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MIAMI -- The oft-cited claim that there are where can you get zithromax more than 8,000 nerve endings in the clitoris comes from a 1976 book by Thomas Lowry and Thea Lowry, in reference to a study of cows. No one had fact-checked that claim in humans -- until now.There are, in fact, an average of 10,280 nerve where can you get zithromax fibers according to a histomorphometric evaluation of the dorsal nerve of the clitoris presented by Blair Peters, MD, of Oregon Health &. Science University in Portland, at the Sexual Medicine Society of North America annual meeting."This information is already directly informing techniques I use to optimize sensation in gender-affirming surgeries, and should inform future work" related to restoring sensation for patients with dorsal nerve or clitoris injuries, said Peters.The researchers found a mean number of 5,140 nerve fibers (range 4,926 to 5,543) in individual clitoral dorsal nerve samples from consenting transmasculine patients undergoing phalloplasty. Because there are two dorsal nerves in the clitoris, doubling where can you get zithromax the mean nerve fibers count brought the number to 10,280 (range 9,852 to 11,086)."Compare that to the median nerve that we're all familiar with for carpal tunnel syndrome that innervates most of the human hand -- that is 18,000 nerve fibers," said Peters.

"So compare the size of a hand to the size of the glans of the clitoris, and it gives you context of how densely innervated the structure actually is."While medical study of the penis, including its sensory anatomy, is extensive, the clitoris has long been overlooked in medical literature, and its nerves poorly represented in medical textbooks. Quantifying the nerve fibers in the human clitoris has a range of practical applications, from improving reconstruction following clitoral injuries, restoration following genital mutilation, and improving sensory outcomes in gender-affirming surgery."There are people who have entire fellowships that are devoted to where can you get zithromax preserving erectile function, making erections straight, and they spend years and years doing this really specialized technical training, becoming really familiar with the innervation of not only the skin, but the corporal bodies that fill with blood," said Rainey Horwitz, MS, a medical student at St. Louis University School of Medicine, who was not involved in the study. "Not a single specialty has done that for the clitoris, or really feels any urgency or need to do that."Kimberly Lovie, MD, director of medical imaging and AI at New H Medical in New York City and the director of research and development at the sexual wellness company Cerē, said that this research is a basis for preventing damage to the clitoris during surgery for endometriosis or labiaplasty, for example.For many other parts of the body, "you do after-imaging to see if your surgery helped, if it caused harm by accident, and to see if there were where can you get zithromax any complications," said Lovie, who was not involved in the study.

"And that's really not done for the vulva at all. It's not done for the clitoris."Researchers where can you get zithromax used dorsal clitoral nerve samples from seven transmasculine patients prior to phalloplasty. To count the nerves, the 5 mm samples were sectioned into thin 1 μm cross-sections, stained, and then magnified 1,000 times using a microscope and imaging software. The researchers where can you get zithromax assumed anatomic symmetry of the two dorsal nerves to get their total nerve count.

Peters noted that the study did not account for unmyelinated nerves, so the count is likely higher.Neither Horwitz nor Lovie said they had ever learned about the anatomy of the clitoris in medical school, a fact that bothered them when patients asked questions."The significance is," Horwitz said of the new study, "we're not cows." Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, where can you get zithromax Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow Disclosures The study authors reported no disclosures.

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2 what is zithromax. Urushiol (Credit. RSnapshotPhotos/Shutterstock) For some people, mangos need a warning label. Mango skin, as well as the tree leaves and bark, what is zithromax contain urushiol, a toxin that can cause contact dermatitis.

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For apples, a person would have to pick out 200 seeds from the core and then ingest them, which is the equivalent of eating 40 cores in one sitting. Apple juice is also safe for people to drink. One study tested the cyanide content of more than a dozen apple juice brands and found the levels were so low they were not a health hazard.

Warning labels where can you get zithromax didn’t become consistent until the https://www.feuerwehr-oespel-kley.de/how-do-you-get-renova/ 1960s. Dangerous substances, particularly ones that children can easily access, are now subject to a variety of packaging and labeling regulations. But not all toxic substances come in a bottle. While claims of "toxic" food items aren't always supported by science, some substances where can you get zithromax found in everyday foods or ingredients can be damaging or even deadly.

