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The consistency of this study with data from randomised trials and observational registries leads us to agree that computed tomography has primacy as gatekeeper for the cardiac catheter laboratory irrespective of the level of pre-test probability. This latest addition to the growing and large body of evidence does beg the question of why guidelines do not now recommend CCTA as the first line test of choice for the non-invasive investigation of all patients with stable coronary artery disease? Crown All rights reserved.BACKGROUND Although computer-aided design and computer-aided manufacturing has been successfully used in fabricating removable partial dentures (RPDs), making altered cast impressions is still a time-consuming and labor-intensive process for fabricating RPDs with a distal extension. An alternative digital technique has been developed to simplify this process. METHODS The authors present a case in which they sought to improve the efficiency and simplicity in obtaining altered cast impressions by means of digital technology. Initially, a primary plaster cast was scanned as a digital cast. Based on the digital cast, a novel custom tray was designed and fabricated using a 3-dimensional printing method. With the custom tray, the novel altered cast impression was fabricated and scanned, and the final virtual altered cast was reconstructed by a stitching method. NSC 127716 RESULTS Based on the virtual altered cast, the authors designed the virtual RPD framework. Finally, the titanium alloy framework was fabricated using a 3-dimensional printing process, and the authors fit the final RPD to the patient. CONCLUSIONS This novel digital altered cast impression technique may eliminate interoperator variability and increase precision compared with the traditional technique. PRACTICAL IMPLICATIONS This technique showed the potential for reducing clinical appointments, chair time, and laboratory procedures. BACKGROUND Integrating preventive oral health services (POHS) into medical offices may ease access to care for children with intellectual and developmental disabilities (IDD). The authors examined the impact of state policies allowing delivery of POHS in medical offices on receipt of POHS among Medicaid enrollees with IDD. METHODS The authors used 2006 through 2014 Medicaid data for children with IDD aged 6 months through 5 years from 38 states. IDD were defined using 14 condition codes from Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. The length of the state's medical POHS policy (no policy, less then 1 year, 1 year, 2 years, 3 years, or ≥ 4 years) was interacted with an indicator that the child was younger than 3 years. The authors used logistic regression models to estimate the likelihood that a child received POHS in a medical office or in a medical or dental office in a given year. RESULTS Among 447,918 children with IDD, 1.6% received POHS in medical offices. Children younger than 3 years in states with longer-enacted policies had higher rates of receiving POHS. For example, the predicted probability of receiving POHS was 40.6% (95% confidence interval, 36.3% to 44.9%) for children younger than 3 years in states with a medical POHS policy for more than 4 years compared with 30.6% (95% confidence interval, 27.8% to 33.5%) for children in states without a policy. CONCLUSIONS State Medicaid policies allowing delivery of POHS in medical offices increased receipt of POHS among Medicaid-enrolled children with IDD who were younger than 3 years. PRACTICAL IMPLICATIONS Few children with IDD receive POHS in any setting. Efforts are needed to reduce barriers to POHS for publicly insured children with IDD. Each week, I record audio summaries for every paper in JACC, as well as an issue summary. Although this process is quite time-consuming, I have become familiar with every paper that we publish. Thus, I have personally selected the top 100 papers (both Original Investigations and Review Articles, and an occasional Editorial Comment) from the distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC, as well as most of the central illustrations, with the realization that a magnifying glass will be be needed for appropriate visualization. The highlights comprise the following sections Basic & Translational Research, Cardiac Failure & Myocarditis, Cardiomyopathies/Congenital & Genetics, Cardio-Oncology, Coronary Disease & Interventions, Hypertension, Imaging, Metabolic & Lipid Disorders, Neurovascular Disease & Dementia, Promoting Health & Prevention, Rhythm Disorders & Thromboembolism, Valvular Heart Disease, and Vascular Medicine (1-100). BACKGROUND A gut-microbial metabolite, trimethylamine N-oxide (TMAO), has been associated with coronary atherosclerotic burden. No previous prospective study has addressed associations of long-term changes in TMAO with coronary heart disease (CHD) incidence. OBJECTIVES The purpose of this study was to investigate whether 10-year changes in plasma TMAO levels were significantly associated with CHD incidence. METHODS This prospective nested case-control study included 760 healthy women at baseline. Plasma TMAO levels were measured both at the first (1989 to 1990) and the second (2000 to 2002) blood collections; 10-year changes (Δ) in TMAO were calculated. Incident cases of CHD (n = 380) were identified after the second blood collection through 2016 and were matched to controls (n = 380). RESULTS Regardless of the initial TMAO levels, 10-year increases in TMAO from the first to second blood collection were significantly associated with an increased risk of CHD (relative risk [RR] in the top tertile 1.58 [95% confidence interval (CI) 1.05 to 2.38]; RR per 1-SD increment 1.33 [95% CI 1.06 to 1.67]). Participants with elevated TMAO levels (the top tertile) at both time points showed the highest RR of 1.79 (95% CI 1.08 to 2.96) for CHD as compared with those with consistently low TMAO levels. Further, we found that the ΔTMAO-CHD relationship was strengthened by unhealthy dietary patterns (assessed by the Alternate Healthy Eating Index) and was attenuated by healthy dietary patterns (p interaction = 0.008). CONCLUSIONS Long-term increases in TMAO were associated with higher CHD risk, and repeated assessment of TMAO over 10 years improved the identification of people with a higher risk of CHD. Diet may modify the associations of ΔTMAO with CHD risk.