Treatment of a symptomatic cervical cerebrospinal fluid fistula after full endoscopic cervical foraminotomy with CT-guided epidural fibrin patch

Background There is only limited data on the management of cerebrospinal fluid (CSF) fistulas after cervical endoscopic spine surgery. We investigated the current literature for treatment options and present a case of a patient who was treated with CT-guided epidural fibrin patch. Methods We present the case of a 47-year-old female patient with a suspected CSF fistula after endoscopic decompression for C7 foraminal stenosis. She was readmitted 8 days after surgery with dysesthesia in both upper extremities, orthostatic headache and neck pain, which worsened during mobilization. A CSF leak was suspected on spinal magnetic resonance imaging. A computer tomography (CT)-guided epidural blood patch was performed with short-term relief. A second CT-guided epidural fibrin patch was executed and the patient improved thereafter and was discharged at home without sensorimotor deficits or sequelae. We investigated the current literature for complications after endoscopic spine surgery and for treatment of postoperative CSF fistulas. Results Although endoscopic and open revision surgery with dura repair were described in previous studies, dural tears in endoscopic surgery are frequently treated conservatively. In our case, the patient was severely impaired by a persistent CSF fistula. We opted for a less invasive treatment and performed a CT-guided fibrin patch which resulted in a complete resolution of patient’s symptoms. Discussion and conclusion CSF fistulas after cervical endoscopic spine procedures are rare complications. Conservative treatment or revision surgery are the standard of care. CT-guided epidural fibrin patch was an efficient and less invasive option in our case

Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients

Introduction: Close monitoring and repeated risk assessment of sepsis patients in the intensive care unit (ICU) is important for decisions regarding care intensification or early discharge to the ward. We studied whether considering plasma kinetics of procalcitonin, a biomarker of systemic bacterial infection, over the first 72 critical care hours improved mortality prognostication of septic patients from two US settings. Methods: This retrospective analysis included consecutively treated eligible adults with a diagnosis of sepsis from critical care units in two independent institutions in Clearwater, FL and Chicago, IL. Cohorts were used for derivation or validation to study the association between procalcitonin change over the first 72 critical care hours and mortality. Results: ICU/in-hospital mortality rates were 29.2%/31.8% in the derivation cohort (n = 154) and 17.6%/29.4% in the validation cohort (n = 102). In logistic regression analysis of both cohorts, procalcitonin change was strongly associated with ICU and in-hospital mortality independent of clinical risk scores (Acute Physiology, Age and Chronic Health Evaluation IV or Simplified Acute Physiology Score II), with area under the curve (AUC) from 0.67 to 0.71. When procalcitonin decreased by at least 80%, the negative predictive value for ICU/in-hospital mortality was 90%/90% in the derivation cohort, and 91%/79% in the validation cohort. When procalcitonin showed no decrease or increased, the respective positive predictive values were 48%/48% and 36%/52%. Discussion In septic patients, procalcitonin kinetics over the first 72 critical care hours provide prognostic information beyond that available from clinical risk scores. If these observations are confirmed, procalcitonin monitoring may assist physician decision-making regarding care intensification or early transfer from the ICU to the floor

Stochastic IMT (insulator-metal-transition) neurons: An interplay of thermal and threshold noise at bifurcation

Artificial neural networks can harness stochasticity in multiple ways to enable a vast class of computationally powerful models. Electronic implementation of such stochastic networks is currently limited to addition of algorithmic noise to digital machines which is inherently inefficient; albeit recent efforts to harness physical noise in devices for stochasticity have shown promise. To succeed in fabricating electronic neuromorphic networks we need experimental evidence of devices with measurable and controllable stochasticity which is complemented with the development of reliable statistical models of such observed stochasticity. Current research literature has sparse evidence of the former and a complete lack of the latter. This motivates the current article where we demonstrate a stochastic neuron using an insulator-metal-transition (IMT) device, based on electrically induced phase-transition, in series with a tunable resistance. We show that an IMT neuron has dynamics similar to a piecewise linear FitzHugh-Nagumo (FHN) neuron and incorporates all characteristics of a spiking neuron in the device phenomena. We experimentally demonstrate spontaneous stochastic spiking along with electrically controllable firing probabilities using Vanadium Dioxide (VO$_2$) based IMT neurons which show a sigmoid-like transfer function. The stochastic spiking is explained by two noise sources - thermal noise and threshold fluctuations, which act as precursors of bifurcation. As such, the IMT neuron is modeled as an Ornstein-Uhlenbeck (OU) process with a fluctuating boundary resulting in transfer curves that closely match experiments. As one of the first comprehensive studies of a stochastic neuron hardware and its statistical properties, this article would enable efficient implementation of a large class of neuro-mimetic networks and algorithms.Comment: Added sectioning, Figure 6, Table 1, and Section II.E Updated abstract, discussion and corrected typo

