Energetic Electron Precipitation Driven by Electromagnetic Ion Cyclotron Waves from ELFIN's Low Altitude Perspective.

We review comprehensive observations of electromagnetic ion cyclotron (EMIC) wave-driven energetic electron precipitation using data collected by the energetic electron detector on the Electron Losses and Fields InvestigatioN (ELFIN) mission, two polar-orbiting low-altitude spinning CubeSats, measuring 50-5000 keV electrons with good pitch-angle and energy resolution. EMIC wave-driven precipitation exhibits a distinct signature in energy-spectrograms of the precipitating-to-trapped flux ratio: peaks at >0.5 MeV which are abrupt (bursty) (lasting ∼17 s, or ΔL∼0.56) with significant substructure (occasionally down to sub-second timescale). We attribute the bursty nature of the precipitation to the spatial extent and structuredness of the wave field at the equator. Multiple ELFIN passes over the same MLT sector allow us to study the spatial and temporal evolution of the EMIC wave - electron interaction region. Case studies employing conjugate ground-based or equatorial observations of the EMIC waves reveal that the energy of moderate and strong precipitation at ELFIN approximately agrees with theoretical expectations for cyclotron resonant interactions in a cold plasma. Using multiple years of ELFIN data uniformly distributed in local time, we assemble a statistical database of ∼50 events of strong EMIC wave-driven precipitation. Most reside at L∼5-7 at dusk, while a smaller subset exists at L∼8-12 at post-midnight. The energies of the peak-precipitation ratio and of the half-peak precipitation ratio (our proxy for the minimum resonance energy) exhibit an L-shell dependence in good agreement with theoretical estimates based on prior statistical observations of EMIC wave power spectra. The precipitation ratio's spectral shape for the most intense events has an exponential falloff away from the peak (i.e., on either side of ∼1.45 MeV). It too agrees well with quasi-linear diffusion theory based on prior statistics of wave spectra. It should be noted though that this diffusive treatment likely includes effects from nonlinear resonant interactions (especially at high energies) and nonresonant effects from sharp wave packet edges (at low energies). Sub-MeV electron precipitation observed concurrently with strong EMIC wave-driven >1 MeV precipitation has a spectral shape that is consistent with efficient pitch-angle scattering down to ∼ 200-300 keV by much less intense higher frequency EMIC waves at dusk (where such waves are most frequent). At ∼100 keV, whistler-mode chorus may be implicated in concurrent precipitation. These results confirm the critical role of EMIC waves in driving relativistic electron losses. Nonlinear effects may abound and require further investigation.

Myrica salicifolia Hochst. ex A. Rich. suppress acetic acid-induced ulcerative colitis in rats by reducing TNF-alpha and interleukin-6, oxidative stress parameters and improving mucosal protection.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) with rising prevalence in developing countries, and limited success of current therapies, natural products have immense potential for therapy due to their "disease modifying and side-effect neutralizing" potential. Myrica salicifolia is traditionally used for gastrointestinal diseases and have reported antiinflammatory activities, but its use in IBD has not yet been studied. Therefore, in the present study, the effects of the root extract of M. salicifolia (Ms.Cr) were investigated using the acetic acid-induced UC model in rats. For 6 days, the rats were given either vehicle (10 mL/kg), lower (200 mg/kg), and higher (400 mg/kg) doses of Ms.Cr, or the positive control drug (prednisolone; 2 mg/kg) orally. A single dosage of 5% acetic acid (1.0 mL) was administered intrarectally to rats on day 6 to induce UC. Disease activity index (DAI), histological observations, the biochemical parameters related to oxidative stress, and specific cytokines such as interleukin-6 (IL-6) and the tumor necrosis factor-α (TNF-α) were determined to assess the effect of Ms.Cr. In comparison to the AA-induced colitis rats, Ms.Cr's pretreatment significantly decreased DAI, colonic ulceration, and inflammatory score. Total glutathione levels and catalase activity were considerably recovered in the colitis group treated with Ms.Cr, whereas enhanced lipid peroxidation in colon tissues was significantly decreased. Moreover, Ms.Cr pretreatment also caused inhibition of the activation of IL-6 and TNF-α in the colonic tissues of respective groups. Based on these findings, Ms.Cr might be developed to treat UC in the future.

Inhibition of prostaglandin-degrading enzyme 15-PGDH rejuvenates aged muscle mass and strength.