Here are four common toxins found in your fridge or pantry that have serious poison potential — particularly when consumed in large amounts — and when to avoid them. 1. MyristicinThe seeds and mace where can you get zithromax of the nutmeg plant, which is known to contain myristicin. (Credit.

Embong Salampessy/Shutterstock) Myristicin is a chemical compound that can spark hallucinations, delirium and feelings of euphoria. In large where can you get zithromax quantities, it can cause neurological damage and be fatal. Myristicin is found in black pepper, carrots, celery, dill and parsnips. Nutmeg also has, as one study put it, “volatile oils” that contain myristicin.

The first documented case of someone buzzing on nutmeg comes from 1576 when an English woman took 10-12 nutmegs with the where can you get zithromax intent of getting high. Nutmeg has long been a substitute for other drugs, and there’s also a documented history of users experiencing brain damage or death. Fortunately, nutmeg abuse isn’t common. Poison control for the state of where can you get zithromax Texas, for example, reported only 17 calls for nutmeg poisoning between 1998 and 2008.

About 65 percent of these calls were due to intentional ingestion, and most of these users were adolescent males. Five grams of nutmeg containing one to two milligrams of myristicin content is the minimum dosage needed to elicit hallucinations. Nutmeg, however, should not be a contender where can you get zithromax for the next TikTok challenge. People under the influence have reported a miserable experience.

Instead of euphoria and hallucinations, people have described feeling severely anxious. They may even experience where can you get zithromax a sense of dread and terrible hallucinations that make “Pink Elephants on Parade” from Dumbo seem like a mild fever dream. Another reason to avoid an overdose — there is no clinical data to help clinicians provide treatment. They can only address symptoms, like nausea and vomiting, which can last for an agonizing 72 hours.

2 where can you get zithromax. Urushiol (Credit. RSnapshotPhotos/Shutterstock) For some people, mangos need a warning label. Mango skin, as well as the tree leaves and bark, contain urushiol, a toxin that can where can you get zithromax cause contact dermatitis.

Urushiol is also found in poison oak and poison ivy. In one case study, a patient presented in the ER after touching and eating mangos two days earlier. The patient where can you get zithromax had a history of irritation from poison ivy, which helped the physicians identify the urushiol as the culprit. The man had an intense rash on “all extremities,” and only his palms, soles of his feet, and lips were spared.

Treatment was antihistamines and steroids and he recovered in several days. The urushiol in mangos can also cause an allergic reaction where can you get zithromax when consumed. Depending on a person’s sensitivity, one bite can cause anaphylaxis or pulmonary edema. Urushiol is also found in raw cashews, which is why these nuts are steamed prior to sale.

3. Lectins(Credit. Sasimoto/Shutterstock) Lectins are a defense mechanism for plants because they are very hard for humans to digest. They are seen in a variety of foods including beans, carrots, cherries, corn, garlic, lentils, peanuts, peas, potatoes and soybeans.

Lectins are proteins that bind to carbohydrates. If foods like beans are soaked and then heated thoroughly, the lectin content lessens and the food is safe to eat. Red kidney beans have a high lectin content, and eating a raw handful can lead to a painful reaction. People have reported experiencing nausea, gas, bloating, vomiting and diarrhea.

In the long term, continuous lectin ingestion can cause serious issues. Lectin interferes with nutrient absorption, and it also disrupts needed bacteria in the digestive tract. In extreme cases, lectin can cause organ damage. 4.

Cyanide(Credit. Ivaschenko Roman/Shutterstock)Cyanogenic glycosides are a plant’s way of protecting itself from predators, and there are more than 2,600 species of plants that contain cyanide, a deadly poison. Cyanide is found in many foods kept in pantries and fridges, including almonds, apple seeds, apricot pits, bamboo shoots, cherry pits and lima beans. All of these items, however, have low quantities of cyanide, and a person would intentionally have to eat significant amounts to feel the effects.

For apples, a person would have to pick out 200 seeds from the core and then ingest them, which is the equivalent of eating 40 cores in one sitting. Apple juice is also safe for people to drink. One study tested the cyanide content of more than a dozen apple juice brands and found the levels were so low they were not a health hazard.

