2.5%) ACA, and 22 (5.4%) PCA occlusions, there were 376 DAO with pre-morbid mRS 0-2 which were compared with 1268 PAO patients. The median baseline NIHSS score was lower in DAO (13 [8-18] vs 16 [12-20], P<0.001). There were no differences in terms of age, sex, IV-tPA use, co-morbidities, or time to treatment across DAO vs PAO. The rates of post-procedure reperfusion, symptomatic intracranial hemorrhage (sICH), and 90-mortality were comparable between both groups. DAO showed significantly higher rates of 90-day mRS 0-2 (68.3% vs 56.5%, P<0.001). After adjustment for potential confounders, the level of arterial occlusion was not associated with the chances of excellent outcome (DAO for 90-day mRS 0-1: OR; 1.18, 95% CI [0.90 to 1.54], P=0.225), successful reperfusion or SICH. However, DAO patients were more likely to be functionally independent (mRS 0-2: OR; 1.45, 95% CI [1,09 to 1.92], P=0.01) or dead (OR; 1.54, 95% CI [1.06 to 2.27], P=0.02) at 90 days. CONCLUSION: Endovascular therapy in DAO appears to result in a comparable safety and technical success profile as in PAO. The potential benefits of DAO thrombectomy should be investigated in future randomized trials.

Virtual Materials Intelligence for Design and Discovery of Advanced Electrocatalysts.

Similar to advancements gained from big data in genomics, security, internet of things, and e-commerce, the materials workflow could be made more efficient and prolific through advances in streamlining data sources, autonomous materials synthesis, rapid characterization, big data analytics, and self-learning algorithms. In electrochemical materials science, data sets are large, unstructured/heterogeneous, and difficult to process and analyze from a single data channel or platform. Computer-aided materials design together with advances in data mining, machine learning, and predictive analytics are expected to provide inexpensive and accelerated pathways towards tailor-made functionally optimized energy materials. Fundamental research in the field of electrochemical energy materials focuses primarily on complex interfacial phenomena and kinetic electrocatalytic processes. This perspective article critically assesses AI-driven modeling and computational approaches that are currently applied to those objects. An application-driven materials intelligence platform is introduced, and its functionalities are scrutinized considering the development of electrocatalyst materials for CO2 conversion as a use case.

Clinical Course and Outcomes of Small Supratentorial Intracerebral Hematomas.

BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) volume, particularly if ≥30 mL, is a major determinant of poor outcome. We used a multinational ICH data registry to study the characteristics, course, and outcomes of supratentorial hematomas with volumes <30 mL. METHODS: Basic characteristics, clinical and radiological course, and 30-day outcomes of these patients were recorded. Outcomes were categorized as early neurological deterioration (END), hematoma expansion, Glasgow Outcome Scale (GOS), and in-hospital death. Poor outcome was defined as composite of in-hospital death and severe disability (GOS ≤ 3). Comparison was conducted based on hemorrhage location. Logistic regression using dichotomized outcome scales was applied to determine predictors of poor outcome. RESULTS: Among 375 cases of supratentorial ICH with volumes <30 mL, expansion and END rates were 19.2% and 7.5%, respectively. Hemorrhage growth was independently associated with END (odds ratio: 28.7, 95% confidence interval [CI]: 8.51-96.5; P < .0001). Expansion rates did not differ according to ICH location. Overall, 13.9% (exact binomial 95% CI: 10.5-17.8) died in the hospital and 29.1% (CI: 24.5-34.0) had severe disability at 30 days; there was a cumulative poor outcome rate of 42.9% (CI: 37.9-48.1). Age, admission Glasgow Coma Scale, intraventricular extension, and END were independently associated with poor outcome. There was no difference in poor outcome rates between lobar and deep locations (40.2% versus 43.8%, P = .56). CONCLUSION: Patients with supratentorial ICH <30 mL have high rates of poor outcome at 30 days, regardless of location. Nearly 1 in 5 hematomas <30 mL expands, leading to END or death.

Revisiting the chemical reactivity indices as the state function derivatives. The role of classical chemical hardness.

The chemical reactivity indices as the equilibrium state-function derivatives are revisited. They are obtained in terms of the central moments (fluctuation formulas). To analyze the role of the chemical hardness introduced by Pearson [J. Am. Chem. Soc. 105, 7512 (1983)], the relations between the derivatives up to the third-order and the central moments are obtained. As shown, the chemical hardness and the chemical potential are really the principal indices of the chemical reactivity theory. It is clear from the results presented here that the chemical hardness is not the derivative of the Mulliken chemical potential (this means also not the second derivative of the energy at zero-temperature limit). The conventional quadratic dependence of energy, observed at finite temperature, reduces to linear dependence on the electron number at zero-temperature limit. The chemical hardness plays a double role in the admixture of ionic states to the reference neutral state energy: it determines the amplitude of the admixture and regulates the damping of its thermal factor.