Treatments are lacking for sarcopenia, a debilitating age-related skeletal muscle wasting syndrome. We identifed increased amounts of 15-hydroxyprostaglandin dehydrogenase (15-PGDH), the prostaglandin E2 (PGE2)-degrading enzyme, as a hallmark of aged tissues, including skeletal muscle. The consequent reduction in PGE2 signaling contributed to muscle atrophy in aged mice and results from 15-PGDH-expressing myofibers and interstitial cells, such as macrophages, within muscle. Overexpression of 15-PGDH in young muscles induced atrophy. Inhibition of 15-PGDH, by targeted genetic depletion or a small-molecule inhibitor, increased aged muscle mass, strength, and exercise performance. These benefits arise from a physiological increase in PGE2 concentrations, which augmented mitochondrial function and autophagy and decreased transforming growth factor-ß signaling and activity of ubiquitin-proteasome pathways. Thus, PGE2 signaling ameliorates muscle atrophy and rejuvenates muscle function, and 15-PGDH may be a suitable therapeutic target for countering sarcopenia.

Ambulatory blood pressure monitoring on admission in survivors of recent stroke entering inpatient rehabilitation.

Arterial hypertension (AHT) is a major risk factor for stroke, yet blood pressure (BP) goals thereafter remain uncertain. Although additional prognostic value of 24-hour ambulant BP monitoring (ABPM) is acknowledged, its clinical impacts remain limited. We suspected that routine ABPM could identify characteristic circadian BP patterns in different brain lesion types, the knowledge of which might, in turn, be helpful in improving overall BP management in patients after stroke. In our study, we compared cardiovascular parameters derived from ABPM and traditional blood pressure measurements (TBPM) among 105 stroke survivors who entered our inpatient neuro-rehabilitation program. The mean age of mostly male (64.8%) patients was 71 ± 12 years. Ischemic strokes were predominant (75.2%). Despite normotensive systolic BP means in TBPM (133.5 ± 18.2 mmHg) and ABPM (24 h: 122.8 ± 14.7 mmHg), AHT persisted in up to 67.6% of all patients, with ABPM uncovering nocturnal systolic non- or reversed dipping in 89.5% and 53.3%, respectively. The latter was predominant (85.7%) in the hemorrhagic subgroup which also displayed lower daytime SBP than the ischemic one (ABPM: 117.1 ± 11.8 vs 124.7 ± 14.7 mmHg, p = 0.033). Further differences were present among distinct brain lesion types. Sufficient dippers were younger (58 ± 12 vs 75 ± 11 years, p < 0.001), but adjusting for age yielded no independent correlations. In spite of normotensive daytime BP measurements, ABPM detects latent AHT and insufficient nocturnal BP dipping after the acute phase of stroke. Further studies are needed to elucidate the role of increased nocturnal BP in patients after stroke.

The impact of domestic rainwater harvesting systems in storm water runoff mitigation at the urban block scale.

In the framework of storm water management, Domestic Rainwater Harvesting (DRWH) systems are recently recognized as source control solutions according to LID principles. In order to assess the impact of these systems in storm water runoff control, a simple methodological approach is proposed. The hydrologic-hydraulic modelling is undertaken using EPA SWMM; the DRWH is implemented in the model by using a storage unit linked to the building water supply system and to the drainage network. The proposed methodology has been implemented for a residential urban block located in Genoa (Italy). Continuous simulations are performed by using the high-resolution rainfall data series for the ''do nothing'' and DRWH scenarios. The latter includes the installation of a DRWH system for each building of the urban block. Referring to the test site, the peak and volume reduction rate evaluated for the 2125 rainfall events are respectively equal to 33 and 26 percent, on average (with maximum values of 65 percent for peak and 51 percent for volume). In general, the adopted methodology indicates that the hydrologic performance of the storm water drainage network equipped with DRWH systems is noticeable even for the design storm event (T = 10 years) and the rainfall depth seems to affect the hydrologic performance at least when the total depth exceeds 20 mm.

Venous Thromboembolism in Cancer: Frequently Asked Questions When Guidelines are Inconclusive.

Management of Venous thromboembolism (VTE) in cancer patients is difficult when guidelines are inconclusive. To share a reasonable and homogeneous behavior in such circumstances, four issues, which are felt as problematic by oncologists and surgeons, have been selected; all were uncovered or only partially covered by current guidelines. Results from the literature and author's specific experience in the field were utilized to suggest reasonable solutions to the raised questions. The reported experience is the first to provide real-world management guidance for VTE in cancer patients. The effort of putting together literature review and author's experience brought to the adoption of a common behavior.