Evaluación de riesgos ecotoxicológicos derivados del empleo del hongo entomopatógeno Metarhizium spp. para el control de plagas

La agricultura ha provisto de alimentos al ser humano desde su origen, pero en el último siglo, la producción agraria se ha intensificado gracias, entre otros, al empleo de insecticidas. Sin embargo, esta intensificación no ha estado exenta de problemas de contaminación por residuos en los alimentos o de efectos negativos sobre la biodiversidad y el medioambiente. La legislación agraria actual promueve una agricultura acorde con la creciente preocupación de los consumidores por la salud y por el medioambiente. En este escenario, el desarrollo de estrategias ambientalmente sostenibles y seguras para los consumidores se sitúa en primera línea en los programas de investigación para el control de plagas. Los ascomicetos mitospóricos entomopatógenos (AMEs) y en particular el género Metarhizium, cumplen los requisitos de seguridad para el ser humano y el medio ambiente y además han mostrado un gran éxito en el control de plagas de insectos debido a su modo de acción por contacto, su presencia natural en diversos ecosistemas y su capacidad de secretar compuestos con actividad insecticida. No obstante, la implantación en el mercado de los micoinsecticidas es lenta, y tropieza con una barrera fundamental que es la escasa información sobre el destino de algunos metabolitos secundarios en la cadena alimentaria y su riesgo para la salud humana y animal, información clave para abordar su registro. Por tanto, existe la necesidad de desarrollar y validar métodos analíticos con alta sensibilidad para su determinación a bajas concentraciones en diferentes matrices biológicas. La destruxina A es uno de los principales metabolitos secundarios producidos por el AME Metarhizium spp., pero la falta de estudios sobre su producción por parte del hongo es probablemente el mayor obstáculo para el registro de nuevas cepas de esta especie fúngica. El objetivo principal de esta tesis ha sido desarrollar nuevas herramientas para la detección y cuantificación de destruxinas, así como investigar el destino de la destruxina A en la cadena trófica. En el capítulo II de esta Tesis, se ha determinado la producción de destruxinas por parte de cuatro cepas de Metarhizium (BIPESCO5, EAMa 01/58-Su, ARSEF 23 y ART 2825) con un método mejorado de cromatografía líquida de ultra alto rendimiento en tándem con espectrometría de masas (UHPLC-MS / MS) en cuatro medios de cultivo (CM, MM, CN2, OSM) que representan diferentes condiciones de estrés. Cada 3 días durante 18 días se tomaron muestras para análisis que permitieron detectar 15 destruxinas, siendo las destruxinas A y B las más abundantes. Además, se detectaron diferencias significativas entre las cepas en la producción de destruxinas, que a su vez fue altamente dependiente del medio de cultivo. En el capítulo III la colonización endofítica y la producción de destruxina A en plantas de patata se monitorizaron a las 24, 48, 72, 96 y 120 h después de la inoculación con dos cepas de Metarhizium brunneum Petch. (BIPESCO5 y EAMa 01/58-Su), lo que puso de manifiesto que la concentración de destruxina A en los tejidos vegetales es muy baja en comparación con los niveles de colonización. Aunque se observó una colonización similar para ambas cepas, hubo diferencias a lo largo de la planta, con valores más altos en las hojas a 96 h para EAMa 01/58-Su (83.3 %) y BIPESCO5 (81.6 %), y más bajos en tubérculo y raíz a las 72, 96 y 120 h después de la inoculación para ambas cepas (10.0-13.3 %). Para la cepa EAMa 01/58-Su, la destruxina A se cuantificó a las 24 h en el tubérculo y la raíz (2.0 ± 1.4 y 2.49 ± 1.7 μg / kg, respectivamente) y a las 96 h con igual concentración también en tubérculo y raíz (2.5 ± 1.7 μg /kg); para BIPESCO5, solamente se cuantificó destruxina A en el tubérculo a las 24 h y en la raíz a las 48 h (6.8 ± 4.8 y 2.1 ± 1.4 μg / kg, respectivamente). En el capítulo IV se investiga por primera vez la dinámica de crecimiento de las cepas BIPESCO5 y EAMa 01/58-Su de M. brunneum y la secreción de destruxina A durante el proceso de infección de larvas del insecto modelo Galleria mellonella L. (Lepidoptera; Pyralidae). Se observó que la secreción de destruxina A fue paralela a la evolución de la cantidad de ADN fúngico en el interior del insecto para la cepa EAMa 01/58-Su, no así para BIPESCO5. Las cepas EAMa 01/58-Su y BIPESCO5 secretaron destruxina A desde los días 2 al 6 y desde el día 2 hasta el día 5 después del tratamiento, respectivamente. Para