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AbstractGGC repeat expansion in the 5′ untranslated region of NOTCH2NLC http://rheartzone.com/generic-cipro-prices/ is does zithromax have penicillin in it the most common causative factor in neuronal intranuclear inclusion disease (NIID) in Asians. Such expanded GGC repeats have been identified in patients with leukoencephalopathy, essential tremor (ET), multiple system atrophy, Parkinson’s disease (PD), amyotrophic lateral sclerosis and oculopharyngodistal myopathy (OPDM). Herein, we review the recently reported NOTCH2NLC-related disorders and potential disease-causing mechanisms. We found that visual abnormalities may be NOTCH2NLC-specific and should be investigated in other patients with NOTCH2NLC mutations does zithromax have penicillin in it. NOTCH2NLC GGC repeat expansion was rarely identified in patients of European ancestry, whereas the actual prevalence of the expansion in European patients may be potentially higher than reported, and the CGG repeats in LRP12/GIPC1 are suggested to be screened in European patients with NIID.

The repeat size and interruptions in NOTCH2NLC GGC expansion confer pleiotropic effects on clinical phenotype, a pure and stable ET phenotype may be an early symptom of NIID, and GGC repeats in NOTCH2NLC possibly give rise to ET. An association may also exist between intermediate-length NOTCH2NLC does zithromax have penicillin in it GGC repeat expansion and patients affected by PD and ET. NOTCH2NLC-OPDM highly resembles NOTCH2NLC-NIID, the two disorders may be the variations of a single neurodegenerative disease, and there may be a disease-causing upper limit in size of GGC repeats in NOTCH2NLC, repeats over which may be non-pathogenic. The haploinsufficiency of NOTCH2NLC may not be primarily involved in NOTCH2NLC-related disorders and a toxic gain-of-function mechanism possibly drives the pathogenesis of neurodegeneration in patients with NOTCH2NLC-associated disorders.geneticsgenotypephenotypeDNA repeat expansion.

AbstractGGC repeat http://rheartzone.com/generic-cipro-prices/ expansion in the 5′ untranslated region of NOTCH2NLC is the most common causative factor in neuronal intranuclear inclusion disease (NIID) in where can you get zithromax Asians. Such expanded GGC repeats have been identified in patients with leukoencephalopathy, essential tremor (ET), multiple system atrophy, Parkinson’s disease (PD), amyotrophic lateral sclerosis and oculopharyngodistal myopathy (OPDM). Herein, we review the recently reported NOTCH2NLC-related disorders and potential disease-causing mechanisms.

We found that visual abnormalities may be NOTCH2NLC-specific and should be investigated in other patients with NOTCH2NLC mutations where can you get zithromax. NOTCH2NLC GGC repeat expansion was rarely identified in patients of European ancestry, whereas the actual prevalence of the expansion in European patients may be potentially higher than reported, and the CGG repeats in LRP12/GIPC1 are suggested to be screened in European patients with NIID. The repeat size and interruptions in NOTCH2NLC GGC expansion confer pleiotropic effects on clinical phenotype, a pure and stable ET phenotype may be an early symptom of NIID, and GGC repeats in NOTCH2NLC possibly give rise to ET.

An association may also exist where can you get zithromax between intermediate-length NOTCH2NLC GGC repeat expansion and patients affected by PD and ET. NOTCH2NLC-OPDM highly resembles NOTCH2NLC-NIID, the two disorders may be the variations of a single neurodegenerative disease, and there may be a disease-causing upper limit in size of GGC repeats in NOTCH2NLC, repeats over which may be non-pathogenic. The haploinsufficiency of NOTCH2NLC may not be primarily involved in NOTCH2NLC-related disorders and a toxic gain-of-function mechanism possibly drives the pathogenesis of neurodegeneration in patients with NOTCH2NLC-associated disorders.geneticsgenotypephenotypeDNA repeat expansion.

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Although the experience of bullying is subjective, there is Get propecia prescription increasing evidence that bullying during physician training is associated with an increased risk zithromax 200mg 5ml suspension of serious medical errors as well as negatively impacting job satisfaction and the likelihood of remaining in fulltime medical practice. In a survey of 1358 cardiology trainees between 2017 and 2020, Camm and colleagues1 found that bullying was reported by 11% overall. Compared with men, women were more likely to be bullied (OR zithromax 200mg 5ml suspension.