Reprogramming activity of NANOGP8, a NANOG family member widely expressed in cancer.

NANOG is a key transcription factor for pluripotency in embryonic stem cells. The analysis of NANOG in human cells is confounded by the presence of multiple and highly similar paralogs. In particular, there are three paralogs encoding full-length proteins, namely, NANOG1, NANOG2 and NANOGP8, and at least eight additional paralogs that do not encode full-length NANOG proteins. Here, we have examined NANOG family expression in human embryonic stem cells (hESCs) and in human cancer cell lines using a multi-NANOG PCR that amplifies the three functional paralogs and most of the non-functional ones. As anticipated, we found that hESCs express large amounts of NANOG1 and, interestingly, they also express NANOG2. In contrast, most human cancer cells tested express NANOGP8 and the non-coding paralogs NANOGP4 and NANOGP5. Notably, in some cancer cell lines, the NANOG protein levels produced by NANOGP8 are comparable to those produced by NANOG1 in pluripotent cells. Finally, we show that NANOGP8 is as active as NANOG1 in the reprogramming of human and murine fibroblasts into induced pluripotent stem cells. These results show that cancer-associated NANOGP8 can contribute to promote de-differentiation and/or cellular plasticity.

Designing domestic rainwater harvesting systems under different climatic regimes in Italy.

Nowadays domestic rainwater harvesting practices are recognized as effective tools to improve the sustainability of drainage systems within the urban environment, by contributing to limiting the demand for potable water and, at the same time, by mitigating the generation of storm water runoff at the source. The final objective of this paper is to define regression curves to size domestic rainwater harvesting (DRWH) systems in the main Italian climatic regions. For this purpose, the Köppen-Geiger climatic classification is used and, furthermore, suitable precipitation sites are selected for each climatic region. A behavioural model is implemented to assess inflow, outflow and change in storage volume of a rainwater harvesting system according to daily mass balance simulations based on historical rainfall observations. The performance of the DRWH system under various climate and operational conditions is examined as a function of two non-dimensional parameters, namely the demand fraction (d) and the modified storage fraction (sm). This last parameter allowed the evaluation of the effects of the rainfall intra-annual variability on the system performance.

Discharge-driven electric oxygen-iodine laser superlinear enhancement via increasing g0L.

The authors report the development of an electric oxygen-iodine laser with higher output using a larger product of gain and gain length, g0L. A factor of 4.4 increase in laser power output on the 1315 nm atomic iodine transition was achieved with a factor of 3 increase in gain length. I(2P1/2) is pumped using energy transferred from O2(a1Δ) produced by flowing a gas mixture of O2-He-NO through three coaxial geometry radio-frequency discharges. Continuous wave (CW) average total laser power of 481 W was extracted with g0L=0.042.

Is incidentally detected pulmonary embolism in cancer patients less severe? A case-control study.

Incidental pulmonary embolism (PE) in cancer patients is usually thought to be of mild degree. We investigated the severity of PE and evaluated the potential of raising the suspicion of PE in such patients. The computed tomography (CT) extent of PE was evaluated in 19 consecutive unsuspected and 19 randomly selected symptomatic patients. A clinical pattern useful for suspecting PE was also searched. On CT, number of embolized vessels, location of emboli, and simple instrumental findings were not different in the two groups. PE is not less severe in unsuspected cancer patients; moreover, PE may be clinically suspected in such patients.

Storm water infiltration in a monitored green roof for hydrologic restoration.

The objectives of this study are to provide detailed information about green roof performance in the Mediterranean climate (retained volume, peak flow reduction, runoff delay) and to identify a suitable modelling approach for describing the associated hydrologic response. Data collected during a 13-month monitoring campaign and a seasonal monitoring campaign (September-December 2008) at the green roof experimental site of the University of Genova (Italy) are presented together with results obtained in quantifying the green roof hydrologic performance. In order to examine the green roof hydrologic response, the SWMS_2D model, that solves the Richards' equation for two-dimensional saturated-unsaturated water flow, has been implemented. Modelling results confirm the suitability of the SWMS_2D model to properly describe the hydrologic response of the green roofs. The model adequately reproduces the hydrographs; furthermore, the predicted soil water content profile generally matches the observed values along a vertical profile where measurements are available.

Antihysteresis of perceived longitudinal body axis during continuous quasi-static whole-body rotation in the earth-vertical roll plane.