EAMa 01/58-Su y BIPESCO5, la máxima cantidad de destruxina A producida en el insecto hospedante fue de 0.369 y 0.06 μg/larva a los 4 días del tratamiento, respectivamente, y a lo largo del proceso patogénico, la producción fue de 0.6 y 0.09 μg / larva, respectivamente. En el capítulo V se realizaron bioensayos presa-depredador para evaluar el comportamiento y la supervivencia de las larvas del depredador generalista Chrysoperla carnea (Stephens) (Neuroptera; Chrysopidae) al alimentarse con larvas insecto polífago Spodoptera littoralis (Boisd.) (Lepidoptera; Noctuidae) inoculadas con las cepas BIPESCO5 y EAMa 01/58-Su. Además, se llevaron a cabo estudios ecotoxicológicos para supervisar el destino de la destruxina A en el sistema presa-depredador. La concentración máxima de destruxina A producida por la cepa BIPESCO5 fue el día 4 con un valor de 0.000054 μg/insecto (aproximadamente 0.014 μg/g) y para la cepa EAMa 01/58-Su el día 5 con 0.00012 μg/insecto (aproximadamente 0.031 μg/g), mientras que el metabolito no se detectó en larvas de C. carnea. El porcentaje de crisopas que se alimentó de larvas de S. littoralis 24 horas después de la infección fue de 96.6, 75.0 y 65.0 % para el control, EAMa 01/58-Su y BIPESCO5, respectivamente, mientras que 5 días después de la infección fue 38.3 % para control y 33.3 % en los tratamientos con las cepas EAMa 01/58-Su y BIPESCO5. La cantidad de larvas de S. littoralis consumidas por C. carnea 24 h después de la infección fue 5.6, 2.2 y 2.3 para las tratadas con el control, EAMa 01/58-Su y BIPESCO5 respectivamente, mientras que 5 días después de la infección consumió una sola larva per cápita. Esto puso de manifiesto que los tratamientos de M. brunneum contra las larvas de S. littoralis fueron seguros para C. carnea debido tanto a la ausencia de mortalidad relacionada con los hongos en el depredador como a la falta de movimiento de la destruxina A de la presa al depredador. Es importante resaltar que en los capítulos IV y V, para ambas cepas, la mortalidad de las larvas debido a otras causas fue mucho mayor que la mortalidad con crecimiento fúngico. Sin embargo, la secreción de destruxina A fue mayor para EAMa 01/58-Su que para BIPESCO5, lo que sugiere que la destruxina A podría ser un factor de virulencia de la primera, mientras que la segunda podría requerir la participación de otros factores además de destruxina A durante el proceso de infección. Los resultados obtenidos proporcionan métodos analíticos valiosos para llevar a cabo evaluaciones de riesgo sobre el empleo de AME, así como resultados que indican que su empleo supone un bajo nivel de riesgo para la salud humana, animal y medio ambiental.Agriculture produces the vast majority of the world’s food supply, and in last century the global food production has grown at a huge rate mainly from the increased yields resulting from greater inputs of insecticides and other technologies. Meanwhile overuse or improper use of insecticides and other agrochemicals has raised issues about related environment and health costs, with current legislation promoting sustainable agriculture, in which scenario, the development of environmentally sustainable strategies is mandatory for research programs regarding pest control. The entomopathogenic mitosporic ascomycetes (EMAs) and in particular the genus Metarhizium have shown great success in the control of insect pests due to their contact mode of action, natural presence in the ecosystems and their ability to secrete compounds with insecticidal activity, and even, they comply with the security requirements for human health and environment, whereas information about the fate of their secondary metabolites in the food chain and their risk to human and animal health is still scarce. There is a need to develop and validate analytical methods with high sensitivity for metabolite determination at low concentrations in different biological matrices. Destruxin A is one of the major secondary metabolite produced by the genus Metarhizium spp., but the lack of studies concerning destruxin A production is most likely the biggest obstacle for registration of new fungal strains. The main goal of this research has been to develop new tools for destruxin detection and quantification and to investigate the fate of destruxin A in the trophic chain. In chapter II, destruxin production for Metarhizium strains BIPESCO5, EAMa 01/58- Su, ARSEF 23 and ART 2825 was determined with an improved method of ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), which has