1.55 95% CI 1.08 to 2.21) and to report sexist language (14% vs 4%, p<0.001). Graduates from medical schools outside the UK, including those from the European Economic Area (EEA) schools) also were more likely to be bullied and to experience racist language (UK 1.5%, EEA 6%, other locations 7%, p=0.006). The most common job roles of those reported to be bullying included cardiology and other zithromax 200mg 5ml suspension consultants, other medical staff and non-medical staff, but only rarely other trainees.

An even larger issue is that 33% of trainees experienced inappropriate behaviour (figure 1), even when not reported as bullying.Bar plot demonstrating inappropriate behaviour reported by cardiology trainees divided into those who reported bullying (blue) and those who did not (white). Bars represent the percentage of trainees reporting inappropriate zithromax 200mg 5ml suspension behaviour. Participants limited to those completing the survey in 2020 (n=252)." data-icon-position data-hide-link-title="0">Figure 1 Bar plot demonstrating inappropriate behaviour reported by cardiology trainees divided into those who reported bullying (blue) and those who did not (white).

Bars represent the percentage of trainees reporting inappropriate behaviour. Participants limited to those completing the survey in 2020 (n=252).In the accompanying editorial, Baruah zithromax 200mg 5ml suspension and Sedgwick2 discuss approaches to eliminating bullying which include ‘focusing on improvements in seemingly tangential issues, such as wider work-life balance, remuneration, working conditions and workload, which may act to improve workplace culture and prevent the behaviours occurring in the first place, making a better working environment for all.’ In addition, we need to create behaviour toolkits, workshops and behaviour champions. €˜Both perpetrators and victims need to be involved and supported in order to bring about organisational behavioural change through reflection, counselling, training and coaching, with an avoidance of placing too much onus on the ‘victim’ and their supposed resilience.’In order to better define the role of coronary fractional flow reserve calculated by CT imaging (FFRCT) for prediction of prognosis in patients with stable coronary artery disease (CAD), Nørgaard and colleagues3 performed a systematic review and meta-analysis with a primary endpoint of all-cause mortality or myocardial infraction over a 12 month follow-up period.

An FFRCT >0.80 identified a higher risk group with the primary endpoints occurring in 1.4% (47/3334) compared with only 0.6% (13/2126) of those with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI zithromax 200mg 5ml suspension 1.29 to 4.13), p=0.005) (figure 2). There was a continuous inverse relationship between FFRCT and the risk of adverse events with each 0.10-unit FFRCT reduction associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).0.80. N=number of patients with adverse events.

T=total number zithromax 200mg 5ml suspension of patients. FFRCT≤0.80. N and t=number of patients with adverse events zithromax 200mg 5ml suspension and total number of patients.

Strata with zero events were not included in the analysis. Mace (major adverse cardiac event) was defined as a composite of death, any MI or unplanned revascularisation. Unplanned revascularisation was defined as any revascularisation (percutaneous coronary intervention and/or coronary artery bypass grafting) occurring between 3 month and zithromax 200mg 5ml suspension 12 month follow-up.

ADVANCE, assessing diagnostic value of non-invasive FFRCT in coronary care’ study19. FFRCT, CTA-derived zithromax 200mg 5ml suspension fractional flow reserve. MI, myocardial infarction.

NXT, analysis of coronary blood flow using CT angiography. Next steps trial23 zithromax 200mg 5ml suspension. PLATFORM, prospective longitudinal trial of FFRCT.

Outcome and resource zithromax 200mg 5ml suspension impacts trial18. RR, risk ratio." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-171166071" data-figure-caption="Meta-analysis of the primary composite endpoint (death or any MI) and secondary endpoints at 12 month follow-up. FFRCT>0.80.

N=number of patients with zithromax 200mg 5ml suspension adverse events. T=total number of patients. FFRCT≤0.80.

N and t=number of patients with adverse events and total number of patients. Strata with zero events were not included in the analysis. Mace (major adverse cardiac event) was defined as a composite of death, any MI or unplanned revascularisation.

