Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination.

NT-proBNP, a marker of cardiac failure, has been shown to be stable in post mortem samples. The aim of this study was to assess the accuracy of NT-proBNP to detect heart failure in the forensic setting. One hundred sixty-eight consecutive autopsies were included in the study. NT-proBNP blood concentrations were measured using a chemiluminescent immunoassay kit. Cardiac failure was assessed by three independent forensic experts using macro- and microscopic findings complemented by information about the circumstances of body discovery and the known medical story. Area under the receiving operator curve was of 65.4% (CI 95%, from 57.1 to 73.7). Using a standard cut-off value of >220 pg/mL for NT-proBNP blood concentration, heart failure was detected with a sensitivity of 50.7% and a specificity of 72.6%. NT-proBNP vitreous humor values were well correlated to the ones measured in blood (r (2) = 0.658). Our results showed that NT-proBNP can corroborate the pathological findings in cases of natural death related to heart failure, thus, keeping its diagnostic properties passing from the ante mortem to the post mortem setting. Therefore, biologically inactive polypeptides like NT-proBNP seem to be stable enough to be used in forensic medicine as markers of cardiac failure, taking into account the sensitivity and specificity of the test.

Friday Facts, May 7, 2010, Vol. 57

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

Adult-type rhabdomyosarcoma: analysis of 57 cases with clinicopathologic description, identification of 3 morphologic patterns and prognosis.

Adult-type rhabdomyosarcoma (RMS) has been classically defined as a pleomorphic sarcoma with desmin expression occurring in adult patients. To reevaluate this entity, we analyzed a series of 57 cases using immunohistochemistry for desmin, myogenin, alpha smooth muscle actin, h-caldesmon, pankeratin AE1/AE3, epithelial membrane antigen (EMA), S100 protein, CD34, MDM2, and CDK4. In this series, there were 36 men and 21 women aged from 22 to 87 years (median: 59). Tumors were mainly located in the lower limbs (27 cases), trunk wall (15 cases), and upper limbs (10 cases). Most tumors were deeply located (51/54) with a size from 1 to 30 cm (median: 8 cm). Cases were classified in 3 histologic categories: spindle cell RMS (25 cases), pleomorphic RMS (16 cases), and mixed type (16 cases). Forty-one tumors were grade 3 and 16 grade 2. Immunohistochemistry showed that every case was positive for desmin and myogenin. Alpha smooth muscle actin was positive in 21%, pankeratin AE1/AE3 in 20%, and CD34 in 13.2%. Treatment modalities and follow-up were available in 46 cases. Median follow-up was 60.9 months. Eight patients developed a local recurrence and 16 a distant metastasis with a 5-year overall survival rate of 52.6% and a 5-year metastasis-free survival of 62.9%. The only predictive factor for metastasis was histologic grade. In conclusion, adult-type RMS is a rare sarcoma occurring mainly in the extremities and trunk wall with 2 main histologic patterns, spindle cell, and pleomorphic patterns, which represent the end of the spectrum of a single entity.

European Cardiovascular Magnetic Resonance (EuroCMR) registry--multi national results from 57 centers in 15 countries.

BACKGROUND: The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. METHODS: Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. RESULTS: The most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year). CONCLUSION: The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

Development of Quality Standards for Inclusion of High Recycled Asphalt Pavement Content in Asphalt Mixtures – Phase II, TR-658, 2015