shown high precision in the detection and quantification of destruxins in four culture media (CM, MM, CN2, OSM) representing different stress conditions. Every 3 days samples were taken for analysis over 18 days that allowed detecting 15 destruxins, with destruxin A and B as the most abundant. However, significant differences among strains in destruxin production were detected, and for each strain, destruxin production was highly dependent on culture medium. In chapter III, endophytic colonisation and destruxin A production on potato plants were monitored at 24, 48, 72, 96 and 120 h after inoculation with Metarhizium brunneum strains (BIPESCO5 and EAMa 01/58-Su), which showed that the concentration of destruxin A in plant tissues was very low compared to the colonisation levels. Although a similar colonisation was observed for both strains, there were differences in percentages in different parts of the plants, with the higher values occurring in the leaves at 96 h for EAMa 01/58-Su (83.3 %) and BIPESCO5 (81.6 %), and the lower ones, 10.0-13.3 %, observed in tuber and root at 72, 96 and 120 h post-inoculation for both strains. For strain EAMa 01/58- Su, destruxin A was quantified at 24 h (2.49 ± 1.7 and 2.0 ± 1.4 μg/kg, respectively), and the same concentration was found in both tuber and root at 96 h (2.5 ± 1.7 μg/kg); for BIPESCO5, the concentrations differed in tuber at 24 h and in root at 48 h (6.8 ± 4.8 and 2.1 ± 1.4 μg/kg, respectively). In chapter IV, the dynamic of fungal growth and secretion of destruxin A by strains BIPESCO5 and EAMa 01/58-Su of Metarhizium brunneum Petch. during the infection process of larvae of the model insect Galleria mellonella L. (Lepidoptera; Pyralidae) was monitored for the first time. Data showed that destruxin A secretion was parallel to the fungal growth of EAMa 01/58-Su but not coupled with that for BIPESCO5. EAMa 01/58-Su and BIPESCO5 strains secreted destruxin A from days 2 to 6 and from day 2 to day 5 post treatment, respectively. For EAMa 01/58-Su and BIPESCO5, the maximum titer in the host on day 4 after treatment was 0.369 and 0.06 μg/larva, respectively, and throughout the pathogenic process, the production was 0.6 and 0.09 μg/larva, respectively. In chapter V, predator-prey bioassays were performed to evaluate the behavior and survival of larvae of the generalist predator Chrysoperla carnea (Stephens) (Neuroptera; Chrysopidae) when feeding on larvae of the polyphagous pest Spodoptera littoralis (Boisd.) (Lepidoptera; Noctuidae) challenged by M. brunneum BIPESCO5 and EAMa 01/58-Su strains. In addition, ecotoxicological studies based on HPLC-MS were performed to monitor the fate of destruxin A in the prey-predator system. The maximum concentration of destruxin A produced by the BIPESCO5 strain was on day 4 after treatment with a value of 0.000054 μg/insect (approx 0.014 μg/g), and for EAMa 01/58-Su was on day 5 with a value of 0.00012 μg/insect (approx 0.031 μg/g), whereas the metabolite was no detected in C. carnea larvae. The percentage of lacewings feeding on S. littoralis larvae 24 hour-post infection was 96.6, 75.0, and 65.0 % for the control, EAMa 01/58-Su, and BIPESCO5 treatments, respectively, whereas 5 days-post infection armyworm larvae were consumed by only 38.3 % of the control lacewings and 33.3 % of the EAMa 01/58-Su and BIPESCO5 treatment groups. C. carnea larvae feeding on 24 h-post infection armyworm larvae preyed 5.6, 2.2 and 2.3 larvae for the control, EAMa 01/58-Su and BIPESCO5 treatments, respectively, whereas those predator larvae feeding on 5 days-post infection armyworm larvae preyed on only one per capita larva. It showed that the M. brunneum treatments against S. littoralis larvae were safe for C. carnea due to both the lack of fungus-related mortality in the predator and the lack of movement of destruxin A from the prey to the predator. Notably in chapters IV and V, in both M. brunneum strains, mortality from other causes was higher than mortality with fungal outgrowth. However, destruxin A secretion was higher for EAMa 01/58-Su than for BIPESCO5. These results suggested that destruxin A could be a virulence factor for EAMa 01/58-Su strain, whereas for BIPESCO5, the virulence could require the involvement of other factors as well as destruxin A during the infection process. The results obtained provide valuable analytical methods for carrying out risk assessments on the use of EMAs. In addition, results indicate that their use poses a little potential hazard to human and animal health and the environment