Unplanned revascularisation was defined as any revascularisation (percutaneous coronary intervention and/or coronary artery bypass grafting) occurring between 3 month and 12 month follow-up. ADVANCE, assessing diagnostic value of non-invasive FFRCT in coronary care’ study19. FFRCT, CTA-derived fractional flow reserve.

MI, myocardial infarction. NXT, analysis of coronary blood flow using CT angiography. Next steps trial23.

PLATFORM, prospective longitudinal trial of FFRCT. Outcome and resource impacts trial18. RR, risk ratio." data-icon-position data-hide-link-title="0">Figure 2 Meta-analysis of the primary composite endpoint (death or any MI) and secondary endpoints at 12 month follow-up.

FFRCT>0.80. N=number of patients with adverse events. T=total number of patients.

FFRCT≤0.80. N and t=number of patients with adverse events and total number of patients. Strata with zero events were not included in the analysis.

Mace (major adverse cardiac event) was defined as a composite of death, any MI or unplanned revascularisation. Unplanned revascularisation was defined as any revascularisation (percutaneous coronary intervention and/or coronary artery bypass grafting) occurring between 3 month and 12 month follow-up. ADVANCE, assessing diagnostic value of non-invasive FFRCT in coronary care’ study19.

FFRCT, CTA-derived fractional flow reserve. MI, myocardial infarction. NXT, analysis of coronary blood flow using CT angiography.

Next steps trial23. PLATFORM, prospective longitudinal trial of FFRCT. Outcome and resource impacts trial18.

RR, risk ratio.Williams and Newby4 discuss the ability of coronary CT angiography (CCTA) to measure stenosis severity, visualise plaque and determine FFRCT (figure 3). They raise ‘the question of what is driving the association between FFRCT and clinical outcome. Is it the ischaemic burden measured by the fractional flow reserve or is it mediated through the association of fractional flow reserve with adverse plaque characteristics?.

€™ Either way, ‘FFRCT is only one of the many measures that CCTA can provide and other variables, such as quantitative plaque assessment, are emerging as important prognostic indicators. We now need to identify which are the best to use for diagnosis, risk stratification and treatment decisions to enable the optimal management and outcomes for our patients.’Overlap between coronary CT angiography (CCTA) parameters in coronary artery disease." data-icon-position data-hide-link-title="0">Figure 3 Overlap between coronary CT angiography (CCTA) parameters in coronary artery disease.Another interesting paper in this issue of Heart reports hospital re-admission rates after transcatheter aortic valve implantation (TAVI) based on a database that included almost 45 thousand TAVI procedures.5 Although the median 30-day re-admission rate was 11.8%, there was wide variation between hospitals related to patient, hospital and economic factors. Further understanding of the factors leading to this variance might result in lower re-admission rates.A review article in this issue summarises the association between preterm birth and the lifetime risk of ischaemic heart disease and heart failure in the context of a higher prevalence of cardiovascular risk factors that include hypertension, metabolic syndrome and diabetes6 (figure 4).Exposures and mechanisms for altered cardiac structure and function in young adults born preterm.

BP, Blood pressure. DA, ductus arteriosus. LV, left ventricle." data-icon-position data-hide-link-title="0">Figure 4 Exposures and mechanisms for altered cardiac structure and function in young adults born preterm.

BP, Blood pressure. DA, ductus arteriosus. LV, left ventricle.The Education in Heart article in this issue7 provides the basic principles for implantable left ventricular assist devices including indications, eligibility and current outcomes.

Key messages are:“Continuous-flow left ventricular assist devices (LVADs) are an established treatment for carefully selected patients with advanced heart failure, with superior survival to those managed on medical therapy alone.The majority of patients supported on LVAD have significantly improved quality of life and increased functional status following implantation.Although 2 year survival following LVAD implantation is now similar to that following cardiac transplantation, medium-term to longer-term survival remains superior in those undergoing transplantation., bleeding and neurological events remain the predominant adverse events after implant.Reduction in readmissions and adverse event rates is necessary for LVADs to become cost-effective and a viable longer-term alternative to cardiac transplantation.”Ethics statementsPatient consent for publicationNot applicable.Ethics approvalThis study does not involve human participants..