Small vessel cerebrovascular disease: the past, present, and future.

Brain infarction due to small vessel cerebrovascular disease (SVCD)-also known as small vessel infarct (SVI) or "lacunar" stroke-accounts for 20% to 25% of all ischemic strokes. Historically, SVIs have been associated with a favorable short-term prognosis. However, studies over the years have demonstrated that SVCD/SVI is perhaps a more complex and less benign phenomenon than generally presumed. The currently employed diagnostic and therapeutic strategies are based upon historical and contemporary perceptions of SVCD/SVI. What is discovered in the future will unmask the true countenance of SVCD/SVI and help furnish more accurate prognostication schemes and effective treatments for this condition. This paper is an overview of SVCD/SVI with respect to the discoveries of the past, what is known now, and what will the ongoing investigations evince in the future.

Cardiac manifestations of subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) is a devastating condition. It carries a high mortality rate, with 12% of patients dying before reaching the hospital. Aside from its neurological morbidities, SAH is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in SAH patients. This article will discuss the cardiac manifestations of SAH.

Use of hypertonic continuous venovenous hemodiafiltration to control intracranial hypertension in an end-stage renal disease patient.

Continuous venovenous hemodiafiltration (CVVHDF) using solutions designed to maintain hypernatremia is described in an end-stage renal disease (ESRD) patient with cerebral edema (CE) due to an intracerebral hemorrhage (ICH). Hypernatremia was readily achieved and maintained without complication. CVVHDF should be considered as an alternative treatment option in ESRD patients with cerebral edema who require hypertonic saline therapy.

Thromboembolic events associated with Neuroform stent in endovascular treatment of intracranial aneurysms.

BACKGROUND: The incidence of thromboembolic events associated with Neuroform stent (Boston Scientific Target, Fremont, CA) is known from previous studies but there are uncertainties of scale. PURPOSE: To report our rate of ischemic events associated with Neuroform stent. METHODS: Consecutive patients treated with Neuroform stent for intracranial aneurysms were prospectively enrolled from January 2003 to August 2006. Thromboembolic events as well as clinical outcomes were measured. Mean follow-up was 12 months. RESULTS: Successful stent deployment was achieved in (65/67) 97% of patients without any ischemic event. However, postoperative thromboembolic events were observed in 3 patients despite being on clopidogrel and aspirin. These 3 patients demonstrated poor platelet inhibitions in platelet aggregation (aggregometry) studies, and were successfully treated with intravenous eptifibatide with good outcome. The majority of the patients had good outcomes [Glasgow Outcome Score (GOS) 5 or National Institute of Health Stroke Scale (NIHSS) 0 in (63/67) 94%, GOS 4 or NIHSS 2 in 1 patient, and GOS 3 or NIHSS 4 was observed in 3 cases]. CONCLUSION: Our study reveals that the thromboembolic events associated with Neuroform stent may present in a delayed fashion. These events can be successfully treated with good outcome. Therefore, postoperative close follow-up is strongly recommended for all Neuroform stent-treated patients.

Complications of Neuroform stent in endovascular treatment of intracranial aneurysms.

BACKGROUND: The Neuroform stent can help in the treatment of difficult, wide-necked intracranial aneurysms. The objective of our study is to report some of the challenges associated with the Neuroform stent in the treatment of intracranial aneurysms. METHODS: From January 2003 to August 2006, consecutive patients treated with Neuroform stent for intracranial aneurysms were prospectively enrolled. Information on patient demographics, cerebrovascular risk factors, aneurysm size and location were collected. Technical and clinical complications as well as clinical outcomes were measured. Data were analyzed retrospectively using SPSS software version 11.5. RESULTS: Successful deployment of the stent, in the target artery, was achieved in 65/67 (97%) patients. Stent deployment failed in two cases and the migration of stent developed in one during coiling. Postoperative thromboembolic events developed in three patients. These three patients possessed hyperactive platelets, and were treated with intravenous eptifibatide. Intraoperative rupture of aneurysm developed in one patient, which was secured by subsequent coiling. Majority of the patients had good outcomes GOS (Glasgow Outcome Score) 1 or NIHSS (National Institute of Health Stroke Scale) 0 in 63/67 (94%), GOS 2 or NIHSS 2 in one patient and GOS 3 or NIHSS 4 was observed in three cases. CONCLUSION: Despite a low rate of intraoperative complications, post-procedural thromboembolic events were common in Neuroform stent-treated patients, which might be associated with hyperactive platelets. Further studies are warranted to identify any potential relationship between post-stent hyperactive platelets and thromboembolism.