Estimation of subjective whole-body tilt in stationary roll positions after rapid rotations shows hysteresis. We asked whether this phenomenon is also present during continuous quasi-static whole-body rotation and whether gravitational cues are a major contributing factor. Using a motorized turntable, 8 healthy subjects were rotated continuously about the earth-horizontal naso-occipital axis (earth-vertical roll plane) and the earth-vertical naso-occipital axis (earth-horizontal roll plane). In both planes, three full constant velocity rotations (2°/s) were completed in clockwise and counterclockwise directions (acceleration = 0.05°/s(2), velocity plateau reached after 40 s). Subjects adjusted a visual line along the perceived longitudinal body axis (pLBA) every 2 s. pLBA deviation from the longitudinal body axis was plotted as a function of whole-body roll position, and a sine function was fitted. At identical whole-body earth-vertical roll plane positions, pLBA differed depending on whether the position was reached by a rotation from upright or by passing through upside down. After the first 360° rotation, pLBA at upright whole-body position deviated significantly in the direction of rotation relative to pLBA prior to rotation initiation. This deviation remained unchanged after subsequent full rotations. In contrast, earth-horizontal roll plane rotations resulted in similar pLBA before and after each rotation cycle. We conclude that the deviation of pLBA in the direction of rotation during quasi-static earth-vertical roll plane rotations reflects static antihysteresis and might be a consequence of the known static hysteresis of ocular counterroll: a visual line that is perceived that earth-vertical is expected to be antihysteretic, if ocular torsion is hysteretic.

Velocity storage contribution to vestibular self-motion perception in healthy human subjects.

Self-motion perception after a sudden stop from a sustained rotation in darkness lasts approximately as long as reflexive eye movements. We hypothesized that, after an angular velocity step, self-motion perception and reflexive eye movements are driven by the same vestibular pathways. In 16 healthy subjects (25-71 years of age), perceived rotational velocity (PRV) and the vestibulo-ocular reflex (rVOR) after sudden decelerations (90°/s(2)) from constant-velocity (90°/s) earth-vertical axis rotations were simultaneously measured (PRV reported by hand-lever turning; rVOR recorded by search coils). Subjects were upright (yaw) or 90° left-ear-down (pitch). After both yaw and pitch decelerations, PRV rose rapidly and showed a plateau before decaying. In contrast, slow-phase eye velocity (SPV) decayed immediately after the initial increase. SPV and PRV were fitted with the sum of two exponentials: one time constant accounting for the semicircular canal (SCC) dynamics and one time constant accounting for a central process, known as velocity storage mechanism (VSM). Parameters were constrained by requiring equal SCC time constant and VSM time constant for SPV and PRV. The gains weighting the two exponential functions were free to change. SPV were accurately fitted (variance-accounted-for: 0.85 ± 0.10) and PRV (variance-accounted-for: 0.86 ± 0.07), showing that SPV and PRV curve differences can be explained by a greater relative weight of VSM in PRV compared with SPV (twofold for yaw, threefold for pitch). These results support our hypothesis that self-motion perception after angular velocity steps is be driven by the same central vestibular processes as reflexive eye movements and that no additional mechanisms are required to explain the perceptual dynamics.

Childhood traumata, Dexamethasone Suppression Test and psychiatric symptoms: a trans-diagnostic approach.

BACKGROUND: Childhood traumatic events and functional abnormalities of the hypothalamus-pituitary-adrenal (HPA) axis have been widely reported in psychiatric patients, although neither is specific for any diagnosis. Among the limited number of studies that have evaluated these topics, none has adopted a trans-diagnostic approach. The aim of the present research is to explore the relationship between childhood stressors, HPA axis function and psychiatric symptoms, independent of the diagnosis. METHOD: A total of 93 moderate to severely ill psychiatric out-patients of Florence and Pisa University Psychiatric Units and 33 healthy control subjects were recruited. The assessment consisted of salivary cortisol pre- and post-low dose (0.5 mg) Dexamethasone, early and recent life events, 121 psychiatric symptoms independent of diagnosis, SCID, BPRS. RESULTS: In total, 33.5% of patients were Dexamethasone Suppression Test (DST) non-suppressors, compared with 6.1% of controls (p=0.001). Among patients, non-suppression was associated with particular symptoms (i.e. depressive and psychotic), but not to any specific diagnosis. Early stressful life events were significantly associated with higher salivary cortisol levels, with DST non-suppression and with approximately the same subset of symptoms. A recent stressful event seemed to be associated to the HPA response only in those subjects who were exposed to early traumata. CONCLUSIONS: Our report suggests a relationship between life stress, HPA axis and psychopathology. A cluster of specific psychiatric symptoms seems to be stress related. Moreover, it seems that an abnormal HPA response is possibly triggered by an excessive pressure in vulnerable individuals.