Hydrocephalus, cerebral vasospasm, and delayed cerebral ischemia following non-aneurysmatic spontaneous subarachnoid hemorrhages: an underestimated problem

Non-aneurysmal subarachnoid hemorrhage (NASAH) is rare and mostly benign. However, complications such as cerebral vasospasm (CV), delayed cerebral ischemia (DCI), or post-hemorrhagic hydrocephalus (HC) may worsen the prognosis. The aim of this study was to evaluate the rate of these complications comparing perimesencephalic (PM) and non-perimesencephalic (NPM) SAH. Monocentric, retrospective analysis of patients diagnosed with NASAH from 01/2010 to 01/2021. Diagnosis was set only if vascular pathologies were excluded in at least one digital subtraction angiography, and NASAH was confirmed by cranial computed tomography (cCT) or lumbar puncture (LP). One hundred patients (62 female) with a mean age of 54.9 years (27–84) were identified. Seventy-three percent had a World Federation of Neurological Surgeons (WFNS) grading scale score I, while 9% were WFNS score IV or V at the time of admission. SAH was diagnosed by cCT in 86%, in 14% by lumbar puncture. Twenty-five percent necessitated short-term CSF diversion by extraventricular drainage or lumbar drainage, whereof 7 suffered from long-term HC treated with ventriculoperitoneal shunting (VPS). One patient without a short-term CSF drainage developed long-term HC. Ten percent developed CV, four of whom received intraarterial spasmolysis. Radiological DCI was diagnosed in 2%; none of these correlated with CV. Despite a mortality of 3% occurring solely in NPM SAH, the analyzed complication rate was comparable in both groups. We observed post-hemorrhagic complications in 35% of cases during the first 3 weeks after bleeding, predominantly in patients with NPM SAH. For this reason, close observation and cranial imaging within this time may be indicated not to overlook these complications

Prevalence and factors associated with sleep disturbance in adult patients with psoriasis

Background: Sleep, which is crucial for restoring of physiological functions and health, is reportedly impaired in psoriasis. The role of different potential sleep confounding factors, including detailed pruritus characteristics, and the complex interplay between psychological variables (anxiety and depression), pruritus and sleep disturbance in psoriasis remain insufficiently investigated. Objectives: To investigate sleep characteristics and to identify clinical, demographic and psychological factors associated with sleep disturbance in psoriasis. Methods: This cross-sectional study included 334 psoriasis patients (response rate 86%) and 126 control subjects (response rate 82%). Measures included sleep quality [Pittsburgh Sleep Quality Index (PSQI)], psoriasis severity, pruritus characteristics, including average pruritus intensity [visual analogue scale (VAS)], severity of comorbidities, anxiety and depression (Hospital Anxiety and Depression Scale - HADS) and quality of life (Dermatology Life Quality Index - DLQI, and Short Form 12 - SF12). Results: Fifty-nine per cent of patients and 34% of control subjects (P 5). Patients slept 1 h less than control subjects (median 6 vs. 7 h, P < 0.001). Patients without pruritus had less impaired sleep (global PSQI) than patients with strong (P < 0.001) and very strong pruritus (P < 0.001). Anxiety (HADS-A) and depression (HADS-D) levels were the strongest predictors of sleep impairment, followed by pruritus exacerbation at night, age, female sex, pruritus exacerbation in the morning, average pruritus intensity (VAS), diagnosed depression and gastroesophageal reflux disease, altogether explaining 32%-37% of the variance in global sleep quality. Both anxiety (HADS-A) and depression (HADS-D) were significant mediators explaining the association between pruritus intensity (VAS) and sleep impairment in 42% and 37% respectively. Conclusions: Sleep disturbance in patients with psoriasis is highly prevalent. Patients with psoriasis should be assessed for sleep impairment, pruritus, anxiety and depression. Reduction in pruritus should be considered as an important therapeutic goal, along with therapies aimed at reducing anxiety and depression

