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rating characteristic curve was 99% (95% CI 97, 100). Mean processing and notification time was 3 minutes 18 seconds. Conclusion The results confirm the feasibility of fast automated high-performance detection of intracranial internal carotid artery and middle cerebral artery M1 occlusions. © RSNA, 2021 See also the editorial by Kloska in this issue.Background Multidetector CT (MDCT) enables rapid and accurate diagnosis of head and neck (HN) injuries in patients with blunt trauma (BT). However, MDCT is overused, and appropriate selection of patients for imaging could improve workflow. Purpose To investigate the effect of implementing clinical triaging algorithms on use of MDCT in the HN in patients who have sustained BT. Materials and Methods In this retrospective study, patients aged 15 years or older with BT admitted between October 28, 2007, and December 31, 2013, were included. Patients were divided into pre- and postalgorithm groups. The institutional trauma registry and picture archiving and communication system reports were reviewed to determine which patients underwent MDCT of the head, MDCT of the cervical spine (CS), and MDCT angiography of the HN at admission and whether these examinations yielded positive results. Injury Severity Score, Acute Physiology and Chronic Health Evaluation II score (only those patients in the intensive care unit), length of hospital stay (LOS), length of intensive care unit stay (ICULOS), and mortality were obtained from the trauma registry. Results A total of 8999 patients (mean age, 45 years ± 20 [standard deviation]; age range, 15-101 years; 6027 male) were included in this study. A lower percentage of the postalgorithm group versus the prealgorithm group underwent MDCT of the head (55.8% [2774 of 4969 patients]; 95% CI 54.4, 57.2 vs 64.2% [2589 of 4030 patients]; 95% CI 62.8, 65.7; P .99). Conclusion Implementation of a clinical triaging algorithm resulted in decreased use of multidetector CT of the head and cervical spine in patients who experienced blunt trauma, without increased adverse outcomes. © RSNA, 2021 See also the editorial by Munera and Martin in this issue.Background Digital breast tomosynthesis (DBT) with or without digital mammography (DM) is the primary method of breast cancer screening. However, the sufficiency of DBT screening for women at average risk and the need for supplemental whole-breast US needs further investigation. Purpose To evaluate the added value of supplemental US screening following combined DM/DBT. Materials and Methods A retrospective database search identified consecutive asymptomatic women who underwent DM/DBT and radiologist-performed screening breast US simultaneously between March 2016 and December 2018. The cancer detection rate (CDR) per 1000 screening examinations, sensitivity, specificity, and abnormal interpretation rate of DM/DBT and DM/DBT combined with US were compared. Results A total of 1003 women (mean age, 56 years ± 8.6 [standard deviation]) were included. Among them, 12 cancers (mean invasive tumor size, 14 mm; range, 6-33 mm) were diagnosed. With DM/DBT and DM/DBT combined with US, the CDRs were 9.0 per 1000 screeningfor this article. See also the editorial by Rahbar in this issue.Rationale There is an urgent need for simple, cost-effective prognostic biomarkers for idiopathic pulmonary fibrosis (IPF); biomarkers that show potential include monocyte count. Objectives We used pooled data from pirfenidone and IFNγ-1b trials to explore the association between monocyte count and prognosis in patients with IPF. Methods This retrospective pooled analysis included patients (active and placebo arms) from the following four phase III, randomized, placebo-controlled trials ASCEND (NCT01366209), CAPACITY (NCT00287729 and NCT00287716), and INSPIRE (NCT00075998). Outcomes included IPF progression (≥10% absolute decline in FVC% predicted, ≥50 m decline in 6-minute-walk distance, or death), all-cause hospitalization, and all-cause mortality over 1 year. The relationship between monocyte count (defined as time-dependent) and outcomes was assessed using bivariate and multivariable models. Measurements and Main Results This analysis included 2,067 patients stratified by monocyte count (at baseline less then 0.60 × 109 cells/L [n = 1,609], 0.60 to less then 0.95 × 109 cells/L [n = 408], and ≥0.95 × 109 cells/L [n = 50]). In adjusted analyses, a higher proportion of patients with monocyte counts of 0.60 to less then 0.95 × 109 cells/L or ≥0.95 × 109 cells/L versus less then 0.60 × 109 cells/L experienced IPF progression (P = 0.016 and P = 0.002, respectively), all-cause hospitalization (P = 0.030 and P = 0.003, respectively), and all-cause mortality (P = 0.005 and P  less then  0.001, respectively) over 1 year. Change in monocyte count from baseline was not associated with any of the outcomes over 1 year and did not appear to be affected by study treatment. Conclusions In patients with IPF, elevated monocyte count was associated with increased risks of IPF progression, hospitalization, and mortality. Monocyte count may provide a simple and inexpensive prognostic biomarker in IPF.Background Q fever is a worldwide zoonosis caused by Coxiella burnetii. This study was carried out to investigate the occurrence of C. burnetii among apparently healthy pregnant, parturient, and postparturient dogs and cats to highlight their role in the transmission of such disease to humans. Materials and Methods A total of 88 apparently healthy pet animals (48 dogs and 40 cats) were enrolled in this study, vaginal swabs were obtained from pregnant and postparturient animals while birth fluids were collected from parturient ones. All samples were subjected to DNA extraction followed by nested PCR for molecular detection of C. selleck burnetii. Results Out of 40 cats, 3 were