Abstract Funding Acknowledgements Type of funding sources: None. Introduction Stress echocardiography (SE) can assess the significance of moderate/severe stenoses found on CT coronary angiography (CTCA), as a gatekeeper to invasive coronary angiography (ICA). In 2017, the UK National Institute for Health and Care Excellence (NICE), recommended CT fractional flow reserve (CTFFR) on all patients with coronary stenoses on CTCA to reduce downstream ICA and reduce costs. Aim We describe our experience of using CTFFR and compare this with previously accepted practice of judicious use of SE in patients with moderate/severe CTCA stenosis, and subsequent rate of ICA. Method An electronic patient record identified patients undergoing CTFFR between January 2019 and March 2020, and CTCA between January 2017 and June 2018, at our centre. We assessed downstream testing following CT evidence of moderate/severe stenoses and undertook a cost analysis per patient (PP) with the following NHS tariffs; CTCA=£220, CTFFR=£530, SE=£177, ICA=£1000. Results 140 patients were referred for CTFFR with 125 analysed (rejection rate 11%) of which 81 had moderate/severe stenoses. The baseline audit comprised 652 patients undergoing CTCA of which 92 had moderate/severe stenoses. Moderate CTCA stenosis: Baseline audit 58 had moderate stenosis, 18 (31%) underwent SE, with 1 positive and subsequent ICA. 36 (62%) were referred directly for ICA. In total 17 (46%) were revascularised. Cost of £1224 PP. CTFFR audit 44 had moderate stenosis, with 35 negative and 9 positive CTFFR. 9 (26%) and 7 (78%) following negative and positive CTFFR respectively, were subsequently referred for ICA. In total 16 (36%) were referred for ICA, and 44% revascularised. Cost of £1425 PP. Severe CTCA stenosis: Baseline audit 34 had severe stenosis, 1 (3%) underwent SE. 33 (97%) were referred directly for ICA. In total 18 (60%) were revascularised. Cost of £1418 PP. CTFFR audit 37 had severe stenoses, with 10 negative CTFFR and 27 positive CTFFR. 5 (50%) and 22 (81%) following negative and positive CTFFR respectively were referred for ICA. In total 27 (73%) were referred for ICA and 70% revascularised. Cost of £1719 PP. Importantly 14 patients underwent ICA following negative CTFFR with 29% revascularised. Conclusion CTFFR use in all patients with moderate/severe stenosis reduced the rate of downstream ICA compared with previous judicious use of SE, albeit at greater cost and similar revascularisation rates. A small number of patients underwent ICA despite negative CTFFR due to clinical concerns. The NICE guidance recommending CTFFR on all patients with moderate/severe CTCA stenosis reduces ICA. However, assuming equal efficacy, based on the non-invasive arm of the Platform trial1, SE would achieve this at lower cost. Notably, CTFFR benefits from completing assessment within a single visit, which is pertinent in the COVID-19 era and negates inherent delays between multiple tests.

Australian Veterinary JournalVolume 70, Issue 12 p. 463-463 Dog and Cat Reproduction, Contraception and Artificial Insemination JA Rodger, JA RodgerSearch for more papers by this author JA Rodger, JA RodgerSearch for more papers by this author First published: December 1993 https://doi.org/10.1111/j.1751-0813.1993.tb00864.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, Issue12December 1993Pages 463-463 RelatedInformation

As a result of research in the 1980s on in vitro maturation, sperm capacitation, and in vitro fertilization, the bovine is now one of the important models for development. Further, the current production of bovine embryos in vitro rivals that of in vivo embryo production for commercial applications. Researchers of today may be unaware of why decisions were made in the procedures. This review addresses the state of the art at the time of the work by Parrish et al. (Bovine in vitro fertilization with frozen thawed semen. Theriogenology 1986;25:591–600), and how later work would explain success or failure of competing procedures. Important was the use of frozen semen and heparin capacitation, because this allowed future researchers/practitioners to change sperm numbers and capacitation conditions to adjust for variations among bulls. The large numbers of citation of the original work stand the testament of time in the repeatability and success of the procedures. The work was done within the environment of the N.L. First laboratory and the unique interactions with a large number of talented graduate students, postdoctoral researchers, and technicians.