Although the Get propecia prescription experience of bullying is subjective, where can you get zithromax there is increasing evidence that bullying during physician training is associated with an increased risk of serious medical errors as well as negatively impacting job satisfaction and the likelihood of remaining in fulltime medical practice. In a survey of 1358 cardiology trainees between 2017 and 2020, Camm and colleagues1 found that bullying was reported by 11% overall. Compared with men, women were more likely to be bullied where can you get zithromax (OR. 1.55 95% CI 1.08 to 2.21) and to report sexist language (14% vs 4%, p<0.001).

Graduates from medical schools outside the UK, including those from the European Economic Area (EEA) schools) also were more likely to be bullied and to experience racist language (UK 1.5%, EEA 6%, other locations 7%, p=0.006). The most common job roles of those reported to be where can you get zithromax bullying included cardiology and other consultants, other medical staff and non-medical staff, but only rarely other trainees. An even larger issue is that 33% of trainees experienced inappropriate behaviour (figure 1), even when not reported as bullying.Bar plot demonstrating inappropriate behaviour reported by cardiology trainees divided into those who reported bullying (blue) and those who did not (white). Bars represent where can you get zithromax the percentage of trainees reporting inappropriate behaviour.

Participants limited to those completing the survey in 2020 (n=252)." data-icon-position data-hide-link-title="0">Figure 1 Bar plot demonstrating inappropriate behaviour reported by cardiology trainees divided into those who reported bullying (blue) and those who did not (white). Bars represent the percentage of trainees reporting inappropriate behaviour. Participants limited to those completing the survey in 2020 (n=252).In the accompanying editorial, Baruah and Sedgwick2 discuss approaches to eliminating bullying which include ‘focusing on improvements in seemingly tangential where can you get zithromax issues, such as wider work-life balance, remuneration, working conditions and workload, which may act to improve workplace culture and prevent the behaviours occurring in the first place, making a better working environment for all.’ In addition, we need to create behaviour toolkits, workshops and behaviour champions. €˜Both perpetrators and victims need to be involved and supported in order to bring about organisational behavioural change through reflection, counselling, training and coaching, with an avoidance of placing too much onus on the ‘victim’ and their supposed resilience.’In order to better define the role of coronary fractional flow reserve calculated by CT imaging (FFRCT) for prediction of prognosis in patients with stable coronary artery disease (CAD), Nørgaard and colleagues3 performed a systematic review and meta-analysis with a primary endpoint of all-cause mortality or myocardial infraction over a 12 month follow-up period.

An FFRCT >0.80 identified a higher risk group with the primary endpoints occurring in 1.4% (47/3334) compared with only 0.6% (13/2126) of those with FFRCT ≤0.80 where can you get zithromax (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005) (figure 2). There was a continuous inverse relationship between FFRCT and the risk of adverse events with each 0.10-unit FFRCT reduction associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).0.80. N=number of patients with adverse events. T=total number of patients where can you get zithromax.

FFRCT≤0.80. N and t=number of patients with where can you get zithromax adverse events and total number of patients. Strata with zero events were not included in the analysis. Mace (major adverse cardiac event) was defined as a composite of death, any MI or unplanned revascularisation.

Unplanned revascularisation was defined as any revascularisation (percutaneous coronary intervention and/or coronary artery bypass where can you get zithromax grafting) occurring between 3 month and 12 month follow-up. ADVANCE, assessing diagnostic value of non-invasive FFRCT in coronary care’ study19. FFRCT, CTA-derived fractional where can you get zithromax flow reserve. MI, myocardial infarction.

NXT, analysis of coronary blood flow using CT angiography. Next steps trial23 where can you get zithromax. PLATFORM, prospective longitudinal trial of FFRCT. Outcome and resource where can you get zithromax impacts trial18.

RR, risk ratio." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-171166071" data-figure-caption="Meta-analysis of the primary composite endpoint (death or any MI) and secondary endpoints at 12 month follow-up. FFRCT>0.80. N=number of patients with where can you get zithromax adverse events. T=total number of patients.

FFRCT≤0.80. N and t=number of patients with adverse events and total number of patients. Strata with zero events were not included in the analysis. Mace (major adverse cardiac event) was defined as a composite of death, any MI or unplanned revascularisation.