Nelson syndrome: comprehensive review of pathophysiology, diagnosis, and management.

Nelson syndrome (NS) is a rare clinical manifestation of an enlarging pituitary adenoma that can occur following bilateral adrenal gland removal performed for the treatment of Cushing disease. It is characterized by excess adreno-corticotropin secretion and hyperpigmentation of the skin and mucus membranes. The authors present a comprehensive review of the pathophysiology, diagnosis, and management of NS. Corticotroph adenomas in NS remain challenging tumors that can lead to significant rates of morbidity and mortality. A better understanding of the natural history of NS, advances in neurophysiology and neuroimaging, and growing experience with surgical intervention and radiation have expanded the repertoire of treatments. Currently available treatments include surgical, radiation, and medical therapy. Although the primary treatment for each tumor type may vary, it is important to consider all of the available options and select the one that is most appropriate for the individual case, particularly in cases of lesions resistant to intervention.

Sapphire platinum detachable coil experience in a tertiary-care facility.

BACKGROUND: The Guglielmi Detachable Coil introduced by the Boston Scientific Corporation has been widely used for endovascular coiling of aneurysm. Recently, Sapphire platinum detachable coils (eV3, Irvine, CA) have been introduced for aneurysm coiling. Herein, we report our clinical experience with the Sapphire coil to evaluate the incidence of coil related complications and the rate of aneurysm occlusion. METHODS: Consecutive patients who underwent embolization with Sapphire detachable coils were prospectively enrolled from January 2004 to September 2004 and the data were retrospectively analyzed. Patient demographics, including age, gender, presenting symptoms, Hunt and Hess grade, Fisher grade and locations of the vascular anomalies were collected. Additionally, complications associated with the coils and rates of aneurysm occlusion were observed and the data compiled. RESULTS: 29 patients underwent Sapphire coil embolization for intracranial aneurysms. Mean age was 50 +/- 18 (mean +/- SD) years with 81% being females. Aneurysm neck reconstruction was required in 7 cases, 6 with Neuroform stent (5 unruptured aneurysms) and 1 with balloon assistance (ruptured aneurysm). In 7 cases, Sapphire coils were used along with other coils. There were no events of thromboembolism or ruptures of aneurysms during coil embolization. However, multi-diameter coils demonstrated stretching in 4 stent-assisted cases without any adverse consequences. Complete occlusion of the aneurysm was achieved in 79.31% of the patients, neck remnant in 6.89, and partial coiling was achieved in 13.79%. CONCLUSION: The Sapphire coil could safely be used in the treatment of both ruptured and unruptured aneurysms. However, multi-diameter non-stretch resistant coils may be associated with coil stretching when used in conjunction with a stent. Further study is still required for definitive results.

Wilderness and recreational neurology.

With increased access to once remote regions of the planet and renewed interest in exploring natural surroundings, previously geographically isolated and rare neurologic conditions can be encountered in any patient population. Rare envenomations and poisonings, once the purview of the tropical neurologist, now can be encountered by travelers to areas where creatures that have developed specialized defenses are endemic. Recognition, therefore, of the potentially neurotoxic fauna and flora in these areas holds value, even for the urban neurologist.

Too much lumping in ischemic stroke - a new classification.

BACKGROUND: The heterogeneity of ischemic stroke syndromes with treatment of disparate categories may be a factor in clinical stroke trial failure. Recent advances include a multitude of stroke investigative modalities that are noninvasive, allowing more precise mechanistic determination. MATERIAL/METHODS: We retrospectively analyzed our young stroke patient population for stroke etiology according to the TOAST classification with five different etiological groups. Patients were assessed quantitatively according to the National Institute of Health Stroke Scale for neurological deficit and Rankin Scale for neurological handicap. Investigations included laboratory, Doppler sonograms of the cervicocephalic vessels, cardiac echocardiography and multimodality magnetic resonance imaging in all patients. Statistical analysis was performed, using a logit model for nominal response: log piJ/piJ)=alphaj+betajX. RESULTS: Amongst young stroke patients (n=133, women n=72) causes included other (n=77/119;65%), large vessel disease (LVD) (n=8/119;7%), small vessel disease (SVD) (n=17/119;14%), unknown (n=3/119;2%) and cardiac (n=14/119;12%). Within the other category at least 20 different etiologies were delineated. There were significant differences among the various categories (multinomial distribution with equal probabilities p=<0.0001). CONCLUSIONS: We recommend an expanded classification for stroke to include large vessel cerebrovascular disease, small vessel cerebrovascular disease, cardiogenic, dissection, prothrombotic states, migraine induced, cerebral venous thrombosis, vasculitides, vasculopathy other, miscellaneous and unknown.