positive for C. burnetii with an overall prevalence of 7.5%, all positive samples were birth fluids of parturient queens with a prevalence of 15.8% (3/19) while all pregnant and postparturient animals were negative. In contrast, none of 48 dogs yielded positive result. Moreover, the phylogenetic analysis and sequence identity matrix of the obtained sequence from a parturient cat showed high genetic relatedness to strains derived from human cases rather than those of ruminants to indicate the public health burden of such strain. Conclusion This study underscores the occurrence of C. burnetii among parturient cats to point out the possible zoonotic transmission to human contacts.The tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus responsible for the ongoing coronavirus disease 2019 (COVID-19) pandemic, toward the host cells is determined, at least in part, by the expression and distribution of its cell surface receptor, angiotensin-converting enzyme 2 (ACE2). The virus further exploits the host cellular machinery to gain access into the cells; its spike protein is cleaved by a host cell surface transmembrane serine protease 2 (TMPRSS2) shortly after binding ACE2, followed by its proteolytic activation at a furin cleavage site. The virus primarily targets the epithelium of the respiratory tract, which is covered by a tightly regulated airway surface liquid (ASL) layer that serves as a primary defense mechanism against respiratory pathogens. The volume and viscosity of this fluid layer is regulated and maintained by a coordinated function of different transport pathways in the respiratory epithelium. We argue that SARS-CoV-2 may potentially alter evolutionary conserved second-messenger signaling cascades via activation of G protein-coupled receptors (GPCRs) or by directly modulating G protein signaling. Such signaling may in turn adversely modulate transepithelial transport processes, especially those involving cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial Na+ channel (ENaC), thereby shifting the delicate balance between anion secretion and sodium absorption, which controls homeostasis of this fluid layer. As a result, activation of the secretory pathways including CFTR-mediated Cl- transport may overwhelm the absorptive pathways, such as ENaC-dependent Na+ uptake, and initiate a pathophysiological cascade leading to lung edema, one of the most serious and potentially deadly clinical manifestations of COVID-19.The COVID19 pandemic has caused more than a million of deaths worldwide, primarily due to complications from COVID19-associated acute respiratory distress syndrome (ARDS). Controversy surrounds the circulating cytokine/chemokine profile of COVID19-associated ARDS, with some groups suggesting that it is similar to patients without COVID19 ARDS and others observing substantial differences. Moreover, although a hyperinflammatory phenotype associates with higher mortality in non-COVID19 ARDS, there is little information on the inflammatory landscape's association with mortality in patients with COVID19 ARDS. Even though the circulating leukocytes' transcriptomic signature has been associated with distinct phenotypes and outcomes in critical illness including ARDS, it is unclear whether the mortality-associated inflammatory mediators from patients with COVID19 are transcriptionally regulated in the leukocyte compartment. Here, we conducted a prospective cohort study of 41 mechanically ventilated patients with COVID19 infection using highly calibrated methods to define the levels of plasma cytokines/chemokines and their gene expressions in circulating leukocytes. Plasma IL1RA and IL8 were found positively associated with mortality, whereas RANTES and EGF negatively associated with that outcome. However, the leukocyte gene expression of these proteins had no statistically significant correlation with mortality. These data suggest a unique inflammatory signature associated with severe COVID19.Objective To compare the effects of leukocyte and platelet-rich fibrin (L-PRF) and photobiomodulation therapy (PBMT)-applied L-PRF (PBMT/L-PRF) as barrier membranes on new bone formation (BV/TV) for the treatment of critical-sized bone defects. Materials and methods The right iliac crests of five sheep were used in this experimental animal study. Eight critical-sized defects were surgically created in each sheep and a total of 40 defects were obtained. A deproteinized bovine bone graft was placed in all defects, and the defects were divided into four groups to be covered with L-PRF membrane, PBMT/L-PRF membrane, collagen membrane, or left uncovered as controls. Animals were sacrificed at 1 month. The sections obtained were histomorphometrically analyzed. Results The results showed that the collagen group presented significantly higher values for main bone healing parameters (BV/TV, bone volume, and bone surface; p  0.05). Conclusions The findings show that PBMT may provide additional regenerative properties to L-PRF when used as barrier membranes. However, these results did not reach the collagen membranes, which warrants further studies for adapting the laser parameters to increase regenerative capacity of L-PRF.According to the American Society of Anesthesiologists (ASA), basic anesthetic monitoring addresses a set of parameters (oxygenation, ventilation, circulation, and temperature) that should be continually evaluated. Among these, temperature monitoring might be the most neglected by medical staff, entailing various consequences that might be undervalued and not seen as directly correlated with poor patient outcome. This clinical case depicts a postoperative patient with a state of hypothermia and severe shivering, clinically and objectively registered, that could have led to disastrous consequences, highlighting the importance of normothermia throughout the perioperative period.