Sodium, potassium and water balance were studied throughout pregnancy in sheep on diets providing 1 mmol/kg body weight/d (H) or 0·1 mmol/kg body weight/d (L) of sodium, as well as non-pregnant controls. The polydipsia of pregnancy preceded the polyuria and the latter was greater in twin pregnancies. Faecal water loss also increased. Water turnover was particularly high in sheep excreting the majority of their sodium in urine rather than faeces; they also had greater total sodium loss at the end of pregnancy on the L diet. Sodium conservation was sustained throughout pregnancy on L diets but on H diets the increased output of urine and faeces led to increased sodium losses beyond day 90. Aldosterone secretion rose to a peak around day 100 in L sheep but was suppressed throughout pregnancy in H sheep, suggesting that this level of intake was well above requirement. The results are discussed in relation to the fluid and electrolyte physiology of pregnancy and the dietary sodium requirement.

La ecografía es una técnica diagnóstica no invasiva, asequible y versátil que emplea el ultrasonido para definir los órganos del cuerpo humano, sin radiaciones ionizantes, en tiempo real y con capacidad de visualizar varios planos.La gran rentabilidad diagnóstica de la técnica, unida a su facilidad de realización, y a las características antes mencionadas, la han colocado en la actualidad como un método de rutina en la práctica médica diaria. Es por esto por lo que, día tras día, se refuerza el carácter multidisciplinario de la técnica.Para una adecuada realización de la técnica se requiere tener conocimientos de los principios físicos del ultrasonido, del método e instrumental y de la anatomía humana, para así conseguir recopilar la máxima información posible y evitar errores de diagnóstico por mala interpretación u omisión de información.Ultrasound is a non-invasive, accessible, and versatile diagnostic technique that uses high frequency ultrasound waves to define outline the organs of the human body, with no ionising radiation, in real time and with the capacity to visual several planes.The high diagnostic yield of the technique, together with its ease of uses plus the previously mentioned characteristics, has currently made it a routine method in daily medical practice. It is for this reason that the multidisciplinary character of this technique is being strengthened every day.To be able to perform the technique correctly requires knowledge of the physical basis of ultrasound, the method and the equipment, as well as of the human anatomy, in order to have the maximum information possible to avoid diagnostic errors due to poor interpretation or lack of information.

The amniotic sac of 10 ewes was catheterised at 90–105 days of gestation. In eight ewes a suspension of a β-haemolytic strain of Staphylococcus aureus containing between 3.1 × 108 and 4.4 × 109 colony-forming units was infused 7–16 days after surgery. Two of the ewes were not infused with the test inoculum because fungi were identified in samples of amniotic fluid 13 days after catheterisation.

The effects of oestrogen and progesterone, injected alone or during successive periods, were studied in mature ovariectomised ewes on sodium intakes ranging from 1 to 4 mmol kg-1 d-1. Progesterone had no effect on fluid and electrolyte balance. Oestrogen (17 beta oestradiol) inhibited drinking but had little effect on water excretion whereas it reduced both food intake and urinary potassium concentration. Since the resulting changes in potassium intake and excretion were very similar, oestrogen had little net effect on potassium balance; neither change lasted beyond the treatment period. Oestrogen had a biphasic effect on urinary and faecal sodium excretion, an initial enhancement of salt loss being followed by sodium retention. Faecal sodium retention and the biphasic effect on renal sodium excretion were independent of changes in food intake. These observations are discussed in relation to the pattern of change of electrolyte balance during the reproductive cycle and the influence of changes in food intake and factors affecting sodium preference. The fact that a variety of responses is involved in a coordinated change of sodium balance is emphasised and its possible importance is considered.