The clinical course of pulmonary embolism patients anticoagulated for 1 year: results of a prospective, observational, cohort study.

BACKGROUND: Few studies have examined the clinical course of pulmonary embolism (PE) in patients anticoagulated continuously for 1 year. OBJECTIVE: We sought to determine the incidence of death, recurrent PE and bleeding during anticoagulation in the first year after acute PE, and to assess associated risk factors. METHODS: All consecutive PE patients who were referred to our center in Pisa, Italy between 2001 and 2005 received a conventional initial treatment, followed by vitamin K antagonists [international normalized ratio (INR), 2.0-3.0] for 1 year. They were followed-up at scheduled times at the study center. The development of recurrent PE was objectively documented and recorded. RESULTS: Out of 497 patients, 48 (9.6%) developed recurrent PE, which was fatal in 36. Of these 48 events, 39 occurred within 10 days of diagnosis and only two patients had a non-fatal recurrent PE between 6 and 12 months. Risk factors associated with the risk for overall recurrent PE were persistent severe dyspnoea (P = 0.007), a high perfusion defect score index (PDI) (P = 0.003) and cardiopulmonary co-morbidities (P = 0.005). Unprovoked presentation (P = 0.030), persistent severe dyspnoea (P = 0.011) and a high PDI (P = 0.001) predicted the risk for fatal PE. Overall bleeding incidence was 3.4%, no cases of bleeding occurred between 180 and 360 days post-diagnosis. CONCLUSIONS: In spite of conventional anticoagulation, a proportion of patients with PE experience both a fatal and non-fatal recurrent embolism within the first year. The large majority of these occur within the days proceeding diagnosis, with only a small minority occurring in the last 6 months. No bleeding was observed after 6 months. Therefore, prolonging anticoagulation for 1 year represents both a safe and effective treatment.

The diagnosis of pulmonary embolism.

The diagnosis of pulmonary embolism is challenging, and autoptic series have demonstrated that a high percentage of cases are not recognized ante-mortem. A number of predisposing factors, symptoms and signs associated with pulmonary embolism have been recognized, and should be used to raise the suspicion of the disease. These include immobilization, recent surgery, active cancer, previous thromboembolism, syncope, dyspnoea, chest pain, haemoptysis, signs of deep vein thrombosis, hypocarbic hypoxemia. Once pulmonary embolism is suspected, the clinical probability of the disease should be assessed; to this end, three clinical rules have been proposed and validated (the revised Geneva score, the Wells score and the PISA-PED score) while others await clinical validation. In case of low clinical probability, a negative a D-dimer test is sufficient to rule out the diagnosis, while if the clinical probability is high, or the D-dimer test is positive, further tests are necessary. Computer tomography angiography or perfusion lung scan are the imaging tests of choice, depending on local availability and experience. If the clinical probability and the results of the imaging test are concordant, a definitive diagnosis can be obtained; if the results are discordant, further testing is necessary. In particular, in the specific case of a small clot (i.e. segmental or subsegmental) incidentally recognized at a computer tomography obtained for other reasons in a patient without a clinical suspicion of pulmonary embolism, an occurrence whose frequency is rapidly increasing in clinical practice, a final diagnosis cannot be made without further confirmatory testing.

Progressive vestibular impairment in patients with polyneuropathy.

It is generally assumed that imbalance in patients with polyneuropathy (PNP) results from deficient proprioceptive input arriving from the lower limbs. Polyneuropathic processes, however, may also impair vestibular function. In fact, we observed that two-thirds of patients with PNP show unilateral or bilateral impairment of vestibular function as assessed with search-coil head impulse testing. In the present work, we analyzed the same database of 37 polyneuropathic patients to find out whether the presence of a unilateral or bilateral vestibular deficit reflects a progression of the vestibular impairment. Results suggest that vestibular function in PNP patients deteriorates asymmetrically, first affecting one side and later both sides.

Deficient high-acceleration vestibular function in patients with polyneuropathy.

