***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Acute pulmonary embolism ( PE ) can worsen quality of life due to persistent dyspnea or exercise intolerance . OBJECTIVE Test if tenecteplase increases the probability of a favorable composite patient-oriented outcome after submassive PE . METHODS Normotensive patients with PE and right ventricular ( RV ) strain ( by echocardiography or biomarkers ) were enrolled from eight hospitals . All patients received low-molecular-weight heparin followed by r and om assignment to either a single weight-based bolus of tenecteplase or placebo , administered in a double-blinded fashion . The primary composite outcome included : ( i ) death , circulatory shock , intubation or major bleeding within 5 days or ( ii ) recurrent PE , poor functional capacity ( RV dysfunction with either dyspnea at rest or exercise intolerance ) or an SF36 ( ® ) Physical Component Summary ( PCS ) score < 30 at 90-day follow-up . RESULTS Eighty-three patients were r and omized ; 40 to tenecteplase and 43 to placebo . The trial was terminated prematurely . Within 5 days , adverse outcomes occurred in three placebo-treated patients ( death in one and intubation in two ) and one tenecteplase-treated patient ( fatal intracranial hemorrhage ) . At 90 days , adverse outcomes occurred in 13 unique placebo-treated patients and five unique tenecteplase-treated patients Thus , 16 ( 37 % ) placebo-treated and six ( 15 % ) tenecteplase-treated patients had at least one adverse outcome ( exact two-sided P = 0.017 ) . CONCLUSIONS Treatment of patients with submassive pulmonary embolism with  tenecteplase  was associated with increased probability of a favorable composite outcome BACKGROUND The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial . METHODS In a r and omized , double-blind trial , we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism . Eligible patients had right ventricular dysfunction on echocardiography or computed tomography , as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin T. The primary outcome was death or hemodynamic decompensation ( or collapse ) within 7 days after r and omization . The main safety outcomes were major extracranial bleeding and ischemic or hemorrhagic stroke within 7 days after r and omization . RESULTS Of 1006 patients who underwent r and omization , 1005 were included in the intention-to-treat analysis .  Death or hemodynamic decompensation occurred in 13 of 506 patients ( 2.6 % ) in the tenecteplase group as compared with 28 of 499 ( 5.6 % ) in the placebo group ( odds ratio , 0.44 ; 95 % confidence interval , 0.23 to 0.87 ; P=0.02 ) . Between r and omization and day 7 , a total of 6 patients ( 1.2 % ) in the tenecteplase group and 9 ( 1.8 % ) in the placebo group died ( P=0.42 ) . Extracranial bleeding occurred in 32 patients ( 6.3 % ) in the tenecteplase group and 6 patients ( 1.2 % ) in the placebo group ( P<0.001 ) . Stroke occurred in 12 patients ( 2.4 % ) in the tenecteplase group and was hemorrhagic in 10 patients ; 1 patient ( 0.2 % ) in the placebo group had a stroke , which was hemorrhagic ( P=0.003 ) . By day 30 , a total of 12 patients ( 2.4 % ) in the tenecteplase group and 16 patients ( 3.2 % ) in the placebo group had died ( P=0.42 ) . CONCLUSIONS In patients with intermediate-risk pulmonary embolism , fibrinolytic therapy prevented hemodynamic decompensation but increased the risk of major hemorrhage and stroke . ( Funded by the Programme Hospitalier de Recherche Clinique in France and others ; PEITHO EudraCT number , 2006 - 005328 - 18 ; Clinical Trials.gov number , NCT00639743 . ) BACKGROUND Elevated blood concentrations of troponin proteins or brain natriuretic peptide ( BNP ) worsen the prognosis of patients with pulmonary embolism ( PE ) . Novel biomarkers that reflect mechanisms of right ventricle ( RV ) damage from PE may provide additional prognostic value . We compare the prognostic use of BNP , troponin I , D-dimer , monocyte chemoattractant protein-1 , matrix metalloproteinase , myeloperoxidase , C-reactive protein , and caspase 3 as biomarkers of RV damage and adverse outcomes in submassive PE . METHODS This article used a prospect i ve cohort study of normotensive ( systolic blood pressure always > 100 mm Hg ) patients with computed tomographic angiography-diagnosed PE . All patients underwent echocardiography and phlebotomy at diagnosis , and survivors had another echocardiography 6 months later . We tested each biomarker for prognostic significance , requiring a lower limit 95 % CI > 0.50 for the area under the receiver operating characteristic curve ( AUROC ) with a reference st and ard positive of RV hypokinesis on either echocardiogram . Biomarkers with prognostic significance were dichotomized at the concentration that yielded highest likelihood ratio positive and mortality rates compared ( Fisher exact test ) . RESULTS We enrolled 152 patients with complete data . Thirty-seven ( 24 % , 95 % CI 18%-32 % ) had RV hypokinesis . Only BNP and troponin had significant AUROC values as follows : 0.71 ( 95 % CI 0.60 - 0.81 ) and 0.71 ( 95 % CI 0.62 - 0.82 ) , respectively . Overall mortality was 13/153 ( 8.5 % ) ; mortality rate for BNP > 100 versus < or = 100 pg/mL was 23 % versus 3 % ( P = .003 ) , respectively . Mortality rate for troponin I > 0.1 versus < or = 0.1 ng/mL was 13 % versus 6 % ( P = .205 ) , respectively . CONCLUSIONS Of 8 mechanistically plausible biomarkers , only BNP and troponin I had significant prognostic use with BNP having an advantage for predicting mortality BACKGROUND The Pulmonary Embolism Quality of Life question naire ( PEmb-QoL ) is a 40-item question naire to measure health-related quality of life in patients with pulmonary embolism . It covers six 6 dimensions : frequency of complaints , limitations in activities of daily living , work-related problems , social limitations , intensity of complaints , and emotional complaints . Originally developed in Dutch and English , we prospect ively vali date d a German version of the PEmb-QoL. METHODS A forward-backward translation of the English version of the PEmb-QoL into German was performed . German-speaking consecutive adult patients aged ≥18 years with an acute , objective ly confirmed pulmonary embolism discharged from a Swiss university hospital ( 01/2011 - 06/2013 ) were recruited telephonically . Established psychometric tests and criteria were used to evaluate the acceptability , reliability , and validity of the German PEmb-QoL question naire . To assess the underlying dimensions , an exploratory factor analysis was performed . RESULTS Overall , 102 patients were enrolled in the study . The German version of the PEmb-QoL showed a good internal consistency ( Cronbach 's alpha ranging from 0.72 to 0.96 ) , item-total ( 0.53 - 0.95 ) and inter-item correlations ( > 0.4 ) , and test-retest reliability ( intra-class correlation coefficients 0.59 - 0.89 ) for the dimension scores . A moderate correlation of the PEmb-QoL with SF-36 dimension and summary scores ( 0.21 - 0.83 ) indicated convergent validity , while low correlations of PEmb-QoL dimensions with clinical characteristics ( -0.16 - 0.37 ) supported discriminant validity . The exploratory factor analysis suggested four underlying dimensions : limitations in daily activities , symptoms , work-related problems , and emotional complaints . CONCLUSION The German version of the PEmb-QoL question naire is a valid and reliable disease-specific measure for quality of life in patients with pulmonary embolism Over the ensuing seven months she had three more clinical relapses , each accompanied by reappearance in the stools of either the organism or its cytotoxin , or both . Each improvement after vancomycin ( eight to 14-daycourses ) was accompanied by disappearance of the organism . At one point she was given cholestyramine , but she was unable to tolerate it . Her illness was punctuated by malnutrition and episodes of heart failure . She was given no other antibiotics . After the sixth relapse maintenance treatment with oral vancomycin 125 mg eight-hourly was begun . With this regimen diarrhoea was controlled and stools over the next 10 weeks remained negative for C difficile and its cytotoxin . There was no adverse reaction to vancomycin throughout The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism ( PE ) has not been investigated . Because the lungs are very sensitive to thrombolysis , we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator . The purpose of the present study was to evaluate the role of this " safe dose " thrombolysis in the reduction of pulmonary artery pressure in moderate PE . During a 22-month period , 121 patients with moderate PE were r and omized to receive a " safe dose " of tissue plasminogen activator plus anticoagulation ( thrombolysis group [ TG ] , n = 61 patients ) or anticoagulation alone ( control group [ CG ] , n = 60 ) . The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months . Pulmonary hypertension and the composite end point developed in 9 of 58 patients ( 16 % ) in the TG and 32 of 56 patients ( 57 % ) in the CG ( p < 0.001 ) and 9 of 58 patients ( 16 % ) in the TG and 35 of 56 patients ( 63 % ) in the CG ( p < 0.001 ) , respectively . The secondary end points were total mortality , the duration of hospital stay , bleeding at the index hospitalization , recurrent PE , and the combination of mortality and recurrent PE . The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG ( p < 0.001 ) . The combination of death plus recurrent PE was 1 ( 1.6 % ) in TG and 6 ( 10 % ) in the CG ( p = 0.0489 ) . No bleeding occurred in any group , and despite a positive trend in favor of a " safe dose " thrombolysis , no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently . In conclusion , the results from the present prospect i ve r and omized trial suggests that " safe dose " thrombolysis is safe and effective in the treatment of moderate PE , with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months Background The PEmb-QoL is a vali date d 40-item question naire to quantify health-related quality of life in patients having experienced pulmonary embolism ( PE ) . It covers six health dimensions : frequency of complaints , activities of daily living limitations , work-related problems , social limitations , intensity of complaints , and emotional complaints . Originally developed in Dutch and English , we sought to prospect ively vali date the psychometric properties of a French version of the PEmb-QoL. Methods We performed a forward and backward translation of the English version of the PEmb-QoL into French  . French-speaking consecutive adult patients with an acute , objective ly confirmed PE admitted to the emergency department of a Swiss university hospital between 08/2009 and 09/2011 were recruited telephonically . We used st and ard psychometric tests and criteria to evaluate the acceptability , reliability , and validity of the French version of the PEmb-QoL. We also performed an exploratory factor analysis . Results Overall , 102 patients were enrolled in the study . The French version of the PEmb-QoL showed good reliability ( internal consistency , item – total and inter-item correlations ) , reproducibility ( test-retest reliability ) , and validity ( convergent , discriminant ) in French-speaking patients with PE . The exploratory factor analysis suggested three underlying dimensions : limitations in daily activity ( items 4b-m , 5a-d ) , symptoms ( items 1a-h and 7 ) , and emotional complaints ( items 9a-f and j ) . Conclusion We successfully vali date d 
    Output:
    
Persistent RV dysfunction , impaired functional status , diminished exercise capacity , and reduced QoL are common in PE survivors .