Unplanned revascularisation was defined as any revascularisation (percutaneous coronary intervention and/or coronary artery bypass grafting) occurring between 3 month and 12 month follow-up. ADVANCE, assessing diagnostic value of non-invasive FFRCT in coronary care’ study19. FFRCT, CTA-derived fractional flow reserve. MI, myocardial infarction.

NXT, analysis of coronary blood flow using CT angiography. Next steps trial23. PLATFORM, prospective longitudinal trial of FFRCT. Outcome and resource impacts trial18.

RR, risk ratio." data-icon-position data-hide-link-title="0">Figure 2 Meta-analysis of the primary composite endpoint (death or any MI) and secondary endpoints at 12 month follow-up. FFRCT>0.80. N=number of patients with adverse events. T=total number of patients.

FFRCT≤0.80. N and t=number of patients with adverse events and total number of patients. Strata with zero events were not included in the analysis. Mace (major adverse cardiac event) was defined as a composite of death, any MI or unplanned revascularisation.

Unplanned revascularisation was defined as any revascularisation (percutaneous coronary intervention and/or coronary artery bypass grafting) occurring between 3 month and 12 month follow-up. ADVANCE, assessing diagnostic value of non-invasive FFRCT in coronary care’ study19. FFRCT, CTA-derived fractional flow reserve. MI, myocardial infarction.

NXT, analysis of coronary blood flow using CT angiography. Next steps trial23. PLATFORM, prospective longitudinal trial of FFRCT. Outcome and resource impacts trial18.

RR, risk ratio.Williams and Newby4 discuss the ability of coronary CT angiography (CCTA) to measure stenosis severity, visualise plaque and determine FFRCT (figure 3). They raise ‘the question of what is driving the association between FFRCT and clinical outcome. Is it the ischaemic burden measured by the fractional flow reserve or is it mediated through the association of fractional flow reserve with adverse plaque characteristics?. €™ Either way, ‘FFRCT is only one of the many measures that CCTA can provide and other variables, such as quantitative plaque assessment, are emerging as important prognostic indicators.

We now need to identify which are the best to use for diagnosis, risk stratification and treatment decisions to enable the optimal management and outcomes for our patients.’Overlap between coronary CT angiography (CCTA) parameters in coronary artery disease." data-icon-position data-hide-link-title="0">Figure 3 Overlap between coronary CT angiography (CCTA) parameters in coronary artery disease.Another interesting paper in this issue of Heart reports hospital re-admission rates after transcatheter aortic valve implantation (TAVI) based on a database that included almost 45 thousand TAVI procedures.5 Although the median 30-day re-admission rate was 11.8%, there was wide variation between hospitals related to patient, hospital and economic factors. Further understanding of the factors leading to this variance might result in lower re-admission rates.A review article in this issue summarises the association between preterm birth and the lifetime risk of ischaemic heart disease and heart failure in the context of a higher prevalence of cardiovascular risk factors that include hypertension, metabolic syndrome and diabetes6 (figure 4).Exposures and mechanisms for altered cardiac structure and function in young adults born preterm. BP, Blood pressure. DA, ductus arteriosus.

LV, left ventricle." data-icon-position data-hide-link-title="0">Figure 4 Exposures and mechanisms for altered cardiac structure and function in young adults born preterm. BP, Blood pressure. DA, ductus arteriosus. LV, left ventricle.The Education in Heart article in this issue7 provides the basic principles for implantable left ventricular assist devices including indications, eligibility and current outcomes.

Key messages are:“Continuous-flow left ventricular assist devices (LVADs) are an established treatment for carefully selected patients with advanced heart failure, with superior survival to those managed on medical therapy alone.The majority of patients supported on LVAD have significantly improved quality of life and increased functional status following implantation.Although 2 year survival following LVAD implantation is now similar to that following cardiac transplantation, medium-term to longer-term survival remains superior in those undergoing transplantation., bleeding and neurological events remain the predominant adverse events after implant.Reduction in readmissions and adverse event rates is necessary for LVADs to become cost-effective and a viable longer-term alternative to cardiac transplantation.”Ethics statementsPatient consent for publicationNot applicable.Ethics approvalThis study does not involve human participants..

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