BACKGROUND: Unsteadiness during standing and walking is a frequent complaint of patients with polyneuropathy (PNP). OBJECTIVE: To determine whether balance disorders in patients with PNP may be caused by reduced proprioceptive input from the feet alone or whether impaired vestibular input, resulting from involvement of the vestibular nerve, can be an additional factor. METHODS: A total of 37 patients (mean age 65 years +/- 12 SD; 12 women) with electrodiagnostically confirmed PNP (predominantly axonal: 18; predominantly demyelinating: 19) underwent horizontal search-coil head-impulse testing, which assesses the high-acceleration vestibulo-ocular reflex (VOR). RESULTS: Relative to a healthy comparison group, the gains (eye velocity divided by head velocity) of the horizontal VOR were reduced in 27 of 37 patients (unilateral: 13; bilateral: 14). The percentages of patients with unilateral or bilateral VOR deficits were not significantly different between patients with axonal or demyelinating PNP. CONCLUSIONS: Two thirds of patients with axonal or demyelinating polyneuropathy (PNP) showed unilateral (approximately 50%) or bilateral (approximately 50%) gain reductions of the horizontal high-acceleration vestibulo-ocular reflex. This finding suggests that, in many patients with PNP, the neuropathic process includes the vestibular nerve. Such information is highly relevant for subsequent physical therapy, since vestibular exercise improves balance control and reduces disability.

Gaze fixation deficits and their implication in ataxia-telangiectasia.

BACKGROUND AND AIMS: Ataxia-telangiectasia (A-T) is an autosomal recessive disorder characterised by progressive neurological deficits, including prominent ocular motor dysfunction. Unstable fixation often leads to difficulty reading and blurred vision. Here we characterise the disturbance of visual fixation in A-T. METHODS: Eye movements were recorded from 13 A-T patients (with dual search coils in five patients and video oculography in seven) during attempted fixation. RESULTS: Two abnormalities--nystagmus and saccadic intrusions--were common. Horizontal, vertical and torsional nystagmus was present in straight ahead (spontaneous nystagmus) and eccentric gaze (gaze evoked nystagmus). In eight patients the horizontal nystagmus changed directions--periodic alternating nystagmus (PAN). Two types of saccadic intrusions were seen--micro-saccadic oscillations (SO) and square wave saccadic intrusions (SWSI). SO were small amplitude (0.1-0.9 degrees) and high frequency (14-33 Hz) back to back horizontal saccades. SWSI ranged between 1 degree and 18 degrees (median 3 degrees) with an intersaccadic interval ranging between 50 and 800 ms (median 300 ms). The potential impact of abnormal gaze stabilisation on vision was quantified. DISCUSSION: Degeneration of cerebellar Purkinje neurons disinhibit the caudal fastigial oculomotor region (FOR) and vestibular nuclei (VN). Disinhibition of VN can cause nystagmus, including PAN, while disinhibition of FOR can affect saccade generating mechanisms, leading to SWSI and SO.

Risk stratification and outcomes in hemodynamically stable patients with acute pulmonary embolism: a prospective, multicentre, cohort study with three months of follow-up.

BACKGROUND: The role of risk stratification in normotensive patients with acute pulmonary embolism (PE) is still unclear. OBJECTIVES: We evaluated, in these patients, the usefulness of six prognostic markers for predicting in-hospital adverse events related to PE and 3-month mortality. PATIENTS/METHODS: Two hundred and one consecutive patients with confirmed acute PE and normal blood pressure, who were administered conventional anticoagulation, were recruited in a multicentre prospective cohort study with 3 months of follow-up. At baseline, they received a comprehensive risk-evaluation including echocardiographic assessment of right ventricular dysfunction, determination of troponin I, brain natriuretic peptide and D-dimer, arterial blood gas analysis and a clinical score. Primary outcome of the study was PE-related in-hospital death or clinical deterioration. Secondary outcomes were in-hospital and 3-month all-cause mortality. RESULTS: The primary outcome occurred in one patient (0.5%), who died from PE during hospitalization. The in-hospital and 3-month all-cause mortality were 2% and 9%, respectively. None of the prognostic markers was predictive of the primary outcome. Clinical score, troponin I and hypoxemia predicted in-hospital all-cause mortality (P = 0.02, 0.01 and < 0.01, respectively). Clinical score (HR, 4.7; 95% CI, 1.9-12.0), D-dimer (4.8; 1.4-16.3), hypoxemia (5.7; 2.1-15.1) and troponin I (7.5; 2.5-22.7) were predictors of 3-month all-cause mortality on univariate analysis. On multivariate analysis clinical score and troponin I remained independently predictive. CONCLUSIONS: We did not find prognostic markers useful as predictors of in-hospital PE-related adverse events. Clinical score, troponin I and hypoxemia predicted in-hospital all-cause mortality. Clinical score and troponin I independently predicted 3-month all-cause mortality.