To conserve natural resources and energy, the amount of recycled asphalt pavement has been steadily increasing in the construction of asphalt pavements. The objective of this study is to develop quality standards for inclusion of high RAP content. To determine if the higher percentage of RAP materials can be used on Iowa’s state highways, three test sections with target amounts of RAP materials of 30%, 35% and 40% by weight were constructed on Highway 6 in Iowa City. To meet Superpave mix design requirements for mixtures with high RAP contents, it was necessary to fractionate the RAP materials. Three test sections with actual RAP materials of 30.0%, 35.5% and 39.2% by weight were constructed and the average field densities from the cores were measured as 95.3%, 94.0%, and 94.3%, respectively. Field mixtures were compacted in the laboratory to evaluate moisture sensitivity using a Hamburg Wheel Tracking Device. After 20,000 passes, rut depths were less than 3mm for mixtures obtained from three test sections. The binder was extracted from the field mixtures from each test section and tested to identify the effects of RAP materials on the performance grade of the virgin binder. Based on Dynamic Shear Rheometer and Bending Beam Rheometer tests, the virgin binders (PG 64-28) from test sections with 30.0%, 35.5% and 39.2% RAP materials were stiffened to PG 76-22, PG 76-16, and PG 82-16, respectively. The Semi-Circular Bending (SCB) test was performed on laboratory compacted field mixtures with RAP amounts of 30.0%, 35.5% and 39.2% at two different temperatures of -18 and -30 °C. As the test temperature decreased, the fracture energy decreased and the stiffness increased. As the RAP amount increased, the stiffness increased and the fracture energy decreased. Finally, a condition survey of the test sections was conducted to evaluate their short-term pavement performance and the reflective transverse cracking did not increase as RAP amount was increased from 30.0% to 39.2%.

Collection de copies de pièces sur l'histoire de France, formée par François DE CAMPS, abbé de Signy (1723). II PROVINCES. 57 Lyon et Lyonnais.

« De la souveraineté des rois de France sur la ville et le comté de Lion » (fol. 2, 93, 120) : pièces justificatives, 942-1320 (132, 183). — Lettre critique sur l'Histoire civile ou consulaire de la ville de Lyon du P. Menestrier (90). — Primatie de Lyon (186). Extraits « ex cartulario episcopatus Diensis, quod est conventus fratrum Minimorum Parisiensium, » 1158-1229 (193). Diplômes de l'empereur Frédéric II, copies extraites des archives du Domaine royal en Languedoc, arm. B (196). Inventaire des chartes du Trésor relatives au Lyonnais (218).

West 1 St Street/ IA 57 from Highland Drive to Center Street/Franklin Street, Blackhawk County, Iowa, Project # STP-57-2(28)--2C-07, Environmental Assessment and Section 4(f) De Minimis Impact Finding, 2015

From Proposed Action: "Iowa Northland Regional Council of Governments (INRCOG) and the City of Cedar Falls, in coordination with the Iowa Department of Transportation (Iowa DOT) and the Federal Highway Administration (FHWA), are proposing to upgrade and modernize an approximate 4,900-foot segment of Iowa Highway 57 (IA 57), locally known as West 1st Street, in Cedar Falls, Black Hawk County, Iowa."

Road Safety Audit for Intersection of US 218 and County Road C-57 (West Cedar Wapsi Road) in Black Hawk County, Iowa, 2009

Beginning on June 22, 2009, a road safety audit was initiated for the intersection of US 218 and County Road C-57 in Black Hawk County, Iowa. Due to the traffic volumes and the number of conflicting traffic movements on these two roadways, this intersection has developed a crash history that concerns the Iowa Department of Transportation (Iowa DOT), Iowa State Patrol, and local agencies. This intersection is ranked seventh in Iowa for the highest number of at-grade expressway intersection crashes. Considering this, Black Hawk County and the Iowa DOT requested that a road safety audit be conducted to address the safety concerns and recommend possible mitigation strategies.

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[Traditions. France. Berry]

[Archives de la parole]. , [Conversation] / [Ferdinand Brunot], collecteur ; [Mélanie Touzet, 57 ans, garde-barrière] ; [Mme Rivière, 78 ans cultivatrice], voix. [Le vingt-cinq de décembre, je me suis t'engagé] : [chanson] / [Ferdinand Brunot], collecteur ; [Jean Ducroc, 51 ans, cultivateur], chant. [Briolée aux boeufs] : [chanson] / [Ferdinand Brunot], collecteur ; [Jean Ducroc, 51 ans, cultivateur], chant. [L'amoureux infidèle] : [chanson] / [Ferdinand Brunot], collecteur ; [Mme Rivière, 78 ans cultivatrice], chant

[Traditions. France. Berry]