Towards a Generally Accepted Validation Methodology for Sensor Models - Challenges, Metrics, and First Results

In order to significantly reduce the testing effort of autonomous vehicles, simulation-based testing in combination with a scenario-based approach is a major part of the overall test concept. But, for sophisticated simulations, all applied models have to be validated beforehand, which is the focus of this paper. The presented validation methodology for sensor system simulation is based on a state-of-the-art analysis and the derived necessary improvements. The lack of experience in formulating requirements and providing adequate metrics for their usage in sensor model validation, in contrast to e.g. vehicle dynamics simulation, is addressed. Additionally, the importance of valid measurement and reference data is pointed out and especially the challenges of repeatability and reproducibility of trajectories and measurements of perception sensors in dynamic multi-object scenarios are shown. The process to find relevant scenarios and the resulting parameter space to be examined is described. At the example of lidar point clouds, the derivation of metrics with respect to the requirements is explained and exemplary evaluation results are summarized. Based on this, extensions to the state-of-the-art model validation method are provided

Reduced Basal Autophagy and Impaired Mitochondrial Dynamics Due to Loss of Parkinson's Disease-Associated Protein DJ-1

BACKGROUND: Mitochondrial dysfunction and degradation takes a central role in current paradigms of neurodegeneration in Parkinson's disease (PD). Loss of DJ-1 function is a rare cause of familial PD. Although a critical role of DJ-1 in oxidative stress response and mitochondrial function has been recognized, the effects on mitochondrial dynamics and downstream consequences remain to be determined. METHODOLOGY/PRINCIPAL FINDINGS: Using DJ-1 loss of function cellular models from knockout (KO) mice and human carriers of the E64D mutation in the DJ-1 gene we define a novel role of DJ-1 in the integrity of both cellular organelles, mitochondria and lysosomes. We show that loss of DJ-1 caused impaired mitochondrial respiration, increased intramitochondrial reactive oxygen species, reduced mitochondrial membrane potential and characteristic alterations of mitochondrial shape as shown by quantitative morphology. Importantly, ultrastructural imaging and subsequent detailed lysosomal activity analyses revealed reduced basal autophagic degradation and the accumulation of defective mitochondria in DJ-1 KO cells, that was linked with decreased levels of phospho-activated ERK2. CONCLUSIONS/SIGNIFICANCE: We show that loss of DJ-1 leads to impaired autophagy and accumulation of dysfunctional mitochondria that under physiological conditions would be compensated via lysosomal clearance. Our study provides evidence for a critical role of DJ-1 in mitochondrial homeostasis by connecting basal autophagy and mitochondrial integrity in Parkinson's disease

Diagnostic Value of Fully Automated Artificial Intelligence Powered Coronary Artery Calcium Scoring from 18F-FDG PET/CT

OBJECTIVES The objective of this study was to assess the feasibility and accuracy of a fully automated artificial intelligence (AI) powered coronary artery calcium scoring (CACS) method on ungated CT in oncologic patients undergoing 18F-FDG PET/CT. METHODS A total of 100 oncologic patients examined between 2007 and 2015 were retrospectively included. All patients underwent 18F-FDG PET/CT and cardiac SPECT myocardial perfusion imaging (MPI) by 99mTc-tetrofosmin within 6 months. CACS was manually performed on non-contrast ECG-gated CT scans obtained from SPECT-MPI (i.e., reference standard). Additionally, CACS was performed using a cloud-based, user-independent tool (AI-CACS) on ungated CT scans from 18F-FDG-PET/CT examinations. Agatston scores from the manual CACS and AI-CACS were compared. RESULTS On a per-patient basis, the AI-CACS tool achieved a sensitivity and specificity of 85% and 90% for the detection of CAC. Interscore agreement of CACS between manual CACS and AI-CACS was 0.88 (95% CI: 0.827, 0.918). Interclass agreement of risk categories was 0.8 in weighted Kappa analysis, with a reclassification rate of 44% and an underestimation of one risk category by AI-CACS in 39% of cases. On a per-vessel basis, interscore agreement of CAC scores ranged from 0.716 for the circumflex artery to 0.863 for the left anterior descending artery. CONCLUSIONS Fully automated AI-CACS as performed on non-contrast free-breathing, ungated CT scans from 18F-FDG-PET/CT examinations is feasible and provides an acceptable to good estimation of CAC burden. CAC load on ungated CT is, however, generally underestimated by AI-CACS, which should be taken into account when interpreting imaging findings